Postpartum depression is a fairly common condition that can affect patients in many ways. According to the Diagnostic and Statistical Manual (DSM-IV), postpartum depression is defined as two or more weeks of persistent depressed mood, loss of interest in daily activities plus four associated symptoms (appetite disturbance, sleep disturbance, psychomotor agitation or slowing, fatigue, feelings of worthlessness or inappropriate guilt, poor concentration, or suicidal ideation) that occurs within 4 weeks of child delivery.¹ It is different from "baby blues," which is a term used to describe brief crying spells, irritability, nervousness, poor sleep, and emotional reactivity that occurs within 1-2 days of delivery and subsides by 10 days following delivery.¹ "Baby blues" appears to affect between 75%¹ to 80%² of postpartum women. According to CDC Research, which used the Pregnancy Risk Assessment Monitoring System, it found that about 1 in 9 women in the US experience symptoms of postpartum depression. However, it found that this incidence rate varied according to age, race/ethnicity, and geography. In some states, the incidence of postpartum depression can be as high as 1 in 5 women.³

Risk factors for postpartum depression include a history of depression during or after a previous pregnancy, history of depression or bipolar disorder, family history of depression or other mental illness, stressful life event during pregnancy or shortly following pregnancy, childbirth complications (eg, premature delivery, complications with child), mixed feelings regarding pregnancy, lack of strong family/friend emotional support, or presence of alcohol or other substance abuse problem.²

Healthcare providers should also be aware that postpartum depression is not unique to only mothers; it may also occur in fathers. It is estimated that it occurs in 8-10% of fathers with the highest occurrence happening within 3-6 months postpartum but also occurring after a year postpartum. Risk factors may include a history of depression, marital problems, financial issues, accidental pregnancy, and sleep disturbance.⁴

There are various treatment options for postpartum depression. This may include talk therapy, which involves talking to a mental healthcare professional (eg, a counselor, therapist, psychologist, psychiatrist, or social worker).³ Two types of counseling that may be performed during talk therapy are cognitive behavioral therapy which helps people to identify and change negative thoughts and behavior and interpersonal therapy which is used to help individuals recognize and fix difficult personal relationships.²

Multiple drug therapies may be used to treat postpartum depression. Antidepressants such as fluoxetine, sertraline, nortriptyline, and venlafaxine have been shown to be effective in treating postpartum depression.¹ Another drug treatment option is a new therapy that was approved by the FDA in March 2019 called Zulresso (brexanolone). This is a neuroactive steroid gamma-aminobutyric acid receptor-positive modulator that is chemically identical to endogenous allopregnanolone.⁵ This is the first drug therapy that has been specifically approved for postpartum depression. Zulresso is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS), called Zulresso REMS, because it contains a boxed warning regarding risk of excessive sedation or sudden loss of consciousness during administration. It is a medication that is required to be administered via IV infusion over 60 hours by a healthcare professional in a healthcare facility.⁶ Outside of pharmacotherapy, electroconvulsive therapy is also an option that has been used to treat severe cases of postpartum depression.⁷

Although postpartum depression is a very serious issue, it is treatable, and healthcare professionals should be aware of the signs and symptoms and treatment options available.

References
1. Sit DK, Wisner KL. The Identification of Postpartum Depression. Clin Obstet Gynecol. 2009;52(3):456–468. doi:10.1097/GRF.0b013e3181b5a57c 2. National Institute of Mental Health website. Postpartum Depression Facts. https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml. Accessed March 9, 2020. 3. Centers for Disease Control and Prevention website. Depression Among Women. https://www.cdc.gov/reproductivehealth/depression/#Postpartum. Updated December 5, 2019. Accessed March 9, 2020. 4. Scarff JR. Postpartum Depression in Men. Innov Clin Neurosci. 2019;16(5-6):11–14. 5. U.S. National Library of Medicine website. Label: Zulresso - brexanolone injection, solution. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b40f3b2a-1859-4ed6-8551-444300806d13. Updated November 18, 2019. Accessed March 9, 2020. 6. U.S. Food and Drug Administration website. FDA approves first treatment for post-partum depression. https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression. Updated March 19, 2019. Accessed March 9, 2020. 7. Office on Women’s Health website. Postpartum depression. https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression. Updated May 14, 2019. Accessed March 9, 2020.