Postpartum Depression Treatment With and Without Medications

Believe it or not, postpartum depression or post pregnancy depression is pretty common. While the abundant joy of welcoming a new baby into the world is wonderful, sometimes the mental anguish that comes with it can be debilitating. This feeling can last for weeks or months and can be treated with medication, counseling, and lifestyle changes. Coping with depression doesn’t have to be something you need to do on your own, and you will need a good, strong support system to help you through. Postpartum depression treatment is multi faceted, and without all the pieces coming together, you could be in for an uphill climb. Attacking anxiety and depression head on is the best way to rid yourself of the baby blues.

Talk to your doctor about antidepressants. They are commonly used for postpartum depression treatment, and although they enter the breast milk, most are associated with little risk while you are nursing. If your doctor prescribes medication for you, it’s important to take it as prescribed and for as long as recommended. Your doctor will help you to weigh the risks associated with taking antidepressants.

In conjunction with medical intervention, make sure that your lifestyle is conducive to promoting wellness. The sleep deprivation depression link cannot be stressed enough, and while having a newborn may make for many sleepless nights, work with your partner and helping hands to ensure that you are getting enough winks overnight. Postpartum depression treatment is nearly impossible without you taking care of yourself inside and out. Taking care of yourself also includes making sure that you are allowing for enough “you” time, and not making yourself crazy trying to take on too much or not ask for help when you need it. Additionally, make sure that your diet is working in your favor and not against you. High fat and high sugar foods might make you feel great when you’re horking them down, but long term, they will do little to benefit your mind, body or soul.

Natural depression remedies including St. John’s Wort and Omega 3 fatty acids can help boost your mood and are readily available. However, it’s important to discuss any supplements or vitamins that you are taking with your health care provider, especially if you are taking antidepressants to ensure that you are not taking anything that might interfere with your medications.

Postpartum depression treatment is a combination of many things all working together to help you in time have a more positive outlook and ability to look at each day in a new way. Combining counseling, medication, and lifestyle changes, you will be well on your way to feeling like your old self, which is a great thing because you now have someone very small who is going to demand a lot of the new you!

TMS therapy is very beneficial in the treatment of postpartum treatment. Its drug free and delivers a very focused magnetic pulses to the mood center of the brain. Thus it helps in avoiding any kind of adverse effects on the baby!!

Treatments for Depression

Depression is most often treated with psychotherapy (talk-therapy) and antidepressant medications administered together. Although antidepressants can be effective for many patients, they do not work for everybody. Additionally, since antidepressants are typically taken by mouth, they circulate in the bloodstream throughout the body, often resulting in unwanted side effects.

More than 4 million patients do not receive adequate benefit from antidepressant medications and/or cannot tolerate the side effects caused by them. For these patients, non-drug treatments are available. Some of these treatments include: electroconvulsive therapy (ECT), vagus nerve stimulation (VNS) and transcranial magnetic stimulation

Medications:

A number of antidepressant medications are available to treat depression. There are several different types of antidepressants. Antidepressants are generally categorized by how they affect the naturally occurring chemicals in your brain to change your mood.

