QUESTION: I have been diagnosed with
major postpartum depression. I am in therapy as well as consulting
a psychiatrist. I have asked my psychiatrist how we will know when
it is time to start weaning off the antidepressants. I feel she has
not adequately explained this to me and I do not want to be on antidepressants
forever. I am now functioning normally and I feel 90 percent back
to my normal self.
ANSWER: Antidepressants can be useful
aids in making therapy more productive when depression is severe enough
that it becomes difficult or impossible to function. Recommendations
for length of time to use antidepressants varies, depending on your
history of symptoms and precipitating factors.
When there is a history of depression in your family,
some psychiatrists believe there is more of a tendency for you to
have a permanent biochemical imbalance. Some studies suggest, however,
that these imbalances are set in motion by a stressful adolescence,
which may cause brain chemistry to become established at lowered serotonin
levels. If your depression dates as far back as adolescence or earlier
childhood, but depression does not run in your family, it is often
recommended that once on an antidepressant, you consider staying on
it for at least six months after the factors that have caused your
depression have resolved -- and sometimes as long as one to three
years.
Every individual's neurochemistry is unique. Some
of us are sensitive to neurohormonal changes and others are not. Hormonal
changes throughout life may alter the way your body reacts to the
neurotransmitters affected by modern psychopharmacological drugs.
Our medical science has not yet caught up with a level of sophistication
that can explain how your brain chemistry will be altered and how
that in turn can impact your mood.
Although your psychiatrist can describe the effect
the antidepressant should have on your biochemical process, it is
unlikely that she will be able to tell you how long it will be sustained
in your body, or whether you will feel in good spirits once you reduce
the dosage or stop taking it altogether. Nor will she be able to tell
you what percentage of your improvement is therapy and what part is
specifically pharmacological.
Some psychiatrists believe that taking an antidepressant
indefinitely is appropriate, particularly if they ascribe to a biochemical
model alone. I have found that psychiatrists who consult and share
information with the therapist have a more complete picture of the
patient they are treating. Consult with your psychiatrist and your
therapist about your needs and request that they consult with each
other about your care.
Certainly transitions, such as becoming a mother,
represent major upheaval and the first year of life has many new challenges.
You are 90 percent back to yourself again! Consider what made the
difference for you and what it will take to be 100 percent. Ask yourself
whether your level of confidence is built on substantial new experiences
of successful coping, or whether you are just "feeling good" but are
unsure of the reasons why.
The latter would reflect the possibility of an illusory
"flight into health" rather than a real change in your ability to
cope. Use your therapy to clarify the issues that you have worked
through and identify the coping abilities or ways of perceiving your
life that are different now from when you were depressed and unable
to function.
But keep in mind, as with your decision to begin taking
an antidepressant, the choice to continue, or the timing to stop,
is also yours.
