Postpartum depression. Overview and treatment.
Keywords:
postpartum depression, major depressive disorder, drugs, antidepressants, pharmacological alternativesAbstract
Postpartum depression (PPD) represents a significant clinical challenge, affecting both the mother and the baby's development. Traditionally, its management has included psychological therapies such as cognitive behavioral therapy (CBT) and conventional antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs). Although effective, these treatments have limitations in the postnatal period: latency of effect, incomplete response, and lack of focus on the specific pathophysiology of PPD. This article reviews some general aspects of the disorder and other pharmacological treatments besides SSRIs. The search for therapeutic alternatives for this pathology continues to be a subject of research, as the aim is to avoid long-term effects on the mother and, above all, on the mother/child dyad.
References
1. Perinatal conditions. Mortality Database. World Health Organization. 2026; Disponible en: https://platform.who.int/mortality/themes/theme-details/topics/topic-details/MDB/perinatal-conditions
2. Van Niel MS, Payne JL. Perinatal depression: A review. Cleve Clin J Med. 2020;87(5):273–7. Disponible en: http://dx.doi.org/10.3949/ccjm.87a.1905
3. Shorey S, Chee CYI. Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. J Affect Disord. 2021;277:65-73. https://doi.org/10.1016/j.jad.2020.07.091
4. Woody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2023;338:12-25. https://doi.org/10.1016/j.jad.2023.06.015
5. O'Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol. 2020;69:4-12. https://doi.org/10.1016/j.bpobgyn.2020.05.009
6. Batt MM, Duffy KA, Novick AM, Metcalf CA, Epperson CN. Is postpartum depression different from depression occurring outside of the perinatal period? A review of the evidence. Focus Am Psychiatr Publ. 2020;18(2):106–19. Disponible en: http://dx.doi.org/10.1176/appi.focus.20190045
7. Putnam KT, Wilcox M, Robertson-Blackmore E, Sharkey K, Bergink V, Munk-Olsen T, et al. Clinical phenotypes of perinatal depression and time of onset: a systematic review. J Affect Disord. 2022;296:195-209. https://doi.org/10.1016/j.jad.2021.09.013
8. Osborne LM, Gispen F, Sanyal A. Neurobiological basis of postpartum depression: GABA and neurosteroids. Trends Neurosci. 2022;45(6):400-412. https://doi.org/10.1016/j.tins.2022.02.006
9. Ambrosini A, Stanghellini G. Myths of motherhood. The role of culture in the development of postpartum depression. Ann Ist Super Sanita. 2012;48(3):277-86. http://dx.doi.org/10.4415/ANN_12_03_08
10. Silverman ME, Reichenberg A. The course of depressive symptoms during pregnancy and the postpartum period: a longitudinal study. Lancet Psychiatry. 2020;7(3):206-215. https://doi.org/10.1016/S2215-0366(19)30505-6
11. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR). Washington, DC: APA; 2022.
12. World Health Organization. Mental or behavioral disorders associated with pregnancy, childbirth or the puerperium, without psychotic symptoms. International Classification of Diseases, 11th revision (ICD-11); 2019.WHO.
13. National Institute for Health and Care Excellence (NICE). Antenatal and postnatal mental health: clinical management and service guidance. NICE Guideline. 2020. https://www.nice.org.uk/guidance/cg192
14. Slomian J, Honvo G, Emonts P, Reginster JY, Bruyère O. Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Womens Health. 2023;19:17455057231152275. https://doi.org/10.1177/17455057231152275
15. Netsi E, Pearson RM, Murray L, Cooper P, Craske MG, Stein A. Association of persistent and severe postnatal depression with child outcomes. JAMA Psychiatry. 2020;77(9): 924-933. https://doi.org/10.1001/jamapsychiatry.2020.0989
16. Howard LM, Khalifeh H. Perinatal mental health: a review and new directions. Lancet Psychiatry. 2020;7(5):416-428. https://doi.org/10.1016/S2215-0366(19)30482-2
17. Thorsteinsson EB, Loi NM, Farr K. Changes in stigma and help-seeking in relation to postpartum depression: non-clinical parenting intervention sample. PeerJ. 2018;6(e5893):e5893. http://dx.doi.org/10.7717/peerj.5893
18. Tosto V, Ceccobelli M, Lucarini E, Tortorella A, Gerli S, Parazzini F, Favilli A. Maternity Blues: A Narrative Review. J Pers Med. 2023;13(1):154. doi:10.3390/jpm13010154
19. Meltzer-Brody S, Colquhoun H, Riesenberg R, Epperson CN, Deligiannidis KM, Rubinow DR, et al. Brexanolone injection in postpartum depression: two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials. Lancet. 2020;392(10152):1058-1070. https://doi.org/10.1016/S0140-6736(18)31551-4
20. Deligiannidis KM, Meltzer-Brody S, Gunduz-Bruce H, Doherty J, Jonas J, Li H, et al. Effect of zuranolone vs placebo in postpartum depression: a randomized clinical trial. Am J Psychiatry. 2021;178(7):602-611. https://doi.org/10.1176/appi.ajp.2020.20050543
21. Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and health predictors of national postpartum depression prevalence: A systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. J Affect Disord. 2018;227:672-684. https://doi.org/10.3389/fpsyt.2017.00248
22. O’Hara MW, McCabe JE. Postpartum depression: Current status and future directions. Annu Rev Clin Psychol. 2013;9:379-407. PMID: 2339422. 10.1146/annurev-clinpsy-050212-185612
23. Shorey S, Chee CYI, Ng ED, Chan YH, Tam WWS, Chong YS. Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. J Psychiatr Res. 2018;104:235-248. 10.1016/j.jpsychires.2018.08.001
