In recent years, mental health struggles have become the leading cause of maternal mortality in the United States, primarily due to suicides and drug overdoses. One in eight new mothers is estimated to suffer from postpartum depression, and some research has suggested that the prevalence rose to one in three during the early days of the pandemic.
However, about half of women who are struggling with their mental health after pregnancy do not receive treatment. Barriers to care include a lack of awareness about symptoms and treatments, inability to access resources, and stigma.
Postpartum depression has historically been underdiagnosed and understudied, but recognition of the condition is finally growing. As a result, more treatment options are available than ever before, including innovative treatment models and at least one new drug.
Diagnose postpartum depression
Many women experience mood swings in the days and weeks after giving birth due to the dramatic hormonal changes that occur. Sometimes called the baby blues, symptoms include feelings of sadness, anxiety, tearfulness, or overwhelm; they typically subside within a week or two.
New moms feel like they’re on a hormonal ride because they are, said Dr. Village. It happens to every single person who gives birth, and this is considered a normal part of the transition from pregnancy to the postpartum period.
Postpartum depression is different. It is defined as a major depressive episode that lasts at least two weeks and begins during the year following birth, usually emerging in the first few weeks.
To meet the criteria for a postpartum depressive episode, you must meet the criteria for a major depressive episode, said Dr. Meltzer-Brody. These include persistent low mood, low energy, feelings of worthlessness or guilt, suicidal thoughts, and loss of interest in things that were previously pleasurable.
The condition is typically screened for using a questionnaire known as the Edinburgh Postnatal Depression Scale, which is ideally (but not always) administered during the six-week postpartum visit to the obstetrician’s office. Pediatricians are also encouraged to ask about postpartum depression because they see family more frequently in the year following the birth. Risk factors include a history of depression, a traumatic birth experience and a lack of social support, said Dr. Latoya Frolov, a perinatal psychiatrist at the University of Texas Southwestern Medical Center.
Postpartum depression can affect not only the health of the mother but also that of her baby. Some research has shown that babies born to depressed mothers gain less weight and have more illness and developmental delays (although other studies have not). Consequently, prompt treatment is important.
Treatment options
The treatment a woman receives should depend on her Edinburgh Scale score, but too often there is no follow-up care, either because adequate mental health resources are not available or because she cannot access it.
It’s hard to get to an appointment when you’re overwhelmed, exhausted and depressed, especially if you don’t have easy transportation or childcare, Dr. Frolov said. When I see someone come to an appointment with me, I’m overjoyed, honestly, to see them in my office, because I know there’s often a lot going on.
Therapy
If a woman is found to be suffering from mild to moderate depression, she should be referred to some sort of therapy quickly.
Group therapy is often recommended for new moms who are struggling and can be one of the most powerful interventions, said Paige Bellenbaum, a licensed clinical social worker and founding director of The Motherhood Center, a New York City clinic that offers critical care outpatient care for women with postpartum depression. It’s the support women provide for each other, she said, that helps them feel a lot less alone on this really, really challenging journey.
In individual therapy, counselors often use approaches such as cognitive behavioral therapy, dialectical behavior therapy, and interpersonal therapy, which equip women with skills to help them manage their emotions, avoid or reframe negative thoughts, and improve communication with their partner. own partner.
Drug
For women experiencing moderate to severe postpartum depression, experts often recommend the drugs most commonly selective serotonin reuptake inhibitors, or SSRIs. There is limited research specifically testing SSRIs for postpartum depression, but a meta-analysis assessing six Studies have indicated that just under half of women who take them see an improvement.
Traditionally, doctors have worried that these drugs aren’t safe for pregnant or breastfeeding women, but Dr. Frolov said the risks are small, especially compared to those associated with postpartum depression. He said Zoloft, in particular, is often prescribed because fewer drugs are secreted into breast milk than other SSRIs.
Dr. Frolov is trying to enable doctors who work with pregnant and postpartum women to feel more comfortable prescribing SSRIs, especially women who are struggling but unable to see a mental health professional. I always encourage OBs to negotiate, he said. It’s not enough to shield.
New options
For women who do not respond to these therapies, more intensive treatment options are starting to become available, including full-time inpatient and outpatient facilities dedicated to maternal mental health, such as the Motherhood Center and the UNCsperinatal psychiatry unit.
Now there is also the first drug specifically for postpartum depression and it works differently from SSRIs. Treatment with the drug, called Brexanolone, causes a significant reduction in depression scores for about 70 percent of women who receive it, said Dr. Meltzer-Brody, who led the clinical trials at UNC Specifically, it works within 24 hours, versus the weeks or months it takes to see a benefit from therapy or SSRIs
While the efficacy of Brexanolones is promising, it must be administered in the hospital via an IV for 60 consecutive hours, making it extremely difficult to access. As a result, only a few hundred women, usually the most severe cases, have been treated with the drug since it was approved in 2019.
Experts are optimistic that a related fast-acting drug that can be given in pill form may soon become available. The drug, called Zuranolone, is currently under review by the Food and Drug Administration, for both postpartum depression and major depressive disorder; a ruling could come as soon as Labor Day.
Perhaps even more important than the new drugs themselves, Ms. Bellenbaum said, is the fact that the medical and scientific community is investing in postpartum depression research. The field of maternal mental health is finally starting to matter, she said.
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