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Postpartum Depression

Contact Hours: 4

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Contact Hours: 4

This educational activity is credited for 4 contact hours at completion of the activity.

Course Purpose

The purpose of this course is to provide healthcare professionals with a brief overview of Postpartum depression (PPD), its causes, risk factors, and differences from major depression. This course also provides an overview of current treatment options and nursing considerations for the best health outcomes.

Overview

Postpartum depression (PPD) is a variation of clinical depression that occurs after childbirth, typically within the first few weeks to months, and can last up to a year or longer. Also known as postnatal depression, it is a serious mental health and mood disorder that can happen to anyone who has recently given birth, regardless of whether it is their first pregnancy. Despite its seriousness, research suggests as much as half of new mothers with PPD go undiagnosed.Lack of education, misconceptions, and social stigma prevent women from seeking treatment, and even those diagnosed forgo treatment for various reasons. This course takes a closer look at postpartum depression, its causes, risk factors, and differences from major depression. This course also discusses how patients with PPD can seek help, current treatment options, and nursing considerations for the best health outcomes.

Course Objectives

Upon completion of the independent study, the learner will be able to:

  • Review the hormonal changes that occur in the postnatal period, and how those changes can affect postpartum depression.
  • Review risk factors associated with postpartum depression.
  • Understand the signs and symptoms associated with postpartum depression, and how they differ from major depression.
  • Differentiate between baby blues and postpartum depression.
  • Review therapeutic and medication treatment options for postpartum depression.

Policy Statement

This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.

Disclosures

Fast CE For Less, Inc and its authors have no disclosures. There is no commercial support.

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Definitions
AllopregnanoloneA naturally occurring neurosteroid which is made in the body from the hormone progesterone.
Baby BluesA short period after giving birth that is filled with bouts of sadness, anxiety, stress, and mood swings.
Cognitive-Behavioral Therapy (CBT)A short-term form of behavioral treatment that helps people problem-solve.
Cortisola glucocorticoid hormone that the adrenal glands produce and release.
DelusionsFalse beliefs that persist despite evidence to the contrary.
EstradiolA female hormone.
EstrogenA category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics.
Food And Drug Administration (FDA) An agency that is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs.
Group TherapyInvolves one or more psychologists who lead a group of 5 to 15 patients. 
HallucinationsFalse perceptions of reality that can affect any of the five senses.
HPA AxisA major neuroendocrine system that controls reactions to stress and regulates many body processes, including digestion, immune responses, mood and emotions, sexual activity, and energy storage and expenditure.
HypomanicCharacterized by overactive energy, mood, behavior, and activity levels significantly different from your normal state of mind.
Interpersonal Therapy (IPT)An evidence-based therapy for depression, which can improve outcomes in the patients.
Major DepressionAlso known as clinical depression, is a mental disorder  characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities.
ManicA high state that happens when a person has a mental illness called bipolar disorder. 
MidwifeTrained health professionals who care for women and babies before, during and after childbirth.
Mindfulness-Based Cognitive Therapy (MBCT)Utilizes elements of cognitive therapy to help one recognize and reassess their patterns of negative thoughts and replace them with positive thoughts that more closely reflect reality.
Mindfulness-Based Stress Reduction (MBSR)An effective, scientifically researched method for reducing physical and psychological suffering while building resilience, balance, and peace of mind.
Mindfulness-Based TherapiesUses cognitive behavioral therapy methods in collaboration with mindfulness meditative practices and similar psychological strategies.
MiscarriageThe loss of a pregnancy before 20 weeks.
NeurosteroidAlso known as neuroactive steroids, are endogenous or exogenous steroids that rapidly alter neuronal excitability through interaction with ligand-gated ion channels and other cell surface receptors.
Obstetrician-Gynecologist (Ob-Gyn)Medical professionals who specialize in treating the uterus and associated anatomy.
Parent-Infant PsychotherapyA dyadic intervention that works with parent and infant together, with the aim of improving the parent-infant relationship and promoting infant attachment and optimal infant development. 
Perinatal PeriodEncompasses the period from one year before to 18 to 24 months after the birth of the child.
Postnatal DepressionA mood disorder that can start during pregnancy or after childbirth. 
Postpartum Depression (PPD)Also called postnatal depression, is a type of mood disorder experienced after childbirth.
Postpartum PsychosisA severe mental illness that can affect a woman after she has a baby.
Preterm DeliveryThe birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks.
Preterm LaborLabor occurring between after 20 and before 37 weeks gestation. 
ProgesteroneA type of female hormone (progestin).
Psychodynamic TherapyAn in-depth form of talk therapy based on the theories and principles of psychoanalysis. 
Selective Serotonin Reuptake Inhibitor (SSRI)A class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions.
SerotonergicA variety of single-cell organisms for various purposes. 
SerotoninA chemical that helps your brain and body communicate and regulate your mood, sleep, appetite, and more.
Serotonin SyndromeA group of symptoms that may occur with the use of certain serotonergic medications or drugs.
Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)A class of medications that are effective in treating depression.
StillbirthWhen a baby is born dead after 24 Completed weeks of pregnancy.
Supportive PsychotherapyA type of therapy that primarily focuses on providing emotional support, encouragement, and validation during difficult life circumstances or psychological challenges.
Telehealth TherapyTherapy is done over the phone or through a videoconferencing platform. 
Tricyclic Antidepressant (TCA)A class of medications that are used primarily as antidepressants, which is important for the management of depression. 
Introduction

