Postpartum Depression Treatment Is Here — But What About Prevention?

Finally, postpartum depression treatment is gaining attention, largely thanks to the recently developed and FDA-approved medication zuranolone1. This pill has shown promise in easing depressive symptoms in new moms noticeably quicker than traditional antidepressants. 

This advancement comes during a trying time—postpartum depression has increased from 10.3% in 2014 to 16% in 2018, to 23.9% in 20202. The new medication is a desperately needed immediate intervention, given that suicide is a leading cause of death in the perinatal period3 (including pregnancy and one year postpartum). 

Still, a critical part of the postpartum depression conversation needs to be amplified: prevention. 

It's no secret that the United States falls behind many other countries when it comes to maternity leave. We offer 12 weeks of unpaid, job-protected leave, while Bulgaria, for example, provides 410 days, beginning 45 days before the due date. 

Now plenty of countries fall in between these two extremes, and there are certainly many factors contributing to the requirements and also plenty of variability within companies creating their own maternity leave protocols. Nevertheless, we can't deny that the expected quick recovery may add pressure to new mothers. 

While lack of paid leave may be the most obvious contributor to significant PPD rates in the U.S., it's actually not the most common cause that these experts hear from their clients. Instead, the notable disparity between the U.S. and other countries lies in the significant lack of community around childbirth and postpartum care in this country. 

Some families may live together in one household, and some new mothers may have wide groups of ready-to-help friends, but plenty of others don't have anyone except themselves or a partner to assist with care. As Oreck stresses, "A baby doesn't happen to just one person," and outside help is simply critical.

Financial concerns are another contributor to PPD onset and severity, Oreck says. In the U.S., it's common to pay thousands upon thousands of dollars just to birth a child (whether you have insurance or not), undeniably worsening financial stress for so many Americans. Forbes recently reported an average of over $18,000 in childbirth hospital bills in 2023.

Not to mention, the conversation about postpartum depression is still relatively hush-hush—at least when it comes to the severe end of the spectrum. For some women, postpartum depression is similar to the feeling of mild "baby blues," but for many others, it's debilitating depression, violent thoughts toward one's child and oneself, and a feeling of pure hopelessness—hence why the term "baby blues" can be seen as dismissive in some cases. 

Systemic and lifestyle factors aside, some women are more at risk for postpartum depression. And understanding these risk factors is an important step toward the prevention and early treatment of PPD. 

Postpartum depression is, at the physiological root, caused by a hormonal shift in estrogen and progesterone that takes place almost immediately once a pregnancy has ended, Eyvazzadeh explains. 

Women who experience strong PMS symptoms and those with premenstrual dysphoric disorder (PMDD) may be more susceptible to PPD, Oreck states. Since these women have historically been more sensitive to hormonal shifts, they may be more affected by the extreme hormone drop post-birth, Snyder adds.

In addition, anyone struggling with depression or anxiety before pregnancy may be at a higher risk for PPD, too. Genetics plays a role as well, with recent clinical reviews confirming the strong maternal heritable phenotype for PPD. Oreck adds that women with a history of fertility challenges and miscarriage are also at a higher risk. 

Whether or not postpartum depression can be prevented, especially in a country where our culture and policies directly contribute to it, is up for debate.

Research shows that 50% of PPD cases go undiagnosed4. A critical step to alleviating PPD's effects is identifying it when it shows up.

Postpartum depression is a different experience for every single person, and as Eyvazzadeh adds, may even look different from one pregnancy to the next. Knowing what postpartum depression looks and feels like without dismissing it as "normal" and something to deem just "a part of the process" is essential.

Oreck stresses the importance of having a helping hand, whether it be friends or family. In many cultures, it's completely normal for a mother to move in with her parents (or vice versa) for the first few months after birth to have in-house support—but that's certainly less common in the United States. 

For those who aren't living near friends or family or crave additional support, there are virtual chat groups like this one from the nonprofit Postpartum International. 

Sleep deprivation has been historically used as a torture tactic, Oreck reminds me in our conversation. As research shows time and time again, lack of sleep greatly contributes to feelings of depression and anxiety6—given that many new moms clock a few hours a night during the newborn period, this is one area worth focusing on. 

"Your lifestyle and diet are what help you create hormones," Eyvazzadeh says. Given that hormone fluctuations are at the center of PPD, it makes sense that nutrition and lifestyle adaptations can have some kind of impact—both on your hormones directly and overall mental health. Snyder explains that nutrition alone won't cause or prevent PPD entirely—but it can make a big difference.

We know that vitamin deficiencies can have a significant impact on mental health, and this same rule applies during the postpartum period. For example, research shows that vitamin D levels tend to be particularly suboptimal during the postpartum period, contributing to PPD7. New moms should consider asking their doctor about postpartum supplements.

Whether it's one-on-one therapy or support groups, asking for help sooner rather than later will pay off. Oreck suggests using the more or less nine-month pregnancy period to prepare for the postpartum in more ways than one—she encourages her clients to sign up for couples' therapy (if they're co-parenting), find a therapist that they connect with for their independent needs, opt for financial planning assistance, and get connected with online or in-person parenting communities. 

Oreck is so passionate about this point she, along with a team of other mental health experts, started Mavida Health this past year—an M.D.-led reproductive mental health telehealth center that includes individual, group, and couples' therapy along with educational resources, events, support groups, and discussion forums. 

Studies show that exercise during pregnancy can help to minimize the risk of postpartum depression and reduce the symptoms of depression8—which is why Oreck suggests her clients get moving when they can both during pregnancy and after childbirth. 

"A lot of doctors say 'it's normal, it's common,' and just make a woman deal with it," Eyvazzadeh says about PPD. "Just because it is normal or common doesn't mean the woman doesn't need help," she adds. 

Part of the reason parental depression goes unnoticed by health care professionals is due to the automatic shift from focus on the mother to focus on the newborn—how often the baby is eating, how well they're sleeping, how often they cry or feel uncomfortable—but those same questions aren't often asked about the mother. 

According to the American Academy of Pediatrics (AAP), "A 2019 survey of AAP members found that only about half of pediatricians (53.9%) conduct formal screening for maternal depression9."

The AAP encourages practitioners to check in with mothers during their one-, two-, four-, and six-month infant visits. But one 2020 study suggests PPD may last even longer than six months—reaching three to five years for some10. These findings may help mental health professionals support mothers of younger children for years after giving birth. 

Physicians should also be aware of the elevated PPD rates among Black women and Asian women11 and diligently work to eliminate this racial disparity and advocate for both diversity training and hiring diverse health care professionals. Outside of the medical system, cultural and political shifts must take place as well.

Thankfully, we are seeing early signs of change. Most recently, the Pregnant Workers Fairness Act was passed—requiring employers to provide time off for parents seeking postpartum depression treatment.

Postpartum depression treatments are advancing, but prevention education must follow suit. The pillars of preventing some postpartum depression symptoms include proper diagnosis, community building, and prioritizing sleep, nutrition, movement, and therapy when possible. Given that much of the burden of postpartum depression is heightened by social, economic, and health predispositions, systemic change is also needed within the medical field and culture in the U.S.