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.
What Are The Main Causes Of Postpartum Anxiety
There is no one cause for postpartum anxiety. Healthcare providers think several factors can cause it:
- Change in hormones: The sharp decrease in hormones after delivery can cause changes in mood or cause you to overreact to stress.
- Lack of sleep: Caring for newborns can be a 24-hour job and cause sleep deprivation.
- Feelings of responsibility: You may be overcome with feelings of needing to protect and care for your new baby.
- Stressful events: Certain milestones or events in your baby’s life could trigger anxiety. For example, issues with breastfeeding, a difficult pregnancy or stressful delivery.
- Risk factors that increase your chances of postpartum anxiety: Health conditions and past experiences may put you at a higher risk for developing anxiety.
Treating Postpartum Depression With Antidepressants
Antidepressants are the most common psychiatry medications prescribed to women suffering from postpartum depression. Antidepressants work to balance a persons neurotransmitters, the brain chemicals that affect mood and emotions.
When antidepressants are taken for clinical purposes, the results include:
- Improved appetite
- Other general improvements in well-being
It generally takes at least four weeks for antidepressants to take full effect. However, some people may feel better much sooner.
Several types of antidepressants are prescribed based on various factors. Selective Serotonin Reuptake Inhibitors are drugs that specifically improve serotonin levels in the brain. Serotonin is one type of neurotransmitter responsible for emotions and mood. SSRIs block the reabsorption of serotonin in the brain, making it more readily available to the brain. Serotonin helps to elevate mood and reduce general symptoms of postpartum depression.
Other types of antidepressants include Serotonin-Norepinephrine Reuptake Inhibitors . This type improves levels of both serotonin and norepinephrine, another neurotransmitter.
Tricyclic Antidepressants and Monoamine Oxidase Inhibitors are two other antidepressant medications.
Regardless of the type of antidepressant, women must take them as instructed at the same time each day. Doing so improves their effectiveness in reducing postpartum depression symptoms.
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How Can I Reduce My Risk For Postpartum Anxiety
Sometimes there isn’t anything you can do to prevent postpartum anxiety. It’s not your fault and not caused by anything you did or didn’t do. If you know of specific triggers from your past or have a history of anxiety or depression, talk to someone during your pregnancy. Talking with a counselor and learning coping tools before your baby is born can reduce the intensity of your anxious thoughts during the postpartum period.
What Is The Difference Between Postpartum Anxiety And Postpartum Depression
If you have postpartum depression, you may experience excessive sadness, frequent crying or feel like you can’t take care of yourself or your baby. You may have trouble finding joy in your baby or feel like you aren’t capable of being a parent. Postpartum anxiety is associated with excessive worrying, not with sadness. If you feel panicked or overwhelmed with fearful thoughts, you may be suffering from postpartum anxiety.
Many of the signs of postpartum depression overlap with postpartum anxiety like disrupted sleep, heart palpitations or feeling afraid. It’s common for people with postpartum depression to experience signs of postpartum anxiety. However, not everyone with postpartum anxiety is also depressed.
It’s important to discuss all of your symptoms and feelings with your healthcare provider so they can help you.
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Are Some Women More At Risk Of Postpartum Depression
Yes. You may be more at risk of postpartum depression if you:3
- Have a personal history of depression or bipolar disorder
- Have a family history of depression or bipolar disorder
- Do not have support from family and friends
- Were depressed during pregnancy
- Lose your appetite
- Have trouble sleeping
The baby blues usually go away in 3 to 5 days after they start. The symptoms of postpartum depression last longer and are more severe. Postpartum depression usually begins within the first month after childbirth, but it can begin during pregnancy or for up to a year after birth.5
Postpartum depression needs to be treated by a doctor or nurse.
Fda Approves First Drug For Postpartum Depression
The medication works quickly, within 48 hours. But its an expensive infusion and requires a stay in a medical center.
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By Pam Belluck
The first drug for women suffering postpartum depression received federal approval on Tuesday, a move likely to pave the way for a wave of treatments to address a debilitating condition that is the most common complication of pregnancy.
The drug works very quickly, within 48 hours a significant improvement over currently available antidepressants, which can take two to four weeks to have an effect, if they work at all.
Experts say the new treatment will provide immediate relief for mothers whose depression keeps them from providing their babies with the care, bonding and nurturing that is crucial for healthy development. As many as one in seven American women experience depression during or after pregnancy.
Postpartum depression is a serious condition that, when severe, can be life-threatening, Dr. Tiffany Farchione, acting director of the Division of Psychiatry Products at the Food and Drug Administrations Center for Drug Evaluation and Research, said in a statement.
This approval marks the first time a drug has been specifically approved to treat postpartum depression, providing an important new treatment option.
She did not stop antidepressants altogether, but switched to a low dose of Effexor.
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How Is Postpartum Depression Diagnosed
There is not a specific test that diagnoses postpartum depression. Your healthcare provider will evaluate you at your postpartum visit. This visit may include discussing your health history, how youâve felt since delivery, a physical exam, pelvic exam and lab tests. Many providers schedule visits at two or three weeks postpartum to screen for depression. This ensures you get the help you need as soon as possible.