Postpartum depression (PPD) is a variation of clinical depression that occurs after childbirth, typically within the first few weeks to months, and can last up to a year or longer. Also known as postnatal depression, it is a serious mental health and mood disorder that can happen to anyone who has recently given birth, regardless of whether it is their first pregnancy.1,2  Postpartum depression is one of the most prevalent non-obstetric childbearing complications, affecting an estimated 13 – 20% of new mothers. With approximately 4 million births in the US annually, these statistics mean anywhere from 520,000 to 800,000 women are affected by PPD every year. Postpartum depression has significant consequences for both the mother and the infant. Described as the “thief that steals motherhood, ” PPD can severely impair maternal-infant bonding, deteriorate maternal physical and mental health, lead to poor infant growth and development, and increase the risk of behavioral and emotional problems in infants as they grow.1

Despite its seriousness, research suggests much as half of new mothers with PPD go undiagnosed.2 Lack of education, misconceptions, and social stigma prevent women from seeking treatment, and even those diagnosed forgo treatment to avoid being perceived as an unfit mother.2,3 This course takes a closer look at postpartum depression, its causes, risk factors, and differences from major depression. This course also discusses how patients with PPD can seek help, current treatment options, and nursing considerations for the best health outcomes.

Postpartum Depression Definition

Postpartum depression (PPD) is primarily characterized by overwhelming sadness and hopelessness. These symptoms typically develop within the first few weeks of childbirth, with the highest incidence within the first 3 to 6 months. Postpartum depression is often mistaken for the “baby blues,” a milder condition that an estimated 80 – 85% of new mothers experience in the first few days following birth.2,3 However, the “baby blues” symptoms resolve within the first two weeks following delivery, while PPD continues. The symptoms of PPD are far more intense and persistent to the point that a new mother is severely impaired and unable to care for herself or her infant.2,4

The exact cause of PPD is not fully understood. Still, it is believed to arise from the combined effect of the physically taxing process of pregnancy and childbirth, sudden hormonal changes, psychological factors, genetic predisposition, and environmental factors.2,4

After childbirth, there is a natural, albeit drastic, change in hormone levels. Hormones such as estrogen, progesterone, estradiol, and cortisol drop, returning to pre-pregnancy levels within 24 hours of birth. This sudden decrease can cause significant mood dysregulation.5

Further research into this hormonal effect suggests it may specifically deregulate the HPA axis, which in turn may be involved in developing PPD. The HPA axis is a cascade of endocrine pathways that plays a role in appropriate behavioral and physiological stress responses in adulthood following specific negative feedback loops. However, the hormonal fluctuations after childbirth can disturb this pathway allowing depression-like symptoms.5,6

Additional research points to the interplay of these sudden biological changes in the presence of other stress-inducing factors, such as the constant demands of caring for a newborn, sleep deprivation, improper nutrition, lack of support, major life events like financial difficulties, or significant life changes. All these factors can contribute to overwhelming feelings of sadness, triggering PPD.2,4

Additionally, some new mothers may be more biologically susceptible to experiencing depression, such as those with a medical history of depressive episodes, anxiety, or other mental health conditions. This vulnerability may be triggered or exacerbated by the hormonal changes and physical stresses of pregnancy and childbirth.2,4

