Treatment For Postpartum Depression While Breastfeeding

No Association Or Nonsignificant Trends

A number of studies have reported no significant relationship between postpartum depression and breastfeeding status . However, two of these studies did report finding a nonsignificant trend suggestive of an inverse association . In any case, most of these findings were incidental the primary purpose of those investigations was not to evaluate the association between breastfeeding and postpartum depression. However, recent data analyzed in our lab also failed to find support for a relationship between breastfeeding intention and initiation when controlling for other risk factors for postpartum depression.

Who Is At Risk

While no one is immune to PPD, some factors can increase the risk for many people, such as:

-A history of depression during or after previous pregnancies

-Previous bipolar episodes

-A family history of mental health issues

-Experiencing significant life stressors during or after pregnancy such as job loss, death of a loved one, or domestic violence

-Medical issues during the pregnancy

-Traumatic birth experience

-A lack of support system

-A history of substance abuse

PPD usually begins within a month after childbirth, but it can present anytime during the first year. Its likely to be caused by a mixture of emotional and physical factors. A womans body undergoes considerable hormonal changes after giving birth, and these changes can lead to erratic behavior and drastic mood swings. In addition, the sleep deprivation that comes along with having a newborn baby can exacerbate many of the symptoms of PPD.

Mothers dealing with postpartum may also struggle with bonding and doubt their ability to care for their new baby. In the most severe cases of postpartum, a new mom may have thoughts of harming herself or her child, which is why early treatment of PPD is vital.

What Are The Side Effects And Rids Of Specific Antidepressants

The InfantRisk Center believes that all parents should be empowered to make evidence-informed decisions together with their healthcare providers. While we will report adverse effects of antidepressants below, please remember than many mothers successfully breastfeed healthy infants while on antidepressants. We simply want you to be aware of the risks and benefits, and will report the rare instances we have of infant harm to provide a balanced picture.

Selective Serotonin Reuptake Inhibitors

Tricyclic Antidepressants

Serotonin Norepinephrine Reuptake Inhibitors

Desvenlafaxine and venlafaxine have an RID of 6.5%. Infants whose mothers take desvenlafaxine have serum levels that range from undetectable to 37% of maternal levels. These SNRIs have caused drowsiness and/or agitation in some cases. Overall, they have few adverse reactions and there is no evidence that suggests they hinder development.1

Bupropion

Other Antidepressants

There are many other options for depression treatment. Most have not yet been studied in lactating women and their infants. For more information, please call the InfantRisk Center to speak to a nurse or download our app MommyMeds.

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Breastfeeding And Maternal Mood

A number of studies report that women who are not breastfeeding are more likely to have higher levels of depressive symptoms than women who are breastfeeding . For example, a recent longitudinal study by Nishioka and colleagues found that at 5 months postpartum the proportion of mothers with an Edinburgh Postnatal Depression Scale score of 9 was significantly lower for women who were breastfeeding compared to women who were formula feeding . Moreover, the inverse relationship between breastfeeding and postpartum depressive symptoms was found to persist even once age and education were controlled and when income, race, previous history of depression, or current psychoactive medication use was controlled . Interestingly, one study found that depression severity was not related to breastfeeding status in a group of women diagnosed with postpartum depression . Thus, while breastfeeding may be associated with depressive symptoms, it may not influence the severity of the symptoms.

The Potential Risk Of Long

Several studies have investigated the possible effect of SSRI exposure via breast milk and body weight increase during the first year of life. In a study of 78 nursing infants whose mothers were treated with SSRIs or venlafaxine , there were no differences in body weight compared to values from normative populations . In a study on 11 infants exposed to citalopram, there were no differences in body weight after 12 months compared to 10 infants of medication-free mothers . Finally, in a study on 27 infants exposed to paroxetine, there were no differences in body weight at 6 and 12 months compared to 27 breastfeed and 19 bottle-feed infants of medication-free mothers .

