Editing Postpartum depression (section)

==Treatments==
Treatment for mild to moderate PPD includes psychological interventions or antidepressants. Women with moderate to severe PPD would likely experience a greater benefit with a combination of psychological and medical interventions.<ref name="Langan_2016">{{cite journal | vauthors = Langan R, Goodbred AJ | title = Identification and Management of Peripartum Depression | journal = American Family Physician | volume = 93 | issue = 10 | pages = 852–858 | date = May 2016 | pmid = 27175720 | url = http://www.aafp.org/afp/2016/0515/p852.html | url-status = live | archive-url = https://web.archive.org/web/20171025132458/http://www.aafp.org/afp/2016/0515/p852.html | archive-date = 2017-10-25 }}</ref> Light aerobic exercise is useful for mild and moderate cases.<ref>{{cite journal | vauthors = McCurdy AP, Boulé NG, Sivak A, Davenport MH | title = Effects of Exercise on Mild-to-Moderate Depressive Symptoms in the Postpartum Period: A Meta-analysis | journal = Obstetrics and Gynecology | volume = 129 | issue = 6 | pages = 1087–1097 | date = June 2017 | pmid = 28486363 | doi = 10.1097/AOG.0000000000002053 | s2cid = 43035658 }}</ref><ref>{{cite journal | vauthors = Pritchett RV, Daley AJ, Jolly K | title = Does aerobic exercise reduce postpartum depressive symptoms? a systematic review and meta-analysis | journal = The British Journal of General Practice | volume = 67 | issue = 663 | pages = e684–e691 | date = October 2017 | pmid = 28855163 | pmc = 5604832 | doi = 10.3399/bjgp17X692525 }}</ref>

=== Therapy ===
Both individual social and psychological interventions appear equally effective in the treatment of PPD.<ref>{{cite journal | vauthors = Dennis CL, Hodnett E | title = Psychosocial and psychological interventions for treating postpartum depression | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD006116 | date = October 2007 | pmid = 17943888 | doi = 10.1002/14651858.CD006116.pub2 }}</ref><ref>Pearlstein, T., Howard, M., Salisbury, A., & Zlotnick, C. (2009). Postpartum depression. American journal of obstetrics and gynecology, 200(4), 357-364.</ref> Social interventions include individual counseling and peer support, while psychological interventions include [[cognitive behavioral therapy]] (CBT) and [[interpersonal therapy]] (IPT).<ref name="Fitelson_2010">{{cite journal | vauthors = Fitelson E, Kim S, Baker AS, Leight K | title = Treatment of postpartum depression: clinical, psychological and pharmacological options | journal = International Journal of Women's Health | volume = 3 | pages = 1–14 | date = December 2010 | pmid = 21339932 | pmc = 3039003 | doi = 10.2147/IJWH.S6938 | doi-access = free }}</ref><ref>Smith, E. K., Gopalan, P., Glance, J. B., & Azzam, P. N. (2016). Postpartum depression screening: a review for psychiatrists. Harvard Review of Psychiatry, 24(3), 173-187.</ref> Support groups and group therapy options focused on psychoeducation around postpartum depression have been shown to enhance the understanding of postpartum symptoms and often assist in finding further treatment options.<ref>{{Cite journal| vauthors = Anderson LN |date=2013|title=Functions of Support Group Communication for Women with Postpartum Depression: How Support Groups Silence and Encourage Voices of Motherhood|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/jcop.21566|journal=Journal of Community Psychology |language=en |volume=41|issue=6|pages=709–724|doi=10.1002/jcop.21566|issn=1520-6629}}</ref> Other forms of therapy, such as group therapy, home visits, counseling, and ensuring greater sleep for the mother may also have a benefit.<ref name="OBOS" /><ref name=Ste2019 /><ref>Beck, C. T. (2008). State of the science on postpartum depression: What nurse researchers have contributed—Part 2. MCN: The American Journal of Maternal/Child Nursing, 33(3), 151-156.</ref> While specialists trained in providing counseling interventions often serve this population in need, results from a 2021 [[systematic review]] and [[meta-analysis]] found that nonspecialist providers, including lay counselors, nurses, midwives, and teachers without formal training in counseling interventions, often provide effective services related to perinatal depression and anxiety<ref>{{cite journal | vauthors = Singla DR, Lawson A, Kohrt BA, Jung JW, Meng Z, Ratjen C, Zahedi N, Dennis CL, Patel V | title = Implementation and Effectiveness of Nonspecialist-Delivered Interventions for Perinatal Mental Health in High-Income Countries: A Systematic Review and Meta-analysis | journal = JAMA Psychiatry | volume = 78 | issue = 5 | pages = 498–509 | date = May 2021 | pmid = 33533904 | pmc = 7859878 | doi = 10.1001/jamapsychiatry.2020.4556 }}</ref> which promotes task-sharing and [[telemedicine]].<ref>{{Cite journal |last1=Singla |first1=Daisy R. |last2=Silver |first2=Richard K. |last3=Vigod |first3=Simone N. |last4=Schoueri-Mychasiw |first4=Nour |last5=Kim |first5=J. Jo |last6=La Porte |first6=Laura M. |last7=Ravitz |first7=Paula |last8=Schiller |first8=Crystal E. |last9=Lawson |first9=Andrea S. |last10=Kiss |first10=Alex |last11=Hollon |first11=Steven D. |last12=Dennis |first12=Cindy-Lee |last13=Berenbaum |first13=Tara S. |last14=Krohn |first14=Holly A. |last15=Gibori |first15=Jamie E. |date=2025 |title=Task-sharing and telemedicine delivery of psychotherapy to treat perinatal depression: a pragmatic, noninferiority randomized trial |journal=Nature Medicine |language=en |volume=31 |issue=4 |pages=1214–1224 |doi=10.1038/s41591-024-03482-w |issn=1546-170X |pmc=12003186 |pmid=40033113}}</ref>

