Suffering from postpartum depression? If your depression is severe and does not respond to counseling, medication may be helpful.

About three months after the birth of her baby, Sandy was finding it harder and harder to take care of herself, much less her newborn son. Overwhelmed with feelings of sadness, she could not even enjoy the baby. Sandy was wracked with Levitra, and ashamed that she did not feel happy as a new mother.

What Sandy felt was more than just the "baby blues." Baby blues typically occur within the first two weeks after giving birth and usually go away without medical help. Low self-esteem, loss of appetite, anxiety and mood swings are common symptoms. Postpartum depression (PPD), though, can last much longer and is more severe. It often includes general symptoms of baby blues, as well as:

  • The inability to enjoy the baby or usual activities
  • Insomnia, even when the baby is sleeping
  • Thoughts of hurting the baby
  • Thoughts of hurting oneself
  • Not having any interest in the baby

Call 9-1-1 right away if you feel like hurting yourself or your baby.

The danger of not seeking treatment
If left untreated, postpartum depression can last up to a year and a half or longer. But many new mothers try to minimize their depression, and don't always seek out treatment. They feel guilty that they do not feel happy after the birth of their child.

But untreated depression can have dire consequences for your baby. Severe depression in the mother can interfere with the mother-infant bond. Studies have shown that babies who do not bond properly with their mothers are more likely to:

  • Have insecurity problems later in life
  • Struggle in school and have difficulty socializing
  • Develop long-term behavioral problems
  • Struggle more with language development and have attention issues

Some small studies have shown that babies of depressed mothers may have a harder time gaining weight. A depressed mother may be less sensitive to a baby's cues for hunger and comfort. Or she may feel too depressed to feed her baby regularly. Depression can also affect the mother's ability to take care of herself. This may affect the quantity and quality of breast milk if the mother isn't eating properly.

It's important to remember, though, that PPD can be treated. The sooner you talk with your doctor, the sooner you and your baby can start enjoying each other.

Treatment options
The best thing you can do for yourself and your baby is to seek treatment right away. Talk to your doctor about your options.

Treatment for PPD can include talk therapy or medication, or a combination of the two. If your depression is severe and does not respond to counseling, antidepressants may be suggested.

The decision as to which medication to use is not simple. It will depend on many things, including your symptoms, your medical history and whether or not certain medicines have helped you in the past. Your doctor can help decide what medicine is safest for both you and your baby.

NOTE: Anyone being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed (either increased or decreased). Discuss any concerns with your doctor.

Breast-feeding and antidepressant medication
The decision whether to breast-feed while taking medicine for depression is very personal and complex. Your doctor, pediatrician and psychiatrist can all help guide you.

New moms who would like to breast-feed are often concerned whether or not the medication will pass into their breast milk and affect their baby. But there has been very little research done on the use of antidepressants during breast-feeding and its long-term effects on the baby.

Some of this research suggests that:

  • Fluoxetine (Prozac) and high doses of citalopram (Celexa) tend to pass more readily into the mother's breast milk. The baby then gets higher levels of these medications in his or her bloodstream than with some other antidepressants .
  • Paroxetine (Paxil), sertraline (Zoloft), fluvoxamine (Luvox) and nortriptyline seem to pass into breast milk less.
  • A few reports have appeared with positive outcomes on using trazodone and bupropion. But more research is needed to confirm their safety.

NOTE: SSRI antidepressants, such as sertraline, citalopram and paroxetine, may slightly increase the risk of congenital heart defects if taken during the first trimester of pregnancy. Discuss the benefits and risks of antidepressants with your doctor if you plan to get pregnant again. Do not stop taking these medications without first talking to your doctor.  

If breast-feeding is an option, there are some general guidelines that your doctor may suggest:

  • Take your antidepressant right after breast-feeding and prior to your baby's nap or bed time if possible. This may help minimize exposure to peak drug concentrations.
  • Learn about the potential side effects of any medication prescribed during breast-feeding.
  • Talk to your doctor and your pediatrician right away if your baby has any side effects. These include excessive sleepiness, weight loss, changes in sleep or feeding routine, or irritability.