From the Guidelines
Postpartum depression symptoms include persistent sadness, severe mood swings, excessive crying, withdrawal from family and friends, difficulty bonding with the baby, changes in appetite or sleep, overwhelming fatigue, intense irritability, feelings of worthlessness or guilt, severe anxiety, and thoughts of harming oneself or the baby, and treatment typically involves a combination of psychotherapy and medication, with the most recent and highest quality study 1 suggesting the use of patient-reported outcome measures such as the Edinburgh Postnatal Depression Scale to screen for postpartum depression.
Symptoms of Postpartum Depression
The symptoms of postpartum depression can vary, but common symptoms include:
- Persistent sadness
- Severe mood swings
- Excessive crying
- Withdrawal from family and friends
- Difficulty bonding with the baby
- Changes in appetite or sleep
- Overwhelming fatigue
- Intense irritability
- Feelings of worthlessness or guilt
- Severe anxiety
- Thoughts of harming oneself or the baby
Treatment Options
Treatment for postpartum depression typically involves a combination of psychotherapy and medication.
- Psychotherapy options include cognitive behavioral therapy (CBT) and interpersonal therapy (IPT), typically lasting 12-16 weekly sessions.
- Antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) like sertraline (50-200 mg daily) or fluoxetine (20-60 mg daily) are commonly prescribed, with treatment usually continuing for 6-12 months after symptoms improve.
- For nursing mothers, sertraline and paroxetine are often preferred due to minimal presence in breast milk.
- Support groups, regular exercise, adequate sleep, healthy nutrition, and avoiding alcohol and drugs are important complementary approaches.
- Partners and family members should be involved in the treatment process to provide emotional support. As noted in the study by 1, it is critical that services are provided to women with depressive and anxiety disorders and their children in order to reduce the risk of offspring neurodevelopmental problems. Additionally, the study by 1 suggests that clinicians should consider CBT or other evidence-based counseling interventions when managing depression in pregnant or breastfeeding women, given the potential harms to the fetus and newborn child from certain pharmacologic agents. The study by 1 highlights the importance of identifying biological and psychosocial predictors of postpartum depression, including hypothamric-pituitary-adrenal dysregulation, inflammatory processes, and genetic vulnerabilities, as well as severe life events, relationship quality, and support from partner and mother. Overall, seeking help promptly is crucial as treatment is highly effective, allowing mothers to fully enjoy this important time with their newborn.
From the Research
Symptoms of Postpartum Depression (PPD)
- Depression during the first year postpartum impacts millions of women and their families worldwide 2
- Peripartum depression affects up to one in seven women and is associated with significant maternal and neonatal morbidity if untreated 3
- A history of depression is the strongest risk factor for developing peripartum depression 3
- Symptoms can be distinguished from the baby blues, which is characterized by short duration, mild symptoms, and minimal impact on functioning 3
Treatment Options for PPD
- Psychological treatments are effective and preferred by many perinatal patients over medications, but they often remain inaccessible 2
- Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, are generally the first-line antidepressant medication recommended to women in the postpartum period due to their minimal passage into breastmilk and corresponding decades of safety data 2, 4, 3, 5
- Neurosteroids are emerging as an effective treatment for postpartum depression, although currently this treatment is not widely available 2
- Mild to moderate depression should be treated with psychotherapy or SSRIs, whereas moderate to severe depression should be treated with a combination of psychotherapy and medication 3
- Citalopram, escitalopram, and sertraline appear to be the safest SSRIs during pregnancy, whereas fluvoxamine, paroxetine, and sertraline are preferred in breastfeeding women because they lead to the lowest serum medication levels in breastfed infants 3, 5