Physicians typically recommend the following treatments for postpartum depression (PPD):

• Antidepressant medications. These medications are often indicated for the management of PPD. There are a number of different antidepressants available, including selective serotonin reuptake inhibitors (SSRIs), which regulate the levels of serotonin (a chemical linked to mood) in the brain and serotonin-norepinephrine reuptake inhibitors (SNRIs), which regulate level of both serotonin and another chemical called norepinephrine in the brain. People with depression often have low levels of serotonin and norepinephrine. It is safe for women who are breastfeeding to take certain types of SSRIs or SNRIs. Although antidepressants are excreted in breast milk, research has shown that certain types pose little risk to babies. However, no long-term studies of infants exposed to SSRIs or SNRIs have been conducted.
  
  Antidepressants are a complex class of medications. A physician may need to adjust the dosage or completely change the prescription to find a medication that provides optimal results with minimal side effects. In addition, certain patients cannot take antidepressants. The Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in patients under age 25 and all people being treated with them should be monitored closely for unusual changes in behavior. Treatment might continue for up to a year after symptoms abate.
• Psychotherapy. Psychotherapy is often the first treatment for PPD and may be the only therapy available to women who refuse antidepressants. During psychotherapy, patients are encouraged to discuss their condition and any related issues with a mental health professional such as a psychiatrist. The length of time patients with PPD receive psychotherapy varies, but typically ranges from 6 to 12 one-hour sessions. Sometimes, the new mother may be given “homework” assignments between sessions. There are several different types of psychotherapy:
  
  
• • Cognitive behavioral therapy (CBT). Combines cognitive therapy, which focuses on thoughts, assumptions and beliefs, and behavioral therapy, which teaches people to learn how to change their behaviors. This can help patients modify thoughts and behaviors that contribute to depression.
  • Interpersonal psychotherapy (IPT). A short-term therapy aimed at addressing interpersonal issues. This can help patients whose depression is linked to problems with relationships and other interpersonal issues.
  • Group therapy. A type of therapy in which patients meet with a therapist in a group setting. During the session, patients typically decide the topics of discussion. This is particularly effective with patients who are feeling socially isolated.
  • Family and marital therapy. A type of therapy in which the patient attends counseling sessions with a partner or other family member. Women with PPD recover more quickly with the support of a partner or other family member.

Women experiencing PPD also may benefit from joining a support group to help cope with their depression. There are various support groups formed by patients that offer support and education to women with PPD or other conditions. Meetings are held to discuss PPD issues and educational information is available through these groups. A woman’s physician may refer her to a support group for postpartum depression.

In many cases, patients benefit from a combination of antidepressants and psychotherapy.

Massage therapy and relaxation training for the mother and infant may help to improve the mood of a new mother with PPD, and may also improve mother-infant interaction and infant health. However, these therapies tend to be more effective when combined with psychotherapy or other treatments.

If impaired thyroid gland function is detected, medications are administered. In such cases, depression often improves without the need for psychotherapy or antidepressants.

Patients with postpartum psychosis (PPP) may require hospitalization and treatment with antipsychotic medications (used to treat psychotic disorders, such as schizophrenia), antidepressant medications or lithium carbonate (medication used to treat bipolar disorder, which is characterized by mood swings between mania and depression).

Women with PPD that does not respond to medication and/or psychotherapy may also receive electroconvulsive therapy (ECT) in which a small amount of electrical current is delivered to the brain through electrodes. The electrical current results in a 30- to 60-second seizure that alters brain functioning. When administered on a regular basis, ECT can reduce symptoms. Although often reserved for severe cases, ECT may be a safe option for breastfeeding mothers because there are no effects on the infant. Women suspected of having PPD or PPP should receive immediate medical attention.

Antidepressants or psychotherapy may be started in the first couple of days after delivery as preventive measures. This issue must be discussed with a physician, preferably an obstetrician-gynecologist (ObGyn).