From the Guidelines
The best medications for postpartum depression typically include selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft), which is often prescribed at 50-200 mg daily, or fluoxetine (Prozac) at 20-60 mg daily. These medications are generally considered first-line treatments due to their effectiveness and relatively favorable safety profile during breastfeeding 1. Other options include escitalopram (Lexapro) at 10-20 mg daily or citalopram (Celexa) at 20-40 mg daily. For more severe cases or when a quicker response is needed, brexanolone (Zulresso) may be considered, though it requires intravenous administration in a healthcare setting over 60 hours.
Key Considerations
- Treatment typically continues for 6-12 months after symptoms resolve to prevent relapse.
- When starting medication, patients should be aware that SSRIs may take 2-4 weeks to show full benefits, and side effects like nausea, headache, or insomnia may occur initially but often subside.
- It's essential to combine medication with psychotherapy when possible and maintain regular follow-up appointments to monitor response.
- Medication choice should be individualized based on prior response to antidepressants, side effect profiles, and breastfeeding status, as some medications transfer less into breast milk than others 1.
Safety Profile
- SSRIs are associated with a small to moderate risk of harms, including an increased risk of suicidal behaviors in adults aged 18 to 29 years and an increased risk of upper gastrointestinal bleeding in adults older than 70 years 1.
- Antidepressant use during pregnancy has not been shown to improve outcomes and may increase the risk of preterm delivery compared with untreated women who have depression 1.
- Breastfeeding women can use SSRIs, as they transfer in low concentrations into breast milk, with paroxetine and sertraline being the most commonly prescribed antidepressants during breastfeeding 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medications for Postpartum Depression
The following medications are considered effective for treating postpartum depression:
- Selective serotonin reuptake inhibitors (SSRIs), with sertraline being a commonly recommended first-line treatment due to its minimal passage into breastmilk and decades of safety data 2, 3, 4
- Neurosteroids, which are emerging as an effective treatment, although not yet widely available 2
Key Findings
- Studies have shown that SSRIs, such as sertraline, are efficacious and well-tolerated in the treatment of postpartum depression, with higher response and remission rates compared to placebo 3, 4
- Cognitive behavioral therapy (CBT) is also an effective treatment for postpartum depression, and may be preferred by some women over medication, especially during breastfeeding 5, 6
- Combination therapy of pharmacological and psychological treatments may not offer a clear advantage over mono-therapy in the short term 6
Treatment Considerations
- The choice of treatment should be based on the severity of depressive symptoms and individual patient preferences 5
- Parenting support is an important component of modern care for women with postpartum depression 5
- Systematic cooperation between psychiatrists and gynecologists-obstetricians is essential for effective treatment 5