Postpartum Depression Treatment Options: Therapy, Antidepressants and Zuranolone

Postpartum depression is treatable, and the main options are psychotherapy, antidepressants, or both. Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are the evidence-based therapies, and standard antidepressants usually take 4 to 8 weeks to work. Zuranolone (Zurzuvae), approved by the FDA in August 2023, is the first oral medication specifically for postpartum depression in adults and is taken for 14 days.

Brexanolone (Zulresso), the earlier IV treatment, is no longer an option: its maker stopped marketing it and the FDA withdrew its approval effective April 14, 2025. Some antidepressants can be used while breastfeeding; LactMed describes sertraline as a preferred choice. Postpartum psychosis is different from postpartum depression and is a psychiatric emergency.

Baby blues, postpartum depression or something more urgent?

Many new parents have brief mood swings, tearfulness and worry in the first two weeks after birth. NIMH describes these "baby blues" as common and short-lived, and says symptoms that are severe or last longer than 2 weeks may signal postpartum depression. Without treatment, postpartum depression usually does not go away on its own.

Postpartum depression can start during pregnancy; NIMH uses the term perinatal depression to cover depression during pregnancy and after birth. In the zuranolone trials, for example, participants' depressive episodes began in the third trimester or within 4 weeks of delivery.

Many parents with postpartum depression or anxiety have unwanted, frightening thoughts about harm coming to the baby. These intrusive thoughts are distressing precisely because they feel alien, and they are a reason to talk to a clinician, not a sign you will act on them. A clinician can help tell them apart from psychosis.

Treatment options at a glance

Therapy: CBT and interpersonal therapy

NIMH names CBT and IPT as the evidence-based therapies for perinatal depression. The US Preventive Services Task Force also recommends that clinicians provide or refer pregnant and postpartum people at increased risk of perinatal depression to counseling to help prevent it, based mainly on studies of CBT and IPT. The two approaches differ in focus.

• CBT works on the thought patterns and behaviors that keep depression going: harsh self-judgment about parenting, all-or-nothing standards, withdrawal from people and activities. It often includes scheduling small, doable activities and testing beliefs such as "a good mother would never feel this way."
• IPT focuses on relationships and role changes. The transition to parenthood is a classic IPT focus, along with conflict with a partner, isolation, and grief for the life before the baby. See interpersonal therapy for depression for how a course runs.

For mild to moderate symptoms, therapy alone is a reasonable first step for many people. For more severe depression, or when therapy alone has not been enough, adding medication is common. Telehealth sessions during naps or with a partner holding the baby can make therapy realistic in the first months. The site's page on psychotherapy describes the practice's therapy approach.

Antidepressants and breastfeeding

SSRIs are commonly used after birth. Sertraline, for example, is FDA-approved for major depressive disorder, and the FDA describes postpartum depression as a major depressive episode that typically occurs after childbirth but can begin late in pregnancy. They usually need 4 to 8 weeks to work, and sleep, appetite and energy often improve before mood does.

For breastfeeding, the National Library of Medicine's LactMed database is the standard reference. Its sertraline summary says amounts in breast milk are low, the drug is usually not detected in infants' blood, no effects on development have been found in infants followed for up to 5 years, and most authoritative reviewers consider sertraline a preferred antidepressant during breastfeeding. It also notes that preterm infants with immature metabolism might rarely accumulate the drug, which is one reason the baby's pediatrician should know about any medication.

If an antidepressant worked well for you before or during pregnancy, tell your prescriber; past response is useful information. The detailed comparison is in psychiatric medications while breastfeeding, and medications during pregnancy covers decisions made earlier. SSRIs carry a boxed warning about suicidal thoughts and behaviors in children, adolescents and young adults, so close follow-up after starting is standard for younger parents. The site's guide to the first two weeks on an SSRI covers early side effects.

Do not stop an antidepressant because you are pregnant, delivered, or started breastfeeding without talking to your prescriber. Stopping suddenly can cause withdrawal symptoms and relapse.

