Postpartum Depression (PPD) Treatment Options

Postpartum depression (PPD) is a serious mental health condition affecting 1 in 8 new parents within the first year after childbirth. Treatment typically includes a combination of psychotherapy and medication. Lifestyle changes, support groups, and support from family and friends can also be helpful.

Unlike the “baby blues,” which are normal mood swings that happen within the week or two after childbirth, postpartum depression lasts two or more weeks and includes more severe symptoms of depression.

Symptoms of PPD include feeling hopeless, worthless, and distanced from your baby. At times, you may have thoughts of harming yourself or your baby. PPD may significantly limit your ability to function, bond with your baby, and take care of yourself or your baby. All of this is why treatment is crucial.

For people with mild to moderate postpartum depression, starting treatment with psychotherapy alone may be an option.

If you have moderate to severe PPD, your healthcare provider may recommend medication paired with psychotherapy. People with mild to moderate PPD may also want to consider medication to help manage their symptoms.

Antidepressants

Antidepressant medications are a first-line treatment for postpartum depression, along with psychotherapy. The American College of Obstetricians and Gynecologists (ACOG) recommends antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants.

Some antidepressants commonly used to treat PPD include:

• Zoloft (sertraline)
• Lexapro (escitalopram)
• Prozac (fluoxetine)
• Paxil (paroxetine)

It can sometimes take 3-4 weeks for an antidepressant to kick in and to begin feeling better. Antidepressants can have side effects such as nausea, weight gain, and fatigue, but most side effects are temporary and go away as your body adjusts to the medication.

While antidepressants may pass into breast milk, the amount that enters the milk is typically low. Talk to your provider if you have concerns about breastfeeding while taking antidepressant medication.

Zuranolone

Zurzuvae (zuranolone) is a postpartum depression medication that was approved by the United States Food and Drug Administration (FDA) in August 2023. It’s the first oral (taken by mouth) medication that’s FDA-approved to treat PPD. Previously, the only FDA-approved PPD treatment was administered by IV injection in a clinic, and it may not have been safe to take while breastfeeding.

Zuranolone is generally prescribed to be taken once per day for 14 days. Side effects are possible, including exhaustion, diarrhea, and dizziness. You may also experience urinary tract infections and cold symptoms.

Zuranolone can pass into your breast milk, but there isn’t enough research to determine how it may affect babies or the milk supply. Talk to your healthcare provider about your concerns regarding breastfeeding while on zuranolone.

Therapy, along with medication, is a first-line treatment for postpartum depression. Therapy alone might be sufficient to treat postpartum depression, but if your depression is moderate or severe, you will likely need medication along with therapy. Different therapy modalities can help treat PPD.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a method that focuses on identifying negative thoughts and emotions and then learning techniques to manage them. CBT usually takes 6-10 sessions. Research evidence suggests that it’s an effective treatment for PPD.

Interpersonal Therapy

In interpersonal therapy, you focus on improving your relationships with people close to you, such as partners and close family members. Interpersonal therapy is often used during transition periods, such as entering new parenthood. It’s effective at decreasing PPD symptoms for many people.

Psychodynamic Therapy

Psychodynamic therapy is another effective psychotherapy for PPD. It focuses on your unconscious thoughts and how they influence you. Gaining a better understanding of these thoughts can help you understand your motivations and emotions better.

Lifestyle changes alone can’t cure postpartum depression, and it’s important not to rely on them as the only way to manage your symptoms. That said, making more positive and healthy choices can help your recovery from PPD. These choices can also help you stay well after you’ve recovered.

The following are some lifestyle modifications that may help, especially when combined with therapy or medication:

• Prioritize rest and sleep: If and whenever possible, have a loved one or other helper care for your baby while you nap or sleep in after being up all night with the baby.
• Ask for help: Ask your family, friends, and others for help.
• Stay active: A daily short walk around the block counts.
• Eat nutritious foods: Make sure you’re well nourished, eating and hydrating regularly.
• Connect with others: When possible, get out of the house and engage with other adults. Find “your tribe,” which may include other parents who have experienced PPD.
• Join a PPD support group: You can search for local and in-person support groups or join an online group. Your healthcare providers may be able to help you find one.
• Be open and honest: Tell your loved ones or healthcare providers if your symptoms get worse or you’re having trouble making it through your day.

The goal of postpartum depression treatment is to improve or resolve your symptoms so that you can feel better, live a more functional life, and take care of yourself and your child. Your obstetrician-gynecologist (OB-GYN), midwife, or licensed mental health professional can help you manage your treatment.

Left untreated, PPD may continue to cause symptoms for several months. About 30% of people will still experience symptoms a year after giving birth. Untreated PPD can also result in chronic depression disorder and can set you up for future periods of major depression.

Untreated PPD can make it much harder to parent, and it can put you at risk for severe mental health challenges, including self-harm. It can also affect others around you, including your child and their development.

It’s important to seek care for postpartum depression. Help is out there for you, and you can feel better again.

One of the greatest challenges with postpartum depression is that many people don’t recognize they’re having symptoms. They may also feel ashamed to seek care or may not have the resources or headspace to get the treatments they need.

If you aren’t sure where to start when it comes to postpartum depression treatment, here are some ideas: