Intervention and treatment

The approach to perinatal depression should be comprehensive, personalized and focused on the well-being of both mother and baby. Early intervention and appropriate treatment can prevent serious outcomes and promote healthy mother-infant bonding.

This approach includes psychoeducation, emotional support, psychotherapy, the use of safe psychotropic drugs and complementary therapies that contribute to the overall well-being of the patient.

Psychoeducation and emotional support

Psychoeducation is the cornerstone of any initial intervention. Informing the mother and her support network about the symptoms, causes, and treatment options for perinatal depression helps reduce stigma and encourages her to seek help.

It is essential to convey that this is an illness, not a personal failure, and that effective treatments are available. Involving the partner or support network in this process improves treatment adherence and prognosis. It is recommended to reinforce the idea that “a mother who asks for help is a mother who cares.”

Individual psychotherapy

In mild to moderate cases, psychotherapy is the first-line treatment. Cognitive behavioral therapy (CBT) has been shown to be effective in reducing depressive and anxiety symptoms, addressing cognitive distortions, and improving stress management.

Psychodynamic approaches may also be used, especially in women with unresolved conflicts, complex family ties, or previous traumatic experiences. In all cases, the therapeutic relationship should be based on empathy, emotional validation, and respect for the maternal process.

Safe pharmacotherapy during pregnancy and breastfeeding

In moderate to severe cases, with psychotic symptoms or suicidal ideation, pharmacological treatment should be considered. The decision must be individualized, weighing the risks and benefits for both the mother and the fetus or infant.

Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, fluoxetine, and escitalopram are the most commonly used drugs due to their efficacy and safety profile. Sertraline is the antidepressant of choice during both pregnancy and breastfeeding. If anxiolytics are required, lorazepam can be used at low doses, especially to treat insomnia.

Some atypical antipsychotics such as quetiapine are also considered safe. Drugs with good evidence, low bioavailability in breast milk, and a short half-life are always preferred.

Paroxetine is avoided during pregnancy, and clozapine and lepromine are not recommended due to their adverse effects. It is essential to accompany any pharmacotherapy with clinical monitoring and pediatric guidance.

Adjunctive therapies: sleep, mindfulness, and breastfeeding

Sleep hygiene is essential in the management and prevention of perinatal depression. Sleeping at least 4 hours continuously per night significantly reduces depressive symptoms. Therefore, it is vit