A Call for Better Guidance and Treatments for Comorbid Postpartum Depression and Substance Use Disorders

Postpartum depression is a serious, but treatable condition experienced after childbirth. While most cases do not involve excess substance use, alcohol and other substance use have been strongly associated with this condition. While serotonergic antidepressants have been a mainstay of pharmacologic therapy for postpartum depression, studies of antidepressant use in postpartum depression have largely excluded those with substance use disorder, and meta-analyses suggest antidepressants offer limited benefit in those with depression and co-occurring substance use disorder. There is also under-appreciated literature demonstrating the potential for a medication-mediated increase in substance use in some individuals taking serotonergic antidepressants. These facts and an examination of guideline recommendations on the treatment for postpartum depression highlight the need for new research and practice improvements for patients with comorbid substance use disorder and postpartum depression.