Zuranolone (Zurzuvae): what to know

The FDA approved zuranolone on August 4, 2023, as the first oral medication indicated for postpartum depression in adults. Before that, the only PPD-specific drug was an IV infusion given in certain health care facilities. Key points from the prescribing information:

• It is taken once daily in the evening with fat-containing food for 14 days, at a dose set by the prescriber.
• It carries a boxed warning: it causes driving impairment, and patients should not drive or do other potentially hazardous activities for at least 12 hours after each dose during the course. People may not be able to judge their own impairment.
• It is a Schedule IV controlled substance, and combining it with alcohol, opioids, benzodiazepines or other sedating drugs increases sedation and breathing risks.
• It can be used alone or added to an oral antidepressant.
• It can cause fetal harm based on animal studies, so the label advises effective contraception during treatment and for 1 week after the last dose.
• Zuranolone passes into breast milk in low amounts; there are no data on effects in breastfed infants, so the label asks prescribers and parents to weigh the benefits of breastfeeding against the parent's need for treatment.

The driving warning has practical consequences for a parent with a newborn: evening dosing, no driving the next morning until 12 hours have passed, and someone else available for night feeds and any early-morning drives. Ask your prescriber how worsening mood or suicidal thoughts during the course will be handled; the label advises considering a change in treatment if that happens. What happens after the 14 days, including whether to continue or start another antidepressant, is a plan to make with the prescriber before you begin.

What about brexanolone?

Brexanolone (Zulresso) was given by IV in certain health care facilities. Sage Therapeutics told the FDA the product was no longer marketed and asked the agency to withdraw approval; the FDA withdrew it effective April 14, 2025, and the notice gives no safety or effectiveness reason. Older articles and websites may still describe it as an available option.

If the first treatment does not help

Postpartum depression that does not improve after a fair trial of therapy or medication happens, and it should not be read as failure. Before changing course, a clinician will usually check a few things:

• Whether the diagnosis is complete. Anxiety, obsessive-compulsive symptoms, trauma from the birth, or bipolar disorder can look like or accompany postpartum depression and change the right treatment. A history of mood episodes with high energy and little need for sleep is especially important to mention.
• Whether medical problems are contributing. Thyroid changes after pregnancy, anemia and severe sleep loss can all worsen mood and fatigue; the guide to medical causes to rule out lists common ones.
• Whether the trial was adequate: a long enough course of therapy, or a medication given enough time at a suitable dose.
• Whether practical barriers got in the way, such as missed sessions because of childcare or doses skipped over breastfeeding worries.

Next steps may include adding medication to therapy or therapy to medication, switching medication, considering zuranolone, or moving to a more intensive level of care. If symptoms are severe or safety is a concern at any point, do not wait for the next routine appointment.

The basics that help treatment work

Treatment works better when the basics are covered. Protected sleep is a common priority: a longer stretch of rest, with a partner or family member handling a night feed, can help mood and make it easier to keep up with therapy or medication. Other supports that help are regular meals, short periods out of the house, and honest conversations with people you trust about how you are doing. These do not replace treatment for postpartum depression, but they make it easier to take part in it. If you are breastfeeding and worried about medication, ask about it rather than avoiding treatment; there are options with substantial safety information.

Who treats postpartum depression

• Your obstetrician, midwife or primary care doctor often screens for depression and can start treatment or refer.
• A psychotherapist trained in CBT or IPT provides therapy.
• A psychiatrist or psychiatric nurse practitioner is helpful for moderate to severe depression, for medication decisions while breastfeeding, for a history of bipolar disorder or psychosis, or when a first treatment has not worked. A reproductive psychiatrist focuses on these questions; see what a reproductive psychiatrist does.
• Postpartum Support International (PSI) runs a HelpLine at 1-800-944-4773 (call; text in English at 800-944-4773, in Spanish at 971-203-7773) and keeps a directory of perinatal mental health providers in the US and Canada. The HelpLine is a support line that returns messages; it is not for emergencies.
• The National Maternal Mental Health Hotline, 1-833-852-6262 (1-833-TLC-MAMA), offers free, confidential call or text support around the clock in English and Spanish.

