Postpartum Depression Treatment: Therapy, Medication, & Self-Coping Options

What Is Postpartum Depression?

Postpartum depression, now termed peripartum depression by the DSM-V, is one of the most common complications experienced by parents following the birth of a baby. Postpartum depression doesn’t just affect first-time parents; it can also impact those with multiple children even if they have not experienced the condition before.^2,3,4

The symptoms of PPD are most commonly felt during the first three weeks after delivery, but can also be persistent, lasting longer than a year. A person with PPD might feel hopeless, sad, and guilty, because they may not be able to bond with or care for their baby. After a birth, many parents experience bouts of sadness, but if these feelings worsen or persist beyond two weeks, you may be experiencing postpartum depression. Additionally, symptoms can further develop into a major depressive disorder if left untreated.²

Parents who have experienced depression before pregnancy, feel unprepared for parenting, or are dealing with unemployment/financial difficulties are at higher risk for developing postpartum depression. Men can also experience PPD, including new fathers with a personal or family history of depression. Struggling with work-life balance, problems with communication, and division of labor in the family can all exacerbate the transition into parenthood.^4,5,6

Common symptoms of postpartum depression may include:

• Depressed mood or severe mood swings
• Excessive crying
• Difficulty bonding with your baby
• Withdrawing from family and friends
• Loss of appetite or eating much more than usual
• Inability to sleep (insomnia) or sleeping too much
• Intense irritability and anger
• Fear that you’re not a good parent
• Hopelessness
• Thoughts of harming yourself or your baby
• Thoughts of death or suicide

Is It Postpartum Depression or Baby Blues?

Many parents experience low moods or even sadness for a few days following birth, which can be attributed to hormonal changes and are entirely normal. About 80% of women experience baby blues, starting within the first two or three days after birth and lasting for up to two weeks.

Symptoms that last longer than a couple of weeks–including thoughts or plans of hurting yourself or the baby, hallucinations, or other symptoms of psychosis–should be brought to your doctor immediately. Baby blues usually resolve independently of further treatment.³

Signs of baby blues may include the following:

• Mood swings
• Crying episodes
• Anxiety
• Sadness
• Feeling overwhelmed or irritable
• Difficulty sleeping and eating
• Difficulty concentrating

How Is Postpartum Depression Diagnosed?

Ultimately, it is better to use caution and get checked by your doctor if something feels off, rather than minimizing what may develop into a severe condition. To provide a PPD diagnosis, a doctor will often ask questions as part of an evaluation, including about one’s current symptoms and history of depression. In addition, they may perform a depression screening, request completion of a questionnaire, or order blood tests to determine whether a physical medical condition contributes to symptoms.

Postpartum Depression Treatment Options

Standard postpartum depression treatment options include therapy, medications, and educational/support groups. However, psychotherapy is considered to be the first-line treatment option for parents with peripartum depression.

Therapy

It may help to discuss your concerns with a psychiatrist, psychologist, or other mental health professional. You can find better ways to cope with your feelings, solve problems, set realistic goals, and respond to situations positively through therapy. Sometimes family or relationship therapy also helps to support the dynamics in the family and the new parents.^5,6 Additionally, if you’re struggling with stress; adjustment to parenting; Baby Blues; pregnancy; postpartum depression; or anxiety, support and educational groups may be available in your community.

Therapy options for postpartum depression may include:

• Cognitive behavioral therapy (CBT): CBT is an effective treatment for depression, and is used to treat a wide range of other mental health conditions. It’s often the preferred type of psychotherapy, because it generally requires fewer sessions than other types of therapy.⁷
• Individual therapy: Individual therapy allows you to talk one-on-one with your own therapist, and provides a safe place to express yourself without judgment.
• Family therapy: Family therapy can be helpful for all members to express how they’re feeling about a given situation.

Medications

Antidepressant medication (pharmacological treatment) in conjunction with psychotherapy is recommended for women with moderate-to-severe depression. Your doctor may suggest an antidepressant to help manage and minimize your symptoms of depression.

Medications for depression help balance the chemicals in your brain that affect your mood. Any prescriptions you take will enter your breast milk if you’re breastfeeding; but, most antidepressants can be used safely, with little risk of affecting your baby. Work with your doctor to weigh the potential risks and benefits of specific antidepressants, and keep in mind that it can take a few weeks for them to begin working.^5,9,10

Medications for treating postpartum depression include:

SSRIs

Some of the preferred antidepressants include the category known as selective serotonin reuptake inhibitors (SSRIs). These are often a popular choice from providers, due to their low risk of side effects, limited effect on breastfeeding, and effectiveness in improving symptoms.

Common SSRIs include:

• Celexa (citalopram)*
• Lexapro (escitalopram)*
• Luvox (fluvoxamine)*
• Paxil (paroxetine)*
• Prozac (fluoxetine)*
• Zoloft (sertraline)*

*This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

SNRIs

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a class of medications that are effective in treating depression. Typically the benefits of antidepressants outweigh the possible side effects. Which antidepressant is best depends on several issues, such as your symptoms and other health conditions.

Common SSRIs include:

• Desvenlafaxine (Pristiq)*
• Duloxetine (Cymbalta)*
• Levomilnacipran (Fetzima)*
• Venlafaxine (Effexor XR)*

*This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

Benzodiazepines

While antidepressants are the optimum medication choice for PPD, some doctors will also prescribe benzodiazepines. These rapid acting anti-anxiety medications are often used while waiting for an SSRI to take effect. Since tolerance can develop with the use of these drugs, please make sure to talk to your prescriber about long-term use.¹

Common benzodiazepines include:

• Valium (diazepam)**
• Ativan (lorazepam)**
• Xanax (alprazolam)**
• Ativan (lorazepam)**
• Klonopin (clonazepam)**

**This medication has black box warnings, the most serious kind of warnings from the FDA for abuse or misuse, risk of physical dependence and risk of serious side effects, including death, when combined with an opioid.

Other Postpartum Depression Medications

Other medications are now being developed as options for treating postpartum depression, with two recently FDA-approved medications being released in the past few years. Zulresso is taken as an infusion, and Zurzuvae is a fast-action treatment taken as a once-daily capsule. These new treatments offer additional options for those seeking relief from postpartum depression symptoms.

• The Postpartum Depression Workbook
• Zurzuvae (Zuranolone) Side Effects: Common Symptoms & What to Do About Them
• How to Help Your Wife With Postpartum Depression