After receiving a postpartum depression (PPD) diagnosis, your doctor will work with you to establish a treatment plan. While the specific elements of a postpartum depression treatment plan will depend on your specific needs, it usually includes a combination of medication, such as antidepressants; psychotherapy; lifestyle measures; and support from family, friends, and peer groups.
As you work with your doctor to create or modify the best postpartum depression treatment plan for you, you may have questions, particularly about the safety and effectiveness of the treatment.
1. Can My Prescribed Medication Harm My Baby if I’m Breastfeeding?
It goes without saying that mothers who have been prescribed medication for postpartum depression may worry about any potential health implications for their baby. But here’s the good news: “The vast majority of medications used to treat PPD are safe to use for breastfeeding and lactating women,” says Alison Hermann, MD, a psychiatrist at Weill Cornell/NewYork-Presbyterian in New York City who practices general adult psychiatry and reproductive psychiatry.
The selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) is a common first-line treatment for postpartum women because of its minimal transfer to breast milk. That said, Dr. Hermann notes that not all postpartum depression medications have the same minimal risks to your baby, so it’s important to discuss any potential effects with your doctor.
2. Will PPD Go Away on Its Own Without Any Treatment?
Generally, no. But that doesn’t mean you necessarily need to take medication or have formal psychotherapy to find relief from symptoms, says Hermann. “Some women get significant relief from interventions such as improving sleep and increasing social support.”
3. Can I Manage PPD With Lifestyle Measures Alone?
It’s possible to manage depression with tweaks to your day-to-day, but that doesn’t work for everyone. “It depends on the severity and individual needs of the woman affected by PPD. Some women need medication to get better, and some do not,” says Hermann. The most important lifestyle change is focusing on sleep, she says. “Getting four-hour stretches of uninterrupted sleep at least once in a 24-hour period can make a massive difference.”
Other strategies — like eating healthy, getting regular exercise (once cleared by your obstetrician), spending some time outside in the fresh air, and getting help with cleaning and other household chores — may help symptoms, too, whether or not you take medication.
4. Are There Any Effective Complementary and Alternative Treatments That Can Help PPD?
“Access to therapy can be difficult, but when possible, medication plus psychotherapy is known to be the most effective treatment,” says Naomi Torres-Mackie, PhD, a clinical psychologist specializing in women’s mental health and reproductive mental health at Northwell Health’s Lenox Hill Hospital in New York City. But there are things that can be helpful add-ons.
Acupuncture can be a useful complementary therapy for some women with postpartum depression, says Hermann. There’s also been a moderate amount of evidence showing that noninvasive neurological treatment called repetitive transcranial magnetic stimulation, which uses magnetic pulses to stimulate underactive areas of the brain, may be helpful in treating postpartum depression.
And while some research has suggested other complementary therapies, such as bright light therapy and omega-3 fatty acid or vitamin D3 supplements, may help postpartum depression, one review found little evidence to support those measures.
5. How Will I Know if the PPD Treatment Plan Is Working?
It’s important to discuss with your doctor how they’ll be monitoring the condition, but typically they’ll look for improvements in both the severity of symptoms and how you’re functioning in daily activities, relationships, and responsibilities. “The symptoms come in three major buckets: problems with mood, such as dysphoria, irritability, or anxiety; problems with thinking, such as distractibility, memory problems, or rumination [dwelling on negative thoughts and emotions]; and problems with the physical body, such as sleeping, eating, or energy levels,” says Hermann.
To track your progress, she says, your doctor or therapist might use a self-reported scale, such as the Edinburgh Depression Scale, every couple of weeks to see how treatment is working.
6. If I Start Treatment, Will I Have to Continue It Long Term?
How long postpartum depression treatment will be necessary depends on the individual and factors such as how early you received a diagnosis and the severity of the symptoms. That said, “For most women, we recommend treatment for PPD to be relatively short term,” says Hermann.
If you take part in cognitive behavioral therapy or another form of psychotherapy, the treatment will probably be about 12 weeks, and antidepressant medications are intended to be used for about six months, she says. It could be significantly shorter, depending on the prescription. A drug called zuranolone (Zurzuvae), the first oral treatment approved by the U.S. Food and Drug Administration specifically for addressing postpartum depression, is meant to be taken for only two weeks. Dr. Torres-Mackie notes that not all clinics have access to it, though, so more traditional meds with longer prescriptions may be necessary.
After that initial treatment wraps up, you should reassess your needs with your doctor. “At that point, some women choose to continue with their treatments for a longer period, and some choose to taper off,” says Hermann.
Just remember that it’s important not to cut yourself off from treatment suddenly and to work with your doctor’s supervision to avoid withdrawal symptoms or relapse, she adds. The last thing you want after addressing postpartum depression is to have the symptoms come right back.
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