April 14, 2026

Pharmacologic Treatment of Postpartum Depression: What Happens in the Real World?

Postpartum Depression, Postpartum Psychiatric Disorders, Treatment

New data reveal that while most women with postpartum depression start antidepressant treatment, many discontinue treatment early—highlighting persistent gaps in postpartum care.

MGH Center for Women's Mental Health

In This article

Two large U.S. claims databases analyzed treatment patterns for postpartum depression (PPD).
Most women with PPD filled an antidepressant prescription after diagnosis.
Discontinuation rates were high, with many stopping treatment within 60 days.
Obstetric providers often initiate prescriptions, but continuity of care remains a challenge.
New initiatives like STEPS for PPD aim to improve screening and sustained access to care.

Current guidelines recommend psychotherapy for milder symptoms of postpartum depression (PPD) and the addition of antidepressant medications for those with moderate to severe symptoms. First-line treatments include SSRIs and SNRIs, which are effective not only for depression but also for generalized anxiety and OCD symptoms that often co-occur with PPD. The use of neurosteroid antidepressants–brexanolone and zuranolone–may be considered for individuals with more severe depressive symptoms.

While this treatment algorithm appears fairly straightforward, real-world practice often diverges from recommendations. A recent study examines treatment patterns using data from two large claims databases in the United States.

The researchers evaluated two cohorts of patients diagnosed with PPD within 180 days of delivery between October 2015 and January 2022 using two U.S. claims databases: Symphony Health (SH) and Myriad Genetics-Komodo Health (MGKH). The SH cohort included over 4 million patients with evaluable claims data; the MGKH cohort included 198,419 patients. ICD codes identified those with a documented diagnosis of PPD. Using pharmacy claims, the researchers recorded prescription fills for specific psychiatric medications within 365 days after the PPD diagnosis.

The prevalence of PPD was 3.3% in the SH cohort and 13.4% in the MGKH cohort. It is unclear why prevalence differed so widely between the two cohorts. Considering that PPD prevalence typically ranges from 10% to 15%, the lower rate in SH may reflect underdiagnosis or incomplete capture of PPD in claims data.

Good News: Most patients with PPD (SH: 64.9%, MGKH: 76.4%) filled at least one prescription for a psychotropic medication in the year following diagnosis. This is encouraging, as earlier studies have reported far lower treatment rates for PPD. In both cohorts, selective serotonin reuptake inhibitors (SSRIs) comprised 72.2% of first-line treatments following PPD diagnosis, with sertraline being the most commonly prescribed first-line SSRI (39.4% in SH and 41.4% in MGKH).

Bad News: The majority of patients treated with antidepressants did not receive a full course of treatment. Discontinuation rates were high, with 76.4% (SH) and 62.7% (MGKH) stopping treatment at least once. In particular, 38.5% of the SH cohort and 27.8% of the MGKH cohort discontinued medications after an initial treatment episode of 60 days or less. Additionally, 21.3% (SH) and 14.7% (MGKH) filled only a single prescription after diagnosis.

Medication changes were also frequent: 16.6% (SH) and 18.3% (MGKH) of treated patients filled three or more prescriptions for unique psychiatric medications, suggesting switching or augmentation strategies.

Room for Improvement

While PPD is common, previous studies have shown low rates of treatment initiation. The current study, however, suggests improvement—at least two-thirds of patients with PPD began treatment with an antidepressant. Nevertheless, most did not receive an adequate course of antidepressant treatment, as discontinuation rates remained high. Because claims data cannot identify reasons behind discontinuation, understanding these gaps requires additional research.

Several possible explanations include:

Continuity of care: In the MGKH cohort, most prescriptions were initiated by obstetric providers. Patients may begin treatment while receiving obstetric care but may struggle to transition care to a primary care or mental health provider for continued management.
Inadequate support: Claims data do not provide information on psychosocial supports or concurrent psychotherapy. Lack of support—especially during the early weeks before antidepressants take effect—may make it more difficult for patients to continue treatment.
Expertise in perinatal mental health: It is unclear whether prescribers had specific training in perinatal mental health. First-line treatment should include an SSRI or SNRI, which appears consistent with the findings of this study; however, we lack information on dosing, side effect management, or patient education. These are important factors that could affect adherence to treatment.

STEPS for PPD

Rachel Vanderkruik, PhD, and colleagues from the Center for Women’s Mental Health at MGH recently launched a research study: the Screening and Treatment Enhancement Program for Postpartum Depression, or STEPS for PPD. This initiative will evaluate how screening and treatment pathways function for women who screen positive for PPD across the Mass General Brigham (MGB) hospital system. Working with multiple obstetric clinics, the project will examine clinical and treatment outcomes following postpartum screening and explore barriers and facilitators to care.

STEPS builds on a previous smaller study investigating PPD screening, referral, and treatment systems. Ultimately, the goal is to ensure that all patients are screened for PPD after delivery and, if they screen positive, are referred for appropriate care. The study’s findings will help identify factors associated with utilization of treatment services and inform strategies to improve access and adherence for future patients.