Postpartum Depression: What’s a Mother to do?

By: Rupali Chadha, MD • Posted on May 10, 2019 • Updated March 04, 2024

Postpartum Blues

What does a new mother do when she has a new bundle, but not the joy? Postpartum blues, or baby blues, are more common than we talk about in society. Oftentimes, postpartum blues can even develop into postpartum depression. This is a serious medical illness that requires immediate attention for both the sake of mom and baby (and additional children who may be at home). Postpartum depression can also come with anxiety and even psychotic symptoms like hearing voices.

Symptoms of Postpartum Blues

Postpartum blues or baby blues can develop in 50 percent of women in the first two weeks after delivery and usually, resolves on its own in that time frame as well. Symptoms include mild depressive symptoms such as:

• sadness
• crying
• irritability
• anxiety
• insomnia
• exhaustion
• decreased concentration

As mentioned, the key feature is that this is self-limited and stops on its own in two weeks. If the above symptoms persist and become more severe and/or one has thoughts of suicide, that is when postpartum depression is suspected.

Screening for Postpartum Depression

All healthcare clinicians that care for new mothers are to screen for postpartum depression. It is important to tell mothers that this is not their fault. They are not bad mothers! The huge estrogen withdrawal at birth can cause changes in our brain chemistry and hijack our moods and motivations.

Postpartum depression must be treated. Not just for the sake of the suffering mother, but for the development of the new baby. Studies have shown that babies of mothers with postpartum depression can suffer in their brain development and can also have psychiatric issues later themselves, including ADHD. This is both due to nature and nurture - both genes which are inherited, and the critical mother baby bonding time can play a role.

Treatment for Postpartum Depression

Many treatments are available, but the main treatment is Selective Serotonin Re-uptake Inhibitors (SSRI) antidepressants. Of course, breastfeeding mothers need to discuss risks and benefits with their OB-GYN, pediatrician and/or family physician, and it is always good to have all doctors working as part of a team.

SSRIs take 3-4 weeks for a response and up to two months for a maximal response. If a mother has had depression in the past or postpartum depression with a previous pregnancy, treatment is recommend in the last trimester or right as soon as she delivers. A wait and watch approach is also appropriate.

IV Infusion Drug for Postpartum Depression

There is an IV infusion drug available that must be done as an inpatient and is also very expensive, but the plus side is that it works within 60 hours. For severely depressed mothers or those with thoughts of suicide or of harming their baby, this may be an important option and one that works faster than other traditional anti-depressants.

New Oral Medication for Postpartum Depression

The FDA-approved Zurzuvae (zuranolone) is an oral medication indicated to treat postpartum depression in adults. The daily recommended dose is 50mg and is taken once a day for 14 days, in the evening with a full meal.

Postpartum depression affects nine percent of mothers worldwide. It is a medical illness that is the result of changed brain chemistry in response to changed body chemistry and one cannot just snap back to wellness. Motherhood is joyous and is a feat of nature. But when chemicals override our brain, there is nothing wrong with getting some help to get back on track. Your doctor and healthcare team are there for you.

Be Strong. Be Healthy. Be in Charge!
-Rupali Chadha, MD

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