Fertility

Postpartum Depression Treatment & Diagnosis

Updated on 3 March 2022 • 12 minute read

 

Overview

Around 21.9% of new moms might experience postpartum depression during the first year after birth. What’s sad, however, is that only about 14% seek treatment. (1)

It’s a cause for concern because maternal depression can affect child development, including poor cognitive performance, mild behavioral difficulties, and insecure attachment to you. (1)(2)

What are the causes and symptoms of PPD, can it go away without medication, and what treatment options are available? 

How do you cope with postpartum depression, and what antidepressants are used for treating this mental health concern? Are there home remedies for PPD?

Learn more about PPD, diagnosis, and other information below.

 

Is PPD Curable?

Yes. Postpartum depression is a treatable mental health condition. PPD isn’t your fault and doesn’t indicate your failure as a parent. Although it might currently be interfering with parent-child bonding, this can improve with treatment. (3)(4)

 

What Treatment Is Available For PPD?

Talk Therapy

There are several forms of treatment for postpartum depression, including talk therapy or the use of antidepressants.

ACOG (American College of Obstetricians and Gynecologists) and APA (American Psychiatric Association) agree that psychotherapy or talk therapy can be ideal for mild to moderate cases. (3)(4)

Common forms of talk therapy used for PPD:

 

CBT (Cognitive Behavioral Therapy)

  • It can help manage your negative thoughts by improving how you think and act. 
  • One way of doing this is for the therapist to help you identify negative thoughts or behaviors and set goals to start thinking and acting differently.

 

IPT (Interpersonal Therapy)

  • It can help you identify and deal with conditions or problems in your personal life and other interpersonal relationships (with your partner, family, neighborhood, or work).
  • It might also help you deal with having a medical condition or losing a loved one
  • Common techniques can include role-playing, decision analysis (looking closely at how you make decisions), answering open-ended questions (not just “yes” or “no” questions), and communication analysis (how you communicate with others).

 

Family & Social Support

It’s not a direct treatment, but the NIMH (National Institute of Mental Health) believes that family support can help a mom with postpartum depression. (5)

Sometimes, family members might notice the first signs of PPD and help you seek treatment.

They can also provide you with emotional support and assist in caring for your baby or other tasks. 

PPD treatment is important for recovery. Aside from your family offering encouragement and assistance, you can also turn to support groups to help you cope with PPD. The NIMH recommends advocacy groups like Postpartum Support International.

 

Hormone Treatments

Estrogen Patch

PPD can be caused by hormonal changes, particularly the sudden drop in estrogen and progesterone levels after birth. (6)

So, your doctor might also recommend using an estrogen patch to increase these hormone levels in your body. (6)

However, this treatment isn’t advisable for breastfeeding moms because the hormones can pass through breast milk to your baby. (6)

 

Brexanolone

It’s the first FDA-approved drug for PPD treatment. It can mimic allopregnanolone, a progesterone derivative, a hormone that fluctuates during pregnancy and after birth. Stabilizing allopregnanolone levels can reduce postpartum depression symptoms. (7)

Brexanolone is administered through an IV line (intravenous) for 2½ days (60 hours). Due to the treatment duration and risk of side effects, it can only be given in a clinic or hospital while you’re under medical supervision. 

Clinical trials show that it can effectively reduce PPD symptoms and continue working 30 days post-treatment. (7)

This treatment might not be safe for use if you’re pregnant or breastfeeding.

 

What Antidepressants Are Used For PPD?

Antidepressant medications are used as a primary treatment for severe anxiety and PPD.

These prescription drugs can stabilize your mood, preventing irritability, sadness, mood swings, and other PPD symptoms.

Different types of antidepressants have different effects on the brain.

  • SSRIs (Selective Serotonin Reuptake Inhibitors) are drugs that specifically improve the brain’s serotonin levels. Serotonin is a neurotransmitter (chemical “messenger” in the brain) responsible for moods and emotions. SSRIs block serotonin reabsorption in the brain, ensuring that it’s readily available. This can help elevate your mood and reduce the symptoms of postpartum depression. (8)
  • SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) improve the levels of serotonin and another neurotransmitter, norepinephrine. (8)
  • TCAs (Tricyclic Antidepressants) also block the reabsorption of serotonin and norepinephrine (9)
  • MAOIs (Monoamine Oxidase Inhibitors) work by blocking the enzyme that breaks down neurotransmitters like dopamine, norepinephrine, serotonin, and tyramine to increase their levels in the brain (10)

 

ECT (Electroconvulsive Therapy)

This hospital treatment is reserved for severe cases (especially depression with psychosis or hallucinations) that didn’t respond to other medications. (11)

It involves passing controlled electric currents through the brain, causing a controlled seizure that affects the brain’s chemical composition. It’s done under general anesthesia. (11)

Major improvement might be observed after around four to six treatments, followed by “maintenance ECT, which can be done at longer intervals (from once a month to once a year), depending on your progress.

