Introduction
Postpartum depression is a form of depression in a woman who just gave birth to a child.
Many women feel guilty when they suffer of depression after a delivery. Everybody tells them how happy they should feel about having a new baby. However, the body chemistry in one person is not the same as in another. A mental illness can be triggered by an event like a delivery of a baby similar to other life stresses that can be a cause of depression. When saliva progesterone levels are measured in women affected by postpartum depression, quite often there is an extremely low progesterone level found.
Often postpartum depression will not happen right away, although sometimes it can happen only days after a delivery, but usually it takes a certain incubation time before postpartum depression becomes clinically apparent.
The reason this condition is so important to recognize is that in the extreme case a woman can develop a suicidal tendency or even become homicidal regarding the baby.
The tragedy in cases like this is that the depression disorder can easily be treated with psychotherapy and antidepressant medication.
Often there is a past history of depression in a woman who comes down with postpartum depression. Therefore, a woman who had a history of depression should be particularly carefully monitored for postpartum depression after a delivery. It occurs in women with a frequency of about 1:500 or 1:1000 deliveries. A certain percentage of these present with a psychotic depression, which needs to be treated in a psychiatric hospital.
Postpartum Depression
Treatment
Postpartum depression is treated with antidepressants, particularly with paroxetine (brand name: Paxil) rather than Prozac. Studies with lactating moms who had postpartum depression and were treated with SSRI antidepressants have shown that the paroxetine level was lowest in breast milk.
Dr. Shaila Misri, a psychiatrist at the Women’s Hospital in Vancouver, reported that the level of paroxetine is highest about 7 to 8 hours after taking the antidepressant pill. This breast milk should be discarded. However, at all the other times it is safe to nurse the baby.
However, she found also by measuring the babies’ blood levels that the woman should feed the foremilk (the initial milk when the baby feeds), but she should discard the hindmilk (the late breast milk towards the end of a feeding) (Ref. 3). Treatment needs to be carried on until the mood disorder stabilizes, which is commonly after 6 to 12 months.
With a subsequent pregnancy there is a 30% to 50% chance of postpartum depression again.
Bioidentical progesterone replacement
Some studies have shown that 100mg to 200 mg of Prometrium (=micronized, slow release progesterone) given at bedtime will stabilize the mood. It appears that woman who develop postpartum depression are the ones whose placenta did not produce enough progesterone during the pregnancy and their ovaries and adrenal glands also do not produce enough progesterone at that time, so it makes sense that the physician helps along by replacing with bio-identical progesterone (Ref. 11 and 12).Often the best treatment could be a combination of both (antidepressant and progesterone), but the caregiver needs to judge what is the best treatment option for his/her patient.
References:
1. Dr. David Burns: “Feeling good –The new mood therapy”, Avon Books, New York,1992.
2. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV),American Psychiatric Association, Washington,DC,1994.
3. Dr. Shaila Misri at the 46th St. Paul’s Hosp. Cont. Educ. Conference, November 2000, Vancouver/B.C./ Canada.
4. JM Loftis et al. J Neurochem 2000 Nov 75(5): 2040-2050.
5. B. Zilbergeld et al. “Hypnosis – Questions& Answers”, W.W. Norton & Co, New York,1986: 307-312.
6. MH Erickson & EL Rossi:”Hypnotherapy, an exploratory casebook”, Irvington Publishers Inc., New York, 1979: chapter 8, 314-363.
7. G Steketee et al. Compr Psychiatry 2001 Jan 42(1): 76-86.
8. DS Mennin et al. J Anxiety Disord 2000 July-Aug 14(4): 325- 343.
9. J Hartland: “Medical &Dental Hypnosis and its Clinical Applications”, 2nd edition, Bailliere Tindall,London,1982, page: 326-336.
10. Merck Manual: Postpartum Depression (thanks to www.merckmanuals.com for this link)
11. Dr. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. On page 253 and 254 he describes how progesterone can be used as a cream to treat estrogen dominance.
12. Dr. John R. Lee: Natural Progesterone- The remarkable roles of a remarkable hormone”, Jon Carpenter Publishing, 2nd edition, 1999, Bristol, England.
