Postpartum Depression Medication Guide

What is Postpartum Depression (PPD)?

Postpartum depression (PPD), also known as peripartum depression, is a type of depressive mood disorder that develops in the first year after the birth of a child. This type of depression can affect a woman’s ability to take care of her child. This is different from “baby blues,” which occurs about 2 to 3 days after childbirth, where some women begin to feel depressed, anxious, and upset. These feelings may come and go in the first few days after childbirth, which often improves within a few days or weeks without any treatment.

Postpartum depression can occur up to 1 year after having a baby, but it most commonly starts about 1 to 3 weeks after childbirth and is more severe than baby blues.¹ To be diagnosed with PPD, you have to display at least five depressive symptoms for at least two weeks; for example, insomnia, loss of interest or pleasure, depressed mood, loss of energy, suicidal ideation, and more.²

If PPD is suspected, your healthcare provider will have you complete a depression screening. This will involve you filling out a questionnaire with a list of questions involving your mood and mental state. Your provider will likely have you do bloodwork as well to rule out other issues that could possibly cause your symptoms, such as thyroid disorders.

What Causes PPD?

Postpartum depression is likely caused by a combination of factors. If a woman has a history of depression at any time before, during, or after the pregnancy, this may increase their risk of developing PPD. Hormone levels may also trigger PPD as hormones such as progesterone and estrogen decrease sharply in the hours after childbirth, similar to how hormone levels trigger mood swings before menstrual periods.

Women with PPD often struggle with anxiety, sadness, difficulty sleeping, or disturbing thoughts. There could also be social components to PPD; life events and factors such as the death of a loved one, lack of social support, or other similar issues could increase the likelihood for a person to develop PPD. Pregnancy is a difficult, life-changing event, and this can be profoundly distressing if the pregnancy was not planned or wanted, and it can take new parents time to adjust to having a new baby. Overall, it is hard to pinpoint exactly why PPD occurs because there could be multiple reasons for an individual to develop the condition.¹

How Long Does PPD Usually Last?

There is no definitive amount of time that PPD lasts for. Untreated, PPD can last for months or longer and can sometimes develop into an ongoing depressive disorder. It is a serious medical condition that can last for years. Some studies suggest that the severity of PPD decreases over time but that the decrease does not always mean that the depression has resolved.³ Personal factors could determine how long PPD lasts, such as a history of depression and a lack of social support from family or friends.

What Medications Are Used to Treat Postpartum Depression?

There are treatments available for those suffering from PPD. Common medications like SSRIs, SNRIs, and bupropion can be used, as well as nortriptyline and a newer medication called Zulresso. Nortriptyline belongs to an older class of medications called TCAs, while SSRIs, SNRIs, and Wellbutrin are newer and are some of the first agents used when treating depression.

Zulresso is a recently FDA-approved medication specifically used in the treatment of postpartum depression. Which medication you will get put on depends on personal factors, such as your prior history with antidepressants and if you are breastfeeding.⁴

Here are the most commonly prescribed medications for PPD symptoms:*⁵

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are common antidepressants and are one of the go-to medications for depression treatments. They can be used off-label for PPD and is generally a well-tolerated medication. Medications that belong to the SSRI class are Zoloft (sertraline) and Lexapro (escitalopram).

Serotonin-norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are another class of medication that is used off-label in the treatment of PPD. This class of medication has a similar side effect profile to SSRIs, but they tend to cause more nausea, insomnia, and dry mouth. Most of its side effects are temporary and go away as the body gets used to the medication.

Wellbutrin (Bupropion)

Wellbutrin is a medication that can be considered in moderate to severe PPD patients. Studies on the use of Wellbutrin, like others, for PPD are limited, but it is suggested that it can be helpful for those with PPD, even if they are nursing. Those on this medication should stay in contact with their doctor and get immediate help if they develop new or worsening suicidal thoughts and behaviors. Side effects of Wellbutrin are similar to the above class of medications.⁶

Nortriptyline

Nortriptyline belongs to a class of medications called TCAs, also known as tricyclic antidepressants. It’s an older class of medications that is typically not used first due to its side effect profile. Despite this, it is a safe and efficacious medication for PPD, especially if the patient has responded to the medication favorably in the past.⁷

Zulresso

Zulresso, also known as brexanolone, is a medication that is specifically indicated in the treatment of postpartum depression in adults. This medication is unique in that it can only be given by healthcare professionals as it is an IV infusion. This medication is a continuous infusion that lasts over 60 hours. Zulresso is given in a clinic setting due to the potential risk of excessive sedation and sudden loss of consciousness, which medical staff are trained to look out for.⁸

*Antidepressant medications have a risk of side effects, including serious side effects. You should talk with your healthcare professional about the benefits and risks of any medication before starting treatment.

