What Medication For Postpartum Depression

Treating Postpartum Depression With Complementary Or Alternative Medicine

Editors note: Baby blues affects about 75% of all pregnant women, starting on the fourth or fifth day after giving birth. Women who suffer more severe symptoms are more likely to develop post-partum depression. I saw an interesting study that looked at providing nutritional supplements during those days to see if these changes in mood could be lessened. Although the study was small and it didnt include a placebo, women taking the supplements had much better mood scores when checked 5 days after delivery. This study prompted me to ask my colleague, Dr. Harrison, about other interventions for post-partum depression.

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.

Causes Of Postpartum Depression

Postpartum depression can have multiple causes and is often connected to the sudden hormonal changes a woman experiences just after giving birth. Hormone levelsspecifically estrogen and progesteronedrop significantly after giving birth, which can trigger PPD in some women.

• Pre-existing mental disorders
• Traumatic birth experiences
• Occurrence of PPD with previous birth
• Stressful life events

Also Check: How To Deal With Anxiety And Depression While Pregnant

Get A Support System In Place

Before your babys birth, get your support system in place so you can reach out when you need help. Friends and family want to pitch in, so let them. Dont be shy about asking your partner, family member or friend to hold the baby while you take a shower or letting your mother do a load of laundry. Even five minutes of venting to a pal about how sore your nipples are can make things more bearable.

Natural Treatment For Postpartum Depression

1. Omega-3 Fatty Acids

According to researchers at The University of Kansas Medical Center, there is a growing body of clinical evidence that suggests that low dietary intake or tissue levels of omega-3 fatty acids are associated with postpartum depression. Omega-3 benefits are known to include relieving depression and feelings of anxiety. Low tissue levels of DHA are reported in patients with postpartum depression and the physiological demands of pregnancy and lactation put a childbearing women at particular risk of experiencing a loss of DHA. Animal studies indicate that decreased brain DHA in postpartum females leads to several depression-associated neurobiological changes that inhibits the brains ability to respond to stress appropriately.

A 2014 study involving female fats found that menhaden fish oil benefits include exerting beneficial effects on postpartum depression and decreasing the biomarkers related to depression, such as corticosterone and pro-inflammatory cytokines.

A review published in the Journal of Midwifery and Womens Health discusses the recent research on omega-3s and womens mental health, with a particular focus on the perinatal period. These studies include population studies examining fish consumption and studies testing the efficacy of EPA and DHA as treatments for depression. The majority of studies indicate that EPA is able to treat depression either alone or in combination with DHA and/or antidepressant medications.

2. Acupuncture

3. Exercise

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Moderate To Severe Depression Currently Breastfeeding

Case C Presentation

Case C Discussion

Ms. C is experiencing moderate to severe depressive symptoms and pharmacological intervention is recommended. While this is similar to Ms. Bs case, it differs in that psychotherapy as a monotherapy is clearly not effective at this time and a trial of continued therapy and symptom monitoring would not be sufficient or advised. She also is breastfeeding and experiencing co-morbid generalized anxiety disorder. Anxiety symptoms are common in this population and can often be the presenting complaint of many women with postpartum depression. Treatment needs to address both depression and anxiety in the context of breastfeeding.

The benefits of breastfeeding must be weighed against the risks of untreated illness as well as the potential risks and benefits associated with antidepressant treatment during lactation. Recommendations regarding the use of antidepressant medications while breastfeeding are available based on case reports, studies with small samples, as well as expert consensus and opinion. 47 In particular, three scientific commissions including the American Academy of Breastfeeding Medicine, the American College of Obstetrics and Gynecology and the National Institute of Clinical Excellence have published practical recommendations based on available albeit limited evidence to guide clinicians in the use of antidepressant medications among breastfeeding women. 4850 The reports are in agreement with the following recommendations.

How Can I Help A Loved One

Postpartum depression can be a difficult experience for everyone. Most people expect the arrival of a child to be happy and joyful, and postpartum depression is none of those things. Its important to know that postpartum depression is no ones fault, but you can play a big role in a loved ones recovery.

