Postpartum Depression

Often this will not happen right away, although sometimes it can happen only days after a delivery, but usually it takes a certain incubation time before postpartum depression becomes clinically apparent.

The reason this condition is so important to recognize is that in the extreme case the woman can develop a suicidal tendency or even become homicidal regarding the baby.

The tragedy in cases like this is that the depression disorder can easily be treated with psychotherapy and antidepressant medication.

Often there is a past history of depression in a woman who comes down with post partum depression. Therefore, a woman who had a history of depression should be particularly carefully monitored for postpartum depression after a delivery. It occurs in women with a frequency of about 1:500 or 1:1000 deliveries. A certain percentage of these present with a psychotic depression, which needs to be treated in a psychiatric hospital.

Postpartum depression is treated with antidepressants, particularly with paroxetine (brand name: Paxil) rather than Prozac. Studies with lactating moms who had postpartum depression and were treated with SSRI antidepressants have shown that the paroxetine level was lowest in breast milk.

Dr. Shaila Misri, a psychiatrist at the Women's Hospital in Vancouver, reported that the level of paroxetine is highest about 7 to 8 hours after taking the antidepressant pill. This breast milk should be discarded. However, at all the other times it is safe to nurse the baby.

However, she found also by measuring the babies' blood levels that the woman should feed the foremilk (the initial milk when the baby feeds), but she should discard the hindmilk (the late breast milk towards the end of a feeding) (Ref. 3). Treatment needs to be carried on until the mood disorder stabilizes, which is commonly after 6 to 12 months.

With a subsequent pregnancy there is a 30% to 50% chance of postpartum depression again.

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

  1. Dr. David Burns: "Feeling good --The new mood therapy", Avon    Books, New  York,1992.

  2. Diagnostic and Statistical Manual of Mental Disorders, Fourth    Edition, (DSM-IV),American Psychiatric Association,    Washington,DC,1994.

  3. Dr. Shaila Misri at the 46th St. Paul's Hosp. Cont. Educ. Conference,    November 2000, Vancouver/B.C./ Canada.

  4. JM Loftis et al. J Neurochem 2000 Nov 75(5): 2040-2050.

  5. B. Zilbergeld et al. "Hypnosis - Questions& Answers", W.W. Norton    & Co, New York,1986: 307-312.

  6. MH Erickson & EL Rossi:"Hypnotherapy, an exploratory casebook",     Irvington Publishers Inc., New York, 1979: chapter 8, 314-363.

  7. G Steketee et al. Compr Psychiatry 2001 Jan 42(1): 76-86.

  8. DS Mennin et al. J Anxiety Disord 2000 July-Aug 14(4): 325- 343.

  9. J Hartland: "Medical &Dental Hypnosis and its Clinical Applications",     2nd edition, Bailliere Tindall,London,1982, page: 326-336.

Last Modified: Jan. 19, 2008