Therapy Choices for the Postpartum Woman


Once diagnosed with a Postpartum Mood Disorder, you are then faced with a literal bevy of choices regarding your path to wellness.

Some doctors may toss pills at you. If that happens, run. Run very fast and very far away from any physician who shoves anti-depressants your way before you’ve even finished describing what’s wrong. A good prescribing doctor will sit down with you and hear you out before grabbing for his pen and pad (or these days, keyboard and internet connection). A good physician should also run a couple of simple blood tests first to rule out thyroid disorders or anemia which need completely different types of medication to show improvement.

Some doctors may suggest psychotherapy. And that is where things start to get a little sticky. What kind of talk therapy? Will there be a couch? Will it be comfy? Will I have to talk about how my Great Aunt Edna used to kiss me on the cheeks and leave funny lipstick stains? Will I have to talk about things not related at all to my current state of mind? Will I be hypnotized? Or any other strange mumbo jumbo I’ve seen happen on TV or in the movies or from my best friend who found this website and…

Hold the phone there.

Cognitive Behavioral Therapy proved to be the best option out there for me. There was a couch but I didn’t lay down on it. I sat cross-legged on it as I drank coffee and chatted with my therapist. She sat in a really cool rocking chair with a foot stool. I got along fabulously with my therapist. That’s not to say we were bestest of buds but she knew what she was doing, just let me talk and work a lot of my issues out. I did occasionally talk about things in my past but it wasn’t at all like “So, you were born… let’s start there.” She met me where I was and let things fall where they fell. Or at least she seemed to. She did ask questions to get me to think about issues and how I was reacting to them. I had not planned on staying in therapy for long but once I became pregnant again, I made the decision to stay in through my pregnancy. Therapy gradually stopped at about 6 months postpartum of that pregnancy as we scaled our sessions back.

While I will not be covering every single last type of therapy out there, my goal is to provide some basic information for the most common therapies  used with Postpartum women.

At the top of the list is Cognitive Behavioral Therapy which is actually a blanket term for several types of therapies with similar traits. Primarily Cognitive Behavior Therapy (CBT) promotes that WE have power over our moods through our thoughts. You can read more about it by clicking here. A great resource now available for women and clinicians alike when it comes to treating Postpartum Depression is Karen Kleiman’s Therapy and the Postpartum Woman. You can read more about it by clicking here. (In the interest of full disclosure now required by the FTC, I have not been compensated at all for including this link. I sincerely believe it’s a good resource.)

EMDR or Eye movement desensitization and reprocessing is gaining popularity as an option. EMDR is most effective with Post Traumatic Stress Syndrome. You can read more about this approach by clicking here.

Peer Support/Group therapy is also an option. The primary benefit of this option is the realization it provides to women of not being alone. They really aren’t the only ones having a panic attack when they get in a car or experiencing frightening thoughts prancing through their mind at the most inopportune moments. Many times this option is a cost-effective option as well because many groups do not charge. A group led by a therapist may only charge a small fee such as $10-15 for attending. While peer support should absolutely not replace professional medical care for Postpartum Mood Disorders, it is an important aspect to add to recovery. If your area does not have a local peer group, you can find help online. The Online PPD Support Page has a very active forum for postpartum women. You can also visit the iVillage Postpartum or the Pregnant & Depressed/Mental Illness Boards. (Shameless plug on the iVillage boards, I am the Community Leader for both.) Another bonus of peer support? It reduces the recovery time.

