The Boob Group
Postpartum Depression and Breastfeeding Friendly Treatments
ROBIN KAPLAN: Approximately 15% of women suffer from postpartum depression each year and that is only what a self-reported. This number is higher than the amount of women who will get diabetes, suffer a stroke or get diagnose with breast cancer in one year. A few months ago, we have discussed the symptoms and triggers for postpartum depression.
Today, we have invited back our expert Kathleen Kendall-Tackett to discuss: “Breastfeeding, Friendly Treatments for Postpartum Depression.” Kathleen Kendall-Tackett is a clinical associate professor of paediatrics at Texas Tech University School of Medicine in Amarillo, Texas; an International Board Certified Lactation Consultant, an owner and editor-in-chief of Praeclarus Press – a small press specializing in women’s health.
Today, we’re discussing: “Postpartum Depression and Breastfeeding Friendly Treatments.” This is The Boob Group Episode 87.
[Theme Music/ Intro]
ROBIN KAPLAN: Welcome to The Boob Group broadcasting from the Birth Education Centre 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 Centre.
Did you now know that you can find over 80 free episodes of The Boob Group on our website? Our topics range from treating sore nipples to tricks from breastfeeding in public to breastfeeding newborns, infants, toddlers and beyond actually. You can find also wonderfully written blog articles by our team of mommy bloggers. Don’t miss out on all of these breastfeeding resources and please make sure to check out our website today.
Today, we are joined by four lovely panellists in the studio. So, ladies – will you please introduce yourself? Corinne, do you want to go ahead and get started?
CORINNE MCDANIELS: Sure. My name is Corinne. I’m 31 years old. I am an Epidemiologist and I have one little girl, Abigail. She is four months old on Monday.
ROBIN KAPLAN: Congratulations. Ashley, do you want to go ahead?
ASHLEY WILLIAMSON: Hi. My name is Ashley. I’m about, going to be 24 pretty soon. My daughter is Zoey will be 10 months this month.
ROBIN KAPLAN: Wonderful and Molly.
MOLLY RIFFEL: My name is Molly. I’m a teacher. I’m 32. I have two girls – one is Abigail, she is two and a half and Riley is eight months.
ROBIN KAPLAN: Okay and Krista?
KRISTA LEIRMOE: I’m Krista. I’m 42 and I have a boy age seven and I’m a councillor.
ROBIN KAPLAN: Wonderful. All right ladies. Well, welcome to the show. So, here’s a question for one of our experts. This is from Nicole Rogers. Okay, so I exclusively breastfeed, no bottles or anything. I’ve always had more than enough milk. I noticed a little deep around my cycle but nothing a little mother’s milk tea can take care off. My daughter is seven months old, still nurses at night and on demand so plenty of breast stimulation.
We occasionally give her baby food that I make myself and I’ve been able to pump milk for that and still have enough for her. This past week though, she’s only been breastfeeding. I’ve also always have a strong let-down that as of yesterday – I didn’t feel the let-down at all or if I do, it takes forever. My left side has always felt pretty full and all of a sudden it’s limp.
My daughter seems to feel frustrated too – pushing on the breast, tugging on the nipple and it just feels different. Nothing’s change so what could be causing this? The thought I might be drying up as heartbreaking and the thought of giving her formula just makes me sick to my stomach. Please help, thank you – Nicole.
ANDREA BLANCO: Hi Nicole, this is Andrea Blanco. I’m a Lactation Consultant out of South Florida. Congratulations on seven months of breastfeeding that is no small fee. If your baby is continuing to gain well then the way the breast feel may not be as important as it seems. Not all mothers experience feeling the let-down and for those that do, the feeling often subsides overtime and this can vary from mother-to-mother.
To be thorough, I would monitor your baby’s diapers weight gain and behaviour and if any one of these things seems of then I will explore possible hormonal causes such as problems with their fibroid to a possible pregnancy; or even hormonal birth control that maybe affecting your supply. This also includes the mini pill.
You may find that the deepen supply associated with your period baby getting more pronounced. If that is the case, kellymom.com has a great protocol for low milk supply associated with menstruation. If those things are all found to be normal then I would also look in to how effectively the baby is able to transfer milk.
Meeting with an IBCLC an International Board Certified Lactation Consultant who can help you rule out different causes for a sudden deep and supply will probably be your best bet.
ROBIN KAPLAN: Today on The Boob Group, we’re discussing: “Breastfeeding Friendly Treatments for Postpartum Depression.” Our expert Kathleen Kendall-Tackett is a Health Psychologist, International Board Certified Lactation Consultant and Clinical Associate professor of paediatrics at Texas Tech University School of Medicine in Amarillo, Texas.
Kathy, that is very – that’s a huge mouthful.
KATHLEEN KENDALL-TACKETT: Yeah, sorry.
ROBIN KAPLAN: No way, I love it. She’s also the owner and editor-in-chief of Praeclarus Press, a small press specializing in Women’s health as well as the author of Depression in New Mother’s Second Edition. Thank You for joining us Kathy and welcome back to the show.
