Having a baby is often described as one of the happiest times in a person’s life, but it can also bring unexpected challenges. About 1 in 8 mothers experience postpartum depression (PPD), as do some fathers, nonbinary parents, and other non-birthing parents. It is a serious mental health condition that affects both the mind and the body. If you or a loved one has PPD, there are treatment options, like antidepressants, available to help.

With early diagnosis and the help of therapy (such as talk therapy or counseling), medication, or both, most people with PPD make a full recovery. This article explores five antidepressants that can treat PPD. Some are specifically approved by the U.S. Food and Drug Administration (FDA) for this condition, while others are commonly prescribed for general depression but work well for postpartum depression too.

1. Zuranolone (Zurzuvae)

Zuranolone is an FDA-approved treatment for PPD. It is a pill that you take at home once daily for 14 days. This makes it a convenient option if you prefer an at-home treatment.

Zuranolone helps regulate mood by targeting a system in the brain called the gamma-aminobutyric acid (GABA) system. Most people who take it notice their symptoms improve shortly after beginning the medication. Common side effects include drowsiness and dizziness, which might make it harder to do daily tasks like driving. The FDA warns that you should not drive for at least 12 hours after taking the medication and that you may not be able to judge your own ability to drive. Studies show that only a small amount of this drug makes its way into breast milk, suggesting it’s likely safe to take if you’re breastfeeding. You should use birth control during treatment and for at least one week after your final dose, because data from animal studies suggests that it may pose risks to the fetus during pregnancy. Zuranolone must be taken with a meal rich in fats for your system to properly absorb the medication.

2. Selective Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed types of antidepressants used in postpartum depression. Some examples include:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

These medications work by increasing serotonin levels in the brain, which helps improve mood and reduce anxiety.

SSRIs are usually taken once daily as pills, and they are considered long-term treatments. They can take two to four weeks to work and up to eight weeks for the full effects to be noticeable. Sertraline is considered generally safe if you are breastfeeding because only a tiny amount gets into breast milk. Researchers can detect some citalopram and escitalopram in breast milk, but they can detect very little after that milk is ingested by the infant, which suggests that these may be a safe option if you are breastfeeding as well.

Fluoxetine promotes more breast milk production, but there are several reports of it affecting breastfed infants by causing irritability, vomiting, watery stools, seizurelike activity, and problems with blood sugar. For this reason, fluoxetine is not generally recommended if you are breastfeeding. Paroxetine has been detected at low levels in breast milk. The effects of the drug are unclear.

Of the SSRI group, sertraline and paroxetine are the most widely studied and recommended for PPD treatment if you are breastfeeding. In comparison to most other antidepressant medications, these two medications result in lower amounts of drug in the breast milk and therefore result in less exposure to the infant.

3. Serotonin-Norepinephrine Reuptake Inhibitors

Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor) and duloxetine (Cymbalta), are another possible option for treating PPD. These medications increase your levels of serotonin and norepinephrine, two chemicals in the brain that help regulate mood and energy.

SNRIs are taken daily as pills and are often prescribed for long-term use. It can take up to eight weeks to feel the full effect and relief of symptoms. Side effects like nausea and diarrhea are common but manageable. Small amounts of venlafaxine do pass into the breast milk, with very few reports of side effects in nursing babies. Overall, venlafaxine is considered safe for use if you are breastfeeding. There isn’t as much data to support using duloxetine over other antidepressants while breastfeeding, though only a few case studies have been carried out. In one study, the amount of the drug detected in breast milk and serum was low, though that study tested only two infants.

4. Tricyclic Antidepressants

Tricylic antidepressants (TCAs), such as nortriptyline (Pamelor) and amitriptyline (Elavil), are older antidepressants that are still used in some cases of PPD. These medications also affect serotonin and norepinephrine levels but may cause more side effects than newer drugs.

TCAs are typically taken once daily, usually at bedtime to reduce daytime drowsiness. They may take two to four weeks to start working, and these medications are generally used for several months or longer. Nortriptyline is considered safe if you are breastfeeding, because only tiny amounts of the drug are found in breast milk and there are no known side effects for babies. Nortriptyline is preferable if you are postpartum and lactating because of its positive safety record. In one case, Amitriptyline was reported to cause extreme drowsiness in an infant, so it may be best to choose a TCA with a larger body of data in the breastfeeding population, like nortriptyline.

5. Bupropion

Bupropion (Wellbutrin) is an atypical antidepressant that works differently from SSRIs and SNRIs. It targets dopamine and norepinephrine in order to boost energy and motivation. This may make it a promising choice for parents whose PPD symptoms include fatigue or low energy.

Bupropion is usually taken once or twice daily as a pill. As with the other antidepressants discussed, improvement of symptoms may take several weeks. Bupropion does appear in breast milk, but only in small amounts if the dose is less than 300 milligrams per day. There have been some case reports of adverse effects in infants, including one report of seizure in a breastfed baby at six months of age. Because there is less data to support the drug’s compatibility with breastfeeding, you should take bupropion with caution if you are breastfeeding, and you may prefer a different medication or treatment.

Medication and Breastfeeding

Breastfeeding parents often worry about taking medications, but many antidepressants are safe. Medications like sertraline and nortriptyline are considered some of the safest options, as they transfer very little into the breast milk and have no known adverse effects on babies. For newer drugs like zuranolone, early studies suggest minimal transfer into breast milk, but more research is needed.

Everyone’s situation is different. A healthcare provider can help weigh the risks and benefits of each medication, especially if your baby is preterm or has medical concerns. If you were already on an antidepressant before giving birth, it is important to discuss it with your doctor — you may be able to continue taking it, or you may need to try a new approach. Using an antidepressant can often be a deeply personal and complex choice for new parents, and an open dialogue with your doctor will be key to a successful conversation.

Postpartum depression can feel overwhelming and lonely, but it’s important to remember that it’s treatable and you’re not alone. From new medications like zuranolone to tried-and-true options like SSRIs, there is help available. With the right treatment, recovery is possible, and you can begin to enjoy time with your baby again.

Find Your Team

MyDepressionTeam is the social network for people living with all types of depression, including postpartum depression, and their loved ones. Members come together to ask questions, offer support and advice, and share their stories with others who understand life with PPD.

Did you know about the risk factors for postpartum depression before your baby was born? Do you have any advice for others managing these risks? Share your experience, or start a conversation by posting on your Activities page.