=== Psychotherapy ===
[[Psychotherapy]] is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy can be super beneficial for mothers or fathers that are dealing with PPD. It allows individuals to talk with someone, maybe even someone who specializes in working with people who are dealing with PPD, and share their emotions and feelings to get help to become more emotionally stable. Psychotherapy proves to show efficacy of [[Psychodynamic psychotherapy|psychodynamic]] interventions for postpartum depression, both in home and clinical settings and both in group and individual format.

=== Cognitive behavioral therapy ===
Internet-based [[cognitive behavioral therapy]] (CBT) has shown promising results with lower negative parenting behavior scores and lower rates of anxiety, stress, and depression. CBT&nbsp; may be beneficial for mothers who have limitations in accessing in-person CBT. However, the long-term benefits have not been determined. The implementation of cognitive behavioral therapy happens to be one of the most successful and well-known forms of therapy regarding PPD. In simple terms, [[cognitive behavioral therapy]] is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. While being a wide branch of therapy, it remains very beneficial when tackling specific emotional distress, which is the foundation of PPD. Thus, CBT manages to further reduce or limit the frequency and intensity of emotional outbreaks in the mothers or fathers.

=== Interpersonal therapy ===
[[Interpersonal therapy]] (IPT) has shown to be effective in focusing specifically on the mother and infant bond.<ref>{{cite journal | vauthors = Stuart S | title = Interpersonal psychotherapy for postpartum depression | journal = Clinical Psychology & Psychotherapy | volume = 19 | issue = 2 | pages = 134–140 | date = 2012 | pmid = 22473762 | pmc = 4141636 | doi = 10.1002/cpp.1778 }}</ref> Psychosocial interventions are effective for the treatment of postpartum depression. [[Interpersonal therapy]] otherwise known as IPT is a wonderfully intuitive fit for many women with PPD as they typically experience a multitude of [[Biopsychosocial model|biopsychosocial]] stressors that are associated with their depression, including several disrupted interpersonal relationships.

