The Boob Group
Postpartum depression and Breastfeeding
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ROBIN KAPLAN: Approximately 15 percent of women suffer from postpartum depression each year and that is only when it’s self reported. This number is higher than the amount of women who will get diabetes, suffer a stroke or get diagnosed with breast cancer in one year. Clearly this is something that needs to be discussed which is why I am so thrilled to introduce our expert Kathleen Kendall-Tackett, a clinical associate professor of pediatrics at Texas Tech University School of Medicine in Amarillo, Texas, she’s also an International Board Certified Lactation Consultant and owner and editor-in-chief of Praeclarus Press, a small press specializing in women’s health. Today we are discussing Postpartum Depression and Breastfeeding, this is the Boob Group, episode 69.
ROBIN KAPLAN: Welcome to the Boob Group, Broadcasting from the Birth Education Center of San Diego. The Boob Group is your weekly online on-the-go support group for all things related to breastfeeding. I’m your host Robin Kaplan. I’m also an International Board Certified Lactation Consultant and owner of the San Diego Breastfeeding Center.
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Throughout the month we will be posting on facebook and twitter information about upcoming episode topics as well as information about our featured experts for these episodes. This is a great way for you to post your questions you would like to ask our experts and we will do everything we can to incorporate them in to our show.
And on our recording days, our producer MJ Fisher who is on the studio will be tweeting about our episodes as we are recording which will allow you to engage in the conversation, learn some awesome tidbits about the topic even before the episodes been released post questions for our expert and share your experience with our audience, all you have to do is follow our hash tag #theboobgroupvp, standing for virtual panelist and join the conversation. So MJ, you wanted to say a little bit about this because I know that you’re actually on facebook as well, correct?
MJ FISHER: Yeah, we are posting live status updates about the show, information and questions that we’re covering on facebook and then tweeting live as well so if you can’t be a panelist in the studio then you can definitely be a part of the show and share your story or give tips about breastfeeding.
ROBIN KAPLAN: Awesome. Thanks MJ. Well we are joined by two lovely panelists in this studio. Ladies, will you please introduce yourselves?
KATIE JACQUET REED: Hi! I’m Katie and I’m 31 years old. I’m a full time mom and I work part time at the Domestic Violence Shelter. I have 2 kids, my son Logan is 2 years old and my daughter Arwen is 3 months
ROBIN KAPLAN: Thank you! And then Molly?
MOLLY RIFFEL: And I’m Molly, I’m 32. I’m a teacher but currently a stay-at-home mom. I have two girls, Abigail who is two and Riley who is four months, who’s here with me right now
ROBIN KAPLAN: Here in the studio
ROBIN KAPLAN: Before we get started we are going to do a very quick app review that’s one of the things we like to do on the Boob Group. Let’s talk about all the amazing apps that are out there that make life easier for breastfeeding moms. So, the one that we’re going to talk about today is called LactMed, and the wonderful thing about this app, which, I’ll just tell a little bit about it, and then we’ll ask our panelist to kind of chime in.
So this is a place that you can look up any medication that you might have to take and it tells you about how it’s used the drug levels if it gets into the infants, it’s effects on lactation and milk supply some possible alternate drugs that you could use instead of this one and just pretty much gives you all the information to know if it’s safe to breastfeed while you were using these drugs. So, Katie, what did you think about it when you just kind of poked around?
KATIE JACQUET REED: It looks amazing. I know that I frequently I can’t find a computer when I needed to look up online if I’m going to take the drug that I’m not sure about with breastfeeding. So, instead of having to kind of pause everything and go back home and check online, I can just put up my phone and look right there.
ROBIN KAPLAN: Every great thing even the take if you’re going into the pharmacy for example, because not only it includes medications that you have to get a prescription for but it actually has all of those over the counter medications as well which I thought was really great, I mean I was looking up Sudafed, Tylenol, like lots of questions that I get from moms and again I didn’t you know when I had to run home and you know I’d say I’ll text you later. But, now that I have it just right up my phone it seems to be really conclusive. MJ, did you look at it at all?
