What's the Best Treatment for Post-Partum Depression?

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Summary: The best treatment for post-partum depression is an integrated, patient-centered combination of psychotherapy, social support, lifestyle changes, and medication if needed.

Key Points:

Post-partum depression (PPD) is more than what people call the baby blues.
Although new fathers can get PPD, it’s far more common in new mothers.
Many mothers who develop PPD symptoms may not report them out of fear of stigma and judgment.
It’s important to understand that talk therapy, education, and social support can be as effective as medication, and may be the best first-line treatments/interventions of new mothers with PPD.

What is Post-Partum Depression?

The article “Is Postpartum Depression Different From Depression Occurring Outside of the Perinatal Period? A Review of the Evidence” describes the evolution of the PPD diagnosis in the mental health field as follows:

Case studies from the mid-19^th century identify a type of mental illness related to motherhood as distinct from other mental illnesses.
In the 1960s, researchers described depression after childbirth as “nonclassical depression.”
In 1994, the Diagnostic and Statistical Manual of Mental Disorders – Volume 4 (DSM-IV) identified depression that starts within three weeks after birth as major depressive disorder (MDD) with postpartum onset.
When the latest edition of the DSM appeared in 2013 – the DSM-V – authors kept the DSM-IV language and included another category, perinatal depression, which is major depressive disorder (MDD) with peripartum onset.

The American Psychological Association (APA) offers this simple definition of post-partum depression:

“A major depressive episode or, less commonly, minor depressive disorder that affects some women within 4 weeks to 6 months after childbirth.”

The U.S. Department of Health and Human Services (HHS) operates the Office on Women’s Health, which operates a website (click the link) that provides a wealth of information on maternal physical and mental health, including risk factors to understand, and warning signs and symptoms to watch for.

Risk Factors for PPD

Diagnosis of depression before pregnancy
Diagnosis of depression during pregnancy
Family history of depression
History of physical, emotional, or sexual abuse
Problems or difficulties during pregnancy or delivery
Absence/lack of support from partner, family, or friends
History of domestic violence
Extreme relationship, financial, or other stress
Being younger than 20 years old
Problems breastfeeding
Premature delivery
Baby with health problems or other special needs
Unplanned/unwanted pregnancy

Women who need immediate support in a dangerous domestic situation can seek help safely and anonymously by calling the National Domestic Violence Hotline at 1-800-799-SAFE (1-800-799-7233)

Signs and Symptoms of PPD

Anger
Sadness/hopelessness
Extreme feelings of shame or guilt
Feeling worthless
Extreme mood swings
Drastic changes in eating habits: eating far more or less than previously
Drastic changes in sleep habits: sleeping far more or less than previously
Excessive sadness/crying
Declining interest in formerly favorite activities
Withdrawal from friends and family
Thoughts/fear of causing harm to infant or self

Women experiencing symptoms of depression who need confidential support, advice, or a sympathetic ear can call the National Maternal Mental Health Line at 1-833-TLC-MAMA (1-833-852-6262). This is a support line rather than an emergency line. For mental health emergencies, women experiencing severe depressive symptoms who are at risk of harming themselves should call the 988 National Suicide and Crisis Lifeline.

It’s important for mothers experiencing signs of PPD to get help and support. The consequences of untreated depression can be severe and disruptive. Mild depression can mean a lack of motivation, persistent sadness, and an inability to connect with the infant, partner, and others. Severe depression can be totally disruptive, and include extreme consequences, up to and including suicidality.

In the article “Treating Postpartum Depression” published by the American Psychological Association (APA), Dr. Susan Friedman of Case Western Reserve University observes:

“There’s so much stigma about postpartum depression. As a society, we expect it to be the happiest time of a woman’s life. A lot of women don’t report if they’re having symptoms.”

That’s an unfortunate aspect of stigma associated with PPD. A mother may want to be happy, enjoy caregiving in early infancy, but PPD – a real medical condition – prevents them from meeting those expectations. New mothers may keep symptoms to themselves – as D. Friedman observes – which can lead to long-term complications for mother and child.

Before we discuss the best treatment for post-partum depression, we’ll share the latest facts on the prevalence of PPD.

Prevalence of Post-Partum Depression in the U.S.

A study published by the Centers for Disease Control (CDC) in 2021 – “CDC Report on Maternal Physical and Mental Health” – shows the following rates of post-partum depressive symptoms among mothers between 2016 and 2020.

