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Postpartum Depression (PPD) Treatment

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About 13 percent of Americans have postpartum depression (PPD), a condition that occurs within the first year after childbirth. It’s one of the most common health issues pregnant people encounter.

 There are a variety of treatments for PPD, including talk therapy, medication, and lifestyle modifications. Here’s an overview of the options.

Psychotherapy (aka talk therapy) is the first line of treatment for mild cases of PPD, says Nancy Byatt, DO, a perinatal psychiatrist and physician-scientist at the University of Massachusetts Chan Medical School in Worcester, where she focuses on women’s mental health, specifically in pregnancy and postpartum. Byatt is also the founding medical director of Massachusetts Child Psychiatry Access Program for Moms (MCPAP), an initiative she developed and launched to train physicians, midwives, and obstetrics nurses in identifying symptoms of depression in new moms.

Psychotherapy for PPD may consist of one or a combination of:

Individual Therapy

In individual therapy, you’ll meet with a mental health professional weekly or at a similar cadence, Dr. Byatt says. Some people may attend therapy for a short time, such as three to six weeks, but others may continue to see their therapist for several months or more. Some types of therapy that can help people with PPD, says Byatt, include:

  • Cognitive Behavioral Therapy (CBT) CBT helps people learn to identify inaccurate or negative thinking in order to view difficult situations more clearly and cope with them in a more constructive way.

     “With therapy like CBT, you’re changing your thought processes, becoming aware of them, and challenging them so they no longer make us anxious,” Byatt says.
  • Interpersonal Therapy (IPT) IPT focuses on helping people improve their interpersonal relationships to relieve mental health symptoms. Researchers have found that four to eight sessions of IPT may help reduce symptoms of postpartum depression and improve satisfaction with family relationships and support, too.

Family and Couples Therapy

Women with PPD may decide to go to couples therapy with their partners or family therapy with several family members. These types of therapy can help people better understand their symptoms and how they’re affected by relationship or family dynamics.

Group Therapy

Group therapy is another helpful resource for postpartum parents. Therapy groups for PPD can provide useful information on how to handle day-to-day stresses and create a sense of community among new parents sharing the same experiences. One meta-analysis found that group therapy set a “foundation” for women to share their challenges, wisdom, and guidance in a safe space; build feelings of validation and empowerment; and reduce depressive symptoms.

Medication used to treat PPD is similar to that for major depression, with a focus on antidepressants and anti-anxiety medication depending on symptoms and severity, says Nona Nichols, MD, a consultation-liaison psychiatrist at the Center for Adult Behavioral Health at Cleveland Clinic in Ohio.

“For women with mild-to-moderate depression, we would typically consider antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs), as the first-line medications. Fortunately, these medications are considered safe in breastfeeding as well,” Dr. Nichols says.

Standard Antidepressants

As mentioned, psychotherapy is the gold standard treatment for PPD in pregnant and breastfeeding women when symptoms are mild. But in women with moderate or severe PPD, antidepressants are considered a primary treatment alongside therapy.

Antidepressants help to balance the chemicals in your brain that affect mood. They can take at least three to four weeks to start working.

 About half of women with PPD are treated with antidepressants, and although they’re not completely without risk, their use is generally safe for breastfeeding women.

They can, however, come with side effects, including headache, nausea, constipation, drowsiness, insomnia, increased appetite leading to weight gain, loss of libido, and nervousness.

Common antidepressants used to treat postpartum depression include:

If a patient has symptoms of postpartum anxiety, such as racing thoughts, irrational fears, or an inability to relax or keep calm, doctors may also prescribe the above for treatment.

Brexanolone

If your doctor spots PPD symptoms while you’re still in the hospital after giving birth, they may recommend an intravenous (IV)-drip medication called brexanolone (Zulresso).

 Approved by the U.S. Food and Drug Administraition (FDA) in 2019 to treat PPD, brexanolone is given as an infusion in the hospital over the course of two or three days under medical supervision. This is done because the medication can cause loss of consciousness in some people.

When a baby is about to be born, progesterone levels spike in the mother’s body, then fall steeply after birth. Brexanolone helps maintain progesterone levels in order to balance hormones and mood in new moms.

Brexanolone is very effective, but because it requires 60 hours of in-clinic IV-drip therapy, it may not be readily accessible for everyone.

Zuranolone

In 2023, the FDA approved zuranolone (Zurzuvae), the first oral medication for PPD. It’s taken once daily, typically with dinner, for 14 days. Clinical studies showed it helps to stave off symptoms of depression quickly and for several weeks after the last dose.

