What Should You Do If You Think You Have Postpartum Depression?
Talk to your OB-GYN, midwife, or primary care doctor immediately — PPD is a treatable medical condition. Screen yourself using the Edinburgh Postnatal Depression Scale (EPDS). Accept help from family and friends. Know that seeking treatment is a sign of strength and the best thing you can do for yourself and your baby.
The Edinburgh Postnatal Depression Scale (EPDS) is a validated 10-question screening tool recommended by ACOG for universal screening during pregnancy and postpartum. A score of 10 or higher suggests possible depression warranting further evaluation, while a score of 13 or higher is a strong indicator of depression. ACOG recommends screening at least once during the perinatal period, but many experts advocate for screening at every postpartum visit. Question 10 specifically asks about self-harm thoughts and should always trigger immediate clinical assessment if endorsed.
Treatment should begin as soon as possible. For mild-to-moderate PPD, psychotherapy is the first-line treatment. Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) have the strongest evidence, with response rates of 50-70%. For moderate-to-severe PPD, a combination of therapy and medication is recommended. SSRIs, particularly sertraline, are the most commonly prescribed first-line medications. Zuranolone (Zurzuvae), an oral neuroactive steroid approved by the FDA in August 2023, offers a rapid-onset alternative — a 14-day course demonstrated significant improvement within 3 days in clinical trials.
Zuranolone demonstrated significant improvement within 3 days in clinical trials
What Are the Symptoms of Postpartum Depression?
PPD symptoms include persistent sadness or emptiness, loss of interest in activities (including the baby), severe fatigue beyond normal new-parent tiredness, sleep disturbances (insomnia despite exhaustion or excessive sleeping), feelings of worthlessness or guilt, difficulty concentrating, appetite changes, anxiety, and in severe cases, thoughts of self-harm or harming the baby.
PPD differs from baby blues in severity, duration, and functional impact. While baby blues involve mild emotional lability that resolves within 2 weeks, PPD symptoms persist beyond 2 weeks, typically worsen without treatment, and significantly impair the mother's ability to care for herself and her infant. Specific postpartum features include excessive worry about the baby's health, feeling disconnected or unable to bond with the baby, frightening intrusive thoughts about harm coming to the baby, and guilt about not feeling happy or maternal enough.
Postpartum anxiety is increasingly recognized as a distinct or co-occurring condition, affecting approximately 15-20% of new mothers. Symptoms include persistent excessive worry, racing thoughts, inability to sit still, difficulty sleeping despite exhaustion, physical symptoms (heart palpitations, shortness of breath, nausea), and in some cases, panic attacks. Postpartum psychosis is a rare (1-2 per 1,000 births) but severe psychiatric emergency involving hallucinations, delusions, mania, and confusion requiring immediate hospitalization.
What Treatments Are Available for Postpartum Depression?
Evidence-based treatments include psychotherapy (CBT and interpersonal therapy as first-line), SSRI antidepressants (sertraline most commonly prescribed), and newer PPD-specific medications including zuranolone (Zurzuvae, oral, 14-day course) and brexanolone (Zulresso, IV infusion). Treatment choice depends on severity, breastfeeding status, and patient preference.
Interpersonal therapy (IPT) addresses the interpersonal disruptions common in postpartum life — role transitions, relationship conflicts, social isolation, and grief. A meta-analysis found IPT reduces depressive symptoms by a standardized mean difference of 0.63 compared to controls, with effect sizes comparable to antidepressants. CBT focuses on identifying and changing negative thought patterns and behaviors. Both therapies can be delivered individually, in groups, or via telehealth, increasing accessibility for new mothers who may struggle to attend in-person appointments.
For medication management, sertraline is the preferred first-line SSRI due to its extensive lactation safety data — infant serum levels are typically undetectable. Escitalopram and paroxetine are alternatives with favorable breastfeeding profiles. The novel neuroactive steroids represent a breakthrough in PPD treatment. Brexanolone (Zulresso), a synthetic allopregnanolone given as a 60-hour IV infusion, produced rapid and sustained improvement in severe PPD. Zuranolone (Zurzuvae) is the oral equivalent — a 14-day course showed significant improvement as early as day 3 and sustained benefit at day 45.
Zuranolone showed significant improvement as early as day 3 and sustained benefit at day 45