Pharmaceutical therapy is also an available option. Some women are against taking medication and that’s perfectly okay. No one should ever be forced to take medication. Typically, pharmaceutical therapy is paired with another type of therapy. In fact, combining pharmaceutical therapy with a type of Cognitive Behavioral Therapy has proven to be one of the most successful approaches for the Postpartum Woman. Sinead O’Connor really put it best during an appearance on Oprah in regards to the function of psychiatric medications. They are the scaffolding holding you up as you revamp yourself. There are risks involved with taking medications and you should absolutely educate yourself, talk with your doctor, and if you end up deciding to take medication, be sure to inform your child’s pediatrician if you are nursing so they can be involved in monitoring for any potential issues.You should also familiarize yourself with the symptoms of Serotonin Syndrome, a fast-acting reaction which occurs for some people when they do not metabolize medication quickly enough. The build up results in a severe toxic situation. You should also avoid stopping any pharmaceutical therapy without consulting with a physician. Stopping suddenly can cause very negative symptoms similar to Serotonin Syndrome. If you have any signs or symptoms of Serotonin Syndrome, get medical help immediately.

For more serious cases of Postpartum Depression that do not respond to medication, Electroconvulsive Therapy may be suggested. ECT has come a long way since the 50’s and is a viable choice for many women who do not respond to medication. Now, I am not saying that if you choose not to take medication, you’ll be given ECT. This is for women with severe depression who cannot metabolize or do not respond at all to medication. Choosing not to take medication does not buy you an ECT ticket at all.

For women who want to use a more natural approach, there are a lot of choices. Again though, I have to urge you to make sure you are seeing a professional during your recovery. Don’t take something because it worked well for Aunt Martha. Check with your doctor and make sure it’s applicable to your situation and okay for you to take in combination with any other medication you may already be taking. Be sure your naturalist or herbalist is licensed and trained. You’ll also want to make sure that any herbs/natural supplements you are taking are compatible with breastfeeding if you are doing so. You can visit the blog over at Rebuild from Depression for a food/diet based approach.

Note: I had a reader, Steve, from Noblu.org leave a comment regarding IPT or Interpersonal Therapy. You can click here to read his comment. Thanks, Steve, for stopping by and sharing your knowledge with us!

As you can see, there are a lot of options available if you are diagnosed with a Postpartum Mood Disorder. More and more practitioners are becoming familiar with these disorders. More help is available today than even 6 years ago when I was first diagnosed. Remember to ask questions when choosing a therapist, advocate for yourself and what best fits your personal lifestyle philosophy. Don’t settle just because you want to heal. You have the power to say no. It’s your body, your mind, your say.

Tomorrow we’ll be discussing some things you can do on your own to help your recovery along. Stay tuned!

Sharing the Journey with Susan Dowd-Stone


As the immediate past President of Postpartum Support International, Susan continues to be committed to supporting women with Postpartum Mood Disorders through advocacy and treatment. Susan has been very encouraging towards the beginnings of my work and advocacy with Postpartum Mood Disorders which has been very meaningful to me. As President of PSI, she was aided in the development of a series of PSA’s with CBS that highlighted increased awareness of PPMD’s and has also been very active in support for The MOTHER’S Act. She maintains a private practice, Blue Sky Consulting as well as a website, Perinatal Pro.  Thank you for all your hard work and for being such an influential voice for so many women, Susan. We are fortunate to have such a wonderfully compassionate ally!

Susan, along with Alexis Menken, have put together a wonderful book, Perinatal and Postpartum Disorders: Perspectives and Treatment Guide for the Health Care Practitioner. This book offers a major resource for healthcare professionals, mental health professionals, and medical, nursing, psychology, and social work students who will be confronting this problem in their practices. The contributions, by renowned experts, fill a glaring gap in the knowledge professionals need in order to successfully manage maternal mental health. Click here to order.

Tell us a little about yourself – just who IS Susan Dowd Stone when she’s not advocating for women and families struggling with Postpartum Mood Disorders?

An empty nester, I enjoy teaching and clinical social work. I am ardently involved in the promotion of animal assisted therapy, i.e. exploring and demonstrating the curative powers of our animal companions in therapeutic settings. Through associations with Angels on a Leash and The Delta Society I have initiated and helped sustain AAT programs in hospitals. After the death of my canine partner,I began facilitating a pet bereavement program on a volunteer basis and writing a column on pet loss for the Animal Companion Magazine. Deeply mourning the loss of companion animals is sometimes viewed askance leading to another form of disenfranchised grief. Currently I evaluate teams of handlers and animals for hospital work and live with 3 spoiled dogs and a husband who completely enables this.

