PPD Evaluation & Medication Management

Postpartum Depression Evaluation & Medication Management

Postpartum depression often requires medication management alongside other treatments. At KwikPsych, Dr. Monika Thangada, MD, provides comprehensive psychiatric evaluation and expert medication management for postpartum depression, with special attention to safety during breastfeeding.

Whether you're struggling with depression in the first weeks after birth or months into the postpartum period, our evidence-based medication approach can provide relief and support recovery.

Why Medication Evaluation Is Important for Postpartum Depression

For moderate to severe postpartum depression, or when therapy alone is insufficient, antidepressant medication is a critical component of treatment. Untreated postpartum depression can have serious consequences—affecting maternal health, mother-infant bonding, infant development, and family functioning.

Medication management requires expertise in:

• Selecting antidepressants with the best safety profile during breastfeeding
• Starting at appropriate doses and adjusting carefully
• Managing side effects
• Monitoring infant exposure and safety
• Recognizing when medications need adjustment or switching
• Supporting medication adherence and managing concerns

Dr. Thangada brings specialized knowledge of postpartum psychiatry and medication management specifically tailored to the postpartum period.

Comprehensive Postpartum Depression Evaluation

The foundation of effective medication management is accurate diagnosis through comprehensive psychiatric evaluation.

Complete Assessment Components

1. Detailed Symptom History

• When depression began (exact timeline)
• How symptoms have progressed and worsened
• Current symptom severity and impact
• Previous episodes of depression or anxiety
• Seasonal patterns (if applicable)
• Specific depressive symptoms present (mood, guilt, concentration, energy, sleep, appetite, suicidal thoughts)

2. Screening Tool Administration

• Edinburgh Postnatal Depression Scale (EPDS): 10-item standardized screening tool for postpartum depression specifically; score guides severity assessment
• Patient Health Questionnaire-9 (PHQ-9): 9-item depression severity scale; score 0-27 helps determine mild, moderate, or severe depression
• Generalized Anxiety Disorder-7 (GAD-7): Assesses anxiety symptoms (common alongside postpartum depression)
• Columbia-Suicide Severity Rating Scale (C-SSRS): Detailed suicide risk assessment if indicated

3. Psychiatric and Medical History

• Previous depressive episodes (age of onset, severity, treatment response)
• History of bipolar disorder, anxiety disorders, or psychosis
• Family history of mental illness
• Previous medication trials: which medications worked, which didn't, side effect profile
• Medical conditions affecting mood (thyroid disease, anemia, autoimmune conditions)
• Current medical medications
• Substance use history
• Previous psychiatric hospitalizations or crisis interventions

4. Peripartum Context Assessment

• Complications during pregnancy (gestational diabetes, preeclampsia, bed rest)
• Labor and delivery experience (traumatic birth, emergency C-section, need for interventions)
• Infant health status (premature birth, NICU stay, health complications)
• Infant feeding: breastfeeding, formula feeding, combination (crucial for medication selection)
• Breastfeeding goals and concerns about medication exposure
• Sleep patterns: both maternal sleep deprivation and infant sleep

5. Psychosocial Context

• Relationship quality with partner (supportive, conflicted, absent)
• Partner's mental health and engagement
• Family and social support availability
• Financial stress
• Housing stability
• Recent major stressors (death, loss, relocation, job loss)
• Isolation or limited social contact
• Cultural or religious factors affecting treatment preferences

6. Safety Assessment

• Direct questions about suicidal ideation: Have you thought about harming yourself?
• Suicidal planning: Do you have a plan? Access to means?
• Thoughts of harming the baby: Have you had thoughts about hurting your baby?
• Homicidal ideation: Are you having thoughts about harming others?
• Previous suicide attempts or self-harm
• Protective factors that reduce risk (reasons to live, responsibility for baby, social support)

7. Symptom-Specific Inquiries

• Intrusive thoughts (common in postpartum depression): Unwanted thoughts about harm coming to baby, preoccupation with infant safety
• Obsessive concerns: Repetitive worry, need for reassurance, checking behaviors
• Anxiety and panic: Panic attacks, phobias, generalized worry
• Irritability and anger: Difficulty with infant crying, partner conflicts, verbal aggression
• Physical symptoms: Aches, pains, stomach problems (depression often manifests physically)

