Modern approaches to the pharmacotherapy of postpartum depression

Abstract

Postpartum or postnatal depression (PDD) is a common disorder that has serious negative effects on a woman’s health and increases the risk for a child’s emotional, social, and cognitive development outcomes. There are a few unresolved problems in the PDD pharmacotherapy caused by the lack of evidence about drug safety and effectiveness. This review provides a timely update on the current understanding of approaches to the diagnosis and treatment of patients with PDD as part of recurrent depression and bipolar disorder, the features of pharmacotherapy in the postpartum period depending on the manifestations and course of the disease. In accordance with the current guidelines, the treatment of PDD requires the use of the same standard approaches, as in the treatment of depression not associated with pregnancy and childbirth, while it is recommended to refuse breastfeeding in most cases, which runs somewhat contrary to the literature. Several clinical studies have shown that some psychotropic drugs are safe to use in breastfeeding mothers as they demonstrate low transfer into breast milk and rarely cause adverse events in infants. With this respect, sertraline is regarded as the first choice among antidepressants (AD), and quetiapine and valproate among normotimics, however, the limited amount of data does not allow us to make final conclusions about short-term and long-term risks for children. The article also outlines promising directions in the development of new neurosteroid-based antidepressant drugs for the treatment of PDD. Their mechanism of action is mainly associated with a modulating effect on GABAergic neurotransmission.