Postpartum Depression

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
	Credits

What is postpartum depression?

Postpartum depression (PPD) is a serious medical condition that can develop some time in the first few months after childbirth. Without treatment, PPD can be prolonged and disabling. Postpartum depression is very common, affecting 1 in 8 women during the first months after childbirth.¹ It can also strike after miscarriage, stillbirth, and adoption.

In rare cases, a woman may have psychotic symptoms that could put herself or others in danger. She may or may not seem depressed. This is called postpartum psychosis.

What are common symptoms?

Symptoms of postpartum depression include extreme fatigue, loss of pleasure in daily life, sleeplessness (insomnia), sadness, tearfulness, anxiety, hopelessness, feelings of worthlessness and guilt, irritability, appetite change, and poor concentration.

It may be helpful to make a list of postpartum depression symptoms that you can take to your health professional. See a postpartum depression checklist (What is a PDF document?).

Although any women with PPD can have fleeting, frightening thoughts of suicide or of harming their babies, women with rare postpartum psychosis experience these thoughts as urges they feel compelled to act on. If you think you can't keep from hurting yourself, your baby, or someone else, see your health professional immediately or call 911 for emergency medical care. Other resources include:

• The national suicide hotline, National Hopeline Network, at 1-800-784-2433.
• The National Child Abuse Hotline at 1-800-422-4453.

What causes postpartum depression?

Postpartum depression seems to be triggered by the changes in hormone levels that occur after pregnancy. These hormonal changes are especially likely to lead to postpartum depression if you've had depression before. You are also more likely to have PPD if you have poor support from your partner, friends, or family, have a sick or colicky baby, or are under significant additional stress.¹

Every woman has a risk of postpartum depression during the first several months after childbirth, miscarriage, or stillbirth. Women with a history of depression or postpartum depression have an even greater risk.

A personal or family history of bipolar disorder, also known as manic-depression, increases the risk of postpartum psychosis.

How is postpartum depression diagnosed?

Be sure to report any feelings of postpartum blues to your health professional at your first postpartum checkup, so he or she can follow up with you. Postpartum depression may seem like the blues that have become worse. Or you may notice it weeks after delivery. (However, the less common symptoms of postpartum psychosis can be noted as soon as 1 to 2 days after delivery.)

How is it treated?

PPD is best treated with counseling, certain antidepressant medications, or a combination of the two. Counseling and antidepressant medication have proven to be equally effective for milder depression, and some medications may be used while breast-feeding. Some women gain significant relief after a week or two of starting treatment either with medication or cognitive-behavioral counseling.²

You can further improve how you feel by getting help and support from others, eating well, getting daily walks or other exercise, and getting as much nighttime sleep as possible.

What are the risks of not treating postpartum depression?

PPD affects both you and your baby. It interferes with your ability to function normally, including caring for and bonding with your baby. Over time, your baby's development and behavior are likely to suffer from the effects of PPD.¹

Getting treatment for postpartum depression is important for both you and your baby. On average, untreated PPD lasts 7 months and can continue for over a year.¹ With treatment, symptoms improve much more quickly.²

Frequently Asked Questions

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	Managing postpartum depression

Postpartum depression seems to be triggered by the sudden hormone changes that happen after childbirth. These hormonal changes most commonly lead to postpartum depression when paired with risk factors such as previous depression (including bipolar disorder), poor support from your partner, friends, and family, or a high level of stress.¹

The hormone changes and grief following miscarriage and stillbirth also trigger PPD in many women.³

Postpartum blues. A certain amount of insomnia, irritability, tears, overwhelmed feelings, and mood swings are normal during the first days after childbirth. These "baby blues" usually peak around the fourth postpartum day and subside in less than 2 weeks, when hormonal changes have settled down. If you have postpartum blues after childbirth, you're not alone—more than half of women have temporary mild symptoms of depression mixed with feelings of happiness after having a baby.¹

Be sure to report any feelings of postpartum blues to your health professional at your first postpartum checkup, so he or she can follow up with you.

