Postpartum Depression - Medications

Medications

Antidepressants are commonly used to treat postpartum depression (PPD), usually in combination with counseling and support.⁶

• For moderate to severe PPD, experts recommend an antidepressant combined with support and counseling.
• Some experts recommend starting an antidepressant for prevention, but so far no studies have shown this to be effective.¹¹

Breast-feeding is good for you and your baby, both physically and emotionally. For this reason, experts have studied which antidepressants seem safest for breast-feeding babies. So, you need not stop breast-feeding while taking an antidepressant for postpartum depression.¹

Whether or not you are breast-feeding, your health professional is likely to recommend a selective serotonin reuptake inhibitor (SSRI). This class of medication is highly effective for most women, with fewer side effects than tricyclics.² Most tricyclic antidepressants can be used while breast-feeding with minimal risk, but for the mother, side effects are sometimes a problem.

Your health professional may start you out with a low dose to help you adjust to the medication.

Medication Choices

Selective serotonin reuptake inhibitors (SSRIs) are usually the first-choice medication for treating postpartum depression. Most SSRIs are thought to be safe for use while breast-feeding because in general they pass into the breast milk at low levels. (But fluoxetine (Prozac) and citalopram (Celexa) have been found in higher levels in breast-feeding babies, and are linked to some reports of side effects in babies.^{12, 10})

Tricyclics have not caused any known breast-feeding baby problems and are not passed on to a breast-feeding baby in measurable amounts (with the exception of doxepin [Adapin, Sinequan], which is not considered safe while breast-feeding).^{1, 11}

You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.

What To Think About

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 thinking about discontinuing it. Experts recommend long-term antidepressant treatment for women who have had three or more depressive episodes in the past.¹

Never suddenly stop taking an SSRI. An SSRI should be tapered off slowly and only under the supervision of a health professional. Abruptly stopping SSRI medication can cause flu-like symptoms, headaches, nervousness, anxiety, or insomnia.

If you are breast-feeding and taking an antidepressant or any other medication, let your baby's pediatric health professional know.

Taking an antidepressant you've taken before. After having your baby, talk to your health professional before taking any medication, especially if you are breast-feeding. You may be more sensitive to medication side effects during your postpartum period, and may need a lower dose than before. Some medications are considered safer than others when a woman is breast-feeding.

Hormone therapy.Estrogen treatment for PPD has been studied on a limited basis. While women taking estrogen have shown improvement, many were also taking an antidepressant, making it difficult to know whether estrogen was responsible.⁴ Estrogen therapy is unlikely to become a common treatment for PPD, because it increases the risk of blood clots (deep vein thrombosis) and of cancer in the uterine lining (endometrium). Adding progestin eliminates estrogen's endometrial cancer risk but is known to trigger PPD when taken after childbirth.¹³