They may do a depression screening or ask you a series of questions to assess if you have postpartum depression. They’ll ask how you’re feeling and how your baby is doing. Be open and honest with your provider to ensure they get an accurate picture of your emotions and thoughts. They can help distinguish if your feelings are typical or symptoms of postpartum depression.
Your healthcare provider may order a blood test because postpartum depression can cause symptoms similar to many thyroid conditions.
Remember, your healthcare provider is there to support you and make sure you are healthy, so be honest with them. There is no judgment, and you arenât alone in your feelings.
Medications For Postpartum Depression
The first step in treatment is to resolve immediate problems such as sleep and appetite changes. Antidepressants are usually very effective for this.
You and your doctor will need to make a careful decision about the use and choice of antidepressants if youâre breastfeeding. Some antidepressants are secreted in small amounts in breast milk. Other medications, such as lithium, are more controversial in breastfeeding because of concerns that they may cause infant toxicity, although there is debate about whether lithium poses a real risk.
Talk to your doctor to determine if the benefits of antidepressant therapy outweigh the risk. If you take an antidepressant, youâll probably be advised to take it for at least 6 months to a year to avoid a relapse and then to taper it off or continue it, depending on your symptoms and history.
Also, if youâve had a previous episode of postpartum depression, your doctor may suggest that you take preventive medicine shortly after the baby is born or during pregnancy.
Most antidepressants donât pose any major risks to a developing fetus, although all medications have potential risks. Some antidepressants, including the selective serotonin reuptake inhibitors Celexa, Paxil, Zoloft, and Prozac, have been associated with cardiac and cranial defects when taken early in the pregnancy. Older reports that some tricyclic antidepressants may cause limb deformities have not been confirmed in larger, more modern studies.
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What Are The Symptoms Of Postpartum Anxiety
Anxiety is your body’s way of responding to danger or threats. If you have postpartum anxiety, you may feel like you or your baby is in constant danger. The symptoms you feel are your body’s way of reacting to this constant sense of worry or fear.
Common signs of postpartum anxiety are:
Physical symptoms
- Feeling on edge or fearful.
Behavioral symptoms
- Avoiding certain activities, people or places.
- Being overly cautious about situations that aren’t dangerous.
- Checking things over and over again.
- Being controlling.
There are certain conditions like obsessive-compulsive disorder or panic disorders that can affect you during the postpartum period. If you are suffering from either of these conditions, you may have panic attacks or obsessive thoughts.
Be honest with your healthcare providers about all the symptoms you feel. They are there to support you and recommend treatments to help.
Does Insurance Cover Zulresso
Speak to your insurance provider to find out about your coverage for treatment with Zulresso. Sage Central offers financial assistance programs to help patients reduce their out-of-pocket costs related to their treatment. Through the Zulresso Drug Co-Pay Assistance Program some patients may be eligible for copay assistance to reduce their out-of-pocket, drug-related copay costs up to $15,000.
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What Medications Can I Take For Postpartum Depression
Your healthcare provider may prescribe antidepressants to manage symptoms of postpartum depression. Antidepressants help balance the chemicals in your brain that affect your mood.
If you’re breastfeeding, talk to your healthcare provider about the risks and benefits of taking an antidepressant. Medications can transfer to your baby through your milk. However, the transfer level is generally low, and many antidepressant medications are considered safe. Your provider can help you decide what medicine is right for you based on your symptoms and if you’re nursing.
Some common antidepressants for postpartum depression are:
- Selective serotonin reuptake inhibitors such as sertraline and fluoxetine .
- Serotonin and norepinephrine reuptake inhibitors such as duloxetine and desvenlafaxine .
- Tricyclic antidepressants such as amitriptyline or imipramine .
Keep in mind that it takes at least three or four weeks for antidepressants to work. Talk to your healthcare provider before stopping the medication. Stopping your medication too soon can cause symptoms to return. Most providers will recommend reducing your dose before stopping completely.
If your provider detects postpartum depression while youâre still in the hospital, they may recommend IV medication containing brexanolone.
A $34000 Drug For Postpartum Depression Brings Praise Price Concerns
The most common complication of postpartum can last for weeks to months. A powerful but pricey new drug could offer quick treatment for affected mothers.
A one-time infusion that provides fast relief for postpartum depression has sparked excitement about the medicines potential and concerns over its $34,000 price tag.
Brexanolone provides a synthetic source of allopregnanolone a neurosteroid that decreases after childbirth. Approved last month by the Food and Drug Administration, it is the first drug specifically meant to treat postpartum depression.
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The drug is also unique because allopregnanolone, which binds to receptors in the brain that help regulate mood and well-being, hasnt previously been a focus.
I am absolutely excited about this new treatment target, says , an associate professor of psychiatry and obstetrics and gynecology at Michigan Medicine. For these severely depressed moms to feel better quickly, theres no question that this is wonderful.
Three clinical trials involving more than 200 Zulresso recipients noticed improvement within hours after receiving the infusion. Better yet, the medication was still effective 30 days later.
