Antidepressants For Postpartum Depression
Medications For Treating Postnatal Depression

postnatal depression

anti anxiety meds

Antidepressants For Postpartum Depression


What Is The Dosage?
How Long Will I Need To Take Antidepressants?
Can I Take Antidepressants While Breastfeeding?
Weighing The Risks And Benefits
Taking Antidepressants As A Deterrent
Anti Anxiety Medications
Sleeping Pills
Mood Stabilizers
List Of Medications And Side Effects

Overview of Condition

Postnatal Depression

Treating Postpartum Depression With Antidepressants

Women who receive a postpartum depression diagnosis may be treated with antidepressant drugs if their symptoms are considered moderate to severe (they are not for example prescribed to women with temporary baby blues). There are two main types of antidepressants commonly prescribed, these are: Selective Serotonin Reuptake Inhibitors (SSRIs) and Tricyclics (TCAs). SSRIs are a newer type of drug and studies show that women with postpartum depression respond better to them than TCAs. If they don’t respond, then they can be switched to TCAs as a backup. That said, there is no evidence that any one brand of antidepressant is better than another in treating symptoms of postpartum depression (PPD). One size does not fit all, and there may initially be some trial-and-error in finding the best medication for you. If you are taking medications, it is important to keep taking them until your doctor tells you to stop. While you may be feeling much better after a few days, the reason you do so is because of the medications. Most psychiatrists recommend a consistent period of feeling good - where you feel like your old self - for several months before stopping the meds in case the depression returns.

What Is The Dosage?

Your doctor will start you on the lowest possible dose for 4 to 7 days and encourage you to combine it with natural treatments for postpartum depression like taking specific vitamins, going out in the sunlight and napping more. You may then be assessed with the postpartum depression quiz (also known as the Edinburgh Postnatal Depression Scale, EPDS). If your score improves by more than 4 points or the total is less than 12, you will continue taking the pills at the same dosage and be reassessed in another 2 to 4 weeks. If there is no improvement (and no side effects or reactions reported) the dose will be increased and you will be revaluated in another 2 weeks. If there is still no improvement the dose may be increased again and/or you will be recommended psychotherapy (if not already doing so). If you continue to decline or show no signs of improvement you will be referred for psychiatric evaluation.

How Long Will I Need To Take Antidepressants?

Once your symptoms are in remission for several months, treatment is typically continued for 8 to 12 months before the medication is gradually tapered off over 2 weeks. This tapering or weaning process is particularly important for women taking paroxetine, Effexor XR and Pristiq to prevent influenza-like symptoms occurring.

Can I Take Antidepressants While Breastfeeding?

Yes, you can. Doctors usually prescribe SSRIs to breastfeeding mothers because countless studies demonstrate they have little to no effect on breast-fed babies. There is no recommended dosage for the mother but ideally the lowest effective dose is prescribed. That said, some doctors still prefer to prescribe TCAs - simply because they have been around longer and long-term studies into adverse effects are well documented (no serious adverse effects have been reported). SSRIs on the other hand are newer and it is still too soon to see long-term evaluations published on babies exposed to them. Finally, although breastfed infants are unlikely to suffer, they should still be monitored for signs of persistent irritability, poor weight gain and decreased feeding. See also, breastfeeding guide for more general advice.

Weighing The Risks And Benefits

Ultimately the decision whether or not to start taking antidepressants will be left to the mother. If you are reluctant to take the drugs for fear of harming your child, discuss the risks in detail with your physician. He should be able to help you evaluate the potential benefits and set appropriate recovery goals. He will discuss the risks to the child if you do not treat your symptoms - these include infant sleep disturbances, poor bonding, delays in growth and IQ, and increased risk of mood disorders later in life. Additionally, read of our article treatment for postpartum depression for an overview of your options; as well as books on depression for published personal experiences.

Taking Antidepressants As A Deterrent

Women who have already experienced PPD in a previous pregnancy are justifiably concerned about a recurrence in subsequent pregnancies. The risk of a recurrence of postpartum depression is 25 percent (and as high at 68 percent if depression began during pregnancy). Preventative therapy after childbirth may be considered in such instances. Whatever drug they responded to before is usually the first line of treatment. At a minimum, if they don't want to take medications without depressive symptoms, they should be closely monitored for signs of a recurrence and treated instantly if signs occur. See also prevention of postpartum depression.

Anti Anxiety Medications

Anxiety is a major symptom of PPD - in fact women with PPD identify more with being anxious than depressed. To address this, a doctor may prescribe an anti anxiety medication like Valium or Xanax to help reduce anxiousness. Anti anxiety meds are often only prescribed temporarily until the antidepressant kicks in. Unlike antidepressants, you don’t need to take these pills every day. They need only be taken if you feel like a panic attack is building up.

Sleeping Pills

If a mother has problems sleeping this may determine which antidepressant she is prescribed - TCAs such as Pamelor and Elavil have a sedative effect and so can double up as a sleep aid. Occasionally a separate sleeping pill will be prescribed (such as Ambien or Desyrel) until the main antidepressant has kicked in.

Mood Stabilizers

Women diagnosed with bipolar disorder are prone to massive mood swings, highs and lows. Very often they will be prescribed a mood stabilizer in addition to an antidepressant to control the fluctuations. Even if you are not bipolar your psychiatrist may recommend a mood stabilizer. Depakote and Tegretol are two such medications and they have been approved for breastfeeding mothers by the American Academy of Pediatrics. Lithium, another stabilizer has not been approved but it is the medication of choice during pregnancy.

List Of Medications For Treating PPD And Side Effects

Medication Side Effects
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Duloxetine (Cymbalta) Venlafaxine (Effexor, Effexor XR) Desvenlafaxine (Pristiq)
SSRIs can cause tummy problems, most commonly diarrhea and nausea. They can also lower the libido (and this doesn't improve). It can also make you feel tired and foggy while others gain clarity.

SNRIs or serotonin and norepinephrine reuptake inhibitors are in the same class of drugs as SSRIs. Side effects are similar.

Amitriptyline (Elavil)
Desipramine (Norpramin)
Nortriptyline (Pamelor)
Imipramine (Tofranil)
TCAs can cause dry mouth, weight gain, dizziness, constipation and heart palpitations. This probably explains why SSRIs are so much more popular.
Anti Anxiety Pills
Lorazepam (Ativan)
Alprazolam (Xanax)
Diazepam (Valium)
Clonazepam (Klonopin)
Anti anxiety meds are also called benzodiazepines. The main problem with this category of drugs is that they can be habit forming or addictive. They can also make you very tired and lethargic, so getting the dosage right is critical.
Sleep Aids
Zolpidem (Ambien)
Trazodone (Desyrel)
Sleeping pills can become habit forming and the person wakes up feeling 'drugged', as though they haven't slept off the medication.
Mood Stabilizers
Approved while breastfeeding:

Valproate (Depakote)
Carbamazepine (Tegretol)
Not approved while breastfeeding but approved during pregnancy:
Mood stabilizers can slow your metabolism and increase your appetite, so weight gain is very common. Some women with bipolar disorder miss the fact that they no longer become 'high' (bipolar patients typically swing from extreme highs to lows) and see this as a downside.
Antipsychotics Drugs
Haloperidol (Haldol)
Olanzapine (Zyprexa)
These have a powerful sedative effect which can help women with insomnia, but they are likely to feel permanently drugged. Haldol is approved for breastfeeding moms. Occasionally Zyprexa, a powerful sedative, is prescribed to women who are not psychotic but who suffer severe insomnia.

  Related Articles on Postnatal Depression

For more information, see the following:

• What are the causes of postpartum depression?

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