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.
A correlation between postpartum thyroiditis and postpartum depression has been proposed but remains controversial. There may also be a link between postpartum depression and anti-thyroid antibodies. Psychosocial
Prenatal depression or anxiety
A personal or family history of depression
Moderate to severe premenstrual symptoms
Stressful life events experienced during pregnancy
Postpartum blues
Birth-related psychological trauma
Birth-related physical trauma
History of sexual abuse
Childhood trauma
Previous stillbirth or miscarriage
Formula-feeding rather than breast-feeding
Low self-esteem
Childcare or life stress
Low social support
Poor marital relationship or single marital status
Low socioeconomic status
A lack of strong emotional support from spouse, partner, family, or friends
Infant temperament problems/colic
Unplanned/unwanted pregnancy
Breastfeeding difficulties
Maternal age, family food insecurity and violence against womenThe psychosocial risk factors for postpartum depression include severe life events, some forms of chronic strain, relationship quality, and support from partner and mother. There is a need for more research in regard to the link between psychosocial risk factors and postpartum depression. Some psychosocial risk factors can be linked to the social determinants of health. Women with fewer resources indicate a higher level of postpartum depression and stress than those women with more resources, such as financial.Rates of PPD have been shown to decrease as income increases. Women with fewer resources may be more likely to have an unintended or unwanted pregnancy, increasing risk of PPD. Women with fewer resources may also include single mothers of low income. Single mothers of low income may have more limited access to resources while transitioning into motherhood. These women already have fewer spending options, and having a child may spread those options even further.