Postpartum Depression and Major Depression Differences

While postpartum depression (PPD) and major depression have several similar symptoms, they are medically different in terms of context, mechanisms, and risk factors.9 As the name suggests, PPD specifically affects women in the postpartum period, typically within the first few weeks to months after childbirth. It is linked to the physiological and emotional changes associated with pregnancy, childbirth, and the early stages of parenting. Major depression, on the other hand, can happen to anyone at any time in a person’s life, unrelated to childbirth or specific life events. It is not limited to a particular sex, gender, period, or context.9 Postpartum depression is also believed to be influenced by the combined effect of hormonal fluctuations, sleep disturbances, and the emotional stressors associated with pregnancy, childbirth, and new parenthood. In addition, the rapid reduction in hormone levels after childbirth is thought to play a significant role in triggering PPD.9  However, major depression is believed to result from a combination of biological, psychological, genetic, and environmental factors. It may be related to family history, brain chemistry imbalances, significant life stressors, trauma, or a personal history of depression. 9

While PPD shares many symptoms with major depression, there is often a unique emphasis on issues related to parenting, such as heightened anxiety about the baby’s health and well-being. Major depression has a comparatively broader presentation encompassing a wide range of depressive symptoms, which may not be exclusively related to postpartum experiences. 9 One of the risk factors of PPD is the personal or family history of PPD, as it is closely tied to events in the perinatal period; the time including pregnancy to a year after giving birth. The risk factors of major depression are far more diverse, including a range of components from genetic predisposition and trauma to underlying health conditions. 9

Risk Factors

While the exact mechanism of postpartum depression (PPD) remains unknown, researchers have identified certain biological and psychosocial factors that may increase the likelihood of developing PPD.1,7 One of the most prevalent factors included a personal medical history of depression or PPD, with findings showing that women with a history of depression are up to 20 times more likely to develop PPD than those without. Moreover, a family history of depression or PPD may also contribute to PPD, thus supporting findings that this form of depression has a hereditary or genetic component.7

Other significant risk factors for PPD include maternal issues such as advanced maternal age (above 35), anemia during pregnancy, vitamin D deficiency, shorter gestational periods, and diabetes (or gestational diabetes). Research suggests that these factors increase the risk of pregnancy complications such as preterm labor, preterm delivery, birth defects, miscarriage, and stillbirth, resulting in increased stress and negative experiences surrounding the pregnancy. Coupled with the mood deregulation post-delivery, these negative experiences contribute to overpowering feelings in the postpartum period that may lead to the development of PPD.1,7,8

Other negative experiences following pregnancy such as difficult labor cesarean section, postpartum anemia, persistent infant health problems, difficult infant temperament, difficulties breastfeeding, or stress factors outside of childbearing such as personal, work, or income issues, domestic/partner violence, or major life events can have a similar effect. 1,7,8 Additionally, the transition to parenthood, especially for first-time mothers, can be challenging and impact emotional well-being. Issues such as sleep deprivation, feelings of being unprepared for pregnancy or motherhood, as well as unwanted pregnancies can impair a mother’s ability to adjust to this new way of life, all resulting in a higher risk of PPD.1,7 Also, mothers who have to deal with all the challenges of motherhood with limited social support from family, friends, or a partner are more likely to feel isolated or disconnected from social networks, resulting in PPD.1,7

Signs and Symptoms

The presentation of postpartum depression (PPD) is like feelings associated with “baby blues,” such as mood swings, tearfulness, irritability, confusion, and fatigue. However, “baby blues” typically peak in the first week and do not require any intervention, but if its associated feelings intensify or persist beyond the first few weeks of childbirth, they may indicate PPD.1,4

Postpartum depression is diagnosed when at least five of the nine major depression symptoms are present for a minimum of two weeks, as given below:2

  1. A marked reduction or complete loss of pleasure or interest in activities that previously brought satisfaction or joy.
  2. A persistent unhappy mood or dysphoria that may include feelings of sadness, hopelessness, distress, and anxiety.
  3. Difficulty focusing, concentrating, and making decisions, frequently referred to as cognitive impairment or “brain fog.”
  4. Experiencing profound fatigue, slowed movement and response, or reduced physical activity levels.
  5. Hyperactivity, restlessness, or inability to sit still.
  6. Persistent feelings of inadequacy, guilt, or unworthiness that go beyond normal self-reflection. This may also include feelings of doubt about the ability to care for the infant.
  7. Significant changes in appetite and weight, often leading to substantial weight loss or gain. Clinically, a weight change of 5% in a month is concerning.
  8. Sleep disturbances such as insomnia and hypersomnia.
  9. Suicidal or homicidal thoughts of self-harm or harm to the baby.

