What are the treatments available for postnatal depression?

The treatment or management of Postnatal Depression varies depending on the severity of the illness and the individual. However there are 3 main “prongs” involved in recovery.: Biological, Psychological and Social.

Biological refers to medical management with antidepressant medication. This is more likely to be used in moderate to severe depression.

Psychological management refers to counselling and Social Management refers to support groups and connecting with others around you.

There are type different types of postnatal depression (PND) and the treatment differs for each. The first is Melancholic Depression, which is the less common type (only affects 1- 2 % of adults). It is typically the more severe form and seems to have a greater genetic basis. Symptoms of Melancholic Depression typically include slower thinking processes, poor concentration, and agitation or slowed physical movements, as well as the typical symptoms associated with Non-Melancholic PND. Research indicates that Melancholic Depression is best treated with antidepressant medication and psychotherapy, but that it may be less responsive to psychotherapy alone. Research also seems to indicate that this type of PND rarely goes away without medication.
 
Non-melancholic is the second, more common type of PND and is more strongly associated with psychosocial factors, which include level of support, expectations of ones self, financial strain etc. Psychotherapy alone is better suited to this type of PND, although medication may also be required.
Evidence based psychotherapies for PND include Cognitive Behaviour Therapy, Mindfulness- based Therapy and ACT (Acceptance and Commitment Therapy). Therapies can be provided in a group format or individually, depending on personal preference. 

Treatment of postnatal depression is dependent upon symptom severity and the reasons for becoming depressed in the context of having a baby.  For a mild-moderate depression in the postnatal phase cognitive behaviour therapy (CBT), interpersonal therapy (ITP) and psychodynamic therapy have all been shown to be effective in reducing symptoms.  For a moderate-severe depression a combined approach of medication and psychological treatment has been found to be most effective for most women. 
 
It is important to recognise that postnatal depression occurs in a context – at a time when there is great change and a new relationship is being formed.  When a mother experiences postnatal depression, it affects her in many ways.  It may affect how she feels about herself, her ability and self-confidence in mothering, and her capacity to interact with other important people in her life, particularly her infant and partner.  
 
It is therefore important to hold in mind all members of the family when treating postnatal depression and to explore how the depressed mother is feeling about her baby and partner and how she is managing the day-to-day tasks of parenting.  For depressed women who wish to improve their relationship with their baby or confidence with parenting as well as improve their depressed mood, a range of dyadic (mother-infant) interventions are available and evidence-based.  These include ‘Watch, Wait and Wonder’, ‘Circle of Security’ or attachment-oriented interventions and ‘Interaction Guidance’.  Some psychologists and infant mental health specialists work with the mother and baby together, incorporating some of these approaches.   Treating mother and baby together often results in better outcomes for the relationship and mothers report greater joy in their interactions with their baby.  These approaches can also facilitate a healthy attachment relationship between infant and mother.
 

The previous three responders have covered the options of Psychological, Social or Biological treatment in detail. I would like to address a couple of treatment options that sit well with all of these therapies and are a must to ensure progress in treatment.
DIET Adequate nurition is important in the recovery process. Maintaining a healthy diet can be difficult for new mothers as they are often so focused on feeding their baby that they neglect eating properly themselves, either skipping meals or eating food that is not nutritious. Women should aim to eat regular meals that incorporate fresh fruit and vegetables, lean meat, whole grains and low-fat dairy products. Having an assortment of quality foods to snack on (e.g. fruit, low fat yoghurt, raw nuts and seeds, raw vegetable sticks, whole grain crackers) can be helpful if women can't find the time or motivation to prepare a meal. Women should also try and avoid the use of stimulants like alcohol, coffee, tea, cola and energy drinks.
PHYSICAL ACTIVITY Unfortunately, when someone is depressed, they often lack the motiviation to participate in physical activity. The effects of sleep deprivation associated with a new baby can also make women feel too tired. Physical activity, however, is an excellent way that women can help themselves. Regular physical activity has been shown to improve one's mood and sense of well-being. Walking is an excellent activity for new mothers as it is not too strenuous and with the right stroller or carrier, baby can come along too. For some women exercising with a friend or organised group is a good idea as not letting others down provides extra motivation.
COMPLEMENTARY THERAPIES
It is important that anyone using complementary therapies informs their health professional as they can have side effects, interact with other treatments or be unsafe to use during breastfeeding. St John's Wort (a herbal remedy) has been found to be effective in treating mild to moderate depression. It can interact with a large number of medications including warfarin, anticonvulsants, oral contraceptives and antidepressants. Other complementary therapies for which there is some positive evidence include folate supplementation, acupuncture, bibliotherapy (self help books), light therapy, massage, air ionisation and yoga.

Vivienne
Women’s Health Educator
Health Information Line, Women’s Health Queensland Wide

Women living in Queensland can also call our Health Information Line - a free information and referral service for Queensland women - on 3839 9988 or 1800 017 676 (toll free outside Brisbane).

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