> Post partum depression: what to do, what care


drug Therapy

integrated Therapy

The care of post-natal depression. Effectiveness of psycho-therapy, drug therapy, and integrated therapy (the psycho-pharmacological therapy).

The psycho-therapy

sometimes agree to ask for help è the più great form of courage and of love for sé and the baby. Contact someone is to accept to be missing, a first step is to attach the impotence/onnipotenzacontenuta and hidden in the symptom.

starting to question the ideals, recognizing their value to the obstacle, inhibition of the feeling and emotions that seemed to be frozen.

We need someone non-judgmental to console us for the disappointment and trauma, trauma old, and the sufferings of childbirth, the difficultyà of the meeting with the child, all the small and big things that did not go according to expectations, the moments of rejection of the new realityà,the sometimes contradictory and shameful.

Begins a journey that porterà to see things that not always would like to know, that we put anà at times in the discussion, but letà the emergence of unexpected resources that we did not have. Behind the child that has made us suffer, that we nailed to our deficit, revives the alliance with the child deeply loved.

The psycho-therapy must be, first of all, the individual, but also assisted, when possible, from self-help groups, guided tours, or group psychotherapy that can reduce the sense of isolation and promote compliance to therapy.

should always Be made of the interviews with the partners and the parental couple, with the help of other therapists.

A very important aspect is the home therapy. It is carried out one or two times a week, from traders who have a dual competence as a midwife and psychological, that can observe the mother-child relationship as it unfolds, giving support, useful observations, by verifying the ability of a continuation or an interruption of breast-feeding and provide the therapist with essential information.

Must be quite reassuring to the effect that" the mother perceives to be his part and not as figures-intrusive. While very often the presence empathetic to people outside of the family context può alleviate the fear of being judged and to have points of reference too idealized, as mothers, as fathers-in-law, sister-in-laws.

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this Is to be at the side of the mother without taking her, making use of his skills and his abilityà of the recovery of the relationship.

Remember that an event così traumatic for the mother-child pairs, può generate reactions, difficultyà to be part of the baby that the mother may register as a refusal to be catastrophic, with the risk of establishing dangerous vicious circles.

Drug therapy

The pharmacological therapy of depression is very delicate, and only in the forms più mild può be mono-drug. The antidepressants that are the drugs of choice (there are now on the market an infinite series: serotonergic as Citalopram, Paroxetine, Fluoxetine, noradrenergic such as Amitriptyline, mixed as Venlafaxine, dopamminergici such as Amisulpride, and così via) they forò have a very important problem: they work more quickly on the components of inhibition, psycho-motor and autonomic-related depression and only later on the moral suffering, which is the aspect of subjectively più painful and cause suicide risk.

because of this characteristic, the antidepressants should initially be assisted by medicines of the più protective than to pass upon (define così the dangerous actions that often have as its sole purpose the irrational and impulsive to get out quickly from a situation which is unsustainable, a sort of exit from the scene).

There are two types of medications that have a protective action with respect to this phenomenon:

mood stabilizers: drugs with a powerful regulatory action on the mood, such as Depakin (Carbamazepine), Neurontin (Acid Gabergico), Lamictal (Lamotrigine),Topamax (Topiramate), Tolep (Oxcarbamazepina). Drugs are very different between them which, often, have a very useful, in the early days, on the control of the impulsività.

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Neuroleptic: antipsychotic drugs (many also have a protective function on the trend at the time, but are indispensable when the depression is associated with delusions, hallucinations, confusion. Give different noise annoying side, which forò can not be avoided, considering them the lesser evil.

A side-effect such as sleepiness, può be forò very useful in the early days of treatment. A good night’s sleep, especially for those who are sleepless, è was a prey to thoughts penosissimi, può be the only immediate remedy pending the actual therapeutic action is instituted.

it is an effect that tends to disappear after the first few days, as the majority of the side effects of antidepressants (Nausea, dizziness, gastric disorders, etc.).

anxiolytics: cooperate with, the action described above, at low doses act on the anxiety and anguish (Xanax, Lexotan, Tavor, etc) and at doses the più high damage drowsiness, some are more effective in the induction of sleep ( Minias, EN, Rivotril, etc.). Can reduce the unpleasant effects of other medicines.

Gabapentin and benzodiazepines have an action of a stimulus on endorphins and all those substances that mediate the sensations of pleasure. Then have an action is quite rapid (absorption per os or intramuscolo always requires a half-hour, but the appearance of the placebo accelerates the time) which is accompanied with a feeling of relief and well-being.

All of this is very valuable to resolve the anguish immediately linked to a case of acute panic attacks, insomnia, persistent, etc., but becauseé are drugs that addictive (you need a dose gradually increased to saturate the receptors) and dependence, it is necessary to reduce them, and eliminate the più soon as possible.

So ultimately, if a situation is serious and morally very painful you need a therapy first enough sedative that rapidly reduces when the effect of antidepressants takes hold (about 10-15 days to be a full).

Integrated therapy

postpartum depression is a disorder that può be taken care of in an effective way. A couple of months, from the beginning of treatment, are needed to restore a condition of mood appropriate, but the drug therapy, according to international guidelines, should continue for at least a year, even in the absence of major symptoms. All of the medical manual warn against the early breaks, being fooled by the first signs of recovery.

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my personal opinion is that is always appropriate on a case by case assessment, considering that as soon as the woman feels the desire to take care of the child you must help him to do it at the height of his strength, “possible“. Always remember thereò that è can and thereò not è. Thereò that must be accepted.

Then, while taking account of international guidelines, I believe that the treatment must necessarily be a custom, in the context of an integrated treatment (pharmacological, psychotherapy, individual, couple, or group).

All the psycho-therapeutic aim to prevent the chronicity of the disorder, reduce the seriousnessà, the duration, and the effects on the child, and, last but not least, promote the recovery of the maternal care that the depression has hindered

supplements. You have to remember that there are small supplements such as st. john’s Wort, Magnesium, Adenosine – methionine (Samyr), which are of minor natural antidepressants as the rest of the homeopathic medicines; all of these principals can be very useful in the mild.

the Center Depression Post-Partum ASL ROMA 3, Via Colautti 30 – Contact person: Dr. ssa Elisabetta Spinelli Tel: 333 3517503 Mail: This email address is being protected from spambots. Is must enable JavaScript to see it.



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February 16, 2017