24. World Health Organization. Maternal mental health: postpartum depression factsheet. Geneva: WHO; 2022.
25. Vilarim M, Rebelo F, Vieira I, et al. Prevalence of postpartum depression symptoms during the COVID-19 pandemic: A systematic review and meta-analysis. Braz J Psychiatry. 2024;46:e20233453. PMID: 38343174.
26. Bradshaw H, Riddle JN, Salimgaraev R, Zhaunova L, Payne JL. Risk factors associated with postpartum depressive symptoms: A multinational study. J Affect Disord. 2022;301:345-51. http://dx.doi.org/10.1016/j.jad.2021.12.121
27. Rasmussen M-LH, Strøm M, Wohlfahrt J, Videbech P, Melbye M. Risk, treatment duration, and recurrence risk of postpartum affective disorder in women with no prior psychiatric history: A population-based cohort study. PLoS Med. 2017; 14(9):e1002392. http://dx.doi.org/10.1371/journal.pmed.1002392
28. Fisher J, et al. The prevalence of common perinatal mental disorders in low- and middle-income countries: A systematic review. Bull World Health Organ. 2012;90:139-149. PMID: 22423165.
29. Parsons CE, Young KS, Rochat TJ, Kringelbach ML, Stein A. Postnatal depression and its effects on child development: A review of evidence from low- and middle-income countries. Br Med Bull. 2012;101:57-79. 10.1093/bmb/ldr047.
30. Sheng JA, Bales NJ, Myers SA, Bautista AI, Roueinfar M, Hale TM, et al. The hypothalamic-pituitary-adrenal axis: Development, programming actions of hormones, and maternal-fetal interactions. Front Behav Neurosci. 2020;14:601939. http://dx.doi.org/10.3389/fnbeh.2020.601939
31. Genchi-Gallardo FJ, Paredes-Juárez S, Solano-González NL, Rios-Rivera CE, Paredes-Solís S, Andersson N. Prevalencia de depresión posparto y factores asociados en usuarias de un hospital público de Acapulco, Guerrero, México. Ginecol Obstet Mex. 2021;89(12): 927-936. https://doi.org/10.24245/gom.v89i12.6947
32. Zhu J, Jin J, Tang J. Inflammatory pathophysiological mechanisms implicated in postpartum depression. Front Pharmacol [Internet]. 2022;13:955672. Disponible en: http://dx.doi.org/10.3389/fphar.2022.955672
33. Dimcea DA-M, Petca R-C, Dumitrașcu MC, Șandru F, Mehedințu C, Petca A. Postpartum depression: Etiology, treatment, and consequences for maternal care. Diagnostics (Basel) [Internet]. 2024;14(9):865. Disponible en: http://dx.doi.org/10.3390/diagnostics14090865