Among those risks: inability to bond with an infant, feelings of sadness or anxiety, and, in severe cases, thoughts of suicide or harming the child.
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Postpartum Depression: Citalopram Benefits Explained
Scientists claim to have found out precisely why the commonly prescribed drug citalopram is effective in treating postpartum depression. New research suggests that the antidepressant may restore the connections between brain cells that are impeded by the effects of pregnancy-induced stress.
The study, conducted by scientists from Ohio State University, examined the brain cells of rats that were chronically stressed during pregnancy. The research was presented at Neuroscience 2014, the annual meeting of the Society for Neuroscience.
The aim of the research was to identify the changes in the brain that may cause the symptoms of postpartum depression, focusing on an area within the brain that controls the reward system, known as the nucleus accumbens.
We have a suspicion that stress during pregnancy is somehow altering the reward system in the brain, producing anhedonia and making these depressed mothers less rewarded by their offspring and less motivated to care for them, says senior author Benedetta Leuner. Its possible that the effects of stress on the brain circuit regulating reward can lead to these symptoms.
Postpartum depression, whereby new mothers experience a long-lasting form of depression, is a serious health problem that can have consequences for both the new mother and her family. According to the American Psychological Association , an estimated 9-16% of new mothers develop the condition.
Can I Still Breastfeed
If youâre still nursing your baby, youâre probably wondering if itâs safe to take antidepressants. Most likely yes, depending on the medication.
Antidepressants have shown up in breast milk in very low amounts. Studies have found that neither the old or new drugs have harmful effects on babies when small amounts are passed through breast milk. But be sure to tell your doctor that youâre nursing, just to be safe.
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How Is Postpartum Depression Treated
Postpartum depression is treated differently depending on the type and severity of your symptoms. Treatment options include anti-anxiety or antidepressant medicines, psychotherapy and support group participation.
Treatment for postpartum psychosis may include medication to treat depression, anxiety and psychosis. You may also be admitted to a treatment center for several days until you’re stable. If you don’t respond to this treatment, electroconvulsive therapy can be effective.
If you are breastfeeding , don’t assume that you can’t take medicine for depression, anxiety or even psychosis. Talk to your healthcare provider about your options.
Moderate To Severe Postpartum Depression Not Currently Breastfeeding
Case B Presentation
Case B Discussion
Given the duration and severity of Ms. Bs current mood symptoms, past psychiatric history and degree to which her mood symptoms are impairing her functioning, she would benefit from antidepressant medication alone or in combination with therapy. Based on the available evidence, there is no clear first line choice of antidepressant medication for peripartum depression in women who choose not to breastfeed. There are a total of ten published clinical trials that have assessed the efficacy of antidepressants for postpartum depression. 3342 Only three studies have employed a double-blind placebo controlled study design. In one randomized, double-blind study of CBT + fluoxetine compared to CBT + placebo , fluoxetine +CBT was significantly more effective than CBT + placebo in decreasing postpartum depressive symptoms.33 In an adequately powered randomized trial of paroxetine compared to placebo , depressive symptoms in both groups improved but group differences were not statistically significant. 34 In a third study , sertraline or placebo was added to a form of psychotherapy called brief dynamic psychotherapy. 35 While both groups improved significantly, there were no significant differences between groups. This latter study is limited by its small sample was likely underpowered to detect differences between groups. All of these studies highlight the need for a placebo arm in evaluating the efficacy of treatments for this population.
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Do I Have Postpartum Anxiety Or Postpartum Depression
Postpartum anxiety and postpartum depression share some symptoms, but they are different conditions. Excessive worrying, feeling panicky for no reason and having irrational fears or obsessions are all signs of postpartum anxiety. It’s important to discuss all your symptoms with your healthcare provider so they can get you the help you need.
How Long Does Postpartum Anxiety Last
It varies depending on the person. Postpartum anxiety doesn’t last forever but also doesn’t typically go away on its own. Getting prompt treatment from your healthcare provider is the best way to recover from postpartum anxiety. Do not be afraid of the stigma associated with anxiety or let it prevent you from seeking help.
Can postpartum anxiety come back?
Yes, it can. Unfortunately, excessive anxiety can strike at any time. It may not be labeled as postpartum anxiety if it occurs 12 months after your baby is born, but anxious feelings related to your children can develop at any time. It’s important to talk with your healthcare provider if extreme worry interferes with your life, no matter your child’s age.
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How Is Depression Treated
Depression is treatable with high rates of success. Treatments may include:
- Antidepressants, such as Selective Serotonin Reuptake Inhibitors , Serotonin Norepinephrine Reuptake Inhibitors , tricyclic antidepressants , monoamine oxidase inhibitors .
Responses to antidepressants vary, and most antidepressants take 4 to 6 weeks for full effect. About 50% of patients respond to the first treatment, whereas others may have to try a few different types of antidepressants before they find the best one for them.
There are several things you can do to help with your symptoms as well, such as:
- Setting realistic and daily goals
- Developing strategies to work through crises situations
- Developing coping and problem-solving skills
- Learning how to develop positive relationships
- Replacing negative thoughts with positive ones.