Postpartum depression is a recognized and treatable medical problem.
Treatment depends on the severity of your depression and your individual
needs, but it may include psychotherapy, antidepressant medications and
hormone therapy.
Psychotherapy
Psychotherapy can help you change behaviors and thoughts that contribute
to mental illness. There are several types, but each type involves a
short-term, goal-oriented approach aimed at helping you deal with a
specific issue.
If your symptoms of postpartum depression are mild, psychotherapy may be
all that's needed. Research shows that individual psychotherapy — in
which you work one-on-one with a psychiatrist, psychologist or other
mental health professional — is an effective treatment for postpartum
depression. The number of sessions required typically ranges from six to
12. More severe cases of postpartum depression typically require both
psychotherapy and medications.
Antidepressant medications
Today, many women with postpartum
depression are treated with
antidepressants called selective serotonin reuptake inhibitors (SSRIs),
which seem to work by increasing the availability of the
neurotransmitter serotonin in your brain. Studies suggest that they're
just as effective as older-generation antidepressants, such as
tricyclics and monoamine oxidase inhibitors (MAOIs), but have fewer side
effects. Commonly prescribed SSRIs include paroxetine (Paxil) and
sertraline (Zoloft).
If you're breast-feeding, you may be concerned about taking
antidepressants. All antidepressants are excreted in breast milk, but
multiple case studies suggest that some SSRIs can be taken with little
risk to your baby. Researchers who've studied the possible impact of
sertraline (Zoloft) and paroxetine (Paxil) on breast-fed infants have
found no adverse effects. Fluoxetine (Prozac), however, persists in the
bloodstream longer than do other antidepressants and may reach higher
levels in breast-fed infants. In one study, the babies of breast-feeding
mothers taking fluoxetine had concentrations of the drug in their
systems that were in the therapeutic range for adults. Fluoxetine has
also been linked with irritability, sleep disturbance and poor feeding
in some infants exposed through breast-feeding.
No long-term studies of infants exposed to SSRIs through breast milk
exist. So doctors and scientists can't be sure what the long-term
effects might be. There could be risks to the developing
neurotransmitter system in the brain. However, not treating postpartum
depression also poses risks. Stressful interactions between mother and
infant have been linked to poor bonding and cognitive and behavioral
problems in children. Having a parent with a mental illness also can
cause family discord and loss of income, both of which can affect child
development.
If you're concerned about taking antidepressants while breast-feeding,
talk to your doctor. Together, you can weigh the potential risks and
benefits and decide on the treatment that's right for you.
Hormone therapy
Using an estrogen patch — a patch containing estrogen that you wear on
your skin — can help counteract the rapid drop in estrogen that
accompanies childbirth. In a study of 61 women with postpartum
depression, those who used the estrogen patch every day were less
depressed than those not using it. However, estrogen therapy in the
postpartum period may pose possible risks, such as decreased milk
production and the risk of developing a blood clot in the legs that
could travel to the lungs (thromboembolism). More research is needed.
Treating postpartum psychosis
If you have the rare condition of postpartum psychosis, you need
immediate treatment and nearly always need medication. You generally
need to stay in the hospital because you're at risk of hurting yourself
or others. In some cases, this treatment is life-saving. The length of
treatment varies from person to person. Therapies used to treat
postpartum psychosis include antidepressant medications and hormone
therapy, but also may include:
-
Antipsychotic
agents.
These medications, also called neuroleptics, are typically used to
treat psychotic disorders, such as schizophrenia. They may also be
used to treat severe cases of depression accompanied by psychosis.
-
Electroconvulsive therapy.
In this therapy, a small amount of electrical current is delivered
to your brain through electrodes, producing a controlled seizure
that usually lasts 30 to 60 seconds. Doctors believe that chemical
aspects of brain functioning are altered during and after this
seizure activity. When you receive electroconvulsive therapy (ECT)
on a regular basis, these chemical changes build on each other,
reducing symptoms. ECT can be an effective treatment for severe depression, especially when other treatments have failed or when you
need immediate results and can't wait for medications to begin
working.
-
Lithium
carbonate.
This medication, known as a mood stabilizer, is generally taken to
help treat bipolar disorder, which is characterized by swings in
mood between depression and mania. It works by balancing out such
mood swings.
Self-care
If you have postpartum depression, you can take steps to aid your
recovery. Try these tips:
-
Practice good
health habits.
Get as much rest as you can. Rest or sleep while your baby sleeps.
Exercise and eat a nutritious diet, too, emphasizing grains, fruits
and vegetables.
-
Make time for
yourself.
If you feel like the world is coming down around you, take some time
for yourself. Get dressed, leave the house and visit a friend or run
an errand. Or schedule some time alone with your partner.
-
Avoid
isolation.
Talk with your partner, family and friends about how you're feeling.
Also talk with other mothers so that you can learn from their
experiences. Ask your doctor about groups for new moms in your
community or support groups for women with postpartum depression.
-
Have realistic
expectations.
Scale back your expectations of having the perfect household. Do as
much as you comfortably can and leave the rest. Ask for occasional
help with child care and household responsibilities from friends and
family.
