As a pharmacist, I get a lot of questions from female patients regarding mental health meds for postpartum depression, breastfeeding, and non-prescription alternatives. To answer some of these, I sat down with Dr. Seeman, a practicing OB-GYN specializing in high risk obstetrics, robotic surgery, and primary care for women. She’s known as Dr. Fit and Fabulous, and you can find her Instagram at @doctorfitandfab.
Dr. Jessica: Hi Dr. Seeman! Thank you for taking the time to speak with me today. It’s a pleasure having you and getting your take on women’s health and postpartum depression. Let’s start by acknowledging that postpartum depression is a very real thing. Would you agree?
Dr. Seeman: Yes, this is a real problem that I encounter daily. 1 in 10 women will meet criteria for a major depressive disorder not only postpartum, but even during the pregnancy. In my personal opinion the rate is likely even higher and a large majority of moms will develop “postpartum blues,” a mild form of postpartum depression.
Any woman with changes in sleep, appetite, and libido should speak to their doctor—many women go unscreened and untreated. Common symptoms I see are crying spells, loss of appetite, anger and sadness. Postpartum anxiety is real too and never talked about either.
Dr. Jessica: As a pharmacist, women ask me all the time how long they should breastfeed for. Many women avoid drinking wine or going out with their partner and fall into a slump due to breastfeeding schedules and pumping. The American College of Obstetricians and Gynecologists and the American Academy of Pediatricians both recommend exclusive breastfeeding for the first six months of life. What’s your take?
Dr. Seeman: We need to support breastfeeding moms. We don’t do a great job at this. Moms should attempt to breastfeed their babies for a minimum of 6 months and continue to breastfeed for 12 months or longer until weaning occurs. There are major benefits for both the baby AND mom!
Return to work is a major risk factor for drop in supply as the pump is not as efficient as the baby and work schedules can be restrictive for moms just logistically pumping enough to keep up. Any amount of breast milk you can give your baby is worth it. We need better postpartum lactation support for moms in this country.
Dr. Jessica: For those women who would like to try a more natural approach before turning to prescription medication, what are your recommendations?
Dr. Seeman: The absolute number one thing we need to look at to address postpartum depression and anxiety is diet. Nutrition plays a major role in our gut microbiome. Our gut secretes upwards of 90% of our neurotransmitters like dopamine and serotonin. What happens postpartum is these large hormonal shifts, an imbalance of neurotransmitters and you put on top of that the poor sleep and poor nutrition and it is a recipe for disaster.
Mom should focus on single ingredient whole foods. Adequate protein, healthy fats, vegetables and fruits with limitations in sugar and processed carbohydrates. Exercise is also beneficial so after a mom has been cleared by her physician it is a good idea to start moving her body.
Dr. Jessica: I think we would both agree that some women need a little more help with postpartum depression than others, and that’s ok. For women being prescribed antidepressants, how long do you recommend staying on them?
Dr. Seeman: Medical therapy does have a role for some women. Counseling should be initiated at the same time as medication. The most commonly used medicines in breastfeeding women are SSRIs, which act to increase serotonin levels. Medicines should only be used for the shortest duration possible. This means I have women follow up frequently in my clinic to determine if we need a change in dosage or if they may be stable enough to start weaning.
Dr. Jessica: Many women participate in support groups for postpartum depression, but do you feel like most women are scared to talk about postpartum depression with their physician?
Dr. Seeman: If we don’t ask about it, a lot of women will not bring it up. There is this pressure in America today for moms to be superheroes. They feel isolated postpartum, and no one prepared them for how they might feel so they may never bring it up because they’re embarrassed. Postpartum support groups are a great idea. First it gets the mom out of the house and around other moms, so it is good for psychosocial interaction. Second, it allows them a place to process these emotions amongst people in a common period of life. We are changing the way we take care of women postpartum, and they should be getting screened by their doctor frequently, but don’t ever be afraid to bring it up. It is not “normal” to feel this way.
Dr. Jessica: What advice would you give to new father’s dealing with their partner’s postpartum depression?
Dr. Seeman: Oh this is so hard. I can see it in their faces. They want so badly to help their partners, but they don’t know what to do. The best thing a partner can do is communicate! Acknowledge their partners emotions first and then make a plan. It might be preparing meals, changing diapers before feeding, and allowing mom-time away from the baby. Also allowing mom to get periods of restful sleep. I remind moms that if you can’t take care of yourself, you can’t take care of your baby. This is where partners can help, allowing mom to take a shower, brush her teeth, and reset. Even the smallest things will make a difference for her.
Dr. Jessica: Do you feel that the partner of a woman experiencing postpartum depression can play a more active role in this transitional period?
Dr. Seeman: Every set of parents have different social circumstances, and many partners are returning to work very quickly after the birth of the baby. It can be very helpful to have both parents home in this early transition period and can take a lot of stress off the mother. If it can’t be the partner, then sometimes asking for help from grandparents or other family friends can help too. If you know someone struggling, don’t go over there and hold the baby and chat. Do a load of laundry, prepare a meal, clean the kitchen, give her permission to take care of herself.
Dr. Jessica: Do you believe that if a woman experiences postpartum depression after their first pregnancy, then they are more likely to experience it again?
Dr. Seeman: 100 percent! If a mom has any history of anxiety or depression, she is far more likely to have issues in pregnancy and beyond.
Dr. Jessica: And lastly, about 90% of women who have postpartum depression can be treated successfully with medication or a combination of medication and psychotherapy. Between Zoloft, Paxil, Celexa or Prozac, what do you see being prescribed more?
Dr. Seeman: One of the most commonly used medications in my practice is Sertraline or Zoloft. There are some studies indicating that both SSRIs and SNRIs are safe for breastfeeding moms based on limited human clinical data. With all medication use we have to weigh both the risks of non treatment alongside risks of neonatal exposure.