8. Physical Examination

• General observation of hygiene, appearance, behavior (signs of neglect suggest severity)
• Vital signs
• Neurological examination (if indicated)
• Assessment for obvious medical causes (enlarged thyroid suggesting thyroiditis)

9. Medical Workup

• Thyroid Function Tests (TSH, Free T4): Postpartum thyroiditis can mimic depression; must be ruled out
• Complete Blood Count (CBC): Anemia (common postpartum) can cause fatigue and depression symptoms
• Comprehensive Metabolic Panel: Assesses kidney, liver function; identifies electrolyte imbalances
• Vitamin B12 and Folate Levels: Deficiency associated with depression
• Iron Studies: Postpartum anemia affects energy and mood

Outcome of Evaluation: Detailed diagnosis, severity assessment, identification of any complicating medical conditions, and informed recommendation for treatment approach.

Medication Selection for Postpartum Depression

Once diagnosis is confirmed, medication selection depends on several factors. We use evidence-based guidelines informed by decades of clinical experience with postpartum women.

Factors Guiding Medication Choice

1. Previous Medication Response

• If you responded well to a specific antidepressant before pregnancy or previously, we typically continue that medication
• Changing medications introduces risk of poor response
• Consistency provides better chance of therapeutic benefit

2. Breastfeeding Status and Goals

• This is paramount in medication selection
• We discuss your breastfeeding plans, concerns, and timeline
• Extensive safety data guides selection of lowest-exposure options
• Breastfeeding should not be discouraged due to medication; benefits typically outweigh small risks

3. Symptom Profile

• Pure depression: SSRIs typically adequate
• Depression + anxiety: SNRIs, SSRIs with anxiolytic properties, or SSRIs + anti-anxiety medication
• Depression + severe insomnia: Medications with sedating properties (mirtazapine, tricyclics)
• Depression + poor appetite/weight loss: Medications that don't suppress appetite

4. Side Effect Tolerability

• Sexual dysfunction concerns: Bupropion or mirtazapine preferable
• Weight gain concerns: SSRIs or bupropion better tolerated
• Sedation desired (for insomnia): Mirtazapine, tricyclics
• Activation needed (for lethargy): SSRIs, bupropion, SNRIs
• Nausea concerns: Start with food, choose medications less likely to cause nausea

5. Medical Comorbidities

• Cardiac history: Avoid tricyclics, some SSRIs; choose safer options
• Seizure history: Avoid bupropion (lowers seizure threshold)
• Liver disease: Metabolism affected; dose adjustments needed
• Chronic pain: SNRIs, tricyclics may help both depression and pain

6. Infant Safety Considerations

• Relative infant dose (% of maternal dose entering breast milk)
• Infant serum concentrations reported in studies
• Long-term safety data (years of experience vs. newer medications)
• Need for pediatric monitoring

First-Line Antidepressants for Postpartum Depression

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are first-line antidepressants for postpartum depression, particularly in breastfeeding women, due to extensive safety data and efficacy.

Sertraline (Zoloft) - Most Recommended for Postpartum/Breastfeeding

Why Sertraline Is Our Top Choice:

• Minimal infant exposure through breast milk (relative infant dose <0.5%)
• Lowest infant serum concentrations of all SSRIs
• Decades of clinical experience specifically in postpartum women
• Rapid onset (improvement often by week 2-3)
• Once-daily dosing
• Well-tolerated side effect profile
• Reversible side effects (can stop if needed)
• Safe across dose range

Dosing and Timeline:

Starting Phase (Week 1-2)

• Initial dose: 50 mg once daily
• Timing: Take same time each morning (morning dosing may reduce insomnia risk; some patients prefer evening)
• Food: Can take with or without food (take with food if nausea occurs)
• Expected effects: Possible mild side effects (nausea, nervousness, headache); no significant mood change expected yet

Adjustment Phase (Week 2-4)

• Increase by 50 mg every 5-7 days if tolerated and insufficient response
• Typical dose range: 50-200 mg daily
• 75-100 mg is effective for many patients with moderate depression
• 150-200 mg needed for some patients
• Monitor for side effects and early signs of response (slight mood lift, improved energy)

Response Phase (Week 4-8)

• Week 4: Assess response; if inadequate, increase dose
• Week 6: Most patients show noticeable improvement by this point
• Week 8: Adequate trial at therapeutic dose (8 weeks minimum to assess full effectiveness)
• If insufficient response at week 8, discuss with Dr. Thangada: increase dose further, add medication, switch medications, or consider other factors

