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Treatment Options

Services for Mothers

Focus on symptom reduction and enhancement of general functioning.

I. Primary Services


  • First-line treatment for mild to moderate PPD (PPD)1-4
  • For severe PPD, may use in conjunction with pharmacological treatment1-4
  • Effective approaches include Interpersonal Therapy5-11 and Cognitive Behavior Therapy8-15

Pharmacological Treatment

  • First-line treatment for severe PPD16-18
  • Effective antidepressant medications include Sertraline,5,11,19-21 Paroxetine,11,21-23 and Nortriptyline11,19

II. Complimentary Services

Peer Support

  • Entails provision of reassurance and emotional support, validation of feelings, and informational assistance24
  • Delivery varies from in-person peer support groups to telephone-based peer support8
  • Emerging evidence for effectiveness,8,9,24,25

Services that Address Poor Sleep Quality

  • May involve a range of interventions, from education about sleep hygiene practices and counseling to medications.26
    • Rehabilitation counselors can provide mothers with information about sleep hygiene practices and help mothers develop a plan to decrease infant-related sleep interruptions by enhancing support in nighttime infant-care26
    • Sleep hygiene practices include practices such as only using the bed for sleeping, getting out of bed and engaging in a non-stimulating activity after 20 minutes of trying to sleep, avoiding stimulating substances or activities within four hours of desired bedtime, and establishing a night-time routine. 27

Supported Employment

  • Evidence-based practice that entails assisting individuals in every stage of employment28
  • Employment is an important component of risk and recovery in PPD29-31
    • Study found that at six months postpartum, employed mothers were less likely to have depressive symptoms than unemployed mothers29
    • Two other studies found that returning to work after childbirth was an important factor in recovery for consumers with PPD30,31
  • Because supported employment enhances employment outcomes—and employment itself promotes recovery32—this practice may facilitate recovery for women with severe PPD33

Services for Parenting and the Mother-Infant Relationship

Focus on enhancing parenting skills and developing healthy mother-child relationships. Important component of treatment,34, 35 as treatment of PPD symptoms does not significantly improve the mother-child relationship.36

Parent Education

  • Provides parents with knowledge and techniques for meeting the physical and emotional needs of their infants.37 
  • One review found improvements in mothers’ psychosocial health, with mothers in the parent training group showing a reduction in depression and anxiety compared to the control group.38
  • Another review found that children from birth to age three showed significant improvement in behavioral and emotional adjustment after their parents’ completion of parenting programs.39
  • Includes parent education workshops37 and manualized parent education programs such as The Incredible Years program.40  

Home Visiting

  • Nurses, Social Workers, or trained volunteers provide in-home parenting support and training.41
  • More effective when delivered by nurses, rather than by paraprofessionals.42,43
  • Includes the Nurse-Family Partnership (NFP)
    • Provide home visiting services for low-income, first-time mothers that begin in pregnancy and continue until the child is two years old.44
    • Offer parent education and skills training, counseling and parenting support, and referrals to other services (e.g. job training, healthcare, childcare, etc.).44
    • Longitudinal, randomized controlled trials found nurse visited mothers and children had more responsive interactions,42 and that children showed superior language and cognitive development,42, 43, 45 had higher academic achievement,45-47 had fewer behavior problems and less aggression,45 and were less likely to have internalizing disorders47 than controls.
  • Also includes the Parents as Teachers (PAT) program
    • Home visiting program that provides parent education based on the Born to Learn curriculum, as well as community resource referral, and family support from birth to 5 years. Also, parenting coaching and dev screenings.48, 49
    • Several studies have found beneficial effects for enrolled families in the areas of parenting practices,49, 50 and school achievement and readiness.49

Mother-Infant Therapies

  • Dyadic therapies that involve both the mother and the infant, focusing on altering negative maternal representations and/or behaviors to improve mother-infant interactions.51
    • For example, Toddler Parent Psychotherapy (or Child Parent Psychotherapy) is a mother-infant therapy that focuses on altering negative maternal representations of one’s child, of oneself as a mother, and of one’s relationship with her child.52 
  • Several approaches have been found to improve both mother-infant interactions and infant attachment security, including:
    • Toddler Parent Psychotherapy52, 53, 54
    • Psychodynamic Psychotherapy (PPT)55, 56
    • Watch, Wait and Wonder (WWW)57, 58
  • Other approaches—such as Parent Child Interaction Therapy59, 60 and Infant Massage61-64—were found to improve mother-infant interactions by enhancing maternal responsiveness.
    • Interaction Coaching also enhances maternal responsiveness.11, 65

Services for infants

Focus on remediating developmental delays, preventing impaired development, and optimizing developmental outcomes.

Early Head Start

  • Provide center-based daycare services and case management to low-income families with children under 3 years of age.66-68
    • Some programs also offer home visiting and parenting education.66-68
  • A randomized controlled trial found that 3 year old children in the program had greater sustained attention, less aggressive behavior, and better language and cognitive development than control children.67


