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What Do They Prescribe For Postpartum Depression

How Effective Is Zulresso In Treating Postpartum Depression

Do I have postpartum depression?

Clinical studies have shown Zulresso to be effective in improving the symptoms of PPD. One study included patients with severe PPD and the other included patients with moderate PPD. In both studies, depressive symptoms improved at the end of the first infusion of Zulresso and were observed again at the end of the 30-day follow-up period. Zulresso does not cure PPD, but it can lessen its symptoms.

Exercise And Postpartum Depression

Exercise can help lift your spirits. Once you’ve recovered physically from giving birth, try to get some exercise every day. One study has shown that vigorous exercise after recovering from childbirth is associated with an increased feeling of well-being. Your doctor can help you plan an exercise program that’s right for you.

What Medications Can I Take For Postpartum Depression

Your healthcare provider may prescribe antidepressants to manage symptoms of postpartum depression. Antidepressants help balance the chemicals in your brain that affect your mood.

If you’re breastfeeding, talk to your healthcare provider about the risks and benefits of taking an antidepressant. Medications can transfer to your baby through your milk. However, the transfer level is generally low, and many antidepressant medications are considered safe. Your provider can help you decide what medicine is right for you based on your symptoms and if you’re nursing.

Some common antidepressants for postpartum depression are:

Keep in mind that it takes at least three or four weeks for antidepressants to work. Talk to your healthcare provider before stopping the medication. Stopping your medication too soon can cause symptoms to return. Most providers will recommend reducing your dose before stopping completely.

If your provider detects postpartum depression while youâre still in the hospital, they may recommend IV medication containing brexanolone.

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Learn About The Signs And How To Find Support

Having a new baby brings on a lot of big feelings love, joy, excitement, frustration, and nervousness to name a few. Experiencing highs and lows in the first weeks and months after birth are to be expected given the big emotional and physical changes that come with having and caring for a new little one. But for many, feelings of depression and anxiety can overshadow the celebration of welcoming your new family member. We spoke to Dr. Alison Stuebe, maternal-fetal medicine sub-specialist and professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine, about postpartum depression and the steps you can take to find support.

The topic of experiencing mental health challenges may be difficult for some readers. If you or a loved one is struggling with their mental health, please seek support by accessing the following resources: United for Global Mental Health and Open Counseling Suicide Hotline Database. If your country does not have a national helpline please seek professional support from a trained carer, especially before making any decisions on treatment.

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What Are The Treatments For Postpartum Depression

Dealing with Postpartum Depression

Postpartum depression sometimes goes away on its own within 3 months of giving birth. But if it interferes with your everyday life at any time, or if “the blues” last longer than 2 weeks, you should seek treatment. About 90% of women who have postpartum depression can be treated successfully with medication or a combination of medication and psychotherapy. A support group may also be helpful.

In cases of severe postpartum depression or postpartum psychosis, hospitalization may be necessary. Sometimes, if symptoms are especially severe, electroconvulsive therapy may be used to treat severe depressions with hallucinations or delusions or overwhelming suicidal thoughts.

It is best to seek treatment as soon as possible. If it’s detected late or not at all, the condition may get worse. Also, experts have found that children can be affected by a parent’s untreated PPD. They may be more prone to sleep disturbances, impaired cognitive development, insecurity, and frequent temper tantrums.

While youâre recovering from postpartum depression, youâll probably see an improvement from month to month. Be aware that your symptoms may flare up before a menstrual period because of fluctuations in your hormones.

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Certain Kinds Of Counseling Can Help Prevent Depression If Youre At Risk For Depression Talk To Your Provider About Finding A Counselor

What is postpartum depression?

Postpartum depression is a medical condition that many women get after having a baby. Its strong feelings of sadness, anxiety and tiredness that last for a long time after giving birth. These feelings can make it hard for you to take care of yourself and your baby. PPD can happen any time after childbirth. It often starts within 1 to 3 weeks of having a baby. It needs treatment to get better.

PPD is a kind of perinatal depression. This is depression that happens during pregnancy or in the first year after giving birth. PPD is the most common complication for women who have just had a baby. It affects up to 1 in 7 women .

For half of women diagnosed with PPD, its their first time to have depression. And they may have had signs and symptoms of depression during pregnancy. If you have PPD in one pregnancy, youre likely to have it again in another pregnancy.

PPD is not your fault. It doesnt make you a bad person or a bad mother. If you think you have PPD, tell your health care provider.

Is PPD the same as the baby blues?

No. PPD lasts longer and is more serious than baby blues. Baby blues are feelings of sadness you may have after having a baby. Baby blues can happen 2 to 35 days after you give birth and can last up to 2 weeks. You may have trouble sleeping, be moody or cranky, and cry a lot. If you have sad feelings that last longer than 2 weeks, tell your provider. She can check to see if you may have PPD.

Changes in your feelings:

Selective Serotonin Reuptake Inhibitors

Generic Name

Important Information:

  • Esketamine must be taken with an oral antidepressant.
  • Esketamine should be used only in patients who have tried other depression medicines that did not work for them.
  • Patients may experience sedation and dissociation after administration.
  • Because of these risks, esketamine is available only through a restricted program, called the Spravato REMS.
  • Esketamine is a nasal spray that must be administered in a healthcare setting that is certified in the REMS program where the healthcare provider can monitor the patient for sedation and dissociation for two hours after each dose.

