I am not a doctor, much less a psychiatrist or psychologist. Neither am I female. I have, however, had direct experience of what it’s like to have a wife with postpartum depression, and of the difference that a doctor who specializes perinatal and postpartum depression can make.
Because my wife had been mildly depressed at various times through her early adult life, a doctor who knew her fairly well prescribed Paxil (an SSRI anti-depressant) for her a few years before we got married. It helped a lot, but the side effects were more than she wanted to continue dealing with, and in any case our intention was to start a family as soon after our marriage as possible (we dated for eight years before our wedding). Since there was (and still is) relatively little clinical evidence regarding possible complications from use of Paxil during pregnancy and nursing, the recommendation has been to stop use of Paxil if you’re likely to become pregnant. She did so, and after a brief but unpleasant withdrawal period did quite well.
Because of this history, and because hers was an extremely high-risk pregnancy (because of some structural abnormalities with her reproductive system), her OB/GYN referred her to a psychiatrist who specializes in perinatal depression (indeed, is one of the leading researchers in the field). She saw him a couple of times before our son was born, and regularly thereafter for a year or so as part of study he was conducting, and has continued to see him occasionally thereafter, particularly after the birth of our second child.
What I liked best about his approach was that, while a strong believer in medication where appropriate, he does not regard it as sufficient in itself. He’s quite ready to prescribe SSRIs or other anti-depressants when they are, in his judgement, called for, but he also insists on his patients understanding the nature of depression in general and perinatal depression specifically, and provides a great deal of guidance on cognitive strategies, either alone or in conjunction with medication, that can be effective in controlling depression. Early on, he had my wife read This Isn’t What I Expected by Kleiman and Raskin (mentioned above), helped her to recognize the precursors of a depressive episode, gave her recommendations on eating and sleeping habits, etc. Because she was intensely committed to breastfeeding, she wanted, if at all possible, to avoid going on medication again, and has managed to do so for over five years now, even through some fairly serious depressive episodes after the birth of our second child.
More than anything else, I think it has been the knowledge that someone besides me was available to help her deal with her depression, and that even if it got much worst than it had there were still additional possibilities for controlling it, that has kept her on a fairly even keel through that time. There have been times when both her doctor and I felt that she’d have been better served by resuming medication, but so far she’s managed to cope without it, and now that our daughter is two years old and is weaned, if things got really bad I think she’d be more willing to give medication another try. I especially do not want to give the impression that I’m saying that since she’s managed without SSRIs or other drugs for so long that anyone else should be able to do so; in her doctor’s opinion, there are clinical situations where it’s perhaps the only strategy that will provide enough initial stability for the other techniques to be of any use, and I’m convinced he’s right.
My wife has said on several occasions that the biggest benefit that the medication and regular consultations with a psychiatrist who specializes in this field have had for her has been that they allowed her to see that it is possible to control depression, that there are alternatives to being depressed once an episode starts. Before, she felt that there was nothing she could do about it; now she knows better, even if she chooses not to use all of the strategies that are available. That knowledge alone has made an enormous difference for her, but by itself it’s not enough for everyone who’s fighting depression.
I have to comment, though, that it may be difficult to find the right doctor, particularly in more remote areas. I’ve seen plenty of otherwise competent doctors (especially GPs and OB/GYNs who are not specially trained in this area) drop the ball completely on perinatal depression – some of them in dealing with my wife, some in dealing with other women of our acquaintance. For any woman who’s dealing with this or thinks she might be susceptible, I’d urge continuing to ask for referrals or seeking out different doctors on her own unless the doctor shows a solid grasp on the symptoms and strategies for dealing with them. Unfortunately, for a depressed person with a sense of hopelessness about her situation, that’s a difficult thing to do. Every time I hear about a situation like the one in Houston, I’m grateful that we were fortunate enough to find a great doctor and that my wife has been able to cope. I’m also grateful that if either of us began to think that she was no longer able to deal with things, we’d know exactly where to turn for help.
