Depression that occurs following childbirth is called postpartum depression. Pregnancy and childbirth are often of excited anticipation and joyous celebration.  But for many women, they are also times of stress.  Not surprisingly, during this period, new mental health issues such as depression may emerge.

This article discusses the nature of depression after childbirth, its risk factors, and its treatments.

Understanding postpartum depression

Postpartum depression shares much in common clinical depression: It is usually associated with sadness, feelings of worthlessness, fatigue, inability to experience pleasure, changes in appetite and sleep, agitation or slowed movements, difficulty concentrating, and thoughts of suicide and death.  In some cases, postpartum depression is associated with severe anxiety and panic as well.

Risk factors for postpartum depression include the following:

  1. Depression during pregnancy
  2. Anxiety during pregnancy
  3. Recent stressful life events
  4. History of depressive illness
  5. Low self-esteem
  6. Childcare stress
  7. Difficult infant temperament
  8. Baby blues (i.e. moodiness for a short time following childbirth)
  9. Lack of social support
  10. Poor marital relationship
  11. Low socioeconomic status
  12. Unwanted or unplanned pregnancy
  13. Single marital status

Treatments for postpartum depression

One option for treating depression that occurs during pregnancy or after childbirth is the use of antidepressants, particularly selective serotonin reuptake inhibitors or SSRIs (e.g., Prozac, Zoloft).  These medications are considered first-line treatments for depression in the general population.

Patients who do not respond well to SSRIs may be switched to a different class of antidepressants, like the serotonin and norepinephrine reuptake inhibitors or SNRIs (e.g., Cymbalta, Effexor).  Or they can be switched to medications like Wellbutrin, Remeron, or certain tricyclic antidepressants.

Those interested in new drug treatments for depression may want to consider Zulresso, which was approved in 2019 by the FDA specifically for the management of postpartum depression.  This medication is available only through a special program.

Zulresso is given intravenously.  The infusion takes around 60 hours and must be done under medical supervision.

Though antidepressants are generally safe to use during pregnancy and while breastfeeding, the decision to use antidepressants will need to be made on a case-by-case basis.  A patient’s health provider will weigh the potential benefits of an antidepressant against its potential risks (e.g., infant exposure to the antidepressant through breast milk).

After being informed of the risks and benefits, the patient can decide if an antidepressant is right for them.  Patients concerned about potential risks of psychiatric medications for depression will have other options to consider, the main one being psychological treatments.

A commonly utilized psychological treatment for depression is cognitive-behavioral therapy (CBT).  CBT helps modify dysfunctional thinking and behavior patterns and, as a result, improves mood and reduces anxiety.  Another psychological treatment is interpersonal therapy, which focuses on resolving relationship problems that contribute to depression.

A variety of non-medical treatments (e.g., exercise, light therapy) may also reduce postpartum depression, though data on their effectiveness is limited.

The sooner treatment the better

If you are experiencing postpartum depression, the sooner you get treatment, the better.  When it comes to treatment, you have many options—medications (e.g., SSRIs), psychotherapy (e.g., cognitive-behavioral therapy), complementary therapies (e.g., meditation), social interventions (e.g., support groups), etc.  So, work with a knowledgeable provider to find the depression treatment right for you.

Remember, by treating your depression, you are not only helping yourself feel better, but you are also helping your child.  After all, raising a child requires considerable time, energy, and psychological resources.  In short, take good care of yourself so you can take good care of your child.