 

rTMS (Repetitive Transcranial Magnetic Stimulation)

Instead of electric currents, this procedure uses magnetic energy. An electromagnetic coil is placed over your forehead and is used to create short pulses to your brain. (11)(12)

The procedure can last about 40 minutes per session, but major improvement might take longer than ECT. Although it might help with depression, it isn’t recommended for patients with psychosis or higher suicide risk. (11)

Around 50-70% of patients might respond positively to ECT and rTMS, leading to a marked improvement in their depression symptoms. (12)

 

Things To Know When Undergoing Treatment

Regular Intake

Regardless of the type of antidepressant your doctor prescribes, be sure to take them as instructed and at the same time each day. This helps improve their effectiveness in reducing your postpartum depression symptoms.

In some cases, postpartum depression can become chronic depression. It’s important to continue treatment even after you begin to feel better. Stopping treatment too early may lead to a relapse.

 

Breastfeeding While Undergoing Treatment

APA, ACOG, and other experts specializing in mental and women’s health recommend continued breastfeeding even if you take antidepressants. But make sure to get the green light from your doctor. (4)

 

Side Effects

You might also experience side effects with antidepressants. These prescription drugs are often linked to sexual dysfunction and similar side effects in women, including reduced sexual desire, delayed orgasm, etc.) (13)

Side effects can show around one to three weeks from the start of treatment. Your doctor can recommend complementary therapy, but exercise, acupuncture, and essential oils might also help reduce these side effects. (13)

Some antidepressants such as TCAs (Tricyclic Antidepressants) can have more serious side effects: (14)

  • Confusion
  • Irregular heart rate
  • Increased risk of seizure episodes for those who already suffer from seizures

 

However, TCAs might still be a good form of medication for some moms with PPD. Be sure to have someone monitor your vitals and behavior while taking these medications.

ECT (Electroconvulsive Therapy) can cause: (11)

  • Nausea or headaches
  • Muscle pain
  • Confusion (might last a few minutes or for some hours)
  • Memory loss (short-term or long-term, depending on treatment frequency and length)

 

rTMS (Repetitive Transcranial Magnetic Stimulation) can lead to: (11)

  • Headaches or light-headedness
  • Muscle contractions
  • Tingling in your face or jaw
  • Seizures (if you have a history of seizures)

 

Diagnosis

Many health care professionals now check for PPD risk factors in pregnant women as early as your first prenatal care visit. 

Unlike physical disorders, however, there isn’t any blood test or body scan that can show whether you have a mood disorder and what type of PPD you might have. 

Instead, your OB-GYN might offer a referral to a mental health professional (psychologist or psychiatrist) who can assess your state of mind using depression screening tools.

 

EPDS (Edinburgh Postnatal Depression Scale)

It’s considered one of the best methods to check for PPD

You have to answer a checklist with 10 short statements relating to how you felt in the past seven days. 

Questions can include:

  • “I have blamed myself unnecessarily when things went wrong.”
  • “I have been anxious or worried for no good reason.”
  • “The thought of harming myself has occurred to me.”

 

You get different points depending on your answers on the checklist. The maximum number of points is 30, with scores above 10 possibly indicating depression. (15)

Although it’s readily available online, you mustn’t self-diagnose your condition. Answer this checklist as honestly as possible, but your doctor should be the one to make the diagnosis and prescribe the right treatment.

 

PHQ-2 (2-Question Patient Health Questionnaire)

It might be short, but this test remains a common tool in screening new mommies for PPD. (16)

The purpose of the questionnaire is to assess depression in a “first-step approach.

You have four choices that range from “not at all” to “nearly every day.” The two questions ask how often you felt bothered by the following problems over the past two weeks:

  • Little interest or pleasure in doing things
  • Feeling down, depressed or hopeless

 

You get different points depending on your answers. If you score higher than three points, you might have a major depressive disorder.