Maintenance (Week 8+)

• Continue therapeutic dose once remission achieved
• Typical duration: 6-12 months minimum for first postpartum depression episode
• Longer duration for recurrent depression or if previous episodes
• Don't discontinue abruptly (taper gradually to avoid withdrawal symptoms)

Side Effects and Management:

When Side Effects Persist:

• Most resolve within first week
• If significant side effects persist beyond 2 weeks: reduce dose slightly, adjust timing, or consider switching medications
• Don't stop abruptly without discussing with Dr. Thangada

Breastfeeding Safety Profile:

• Relative infant dose: <0.5% (minimal)
• Infant serum concentrations: Usually undetectable
• Safety data: Decades of clinical use; no serious adverse effects reported in infants
• Preferred choice by American Academy of Pediatrics, American Psychiatric Association
• Coordinate with infant's pediatrician for baseline assessment and monitoring

Long-Term Monitoring During Breastfeeding:

• Establish baseline infant behavior, feeding, alertness, sleep
• Monthly assessment for: irritability, agitation, crying, feeding problems, sleep disturbances
• If adverse effects suspected, contact Dr. Thangada and pediatrician
• Routine infant serum drug levels not recommended; helpful if adverse effects present

Stopping Sertraline:

• Do not stop abruptly (can cause withdrawal symptoms)
• Taper gradually over 2-4 weeks by reducing dose every 5-7 days
• Discuss timing of discontinuation with Dr. Thangada
• Consider continuing at least 6-12 months to reduce relapse risk

Paroxetine (Paxil) - Alternative First-Line SSRI

When to Consider Paroxetine:

• Very low breastfeeding exposure (relative infant dose <0.5%)
• Good efficacy
• Consider if: sertraline ineffective, previous positive paroxetine response

Drawbacks:

• Discontinuation syndrome more common than with other SSRIs (withdrawal if stopped abruptly)
• Sexual dysfunction more frequent than sertraline
• Weight gain slightly more common

Dosing: 20-60 mg daily

Citalopram (Celexa) or Escitalopram (Lexapro) - Alternative SSRIs

When to Consider:

• Slightly more infant exposure than sertraline/paroxetine but still low
• Good efficacy
• Consider if sertraline/paroxetine not tolerated
• Escitalopram slightly more potent than citalopram

Dosing: Citalopram 20-40 mg daily; Escitalopram 10-20 mg daily

Fluoxetine (Prozac) - Less Preferred Initially

When to Consider:

• Longer half-life provides buffer if dose missed (benefit for adherence issues)
• Consider if: previous positive fluoxetine response
• Lower priority initially due to longer half-life = more infant accumulation

Dosing: 20-60 mg daily

Why Not First-Line: Longer half-life (24-72 hours) means drug accumulates in infant system over time; higher infant serum concentrations than sertraline.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are second-line options, typically used when SSRIs ineffective or additional benefits desired.

Venlafaxine (Effexor)

• Useful when depression + anxiety both present
• Higher breastfeeding exposure than SSRIs (infant serum levels more detectable)
• Consider if: SSRI inadequate, co-morbid anxiety disorder, previous positive venlafaxine response
• Dosing: 75-375 mg daily in divided doses

Desvenlafaxine (Pristiq) - Active metabolite of venlafaxine

• Slightly lower breastfeeding exposure than venlafaxine
• Similar indications
• Dosing: 50-400 mg daily

Atypical Antidepressants - Special Scenarios

Bupropion (Wellbutrin)

• No sexual dysfunction (advantage for some patients)
• Activating (helps if lethargy severe)
• Low breastfeeding exposure
• Caution: Lowers seizure threshold; avoid if seizure history
• Consider if: SSRI sexual dysfunction problematic, additional energy needed
• Dosing: 300-450 mg daily in divided doses

Mirtazapine (Remeron)

• Sedating (helpful if severe insomnia)
• Stimulates appetite (helpful if poor appetite/weight loss)
• Safe during breastfeeding
• Weight gain possible concern
• Consider if: severe insomnia, poor appetite, anxiety prominent
• Dosing: 15-45 mg daily, often given at bedtime

