Postnatal Depression is a common disorder affecting between 10 and 15% of women in the first six months postpartum. The clinical picture of postnatal depression is generally considered to be that of non-melancholic major depression, with risk factors being predominantly psychosocial. There are however, many women who do not present with this typical clinical picture of postnatal depression. In this paper we will report on the clinical presentation of women who present with a melancholic type of depression. This form of depression arises earlier than the more typical postnatal depression. It is characterised by symptoms of melancholia with psychomotor change, particularly agitation. These women often have an obsessional premorbid personality type, a family history of depression and generally are in a stable and supportive relationship. They respond well to tricyclic antidepressants or ECT but do tend to relapse into depression following subsequent pregnancies.

The relationship of this form of postnatal depression to the more typical form of postnatal depression and puerperal psychosis will be discussed. The clinical similarities between this clinical presentation and that of earlier descriptions of involution of melancholia will be raised as will the role of oestrogen changes contributing to the onset of this disorder.