Again, only answer this questionnaire and let your health care provider make the assessment.

 

PHQ-9 (9-Question Patient Health Questionnaire)

If you test positive with PHQ-2, your doctor will proceed with PHQ-9. Your answer options remain the same, but the questions now include other factors, such as your depressed thoughts, having low energy, appetite changes, and trouble sleeping or focusing. (17)

Your doctor might also screen for other mood-related symptoms, such as bipolar disorder or postpartum psychosis.

Because thyroid problems can cause similar symptoms as postpartum depression, your doctor might also screen for thyroid function or hormone levels.

 

Preparing For Your Appointment

Find Support

Ask a trusted family member or your partner to accompany you to your appointment with a mental health professional. They can help you remember the information discussed and assist with your treatment plan.

 

Bring Your List

Make a list with the following information:

  • Symptoms you’re experiencing, including how long you might have been experiencing them
  • All of your physical and mental health issues
  • Medications you’re taking (including herbs, vitamins, supplements, prescription drugs, and over-the-counter medications)
  • Questions you want to ask your doctor

 

Some questions you might want to ask your doctor:

  • What’s my diagnosis?
  • What treatments can help me?
  • Are these medications safe to take while breastfeeding?
  • How much are these treatment options?
  • How soon do you expect my PPD symptoms will improve with treatment?
  • Are there side effects to the treatments you’re proposing?
  • How long will I need to be treated?
  • Are there lifestyle changes I need to make to help me manage my symptoms?
  • How often should I come back for follow-up visits?
  • Are there any printed materials I can have or websites you can recommend?
  • Am I at increased risk for other mental health problems?
  • Am I at risk of a recurring condition if I have another baby?
  • If yes, can that be prevented?

 

Feel free to ask any other questions, which can also put your mind at ease during your appointment.

 

Questions Your Doctor Might Ask

You can also add answers to these questions to your list, so you won’t forget when you’re talking to your doctor:

  • What are your symptoms?
  • When did they start?
  • Are these symptoms affecting your ability to care for your baby?
  • Did your symptoms get better or worse over time?
  • Do you feel bonded to your baby?
  • Do you have any support in caring for your baby?
  • Has your appetite changed?
  • How’s your energy level?
  • Do you get to sleep when you have the chance?
  • How often would you say you feel angry, anxious, or irritable?
  • Are there significant stressors in your life, such as relationship or financial problems?
  • Have you experienced having thoughts of harming yourself and/or your baby?
  • Have you been diagnosed with any medical condition?
  • Have you been diagnosed with any mental health condition, such as bipolar disorder or depression? If yes, what type of treatment helped you the most?

 

Your mental health clinician will have other questions to ask based on your symptoms, responses, and needs. 

 

How Do I Cope With Postpartum Depression?

Some of the most common ways to cope with PPD:

  • Find some “me time” (make time to go out and visit your friends or your partner).
  • Use essential oils to help improve your mood.
  • Find emotional support from family members and friends.
  • Join a mom’s support group and learn from their experiences.
  • Avoid alcohol and recreational drugs because they can affect your body and interfere with PPD medication (they can pass to your baby through breast milk). (18)
  • Identify and reduce your stressors with stress management habits.

 

How Can I Help A Family Member With PPD?

  • Show your support.
  • Constantly tell them that everything is going to be alright.
  • Try to help ease their anxiety.
  • Offer support in caring for their baby.
  • If you think their condition is serious, encourage them to seek help from a mental health professional to get the right treatment. However, don’t “force” them into getting help. Encouragement is the key.

 

What Happens If Postpartum Depression Is Left Untreated?

Postpartum depression can affect you and your family:

 

Effect On Moms

  • It can affect your health and quality of life.
  • It could progress into chronic depressive disorder.
  • It might cause bonding issues with your baby.
  • It might also affect your relationship with your partner.

