Real-world pharmacotherapy treatment patterns among patients diagnosed with postpartum depression in the United States

BMC Psychiatry volume 25, Article number: 572 (2025) Cite this article

Pharmacotherapy is one modality recommended to treat postpartum depression (PPD), but treatment patterns are not well characterized. In this study we characterized psychiatric medications used to treat PPD in real-world settings.

Two cohorts of patients diagnosed with PPD within 180 days of delivery between October 2015 and January 2022 were retrospectively studied using two U.S. claims databases (Symphony Health [SH], Myriad Genetics-Komodo Health [MGKH]). Prescription fills of select psychiatric medications in the 365 days after PPD diagnosis were assessed using pharmacy claims.

The two cohorts (SH, MGKH) included 124,742 and 22,141 patients with PPD, respectively. Most patients with PPD (SH: 64.9%, MGKH: 76.4%) filled at least 1 prescription in the year following diagnosis; of those, 76.4% and 62.7%, respectively, discontinued treatment at least once. Medication changes were also common among treated patients, with 16.6% in SH and 18.3% in MGKH filling 3 or more unique psychiatric medications. In each cohort, selective serotonin reuptake inhibitors (SSRIs) comprised 72.2% of observed first-line treatments following PPD diagnosis, and sertraline was the most common first-line SSRI (39.4% and 41.4% of first-line treatments, respectively). Later-line therapies were not dominated by any single medication or medication class.

While the majority of patients with PPD were prescribed pharmacotherapy, treatment patterns were heterogeneous and characterized by frequent discontinuation and medication switching. These results suggest that first-line treatments may fail, and that some patients may need multiple medication trials to improve symptoms.

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Postpartum depression (PPD) is a serious mental illness affecting 17% or more of childbearing individuals worldwide [1, 2], with potentially debilitating consequences for the affected individual, child, and family [3]. The term PPD is often used interchangeably with perinatal depression, which the American Psychiatric Association defines as the onset of depressive symptoms either during pregnancy or within 4 weeks of childbirth [4]. However, in clinical practice, PPD may be diagnosed up to 12 months after childbirth [5, 6]. If untreated, PPD can lead to significant deficits in infant cognitive and behavioral development, poor parent-to-child bonding, as well as negative impacts on child physical and mental health [7]. In severe cases, PPD can lead to suicide and infanticide [8].

Most patients with PPD have one or more comorbid psychiatric conditions, most frequently anxiety [8]. Risk factors for PPD include a personal or family history of psychiatric disorders, personal history of substance abuse disorder, a multiple birth, a difficult pregnancy, an unwanted pregnancy, lack of social support with low socioeconomic status, or a history of abuse [8]. Both the American College of Obstetricians and Gynecologists (ACOG) and the US Preventive Services Task Force recommend screening for depression during pregnancy and at postpartum visits [9, 10]. In addition to the importance of diagnosing PPD, treatment is an essential part of improving outcomes. Clinical guidelines for treatment of PPD recommend either or both psychotherapy and pharmacotherapy as first-line, depending on the severity of the illness and past history of response to antidepressants [5, 11, 12]. The recent guideline from ACOG recommends that obstetricians initiate pharmacotherapy in newly diagnosed patients when indicated, acknowledging that psychotherapy is not directly within the scope of a obstetrician’s clinical practice and also may not be available or acceptable to a patient [5]. These guidelines recommend that risk to the breastfeeding infant should be considered, but also note that many antidepressants do not appreciably enter breastmilk. In addition, new pharmacotherapies are indicated specifically for the treatment of postpartum depression, but these are either complex to administer (brexanolone, which must be administered intravenously at a certified healthcare facility) or availability is not clear (zuranolone, which is only recently approved) [13].

Although guidelines recommend pharmacotherapy, it is not known how many PPD patients actually receive pharmacotherapy. Guidelines acknowledge that breastfeeding patients may be reluctant to initiate pharmacotherapy. In addition, some community health providers may be reluctant to provide pharmacotherapy to patients with PPD [14]. Data from small studies estimate that only 16% of patients with PPD receive any treatment, whether pharmacotherapy or psychotherapy [2]. In contrast, a claims study of over 10,000 patients with PPD without a history of mental health disorder found that approximately half received medications [15]. Another claims study which evaluated patients with postpartum mental health conditions (including PPD) also found that approximately half received medications, but did not detail which medications were being prescribed [16]. As such, the proportion of patients with PPD that are receiving pharmacotherapy, as well as the specific medications being used, are unclear.

