3 Treatment Options for Postpartum Depression

If you just had a baby, finding time to take care of yourself is difficult—especially if you’re among the 1 in 7 women who experience postpartum depression. But it’s important to take steps to feel better, both for you and for your baby.

The good news is that postpartum depression is treatable, and several of those treatment options are safe if you are breastfeeding.

UNC Health psychiatry specialist Anne Ruminjo, MD, MPH, explains the symptoms of postpartum depression and breaks down a few treatment methods.

Know the Symptoms of Postpartum Depression (PPD)

Postpartum depression is a severe form of depression that can occur after a woman has a baby. It is very similar to depression, but it’s unique because anxiety and worry can be core features.

It is different from the “baby blues,” which are generally mild feelings of worry and sadness that last about two weeks. Women with postpartum depression have more trouble functioning and have symptoms that last longer than two weeks.

Symptoms of postpartum depression can include:

  • Feeling sad and depressed or crying a lot
  • Loss of interest in usual activities
  • Difficulty with sleep (even when the baby is sleeping)
  • Difficulty with appetite
  • Feelings of guilt, worthlessness or incompetence
  • Not wanting to be with or bond with the baby
  • Intense anxiety
  • Persistent worries or fears about hurting the baby
  • Suicidal thoughts

Postpartum depression is often missed because many of the symptoms—including fatigue, lack of sleep and difficulty with concentration—commonly occur in parents who have a new baby, Dr. Ruminjo says.

If you’ve just had a baby, it’s critical to check in with yourself often and prioritize self-care. If your symptoms last longer than a few weeks after delivery, reach out for help.

Treatment Options for Postpartum Depression

There are a wide range of treatment options for postpartum depression. Your provider will determine the best one for you by assessing the severity of your symptoms and your history of depression treatment, if applicable.

Below are a few available treatment methods.

Psychotherapy: For people experiencing mild to moderate postpartum depression, psychotherapy (sometimes referred to as “talk therapy”) is usually the first method of treatment. During psychotherapy, a clinician will help you work through challenging feelings by prompting you to talk about them.

This might include discussing the transition to becoming a mom, the expectation the role brings and any hardships you’re experiencing. The clinician will also help you assess your support system and how to strengthen it, if needed.

Sessions usually take place weekly or every other week for a specified period. Talk therapy requires commitment to attending the sessions and being vulnerable and honest.

“We find that many moms dealing with postpartum depression are usually very motivated to engage in psychotherapy and prefer this modality of treatment. Psychotherapy is also unique in that it targets both mother and baby by addressing the mother-infant bond,” Dr. Ruminjo says.

Antidepressants: If you have moderate to severe depression, medication is recommended to help boost your body’s feel-good hormones and keep depression at bay. The majority of people who experience moderate to severe postpartum depression are prescribed an antidepressant in addition to psychotherapy.

Some women worry about passing the medication on to the baby through breast milk. However, there are several antidepressants that are relatively safe and compatible with breastfeeding, Dr. Ruminjo says.

And in the case of severe depression, she says, the benefits of treatment far outweigh the risks.

“Untreated postpartum depression has negative effects on the mother, including increased risk of suicide. It also can impact babies. Studies show children whose moms had postpartum depression having increased risk of behavioral issues, lower IQ and slower language development,” Dr. Ruminjo says.

Commonly prescribed antidepressants that are generally safe in breastfeeding women include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

These medications usually take effect in four to six weeks. They work by increasing levels of neurotransmitters (chemical messengers) in the brain that are involved in regulating mood and anxiety.

“If patients have experience with antidepressants in the past, we’ll try to choose one that they have previously had success with,” Dr. Ruminjo says.

Brexanolone (IV infusion): A new medication treatment, brexanolone (Zulresso), is the only therapy approved by the Food and Drug Administration specifically for moderate to severe postpartum depression.

It is given as a continuous IV infusion over 2½ days and helps to regulate GABA receptors, producing an antidepressant effect. GABA receptors are chemical messengers in the brain that slow it down by blocking specific signals in the central nervous system.

Samantha Meltzer-Brody, MD, MPH, chair of psychiatry and director of the UNC Center for Women’s Mood Disorders, was the academic principal investigator for the clinical trials of brexanolone, which led to FDA approval in 2019.

Dr. Meltzer-Brody says the powerful medication can bring relief in a matter of days for women dealing with severe postpartum depression, and it is offered at the UNC Medical Center. It is usually given as a one-time infusion. The clinical trial data showed that the treatment lasted at least one month, and additional data demonstrates that the treatment effects can be long-lasting.

It can also cause excessive sleepiness, so it must be given in a medically supervised setting to watch for side effects.

Early studies do not suggest adverse outcomes for infants exposed to brexanolone. Contact your provider if you are breastfeeding.

There are other treatment options for people with severe postpartum depression who don’t respond to medication. Always talk with your provider to find the treatment that is best for you.

Postpartum Depression Can Affect Dads, Too

If mom has postpartum depression, it’s possible that dad has it, too. It can be caused by decreased sleep, increased stress and the relationship change between partners that often happens while caring for a newborn. Complications during delivery or with the baby can increase dad’s chances of experiencing depression.

“We’ve started seeing postpartum depression in dads more frequently,” Dr. Ruminjo says. “It can make for an incredibly stressful family dynamic, particularly if mom is also sick. Thankfully, we are now starting to recognize it and ask families about it.”

What to Do if You’re Experiencing Postpartum Depression

If you’re a mother or father who is showing signs of postpartum depression, the first step is to tell someone. This can be your provider, partner, a family member or a friend. Make sure you reach out to your obstetric provider or a mental health professional for help. For more information, visit Postpartum Support International.

If you have any thoughts of suicide, call 911 or the National Suicide Prevention Lifeline at 988.

Looking for a mental health professional? Find one near you or contact the UNC Center for Women’s Mood Disorders.