Tricyclic Antidepressants - Historical Options

Amitriptyline, Nortriptyline

• Less commonly used first-line due to side effects
• Sedating (helpful for insomnia)
• Safe during breastfeeding
• Side effects: dry mouth, constipation, weight gain, sedation
• Consider if: SSRIs ineffective, previous positive tricyclic response, severe insomnia
• Dosing varies widely

Rapid-Acting Novel Treatments

Brexanolone (Zulresso)

• FDA-approved specifically for postpartum depression (2019)
• Mechanism: GABA_A receptor positive allosteric modulator; mimics natural neurosteroid changes in pregnancy
• Administration: 60-hour IV infusion in hospital or clinic setting
• Onset: Rapid (24-48 hours)
• Efficacy: Significant symptom reduction within first 3-5 days
• Breastfeeding: Safety profile appears favorable; careful coordination with pediatrician recommended
• Use when: severe depression with suicidal ideation where rapid response critical; hospitalization beneficial
• Limitation: Requires hospitalization; cost; limited availability

Zuranolone (Zurzuvae)

• FDA-approved 2023
• Oral version of brexanolone
• Administration: 14-day oral course
• Onset: Rapid (within 3-5 days)
• Breastfeeding: Safety profile appears favorable; needs discussion
• Major advantage: Oral, no hospitalization required, rapid onset
• Emerging option representing significant advancement

Medication Management Process at KwikPsych

Initial Medication Appointment

What Happens:

1. Comprehensive evaluation (as outlined above)
2. Discussion of treatment options
3. Recommendation for specific medication and dosing
4. Education about expected timeline to improvement
5. Detailed discussion of potential side effects
6. Breastfeeding safety information provided
7. Prescription provided with clear instructions
8. Contact instructions for questions or concerns

Time Needed: 60-90 minutes

Follow-Up Contact: Phone contact within 5-7 days to check tolerability

Week 1-2: Medication Initiation

Your Responsibilities:

• Start medication as prescribed
• Take consistently, same time daily
• Monitor for side effects
• Document any reactions (helpful for Dr. Thangada)
• Call if experiencing severe side effects or concerns

Dr. Thangada's Monitoring:

• Phone contact 5-7 days after starting
• Assess tolerability
• Reassure about expected side effects (most resolve within 1 week)
• Discuss plan for dose increase if tolerating well
• Adjust timing if side effects bothersome (e.g., change to morning dosing for insomnia)

Week 2-4: Dose Adjustment Phase

What Happens:

• Dose increased gradually (every 5-7 days if tolerating)
• Continue monitoring for side effects
• Watch for early signs of improvement (slight mood lift, increased energy, better sleep)
• Regular phone or in-office check-ins

Your Responsibilities:

• Take medication exactly as prescribed
• Note any changes in symptoms or side effects
• Communicate concerns to Dr. Thangada
• Continue other treatments (therapy, lifestyle modifications)

Dr. Thangada's Role:

• Assess response and tolerability
• Increase doses as needed
• Educate about expected timeline (improvement often by week 3-4)
• Adjust plan based on feedback

Week 4-8: Response Assessment Phase

Key Milestone: Week 8 assessment determines if medication working adequately

What Happens:

• In-person or telehealth appointment with Dr. Thangada
• Formal symptom assessment using PHQ-9 or EPDS scores
• Comparison to baseline assessment
• Discussion of response adequacy

Three Scenarios:

Scenario 1: Good Response (60%+ symptom reduction)

• Continue current dose
• Schedule maintenance appointment
• Continue psychotherapy
• Plan for long-term treatment

Scenario 2: Partial Response (30-60% improvement)

• Options: increase dose, add medication, or continue with current dose if improvement continuing
• Discuss pros/cons of each approach
• Plan reassessment in 2-4 weeks

Scenario 3: Inadequate Response (less than 30% improvement)

• Assess medication adherence (are you taking it as prescribed?)
• Assess for other diagnoses: bipolar disorder, anxiety disorder, medical causes (thyroid, anemia)
• Options:
• Increase dose (if not at maximum)
• Switch to different medication
• Add another medication
• Consider other treatments (hospitalization if severe/unsafe)
• Discuss with Dr. Thangada

Week 8-12: Optimization Phase

If Adequate Response Achieved:

• Continue current medication dose
• Space appointments to every 4-6 weeks
• Maintain psychotherapy
• Monitor for sustained improvement
• Discuss timeline for continuing medication (typically 6-12 months minimum)