Understanding how medications are prescribed for PPD in clinical practice may help to identify gaps in care. For major depressive disorder (MDD), an analysis of treatment patterns revealed complex patterns including medication switching and combination therapies [17]. In addition, while antidepressants were most frequently prescribed, many patients received anxiolytics and antipsychotics. Finally, many patients did not receive any pharmacotherapy in the 3 years after diagnosis. These data highlight the heterogeneity of depression, the difficulty of identifying medications which might be efficacious for the individual patient, and the need for tools such as pharmacogenomic testing that assist in choosing such medications [18,19,20]. In this study, we have conducted a descriptive analysis of medication treatment patterns for PPD using two large, U.S. claims datasets. Our objective was to understand how the general population of patients with PPD are treated, regardless of comorbidities, history of mental health disorders, or prior pharmacotherapy. We hypothesized that PPD treatment is heterogeneous, and that some patients may require multiple medication trials or combination therapies.

A retrospective cohort study was carried out using two U.S. insurance claims databases: one with open claims and one with closed claims. Open claims are derived from multiple sources such as facilities and pharmacy systems and may include some healthcare interactions from each patient over an open-ended period [21]. Closed claims are derived directly from insurance providers [21] and show a comprehensive view of each patient’s healthcare interactions, but only during the patient’s enrollment period. The databases used in this study were:

Both databases used in this study contained medical and pharmacy claims in addition to limited payer and demographic information. Of note, pharmacy claims are structured similarly in both databases despite being derived from different sources, though they vary in completeness based on the open or closed claims nature of the dataset [21]. Data linkage for the MGKH cohort was performed using tokenization to maintain patient privacy in Myriad’s and Komodo’s individual data sources (Datavant, Inc., San Francisco, CA) [22]. Symphony Health data was not linked to Myriad Genetics data. This study utilized de-identified data obtained in compliance with HIPAA regulations. Consequently, the study did not meet the U.S. Department of Health and Human Services' definition of research involving human subjects (45 CFR 46.102). Therefore, it was not submitted for Institutional Review Board approval, nor did it require consent to participate. Additionally, the study adhered to the ethical principles outlined in the Declaration of Helsinki.

A cohort of individuals with PPD was assembled from each database. Exclusion and inclusion criteria differed slightly between the two cohorts based on the open vs. closed nature of the databases (Fig. 1). For both datasets, patients 18 years and older with an International Classification of Diseases 10th revision (ICD-10) code for outcome of delivery (Z37.xx) were identified between October 1, 2015 and December 31, 2017 for the SH cohort and between October 1, 2015 and January 31, 2022 for the MGKH cohort. Among these, patients with at least one ICD-10 code for depression (Table S1) between 5 and 180 days following the first delivery code, as well as a full 365 days of follow-up after the first depression diagnosis date (henceforth called the PPD diagnosis date), were included. Notably, the ICD-10 code (F53) was included; although it was labeled ‘Puerperal psychosis,’ it was intended to be used for both PPD and postpartum psychosis prior to October 2018. A similar approach, i.e., considering codes for both PPD and MDD used during the postpartum period as indicative of a PPD diagnosis, has been used by several other claims-based studies [15, 16, 23,24,25]. A buffer of 5 days after delivery was used to avoid capturing depression diagnoses coded during hospitalization for delivery; these codes may be referencing historical rather than ongoing conditions. In the MGKH cohort, patients were required to have at least 180 days of closed enrollment in medical and pharmacy coverage following delivery and at least 365 days of closed enrollment in pharmacy coverage following PPD diagnosis to ensure complete capture of diagnosis codes and medication fills. The study objective was to describe treatment patterns in all patients with PPD; therefore, patients with a history of depression or previous treatment for depression, who themselves have a higher risk of being diagnosed with PPD [24, 26], were included in the study.

Baseline characteristics were defined at the time of delivery, PPD diagnosis date, or using the closest available claims or enrollment data. Ethnicity data in the MGKH cohort was self-reported by patients and collected by Myriad Genetics, Inc. at the time the prenatal test was ordered. The frequency of psychiatric medication fills during the presumed pregnancy period (280 days before delivery) and pre-pregnancy period (560 to 281 days before delivery) was assessed in the SH cohort as a proxy for prior mental health treatment. The frequency of diagnoses for anxiety (ICD-10 codes F41.xx), bipolar disorder (ICD-10 codes F31.xx), and schizophrenia/schizoaffective disorder (ICD-10 codes F20.xx, F25.xx) during the study period (5 to 180 days after delivery) was also assessed.

