What treatments are available for postpartum depression, or depression after childbirth?

Postpartum depression is depression that occurs after childbirth. It typically occurs within three weeks after birth. A serious, treatable illness, it can include feelings of sadness, hopelessness, indifference or anxiety, and changes in energy, sleep, or appetite. Postpartum depression can be treated effectively in most women with psychotherapy, medication or a combination of the two. In severe postpartum depression, hospitalization may be necessary to protect the mother or baby. There is a need for prompt treatment of postpartum depression, since it can have negative effects on the mother and on infant development. Antidepressant medications can be effective. While medications enter the breast milk, most antidepressants can be used during breast-feeding with little risk for the baby. The FDA has approved brexanolone specifically for the treatment of postpartum depression. Brexanolone is a neurosteroid that acts as a modulator of the GABA-A receptor. It is administered by intravenous infusion over a 60-hour period under medical supervision. In three clinical trials, it was safe and effective for moderate or severe postpartum depression. Most research participants were not taking antidepressant medication. The medication was generally well tolerated. Side effects included sedation or loss of consciousness in a small percentage of patients. Average improvement was about 4 to 6 points greater on the Hamilton Depression rating scale, compared with placebo. Most responders maintained improvement for 30 days, the duration of the research. The main advantage of brexanolone is speed of response, within a few days. Response to antidepressant medication takes substantially longer. To use brexanolone, both the patient and clinician must enroll in the REMS program. This REMS has multiple requirements, including continuous monitoring, pulse oximetry, and fall precautions. Sage Therapeutics maintains a list of certified providers; you can call 844-472-4379 for more information.

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