Antidepressants For Postpartum Depression
Overview of Condition
|Treating Postpartum Depression With Antidepressants
Women who receive a postpartum depression diagnosis may be treated with antidepressant drugs if their symptoms are considered moderate to severe (they are not for example prescribed to women with temporary baby blues). There are two main types of antidepressants commonly prescribed, these are: Selective Serotonin Reuptake Inhibitors (SSRIs) and Tricyclics (TCAs). SSRIs are a newer type of drug and studies show that women with postpartum depression respond better to them than TCAs. If they don’t respond, then they can be switched to TCAs as a backup. That said, there is no evidence that any one brand of antidepressant is better than another in treating symptoms of postpartum depression (PPD). One size does not fit all, and there may initially be some trial-and-error in finding the best medication for you. If you are taking medications, it is important to keep taking them until your doctor tells you to stop. While you may be feeling much better after a few days, the reason you do so is because of the medications. Most psychiatrists recommend a consistent period of feeling good - where you feel like your old self - for several months before stopping the meds in case the depression returns.
Your doctor will start you on the lowest possible dose for 4 to 7 days and encourage you to combine it with natural treatments for postpartum depression like taking specific vitamins, going out in the sunlight and napping more. You may then be assessed with the postpartum depression quiz (also known as the Edinburgh Postnatal Depression Scale, EPDS). If your score improves by more than 4 points or the total is less than 12, you will continue taking the pills at the same dosage and be reassessed in another 2 to 4 weeks. If there is no improvement (and no side effects or reactions reported) the dose will be increased and you will be revaluated in another 2 weeks. If there is still no improvement the dose may be increased again and/or you will be recommended psychotherapy (if not already doing so). If you continue to decline or show no signs of improvement you will be referred for psychiatric evaluation.
Once your symptoms are in remission for several months, treatment is typically continued for 8 to 12 months before the medication is gradually tapered off over 2 weeks. This tapering or weaning process is particularly important for women taking paroxetine, Effexor XR and Pristiq to prevent influenza-like symptoms occurring.
Yes, you can. Doctors usually prescribe SSRIs to breastfeeding mothers because countless studies demonstrate they have little to no effect on breast-fed babies. There is no recommended dosage for the mother but ideally the lowest effective dose is prescribed. That said, some doctors still prefer to prescribe TCAs - simply because they have been around longer and long-term studies into adverse effects are well documented (no serious adverse effects have been reported). SSRIs on the other hand are newer and it is still too soon to see long-term evaluations published on babies exposed to them. Finally, although breastfed infants are unlikely to suffer, they should still be monitored for signs of persistent irritability, poor weight gain and decreased feeding. See also, breastfeeding guide for more general advice.
Weighing The Risks And Benefits
Women who have already experienced PPD in a previous pregnancy are justifiably concerned about a recurrence in subsequent pregnancies. The risk of a recurrence of postpartum depression is 25 percent (and as high at 68 percent if depression began during pregnancy). Preventative therapy after childbirth may be considered in such instances. Whatever drug they responded to before is usually the first line of treatment. At a minimum, if they don't want to take medications without depressive symptoms, they should be closely monitored for signs of a recurrence and treated instantly if signs occur. See also prevention of postpartum depression.
Anxiety is a major symptom of PPD - in fact women with PPD identify more with being anxious than depressed. To address this, a doctor may prescribe an anti anxiety medication like Valium or Xanax to help reduce anxiousness. Anti anxiety meds are often only prescribed temporarily until the antidepressant kicks in. Unlike antidepressants, you don’t need to take these pills every day. They need only be taken if you feel like a panic attack is building up.
|Related Articles on Postnatal Depression
For more information, see the following:
• What are the causes of postpartum depression?
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