MJ FISHER: I sure did. I think one of the things that a lot of moms post about like when were sick and you know we don’t want to give anything to our babies but we want to be able to
ROBIN KAPLAN: Function
MJ FISHER: Exactly and maybe have some of our symptoms subside or go away and so that you know it’s great to have something like this because our first priority is to take care of our kids but you know we got to take care of ourselves too in order to do that, so, this is, it’s awesome to have this and be able to look it up and see what you can take
ROBIN KAPLAN: Great. So, yeah, so LactMed, it’s L-A-C-T-M-E-D and we will have a link to it on our website’s page as well but we give it two thumbs up. We just love it, and it’s free so bonus. And even though it’s free, it’s helpful, we couldn’t ask for more.
ROBIN KAPLAN: So, today on the Boob Group, we’re discussing the symptoms causes and treatments for postpartum depression. Our expert Kathy Kendall-Tackett, Ph.D., is a health psychologist, International Board Certified Lactation Consultant and clinical associate professor of pediatrics at Texas Tech University School of Medicine in Amarillo, Texas. She is also the owner and editor-in-chief in Praeclarus Press, a small press specializing in women’s health as well as the author of Depression in New Mothers the second edition. Thanks so much for joining us Kathy and welcome to the show
KATHLEEN KENDALL-TACKETT: Thanks for having me Robin
ROBIN KAPLAN: Sure. So, Kathy what are some signs of postpartum depression?
KATHLEEN KENDALL-TACKETT: Well, postpartum depression can show up in a lot of different ways. For a lot of moms, one of the most obvious things of course is feelings of sadness. There’s a symptom that’s really common called Anhedonia, it means inability to experience pleasure or joy out of things you used to enjoy, but also numbing, sleep problems, some other’s actually experience more bodily pains, aches and pains, sort of feeling detached from other people, those are all kind of really common symptoms of depression.
ROBIN KAPLAN: Okay. And what are some causes for this, for postpartum in particular?
KATHLEEN KENDALL-TACKETT: Well, it’s actually kind of an interesting thing because you know it’s like I said it’s we kind of shifted in our thinking over the last probably seven or eight years about what causes depression in mothers. Originally, when I wrote my very first book on this back in 1992 we were so talking about estrogen and progesterone and it was this is a very kind of old model but it was assumption that depression was caused by the drop in estrogen and progesterone after birth. But then the problem was we started doing more research in finding out that mothers were actually more likely to be depressed in the last trimester of pregnancy.
So there were a lot of reasons why that explanation didn’t really make a lot of sense. And it was a researcher actually in the Netherlands by the name of Michael Moss who really I think kind of I won’t be stumbled on but I think really kind of came up with this initial study that people are looking at a different direction. And what he actually found was, he found that actually mothers who had either depression or anxiety postpartum will more likely to have more of these inflammatory modules in their system and that’s the result of the stress system being sort of up regulated. And so basically kind of what he found is that this inflammation was sort of underlying kind of all of these other risk factors for depression that we know about.
Things like lack of social support, not getting enough sleep, previous episode of depression, history of trauma, all of these things, we come back to a physiological mechanism that ties them all together is this some sort of up regulated stress system and particularly that sort of up regulation of the inflammatory response system. So we see this kind of information thing, kind of underlying all of the depressive kinds of risk factors and again I can say once we kind of sort of thinking that it really kind of turned our focus in a kind of a different direction because all of a sudden we started thinking “Ha! Okay” Once we knew about this underlying mechanism, it really kind of changed how we thought about prevention, how we thought about treatment and actually, interestingly it really kind of shows us where breastfeeding fits into this. In a way that we really haven’t been thinking about it before
ROBIN KAPLAN: That’s fascinating and you know I was perusing your amazing website www.UppityScienceChick.com and one of your articles really struck me because you talk about the way other cultures prevent postpartum depression and it seems to really tie in to this philosophy of reducing stress which henceforth will reduce inflammation. So, is the incidence of postpartum depression lower in other cultures?
KATHLEEN KENDALL-TACKETT: Oh, it absolutely yes. And again like I said the rates of postpartum depressions vary across different kind of cultures. You do see it pretty much around the world but in much larger/smaller percentages depending on the culture. And one of that kind of hallmarks of cultures that have higher rates is really their lack of support for new mothers and again this was actually a critique that was actually first raised by a couple of anthropologists named Stern and Kruckman back 1983 and just an outstanding article in effect that’s the one I summarize in the article about postpartum rituals. That they actually said “Look if you look at all these different cultures, and you see these cultures with very low rates.
The thing that we see that those cultures all have in common is these sorts of rituals that take place around the postpartum period.” And they said “The cultures themselves are very different but these are like common threads and actually again getting back to what we were saying about estrogen and progesterone that was actually one of the arguments that they explicitly made. Because they said if it was just this physiology, he said you would see this same rate across the world. They said that the fact that you don’t see that and that social support can make such a huge difference. It shows that there’s not some kind of universal physical mechanism that that was their argument.
But one of the things that they were saying is, you know like in our culture we really don’t recognize postpartum, and the mothers do not get this sort of help and support they need because of that. When we have moms who are going home from the hospital and they’re stepping right back into their lives, he said that that’s kind of ridiculous, when you look into some of these other cultures where mothers are pretty much sort of isolated and cared for anywhere from 6 weeks to 3 months after the baby is born.
They’re not expected to sort of get in there and take care of everybody and then we get a lot of our moms who go on home even after a C-section and they’re out making snacks for everybody. So everybody’s passing the baby around. I mean, it’s kind of an absurd thing and it’s like, I had this story I used read a lot when I would do presentations and it was from this and I used to just read this sort of paragraph and people just with their mouth open because they were talking about as a mother sort of emerges from this sort of hut where she’s been isolated and she emerges and she walks toward the village with their baby and they’re singing songs to her sung by that they sing for warriors returning from battle, it’s a totally different thing than what our moms experience.
Even some of the moms they interviewed for the books were saying “I had an emergency c-section” one of them had an emergency c-section under general anesthesia was actually really scarier; she and the baby actually had a very good chance of actually dying but she said everybody just expected her to just step back out there alive like nothing happened. And she said “You know they would’ve paid much attention to me if I’d had my appendix out”. Yeah I think that actually that that was kind of thing that they were sort of getting out of that sort of lack of recognition and that lack of support that mothers have and I think we just really really fall short on that
ROBIN KAPLAN: Okay. I’d love to open it up to our panelists now and I guess I should mention is also we have two panelists and I’m happy to kind of jump in on this as well because I definitely dealt with postpartum depression not only with my first but even more significantly with my second. So, ladies, when did you first feel like you were dealing with postpartum depression? Do you mind starting first Katie?
KATIE JACQUET REED: Sure. I had postpartum depression with both my son and my daughter. However with my daughter my depression actually started in pregnancy and that was very different than my first with my son. So, I made a decision to go on anti-depressants in my first trimester because I have such an extensive history of depression and I knew myself and it got to the point where I couldn’t get out of bed and I couldn’t care for my toddler, so I didn’t make that decision lightly by any means but since I had to consider my toddler as well as my daughter that was growing inside of me, I made the decision to go on an anti-depressants
ROBIN KAPLAN: How about you Molly?
MOLLY RIFFEL: I experienced postpartum depression with both my kids. My first one wasn’t as bad as my second one. My second ended up, she was seven weeks early and was in the NICU and we knew she was to be born with some complications and some problems and so, knowing that I was going into labor early that just started almost immediately and when I couldn’t even do my birthing the way I wanted to with my second one because of the depression and the anxieties that I was feeling, knowing what was coming was that our child whose coming with all these complications and issues.
So, I had to, you know with my first one that was, I think by the time we went home I started feeling the depression. Once I was out of the hospital and being taken care of and being home was like okay, now you’re doing it all, I had my husband there who support us and my mom was there, my family, but it was still like okay this is us now we got to do it on our own and just hits you
ROBIN KAPLAN: My boys are 15 months apart and not on purpose and so the second time around having and my son, my older son was developmentally delayed and didn’t lock until he was 22 months, so I had a barely crawling 25 pounds toddler and a new born and so it definitely it really hit as my younger son was a couple of months old and same thing I just felt I couldn’t get out of bed and that’s when I knew it was time to get some assistance. So, Kathy, how does breastfeeding play into postpartum depression? You kind of eluded to this a little bit, can it trigger post partum depression? Does it help?
KATIE JACQUET REED: Well, okay this is kind of an interesting question I get and first of all I just want to say to our panelist, I think you actually made absolutely right decision to get treatment because again like I said, depression by itself doesn’t tend to go away, it’s like when you look sort of lounge it 2 to 3 years I mean you see actually only about half of moms actually spontaneously recover who totally made the right decision when I think about that and also you do need to be able to function for your kids and so I’m glad that you made the step that you did and I think actually just the things that were describing I mean are total risk factors, I mean, I would absolutely not be surprised at all to find out that you had depression after the things that you went through.
