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.
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.
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.
Psychotherapies
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.
Medications
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.
The atypical antidepressant medications work
differently than the commonly used SSRIs. The following medications might be
prescribed when SSRIs have not worked:
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
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
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
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