I work with women in my Boulder, Colorado psychotherapy practice, and most of them are struggling in one way or another with their transition to motherhood. While the range of challenges varies, the desire to feel differently is pretty consistent. Whether a woman is trying to conceive, pregnant, newly postpartum, or more “seasoned” in motherhood, she always sits in my office and says that she wishes that she felt better.
“How long will it take?”
“When will I feel better?”
“Will I ever feel like myself again?”
And then, almost always, “Do I have to go on meds?”
Usually, after learning a bit more about her individual feelings on the issue, the answer to this question is often “only if you choose to.” While Perinatal Mood Disorders such as Postpartum Psychosis and Postpartum OCD really do require medication in order to balance out brain chemistry, many PPMDs such as milder forms of postpartum depression and postpartum anxiety can be supported through psychotherapy and other complimentary treatments shown to decrease symptoms.
But it is important that each mom know the facts. I am a strong believer that each woman knows what is the best course of treatment for herself and her family, but it is important that she understand the specifics of her choices before she makes one. Many women say that they don’t want to take medication, for example, without knowing that many anti-depressants are known to be safe for pregnant and nursing moms.
So, below is some information on the options. While all of these options are known to be effective in treating PPD, it is important to note that usually a combination of treatment modalities is the most comprehensive way to go. And, without a doubt, psychotherapy is an important piece of the puzzle, as it offers a safe space to receive validation and support, education, case management, self care strategy building, and- when necessary-the processing of important family of origin or previous trauma histories that may be contributing to a mom’s overwhelm.
Individual Psychotherapy: Weekly therapy with a licensed psychotherapist trained in working with Postpartum Mood Disorders is, as mentioned, an important piece of treatment. This therapist will take a thorough history and help you to identify key pieces of your physical, psychological, and social worlds that may be contributing to your suffering. This therapist will ask you important questions about both how you feel now as well as how you have felt in the past in order to better understand how having a baby or children has effected you. He or she will take a thorough family history that includes both aspects of physical as well as emotional health. He or she will evaluate your basic needs (sleep, nutrition, social support) and help you strategize about ways to fill the gaps, if they exist. This therapist may play an active role in providing other referrals and collaborating with other providers in your community to better support you (such as ObGyn/ Midwife, psychiatrist, postpartum doula, acupuncturist, massage therapist or other body workers, nutritionist, pediatrician, parenting coach, or lactation consultant.) He/she will help you to set concrete goals toward a greater feeling of health and wellness.
Couples Therapy: Experiencing conflict in a marriage or partnership can be a contributing factor to emotional vulnerability and overwhelm, and having a new baby almost always shakes up feelings of stability. Working with a psychotherapist who is trained in couples work can be an incredibly rewarding piece of the treatment for many women. While it is important to realize that it is totally normal for conflict to arise after having a baby, it is also important to pay attention to this without assuming that things will clear up on their own. A couples therapist can help to mediate conflict, re-set expectations within a relationship, and offer new perspective that can help to get a couple back on track quickly. The strongest marriages out there are often those that have worked with a therapist during periods of vulnerability. And a parenting team is, without doubt, an important piece of family health.
Group Therapy: Mom and Baby groups and more structured PPD support groups offer a space for community and support that is invaluable. Usually these groups will be led by a trained and licensed psychotherapist, other birth or medical professionals, or moms who have recovered from PPD. Connecting with other women at this time can be validating, can offer important perspective, and can provide community when it may be otherwise lacking.
Psychopharmacology (ie: antidepressant and anti-anxiety medication): There is a lot of misinformation out there about the safety of antidepressant medication during pregnancy and while breastfeeding and, as a result, many women are told that they need to go off their antidepressant medication that they are taking if and when they become pregnant. And other women who suffer from extreme depression and/or anxiety postpartum are told that going on a medication to help with these symptoms is not a possibility. The truth around this is that we know that untreated depression and anxiety can pose more serious risk to a fetus or baby than the potential risks from medication (See “How Maternal Depression Affects Children” here). Babies and children with mothers who’s severe depression and anxiety was untreated are at a pretty high risk of developing delays in their emotional, social, and cognitive development. The risks to babies who’s mother is taking medication for her symptoms are low- There are, in fact, many safe and effective medications that moms who are suffering can take if and/or when there is a need. If you choose to take medication, you can usually expect to begin to feel better within 2-3 weeks, and it is recommended that you remain on your medication for at least 6-months AFTER you feel better. To learn more about medication while pregnant or breast feeding visit the Mass General Hospital’s Center for Women’s Health.
Acupuncture: I previously wrote about a study done at Stanford University that found there to be huge benefits on acupuncture as a form of treatment for moms suffering with depression and anxiety. This is great news for women who choose not to go the medication route. As with any professional who you seek, it is important to find an acupuncturist who is familiar with and experienced in the specifics of PPD.
Nutritional Consultation: Pregnancy, childbirth, and nursing are hugely depleting on a mom’s nutritional reserves. While a baby will get all that he/she needs from you, it is important that you replenish yourself with important nutrients so that your body doesn’t become depleted through your generous donations to your baby. We know that nutrient depletion can play a big role in a mom’s emotional vulnerability and the development of PPD, and so you need to be giving yourself the important nutritional building blocks for serotonin and other “feel good hormones”. A study done at Penn State University and published in The Journal of Nutrition found a connection between maternal Anemia and the development of PPD, some research has found a connection between PPD and lower levels of Omega 3, and recently, a study published in the Archives of General Psychiatry found that PPD may be associated with higher levels of a brain protein called monoamine oxidase A (MAO-A) which removes chemicals that stabilize mood. This study suggests that nutrient supplements specific to the proteins lost thru MAO-A may help to prevent PPD. Working with a trained professional around some of these issues can lead to better mood and increased ability to sleep for many women.