Maternal Mental Health, Postnatal depression
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Dr Leigh Neal highlights the treatments available for Postnatal depression following Maternal Mental Health Awareness Month

It’s a common problem, affecting more than 1 in every 10 women within a year of giving birth. It can also affect fathers and partners. Research has actually found that up to 1 in 10 new fathers become depressed after having a baby. 

The symptoms can last months or longer and have a significant impact on the parents, baby and the family. Many women feel a bit down, tearful or anxious in the first week after giving birth. This is often called the “baby blues” and is so common that it’s considered normal. The “baby blues” tend not to last for more than 2 weeks after giving birth.

If the symptoms last longer or start later, it could be postnatal depression. Postnatal depression can start any time in the first year after giving birth. The symptoms of postnatal depression are not dissimilar to other depressions and include a persistent feeling of sadness and low mood, lack of enjoyment and loss of interest in the wider world, lack of energy and fatigue, trouble sleeping at regular times, difficulty in bonding with the baby and problems concentrating and making decisions.

The development of postnatal depression is gradual and many women do not realise that they have it at first. There is a range of treatments on offer to those suffering with the condition. At first, the person should speak to their GP or health visitor. Many health visitors have been trained to recognise postnatal depression and have techniques that can help.

Self-help methods include talking to family and friends about feelings and what they can do to help, making time for yourself to do things you enjoy, resting whenever you get the chance and getting as much sleep as you can at night, exercise regularly and eating a healthy diet.

If these do not work, then the next step is psychological therapy. GPs will be able to recommend talking therapies such as CBT to new mothers suffering with postnatal depression.

When psychological therapies are ineffective, antidepressants can be beneficial. However, some antidepressants are not recommended with breastfeeding because the medication can enter breast milk and some people experience unpleasant side effects. Studies evaluating the safety of a particular type of antidepressant (SSRIs) in breastfeeding have demonstrated detectable antidepressant levels in breast milk for all antidepressants, but undetectable infant serum levels for the medication. No short-term adverse events have been reported with the use of these drugs.

While these findings are consistent across multiple laboratories and studies, the studies are small and the long-term effects are unknown. Further research is needed to determine the safety of these medications in breastfeeding with control for maternal depression. Tricyclic antidepressants (TCAs) have a similar evidence base as SSRIs and can be considered for breastfeeding women with moderate to severe depressive symptoms. The main limitation of TCAs, however, is the poor side effect profile for the mother. Often TCAs are not well tolerated, necessitating a switch to another medication, resulting in exposure of the infant to two antidepressant agents.

With a surge in medtech innovation over the last decade, one treatment that has been proven to be effective in the treatment of a range of mental conditions including depression, anxiety and OCD is Transcranial Magnetic Stimulation (TMS). TMS was approved by NICE (2015) for the treatment of depression. This does not have any systemic effects and therefore should not have any impact on the breastfeeding baby. Initial results from studies of TMS in postnatal depression are promising in terms of the treatment of depression and the health of the baby and mother.

In a study of the effectiveness of TMS in the treatment of post-natal depression, nine antidepressant-free women with post-natal depression were given TMS treatment over four weeks. Significant improvement in the depression was noticed after only two weeks of treatment, with eight out of nine patients remitting from depression after four weeks, and seven out of these eight patients remaining in remission after five months.

A review of many studies suggests that TMS increases cognitive function in individuals suffering from major depression, which may be beneficial in the post-natal period. In 2012 a randomized, placebo-controlled, double-blind study evaluated the impact of TMS on clinical, cognitive, and social performance in women suffering with postpartum depression.

Fourteen patients were randomized to receive 20 sessions of sham TMS or active TMS. The active TMS group showed significant improvement in depression 2 weeks after the end of TMS treatment in week 6. This study indicated that TMS has the potential to improve the clinical condition in postpartum depression, while also producing gains in social and cognitive function.

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