Early detection and treatment of depression after and during pregnancy is important because of the many adverse outcomes, including infant care and development. Experts have recommended screening for postpartum depression at the first postnatal obstetrical visit, which is typically 4–6 weeks after delivery. As a screening tool, many healthcare practitioners use a 10-item self-report that emphasizes emotional and functional factors.
Common forms of psychotherapy include interpersonal therapy and short-term cognitive-behavioral therapy. Family physicians are key players in the detection and treatment of postpartum depression; this is because new mothers have a tendency to negate their feelings as something other than a treatable psychiatric illness. Depressed mothers also report that they don’t receive the social support that they desire in this time of need. This lack of perceived support occurs in women’s relationships with their parents, relatives and friends, but it most pronounced in their relationships with their partners.
Interpersonal psychotherapy is a short-term, limited focus treatment that targets the specific interpersonal disruptions experienced by women in the postpartum period. Plus, a recent systematic review found that patients with major depressive disorder in primary care actually prefer psychotherapy over antidepressant medication for treatment, especially women with postpartum depression.
One study reported that 31 percent of breastfeeding women with postpartum depression declined antidepressant medication because they were breastfeeding; these women are better suited for psychotherapy as a conventional treatment option. Several studies show the positive results of psychotherapy, both in an individualized setting and in a group format.
Postpartum depression demands the same pharmacologic treatment as major depression does, with similar doses as those given to patients with depression that isn’t associated with pregnancy. Selective serotonin reuptake inhibitors (SSRIs) are usually the first-choice medicines for women with postpartum depression. They can ease the symptoms of moderate-to-severe depression by affecting blocking the reabsorption of the neurotransmitter serotonin in the brain. Changing the balance of serotonin may help brain cells send and receive chemical messages, which boosts mood.
Tricyclic antidepressants are also commonly prescribed. This type of medication eases depression by affecting naturally occurring chemical messengers (neurotransmitters), which are used to communicate between brain cells.
Researchers suggest that mothers should continue medication for 6–12 months postpartum to ensure a complete recovery; however, there are concerns of breastfeeding mothers about exposure of the infant to the antidepressant medication. Infants are especially vulnerable to potential drug effects due to their immature hepatic and renal systems, immature blood-brain barriers and developing neurological systems. There are also concerns that treatment with antidepressant medication may result in metabolic changes in the postpartum period, and may effect the mother’s ability to care for a new baby.
A 2003 study published by the Journal of the American Board of Family Practice suggests that of the more frequently studied antidepressant drugs in breastfeeding women, paroxetine, sertraline and nortriptyline have not been found to have adverse effects on infants. Fluoxetine, however, should be avoided in breastfeeding women.
Because there is a dramatic drop in maternal levels of estrogen and progesterone at the time of delivery, this shift may contribute to the onset of postpartum depression in some women and hormone therapy may be beneficial. Estrogen has been used as a treatment of postpartum depression and some studies have showed promising results.
However, estrogen therapy should not be used in women with an increased risk of thromboembolism, and estrogen therapy can interfere with lactation, cause endometrial hyperplasia and elevate the risk of endometrial cancer.