So, again this is a NICU moms you mention I mean that is the you know that’s a very high risk group and I don’t think it’s a group that’s got the attention that we kind of need. And so again like I said I applaud you’re coming forward about this but also that your decision to step out and seek treatment, I think you did absolutely the right thing. But to get back to Robin’s question about breastfeeding, this was something that I used to hear about a lot because when I first started in this field, there’s sort of a line a curvy line in the postpartum depression world was you know we pretty much discourage mothers from breastfeeding, if they absolutely insist, we’ll let them, but we want them all on medication, it was just, you know that kind of thing.
Even back then I question that, it didn’t really kind of make a lot of sense to me and I met so many mothers give up my phone number anytime anybody called the international office and told them that they were depressed. They didn’t actually tell me that they were going to do this before they did it so, I get calls from mothers all over the country and the thing I heard over and over and over again is I’ve been told I have postpartum depression, I have to wean my baby and this is the only thing that is going well for me. So that actually in a lot of ways made me kind of like jump into this whole issue of treatment because honestly, back then, we didn’t really have very good resources and so we were kind of flying blind in terms of what to tell somebody’s moms.
But sometimes I still get comments from people, when people will email me and say, they just attended a workshop and I’ve heard that breastfeeding is a risk factor and that it causes depression. I will be very clear about this, no, it doesn’t. And from physiological standpoint that doesn’t make sense, that’s something that is supposed to aid in our survival would cause mothers to be depressed? Again you know like I said they were pieces of that that didn’t make sense to me but breastfeeding problems can cause depression. And again it’s all the more reason why lactation people need to be involved in these conversations about depression because we got most of our new moms starting to breastfeed now, this isn’t just kind of a friends issue.
But in terms of what breastfeeding actually does, remember we talked about that sort of up regulated stress response, you know again like I said all those external factors that we’ve talked about, you know the birth experience, and trauma history, and depression history and lack of social support, all those things actually can make that stress response rise. Breastfeeding is one of the things that actually turns it off. It actually down regulates that stress response so it’s protected now it’s not to say that a mom will not get depressed even if she’s breastfeeding. Okay or a breastfeeding mom will never get depressed but it lowers her risk and it actually helps with a lot of these sorts of physiology of depression and so even if a mom is depressed if you find that she’s breastfeeding actually her symptoms are less severe.
So it lowers her risk and if she is depressed, her symptoms it can be less severe. And we actually found this kind of interesting way looking at a sample on of sexual assault survivors okay so that’s a group where everybody says, you can’t make them breastfeed, you can’t force them to breastfeed. Well in my experience, actually there are group that is easily fully likely to breastfeed and that’s actually what we found in our study. But what was interesting is when we’d looked at all the sleep parameters in the depression parameters, you know sexual assault itself had a terrible effect on new motherhood, I mean, they were more depressed and every parameter of sleep we looked at was bad. Their daily energy was bad.
They raided their physical help as worse I mean, the exact effects we would expect based on the literature. However, if they were breastfeeding you could still see an effect with the sexual assault but it was less. It was actually much less. Basically what we were seeing there is again that physiological turning off of that up regulated stress response, cause that’s one thing trauma does is to get that stress response sort of turned on and then it doesn’t turn off and so we found that breastfeeding actually turned it at least down if not completely off.
So breastfeeding is actually extremely protective in terms of maternal mental health. But that does not mean that if a moms having breastfeeding problems I mean I hear heartbreaking cases all the time, I know Robin does too, but moms who soldered on for weeks you know shredded nipples and low milk supply and the babies on them all the time. That’s a time when you do need some lactation help because of that situation can actually cause depression
ROBIN KAPLAN: Yeah, it can make it worse
KATHLEEN KENDALL-TACKETT: Absolutely and if breastfeeding but if breastfeeding is going well for the moms it is actually very protective
ROBIN KAPLAN: Okay. What is your first recommendation for a mother who feels like she is starting to have these symptoms of postpartum depression?
KATHLEEN KENDALL-TACKETT: Well, I would say, my first recommendation would be to talk to somebody. Ideally you would say talk to a health care provider, I definitely say you know talk to your partner or talk to your friends, let somebody know that you are suffering and I would put that with a proviso though that you have to make sure that like if the person that you talk to doesn’t give you the right answer you need to feel like you can go on and talk to somebody else.