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What Are The Types Of Postpartum Depression

There are three different types of postpartum mood disorders:

Postpartum blues or baby blues

The baby blues affect between 50% and 75% of people after delivery. If you’re experiencing the baby blues, you will have frequent, prolonged bouts of crying for no apparent reason, sadness and anxiety. The condition usually begins in the first week after delivery. Although the experience is unpleasant, the condition usually subsides within two weeks without treatment. The best thing you can do is find support and ask for help from friends, family or your partner.

Postpartum depression

Postpartum depression is a far more serious condition than the baby blues, affecting about 1 in 7 new parents. If you’ve had postpartum depression before, your risk increases to 30% each pregnancy. You may experience alternating highs and lows, frequent crying, irritability and fatigue, as well as feelings of guilt, anxiety and inability to care for your baby or yourself. Symptoms range from mild to severe and may appear within a week of delivery or gradually, even up to a year later. Although symptoms can last several months, treatment with psychotherapy or antidepressants is very effective.

Postpartum psychosis

Antidepressant Use While Breastfeeding: What Should I Know

The postpartum period can be a magical time when a mom finally gets to meet and spend time with their new baby. However, this time can also be challenging for many mothers. It is estimated that at least 1 in 7 mothers suffers from postpartum depression.1 Psychotherapy is certainly useful during this time, but medication may also be necessary to adequately treat psychiatric illnesses. Needing and taking new medications while breastfeeding can bring about many questions. The InfantRisk Center is here to help you find answers.

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Catching Postpartum Depression Quickly

Because postpartum depression affects the health of the woman, her infant, and her entire family, it is very important to screen for postpartum depression risk. Most obstetricians are now implementing some type of screening tool during the postpartum checkup. Screening is very important because studies have shown that many women with postpartum depression are ashamed of their symptoms and are afraid of the social stigma associated with the diagnosis.

Although symptoms of postpartum depression can vary, the typical symptoms include:

• sleep disturbances
• feeling overwhelmed
• preoccupation with babys health or feeding

Making the diagnosis of postpartum depression is based on more than just the presence of these symptoms. Some of these can be normal, especially after a difficult sleepless night caring for a newborn. It is the intensity of the symptoms and how they affect a womans ability to adjust and cope with life stressors that are key to making the diagnosis of postpartum depression.

Breastfeeding And Postpartum Depression: Treatment Options

by Miranda Wicker |

My father passed away in August. As I waited for news about his arrangements, I felt the pangs of anxiety building. Knowing that I have a history of anxiety, I called the only doctor Ive seen in 2 yearsmy obstetrician.

I explained to the receptionist what I was going through and that I knew I needed to get in with someone, a therapist, for treatment, but that I didnt know where to start and the wait time would likely be too great to treat my immediate needs. I asked if they could they prescribe something to help. The nurse practitioner called me back that afternoon.

Are you breastfeeding?Yes. A few times a day. My daughter is 16 months old.Theres only one medication we can give you.

Currently, there is only one medication on the market specifically approved by the FDA for use in breastfeeding mothers, and it isnt the medication with which Im most experienced or even the best one for treating anxiety. It also isnt the only medication that has been proven safe for breastfeeding mothers in study after study.

I was sort of crushed by the lack of options given to me by my doctors office. I felt like I was being told to choose between the extended breastfeeding relationship I have with my daughter and treating my anxiety with a medication I knew to be safe and effective. I was angry for other moms who might find themselves in similar situations.

Theres more than one way to save a mom.

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How To Treat Postpartum Depression While Breastfeeding According To A Therapist

The essence of motherhood is self-sacrifice: You carry your babies in your body, sacrificing your own comfort, and sometimes even health, to bring them into this world. For some, the life they’ve given their child means that they themselves suffer from postpartum depression , and many delay seeking treatment while they’re breastfeeding out of concern for their infant. But while motherhood does require sacrifice, it should never be at the expense of your own mental health. Knowing how to treat postpartum depression while breastfeeding is necessary for you and your baby.