Antidepressant Side Effects

As with all medications, there are side effects associated with antidepressant treatments used in postpartum depression. The newer antidepressants – SSRIs, SNRIs, Wellbutrin – are usually well-tolerated and have the added benefit of being less likely to cause the drying side effects (ie dry mouth, constipation, etc) that older antidepressants -tricyclics (TCAs), monoamine oxidase inhibitors (MAOIs) – are associated with.

Newer antidepressant medications are generally considered safe during pregnancy, although there are still potential risks that can be associated with their usage. Each person is different, and the right decision for you should be discovered through a conversation with your doctor.⁴

Newer antidepressants can cause side effects such as:*⁹

• Sexual dysfunction (ie, low sex drive, erectile dysfunction, etc.)
• Insomnia
• Dizziness
• Gastrointestinal distress (nausea, vomiting, diarrhea)

Older antidepressants can cause side effects such as:*^{10, 11}

• Dizziness
• Dry mouth
• Constipation
• Blurry vision
• Confusion
• Urinary retention

*All medications, including antidepressants, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.

Can I Still Breastfeed While Taking Antidepressants?

There are benefits to breastfeeding, and organizations such as the American Academy of Pediatrics and World Health Organization recommend that breastfeeding be done for at least the first 6 months. Breastfeeding can be done while a woman is on antidepressants, but there is potential for the medication to pass through their breast milk.

Long-term risks of low-level exposure to antidepressant medication in breast milk in infants are largely unknown. Doctors have to determine if the risk of untreated depression outweighs the potential risk of breastfeeding while on antidepressants. The infant’s pediatrician should be aware of the potential exposure and monitor for changes in the infant or for signs of drug toxicity.¹²

Is Talk Therapy a Good Treatment for PPD?

Talk therapy is a recommended treatment for postpartum depression. PPD is a difficult condition that is often overlooked due to the emotional nature of birthing a child, along with social stigmas regarding mental health. Psychotherapy can help those suffering from PPD and give them the support or skills to learn how to cope with their condition. Some are evidence-based, such as CBT and interpersonal therapy, while others are there to give the person an outlet to talk about their emotions and problems.

Commonly used therapies to treat PPD symptoms include:¹³

• Cognitive-behavioral therapy (CBT): CBT is a therapy that has been well studied in PPD treatment and proven effective. It is a time-limited therapy that offers therapeutic techniques for your desired goals.
• Interpersonal therapy: Interpersonal therapy is a brief therapy that centers on resolving interpersonal problems and is completed within 12-16 weeks. This is a therapy that has evidence of providing support for those suffering from PPD.
• Support groups: Finding a community that can empathize with what you are going through can help immensely with your own condition.

How to Cope With PPD Symptoms

Parenthood is a challenging time, especially if someone is new to it. A person could become stressed and anxious, exacerbating their PPD symptoms. Being mindful of yourself and practicing self-care techniques can help to manage PPD symptoms and keep them from getting worse.

Here are coping skills to help with PPD symptoms:

• Get regular exercise: There are mental health benefits to exercise that could potentially help with PPD symptoms. Exercising may help with reducing stress and anxiety and give you more energy to deal with the intensity of parenthood.
• Maintain a healthy diet: A healthy diet can make a difference as to whether or not you feel energized and have the fuel you need to get through the day.
• Make time to rest: Parenthood takes a lot of time and effort, so it is important that new parents try to take care of themselves, as your physical state can reflect your mental state. Make sure to practice good hygiene and try to take naps when appropriate.
• Psychotherapy: Mental health counseling or talk therapy can benefit a new parent. You can discuss your feelings, set goals, and learn how to respond to situations in a healthy manner.
• Build a support network: Being a new parent, or just having a new child, can be a challenging stage of life. Receiving help and support, whether that be physical or emotional, can enable you to cope with your problems better.

Questions to Ask Your Healthcare Provider About Postpartum Depression Medications

If your healthcare provider prescribes medication to treat postpartum depression symptoms, you are likely to have questions. Knowing what to expect from the medication, such as how long it takes to work and potential side effects, can help you gain the most benefit from your treatment. It is important to have an open and honest conversation with your doctor or psychiatrist so as to have realistic expectations of the treatment. Online psychiatry services can be an option if you are unable to visit a doctor in person or need to switch physicians.

Questions to ask your care team about postpartum medications include:

• How long will it take for me to adjust to taking medications for postpartum depression?
• Am I at risk for more severe symptoms if I am already taking other anxiety /depression medications?
• What is the best dosage to ensure fewer side effects?
• When should I reach out to you if I am experiencing sexual side effects?
• Is there anything I should tell my therapist about this new medication?
• How long does it take for the medications to work?
• Does this medication work with my current medications and condition?
• How do I know if the medication is working for me?