Psychiatric medication fills were identified for all patients in the 365 days following the PPD diagnosis. The 56 medications of interest (Table S2) included antidepressants (selective serotonin reuptake inhibitors [SSRIs], serotonin/norepinephrine reuptake inhibitors [SNRIs], serotonin antagonist and reuptake inhibitors [SARIs], bupropion, monoamine oxidase inhibitors [MAOIs], tricyclics, novel, and alpha-2 antagonists), antipsychotics (typical and atypical), and select mood stabilizers (antiseizure agents and lithium). The drug generic name, start date, and days of supply were captured for each fill.

Treatment patterns in the 365 days following PPD diagnosis were described by the number of unique psychiatric medications filled and the number of treatment lines. The number of treatment lines was defined as the number of times any new medication(s) was(were) filled during the study period, regardless of whether previous medications were continued. For example, if a patient filled one medication on the day of diagnosis and another two medications were later filled on the same date one month later, this was considered two distinct treatment lines and three distinct medications. The time in days from PPD diagnosis to the first observed fill in the study period and the proportion of patients who filled only one prescription were also reported. The top ten most common medications and medication classes were summarized by treatment line up to the third treatment line following diagnosis. Treatment lines were numbered based on observation within the study period; as such, a ‘first-line’ treatment in this study may have previously been prescribed to that patient before the study period began.

Additionally, continuous-treatment episodes were determined using the AdhereR package [27] applied in two ways: 1) applied to all psychiatric medications together to define each patient’s continuous-treatment episodes on any medication, which was used to estimate the length of pharmacotherapy and the timing and frequency of discontinuation, and 2) applied to each psychiatric medication individually to define each patient’s continuous-treatment episodes for each specific medication filled, which was used to characterize the frequency of different medication combinations. A continuous-treatment episode was defined based on the timing of fills as well as the days of supply of each fill, allowing for gaps of ≤30 days between when the previous medication supply would have run out and the next medication was filled [17]. Medication supply was allowed to carry over within a given drug, so that if a prescription was refilled before the previous supply ran out, the refilled drug was assumed to have been started once the previous supply was finished. Discontinuation was defined by the presence of any gap in treatment episodes > 30 days, while medication combinations were defined as periods where two or more medication-specific treatment episodes overlapped for ≥30 days.

This was a descriptive study; no statistical testing was performed. The analyses were performed using R Statistical Software (version 4.3.1; R Core Team 2023; R Foundation for Statistical Computing, Vienna, Austria; URL: https://www.R-project.org/).

The proportion of patients with PPD was 3.3% in the SH open claims database and 13.4% in the MGKH closed claims database, resulting in a study cohort of 146,883 patients: 124,742 in the SH cohort and 22,141 in the MGKH cohort (Table 1). The MGKH patients were slightly older at the time of delivery and included a larger proportion of Medicaid patients compared to SH (Table 1). The MGKH cohort was an ethnically diverse population, including 22% of patients with African, Asian, or Hispanic ancestries (ethnicity was not available in the SH cohort). In the MGKH cohort, PPD was frequently diagnosed in an outpatient setting (80.9%) by an obstetrician-gynecologist (21.5%), psychiatrist/behavioral care specialist (18.3%), or internal/family medicine physician (14.6%). Due to missingness in open claims, the majority of provider types diagnosing PPD were unknown in SH.

Table 1 Characteristics of patients diagnosed with postpartum depression in each cohort

Full size table

In the SH cohort, 32,108 patients (25.7%) with PPD had a previous prescription fill for a psychiatric medication of interest in the presumed pregnancy period, and 31,851 patients (25.5%) had a psychiatric prescription fill in the pre-pregnancy period (34.8% total had a prescription fill in either period). During the study period, 34.1% of patients with PPD in the SH cohort also had a diagnosis code for anxiety, 4.9% had a diagnosis code for bipolar disorder, and 0.8% had a diagnosis code for schizophrenia or schizoaffective disorder. Similar analysis was not conducted for the MGKH cohort.

