Postpartum Depression Treatment Options
Author: Dr. Anna Kaplan
Postpartum depression (PPD) is a common condition which may affect between 1% and 5.7% of women within the first six months after delivery. More new mothers experience postpartum or baby blues, perhaps as few as 15% or as many as 85%, depending on how it is defined. These feelings peak at day 5 and are usually gone by a week to ten days after the baby's birth. Postpartum depression is more serious and lasts much longer. It can peak at around six months.
It is often difficult for new mothers and fathers to recognize postpartum depression, and the same is true for some of the doctors that may interact with the parents and their baby. Understanding of postpartum depression is increasing, as is appreciating how common it is. Researchers are attempting to discover what might cause a woman to suffer from PPD or what factors might put someone at greater risk. These factors may include heredity, previous problems with depression, hormonal influences, outside stress, difficult pregnancies, medical problems, and many other things.
For a woman with PPD, the choice of treatment may be difficult. There are two major ways to treat depression in general. One way is with medication; the other is with counseling of some type.
Counseling has been proven effective for PPD in some controlled trials, especially for mild to moderate symptoms. For PPD, this usually means individual sessions at least once a week for 6 to 12 weeks. Most types of counseling or psychotherapy can be costly and, therefore, not available to everyone with PPD who might benefit from them. Shorter lengths of treatment, group therapy, and treatment by non-professionals have not been proven as effective. When a woman with mild to moderate depression can get counseling, this may be the best method because it does not have side effects or any risks for the breastfeeding baby.
Antidepressant medication has been proved effective for major depressive disorders in non-pregnant women. There have been studies in postpartum depression showing that many different antidepressants do work for PPD. Most trials have excluded breastfeeding women.
A number of specific antidepressants have been studied to evaluate their presence in breast milk, as well as their possible effects on breastfeeding infants. Studies of sertraline (Zoloft), paroxetine (Paxil), and nortriptyline (Pamelor) have shown no adverse effects on infants, and most have found no medication in breast milk. One of these may be the best choice for a woman with PPD.
The lowest dose of the safest antidepressant should be taken. Doctors who prescribe antidepressants to women with PPD should counsel them as to the best timing of breastfeeding depending on when the medicine is taken. There are times during any 24 hour period when the level of the antidepressant will be highest and when it will be lowest. It may be possible to adjust feeding times or use a breast pump to collect milk at the best time for one or more other feedings. The baby's pediatrician should be told so he or she can monitor the baby for any side effects from getting antidepressants into his or her system. Side effects have been seen with other antidepressants, especially fluoxetine. These include crying, colic, and irritability, among other symptoms. However, with the right antidepressant, the baby usually does not have any problems.
There are other additional ways to combat depression that may help. Supplemental estrogen has shown some effectiveness in a number of small trials. Nurse home visits, which are popular in Europe, may be of some benefit. Other possible treatments include exercise, vitamins, getting enough sleep, light therapy, and massage therapy, all of which might be helpful but have not been proven so.
It is very important to know that some studies have shown that babies do not thrive as well when cared for by significantly depressed mothers. There can be problems with the mother-baby bond, the baby's early development, and the mother's emotional state. There is a definite risk involved in doing nothing.
Anyone suffering from PPD needs to know that gritting your teeth, or grinning and bearing it, are not good choices for you or the baby. This should be recognized by new moms, as well as new dads and other family members. New moms owe it to both themselves and their baby to get treatment.