If Adjustment Needed:

• Change implemented (dose increase, medication switch, addition)
• Reassessment in 2-4 weeks
• New cycle of evaluation and optimization

Ongoing Maintenance (3+ Months)

Typical Schedule:

• Monthly appointments during first 3 months
• Every 6-8 weeks during months 3-12
• Every 3-6 months if continuing beyond 1 year
• More frequent if new symptoms or concerns

What Happens at Maintenance Visits:

• Symptom assessment (residual symptoms? any worsening?)
• Side effect assessment
• Medication adherence check
• Medication refills
• Psychotherapy coordination
• Planning for continuation vs. discontinuation as treatment goes on

Duration of Treatment:

• Minimum 6 months at therapeutic dose after remission
• Longer (12+ months) recommended for moderate to severe episodes
• Much longer if previous depressive episodes or risk of recurrence
• Discuss individual plan with Dr. Thangada

Managing Breastfeeding While on Antidepressants

Coordinated Care with Pediatrician

When medication used during breastfeeding:

• Dr. Thangada notifies infant's pediatrician
• Pediatrician conducts baseline infant assessment
• Establishes monitoring plan for infant
• Communicates any concerns about infant behavior

Infant Monitoring Schedule

Typical monitoring by pediatrician:

• Baseline (before maternal medication starts or shortly after):
• Establish normal infant behavior, feeding patterns, sleep, alertness
• Physical examination
• Record baseline observations

• Monthly During First 3 Months:
• Office visit or phone check-in
• Assess for: irritability, agitation, crying, feeding problems, poor weight gain, sleep disturbances
• Measure weight gain
• Physical examination if indicated

• As-Needed Assessment:
• If any concerning symptoms, contact pediatrician and Dr. Thangada immediately
• Potential adverse effects: jitteriness, tremor, poor feeding, excessive crying, sleep problems
• If adverse effects suspected, may reduce/suspend breastfeeding to determine if medication-related

Protecting Sleep While Breastfeeding

Sleep deprivation is major risk factor for postpartum depression exacerbation. Strategies to protect maternal sleep:

• Partner does one designated nighttime bottle-feeding
• Mother pumps during day; partner gives expressed milk at night
• If inadequate pumped supply, formula for nighttime bottle is acceptable
• Goal: Mother gets one uninterrupted 4-5 hour sleep block
• Breastfeeding can continue with this arrangement

Timing and Breast Milk "Discarding"

Myths to Ignore:

• Taking medication "right after nursing" reduces infant exposure: Not supported by evidence
• Discarding breast milk at peak drug concentration reduces exposure: Not supported by evidence; impractical; disrupts breastfeeding

Reality:

• Medication timing doesn't meaningfully reduce infant exposure
• Most antidepressants reach steady state in breast milk anyway
• Timing becomes impractical with multiple daily feedings
• Focus on medication selection (low-exposure options) and monitoring rather than timing

Side Effects and Management

Common Side Effects of Sertraline (and Most SSRIs)

Early Side Effects (Usually Resolve in 1-2 Weeks)

Ongoing Side Effects

When to Contact Dr. Thangada

Call Same Day:

• Severe allergic reaction (rash, difficulty breathing)
• Severe dizziness or fainting
• Chest pain or palpitations
• Difficulty urinating
• Eye pain or vision changes
• Confusion or severe cognitive changes

Call Within 24-48 Hours:

• Severe nausea/vomiting preventing medication intake
• Severe insomnia lasting multiple nights
• Severe anxiety or panic
• Any concerning new symptoms

Routine Issues (Address at Next Appointment):

• Mild nausea
• Mild insomnia
• Sexual dysfunction
• Appetite changes
• Mild emotional blunting

Switching or Stopping Medications

If Current Medication Not Working

After adequate trial (8 weeks at therapeutic dose):

• Dr. Thangada assesses: medication adherence, diagnosis accuracy, adequate dosing
• Options:
• Increase dose (if below maximum)
• Add medication (augmentation)
• Switch to different medication
• Consider hospitalization if safety concerns

Medication Switching:

• Switching between different SSRIs: usually taper first SSRI over 1-2 weeks while starting second SSRI
• Switching from SSRI to different class: may need washout period or careful cross-titration depending on medications involved
• Dr. Thangada coordinates timing and dosing

