Postpartum Depression - Treatments

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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 determine methods to solve problems and cope with all forms of depression, including postpartum depression. It can be a powerful intervention and may produce, positive biochemical changes in the brain. This is a particularly important alternative to treatment with medication in women who 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 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 return 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 an antidepressant medication. The major types of antidepressant medication are the selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine/dopamine reuptake inhibitors (NSRIs), the tricyclic antidepressants (TCAs), and the monoamine oxidase inhibitors (MAOIs). 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. 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)

SNRIs and NDRs:

  • Bupropion (Wellbutrin)
  • Mirtazapine (Remeron)
  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)
  • Desvenlafaxine (Pristiq)

TCAs are sometimes prescribed in severe cases of depression or when SSRIs or SNRIs are ineffective. 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 improve. It may take anywhere from one to six weeks of taking medication at its effective dose to notice mood improvement. It is, therefore, important not to stop taking the medication because benefits may not be seen immediately. The MAOIs are not often used since the introduction of the SSRIs. Because of the possibility of interactions, 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 also be present 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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