Postpartum Depression

Diagnosis

Your health care provider will talk with you about your feelings, thoughts and overall mental health to determine whether you are experiencing short-term postpartum baby blues or a more severe form of postpartum depression. Postpartum depression is common, so it is important to share your symptoms openly to help develop an effective treatment plan.

As part of the evaluation, your provider may conduct a depression screening, which often includes filling out a questionnaire. Additional tests may be ordered, if needed, to rule out other medical causes for your symptoms.

Treatment

Treatment and recovery time depend on the severity of your depression and your individual needs. If you have an underactive thyroid or another underlying illness, your provider may treat those conditions or refer you to a specialist. A referral to a mental health professional may also be recommended.

Baby blues

Baby blues usually fade on their own within a few days to 1 to 2 weeks. During this time, it may help to:

• Get as much rest as possible

• Accept support from family and friends

• Connect with other new mothers

• Create time for self-care

• Avoid alcohol and recreational drugs

• Seek support from a lactation consultant if you are having breastfeeding or milk production challenges

Postpartum depression

Postpartum depression is commonly treated with psychotherapy, medicine or a combination of both.

Psychotherapy involves talking with a psychiatrist, psychologist or other mental health professional. Through therapy, you can learn effective coping strategies, problem-solving skills, realistic goal setting and positive ways to respond to difficult situations. Family or relationship therapy may also help. Common therapy approaches include cognitive-behavioral therapy and interpersonal psychotherapy.

Antidepressants may be recommended to help manage symptoms. If you are breastfeeding, the medicine can enter your breast milk, but most antidepressants are considered safe for breastfeeding with minimal risk to the baby. Work with your provider to understand the risks and benefits of each option.

Other medicines may be added if needed. For example, if severe anxiety or insomnia is present, an antianxiety medicine may be prescribed for short-term use.

Brexanolone is the first medicine specifically approved for postpartum depression. It helps slow the rapid hormone changes after childbirth. Due to potential serious side effects, brexanolone must be given in a monitored health care facility through a vein over a 60-hour period, which limits its availability.

Research is ongoing for an oral medicine that works similarly to brexanolone. Early results are promising, suggesting it could be taken daily in pill form without the same level of side effects.

With proper treatment, symptoms usually improve. However, postpartum depression can continue in some cases and become chronic. Continuing treatment even after you feel better is important to prevent relapse.

Postpartum psychosis

Postpartum psychosis is a medical emergency that requires immediate treatment, usually in a hospital setting. Treatment may include:

• Antidepressants, antipsychotics, mood stabilizers and benzodiazepines

• Electroconvulsive therapy if symptoms do not respond to medicine

A hospital stay may disrupt breastfeeding due to separation from your baby. Your provider can recommend lactation support to help maintain breast milk production during treatment.