The symptoms of depression or anxiety that occur amongst childbearing women are similar to those that occur at other times of life, however the choices for treatment may differ during pregnancy or when a woman is breastfeeding.
Treatment options include counselling, psychological therapies and medications.
It is important to treat depression and anxiety as early as possible because these conditions not only cause distress for the mother but also influence her ability to cope with the infant, and their developing relationship. Partners and young children can also feel stressed when a parent is anxious or depressed.
Types of treatment will vary with the nature and severity of the symptoms and the subtype of the disorder. Psychological therapies and counselling are appropriate and sufficient for many women especially those with non-melancholic subtypes of depression where there are stresses from life events, relationship disturbances, or personality patterns contributing to the difficulties of coping with a newborn baby.
Wherever possible doctors try to avoid the use of medication that might affect the developing foetus or the breastfeeding infant however the severity of symptoms sometimes make it necessary for medication to be used as part of the treatment. A consultation with your GP or psychiatrist will assist you to obtain advice about management of your symptoms including the best types of treatment.
Where there is a problem related to the infant that is causing distress such as difficulty settling or excessive crying, practical help, advice on coping methods, and psychological support may be sufficient to help settle the distress for mother and baby. When symptoms are not responsive to these methods medications may be needed under the care of a GP or a psychiatrist.
NOTE: Some physical illnesses are accompanied by symptoms of depressed mood and a medical examination may be required to detect these e.g thyroid disorder, anaemia. See your doctor if you think you might have a medical condition associated with depression. |
The most simple treatments are those that are supportive, educational and that aim to give the women and her partner some understanding and acceptance of the causes for the depression or anxiety disorder and information about methods for coping.
There are some situations where depression is triggered by unnecessary worrying, lack of information, or incorrect beliefs about a situation. Getting correct information can help greatly in such instances once the source of the worrying is understood. Doctors, midwives, child and family health nurses, and parent educators all play a part in providing information for new and prospective parents about pregnancy and normal behaviours of newborn infants. They can also correct misinformation. It is important to ask questions rather than to worry in silence. When symptoms persist in spite of reassurances and provision of correct information other treatment approaches will be considered.
There are also various counselling approaches such as cognitive behaviour therapy (CBT) and interpersonal therapy (IPT) which teach women the skills to deal with situations that trigger or increase distress. These therapies can be done individually or in groups and usually take place weekly for 6-12 sessions. They might be provided by a doctor, psychologist, social worker, midwife or nurse trained in the methods.
For women with long-standing problems arising in childhood, there are other forms of psychotherapies that require longer term treatment. Some therapists will work with the mother and baby together or with both parents together. Couple counselling can be useful for problems in the parent’s relationship including communication problems and sexual difficulties.
Always discuss medication issues with your doctor before taking any medication whilst pregnant or breastfeeding. If you are taking prescribed medication and plan to become pregnant discuss your plans with your doctor before discontinuing your medication to ensure that you do not experience adverse withdrawal effects or a relapse of the condition being treated. |
The use of medications in the perinatal period is usually avoided wherever possible because of the risks of exposure for the foetus and breastfeeding infant. However decisions about the use of medication involve weighing up of the risks against the benefits for each woman with her doctor taking into account the type of depression and the severity of the symptoms.
It is important to remember that a mother who is seriously depressed or anxious will find it difficult to be available emotionally for her baby and this can interfere with the developing relationship between the mother and infant. In some situations, under medical guidance it is better to treat the symptoms using medication to shorten the period of distress. Such decisions need to be weighed carefully and discussed in detail ideally with both the woman and her partner or a family member present.
Our knowledge about the safety of antidepressant medication in pregnancy and whilst breastfeeding is improving. Some antidepressant medications are relatively safe for use in pregnancy and do not appear to cause abnormalities. A recent drug company alert on Aropax (an SSRI) suggests that it may be associated with heart defects and thus should not be taken in pregnancy. Your doctor will know which are the safest medications for use at these times. In breastfeeding, less than 5% and as little as 1% of the drug passes into the breastmilk which means that exposure of the baby to the drugs is minimal. Some babies show withdrawal effects from SSRIs and may need medical supervision for a short time.
Antidepressant medications are also very useful for treatment of anxiety symptoms.
Read our Fact sheet: Safety of Antidepressants in Pregnancy and Breastfeeding
Page last updated: 15-Jan-2009
Depression and Bipolar Disorder Information Australia - Black Dog Institute.
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