How to help my daughter, 26 with postpartum depression?

Question

Hello doctor,

My 26-year-old daughter has been struggling with major depressive disorder since high school, but it has gotten much worse after experiencing postpartum depression following the birth of her son eight months ago.

She was on Sertraline during pregnancy but had to increase the dose to 150 mg after delivery because her symptoms became so severe. Her depression makes it difficult for her to bond with the baby, and she constantly feels guilty about not being a good mother. She tried therapy but says it does not help, and she has missed several appointments because even getting out of bed is too difficult.

Her sleep is completely disrupted; sometimes she cannot fall asleep at all, and other times she sleeps for more than 12 hours but still feels exhausted. She stopped breastfeeding because the antidepressant was making the baby fussy, and that made her depression worse.

Her psychiatrist now wants to try adding Bupropion, but she is worried about taking multiple medications while caring for an infant. Her depression has also affected her appetite, and she has lost 20 pounds since delivery.

Her husband works long hours, so she spends most of the day alone with the baby, which worsens her symptoms. We are worried because she often talks about feeling hopeless, and I am scared she might hurt herself. Is ECT treatment safe for young mothers in her condition?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I can hear how difficult this has been for your daughter and for you as her mother. From what you have described, she is experiencing severe postpartum depression, and her risk is high given her hopelessness, weight loss, disrupted sleep, and difficulty bonding with her baby. It is very important that her psychiatrist is aware of the severity of her symptoms and the concerns about her safety.

About ECT (Electroconvulsive therapy):

ECT is considered a safe and effective treatment for severe depression, including postpartum depression, especially when medication and therapy have not helped or when there is a high risk of suicide.
It does not harm the baby since the treatment is given directly to the mother, and it can often work faster than medications.
The main side effects are short-term memory issues, headaches, or temporary confusion, but these usually improve after the course is complete.

Other important points:

Taking more than one antidepressant (such as Sertraline with Bupropion) is common in treatment-resistant depression and can be safe under a psychiatrist’s supervision.
Since she is no longer breastfeeding, medication choices are broader and safer.
She needs strong support at home, having someone else care for the baby during her most difficult times, and helping her attend appointments is very important.
Encourage her to avoid isolation. Even short visits from friends, family, or a support group for mothers with postpartum depression can help reduce guilt and loneliness.

Please let her psychiatrist know right away about her suicidal thoughts. If she expresses any intent to harm herself, take her to the emergency department immediately.

ECT is safe for young mothers and may be a good option if her depression is not improving with medication and therapy. Acting quickly will give her the best chance to recover and bond with her baby.

I hope this has helped you.

Please feel free to reach out to me again if you have further queries.

Thank you.