Postpartum Depression - Treatment Overview

Treatment Overview

Early treatment of postpartum depression (PPD) is important for you, your baby, and the rest of your family. The sooner you start, the more quickly you will recover, and the less your depression will affect your baby. Babies of depressed mothers can be less attached to their mothers and lag behind developmentally in behavior and mental ability.¹

Treatment choices for postpartum depression include:

• Counseling for both you and your partner.⁶ A form of counseling called cognitive-behavioral therapy has proven to be as effective as antidepressant medicine for milder postpartum depression.⁸ Cognitive-behavioral therapy helps you take charge of the way you think and feel. Interpersonal counseling is also a good treatment choice for postpartum depression. (You may find a counselor who offers both cognitive-behavioral therapy and interpersonal counseling.)^{8, 9} Interpersonal counseling focuses on relationships and the personal changes that come with having a new baby. It gives you emotional support and helps with problem-solving and goal-setting. For your partner, counseling may help with the demands of having a new baby. It can also help your partner support you.
• Antidepressant medicine, which effectively relieves symptoms of postpartum depression for most women. Since breast-feeding is also important for your baby, talk to your doctor and your baby's doctor about an antidepressant medicine you can use while breast-feeding. Certain selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants are considered relatively safe for use while breast-feeding.¹⁰

Talk to your health professional about your symptoms and decide on what type of treatment is right for you. Counseling and support are considered a first-line treatment for mild to severe PPD. Women with mild PPD are likely to benefit from counseling alone. Those with moderate to severe PPD are advised to combine counseling with antidepressant medicine.⁶

You may also benefit from:

• A part-time or full-time mother's helper, which is recommended for both mild and more severe postpartum depression.⁶
• Parent coaching or infant massage classes, for strengthening mother-baby attachment.

Your health professional may recommend a licensed counselor who specializes in treating postpartum depression.

What To Think About

Can I take antidepressant medicine and breast-feed my baby?

Treating your depression is very important for your baby. Breast-feeding is good for your baby's health and your baby's bond with you, too. At best, you will be able to treat your depression and breast-feed your baby. But if you decide to choose between taking medicine and breast-feeding, treat your depression.

Talk to your doctor and your baby's doctor about your antidepressant choices. Any antidepressant can get into mother's milk, but some do so in such small amounts that they can't be measured in babies' blood.

• Of the SSRIs, sertraline (Zoloft) is usually the first-choice medicine for breast-feeding mothers. It is most studied and generally does not seem to affect breast-feeding babies.¹⁰
• There have been reports of side effects in babies exposed to paroxetine (Paxil), fluoxetine (Prozac), and citalopram (Celexa).^{11, 12}
• Fluvoxamine (Luvox) has not been well studied.

Some SSRIs, such as fluoxetine, are passed on to the breast-fed baby more than others. And every woman uses (metabolizes) and passes on medicine in different amounts. Overall, your milk has the lowest possible level of medicine just before you take a daily dose. Each SSRI is different, but in general the medicine is highest in your breast milk several hours after taking a daily dose.

Researchers are studying children who breast-fed while their mothers took SSRIs. So far, they have seen no signs of unusual problems in these children into their preschool years.⁴

How long do I need to take antidepressant medicine for postpartum depression?

Antidepressants are typically used for at least 6 months, first to treat postpartum depression and then to prevent a relapse of symptoms. To prevent a relapse, your health professional may recommend that you take medication for up to a year before considering tapering off of it. Experts recommend long-term antidepressant treatment for women who have had three or more depressive episodes in the past.¹