KATHLEEN KENDALL-TACKETT: Thank you very much Robin.
ROBIN KAPLAN: So Kathy, before we discuss treatments for postpartum depression, can you help us differentiate between the symptoms of postpartum depression and baby blues?
KATHLEEN KENDALL-TACKETT: Well, it’s really kind of just a matter of clarity. The postpartum blues kind of by definition are born sort of self-right within a couple of week. You typically kind of see moms anywhere in that sort of first week. All of a sudden, they feel very weepy. They feel sort of very sad. Maybe they are not sleeping very well but within a few days, it tends to kind of stop.
Depression by definition has to go on for at least two weeks. So, again like I said: “These are symptoms that are – they can range from sort of mild of kind of depressive symptoms to more severe.”
ROBIN KAPLAN: So, Kathy when you’re meeting with moms as a Lactation Consultant and they start talking to you about postpartum depression. What are your first steps for kind of looking into treatment to dealing with the symptoms that they’re describing to you?
KATHLEEN KENDALL-TACKETT: I think one of the first things that we have to do is we have to kind of figure out what’s going on with her. What is it that’s kind of difficult for you right now? Often times, I heard that in the stories from the moms in your studio that often times, their support is kind of was suddenly withdrawn from them. They’re all kind of flex at one week postpartum and they’re sort offending for themselves.
That’s a very kind of typical thing that kind of happens in American Culture but it’s something that’s really weird when you look at it kind of in the world perspective. Because you know, even countries that are a lot lower income than ours; you find that actually that they do a lot better or job – this is kind of supporting new mothers.
Again, you know mothers feeling like: “They can’t do anything right or breastfeeding is not going very well is just sort of overwhelmed that’s a sudden responsibility of you know being 24/7 care for this helpless little creature.” So, that could be – when I kind of find out what kind of stuff is going on because again a lot of it it’s kind of environmental. Maybe we can get some things in place that will help that and maybe it help kind of headed off.
Now the other thing I try to kind of get a handle on when I talk to moms is just kind of where they are in terms of how severe are these symptoms. They worried about how this is going to impact breastfeeding. You know and unfortunately – mothers still get told to wean. You know if they’ve been diagnosed from the depression. I think that’s happening less often than it used to.
It used to be pretty much matter. But, often times you know – their moms are being kind of told they need to wean their babies and again, I want to kind to get an idea. You know, some breastfeeding problems – hey, let’s make sure she’s got the breastfeeding support. If she’s very socially isolated – okay, what kind of things can we do about that? Does she have a family history? Does she have a severe history of depression? That might be you know something that would maybe govern a different choice.
So again, like I’ve said – what I always just kind of to do my role in being is just offering her option.
ROBIN KAPLAN: Sure.
KATHLEEN KENDALL-TACKETT: I’m not trying to sort of diagnose and treat the same you know. Here are some options that you can look at that have good evidence. Here’s kind of where you can find out information about those and also, then you got to figure out what you’re going to do. Because again, I think it’s very important we have the mothers buy-in to whatever treatment modality is involved.
ROBIN KAPLAN: Absolutely. Well, it doesn’t make sense if there’s no buy-in because then it’s not going to help anyway.
KATHLEEN KENDALL-TACKETT: Absolutely.
ROBIN KAPLAN: Nancy, in one of your articles on your website the uppitysciencechick.com you mentioned some non-drug treatments that can be helpful retreating postpartum depression and so, I would love to go through each of these.
KATHLEEN KENDALL-TACKETT: Okay.
ROBIN KAPLAN: The omega three fatty acids, bright light therapy, exercise, St. John’s Wort and psychotherapy. So, if we can start with the Omega Three Fatty Acids. What is it about these fatty acids that help with postpartum depression and are all Omega Threes the same?
KATHLEEN KENDALL-TACKETT: No, actually they aren’t. That’s very good question. What we really need to be looking at is the long chain Omega Three Fatty Acids. So, for treating depression – what we’re looking as an actually EPA and again, unfortunately that means that it’s Flaxseed which isn’t Omega Three Fatty Acids. It’s Parent Fatty Acid. It’s not anti-inflammatory enough. That’s really kind of the problem.
So, the EPA – so far, the only source they have for that is fish products and that’s kind of a shame in some ways because I work with a lot of moms who are vegetarians. But that’s the thing that kind of treats it. And what it basically does is it addresses the inflammatory aspect of depression. We actually know that there’s underlying inflammation that happens in depression and Omega Three’s actually all of these treatments for depression actually address that underlying inflammation.
But, specifically, Omega Threes do that. And again, many of our mothers are very deficient in these because we don’t get a lot of them in our diets anymore. We do get some very pro-inflammatory six’s which are vegetable oil, so they are in everything. They’re in anything with many salad dressing, any kind of commercial baked good. We get these pro-inflammatory oils and we get very little of the anti inflammatory.
So, again, we do know that there are helpful for prevention. They also seem to be very helpful for treatment.