Depressive Symptoms After Pregnancy

2016: 12.8% (35,081)
2017: 12.5% (37,573)
2018: 13.4% (43,479)
2019: 13.4% (44,095)
2020: 13.4% (40,691)

Those figures show a 15.9 percent increase between 2016 and 2020. Overall, pooled data from additional studies analyzed by the CDC indicate that over the past several decades, roughly 1 out of every 8 women in the U.S. experience post-partum depression (PPD).

Evidence-Based Treatment for Post-Partum Depression

If you recognize the warning signs of PPD in yourself or someone you know or love, and can also identify the presence of risk factors for PPD in your life or the life of someone you or love, the best first step is to arrange a full screening for depression administered by a mental health professional. A qualified provider can offer a diagnosis and provide referrals for treatment.

Evidence-based treatment for PPD includes a combination of therapy, medication, social support, and lifestyle changes. Methods and approaches include, but are not limited to:

Therapy/counseling:

Cognitive behavioral therapy (CBT). This approach can help new mothers address and resolve patterns of thought lead to the negative emotions and behaviors associated with PPD. Evidence also shows CBT can help reduce symptoms of anxiety in new mothers with PPD.
Interpersonal therapy (IPT). This approach can help new mothers explore and resolve life events and interpersonal relationship issues that can exacerbate PPD. IPT therapists help new mothers develop effective communication skills, expand their supportive social network, and improve stress management and distress tolerance skills, which can lead to a reduction in symptoms and improved quality of life.

Social support:

New mother support groups. In many cases, a new mother may not want to share her fears, worries, and anxieties with friends or family. Even when they believe family and friends won’t judge them, they may still feel more comfortable sharing their issues in a group of new mothers they don’t know, who are facing some of the same issues they are, and at the same time.
In some cases, open and honest dialogue with friends – especially other mothers who may have had PPD – can make all the difference and help mother with early PPD understand and manage their symptoms.
In other cases, a trusted family member can offer the support a new mother needs. Taking the time to listen with compassion and empathy can help in the same way talking to close, supportive friends can help.

Medication, if indicated:

Selective serotonin reuptake inhibitors (SSRIs)
Serotonin and norepinephrine reuptake inhibitor (SNRIs)
Tricyclic antidepressants (TCAs)

Lifestyle adjustments:

Exercise
Healthy eating
Sleep hygiene

While the idea of sleep hygiene and finding time to exercise for a new mom almost seems impossible and will likely make a new mom guffaw and say, “yeah right,” it’s achievable – but a new mother has to either ask for help or have friends and family see the need and intervene proactively. Accepting or enlisting the support of friends and family can give a new mother the hours of sleep they may need to restore mind and body and reduce symptoms of depression.

The Growing Awareness That Clinician Should Emphasize Social Support and Psychotherapy

In the APA article we cite above, Dr. Christina Hibbert – a clinical psychologist who specializes in PPD, who herself has a personal history of PPD – discusses the relationship between PPD, medication, talk therapy (i.e. psychotherapy), and social support:

“The medications absolutely do help, when needed. The problem has been that too often women are not given options other than medication. Many women do not want to take medication, especially if they are pregnant or nursing, and many might not need medication to be well, but feel they have no other choice. Many women end up on medications who wouldn’t need them if they had a safe place to talk and receive coping strategies.”

This idea is not new. Over 20 years ago, in a paper called “The Prevention and Psychotherapeutic Treatment of Postpartum Depression,” Dr. Michael O’Hara observes:

“Data suggest that psychotherapy should be considered a first-line treatment, rather than as an adjunct to medication treatment.”

In a more recent study, published in 2019, called “A Group-Based Online Intervention to Prevent Postpartum Depression,” O’Hara and a team of researchers observed significant reductions in PPD symptoms among women with PPD who participated in an online, cognitive behavioral therapy (CBT) group treatment program. At the beginning of the study, twenty four women reported symptoms of PPD, but after six weeks, only one met clinical criteria for a PPD diagnosis.

Dr. O’Hara’s team on the study concluded:

“[Participants] were responsive to both peer support and individual internet interventions to prevent PPD. Peer support may be a useful feature to keep participants adherent.”

In other words, the new mothers in the study showed improvement, and that both individual CBT and peer-supported CBT are effective approaches for reducing depressive symptoms associated with PPD. That’s good news for new or expecting mothers with depressive symptoms: talk therapy is effective, and patients concerned about taking antidepressants or other psychiatric medication can experience symptom relief without the need for medication.