It can be taken alone or in combination with SSRIs or SNRIs. However The American College of Obstetricians and Gynecologists (ACOG) note that patients should use contraception during the 14-day treatment course and for one week after the final dose, as zuranolone may cause harm to a new pregnancy.

Common side effects of zuranolone include:

  • Cold-like symptoms
  • Dizziness
  • Drowsiness
  • Diarrhea
  • Fatigue
  • Urinary tract infections
  • Sedation
  • Confusion
Due to side effects like sedation, confusion, and dizziness, people who receive zuranolone should not drive or engage in activities that require full mental alertness for 12 hours afterward.

Some new parents may believe they need to ignore their needs to tend to their baby first, but this is a misconception, Byatt says. “The best way to take care of our children is to take care of ourselves,” she says. Nichols uses the acronym NESTS to explain the importance of self-care for PPD. It includes:

Nutrition

What you eat has a direct impact on mental health and mood, including during the postpartum period. Researchers have found that maternal depression is tied to a low intake of nutrients like calcium, iron, and folate,

 with one study noting that postpartum women with depression tend to eat less vegetables and had, overall, less variety in their meals.

Try to focus on eating a diet rich in whole foods, such as fruits, vegetables, lean proteins, and healthy fats to support your energy levels and brain function and regulate mood, Byatt says.

Exercise

The ACOG recommends postpartum women aim for at least 150 minutes of moderate-intensity exercise per week. Not only can this help strengthen your abdominal muscles and boost energy, but it can help with PPD.

 One study found exercise is effective for helping manage perinatal and postpartum depression symptoms.

Check with your healthcare team before you start exercising after having a baby. If you had an uncomplicated pregnancy and vaginal delivery, it’s usually safe to begin light exercise a few days after giving birth or when you feel ready. But if you’ve had a C-section, extensive vaginal repair, or a complicated birth, you may need guidance on when and how to start your exercising.

 Exercise may look like a daily walk outside and getting some fresh air and sunshine to start, Byatt says.

Sleep

Try your best to make sure you and your partner are getting enough sleep. One review noted that poor sleep after having a baby is a predictor of postpartum depression. The review also suggested that poor postpartum sleep and postpartum depression are intertwined, with each increasing the risk of the other.

As tricky as it can be, especially with a newborn, try your best to practice healthy sleep habits, Byatt says. That includes sleeping in a cool, dark room, limiting screen time before bedtime, sticking to a consistent sleep schedule, and taking turns with feeding and changing your baby overnight. According to the same review, having one four- to five-hour period of sleep each night can help ease symptoms of moderate to severe PPD and reduce risk among parents at high risk of PPD, and having another adult step in for one to two feedings each night can help.

Time for Yourself

Whether you’re taking time out each day for a shower or to catch up on your favorite show, it’s crucial for new parents to have moments for themselves, Nichols says. Byatt also recommends using this time for meditation, yoga, or any activity that allows you to pause and destress.

Support

It’s okay to ask for help, Byatt says. Consider joining a maternal support group to make friends, lean on your loved ones to batch cook and deliver some meals, or hire a professional cleaning service once a week if you can afford it. “I always ask my patients about their support systems and encourage them to ask for help and tag-team childcare as much as possible so that women have time to take care of themselves,” Nichols says.

National Maternal Mental Health Hotline

If you’re struggling with your mental health while pregnant or after giving birth, call or text 833-TLC-MAMA (833-852-6262), which is a free, confidential hotline for pregnant and new moms in English and Spanish, 24/7.

Postpartum Support International

Call 800-944-4PPD (4773) to connect with trained volunteers who provide support, encouragement, information and resources by phone, text, or email and connect pregnant, postpartum and post-loss families with local healthcare providers who treat perinatal mood and anxiety disorders.

American Academy of Family Physicians (AAFP)

AAFP is an organization representing family physicians in the United States. It provides information on PPD and a Postpartum Depression Toolkit with resources for PPD screening, diagnosis, treatment, and patient self-help.

  • Having a baby is a life-changing experience. New parents can feel overwhelmed, anxious, sad, or fearful. Postpartum depression is a common experience for women, with symptoms ranging from loneliness and crying spells to severe mood swings and disinterest in tending to yourself and your baby.
  • Treatment options are effective and range from medication to therapy.
  • Self-care is an important part of treatment — this includes making sure you’re eating healthy meals, getting adequate sleep and taking care of your mind and body.

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