Because unfortunately what happens sometimes a mom will go see their health care providers and they get a sort of you know blown off “Oh, c’mon it’s just new motherhood”. I’ve had mothers tell me their doctors told them to go buy a new dress. It was like “Yeah okay” or go get your nails done I mean you know it was like okay you know right okay this is a great advise right? But I would say definitely don’t try to sort of solder on by yourself. Get some kind of support.
Now that doesn’t necessarily in every case mean medication but I would say definitely you sort of reach out, I would say that would be the first step. I would say probably also investigate what your options are, because you do have a lot of options and so again thinking about kind of sort you know of what your needs are what your feelings are about being on medication and that’s kind of an important thing you know the severity of your depression always depend on factors that kind of weigh in but I would say you know sort of talk to somebody, educate yourself about what your kind of options are and then take some actions
ROBIN KAPLAN: Okay. Ladies, what was your first step in your treatment and your healing process? Molly?
MOLLY RIFFEL: Well I, like you were saying Kathy had problems with my daughter’s latching, she was tongue tied we had issues it was painful with my first one and so I actually knew this was going to happen I have a taste of depression so I beforehand set up to have my placenta encapsulated and so my first step was to start taking that and then once I was home and comfortable and was doing that I actually started going to Robin’s support groups and that made the biggest impact ever because I was able to sit and talk to other moms who were experiencing the same thing.
Because I could talk to my husband, I could talk to my mom, I could talk to my sister but none of them understood in exact place. So when I went and talk to other moms and came across moms who you know “Oh yeah I’m doing that too, or yeah, mine was doing the same thing” it was helpful to know that I’m not alone in this and then I made some friends. I made some lifelong friends and you know speaking out and reaching out for help other than my close family was the biggest step for me
ROBIN KAPLAN: How about you Katie?
KATIE JACQUET REED: Lots to think about. My postpartum depression actually manifests more as anxiety and what I found, my medication has not been sufficient in helping with that sleep is key and everyone will tell you that and it kind of feel validated sometimes when I tell other moms, yeah I just really need to sleep like “oh, honey everyone does” and you’ll get used to functioning on you know little sleep.
But for people with histories of mood disorders, it’s even more essential and like I literally feel like I’m two different people if I’m all rested or not, what I mean well rested even like a solid 4, 6 hour block is better than being constantly interrupted but the breastfeeding struggles, that’s exactly what we’re talking about. It is probably even more than sleep what has drive my depression and it happened with my son as well and I originally said I’m not going to do it with my daughter, I can’t pump exclusively when I also have a toddler to raise and yet I’m still doing it somehow. Pumping on, pumping in the car, I don’t recommend that maybe I don’t know if that’s
ROBIN KAPLAN: No, no, no, we talk about it all the time
KATIE JACQUET REED: Do you? Okay, so the only way you can pump with a toddler let me tell you. But having a NICU baby, very different pregnancy and also really feeling like did me choosing to take anti-depressants during my pregnancy contribute to having a pre term baby especially since I didn’t have that with my son and to really-really struggling with that but to protect myself I’ve chosen to stop and I’m not going to go there. But really one thing that’s kind of interesting as far as with breastfeeding my daughter because of her reflex. I started to eliminate certain things from my diet and this is, I’m not kidding when I say this, when I eliminated gluten I actually felt a lot better a couple of days afterwards my anxiety, that sense of being on edge almost disappeared and I was thinking it’s not the placebo because I wasn’t looking for that it was for my daughter and yet I really, I felt better
KATHLEEN KENDALL-TACKETT: Well and see that’s kind of goes back to what we were talking about inflammatory response. If you talk about something you know an allergen and we got more and more people who are sensitive to gluten. That is one of the other thing that can kind of trigger that inflammatory response. So, actually that’s really consistent, your experiences are really consistent with what the physiology of depression is, so that actually makes, actually makes perfect sense to me
ROBIN KAPLAN: Well thank you, so when we come back we will discuss with Kathy her recommendations for non medication treatments as well as prescription medications when they are necessary for postpartum depression. So, we’ll be right back.
ROBIN KAPLAN: Welcome back to the show, we’re here with Kathy Kendall-Tackett, PH.D., an International Board Certified Lactation Consultant and we are talking about postpartum depression and breastfeeding. So, Kathy in one of your articles you mention several non drug treatments that can be helpful with treating postpartum depression and just to mention them, so you have Omega 3 fatty acids, bright light therapy, exercise, Saint John’s wort and psychotherapy and so, I was wondering if you wouldn’t mind just touching on each of these just a little bit, to kind of let us know, why are these treatments helpful?