Postpartum depression (PPD). Symptoms of postpartum depression can follow postpartum blues. They can feel like more of the same, or worse than before. Postpartum depression can also happen months after childbirth or pregnancy loss. In some cases, symptoms peak after slowly building for 3 or 4 months. Possible PPD symptoms require evaluation by a health professional.

If you have postpartum depression, you have had five or more depressive symptoms (including one of the first two listed below) for most of the past 2 weeks, including:¹

• Depressed mood—tearfulness, hopelessness, and feeling empty inside, with or without severe anxiety.
• Loss of pleasure in either all or almost all of your daily activities.
• Appetite and weight change—usually a drop in appetite and weight, but sometimes the opposite.
• Sleep problems—usually trouble with sleeping, even when your baby is sleeping.
• Noticeable change in how you walk and talk—usually restlessness, but sometimes sluggishness.
• Extreme fatigue or loss of energy.
• Feelings of worthlessness or guilt, with no reasonable cause.
• Difficulty concentrating and making decisions.
• Thoughts about death or suicide. Some women with PPD have fleeting, frightening thoughts of harming their babies: these thoughts tend to be fearful thoughts, rather than urges to harm.

Early treatment of PPD is important for both you and your baby. It may be helpful to make a list of postpartum depression symptoms that you can take to your health professional. See a postpartum depression checklist (What is a PDF document?).

Postpartum psychosis. This severe condition is most likely to affect women with bipolar disorder or a history of postpartum psychosis. Symptoms, which usually develop during the first 3 postpartum weeks (as soon as 1 to 2 days after childbirth), include:

• Feeling removed from your baby, other people, and your surroundings (depersonalization).
• Disturbed sleep, even when your baby is sleeping.
• Extremely confused and disorganized thinking, increasing your risk of harming yourself, your baby, or another person.³
• Drastically changing moods and bizarre behavior.
• Extreme agitation or restlessness.
• Unusual hallucinations, often involving sight, smell, or touch.
• Delusional thinking that isn't based in reality.

Postpartum psychosis is considered an emergency requiring immediate medical treatment. If you have any psychotic symptoms, seek emergency help immediately. Until you tell your health professional and get treatment, you are at high risk of suddenly harming yourself or your baby.

Postpartum blues and depression

Over half of all women have some mood-related symptoms during the first 2 weeks after childbirth. Most women with postpartum blues, or "baby blues," find that their mood swings, insomnia, overwhelmed feelings, and agitation go away within 2 weeks. However, 1 in 8 women develop longer-lasting postpartum depression (PPD) in the weeks to months after childbirth.¹ The hormone changes and grief following miscarriage and stillbirth also trigger PPD in many women.³

Postpartum depression makes it hard for you to function well, including caring for and bonding with your baby. Babies of depressed mothers tend to be poorly attached to their mothers and to be slower in behavior, language, and mental development.⁴

Without treatment, PPD goes on for an average of 7 months, and can continue for over a year.⁵ Prompt PPD treatment is important for both you and your baby. The earlier you are treated, the more quickly you will recover, the less your chances of repeat depression, and the less your baby's development will be affected by your condition.^{6, 3}

Postpartum psychosis

In rare cases (up to 1 in 500), dangerous postpartum psychosis symptoms—such as bizarre behavior, sight-, smell-, or touch-related hallucinations, feeling detached from others and reality, and urges to hurt oneself or others—can suddenly develop within the first 3 postpartum weeks, as soon as 1 to 2 days after childbirth.^{5, 3} These symptoms tend to be more severe than those of psychosis unrelated to childbirth and can trigger life-threatening behaviors without warning. Postpartum psychosis is more likely to affect women who have bipolar disorder or have had postpartum psychosis before.³

Postpartum psychosis is considered an emergency requiring immediate medical treatment and follow-up care. Often, psychotic symptoms that have been successfully treated can still be followed by postpartum depression symptoms that require additional treatment.

