Postpartum depression is a depressive episode beginning in pregnancy or within a year of birth, affecting about one in eight mothers. It is treated with psychotherapy, antidepressants compatible with breastfeeding such as sertraline, and, for moderate to severe cases, zuranolone, the first oral medication FDA-approved specifically for postpartum depression. Most mothers improve within weeks of starting treatment.
Stedfast Psychiatry treats perinatal mood disorders with care that accounts for pregnancy and breastfeeding at every step. Our women's mental health providers choose medications with the best safety data, coordinate with obstetricians and pediatricians, and offer telehealth so that a new mother does not have to arrange childcare and a drive to get help.
Symptoms of postpartum depression
- Persistent sadness, emptiness or crying lasting beyond two weeks after birth
- Feeling unable to bond with or enjoy your baby
- Intense anxiety, panic or constant worry about the baby's health
- Intrusive thoughts of harm coming to the baby that feel horrifying
- Inability to sleep even when the baby sleeps
- Loss of appetite or eating much more than usual
- Feeling like a failure as a mother or that your family would be better off without you
- Irritability, anger or withdrawal from your partner and friends
- Difficulty concentrating or making simple decisions
- Thoughts of harming yourself
Causes and risk factors
The sharp fall in estrogen and progesterone after delivery, combined with sleep deprivation, physical recovery, pain and the demands of a newborn, creates a window of vulnerability. Women with a history of depression, anxiety or bipolar disorder, prior postpartum depression, premenstrual dysphoric disorder, or a family history of mood disorders are at higher risk. Lack of support, relationship stress, financial strain, a difficult or traumatic birth, a baby in the NICU, breastfeeding difficulties and an unplanned pregnancy all add to it. Changes in the GABA-modulating neurosteroid allopregnanolone after birth are one mechanism, which is why brexanolone and zuranolone, which act on that system, were developed. Thyroid dysfunction after delivery is common and can mimic depression.
About one in eight women who give birth in the US report symptoms of postpartum depression.
Source: CDC, Pregnancy Risk Assessment Monitoring System
Perinatal depression affects up to 1 in 7 women during pregnancy or the first year after birth, and fewer than half are diagnosed.
Source: American College of Obstetricians and Gynecologists
Zuranolone was FDA-approved in August 2023 as the first oral treatment specifically for postpartum depression, taken once daily for 14 days.
Source: US Food and Drug Administration
Mental health conditions, including suicide and overdose, are the leading underlying cause of pregnancy-related deaths in the US.
Source: CDC Maternal Mortality Review Committees, 2017 to 2019 data
How we diagnose it at Stedfast Psychiatry
We evaluate perinatal mood disorders with a clinical interview and the Edinburgh Postnatal Depression Scale (EPDS), the standard screening tool, along with the GAD-7 and a review of obsessive thoughts, panic, trauma symptoms and sleep. We ask carefully about any history of bipolar disorder or hypomania, because the postpartum period is a high-risk time for a first manic episode and antidepressants alone can trigger one. We screen for postpartum psychosis (confusion, hallucinations, paranoia, rapid mood shifts), which requires emergency care. We check thyroid function (TSH), a complete blood count for anemia, and vitamin D and B12 when indicated. We ask about breastfeeding, your baby's health and your support at home, and with your permission we coordinate with your OB-GYN and your baby's pediatrician.
Treatment options
Medication management
SSRIs are first-line and most are compatible with breastfeeding. Sertraline has the most safety data and passes into breast milk in very low amounts; escitalopram, citalopram and paroxetine are also used, and if you took a medication successfully before pregnancy we usually prefer to resume it. Improvement begins in two to four weeks with full benefit at six to eight weeks, and treatment continues for at least six to twelve months. Zuranolone (Zurzuvae), FDA-approved in 2023, is the first oral medication specifically for postpartum depression: a 14-day course that produces improvement within days in clinical trials, with the trade-off that it causes drowsiness and you cannot drive for 12 hours after each dose. Brexanolone (Zulresso), a 60-hour IV infusion, is also FDA-approved for postpartum depression and given in a hospital setting. For postpartum anxiety and OCD, SSRIs at adequate doses work well. We monitor for sedation, feeding changes in the baby, and emerging hypomania.