Warnings:

  • Risk for temporary sedation and dissociation after administration.
  • Esketamine is a federal controlled substance and has the potential to be misused and abused.
  • May cause temporary difficulty with attention, judgment, thinking, reaction speed, and motor skills.
  • Do not drive or operate machinery until the next day after a restful sleep.
  • May harm an unborn baby. Patients should talk to their healthcare provider about the risks of taking this medicine during pregnancy.

Common Side Effects:

Warnings:

Common Side Effects:

Less Common, but Serious, Side Effects:

  • Suicidal thoughts and behaviors

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Treating Postpartum Depression With Antidepressants

Antidepressants are the most common psychiatry medications prescribed to women suffering from postpartum depression. Antidepressants work to balance a persons neurotransmitters, the brain chemicals that affect mood and emotions.

When antidepressants are taken for clinical purposes, the results include:

  • Improved appetite
  • Other general improvements in well-being

It generally takes at least four weeks for antidepressants to take full effect. However, some people may feel better much sooner.

Several types of antidepressants are prescribed based on various factors. Selective Serotonin Reuptake Inhibitors are drugs that specifically improve serotonin levels in the brain. Serotonin is one type of neurotransmitter responsible for emotions and mood. SSRIs block the reabsorption of serotonin in the brain, making it more readily available to the brain. Serotonin helps to elevate mood and reduce general symptoms of postpartum depression.

Other types of antidepressants include Serotonin-Norepinephrine Reuptake Inhibitors . This type improves levels of both serotonin and norepinephrine, another neurotransmitter.

Tricyclic Antidepressants and Monoamine Oxidase Inhibitors are two other antidepressant medications.

Regardless of the type of antidepressant, women must take them as instructed at the same time each day. Doing so improves their effectiveness in reducing postpartum depression symptoms.

Other Nonpharmacologic Treatments For Postpartum Depression

Postpartum Depression

Many women suffering from PPD and their healthcare providers may seek alternatives or adjuncts to standard psychological or pharmacologic treatments because of their concern about the effects of pharmacological treatment on breastfeeding,122 access to care, issues of stigma in the treatment of mental illness, limited effectiveness, or personal beliefs. In the following we have provided an overview of a variety of evidence-based nonpharmacologic treatments for postpartum depression.

Electroconvulsive therapy

As with treatment-refractory major depression in the general population, electroconvulsive therapy is an option for depressed postpartum women who do not respond to antidepressant medication or who have severe or psychotic symptoms. Data specific to this population are very limited. One small study of 5 women receiving ECT for refractory postpartum depression reported a 100% remission rate.123 Apart from concerns regarding anesthesia and breast feeding, the use of ECT for postpartum depression does not differ from its use in major depression.124 Anesthetic agents used in ECT are typically rapidly metabolized, and risk of transmission in breast milk can be minimized by timing breast feeding accordingly.

Bright light therapy

Omega-3 fatty acids

Acupuncture and massage

Exercise

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How Can My Partner Support Me At Home

Throughout human history, communities have cared for babies together. Everybody needs a village, and it’s incredibly important that people who have just given birth have someone taking care of them while they’re taking care of their baby. Dr. Stuebe recommends that partners or other loved ones can be supportive by doing the following:

  • Make sure that your partner is eating enough and often enough
  • Ensure that your partner has time to bathe themselves
  • Allow your partner to get adequate sleep by sleeping in shifts

You are not alone, you are not to blame, and with help you will get better.

Causes And Risk Factors

A rapid decrease in some hormones after delivery is thought to be one contributing factor to the development of postpartum depression. But other risk factors include stressors, previous depressive episodes, depression during pregnancy, complications during pregnancy and/or delivery, and a family history of mood disorders.

Recent studies have shown that among women who are diagnosed, about one-third had depression prior to their pregnancy, one-third have depression that began during pregnancy, and one-third experienced the onset of depression after delivery.

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How Much Does Zulresso Cost

According to Sage Therapeutics, the biopharmaceutical company taking Zulresso to market, the drug will cost around $7,450 a vial, which amounts to approximately $34,000 before discounts or insurance. It’s important to note that the high price tag does not include the cost of staying at a medical facility for more than two days.

How Can I Help Someone With Postpartum Depression

Postpartum Depression

People with postpartum depression need lots of support. Here are some ways you can help:

  • Know the signs of depression and anxiety and urge your friend or partner to seek medical care.
  • Be a good listener. Let them know you’re there to listen and help.
  • Offer to help them with daily tasks like cleaning and running errands.
  • Offer to help watch their baby while they sleep or rest.
  • Encourage them to seek help from a therapist or other mental health provider. Offer to set up an appointment or go with them as a support person.

