Week 9 Journal
Treatment of Postpartum Depression
Medications postpartum are also important to assess for safety. It is important for the provider to know if the patient is breastfeeding or bottle-feeding due to medications being excreted through breast milk to the baby. In this case the mother was breastfeeding. Antidepressants are used to treat postpartum depression and are excreted in breast milk, although the levels have been found to be very low. The mother has to decide of the benefits of the mediation outweigh the risk of the baby being exposure to the medication. In this case the patient agreed to take the medication. I suggested the patient be started on Zoloft 25 mg 1 tab by mouth daily – my preceptor prefers to start at the lowest dose and titrate up as needed (I only mention that because throughout my clinical experience I noticed postpartum women with PPD seemed to do better once increased to Zoloft at 50 mg daily but I understand the need to start low). I also offered to refer the patient to a counselor – she refused at this time but stated she would keep it in consideration. I informed the patient antidepressants take time to build up in the body and it can take 3 to 4 weeks before she began to feel better. I also discussed birth control options with the patient and she opted for the Mirena IUD. IUD to be ordered and patient informed she would be notified once the IUD was received from her insurance company to schedule an appointment.
Follow-up Care
The patient seemed was much calmer at the end of the visit. I offered as much support and encouragement as possible during the visit. I made sure I was sitting during this visit and that I was actively listening to the patient and validating her feelings. Creating a non-judgmental environment helps develop trust that women seek when discussing their private issues or feelings (Tharpe, Farley, & Jordan, 2013). The patient was scheduled to come back in two weeks to complete the 6 weeks of postpartum care but patient was informed she would be followed until she felt the Zoloft dose was at a therapeutic level.
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