Treatment of PMD

Until recently, the treatment of PMD (postpartum major depression) has not been a subject of research because 
most investigators and clinicians have considered PMD too (dans ce cas : trop) similar to its nonpuerperal 
counterpart to warrant such investigation. The most compelling (qui s'impose) reason that this topic is now 
being addressed is preclinical and clinical evidence that sex steroids have pronounced effects on the central 
nervous system, including the areas responsible for mood and cognition. Moreover, the observation that women 
become depressed at twice the rate of men and are particularly vulnerable at times of hormonal fluctuation 
suggests that depression occurring at such times may be, in part, hormonally driven (induit). Because of this 
association, several investigators have examined the role of estrogen in the treatment and prophylaxis of PMD. 
However, results of these studies, which support the hypothesis that puerperal psychiatric disorders may be 
triggered in part by estrogen withdrawal, must be replicated before estrogen replacement can be recommended 
in the treatment or prophylaxis of puerperal affective disorders.

In the meantime, despite few controlled studies, the treatment of PMD is based on that of nonpuerperal 
depression. Psychotherapy or pharmacotherapy may be used alone or in combination. Because no modality has 
been shown to be superior to any other, some authors argue that the choice of therapy, pharmacologic and/or 
psychotherapeutic, for mild to moderate PMD may be left to the patient.

Psychotherapy
Because of the relative dearth (pénurie, absence marquée) of information regarding the safety of antidepressant 
use during lactation, many women may understandably choose a nonpharmacologic form of treatment to avoid 
exposing their infant to psychotropic medication. Interpersonal therapy is a form of psychotherapy that may be 
particularly suitable for use in postpartum women because it focuses on the patient's interpersonal 
relationships and changing roles. Marital counseling is warranted (être fortement recommandé) when marital 
conflicts are distressing and perhaps contributing to the woman's depression. At the least, spouses and 
significant others should be educated about the nature and treatment of PMD and what they can do to find 
support for themselves and their loved ones during this stressful time. 

Antidepressant Therapy
Although it is arguable that all women with PMD should seek (rechercher) some type of counseling, a woman 
whose depression is persistent or so severe that she is having difficulty taking care of herself or functioning as 
a mother, or is having thoughts of harming herself (se faire du mal - physiquement) or her child should be 
evaluated for antidepressant treatment. Frequently, PMD is accompanied by severe anxiety, agitation, or both. 
Although benzodiazepines may be used to treat anxiety, it is important to consider them as an adjunct to 
antidepressants because they are not effective in alleviating (soulager) the core symptoms of depression.