Pharmacotherapy of postpartum depression: An update

Postpartum depression (PPD) is a mood disorder with depressive symptoms during perinatal period. It negatively impacts women, child, family, and society and hence must be promptly diagnosed and adequately treated. Etiopathogenesis of postpartum depression is not known but is hypothesized to be a complex interplay among various maternal, biological, psychosocial, and genetic factors. Maternal factors encompass high or tender age at pregnancy, while the biological factors include fluctuation of hormones like estrogen and progesterone during perinatal period and dysfunction of HPA-axis. Recognized psychosocial factors are history of depression, symptoms of depression or anxiety during pregnancy, stressful life events and postpartum blue symptoms, single status, lower educational level, multiple offsprings, poor marital relationship and low socioeconomic status. Genetic variations in hemicentin-1 (HMCN1) gene have been found to have increased susceptibility to PPD. Women with PPD presents with fatigue, sadness anhedonia, impaired concentration, irritability, guilt, psychomotor agitation, sleep disturbances and changes in appetite and weight. Management of PPD is a multidisciplinary approach and encompasses complementary health practices, psychological interventions, pharmacotherapy, and somatic therapy. Complementary health practices are educating women about self-care and about growing treatment-seeking behaviour. Cognitive behavioral therapy (CBT) and Interpersonal psychotherapy (IPT) are specifically adapted and well-studied psychological interventions for PPD. Many drugs like antidepressants, estrogen and progesterone have been used for long time for treatment of PPD but their use has not been approved by any regulatory authorities. The First drug approved by U.S. Food and Drug Administration (US FDA) for PPD was brexanolone which is an injectable. Zuranolone is recent addition to this approved category and is an oral one. Both brexanolone and zuranolone are indicated for severe PPD where psychological interventions and antidepressants are usually ineffective.