"Across different cultures, traditional rituals for postpartum care may be preventative for PPD, but are more effective when the support is welcomed by the mother.In couples, emotional closeness and global support by the partner protect against both perinatal depression and anxiety. In 2014, Alasoom and Koura found that compared to 42.9 percent of women who did not get spousal support, only 14.7 percent of women who got spousal assistance had PPD. Further factors such as communication between the couple and relationship satisfaction have a protective effect against anxiety alone.In those who are at risk counselling is recommended. In 2018, 24% of areas in the UK have no access to perinatal mental health specialist services.Preventative treatment with antidepressants may be considered for those who have had PPD previously. However, as of 2017, the evidence supporting such use is weak. Treatments
Treatment for mild to moderate PPD includes psychological interventions or antidepressants. Women with moderate to severe PPD would likely experience a greater benefit with a combination of psychological and medical interventions. Light aerobic exercise has been found to be useful for mild and moderate cases. Therapy
Both individual social and psychological interventions appear equally effective in the treatment of PPD. Social interventions include individual counseling and peer support, while psychological interventions include cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Interpersonal therapy (IPT) has shown to be effective in focusing specifically on the mother and infant bond.
Therefore, it is not completely clear which antidepressants, if any, are most effective for treatment of PPD, and for whom antidepressants would be a better option than non-pharmacotherapy.Some studies show that hormone therapy may be effective in women with PPD, supported by the idea that the drop in estrogen and progesterone levels post-delivery contribute to depressive symptoms. However, there is some controversy with this form of treatment because estrogen should not be given to people who are at higher risk of blood clots, which include women up to 12 weeks after delivery. Additionally, none of the existing studies included women who were breastfeeding. However, there is some evidence that the use of estradiol patches might help with PPD symptoms.Oxytocin has been shown to be an effective anxiolytic and in some cases antidepressant treatment in men and women. Exogenous oxytocin has only been explored as a PPD treatment with rodents, but results are encouraging for potential application in humans.In 2019, the FDA approved brexanolone, a synthetic analog of the neurosteroid allopregnanolone, for use intravenously in postpartum depression. Allopregnanolone levels drop after giving birth, which may lead to women becoming depressed and anxious. Some trials have demonstrated an effect on PPD within 48 hours from the start of infusion. Other new allopregnanolone analogs under evaluation for use in the treatment of PPD include zuranolone and ganaxolone.Brexanolone has risks that can occur during administration, including excessive sedation and sudden loss of consciousness, and therefore has been approved under the Risk Evaluation and Mitigation Strategy (REMS) program.