===Medication===
A 2010 review found few studies of medications for treating PPD noting small sample sizes and generally weak evidence.<ref name="Fitelson_2010" /> Some evidence suggests that mothers with PPD will respond similarly to people with [[major depressive disorder]].<ref name="Fitelson_2010" /> There is low-certainty evidence which suggests that [[selective serotonin reuptake inhibitors]] (SSRIs) are an effective treatment for PPD.<ref name="Brown_2021">{{cite journal | vauthors = Brown JV, Wilson CA, Ayre K, Robertson L, South E, Molyneaux E, Trevillion K, Howard LM, Khalifeh H | title = Antidepressant treatment for postnatal depression | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 2 | pages = CD013560 | date = February 2021 | pmid = 33580709 | pmc = 8094614 | doi = 10.1002/14651858.cd013560.pub2 }}</ref> The first-line anti-depressant medication of choice is [[sertraline]], an SSRI, as very little of it passes into the [[breast milk]] and, as a result, to the child.<ref name="Ste2019"/> However, a recent study has found that adding [[sertraline]] to psychotherapy does not appear to confer any additional benefit.<ref>{{cite journal | vauthors = McDonagh MS, Matthews A, Phillipi C, Romm J, Peterson K, Thakurta S, Guise JM | title = Depression drug treatment outcomes in pregnancy and the postpartum period: a systematic review and meta-analysis | journal = Obstetrics and Gynecology | volume = 124 | issue = 3 | pages = 526–534 | date = September 2014 | pmid = 25004304 | doi = 10.1097/aog.0000000000000410 | s2cid = 1508392 }}</ref> Therefore, it is not completely clear which antidepressants, if any, are most effective for the treatment of PPD, and for whom antidepressants would be a better option than non-pharmacotherapy.<ref name="Brown_2021" />

Some studies show that [[hormone therapy]] may be effective in women with PPD, supported by the idea that the drop in estrogen and progesterone levels post-delivery contributes to depressive symptoms.<ref name="Fitelson_2010" /> However, there is some controversy with this form of treatment because estrogen should not be given to people who are at higher risk of [[Venous thrombosis|blood clots]], which include women up to 12 weeks after delivery.<ref>{{cite news|title=Postpartum VTE Risk Highest Soon After Birth | vauthors = MacReady N |date=April 7, 2014|url=https://www.medscape.com/viewarticle/823218|work=[[Medscape]]|access-date=2017-10-31|url-status=live|archive-url= https://web.archive.org/web/20170206205347/http://www.medscape.com/viewarticle/823218 |archive-date=2017-02-06 }}</ref> Additionally, none of the existing studies included women who were breastfeeding.<ref name="Fitelson_2010" /> However, there is some evidence that the use of [[Estrogen patch|estradiol patches]] might help with PPD symptoms.<ref name="Frieder_2019">{{cite journal | vauthors = Frieder A, Fersh M, Hainline R, Deligiannidis KM | title = Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development | journal = CNS Drugs | volume = 33 | issue = 3 | pages = 265–282 | date = March 2019 | pmid = 30790145 | pmc = 6424603 | doi = 10.1007/s40263-019-00605-7 }}</ref>

[[Oxytocin]] is an effective anxiolytic and in some cases antidepressant treatment in men and women. Exogenous oxytocin has only been explored as a PPD treatment with rodents, but results are encouraging for potential application in humans.<ref name="Kim_2014" />

In 2019, the FDA approved [[brexanolone]], a synthetic analog of the [[neurosteroid]] [[allopregnanolone]], for use [[intravenous]]ly in postpartum depression. Allopregnanolone levels drop after giving birth, which may lead to women becoming depressed and anxious.<ref>{{Cite web|url=https://www.nih.gov/news-events/news-releases/bench-bedside-nimh-research-leads-brexanolone-first-ever-drug-specifically-postpartum-depression|title=Bench-to-bedside: NIMH research leads to brexanolone, first-ever drug specifically for postpartum depression|date=2019-03-20|website=National Institutes of Health (NIH)|language=EN|access-date=2019-08-02}}</ref> Some trials have demonstrated an effect on PPD within 48 hours from the start of infusion.<ref>{{cite web |title=Press Announcements - FDA approves first treatment for post-partum depression |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm633919.htm |website=www.fda.gov |access-date=23 March 2019 }}</ref> Other new allopregnanolone analogs under evaluation for use in the treatment of PPD include [[zuranolone]] and [[ganaxolone]].<ref name="Frieder_2019" />

