Louise
when thinking of insomnia, it is always useful to look for the
cause of the insomnia rather than just knocking out the client!! This
lady must be glad she came to you for some help.
 I agree that the
woman you describe could certainly be depressed, and that her
insomnia is part of her depression. If her depression is treated,
then her insomnia will resolve as well. Some antidepressants are
sedatives as well (especially the tricyclics). Some mothers find that
the degree of sedation is uncomfortable at a dose which is
appropriate for depression, and that other side effects are
troublesome. Some SSRIs such as zoloft can cause agitation, which may
not be desirable in this woman if she is already anxious.  As it has
a short half -life, it may be worth trying to see if it effective.
With any antidepressants, the actual effect on depression can take a
few weeks to kick in. One of the earliest improvements is with sleep,
and if the mother is counselled and supported, understands the reason
for her insomnia, and is calmer on medication, all these things will
help her sleep as well.
I have heard of lactating women being treated with the reversible
MAOI  moclobemide (brand name Aurorix in Australia), as it does not
seem to agitate the way that SSRIs can. It has not been widely used,
and literature is hard to find.
Generally, although insomnia is often listed as a problem with some
antidepressants, I find it is not that troublesome in most cases.
Holistic care goes a long way to helping anyone with depression.
Hope this helps
Fiona


Fiona Coombes MBBS IBCLC               [log in to unmask]
Lactation Consultant, Family Physician
Perth Western Australia