According to Licensed Marriage and Family Therapist Jaime Filler, breastfeeding moms all too often avoid talking to their healthcare provider about their postpartum depression out of concern for the potential of harming their baby. “However,” Filler tells Romper in an exclusive interview, “treatment for PPD does not always include medication. Many women find that their symptoms can be treated by meeting with a psychotherapist who specializes in maternal mental health. Often the use of cognitive behavioral therapy can be more than sufficient to address a new mom’s postpartum depression or anxiety.”

Sounds great, right? But what about the headache of actually finding childcare while you’re attending those much needed therapy sessions? Filler says if the therapist specializes in maternal mental health, your baby should be welcome in the sessions, too.

Can Postpartum Depression Be Prevented

Postpartum depression isn’t entirely preventable. It helps to know warning signs of the condition and what factors increase your risk. Here are some tips that can help prevent postpartum depression:

• Be realistic about your expectations for yourself and your baby.
• Limit visitors when you first go home.
• Ask for help â let others know how they can help you.
• Sleep or rest when your baby sleeps.
• Exercise â take a walk and get out of the house for a break.
• Keep in touch with your family and friends â don’t isolate yourself.
• Foster your relationship with your partner â make time for each other.
• Expect some good days and some bad days.

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Other Nonpharmacologic Treatments For Postpartum Depression

Many women suffering from PPD and their healthcare providers may seek alternatives or adjuncts to standard psychological or pharmacologic treatments because of their concern about the effects of pharmacological treatment on breastfeeding,122 access to care, issues of stigma in the treatment of mental illness, limited effectiveness, or personal beliefs. In the following we have provided an overview of a variety of evidence-based nonpharmacologic treatments for postpartum depression.

Electroconvulsive therapy

As with treatment-refractory major depression in the general population, electroconvulsive therapy is an option for depressed postpartum women who do not respond to antidepressant medication or who have severe or psychotic symptoms. Data specific to this population are very limited. One small study of 5 women receiving ECT for refractory postpartum depression reported a 100% remission rate.123 Apart from concerns regarding anesthesia and breast feeding, the use of ECT for postpartum depression does not differ from its use in major depression.124 Anesthetic agents used in ECT are typically rapidly metabolized, and risk of transmission in breast milk can be minimized by timing breast feeding accordingly.

Bright light therapy

Omega-3 fatty acids

Acupuncture and massage

Exercise

Postpartum Depression While Breastfeeding

PPD is more common in women who have difficulty nursing their newborns. A significant part of a mothers interaction with her new baby happens during feedings. This special time is a major source of infant-mother bonding.

When a mother cant successfully nurse, painful effects often ensue:

• Feelings of low self-confidence and low self-worth
• Guilt that interferes in daily life
• Stress that can lead to postpartum depression and postpartum anxiety

This mental health challenge can occur while trying to breastfeed. Postpartum depression can also happen after stopping breastfeeding. Women stop for myriad reasons, all personal and all perfectly okay despite a society that often says otherwise.

Pain, lack of sufficient milk production, difficulty getting the baby to latch, and breast infection are effects of nursing difficulties that contribute to postpartum depression. Pain is strongly correlated to PPD. All types of depression increase pain sensitivity, so women with PPD likely experience higher levels of pain than those without PPD. Additionally, women who experience breastfeeding pain are twice as likely to develop PPD. .

Breastfeeding difficulties are linked to postpartum depression however, theyre not the only factor that plays a role in a womans PPD.

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Breastfeeding And Postpartum Depression: An Overview And Methodological Recommendations For Future Research

Carley J. PopeAcademic Editor: Received

Abstract

1. Introduction

Postpartum depression is a serious mental health condition that affects an estimated 13% to 19% of women who have recently given birth . Postpartum depression is characterized as a persistent low mood in new mothers, which is often accompanied by feelings of sadness, worthlessness, and/or hopelessness. Postpartum depression differs from the baby blues, as the baby blues is a briefer period of emotional disturbance that is experienced by up to 4 in 5 women within the first few days following childbirth and usually remits within 10 days .

