Your Questions Answered About Medication for Postpartum Depression

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The absolute last thing you have desired or even considered upon having a baby is the need to show up in a psychotherapist’s office to talk about postpartum depression. Dreaming about life with a baby usually involves ideas about long and warm cuddles, of peaceful walks with Moby wraps and ergos and baby Bjorns, of everlasting happiness and soft, adorable kisses. So, when the realization comes that you may be actually spending week after week on a therapist’s couch working through unexpected emotional turbulence rather than on your own with a peaceful baby in your arms, you may feel deep and unrelenting disappointment. And frustration. And a (very valid) “why me”??!

And then? A medication evaluation and possible antidepressant on top of it all? Most new moms certainly were not expecting that. Almost every mom who walks into my office for a first visit says something like: “I am really really suffering. I cannot bear to feel like this any more. But I am NOT taking an antidepressant.”

Now, let me disclose here that I live and work in a community where “natural living” is idealized and many women feel an intense pressure to avoid medication whenever possible. But I think it’s probably pretty fair to suggest that most new moms are somewhat apprehensive to include medicine in their treatment plan, if at least initially. When this is the case, as I have seen, most of this comes from the uncertainty surrounding several questions:

  1. What will it do to my baby if I am breastfeeding?
  2. Will it make me happy all the time? Or numb?
  3. What are the side effects?
  4. Will I have to be on medicine forever?
  5. Can’t I just get through all of this pain and suffering without medication?
  6. Isn’t taking medication a weakness? It means that I can’t do this!

So, in light of some recent blog posts, facebook posts, and real time questions in my office, I thought I’d try and ease some of this uncertainty.

1. Most studies have shown that the risk of certain SSRI medications on breastfed babies is extremely low. But we do know that the developmental risks for babies of depressed or anxious moms are high. Because of this, experts who treat postpartum depression and anxiety will say that the risk of untreated depression/anxiety outweighs the potential risk of these medications in breastmilk. Like many others in my field, I feel strongly that the absolute best gift we can give our children is our own health and happiness. So, by taking these medications, if you need them, you will most likely be able to be present, be more content, have more energy, and attach and bond to your babies in ways that are undeniably healthy for him or her. Moms may choose to stop breastfeeding when taking their medications, but they don’t necessarily need to do so. What will it do to your baby? It will give him his mother back.

2. Antidepressant medication will not make you happy all the time. It will not take away the fact that caring for a baby is exhausting and at times overwhelming. It will not make you love changing diapers at 3am and it will not ensure that you are a mom who runs cheerfully barefoot with your baby in the freezing rain singing at the top of your lungs (well, maybe). What it will likely do is make it easier for you to sleep at night because your rambling brain will quiet down and stop its noise. What it will do is decrease many of your postpartum depression symptoms so that you feel more motivated, interested, and engaged in things that do make you happy. Medication does not change who you are. It takes away the noise and the pain and the distraction so that you can be more of who you are.

3. The side effects vary from person to person, and if you are struggling with side effects that are intolerable to you, you will probably need to switch to a different medication. The most common side effect that I have seen in my office is a lowered libido, but many women who are depressed or anxious don’t really feel like having sex anyway. Sometimes when starting with a new SSRI, some women feel slightly agitated for a few days, but this should be tolerable and the heightened agitation should go away in several days. It is always important to give your doctor a full medical history as women who have a history of bipolar disorder are better served by a mood stabilizer than an antidepressant such as an SSRI (which can often initiate a manic period).

4. Most people who go on an antidepressant during pregnancy or postpartum do not need to be on that medication forever. Clinically it is important to stay on your medicine for at least 6 months to a year after you begin to feel better, and women who go off sooner than that are much more likely to relapse. Once the brain is functioning more efficiently, it needs time to get used to functioning in this capacity; and you need time to gather all of the stress reduction, mindfulness, and/or cognitive behavioral skills needed to maintain your wellbeing if and when you decide to go off the medication.

5. The question of whether you should be able to do this on your own? I get this question all the time. The answer is: not likely if you are suffering from moderate or severe symptoms of depression or anxiety. I have mom after mom in my office who knows exactly what she needs to feel better (be it yoga or exercise or sleep or community) but no matter how hard she tries, she can’t make these things happen, or she is doing them but they aren’t having the desired effect. With each attempt she becomes more depleted, frustrated and insecure. The thing is that if your brain chemistry is off, no yoga, hike, lunch with a friend, or restless nap is going to make you feel better for very long. When moms in my office who really do need medication in their recovery finally do decide to go that route, they find that they are finally motivated to get to yoga, have the energy for a hike, sleep better, and can think more clearly through the logistics needed for self care.

