There are times when psychotherapy alone is not enough to help those struggling with their mental health. Often times, people are prescribed psychotropic drugs to help enhance their wellbeing while still attending therapy sessions. However, taking psychotropic drugs could potentially pose a risk to the baby if the person struggling with their mental health is pregnant or breastfeeding. The decision to use medications to treat a mother’s mental health condition should not be taken lightly. To help develop a treatment plan that best fits the mother’s needs while protecting her baby, please browse these resources that provide information on how to use psychiatric drugs during pregnancy and breastfeeding. The Massachusetts General Hospital Center for Women’s Mental Health has created a Women’s Mental Health website that has an entire section around Breastfeeding and Psychiatric Medications. This section has blog articles written by physicians as well as links to clinical research studies. You can find the specialty section of their website on Breastfeeding & Psychiatric Medications here, as well as use that to navigate to other areas of women’s mental health. Women’s Mental Health website The National Institute of Mental Health has a section of its website dedicated to mental health medications with a special section on children, older adults, and pregnant women. It gives broad guidelines about which types of medications are thought to be safe for pregnant and breastfeeding women and which types to avoid. This information can be found on the NIMH website: National Institute of Mental Health Mother to Baby is a non-profit dedicated to providing evidence-based information on medications during pregnancy and breastfeeding. On their website, they have fact sheets for almost 100 different types of medications and what research says about the safety of use during pregnancy, as well as similar fact sheets on herbal products, infections and vaccines, maternal medical conditions (including depression), substances of abuse, occupations exposures, and other common exposures. These fact sheets can be viewed online or downloaded as PDF in both English and Spanish. Mother to Baby Fact Sheets The American Congress of Obstetricians and Gynecologists also has many resources available on their website for members, including a chart that outlines the safety of the use of psychiatric medications during pregnancy and lactation. If you’re a member, be sure to visit their website to see the most up to date chart of medications.

PSYCHOTHERAPY

Psychotherapy is a practical, effective method of non-medical treatment for mental health disorders. The most popular, evidence-based treatments for postpartum depression and other perinatal mood disorders are Cognitive Behavioral Therapy and Interpersonal Psychotherapy. Below are some guides for integrating CBT, IPT and other forms of therapeutic treatment into your practice. The ECHO project was developed at the University of Michigan and is an adapted form of cognitive-behavioral therapy for those with postpartum depression which is designed to be completed in 8 sessions where each session is roughly 45 minutes long. The goal of the ECHO project is to have a therapy style that will help develop a realistic approach to address factors that stop those suffering from postpartum depression from being mentally well. ECHO Therapist’s Manual PDF Download Interpersonal psychotherapy is a short term type of psychotherapy, roughly lasting 12 to 16 weeks. The main focus of IPT is resolving interpersonal problems or problems with your relationships with others. Those who perform interpersonal therapy believe that psychological symptoms are in response to such interpersonal problems. The manual below was developed by the US Department of Veterans Affairs to use IPT to treat depression in veterans, however, it can easily be adapted for use with mothers and their partners who are suffering from postpartum depression. IPT Manual PDF Download The IWK Reproductive Mental Health Service and Family Resources Centres in Nova Scotia, Canada have developed a Mother’s Mental Health group therapy curriculum to help support new mothers. In this method of treatment, a small group of mothers comes together for information and support for 2 hours a week for 8 weeks. Each week focuses on something different and each focus point is openly discussed by all in the group to help promote personalized support for each mother in the group. In this type of therapy, child care is often included during group therapy sessions. You can visit this link to find both their Mother’s Mental Health Toolkit: A Resource for the Community and the Mothers’ Mental Health Toolkit: Group Practice, a guide for community mental health workers who wish to organize and facilitate group therapy sessions. Mother’s Mental Health Toolkit

ALTERNATIVE TREATMENT OPTIONS

In addition to medication and talk therapy, there are a number of different alternative treatments with varying degrees of research behind them. Sleep and Exercise Because depression can so strongly affect your sleep and energy levels, adjusting your sleep and exercise are widely thought to be effective mediators for depression symptoms. Here are tips for getting better, more restful sleep, through the stages of your pregnancy and into postpartum. Additionally, you may want to use the Sleep and Mood Diaries. Sleep Diary Download Mood Diary Download Yoga and Relaxation Recently yoga has begun to receive a lot of attention as a possible remedy for depressive symptoms. Although there is not a large body of research to support that, a 2015 review of research into yoga as a treatment for depression in pregnant women showed that prenatal yoga may be helpful to decrease maternal depressive symptoms, that both depressed and non-depressed women can benefit from yoga, and that integrated yoga (which includes physical exercise, but also pranayama, meditation, or deep relaxation) seems to be more effective in treating depression than just physical-exercise-based yoga. Complementary and Alternative Therapies Although ample research has shown that many medications pose minimal risk to developing fetuses and breastfeeding babies, many women still choose to not rely on medications for depression treatment in this period. In order to identify other effective and safe treatments for mothers in the perinatal period, more attention is being given to researching complementary and alternative medicine therapies for perinatal depression. An article in the peer-reviewed journal Best Practice & Research Clinical Obstetrics & Gynaecology reported on some common complementary and alternative medicine therapies:

• There is evidence for augmentation with omega-3 fatty acids, exercise or folate with standard treatments for perinatal depression
• Bright light therapy may be a reasonable therapeutic option for some individuals who prefer non-pharmacologic interventions.
• Acupuncture and massage may provide benefit in the treatment of perinatal depression at this time, but should not replace more standard therapies.

Transcranial Magnetic Stimulation Transcranial magnetic stimulation (TMS) is a relatively new therapy for treatment of depression symptoms that have recently been approved by the FDA and is now often covered by insurance plans. It is generally used as a last resort after medications have proven ineffective. It consists of using a magnet to administer a series of pulses in rapid succession to an isolated portion of the brain. Research on non-pregnant patients has shown that TMS is effective as at least a subset of commercially available antidepressant medications, and also has been shown to have few side effects and is well tolerated by patients. Less research has been done on TMS as an effective treatment in the realm of perinatal depression. However, a search of current research revealed one pilot study of the use of TMS to treat postpartum depression in mothers who were not using antidepressant medications. Although the treatment produced promising results, more research is necessary to make any validated claims about the effectiveness of TMS in the treatment of perinatal depression. Sources: Deligiannidis, K. M., & Freeman, M. P. (2014). Complementary and alternative medicine therapies for perinatal depression. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(1), 85-95. Gong, H., Ni, C., Shen, X., Wu, T., & Jiang, C. (2015). Yoga for prenatal depression: a systematic review and meta-analysis. BMC psychiatry, 15(1), 1. Schutter, D. J. L. G. (2009). Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis It’s always good to have handy information close by for both you and your patients.