KATHLEEN KENDALL-TACKETT: Okay, well I’ll give you kind of like the big you know, sort of answer to that and then we could kind of go a little bit with each one. The big answer on the thing all of these treatment regimens have in common is that they have low inflammation and this is something we kind of discovered outside of the postpartum depression world.
But again it was Michael Moss’s actually the researcher I mentioned earlier from Belgium is the one who kind of started putting some of these together and in my own work I started kind of seeing this too and I thought of this is just wild. We know psychotherapy helps we know social support lowers inflammation we know things like infant massage, lower inflammation. We’re starting to see some literature on Yoga, guess what that does, downgrade your stress response, lowers inflammation.
So do Omega 3’s so does exercise and being more physically fit. So all of these things, this, even though they’re all really different again thinking about that sort of common mechanism, we know that they all kind of help with that, and so, I can’t believe I said it, it’s a very exciting time to be in this field because we’re also starting to see a lot of like people combining regimens like combining say Omega 3’s with anti-depressants, oh by the way, anti-depressants are anti-inflammatory, and so, they’re starting to see like okay, like we had omega 3’s, 2 anti-depressants, but the anti-depressants are not working.
We know that that seems boost the effectiveness and again it’s because it boost that anti-inflammatory aspect. So those are kind of all of the things. In terms of treatments we actually have a lot of good evidence based treatments all the ones that you mentioned. We have a nice strong evidence based for exercises are really good kind of nice alternative treatment especially if somebody doesn’t want to be any anti-depressants we actually have 2 now really good studies coming out of medical center showing that exercise put head to head with Zoloft it’s as effective as a treatment for major depression. Okay and so that was kind of big news I did randomized trials on it and get one group who got Zoloft and the other group got exercise.
ROBIN KAPLAN: Did it matter if it was strength or cardio?
KATHLEEN KENDALL-TACKETT: In these studies they’re mostly just cardio. I’ve seen a couple who kind of cross overs that suggest that you get something similar with straining although the effects don’t seem to be a strong
ROBIN KAPLAN: That’s fascinating. Oh my goodness. Ladies, were you informed of the multiple ways to treat postpartum depression, have you tried any of these non drug therapies? And if you did, did any of them even worked for you? Molly how about you?
MOLLY RIFFEL: Like I said I did the placenta encapsulation and because I’d choose not to do the drugs just for my own sanity because I have issues with doing the drugs. The placenta works great. I, I mean, even with my second one, being in the NICU I could tell and knew we’re having problems and even my husband would go you know “have you taken your pills today?” “No, I forgot” “Well then go take them” I mean it worked wonders like half an hour after taking a pill I could feel like that I was no longer weak or I was no longer having my problems. I still every once in a while take some just in case from having a bad day, I’ll take a few of my pills and it still works.
My second one is 4 months old and I’m still enjoying that. I haven’t tried any of the other ones, I’m doing okay right now, I’m sure once we go in for a second surgery for Riley we all have need to look into something else. But with that you know issues with the pumping because I exclusively pump and I’m going to need to start taking something to help with the anxieties and the depression for sure so we’ll be looking into these
KATHLEEN KENDALL-TACKETT: Actually, one thing you really look into is also the omega 3’s because most people in the United States are really quiet deficient and actually we’ve gotten some good evidence that they’re helpful
MOLLY RIFFEL: Cool. Awesome. Thank you
KATHLEEN KENDALL-TACKETT: And it’s one of those things that actually will kind of also help in a lot of other ways
MOLLY RIFFEL: Right, right
ROBIN KAPLAN: Absolutely. How about you Katie?
KATIE JACQUET REED: I’ve made a mistake of waiting too long to get help with my depression and my pregnancy. I went off the anti-depressant I was taking when I found out I was pregnant because I did that with my son and I was fine. Not the same case with my daughter and by the time I finally sought help, I had waited too long I think for those treatments to be as effective, so I had to go for me on the anti-depressant based on my history. But now like I said the gluten, it really helps, that was a very pleasant surprise. I’d also see a personal therapist and a couples counsel and that’s important too when you have 2 kids underneath you need it too. So that’s very helpful. I would love to exercise because that’s also helped a lot in the past it’s just finding the time.