6. From where I sit — and, yes, these things are always much easier said than done — making the decision to take medication if needed is an undeniable strength. It is brave and in service of both self and others. Strength comes from conquering fear and uncertainty, does it not?

I am by no means a “pill pusher” and, in most cases, unless a mom is in real crises, I believe fully that each mom should be able to make her own choices around her treatment. But what I do want to do is to make sure that each women who walks into my office is informed, and that those who are quick to deny medicine understand why they are making that choice and aren’t selling themselves short because of (understandable and hugely challenging) stigma, judgment and ignorance. Sometimes women suffer for much longer than they need to. More times than not I have heard women say “If only I had been willing to do this sooner…”

Kate Kripke, LCSW

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  1. LOVE LOVE LOVE this piece, esp this part: " Medication does not change who you are. It takes away the noise and the pain and the distraction so that you can be more of who you are." Thank you for clarifying this…I had such issues with taking meds because I thought they would turn me into a zombie.

  2. Great post! Even a trauma experienced while having your little one (i.e., a single moment of sheer terror during the birthing process) may alter brain chemistry – stress hormones (adrenaline and cortisol) can impair the 'feel good' chemicals (neurotransmitters) in your brain (often the area of the hippocampus) and while there might be an intellectual understanding that you reach in therapy that you're just not feeling good, sometimes until the your neurobiology or brain chemistry is straightened out, it's difficult to move through the depression.

  3. Thanks for the helpful post. It was certainly my experience that, although reluctant to go onto medication, I needed it in order for all the other things I was trying (exercise, talk therapy, self care, etc) to work. And I was amazed, once it built up in my system how well it worked. It was such a relief to be 'me' again and to be coping with and enjoying life again.

  4. Thanks so much for this post. It has come at just the right time for me!! I keep waffling with my meds and it's definitely making me weird. I'm calling my doctor today:)

  5. I struggled for three years before deciding to get on some meds. Now it's my goal to make sure that other moms don't suffer as long as I did because they are afraid to get help! I think it's important for people to know the chemical side of the story. So thanks for this post!

  6. As always, I am so glad that this post has been useful. One thing that I suggest to those of you who might be struggling with the decision of whether or not to go this route: talk to someone who has… While each mom's process, symptoms, situation, and experience may be unique, it can be very helpful to speak with a mom who has muddled through this choice and who now has a perspective from the other side. In my practice, I have several moms who have suffered, struggled with the decision, are now taking medication and recovering fully, and who have now volunteered to talk to moms who are unsure of what to do. It is important, of course, that we each respect and value the choice that everyone makes for themselves, whether similar or different, but there is no doubt so much that we can all learn from each other.

  7. I really needed to read this today. My daughter is two and I am still on medication. I am contemplating another child and I think I will need to be on medication for that. It is hard to accept but is the wisest choice for me and my family.

  8. Marion- Sometimes being on medication is a longer journey than anticipated. And..continuing to do what you need to do for you is wise and selfless and admirable. Your children are lucky to have you…

  9. Just last week I went for help (finally after 5 mths) and realized that I needed medication. Unfortunately, after just 2 SSRI pills, I learned that I was one of the few whose depression gets worse on SSRIs. I called my doctor, explained what was happening, and he switched my drugs. I'm dealing with the heightened anxiety of the new drugs at the moment, and while manageable, I sometimes wonder if the medication route is the right one for me because of the side effects. Talking with other mothers who have "been there" has been a great help for me to try to stick out the early side effects.

  10. About the low libido- I switched from Zoloft to Wellbutrin and it was the best decision ever. Just so you know, it hasn't been tested in nursing infants. However, I did choose to continue to breastfeed and my little two year old is all the better for it.

  11. Hiya … I couldn't help but comment as well! SSRIs are a trainwreck for me. I'd tried them in the past for PMDD and didn't want to go that route with PPD. So I asked my psychiatrist and therapist about Wellbutrin — it has changed my life and like Andrea said, was the best decision ever. For me, it dried up my milk almost instantly, which was just so sad. However, I am a lot better off as a mom with Wellbutrin, and my little dude is doing just fine on formula. :)

    • Will I ever get past it Cruz I feel like I won’t sound some times makes my head feel like it is going explode help

  12. Pingback: How are PPD & Anxiety Treated? | Postpartum Progress