Treatment Options for Perinatal Depression/Anxiety
About 10% of women will have thyroiditis during the postpartum period. Thyroid disorders can cause anxiety and depression. In order to rule out thyroiditis, a thyroid test (free T4, TSH, anti-TPO, anti-thyroglobulin) is recommended after six months postpartum if the woman is experiencing symptoms of depression or anxiety.
Lowering Inflammation: Key approaches
Recent research has linked PPD/anxiety and other perinatal illnesses with increased levels of inflammation in the body. Inflammation levels generally rise at the end of pregnancy and chronic stress before, during, or after pregnancy can significantly increase inflammation leading to symptoms of depression and anxiety. The below treatments, including psychotropic medication, help to lower inflammation levels.
Deficiencies in major vitamins and minerals can cause symptoms of depression and anxiety. Continuing to take a high-quality food-based prenatal vitamin can help rule out this potential underlying cause. Ask your healthcare provider to test your vitamin D levels as low levels of this hormone can greatly influence mood. Omega-3 fatty acids have been shown to prevent and treat mild to moderate depression and anxiety in perinatal women at a dosage of 1000-3000mg combined DHA and EPA, and are considered safe for nursing. Some practitioners may recommend up to 9000mg depending on severity. They can be used along with psychotropic medications safely.
Social support in various forms has been shown to both prevent and mitigate the symptoms of PPD/anxiety. PPD support groups usually offer education and resources on her symptoms or mood disorders and often friendships formed in these support groups last for a long time. Usually babies are welcome in these groups. For a list of nationwide support groups contact Postpartum Support International at www.postpartum.net or 805-967-7636.
It is very important that a mother with symptoms of perinatal mood or anxiety disorders seek treatment from a therapist who specializes in treating pregnant and postpartum women or who is willing to get educated about these issues. A therapist who is well connected to the perinatal professional community should be a member of one of the major organizations that serve perinatal women, such as Postpartum Support International (www.postpartum.net or 805-967-7636). Postpartum depression is different from other types of depression. In fact, the term “Postpartum Depression” is used very loosely to also include postpartum anxiety, panic disorder (panic attacks), posttraumatic stress disorder (PTSD), and postpartum OCD (obsessive-compulsive disorder). The postpartum mother should ask the therapist what type of therapy the person would use. Research has shown that cognitive-behavioral and interpersonal psychotherapies are the most effective modalities to treat postpartum depression.
Recent research also supports the use of acupuncture, bright light therapy, and yoga as effective treatments of mild to moderate depression in pregnant and postpartum women. St. John’s Wort, has been shown to be effective in treating mild to moderate symptoms in postpartum women but warrants further research on safety during pregnancy. Other approaches include amino acid therapy. Both 5-HTP and SAM-E are evidenced based treatments for depression and anxiety and do not require a prescription. Like many anti-depressants, they have not been well studied in nursing women. Ask your healthcare provider for more information.
Postpartum doula care, exercise, massage, homeopathic remedies, chiropractic, hypnotherapy, and nutritional support are all being studied for effectiveness in prevention and treatment and are often helpful options for women to consider as they tailor a treatment plan unique to them. Women should always check with their healthcare provider for safety, as some herbs and illegal drugs can cause serious damage to both mother and infant. Often alternative therapies can complement counseling and/or medication when provided by a licensed healthcare professional.