ROBIN KAPLAN: Okay. What about bright light therapy; what exactly is this and how does it treat postpartum depression?
KATHLEEN KENDALL-TACKETT: Well, it’s a got a very long history of treating depression that cause by seasonal changes. It really has to do with how early in the day you’re exposed to bright light. So, again – in places where say – it doesn’t get light until like I was up in Alaska last in January. It’s not a good time to visit.
But, 10:00 in the morning and it’s still pitch black. It’s like it’s not surprising that a lot of people that have depression because again, it has to do with sort of when they are exposed of that kind of light. So, bright light is actually a really helpful treatment for seasonal depression. We find that it’s as effective as medication. There’s been a ton of clinical trials.
Recently, it’s been used to treat postpartum. We have some case studies and from what I understand, there is a big trial in the works. What it basically does is, it again; it changes Circadian Rhythms and it actually again, like I’ve said – it gets bright light exposure with the call that Early Dawn Interval. That seems to alleviate symptoms to depression.
Whether they use it as postpartum is either by itself or sometimes in combination with medication like if medication is not really quite getting the treatment for depression, they may add bright light therapy. A lot of people like it because there’s no impact at all; if they use it during pregnancy or breastfeeding on the baby.
ROBIN KAPLAN: Yeah, I mean there are no negatives to it.
KATHLEEN KENDALL-TACKETT: Right.
ROBIN KAPLAN: That’s perfect and how about exercise? How often do you recommend mothers with postpartum depression to exercise per week and does it matter what type of exercise, are we looking at strength versus cardio or combination of both?
KATHLEEN KENDALL-TACKETT: Well, the things we’ve see the best record with is actually cardio. Again like I’ve said: “The amount that the mom has exercised really depends on how depress she is.” For mild mother depression will probably talking about two to three times a week – 20 to 30 minutes at a crack. So, it’s sort of moderate intensity. So, it doesn’t have to be something that’s really intense.
I think actually that’s quite doable for a lot of moms. When I’ve gone around the different places in the country, they’ve told me that since I’ve been there, they started a program for the moms where they get them all together and they go out and they go outside. They go exercise. They’re taking Omega Threes and they said they found that their pressure rates actually have dropped quite a bit.
You know, it’s a good kind of preventative but for major depression, what’s you’re really looking at is something more intense. You’re looking probably four to five times a week probably anywhere from 47 minutes to 60 minutes. Again, the two studies that I’ve looked at was major depression actually found it was as affective as Zoloft.
ROBIN KAPLAN: Wow.
KATHLEEN KENDALL-TACKETT: So again sometimes people think: “Yeah, you can’t use exercise for depression.” Well, yes you can. You know and there are two studies that came out of the Duke University Medical Centre. They were really good randomized clinical trials and put exercise head-to-head with Zoloft. So it does definitely work but that’s actually a fairly intense amount. So again, it really – this is where they buy-in kind of comes becomes important
ROBIN KAPLAN: Sure.
KATHLEEN KENDALL-TACKETT: Because you’re depressed. Somebody tells you to exercise. That is honestly the last thing you tried doing. So, moms have to be kind of motivated to try that. Again, like I’ve said – recognizing that it is kind of probably take them; it’s going to be a little more intense. So, they’re going to make a commitment to do it.
ROBIN KAPLAN: Okay and then psychotherapy, what recommendations do you have for a particular type of therapy, is that one that tends to work the best?
KATHLEEN KENDALL-TACKETT: Well, there are two that I talked a lot about with postpartum depression. Kind of sort of – you know, the big pool of depression treatment is Cognizant Behavioural Therapy. Again, a very long track record, it really cause kind of a revolution and psychology and psychiatry in the 70’s because the first time that really depression responded quickly to treatment, to talk therapy.
Basically, it’s kind of based on the idea that you pay attention to those little cognition or beliefs that are sort of always running as the little tape. You know in the back of your head – you know the things that’s: “I can’t believe you did this.” What makes you think you could be a good mother? Look at what you did. You took 10 seconds to get to your baby and what kind of mother does that?
Basically, it’s teething – the last time that little voice is going on, we’re not even paying attention to it. But, it’s impacting our mood. So, a Cognitive Behavioural Therapy does it say, “Hey, wait a second. Is that true?” It challenges that and it kind of teaches you ways to maybe think about things differently and it’s very, very powerful.
So, yeah like I said, that is when used very effectively with depression in kind of in general. The one I think that were going to see kind of almost out stripped that one in terms of using particularly with parent natal women. If something called – interpersonal psychotherapy and it does some similarities to cognitive behavioural therapy. It tends to be kind of a short term treatment and again, it doesn’t try to get in to kind of all the certain background that the mom’s kind of brings. It really is very focused and it’s focused on mother’s social support, her social relationships and how she can get more support.
I think you may find; a lot of times when mother’s go to the sort of transition to motherhood then we’d be the only one that they know that’s a mom. So, in a personal psychotherapy would be like helping her, like find other mothers that she can hang out with. You know and how do you get kind of support from people – you know, it could be how do you get support from your partner, from others in your family.
