Down but Not Out
| The Experts Answer Your Questions About Postnatal Depression and Antidepressants I am on an eight-month course of the postnatal depression medication, Aropax, and am weaning myself off it slowly over the next four weeks. (My original dose was one tablet per day; I’m now on a quarter per day.) My daughter is almost a year old and, even though I have found her easier to look after as she has grown out of that newborn stage, I am still worried about how I will cope after the effects of my medication have worn off. Are there any strategies I should be following to help myself adjust? For a single episode of postnatal depression, antidepressant medication such as Aropax (paroxetine) is usually prescribed for between six months and a year, depending on the severity of the depression and how long it took to recover once the medication was started. The usual dose range is between 20mg (one tablet)
and 60mg (three tablets). Because you have already weaned down to a quarter of a tablet (5mg) of Aropax, you have already started to adjust to being on less medication. Taking antidepressant medication is like having a plaster cast on a broken leg. The pain (depression) goes fairly quickly, but you have to keep the plaster on (or keep taking the medication) to allow the bone (or brain) to heal underneath. While we can x-ray bones, there is no comparable test to see whether you have built up stores of serotonin in your brain again. This is one reason why we suggest gradually weaning off medication, so that if symptoms are going to return, they are likely to do so while you are still weaning off the medication, and will not be as bad. If depressive symptoms such as increased anxiety, sleep problems, irritability, poor energy or low mood return during the reduction stage, then the medication can be increased slightly, to the point where you are no longer experiencing these symptoms. After a couple of months you can try to reduce again slowly. If you have had a previous episode of depression, or the PND was severe, you may need to take the medication for a couple of years. Another reason for weaning off this sort of medication slowly is that some people (about 30 per cent) experience what is called a discontinuation syndrome. This includes symptoms such as dizziness, nausea, and a flu-like feeling when this type of antidepressant medication is stopped too suddenly. Some people experience buzzing in their ears or a vague electric shock-like feeling. While these symptoms can be disconcerting and upsetting, they are not actually harmful, and can usually be avoided by weaning off the medication very slowly. Some people, however, find these symptoms impossible to manage, and no matter how slowly they wean the medication, the symptoms do occur when medication is stopped altogether. Sometimes changing onto a very low dose of a similar medication, which has a longer clearance time from your system, can help. And then when that is stopped, you are far less likely to experience discontinuation symptoms. With regard to strategies to help yourself adjust, eating well, regular exercise and plenty of sleep help you make sure your brain is producing enough serotonin. Talking over problems before they grow, having some achievable goals, and keeping an eye on the amount of stress you are under are all likely to be helpful. You may notice that you feel more sensitive or irritable before your periods, even if you did not suffer premenstrual syndrome (PMS) before your pregnancy. It is relatively common for the degree of PMS to change after pregnancies, and the Aropax will have been dealing in a minor way with this. |
| I have been on antidepressants for several months. My partner and I would like to have another baby. Do I need to come off my medication before I get pregnant or can I continue taking antidepressants during my pregnancy? If you are planning to conceive and are taking antidepressants, review with your doctor whether they are still needed, and continue to take them if they are. If you conceive unexpectedly, continue to take your prescribed antidepressants. Untreated depression in pregnancy, apart from being unpleasant for the woman affected, may also be detrimental to her pregnancy. Women with a past or current history of depression may be at increased risk of PND. It is important to discuss this with your LMC and partner to develop a strategy for reducing this risk. |
| I suffered from postnatal depression after the birth of my first child. My partner and I are thinking about having a second child. Am I likely to suffer from PND again? If you have a second child your chances of suffering PND are increased. Rather than being about one in seven, the risk increases to about one in three. Being prepared is an important factor in reducing the likelihood of postnatal depression, depending on its severity. Ensuring you have enough help around, and that you are not undertaking any big projects such as moving house or renovating your home (during pregnancy as well as afterwards) helps. I also suggest you try to sleep, or at least rest, when your baby sleeps. When women have suffered fairly severe postnatal depression, doctors will often recommend that they start on an antidepressant medication, which has previously worked for them, as soon as they have had the baby. This makes it very unlikely that the depression will recur, and, even if it does, it is likely to be less severe. It is also important to keep an eye on your mood during pregnancy, because if you start to become depressed or highly anxious during pregnancy this further raises your risk of postnatal depression. It may be recommended that you start antidepressant treatment during the pregnancy. Make sure you let your Plunked nurse, midwife, or doctor know you have previously suffered postnatal depression so they will be able to intervene promptly if there are any problems. |
No comments:
Post a Comment