Depression
Post-Partum Depression: What It Is and How It Is Treated
A new medication adds more treatment options.
Updated August 26, 2026
While childbirth is a peak experience of a woman’s life, serious mental illness can appear during the weeks and months after giving birth. And this is not infrequent: post-partum depression is estimated to occur in up to one in ten births.
Unfortunately, 50 percent of the women with postpartum depression never get screened and identified. Even less get effective and adequate treatment. And for those with the most severe form, who need a rapidly-acting effective treatment, there has not - until now - been anything available.
That has changed: A new medication, brexanolone (brand name Zulresso), has been approved for this condition.
What’s Normal After Childbirth
"Baby Blues." The ‘baby blues’ occur in up to 75 % of women during the first week or so after delivery. The mother may have a thought such as ‘no one called or came by this morning’ and break into sobs. Sometimes a thought isn’t even necessary: for no reason, she can identify, she simply bursts into tears. This may be due to the sudden and major shifts in hormones and other substances that take place after pregnancy ends. It lasts no longer than hours or a few days, is self-limiting, and requires no treatment.
Anxiety and momentary resentment. Feeling one’s mind is fuzzy, due to lack of sleep is also normal, as is occasional irritability. Some anxiety because of the 24-hour demand to keep this new young human alive is normal. So are occasional moments of resentment at the unceasing demands, even fleeting annoyance at the newborn mixed in with the predominant feelings of wonder and joy. Such moments. moods and thoughts are temporary.
Self-help techniques. These can be useful. Scientifically-sound recommendations are found in this post.
What’s Not Normal
Major Depressive Disorder with Post-Partum Onset. Depressed mood can be a mild sadness, lasting for only a few days at a time, that can be shaken off when in the presence of favorite people or favorite music, for example. But it is a Major Depressive Disorder (MDD) that begins in the weeks or months after delivery, or even during the pregnancy itself, that is of serious concern.
Because so many of the symptoms of MDD, such as lack of energy and trouble concentrating, overlap with what normally occurs after delivery, MDD may not be suspected. But when these symptoms coexist with a predominantly depressed mood that is present all day; when there is a loss of interest and a lack of pleasure; when the symptoms last for at least two weeks, that is not a normal consequence of childbirth. And it needs to be evaluated and treated.
Post-Partum Psychosis. This occurs much less frequently but is even more serious. Information about the differences between post-partum depression and post-partum psychosis can be found in this article.
Current Treatments
Treatment is necessary. Without treatment, depression can last for months or years. In addition to the personal suffering, the depression can interfere with the mother’s ability to connect and interact with her baby, which will negatively affect the child’s development.
Psychotherapy. Psychotherapy can be highly effective. Two particular kinds of psychotherapy have been shown through research studies to have good treatment results: CBT (cognitive behavioral therapy) and IPT (interpersonal therapy.
Anti-depressant Medication. Approximately 60% of women respond well to this kind of medication. It usually takes 3-4 weeks for the medication to be effective and improve mood—although slowness, decreased energy and another component of depression may improve more rapidly. For those not responding, switching to another antidepressant medication may bring relief.
Choosing between these two types of treatments: psychotherapy and medication, need not be an either/or choice. As with many other forms of depression, a combination of the two may be most effective.
Newer Treatment Options
Ketamine is being used in the treatment of major depressive disorder in general. It has a rapid onset of action compared to standard anti-depressants.
Zuranolone (commercial brand name Zurzuvae )
This medication is specifically for use in post-partum depression. Allopregnanolone is a steroid that is naturally produced by our brains. Allopregnanolone is formed in the brain when it modifies the natural hormone progesterone. Both women and men produce progesterone and allopregnanolone. Allopregnanolone works by modulating the effect of the brain's most important 'quieting' molecule: GABA, at GABA’s receptors on brain cells. Allopregnanolone levels fall sharply after delivery. Zuranolone is a synthetic analog of allopregnanolone. It is taken orally for two weeks, and has a rapid onset of action, often in days.
Breast-feeding: zuranolone does pass into breast milk. Its effects on children are not yet known. As with other antidepressants taken after childbirth, a discussion between doctor and patient can help clarify the risks and benefits and the decision about breastfeeding. (At this point, it may be safest safest not to feed breast milk to babies during the time of administration, and for some period afterward.)
The Cost. At present, the cost established by the company for a course of treatment is approximately $16,000. Fortunately, many commercial plans and some state's Medicaid programs have added coverage for it. This is the optimal situation where the cost of the treatment is deemed less than the cost to the mother, the baby, and the entire family when untreated severe post-partum depression is allowed to wreak its havoc.