So, it gives you some kind of skills and it’s been extremely effective. You know it’s very high risk mothers you know that during pregnancy and they’ve actually done postpartum and found that it was actually preventative of postpartum depression.
ROBIN KAPLAN: Wow.
KATHLEEN KENDALL-TACKETT: So, I think we’re going to really see that one become kind of the treatment of choice. It’s like psychotherapy of choice but both are actually really effective.
ROBIN KAPLAN: Okay and last one I want to touch upon before we ask our panellists – what kind of, they sought out is St. John’s Wort. What is this? Why is it effective and can you take it while you’re pregnant and obviously you can take it while you’re breastfeeding because otherwise you wouldn’t be recommending it but how does it work?
KATHLEEN KENDALL-TACKETT: Well, St. John’s Wort. First of all, I’ll just say that it’s the most widely prescribed anti depressant in the world. So, when people kind of say: “Well you know, it’s just a plant.” It’s really kind of again, kind of ignorant in terms of what goes on in the rest of the world. It has a very, very long history. You know, one country that has used it really kind of constantly is Germany.
The herbal medicine never really sort of died out the way it did here. So, it’s kind of used alongside you know in sort of more standards kind of Allopathic Treatments. Herbal medications and herbal treatments have a very long history there. So, a lot of the original research out of this actually was published in German.
Now, we’re actually seeing you know of course you know because there’s been a huge consumer demand in United States. So, were seeing more kind of English kind of articles come out. But we do a have a long history about it but we do have a very long history about it. But, the one thing about St. John’s Wort is to drive people kind of nuts because they don’t exactly say how it works.
You know, for a while we thought that the main constituents of St. John’s Wort was something called Hypericin. So, all the medications are actually standardized to that. But then, it kind of came back later and said well, no-no, it’s not Hypericin it’s something called Hyperforin.
Okay, so now we look at Hyperforin and Hyperforin does have definitely some anti depressant you know parts I mean the way it works. Reality, you know botanicals actually I think one of their straints is that often times there’s a synergy between the different elements but one thing that’s kind of interesting about Hyperforin is – Hyperforin is a very strongly anti-inflammatory and it’s been used actually on a lot of other applications because of that.
Again, we never thought that, that – we knew that it was actually anti inflammatory which is in think it hadn’t anything to do with why it works. But, now we actually know better. It does seem to also have some similar functions in terms of raising Norepinephrine Serotonin levels which is very similar to what more standard medications do.
But it does, it seems to have kind of more of a synergistic effect. I will tell you this, “Most herbalists will tell you it’s really kind of preferred for a more mild to moderate depression not necessarily major depression.”
ROBIN KAPLAN: Okay.
KATHLEEN KENDALL-TACKETT: Oftentimes, it gets used in combination with other things. We tend to sort of swap it out. We say, “Okay, instead of taking Zoloft you can take this.” It’s a little kind of different use and in studies it’s been used of major depression and it does seem to work. The comment you hear from people is in the studies is you know they said, “It’s as effective you know and it’s been compared to Paxil and Zoloft in different studies as effective in a patient’s like to better.”
So, it has a much better side effect profile. But, you just got to be careful with it. The thing that’s a little scary is mom’s going at buying it and not talking to the health care provider about it because it can interact with any other prescription meds that she’s on. So, it’s just important that we recognize that it is a medication. Just because it’s natural doesn’t mean that you can take it from what you want.
ROBIN KAPLAN: Yeah.
KATHLEEN KENDALL-TACKETT: Lots of things are natural. Arsenic’s natural. But, it does have very good medicinal properties. So, it does work. It’s quite effective.
ROBIN KAPLAN: Okay, wonderful. Thank you for breaking those down so nicely and so sync fully balance. That was perfect. Ladies, I would love to ask you: “Did you try any of these treatments? Were any of them recommended to you; if so, did any of them work?” Corinne, did you mind starting?
CORINNE MCDANIELS: Sure, fortunately for me about it took about a week for me to realize that I was having postpartum depression and anxiety. At that time, I was not able to reach out to anyone to ask for help. So, I didn’t call my care provider. The only people that I called are the people that I tell them my parents and so, I didn’t try any of these.
I was also not quite healed enough to where I can exercise. That’s usually my go-to when I start feeling depressed. I have a history of major depressive disorder. And so, I wasn’t unable to exercise. I wasn’t healing and so unfortunately, I wasn’t able to try any of these.
ROBIN KAPLAN: Sure. Well, it’s hard too because most of you have mentioned that you really started noticing the setting in the first week or two – and that, would not be a time to start the exercise until you’re at least cleared after about six weeks and possibly even later depending on what the birth look like. How about you Ashley?
ASHLEY WILLIAMSON: I had some of the issues with the healing and the lack of exercise but inadvertently tried fatty acids. My daughter had a milk allergy and egg allergy so I cut out serial on eggs which was I was living on because I had a c-section and I was just you know. So, I cut out basically my main food source. So, I had you know already depleted on in nutrition and just feeling really, really bad.