For more information about what increases your chances of having postpartum depression and psychosis and of developing them after more than one pregnancy, see the What Increases Your Risk section of this topic.

Every woman is at risk for temporary "postpartum blues" during the first 2 weeks after childbirth, because of sudden hormone changes and the challenges of caring for a newborn. Women who have miscarried or had a stillbirth are also at risk. Overall, 20% of women with postpartum blues go on to suffer from postpartum depression (PPD).

However, there are also known factors that increase your risk of having long-term depression after pregnancy. If you have had postpartum depression before, you are at high risk of having it again. About 50% of women with a PPD history will have PPD after a later pregnancy.⁷ Other risk factors include:

• Poor support from family, partner, and friends.
• High life stress, such as a sick or colicky newborn, financial troubles, or family problems.⁸
• Physical limitations or problem symptoms after childbirth.⁸
• First-time pregnancy.⁵
• Depression during a current pregnancy; 75% of women who are depressed during pregnancy will also have postpartum depression.⁷
• Previous depression; 25% of women who have ever had depression will have PPD.⁷
• Bipolar disorder, also known as manic-depression, which also increases the risk of dangerous psychotic behavior after childbirth.⁷
• A family history of depression or bipolar disorder.
• Previous premenstrual dysphoric disorder (PMDD), the severe type of premenstrual syndrome (PMS).

Postpartum psychosis

Risk factors for postpartum psychosis include:^{3, 5}

• A personal or family history of bipolar disorder. Women with this risk factor are 3 times more likely to have postpartum psychosis symptoms than women with no bipolar history.⁵
• Previous postpartum psychosis.

If you have had postpartum psychosis before, you are at high risk for having psychotic symptoms again in the future.⁵ Your health professional will want to watch you closely, particularly if you become pregnant again.

Call 911 or other emergency services if you think you cannot keep from harming yourself, your baby, or another person. You can also call the national suicide hotline, National Hopeline Network, at 1-800-784-2433 or the National Child Abuse Hotline at 1-800-422-4453.

Call your health professional immediately if:

• You are not having symptoms of postpartum depression (listed below), but you have hallucinations involving smell, touch, hearing, or sight or have thoughts that may not be based in reality (delusions). Examples of delusions are fears that someone is watching you, stealing from you, or reading your mind.
• You have severe symptoms of postpartum depression.
• You have any symptoms of depression and have had depression or postpartum depression before.
• You have had any symptoms of depression for longer than 2 weeks. You don't necessarily have all possible symptoms when you have depression. Call sooner rather than later, before your condition gets worse.

Symptoms of postpartum depression include:

• Depressed mood—tearfulness, hopelessness, and feeling empty inside, with or without severe anxiety.
• Loss of pleasure in either all or almost all of your daily activities.
• Appetite and weight change—usually a drop in appetite and weight, but sometimes the opposite.
• Sleep problems—usually trouble with sleeping, even when your baby is sleeping.
• Noticeable change in how you walk and talk—usually restlessness, but sometimes sluggishness.
• Extreme fatigue or loss of energy.
• Feelings of worthlessness or guilt, with no reasonable cause.
• Difficulty concentrating and making decisions.
• Thoughts about death or suicide. Some women with PPD have fleeting, frightening thoughts of harming their babies: these tend to be fearful thoughts, rather than urges to harm.

Watchful Waiting

If your symptoms are new and not severe, you can wait up to 2 weeks to see if they will go away. Otherwise, call your doctor as soon as you notice symptoms. The earlier you are treated, the more quickly you will recover, and the less your baby's development will be affected by your condition.⁶

Who To See

Your obstetrician may be the first health professional to note and diagnose PPD. This is one of many reasons why it's important to have a medical check 3 to 6 weeks after childbirth. Treatment for PPD ideally involves both medication and some form of professional counseling. To effectively treat depression, it's important that you and your counselor have a comfortable relationship.