I see many human parallels in maternal animal behavior which has broadened my understanding of birth trauma. For example, I watched a show on HBO called “Weeping Camel” about a mother camel who had an excruciating breach birth. When her baby was born after two agonizing days, she rejected it. The movie focused on frantic efforts to effect that maternal infant bond, seemingly to no avail. Finally a shaman was called in to play soothing music while the baby was again brought to his mother. The moment of reunification was deeply moving. Yet, when human mothers suffer greatly during pregnancy, the birth process or its aftermath, we unrealistically maintain expectations of immediate maternal bonding and bliss.

How did you get involved in advocating for women and families struggling with PMD’s?

As a social worker in the Department of Psychiatry at Hackensack University Medical Center, I was charged with guiding the hospital’s implementation of the emerging, but not yet passed, NJ PPD legislative mandates. We initiated a free mother baby support group and invited every mother who gave birth at HUMC to attend. In addition, we developed a postpartum depression psychotherapy program for women identified or diagnosed with a perinatal mood disorder. As the programs facilitator I became more involved in the process and developed awareness of my own isolating experience with the illness, never acknowledged and never treated. I then became involved in a specialty peer group, was recruited by PSI to be their conference chair and then their president. The legislative work continues and I believe we will prevail.

Postpartum Mood Disorders are receiving more and more press coverage these days. Recognition and even treatment options have come a long way but in your opinion, what else needs to happen to improve the current atmosphere and attitude towards these disorders?

We need to spread the message that these are MEDICAL ILLNESSES with true biological underpinnings. It neither signifies weakness or strength if a woman does or does not develop a pregnancy related mood disorder. These disorders have no association to a woman’s character.  Such stigma is crippling to progress understanding and obscures our ability to appropriately respond. The only time we can surely associate character with PPD is through acknowledgement  of the tremendous bravery and courage it takes each woman to reach out and accept needed help.

We often encourage mothers to remember to take time for themselves. What is it that YOU do to recharge your batteries?

Top of the list is spending time with my “baby” girl Julia now 29. Like any proud mom, being in her presence brings incomparable joy which keeps me buzzed long after our lunches or conversations have ended.She’s a  an intelligent hard working entertainment news executive who retains her grace and tender heart. My husband and I hike, read and sometimes just watch the sky. We are easily entertained by simple pleasures.

I find great solace and restoration in nature and try to practice Mindfulness when stressed.  I am captivated by hummingbirds. Their population peaks in August when the babies start coming to the feeders; they do not know fear and will perch a foot away and watch you intently, a truly magical exchange. It reminds me that fear is a learned response. Their long migration every fall to Mexico and return to their same home each spring is profoundly wondrous natural mystery.

I am always interested in new and different therapies used in treating PMD’s. Would you share a little bit with us about EMDR as a type of therapy? What is the basic idea behind this therapy and who would typically benefit from it the most?

EMDR can be a powerful adjunct to psycho dynamic or CBT oriented therapy. It is an empirically validated treatment with solid research to support its application in trauma, but its mechanisms are not entirely understood. Theory postulates that stimulation of eye movement “loosens” traumatic memories held either by the body without conscious awareness, or stored in our brains’s trauma sector (the amygdala) where their reactivation can be stimulated by sights sound and smells associated with the original trauma. This may cause the victim to feel as if they are re experiencing the event and its accompanying feelings of terror and helplessness.

EMDR seems to enhance the conscious processing of such memories allowing analysis and sometimes rapid resolution of troubling symptoms when managed in a secure safe environment. EMDR is especially helpful in supporting recovery from PTSD including war and other disasters. Offered prior to  infant delivery it can help increase levels of tolerance and acceptance in  women who have suffered physical or sexual abuse in the past, or who are fearful about delivery. In addition, it can be helpful in the postpartum for women who have had traumatic birth experiences and are “stuck” in an endless loop of traumatic recollection.

