Overview Of Postpartum Depression
Understanding what PPD is helps to understand the medications that might be needed to treat postpartum depression. Simply put, postpartum depression is a mood disorder that affects roughly 15% of women during their first year of pregnancy.
Due to the hormonal changes that occur during and after pregnancy, depression is common amongst women and new mothers. Depression during and after pregnancy is known as perinatal depression, whereas depression that occurs after giving birth and lasts more than two or three weeks is known as postnatal depression or PPD.
Women experience a sudden drop in estrogen and progesterone within the first few days after the baby is born, resulting in mood swings and symptoms of depression. This short, common phase of depression is often called the baby blues and usually lasts for a few weeks.
However, if depression symptoms worsen, last longer than a few weeks, or include other symptoms, the Office of Womens Health recommends talking with your doctor to receive screening for postpartum depression. Your doctor may also run blood tests to eliminate any additional issues, such as problems with your thyroid.
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Psychological health services in the UK as well as US are comparable however not similar. The psychological health services in the United States are much more easily accessible to individuals that could not manage them.
The Mental Wellness Provider Act of 2007 was passed in the USA, and it made a lot of modifications to just how mental health services were supplied. One major change was no more a solitary entity in charge of giving these solutions. Instead, several organizations provide mental healthcare.
Treatment For Postpartum Depression Overview
According to the American College of Obstetricians and Gynecologists , postpartum depression is a type of mood disorder that can cause depression and other side effects in women. PPD can appear anytime within the first year after giving birth but typically within the first few weeks.
Having a new baby can be challenging enough for new parents, but dealing with PPD also adds an additional hurdle to overcome.
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Postpartum Depression Causes And Risk Factors
The physical, hormonal, and emotional changes caused by childbirth and new motherhood can contribute to the development of postpartum depression. Certain risk factors can also make you more likely to develop this condition, including:
- A previous history or family history of depression, anxiety, or mental illness
- Trauma or significant life events occurring before, during, or after your pregnancy
- Medical complications during your pregnancy or childbirth or with your childs health
- Lack of support from your family and friends
If you are taking medication for a mental health disorder like depression, anxiety, or psychosis, do not stop taking your medication when you become pregnant without talking to your doctor. The risk of many medications affecting your baby is low, but the risk of you becoming ill from stopping your medication suddenly is high.
Types Of Postpartum Depression Medication
There are different types of medications that can be taken for postpartum depression. The type of medication prescribed largely depends on the set of symptoms and the specific type of postpartum depression someone is suffering from.
Depending on the severity of the condition, clinicians may prescribe two or more types of medications to be taken together. In these cases, the postpartum depression medications work on different symptoms. Most symptoms can be managed by taking several medications together, often alongside some form of psychotherapy .
As of 2019, the medication Brexanolone was approved by the US Food and Drug Administration specifically for treating postpartum depression. Brexanolone is a fast-acting one-time infusion, bringing almost instant relief to new mothers suffering from postpartum depression.
Postpartum suicide is the second-leading cause of maternal postpartum mortality. I think is going to be very helpful for high-risk, severely depressed moms.
Maria Muzik, M.D. | Associate Professor of Psychiatry and Obstetrics & Gynecology at Michigan Medicine
The following are the other common medications that may be prescribed to treat symptoms of postpartum depression.
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Psychological And Psychosocial Treatments For Postpartum Depression
Many mothers with postpartum depression are hesitant to take antidepressants due to concerns about infant exposure to medication through breast milk or concerns about potential side effects,95 and therefore often prefer psychological treatments.49,50,96 Although relatively few studies have systematically investigated nonpharmacologic treatments for PPD, existing research supports the use of both psychological treatments , as well as psychosocial interventions, such as nondirective counseling. A Cochrane meta-analysis of ten randomized controlled trials of psychosocial and psychological treatments for postpartum depression concluded that both psychosocial and psychological interventions are effective in decreasing depression and are viable treatment options for postpartum depression.97
Interpersonal therapy
Cognitive behavioral therapy
Nondirective counseling
Peer and partner support
Comparisons of psychological and psychosocial treatments
A recent meta-analysis compared psychological and psychosocial interventions for PPD, including CBT, IPT, and nondirective counseling, as well as peer support.121 This study did not find any difference in effect size for any of these treatments, and concluded that different types of psychological interventions seem equally effective for treatment of PPD.
Treatment Options For Postpartum Depression
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The time after giving birth can be emotional for new mothers.
Along with the happiness of having a new baby, many mothers experience the baby blues feelings of sadness or worry after giving birth. They may feel tired, overwhelmed, and have trouble sleeping or eating.
The baby blues are common. If they fade after a few days or a week, treatment usually is not necessary.
In some cases, however, feelings of sadness or emptiness after birth can continue for two weeks or longer. This is known as postpartum depression, and mothers experiencing it should get treatment to avoid complications.
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How Do Antidepressants Work
Antidepressants are believed to work by influencing the production and function of neurotransmitters in the brain. Neurotransmitters are naturally occurring chemicals that control mood, emotions and behavior throughout the brain.