Other observable symptoms that may indicate PPD include social withdrawal, noted by the tendency to avoid interacting with friends and family, lack of participation in social activities, and the inability to bond with the baby.1,4 The difficulty in forming a strong emotional bond with the newborn significantly affects maternal-infant attachment and feeds the negative feelings already present. This can result in heightened anxiety levels, potentially encompassing excessive worry or unwarranted fear, including concerns about the baby’s well-being.1,4

With these emotional symptoms, there may also be physical manifestations of other symptoms, such as headaches, gastrointestinal discomfort, or muscle pains.4  Note that while PPD is not known for manic or hypomanic episodes, the severity of the symptoms may fluctuate during the postpartum period, thereby resembling such an episode. Furthermore, there have been reports of new mothers diagnosed with PPD experiencing psychotic symptoms such as hallucinations or delusions telling them to hurt the baby. However, recent research suggests such cases are better classified as postpartum psychosis, a psychiatric emergency usually requiring immediate hospitalization.4

When to Seek Help

New mothers must seek help as soon as they notice any signs or symptoms of postpartum depression (PPD) for better chances of effective treatment and recovery. This is especially true for any new mothers with a personal or family history of depression, PPD, or other mood disorders.1,10  Initial warning signs that indicate it is time to seek professional help include persistent negative thoughts and feelings such as having doubts about being a good mother, no longer feeling like oneself, being overwhelmed by the challenges of new parenthood, experiencing difficulties bonding with the baby or struggling with the emotional adjustments.10,11 Additionally, any strong negative emotions, such as any persistent feelings of sadness, hopelessness, anxiety, or other depressive symptoms that last beyond the initial two-week postpartum period require professional attention.10,11

It is also critical to seek help if new mothers find they find they are losing interest in their favorite activities or are unable to take care of themselves or their baby or manage daily responsibilities, such as eating, sleeping, or getting out of bed.10,11  Professional help is also important if mothers feel their symptoms are not improving or worsening despite trying to cope with PPD by themselves with support from friends and family. If these symptoms increase to the point of self-harm or harming the baby, immediate help is vital.10,11

When to Intervene

The postpartum period can be stressful for many new mothers. Unfortunately, social norms have many believing it is supposed to be a difficult time and to prove they are “good mothers,” they will try to adjust by ignoring or hiding symptoms of PDD. Because of this ideology and attempting to mask PDD, symptoms can intensify to become more serious.10

If well-wishers such as family members, friends, or one’s partner express concern or notices significant changes in behavior or mood, they should not be dismissed and warrant intervention and treatment from a healthcare professional.10,11

For the best outcome for both the mother and the baby, intervention for PPD should not wait until the mother becomes a danger to herself or her baby. The sooner support is provided, the faster the recovery with the mother regaining emotional stability.10,11Healthcare professionals must be aware of the first signs of PPD, especially in populations with the highest risk. Suppose the mother is experiencing persistent sadness, mood changes, difficulty bonding with the baby, or any other symptoms of PPD that may or may not be impacting her daily functions. In that case, it is critical to get her help to prevent further deterioration of her well-being.10,11 If the mother has thoughts of self-harm or harm to the baby, immediate intervention is necessary to ensure she receives effective medical attention.10,11

Who to Contact

There are several professionals available who can provide support and assistance for postpartum depression (PPD), and any of them can be contacted.11,12The primary healthcare provider, such as the obstetrician-gynecologist (OB-GYN) or Midwife, is an excellent starting point. These professionals are familiar with the mother and have the expertise to assess symptoms, provide medical advice, and refer patients to specialists if needed. They may also help monitor physical health and discuss potential treatment options.12

As PPD is a mental health disorder, a psychologist or psychiatrist can assist in diagnosing and treating PPD. A licensed therapist or counselor specializing in perinatal mental health or postpartum depression can offer similar assistance. All these professionals can provide counseling, therapy, and guidance on managing symptoms through individual or group sessions, helping mothers with PPD manage symptoms and navigate the challenges of new parenthood.11,12

Many organizations specialize in supporting those with postpartum depression with resources, information on new treatments and clinical trials, and support groups. They can be local establishments or online mental health platforms that offer virtual therapy sessions or digital mental health resources.12,13

Joining a local or online support group can be particularly beneficial before or following diagnosis. Sharing experiences with others going through similar challenges can be extremely cathartic, offering emotional validation and practical advice.14,15

For immediate help, there are mental health helplines (988), crisis hotlines (800-273-TALK), and emergency services (911). These channels allow new mothers to speak with a trained counselor or mental health professional who can offer support and guidance, preventing a new mother from hurting herself or her baby.1,14,15

