Postpartum depression part 2: Diagnosis and treatment

Key Takeaways:

• Postpartum depression is diagnosed though a clinical evaluation, which includes a review of symptoms.
• Talk therapy and medication can treat postpartum depression.
• Most of the medications used to treat depression are safe to use during and after pregnancy, including while breastfeeding.

In the first part of this series, we discussed what postpartum depression is, and the symptoms to watch for. 

While postpartum depression affects about 1-in-7 women, there is good news: effective treatments are available, and recovery is possible.

In this installment, we’re going to talk about how postpartum depression is diagnosed and the treatment options available. 

How is postpartum depression diagnosed?

There is no blood test or scan that can diagnose postpartum depression.  Instead, it is diagnosed by talking with patients about their symptoms, how long those symptoms have been present, and how they are affecting daily life.

It’s diagnosed based on the constellation of symptoms discussed in the first blog post.

Brief screening questionnaires help identify symptoms of depression. They can be filled out in just a few minutes and are commonly used in obstetric offices, primary care clinics, and even pediatric practices.  They help identify symptoms of depression, particularly for individuals not already connected with mental health, or who have no history of mental health concerns.  

Two of the most commonly used screening tools are the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9).  These take only minutes to complete and can help identify women who may be experiencing symptoms of depression and would benefit from further evaluation.

How is it treated?

Treatment depends on several factors, including the severity of symptoms and whether someone has experienced depression before.

For women with a history of depression, we often recommend continuing a treatment plan that has worked well before pregnancy and considering a similar approach during the postpartum period. Having a history of depression can increase the risk of postpartum depression, so staying connected to treatment is important.

For a new episode of depression, it depends on the severity.   For mild symptoms, therapy is often the first step. Cognitive behavioral therapy (CBT) and other evidence-based therapies can be very effective in helping manage depression.

For more severe symptoms, we often discuss starting medications. Common antidepressants used to treat postpartum depression include selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) and escitalopram (Lexapro).

One newer treatment option is zuranolone (Zurzuvae), a medication approved specifically for postpartum depression.  One advantage is that the medication can work faster than some of the traditional antidepressants.  However, it is not the right choice for everyone, and treatment decisions should always be discussed with your treatment team. 

Is it safe for me to take antidepressants while pregnant and breastfeeding? 

This is a common question I hear from patients.  While no medication can be considered completely risk-free, many of the medications commonly used to treat depression have a large evidence base for use during pregnancy and breastfeeding. For many women, the risks of untreated depression can be greater than the risks associated with treatment.

The decision to take medication during pregnancy or while breastfeeding is highly personal.  This should be made in partnership with a healthcare professional, and together, you can discuss the risks, benefits, and treatment options that best fit your situation.

Can postpartum depression be prevented?

Unfortunately, there is no guaranteed way to prevent postpartum depression. However, there are steps that can help reduce the risk and allow symptoms to be recognized early.

Women with a personal history of depression are at higher risk of developing depression during pregnancy and after delivery. Staying connected with a mental health professional before, during, and after pregnancy can help identify warning signs and ensure support is available when needed.

For some women, that may include continuing medication during pregnancy. Others may choose not to. Whatever decision is made, it is important to remain connected with care, so symptoms can be recognized and treated as early as possible. Early intervention leads to better outcomes and recognition of the warning signs. 

You are not to blame

One of the most important things I want people to understand is that postpartum depression is a medical condition, not a personal failure.  Many women feel guilty and ashamed. But depression is not something you choose, and it is not a sign of weakness.

If you are struggling, know that you are not alone, help is available, and recovery is possible.  Seeking help is a sign of strength, not failure.

If you or someone you know is experiencing postpartum depression, call the WVU Rockefeller Department of Behavioral Medicine and Psychiatry at 304-598-4214 for help.