Here are some tips on supporting a loved one who experiences postpartum depression:

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What Causes Postpartum Depression

More research is needed to determine the link between the rapid drop in hormones after delivery and depression. The levels of estrogen and progesterone increase tenfold during pregnancy but drop sharply after delivery. By three days postpartum, levels of these hormones drop back to pre-pregnancy levels.

In addition to these chemical changes, the social and psychological changes associated with having a baby increase your risk of postpartum depression. Examples of these changes include physical changes to your body, lack of sleep, worries about parenting or changes to your relationships.

If you’ve had any of the following symptoms, please notify your healthcare provider right away.

• Thoughts of harming yourself or your baby.
• Recurrent thoughts of death or suicide.
• Depressed mood for most of the day, nearly every day for the last two weeks.
• Feeling anxious, guilty, hopeless, scared, panicked or worthless.
• Difï¬culty thinking, concentrating, making decisions or dealing with everyday situations.
• Loss of interest or pleasure in most activities nearly every day for the last two weeks.

How To Treat Postpartum Depression Which Affects Both Mom & Baby

By Christine Ruggeri, CHHC

• Closing Thoughts

Did you know that 7080 percent of all new mothers experience some negative feelings after the birth of their child? Its common for women to experience severe mood swings after giving birth, which are known as baby blues. But when this sense of sadness doesnt go away, it may be the start of postpartum depression.

Mothers going through depression often feel too ashamed to talk about how theyre feeling, and researchers feel that this condition is both under-recognized and under-treated. Mothers dont feel like theyre being good mothers and often feel guilty about not wanting to take care of their newborn.

For most women, these feelings of inadequacy and sadness go away naturally, but for some this can turn into lasting depression, which can hinder the relationship between the mother and child. In fact, researchers have reported that postpartum depression has a moderate-to-large adverse effect on mother-infant interaction. Children older than 1 year whose mothers had postpartum depression have been reported to display more behavioral problems and cognitive deficits than children of mothers who were not depressed. For this reason, its important to understand the symptoms of ongoing postpartum depression and take these mood swings and phases seriously.

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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.

What Are Ways To Cope With Postpartum Depression

It’s OK to feel overwhelmed. Parenting is full of ups and downs and having a baby isn’t easy. If you have depression, you don’t have to suffer alone. Your healthcare provider can help find a treatment that works for you.

Here are some things you can do to help cope with postpartum depression:

• Find someone to talk to â a therapist, friend, family member or someone who will listen to you and help you.
• Join a support group for new parents.
• Try to eat healthily and find time for exercise.
• Prioritize rest for yourself.
• Go out with friends or talk to them on the phone.
• Find time for self-care and doing things you enjoy, like reading or other hobbies.
• Get help with household chores or errands.

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What’s The Difference Between Postpartum Depression And The Baby Blues

Though “postpartum depression” and “the baby blues” are sometimes used interchangeably, theyre two distinct conditions:

• The baby blues are very common, experienced by as many as an estimated 80 percent of new moms. After giving birth, women with the baby blues feel weepy, irritable, exhausted and anxious, and also have trouble sleeping. The baby blues usually begin within a few days postpartum and fade within two weeks.
• Postpartum depression symptoms are often similar to those of the baby blues which is why many women have trouble determining which one theyre experiencing. But while the baby blues last for only a short time and symptoms tend to be mild, postpartum depression symptoms can begin anytime within the first year after birth from right after birth to when you get your first period postpartum or wean your baby off breastfeeding. Postpartum depression symptoms tend to be both more pronounced and more enduring, lasting weeks, months or even a year or longer.

Who Does It Affect

Postpartum depression can affect anyone. Although its more commonly reported by mothers, it can affect any new parentsboth moms and dadsand it can affect parents who adopt. Postpartum depression is likely caused by many different factors that work together, including family history, biology, personality, life experiences, and the environment .

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How Do Antidepressants Work

Antidepressants affect certain brainchemicals called neurotransmitters. There are lots of antidepressants. Some types work on different brain chemicals than others.

Many of the new antidepressants have fewer side effects than some older ones. But each targets different brain chemicals, so some work better for certain people than others.

Newer antidepressants include:

• Trimipramine

It can take several weeks for antidepressants to be fully effective, so be patient. With some, youâll slowly increase your dosage. With others you can take the full dose right away.