Types of Therapy

Several therapeutic approaches have been shown to be effective treatments for those experiencing postpartum depression (PPD). These therapies aim to address the emotional, psychological, and interpersonal aspects of PPD as well as improve the mother-infant relation. The most common therapies for PPD are explained below.16

Cognitive-Behavioral Therapy

Cognitive-Behavioral Therapy (CBT) is one of the most common approaches used to identify and modify negative thought patterns and behaviors postpartum. Cognitive-Behavioral Therapy helps new mothers develop healthier coping strategies and challenge distorted beliefs contributing to depression.16,17

Interpersonal Therapy (IPT)

Interpersonal Therapy (IPT) improves interpersonal relationships and addresses social difficulties following pregnancy and childbirth. Interpersonal Therapy helps individuals navigate life transitions, enhance communication skills, and build support systems, which can be particularly relevant during the postpartum period.16

Supportive Psychotherapy

Supportive psychotherapy provides a safe and empathetic environment for new mothers with PPD to express their feelings and concerns. Such supportive therapy focuses on fostering a conducive relationship that helps individuals manage stress and emotional challenges.16

Psychodynamic Therapy

Psychodynamic therapy explores the underlying psychological factors contributing to PPD, including unresolved conflicts or past experiences. It aims to increase self-awareness and understanding of the emotional root causes of depression, which can help develop effective coping mechanisms.16

Mindfulness-Based Therapies

Mindfulness-Based therapies such as mindfulness-based stress reduction (MBSR) or mindfulness-based cognitive therapy (MBCT), help new mothers become more aware of their thoughts and emotions while developing strategies to manage them. Mindfulness practices can help to promote emotional well-being, which, in turn, reduces symptoms of PPD.18

Group Therapy

Group therapy provides a supportive, judgment-free environment where those with PPD can share their experiences, gain insights, and learn coping strategies from the therapist and peers.15,16

Parent-Infant Psychotherapy

Parent-Infant psychotherapy is a type of therapy that focuses on building the mother-infant relationship and addressing attachment issues or difficulties in bonding with the baby. Helping new mothers connect with their newborns can alleviate the negative feelings and doubts following birth.19

Online or Telehealth Therapy

Online or Telehealth Therapy has become more prevalent with the advancement of technology. These online therapy or telehealth options offer accessible and convenient ways for individuals to receive therapeutic support from licensed professionals, especially when face-to-face sessions may be challenging due to the demands of parenthood.16,20

Medication Options

In cases of PPD where symptoms are severe or other therapeutic interventions are ineffective, medication can prove to be a valuable adjunct to the treatment plan.1,16 There are however, many concerns regarding the pharmacologic treatment of PPD, including unpredictable metabolic changes, infant exposure via breast milk, the degree of symptom relief, and the effect it will have on the mother’s ability to care for her infant.1

Antidepressants are the most common medication used for PPD, and these include selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI), and tricyclic antidepressant (TCA) formulations.1,16

Selective Serotonin Reuptake Inhibitors 

Selective serotonin reuptake inhibitors (SSRI) are a class of antidepressant medications to treat the depressive symptoms seen in PPD. Their mechanism of action works by boosting the level of serotonin in the brain, which can improve mood over a few weeks to months. Some SSRIs, such as sertraline or escitalopram, are considered safe while breastfeeding, but for a limited period (6 – 12 months), as small amounts of the drug can pass to the infant via breast milk.21

Regardless of the minimal quantity, it is recommended that nursing mothers start on low doses and increase slowly while monitoring the infant for adverse effects such as sedation, poor weight gain, irritability, or a change in feeding patterns. Selective serotonin reuptake inhibitors are typically well-tolerated and have not been shown to have any long-lasting side effects on new mothers.3

Serotonin-Norepinephrine Reuptake Inhibitors

Similarly, serotonin-norepinephrine reuptake inhibitors (SNRI) like venlafaxine, can also be effective as they increase serotonin and norepinephrine levels in the brain. They are only prescribed when SSRIs are ineffective, as they have comparatively stronger side effects. While SNRIs are considered safe while breastfeeding, research is still underway to compare their effectiveness to other treatments.22

Common side effects of SSRIs and SNRIs include nausea, headache, insomnia, drowsiness, dry mouth, dizziness, decreased libido, and weight changes. In rare cases, particularly if SSRIs or SNRIs are taken in combination with other serotonergic medications, the patient has an increased risk of experiencing serotonin syndrome. This condition is characterized by agitation, rapid heartbeat, high blood pressure, increased body temperature, muscle stiffness, and confusion. This is a severe reaction and requires immediate medical attention.