My lactation consultant said: “Hey, if you want to build up the richness of your milk, take some fish oil caplets.” I realize that in the couple of days, I started feeling a little more energetic and I didn’t make that connection until I started doing some research. I realized, maybe this is something that I should look into and then once, I was little healed more – I did the bright light therapy and exercise kind of together.
In the morning, I would just take her outside if she was getting fuzzy. We would just walk around in the backyard and kind of just enjoy the trees and she loves being outside. So, it was kind of a natural integration like it didn’t really think about it. I just – things started to come to me a little bit naturally then okay, I just need to get out of the house. I have anxiety too. I had it all my life.
So, I was just like, “I need to get out of the house.” So, I just went outside and I walked outside and I started to notice – that started to help. Ultimately, I did I have to go on Zoloft because my anxiety kind of came back when I started back to nursing school. But, the fatty acids I recommend them to everybody that helped me just within a couple of days.
ROBIN KAPLAN: It’s amazing. How about you Molly?
MOLLY RIFFEL: For me, I knew that I was going to have a depression. I have a history of depression and anxiety so I actually capsulated my placenta prior to my first birth. So, I was taking those and my husband instantly could tell if I had missed pills. He’d go, “Do you have you taking your pills?” No, well take some because it was that instantly.
But, I also found a support group. I went to Robin’s Boob Group Support Group and that was a huge help to have other moms to talk to who would have been there, who understood as supposed to talking with my mom who have never have problems with breastfeeding twins and being told that: “You know, I had no problems with you and I was having problems.”
So, I found a support group, incredibly helpful and I still have friends that I did in contact with now. I did do some of the fatty acids because I was eating not the greatest food so I was started taking these fatty acids and that help as well. So, that’s were the ones that worked for me. I did, I do a little bit of exercise when I get cleared but it wasn’t until obviously, later.
ROBIN KAPLAN: How about you Krista?
KRISTA LEIRMOE: Well, I noticed it early on but actually, getting treatment took a while. I did start trying to search for resources almost, almost immediately because my training isn’t psychology so I kind of had a sense of what was happening. But, it is more difficult when you’re in that state of course to find everything and my son was actually was born just a week and a day ago.
Seven years ago but, around the holiday time – it’s also as stressful and more difficult to find resources because they’re not always around.
ROBIN KAPLAN: Around, yeah.
KRISTA LEIRMOE: So, I went and saw two psychiatrists, three therapists. I went to two lactation support groups which actually did get me out of the house. One of the psychiatrist recommended that I go outside in the morning. So, that was my light therapy; also to shut down TV and computer electronic type of equipment after a certain time in the evening so that I could regulate my sleep schedule.
ROBIN KAPLAN: Sure.
KRISTA LEIRMOE: The first therapist was a no good. The second therapist was perfect. She actually does – it’s actually work for trauma and I didn’t have a traumatic birth but I did have trauma from emotional trauma from the birth. It wasn’t well what you would call “physically traumatic birth.”
But, so she did it’s called the Alternative Integrative Therapy. It works with energy psychology and another form is emotional freedom technique which basically integrates the body and the mind and it actually doesn’t have to go through the cognitive piece. I received relief in one session.
ROBIN KAPLAN: Wow.
KRISTA LEIRMOE: One session so I was pretty amazed and continued. I could bring my baby with me. So, he was able to come to the sessions, nurse and basically sustain all of the support so that I gotten with the lactation and so, it was just a beautiful thing like came together to exercise not so much. I ended up having – I wasn’t fully recovered for seven weeks. So, yeah
ROBIN KAPLAN: Thank you so much. Yes, Ashley do you want to add something?
ASHLEY WILLIAMSON: I have one comment on the therapy. When I did seek out therapy, I went to a therapist and she said, “You probably need to go to talk with like you know an upper level therapist.” So, I went to like a medical to my doctor’s office and then she said, “Well, now you need to go to your psychologists.” He said, “Well, you need to go to a psychiatrist.”
So, I had had that issue with – I was just overwhelmed so I said, “Never mind. I’m not doing it.” So, then it got worse because it just was overwhelming to go in and out of all of these offices and everyone was just like, “Well, write down all of your information on this form and then we’ll diagnose you.” It was totally – I mean her saying that she went three different, it was really overwhelming. So, I’m glad that there are natural alternatives.
ROBIN KAPLAN: Yeah, absolutely. Well go ahead Krista.
KRISTA LEIRMOE: And the nutrition piece that you mentioned – I mean I had to do something similar. My son also had problems with dairy in my diet and I’m already vegetarian. So, I had to cut out dairy which
ROBIN KAPLAN: Was a huge protein source.
KRISTA LEIRMOE: Was – so, I had to adapt and some of the physical depletion is just immense.
ASHLEY WILLIAMSON: You had just had a baby. You’re not going to cook some amazing meal. I got some vegan protein shakes and just put them in shape or cups at the beginning of the day and just had them set out and I lived on that basically. Yeah.
