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The year of 2012 was a rough one for Port Elizabeth working mom-of-two Marecia Jacobson*. “In fact, rough doesn’t begin to cover it: my husband was retrenched, my son was hospitalised several times for his asthma, and the ‘easing-off’ period that everyone told me would come when both kids were old enough for nursery school never came,” she says. Marecia wasn’t surprised then when, by the time September rolled around, she’d joined the ranks of her friends who were on antidepressants (ADs) for mild depression.
What did surprise her, however, was the manner in which the drugs were prescribed. “It was so slapdash and rushed that it only hit me after I got home from my appointment that my GP hadn’t even discussed my options with me. She literally didn’t give me one alternative. I didn’t doubt the diagnosis of mild depression – I’d read enough about the signs that I was pretty sure this would be the outcome of the appointment – but I did doubt the treatment plan.”
An easy answer?
And it’s not just those on the patient side of the doctor/patient relationship with this doubt: with an estimated one in four women worldwide – many of them mothers – on ADs, two mental health practitioners (both of whom spoke to Your Baby on condition of anonymity) said they fear we’ve already reached the point where too many anti-depressants are being prescribed. “To be clear, I’m not talking about mothers suffering from severe depression and who are under the care of a psychiatrist who’s treating them with a multi-pronged approach,” said one. “In these cases, there’s clearly far less of an issue with overprescription. Rather I’m talking specifically about women with mild, situation-appropriate depression who could really stand to gain from lifestyle changes, a change in the care dynamic at home (so mom isn’t the only one feeling responsible for the wellbeing of the children), and some short-term therapy.”
The blame game
But, they say, doctors aren’t the only ones who need to take the fall for this problem. “Think of how you are when you go to the doctor with a raging fever – you want antibiotics, end of story, and not the more appropriate course of treatment, which is bedrest. The same goes for a mom coming in displaying the typical signs of mild depression. She doesn’t want me to tell her to exercise more, to ask her partner for more help, and to load her diet with fresh vegetables that are packed with essential vitamins. A lot of the time she feels that her family can’t afford for her to have any downtime, so she wants something that’ll give her a noticeable difference in a week’s time – not in a month’s time.”
Marecia doesn’t dispute this – in fact, she says she probably would have given her doctor a vicious look had she suggested she just “pop” 30 minutes of exercise into her already packed daily schedule that includes school lifts, a full-time job, housework and cooking for her family. “Unless she’s willing to personally look after my kids while I pack a bag, drive to the gym, exercise, shower, and drive home, it’s just not going to happen,” she insists.
So what's going on?
This burden can quickly spiral into a vicious cycle: mothers suffer from mild depression because of the stressors placed on them, but then can’t conceive of following a treatment plan that involves any more time than popping a pill with their first cup of coffee in the morning because of these same stressors. So, more women than men end up taking ADs not because they need them more, but because they feel unable to either stave off the stressors in the first place, or to deal with them in a time-heavy manner.
“From the doctor’s side, we also have limited time with each patient – especially in the public sector, but also in the private sector – so discussing alternatives and really going into the possible side effects falls by the wayside,” explained one of the GPs we spoke to.
Time for change
In the end it was a potential side effect that jolted Marecia – and it wasn’t the side effect she’d been expecting. “I was waiting for the weight gain, but a few weeks after I collected my prescription I followed a link a baby group posted on Twitter, and clicked on the horror story of the New York nanny who killed two of the children she looked after. “The story Marecia refers to is the one that made headlines around the world: Marina Krim returned to her upmarket New York apartment with one of her three children to find her two other children dead and their nanny, Yoselyn Ortega, stabbing herself. Soon after the attacks, relatives came forward claiming that ever since starting a new anti-depressant, Ortega had seem disorientated, distressed, had been “acting differently”.
“I fully accept that this could be speculation, and that the ADs could have had nothing to do with the horrendous attack. But I couldn’t risk it. I think more than anything it just made me realise that I hadn’t taken any responsibility for interrogating my doctor with her proposal. I should have asked, ‘Why is this the best treatment route; what else can I try first?’” While cases such as the nanny murder are rare, other potential side effects are well-known. These include anxiety, sexual dysfunction, weight gain, and insomnia. Again, all issues that can act as further stressors for a harried mom. “I went back to my doctor because I was bit worried about just stopping the drugs cold turkey, and instead started cognitive behavioural therapy (CBT),” says Marecia. “It’s taken a fair amount of shifting of schedules and reorganising household responsibilities, but that’s also a good thing – since when did having a vagina mean I’m the one who has to cook dinner and drop the kids at school?”
On the flipside
The alternative treatment plan that Merecia stumbled upon has been shown to work – and not just for moms, but for their children too. In a study undertaken by Carol Weitzman, an associate professor of developmental-behaviour paediatrics at Yale University School of Medicine, at-risk women whose depression was affecting the behaviour of their children were split into two groups. The control group was given support from a social worker and were helped with referrals to other support mechanisms, while another group had six two-hour CBT sessions. Both groups reported a vast improvement in their depression, and the CBT group in particular “significantly reduced their ratings of problem behaviour in their young children”.
Both mental health professionals we consulted stressed that ADs have their place – “this is undeniable. But what’s also undeniable is that there are other options which are just not employed enough, end of story.”
*Names changed
The alternatives
Here are four alternatives to antidepressants, which can be tried one at a time or in conjunction with one another. As always, Your Baby recommends consulting your doctor before ceasing any medication.
1. Support
This is where the success of all alternative-to-AD treatments lie, because without support you simply aren’t going to be able to find the time or, in some cases, money to implement them. Identify what’s stopping you from a time-dependent treatment: is it that you rush from home to work and back home again, barely having time to fling the kids into the bath and dinner into the oven? Is it that you’re too tired to think of anything but sleep once this is done? Once identified, resolve to find a solution: if your partner takes your kids to school, can you have a weekly therapy session early in the morning? If your domestic helper prepares dinner twice a week can you fit in a gym session? If you make a strict no-electronics-after-6pm rule, can you fit in an extra hour of restorative sleep? Remember that vicious cycle – you might be depressed because of various stressors, and yet you can’t treat them because they exacerbate these stressors– and vow to break it.
2. Exercise
Studies have shown that women who suffer from mild depression often get better long-term results from 30 minutes of exercise a day than from antidepressant medication. That high you get after sweating isn’t just imagined: exercise alters serotonin levels in the brain, leading to an improved mood and feelings of wellbeing. Can’t find the time? Remember point one above.
3. Cognitive behavioural therapy
For Marecia (a mom using alternatives to anti-depressants becaue she is wary of the potential side effects), cognitive behavioural therapy (CBT) worked because it focused on things that were frustrating her now and gave her solutions she could implement. “I also like that it had a fixed life-span – I didn’t have to worry that I’d still be paying for therapy in two years’ time, when I’d be no closer to a resolution.” Studies back up Marecia’s experience – numerous published results have shown CBT to be as effective as antidepressant medication.
4. Vitamin B therapy
Whether it’s a daily Vitamin B tablet or a course of Vitamin B injections (available at most pharmacies), B vitamins play a vital part in mood regulation as they are partly responsible for the production of certain neurotransmitters.