Types of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs). Many doctors start depression treatment by prescribing an SSRI. These medications are safer and generally cause fewer bothersome side effects than do other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). The most common side effects include decreased sexual desire and delayed orgasm. Other side effects may go away as your body adjusts to the medication. They can include digestive problems, jitteriness, restlessness, headache and insomnia.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include duloxetine (Cymbalta), venlafaxine (Effexor XR) and desvenlafaxine (Pristiq). Side effects are similar to those caused by SSRIs. These medications can cause increased sweating, dry mouth, fast heart rate and constipation.
• Norepinephrine and dopamine reuptake inhibitors (NDRIs).Bupropion (Wellbutrin) falls into this category. It’s one of the few antidepressants that doesn’t cause sexual side effects. At high doses, bupropion may increase your risk of having seizures.
• Atypical antidepressants. These medications are called atypical because they don’t fit neatly into another antidepressant category. They include trazodone (Oleptro) and mirtazapine (Remeron). Both of these antidepressants are sedating and are usually taken in the evening. In some cases, one of these medications is added to other antidepressants to help with sleep. The newest medication in this class of drugs is vilazodone (Viibryd). Vilazodone has a low risk of sexual side effects. The most common side effects associated with vilazodone are diarrhea, nausea, vomiting and insomnia.
• Tricyclic antidepressants. These antidepressants have been used for years and are generally as effective as newer medications. But because they tend to have more numerous and more-severe side effects, a tricyclic antidepressant generally isn’t prescribed unless you’ve tried an SSRI first without an improvement in your depression. Side effects can include dry mouth, blurred vision, constipation, urinary retention, fast heartbeat and confusion. Tricyclic antidepressants are also known to cause weight gain.
• Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate) and phenelzine (Nardil) — are usually prescribed as a last resort, when other medications haven’t worked. That’s because MAOIs can have serious harmful side effects. They require a strict diet because of dangerous (or even deadly) interactions with foods, such as certain cheeses, pickles and wines, and some medications including decongestants. Selegiline (Emsam) is a newer MAOI that you stick on your skin as a patch rather than swallowing. It may cause fewer side effects than other MAOIs. These medications can’t be combined with SSRIs.
• Other medication strategies. Your doctor may suggest other medications to treat your depression. These may include stimulants, mood-stabilizing medications, anti-anxiety medications or antipsychotic medications. In some cases, your doctor may recommend combining two or more antidepressants or other medications for better effect. This strategy is known as augmentation.

Finding the right medication
Everyone’s different, so finding the right medication or medications for you will likely take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as your body adjusts. If you have bothersome side effects, don’t stop taking an antidepressant without talking to your doctor first. Some antidepressants can cause withdrawal symptoms unless you slowly taper off your dose, and quitting suddenly may cause a sudden worsening of depression. Don’t give up until you find an antidepressant or medication that’s suitable for you — you’re likely to find one that works and that doesn’t have intolerable side effects.

If antidepressant treatment doesn’t seem to be working, your doctor may recommend a blood test to check for specific genes that affect how your body uses antidepressants. The cytochrome P450 (CYP450) genotyping test is one example of this type of exam. Genetic testing of this kind can help predict how well your body can or can’t process (metabolize) a medication. This may help identify which antidepressant might be a good choice for you. These genetic tests may not be widely available, so they’re an option only for people who have access to a clinic that offers them.

Antidepressants and pregnancy
If you’re pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor if you become pregnant or are planning on becoming pregnant.

Antidepressants and increased suicide risk
Although most antidepressants are generally safe, be careful when taking them. The Food and Drug Administration (FDA) now requires that all antidepressant medications carry black box warnings. These are the strictest warnings that the FDA can issue for prescription medications.

The antidepressant warnings note that in some cases, children, adolescents and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting an antidepressant or when the dose is changed. Because of this risk, people in these age groups must be closely monitored by loved ones, caregivers and health care providers while taking antidepressants. If you — or someone you know — have suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Again, make sure you understand the risks of the various antidepressants. Working together, you and your doctor can explore options to get your depression symptoms under control.

Electroconvulsive Therapy (ECT)

During electroconvulsive therapy (ECT) the patient’s brain is electrically stimulated to cause an intentional seizure. Patients receiving ECT must be sedated with general anesthesia and paralyzed with muscle relaxants. Recovery from an ECT treatment session occurs slowly, and patients are usually closely monitored for minutes or a few hours after a treatment. Short-term confusion and memory loss are common, and long-term disruptions in memory have been shown to occur and may persist indefinitely in some people. Because of the side effects associated with ECT, a significant amount of caregiver support is required.

Vagus Nerve Stimulation (VNS)

Patients receiving vagus nerve stimulation (VNS) are required to have a medical device implanted within their chest. Through a wire, this device is attached to the vagus nerve in the neck. Electrical pulses sent from the device travel up the vagus nerve to the brain. Some risks associated with VNS include persistent voice alteration and potential nerve paralysis. Also, since VNS is an implanted device, patients face surgical risks when choosing to undergo treatment.

Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) therapy uses a pulsed magnetic field to non-invasively stimulate the area of the brain thought to control mood. TMS is administered without medication in a physician’s office while the patient remains awake and alert. TMS is delivered in 37 minute treatment sessions given daily over 4 to 6 weeks. The most common side effects associated with TMS treatment are scalp pain or discomfort at the treatment site —generally mild to moderate and occurring less frequently after the first week of treatment. There is a remote risk of seizure with TMS, occurring in approximately 0.1% of patients.

Tests And Diagnosis

Because depression is common and often goes undiagnosed, some doctors and health care providers may ask questions about your mood and thoughts during routine medical visits. They may even ask you to fill out a brief questionnaire to help check for depression symptoms.

When doctors suspect someone has depression, they generally ask a number of questions and may do medical and psychological tests. These can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:

• Physical exam. This may include measuring your height and weight; checking your vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen.
• Laboratory tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it’s functioning properly.
• Psychological evaluation. To check for signs of depression, your doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. He or she will ask about your symptoms, and whether you’ve had similar episodes in the past. You’ll also discuss any thoughts you may have of suicide or self-harm. Your doctor may have you fill out a written questionnaire to help answer these questions.

Diagnostic criteria for depression
To be diagnosed with major depression, you must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

To be diagnosed with major depression, you must have five or more of the following symptoms over a two-week period. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure. Symptoms can be based on your own feelings or may be based on the observations of someone else. They include:

• Depressed mood most of the day, nearly every day, such as feeling sad, empty or tearful (in children and adolescents, depressed mood can appear as constant irritability)
• Diminished interest or feeling no pleasure in all — or almost all — activities most of the day, nearly every day
• Significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day (in children, failure to gain weight as expected can be a sign of depression)
• Insomnia or increased desire to sleep nearly every day
• Either restlessness or slowed behavior that can be observed by others
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness, or excessive or inappropriate guilt nearly every day
• Trouble making decisions, or trouble thinking or concentrating nearly every day
• Recurrent thoughts of death or suicide, or a suicide attempt

To be considered major depression:

• Your symptoms aren’t due to a mixed episode — simultaneous mania and depression that can occur in bipolar disorder
• Symptoms must be severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others
• Symptoms are not due to the direct effects of something else, such as drug abuse, taking a medication or having a medical condition such as hypothyroidism
• Symptoms are not caused by grieving, such as temporary sadness after the loss of a loved one

Other conditions that cause depression symptoms
There are several other conditions with symptoms that can include depression. It’s important to get an accurate diagnosis so you can get the appropriate treatment for your particular condition. Your doctor or mental health provider’s evaluation will help determine if your symptoms of depression are caused by one of the following conditions:

• Adjustment disorder. An adjustment disorder is a severe emotional reaction to a difficult event in your life. It’s a type of stress-related mental illness that may affect your feelings, thoughts and behavior.
• Bipolar disorder. This type of depression is characterized by mood swings that range from highs to lows. It’s sometimes difficult to distinguish between bipolar disorder and depression, but it’s important to get an accurate diagnosis so that you can get the proper treatment and medications.
• Cyclothymia. Cyclothymia (si-klo-THI-me-uh), also called cyclothymic disorder, is a milder form of bipolar disorder.
• Dysthymia. Dysthymia (dis-THI-me-uh) is a less severe but more chronic form of depression. While it’s usually not disabling, dysthymia can prevent you from functioning normally in your daily routine and from living life to its fullest.
• Postpartum depression. This is a common type of depression that occurs in new mothers. It often occurs between two weeks and six months after delivery.
• Psychotic depression. This is severe depression accompanied by psychotic symptoms, such as delusions or hallucinations.
• Seasonal affective disorder. This type of depression is related to changes in seasons and diminished exposure to sunlight.

Make sure you understand what type of depression you have so that you can learn more about your specific situation and its treatments.

