Major Depressive Disorder with Peripartum onset

Finding The Right Treatment

Treatment for MDD with Peripartum Onset

Getting treatment for MDD with Peripartum Onset is extremely important. Without treatment, depression lingers, and symptoms can intensify over time. Some individuals lose interest in their jobs, their families, and everything else they once cared about. In this pit of despondency, they cannot imagine ever feeling better. The good news is that most people can recover from depression with a combination of therapy, medications, and lifestyle modifications, and lead normal, fulfilling lives.

Finding a therapist

While medications are often a catalyst for change in individuals with MDD, therapy has been proven to yield major improvements in the lives of those struggling. Whether it be early recognition of symptoms that lead to a depressive episode, an understanding of how the past might have impacted a person, or a simple awareness of thoughts and their triggers, therapy can help people become more content versions of themselves.

There are different kinds of professionals who can provide effective therapy, including:

• Clinical psychologists (PhD)
• Licensed clinical social workers (LCSW or LMSW)
• Licensed professional counselors (LPC)
• Licensed clinical professional counselors (LCPC)
• Licensed Marriage and Family Therapists (LMFT)
• National certified counselors (NCC)

There are several styles of therapy that can be helpful for MDD including psychodynamic, interpersonal, and supportive therapy. In recent years, more therapists employ cognitive behavioral therapy (CBT), which is a method that helps the individual identify unhelpful thought patterns, challenge self-destructive cognitions, and replaces them with more constructive thinking. Therapists will also help the individual identify behaviors which may help bring increased pleasure or a return to a sense of confidence.

Many individuals with MDD with Peripartum Onset find therapy to be one of the best ways to prevent future depressive episodes. It is critical to recognize the triggers and signs of an oncoming episode, and therapy can help to detect them. The natural ups and downs of life can often be triggers for depressive episodes, and a good therapist will partner with individuals to plan accordingly, even aiding in advocacy for antidepressant dosing adjustments through these difficult periods.

The decision to start therapy

Many people try to cope with their distress on their own, then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Requesting one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes one's insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.

Medications

Many experts agree that postpartum mood and anxiety disorders can be effectively treated using a combination of therapy and medication, the latter of which can be safely managed during pregnancy under a physician's care. For some, the thought of taking medication while pregnant or breastfeeding can oftentimes cause fear or uncertainty, and understandably so! They want to ensure their child is safe and protected. It is important to remember that the best thing one can do for their child is to give them the gift of a healthy parent.

Medications often play a central role in the lives of people with depression. Finding the right medication is not straightforward, as different individuals metabolize and react to medications differently. Adjusting dosages to manage and prevent depressive episodes can add an additional layer of complexity for those with depression.

First-line treatment

For most types of depression, including MDD with Peripartum Onset, the first step is to try a medication in the category of selective serotonin reuptake inhibitors (SSRIs or SRIs), which include medications such as citalopram (Celexa), escitalopram (Lexapro), and fluoxetine (Prozac). Research has shown that there is a relationship between depression levels and the amount of serotonin in the brain. So, these medications prevent serotonin from being taken out of the system too quickly (through reuptake inhibition).

The other group of commonly used medications are classified as serotonin norepinephrine inhibitors (SNRIs), and these drugs increase the levels of both serotonin and norepinephrine. Examples of these medications include duloxetine (Cymbalta) and venlafaxine (Effexor, Effexor XR).

These medications are commonly referred to as “first-line” antidepressant medications.

**If an individual is pregnant or breastfeeding their baby, rely upon their healthcare provider’s judgment in determining the best medication for them. Some antidepressants have been available for years while others are much newer and less research information has been completed on them. In general, most antidepressants described here are considered safe but one's own personal circumstances should be considered by their healthcare provider.**

As a class of medications, antidepressants often take 10 days to two weeks to begin working. The full effect of the medication is not realized for two months.

If one of the “first-line” medications does not initially work, a prescriber has many options. The first is to ensure that the SSRI/SNRI is dosed adequately. Before abandoning a “first-line” treatment, it is prudent that higher doses are given a chance. Sometimes, however, high doses are not tolerated due to side effects. And, in those situations, other strategies can be employed.

Second-line treatment

A large percentage of people who take antidepressants either do not tolerate the SSRIs/SNRIs or do not see clinical benefit. In these situations, prescribers turn to bupropion (Wellbutrin). Bupropion is a dopamine and norepinephrine reuptake inhibitor (DNRI). It has significant antidepressant properties, particularly as the dose increases. Bupropion does not have serotonin properties, and for this reason, it does not cause sexual side effects. On the downside, bupropion is not considered as effective against anxiety as some of the SSRIs/SNRIs. Bupropion can be used alone; but, not uncommonly, bupropion is added to an SSRI/SNRI.

Treatment-resistant depression / depression and suicidal ideation

The diagnosis of treatment-resistant depression is used when first-line and second line treatments have not been effective, which sometimes happens.

Treatment-resistant depression does occur sometimes with MDD with Peripartum Onset. If an individual is not getting better on antidepressant medications and therapy does not appear to be helping, it is important to re-evaluate their diagnosis. The primary goal of MindMetrix is to assess the level of a person’s symptoms and uncover any conditions that may coexist. For many individuals with treatment-resistant depression, depression is only one element of their lives.

Neuromodulation therapy

Another option for treatment-resistant depression is neuromodulation therapy, and a newer method of neuromodulation used with pregnant women or new mothers with MDD with Peripartum Onset is repeated transcranial magnetic stimulation (rTMS). This is a non-invasive technique. With this procedure, the healthcare professional places an electrode on the skull resulting in the transmission of magnetic waves to a specific part of the brain.

This treatment has been shown to relieve anxiety and depression with a different side effect profile than most medications. For instance, sexual side effects do not result from rTMS, and many patients who cannot tolerate medications migrate towards this option. This highly specialized approach to treatment resistant depression can be very helpful and most treatment centers are located in large cities.

A new infused drug for Postpartum Depression

A medication that is intravenously infused for 60 hours has been approved by the FDA for postpartum depression. This drug, brexanolone (Zulresso) is believed to affect the body levels of the neurotransmitter gamma-aminobutyric acid (GABA), although the mechanism by which the medication works is unknown. Women receiving this drug must be continuously medically monitored.

Electroconvulsive therapy

Electroconvulsive therapy, once referred to as “shock treatments,” is still a feared treatment by many people, largely because of old movies that have no relevance to the world today. Instead, ECT of today uses much lower dosages of electroshock than in past years and does not cause pain in the individual, nor does it result in major memory loss. It is also sometimes used in the case of MDD with Peripartum Onset.

Healthcare providers that can prescribe medications

Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN, or a new primary doctor.

FDA warning about suicide risk with antidepressants

Some research exists that, occasionally, newly initiated anti-depressants may increase the risk of suicide. If an individual begins to have these thoughts after starting an anti-depressant, please stop this medicine and contact a prescriber immediately. This risk is more evident in children, adolescents, and young adults.

Dietary supplements

There are an increasing number of supplements, such as an herb, vitamin, mineral, and other supplements claiming to improve sleep, depression, stress, restlessness, or anxiety. While it is possible for a supplement to improve one’s symptoms, their effects are often unproven.

Be aware that dietary supplements are not controlled by the FDA and, therefore, are not subject to the standards of quality, uniformity, and testing for efficacy and safety as regulated medications. It is important to share a list of all medications and supplements with one's treating provider because some of them may interact with the medications they prescribe.