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Postpartum Depression: Practical Advice.
> 2/12/2006 4:08:11 PM

    The difficulties of managing depression during pregnancy are becoming more complicated with the recent warnings regarding SSRI's and fetal toxicity. Conversely, the management of depression in the postpartum requires an awareness of the high risk for depression as well as the acknowledgement that women with a history of major depression have an increased risk for postpartum major depression to 24% and women who suffered a depression after a previous pregnancy have an increased likelihood of postpartum depression to 50%�60% risk.
    Other risk factors for postpartum depression include stressful life events and lack of support from a partner or spouse or others. Risk factors for postpartum depression include a family history and a personal history of major depression and depressive symptomatology during pregnancy. Marital discord and stressful child care events (e.g., health problems in the baby) also increase the likelihood of postpartum depression.
    The identification of this high risk population has led to prescribing antidepressants prophylactically in these mothers. Given the staggering incidence of depression in this population this recommendation is based on sound science.

The breast feeding component limits the willingness and advisability to prescribe antidepressants since they are readily transferred through breast milk to the fetus.
It is my opinion if the experience of breast feeding can be comfortably forgone then prophylactic antidepressants are wisely instituted in high risk women. I make deals with my patients that if they want to breast feed that they commit to stopping at the first signs of depression reemerging and restarting antidepressants.

Hope this is helpful.

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