Hi, my name is Kimberly LaVoi.  I am  a Nursing Student at the University
of North Dakota in Grand Forks, ND.  For our Childbearing child we were
assigned to research a topic of interest.  I chose to research
breastfeeding and postpartum depression.  Hopkins, Marcus, and Campbell
(1984) estimate that as many as  20% of postpartum women have mild to
moderate depression following childbirth.  It is also known that in 1996,
59.2% of women initiated breastfeeding (Ryan 1997).  This leads me to the
conclusion that over half of the women suffering postpartum depression
could also be breastfeeding.  It should be noted that lactating women are
at no higher risk for depression than non-lactating women, and there is
no causative relationship between breastfeeding and depression (Auerbach
and Jacobi 1990).Leaving me to wonder the relationship between the two.
         Lactating women who are depressed tend to be less aware of their
babys needs, and believe that problems with lactation are an indication
of the babys disinterest in the parent.  Thus worsening the depression,
in turn worsening their problems with lactation.  This is obviously a
vicious cycle that needs intervention.  When interventions such as
support groups, stress relief techniques and positive feedback are not
enough, many women need medical intervention.  Deglin and Vellerand
(1997) note a contraindication of antidepressant use in pregnancy or
lactation, and The American Academy of Pediatrics Committee on Drugs
(1994) lists antidepressants as "Drugs whose Effect on Nursing Infants is
Unknown But Mat Be of Concern." I draw the conclusion that in order to
receive medical treatment cessation of breastfeeding is necessary.  Let
me state that I am aware that abrupt cessation is not indicated because
that would "cause a change in a mothers hormonal balance, and since her
depression may be hormonally related, this may deepen her depression"
(Mohrbacher and Stock, 1997).  The question that I am posing is, What is
recommended for lactating women who suffer postpartum depression, yet
want to continue to breastfeed?


References:

Auerbach, KG, and Jacobi, A:  Postpartum depression in the breast feeding
        mother: In NAACOG Clinical Issues in Perinatal  and Womens Health
        Nursing.  Philadelphia, 1990, J.B. Lippincott Co., pp. 375-84.

Deglin, JH, and Vallerand, AH, (1997).  Davis's drug guide for nurses
        (5th ed.).   Philadelphia:  F.A.  Davis Company.

Hopkins, J., Marcus, M., and Campbell, SB.: Postpartum depression: a
        critical review. Psychology Bulletin 95: 498-515, 1984.

Mohrbacher, Nancy and Stock, Julie, (1997).  La leche league international: the
        breastfeeding answer book (5th ed.).  Schaumburg, Illinois:  La
        Leche League International.

Riordan, J.  and Auerbach, KG.  (1993).  Breastfeeding and human lactation.
        Boston: Jones and Bartlett Publishers.

Ryan, AS, The resurgence of breastfeeding in the United States,
        Pediatrics 1997 APR 1: 99 (4): E12.