Postpartum depression is treated much like other types of depression. The most common treatments for depression are antidepressant medication, psychotherapy, and participation in a support group, or a combination of treatments.
Medications
There are several types of antidepressants. These include newer medications—chiefly the selective serotonin reuptake inhibitors (SSRIs), the tricyclics, and the monoamine oxidase inhibitors (MAOIs). The MAOIs are generally not prescribed for postpartum depression. The SSRIs, and other newer medications that affect neurotransmitters such as dopamine or norepinephrine, generally have fewer side effects than tricyclics. Sometimes the doctor will try a variety of antidepressants, or increase the dosage of one, before finding the most effective medication or combination of medications. Although some improvements may be seen in the first few weeks, antidepressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks) before therapeutic effect occurs.
Patients are often tempted to stop medication too soon. They may think it isn't working, or they may feel better and think they no longer need it. It is important to keep taking medication until it has a chance to work, though side effects may appear before antidepressant activity does. Once the individual is feeling better, it is important to continue the medication for 4 to 9 months to prevent recurrence. Some medications must be stopped gradually to give the body time to adjust, and many can produce withdrawal symptoms if discontinued abruptly. For individuals with bipolar disorder and those with chronic or recurrent major depression, medication may have to be maintained indefinitely.
Antidepressant drugs are not habit-forming. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if the correct dosage is being given. The doctor will check the dosage and its effectiveness regularly.
Some antidepressants can contaminate breast milk. Women who breast-feed should talk to their doctors to determine the most suitable treatment.
Side Effects
Antidepressants may cause mild and, usually, temporary side effects in some people. Typically these are annoying, but not serious. However, any unusual reaction or those that interfere with functioning should be reported immediately.
The most common side effects of tricyclic antidepressants, and ways to deal with them, are:
- Dry mouth—sip water, chew sugarless gum, and clean teeth daily
- Constipation—bran cereals, prunes, fruit, and vegetables should be taken
- Bladder problems—emptying the bladder may be difficult, and the urine stream may not be as strong as usual; the doctor should be notified if there is marked difficulty or pain
- Sexual problems—sexual functioning may change; if troublesome, a patient should discuss this with the doctor
- Blurred vision—this will pass and usually will not necessitate new glasses
- Dizziness—rise from the bed or chair slowly
- Drowsiness as a daytime problem—this usually passes; a person feeling drowsy should not drive or operate heavy equipment; sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness
The newer antidepressants have different types of side effects:
- Headache—this will usually subside
- Nausea—this is also temporary, but even when it occurs it is transient after each dose
- Nervousness and insomnia (trouble falling asleep or waking often during the night)—these may occur during the first few weeks; dosage reductions or time will usually resolve them
- Agitation (feeling jittery)—if this happens for the first time after taking the drug and is more than transient, the doctor should be notified.
Psychotherapies
Many forms of psychotherapy, including some short-term (10 to 20 week) therapies, can help depressed individuals. "Talking" therapies help patients gain insight into and resolve their problems through verbal exchange with the therapist, sometimes combined with "homework" assignments between sessions. "Behavioral" therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to or result from their depression.
Two effective short-term psychotherapies are interpersonal and cognitive-behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate the depression. Cognitive-behavioral therapists help patients change negative thinking and behavior often associated with depression.
Psychodynamic therapies, which are sometimes used to treat depressed persons, focus on resolving the patient's conflicted feelings. These therapies are often reserved until the depressive symptoms are significantly improved. In general, severe depressive illnesses, particularly those that are recurrent, will require medication (or ECT under special conditions) along with, or preceding, psychotherapy for the best outcome.
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is useful, particularly for individuals whose depression is severe or life threatening or who cannot take antidepressant medication. ECT often is effective in cases where antidepressants do not provide sufficient relief. In recent years, ECT has been improved. A muscle relaxant is given before treatment, which is done under brief anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a brief (around 30 seconds) seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. For full therapeutic benefit, at least several sessions, typically at the rate of three per week, are required.
Postpartum Disorder. Last reviewed 09/07/2006
Sources:
- Journal of Abnormal Psychology
- Nursing Research
- Journal of Consulting and Clinical Psychology
- National Institute of Mental Health
- US Department of Health and Human Services
- National Mental Health Association
- National Women's Health Information Center
- Office of Women's Health, US Department of Health and Human Services
- Depressive Symptoms in the Late Postpartum Among Low Socioeconomic Status Women
