Postpartum depression (PPD) medication options may include various antidepressants as well as the drug brexanolone (Zulresso). A person’s doctor will recommend the best choice for them.

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Brexanolone, a medication made specifically to treat PPD, works by helping the body break down the hormone progesterone. This can help improve a person’s mood and energy levels.

Experts do not fully understand how the drug works. It is thought that people experience an increase in the concentration of allopregnanolone, a metabolite of progesterone, during pregnancy. After giving birth, the levels of this metabolite quickly decrease. Zulresso produces a type of allopregnanolone, slowing the decline of the hormone.

PPD involves feelings of sadness and emptiness after childbirth. Many people experience the “baby blues” shortly after giving birth, but this typically resolves on its own. If symptoms of low mood last longer than 2 weeks, it may be PPD.

Read on to learn more about postpartum depression medications, whether they are safe when nursing, alternative treatments, and what to ask a doctor.

The following medications are used to treat PPD.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs, a common treatment option for depression, increase levels of a mood-boosting chemical called serotonin. Scientists theorize that low serotonin levels may cause depression, so medication that raises the levels may help.

One example is fluoxetine (Prozac). The starting dosage is often an oral regimen of 20 milligrams (mg) once daily, but a person’s doctor may increase the dose if needed.

Some of the most common side effects of SSRIs include:

  • insomnia
  • diarrhea
  • nausea

Fluoxetine is excreted in breast milk, so doctors do not recommend that a person take it when breastfeeding. However, different SSRIs can be safe to take while nursing, and a doctor can advise an individual on which is best for their circumstances.

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs increase levels of serotonin and norepinephrine, another chemical that affects mood. They are used to treat depression, anxiety, obsessive-compulsive disorder (OCD), and other mood disorders.

One example is duloxetine (Cymbalta). The starting dosage is an oral regimen of 60 mg once daily, which can increase to 120 mg once daily.

Common side effects include:

  • difficulty sleeping
  • dizziness
  • headaches

Research from 2022 states that a person may use duloxetine while nursing. However, it is a good idea to consult a doctor before doing so.

Brexanolone (Zulresso)

In 2019, the Food and Drug Administration (FDA) approved brexanolone, the first drug made specifically for PPD. Although researchers do not know exactly how it works, it is a formulation of allopregnanolone, which can break down the hormone progesterone.

Brexanolone is only available at certified healthcare facilities, and a person receives it through a 60–hour continuous intravenous infusion. Over the course of the 60 hours, the dosage ranges from 30–90 micrograms/kilogram/hour.

Common side effects include:

  • drowsiness
  • dizziness
  • fainting

The medication passes into breast milk, but the exposure is low. Therefore, it may be safe to take while nursing.

According to the Centers for Disease Control and Prevention (CDC), antidepressants might be safe to take when nursing. Many antidepressants pass into the milk supply, but most have little or no effect on the infant.

However, some medical experts have expressed concerns about nursing while taking antidepressants. For instance, the aforementioned research on fluoxetine advised against it.

People who are nursing should always discuss medications and safety precautions with a doctor.

Below are several alternatives to medications for PPD. It is important to note that these may not always be used in place of medication, and people should speak with a healthcare professional before starting them.

Psychotherapy

According to research, psychotherapy is one first-line treatment for mild to moderate PPD. This involves talking with a healthcare professional to learn strategies to change the effects of depression.

Doctors recommend a combination of psychotherapy and antidepressant medication for moderate to severe PPD.

Transcranial magnetic stimulation (TMS)

TMS involves the use of magnetic waves to activate nerve cells. These cells are often underactive in individuals with major depression.

It is an option for people who do not respond to psychotherapy or antidepressants. Effectiveness usually necessitates five sessions per week for 4–6 weeks.

TMS is safe, but side effects may include:

  • lightheadedness
  • headaches
  • facial muscle twitching

Electroconvulsive therapy (ECT)

ECT is an option when someone does not receive effective results from medication. It involves undergoing general anesthesia, after which a doctor passes small electric currents through the brain to trigger a short seizure.

The procedure can alter brain chemistry, which may quickly alleviate depression.

This treatment is relatively safe, but there are reports that it causes impairments in thinking, especially memory. Doctors typically only recommend ECT after several other treatments have been ineffective.

Below are questions a person may wish to ask a doctor:

  • Could my symptoms mean I have PPD?
  • What treatment would you recommend?
  • What are the side effects of the treatment?
  • If you advise medication, is it safe to breastfeed my baby?
  • How long will the treatment last?
  • When can I expect an improvement?
  • Are there lifestyle changes that may help, such as exercising, visiting friends, or joining a support group?

Several postpartum depression medication options are available, including SSRIs, SNRIs, and the first FDA-approved drug for the condition, brexanolone (Zulresso).

Most medications are safe to take while a person is nursing, but it is a good idea to speak with a doctor first.

People who experience symptoms of depression that linger for several weeks after childbirth should talk with a doctor.