Postpartum Depression (cont.)
Roxanne Dryden-Edwards, MD
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Postpartum depression facts
- What is postpartum depression? Are there different types of postpartum depression?
- What are causes and risk factors for postpartum depression?
- What are postpartum depression symptoms and signs?
- How is postpartum depression diagnosed?
- What are the treatments for postpartum depression?
- What is the prognosis of postpartum depression?
- Can postpartum depression be prevented?
- Where can people get more information about postpartum depression?
- Where can people get support for postpartum depression?
- What research is being done on postpartum depression?
- Pictures of Postpartum Depression - Slideshow
- Pictures of Understanding Depression - Slideshow
- Pictures Depression Tips - Slideshow
- Find a local Psychiatrist in your town
What are the treatments for postpartum depression?
Educational programs and support groups
Treatment of postpartum depression in men and women is similar. Both mothers and fathers with this condition have been found to greatly benefit from being educated about the illness, as well as from the support of other parents who have been in this position.
Psychotherapy ("talk therapy") involves working with a trained therapist to figure out ways to solve problems and cope with all forms of depression, including postpartum depression. It can be a powerful intervention, even producing positive biochemical changes in the brain. This is particularly important as an alternative to medication treatment while women are breastfeeding. In general, these therapies take weeks to months to complete. More intense psychotherapy may be needed for longer when treating very severe depression or for depression with other psychiatric symptoms.
Interpersonal therapy (IPT): This helps to alleviate depressive symptoms and helps the person with PPD develop more effective skills for coping with social and interpersonal relationships. IPT employs two strategies to achieve these goals.
- The first is education about the nature of depression. The therapist will emphasize that depression is a common illness and that most people can expect to get better with treatment.
- The second is defining specific problems (such as child care pressures or interpersonal conflicts). After the problems are defined, the therapist is able to help set realistic goals for solving these problems. Together, the individual with PPD and his or her therapist will use various treatment techniques to reach these goals.
Cognitive behavioral therapy (CBT): This helps to alleviate depression and reduce the likelihood it will come back by helping the PPD sufferer change his or her way of thinking. In CBT, the therapist uses three techniques to accomplish these goals.
- Didactic component: This phase helps to set up positive expectations for therapy and promote cooperation.
- Cognitive component: This helps to identify the thoughts and assumptions that influence behaviors, particularly those that may predispose the person with PPD to being depressed.
- Behavioral component: This employs behavior-modification techniques to teach the individual with PPD more effective strategies for dealing with problems.
Medication therapy for postpartum depression usually involves the use of antidepressant medication. The major types of antidepressant medication are the selective serotonin reuptake inhibitors (SSRIs), the tricyclic antidepressants (TCAs), the monoamine oxidase inhibitors (MAOIs), and the atypical antidepressants. SSRI medications affect levels of serotonin in the brain. For many prescribing doctors, these medications are the first choice because of the high level of effectiveness and general safety of this group of medicines. Examples of antidepressants are listed here. The generic name is first, with the brand name in parentheses.
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluvoxamine (Luvox)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
The atypical antidepressant medications work differently than the commonly used SSRIs. The following medications might be prescribed when SSRIs have not worked:
- Bupropion (Wellbutrin)
- Mirtazapine (Remeron)
- Nefazodone (Serzone)
- Trazodone (Desyrel)
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
- Desvenlafaxine (Pristiq)
TCAs are sometimes prescribed in severe cases of depression or when SSRI or atypical antidepression medication doesn't work. These medications affect a number of brain chemicals (neurotransmitters), especially epinephrine and norepinephrine (also called adrenaline and noradrenaline, respectively). Examples include
- amitriptyline (Elavil),
- clomipramine (Anafranil),
- desipramine (Norpramin),
- doxepin (Adapin),
- imipramine (Tofranil),
- nortriptyline (Pamelor).
Approximately two-thirds of people who take antidepressant medications get better. It may take anywhere from one to six weeks of taking medication at its effective dose to start feeling better. It is, therefore, important not to give up taking the medication because benefits are not felt right away. The MAOIs are not used as often since the introduction of the SSRIs. Because of interactions with some antidepression medications and specific foods, the MAOIs may not be taken with many other types of medication, and some types of foods that are high in tyramine (like aged cheeses, wines, and cured meats) must be avoided as well. Examples of MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate). Atypical neuroleptic medications are often prescribed in addition to a mood-stabilizer medication in people with postpartum psychosis. Examples of atypical neuroleptics include
- aripiprazole (Abilify),
- olanzapine (Zyprexa),
- paliperidone (Invega),
- quetiapine (Seroquel),
- risperidone (Risperdal),
- ziprasidone (Geodon),
- asenapine (Saphris),
- iloperidone (Fanapt).
Non-neuroleptic mood-stabilizer medications are also sometimes used with a neuroleptic medication to treat people with postpartum psychosis because bipolar disorder may be underlying in some patients. Examples of non-neuroleptic mood stabilizers include
- lithium (Lithium Carbonate, Lithium Citrate),
- divalproex sodium (Depakote),
- carbamazepine (Tegretol),
- lamotrigine (Lamictal).
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