I also use EMDR to “install” positive associations between achievement of new skills and feelings of mastery. As interpersonal challenges often accompany new motherhood, many women are motivated to choose different behavioral options to better parent their child. This offers mothers and clinicians alike a unique therapeutic opportunity to remediate long standing issues.

EMDR is not appropriate for women who are experiencing suicidal ideation, who evidence psychosis, or who are extremely anxious. It should always be offered within a supportive psychotherapy framework AFTER the mood has stabilized and works best in this context as an adjunct treatment to supportive therapy.

What is your philosophy regarding your approach to Postpartum Depression? How did you develop this philosophy?

First, that it is a medical illness with optimal recovery dependent on attention to biological, psychological AND social support issues.

Secondly,  NO TWO ILLNESSES or RECOVERY PLANS are alike. I am outraged when I hear someone discouraging a woman from doing what she, her doctor and her family feels will best help her recovery. The incredible guilt associated with these disorders is often unbearable, increasing and prolonging associated symptoms. Well meaning loved ones can make it worse by presenting comparisons and opinions which invalidate sufferers experience.

This philosophy was developed witnessing the agony of women who felt like failures if they were unable to live up to recovery or treatment expectations set forth by others – including practitioners!!! If one recovery plan is not working, we need a new plan… As one of my therapy icons Marsha Linehan of DBT fame says, clients don’t fail, but treatment can!!

What advice would you give to medical professionals who may come in contact with a mother who is depressed? What are some of the best things they could do for this mom? What should they not do?

If depression is identified at a medical visit, an immediate referral should be given for further assessment, along with respectful reassurance that the mother is “not alone, not to blame and with help she will be well!” (PSI’s motto). This simple early validation goes a long way to mediate a mother’s sense of fear, shame, failure and isolation.

Many medical practitioners do not want to be in the business of mental health as their training and practice may not have prepared them for this additional challenge. But developing a referral list of professionals with a specialty in maternal mental health is both doable and essential for obstetrical and pediatric practitioners. This could lead to greater likelihood of more rapid engagement in the recovery process.

No one should EVER say…”Don’t worry, You’ll get over it, this is normal, go home and enjoy your new baby!! Even if a physician has known their patient for 30 years, all bets are off when rapid emotional and hormonal shifts introduce new and powerful vulnerabilities. The moment for connection is then lost and the silent suffering resumes. Many solid homes that lasted through decades of natural wear and tear on the Texas coast couldn’t survive Hurricane Ike! But we don’t blame the builder!

I feel family support is essential to postpartum recovery. What can we do to foster family involvement in the recovery period?

While we are doing a better job of implementing social support for moms, how about support groups for partners? They often feel ignored in the process and may develop their own feelings of depression as dreams of parental bliss are challenged by a mystery illness claiming their partner while increasing their responsibilities. How about friends and family members who want to know WHAT TO DO. Women often ask me “Can you tell that to my husband, father, mother, sister??”  So I bring in the immediate circle who are often grateful for clear information about what is happening to their loved one and how to best support them.

Family and partners MUST be part of the recovery plan. The social work perspective tells us that without environmental (as well as psychological and biological) adjustments, stressors may continue which prolong the primary episode. My assessment always includes inquiry about what has always been important in this new mother’s life, what she has found comforting in the past. If she rates her spirituality at 10, we explore how to incorporate such options. It’s not just about focus on psychological dynamics, mothering skills and past and present relationships, but on reintroducing the uniquely individual environmental and emotional supports that make each woman’s life worth living.

What is it that you are most grateful for today?

The capacity to love and exchange ideas with others. Solid belief in God and country. Optimism.

And last but not least, if you had a chance to give an expectant mother (new or experienced) one piece of advice, what would you tell her?

Successfully parenting your child requires diligent attention to your own needs. Self care and self love are no longer optional and illusive concepts, but requirements of motherhood.