Brexanolone has risks that can occur during administration, including excessive sedation and sudden loss of consciousness, and therefore has been approved under the [[Risk Evaluation and Mitigation Strategies|Risk Evaluation and Mitigation Strategy]] (REMS) program.<ref name="FDA_2019">{{Cite web|url=https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression|title=FDA approves first treatment for post-partum depression | author = Office of the Commissioner |date=2019-04-17|website=FDA|language=en|access-date=2019-08-02}}</ref> The mother is to be enrolled before receiving the medication. It is only available to those at certified healthcare facilities with a healthcare provider who can continually monitor the patient. The infusion itself is a 60-hour, or 2.5-day, process. People's oxygen levels are to be monitored with a [[Pulse oximetry|pulse oximeter]]. Side effects of the medication include dry mouth, sleepiness, somnolence, flushing, and loss of consciousness. It is also important to monitor for early signs of suicidal thoughts or behaviors.<ref name="FDA_2019" />

In 2023, the FDA approved [[zuranolone]], sold under the brand name Zurzuvae for treatment of postpartum depression. Zuranolone is administered through a pill, which is more convenient than brexanolone, which is administered through an intravenous injection.<ref>{{Cite news | vauthors = Walker J |date=2023-08-04 |title=First Pill for Postpartum Depression Is Approved by FDA |language=en-US |work=Wall Street Journal |url=https://www.wsj.com/articles/first-pill-for-postpartum-depression-is-approved-by-fda-62376e41 |access-date=2023-11-16 |issn=0099-9660}}</ref>

=== Breastfeeding ===
The use of SSRIs for the treatment of PPD is not a contraindication for breastfeeding. While antidepressants are excreted in breastmilk, the concentrations recorded in breastmilk are very low.<ref name=":1">{{cite journal | vauthors = Berle JO, Spigset O | title = Antidepressant Use During Breastfeeding | journal = Current Women's Health Reviews | volume = 7 | issue = 1 | pages = 28–34 | date = February 2011 | pmid = 22299006 | pmc = 3267169 | doi = 10.2174/157340411794474784 }}</ref><ref name=":2">{{cite journal | vauthors = Weisskopf E, Fischer CJ, Bickle Graz M, Morisod Harari M, Tolsa JF, Claris O, Vial Y, Eap CB, Csajka C, Panchaud A | title = Risk-benefit balance assessment of SSRI antidepressant use during pregnancy and lactation based on best available evidence | journal = Expert Opinion on Drug Safety | volume = 14 | issue = 3 | pages = 413–427 | date = March 2015 | pmid = 25554364 | doi = 10.1517/14740338.2015.997708 }}</ref> Extensive research has shown that the use of SSRI's by women who are lactating is safe for the breastfeeding infant/child.<ref name=":1" /><ref name=":2" /><ref>{{cite journal | vauthors = Hallberg P, Sjöblom V | title = The use of selective serotonin reuptake inhibitors during pregnancy and breast-feeding: a review and clinical aspects | journal = Journal of Clinical Psychopharmacology | volume = 25 | issue = 1 | pages = 59–73 | date = February 2005 | pmid = 15643101 | doi = 10.1097/01.jcp.0000150228.61501.e4 }}</ref> Regarding allopregnanolone, very limited data did not indicate a risk for the infant.<ref>{{cite web |title=FDA Prescribing Information for Brexanolone |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/211371lbl.pdf |access-date=23 March 2019}}</ref>

===Other===
[[Electroconvulsive therapy]] (ECT) has shown efficacy in women with severe PPD who have either failed multiple trials of medication-based treatment or cannot tolerate the available antidepressants.<ref name="Langan_2016"/> Tentative evidence supports the use of [[Transcranial magnetic stimulation|repetitive transcranial magnetic stimulation (rTMS)]].<ref>{{cite journal | vauthors = Cole J, Bright K, Gagnon L, McGirr A | title = A systematic review of the safety and effectiveness of repetitive transcranial magnetic stimulation in the treatment of peripartum depression | journal = Journal of Psychiatric Research | volume = 115 | pages = 142–150 | date = August 2019 | pmid = 31129438 | doi = 10.1016/j.jpsychires.2019.05.015 | s2cid = 167209199 }}</ref>

As of 2013, it is unclear if [[acupuncture]], massage, bright lights, or taking [[omega-3 fatty acids]] are useful.<ref>{{cite journal | vauthors = Dennis CL, Dowswell T | title = Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 7 | pages = CD006795 | date = July 2013 | pmid = 23904069 | doi = 10.1002/14651858.CD006795.pub3 | pmc = 11536339 }}</ref>
{{Further|Oxytocin treatment for postpartum depression}}