 

Still, even if PPD is treated, it can increase your risk of future episodes of major depression. (19)

 

Effect On Babies

  • It can affect your baby’s well-being, especially if they’re born prematurely, have low birth weight, or have other health complications.
  • It might contribute to sleeping and/or feeding problems for your baby. 
  • It can also lead to poorer cognitive, language, motor, social-emotional, and adaptive behavior development that can extend to adolescence. (20)

 

Effect on Dads

  • PPD is often associated with women, but dads can have it, too. 
  • Studies show that as many as 21% of new fathers may experience PPD. (21)
  • Like with moms, PPD in dads can also cause fatigue and changes in their sleeping or eating cycles.
  • Sometimes, it might be influenced by maternal depression. Researchers discovered that 24-50% of men whose partners have PPD can also experience it themselves. (22)

 

Dads have an increased risk of experiencing PPD if: (21)

  • They’re younger (although the study didn’t indicate the exact parental age to be considered as “young”)
  • They’re jobless or having financial difficulties
  • They have a history of mental health concerns or depression

 

Other Types Of Postpartum Mood Disorders

There are other mood disorders often confused with postpartum depression. So, getting the right diagnosis is essential in receiving the best treatment option from your doctor.

 

Baby Blues or “Postpartum Blues”

You might have heard about baby blues and how it can make a lot of new moms feel weepy for no apparent reason. 

It can affect as many as 85% of new mothers in their first year postpartum. However, it usually lasts for just a few days and might resolve without any medical treatment. (23)

Symptoms can include the following: (24)

  • Crying for no apparent reason
  • Insomnia (even when your baby is sleeping)
  • Anxiety
  • Fatigue
  • Impatience
  • Irritability
  • Restlessness
  • Sadness
  • Mood changes
  • Poor concentration

 

Most of the time, baby blues doesn’t require any treatment because it resolves on its own.

The experience can be unpleasant but subsides within two weeks. 

It might even resolve quicker if you get help taking care of your baby and doing household chores, as well as receiving reassurance or emotional support from your partner and family members.

 

Postpartum Anxiety

It’s a common mood disorder that often gets undiagnosed because people wrongly assume that new moms are naturally anxious. (25)

It can differ from other forms of mood disorders in that you might show more symptoms relating to anxious behaviors.

Symptoms can include: (25)

  • Inability to relax
  • Feelings of high stress or tension 
  • Persistent fears or worries
  • Feeling anxious most of the time
  • Feeling of worthlessness

 

These symptoms can last for a few weeks after birth, with or without treatment.

 

Postpartum Panic Disorder

This mood disorder can occur in up to 10% of new moms. It differs from other forms because you might experience extreme anxiousness and repeated panic attacks. (25)

Symptoms can include: (25)

  • Heart palpitations
  • Tightening of the chest
  • Shortness of breath
  • Excessive worrying or fear, including about going crazy or dying

 

You can have an increased risk of having a postpartum panic disorder if you have:

  • A history of severe anxiety or panic attacks
  • Thyroid dysfunction (the thyroid gland is located in the neck and is responsible for your metabolism) (26)

 

Talk therapy can help in mild to moderate cases, but your doctor might prescribe antidepressants in severe cases.

 

Postpartum OCD (Obsessive-Compulsive Disorder)

It’s estimated that around 3-5% of new moms might experience postpartum OCD. (27)

This anxiety disorder shows obsession and compulsion towards your new baby, which can lead to excessive avoidance (such as avoiding a bath because you’re afraid the baby might drown or excessive washing because you think your newborn might get sick from germs). (28)

Other symptoms can include: (27)

  • Upsetting obsessions about your baby
  • Compulsions (doing certain things over and over again because you believe it can reduce your fears and obsessions)
  • Feeling of horror about your obsessions
  • Hypervigilance in protecting your baby
  • Fear of being left alone with your baby

 

A mom with postpartum OCD knows about their bizarre thoughts but is unlikely to act on them. However, these thoughts aren’t delusional. (27)

You can have a higher risk of developing postpartum OCD if you have a personal or family history of depression, anxiety, or OCD.

Talk therapy (psychotherapy) is one of the most useful treatment options for OCD.

 

Postpartum PTSD (Post-Traumatic Stress Disorder)

Around 9% of new mothers might experience postpartum PTSD stemming from a perceived or real threat, usually during childbirth. (25)

Possible traumatic events:

  • Childbirth complications
  • Unplanned C-sections
  • Injuries during delivery
  • Your baby was sent to NICU (neonatal intensive care unit)

 

Postpartum PTSD symptoms can include: (25)

  • Difficulty sleeping
  • Feeling detached (numb to reality)
  • Constantly reliving the trauma as flashbacks and memories
  • Avoiding trauma triggers (which might include your baby)
  • Anxiety and panic attacks
  • Irritability

 

You might be at a higher risk of developing postpartum PTSD if you experienced violence, sexual assault, or traumatic life events (such as a violent death of a loved one).