Diagnosis and medication management of postpartum depression can be provided by a:

• General practitioner.
• Family doctor.
• Psychiatrist.
• Physician assistant.
• Nurse practitioner.

Professional counseling can be provided by a:

• Psychologist.
• Social worker.
• Licensed professional counselor.
• Psychiatrist (all prescribe medication; many also provide counseling).

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Postpartum depression is a medical condition that requires treatment, not a sign of weakness. It isn't always obvious to an observer, and there are no laboratory tests for depression. This is why it's important that you tell your health professional about your symptoms.

It may be helpful to make a list of postpartum depression symptoms that you can take to your health professional. You don't necessarily have all possible symptoms when you have depression. Regardless of how many symptoms you have, talk to your doctor about any symptoms sooner rather than later, before they get worse. See a postpartum depression checklist (What is a PDF document?).

Your health professional will diagnose and recommend treatment for postpartum depression if you've had five or more of the following symptoms (including the first or second) for most of each day over the past 2 weeks:¹

• Depressed mood—tearfulness, hopelessness, and feeling empty inside, with or without severe anxiety
• Loss of pleasure in either all or almost all of your daily activities
• Appetite and weight change—usually a drop in appetite and weight, but sometimes the opposite
• Sleep problems—usually trouble with sleeping, even when your baby is sleeping
• Noticeable change in how you walk and talk—you may seem restless or move very slowly
• Extreme fatigue or loss of energy
• Feelings of worthlessness or guilt, with no reasonable cause
• Difficulty concentrating and making decisions
• Thoughts about death or suicide

Although the most disturbing symptoms can be the hardest to talk about, it's especially important to tell your health professional about any urges to harm yourself or your baby. If you have compelling thoughts about hurting yourself or others, you must tell your health professional immediately and get treatment.

In addition to screening you for depression, your health professional may also check your thyroid-stimulating hormone (TSH) levels to make sure a thyroid problem isn't contributing to your symptoms.

Early Detection

If you have had depression, postpartum depression, or postpartum psychosis before, are now pregnant and have depression, or have bipolar disorder, ask your health professional and family members to watch you closely. Some experts suggest that high-risk women have their first postnatal checkup 3 or 4 weeks after childbirth, rather than the usual 6 weeks.³

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.⁷ A form of counseling called cognitive-behavioral therapy has proven to be as effective as antidepressant medicine for milder postpartum depression.² 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.)^{2, 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.⁷

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.⁷
• 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.⁵

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

Although you can't prevent the postpartum hormone changes that cause postpartum blues, you can take steps to prevent ongoing postpartum depression (PPD). If you have a history of depression or postpartum depression, you and your health professional have some additional prevention options to choose from.

Basic prevention measures for every woman

To minimize the effects of postpartum hormonal changes and stress, keep your body and mind strong.

• Ask for help from others, so you can get as much sleep, healthy food, exercise, and overall support as possible.
• Stay away from alcohol, caffeine, and other drugs or medications unless recommended by your health professional.
• Close monitoring after childbirth is important. If you are worried about developing PPD, have your first postnatal checkup 3 or 4 weeks after childbirth, rather than the usual 6 weeks.³

Prevention measures for high-risk women

If you have had depression or postpartum depression before, you and your health professional can plan ahead to reduce your higher risk of postpartum depression. Consider the following options if you have:

• A history of depression. If you have no depressive symptoms late in a first pregnancy, watchful waiting is recommended. However, if you have a history of severe depression, some experts recommend counseling and support before childbirth. You and your health professional may choose to start antidepressant medication after the birth to prevent PPD, particularly if you have had PPD before.⁷

  Should I take antidepressants during pregnancy?

