There are several treatments for postnatal depression. Your GP can help
to find the best approach for you, whether that is medication, talking
therapies or supportive counselling (or a combination). You should be
told about all the likely benefits and risks so you can make the best
choice of treatment for you. Don’t feel you have to make an immediate
decision; you can go away and think about it. If depression is severe
and you are at risk of harming yourself or your babies, you may benefit
from a short stay in hospital or a mental health clinic.
Medical Treatment
Medication for postnatal depression has come a long way from the days
of heavy tranquillisers. Forms of drug treatment vary, but they typically
involve a course of antidepressants to correct the chemical imbalance
which causes your symptoms. Antidepressants affect the activity of two
chemicals in the brain, serotonin (also called 5HT) and noradrenaline,
and take about two weeks to start working and may be taken for around
six months after you start to feel better.
You may feel worried about becoming addicted, but most types of antidepressants
are not addictive. It may take a while to find the right antidepressant
for you. If you feel worse, you should ask your doctor to change it. Likewise,
if you have taken your medication for several weeks and it has not made
you feel any better, then talk to your doctor as you may need a stronger
dose or an alternative drug. Many doctors regard antidepressants as a
temporary solution to help you get through a dark period in your life.
That said, when your medication starts to work, don’t be tempted to abruptly
cut short the length of treatment, as you need to give yourself enough
time to fully recover. If your symptoms return, consult your doctor who
can put you back on medication. Many women are also worried that antidepressants
may harm their babies if they are breastfeeding. Unfortunately, not enough
is known about the possible long-term risks of antidepressants on breastfed
babies, as running large scale clinical trials involving babies who have
not given their consent is considered unethical. There are antidepressants
which can be used safely but cautiously when breastfeeding. Please discuss
any concerns in greater detail with your doctor, midwife or contact www.breastfeedingnetwork.org.uk.
Psychological Therapies and Counselling
If your doctor thinks talking therapies may help, you could be referred
to a Clinical Psychologist, Psychiatrist, Cognitive Behavioural Therapist,
Community Psychiatric Nurse or other mental health specialist. There are
different types of psychological intervention. Cognitive Behavioural Therapy
(CBT) and Interpersonal Psychotherapy (IPT) are often the preferred psychological
approaches for treatment of postnatal depression in the NHS.
CBT helps you to identify how you think and make links with the way you
are feeling and what you have been doing. It teaches you coping skills
and focuses on the “here and now” problems and difficulties. It can also
be offered over a relatively short period, perhaps 6-10 sessions with
each session typically lasting for 50 minutes to an hour. Interpersonal
Psychotherapy (IPT) is also a timelimited psychotherapy. IPT is different
from other therapies in that it focuses on the interpersonal (your relationships)
rather than the intrapsychic (what’s in your mind or ‘psyche’).
Your therapist will talk with you about your depression and current relationships
to see how they are connected and how you can make positive changes. Your
therapist may also have an understanding of several other therapeutic
treatment approaches that might better suit your individual needs. Some
psychotherapies explore the causes of your distress or symptoms, by looking
at your relationships or what has happened to you in the past. This may
be more long term; a course may be from 6 weeks to half a year or longer.
Many GP practices have a counsellor attached to the practice. Professional
counselling provides an environment for you to talk to a sympathetic,
understanding, uncritical listener. Some health visitors offer supportive
counselling on a weekly basis, either formally at the clinic or informal
visits to your house for a ‘cup of tea and a chat’. Overall, there is
no quick fix. Initially, you might even feel a bit worse talking about
distressing experiences and personal details that you may have been avoiding.
However, as a safe and trusting relationship develops between you and
your therapist, you should notice a beneficial difference. Your therapist
cannot ‘fix you’, but they can support, listen and act as a guide through
your depression.
Unfortunately there are often long waiting lists in the NHS for psychological
therapies and counselling and you might want to seek out a reputable private
therapist in your area, speak to your GP or seek recommendations from
friends to check out prospective therapists’ credentials. Also check online
at: British Psychological Society (BPS) – www.bps.org.uk
British Association for Counselling and Psychotherapy (BACP) – www.bacp.co.uk
The Health Professions Counsel (HPC) – www.hpc-uk.org
Treating Severe Postnatal Depression
If it is felt that you are at risk of harming yourself or your babies,
you will probably be referred to the local specialist mental health service.
If the illness is particularly severe, you might be admitted to hospital.
Some psychiatric hospitals have mother and baby units attached to them
to treat mothers with severe PND. They tend to be in regional centres,
so there may not be one near to where you live. At the specialised mother
and baby clinics, your babies may need to sleep in a separate nursery
until your symptoms begin to respond to treatment.
If you would prefer and you have family support, the babies may be able
to remain with your partner or family until you are well enough to return
home. If counselling and medication are not working, the hospital or mental
health clinic may advise electroconvulsive therapy (ECT) for severe PND,
although ECT is used increasingly rarely. During ECT, electrodes are placed
on your head and a pulse of electricity is passed through your brain,
which will trigger a carefully controlled fit or seizure (you will be
given a general anaesthetic and medication to relax your muscles).
ECT has been used for more than 50 years, yet it remains one of the most
controversial psychiatric treatments. The precise way in which ECT works
is unknown, but the generally agreed view is that the electricity changes
the chemical composition of the brain and lifts depression. Most people
have between six to twelve sessions of ECT, normally with two sessions
a week.
Herbal Treatment
Traditional supplements taken for depression, such as St John’s wort,
are not recommended by the NHS for treating postnatal depression. There
is little evidence that St John’s wort is safe when breastfeeding and
taking it with some other medications, including antidepressants, can
cause serious problems. You may wish to discuss this further with your
health visitor or GP.
Puerperal Psychosis
Puerperal psychosis is a rare but severe form of depression, occurring
in about one in 1,000 mothers (according to the Institute of Psychiatry).
It can develop in a few hours and can be life-threatening, so needs urgent
treatment. Symptoms can include irrational behaviour, confusion and suicidal
thoughts.
Other people will often notice it, as you may start to say strange things,
frequently change topics when speaking, behave manically and unpredictable,
pick your babies up repeatedly but seem unaware of their needs, have rapid
mood swings, hear voices and have delusions or hallucinations. Women with
puerperal psychosis often need specialist psychiatric treatment and you
may have to go into hospital, but your babies could go with you (please
see treatment above for severe PND).
Courtesy of Tamba - www.tamba.org.uk