When chemical imbalances are triggered, such as with postpartum depression, serious and negative mood and behavioral symptoms occur. Antidepressants regulate these imbalances over time and stabilize the patients mind and body.
Specifically, antidepressants help the brain become better at producing and responding to two types of neurotransmitters: serotonin and norepinephrine. Serotonin regulates mood and emotions. Norepinephrine is often termed the stress hormone as it is produced in response to tense situations. Antidepressants that control and improve serotonin are called Selective Serotonin Reuptake Inhibitors . Antidepressants that control both serotonin and norepinephrine are called Serotonin-Norepinephrine Reuptake Inhibitors .
Antidepressants may take several weeks before their effects are noticeable in controlling symptoms, as it takes time for the body to build up its production of neurotransmitters to levels that will improve the brains mood and behavioral control. Over time, patients who take antidepressants will notice that their quality of life improves as their symptoms dissipate.
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SAMHSAs National Helpline, , or TTY: is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.
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The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. SAMHSAs 2020 National Survey on Drug Use and Health reports that approximately 19.3 million people aged 18 or older had a substance use disorder in the past year.
Other Treatments For Postpartum Depression
Usually, totreat postpartum depression, we first listen to all your symptoms carefully andassess the severity of your PPD. In most cases, we recommend professionaltherapists for further help and will prescribe antidepressant medication suchas Lexapro or Zoloft. These medications help increase serotonin levels and helpbalance hormones.
Themedication isnt meant to be taken for a long period of time, rather, it helpslevel hormones to where mothers can regain control of their coping skills andstart to heal.
I cautionmy patients that have a history of depression to be extra aware of theiremotions throughout their pregnancy, Katie says. Id rather them have a planduring pregnancy to manage their depression, instead of waiting several monthsfor the symptoms to worsen and have to wait 6-8 weeks for a medication to kickin.
Whenprescribing these medications, we discuss the risks and benefits with ourpatients. A common concern is if the medication will transfer through tobreastmilk. A small amount will, but doctors and pediatricians have OKd thesemedications to take while breastfeeding.
The smallrisks to the baby outweigh the benefits of having a healthy, fit mother whoisnt suffering from depression, Katie says.
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How Do I Know If I Am Experiencing Depression
The following questions may help you determine if you are experiencing depression.
During the past two weeks, how often have you been bothered by any of the problems listed below?
Little interest or pleasure in doing things?
Not at all.More than half the days.Nearly every day.
Feeling down, depressed, or hopeless?
Not at all.More than half the days.Nearly every day.
If you answered more than half the days or nearly every day to either question, you may be depressed and should seek help from your health care provider. Your provider can help figure out whether you have depression, and he or she can help find the best treatment for you. Depression can be treated with counseling, medications, or both.
How Do Doctors Screen For Postpartum Depression
It can be hard to detect mild cases of postpartum depression. Healthcare providers rely heavily on your responses to their questions.
Many healthcare providers use the Edinburgh Postnatal Depression Scale to screen for postpartum depression. It consists of 10 questions related to symptoms of depression such as feeling unhappy, anxious or guilty. You’re asked to check the response that comes closest to how you’ve felt the last seven days. A higher score indicates possible postpartum depression.
If your provider feels you have signs of postpartum depression, they will recommend an appropriate treatment.
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How Doctors Treat Postpartum Depression
If you or a loved one suspect youre experiencing signs of postpartum depression, speak to your doctor or a healthcare provider specializing in womens health and pediatrics. Your doctor will often provide a depression screening or a questionnaire to assess your condition and how to meet your needs. They may also perform a blood test to eliminate other conditions, such as thyroid problems.
Your doctor will evaluate:
- The severity of your condition
- Your medical history and background
- Other individual needs
Postpartum depression treatments generally include therapy with a mental health professional, such as a psychiatrist or psychologist. Another standard treatment method used in conjunction with therapy, is prescription medications like antidepressants.
Postpartum depression recovery should also include healthy lifestyle practices.
Mothers affected by PPD can take care of themselves by:
- Getting enough rest
- Avoiding alcohol
- Staying physically active through activities like walking or swimming
Your doctor will also likely recommend a follow-up appointment after about six months. While extremely rare, if postpartum psychosis is present , your doctor may recommend Electroconvulsive Therapy at the beginning of treatment.
Postpartum Psychosis: A Rare Mental Health Emergency
While postpartum depression is relatively common, postpartum psychosis is an extremely rare disorder, affecting just 0.1 percent of new mothers. That number rises to 30 percent in mothers who have bipolar disorder. Symptoms of postpartum psychosis include:
- Confusion and cognitive impairment that may come and go
- Coming in and out of consciousness
- Extremely disorganized behavior
- Hallucinations or delusions
Its important not to ignore these symptoms, even if you have no history of mood disorder. Postpartum psychosis can occur in women with no previous history of psychiatric illness, says Osborne.
She stresses that postpartum psychosis is a psychiatric emergency requiring immediate medical attention because it carries a high rate of suicide and harm to the baby.
The gold-standard treatment for postpartum psychosis includes both lithium and an antipsychotic medication. With these medications, it is important for a doctor to monitor the baby to ensure that breastfeeding is safe.
