Several treatments options are available for postpartum depression, including antidepressants, psychotherapy and counseling. For women who are breastfeeding and concerned about their medication passing into their milk, non-drug options like psychotherapy and psychosocial interventions may be of particular interest.
Antidepressants
Because of a lack of studies specifically involving women with postpartum depression, it is generally assumed that women with postpartum depression will respond to antidepressants in the same way they would with major depressive disorder. The main considerations in selecting an antidepressant then are whether the woman has opted to breastfeed her infant, the side effects of the antidepressant and whether the woman has a previous history of responding to the medication.
Nortriptyline, paroxetine (Paxil), and sertraline (Zoloft) are considered to be the first choices for breastfeeding women, due to the fact that the quantities of these drugs found in the serum of breastfed infants is too small to be measured. Of these, sertraline has been the most studied, with no adverse effects being reported.
Antidepressants which have had negative effects reported in the literature include the selective serotonin reuptake inhibitors (SSRIs) citalopram (Celexa), paroxetine (Paxil), fluoxetine (Prozac) and the tricyclic antidepressant (TCA) doxepin.
With the previously mentioned SSRIs, the adverse effects included mainly irritability, difficulty consoling the infant and poor feeding. In all cases, the reports coincided with elevated serum levels of the drug and/or its metabolite.
Although TCAs are not a first-line treatment for major depression, they do have certain advantages for breastfeeding women. If women have previously responded to these drugs, their low cost and low risk to breastfeeding infants may make them a good choice. Nortriptyline is most studied of these drugs. Doxepin is the only TCA for which an adverse event has been reported.
Psychotherapy
Several types of psychotherapy may be used to treat postpartum depression.
Studies have found that cognitive behavioral therapy is an effective treatment for both major depression and postpartum depression. In fact, an analysis of four separate clinical trials found it to be just as effective as antidepressant medication in severely depressed patients.
Several studies have examined the beneficial effects of interpersonal therapy in treating depression and evidence suggests that it effective in treating postpartum depression as well.
A trial which evaluated the effectiveness of psychodynamic therapy in treating postpartum depression found that it did have a short-term beneficial effect.
Psychosocial Interventions
Research suggests that psychosocial interventions may be helpful for postpartum depression as well.
One type of intervention, called non-directive counseling, in which the counselor's role is to help the person explore and understand their feelings and thus make the decision that is best for them, was evaluated in four different European trials and found to be potentially helpful in mothers with mild to moderate postpartum depression.
Although research has shown a clear link between postpartum depression and a lack of social support, few studies have evaluated the effectiveness of supportive interactions such as support groups. The results of a pilot study which examined the effectiveness of telephone-based mother-to-mother support, however, suggests that peer support could be helpful.
Sources:
Gabbe, Steven G. et. al. eds. Obstetrics: Normal and Problem Preganncies 5th ed. Philadelphia: Churchill Livingstone Elsevier, 2007.
Hodnet, E.D. and C.L. Dennis. "Psychosocial and psychological interventions for treating postpartum depression." Cochrane Database of Systematic Reviews 2007 Issue 4 Art. No.: CD006116. DOI: 10.1002/14651858.CD006116.pub2.
