How is postnatal depression treated?

There are a range of effective treatments and helpful services for managing PND. The earlier a woman seeks help, the faster she can recover. The type of treatment will vary according to the individual and the severity of the illness, but often a combination of treatments is most effective.The following information outline the main types of help available:

Urgent Assistance
If you, or someone you care about, is in crisis and you think immediate action is needed, you can contact the services listed below for assistance.

• Emergency appointment with your local doctor (General Practitioner) check the White Pages for the phone number. You can find a GP in your area who has had extra training in mental health by looking at the beyondblue Find a Doctor List.
  
• Contact your local public hospital.
  
• Lifeline - 13 11 14
  
• Suicide Helpline Victoria  - 1300 651 251
  
• Kids Help Line  (free call) -  1800 55 1800
  
• Mensline  - 1300 789 978
  

Psychological Treatment
Psychological treatments which are often referred to as ‘Talking Therapies’ have generally been found to be the most effective way of treating PND. Psychological treatments can help by:

• changing negative thoughts and feelings
  
• encouraging involvement in activities
  
• speeding recovery 
  
• preventing depression from getting serious again.
  

There are many different types of therapy that can help women manage postnatal depression including:

Cognitive Behaviour Therapy (CBT)
When people are depressed, they may think negatively about: 

• themselves e.g. “I'm a failure.” “ No one loves me.”
  
• the world e.g. “There is nothing good out there.”
  
• the future e.g. “Things will never improve.”.
  

Negative thinking can make it hard for a depressed person to get better.

Cognitive Behaviour Therapy (CBT) is a structured program which recognises that the way people think affects the way they feel. CBT helps people to recognise unhelpful and/or irrational thoughts and replace them with more realistic thoughts. CBT, which is often taught in groups, shows people how to think rationally about common difficulties. It also involves setting goals and planning activities.

Interpersonal Therapy (IPT)
People with depression may sometimes be easily upset by other people's comments. They may feel criticised when no criticism was intended and as a result, feel that people are against them - so they stop joining in normal social activities. IPT helps people find new ways to get along with others.

Psychological therapies can also help families of people with depression find new ways of coping with difficult situations.There are a number of health professionals who may provide effective psychological treatment. These include:

Psychologists
Psychologists are health professionals who provide psychological therapies and treatments for people experiencing a range of general psychological difficulties. Common effective types of psychological therapy are CBT and IPT. These are known as ‘Talking Therapies’. Psychologists (including clinical psychologists) are not medical doctors and cannot prescribe medication in Australia.

Psychiatrists
Psychiatrists are doctors who specialise in mental health. They can make medical and psychological assessments, conduct medical tests and prescribe medication. Psychiatrists often use psychological treatments like CBT, IPT and/or prescribe medication.

Medical Treatment
Psychological therapies like CBT and IPT can help some people reduce their symptoms of depression without the need for medication. However, medication can play an important role in helping people with depression manage from day to day.

Medical research indicates that when people become severely depressed, specific changes in the chemical message systems of the brain (serotonin, noradrenaline, dopamine) occur. Antidepressant medication is designed to correct the imbalance of chemical messages between nerve cells (neurones) in the brain.

Antidepressant medications are safe, effective and not addictive. Some people may worry about how antidepressants will affect a baby who is breastfed. However, remaining on medication can be important in order to avoid significant depression which can have a negative impact for both mother and baby.

For women who are pregnant or breastfeeding, making a decision about whether or not to take an antidepressant can be difficult. The decision to take medication is up to the individual and should be made in consultation with a doctor, after considering the risks and benefits to both the mother and infant.

Alternative Treatment
While there is research to suggest that some alternative treatments are effective in treating depression, there are extra considerations when breastfeeding. That is why alternative treatments should only be used to treat depression postnatally under the close supervision of a medical doctor. See this sheet for more information http://beyondblue.org.au/index.aspx?link_id=89.583&tmp=FileDownload&fid=2357

A person may now receive Medicare rebates for treatment of a mental disorder.

Besides the excellent information posted by Beyond Blue you might find this booklet helpful and it can be useful to share with family members and friends and those supporting you. Just click on the link.

http://www.womhealth.org.au/documents/booklets/Antenatal_Postnatal_Depression.pdf
Brenda

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).

Please note that all health information provided by Women’s Health Queensland Wide is subject to this disclaimer

One therapy that you might be interested to know about is called Acceptance and Commitment Therapy (ACT). You can learn more about ACT here:
http://www.sydneyactcentre.com.au/www.sydneyactcentre.com.au/What_is_ACT.html

In a nutshell it would be important to focus on what matters to you as a person and more specially to you as a parent and then to address the barriers that are standing in your way. For example, if a mum believes it is really important to be a loving and supportive mother and has a lot of anxiety / low mood it is quite possible that her difficult thoughts and feelings might get in the way of living that value so to speak. Typical yucky thoughts might be, “I wish the baby would just shut up”; “I'm a terrible mother for thinking this”; “why do all the other mums seem so competent?”; “I'm going to screw my child up” and so on. Parenting comes with a whole range of difficult emotions such as anxiety, disappointment, guilt, frustration and so on.

ACT is all about helping people recognise what matters to them and then addressing the difficult thoughts and feelings that act as barriers to living according to what matters. It can also include focusing on some very practical changes - e.g. doing less house cleaning, asking others for help; starting some online shopping and so on

Parenting is tough - and getting support is often key to being able to parent in the way one desires!!

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 recognize 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.