• A history of PPD. After childbirth, don't wait till symptoms develop—start with counseling and support (some women start counseling a couple of months before childbirth). You and your health professional may choose a combination of counseling and an antidepressant.⁷
• Depression during pregnancy. If you are taking an antidepressant medication during pregnancy, continue taking it into the postpartum period to reduce your high risk of postpartum depression.

Postpartum depression is a medical condition, not a sign of weakness. Be honest with yourself and those who care about you. Tell them about your struggle. You, your health professional, and your friends and family can team up to treat your symptoms.

• Schedule outings and visits with friends and family, and ask them to call you regularly. Isolation feeds depression, especially when combined with the stresses of caring for a newborn.
• Eat a balanced diet. If you have little appetite, eat small snacks throughout the day. Nutritional supplement shakes are also useful for keeping up your energy.
• Get regular daily exercise, such as outdoor stroller walks. Exercise helps improve mood.
• Get as much sunlight as possible—keep your shades and curtains open, and get outside as much as you can.
• Ask for help with food preparation and other daily tasks. Family and friends are often happy to help a mother with newborn demands.
• Avoid alcohol and caffeine. Avoid using alcohol or other substances to feel better (self-medicating). Talk to your health professional if you're having symptoms that need treatment.
• Don't overdo it, and get as much rest and sleep as possible. Fatigue can increase depression.
• Join a support group of new mothers. No one can better understand and support the challenges of caring for a new baby than other postpartum women. For more information on support groups, talk to your health professional or see the Web site of Postpartum Support International at http://www.postpartum.net.

For more information on how to cope with your symptoms, see:

Managing postpartum depression.

The potential for domestic violence increases during a woman's pregnancy and when a couple is adjusting to a new baby. If your partner is violent or emotionally abusive, you and your baby are physically at risk, and you have an higher risk of postpartum depression. Now more than ever, it's crucial that you protect yourself and your baby—seek support and help. For more information, see the topic Domestic Violence.

Antidepressants are commonly used to treat postpartum depression (PPD), usually in combination with counseling and support.⁷

• 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.³ 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. They tend to take 4 to 8 weeks to improve depression, though some women improve sooner. 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} Tricyclics may take 4 to 8 weeks to improve depression.

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.

FDA advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory to patients, families, and health professionals providers to closely monitor adults and children taking antidepressants for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.

The FDA also advises that patients be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania. It is most important to watch for these behaviors in children who may be less able to control their impulsivity as much as adults and therefore may be at greater risk for suicidal impulses. The FDA has not recommended that people stop using antidepressants, but simply to monitor those taking the medications and, if concerns arise, to contact a health professional.

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.⁵ 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

Postpartum depression does not require surgical treatment.

Poor family and social support and high stress raise the risk of postpartum depression (PPD). For this reason, every woman with a new baby needs plenty of support from family and friends. Any special care you get will help you get through the challenges of the postpartum period.

More formal PPD treatment and prevention measures include cognitive-behavioral or interpersonal counseling. Light therapy has shown promise as a nonmedication treatment of depression, but has not been studied for postpartum depression. Parent coaching and infant massage can further enrich your relationship with your baby.

On rare occasion, electroconvulsive therapy (ECT) is used to treat severe forms of depression. Studies have shown that ECT is an effective short-term treatment for depression.^{14, 15}

Other Treatment Choices

Counseling

Counseling has been proven to help prevent and treat depression during pregnancy and after childbirth.¹ Experts recommend that both parents participate to improve treatment success.^{7, 11} Cognitive-behavioral therapy and interpersonal counseling are well-proven PPD treatments.^{2, 9} In one study, cognitive-behavioral counseling proved to be as effective as medication for mild postpartum depression.²

• Cognitive-behavioral therapy helps you take charge of the way you think and feel. In one study, women with PPD improved after one cognitive-behavioral counseling session and showed significantly greater improvement after six sessions.²
• Interpersonal counseling (focusing on your relationships and the personal adjustments of having a new baby) provides emotional support and help with problem-solving and goal-setting. In one study, more women recovered from PPD after 12 interpersonal counseling sessions than did those who had no counseling.⁹

