Postpartum depression: Getting off antidepressants

I have been diagnosed with major postpartum depression. I am in therapy as well as consulting a psychiatrist. I have asked my psychiatrist how we will know when it is time to start weaning off the antidepressants. I feel she has not adequately explained this to me and I do not want to be on antidepressants forever. I am now functioning normally and I feel 90 percent back to my normal self.

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Gayle Peterson

Gayle Peterson, PhD, is a family therapist specializing in prenatal and family development. She is a clinical member of the Association... Read more

Antidepressants can be useful aids in making therapy more productive when depression is severe enough that it becomes difficult or impossible to function. Recommendations for length of time to use antidepressants varies, depending on your history of symptoms and precipitating factors.

When there is a history of depression in your family, some psychiatrists believe there is more of a tendency for you to have a permanent biochemical imbalance. Some studies suggest, however, that these imbalances are set in motion by a stressful adolescence, which may cause brain chemistry to become established at lowered serotonin levels. If your depression dates as far back as adolescence or earlier childhood, but depression does not run in your family, it is often recommended that once on an antidepressant, you consider staying on it for at least six months after the factors that have caused your depression have resolved -- and sometimes as long as one to three years.

Every individual's neurochemistry is unique. Some of us are sensitive to neurohormonal changes and others are not. Hormonal changes throughout life may alter the way your body reacts to the neurotransmitters affected by modern psychopharmacological drugs. Our medical science has not yet caught up with a level of sophistication that can explain how your brain chemistry will be altered and how that in turn can impact your mood.

Although your psychiatrist can describe the effect the antidepressant should have on your biochemical process, it is unlikely that she will be able to tell you how long it will be sustained in your body, or whether you will feel in good spirits once you reduce the dosage or stop taking it altogether. Nor will she be able to tell you what percentage of your improvement is therapy and what part is specifically pharmacological.

Some psychiatrists believe that taking an antidepressant indefinitely is appropriate, particularly if they ascribe to a biochemical model alone. I have found that psychiatrists who consult and share information with the therapist have a more complete picture of the patient they are treating. Consult with your psychiatrist and your therapist about your needs and request that they consult with each other about your care.

Certainly transitions, such as becoming a mother, represent major upheaval and the first year of life has many new challenges. You are 90 percent back to yourself again! Consider what made the difference for you and what it will take to be 100 percent. Ask yourself whether your level of confidence is built on substantial new experiences of successful coping, or whether you are just "feeling good" but are unsure of the reasons why.

The latter would reflect the possibility of an illusory "flight into health" rather than a real change in your ability to cope. Use your therapy to clarify the issues that you have worked through and identify the coping abilities or ways of perceiving your life that are different now from when you were depressed and unable to function.

But keep in mind, as with your decision to begin taking an antidepressant, the choice to continue, or the timing to stop, is also yours.

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