Questions to bring to an appointment:

1. Is this depression, anxiety, or both, and is anything else (thyroid, anemia, sleep deprivation) contributing?
2. Would you suggest therapy, medication, or both for my level of symptoms?
3. If medication, what is known about it during breastfeeding, and should the baby's pediatrician know?
4. If zuranolone is an option, how would we handle the driving restriction and what comes after the 14 days?
5. Who do I call if I get worse between visits?

Partners and family can help by protecting sleep, taking over night feeds where possible, coming to an appointment, and watching for the urgent signs listed above. The guide on depression treatment options compared covers depression treatment more broadly.

When it is an emergency

NIMH describes postpartum psychosis as a psychiatric emergency that requires hospitalization; anyone with its symptoms should call 911 or go to the nearest emergency room. The same applies to thoughts of suicide or of harming the baby, or being unable to care for yourself or the baby. The article on psychiatric emergency vs urgent care in NYC explains where to go.

If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.

Where the practice fits

Dr. Lewis's team includes psychiatrists, psychiatric nurse practitioners and psychotherapists, and care can combine psychiatric evaluation and medication management with psychotherapy including CBT and DBT, plus nutrition and lifestyle psychiatry. The site's article on depression and anxiety in pregnancy covers related topics. The first contact is a free discovery call by phone or text, where you can ask about care options and whether the team is the right fit for postpartum care, and individual care starts with the Patient Interest Form. If you need care that is in network with your plan, ask the team on the discovery call about options; PSI's directory can also help you find perinatal specialists. For other routes into care, see the Choosing Psychiatric Care guide.

Frequently asked questions

Can I take an antidepressant while breastfeeding?

Many people do. LactMed, the National Library of Medicine's lactation database, describes sertraline as a preferred antidepressant during breastfeeding because infant exposure is low. Your prescriber and the baby's pediatrician should both know what you take.

Is zuranolone better than a regular antidepressant?

It works on a shorter timeline and is taken for only 14 days, but it carries a driving-impairment boxed warning and less is known about long-term outcomes. Which fits you depends on your symptoms, history and circumstances, and is a decision to make with a prescriber.

Is Zulresso still available?

No. Its maker stopped marketing it, and the FDA withdrew its approval effective April 14, 2025.

How long does postpartum depression last without treatment?

It varies, but NIMH notes that postpartum depression usually does not go away on its own. It is worth contacting a clinician rather than waiting it out.

Can postpartum depression start months after birth?

Yes. NIMH describes postpartum depression as depression in the weeks and months after childbirth, and depression can also begin during pregnancy. Any lasting change in mood, sleep beyond what the baby explains, or loss of interest deserves a check-in with a clinician.

I was on an antidepressant before pregnancy. Should I restart it?

Bring that history to your prescriber. How well a medication worked for you before is useful information, but the decision also depends on breastfeeding plans and your current symptoms. Do not restart or change a medication on your own.

Sources

1. Perinatal Depression. National Institute of Mental Health, 2023. nimh.nih.gov
2. FDA Approves First Oral Treatment for Postpartum Depression. U.S. Food and Drug Administration, 2023. fda.gov
3. Zurzuvae (zuranolone) capsules prescribing information. DailyMed / U.S. FDA label, 2026. dailymed.nlm.nih.gov
4. Withdrawal of Approval of a New Drug Application for ZULRESSO (Brexanolone) Solution. Federal Register (FDA notice), 2025. govinfo.gov
5. Sertraline (LactMed: Drugs and Lactation Database). National Library of Medicine (NCBI Bookshelf), 2026. pubmed.ncbi.nlm.nih.gov
6. Zoloft (sertraline) prescribing information. DailyMed / U.S. FDA label, 2023. dailymed.nlm.nih.gov
7. Perinatal Depression: Preventive Interventions (Final Recommendation Statement). U.S. Preventive Services Task Force, 2019. uspreventiveservicestaskforce.org
8. Get Help. Postpartum Support International, 2026. postpartum.net
9. National Maternal Mental Health Hotline. Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau, 2026. mchb.hrsa.gov

Educational information, not medical, tax or legal advice. Decisions about diagnosis, medication and treatment belong with a clinician who knows your history.