Tricyclic Antidepressants

Tricyclic antidepressants (TCA) such as amitriptyline or nortriptyline, are an older class of medication that works on multiple neurotransmitters in the brain. They are reserved for use only when other options are ineffective because of the severity of potential side effects. In addition to the side effects seen in SSRIs and SNRIs, TCAs can also cause dry mouth, blurred vision, constipation, urinary retention, drowsiness, and dizziness.23

One of the most pressing concerns of antidepressant therapy is the long-term effect on infants, which is still inconclusive, and given its concerns, research has shifted to finding effective hormone therapy that can address the drastic drop in hormone levels in the postpartum period that have been linked to PPD.16

In 2019 the FDA approved the first medication for treating severe PPD called brexanolone. 24 Brexanolone is a synthetic allopregnanolone (a naturally occurring neurosteroid made from progesterone) and has been shown to maintain levels of progesterone in the postpartum period, reducing the symptoms of PPD.24  Unlike the antidepressants mentioned above, brexanolone is administered via IV infusion over 2 – 3 days, requiring hospitalization. Moreover, patients must be closely monitored as it can cause adverse side effects such as drowsiness, dizziness, fatigue, sedation, nasopharyngitis (cold-like symptoms), diarrhea, and urinary tract infection.25

Following the promising results of brexanolone, improvements were made to its formulation, and in 2023 the FDA approved a pill form of the neurosteroid known as zuranolone.26  It is the first pill medication approved for treating severe PPD. It has been shown to have a higher bioavailability and bio half-life than brexanolone, making it more suitable for once-a-day use while giving faster results after a 14-day course.27 However, there is insufficient data to determine the long-term physical and neurological effects brexanolone or zuranolone has on developing infants, as trials required mothers to stop breastfeeding throughout the treatment.26

Nursing Considerations

Given the social stigma surrounding postpartum depression (PPD) and nearly 50% of mothers going undiagnosed, healthcare professionals play a critical role in identifying PPD and assisting in early intervention for the overall well-being of mothers and their families. Other nursing considerations to keep in mind are given below.1,2

Screening and Assessment

Healthcare professionals should be trained to recognize the early signs of PPD during pregnancy or after delivery to identify mothers at risk of progressing with more serious symptoms. Standardized assessments and regular evaluations can help providers determine a mother’s emotional well-being, mood, and coping strategies to understand how she feels and manages life with an infant. A comprehensive assessment in the perinatal period can help early detection.10

With these assessments, healthcare providers should educate expecting and new mothers about the signs and symptoms of PPD and stress the importance of seeking help. Teaching mothers about the nature of PPD, its prevalence, treatment options, and the benefits of early intervention can clarify common misconceptions. Teaching also helps dispel the negative associations surrounding mental health, particularly regarding childbearing, encouraging mothers to be more willing to accept treatment.1

The healthcare professional should also offer information about local support groups, mental health resources, and organizations specializing in postpartum mental health. Provide literature and access to online resources that mothers can utilize.10,11,12

Emotional Support

Healthcare professionals should provide emotional support to new mothers with PPD (patients) by actively listening in a non-judgmental manner so they can express their feelings and concerns, while validating the mother’s experiences and providing reassurance that she is not alone in facing the challenges of PPD.10,11,12

The healthcare professional should also encourage the mother to communicate openly with family and friends about her emotional state. This may be difficult for the mother, and the healthcare professional may need to assist the mother with educating those she would like to be informed of her condition, and help them understand the importance of empathy, patience, and active involvement in her recovery from this serious mood disorder, thereby creating a support network and ensuring her needs are met. 10,11,12

Monitor Treatment and Symptoms

The healthcare professional should maintain regular follow-up appointments to assess the mother’s emotional well-being progress and adjust the treatment plan as needed. They should be vigilant for any signs of symptoms worsening, lack of improvement, suicidal ideation, or thoughts of self-harming or harming the infant. If such thoughts are present, the healthcare professional should take immediate action to ensure the safety of the mother and the infant. In severe cases, hospitalization may be necessary to prevent further deterioration.1, 10,11,12

Some patients may have concerns about breastfeeding, especially if they have been prescribed any medications. Healthcare professionals should provide accurate information about the compatibility of PPD medication with breastfeeding and offer support for breastfeeding challenges. 1, 10,11,12 While breastfeeding has been shown to reduce the symptoms of PPD, if a patient faces challenges, it is important to provide alternatives so undue stressors can be removed. 10,11,12

Conclusion

Postpartum depression is a worrying mental health disorder that has negative consequences on both the new mother and her infant. Its high prevalence rate and comparatively lower diagnosed cases raise serious public health concerns about the lack of awareness and education surrounding the well-being of new mothers in our society.

