Postpartum Depression Treatment: Medication
When weighing Postpartum Depression Treatment options, medications almost always come up. Many feel uncertain, however, about taking medications in pregnancy and postpartum, making it one of the most difficult treatment decisions you can make. Here are a few of the questions I hear most often and some answers I hope will help you in your decision-making process.
1) “What exactly do you mean by ‘Postpartum Depression medication’?”
When we talk about postpartum “medications,” we’re really talking about psychotropic medications. Psychotropic medications are those that work on the mind, behavior, and mood. There are many types of psychotropic medications, including antidepressants, anxiolytics (or antianxiety medications), mood stabilizers, and antipsychotics. Any one of these may be recommended for you, depending on your presenting symptoms and severity of illness.
2) “Do they really help?”
Research has shown time and again that psychotropic medications do help pregnant and postpartum women feel better. The trick is finding the right medication and dosage that works for you, and giving it enough time to really kick in.
3) “How do they help? I’m not sure I want to just take a ‘happy pill’.”
First, antidepressants are not “happy pills”—they don’t make everything suddenly better. They simply bring you closer to your “normal” level of functioning. For those with mild to moderate symptoms, I describe it this way: When you’re under the influence of a Perinatal Mood or Anxiety Disorder (PMAD), you wake up each morning feeling lower than your “normal”. You still have your bad days and good days, but your lows can be extremely low, and your “highs” might just feel like your old “normal,” if you’re lucky. Medication works to regulate the chemistry of the brain so that you can start your day closer to your “normal” level. You’ll still have your bad days, but you’ll feel much more able to cope with them. For women with severe symptoms, medications are necessary to help stabilize and re-regulate the brain and body.
4) “If I’m not sure about medication, can I start with therapy or alternative methods first?”
Research suggests that “rather than using medication as a first-line treatment, it could be reserved for more severe depression that does not respond to counseling,”[i] and I agree—for mild to moderate symptoms. Mild symptoms may improve with Self-Help or Alternative Treatment methods like Sleep Treatment, Light Therapy, or Nutritional Supplements. For more moderate symptoms, Psychotherapy works to correct the chemistry of the brain, just like medications do, but it can take longer. I usually suggest starting with therapy; then, if you’re not seeing improvement within 8-12 weeks or if your symptoms worsen, it might be a good time to discuss adding a medication. In general, therapy plus medication is considered the “gold standard” for postpartum depression treatment; therapy helps you learn new ways of coping, and medication can help you feel “well” enough to do the work of therapy.
5) “How do I decide if I should take a medication or not?”
Unless you’re experiencing severe symptoms (like Postpartum Psychosis), the decision to take a psychotropic medication or not is ultimately up to you. Dr. Kathy Smith, a Psychiatrist from the University of Arizona Department of Psychiatry, states that “the decision to use psychotropic medication or not should be made collaboratively with the patient, other health care providers, and family members as appropriate.” Talk to your medical or mental health provider, involve your counselor and family, seek out experts in the treatment of women’s mental health, and make sure you have all the facts before you decide. It’s easy to feel confused by the opinions of others, but it’s also important to work together in order to make the decision that is best for you.
6) “Can I take a medication if I’m pregnant?”
In many cases, “Yes.” Research shows that psychotropic medications do cross the placenta, meaning that some of it may get to the baby. However, research shows that depression and anxiety may also negatively impact the fetus; in fact, Maternal Depression is, the #1 predictor of future behavioral and cognitive problems in a child. So, the question becomes, “What is a bigger risk to the baby—medication, or a depressed/anxious mother?” Dr. Kathy Smith says that “in pregnant women, the clinical challenge is to minimize the risk to the developing fetus, while also limiting the effects of untreated postpartum depression or anxiety on the mother.” Working with a doctor who understands pregnancy and postpartum mental health can help you make the decision that works best for you. As Dr. Smith states, “No decision is risk free, but when made collaboratively with the patient and physician, the outcome can be a positive one.”
7) “Do I have to quit breastfeeding if I decide to start a psychotropic medication?”
No—taking a medication does not necessarily mean you have to stop breastfeeding. Too many women are put on a medication by their doctor and told they have to quit breastfeeding—it’s one of the biggest topics that comes up in my postpartum group and in my practice. Though some of the psychotropic medications are not safe for breastfeeding mothers, many of them are. Again, the small risk to the breastfeeding infant in many cases outweighs the great risk of having a depressed mother. Your doctor should be able to help you weigh the risks and benefits so you can decide what works best for you. If you don’t feel right about what your doctor is telling you, you have the right to seek a second opinion.
8 ) “How long will I have to stay on the medication?”
Most are encouraged to stay on the medication a minimum of six to twelve months in order to give it time to really work (and to possibly prevent future episodes of depression), but this varies greatly. When you feel ready to go off medication, just make sure to bring it up with your provider. Do not quit cold turkey, as it may result in a recurrence of your symptoms. Tapering slowly is the way to go, and this is best done under the care of your physician.
9) “Who can prescribe psychotropic medications and how do I find the right person for me?”
Psychiatrists, primary care physicians, nurse practitioners, and OB/GYNs can all prescribe psychotropic medications. But not all understand perinatal mental health well enough to help you make the most informed decision. It’s best if your provider has had specific education on perinatal medication, especially if you’re pregnant or breastfeeding. Has s/he received specialized training in PMADs? Can s/he name books or resources on postpartum depression? Is s/he affiliated with any postpartum organizations, like Postpartum Support International or a local branch? Is s/he affiliated with a medical center which specializes in the treatment of women’s mental health? If you don’t feel like you are getting the answers you need, keep looking until you do. (See Resources, below, for help).
The Bottom Line…
The bottom line is this: Whether you’re pregnant or postpartum, breastfeeding or not, it’s ok to consider taking a medication. When you need it, it’s a huge help. When you no longer need it, you can taper off. Adding therapy or alternative treatment modalities with the medication is the best way to go. Collaborating with your family, mental health, and medical providers, and finding a doctor trained in Perinatal Mood Disorder medications should provide you with all the facts you need to make the decision that is best for you. In pregnancy and postpartum, your wellness is the most important thing—for you, your baby, your partner, and your family.
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