  1. National Institute for Health and Clinical Excellence. (2007). Antenatal and postnatal mental health: Clinical management and service guidance. Retrieved from http://www.nice.org.uk/nicemedia/live/11004/30433/30433.pdf
  2. Registered Nurses’ Association of Ontario (2005). Nursing best practice guideline: Interventions for postpartum depression. Retrieved from http://www.rnao.org/Storage/11/600_BPG_Post_Partum_Depression.pdf
  3. Cohen, L. S., Wang, B., Nonacs, R., Viguera, A. C., Lemon, E. L., & Freeman, M. P. (2010). Treatment of mood disorders during pregnancy and postpartum. Psychiatric Clinics of North America, 33(2), 273-293. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2010623522&site=ehost-live&scope=site
  4. Hirst, K. P., & Moutier, C. Y. (2010). Postpartum major depression. American Family Physician, 82(8), 926-933. Retrieved from http://www.aafp.org/afp/990415ap/2247.html
  5. Pearlstein, T. B., Zlotnick, C., Battle, C. L., Stuart, S., O’Hara, M. W., Price, A. B., . . . Howard, M. (2006). Patient choice of treatment for postpartum depression: A pilot study. Archives of Women’s Mental Health, 9(6), 303-308. doi: 10.1007/s00737-006-0145-9
  6. Clark, R., Tluczek, A., & Wenzel, A. (2003). Psychotherapy for postpartum depression: A preliminary report. American Journal of Orthopsychiatry, 73(4), 441-454. doi: 10.1037/0002-9432.73.4.441
  7. O’Hara, M. W., Stuart, S., Gorman, L. L., & Wenzel, A. (2000). Efficacy of interpersonal psychotherapy for postpartum depression. Archives of General Psychiatry, 57(11), 1039. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=amed&AN=0021355&site=ehost-live&scope=site
  8. Dennis, C., & Hodnett, E. D. (2007). Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database of Systematic Reviews, (4). Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2009825157&site=ehost-live&scope=site
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  10. Bledsoe, S. E., & Grote, N. K. (2006). Treating depression during pregnancy and the postpartum: A preliminary meta-analysis. Research on Social Work Practice, 16(2), 109-120. Retrieved from https://auth.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2009157197&site=ehost-live&scope=site
  11. Craig, M., Howard, L. (2008). Postnatal depression. Retrieved from Clinical Evidence web site: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907780/pdf/2009-1407.pdf
  12. Appleby, L., Warner, R., Whitton, A., & Faragher, B. (1997). A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. BMJ: British Medical Journal, 314(7085), 932-936. Retrieved from https://auth.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2002021415&site=ehost-live&scope=site
  13. Misri, S., Reebye, P., Corral, M., & Mills, L. (2004). The use of paroxetine and cognitive-behavioral therapy in postpartum depression and anxiety: A randomized controlled trial. Journal of Clinical Psychiatry, 65(9), 1236-1241. Retrieved from https://auth.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2004-19115-013&site=ehost-live&scope=site
  14. Morrell, C .J., Warner, R., Slade, P., Dixon, S., Walters, S., & Paley, G. (2009). Psychological interventions for postnatal depression: Cluster randomised trial and economic evaluation. The PONDER trial. Health Technology Assessment, 13(30). Retrived from http://www.hta.ac.uk.libproxy.lib.unc.edu/project/1336.asp
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  16. Cooper, P. J., Murray, L., Wilson, A., & Romaniuk, H. (2003). Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression. 1. impact on maternal mood. British Journal of Psychiatry, 182(5), 412-419. doi: 10.1192/bjp.182.5.412
  17. Altshuler, L. L., Cohen, L. S., Moline, M. L., Kahn, D. A., Carpenter, D., & Docherty, J. P. (2001). The expert consensus guideline series: Treatment of depression in women [Special issue]. Postgraduate Medicine (1-116). Retrieved from http://www.pmdd.factsforhealth.org/images/depres_in_women_guide.pdf
  18. Nonacs, R. M. (2005). Postpartum mood disorders. In L. S. Cohen & R. M. Nonacs (Eds.), Review of psychiatry: Mood and anxiety disorders during pregnancy and postpartum (Vol. 24, pp. 77-96). Washington, DC: American Psychiatric Publishing.
  19. Wisner, K. L., Hanusa, B. H., Perel, J. M., Peindl, K. S., Piontek, C. M., Sit, D. K. Y., . . . Moses-Kolko, E. (2006). Postpartum depression: A randomized trial of sertraline versus nortriptyline. Journal of Clinical Psychopharmacology, 26(4), 353-360. doi: 10.1097/01.jcp.0000227706.56870.dd
  20. Stowe, Z. N., Casarella, J., Landry, J., Nemeroff, C. B. (1995). Sertraline in the treatment of postpartum major depression. Depression, 3(1), 49-55. Retrieved from http://onlinelibrary.wiley.com.libproxy.lib.unc.edu/doi/10.1002/depr.3050030109/pdf
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  23. Yonkers, K. A., Lin, H., Howell, H. B., Heath, A. C., & Cohen, L. S. (2008). Pharmacologic treatment of postpartum women with new-onset major depressive disorder: A randomized controlled trial with paroxetine. Journal of Clinical Psychiatry, 69(4), 659-665. doi: 10.4088/JCP.v69n0420
  24. Dennis, C. (2003). The effect of peer support on postpartum depression: A pilot randomized controlled trial. Canadian Journal of Psychiatry, 48(2), 115. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=aph&AN=9216413&site=ehost-live&scope=site
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  26. Posmontier, B. (2008). Sleep quality in women with and without postpartum depression. JOGNN, 37(6), 722-737. doi: 10.1111/j.1552-6909.2008.00298.x
  27. Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., Lichstein, K. L. (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004). Sleep, 29(11), 1398-1414. Retrieved from http://www.aasmnet.org/Resources/PracticeParameters/Review_Insomnia.pdf
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  29. Rivières-Pigeon, C., Séguin, L., Goulet, L., & Descarries, F. (2001). Unravelling the complexities of the relationship between employment status and postpartum depressive symptomatology, Women & Health, 34(2), 61-79. doi: 10.1300/J013v34n02_05
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Last Updated August 3, 2011