Generally, the kind of treatment chosen relies on one key thing your symptoms. For mild and moderate symptoms, nonpharmacological (psychotherapy) methods are recommended, but if you do not respond to them, medication will be essential. For severe symptoms, medication together with psychotherapy is the option most preferred.
In most instances, clinicians suggest the use of both pharmacological and non-pharmacological methods at the same time. In fact, many types of research have proved that a combination of the two is the best approach to deal with postpartum depression.
Postpartum depression treatment is divided into two phases- the acute and maintenance. The acute phase aims at treating current symptoms while the maintenance phase focuses on preventing relapse of the negative emotions and actions. The acute phase lasts eight to twelve weeks, and the maintenance phase goes for six to 24 months or even longer.
Table of Contents
- Pharmacological Treatment (Medication)
- Natural Nonpharmacological Therapy
- Electroconvulsive Therapy (ECT)
- 10 Things to Expect When Undergoing Treatment of PPD
Pharmacological Treatment (Medication)
Postpartum depression medication is mainly used to change the chemical composition of the brain to improve emotions, mood, and behavior. The drugs alter certain chemical messengers known as neurotransmitters, which are responsible for communication with emotional and behavioral functions of the brain and other body parts. By taking medication, you can improve symptoms such as anxiety, irritability, lethargy, fatigue, and sadness.
Use of medication for treatment of postnatal depression is a careful balance of dealing with the depressive symptoms as well as preventing exposure to the infant. Though it has its concerns, it is the option of choice if your symptoms are persistent or so severe and especially, if you have thoughts of harming yourself or the baby. The drugs must be prescribed by a clinician.
For most drugs, the doctor prescribes a starting dose, which is reviewed after about two weeks. The dosage can then be adjusted appropriately, depending on your tolerance and response to the drugs.
Drug options include:
a) Selective Serotonin Reuptake Inhibitors (SSRIs)
Such as Celexa, Lexapro, Prozac, Luvox, Paxil, and Zoloft are the mainstay of postpartum medical treatment as they are better tolerated and their dosage frequency is once daily. This class of drugs works by stimulating the brain to release serotonin. With SSRIs, you may start feeling better between one and three weeks, but for some symptoms, it may take six to eight weeks. If by the third week you do not notice any changes, it is prudent to talk to your doctor to either review the dosage or change medication.
When taking SSRIs, you may notice side effects that include a headache, change in sleeping and eating pattern, and change in libido.
b) Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Work by delaying reuptake of serotonin and norepinephrine. Therefore, these two neurotransmitters remain in the blood circulation longer, resulting in elevation of mood and prevention of deterioration of depressive symptoms. They include Effexor, Pristiq, Savella, Cymbalta, Irenka, and Khedezla. Your doctor may suggest this class of drugs either if you have successfully used them before, or SSRIs are ineffective for you. Other than treating the symptoms, SNRIs may also cause constipation, dry mouth, sweating, altered vision, and nervousness.
c) Tricyclic Antidepressants (TCA)
Include Elavil, Tofranil, and Aventyl. They work by inhibiting reuptake of norepinephrine and serotonin, just like the SNRIs. These two neurotransmitters play a role in mood balance. TCAs are used if SSRIs and SNRIs have not worked well. They are effective for other mood disorders not related to pregnancy, but some of them are not considered safe when breastfeeding. Nortriptyline (Aventyl or Pamelor) and imipramine (Tofranil) are only detectable in breastmilk in small amounts, thus can be used by nursing mothers. However, Doxepin is not safe. Tricyclics may also cause troublesome effects, and that is why doctors shy away from using them as a first-line treatment.
If your doctor sees that TCAs are the best options for you, they will start with very low doses then gradually increase, to lower the harshness of the side effects. Their common side effects include dry mouth, blurred vision, fatigue, dizziness when standing up, increased sweating, difficulty in emptying the bladder, and constipation.
It is the least commonly used. They are reserved for the most severe cases of postpartum psychosis and postpartum OCD. They work by blocking dopamine, thus suppressing hallucinations, delusions, and disordered thinking. They are known to calm even the seriously ill patients- just like their name (tranquility) suggests. They are potentially hazardous when breastfeeding, so formula feeding would be the best if these medications are needed. Tranquilizers are also highly addictive and can be abused.
An important thing to note about all these classes of drugs is that you should never suddenly stop taking them. If you do this, you can either relapse or have some very adverse side effects of withdrawal. The medication should slowly be tapered off by your doctor.
Breastfeeding Considerations When on Medication
There is no doubt that breastfeeding is the best food for the baby. The WHO recommends that you should exclusively breastfeed for the first six months. Other than meeting the nutritional requirements of the baby, breastmilk also provides immunity and lowers the risk of allergies.
Antidepressant medications have potential risks to an infant as they cross to breastmilk and thus, are a great concern even for the clinicians. The child is primarily at a risk of liver and kidney image as these two organs are usually immature to metabolize and excrete the drugs.
