Friday
Jan072011

treatment options for postnatal depression

The treatment for depression after birth often includes medication, therapy, or a combination of both - with the combination of medication and therapy giving the best overall results (Beck, 1993).

Support and advice
Understanding and support from family and friends can help sufferers to recover. It is often best for a mother to talk to close friends and family to explain how she feels rather than bottling her feelings up inside.

Support and help from a health visitor (ie a nurse, breastfeeding supporter - the name will depend on which country you are in) can also help.  Above all, new mothers need to tell someone what they are feeling – and often this is difficult to do because they find it hard to admit that they are not coping – particularly when they still hold true the idea that having a baby is “wonderful” and “joyous” for everyone.  

Independent advice about any social problems affecting the mother or family may be available through a variety of sources and of help (money issues, child care, loneliness, relationships, etc). New mothers must be encouraged to ask what help may be available in their area.  There is always the back-up of the medical practitioners sourced via General Practitioners, Paediatricians, or through connection with others who have either survived PNP/PPD and those experiencing it now.

What is most important is that sufferers get a chance to speak with someone who LISTENS – not someone who tries to:

  • fix their problem,
  • pass it off in any way (i.e. "you need to buck up and get over yourself"),
  • spends all their time talking about their own story and experiences rather than letting the sufferer talk about themselves and their experiences,
  • tells them what to do rather than helping them work it out in their own way.

Women experiencing postnatal depression will generally be surprised at how many women feel the same way as they do. Self-help groups are good at providing encouragement and support, as well as giving advice on how best to cope – and studies show that the simple act of regular sharing with someone who listens is the best form of support available.

Antidepressants
Anti-depressant drugs are commonly prescribed for women with moderate or severe postnatal depression. Symptoms such as low mood, poor sleep, poor concentration, irritability, etc, are often eased with an antidepressant. This may then allow mothers to function normally, and increase their ability to cope better with a new baby. There are several types of antidepressant medications that may be given to breastfeeding mothers.

Antidepressants do not usually work straight away. It takes 2-4 weeks before their effect builds up fully. A common problem is that some people stop the drug after a week or so as they feel that it is doing no good. It takes time to work in the first place, and it needs to be continued for a full course of treatment.  A normal course of antidepressants lasts up to six months or more after symptoms have eased. Some people stop treatment too early and the depression quickly returns.

There are several types of antidepressants, each with various 'pros and cons'. For example, they differ in their possible side-effects. (Ask your medical professional for full details of side effects of the various medications available).  If the first one tried does not suit, then another may be found that is fine. Antidepressants are not tranquillisers and are not thought to be addictive.

Communication with the mother’s doctor is important for finding an anti-depressant that suits the individual circumstances and particularly when breastfeeding. Some antidepressants come out in breast milk. The amounts are very small and are unlikely to cause any harm to the baby. Doctors are likely to choose an antidepressant that is well established and has a good safety record with breastfeeding mothers rather than a newer drug with less data about confirming safety in babies.

About 5-7 in 10 people with moderate or severe depression improve within a few weeks of starting treatment with a prescribed antidepressant. However, up to 3 in 10 people improve with dummy tablets (placebo) as some people would have improved in this time naturally. So, an individual is twice as likely to improve with antidepressants compared to taking no treatment. However, they do not work in everybody.

Talking (psychological) treatments
Another treatment option is to be referred to a Therapist, Psychologist, Psychoanalyst or other professional for a talking treatment.  Message provides a list of professionals who can help with PND/PPD – be sure that the one you choose has experience and education in working with your condition, and is someone you feel comfortable with.  Members have found cultural differences (between France and their home country) in the approaches offered here: be sure that you are getting help in a language you feel comfortable using, that you know what the practitioners ideas are around breast feeding, parenting, mental health issues, medication and so on, so that you choose someone who is able to work with your values and beliefs, your goals and motivations – rather than someone who is likely to encourage you to go in a direction you are not comfortable taking.

Talking treatments include the following:

Cognitive therapy. Briefly, cognitive therapy is based on the idea that certain ways of thinking can trigger, or 'fuel', certain mental health problems such as depression. The therapist helps an individual to understand their thought patterns, in particular to identify any harmful, unhelpful, and 'false' ideas or thoughts which contribute to the depression. The aim is then to change ways of thinking to avoid these ideas and make thought patterns more realistic and helpful. Therapy is usually done in weekly sessions over several months. A patient is likely to be given 'homework' between sessions.

Cognitive-behaviour therapy (CBT). This is a combination of cognitive therapy and behaviour therapy. Behaviour therapy aims to change any behaviours which are harmful or not helpful. In short, CBT helps people to achieve changes in the way that they think, feel and behave.

Other types of therapy sometimes used include: interpersonal therapy, problem-solving therapy and psychodynamic psychotherapy. Also, some studies suggest that counselling types of treatment given by other, trained health visitors in short sessions over several weeks can be of help to ease postnatal depression

For moderate depression, the number of people who improve with cognitive therapy and cognitive behaviour therapy is about the same as with antidepressants. Talking treatments may not be so good for some people with severe depression. This is because patients/clients need some motivation to do these treatments and people with severe depression often find motivation difficult.

Some research suggests that a combination of an antidepressant plus a talking treatment such as CBT is better than either treatment alone.

Exercise
Regular exercise (twice a week minimum) such as walking, jogging, swimming, gym sessions, yoga, pilates, cycling etc. is thought to help ease symptoms – for all the same reasons that exercise is good for people without depression. Simply getting out and walking the baby in the pram each day is enough to help positively change the perspective of a new mother, and therefore help her to feel more in control, less overwhelmed and therefore more like she is “coping” with her new life.