How to Treat Postpartum Depression – The New York Times

In recent years, mental health struggles have become the leading cause of maternal mortality in the United States, primarily due to suicides and drug overdoses. It is estimated that one in eight new moms experience postpartum depression, and some research has suggested that the prevalence climbed to as high as one in three during the early days of the pandemic.

Yet roughly half of the women who are struggling with their mental health after pregnancy dont receive treatment. Barriers to care includea lack of awareness about symptoms and treatments, an inability to access resources and stigma.

Postpartum depression has historically been underdiagnosed and under-researched, but recognition of the condition is finally growing. As a result, there are more treatment options available than ever before, including innovative therapeutic models and at least one new medication.

Many women experience mood swings in the days and weeks following birth because of the dramatic hormonal shifts that occur. Sometimes called the baby blues, symptoms includefeelings of sadness, anxiety, tearfulness or overwhelm; they typically subsidewithin a week or two.

New mothers feel like theyre on a hormonal ride because they are, said Dr. Samantha Meltzer-Brody, the chair of the psychiatry department at the University of North Carolina at Chapel Hill, who helped found the universitys perinatal psychiatry inpatient unit the first in the country. That happens to every single person that gives birth, and thats considered a normal part of the transition from pregnancy to the postpartum period.

Postpartum depression is different. It is defined as a major depressive episode that lasts at least two weeks and starts during the year after birth, usually emerging in the first few weeks.

To meet criteria for a postpartum depressive episode, you must meet criteria for a major depressive episode, Dr. Meltzer-Brody said. Those includepersistent low mood, low energy, feelings of worthlessness or guilt, suicidal thoughts and a loss of interest in things that were previously enjoyable.

The condition is typically screened for using a questionnaire known as the Edinburgh Postnatal Depression Scale, which is ideally (but not always) administered at the six-week postpartum visit to the obstetricians office. Pediatricians are also encouraged to ask about postpartum depression because they see the family more frequently in the year after birth. Risk factors include a history of depression, a traumatic birth experience and lack of social support, said Dr. Latoya Frolov, a perinatal psychiatrist at the University of Texas Southwestern Medical Center.

Postpartum depression can affect not only the mothers health but also that of her baby. Some research has shown that infants born to depressed mothers gain less weight and have more illnesses and developmental delays (though some other studies have not). As a result, timely treatment is important.

The treatment a woman receives should depend on her score on the Edinburgh Scale, but all too often there is no follow-up care, either because adequate mental health resources arent available or because she cant access them.

Its hard to make it to an appointment when youre overwhelmed, exhausted and depressed, especially if you dont have easy transportation or childcare, Dr. Frolov said. When I see someone make it to an appointment with me, I am overjoyed, honestly, to see them in my office, because I know that often theres a lot that went into it.

If a woman is found to have mild to moderate depression, she should quickly be referred to some sort of therapy.

Group therapy is often recommended for new moms who are struggling, and it can be one of the most powerful interventions, said Paige Bellenbaum, a licensed clinical social worker and the founding director of The Motherhood Center, a clinic in New York City that offers intensive outpatient care forwomen with postpartum depression. Its the support that women provide to one another, she said, that helps them to feel so much less alone in this really, really challenging journey.

In one-on-one therapy, counselors often use approaches like cognitive behavioral therapy, dialectical behavioral therapy and interpersonal therapy, which provide women with skills to help them manage their emotions, avoid or reframe negative thoughts and improve communication with their partner.

For women who have moderate to severe postpartum depression, experts often recommend medication most commonlyselective serotonin reuptake inhibitors, or S.S.R.I.s. There is limited research specifically testing S.S.R.I.s for postpartum depression, but one meta-analysis assessing six studies indicated that a little less than halfof the women who take them see an improvement.

Traditionally, doctors have worried that these medications are unsafe for women who are pregnant or breastfeeding, but Dr. Frolov said the risks are small, especially compared to those associated with postpartum depression. She said Zoloft, in particular, is frequently prescribed because less medication is secreted into breast milk than with other S.S.R.I.s.

Dr. Frolov is trying to empower physicians who work with pregnant and postpartum women to feel more comfortable prescribing S.S.R.I.s, especially to women who are struggling but arent able to see a mental health professional. I always encourage OBs to treat, she said. Its not enough to screen.

For women who dont respondto these therapies, more intensive treatment options arestarting to becomeavailable, including full-day outpatient and inpatient facilities dedicated to maternal mental health, like The Motherhood Center and U.N.C.sperinatal psychiatry unit.

The first medication specifically for postpartum depressionalso now exists, and it works differently than S.S.R.I.s. Treatment with the drug, called Brexanolone, causes a significant reduction in depression scores for about 70 percent of the women who receive it, said Dr. Meltzer-Brody, who ran the clinical trials at U.N.C. Most notably, it works within 24 hours, compared with the weeks or months it takes to see a benefit from therapy or S.S.R.I.s.

While Brexanolones efficacy is promising, it must be delivered in a hospital via an I.V. for 60 hours straight, which makes it extremely difficult to access. As a result, only a few hundred women, usually the most severe cases, have been treated with the drug since it was approvedin 2019.

Experts are optimistic that a related fast-acting medication that can be delivered in a pill form may soon become available. The drug, called Zuranolone, is currently under review by the Food and Drug Administration, both for postpartum depression and major depressive disorder; a ruling could come as soon as Labor Day.

Perhaps even more important than the new medications themselves, Ms. Bellenbaum said, is the fact that the medical and scientific community is investing in research into postpartum depression. The field of maternal mental health is finally starting to matter, she said.

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How to Treat Postpartum Depression - The New York Times