Since I inadvertently opened this can of worms, I'll try to be more clear,
though some have already expressed many of my thoughts.  As Corrine has so
poignantly and eloquently expressed, PPD is real and I never meant to imply
otherwise.  While any depression can be and often is debilitating, I think
the addition of a baby who needs 24 hr. care makes it especially insidious.

Having said that, I was responding to a small amount of information--that the
mother was 7 mos into it and the Zoloft wasn't working.  As Jack has pointed
out, that whole family of drugs tend to work about the same.  Generally, when
one switches from Paxil to Prozac for instance, it often isn't because it
isn't working but because of undesirable side effects.  Therefore, I was
concerned that this mother needed more.

As to the question of whether Prozac will lift the mood of someone in a
devastating life situation the answer (in my experience) is a resounding
"maybe".  However, one of the common accompaniments to SSRIs is a feeling of
*everything* being dulled around the edges....not just the pain, but also
life's pleasures--certainly not a good thing for a young woman with cancer
who needs to be able to laugh and be joyful when possible.  There may be
sexual side effects that can be quite serious.  Sometimes they create
anxieties.  The list is long.  So, one would have to ask whether this will
truly help someone overwhelmed by life's sufferings.  And maybe she just
needs to grieve, which may include crying all the time.  If I were running
the world this woman would have something like a Grief Duoula who could
lovingly care for her 24 hrs. a day for a while.

My other concern is that often, I think patients are given the meds because
it's easiest for the HCP.  It is a lot of *work* to walk with a burdened
person and help to carry the load.  Just like it's "easier" to hand a can of
formula than it is to spend hours "fixing" the breastfeeding, so too I think
(women especially) patients are often given a pill and sent on their way.
And it is just as dismissive as the can of formula.  I'm not suggesting that
this is what's happening with this particular mom or any of the patients
cared for by Lactnetters (whom we know are all wonderful!).  But of most of
the people I know on various antidepressants,  accompanying therapy is the
exception, not the rule.

I've become convinced that we see so much depression of all kinds because we
now have three generations of adults whose brains developed without the
proper nourishment (breastmilk) as well as decades of parenting styles that
promotes distance between mothers and babies, rather than attachment.  Add to
that any other insult such as substances used in adolescence or abuse or
whatever and we have a society of sub-optimal brains, souls, and psyches.
The task of sorting through a given depression is not easy, but in the case
of young mothers, vitally important.

Nancy

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