Postpartum Depression: Treatment and Prevention

Many women suffer postpartum depression (PPD) in silence, dismissing their struggles as a normal part of pregnancy and childbirth that no one wants to know about. New mothers may feel embarrassed or even guilty that they’re feeling depressed when everyone around them is expecting them to be deliriously happy. In fact, a 2018 study found that stigma was the biggest barrier for women in disclosing postpartum symptoms, often claiming they “don't talk about those things” in their family or community.

In trying to define their feelings, many women with PPD describe a conviction that things are not right or a sense that something bad is going to happen. Others report having overprotective thoughts about their baby getting sick or dying, and regularly feeling disconnected—as if they are not the baby’s mother—which can lead to thoughts of rage or resentment toward their newborns, which in turn can cause feelings of guilt and fear.

Never too early for prevention

A host of screening opportunities are available both before and after pregnancy to help prevent and detect PPD as soon as possible.

In 2019, the U.S. Preventive Services Task Force began recommending that physicians screen pregnant and new moms to identify those who are at an increased risk of PPD, so they can be referred to counseling interventions, such as cognitive behavioral therapy and interpersonal therapy. Additionally, the American College of Obstetricians and Gynecologists recommends early postpartum follow-up care, including screening for depression and anxiety, for all postpartum women.

The Reach Out, Stand Strong, Essentials (ROSE) program for mothers with newborns is an example of a counseling intervention, as is the Mothers and Babies Program. These types of programs typically involve several prenatal group sessions and individual postpartum sessions carried out through home visits or at other locations in the community. Course content includes education on stress management, positive thinking and differentiating the “baby blues” from PPD; the programs also aim to develop a social support system and resolve interpersonal conflicts common around childbirth.

The best prevention strategy, however, is to build and sustain a sufficient support network during pregnancy. Inadequate social support is one of the leading factors in developing postpartum depression. Community support allows for communication, validation, emotional and logistical help, and connection.

There is a treatment just for you

If you have been diagnosed with peripartum or postpartum depression, you should seek treatment immediately, as any delay can have serious health effects on both mother and baby.

The American Psychiatric Association recommends therapy without medication as a first-line treatment when the depression or anxiety is mild. In a talk therapy (or psychotherapy) session, a therapist will help you understand the situation and develop strategies for managing the symptoms. For women with moderate or severe depression or anxiety, a medical intervention is recommended, usually involving antidepressants (specifically those that are considered to be safe and effective during pregnancy and breastfeeding).

Self care is key during and after childbirth and should include some or all of the following:

• Rest as much as you can.
• Make time to go out, visit friends or spend time alone with your partner if possible.
• Talk about your feelings with your partner, supportive family members and friends.
• Join a support group to talk with other mothers who are going through similar experiences.
• Eat, hydrate and exercise regularly.

Don’t risk going without treatment

Ignoring symptoms, keeping your feelings to yourself and being “brave” is not a good strategy. Without treatment, symptoms can persist for months or even years.

Many studies have established that untreated depression during the postpartum period can lead to bonding issues between mother and baby, and contribute to sleeping and feeding problems for the baby. Children of mothers with untreated postpartum depression are at greater risk for cognitive, emotional, developmental and verbal loss, as well as impaired social skills.

Untreated PPD symptoms can increase the risk of suicide, and worse: Mothers with PPD report having thoughts of harming their infants or themselves. Several different studies have identified self-harm as a leading cause of death for women in the first year after pregnancy.

If you or a person you love claims to be considering suicide, always take it seriously and call the National Suicide Prevention Hotline at 800-273-8255.

Postpartum depression is never anyone’s fault. It is a common medical condition that requires professional treatment. And, for most women with PPD, treatment works. Most new parents feel more like themselves within a few weeks of a PPD diagnosis and can get back to experiencing the joy of a new baby.

One final note: It is important to continue treatment even as life begins to feel normal again, to prevent a symptom recurrence.