ROBIN KAPLAN: I think that goes back to also what Kathy was talking about how the support system of setting up where people are actually bringing food so that way. I mean – what are the other culture requires that a mom’s cook on her own meal a week after her birth; except hours. MJ, you had a virtual panellist want to share something?
MJ: Yeah, Leslie Evans commented about postpartum depression runs in my family. So, I took a proactive approach and encapsulated my placenta like Molly was talking about. She said, “She didn’t feel a wink of postpartum depression or the baby blues not to mention that it actually helped her milk coming quicker.”
ROBIN KAPLAN: Awesome.
MOLLY RIFFEL: My milk came in really quick when I had Riley, I knew Riley – we knew was going to have some issues when she was born and she was put into the NICU instantly. So, I had my placenta pills for my first birth with me. I took them instantly and the nurses kept going when I was pumping going, “Why do you have so much milk? Where are you getting this milk?”
I said: “Well, I took my placenta pills.” They looked at me like I was crazy. But, I literally had milk like the next day and it was amazing. It was – that was probably the best thing for my body was to take those pills.
ROBIN KAPLAN: Kathy, is there any research on that?
KATHLEEN KENDALL-TACKETT: Absolutely none. I think it’s actually kind of what we need to, need to see – you know, what we really to see is like a double blind trial.
ROBIN KAPLAN: Sure.
KATHLEEN KENDALL-TACKETT: You know where people are taking capsules but they don’t know what’s in them.
ROBIN KAPLAN: Yeah.
KATHLEEN KENDALL-TACKETT: That’s kind of the lot and we have not ever and there’s not been anything like this because you know – people been talking about this for a while. I would like to see that kind of level of research on that. It wouldn’t actually be that hard to do.
ROBIN KAPLAN: I know right. So, okay when we come back – Kathy is going to be talking about recommendations when considering prescription medication so, if they are necessary. So, we’ll be right back.
ROBIN KAPLAN: All right, well welcome back to the show. We’re here with Kathleen Kendall-Tackett, an International Board Certified Lactation Consultant and a platter of other things. We are talking about postpartum depression and breastfeeding friendly treatments. So, Kathy – how long would you recommend that a mother try these nondrug treatments before considering prescription medication and what might be some science that medication is actually necessary?
ROBIN KAPLAN: Again, it kind of goes back to where the mother is. One of the things I always kind of try to ask is you know like I said: “I used to get especially back before we had all of these nice resources on the internet.” I used to get quite a few referrals from [unclear] and mothers were asked – what are their options.
So, again like I said: “I always try to kind of take her where she was.” But, there are a couple of things that you want to kind of find out and it’s first of all – how serious is her depression; because if you deal with a really severe depression, you probably need medication. You know, like I said – unless some others absolutely adamantly oppose to it. It’s just – you know, I think that that’s probably the safest course to take.
But if you have somebody who’s maybe kind of a little more on the mild to moderate range, she does have some a few more options. But, you may also have a mom who immediately wants to start medication either she has a history of using them or she just really feel that’s the right – so there isn’t a kind of hardened vast rule about it.
I think it’s important though that we listen to what the mom has to say about her feelings about medications. You know because we talk about a plus CBO effect. Well, there’s no CBO effect where actually people can actually make themselves sick from doing something against their will.
I saw that very clearly in a mom one time she was really terrified that her job and she was very vague about her job. You know, I doubt that it was something in kind of military where having you know an antidepressant on your sheet would actually really hurt her chance for job promotions. She was terrified about that.
Anyway, they finally talk her into taking some medication. She took one Effexor and she ended up with every single side effect. She’s making herself sick. Clearly, that’s not going to help her and in fact, she was so upset about that that she just dump the rest of them down the toilet. Here’s the problem: “She’s still depressed.”
So, again it really kind of depends on how the mom feels. But, what I don’t want to ever see happen is the mom will feels like she has to run though all the alternative stuff before she starts medication. If she feels like the medication is right choice for this one she should be on. So again, it really kind of depends on kind of where she’s at.
One of the things that I’ve kind of suggest to the moms sometimes is just – let’s say, “They don’t want to be on medication.” Because a lot of times people will tell them well if you’re on this, you’re going to have to be on it forever. Well, it’s not necessarily true. Again, you can kind of pick an approach where you say: “Okay, let’s do a short course of this.” Let’s think about a short course of this because I will check back in with you in three months and see where you are.
In the meantime, get social support in place, get Omega Threes. Maybe start some you know some short term therapy. I mean these are all kinds of things that can be helpful. So again, like I said – there isn’t kind of a hard [inaudible 00:32:00] you know accept it as long it was very severely depressed. Then I think: “You know the options are more limited.”
ROBIN KAPLAN: Well, I think now I mean even just to mention that the insurances is changing as well because that was the one thing that I had a problem with and I was looking to medication was – red flags you for five years. It follows you and every time you’re looking for a doctor – they’re like, “So, you have depression.”
It makes things really challenging but I guess now, that there are now, what’s the word I’m looking for?