A note from Cleveland Clinic

Postpartum depression is a common mood disorder that affects 1 in 7 people after giving birth. It’s not your fault, and you did nothing to cause it. It doesn’t make you a bad parent or a bad person. The biological, physical and chemical factors that cause PPD are beyond your control. Signs of postpartum depression include feeling sad or worthless, losing interest in things you once enjoyed, excessive crying and mood swings. Talk to your healthcare provider if you think you have postpartum depression. They can figure out how to best manage your symptoms. Counseling, medication or joining a support group can help.

Last reviewed by a Cleveland Clinic medical professional on 04/12/2022.

References

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Are Antidepressant Medications Safe To Take While Breastfeeding

Maybe. Although many medications do pass into breast milk, most have little or no effect on milk supply or on infant well-being. When discussing medications it is important for the healthcare provider to ask a mother about whether she is breastfeeding. Together they can decide which medications are right for her and safe to use while breastfeeding.

Medication Options For Postpartum Depression

Unlike the baby blues, postpartum depression is a medical condition that can last for a significant amount of time, especially if its left untreated. Seeking treatment for postpartum depression can be hard, especially for women who havent needed or looked for mental health treatment in the past.

But pregnancy, delivery, and early parenthood can all take a huge toll, both physically and emotionally, and with postpartum depression, that toll can have an effect on the whole family.

Women who feel they might be experiencing postpartum depression can best address it by acknowledging the problem and seeking out treatment. Treatment of postpartum depression may consist of talk therapy, medication, or some combination of the two.

If PPD is treated promptly and properly, the Mayo Clinic reports that PPD usually goes away within 6 months.

When medication is prescribed

For many women with PPD, medication is an important part of the treatment plan. A combination of medication and talk therapy is a common treatment for PPD.

Two of the more common types of medication that are prescribed for PPD include selective serotonin-reuptake inhibitors , such as fluoxetine and sertraline, and venlafaxine, a serotonin-norepinephrine reuptake inhibitor . SSRIs and SNRIs both affect the way the body transports and processes serotonin, which is a neurotransmitter that impacts many physical processes, including mood, sleep, and memory.

Breastfeeding and antidepressants

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Negative Effects Of Maternal Depression

The adverse impact of maternal depression on infant outcomes has also been studied. Depression has significant negative effects on a mothers ability to interact appropriately with her child.13 Depressed women have been found to have poorer responsiveness to infant cues23 and more negative, hostile or disengaged parenting behaviors.24 These disruptions in maternal-infant interactions have been associated with lower cognitive functioning and adverse emotional development in children, and they appear to be universal across cultural and economic divides.25,26 Other parenting behaviors are also affected, including problematic sleep habits, lower preventative health care utilization and undesirable safety practices.26 Chronic depression in mothers places children at higher risk for behavioral problems27 and later psychopathology, including anxiety, disruptive, and affective disorders conversely, remission of depression in mothers is associated with reduction or remission in the childrens psychiatric diagnoses.28 Maternal depression also increases the risk for negative infant feeding outcomes, including lower rates of initiating or maintaining breastfeeding, lower levels of breastfeeding self-efficacy, and more difficulties while breastfeeding.29 In low-income countries, maternal depression has been associated with both malnutrition and higher rates of diarrheal illness in children.30

What Are Ways To Cope With Postpartum Depression

“Baby Blues” — or Postpartum Depression?

It’s OK to feel overwhelmed. Parenting is full of ups and downs and having a baby isn’t easy. If you have depression, you don’t have to suffer alone. Your healthcare provider can help find a treatment that works for you.

Here are some things you can do to help cope with postpartum depression:

  • Find someone to talk to â a therapist, friend, family member or someone who will listen to you and help you.
  • Join a support group for new parents.
  • Try to eat healthily and find time for exercise.
  • Prioritize rest for yourself.
  • Go out with friends or talk to them on the phone.
  • Find time for self-care and doing things you enjoy, like reading or other hobbies.
  • Get help with household chores or errands.

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Complementary And Alternative Postpartum Depression Treatments

You may not want to take a prescription drug, especially if youâre breastfeeding. Talk to your doctor about whether you should try any of these therapies, either instead of or along with standard medical treatment:

  • Yoga. In one study of depressed new moms, more than three-quarters of them who did yoga twice a week for 8 weeks got better.
  • Massage. It may have a positive effect on postpartum depression. Although more studies are needed, findings suggest that massage helps improve symptoms.
  • Relaxation training. Techniques like deep breathing, guided imagery, and self-hypnosis can teach you to soothe yourself. More than a dozen studies have shown that relaxation training can help you recover from depression.
  • Meditation. Learning to meditate lets you âexist in the moment.â You focus on your breathing and let go of your thoughts. It might help you with your depression.

Study results on herbal and dietary supplements like St. Johnâs wort are mixed. Acupuncture and light therapy have not been shown to be effective with postpartum depression.

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Can A Mother Experiencing Postpartum Depression Continue To Breastfeed

Usually. While some mothers experience positive feelings from breastfeeding, others may not. Healthcare providers can work with mothers to address depression in a timely manner and to help them reach their breastfeeding goals. Healthcare providers can talk to mothers about treatment options for depression including medications and non-pharmacological options and assist mothers in accessing professional breastfeeding support as needed.

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