Overview of Condition
Postpartum Depression Guide
How Is Postpartum Depression Treated?
Until recently postpartum depression (PPD) was treated in much the same way as any other sort of depression which affects men and women. Now however it is being addressed separately because scientists think that is particularly hormonally driven. They came to this conclusion because women are twice as likely to suffer from depression as men and they are particularly vulnerable at times of great hormone fluctuations (menarche, pregnancy and menopause). Researchers are currently examining the use of estrogen replacement therapy for women in the treatment of PPD, but its too soon yet to know if it is benefical. In the meantime, for women who receive a postpartum depression diagnosis, their current medical treatment options are psychotherapy (counseling) or pharmacotherapy (antidepressant medications). These options can be used alone or in combination. As neither treatment has shown advantages over the other in trials, the choice of treatment for mild to moderate PPD is usually left up to the patient.
For alternative options: Natural treatment for postpartum depression.
As many women are uncomfortable with taking antidepressants, particularly if they are breastfeeding, counseling is a popular choice. There are quite a few different types of therapists to choose from (although you may initially go with your doctor's recommendation). The options include:
Clinical Psychologists: These are highly trained personnel who diagnose, treat and prevent mental disorders. They are qualified to a doctorate level, but are not allowed to prescribe medications.
Psychiatrists: Are medical doctors who specialize in mental disorders. They are allowed to prescribe medications.
Marriage Counselors: If marital conflicts are contributing to a woman's depression, a marriage therapist can help. They cannot prescribe medication.
Psychiatric Nurse: These are nurses who have an Advanced Practice Registered Nurse (APRN) license. They can provide a range of psychiatric care, and in some states can prescribe medication.
Therapists use different methodologies to engage with patients, but cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) appear to be the most effective in treating symptoms of postpartum depression.
CBT: This therapy is based on the concept that our negative thoughts, repeated frequently enough, can reinforce depressive symptoms. By making the patient more aware of their thoughts, and then changing them, a more positive mood can rapidly be achieved. First the therapist needs to find out what is going on inside the person’s head and then they work with them to change negative thought patterns into positive ones.
IPT: This type of therapy is about improving the patient’s ability to communicate and interact with other people. The idea is, by strengthening your relationships, you will be able to communicate your needs in a more effective way.
Choosing A Therapist
If you are suffering from PPD, you can easily doubt your own judgment. For this reason, you may find it useful to ask these questions of your therapist in your first session:
What specific training and experience do you have in PPD?
Treating general depression is not the same as treating women with PPD. You really want to choose someone who is experienced with PPD.
What reading materials can you recommend so that I can educate myself about PPD?
If a counselor is used to treating women with PPD, she should be able to provide a list instantly.
Do you have preferred method of therapy?
Studies show that CTB and IPT are most effective in treating PPD. Psychoanalysis is not appropriate for a woman in a crisis.
What do you think causes PPD?
Asking the therapist to give her opinion on the causes of postpartum depression will reveal a lot about her. She will reveal if she believes chemical imbalances at play or if she holds the old-fashioned view that a woman is somehow responsible for her condition.
Do you belong to any PPD organizations?
Someone who is really interested in PPD will be a member of an organization dedicated to research on the condition, such as Postpartum Support International (www.postpartum.net).
Note: If you are relying on your health insurance company to pay for therapy, check with the company first. Many require you to choose from a pre-selected list they have on file.
Who Long Does Therapy Take To Work?
So when will you be feeling 100 percent better? There is no answer to this, each woman is different and to a large extent is depends on how hard she is willing to work at her recovery. As a rough guide, you can expect a full recovery within weeks and months, it does not usually take years. The main thing is, your recovery will be a lot sooner than if you try to go it alone.
Although it may be advisable for all women with PPD to seek some type of counseling, women with symptoms so severe that they cannot take care of themselves or their baby should consider taking antidepressants. The two main types of antidepressants for postpartum depression are:
Selective Serotonin Reuptake Inhibitors (SSRIs): These increase serotonin levels (the 'happy hormone') in the brain and have become increasingly popular. Brand names include Prozac, Paxil, Zoloft, Celexa, Luvox and Lexapro. Women with a personal or family history of bipolar disorder should be closely monitored on SSRIs because they can increase the risk of a manic episode. In such instances the doctor needs to first clearly establish if the depression is PPD or in fact a postpartum bipolar episode. The treatment is different. Bipolar disorder patients usually also need a mood stabilizer.
Tricyclics (TCAs): Around since the 1950s, TCAs are less popular than SSRIs because they have more side effects. They may be prescribed to women who don't respond to SSRIs; although some doctors still use them as a first option because they have been around so long and are tried and tested. Brand names include Elavil, Pamelor, Tofranil and Norpramin.
Note: Medications can also be used as a prophylactic (preventative) treatment. See, prevention of postpartum depression.
Other Medications And Therapies
Anti anxiety Drugs: Anxiety is major symptom of PPD, so frequently a psychiatrist will also prescribe an anti anxiety med like Ativan, Valium, Xanax and Klonopin. Mostly an anti anxiety drug is just prescribed until the antidepressant kicks in. Unlike antidepressants, you don't need to take them every day.
Sleep Aids: Sometimes a doctor will prescribe a sleeping pill until the antidepressants kick in. However some TCAs like Elavil and Pamelor have sedative effects.
Shock Therapy: Sometimes ECT, or electro convulsive therapy is used to treat severe forms of PPD, postpartum psychosis and postpartum bipolar disorder. It is also sometimes suggested for mothers on the verge of suicide because it kicks in quicker than antidepressants. For more see, is electric shock therapy still used to treat depression?
How Long Do Medications Take To Work?
Most women can expect to feel better within 2 to 4 weeks. If no improvement is felt within 2 weeks the initial dosage is increased every 7 days until the medications kick in or is switched. There are no guidelines as to how long women with PPD should remain taking medications, but between 8 and 12 months is common. Although you may be tempted to quit after the first month because you feel so much better, staying the course of your prescription is important. Under-treating can lead to a relapse and chronic long-term illness.