Most patients filled a prescription for at least one psychiatric medication of interest in the year following PPD diagnosis, with 64.9% of the SH cohort and 76.4% of the MGKH cohort receiving pharmacotherapy (Fig. 2, Table 1). Among patients treated with pharmacotherapy, 13.2% and 15.0%, respectively, received 3 or more treatment lines in the year after diagnosis, and 16.6% and 18.3%, respectively, filled 3 or more unique medications (each treatment line may consist of > 1 unique medication) (Table 2). In the MGKH cohort, advanced practice nurses and obstetrician-gynecologists were the most common prescribers of initial pharmacotherapy, comprising 25.7% and 22.6% of first prescriptions, respectively. Prescribing provider specialty was largely not available in the SH cohort.

Table 2 Characteristics of patients diagnosed with postpartum depression who filled any psychiatric medication in each cohort

Full size table

Over half of treated patients filled a prescription for a psychiatric medication of interest within 3 days of their first PPD diagnosis (SH cohort: 50.7%, MGKH cohort: 51.1%). In both cohorts, most treated patients (SH: 76.4%, MGKH: 62.7%) discontinued treatment at least once during the year after diagnosis; further, 38.5% (SH) and 27.8% (MGKH) discontinued treatment after an initial treatment episode of 60 days or less following diagnosis, and 21.3% (SH) and 14.7% (MGKH) discontinued treatment after filling only a single prescription after diagnosis (Table 2).

Of the 56 psychiatric medications of interest, 54 were filled in the SH cohort and 44 in the MGKH cohort (Table S2). The only medication of interest not observed in either cohort was the antipsychotic haloperidol. In each cohort, 72.2% of first-line treatments following PPD diagnosis were SSRIs (Fig. 3), with 39.4% (SH) and 41.4% (MGKH) of all first-line treatments being sertraline (Fig. 4). In second and third-line treatments, the frequency of SSRIs declined while bupropion and atypical antipsychotics (such as quetiapine and aripiprazole) increased, but no single medication made up a plurality of later-line therapies. In the MGKH cohort, non-antidepressant classes comprised 7.4% of first-line treatments but 20.0% and 28.6% of second- and third-line treatments, respectively. Similar frequencies were also observed in the SH cohort.

Medication combinations—where two or more medication-specific treatment episodes overlapped for ≥30 days—were frequently observed across both cohorts, with 24.4% (SH) and 29.5% (MGKH) of all treated patients receiving a combination therapy at some point in the year after diagnosis (Table 2). In total, 636 unique combinations were observed in SH and 416 unique combinations were observed in MGKH. Among all combinations, 7 of the top 10 included SSRIs (Fig. 5). Atypical antipsychotics, bupropion, trazodone, and antiseizure agents were commonly used in combination with SSRIs.

PPD is a common mental health disorder that, if untreated, can lead to serious maternal and child health outcomes [8]. Understanding how PPD is treated in the real-world setting, and specifically whether iterative medication trials may be occurring, may identify areas for improving clinical care. In this study, we characterized treatment patterns for PPD using two U.S.-based claims data sources. Our study builds upon previous claims-based studies on pharmacotherapy for postpartum mental health [15, 16, 28, 29]. Compared to previous studies, our study is large (> 140,000 patients), focuses on PPD patients across the U.S., is not limited to patients without a mental health history, follows patients for a full year after diagnosis, evaluates the prescribing and filling of specific medications, and includes both Medicaid and commercial enrollees from two independent data sources. Our goal was to obtain a detailed understanding of medication treatment patterns for patients with PPD in the U.S.

Our study found that as many as 76% of patients diagnosed with PPD in the U.S. were treated with pharmacotherapy. This is consistent with other real-world claims-based studies showing that over half of patients with perinatal mental health conditions receive pharmacotherapy [15, 16]. The diagnosing provider was most likely to be either an obstetrician-gynecologist or psychiatrist, but the most common prescribers after diagnosis were advanced practice nurses and obstetrician-gynecologists. The number of patients treated by obstetricians may increase in the future, given new guidelines recommending that obstetricians initiate pharmacotherapy in patients with perinatal mental health conditions [5, 9].

Medication patterns for PPD were complex, with over 50 different psychiatric medications filled, over 600 different psychiatric medication combinations observed, about 1 in 7 patients receiving 3 or more treatment lines, and 1 in 6 treated patients filling 3 or more different medications in the year after diagnosis. The heterogeneous medication treatment patterns observed indicate medication switching and combination therapy, and resemble those observed for treatment of MDD [17].