Causes of Depression

It’s not known exactly what causes depression. As with many mental illnesses, it appears a variety of factors may be involved. These include:

• Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
• Neurotransmitters. These naturally occurring brain chemicals linked to mood are thought to play a direct role in depression.
• Hormones. Changes in the body’s balance of hormones may be involved in causing or triggering depression. Hormone changes can result from thyroid problems, menopause or a number of other conditions.
• Inherited traits. Depression is more common in people whose biological family members also have this condition. Researchers are trying to find genes that may be involved in causing depression.
• Life events. Certain events, such as the death or loss of a loved one, financial problems, and high stress, can trigger depression in some people.
• Early childhood trauma. Traumatic events during childhood, such as abuse or loss of a parent, may cause permanent changes in the brain that make you more susceptible to depression.

Is depression a serious disease?

Yes. The National Institute of Mental Health maintains that, “Depressive illness can often interfere with normal functioning and cause pain and suffering not only to those who have the disorder, but to those who care about them. Serious depression can destroy family life as well as the life of the ill person.”

A national study of depression found that nearly all the respondents who reported a major depressive disorder also reported that their social and/or work lives were negatively affected by their illness. In 2000, the economic burden of depression was estimated at $83.1 billion in the US and researchers estimate that by the year 2020, depression will be the second leading cause of disability worldwide. Depression can also be a lethal disease. Each year in the US, over 30,000 people die by suicide, 60% of whom had been diagnosed with major depression.

Symptoms of Depression

Depression symptoms include:

• Feelings of sadness or unhappiness
• Irritability or frustration, even over small matters
• Loss of interest or pleasure in normal activities
• Reduced sex drive
• Insomnia or excessive sleeping
• Changes in appetite — depression often causes decreased appetite and weight loss, but in some people it causes increased cravings for food and weight gain
• Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still
• Irritability or angry outbursts
• Slowed thinking, speaking or body movements
• Indecisiveness, distractibility and decreased concentration
• Fatigue, tiredness and loss of energy — even small tasks may seem to require a lot of effort
• Feelings of worthlessness or guilt, fixating on past failures or blaming yourself when things aren’t going right
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent thoughts of death, dying or suicide
• Crying spells for no apparent reason
• Unexplained physical problems, such as back pain or headaches

For some people, depression symptoms are so severe that it’s obvious something isn’t right. Other people feel generally miserable or unhappy without really knowing why.

Depression affects each person in different ways, so symptoms caused by depression vary from person to person. Inherited traits, age, gender and cultural background all play a role in how depression may affect you.

Depression symptoms in children and teens
Common symptoms of depression can be a little different in children and teens than they are in adults.

• In younger children, symptoms of depression may include sadness, irritability, hopelessness and worry.
• Symptoms in adolescents and teens may include anxiety, anger and avoidance of social interaction.
• Changes in thinking and sleep are common signs of depression in adolescents and adults but are not as common in younger children.
• In children and teens, depression often occurs along with behavior problems and other mental health conditions, such as anxiety or attention-deficit/hyperactivity disorder (ADHD).
• Schoolwork may suffer in children who are depressed.

Depression symptoms in older adults
Depression is not a normal part of growing older, and most seniors feel satisfied with their lives. However, depression can and does occur in older adults. Unfortunately, it often goes undiagnosed and untreated. Many adults with depression feel reluctant to seek help when they’re feeling down.

• In older adults, depression may go undiagnosed because symptoms — for example, fatigue, loss of appetite, sleep problems or loss of interest in sex — may seem to be caused by other illnesses.
• Older adults with depression may have less obvious symptoms. They may feel dissatisfied with life in general, bored, helpless or worthless. They may always want to stay at home, rather than going out to socialize or doing new things.
• Suicidal thinking or feelings in older adults is a sign of serious depression that should never be taken lightly, especially in men. Of all people with depression, older adult men are at the highest risk of suicide.

When to see a doctor
If you feel depressed, make an appointment to see your doctor as soon as you can. Depression symptoms may not get better on their own — and depression may get worse if it isn’t treated. Untreated depression can lead to other mental and physical health problems or problems in other areas of your life. Feelings of depression can also lead to suicide.

If you’re reluctant to seek treatment, talk to a friend or loved one, a health care professional, a faith leader, or someone else you trust.