Addressing Major Depressive Disorder with Postpartum Onset: A Case Study

Introduction

Postpartum depression is one of the most serious mental health disorders in women following
childbirth which is characterized by a depressed mood, low energy, changes in sleep and appetite
patterns as well as anhedonia, which is an expression of lack of pleasure in activities and a negative
view of the future. Moreover, this condition may be embodied in feelings of worthlessness, inability to
enjoy or care about a newborn and rejection of interaction with the baby. In turn, hormonal
fluctuations, genetic factors and environmental and psychosocial stressors contribute to postpartum
depression. Therefore, for those individuals who have this condition it is of utmost importance to offer
drug therapies, psychotherapy, and medical and community support for this patient category. This
paper covers the medical case of a 33-year-old woman who is 6 weeks postpartum and displays
symptoms of major depressive disorder with postpartum onset.

Case Analysis

A 33-year-old new mother who delivered several weeks ago presents with depression. She
reports she has been sad almost all the time, she cannot sleep well, eats little, and feels that she
moves more slowly than usual. She desires to be close to her baby but does not seem to feel any
pleasure regarding the baby. Her spouse is concerned since she is very stimulating; however, she has
rarely spoken in some days. She denies any wish to hurt herself, others, or the baby or any features of
psychosis. She reports that she is determined to continue breastfeeding to establish an attachment
with the baby. The patients’ current medicines include lithium, paroxetine, and sertraline. The patient
denies suicidal ideation, homicidal ideation, or infanticidal ideation and shows no psychotic
symptoms.

Medication Selection

The ideal choice for PPD is sertraline because of proven efficacy and safe breastfeeding. This
contrasts with lithium and paroxetine, which are relative risks to the infant. Sertraline has a rich
profile of adverse effects that can help with decreased appetite and weight loss and a
pathophysiological mechanism relevant to depression and its reinstatement. Daily initiation with one
25 mg tablet of sertraline and up-titration for administration encourages appropriate secure and
effective therapy. The development of depression includes improved mood, energy, appetite, and
sleep. Sertraline selectively inhibits serotonin reuptake targeting the PPD lack of energy and
motivation symptoms and is, therefore, the treatment of choice.

Why Other Medications Are Not Appropriate

Lithium is commonly used as a mood stabilizer in treating bipolar disorder. However, it is

contraindicated in breastfeeding mothers because it shows significant toxicity in infants. Lithium is
excreted in considerable amounts in the breast milk, and the infants may develop severe adverse
effects justifying why this option is unsuitable in this patient. The second option is paroxetine, an SSRI;
although infants exposed through breast milk are likely to suffer withdrawal symptoms, the drug show
causes irritability, poor feeding, or sleep disturbances. Furthermore, the drug has a longer half-life and
a high milk-to-plasma ratio, making the infants susceptible to the adverse effects. Owing to the
increasing risk of adverse effects in this patient, this drug is less suitable.

Patient Education

Comprehensive education should also be provided prior to initiating the use of sertraline by
the patient. The patient must understand that sertraline is an antidepressant aimed at restoring the
balance of serotonin in the brain and thereby helping to lift depressive symptoms. Sertraline is a
reliable agent in coping with a low mood, an interest less state, sleep disturbances. Another important
advantage of the medicine is low toxicity when taken by breastfeeding women. Sertraline is effective
in reducing symptoms of low mood, lack of interest in activities, sleep disturbance. It is relatively safe
for breastfeeding because the drug levels in the baby’s milk are minimal and cannot harm the infant.
However, this medication can cause discomfort in terms of nausea, diarrhea, dizziness, insomnia,
sexual dysfunction. The patient should be advised to take the medication daily and avoid quitting
medicine.

Labs and Diagnostics for Sertraline

Before prescribing sertraline, a thorough medical history and physical examination are necessary
to rule out contraindications, such as a history of serotonin syndrome or interactions with other
medications. Basic blood tests, like a complete blood count (CBC), comprehensive metabolic panel
(CMP), and thyroid function tests, can help exclude other causes of depression symptoms. Additionally, a
psychiatric evaluation is crucial to understand the patient's mental health history and ensure the correct
diagnosis.

Monitoring Efficacy and Side Effects

Regular follow-up appointments are vital to assess the efficacy of sertraline and monitor for side
effects. These follow-ups should include evaluating changes in mood, sleep patterns, appetite, and
energy levels, as well as monitoring for side effects like nausea or dizziness. It's also important to keep an
eye on any changes in suicidal ideation, as some individuals might experience increased suicidal
thoughts when starting antidepressants. If severe side effects occur or symptoms do not improve, the
dose can be adjusted, or another medication can be considered.

Collaboration with Healthcare Providers

Collaborating with other healthcare providers is key to providing comprehensive care for
postpartum depression. The patient's primary care provider should be informed about the diagnosis,
treatment plan, and progress, allowing them to monitor overall health and manage any other conditions.
Coordination with the obstetrician/gynecologist (OB/GYN) is also crucial, especially for addressing
postpartum-related issues. Additionally, educating the patient's family and support network about
postpartum depression and the prescribed medication helps create a supportive environment, aiding in
the patient's recovery.

Addressing Nonadherence

To address potential nonadherence, it's necessary to identify and overcome barriers such as
financial constraints, stigma, lack of understanding, or medication side effects. Providing additional
education, support, and financial assistance can help the patient stay on track with her treatment plan. If
medication adherence remains a problem, alternative treatments can be explored. Cognitive-behavioral
therapy or other psychotherapy methods can offer effective treatment without medication. Other
antidepressants, such as fluoxetine or citalopram, may be considered if the patient is open to them.
Joining a postpartum depression support group can also provide valuable encouragement and reduce
feelings of isolation. Encouraging lifestyle changes like regular exercise, adequate sleep, and a balanced
diet can further support the patient's recovery. Collaboration with the entire healthcare team ensures a
coordinated and holistic approach, increasing the likelihood of a successful outcome.

Treatment Plan

In the event that nonadherence to the prescribed treatment plan becomes a concern, a revised
approach is necessary to ensure the patient's mental health needs are adequately addressed. Firstly, it's
imperative to engage in open dialogue with the patient to understand the underlying reasons for
nonadherence, whether it be concerns about side effects, difficulty adhering to the medication regimen,
or other personal factors impacting treatment compliance. Collaboratively, we may explore alternative
treatment modalities, such as cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT), which
have demonstrated efficacy in treating postpartum depression (PPD) and may be more acceptable to the
patient if medication adherence is challenging. Additionally, involving family members or caregivers in
the treatment process can provide vital support and reinforcement for the patient, helping to bolster
adherence to the recommended therapeutic plan. If pharmacological intervention remains necessary,
considering alternative antidepressant medications with a different side effect profile or administration
schedule may be warranted to enhance tolerability and adherence.

In conclusion, addressing postpartum depression (PPD) requires a comprehensive and

individualized approach that considers the unique needs and circumstances of each patient. In the case
of the 33-year-old woman presented here, a diagnosis of major depressive disorder with postpartum
onset highlights the importance of timely intervention and tailored treatment strategies. Through careful
consideration of medication options, such as sertraline, and ongoing monitoring of efficacy and side
effects, healthcare providers can work collaboratively with patients to mitigate the impact of PPD on
maternal and infant well-being. Furthermore, patient education, regular follow-up, and collaboration
with healthcare providers and support networks are essential components of a holistic treatment plan.