Your Questions Answered About Medication for Postpartum Depression

The absolute last thing you 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.

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.

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 3:00 AM, 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.

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).

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 six 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 well-being if and when you decide to go off the medication.

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.

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