How Perinatal Depression Is Treated

Perinatal depression, or major depressive disorder (MDD) with peripartum onset, is depression that occurs during or after pregnancy.

Many people who are pregnant, and those who have recently given birth, will experience mood changes, but these changes are different from depression.

Perinatal depression is a mental health disorder with symptoms that can include extreme sadness, anxiety, and fatigue. These symptoms can make it challenging for a person to carry out daily tasks, including caring for themselves and others.

If left untreated, perinatal depression can lead to negative outcomes for pregnant and recently pregnant people and their infants. When perinatal depression is recognized and diagnosed, it is treatable.

Treatment often includes a combination of prescription medication and psychotherapy. Lifestyle changes also can help a person manage symptoms.

Prescription Medications

The most common medications that are used to treat perinatal depression are antidepressants. It is estimated that 2%–3% of pregnant people take antidepressant medications.

Certain types of antidepressants are thought to work by improving how the brain uses chemicals that control mood or stress.

The most commonly prescribed antidepressants for perinatal depression are certain selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

These include:

• Celexa (citalopram)
• Zoloft (sertraline)
• Cymbalta (duloxetine)
• Effexor XR (venlafaxine)

Risks

The risk of birth defects and other problems for babies of people taking antidepressants during or after pregnancy is usually very low. 

Risks include maternal weight changes and premature birth. You can discuss these risks and weigh them against the benefits of taking an antidepressant with your doctor.

How Long Will It Take to Work?

Do not expect to see or feel changes right away after you start taking an antidepressant. It may take up to 6–8 weeks for the medication to work.

When you first start taking the medication, you may have some side effects, such as trouble sleeping, nausea, anxiety, or headaches. These side effects may subside once you adjust to the new medication.

Some types of antidepressant medications are not considered first-line treatments for perinatal depression, but your doctor might want you to try them if other medications have not helped.

Examples of other medications you might try include:

• Wellbutrin (bupropion): An antidepressant used to treat major depressive disorder (also known as clinical depression). Unlike SSRIs, which inhibit serotonin reuptake, it's believed that Wellbutrin influences the levels of the neurotransmitters norepinephrine and dopamine in the brain. Some studies have suggested bupropion use during pregnancy might be associated with miscarriage or heart defects.
• Tricyclic antidepressants: This class of antidepressants includes Pamelor (nortriptyline) and Norpramin (desipramine).

Severe Postpartum Depression

The Food and Drug Administration (FDA) has approved the medication Zulresso (brexanolone) to treat severe postpartum depression.

Zulresso is an antidepressant that belongs to a class of drugs known as a neuroactive steroid gamma-aminobutyric acid (GABA) receptor modulators. It is administered as a continuous intravenous (IV) infusion over a total of 60 hours.

This medication is only available through a restricted program called Zulresso REMS. Patients must be enrolled in the program before receiving Zulresso. The drug can only be administered by a healthcare provider in a certified inpatient healthcare facility.

Therapies

Different types of psychotherapy that are used to treat other forms of depression might also help someone with perinatal depression.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is used to treat a wide range of conditions, including depression and anxiety. The goal of CBT is to teach people different ways of thinking, behaving, and reacting to situations.

In addition to identifying negative thought patterns, CBT also gives people strategies to help them overcome their negative thoughts. These techniques include keeping a record of the thoughts, role playing, relaxation techniques, and mental distractions.

Interpersonal Therapy (IPT)

Interpersonal therapy (IPT) is an evidence-based therapy that has been used to treat depression, including perinatal depression. The focus of IPT is resolving a person's interpersonal problems by improving communication skills within relationships and developing social support networks. 

A 2011 study of treatments for perinatal depression found that IPT worked better than CBT in treating perinatal depression.

However, both CBT and IPT have been shown to be effective at significantly reducing symptoms of depression.

Brain Stimulation Therapies

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is the best-studied brain stimulation therapy and has the longest history of use.

It is most often used to treat severe, treatment-resistant depression, as well as other mental health disorders, including bipolar disorder and schizophrenia.

ECT is administered while a person is under general anesthesia and being given muscle relaxants. There are several stages to the process, including:

• Electrodes are placed at precise locations on the patient's head.
• An electric current is passed through the electrodes to the brain, which induces a seizure that generally lasts less than one minute. The seizure is not painful, and a person cannot feel the electrical impulses.

ECT is usually given about three times a week until a person's depression symptoms improve—which may take a few weeks.

There are some potential side effects of ECT, including:

• Headache
• Nausea
• Muscle aches
• Memory issues

Complementary and Alternative Medicine (CAM)

S-Adenosyl-methionine (SAMe) supplements

Proponents of SAMe (S-adenosyl-methionine or ademetionine) say that it can help with depression symptoms. It is sold in the United States as a dietary supplement.

SAMe is the synthetic form of a chemical that is naturally found in the body. Abnormal levels of SAMe have been reported in people with depression. The finding prompted researchers to investigate whether the supplement might be helpful in treating these conditions.

Some studies have shown that taking SAMe has some beneficial effects in the treatment of depression. However, according to the National Center for Complementary and Integrative Health (NCCIH), most of the trials were short—only lasting a couple of weeks—and were not of the highest scientific quality.

Also according to the NCCIH, studies on the long-term safety of SAMe and its safety for use during pregnancy have not been established.

Lifestyle

Experiencing depression during or after pregnancy can be very challenging. It's important to start treatment as soon as possible, but lifestyle changes also can help improve symptoms. Lifestyle changes include:

• Exercising regularly: Doing regular exercise can improve other symptoms you may experience during pregnancy, too. Talk to your doctor if you are not sure a particular activity is safe. 
• Getting enough sleep: Good sleep is especially important during pregnancy, and it is a key factor in managing symptoms of depression. Poor sleep quality has been associated with an increased risk of suicidal ideation (thinking about or planning suicide) in pregnant people.
• Eating a healthy diet: Your diet may change during your pregnancy as your body requires more calories and nutrients, but a nutritious diet can also help support your overall well-being.

A Word From Verywell

If you are experiencing symptoms of depression while you are pregnant, know that you are not alone. Talk to your doctor about how you are feeling. There are many ways to treat depression while you are pregnant and after you give birth.

It might take some time for you to start feeling better even after you start a treatment for perinatal depression. If the first treatment you try does not help, your doctor will help you find another that works for you.