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Postpartum Depression and Medications: Safety and Risks During Breastfeeding


By Pan-American Life

The prevalence of postpartum depression (PPD) has increased dramatically over the last decade. Our research shows a clinical scenario in which there are more diagnoses and more treatment options, but Latinas still must overcome cultural barriers to get timely help.

In the United States, the rate of Latinas with this condition rose from 8.9% to 18.8% between 2010 and 2021. In Latin America, South America has a prevalence of 21.71%. Current findings show that the prevalence of PPD is closely related to the country’s development and national or regional income.

Postpartum depression is becoming a concerning public health problem all over the globe within the framework of a critical mental health situation in general. Although the particular period and context in which PPD occurs offers an opportunity for preventive interventions, pharmacological preventive strategies are still lacking.

It is also a delicate medical situation, as clinicians must titrate the PPD medication the mother needs, especially if she is breastfeeding.

Antidepressants are generally considered relatively safe during breastfeeding when clinically justified. Selective serotonin reuptake inhibitors (SSRIs) in particular are one of the best-studied classes of medications during this period.

Exhaustive reviews have been published on the topic of antidepressants and breastfeeding. In the most rigorous studies, breastfeeding women repeatedly provided breast milk and infant blood samples so that researchers could quantify the baby’s exposure to the medications.

Data have accumulated on the use of various antidepressants during breastfeeding. Available data on the use of tricyclic antidepressants (TCAs), fluoxetine, paroxetine, and sertraline during breastfeeding have been encouraging. They suggest that the amounts of drug to which infants are exposed are low and that significant complications related to neonatal exposure to antidepressants in breast milk appear to be rare.

In general, very low or undetectable levels have been detected in infants’ serum, and a recent report indicates that exposure to medication in breast milk does not cause a clinically significant blockade of serotonin (5-HT) reuptake in infants.

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This generation of medications includes the most recent innovation approved by the US Food and Drug Administration (FDA): Zurzuvae (zuranolone), the first oral medication indicated to treat postpartum depression in adults. Until now, PPD treatment was only available as an intravenous injection administered by a health care provider at certain health facilities.

The efficacy of Zurzuvae to treat postpartum depression in adults was demonstrated in two randomized, double-blind, placebo-controlled, multicenter studies. Trial participants were women with PPD who met the Diagnostic and Statistical Manual of Mental Disorders criteria for a major depressive episode and whose symptoms began in the third trimester or within four weeks of delivery.

Other issues arise with the treatment of postpartum depression in women who already had a depression diagnosis before pregnancy.

However, this is not usually the case with Latinas in societies where depression is still confused with sadness or nerves and who are not proactive in seeking mental health care due to historical taboos.

One study stressed that providers who work with US- or foreign-born Latinas should consider the broader context of a woman’s life that may prevent identification or admission of PPD symptoms. The lack of formalized support in the US for pregnant women and new mothers supports the narrative that PPD is an individual problem that you have to solve on your own.

However, all research on postpartum depression triggers and effective treatment emphasizes the need for more awareness and community support. Openly discussing maternal mental health during the peripartum period can have a major impact on mothers’ abilities to internally and externally confront depression, anxiety, and chronic stress within a safe health care context and offer options to overcome this condition.

This story was produced using content from original studies or reports, as well as other medical research and health and public health sources cited in links throughout the article.