Question:

My daughter has suffered from PMS and depression for more than 20 years and gets very bad mood swings. She is able to conquer the world one day but is in despair the next. She's been on Zoloft for about 17 years gradually increasing the dosage to 250mg as she had bad post-natal depression with her pregnancies. She saw a counsellor each time.

Since the birth of her third baby four months ago she seems to be getting more and more depressed. She says the Zoloft doesn't seem to work anymore. I am also on Zoloft and depression runs in our family. She saw a GP last week who told her she's "not trying hard enough and to think of all the people in the world worse off than her". The GP also told her she shouldn't be on Zoloft.

She is, as we all are, is more confused than ever about what she needs to do. Her moods are up and down like a yoyo each day and seem worse than ever during her PMS cycle. She has a very supportive husband and family and she keeps saying she doesn't want to be like this. Any help would be greatly appreciated.

Answer:

It must be rough on your daughter to experience these repeated depressed moods, especially when she has a new baby in the house. She's lucky to have the support of her husband and family, including you, of course.

Nonetheless, now of all times, she needs the best help she can get for her mental as well as physical health. This includes seeing a GP who fully understands the treatment and support options for depression and for any hormonal and other changes to your daughter's body associated with having a baby.

The doctor also needs to understand the interaction between these two "conditions". Telling someone with depression, "Think of all the people in the world worse off than you", does not suggest that this doctor is going to be especially sensitive to managing this condition.

If your daughter feels she is not receiving the best understanding and treatment from her current GP, then she should discuss this with them, and even consider changing to a different doctor. There may be another one in the same practice who specialises in this area, for example, or your daughter's maternal healthcare professionals may be able to recommend someone else not too far from where she lives.

A new GP could conduct a thorough physical and mental health examination, review her medical history, and then prepare a mental health plan with her. This could include referral for psychological treatment as well as any medication prescribed, whether Zoloft or another antidepressant.

For more information, you can call the SANE helpline from anywhere in Australia on free call 1800 18 SANE (7263) or visit www.sane.org.