Alternative therapies

• Light therapy can be used to treat depression, and it does not have severe side effects. Studies have shown that it improves depression during pregnancy, winter-related depression (seasonal affective disorder), and general depression.^{16, 17} Light therapy may be about as effective as antidepressant medicine, according to a review of studies.¹⁷ It has not yet been widely studied for postpartum depression. For light therapy, you sit in front of a high-intensity (2,500 to 10,000 lux) fluorescent lamp every morning, gradually building up to 1 to 2 hours a day.
• Parent coaching offers both education and support for handling baby care and problems, as well as the personal and couple transition into parenthood.
• Infant massage classes teach you skills for physically and emotionally bonding with your baby and give you a chance to spend time with other postpartum mothers.

What To Think About

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 medication.⁷

Online Resource

Organization

• Anxiety
• Bipolar Disorder
• Breast-Feeding
• Depression
• Miscarriage
• Pregnancy

Citations

1. Wisner KL, et al. (2002). Postpartum depression. New England Journal of Medicine, 347(3): 194–199.

2. Appleby L, et al. (1997). A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. BMJ, 314(7085): 932–936.

3. Miller L (2002). Postpartum depression. JAMA, 287(6): 762–765.

4. Newport DJ, et al. (2002). The treatment of postpartum depression: Minimizing infant exposure. Journal of Clinical Psychiatry, 63(Suppl 7): 31–44.

5. Parry BL (2004). Management of depression and psychoses during pregnancy and the puerperium. In RK Creasy et al., eds., Maternal-Fetal Medicine: Principles and Practice, 5th ed., pp. 1193–1200. Philadelphia: Saunders.

6. Schulberg HC, et al. (1999). Best clinical practice: Guidelines for managing major depression in primary medical care. Journal of Clinical Psychiatry, 60(7): 19–28.

7. Altshuler LL, et al. (2001). The expert consensus guideline series: Treatment of depression in women. Postgraduate Medicine Special Report (March): 1–116.

8. Howell EA, et al. (2005). Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Obstetrics and Gynecology, 105(6): 1442–1450.

9. O'Hara MW, et al. (2000). Efficacy of interpersonal psychotherapy for postpartum depression. Archives of General Psychiatry, 57: 1039–1045.

10. Whitby DH, Smith KM (2005). The use of tricyclic antidepressants and selective serotonin reuptake inhibitors in women who are breastfeeding. Pharmacotherapy, 25(3): 411–425.

11. Brockingham I (2004). Postpartum psychiatric disorders. Lancet, 363(9405): 303–310.

12. Weissman AM, et al. (2004). Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. American Journal of Psychiatry, 161: 1066–1078.

13. Flores DL, Hendrick VC (2002). Etiology and treatment of postpartum depression. Current Psychiatry Reports, 4: 461–466.

14. Butler R, et al. (2005). Depressive disorders. Clinical Evidence (13): 1238–1276.

15. UK ECT Review Group (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: A systematic review and meta-analysis. Lancet, 361(9360): 799–808.

16. Lam RW, Levitt AJ (2000). Canadian Consensus Guidelines for the Treatment of Seasonal Affective Disorder: A Summary of the Report of the Canadian Consensus Group on SAD. Vancouver, BC: Clinical and Academic Publishers. Also available online: http://www.psychiatry.ubc.ca/mood/sad/ccgsad.htm.

17. Golden RN, et al. (2005). The efficacy of light therapy in the treatment of mood disorders: A review and meta-analysis of the evidence. American Journal of Psychiatry, 162(4): 656–662.

Author:	Kathe Gallagher, MSW	Last Updated June 30, 2006
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Lisa S. Weinstock, MD - Psychiatry
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