Treatment of PPD
Due to its manifestation along continuum, some patients encounter relatively moderate or mild symptoms. In others the depression is severe, normally portrayed by major neurovegetative symptoms and significant mutilation of functioning. Initially the evaluation entails thorough examination of medical history of the patient, routine laboratory check-ups and physical examination (McClure, 1998). Treatment of the postpartum depression has to be guided by its severity although before beginning any form of psychiatric treatment, there must be exclusion of any medical affects of mood disturbance such as anemia and thyroid dysfunction.
In women experiencing postpartum depression, non-pharmacological treatment especially non-pharmacological therapy is very helpful. Many randomized studies have made observations indicating that short-term cognitive-behavioral therapy (CBT) is an effective of treating women with PPD in the same manner as fluoxetine. When it comes to women experiencing mild or moderate PPD, the most effective way of treating as established by research is Interpersonal therapy (IPT). Other than IPT effectively treating depression, it has an additional advantage to women who are subjected to it as it notably enhances the standards their interpersonal relationships (McClure, 1998). They may also find support or psycho-educational groups helpful. These non-pharmacological means of intervention are specifically appealing to those patients who are unwilling to utilize psychotropic medications like breast feeding mothers or those mothers who have relatively mild forms of depression.
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In the cases of more severe PPD, patients have a choice of receiving pharmacological treatment either in addition to non-pharmacological therapy or as an alternative. Until now, there are only a few studies that have analytically appraised the pharmacological treatment. Among them, those that have been established to be effective in treating PPD are conventional antidepressant medications including venlafaxine, fluoxetine, fluvoxamine and sertralineal. All the studies have shown that standard antidepressant doses are well tolerated and efficient. The choice for antidepressant to be used on a patient should be determined by their prior response to antidepressants medication and also the side effects profile of that particular medication.
McClure (1998) affirms that additionally, specific serotonin reuptake inhibitors (SSRIs) are used as perfect first-line agents because they are well tolerated, non-sedating and anxiolytic. Some women can not tolerate SSRIs and alternatively they are advised to use Wellbutrin (bupropion) although they are not as effective as SSRIs. Other medication that is regularly used are Tricyclic antidepressants (TCAs) for the reason that they tend to be more sedating and can be effectively used on women with significant sleep disturbance.
Medication for puerperal psychosis, a psychiatric emergency, is inpatient treatment. Here acute treatment involving either atypical medication or typical anti-psychotic is specified. Due to the entrenched correlation between bipolar disorder and puerperal psychosis, postpartum psychosis has to be treated as an affective psychosis and consequently a mood stabilizer is indicated (Gjerdingen, 2007). Lastly, severe postpartum psychosis and depression can be treated by electroconvulsive therapy (ECT) because studies have shown that it is well tolerated other than being rapidly efficient. Insufficient or total failure to treatment can lead to deterioration in the way mother and baby or mother and partner relate. Other consequences of this are increased morbidity risk in both infant and mother and can also negatively affect the infant’s educational and social development.
PPD medication and Breastfeeding. There are many immunological, nutritional and psychological benefits of breastfeeding. To this effect, all women with an intention of breastfeeding have to be made aware of the fact that all psychotropic medication gets secreted in to the breast milk (McClure, 1998). The concentrations of these medications in the breast milk are varied greatly and there are also many factors that determine what amounts an infant gets exposed to. They include: maternal drug metabolism rate, dosage of medication and timing and regularity of feedings. Data concerning the use of different antidepressants over breastfeeding period illustrates that there are odd cases of impediments in relation to neonatal exposure to psychotropic medications in breast milk Bloomfield & McWilliams, 2009). The available data is on fluoxetine, sertralie, paroxetine and tricyclic antidepressants. Even though there is no data concerning other types of antidepressants, no reports concerning severe complications due to their exposure have been recorded.
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However there are concerns of difficult breastfeeding when it comes to women experiencing bipolar disorder. First of all, on-demand breastfeeding can considerably interrupt their sleep hence enhancing their susceptibility to deterioration over the acute postpartum phase. Additionally, there have been cases of poison in nursing infants, associated with exposure to different kinds of mood stabilizers like carbamazepine and lithium present in breast milk. In the mothers’ milk, Lithium gets excreted at elevated rates while levels of serum in infants are moderately high, estimated to be almost a third to a half of the mother’s, consequently this will enhance neonatal toxicity’s risk (Tatano,2008).
Prevention of PPD. Efforts to dependably identify which women across the whole population will encounter postpartum mood disturbance have proved futile. However, there are possibilities of pointing out particular subgroups of women at the greatest risk of postpartum affective illness. Examples are those women with a history of mood disorder and those experiencing some social problems. According to recent studies, if prophylactic measures are initiated close to or during delivery time, there is a reduction in the risk of postpartum illness (Daley & MacArthur, 2006). Prophylactic treatment with lithium administered either before delivery (at thirty six weeks gestation) or within the first 48 hours after delivery is very suitable in helping women who have histories of puerperal psychosis and bipolar disorder. On the other hand those with histories of PPD can get help by using prophylactic antidepressants like SSRIs or TCAs being administered after delivery. There are many services that patients with postpartum psychiatric illness can be subjected by clinicians with specialized expertise in areas such as: medication management, clinical assessment for postpartum anxiety and mood disorders, they can also gat referred to support services in the community, consultations concerning psychotropic medication and breastfeeding, and commendations concerning non-pharmacological treatments.
The family of the patient can play a vital role in ensuring prevention and treatment of PPD. A social worker can help them to this by advising them accordingly on how to handle patients. This will involve avoiding quarrels with mothers during postpartum period, supporting them whenever they need help including financially, socially and physically. The social worker should also refrain from sharing some information considered private and which can cause stigmatization with other people (Tatano,2008). To this effect social workers should know their boundaries and avoid getting too much involved in some family matters. Incase there is any information that touches on the health of the mother to be shared; they should come up with data-sharing agreements with the family.
According to Gjerdingen (2007), in some cases, there is stigma and shame attached to PPD. Some women suffering from postpartum depression shy away from discussing it with others for fear of being viewed with others as mentally ill. Women fear talking about their situation in public and end up suffering greatly due to postpartum illnesses for fear of seeking medication.