If you donât get relief, tell your doctor or counselor. You may do better with a different dosage or another medication. You and your doctor can find the medicine, or combination of medicines, that works best for you.

Why Postpartum Treatment Is So Important

If you think you have postpartum depression, it’s critical that you talk about it with your practitioner and your partner and/or other loved ones.

Left untreated, PPD can last for several months or sometimes even longer, and affect your relationship with your baby and others.

Experts believe that untreated postpartum depression may increase the chance of a baby having language delays, increased crying and behavior problems. And the possible long-term complications of untreated PPD are the same as in major depression which includes being at risk of harming yourself or your baby.

For all these reasons, its extremely important to seek help rather than try to wait it out or deal with it on your own. If youre having serious symptoms for more than a few weeks, chances are they wont go away without professional attention, so dont wait to see if they do.

The good news is that once postpartum depression is diagnosed, there are many safe and effective treatment options.

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Negative Effects Of Maternal Depression

The adverse impact of maternal depression on infant outcomes has also been studied. Depression has significant negative effects on a mothers ability to interact appropriately with her child.13 Depressed women have been found to have poorer responsiveness to infant cues23 and more negative, hostile or disengaged parenting behaviors.24 These disruptions in maternal-infant interactions have been associated with lower cognitive functioning and adverse emotional development in children, and they appear to be universal across cultural and economic divides.25,26 Other parenting behaviors are also affected, including problematic sleep habits, lower preventative health care utilization and undesirable safety practices.26 Chronic depression in mothers places children at higher risk for behavioral problems27 and later psychopathology, including anxiety, disruptive, and affective disorders conversely, remission of depression in mothers is associated with reduction or remission in the childrens psychiatric diagnoses.28 Maternal depression also increases the risk for negative infant feeding outcomes, including lower rates of initiating or maintaining breastfeeding, lower levels of breastfeeding self-efficacy, and more difficulties while breastfeeding.29 In low-income countries, maternal depression has been associated with both malnutrition and higher rates of diarrheal illness in children.30

Postpartum Depression: The Worst Kept Secret

• By Andrea Chisholm, MD, Contributor

Having a baby is one of the happiest times in life, but it can also be one of the saddest.

For most new mothers, the first several days after having a baby is an emotional roller coaster ride. Thrilling moments of happiness and joy are abruptly interrupted by a plunge into moments of depressive symptoms including weeping, anxiety, anger, and sadness. These baby blues usually peak in the first two to five days after delivery, and in most women, go away as quickly as they came.

Except sometimes they dont go away.

For some women, depressive symptoms continue well past those first two weeks or develop over the next several months after having a baby.

A recent article by Drs. Stewart and Vigod published in the New England Journal of Medicine explores postpartum depression, this potentially debilitating condition that affects between 6.5% and 12.9% of new mothers.

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Other Postpartum Depression Treatments

Your doctor may also recommend one or more of the following postpartum depression treatments:

• Psychotherapy . Cognitive behavioral therapy and interpersonal psychotherapy are often effective in pregnant and postpartum women. Youll meet one-on-one with a psychiatrist, psychologist, therapist or other mental health provider who can help you to solve problems and cope with your feelings.
• Light therapy. Bright light therapy has been shown to reduce the symptoms of depression, though experts say some results are conflicting and more research needs to be done. During light therapy, youll sit with your eyes open in front of a light box that mimics daylight, which can cause a positive biochemical change that can help ease symptoms.
• Acupuncture. Some research suggests that acupuncture can help reduce symptoms of depression.
• Support groups. There are plenty of postpartum depression support groups . Talking with others who are experiencing the same thing may help you feel less alone, and you may pick up tips that can help you better handle your symptoms and feelings. But although PPD support groups can be helpful, they shouldnt replace medication or talk therapy.

Antidepressant Treatment In Breastfeeding Mothers

A deterrent to mothers use of antidepressant medications in the postpartum period is concern about potential adverse effects on the nursing infant. Several studies have been conducted to inform these concerns. reports infant serum levels of antidepressants and behavioral outcomes for breastfeeding newborns whose mothers were treated with a variety of antidepressants, including several SSRIs and TCAs. Infant serum levels of antidepressants, rather than breast milk concentrations, are reported, because serum levels are considered to be more direct determinants of drug exposure.

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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: