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Postpartum Depression: A Clinical Review of Impact and Current Treatment Solutions

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Abstract

Depression during the first year postpartum (postpartum depression) impacts millions of women and their families worldwide. In this narrative review, we provide a summary of postpartum depression, examining the etiology and consequences, pharmacological and psychological treatments, and potential mechanisms of change and current barriers to care. Psychological treatments are effective and preferred by many perinatal patients over medications, but they often remain inaccessible. Key potential mechanisms underlying their effectiveness include treatment variables (e.g., dosage and therapeutic alliance) and patient behaviors (e.g., activation and avoidance and emotional regulation). Among pharmacological treatments, the selective serotonin reuptake inhibitor (SSRI) sertraline is generally the first-line antidepressant medication recommended to women in the postpartum period due to its minimal passage into breastmilk and the corresponding decades of safety data. Importantly, most antidepressant drugs are considered compatible with breastfeeding. Neurosteroids are emerging as an effective treatment for postpartum depression, although currently this treatment is not widely available. Barriers to widespread access to treatment include those that are systematic (e.g., lack of specialist providers), provider-driven (e.g., lack of flexibility in treatment delivery), and patient-driven (e.g., stigma and lack of time for treatment engagement). We propose virtual care, task-sharing to non-specialist treatment providers, and collaborative care models as potential solutions to enhance the reach and scalability of effective treatments to address the growing burden of postpartum depression worldwide and its negative impact on families and society.

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Authors and Affiliations

  1. Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada

    Cindy-Lee Dennis, Daisy R. Singla & Katarina Savel

  2. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Rm 280, Toronto, ON, M6J 1H4, Canada

    Cindy-Lee Dennis

  3. Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada

    Cindy-Lee Dennis, Daisy R. Singla, Crystal T. Clark, Sophie Grigoriadis & Simone N. Vigod

  4. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada

    Daisy R. Singla

  5. Department of Health and Society, University of Toronto, Toronto, Canada

    Hilary K. Brown

  6. Women’s College Hospital, Toronto, Canada

    Hilary K. Brown, Crystal T. Clark & Simone N. Vigod

  7. Women’s College Research Institute, Toronto, Canada

    Hilary K. Brown, Crystal T. Clark & Simone N. Vigod

  8. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada

    Sophie Grigoriadis

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  4. Katarina Savel
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  7. Simone N. Vigod
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Correspondence to Cindy-Lee Dennis.

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Dr. Vigod receives royalties from UpToDate Inc. for authorship of materials related to depression and pregnancy. Dr. Clark receives consulting fees for Seven Starling as a Mental Health Consultant. Sophie Grigoriadis has received royalties from UpToDate, Compendium of Pharmaceuticals, and IPT to Go outside the submitted work over the last year. The other authors have no disclosures.

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CLD, DRS and SNV drafted the initial version of this manuscript with significant contributions from KS, HKB, CTC, and SG. All authors have critically reviewed this manuscript, have provided consent for publication, and agree to be accountable for the work.

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Dennis, CL., Singla, D.R., Brown, H.K. et al. Postpartum Depression: A Clinical Review of Impact and Current Treatment Solutions. Drugs 84, 645–659 (2024). https://doi.org/10.1007/s40265-024-02038-z

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