I copied your post to a friend who is a licensed psychotherapist specializing in perinatal mood disorders and asked her if she could advise you on options for treatment that can help with your depression without requiring you to quit breastfeeding. Aside from your preference to continue, you don't want to quit breastfeeding unless you absolutely have to because it can worsen depression. I'm pasting in her response below.
-- Henci
Carrie:
Henci forwarded your contact data and question to me. I'm so sorry that you are finding the transition after your 3rd birth to be so difficult.
I am aflutter with questions, none of which you need to answer to me directly. The questions are more in line with keeping us both open to options. If it is interesting to you to continue a conversation with me by email, you are so, so welcome to do so. It is very common for me to have these sorts of conversations, and I quite enjoy the contacts I make.
So, question #1 - are you SURE you are experiencing postpartum depression?
The term "postpartum depression" is SO vague. PPD is not a specific diagnosis. It's a general category that describes anything from a normal response to challenging life situations (financial stressors, traumatic childbirth experiences, significant stressors in the couple relationship, etc etc) to anxiety disorders (posttraumatic stress disorder from birth itself, or from childhood and/or domestic abuse) to actual major depressive disorders. Whew! That's quite a list! Very often, if the source of the stress is the birth itself, it is the childbirth professional providing the care who also makes the diagnosis of "depression." I'm sure you can imagine how this can be problematic. The mother and/or physician/midwife may not be comfortable asking or answering questions around trauma. Few ask about household tensions, whether this was a planned or unplanned pregnancy, and so forth. The diagnosis of depression is fast, centers the problem in the mother, and allows for a speedy treatment plan.
The most common diagnostic inventory used to discover postpartum "depression" is the Edinburgh Postnatal Depression Inventory. It's one of the few free and easily-available tools out there, so it is used by most providers. Per the authors' own caution, the inventory was never designed to discover anything outside of depression - but *everything* outside of expected limits is marked as such.
Acquiring a diagnosis of depression sets into motion a whole protocol for treatment. SSRIs (selective serotonin reuptake inhibitors) are currently the most popular option. As prescription drugs, they are covered by most insurance plans, have a reduced social stigma (as compared with counseling), and are easy on the provider's time. Interestingly, there is relatively little data on the efficacy of these drugs in the postpartum period when all the factors I discussed above are controlled for. Some, such as zoloft, are very commonly prescribed to breastfeeding women, and the data seem to suggest that there is little to no long-term consequence for the infant. Most mothers, however, prefer not to take prescription drugs while b/f and will, therefore, forgo treatment or breastfeeding in the mix. As Henci says, rapid weaning can have physical and emotional consequences which actually worsen the depression. In my private practice, the cessation of breastfeeding at the suggestion of other providers is the most common source of tears, as mothers describe their grief and guilt.
So what are other options? Well, first - properly assess the situation you find in front of you. There is an Alpha Antenatal Inventory out of Canada that looks at life stressors relative to mood disorders in the perinatal period. If you work through to the end of this article, you will find the inventory: http://www.cmaj.ca/cgi/reprint/173/3/253.pdf
Unfortunately, at this time, there are no proper inventories for doing a "differential diagnosis" in the postpartum period. This means, essentially, asking the question, "What are we REALLY seeing here?" You will need to find a mental health clinician who is a bit sophisticated on that sort of work. Or at the very least, open minded! Peer resources such as International Cesarean Awareness Network and/or Solace for Mothers can help to connect you with providers near to you - if you are in the US or Canada. Further afield takes other resources, however, I do have a list from which you can begin if you have an interest along those lines.
Have your healthcare provider thoroughly check your thyroid and your iron levels. Imbalances in those areas can cause symptoms that mimic PPD. After that, acupuncture, group support, individual psychotherapy, and naturopathic remedies have all been studies as effective for the treatment of postpartum mood and anxiety disorders. A technique such as EMDR has been helpful for some around the resolution of trauma. This period of time is NOT, in my opinion, a time to engage in long-term therapies of any kind. This is a "crisis counseling" situation, and should be brief and very focused on finding you relief asap. That's why a proper assessment is the right place to start, as you can only be brief if you are pointed in the right direction to begin with!
Whew! A long-winded answer to be sure. If you have any further questions, please feel free to send back a note. I'm happy to support you as you discern your options.
Very best wishes,
Sharon Storton |