Talk therapy can help in mild to moderate cases, but your doctor might prescribe antidepressants in severe cases.

 

Postpartum Psychosis

This rare form of postpartum mental illness occurs in around 1-2 mothers out of 1,000 childbirths. The change can be dramatic, but most moms with psychosis might be unaware of their behavior or actions. (25)

It’s considered the most severe postpartum mental disorder and a medical emergency that can lead to infanticide or suicide.

Watch out for these warning signs: (29)

  • Constant restlessness
  • Feeling very confused
  • Feeling too suspicious or fearful
  • Behaving out of character
  • Signs of depression or low mood (anxiety, trouble sleeping, crying, being withdrawn, lacking energy, loss of appetite, or agitation)
  • Delusions (beliefs or thoughts that aren’t likely to be true)
  • Hallucinations (smelling, hearing, seeing, or feeling things that aren’t there)
  • Manic mood (feeling “high” or talking and thinking too quickly or too much)
  • A mix of manic and low moods (or a sudden change between these moods)
  • Loss of inhibitions

 

Some moms might require hospitalization and antidepressants or other relevant prescription drugs.

Your doctor might also consider ECT or rTMS if antidepressants don’t work.

 

 

 

REFERENCES

(1) Wisner KL, Sit DKY, McShea MC, et al. Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings. JAMA Psychiatry. 2013;70(5):490–498. doi:10.1001/jamapsychiatry.2013.87. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1666651

(2) https://pubmed.ncbi.nlm.nih.gov/1577898/

(3) https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/perinatal-depression-preventive-interventions

(4) https://journals.sagepub.com/doi/full/10.1177/0004867418762057

(5) https://www.nimh.nih.gov/health/publications/perinatal-depression

(6) Moses-Kolko, Eydie & Berga, Sarah & Kalro, Brinda & Sit, Dorothy & Wisner, Katherine. (2009). Transdermal Estradiol for Postpartum Depression: A Promising Treatment Option. Clinical obstetrics and gynecology. 52. 516-29. 10.1097/GRF.0b013e3181b5a395. https://www.researchgate.net/publication/26723782_Transdermal_Estradiol_for_Postpartum_Depression_A_Promising_Treatment_Option 

(7) https://www.frontiersin.org/articles/10.3389/fpsyt.2021.699740/full

(8) https://www.postpartumdepression.org/treatment/

(9) https://journals.sagepub.com/doi/full/10.1177/20451253211065859

(10) https://www.ncbi.nlm.nih.gov/books/NBK539848/

(11) https://www.nami.org/About-Mental-Illness/Treatments/ECT,-TMS-and-Other-Brain-Stimulation-Therapies

(12) https://www.health.harvard.edu/mind-and-mood/an-underused-option-for-severe-depression

(13) https://www.health.harvard.edu/womens-health/when-an-ssri-medication-impacts-your-sex-life

(14) https://www.stlukesonline.org/health-services/health-information/healthwise/2015/05/15/14/11/tricyclic-antidepressants-for-postpartum-depression

(15) https://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf

(16) https://www.hiv.uw.edu/page/mental-health-screening/phq-2

(17) https://www.hiv.uw.edu/page/mental-health-screening/phq-9

(18) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742364/

(19) https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression/Major-Depressive-Disorder-with-Peripartum-Onset

(20) https://jamanetwork.com/journals/jamapediatrics/fullarticle/2770120

(21) https://pubmed.ncbi.nlm.nih.gov/20819960/

(22) https://www.nct.org.uk/life-parent/emotions/postnatal-depression-dads-10-things-you-should-know

(23) https://kidshealth.org/en/parents/babyblues.html

(24) https://americanpregnancy.org/healthy-pregnancy/first-year-of-life/baby-blues/

(25) https://www.postpartumdepression.org/postpartum-depression/types/

(26) https://www.btf-thyroid.org/what-is-thyroid-disorder

(27) https://www.postpartum.net/learn-more/obsessive-symptoms/

(28) https://iocdf.org/wp-content/uploads/2014/10/Postpartum-OCD-Fact-Sheet.pdf

(29) https://www.nhs.uk/mental-health/conditions/post-partum-psychosis/

 

 

 

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