Psychotherapy
Cognitive behavioral therapy and interpersonal therapy are both effective for postpartum depression and are a complete treatment for mild to moderate episodes. Interpersonal therapy addresses the role transition, relationship changes and isolation of new parenthood directly. For postpartum OCD, exposure and response prevention helps mothers stop avoiding their baby out of fear of intrusive thoughts. For birth trauma, trauma-focused therapy is used. Partners are welcome in sessions, and we connect families with postpartum support groups through Postpartum Support International.
Interventional options
For postpartum depression that has not responded to two or more antidepressants, Deep TMS is an option. Deep TMS is FDA-cleared for major depressive disorder and anxious depression, involves no medication, and is compatible with breastfeeding; a course is 36 sessions over six to nine weeks at our Palm Beach Gardens office. Spravato (esketamine) is FDA-approved for treatment-resistant depression and for MDD with suicidal ideation in adults 18 and older; it has not been studied in breastfeeding and is generally avoided in women who are nursing, but it may be considered for severe, treatment-resistant postpartum depression when breastfeeding has ended or the risks are weighed carefully. Severe postpartum depression with psychosis or inability to care for oneself may require hospital treatment, and we coordinate that when needed.
What to expect
Your first visit is a 60-minute evaluation that can be done by video from home, with your baby present if that is easiest. We take a full history, complete the EPDS, discuss medication safety for pregnancy or breastfeeding in detail, and agree on a plan that day. Follow-ups are at one to two weeks early on because the postpartum period moves quickly, then every two to four weeks. We offer in-person and telehealth care throughout Florida and South Carolina and coordinate with your OB-GYN and pediatrician with your consent.
When to seek help
Seek help if low mood, anxiety or intrusive thoughts have lasted more than two weeks after birth, if you cannot sleep when the baby sleeps, if you feel disconnected from your baby, or if you had depression in a prior pregnancy and feel it returning. Do not wait for your six-week visit. If you have thoughts of harming yourself or your baby, call or text 988 or go to the nearest emergency room. Confusion, hearing voices, extreme agitation or beliefs that seem strange to others in the weeks after birth can be postpartum psychosis, which is an emergency: call 911 or go to the ER immediately.
The range of perinatal mood and anxiety disorders
Postpartum depression is the best known, but perinatal anxiety is at least as common. Postpartum generalized anxiety involves constant worry about the baby's breathing, feeding and safety that prevents rest. Postpartum panic disorder brings sudden attacks of fear. Postpartum OCD involves intrusive thoughts of harm with checking and avoidance. Postpartum PTSD follows a frightening delivery, emergency cesarean, hemorrhage or NICU stay. Bipolar disorder frequently first appears or relapses after childbirth, and the postpartum period carries the highest risk of a manic episode of any time in a woman's life. Postpartum psychosis affects one to two in 1,000 births, usually within the first two weeks, and is treated in hospital. Each of these responds to treatment, and each is missed when screening stops at depression.
Fathers and partners
About one in ten fathers experiences depression in the first year after a child's birth, with the highest rates at three to six months. It often shows up as irritability, withdrawal, working longer hours or drinking more rather than sadness. A partner's depression raises the risk for the mother and affects the child. We evaluate and treat partners and welcome them in the mother's treatment when she wishes.
Planning before and during pregnancy
Women with a history of depression, anxiety or bipolar disorder benefit from a preconception or early pregnancy consultation. Stopping a stable antidepressant at the start of pregnancy roughly doubles the risk of relapse, and relapse during pregnancy is itself a risk to the baby. We review each medication's data, adjust where needed (for example, moving away from valproate, which causes birth defects), and build a postpartum plan that includes protected sleep, a support schedule and a low threshold for restarting or increasing medication. Lithium, lamotrigine and several antipsychotics can be managed through pregnancy with monitoring.
Sleep, support and recovery
Sleep deprivation is both a cause and a symptom of postpartum depression, and protecting one four to five hour block of sleep per night, with a partner or family member handling feedings or a pumped bottle, is a treatment in its own right. Accepting practical help, keeping some contact with other adults, brief daily walks outdoors and lowering the standard for everything that is not essential all support recovery. Postpartum Support International runs free peer groups and a helpline. Breastfeeding difficulties are a common trigger, and it is legitimate to weigh your mental health in feeding decisions.
