Whether your journey here has been slow and torturous or brutally quick, you have arrived at a diagnosis of postnatal depression. If you have self-diagnosed, through a variety of research and checklists, your next step may be to decide whether or not to take this to your doctor. If it was your doctor who helped you come to the conclusion that you are suffering from PND, they will have run through your treatment options and are waiting for you to decide which route to follow.
Please note that I am NOT a medical practitioner, and the suggestions I make below are all dependent on your seeing a GP for professional guidance.
I'm scared to see a GP - they'll make me take drugs!
No ethical medical professional will ever force you to go down a treatment route that makes you uncomfortable or goes against your wishes. Just because you present with symptoms of PND does not mean they will force you to take brain-altering medication. They will give you the facts - how they normally treat women with PND, what the pros and cons are of each type of treatment, success rates, etc. If they do not readily offer this information, ask. You may find it helpful to prepare a series of questions and take them with you in a notebook. Sometimes talking to a stranger about our rawest emotions can be overwhelming and it's easy to forget what we really want to know.
How do I know if antidepressants are right for me?
Honestly? You won't know until you try. Sometimes our resistance is really about coming to terms with the fact that we're not very well. It can bring up a lot of guilt and shame and sense of failure.
"If I was a good mother I wouldn't need to take medication to feel better".
"As a new mother I should be blissed out on love for my son/daughter - if I start popping pills it means I don't love my baby enough".
It might seem hard to separate the issues, but your anxiety about motherhood and a sense of failure or guilt needs to be addressed while you are getting better. Taking antidepressant drugs does not mean you are a bad mother. Seeking help to improve your psychological wellbeing is actually a sign that you care enough about your baby to be emotionally there for them. This is the case whether you take medication or choose an alternative route. What matters is that you are actively helping yourself to improve your situation.
If I choose to take antidepressants, won't I get hooked?
A lot of people worry about this one. I certainly did before deciding to give them a go. It's true that you need to take your medication for a sustained period of time for it to be effective. Many GPs will recommend you continue for six months after you feel better to ensure the symptoms don't return. During this time (typically a year or two) your body will get used to the chemical mix in your system. So it's normal to worry that you will become dependent on them to feel normal. Talk to your GP upfront about your worries. They should be able to tell you the likelihood of experiencing difficulty reducing your dose or any withdrawal symptoms people may experience.
It used to be very common a few decades ago to experience difficulties coming off medication - but scientific advances, combined with a wide range of different types of antidepressants on the market, mean that it's less of an issue. Your GP should also be able to tell you how they help others reduce their dose, and how long their patients tend to take before coming off them completely. Fear of becoming dependent is perfectly legitimate, but don't let it paralyse you into inaction.
What reactions can I expect when I first take them?
Depending on the type of antidepressant you are prescribed, you may experience a variety of symptoms, from insomnia and heart palpitations to fatigue and restless legs. Your GP should let you know before you start your course what physical and psychological reactions you might expect. Most reactions last just a few days, and should level out within the week. If they continue beyond this time, or you experience severe anxiety or mood swings, go back to your doctor, who may try you on a different type of medication.
It's normal to feel frustrated if this occurs - having made the decision to take antidepressants, you want them to take effect as quickly as possible, and trying different types can feel like you're taking one step forward and three steps back. But if you find the right one, you should start to feel your mood lifting after about 10 to 14 days. When you're desperate, that can feel a lifetime away, but if you can ride it out, there should be light at the end of the tunnel.
What if I decide not to take antidepressants?
If you research the various types of medication your GP suggests and decide not to go down that route there are other avenues open to you to help you feel better. A non-exhaustive list of options includes:
Alternative remedies -The best known and researched is St John's Wort, a herbal compound that has been shown to have similar mood-lifting properties of chemical antidepressants with fewer side effects.
Food and exercise -Good nutrition and exercise will help improve low mood in those with mild anxiety or depression. Foods said to improve depression include garlic, oily fish, brazil nuts and coffee (in moderate doses). To make a difference to mood, exercise should increase the heart rate, such as swimming, running or walking fast. Bear in mind, however, that recent research has shown that exercise only helps mild to moderate depression and has no effect at all on severe depression.
Talking therapies- Many people taking conventional antidepressants will benefit from talking therapies such as counselling or CBT (cognitive behavioural therapy) and they should be seen as complementary to all types of treatment, rather than a straight alternative. However, if you are sure you do not want to take any kind of medication, it is important to acknowledge and treat your condition in some way. Talking to someone about your feelings should help you identify areas of change and see more clearly what action you can take to turn things around.
Taking medication for postnatal depression is very common, but please remember it doesn't mean you have failed as a mother. Rather, it can offer you the emotional resilience to see your situation more clearly and work out what actually needs to change in your life, providing your with the energy and motivation to carry those things out. Once you are able to make those changes, your need for medication will reduce, and your ability to accept and manage your emotions and behaviour will radically improve.