Understanding and treating postpartum depression: a narrative review.

Postpartum depression is increasingly recognized as distinct from major depressive disorder, with unique causal factors including hormone fluctuations (estrogen, progesterone, allopregnolone), pathway imbalances (oxytocin, kynurenine), chronobiological factors, and brain imaging alterations. Treatment approaches are expanding beyond traditional antidepressants like sertraline to include newly approved neurosteroids brexanolone and zuranolone, with others under development. Esketamine, psychedelics, brain stimulation, and light therapy also show benefit. Individualized pharmacological and non-pharmacological therapies are being introduced into routine clinical practice.

Study at a glance

Abstract

Postpartum depression (PPD) is an increasingly prevalent but still poorly characterized disorder. Causal and modulating factors include hormones fluctuations, such as estrogen, progesterone, and allopregnolone, pathways imbalances, such as oxytocin and kynurenine, chronobiological factors, and brain imaging alterations. Treatment may differ from the traditional major depression management, while selective serotonin reuptake inhibitors such as sertraline are commonly used and suggested by guidelines, neurosteroids such as brexanolone and the more convenient zuranolone have been recently approved. Newer neurosteroids such as ganaxolone, valaxanolone, and lysaxanolone are currently under development, but also esketamine and psychedelics are promising potential treatments. Other somatic treatments including brain stimulation techniques and light therapy also showed benefit. PPD is therefore increasingly understood as, at least partially, independent from major depressive disorder. Specific and individualized treatments including pharmacological and non-pharmacological therapies are progressively being introduced in the routine clinical practice.