34. Tal R, Taylor HS. Endocrinology of pregnancy. En: Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000.
35. Worthen RJ, Beurel E. Inflammatory and neurodegenerative pathophysiology implicated in postpartum depression. Neurobiol Dis [Internet]. 2022;165(105646):105646. Disponible en: http://dx.doi.org/10.1016/j.nbd.2022.105646
36. Zhang K, He L, Li Z, Ding R, Han X, Chen B, et al. Bridging neurobiological insights and clinical biomarkers in postpartum depression: A narrative review. Int J Mol Sci. 2024;25(16):8835. Disponible en: http://dx.doi.org/10.3390/ijms25168835
37. Feng YF, Zhou YY, Duan KM. The role of extrasynaptic GABA receptors in postpartum depression. Mol Neurobiol [Internet]. 2024;61(1):385–96. Disponible en: http://dx.doi.org/10.1007/s12035-023-03574-7
38. Meltzer-Brody S, Kanes SJ. Allopregnanolone in postpartum depression: Role in pathophysiology and treatment. Neurobiol Stress. 2020;12(100212):100212. Disponible en: http://dx.doi.org/10.1016/j.ynstr.2020.100212
39. Waqas A, Zafar SW, Akhtar P, Naveed S, Rahman A. Optimizing cognitive and behavioral approaches for perinatal depression: A systematic review and meta-regression analysis. Glob Ment Health (Camb). 2023;10:e22. http://dx.doi.org/10.1017/gmh.2023.8
40. Modzelewski S, Oracz A, Iłendo K, Sokół A, Waszkiewicz N. Biomarkers of postpartum depression: A narrative review. J Clin Med [Internet]. 2023;12(20):6519. Disponible en: http://dx.doi.org/10.3390/jcm12206519
41. Kaufman Y, Carlini SV, Deligiannidis KM. Advances in pharmacotherapy for postpartum depression: a structured review of standard-of-care antidepressants and novel neuroactive steroid antidepressants. Ther Adv Psychopharmacol. 2022; 12:20451253211065859. http://dx.doi.org/10.1177/20451253211065859
42. Patterson, R., Balan, I., Morrow, AL et al. Nuevas terapias con neuroesteroides para la depresión posparto: perspectivas sobre ensayos clínicos, desarrollo de programas, investigación activa y futuras direcciones. Neuropsychopharmacol. 49, 67–72 (2024). https://doi.org/10.1038/s41386-023-01721-1
43. Blum K. Adult inpatient brexanolone service addresses postpartum depression. Johns Hopkins Medicine. 2023. Disponible en: https://www.hopkinsmedicine.org/news/articles/2023/02/adult-inpatient-brexanolone-service-addresses-postpartum-depression?
44. Zheng W, Cai DB, Zheng W, Sim K, Ungvari GS, Peng XJ, Ning YP, Wang G, Xiang YT. Brexanolone for postpartum depression: A meta analysis of randomized controlled studies. Psychiatry Res. 2019 Sep;279:83 89. doi:10.1016/j.psychres.2019.07.006. Disponible en: https://doi.org/10.1016/j.psychres.2019.07.006
45. Biogen UK. Zurzuvae™ (zuranolone) becomes first and only MHRA-licensed treatment for mothers with post-natal depression [Internet]. 2025 Aug 28 [cited 2025 Oct 21]. Disponible en: https://www.pharmiweb.com/press-release/2025-08-28/zurzuvaetm-zuranolone-becomes-first-and-only-mhra-licensed-treatment-for-mothers-with-post-natal-depression
46. Zhang Q, Dai X, Li W. Eficacia comparativa y aceptabilidad de las farmacoterapias para la depresión posparto: Una revisión sistemática y un metanálisis en red. Front Pharmacol. 2022;13:950004. Disponible en: http://dx.doi.org/10.3389/fphar.2022.950004
47. Tabassum N, Ferdousi L, Abouseria A. Zuranolone offers an innovative treatment for postpartum depression. Pharmacy Times [Internet]. 2024 Aug 4 [cited 2025 Oct 21]. Disponible en: https://www.pharmacytimes.com/view/zuranolone-offers-an-innovative-treatment-for-postpartum-depression
Downloads
Published
How to Cite
Issue
Section
License
ARCHIVOS DE MEDICINA,SALUD Y EDUCACIÓN MÉDICA by Universidad Autónoma de Tamaulipas is licensed under a Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional License.
ARCIVOS DE MEDICINA, SALUD Y EDUCACIÓN MÉDICA es una revista digital de acceso abierto (OJS) y editada por la Universidad Autónoma de Tamaulipas, con publicación semestral Sitio web: ... Director de la revista:... Reserva de Derechos al Uso Exclusivo No..... otorgados por el Instituto Nacional del Derecho de Autor (INDAUTOR). Responsable de la última actualización Dr. José Alberto Ramírez de León, con domicilio en calle Matamoros S/N Zona Centro, C.P. 87000 Ciudad Victoria, Tamaulipas, México. Tels. (834) 3181800 y 3181700, ext 1148..
Accepted 2026-09-21
Published 2026-10-15