KATHLEEN KENDALL-TACKETT: Yeah you know it’s funny because a lot of hospitals that I’ve been you know I’ve done training sessions, they contacted me later to tell me that they’ve started doing mother’s groups where they actually get the mother’s together they go out and they take a walk. They get out in the sunshine, they’re taking their omega 3’s and they actually have found their rates of depression are significantly lower than they used to it’s kind of as preventative.
Just kind of one little piece to kind of toss in like if you know something comes up next time. Exercise actually tends to be shorter acting treatments you see it actually show up fairly immediately so again you know in terms of light especially looking at something to sort of get you over the hump that can actually be kind of a shorter term treatment you know something like Saint John’s wort takes longer. Bright light therapy also you tend to see results within about a week versus anti-depressants tend to be between 4 and 6 weeks. So those are kind of again some things that are kind of a little more immediate
ROBIN KAPLAN: Which is what we all need. So actually when we have gotten to that point. Kathy, when taking prescription drugs, how safe are they to take while breastfeeding and do drugs have, different drugs have different safety ratings.
KATHLEEN KENDALL-TACKETT: Well actually the good news is that mostly anti depressants are safe to take while breastfeeding. I should say they’re compatible, that’s what we say, we say it’s compatible with breastfeeding. The thing that you probably want to look at it kind of depends on which medication, some are a little bit better than others in terms of exposure that the baby gets. But the baby actually gets significantly less exposure breastfeeding versus during pregnancy.
And even kind of when you look at kind of long term effects with exposure during pregnancy where the baby is actually getting exposed to a fair amount of what the mom is taking. You see that, there doesn’t seem to be a long term effects of that. Like I said I’m not casual about that I think they always have to weigh risk and balance, you know, risk and benefits for any kind of treatment, but I find that to be reassuring. In terms of breastfeeding though, the amount of exposure for some of the medications especially those that have what we call inert metabolites, in other words when they break down in your body that the parts are not active.
Those medications that have inert metabolites tend to actually result in lower exposure for the baby. So a medication for example like Zoloft, Zoloft is one of the ones that has inert metabolites. The amount of the mother’s dose that gets the baby is less than 1 percent of the mother’s dose. In fact even though we see it in the milk it’s also not seen showing up in infant plasma.
That is actually again baby’s basically getting almost no exposure. Again some people say even that tiny little bit “well you know we’re not actually seeing that research” and we’ve got at this point like 25 years research on somebody’s medications. Taxsol, same thing the other one is Lexipro because again thinking about sort of active compliments that medication break into. Celexa, Lexipro is actually the metabolite of Celexa. So, with Celexa you actually get more of exposure, about 4 percent.
But if you take just that active metabolites which is citalopram that is actually less than 1 percent of the mother’s dose. Again like I said even the medication like Prozac where you’re getting actually a pretty big exposure, the 25 year data are still pretty reassuring in terms of the impact on the baby. Again even sometimes in cases where there’s a bigger exposure but all things being equal I would probably take a medication that had the smallest amount of exposure
KATIE JACQUET REED: I wanted to ask about effexor, what is it? as far as the rate that gets passed to the baby through breast milk
KATHLEEN KENDALL-TACKETT: That one, the effexor comes kind of in the middle there, so the baby gets some exposure but it’s still actually a, well let me actually look it up real quick, it’s still actually not an okay rating, so it’s still a little bit higher than some of the other ones but you know remember Prozac was something like 17 percent of the mother’s dose so it’s kind of right there in the middle
ROBIN KAPLAN: And prozac’s one that’s been studied for a very long time, correct Kathy?
KATHLEEN KENDALL-TACKETT: Yeah, yeah because Prozac was one of the ones we used to kind of steer moms away from because again like I said that’s pretty whooping exposure that now I think for about 30 years in on Prozac. And you know I can tell you what we see I mean, even with exposure during pregnancy you do see some differences that go up to about age 4. You see a little more hyper activity in the kids, again like I said that’s not a negligence symptom but by age 4 the difference has disappeared. And so again like I said it’s not to say there’s no effect of that, but it’s not the sort of dire effects that people sort of predicting, because now we have millions of cases, documenting this. We really actually do have pretty good information.
ROBIN KAPLAN: And Kathy you said you were looking up something and so where can a mom find resources to help her if she feels like she’s dealing with postpartum depression when you obviously have resources for looking up medication but even if a moms not there yet where can she seek support and assistance if she needs it?
