Psychopharmacologic Approach to Postpartum Depression

Postpartum depression (PPD), the most common of the serious postpartum psychiatric disorders, may occur in 10% of mothers. The duration is unknown, but some investigators suggest that PPD lasts 6-8 weeks. Efforts to identify a specific neuroendocrine or neurotransmitter system have been unsuccessful. There are insufficient data to relate PPD to the changes in hormonal status occurring after childbirth, although there is some evidence suggesting an increased incidence of PPD in women with marital conflict and in mothers who developed baby blues. The psychopharmacologic approach to patients with PPD is not based on research but on theoretic concepts. PPD is treated the same as depression occurring outside the postpartum period. Therefore, drug therapy should be aimed at patient-specific target symptoms of depression. Judicious use of psychopharmacologic agents should be employed in mothers who breastfeed, since both short-term and long-term effects of antidepressants on the infant are not fully understood.