5 Signs You Should Change Your Postpartum Depression Treatment

Treatment options for postpartum depression (PPD) may include psychotherapy (talk therapy), medication, lifestyle changes, or a combination of these approaches. The right treatment can take some trial and error to find, and what works well for one person may not be the right fit for another.

Your first treatment plan may not be your final one, and your healthcare provider may make adjustments along the way. They may do this if your symptoms aren’t improving or are worsening, if a prescribed medication is causing difficult side effects, or the type of therapy you’re receiving isn’t resonating with you.

Here are five signs it may be time to talk with your healthcare provider about adjusting your PPD treatment. Don’t stop a medication, change your dose, or alter your treatment plan on your own without consulting your healthcare team first.

1. Symptoms Aren’t Improving — or Are Getting Worse

If you’ve given medication a few weeks to take effect and your symptoms haven’t improved, it’s worth speaking up, says Laudy Burgos, LCSW, a board member of Postpartum Support International and the associate director of social work in the women’s and children’s division at Mount Sinai Hospital in New York City.

“If you tell me six to eight weeks into treatment that how you’re feeling is the same, that’s not a good sign,” Burgos says.

There’s also an important caveat when medication is involved: Medication hasn’t necessarily “failed” unless it’s been taken at an appropriate therapeutic dose for long enough to have its intended effect, says Lulu Zhao, MD, an obstetrician-gynecologist and the codirector of women's behavioral health at the Cleveland Clinic, where she specializes in mood disorders during key reproductive transitions, such as pregnancy and postpartum. Starting doses are often intentionally lower to limit initial side effects, which are common with antidepressants, and your provider will likely increase your dose shortly afterward, she says.

If you’re not feeling better after several weeks or months, let your doctor know. They can help you determine whether you need to give the medication more time to work, a dosage adjustment, another medication, or a completely different approach.

And if your symptoms suddenly worsen at any point after starting a medication, especially if you feel significantly more anxious or unable to sleep, tell your doctor immediately. Those may be signs it might not be the right medication for you. “If you’re telling me you’re sadder, you’re more anxious, you’re more hopeless, you’re having difficulty functioning, or you can barely function, that’s concerning,” Burgos says.

2. You Feel Better — but Only Partially

Feeling better is encouraging, but some improvement doesn’t mean your PPD is fully treated. If you’re noticeably better but still experiencing sadness, anxiety, difficulty coping, or other lingering symptoms, tell your healthcare provider.

“You’re not in remission just because you’re better than you were,” Zhao says. For example, she says, she often sees patients who return to their usual responsibilities, but feel like small stressors may be enough to worsen their PPD symptoms. “You shouldn’t feel like you’re functioning but like it takes just one thing to break the camel’s back,” she says.

That said, this doesn’t mean you should abandon a treatment plan that’s helping. Instead, your provider may recommend continuing it longer or adjusting part of the plan to help you reach full recovery. In some cases, this may involve adding resources, such as a support group with other postpartum moms, rather than replacing what’s working, Burgos says.

3. Medication Side Effects Are Hard to Tolerate

Side effects are common when starting antidepressants. With selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed antidepressants, you may encounter gastrointestinal upset, increased anxiety or feeling “amped up,” and vivid dreams, Zhao says.

“When you have persistent side effects that don’t seem to be an initiation side effect and that can’t be ameliorated by treatment tweaking, that might be a sign that you should try a different medicine,” she says.

Don’t make changes to your medication yourself. “I do recommend that you talk to your doctor before you decide yourself to stop something,” Zhao says. Sometimes, an adjustment as simple as changing the time of day you take the medication may address a problem.

4. Therapy Isn’t Resonating With You

The relationship you have with your therapist matters. In some cases, you may feel like your therapist isn’t listening, their style doesn’t suit you, or the specific type of therapy isn’t clicking.

“The first psychotherapist you find is not necessarily the best match for you, and that’s just like medicine,” Zhao says. “If the first medicine doesn’t work, you should try a different medicine or a different therapist.”

Before immediately switching your therapist or type of therapy, consider telling your therapist what you feel isn’t working. “If you don’t like the way your therapist is approaching things, you think they’re not giving you enough directed guidance, you think they’re too validating, not validating enough, you should just tell them directly,” Zhao says.

Sometimes adjustments can be made between a provider and patient. If it still doesn’t feel right, changing therapists or trying another form of therapy may make sense for you.

5. You’re Having Thoughts of Suicide, Self-Harm, or Harming Your Baby

“If someone wants to hurt themselves or they’re talking about harming their baby, to me, that’s a psychiatric emergency,” Burgos says. “And it requires immediate treatment. That is not something that I would wait to see my therapist in a few days or next week.”

You shouldn’t have to determine how serious the situation is on your own; err on the side of caution, says Zhao. “If you feel you’re experiencing psychosis or hallucinations or thoughts that seem bizarre to you, you should let a medical professional know,” she says.

In severe cases, a higher level of treatment may be necessary. Options can include inpatient hospitalization, intensive outpatient programs, or partial hospitalization programs, depending on a person’s symptoms and safety needs, says Burgos.