Report on 2001 LLLI Conference Session:
Treatment Options for Depressed Breastfeeding Mothers:
Allopathic, Alternative, and Lifestyle Changes
Austin TX USA
From: LEAVEN, Vol. 37
No. 5, October-November 2001, pp. 102-103.
Kathleen Kendall-Tackett is on the faculty at the University of New Hampshire, USA in the Family Research Lab. She is also an LLL Leader, and her understanding of the role LLL Leaders play as lay counselors was at the forefront of her talk on treatment options for depressed breastfeeding mothers. She emphasized that our job as Leaders is to share breastfeeding information and support with mothers, help them brainstorm and problem- solve, but not to diagnose or advise them as to a course of action.
Dr. Kendall-Tackett began by describing the potential effects of depression on breastfeeding mothers and their children. Depression is associated with elevated levels of stress hormones, which are linked to suppression of the immune system and effects on memory. Depression can decrease the mother's sensitivity and responsiveness to her baby or cause a lack of persistence in the face of breastfeeding or other difficulties. It can also be related to what are called maladaptive cognitions-extreme thought patterns that distort reality. Babies of chronically depressed mothers sometimes elicit depression-like behaviors in adults or have abnormal EEG (a brain wave test also know as electroencephalogram) patterns(Ciccheti, D., & Toth 1998). Children of depressed mothers show less regulated, more out-of- control behavior as toddlers. They tend to have poor interaction with peers, somewhat lower IQ scores, and are at a higher risk for future depression. Clearly, depression can have serious consequences for both the mother and her family.
Persons who are depressed often have elevated levels of cortisol, a stress hormone, and show insensitivity to cortisol feedback, that is, the normal mechanisms that monitor cortisol levels do not function the way they should in people who are depressed. They also tend to be low in serotonin, a neurotransmitter, so some anti-depressant medications help increase serotonin's effect on the brain. Other antidepressants influence the levels of neurotransmitters norepinephrine and dopamine instead. Sleep is altered in depression; a hallmark is early awakening, which may be due to REM(rapid eye movement) sleep being moved up earlier than normal in the sleep cycle.
Dr. Kendall-Tackett emphasized that although her talk focused on alternatives to conventional antidepressant therapy for depression, she is not against conventional medication. The alternatives she went on to discuss have been shown to be helpful for mild to moderate depression. If a Leader suspects severe or suicidal depression, the mother should be referred her doctor immediately.
Diet, Exercise and Therapy
An overall healthy diet is a good foundation for mental health. The brain needs carbohydrates to make serotonin. Research showed that an antidepressant effect can be achieved by eating 45 grams of carbohydrates with little or no fat, and with no protein for at least an hour after eating the carbohydrates (Wurtman and Suffes 1997).
Women who are depressed are often low in vitamins B6, B12, folic acid, and choline, and omega-3 fatty acids. Recommendations for supplements were presented.
Exercise boosts serotonin and dopamine levels, and releases endorphins to relieve pain and create a sense of well-being. Either aerobic or strength training is beneficial. Women who are depressed often find it hard to motivate themselves to exercise. As Leaders, we can be sympathetic to the mother's viewpoint, but also explain to her that exercise might help her feel better.
Cognitive-behavioral therapy can be as effective as conventional medication not only for depression, but also for anxiety, obsessive-compulsive disorder, and chronic pain management. The premise is that depression is caused by distortions in thinking. Dr. Kendall-Tackett described 10 types of cognitive distortions (Burns 1989). A few examples include discounting the positive (rejecting positive experiences by insisting that they "don't count"); emotional reasoning (assuming that negative emotions reflect reality); "should" statements (having unrealistic expectations of oneself or others); and personalization and blame (blaming oneself for things one cannot control). Cognitive therapy helps clients identify distorted thoughts and replace them with more accurate ones.
As LLL Leaders, our role is to share information with mothers about herbs or conventional medications from our resources and let the mother make her own decision without interpretation or recommendations. Physicians are legitimately concerned with the self-treating aspect of herbal therapy, combining therapies, and the lack of standardization in herbal preparations. Dr. Kendall-Tackett cautioned that herbs used as antidepressants should not be mixed with conventional antidepressant medications. Mothers would need to wean off one before trying another one. Encourage mothers to consult with their health care provider when they are taking herbs. In general, Dr. Kendall- Tackett said that dietary supplements are okay to take with antidepressant herbs or conventional medication.
