Becoming a mother is a time of immense happiness for most women. But new mothers also experience frustration, worry, disappointment and guilt. Postpartum “baby blues” are common and typically start days after birth and last up to two weeks. Symptoms include mood swings, anxiety, tearfulness, and trouble sleeping. Sometimes this develops into a severe, long-lasting depression called postpartum depression.

Postpartum depression occurs in roughly 20% of women – that’s about 76,000 women in Canada alone.

Many women feel guilty about having postpartum depression. It’s important to remember that it’s not your fault. Pregnancy changes the brain in ways scientists are only beginning to understand. Progesterone and estrogen, hormones that surge dramatically during pregnancy, boost the brain chemicals that help us feel happy and relaxed (serotonin and GABA). After giving birth, progesterone and estrogen quickly plunge down to pre-pregnancy levels. This is one reason why women experience huge emotional changes during the postpartum period.

If you think you may be experiencing postpartum depression, speak to a doctor. Postpartum depression is serious and requires medically supervised treatment to help you feel better as quickly as possible.

When an antidepressant is prescribed

You should not feel guilty about considering medication if that’s what you decide with your doctor. Sometimes no amount of exercise, meditation, or therapy seems to help. An antidepressant can help fix the temporary chemical imbalance in the brain that causes depression.

Research has shown that antidepressants do help women with postpartum depression. A study published in the Journal of the American Medical Association found that 54% of women with postpartum depression reported their symptoms “much improved” after taking SSRIs (a class of antidepressant).

Many mothers are concerned about exposing their newborns to antidepressants through breast milk. But the common thinking by healthcare professionals is that the benefits far outweigh the risks. Postpartum depression can have a devastating effect on the mother-infant relationship. And this impacts child development if left untreated.

Not all antidepressants end up in breast milk to the same degree. Some antidepressants are considered safer than others for mothers who are breastfeeding. According to a paper in Canadian Family Physician, certain antidepressants end up in breastmilk only in very small amounts.

An infant dose of less than 10% of the maternal dose (adjusted for bodyweight) via breastmilk is generally considered safe.

Source: Chad L, et al. Update on antidepressant use during breastfeeding. Canadian Family Physician Vol 59(6): 633-634 (2013).

It is important to keep in mind that antidepressant levels can be higher or lower, depending on how your body metabolizes antidepressants. Your genetics determine drug metabolism, as well as other factors such as body weight. If your body clears an antidepressant too quickly, the medication will be less effective. When medication is cleared too slowly, it builds up in the blood causing adverse side effects and can potentially increase the drug levels in breast milk.

Choosing the right antidepressant for your metabolism can also help you avoid adverse reactions.

Pillcheck tests the genes that determine how you respond to medications. Knowing your inherited drug metabolism can help you and your doctor avoid a trial-and-error approach when choosing an antidepressant.

Future outlook: A more rapid treatment for postpartum depression

Time is critical when it comes to treating postpartum depression. The faster depressed mothers feel better, the sooner normal mother-infant bonding can resume. Traditional antidepressants can take at least 4-6 weeks to kick in.

A new drug called brexanolone is administered by injection and can work in as little as 24 hours. Unlike other types of antidepressants, brexanolone targets the hormonal changes by boosting a hormone that spikes in the brain during pregnancy. So far, 70% of women with severe postpartum depression go into remission with brexanolone. Brexanolone is still undergoing clinical trials and is not yet available in Canada.

While Pillcheck cannot yet tell you how you will respond to brexanolone, Pillcheck can tell you what other medications will work best for your unique genetic make up. With this information and your doctor’s guidance, you may be prescribed an antidepressant that will help you to feel better, faster.

If you or a loved one is suffering from postpartum depression consider getting Pillcheck –the test can help your doctor to select the right medication and optimal dose.

References:

• Hoekzema E, et al. Pregnancy leads to long-lasting changes in human brain structure. Nature Neuroscience Vol 20: 287–296 (2017).
• Barha CK & Galea LAM. The maternal ‘baby brain’ revisited. Nature Neuroscience Vol 20: 134–135 (2017).
• Molyneaux E, Trevillion K, Howard LM. Antidepressant Treatment for Postnatal Depression. JAMA Vol 313 (19): 1965 (2015).
• Chad L., et al. Update on antidepressant use during breastfeeding. Canadian Family Physician Vol 59(6): 633-634 (2013).