Panel Discusses Screening, Treatment, and Challenges for Postpartum Depression

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In the recent Psychiatric Times custom video series Postpartum Depression Management: Exploring Treatment Options for Mothers in Need of Support, panelists Melanie Barrett, MD; Anita Clayton, MD; and Carmen Kosicek, MSN, PMHNP-BC, explored patient cases to discuss key aspects of postpartum depression (PPD), including its diagnosis, treatment options, and emerging therapies. Additionally, “Izzy,” a mother who has experienced PPD, shared her story to help the panel gain deeper insights into PPD’s impact on her quality of life and treatment journey. The discussion underscored the importance of tailoring psychiatric interventions to patients in the postpartum period, integrating innovative pharmacological treatments, and leveraging digital health solutions for enhanced accessibility and follow-up care. Here are the highlights.

1. Differentiation Between Postpartum Blues and PPD

Postpartum blues and PPD are often confused, but clear distinctions exist. Postpartum blues affect up to 75% of new mothers. These mothers present with mood lability, irritability, and transient crying spells. Symptoms typically resolve within 2 weeks without treatment. PPD is a more severe condition meeting the criteria for a major depressive episode, characterized by persistent sadness, anhedonia, sleep disturbances, cognitive impairment, and, in some cases, intrusive thoughts about self-harm or harm coming to the baby. Symptoms extend beyond 2 weeks and lead to functional impairment in daily life.

“Among the statistics that I think are most disturbing is the fact that about 40% of women who have PPD go unrecognized and untreated, and they are still symptomatic 3 years later. It is not only people failing to respond to treatment but also those who are not ever recognized and treated,” said, Clayton, who is chair of the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia in Charlottesville and the Psychiatric Times women’s issues section editor.

The discussion highlighted that early differentiation is critical, as untreated PPD can persist for years and negatively affect maternal-infant bonding and, ultimately, child development. “I really wish that we would start looking for PPD from the time that the mother enters her prenatal care. We should start screening that early and flagging charts for people who have already been on medications for depression,” said Kosicek, who is a psychiatric mental health nurse practitioner practicing in Portland, Oregon.

2. Importance of Early Screening and Intervention

The case discussion stresses the need for systematic screening of PPD. Current guidelines recommend screening at least twice during pregnancy and at postpartum visits, but many cases go undetected. The American College of Obstetricians and Gynecologists as well as the American Psychiatric Association endorse using validated screening tools such as the Edinburgh Postnatal Depression Scale or the Patient Health Questionnaire-9, but these tools alone are not enough. A clinical interview remains essential for capturing functional impairment and distressing intrusive thoughts. Many health care professionals, including pediatricians and obstetrician-gynecologists, interact with patients in the postpartum period but often fail to ask detailed mental health questions. Integrating mental health check-ins into routine postnatal care is a proposed solution.

“If a woman previously had depression, not postpartum depression but depression, and she was on medications, if she stops her medications in order to become pregnant or when she finds she is pregnant, she is at an extremely high risk of developing PPD or depression during the pregnancy. Those are women we need to be monitoring,” Clayton said.

The discussion also explored artificial intelligence (AI)–based screening technologies that analyze speech patterns for signs of depression, potentially improving early detection while reducing reliance on subjective self-reports. “The AI technology that is out there can catch voice inflection, suicidality, tone differentiation, all those things,” Kosicek said.

Barrett, who is a psychiatrist with Live Life Span Health in Edmond, Oklahoma, added that psychoeducation is just as critical as screening: “In addition to starting the conversation during pregnancy or whenever your first contact is with the patient, we must do the screening but also provide education. It is important to educate patients on the warning signs for postpartum depression. What are the risk factors? What are the things that we can mitigate? How can we combine resources and bolster support? I think the earlier, the better as far as bringing up the topic and working to support our patients.”

3. Treatment Options: From SSRIs to Neuroactive Steroids

Findings from one of the case studies highlighted the limitations of traditional selective serotonin reuptake inhibitor (SSRI) treatment for PPD. The patient initially trialed SSRIs, which caused intolerable adverse effects (eg, emotional blunting, loss of motivation) and delayed symptom relief. The discussion questioned the efficacy of SSRIs in PPD, as emerging research suggests only 20% of patients achieve full remission with serotonergic medications alone. Newer treatment options, including neuroactive steroids such as zuranolone (Zurzuvae), show rapid onset of action (within days) and do not require long-term use. The panel compared zuranolone (oral, 14-day treatment) and brexanolone (intravenous, hospital-administered treatment), emphasizing the benefits of shorter courses of medication in treating hormone-sensitive mood disorders such as PPD.

Beyond pharmacology, digital therapeutics, such as computerized cognitive behavioral therapy and interpersonal therapy, are highlighted as promising adjuncts—particularly for patients in remote or resource-limited areas. “Digital therapeutics are studied like a medication with outcomes and data, primary end points,” Kosicek said. “I really like them as an option, even as an add-on for people who are in therapy, which is why I think it is fantastic. At 2 in the morning, you can get on your device and be honest about how you are feeling.”

4. Challenges in Access to Care: Cost, Distribution, and Stigma

The discussion underscored barriers to accessing PPD treatment, such as cost and insurance coverage, pharmacy distribution, and stigma. Newer treatments such as zuranolone have a high list price (approximately $19,000) but may be covered if insurance deductibles are met, making them accessible for some but prohibitive for others. Unlike standard antidepressants, zuranolone is only available through specialty pharmacies, requiring prior authorization and coordination with prescribers. Furthermore, many patients hesitate to disclose intrusive thoughts for fear of being labeled as a danger to their child, leading to underreporting. The panel suggested that normalizing these experiences in psychiatric consultations can encourage more open discussions. The panel advocated for policy changes, such as better insurance reimbursement for short-course, high-efficacy treatments and streamlined specialty pharmacy access to innovative medications.

5. Impact on Family Dynamics and Long-Term Outcomes

“PPD has a big burden to not only the mom but the entire family,” Barrett said. The discussion emphasized that untreated PPD does not just affect the mother; it has multigenerational consequences on infant development, partners, and family finances.

Findings from studies show that infants of mothers with depression exhibit delays in language development, emotional regulation, and cognitive skills, likely due to reduced maternal responsiveness. Additionally, spouses and family members often struggle to understand or validate the mother’s symptoms, leading to increased marital stress and isolation. Lastly, untreated PPD results in longer maternity leaves, reduced work productivity, and financial strain on families.

One case study’s patient described feeling “absent” during her baby’s first months and realizing only later the impact that PPD had on her ability to bond. The panel encouraged early intervention to restore maternal functioning and reduce long-term consequences.

Concluding Thoughts

“The whole pregnancy, it was all about me. What do I want? How am I going to have the baby shower? And then, just like that, it is all about the baby. We need to get back to asking questions to the mother,” Kosicek said. By combining innovative pharmacological treatments, digital therapeutics, and systemic health care improvements, psychiatrists and mental health clinicians can dramatically improve outcomes for patients with PPD and their families.

“PPD is not a reflection on an individual or their ability to be a mom. We have come so far—although we have more work to do—but PPD is treatable. To anyone listening, let me emphasize the importance of asking about PPD, talking about it, and connecting our patients to the resources that they need,” Barrett concluded.

To watch this program, visit psychiatrictimes.com/clinical-case-collective/postpartum-depression-management-exploring-treatment-options-for-mothers-in-need-of-support