Robert Kennedy, Kelley Suttenfield

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In This Article

Treatment

Treatment of PPD generally depends on the type and severity of the symptoms. With postpartum blues, additional emotional support or extra help caring for the newborn may be the only intervention necessary. Patient education is important and women should be directed to contact their physicians if symptoms persist beyond the second postpartum week. If symptoms persist or become more severe then professional treatment may be warranted. In mild cases in which the depression does not interfere with the mother's functioning, psychotherapy may be of benefit. If the symptoms are of a more severe major depression then carefully selected antidepressant medication may be needed and this should be combined with counseling and support as well.

As in non-postnatal depression, there is great variability in the type of symptoms as well as in the intensity of depressed mood. Treatment should be guided by these parameters as well as the degree of functional impairment.

In general, there are too few studies on the most effective treatment of PPD, and "postpartum major depression demands the same course of treatment as nonpuerperal major depression."[2] There is a tendency to treat women with PPD less intensely than those with non-pregnancy-related affective episodes. The dose of medication may be suboptimal or the duration of treatment too short. Women who are breastfeeding must be informed that all psychotropic medications, including antidepressants, are secreted in the breast milk at varying concentrations.[20] "Data do not suggest that one antidepressant is safer than another for women who breastfeed. Choices of medications should be based as usual on prior response to antidepressants and side effect profile."[2]

Some studies have suggested that progesterone and estrogen may be effective agents for treatment of PPD.[21,22] These studies are preliminary, however, and additional research is required to clarify these issues. Also, for severe depression in which medication is either not an option or problematic, electroconvulsive treatment may be a viable alternative.

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