A high discontinuation rate was also observed in our study. More than 60% of patients interrupted their medication therapy at least once during the year after diagnosis and about one-third of patients stopped treatment after an initial treatment episode of 60 days or fewer following diagnosis. While it is possible that some patients discontinued treatment because of symptom improvement or that some patients with milder disease were switched to nonpharmacological interventions only, the high discontinuation rates are concerning given that guidelines recommend continuing pharmacotherapy for at least 6–12 months even after remission is achieved [5]. These discontinuation data suggest that the majority of patients diagnosed with PPD are not being adequately treated and that the few who achieve remission remain vulnerable for relapse. The observed discontinuations along with heterogeneous patterns of multiple medications filled suggest that the first medication prescribed for PPD may not be effective.

Our finding that SSRIs are the most frequently filled medication class is consistent with clinical guidelines recommending SSRIs as first-line therapy for PPD [5, 12]. Sertraline was the most prescribed of the SSRIs, followed by escitalopram, both of which are recommended as safe and reasonable first-line medications for PPD patients without a pharmacotherapy history [5]. Combinations of SSRIs with other antidepressants, mood stabilizers or atypical antipsychotics were also observed. Use of atypical antipsychotics such as quetiapine as an adjunctive therapy with SSRIs is a recommended strategy for treatment-resistant depression [11], and the use of trazodone or quetiapine with antidepressants or antipsychotics may reflect off-label treatment of insomnia in addition to treatment of depression [30]. Patients who were diagnosed with and/or treated for mental health disorders prior to pregnancy comprised approximately one-third of the SH study cohort; in these patients, PPD treatment may have been informed by knowledge of prior medication response.

Some observed treatment patterns appear to contradict treatment guidelines. For example, non-antidepressants such as antipsychotics and lithium may have been filled for PPD patients as a first-line treatment. The use of non-antidepressants could reflect psychiatric comorbidities, such as anxiety, bipolar disorder, or postpartum psychosis, as observed in the SH cohort. Moreover, the use of non-antidepressants could also reflect a requirement for antidepressant augmentation identified prior to or during pregnancy. In addition, some prescribed medications are not recommended for breastfeeding mothers (e.g., doxepin) [31]. Others are controversial (e.g., lithium) or have little or no data with regard to breastfeeding (e.g., loxapine, lumateperone, nefazodone, pimozide, thioridazine, thiothixene, and ziprasidone) [31]. While we were unable to identify whether patients in the study were breastfeeding, CDC estimates that 83% of infants in the U.S. are breastfed at some point [32].

Altogether, our real-world analysis revealed multiple treatment lines, a high discontinuation rate, a mix of combination therapies and many different medications being used to treat patients with PPD. These observations suggest that there is not any one treatment that is effective for all patients with PPD.

Our study was limited to patients with a depression-related diagnosis code in the postpartum period; however, PPD is considered underdiagnosed [2], so we may not have identified all patients with PPD in the two databases. In addition, the ICD-10 code used for PPD prior to October 2018 (F53) was labeled as ‘Puerperal psychosis’, which some providers may not have used to describe PPD. To address this issue, we identified PPD using several types of depression codes (Table S1), which is a common approach in PPD claims studies. Initial analyses were conducted with only PPD codes and similar results were obtained [33].

In the open claims SH cohort, some patients may have been diagnosed or prescribed medications at clinics or facilities that were not represented in the source data. As expected, we observed a lower proportion of PPD diagnoses, lower treatment rates, and higher rates of discontinuation in the SH cohort compared to the closed claims MGKH cohort. However, our primary goal was to describe treatment patterns rather than estimate PPD prevalence, and the overall similar results observed among treated patients in the closed claims MGKH cohort suggest that this limitation did not meaningfully inhibit the generalizability of this dataset. The true rates of medication use and switching may be different than those accounted for in claims data for several reasons. First, pharmacy claims identify when a patient fills a prescription, not necessarily that a patient is taking the medication. Second, medications purchased out-of-pocket and/or with discount cards are not captured in closed claims databases, though they may be partially captured in some open claims databases. Third, this study included outpatient medications available during the study period, but did not capture use of newer drugs that treat PPD (brexanolone, which is administered in-office intravenously, nor the recently approved zuranolone). Additionally, treatment indication is not available in outpatient pharmacy claims data, so we cannot definitively say that the observed medication fills were intended to treat PPD versus another condition.

