With the release of the new FDA-approved medication, Brexanolone, which is indicated for the treatment of postpartum depression, treatments for perinatal mood and anxiety disorders are in the spotlight. While many voices in the medical community are excited about what this could mean for the future of postpartum depression treatment, the drug has been met with some hesitancy.
“I’m optimistic that it will show promise for more women,” says Dr. Kecia Gaither, a board-certified physician in obstetrics & gynecology, and maternal fetal medicine. “I think perhaps a breakthrough has been made, I do think that there needs to be more time and research done on lasting effects.”
Since Brexanolone is an option for a very specific set of women, new mothers who have been diagnosed with severe postpartum depression, it isn’t right for all moms. Perinatal mood and anxiety disorders (PMADs) present in varying severity with a unique set of symptoms from mom-to-mom. Although antidepressants are an option for many moms, postpartum depression can be treated without pharmaceuticals. Here’s when and how.
It’s easy to assume that antidepressants are the first step for struggling moms, but that actually isn’t typically the case. Dr. Carly Snyder, a reproductive and perinatal psychiatrist in New York, says medications are only the first line of treatment for those experiencing moderate to severe depression. For mild to moderate cases, however, psychotherapy is the first step.
“For the vast majority of women who have postpartum depression, the mainstay of treatment, for mild to moderate depression, is psychotherapy,” she tells Romper. “For moderate to severe [depression], there are benefits from adding medication.”
Whether medication is a part of managing postpartum symptoms or not, it isn’t really intended to be the sole means of treatment. Snyder believes that therapy is for everyone, but is especially appropriate for those struggling with perinatal mood disorders.
I still have good days and bad days and I still go to therapy, my son is now 9 months old.
For 32-year-old mom of two Gabrielle Morris, it was EDMR Therapy, a form of therapy that helps your brain process distress and symptoms caused by life experiences, not medication, that provided her with relief from her depression and anxiety after the birth of her second child.
“Slowly, we worked through my trauma and the anxiety with small increasing steps towards my overall wellness,” she explains. “ I noticed I was able to cope better with daily activity and inconvenience. As the anxiety waned so did the depression with it. I still have good days and bad days and I still go to therapy, my son is now 9 months old.”
Outside of treatment options like talk therapy or EDMR therapy, postpartum depression treatment should also begin with addressing the mother’s basic needs. From the outside, pushing for adequate sleep and nutrition might seem common sense, but when you’re a new mom dealing with depression, they’re anything but.
Becoming a mother, whether for the first or fourth time, is an all-consuming task. For most moms, their newborn’s needs take top priority, even if it means sacrificing basic self-care. Add to that equation anxiety and depression, and meeting your own needs might begin to feel impossible.
“The act of taking care of yourself becomes that much more difficult, that much more of a strenuous process,” Snyder says. “The act of going outside and taking a walk becomes like climbing a mountain.”
But it must be a priority. In 2018, research published in the Journal of Behavioral Medicine linked sleep deprivation with worsened symptoms of postpartum depression and anxiety. Although researchers don't make the jump to claiming poor sleep quality is the root cause of postpartum mood disorders, they are certainly convinced it makes managing symptoms much worse.
For this reason, one of Snyder’s favorite approaches to treating postpartum depression is addressing it before it becomes a problem by creating a plan for maternal care before the baby arrives.
We know that sleep is imperative to mental health. We know the new mother needs to eat well to support her healing and mental health. Why do we wait until there’s a problem to prioritize these basic needs? A plan for maternal self-care should be clearly outlined during pregnancy with the mother's partner, family, and friends — involving anyone who will be mom’s support system after the baby arrives.
“Once baby comes, it becomes much more difficult to now sit down and say, ‘OK, I’m going to do this feeding, you’re going to do that feeding,’” she says. “If you plan in advance... It takes the imperative off of mom to be reaching out. It’s already a done deal.”
Exercise is not only safe for most women who are pregnant or in their postpartum phase, but is also an incredibly effective way to improve the symptoms of depression.
Add exercise to that list of basic needs mom needs to be met to treat her postpartum depression. When we began reaching out to moms for stories about managing their anxiety and depression, regular exercise was one thing we heard time and time again.
Jordan Carlson, a 29-year-old living in Hutchinson, Kansas, shares how much discouragement and anxiety she felt after the birth of her fourth child. Her approach to treating her depression and anxiety was multifaceted, including adding supplements, changing her diet, and being vigilant about her sleep routines. Along with all of this, she made a daily walk a big priority, noting how much movement helped to improve her mood.
One research review, published in Birth Issue in Perinatal Care, looked at multiple studies on how exercise can affect perinatal mood disorders, concluding that exercise is not only safe for most women who are pregnant or in their postpartum phase, but is also an incredibly effective way to improve the symptoms of depression. Regular exercise was found to decrease symptoms of anxiety and depression.
Another common approach to treating postpartum depression without pharmaceuticals is with supplements. While there is much debate about the use of essential oils and herbal remedies, there are a few dietary supplements that have been found to have a positive effect on postpartum symptoms. In one study published in The American Journal of Clinical Nutrition, low Omega-3 levels in pregnancy were associated with an increased risk of developing postpartum depression, suggesting supplementation may improve outcomes. Another study, published in 2014, reported that low vitamin D levels were associated with increased risk of postpartum depression.
Other moms are quick to point out that finding something that was just for them was an important part of managing their perinatal mood and anxiety disorder symptoms. One mom began to garden. Another went back to school. A mom of three tells Romper she and her husband scheduled a recurring babysitter from 8 a.m. to 1 p.m. every Wednesday so she could get some alone to go the gym or do something she enjoyed, alone.
No matter the course of treatment, postpartum depression is best managed with the help of a trained professional. There are a lot of concerns about conventional treatment, with worries about medication or being stigmatized because of mental health struggles. However, it is only with a thorough evaluation that a mother can determine exactly what she needs to feel well again, for herself and for her children.
“It’s not a one-shot answer for everybody. Everybody has different issues,” says Gaither, so no matter your case, it's never about finding a single magic pill.
Editor's note: A previous version of this article incorrectly identified Dr. Carly Snyder's specialty. It has been updated.
If you or someone you know is experiencing depression or anxiety during pregnancy, or in the postpartum period, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.