Prognosis
Postpartum depression responds well to treatment, and most mothers recover fully. Untreated, episodes can last a year or more and affect bonding, the partner relationship and the child's early development. Women who have had one episode have about a 30 to 50 percent chance of recurrence after a subsequent birth, which is why we plan for it. With early recognition and treatment, the postpartum year can still be what it was meant to be.
Frequently asked questions
How do I know if it is baby blues or postpartum depression?
Baby blues affect up to 80 percent of new mothers, start within days of birth, involve crying spells and mood swings, and resolve by two weeks without treatment. Postpartum depression lasts beyond two weeks, deepens rather than lifts, and includes hopelessness, inability to sleep when the baby sleeps, loss of interest in the baby or in anything, and sometimes thoughts of self-harm. If you are past two weeks and not improving, or if you feel worse, it is time for an evaluation.
Can I take antidepressants while breastfeeding?
Yes, in most cases. Sertraline is the best-studied and passes into breast milk in very small amounts with no established harm to infants. Escitalopram, citalopram and paroxetine are also considered compatible. We choose based on your history and the data, discuss it openly, and can coordinate with your pediatrician. Untreated postpartum depression carries its own risks for the baby's development, which is part of the balance.
What is zuranolone and how is it different from other antidepressants?
Zuranolone (Zurzuvae) is a once-daily oral capsule FDA-approved in 2023 specifically for postpartum depression. It acts on the GABA system through the same pathway as the neurosteroid allopregnanolone, which drops sharply after delivery. In trials, symptoms improved within three days and the benefit lasted beyond the 14-day course. It causes drowsiness, you cannot drive for 12 hours after a dose, and data on breastfeeding are limited, so it is best for moderate to severe depression where fast relief matters.
I have terrifying thoughts of something happening to my baby. Am I dangerous?
Almost certainly not. Intrusive, unwanted thoughts of harm coming to the baby, including images of dropping or hurting them, affect up to half of new mothers and are a hallmark of postpartum anxiety and OCD. They are horrifying precisely because they are the opposite of what you want, and mothers with these thoughts do not act on them. They respond well to SSRIs and therapy. Postpartum psychosis is different: it involves confusion, hallucinations or beliefs that feel real, and it is an emergency.
Can I be treated by telehealth?
Yes. Video visits are often the best option in the postpartum months because you can be seen from home with your baby, without arranging childcare or a drive. Evaluation, antidepressant management and therapy all work by telehealth, and we serve patients across Florida and South Carolina. In-person visits are available at all 13 offices when you prefer them.
Does insurance cover postpartum depression treatment?
Yes. We accept most major insurance plans and Medicare, and Medicaid acceptance varies by location, so call to confirm for your office. Visits are billed as specialist mental health visits, and our self-pay rate for a new evaluation is $185. SSRIs are inexpensive generics. Zuranolone is brand-name and usually requires prior authorization, which our staff handles, and the manufacturer offers a copay assistance program for eligible commercially insured patients.
Can I be treated for depression during pregnancy?
Yes, and you should be. Untreated depression during pregnancy is linked to poor prenatal care, preterm birth and postpartum depression. Psychotherapy is first-line for mild to moderate symptoms, and for moderate to severe depression SSRIs such as sertraline have decades of safety data in pregnancy. We review the evidence with you, coordinate with your OB-GYN, and plan for the postpartum period in advance.
How long does postpartum depression treatment last?
Most mothers feel significantly better within four to eight weeks of starting an SSRI or therapy, and within days with zuranolone. Antidepressants are continued for at least six to twelve months after recovery to prevent relapse. Women with a history of recurrent depression or bipolar disorder may need longer treatment. Therapy typically runs 12 to 16 sessions. We also plan ahead for future pregnancies, when the risk of recurrence is high.
Where to get treatment for postpartum depression and perinatal mood disorders
Evaluation and treatment for postpartum depression and perinatal mood disorders is available at every Stedfast Psychiatry office and by video across Florida and South Carolina.
Related conditions
If you are thinking about harming yourself, call or text 988 now, or go to the nearest emergency room. This page is educational and does not replace an evaluation. Clinical content reviewed by Dr. David Husted, board-certified psychiatrist.