KATHLEEN KENDALL-TACKETT: Well one good place is Postpartum Support International so that’s www.postpartum.net is their website so they’re kind of the main postpartum depression organization, but again like I said it’s kind of like they have a whole referral list and stuff but it’s I would say going in there as an informed consumer you know it’s the same way that you pick any help practitioner because you may find that they vary in terms of how supportive of breastfeeding.
They are the organization itself is, but sometimes the individual practitioners are a little less and that’s important. I would definitely say just be aware that they may not be as supportive of breastfeeding as you would like. It doesn’t mean necessarily that they’re not good practitioners, just know that sometimes that you know, you may encounter that sort of attitude. I would actually refer you to my website too I’ve got a lot of handouts, I’ve got actually handouts on www.BreastfeedingmadeSimple.com and also the www.uppitysciencechick.com site that Robin mentioned.
I’ve actually tried to put a lot of information on both of the sites about depression, and other things you know like traumas you did with birth, breastfeeding difficulties I mean we have a lot of handouts and information and links to other sites and information to get. Those would be the places I would recommend starting. Because I again like I said you’re going to see a lot of information
ROBIN KAPLAN: And I was going to mention too I mean because we were kind of cut short on our episode because there’s just so much information on this topic that each of the non- drug treatments that we were kind of eluded to and talked about the omega 3’s and bright light therapy and stuff like that, Kathy on her www.uppitysciencechick.com has handouts on each one of those to talk about them and they’re just phenomenal resources so, or I guess one major one that has that talks about all five of it though.
So, we’ll definitely have a link on our website page for this episode so that everyone can find them there. Well Kathy thank you so much and to our panelist thank you so much for sharing a little bit of your lives with us today and about this incredibly valuable information about the symptoms, causes and treatment for postpartum depression. It’s a pleasure to have you Kathy, thank you
KATHLEEN KENDALL-TACKETT: Thanks Robin, it’s been great to be here
ROBIN KAPLAN: Great! And for our Boob Group club members our conversation will actually continue after the end of the show as Kathy will discuss the connection between weaning and postpartum depression. For more information about our Boob Group Club, please visit our website at www.theboobgroup.com
ROBIN KAPLAN: Before we wrap things up, here’s Lara Audelo, talking about ways to overcome societal booby traps
LARA AUDELO: Hi Boob Group listeners! I’m Lara Audelo, a certified Lactation Educator, Volunteer at Best for Babes and author of The Virtual Breastfeeding Culture. I’m here to answer some of your most common questions about how you can achieve your personal breastfeeding goals without being undermined by cultural and institutional booby traps, such as the booby traps that might be placed on maternity leaves and while pumping at work. Here are some booby traps, Lauren Wallace seen, a Human Resources consultant and expert in helping mothers decipher breastfeeding policies identified.
One; returning to work too soon:- Working mothers face the pressure to rush back to work when new mothers return too quickly, they have less time to establish their breastfeeding schedules, so the question becomes, how do we ensure that new mothers maximize their maternity leave. The answer is to be certain to find out which leave laws apply to you in your state and verify your eligibility.
Two; having a place to pump at work is another hurdle that mothers face. Sort out where you’ll pump before your leave begins.
Three; pumping logistics: - Moms who pump at work often have to re schedule calls and meetings to excuse themselves. The easiest way to manage these interruptions in the flow of work is to tell your boss and co-workers that you’re pumping all the while underscoring that your work will still be completed on time.
Four; flexible schedules: - Many new moms would like to transition to a work from home, a part time work schedule following their maternity leave in an effort to make breastfeeding easier. But employers are not always amendable with these types of arrangements. Particularly in cases where the job requires working at the office. If you harbor any dreams of changing your work location or hours be sure you have that conversation shortly after your baby is born.
A special thank you to Tanya Lieberman, IBCLC for providing the Booby Traps series for Best for Babes. Visit www.bestforbabes.org for more great information about how to meet your personal breastfeeding goals and check out my book The Virtual Breastfeeding Culture for collection of breastfeeding stories and be sure to listen to The Boob Group for fantastic conversations about breastfeeding and breastfeeding support.
ROBIN KAPLAN: This wraps up our show for today, we appreciate you listening to The Boob Group don’t forget to check out our sister show Preggie Pals, for expecting parents and our show Parents Savers, for moms and dads with newborns, infants and toddlers. Thanks for listening to The Boob Group, your judgment for your breastfeeding resource.
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
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