Discontinuing Medication

When to Discontinue:

• After adequate remission period (typically 6-12 months)
• After discussion of risk of relapse
• When life circumstances support discontinuation
• When patient confident in other coping strategies

How to Discontinue:

• Never stop abruptly (can cause withdrawal symptoms)
• Taper gradually over 2-4 weeks by reducing dose progressively
• Example: Sertraline 100 mg → 75 mg → 50 mg → 25 mg → stop (over 2-4 weeks)
• Monitor for withdrawal symptoms: dizziness, electric shock sensations, anxiety, insomnia
• If withdrawal occurs, resume lower dose and taper more slowly

Risk of Relapse:

• Risk of postpartum depression recurrence is approximately 50-80% if previous depression
• Discuss relapse prevention strategies with Dr. Thangada
• Some patients benefit from longer-term maintenance medication
• Others taper successfully without relapse

Postpartum-Specific Medication Considerations

Bipolar Disorder vs. Unipolar Depression

Critical: If depression is actually part of bipolar disorder, SSRIs alone can trigger manic episodes.

Red Flags for Bipolar Disorder:

• Previous manic or hypomanic episodes (excessive energy, decreased need for sleep, racing thoughts, risky behavior)
• Rapid mood cycling
• Family history of bipolar disorder
• Depression with psychotic features

Management: If bipolar disorder suspected, Dr. Thangada recommends mood stabilizer (lithium, lamotrigine, valproate) as foundation, rather than SSRI alone.

Postpartum Psychosis

Emergency Requiring Hospitalization:

• Delusions, hallucinations, disorganized thinking
• Typically onset first 2 weeks postpartum
• Requires hospitalization, antipsychotics ± mood stabilizers
• Breastfeeding decisions depend on medications used

Perinatal Anxiety Disorder

If Anxiety Prominent:

• SSRIs effective for anxiety (therapeutic benefit for both depression and anxiety)
• Some SSRIs preferred for anxiety (paroxetine, sertraline)
• May need higher SSRI doses for anxiety
• Consider SNRIs for additional benefit
• May add short-term anti-anxiety medication (carefully in breastfeeding context)

Insurance and Cost

Insurance Coverage

We accept 10+ major insurers:

• Aetna
• BCBS
• Cigna
• UnitedHealthcare
• Superior HealthPlan/Ambetter
• Baylor Scott & White
• Oscar
• First Health Network
• Optum
• Medicare

Psychiatric appointment coverage: Most plans cover psychiatric evaluation and medication management as medical benefit

Copays/Coinsurance: Varies by insurance plan; verified at scheduling

Self-Pay Rates

• Initial consultation: $299
• Follow-up appointments: $179

Medication Costs

Antidepressant Medication Costs:

• Most first-line SSRIs (sertraline, paroxetine) available as generic: $10-30 for 30-day supply
• Brand-name versions (if needed): $100-300
• Newer medications (zuranolone): higher cost; check insurance coverage
• Dr. Thangada helps navigate generic options to minimize cost

We Recommend:

• Generic medications when available (equivalent efficacy, much lower cost)
• Discussing cost concerns at appointment
• Medication samples available for some patients to try before filling prescription

Contact and Scheduling

Dr. Monika Thangada, MD

Board-Certified MD Psychiatrist

Postpartum Depression Specialist

Phone: (737) 367-1230

Location: 12335 Hymeadow Dr, Suite 450, Austin, TX 78750

Telehealth: Available throughout Texas

How to Schedule:

1. Call (737) 367-1230
2. Ask for appointment with Dr. Thangada for postpartum depression medication evaluation
3. Mention urgency (we prioritize postpartum presentations)
4. Choose in-person or telehealth
5. Insurance information needed for verification

What to Bring:

• Insurance card and photo ID
• List of current medications and supplements
• Notes about symptom timeline if helpful
• Pediatrician's contact information (if breastfeeding)

Medical Disclaimer: This information is educational and does not constitute medical advice. Postpartum depression requires professional diagnosis and treatment. If experiencing suicidal thoughts or thoughts of harming your baby, call 911 or the Suicide & Crisis Lifeline at 988, or text HOME to 741741 (Crisis Text Line) immediately.

If you or someone you know is in crisis, call 911 or the Suicide & Crisis Lifeline at 988, or text HOME to 741741 (Crisis Text Line).