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Gaps in Postpartum Depression Diagnosis, With Deb York, PMHNP-BC
Psychiatrists at the 2025 So Cal Psych Conference shared evidence-based tools and therapies to improve mental health outcomes for new mothers.
At the 2025 Southern California Psychiatry (So Cal Psych) Conference in Huntington Beach, CA, psychiatrists Deb York, PMHNP-BC, APRN, CCRA, and Melanie Barnett, MD, presented during the session, “Addressing Postpartum Depression: Are We Providing Timely and Appropriate Psychiatric Care to New Mothers” on Saturday, July 12.
Barnett, a psychiatrist at LifeStance Health, presented on pharmacologic and nonpharmacologic therapy for postpartum depression. York, a psychiatric board-certified nurse practitioner and the director of clinical research & development at Mountain Mind, presented on screening and diagnosis for this mental health condition.
During an on-site interview, York shared what the first thing a clinician should do when a new mother comes to their clinic with depression symptoms. She provides the example of a patient with bipolar disorder.
“This may be a first in the event that they're psychotic, or in the event that they're depressed, we need to know what kind of depression they have,” York said. “Is it a unipolar depression? Is it a bipolar depression that's been undiagnosed? So, we'd like to know what that is because we use different medications for both of those. In the event that they're psychotic, obviously they may need a higher level of care, being hospitalized as well.”
It was shared during the session that bipolar disorder has been misdiagnosed as polar depression in ≥ 40% of cases. 1 in 5 women diagnosed with depression may actually have bipolar disorder.
If a patient does, indeed, have postpartum depression, treatment options include brexanolone, administered via an IV, and zuranolone, an oral GABA-positive allosteric modulator approved by the US Food & Drug Administration (FDA) on August 4, 2023.2 Another treatment option is allopegnanolone, a neurosteroid.
Exercise can be beneficial for postpartum depression. Mothers can take their babies and do exercises that strengthen the pelvic floor or complete mindfulness-based meditation to reduce stress. Although this does not help postpartum depression specifically, breath work stimulates the vagus nerve and triggers the parasympathetic nervous system to promote relaxation.
New mothers could also try red light therapy, which improves serotonin levels, mental melatonin production, and circadian rhythms. Electroconvulsive therapy has shown promise for postpartum depression in clinical trials, specifically for psychotic features; however, it is not approved and has common adverse events, such as memory impairment, confusion, headache, and nausea.
Transcranial Magnetic Stimulation also showed promise for postpartum depression, also not FDA-approved for this indication.
It was also recommended for patients to check out the site babycenter.com, which is updated with evidence-based practice, and to prioritize sleep and a good nighttime routine (no caffeine before bed, no TV in the room, no horror movies before sleep). Clinicians should tell their patients to have a partner or a family member watch the baby so they can sleep. It can also help to reduce noise and clutter in the home.
One of the psychiatrists at the event said she does not increase the medication dose unless they are symptomatic while pregnant. Some women may need to be medicated during their pregnancy, although medications should be discussed in advance. Some women experience body dissatisfaction, and poor body image can be a predictor of depression and anxiety.
York has been seeing more and more patients being referred from an OBGYN to psychiatric clinics. When asked if she follows up with the doctors to see how the patient is doing, she said, “Absolutely.” She educates OBGYNs on the medication their patient are on and how easy it is for new mothers to obtain this treatment after delivery.
For clinicians nervous about treating a patient after a pregnancy due to changing hormones, York would tell them: “[Just] be patient. Our world is so instant…take this time to be with [yourself], be with baby, and…take that time to enjoy this incredible experience of creating life.”
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