Currently, the Diagnostic and Statistical Manual for Mental Disorders-Fifth Edition classifies depression with peripartum onset as beginning during pregnancy or within the first four weeks postpartum . The International Classification of Diseases classifies postpartum depression as occurring within the first six weeks postpartum . In contrast to the current criteria, some researchers recommend that this time frame be extended in future revisions of these guides to account for episode onset within the first six months postpartum . Further, in spite of the current ICD and DSM-5 guidelines, many researchers use a time frame that ranges up to one year postpartum for onset of postpartum depression .

2. Consequences of Postpartum Depression

3. Breastfeeding and Postpartum Depression

4. Breastfeeding Intention and Initiation

5. Breastfeeding and Maternal Mood

12. Future Research

Living With Postpartum Depression

Feeling depressed doesnt mean that you are a bad person. It doesnt mean that you did something wrong or that you brought this on yourself. It also does not mean that you dont love your baby. If you have given birth recently and are feeling sad, blue, anxious, irritable, tired, or have any of the other symptoms of postpartum depression, remember that many other women have had the same experience.

Youre not losing your mind or going crazy. You shouldnt feel that you just have to suffer through it. Here are some things you can do that other mothers with postpartum depression have found helpful:

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How Long Does Postpartum Depression Last

Postpartum depression can last until one year after your child is born. However, this doesn’t mean you should feel “cured” in one year. Talk to your healthcare provider about your symptoms and treatment. Be honest about how you feel. Think carefully about if you feel better than you did at the beginning of your diagnosis. Then, they can recommend ongoing treatment for your symptoms.

You Can Treat Your Postpartum Depression And Still Breastfeed

Despite improved awareness and screening practices, many women with perinatal mood disorders still go untreated.

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This story was originally published on Oct. 23, 2019 in NYT Parenting.

A new mother recently told me that she was afraid to see a psychiatrist for her postpartum depression. Breastfeeding is the one thing I can control, and I dont want to stop if I need medication, she said. Even though she knew she needed to see a mental health specialist, she worried that she might have to stop nursing her baby if she were prescribed antidepressants.

As a pediatrician with specialized training in breastfeeding medicine and postpartum depression and anxiety, I hear stories like this every day. Postpartum depression and anxiety are the most common and serious obstetric complications, affecting up to 25 percent of mothers within the first year of childbirth. And as breastfeeding rates in the United States continue to rise, with over 57 percent of women breastfeeding at the six-month mark, its not surprising that many nursing mothers will also be suffering from a postpartum mood disorder.

Natasha K. Sriraman M.D. is an associate professor of pediatrics at Eastern Virginia Medical School/The Childrens Hospital of the Kings Daughters who blogs regularly on maternal-child health and issues affecting mothers in medicine.

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Postpartum Depression Treatment While Breastfeeding: Whats Safe

If youd like to continue breastfeeding while treating postpartum depression but are worried about your babys health and safety, you can be encouraged by the treatment options available. Some involve medication, while others do not.

Many treatment approaches for PPD dont involve medication. Reading up on PPD and breast- versus bottle feeding empowers you to make decisions that are right for you and your baby. Working with a therapist can help a great deal as well. In addition to working on postpartum depression symptoms, you and your counselor can work to come to terms with stopping breastfeeding if you need or want to do so. Youll build knowledge and confidence.

Medication is a legitimate treatment for postpartum depression. Taking certain antidepressants for postpartum depression while breastfeeding doesnt harm your baby even if small amounts pass into breastmilk. Some, however, are more toxic when they find their way into breastmilk and can be harmful to infants. When talking to your doctor about prescription medication for PPD, always mention that youre breastfeeding, so you receive the best medication for you and your baby.

The best medication for postpartum depression and anxiety during breastfeeding is a class known as selective serotonin reuptake inhibitors . SSRIs help PPD without entering breastmilk. Some of the most commonly prescribed SSRIs for PPD include: