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'.
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So I think I rang up my local doctor the next day, he wasn't there. But I said to them, "I need to come and see a doctor". I said, "I think I've got postnatal". "Yep, yep, come in and see someone". So I did, just to talk to them. And I had a doctor's appointment with my doctor the next day. So I went back again to see him. I said, "I need to see you". He said, "Yeah, I know, I know". He said - I said, "You weren't here yesterday, I had to see someone". He said, "No I understand, you had to see someone". So he was, he could see where I was coming from, and sort of asking me questions and stuff.
And you know basically it was the first time you know, someone had said to me, "You're suffering from postnatal. What do you think of medication?" you know? "What do you think of having some medication to help?" And I said no. "No, no, I'm tired", which is what I think I kept saying the first time. "I'm just so tired. This is hard. It's the first time. First child, and this is the second child, I'm tired. No, no, I don't need medication. May be if I can talk to someone". So right, so he set up for me to see somebody. And I think that was about a week later. But I think within that week, I thought - I think I got my head around the idea that I have a mental illness and I might need medication. And it took me about a week. Then I went back to him and I said, "Okay, I'm ready to try some medication". I've come to terms with it. You know it took, it's taken me a while, and I think it's - you know it probably took me a lot longer. Probably I sat back and thought, 'Well actually it's taken me since my first child was born for me to understand all this'.
Maybe subconsciously I knew something was wrong but I didn't want to know. I didn't want it to be that. I just wanted it to be that it was hard work and I'm just going to have to deal with it. And because it was - maybe if I thought that and then - because I was - the idea - nobody in the family had a mental illness. I really didn't know anyone that had - close to me that had mental illness, and to me mental illnesses were stigmas. Back then. You know, to me things have changed a lot in the last five years about how we approach and deal with people who have mental illnesses, and you know maybe that. So I thought, 'I don't have a mental illness. I refuse to believe that'.
I - physically an illness to me is something - you know, back then, was something physical, it wasn't something mental. It just was something I couldn't approach or probably deal with, that that might be the case.
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'.
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I'd been prescribed something called desvenlafaxine (PRISTIQ) and this time round it's a different antidepressant, it's called mirtazapine (REMERON). And I've always been strongly, strongly resistant to taking any antidepressants - I think because of my experience with my mother - so I've tended to go down the path of complimentary therapies and I know which have been effective up to a point but I think when it comes to an acute case then that's when pharmaceutical drugs are helpful.
But, I think the fact that I actually don't have a really serious mental illness like schizophrenia and what I am dealing with is just a low level mild thing - if it works then I don't mind. Because if it means that I'll be a happier person and therefore a happier mother and therefore generate a happier family environment, then, I'm happy to do that. I just remember mum being zonked out a lot and detached, removed emotionally from me, so I just don't want to repeat that.
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.
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My midwife said, "Whatever you do", - like she didn't want - she was a bit wary of putting me on to mental health and she was a bit wary of me talking to me - like she said, "Oh you know, if you do speak to your GP about this, make sure you make it very out there that you don't want to go on medication". She was like, "You know, you're pregnant - I think you should look at other things before you go on to medication". And she goes, "I don't want - like, you know, you're going to a medical person, I don't want them to be just like, 'Oh here, have some medicine to make yourself feel better'". She said, "You know, I think that you - it'd be better for you to talk it out with someone, let's look at some other options like vitamins and whatever else - like upping those things and improving your diet and stuff like that, before we go down that path".
So she goes, "Just make it very clear to your doctor that you don't want medication, it's not the path that you want to go". "Because", she goes, "'cause you know that's just a quick fix. It's - like it's covering up what you're going through". So when I went to my GP, I just said, "Oh you know, I think I've got depression. I spoke to my midwife about it, we don't want to go down the medication path". She goes, "Oh no, no, no, we're not going to do that".
I was quite happy that I spoke to her 'cause she - the doctor that I had was actually, she came - she has had a lot of - she has, also experience with working with mums and young children, which is why I went and saw - like had her - my daughter and my care. And so I was quite happy that I spoke to her about it because she - my midwife didn't even know about [clinic name]. So I told her about it and she was like, "Oh, great". And she like took all the notes and everything down so that she could use it in future things. Yeah, so no, no-one ever brought up medication really. So that was quite good.