KATHLEEN KENDALL-TACKETT: The pre existing conditions
ROBIN KAPLAN: Thank you pre existing conditions now it’s not such a big deal. So, that actually – that might open about for moms actually feel a little bit more comfortable and less like you’ve mentioned with a job.
KATHLEEN KENDALL-TACKETT: And we’ve got a lot of medications that have gone to generic. So, that I think helps too because you know, there are lot of people can swing $70, $80 a month for medication.
MOLLY RIFFEL: That was one of my concerns. That was one of my concerns with Riley because I can feel my depression coming back; we’re having some issues and you know, having to pay $80 a month for meds it’s like not on our budget right now. I’ve been trying everything I can and it’s just – it’s one of the things just like, “You have to bite the bullet.”
You know, just thinking of having to pay the extra money has made it the depression worst because it’s like: “You’re going on a circle and it’s just now, it’s really point towards like – Okay, we’re going to have just do it and figure out to where to make cuts somewhere else.”
ROBIN KAPLAN: Obviously, we have breastfeeding moms in here and so, how safe are these medications to take while breastfeeding?
KATHLEEN KENDALL-TACKETT: You know, this is actually one thing that – I’m not casual ever about taking medication if that’s what you’re talking about exposing a baby to it. But, in terms of you know comparing it to like taking anti-depressants during pregnancy, this is you know a whole another level of sort of removal for the baby is getting. So, it really is.
I won’t say safe because we never can, a hundred percent say that but it’s about as safe as it can be.
ROBIN KAPLAN: Are there certain ones more than the other?
KATHLEEN KENDALL-TACKETT: Yes. The ones that you really want are the ones – you know, when they break down in the mother’s body, that they don’t become, they’re not active components themselves. You know because the baby gets more exposure to that. So, speaking of an example – Citalopram is or Celexa. The generic name for that is Citalopram.
Well, one of the things that Citalopram breaks down to is something called Escitalopram which is Lexapro. So basically, that medication breaks in to another anti-depressant. So, the baby’s going to get more exposure that way. So, that’s one of the reasons why Lexapro is actually a better choice than Celexa because when it breaks down, it doesn’t break down into another anti-depressant. So, when you Dyslexia, Paxil and Zoloft, those are the ones that really have that kind of low level of exposure for the baby.
Now, Prozac is another one that it actually has a lot of exposure for the baby. You know 10-17 % of the mother’s dose but, it’s been around for like 30 years. So, we have this very long track record with it until again, it’s a mom can only take that medication. It does appear to be relatively safe. I mean you don’t see very long term effects of that.
I would probably lean more toward one of the other ones because the amount of exposure at the baby’s given that is like less than 1% of the mother’s dose. Many of those are not even showing up in the baby’s plasma. You know, may be in the milk but it doesn’t show up in the baby’s plasma. So, that all of the sudden that [inaudible 00:35:14] long term effects – really is kind off the table because baby’s not being exposed to it; the chance of long term affects are actually are really, really slow.
ROBIN KAPLAN: Okay.
KATHLEEN KENDALL-TACKETT: So, those would be the ones I’d kind of head for it.
ROBIN KAPLAN: Okay, ladies for those of you who ended up using medication – did you find that that was the helpful treatment as well? How about you Ashley?
ASHLEY WILLIAMSON: Yeah, definitely. The depression had lessened a little bit but the anxiety had kind of tripled. I just couldn’t get a handle of my, my significant other one at the town and for a month for a work, I had just started back to nursing school and it was just crazy. I went on to Zoloft and finally what got me because I was real like, “No, I can do this by myself. I don’t need any help. I don’t want to hurt my baby.”
Finally, my therapist at school had just told me the effects of you being anxious and uptight and unhealthy are probably more detrimental to her than this medication would be. As soon as that I got in my head I’m just like, “This is a better thing for her.” For me, to be levelled out and for me to really get back to being myself for her is probably better than worrying about the side effects that everyone is telling me.
KATHLEEN KENDALL-TACKETT: Absolutely. I think your therapist gave you very good advice there.
ROBIN KAPLAN: Corinne, did you end up using medication?
CORINNE MCDANIELS: I didn’t. By the time I have finally saw a therapist – I was feeling much better and we’ve discussed what it would take to get me at what point I would go back on medication. I have been on it about 10 years ago and I said that if I got to the point that I was when Abigail was about three or four weeks old that I would absolutely consider going back on medication.
ROBIN KAPLAN: Did you ended up not eating it?
CORINNE MCDANIELS: No.
ROBIN KAPLAN: How about you Molly?
MOLLY RIFFEL: I never did take it with Abigail looking into taking it with Riley. Okay, but she’s eight months old. So, we’ll see how it goes.
ROBIN KAPLAN: Okay and how about you Krista, did you ever need medication?
KRISTA LEIRMOE: It was prescribed to me but I never ended up taking it. I attribute that to large part because of the combination of the therapy that worked immediately and continuing to breastfeed even though the psychiatrist's recommendations were actually to do some form of night weaning so that I could get more sleep. I absolutely didn’t want to do that.
