treatments for postnatal/ pyshcosis

Support and advice

The most important first step in managing postnatal depression is recognising the problem and then taking action to deal with it. The support and understanding of your partner, family and friends can play a big part in your recovery.

However, to benefit from this, it is important for you to talk to those close to you and explain how you feel. Bottling everything up can cause tension, particularly with your partner, who may feel shut out.

Support and advice from social workers or counsellors can be helpful. Self-help groups can also provide good advice about how to cope with the effects of postnatal depression, and you may find it reassuring to meet other women who feel the same as you.

Ask your health visitor about the services in your area.

Exercise

Exercise has been proven to help depression, and is one of the main treatments if you have mild depression.

Your GP may refer you to a qualified fitness trainer for an exercise scheme or you can find out more about starting exercise here.

Read more about exercise for depression.

Psychological treatments

Psychological therapies are usually recommended as the first line treatment for mild to moderate postnatal depression for women with no previous history of mental health conditions.

Some widely used psychological treatments are discussed below.

Guided self-help

Guided self-help is based on the principle that your GP can ‘help you to help yourself’.

For example your GP can provide self-help manuals detailing types of issues you might be facing and practical advice on how to deal with them. They also contain information on using cognitive behavioral techniques to help combat feelings of helplessness (see below for more information).

Your GP may also give details about an interactive computer programme, available via the internet, called ‘Beating the Blues’. This again takes a cognitive behavioral approach to battling depression.

Talking therapies

Talking therapies are where you are encouraged to talk through problems either one-to-one with a counsellor or with a group.

You can then discuss ways to approach problems in a more positive manner.

Two widely used talking therapies used in the treatment of postnatal depression are:

• cognitive behavioural therapy
• interpersonal therapy

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a type of therapy based on the idea that unhelpful and unrealistic thinking leads to negative behaviour.

CBT aims to break this cycle and find new ways of thinking that can help you behave in a more positive way.

For example, thinking there is a perfect ideal of ‘motherly behaviour’ is both unrealistic and unhelpful. All mothers are human and humans make mistakes. It is neither necessary nor helpful to try and be “Super Mum”.

CBT is usually provided in 4-6 weekly sessions.

Interpersonal therapy

Interpersonal therapy (IPT) aims to identify whether your relationships with others may be contributing toward feelings of depression.

Again, IPT is usually provided in 4-6 weekly sessions.

Antidepressants

The use of antidepressants may be recommended if:

• you have moderate postnatal depression and a previous history of depression
• you have severe postnatal depression
• you have not responded to counselling or CBT, or would prefer to try tablets first

A combination of talking therapies and an antidepressant may be recommended.

Antidepressants work by balancing mood-altering chemicals in your brain. They can help ease symptoms such as low mood, irritability, lack of concentration and sleeplessness, allowing you to function normally and helping you cope better with your new baby.

Contrary to popular myth, antidepressants are not addictive. A course usually lasts six to nine months.

Antidepressants take two to four weeks to start working, so it is important to keep taking them even if you do not notice an improvement straight away. It is also important to continue taking your medicine for the full length of time recommended by your doctor. If you stop too early, depression may return.

Between 50 and 70% of women who have moderate to severe postnatal depression improve within a few weeks of starting antidepressants. However, antidepressants are not effective for everyone. 

Antidepressants and breastfeeding

The selective serotonin reuptake inhibitors (SSRI) types of antidepressants are usually recommended for women who are breastfeeding. 

Tests have shown the amount of these types of antidepressants found in breast milk is so small it is unlikely to be harmful.

Side effects of SSRIs include:

• feeling sick
• blurred vision
• diarrhoea or constipation
• dizziness  
• feeling agitated or shaky,
• insomnia (not sleeping well) or feeling very sleep

These side effects should pass once your body gets used to the medication.

Discuss feeding options with your GP when you're making decisions about taking antidepressants.

Many mothers are keen to continue breastfeeding because they feel it helps them to bond with their child and boosts their self-esteem and confidence in maternal abilities. These are important factors in combating symptoms of postnatal depression.

Treating severe PND

Referral

You may be referred to a mental health team if your postnatal depression is severe, or does not respond to treatment. These teams are usually made up of a range of specialists, including psychologists, psychiatrists, specialist nurses and occupational therapists, and can provide intensive talking treatments such as psychotherapy.

If it is felt your postnatal depression is so severe you are at risk of harming yourself or your baby, you may be admitted to hospital or referred to a mental health clinic. If you have support available from your partner or family, it may be recommended they care for your baby until you are well enough to return home.

If you do not have support available to help you care for your baby, or your mental health team feels separation from your baby would adversely affect your recovery, you may be recommended for transfer to a specialised 'mother and baby' mental health clinic.

Your baby may have to sleep in a separate nursery until you are well enough to look after them. Once your symptoms begin to respond to treatment, your baby will sleep in your room.

Medication

A small number of women develop symptoms of psychosis after birth (being unable to tell the difference between reality and their imagination).

If this happens to you, you may be treated with a combination of:

• mood stabling medications such as lithium or an anti-epileptic drug
• an antipsychotic (this helps combat the symptoms of psychosis)
• a tranquiliser, such as a benzodiazepine to help relax you

You cannot breastfeed while taking these types of medications so your baby will have to be bottle fed.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) may be recommended if you have severe postnatal depression, but is only used when antidepressants and other treatments have not worked.

If ECT is recommended, you will be given a general anaesthetic and medication to relax your muscles. Electrodes are  placed on your head and a pulse of electricity passed through your brain. Most people have either six or twelve sessions of ECT, normally with two sessions a week.

For most people ECT is effective in relieving severe depression, but it is necessary to take antidepressants afterwards to keep symptoms under control. It's unclear how ECT works, but the generally agreed view is that electricity changes the chemical composition of the brain in such a way as to elevate mood.

Some people experience unpleasant side effects after having ECT, including headaches and both short-term and long-term memory loss. Due to the risk of memory loss, your memory will be assessed at the end of each ECT session.

If it looks like your memory is being affected, or you experience other adverse side effects, then the ECT sessions will be stopped.