While the exact bio-mechanism of PPD is still under research, there is no question that there are many biological, psychosocial, and environmental factors at play, and the presence of these can increase the likelihood of PPD. Among the most significant factors are a personal or family history of depression or PPD, pregnancy or delivery complications, and a lack of social support in the postpartum period.

Typical treatments for PPD range from psychotherapy and counseling to medication with antidepressants, depending on the symptoms and their severity. While the food and drug administration (FDA) has recently approved two medications for PPD, there is still inadequate literature on the long-term effects of the medications on the mother and infant, which is why preventive measures and early assessments are still the most critical steps for improved health outcomes following delivery.

The most effective treatment involves a multidisciplinary approach collaborating with healthcare professionals, including obstetricians, psychiatrists, nurses, and lactation consultants. Together, these professionals can create a comprehensive care plan that regularly assesses and monitors the new mother, providing the therapeutic and emotional support she needs to keep her and her infant safe and healthy.

References
  1. Hutchens, B. F., & Kearney, J. (2020). Risk factors for postpartum depression: An umbrella review. Journal of Midwifery & Women’s Health, 65(1). https://doi.org/10.1111/jmwh.13067
  2. Grigoriadis, S. (2020). Postpartum depression. Postpartum Mental Health Disorders: A Casebook, 21-30. https://doi.org/10.1093/med/9780190849955.003.0004
  3. Miller, L. J. (2002). Postpartum Depression. JAMA, 287(6), 762. https://doi.org/10.1001/jama.287.6.762
  4. Pearlstein, T., Howard, M., Salisbury, A., & Zlotnick, C. (2009). Postpartum depression. American Journal of Obstetrics and Gynecology, 200(4), 357–364. https://doi.org/10.1016/j.ajog.2008.11.033
  5. Yu, Y., Liang, H.-F., Chen, J., Li, Z.-B., Han, Y.-S., Chen, J.-X., & Li, J.-C. (2021). Postpartum Depression: Current Status and Possible Identification Using Biomarkers. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.620371
  6. Sheng, J. A., Bales, N. J., Myers, S. A., Bautista, A. I., Roueinfar, M., Hale, T. M., & Handa, R. J. (2021). The Hypothalamic-Pituitary-Adrenal Axis: Development, Programming Actions of Hormones, and Maternal-Fetal Interactions. Frontiers in Behavioral Neuroscience, 14(601939). https://doi.org/10.3389/fnbeh.2020.601939
  7. Silverman, M. E., Reichenberg, A., Savitz, D. A., Cnattingius, S., Lichtenstein, P., Hultman, C. M., Larsson, H., & Sandin, S. (2017). The risk factors for postpartum depression: A population-based study. Depression and Anxiety, 34(2), 178–187. https://doi.org/10.1002/da.22597
  8. Gastaldon, C., Solmi, M., Correll, C. U., Barbui, C., & Schoretsanitis, G. (n.d.). Risk factors of postpartum depression and depressive symptoms: umbrella review of current evidence from systematic reviews and meta-analyses of observational studies. The British Journal of Psychiatry, 1–12. https://doi.org/10.1192/bjp.2021.222
  9. Batt, M. M., Duffy, K. A., Novick, A. M., Metcalf, C. A., & Epperson, C. N. (2020). Is Postpartum Depression Different From Depression Occurring Outside of the Perinatal Period? A Review of the Evidence. FOCUS, 18(2), 106–119. https://doi.org/10.1176/appi.focus.20190045
  10. Stewart, D. E., & Vigod, S. N. (2019). Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics. Annual Review of Medicine, 70(1), 183–196. https://doi.org/10.1146/annurev-med-041217-011106
  11. March of Dimes. (2019, March). Postpartum depression. Www.marchofdimes.org. https://www.marchofdimes.org/find-support/topics/postpartum/postpartum-depression
  12. Postpartum Depression. (n.d.). Www.acog.org. https://www.acog.org/womens-health/faqs/postpartum-depression
  13. Depression. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/depression#part_10948
