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Treating a Postpartum Depression

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.


Over all, antidepressants seem to be generally safe for use during breastfeeding [ref, ref]. This is most true for the TCAs and the SSRIs, for which more safety data are available [ref]. However, Citalopram and Fluoxetine should not be used as first-choice medications by breastfeeding mothers because of some reports suggesting that these two medications were associated with some adverse effects in the infants who were breastfed [ref]. Also, not much safety information is available for the novel antidepressants [ref].

Citalopram, Nortriptyline, Sertraline and Paroxetine will be undetectable or in very low blood concentrations in infants of mothers who are breastfeeding and taking these antidepressants [ref]. On the other hand, Fluoxetine may pass more readily into the mother's breast milk.

In general, treating a Postpartum Depression can follow the same approach as for treating a Major Depressive Episode [ref]. However, for mothers who wish to continue breastfeeding, only two medications - Sertraline and Paroxetine - should be included in Step 1b based on the above information. Also, many of the medications listed in Step 2 of these guidelines can be expected to pass into breast milk, and so should be used with caution in breastfeeding mothers. Some mothers may choose to stop breastfeeding while taking those medications.

Although this is true when treating all forms of Depression, special attention should be given to detecting any manic or psychotic symptoms after starting a women with Postpartum Depression on an antidepressant [ref]. This is because about half of all cases of Postpartum Depression are in fact due to an underlying Bipolar Disorder [ref].


During Pregnancy

Premenstrual Dysphoric Disorder (PMDD)