The MGKH cohort includes patients who underwent prenatal cell-free DNA screening between 2015—2022. Until 2020, screening guidelines were focused on high-risk groups [34]. As such, this cohort may have been older, at higher risk of pregnancy complications, and more likely to seek healthcare compared to a general pregnancy population in the U.S. [35]. However, the demographic characteristics across both cohorts suggest that the study population captured a reasonable sample of patients with PPD in the U.S., since all U.S. geographic regions, insurance payer types, and major ethnic groups were included.

Here, we describe the most detailed analysis to date of medication treatment patterns for patients diagnosed with PPD in the U.S. In over 140,000 patients with PPD from two separate claims databases, treatment was heterogeneous, with evidence of discontinuations, multiple treatment lines, and combination therapy. These data suggest that many patients with PPD may not respond to the initial medication prescribed and may be undergoing iterative medication trials. Strategies for optimizing treatment selection, such as pharmacogenomic testing, may have clinical utility. Future studies may include evaluation of previous mental health history and treatment, co-morbid psychiatric disorders, newer pharmacological agents, nonpharmacological treatments, as well as the impact of pharmacogenomic testing on treatment selection and outcomes.

The underlying data that support the findings of this study were sourced from Myriad Genetics, Komodo Health, and Symphony Health, respectively. Summary data and code lists are available from the Myriad research team upon request. If any researcher requires access to the analytic files that were derived from the Komodo Health or Symphony Health databases, a third-party use agreement must be executed by all involved parties.

ACOG:: American College of Obstetricians and Gynecologists
CDC:: Centers for Disease Control and Prevention
ICD-10:: International Classification of Diseases 10th revision
MAOI:: Monoamine oxidase inhibitor
MDD:: Major depressive disorder
MGKH:: Myriad Genetics-Komodo Health
PPD:: Postpartum depression
Rx:: Prescription
SARI:: Serotonin antagonist and reuptake inhibitor
SH:: Symphony Health
SNRI:: Serotonin/norepinephrine reuptake inhibitor
SSRI:: Selective serotonin reuptake inhibitor

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The authors wish to acknowledge John Guittar, Brandon Ulm, and Marriah Lewis for their contributions to this study.

Myriad Genetics, Inc. funded this research and led all aspects of the study, including the design, analysis, interpretation of data, and writing of the manuscript.

Authors

Jennifer L. Payne
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Andria L. Del Tredici
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All authors contributed to the study conception, with A.L.D. leading study conception. D.C.M. and D.C. lead the study design. Data collection and analysis were performed by D.C.M. All authors contributed to data interpretation, with A.L.D. leading the clinical interpretation. The first draft of the manuscript was written by D.C.M. and A.L.D., and all authors commented on previous versions of the manuscript. Generative AI was used to assist with editing. All authors read and approved the final manuscript.

Correspondence to Andria L. Del Tredici.

This study utilized de-identified data obtained in compliance with HIPAA regulations. Consequently, the study did not meet the U.S. Department of Health and Human Services' definition of research involving human subjects (45 CFR 46.102). Therefore, it was not submitted for Institutional Review Board approval, nor did it require consent to participate. Additionally, the study adhered to the ethical principles outlined in the Declaration of Helsinki.

Not applicable.

D.C. Miller, D. Chawla, K. J. Taber, and A.L. Del Tredici are employees and shareholders of Myriad Genetics, Inc. J.L. Payne receives research support from NIMH and Janssen Pharmaceuticals. J.L. Payne has two patents: “Epigenetic Biomarkers of Postpartum Depression” and “Epigenetic Biomarkers of Premenstrual Dysphoric Disorder and SSRI Response.” J.L. Payne has Founder's Stock options in Dionysus Health and has received consulting fees from SAGE Therapeutics, Biogen, Flo Health, Pure Tech, Brii Biosciences, and Merck.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Material 1. Table S1. ICD-10 diagnosis codes used to identify postpartum depression and the proportion of cases defined by each code in each cohort

Supplementary Material 2. Table S2. Psychiatric medications and classes used to characterize postpartum depression treatment patterns and whether they were prescribed in each cohort

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Miller, D.C., Chawla, D., Johansen Taber, K. et al. Real-world pharmacotherapy treatment patterns among patients diagnosed with postpartum depression in the United States. BMC Psychiatry 25, 572 (2025). https://doi.org/10.1186/s12888-025-06977-z

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