  14. Langdon, K. (2016). Support Groups for Postpartum Depression – How They Can Help. PostpartumDepression.org. https://www.postpartumdepression.org/support/groups/
  15. Kamalifard, M., Yavarikia, P., Babapour Kheiroddin, J., Salehi Pourmehr, H., & Iraji Iranagh, R. (2013). The Effect of Peers Support on Postpartum Depression: A Single-Blind Randomized Clinical Trial. Journal of Caring Sciences, 2(3), 237–244. https://doi.org/10.5681/jcs.2013.029
  16. Leight, K., Fitelson, E., Kim, S., & Baker, A. (2010). Treatment of post-partum depression: a review of clinical, psychological and pharmacological options. International Journal of Women’s Health, 3, 1–14. https://doi.org/10.2147/ijwh.s6938
  17. Milgrom, J., Gemmill, A. W., Ericksen, J., Burrows, G., Buist, A., & Reece, J. (2015). Treatment of postnatal depression with cognitive behavioural therapy, sertraline and combination therapy: A randomised controlled trial. Australian & New Zealand Journal of Psychiatry, 49(3), 236–245. https://doi.org/10.1177/0004867414565474
  18. Mackiewicz Seghete, K. L., Graham, A. M., Lapidus, J. A., Jackson, E. L. A., Doyle, O. J., Feryn, A. B., Moore, L. A., Goodman, S. H., & Dimidjian, S. (2020). Protocol for a mechanistic study of mindfulness based cognitive therapy during pregnancy. Health Psychology, 39(9), 758–766. https://doi.org/10.1037/hea0000870
  19. Huang, R., Yang, D., Lei, B., Yan, C., Tian, Y., Huang, X., & Lei, J. (2020). The short- and long-term effectiveness of mother–infant psychotherapy on postpartum depression: A systematic review and meta-analysis. Journal of Affective Disorders, 260, 670–679. https://doi.org/10.1016/j.jad.2019.09.056
  20. Zhao, L., Chen, J., Lan, L., Deng, N., Liao, Y., Yue, L., Chen, I., Wen, S. W., & Xie, R. (2021). Effectiveness of Telehealth Interventions for Women With Postpartum Depression: Systematic Review and Meta-analysis. JMIR MHealth and UHealth, 9(10), e32544. https://doi.org/10.2196/32544
  21. Hantsoo, L., Ward-O’Brien, D., Czarkowski, K. A., Gueorguieva, R., Price, L. H., & Epperson, C. N. (2013). A randomized, placebo-controlled, double-blind trial of sertraline for postpartum depression. Psychopharmacology, 231(5), 939–948. https://doi.org/10.1007/s00213-013-3316-1
  22. Stewart, D. E., & Vigod, S. (2016). Postpartum Depression. New England Journal of Medicine, 375(22), 2177–2186. https://doi.org/10.1056/nejmcp1607649
  23. Kaufman, Y., Carlini, S. V., & Deligiannidis, K. M. (2022). Advances in pharmacotherapy for postpartum depression: a structured review of standard-of-care antidepressants and novel neuroactive steroid antidepressants. Therapeutic Advances in Psychopharmacology, 12, 204512532110658. https://doi.org/10.1177/20451253211065859
  24. Meltzer-Brody, S., Colquhoun, H., Riesenberg, R., Epperson, C. N., Deligiannidis, K. M., Rubinow, D. R., Li, H., Sankoh, A. J., Clemson, C., Schacterle, A., Jonas, J., & Kanes, S. (2018). Brexanolone injection in post-partum depression: two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials. The Lancet, 392(10152), 1058–1070. https://doi.org/10.1016/s0140-6736(18)31551-4
  25. Cornett, E. M., Rando, L., Labbé, A. M., Perkins, W., Kaye, A. M., Kaye, A. D., Viswanath, O., & Urits, I. (2021). Brexanolone to Treat Postpartum Depression in Adult Women. Psychopharmacology Bulletin, 51(2), 115–130. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146562/
  26. AnchorCommissioner, O. of the. (2023, August 4). FDA Approves First Oral Treatment for Postpartum Depression. FDA. https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression
  27. Deligiannidis, K. M., Meltzer-Brody, S., Gunduz-Bruce, H., Doherty, J., Jonas, J., Li, S., Sankoh, A. J., Silber, C., Campbell, A. D., Werneburg, B., Kanes, S. J., & Lasser, R. (2021). Effect of Zuranolone vs Placebo in Postpartum Depression. JAMA Psychiatry, 78(9), 951. https://doi.org/10.1001/jamapsychiatry.2021.1559
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