Your doctor will weigh the risk and benefits of the drugs. If the benefits outweigh the risk, then they will go ahead to prescribe the medication for you. All the antidepressants pass to breastmilk, but the amount that passes varies among different drugs. Citalopram, nortriptyline, sertraline, and paroxetine, the most commonly used drugs, are associated with low levels in the bodies of nursing infants. Research has shown that the amounts that pass do not cause any significant damage.
However, if you are taking antidepressants and also breastfeeding, it is crucial to keep on monitoring the baby for signs of any effects. Some of these negative effects include persistent irritability, sedation, decreased feeding, or poor weight gain.
Sometimes, the drugs that work best for you could be ones that cross to breast milk at higher levels. If this is the case, talk to your clinician, therapist and family members and see whether formula feeding would be a better option.
Remember that getting adequate sleep is essential for your symptoms to improve. Exclusive breastfeeding may be a bit tiresome especially if you have to wake up to feed. In this case, consider pumping some milk so that other family members can feed while you rest.
Natural Nonpharmacological Therapy
Psychotherapy involves intense counseling by a trained therapist. For this reason, it is casually referred to as “talk therapy.” It is an alternative to use of medications, especially when breastfeeding. Many mothers prefer the nonpharmacological route of treatment due to the risk of infant exposure and potential side effects of the antidepressants. Furthermore, research suggests that you should first try psychotherapy if your symptoms are not severe.
The goal of psychotherapy is to help you look at things differently, overcome fears and insecurities and learn new ways to react to the baby, your partner and other people. It focuses on helping you to cope with your feelings, solve problems and change behavior that may be worsening your emotions. Another key thing about psychotherapys that it not only focuses on you alone but also the baby, your partner, and the family.
You will find out that it does not just involve the therapist talking, but it is more of you actively working towards solutions to your emotions. The therapy will focus on both your past and present emotions and thoughts. Focusing on the past will help you explain certain things in your pre-pregnancy and pregnancy period. On the other hand, focusing on the present will help you to deal with your current feelings and prepare for the future.
The success of your psychotherapy treatment will depend on your ability to openly talk to your therapist, make goals and real progress. To achieve this, think of your relationship with your therapist as a partnership. If you are in a business partnership with someone, you will do everything for the business to succeed- right from setting goals, implementing plans and evaluating your success. These are the same expectations that have to be met for your partnership with your therapists to succeed. The two of you must work together for you to feel better.
Your therapist can use various approaches as discussed below. The therapy methods can either be used on their own or together with other approaches. They include:
a) Interpersonal Therapy (IPT)
This approach is mainly time-limited and goal oriented. It majors on teaching you new skills to lessen your symptoms based on the connection between interpersonal problems and emotions. Typically, the sessions take 12 to 20 weeks. During this time, the therapist focuses on helping you to adapt to a new relationship with your baby, partner, family and work colleagues. The therapist does not work towards changing your personality but teaches you new coping mechanisms to your current feelings and actions.
b) Cognitive Behavior Therapy (CBT)
Here, you will be taking the active role to recognize your active thoughts, negative emotions, and beliefs, while the therapist helps you see which ones are counterproductive, for you to change them. For instance, once you speak out your feelings or actions, the mental health care provider helps you see whether they are unhealthy, disruptive and when you have overstepped your boundaries.
This approach requires you to have a calm state of mind and can take independent decisions towards treatment goals. So, it is mostly used for mild and moderate depression or in later stages of treatment. It differs from Interpersonal Therapy in that it focuses on teaching you new behaviors to deal with negative thinking patterns and adapt to your new mommy status.
c) Psychodynamic Therapy (PDT)
This method is also referred to as insight-oriented therapy. Its goal is to help you deal with unresolved conflicts from your past. It increases your self-awareness to understand how your past experiences can influence the present behavior. For instance, a therapist may help you recover from the agony that you experienced in the past if you had a miscarriage, lost a baby or even separated with your partner. Most of these events are predisposing factors for postnatal depression.
Family therapy works to identify difficulties that may be worsening your symptoms. Its goal is to help the family members find effective ways to deal with your symptoms and to help you recover. The therapist teaches the family about your mental health condition and how best to take care of you without disengaging from their efforts or burning out. As a patient, you attend the sessions together with your family members. This approach is combined with other psychotherapy methods.
e) Couples Therapy
Couples Therapy is highly recommended if there is severe marital discord in your marriage. Poor partner relationships are one of the key factors in the development of postpartum depression. If not dealt with, the treatment will most likely not be successful. The distress of the depression is not only on you but also on your partner. Sometimes they may not understand why you behave the way you do. A therapist will not only help them understand what you are going through but will also show them how to help you recover faster.
f) Group Therapy
Group Therapy provides a haven for you to talk about your emotions without judgment and to people who are undergoing the same predicament as you. For group therapy to be effective, your therapist will combine it with other approaches mentioned here. The group sessions may be led by a therapist and different times, by you or other peers. This gives you the self-confidence and willpower to open up and the eagerness to take control of your situation. The best thing about group therapy is that technology has made it extremely easy. You can connect with other members anywhere and anytime through video conferencing, teleconferencing or by social media.