Yeah, I was like, 'Nah, don't want medication really'. I have had friends that had the medication and most of them said that they either - they felt numb from it or they felt like it was a fake happy. So I was like, 'Yeah, I don't really want that'. Because one person said they got more depressed because they knew - like they felt their happiness was fake. So, it was like, well that's a big - not a very good thing for being depressed.
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.
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I think you do what you've got to do. I - that being said, I wouldn't have just taken medicine and not gotten any other support or treatment, because I think you need to do it in conjunction with other things, because if you're just taking medication - in my opinion if you're just taking medication but you're not actually working through, you know, your situation and that sort of thing, getting help, getting external help and support, and - I guess in my mind medicine is kind of to complement the treatment, not to just be the only treatment. And I guess that's been my experience as well.
I'd definitely be - I'd just be open to any sort of treatment people suggest, because like I said everyone's situation is different. What works for me doesn't necessarily mean it's going to work for someone else. But just being open. Don't shut off any channels of assistance just because it's not what you overall think, you know. I mean I understand some people are really against going to medicine, that sort of thing, but why cut back the channels you have to get better? - in my opinion. Why hinder yourself in any way?
Like just - and just because you have a pre-conceived notion that if you're taking medicine for a mental health issue that it's a bad thing. It just seems ludicrous to me. But that also could be because growing up I had family with mental health issues and if they didn't take their medicine it was a nightmare. So I guess, you know, I've had that sort of upbringing. Yeah. I'm not saying everyone should pop a pill, I'm just saying that if it's - in the circumstances, if your healthcare professional is suggesting you try something it can't hurt to try.
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.
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Antidepressants are a bit of a strange beast. They're very different from other kinds of medications I've been on. You know, you go on antibiotics and you see that, you know, almost instant improvement, 48 hours and you're starting to feel better, and it doesn't work like that with antidepressants. It was hard waiting for a prolonged period to see if they even had any impact, you know, to wait six weeks when you're feeling really depressed and not coping is hard. And then - and then upping your dose again is more of a - a statement that okay, I'm still not coping so I need a higher dose, so it's that recognition that things still aren't right and I'm not doing well and, so it was, it was difficult to admit needing to go up to higher dosages, but ultimately if that's what's going to help you get through then you do it.
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.
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I went in to my doctor and I just said to him, "I - this is what happened and I'm not good. I'm not coping and I'm not," - and he basically looked at me and said, well - because naturally I chose to go in after hours. Like, you know, so he wasn't prepared to - to get the whole mental health plan and stuff up and running. He just looked at me, because I was a mess, and he said, "Do you need to be admitted?" And I said, "No, I think I can - I can manage until Monday, but I need to be - I need to be seen, because I - yeah, I'm not in a good place at the moment". I really wasn't. I was running on no sleep. I couldn't - I just couldn't function.
So - but, yeah, I'm just really lucky that I had, you know, a great birth trauma counsellor and a great other counsellor up here, because they were two separate entities. I had someone who was specialised in birth trauma and - and then just a regular psychiatrist, I think.
So - and of course my GP has been fantastic as well. Oh, I can't rave enough about - like, seriously, the city GPs that I had - oh, these guys are amazing, because they're just - well, because you're in a small town, they know - they know you. They know you. So, yeah, I've been really lucky.
They put me on LEXAPRO (escitalopram), I think a 10 milligram dose. And I noticed it straight away, that it just - I felt like I was up here, you know, when I came home and it just brought me right down to a level of [clicks fingers]. You know, there were no - because I was really - I was just riding - a rollercoaster that I could not get off. It was just hideous. Whereas now everything's just, you know, cruisy. It's good. I'm looking forward to being - to coming to the day where I can say, "Yeah, I don't need it anymore". But I think the doctors are all more concerned that I get through the surgeries and everything first, in that respect of my recovery, that... you know, it would be silly to wean off it.
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.
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Sertraline (ZOLOFT) was the first one. Basically I couldn't keep myself awake. I couldn't - I would literally just fall asleep. I was so exhausted that I would go to bed at seven o'clock and then I would still find it difficult to wake up in the morning. So I went back to the doctor, because I felt that wasn't working, and she sent me to the psychiatrist, which was really - really helpful. He tried decreasing my dose and giving me another medication called Reboxetine (EDRONAX), which is when I felt like I was going to have a heart attack. I couldn't see, I couldn't hear properly. I couldn't hold anything, so I'd drop it. I was shaking.
And we went to the doctor and it was a hypersensitivity and I basically had to ride it out and wait for it to finish. So then he changed my medication to - can't remember what it's called. Just gone blank. Oh, that's it, Dothiepin (DOTHEP).
It felt too low. When I first started taking it, I felt really good, and after about probably five days I could notice that I was slipping back. One of the biggest indications for me when I'm going to experience a bad period, is that I don't do the washing up. If I get up in the morning and I haven't washed-up I sort of think back to how I've been feeling and that I need to get on top of things again. Because if I let things like the kitchen or the washing get on top of me, I find it harder to do everyday things. But I blow them out of proportion as well. Like, I can't do anything until the washing-up has been done and it's just ridiculous. So we've increased my medication since and that's been really helpful.
I started on 75. I then increased - no, I started on 50. I then increased it to 100, which was the dose that he wanted me to be on initially. And when that happened I ended up sort of swinging right back to feeling my absolute lowest again and unable to cope with anything. So we cut it back to the 50, then I've since increased it to 75 and not long - probably four weeks ago - increased it to 100 and I feel like it's working a lot better now.
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.
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So I started the medication and it - it was quite good at the start. I did have a lot of side effects but I just sort of pushed through them.
He was treating me for depression and with LEXAPRO (escitalopram) and I knew someone else that had been on LEXAPRO (escitalopram) and they had a very good experience with it and I'd done a bit of research on the internet as well and most of it was very positive. And so I started on it and the side effects I had were I was very, very tired, really tired, and just feeling a bit, just a bit strange. Like I wasn't quite in reality. Some of the side effects can be a worsening of symptoms but I didn't really have any of that. But I definitely had, just feeling really spaced out. Probably like I was on drugs or something. It just - yeah and very tired and that type of thing.
But I pushed through it and I felt quite good for a little while but then I just plateaued and didn't really - didn't really feel any different. I mean I didn't feel amazing but I didn't feel bad. So I don't know if that's how the medication is supposed to work but other people I've spoken to sort of said that they felt really positive and I didn't really feel positive, I didn't feel negative, if that makes any sense. I just - I didn't really feel - I thought I didn't feel different and then my partner and I got it into our minds that we wanted to have another child [laughs] so - so I went off the medication and we tried to get pregnant and it happened very quickly, but I had another miscarriage early on. And then when I came off the medication I really went downhill very, very quickly.
And I suppose at that time I realised that maybe the medication was helping more than I realised so - and plus having the miscarriage it was upsetting. I mean it was very early on but still - and it happened so many times.
I did consult - we did consult with the GP. He - he was concerned with me going off the medication, but I actually, I suppose, tried to convince him that I was fine and that I - cos I actually, I suppose, tried to convince him that I was fine and that I - because I actually felt like I was okay. So yeah, he - we spoke about LEXAPRO (escitalopram) during pregnancy and he was probably more supportive of that side of it, but I sort of said, "No I'm fine, I'm right". So I probably went off it of my own accord, which looking back was probably a bit silly.
So maybe the miscarriage was a blessing in disguise but that was hard to deal with. It was hard to accept that it'd happened again. It was probably about the sixth time it had happened. So yeah, so I then decided to go back on the medication and I saw the GP and he recommended that I go up from 10 milligrams to 20 milligrams. So I thought, you know, I have to just do whatever it takes. I mean things were really good with my son at this point so - but I was still very focused on him, I suppose. And I think the part that I was now starting to struggle with was balancing things out.
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'.
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And the same applies to medication, there's still a lot of stigma associated with the medication and you know, aren't you strong enough to do this by yourself without the help of medicine and you - again you look at it and you go, okay if I told someone that I had blood pressure issues, they'd be like - and I have to be on medication for the rest of my life, they would say, "Ah bad luck, you know, don't worry, at least you know the medication's there". I've made a choice that I want to stay on the medication for the rest of my life because I don't want to risk having a relapse.
And I do get asked the question, "Well what's the matter, can't you do it by yourself?" And when I do explain to them like that, you know, "Would you ask me that if I came to you and said I - look I've just found out I have a blood pressure issue, I'm going to be on this medication for the rest of my life, you wouldn't be asking me this question". And that's the biggest thing that for people to look at mental illness as an illness that happens, happens to be affecting your brain. And therefore just be kinder to yourself about that. And if we all do that then the stigma will naturally disappear, and - which is the reason why you know, I'm willing to speak up and say it's all right to talk about it because it's another medical condition.