Having, my little boy go sleep with us and being able to breastfeed while laying down was what made me being able to actually get more sleep. We did try one night with the postpartum doula come in and so that I would know that he was taking care of and I was awake more. I knew he was okay but it didn’t help me sleep.
ROBIN KAPLAN: Yeah. Kathy, did you see that a lot I know you’re Praeclarus Press actually just has a book now on co-sleeping and things like that. We’ve actually had Wendy on our show. So, are you seeing that that is also helpful for moms who have postpartum depression as well?
KATHLEEN KENDALL-TACKETT: It absolutely is and unfortunately, the psychiatrist advice is unfortunately common but it’s off base. We’ve had a bunch of studies in the last like probably four years that actually shown that exclusively breastfeeding mothers gets significantly more sleep. Even though they wake more, it takes some less time to get to sleep and attend to go into deeper sleep. So, they’re actually getting better sleep.
So, we found that in our study; we had 60, 400 and 10 moms in our study. We ask them whole bunches of questions about you know – how much sleep do you report that you’re getting and how many minutes does it take you fall asleep. I mean all these variables.
We asked them about: “How much energy do you have during the day, physically how do you feel?” The exclusively breastfeeding mothers far and away were significantly different. What was interesting is the mix in the formula-feeding mothers were not significantly different on any measure; I thought what we’re going to see is kind of a dose response effect that -- the more breastfeeding, the better the variables looked.” The mix feeding group did not look significantly different than a formal feeding group.
Unfortunately, the advice is: “If you just use supplement” but everything that we’ve seen in all of these studies and there was a big one that was publish from the Journal Sleep and it’s sounds kind of the same thing. The minute you start supplementing the sleep quality actually decreases and the mother’s get less sleep. So, it’s really not good advice.
ROBIN KAPLAN: What were you’re going to say Krista?
KRISTA LEIRMOE: I was going to say, “I was actually told to pump instead of breastfeeding.”
KATHLEEN KENDALL-TACKETT: Right.
ROBIN KAPLAN: It is way more stress.
KRISTA LEIRMOE: Exactly.
ROBIN KAPLAN: And you have to get out of bed
MOLLY RIFFEL: I give my hands up to women who are exclusive pumpers for whatever reason that they have to. That to me is super mom because but like, she’s said about the co-sleeping – as soon as we got side laying nursing down, I felt so much more, so much better because even before then, one night I was really, really depressed and just over I hate to say this. But, I was just over it.
I had her dad gave her a bottle and the whole time I just felt like a failure. So, you know, it makes it worse when you think about taking them off the breast. That’s the only thing that’s keeping me in-touch with this little baby right now. Don’t take that away from me.
KATHLEEN KENDALL-TACKETT: Right.
ROBIN KAPLAN: Thank you so much Kathy and to our panellists as well for sharing this incredibly valuable information about breastfeeding friendly treatments for postpartum depression. For our Boob Group Club Members, our conversation will continue after the end of the show as Kathy will discuss what a mom can do if our doctor is saying that she must wean her baby before taking medication for postpartum depression.
So, for more information on 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 breast 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 – what do you do when you get bad advice at the pharmacy counter? You may know that nursing moms often get poor advice from providers about medications. But, did you know that the professionals responsible for knowing all about medications and dispensing them may pose a booby trap too?
A 2007 study of two large retail pharmacy chain databases examine the recommendations for use of 14 commonly prescribed medications. The findings by the pharmacist for using outdated sources for making safety recommendations to their breastfeeding patients; a practice which quote: “may result in many women being appropriately advised to stop breastfeedings.” For a drugs consider out of clinically safe that two retail pharmacy databases inappropriately advice mothers to stop nursing at least 75% of the times.
For example, the authors find conflicting advice when they reviewed recommendations for common gastric reflux medications. Dr. Thomas Hale’s medication and Mother’s Milk rated the risk at the lowest, level one meaning it’s the safest. The database isn’t commonly used by pharmacists rated it – in the risk cannot be ruled out, safety unknown, check with the pharmacist unknown whether enters milk and absolutely contraindication.
Think of a few mothers have been told to stop breastfeeding to take this drug. Dr. Moose Sarbartic co-author of this study explained a common mindset among pharmacists when confronted with a nursing mother. Often the pharmacist included the information mistakenly think that if one doesn’t know the safety information for drug, it’s safest to advice the patient to stop breastfeedings.
We need to replace the assumption, when in doubt, don’t breastfeed with the mandate: “When in doubt, look it up in a reliable source.” Special thank you to Tanya Lieberman, IBCLC for writing The Booby Traps Series for Best for Babes; visit bestforbabes.org for more great information about how to make your personal breastfeeding goal.
In my book, The Virtual Breastfeeding Culture – 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 shows, “Preggie Pals for expecting parents”, “Parent Savers for moms and dads with newborns, infants and toddlers” and “Twin Talks” our brand new show dealing life with the twins.” All in honour of Sunny for having her twins; thanks for listening to The Boob Group, your judgment-free 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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