g) Parent-Infant Psychotherapy
With postpartum depression, your interaction with your baby will most probably be strained. A therapist will help you to develop or regenerate a healthy attachment with your little one. Even after your symptoms have disappeared, you will find that the sleeping and feeding patterns of the baby will strain you until they turn three years old. Therefore, you will still need to chart a way forward on how to meet the demands of the baby, without disconnecting your motherly love and warmth.
h) Bright Light Therapy (Phototherapy)
Bright Light Therapy works by stimulating your brain to produce serotonin, the ‘feel good hormone.’ It is not a hormone per say, but a neurotransmitter that is responsible for elevating mood. One sits near a special bright light therapy box whose light mimics sunlight. The light then causes the brain to release this neurotransmitter resulting in positive changes in your mood.
8 Tips on How to Get The Best Out of Your Therapy
- Before starting the therapy sessions, make a list of the things that you need help with, and bring them up to your first appointment. This will set up the direction that your therapist will take with your management. You can include things issues that you are having like your sleeping and eating patterns, your anger, anxiety or troubling thoughts, and problems with your family or baby.
- Do not be afraid to ask your therapist why they are a good fit for your condition. You are entitled to getting a good fit.
- Do not feel embarrassed or ashamed of your emotions- talk about them all.
- Track how you feel each day and review your progress together with your therapist
- Do not ignore any feelings or changes no matter how minimal
- When attending your sessions, forget about the time. Do not hurry it up, let your therapist decide when to wrap up.
- Apply what you learn during your sessions. You will find that the therapist will be giving you assignments to track your change in moods and thoughts. Make sure that you do them.
- Get a journal, take it with you to your sessions, note down what you learn and use it to map your changes.
Exercise may not be an independent treatment by itself, but incorporation it into your daily schedule will go a long way. It may be difficult to gather your little energy to move your body, but all the efforts will pay up. You do not need to lift weights, do some heavy squats or muscle reaping sit-ups. All you need to do is to start with something as simple as a leisure walk for only 30 minutes per day. You can then build up to brisk walking, jogging, pilates, yoga, aerobics and other intense workouts.
Consistent exercise will help to relieve stress, ease depression, and improve sleep and eating patterns. If you choose outdoor physical activities, the change of scenery will not only help to calm your nerves but also to distract your mind from negative thoughts and emotions. Going out will also benefit to soothe the baby, especially when the child is crying uncontrollably.
Exercise will also help you get your pre-pregnant baby shape or even better. When one gets pregnant, working out is the last thing on the mind. Inactivity Coupled with the depressive symptoms, makes you gain unhealthy weight or lose it excessively. Take any chance to move your body, boost your self-esteem and feel great in your skin.
Other than exercise, you need to perform additional self-care activities to deal with postpartum depression and establish other healthy body systems. Some of these activities include eating a healthy balanced diet, taking resting breaks from your parental responsibilities, sparing some time for relaxing and pleasurable activities such as watching TV, playing games or some spa time and getting adequate refreshing sleep.
Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy is the best choice if you do not respond to antidepressants or the symptoms are severe and are accompanied by hallucinations, delusions and overwhelming suicidal thoughts. It is the last resort after all other methods have failed. It is a procedure that is done under general anesthesia and involves passing electrical currents through the brain. The electrical impulses cause a brief intentional seizure to give relief from the symptoms. The ECT sessions are done two to three times per week until one is no longer suffering from the symptoms.
It is a fast way of relieving symptoms, but it comes with serious side effects like memory loss, confusion, and loss of emotional responses. However, if your doctor really thinks that you need the treatment, the effects should not be a hindrance as they subside with time.
10 Things to Expect When Undergoing Treatment of PPD
- The drugs and therapy will not work immediately. You will start seeing a change at least after one week.
- Expect to see improvement from week to week and month to month
- Some days may be better than others
- Some symptoms may take longer to disappear
- Your emotions may flare up just before menstruation because of hormonal fluctuations
- If taking drugs, you may get some side effects, but they should not be a barrier to your treatment. The benefits outweigh the side effects.
- You will be expected to take an active role in your therapy sessions.
- The medication will not be abruptly stopped but will be gradually weaned off
- Your drug doses may change, especially after the initial two weeks
- Be open to change as your mental health care providers may need to adjust your treatment approaches until they get what works for you.
Finally, the heart of motherhood is selflessness. You sacrifice to carry that little angel in your womb and nurture your pregnancy until they arrive in this world. As a result of this sacrifice, you may avoid seeking help for your emotional changes. Never let it be at the expense of your mental health because it will mean that your little one has to suffer too. Call your doctor immediately you realize that emotions are taking a toll on you. The treatment will be more effective and will take a shorter period if you start early.
Do not be held back by worries about the safety of the medications as there are drugs that you can take and still breastfeed. Furthermore, postpartum depression treatment does not always involve medication. There are other psychotherapy approaches that are equally effective. Therefore, do not sit and sulk-your well-being and that of your baby matters.