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Treating Postpartum Mood Disorders
The most important things to know about postpartum mood disorders are that they are highly treatable and not something a new mother needs to feel ashamed about. Even in the most severe cases of postpartum psychosis, one recent study showed that 98 percent of patients got better with treatment.
Treatment for postpartum depression includes antidepressant medications, which have good evidence of safety in breast-feeding.
How Much Does Zulresso Cost
According to Sage Therapeutics, the biopharmaceutical company taking Zulresso to market, the drug will cost around $7,450 a vial, which amounts to approximately $34,000 before discounts or insurance. Its important to note that the high price tag does not include the cost of staying at a medical facility for more than two days.
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How Effective Is Zulresso In Treating Postpartum Depression
Clinical studies have shown Zulresso to be effective in improving the symptoms of PPD. One study included patients with severe PPD and the other included patients with moderate PPD. In both studies, depressive symptoms improved at the end of the first infusion of Zulresso and were observed again at the end of the 30-day follow-up period. Zulresso does not cure PPD, but it can lessen its symptoms.
New Developments To Prevent Postpartum During Delivery
With so manymothers experiencing PPD, a lot of research has been invested to find ways toprevent it. The doctors at Walnut Hill are at the forefront of researching PPDand how it occurs in some women and not others.
Theres atheory that PPD occurs when the brain doesnt tolerate the sudden drop ofpregnancy hormones with the delivery of the placenta, Katie says. Doctors arestudying a new medicine in IV form administered in the hospital, and itslooking promising to help reduce the abrupt change in hormones with the removalof the placenta. The medicine slowly titrated those hormones down and, usuallyover 48 hours, hormones will be balanced to eliminate symptoms of PPD.
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Causes And Risk Factors
A rapid decrease in some hormones after delivery is thought to be one contributing factor to the development of postpartum depression. But other risk factors include stressors, previous depressive episodes, depression during pregnancy, complications during pregnancy and/or delivery, and a family history of mood disorders.
Recent studies have shown that among women who are diagnosed, about one-third had depression prior to their pregnancy, one-third have depression that began during pregnancy, and one-third experienced the onset of depression after delivery.
Find Out If What You Are Experiencing May Be Depression Depression Is Treatable Learn About Seeking Treatment For Yourself Or A Loved One
If you or someone you know is in crisis, tell someone who can help immediately.
or go to the nearest hospital emergency department for emergency medical treatment.
988lifeline.org.988 is confidential, free, and available 24/7/365, connecting those experiencing a mental health, substance use, or suicidal crisis with trained crisis counselors.
24/7, Free, Confidential Hotline for Pregnant and New Moms in English and SpanishCall or text 1-833-9-HELP4MOMS .
Dont be alone.Dont leave another person alone if he or she is in crisis.
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What Should I Do If I Have Symptoms Of Postpartum Depression
- Your baby blues dont go away after 2 weeks
- Symptoms of depression get more and more intense
- Symptoms of depression begin within 1 year of delivery and last more than 2 weeks
- It is difficult to work or get things done at home
- You cannot care for yourself or your baby
- You have thoughts about hurting yourself or your baby
Ask your partner or a loved one to call for you if necessary. Your doctor, nurse, or midwife can ask you questions to test for depression. They can also refer you to a mental health professional for help and treatment.
Medication Options For Postpartum Depression
Unlike the baby blues, postpartum depression is a medical condition that can last for a significant amount of time, especially if its left untreated. Seeking treatment for postpartum depression can be hard, especially for women who havent needed or looked for mental health treatment in the past.
But pregnancy, delivery, and early parenthood can all take a huge toll, both physically and emotionally, and with postpartum depression, that toll can have an effect on the whole family.
Women who feel they might be experiencing postpartum depression can best address it by acknowledging the problem and seeking out treatment. Treatment of postpartum depression may consist of talk therapy, medication, or some combination of the two.
If PPD is treated promptly and properly, the Mayo Clinic reports that PPD usually goes away within 6 months.
When medication is prescribed
For many women with PPD, medication is an important part of the treatment plan. A combination of medication and talk therapy is a common treatment for PPD.
Two of the more common types of medication that are prescribed for PPD include selective serotonin-reuptake inhibitors , such as fluoxetine and sertraline, and venlafaxine, a serotonin-norepinephrine reuptake inhibitor . SSRIs and SNRIs both affect the way the body transports and processes serotonin, which is a neurotransmitter that impacts many physical processes, including mood, sleep, and memory.
Breastfeeding and antidepressants
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When To See A Medical Provider
Even though its common, it can take a little while to determine postpartum depression. PPD symptoms can emerge anytime during the first three months after birth, and if left untreated, it can turn into chronic depression. If you notice symptoms of PPD in yourself or a loved one, especially if it extends beyond two weeks, you should see a healthcare provider. They will be able to diagnose you and discuss the best treatment plan for you. The sooner you get help for PPD and your symptoms, the sooner youll start to feel relief.
If you have been given treatment such as antidepressants, do not stop taking the medication without first discussing with your healthcare provider, even if you find that your symptoms have subsided. If you want to stop for any reason, talk things over with your doctor they can help you stop the medication safely.