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Postpartum depression

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Emotional & Mental Health


Postpartum depression is a recognized and treatable medical problem. Treatment depends on the severity of your depression and your individual needs, but it may include psychotherapy, antidepressant medications and hormone therapy.

Psychotherapy can help you change behaviors and thoughts that contribute to mental illness. There are several types, but each type involves a short-term, goal-oriented approach aimed at helping you deal with a specific issue.

If your symptoms of postpartum depression are mild, psychotherapy may be all that's needed. Research shows that individual psychotherapy — in which you work one-on-one with a psychiatrist, psychologist or other mental health professional — is an effective treatment for postpartum depression. The number of sessions required typically ranges from six to 12. More severe cases of postpartum depression typically require both psychotherapy and medications.

Antidepressant medications
Today, many women with postpartum depression are treated with antidepressants called selective serotonin reuptake inhibitors (SSRIs), which seem to work by increasing the availability of the neurotransmitter serotonin in your brain. Studies suggest that they're just as effective as older-generation antidepressants, such as tricyclics and monoamine oxidase inhibitors (MAOIs), but have fewer side effects. Commonly prescribed SSRIs include paroxetine (Paxil) and sertraline (Zoloft).

If you're breast-feeding, you may be concerned about taking antidepressants. All antidepressants are excreted in breast milk, but multiple case studies suggest that some SSRIs can be taken with little risk to your baby. Researchers who've studied the possible impact of sertraline (Zoloft) and paroxetine (Paxil) on breast-fed infants have found no adverse effects. Fluoxetine (Prozac), however, persists in the bloodstream longer than do other antidepressants and may reach higher levels in breast-fed infants. In one study, the babies of breast-feeding mothers taking fluoxetine had concentrations of the drug in their systems that were in the therapeutic range for adults. Fluoxetine has also been linked with irritability, sleep disturbance and poor feeding in some infants exposed through breast-feeding.

No long-term studies of infants exposed to SSRIs through breast milk exist. So doctors and scientists can't be sure what the long-term effects might be. There could be risks to the developing neurotransmitter system in the brain. However, not treating postpartum depression also poses risks. Stressful interactions between mother and infant have been linked to poor bonding and cognitive and behavioral problems in children. Having a parent with a mental illness also can cause family discord and loss of income, both of which can affect child development.

If you're concerned about taking antidepressants while breast-feeding, talk to your doctor. Together, you can weigh the potential risks and benefits and decide on the treatment that's right for you.

Hormone therapy
Using an estrogen patch — a patch containing estrogen that you wear on your skin — can help counteract the rapid drop in estrogen that accompanies childbirth. In a study of 61 women with postpartum depression, those who used the estrogen patch every day were less depressed than those not using it. However, estrogen therapy in the postpartum period may pose possible risks, such as decreased milk production and the risk of developing a blood clot in the legs that could travel to the lungs (thromboembolism). More research is needed.

Treating postpartum psychosis
If you have the rare condition of postpartum psychosis, you need immediate treatment and nearly always need medication. You generally need to stay in the hospital because you're at risk of hurting yourself or others. In some cases, this treatment is life-saving. The length of treatment varies from person to person. Therapies used to treat postpartum psychosis include antidepressant medications and hormone therapy, but also may include:

  • Antipsychotic agents. These medications, also called neuroleptics, are typically used to treat psychotic disorders, such as schizophrenia. They may also be used to treat severe cases of depression accompanied by psychosis.

  • Electroconvulsive therapy. In this therapy, a small amount of electrical current is delivered to your brain through electrodes, producing a controlled seizure that usually lasts 30 to 60 seconds. Doctors believe that chemical aspects of brain functioning are altered during and after this seizure activity. When you receive electroconvulsive therapy (ECT) on a regular basis, these chemical changes build on each other, reducing symptoms. ECT can be an effective treatment for severe depression, especially when other treatments have failed or when you need immediate results and can't wait for medications to begin working.

  • Lithium carbonate. This medication, known as a mood stabilizer, is generally taken to help treat bipolar disorder, which is characterized by swings in mood between depression and mania. It works by balancing out such mood swings.


If you have postpartum depression, you can take steps to aid your recovery. Try these tips:

  • Practice good health habits. Get as much rest as you can. Rest or sleep while your baby sleeps. Exercise and eat a nutritious diet, too, emphasizing grains, fruits and vegetables.

  • Make time for yourself. If you feel like the world is coming down around you, take some time for yourself. Get dressed, leave the house and visit a friend or run an errand. Or schedule some time alone with your partner.

  • Avoid isolation. Talk with your partner, family and friends about how you're feeling. Also talk with other mothers so that you can learn from their experiences. Ask your doctor about groups for new moms in your community or support groups for women with postpartum depression.

  • Have realistic expectations. Scale back your expectations of having the perfect household. Do as much as you comfortably can and leave the rest. Ask for occasional help with child care and household responsibilities from friends and family.

Postpartum depression > 1 > 2 > 3 > 4

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