Treating Postpartum Depression
Scott Stuart, M.D.
Associate Professor of Psychiatry, Department of Psychiatry
University of Iowa Hospitals and Clinics
To treat new mothers who have postpartum depression, and who are not breastfeeding, any of the
commonly used antidepressant medications for postpartum depression may be prescribed. If there is a
history of depression, the choice of medication should be based on the womans previous
response to medication, or her familys history of response to treatment.
When considering the treatment of depression in women who breastfeed, it is important to
be aware of the risks posed by untreated depression, especially the
adverse effects it can have on child development.
The risks of medication and the benefits of treatment should be carefully weighed.
Experts agree that moderate to severe depression in nursing mothers should be treated
with medication. Current data suggest that the use of tricyclic antidepressants (TCAs)
and the selective serotonin re-uptake inhibitors (SSRIs) is relatively safe for the
Though fewer women have been treated postpartum with the new generation antidepressants, these
medications also appear to be relatively safe during breastfeeding. Electroconvulsive therapy can
be safely used for women with psychotic depression, and for those who do not respond to other
In sum, the current clinical consensus is that antidepressants can be used with breastfeeding women
who have moderate to severe depression. Because commonly used antidepressant medications appear
safe, the guidelines for selection of medication described above (e.g., previous response or
family history of response to treatment) should be used. Supplementation of breastfeeding with
bottle feeding during times of peak exposure may also reduce risks to infants.
Despite data supporting the relative safety of antidepressant medications during
breastfeeding, many women are wary of their use. In one study, only 20% of women with
postpartum depression said that they would consider using antidepressant medications.
Psychotherapy is an effective alternative for women who do not want to use medications
Psychosocial treatments for postpartum mood disorders fall into two categories:
- Preventive treatments. These aim to prevent depression. They begin during pregnancy or soon
after the baby is born.
- Psychosocial intervention for women with postpartum depression.
Research suggests that the use of preventive measures with women who are not at high risk is an
ineffective use of resources. However, the value of community screening has been clearly
demonstrated. Women who are depressed can be identified either through health clinics or by
visiting health care providers. Once identified, such women are often willing to engage in acute
treatment. Given the implications of untreated postpartum depression for both women and their
children, community screening is well worth the effort.
In contrast to preventive measures, treatment of an acute episode of depression with short-term
psychotherapy is often beneficial. Interpersonal psychotherapy, using a time-limited treatment of
12 to 16 weeks, is very effective in reducing depressive symptoms. Cognitive therapy, though not
yet tested as a treatment for postpartum depression, is also likely to be helpful. Studies
comparing the use of psychotherapy with medications for postpartum depression, and evaluating the
use of psychotherapy for women who have depression during pregnancy, are currently underway at the
University of Iowa.
Recommendations for Treatment of Postpartum Depression
Level of depression
Mild to moderate
Interpersonal psychotherapy, cognitive therapy
Moderate to severe
Serotonin re-uptake inhibitors (Fluoxetine, Sertraline, Paroxetine)
Tricyclic antidepressants (Imipramine, Nortriptyline, and others)
New generation antidepressants (Venlafaxine, Buproprion, and others)
Antidepressant treatment during breast-feeding, by KL Wisner et al. (1996) AmJPsychiat
," by S. Stuart (1999). In Postpartum Psychiatric
Disorders, ed. L. Miller.
Postpartum Depression: Causes and Consequences, by MW O'Hara (1994).
Postpartum Health Research Laboratory, University of Iowa; phone 319/335-0307.
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