Treating Postpartum Depression
Scott Stuart, M.D.
Associate Professor of Psychiatry, Department of Psychiatry
University of Iowa Hospitals and Clinics
Spring 2000

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 woman’s previous response to medication, or her family’s history of response to treatment.

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 treatments.

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.

Psychosocial treatments for postpartum mood disorders fall into two categories:

1. Preventive treatments. These aim to prevent depression. They begin during pregnancy or soon after the baby is born.
    
2. 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

Resources
Antidepressant treatment during breast-feeding, by KL Wisner et al. (1996) AmJPsychiat 153:1132-1137.

Interpersonal psychotherapy…," 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.