Experiences of medication for antenatal and postnatal depression

Perinatal depression is most commonly treated via psychological or counselling therapy, medication, hospitalisation, or a combination of one or more of these (see Experiences of hospitalisation for postnatal depression and Non-medical approaches to antenatal and postnatal depression). A number of parents we interviewed who experienced perinatal depression were prescribed or recommended medication, usually in combination with at least one other form of treatment.

Parents who were prescribed medication talked about their attitudes towards and experiences of taking medication including effectiveness, adjusting the dosage, side-effects, having to try different medications, what it was like stopping taking it, and duration of medication use.

Among this group, most people were taking antidepressants while a couple of people were prescribed anti-anxiety medication (for anxiety and/or depression) or antipsychotic medication. A few were taking two different medications at the same time.

Several parents who were prescribed medication for postnatal depression were reluctant to take it, for varied reasons. Some were unwilling to accept the diagnosis of postnatal depression, or were concerned about 'stigma' attached to taking antidepressant or anxiety medication.

Georgia described how her reluctance to take antidepressant medication was tied to her stigmatised view of 'mental illness'.

Other parents' concerns centred on fears about side effects of antidepressant medication, sometimes based on stories of other people's experiences. Some people worried medication would make them 'numb' or not 'feeling'. Melissa who experienced postnatal depression after her second child was reassured by her doctor that, 'the medication wouldn't do anything to me unless there was a chemical imbalance. That made me feel okay, that made me feel better.'

Zara's hesitation towards taking medication for postnatal depression was related to her experience of her mother taking medication for 'schizoaffective disorder'.

A few women who were pregnant or breastfeeding were concerned about the effects of antidepressant or anxiety medication on their baby including Deb who had to try several medications before finding one that was 'right'. She described 'constantly being concerned whether or not [the medication was] going to be safe for my baby, for breastfeeding. It was sort of like, what was going to be the best of the bad options? Or would we continue to live the way that we were and who knows what would have happened? We couldn't stay in that experience. '

A couple of parents consciously avoided taking antidepressant medication. Tony had taken them for depression in the past and described feeling 'bland' while taking them, while Maree had mixed reasons for not wanting to take antidepressants while pregnant.

Maree, her midwife and her GP agreed she did not need to take antidepressants while experiencing antenatal depression.

Not everyone was reluctant to take antidepressant medication. Some parents were taking medication for pre-existing depression and described needing to adjust their dosage when they experienced perinatal depression or distress. Daniel said he felt 'pretty low' after his twin sons via surrogacy died, and explained: 'I'd been on antidepressants for some years already at a low dose and when this happened and I was feeling fully suicidal, the antidepressants went up in dosage and I was more closely monitored by the GP for a while, until things settled down and I was able to reduce the dosage again.' Several mothers who were hospitalised for postnatal depression began taking medication while they were in hospital and discussed medication in the context of their hospitalisation (see Experiences of hospitalisation for postnatal depression). Other parents were open to taking medication 'in conjunction' with other forms of treatment.

Chelsea thought it was important to be 'open' to medication, to 'complement' other forms of treatment.

Several parents said it took some time before they noticed any effects of the medication they were prescribed and commented that antidepressants or anti-anxiety medications were not a 'magic pill' or a 'quick fix'. Others did experience medication taking effect quickly.

Elizabeth said waiting for several weeks to see if her antidepressant medication was having any 'impact' was difficult.

Erin said anti-anxiety medication took effect quickly. Together with counselling and supportive GPs it helped her recovery from postnatal depression and post-traumatic stress after surviving a life-threatening event during childbirth.

A number of parents described going through an extended process of trying different medications or different dosages until they found the right combination. A couple of people had experiences that made them feel worse, including Georgia: 'The second one had a really negative effect. It actually pushed me worse. I realised I was just sitting on the couch. I'd just stare and I wouldn't talk. And I think it was a couple of days on the medication then we sort of realised that maybe it was the medication.'

Deb tried two other antidepressant medications before finding one that suited her. Even then, she had to adjust the dosage.

Several parents suggested that they judged medication to be 'working' when they felt back to their 'normal self' or 'more like myself'. Others only noticed the effects of medication when they tried to alter their dosage or stop taking it.

Melanie 'didn't feel different' while taking antidepressant medication, but 'went downhill very quickly' after she stopped taking it.

Side effects were mentioned by a few people, both in relation to taking and stopping taking antidepressants. These were diverse and included feeling 'dizzy', 'flat', tired, experiencing a worsening of symptoms of depression, 'shaking', and a loss of 'sexual function' or libido. Elizabeth accepted the side effects of her medication, explaining: 'in the end I guess you balance it and you say well, if it's going to make me feel better in terms of mental health, that I can cope and that the world's an okay place then you accept those side effects that you have. And that was how it came out for me. I was much better to be on the antidepressant with the side effects than not'.

Most parents who had been prescribed antidepressant or anti-anxiety medication for postnatal depression were still taking it at the time we talked to them. Some were concerned about how long into the future they would need to remain taking medication, or described being questioned by others about this.

Anna described the double standard she felt existed about long-term medication use for physical conditions as compared with for 'mental illness'.