Dr. Kendall-Tackett focused on the herbs St. John's Wort, kava, and SAM-e (S-adenosyl-methionine). She cautioned that none of these herbs have been studied for their effects in breastfeeding mothers. St. John's Wort is used widely in Germany for mild to moderate depression, and the German Commission E-monographs consider its use safe for pregnancy and breastfeeding. SAM-e is used and studied in Germany and Italy for depression and arthritis. Kava is used in the South Pacific, and can be over sedating.
The Medication Decision
Dr. Kendall-Tackett believes that not every depressed mother needs medication, but some can really benefit from it. When a mother calls a Leader asking for information about antidepressants because she has been told to wean, Dr. KendallTackett suggests that the Leader first commend the mother for being motivated to get more information. Ask her if she has discussed her current level of functioning and her feelings about medication with her health care provider. She needs to be aware of the risks of breastfeeding with medication versus the risks of not breastfeeding, versus the risks of depression. If the mother is unsure or negative about conventional medications, a Leader may suggest other strategies that the mother can discuss with her health care provider.
If a mother has decided to take medication and asks the Leader if it is safe to take while breastfeeding a Leader can ask how old the baby is and what medication and dose her doctor has recommended. The Leader can share information from her resources. Suggest, before beginning the medication, or as soon as possible, that the mother record the baby's typical eating, sleeping, and crying schedule. By writing down these observations the mother can be more objective since her perception may change when she's on medication. It also involves the mother in the process.
When evaluating the safety of a particular drug, factors to consider are the time at which the drug peaks in the mother's plasma, the amount of protein binding, and the nature of the drug's metabolites (Hale 1999).
What a Leader Can Do
Dr. Kendall-Tackett emphasized the importance of listening carefully to what mothers say, which can be powerful and healing. Talk with the mother about the many factors that could be influencing her emotional state. A Leader can teach some specific strategies that can help with her immediate situation, for instance, dealing with postpartum pain. She can also help a mother mobilize her own support system, which may include offering information about community resources, people, and organizations.
Dr. Kendall-Tackett closed with a quote from Sally Webber, a doula in southern California, from an article about the needs of the postpartum mother, emphasizing the importance of sharing our love of parenting and our skills with young parents.
Incredible as it seems, our culture, with its emphasis on education, has left young adults entirely unprepared to face the practical realities of parenting. And this may be the most important job they will ever hold. So, for those of us who are comfortable and happy in the work of parenting, we can serve the future of humanity through our humble sharing of our skills and our love for children and families.
Further information on the ideas in this article, along with the speaker's recommendations, can be found on Kathleen Kendall-Tackett's Web site: www.granitescientific.com
The Postpartum Survival Guide (No. 89-7, $13.95) and the audio book, Overcoming Postpartum Depression (No. 1063-30, $18.95), are both available from LLLI.
Burns, D. D. Feeling Good: The New Mood Therapy. New York: Avon,1999.
Cicchetti, D., and S.L. Toth. The development of depression in children and adolescents. American Psychologist, 1998; 53:221-241.
Hale, T.W. Me&cations and Mothers' Milk. Amarillo, Texas: Pharmasoft Medical Publishing, 1999. (800-378-1317)
Kendall-Tackett, K. When a new mother is depressed. LEAVEN June July 1996; 35-37.
Kendall-Tackett, K. www.granitescientific.com Henniker, New Hampshire: Granite Scientific Press. Accessed 8/16/01.
Wurtman, J.J. and Suffes, S. The Serotonin Solution to achieve Permanent Weight Control. New York: Fawcett Columbine, 1997.
Lisa Albright, a Leader
in Austin, Texas, USA, recently relocated from Pittsburgh, Pennsylvania,
USA. She is an Area Leaders' Letter Administrator for the EUS Division.
Her husband, David McDonough, is a software development manager. They
have two boys, Colin (12) and Kevin (9).