Medications

Reviewed by: HU Medical Review Board | Last reviewed: October 2023

Postpartum depression (PPD) is a common yet serious mental health condition. It causes intense sadness, hopelessness, and anxiety for many parents. Fortunately, there are medicines that can help lessen the symptoms of PPD and provide much-needed relief.1

But medicine is just 1 part of a comprehensive treatment plan for PPD. Therapy, support from loved ones, and self-care are also necessary for healing. If you or someone you know is struggling with postpartum depression, please seek professional help. With the right support, PPD can be successfully treated.1

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a class of antidepressant drugs. They work by increasing the levels of serotonin in the brain. Serotonin is a type of chemical messenger (neurotransmitter) that helps to regulate mood.1,2

Examples of SSRIs that are commonly used to treat PPD include:2

  • Citalopram (Celexa®)
  • Escitalopram (Lexapro®)
  • Fluoxetine (Prozac®)
  • Paroxetine (Paxil®, Pexeva®)
  • Sertraline (Zoloft®)

These medicines are generally considered safe for breast/chestfeeding mothers. But before starting any new medicine, work with your doctor to find the drug and dosage that are appropriate for you.1,2

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Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs are another class of antidepressants used to treat PPD. They work by increasing the levels of the neurotransmitters serotonin and norepinephrine in the brain. SNRIs can be a good option for mothers who do not respond well to or have negative side effects from SSRIs.3

Examples of SNRIs commonly used to treat PPD include:3

  • Desvenlafaxine (Khedezla®, Pristiq®)
  • Duloxetine (Cymbalta®, Drizalma®, Irenka®)
  • Levomilnacipran (Fetzima®)
  • Milnacipran (Savella®)
  • Venlafaxine (Effexor®)

Your healthcare provider will help you assess the risks and benefits of SNRI treatment while breast/chestfeeding.1,3

Bupropion

Bupropion is in a drug class called atypical antidepressants. Bupropion works by affecting the levels of the neurotransmitters dopamine and norepinephrine in the brain. It is sometimes used to treat PPD when other medicines have not worked.1,4,5

Examples of bupropion brand names include:4,5

  • Aplenzin®
  • Forfivo XL®
  • Wellbutrin SR®
  • Wellbutrin XL®
  • Zyban®

Bupropion is a reasonable choice for breast/chestfeeding mothers, as only minimal amounts are passed through breast milk. But each person’s case may be different. Always discuss your treatment plan with a healthcare provider.4,5

Tricyclic antidepressants (TCAs)

TCAs are older antidepressants. They are used to treat PPD usually only when other options have not been effective. These medicines affect multiple neurotransmitters in the brain, including serotonin and norepinephrine.6,7

Examples of TCAs include:6,7

  • Amitriptyline (Elavil®)
  • Nortriptyline (Pamelor®)
  • Imipramine (Tofranil®)

TCAs are generally considered safe for breast/chestfeeding. But they can cause potential side effects and interactions. Your doctor will assess the risks and benefits before prescribing TCAs for PPD.6,7

Neuroactive steroid GABA(A) receptor-positive modulators

Neuroactive steroid GABA(A) receptor-positive modulators are newer treatments for PPD. These medicines target the brain's GABA(A) receptors, which help regulate mood.8

As of 2023, 2 of these drugs have been approved by the US Food and Drug Administration (FDA) to treat PPD:9,10

  • Brexanolone (Zulresso®)
  • Zuranolone (Zurzuvae®)

Brexanolone is given intravenously (with an IV) over a 60-hour period under medical supervision. Zuranolone, on the other hand, comes in a pill form. It does not need to be taken under medical supervision.9-11

Other things to know

All drugs have potential side effects. Side effects can vary depending on the specific drug you are taking.

All SSRIs, SNRIs, TCAs, and bupropion have a boxed warning, the strictest warning from the FDA. They have this warning because these drugs may increase the risk of suicidal thoughts and suicide, especially in people under age 25. Neuroactive steroids also have a boxed warning for their extreme drowsiness (sedation) side effects.2-6,11

Discuss the potential benefits and risks with your healthcare provider before starting any treatment for PPD. They can help determine what kind of medicine is right for you.

Before beginning treatment for postpartum depression, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.