For millennia, physicians from all over the world have been documenting and have recognized the condition that we know today as postpartum depression (PPD). Still, even with hundreds of years of study, this condition is still relatively mysterious to the medical profession. There is no other event that affects the female body as extensively as pregnancy and childbirth. The physical, mental, and hormonal changes involved can have significant, even disastrous effects on the mental and emotional state of the woman who goes through them. Of all women who conceive, up to 32 percent actually consider altering their plans for future children, due to the depressive episodes experienced in the course of their pregnancy.
With or without conception, 20 percent of women will still suffer from depression at some point in their lives. Many seek treatment on their own, but up to 50 percent may go totally unrecognized and therefore untreated. Recognizing and treating depressive disorders during both pregnancy and the postpartum period is absolutely essential to ensure the healthy outcomes of both the mother and infant.
Postpartum depression is identified as a major depressive disorder that has its onset in the postpartum period. It is a major depressive episode that usually begins within the first four weeks following the birth. It can vary wildly in both severity and duration. Symptoms of postpartum depression can include fatigue, changes in appetite or sleep, dysphoric mood, loss of interest in activities that one used to enjoy, psychomotor agitation or retaliation, recurrent thoughts of death or suicide, feelings of worthlessness or guilt (especially in relation to ones ability as a mother), and excessive anxiety over the health and/or wellbeing of the child.
Postpartum psychosis is an even more severe postpartum syndrome. Its onset is usually within the first three weeks following delivery, and often occurs within mere days. Most episodes of this disorder are related to a psychotic condition of bipolar disorder or major depression. Symptoms of postpartum psychosis include delusion and hallucinations, rapid mood swings ranging from depression and irritability to euphoria, sleep disturbances and obsessive thoughts about the baby. The risk of death postpartum psychosis is high; up to five percent of afflicted mothers attempt to commit suicide, and up to four percent of women with postpartum psychosis may attempt infanticide.
Postpartum psychosis is a psychiatric emergency and warrants hospitalization. The prognostic implications are much different from postpartum depression; nearly two-thirds of these patients will suffer subsequent non-puerperal psychotic episodes.
Whatever the manifestation or severity, postpartum mood disorders are common. Nearly 40 percent (or more) of women experience them in some form. Psychiatric hospitalization within the first three months after the birth of a child occurs seven times more often than at other times in a woman’s life.
A traditional approach to therapy in this condition generally involves either psychotherapy or the use of antidepressant medications. In 1988, Dr. Katherina Dalton shared her long experience with the use of progesterone in the treatment of postpartum depression. She further seemed to think that postpartum depression was a very common problem, but this was surprising, as in our own clinical experience, this condition has actually been very rare. The incidence of postpartum depression is only 2.1 percent, and at the time it was thought that progesterone support during pregnancy was common in high-risk pregnancy population, could have had an effect on the overall incidence of postpartum depression in patients.
These discussions led to an interest in the use of progesterone support specifically for the treatment of postpartum depression. We then undertook studies to understand the role of progesterone therapy as a possible treatment course for women with PPD.
As a treatment of postpartum depression symptoms, progesterone can have very dramatic effects. When progesterone was used, the effect the levels of depression, fatigue, crying, anxiety, helplessness, strange thoughts, poor appetite and night sweats in patients were all statistically highly significant. In fact, the incidence of these symptoms decreased significantly.
In addition, the average number of symptoms most patients experience is much higher before progesterone therapy. The number of symptoms experienced prior to progesterone therapy was 7.57, and this decreased after progesterone therapy to only 2.1.
The use of progesterone therapy has multiple advantages. First, it is rapid in onset. Many of the symptoms are lifted within literally minutes or hours after the first injection of progesterone. Secondly, over 95 percent of patients respond positively. While progesterone therapy is not commonly used by obstetrician-gynecologists, (mostly because of their lack of awareness of the effectiveness of progesterone in this situation), it is absolutely an incredibly effective and safe treatment. It far exceeds the effectiveness of either psychotherapy or antidepressants, and should be considered a legitimate and viable option in the treatment of postpartum depression.
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