Treatment-resistant depression management in postpartum depression – a case report and literature review

Iqra Sohail; Pongsirilux Laveewan; Grace Bach; Shabab Islam; Ravi L. Maharaj; Rosy Sinha; Himani J. Suthar; Luis Rodriguez; Aileen Wan; Eric Wang; Ryan Worms; Parinda Parikh

doi:10.18203/2394-6040.ijcmph20263652

Authors

Iqra Sohail Bahria University of Health Sciences (BUHSCk), Karachi, Pakistan
Pongsirilux Laveewan Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
Grace Bach University of South Carolina, Columbia, SC
Shabab Islam TouroCOM Middletown, Middletown, NY, United States
Ravi L. Maharaj University of the West Indies, St. Augustine, Trinidad and Tobago, West Indies
Rosy Sinha Lady Hardinge Medical College, Delhi, India
Himani J. Suthar GMERS Medical College and Civil Hospital, Gandhinagar, Gujarat, India
Luis Rodriguez Universidad de Ciencias Médicas de Habana, Havana, Cuba
Aileen Wan New York University Steinhardt, New York, USA
Eric Wang Stony Brook University College of Arts and Sciences, New York, USA
Ryan Worms University of Delaware, Newark, DE, USA
Parinda Parikh 2ND ARC Psychiatric Associates, White Plains, USA

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20263652

Keywords:

Postpartum, Treatment-resistant postpartum depression, Psychotherapy, Psychosocial support

Abstract

Postpartum depression (PPD) affects approximately 10-15% of women and can cause significant morbidity for mothers, infants, and families. When postpartum depression fails to respond to two adequate trials, it is called as treatment resistant postpartum depression (TRPPD). Treatment of TRPPD is challenging because of breastfeeding, limitation of medication and competing childcare responsibilities. We report the case of a 26-year-old female with a history of anxiety, ADHD, and depressive disorders who developed severe postpartum depression following her two pregnancies. Following her second delivery, she developed severe depressive symptoms within three weeks postpartum, with a PHQ-9 score of 28. Despite multiple sequential pharmacological regimens including desvenlafaxine with bupropion and subsequent dose adjustments, the patient showed only partial and transient improvement. Significant clinical response was achieved after addition of cariprazine along with intensive psychotherapy and structured psychosocial support, including enhanced caregiving assistance. Her PHQ-9 decreased to 5 three weeks after initiation of this regimen. Sustained remission was observed over long-term follow-up continuing to this day. This case demonstrates the complexity of TRPPD and the limitations of monotherapy. Early detection of treatment resistance is crucial in avoiding impaired infant bonding and long-term maternal dysfunction. A multimodal approach comprising psychotherapy, augmentation techniques, antidepressant optimization, and psychosocial support is needed for effective management and long-term remission. TRPPD is a difficult and underdiagnosed disorder that requires individualized, multidisciplinary care. In refractory circumstances, combination medication and targeted psychological therapies may improve effectiveness. More research is required to develop evidence-based treatment approaches and uniform diagnostic standards for TRPPD.

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