Professor Jayashri Kulkarni, from the School of Psychology at Australia's Monash University, found that "women using the pill had an average depression rating scale score of 17.6, compared to 9.8 in the non-user group. The women involved in the study were aged over 18, not pregnant or lactating, had no chemical history of depression, and had not been on anti-depressant medication in the previous 12 months." Subsequent research conducted by www.aphroditewomenshealth.com found that "57 percent of respondents reported mood swings, and 69 percent felt anxious and depressed after taking hormonal contraceptives. Over 50 percent of respondents who were taking anti-depressant medication were doing so to treat depression that occurred after beginning hormonal contraceptives."
Each year hundreds of thousands of women experience pregnancy and postpartum imbalance (commonly referred to as perinatal mood disorders). In conventional medicine, these disorders range from mild hormone-related mood disturbances known as the "baby blues" to a spectrum of perinatal mood and anxiety issues. As a holistic health counselor, I prefer to use the term "imbalance" instead of "disorder" for the simple fact that these issues are temporary and treatable. For example, biochemical imbalance (hormonal, neurochemical, nutritional) inhibits our body from manging stress and experiencing positive moods. When a new mom get's proper treatment in these areas, she becomes more balanced so she can meet the challenges of new motherhood with grace and ease.
As a mom who has healed many of these imbalances myself, I know that the terminology used can be a bit frightening and stigmatizing but it's important to know the terms so you are familiar with them when you speak with a licensed medical doctor. Think of them simply as words to help doctors communicate instead of labels. If you don't buy into the labels, they won't.
The terms most commonly used to describe this spectrum are: antepartum depression and anxiety, postpartum depression, postpartum anxiety, postpartum OCD, postpartum psychosis and postpartum post-traumatic stress disorder. Symptoms begin as early as pregnancy and can first appear any time in the 12 months after birth.
One thing I know from first hand experience is that postpartum imbalance is temporary and treatable when a new Mama seeks the help of trained physicians (Functional Medicine is particularly important), holistic health care providers and soul centered therapists who specialize in postpartum imbalance. However, many women do not get the treatment they need because they are looking for help in the wrong places. There is a misconception that every OB/GYN or physician will know how to promote healing in this area. Many new mothers are baffled that their own doctors don't know how to help them partly because there is very little detail about it in medical and nursing books so it's neglected in medical schools. And because there is so little training, OB/GYNs don't know how to properly diagnose it. Even worse, some are so misinformed that they don't think it's serious until a woman threatens suicide. Don't let this happen to you. If you feel your doctor is dismissing you, seek out a specialist immediately.
Until a mom can get to a postpartum specialist, I suggest she write the following intention down on a piece of paper: "I am safe, I am not alone. I will regain my balance and feel like myself again. I am receiving loving care and effective treatment as I partner with a postpartum specialist to heal any imbalances so I may become reclaim my magnificent self."
DEFINING PERINATAL IMBALANCE
According to A Natural Guide to Pregnancy and Postpartum Health by Dean Raffelock, D.C., Robert Runtree, M.D., and Virginia Hopkins and Melissa Block, the scientific consensus is that postpartum depression (PPD) is multifactorial, which means there are many variables - hormonal, psychological and neurochemical. These factors share one important and commonly overlooked characteristic: The balance of each of these systems relies upon proper nutrition. If the nutritional building blocks that the body needs to make hormones, neurotransmitters, and other mood-altering body chemicals are not present in adequate amounts, mood and physical health can both be compromised." And since the mind and body follows spirit, we must start healing at the spiritual level.
Although you'll read countless articles and books that say we don't know what causes these imbalances, I'm here to say that we do! Research shows perinatal imbalance is likely to result from a combination of three factors: biological, psychological and social. This is referred to as the biopsychosocial model. Another way to simplify this is to say that Perinatal Imbalance is likely to result from a combination of factors relating to Mind, Body & Spirit or what I like to call the biopsychosocialspiritual model:
Mind (psychological, emotional)
Body (biological, biochemical, nutritional, hormonal, neurochemical)
Spirit (energy, connections to society, source and self)
The key in treating perinatal imbalance is to find caregivers who can do 3 things:
1) Screen for risk factors.
2) Provide a comprehensive assessment.
3) Co-create a multifaceted biopsychosocialspiritual treatment plan that identifys the spiritual, psychological, biochemical, nutritional, hormonal and/or lifestyle support a new mother needs.
The key for us as Mothers is to commit to the spiritual journey back to the self - to become empowered and enlightened! To MPOWER-UP and ENLIGHTEN-UP! We MPOWER-UP when we become informed. When we become informed we can make wise empowering choices. (For more info check out our MPOWER-UP and FAST FACTS pages)
SPECTRUM OF POSTPARTUM EMOTIONAL REACTIONS
Nutritional, hormonal and neurochemical imbalance can affect women differently. Below are a list of symptoms compiled from (I'm Listening: A Guide to Supporting Postpartum Families, www.postpartumprogress.com, www.postpartumhope.com) and my personal experience working with Moms):
Antepartum Depression or Anxiety (13%-15% Moms / Onset Pregnancy) "I'm so afraid"
Sadness and unusual weepiness, lethargy, anxiety, insomnia, fear of pregnancy, low appetite, rumination, regret, intense fears.
Baby Blues (60-80% Moms / Onset within first 2-3 weeks) "This is hard - I'm overwhelmed"
Crying, irritability, anger, insomnia, exhaustion, tension, anxiety, restlessness.
Normal Adustment to change and Marathon of Motherhood: Crying/tearfulness, irritability, anger, sleep disturbance, fatigue, dysphoria (sadness), appetite changes, loss of interest in formerly favorite things/activities, anxiety, emotional lability (moodiness), feelings of dout, postpartum exhaustion (denial of depression/anxiety, feeling over-whelmed, unable to sleep/rest, head or stomach aches)
PostPartum Depression (10-20% Moms / Onset within 1st year) "I can't do this - I will never be able to do this." Mama's feel hopeless and trapped and want to run. (This is a worsening of baby blues or normal adjustment symptoms) depressed feelings that don't go away no matter what one does, feeling sad most of the day, more days than not, no energy-tired all the time, frightening feelings and thoughts, over-concern or no feelings for the baby, exaggerated anger or frustration, even over little things; these feelings targeted at baby or spouse, feelings of inadequacy (feeling like a failure most of the time), inability to cope, guilt, helplessness, hopelessness -see no hope of things will get better in the future, lack of interest in sex in spite of physically "being ready" to resume sexual relations, inability to enjoy things one used to enjoy, exaggerated highs or lows, inability to sleep even when the baby is sleeping, no appetite, no enjoyment of food or constant cravings and compulsive overeating, feeling that one would be better off dead than feeling this way, suicidal thoughts.
Postpartum Anxiety or Panic (10% Moms / Onset Any time first year) Rapid heartbeat, temp fluctuations, feeling of dread and apprehension, insomnia, dizziness. Comon fears: goin crazy, illness, losing sight or ability to breathe. Fear of being alone. Fluctuates in intensity and frequency.
Postpartum OCD (3%-5% Moms / Onset Pregnancy through first year) Repetitive and intrusive images, thoughts or fears that are disturbing or abhorrent to the mom. Anxiety about specific places (open spaces seem to trigger this) or activity, ritualized avoidance or compulsive controlling behaviors. Repetitive fears about health and safety.
Postpartum Psychosis (.1%-.2% Moms / Onset Birth-12 months) Hypomanic or manic symptoms, delirium, periods of delusional thought, possible auditory or visual hallucinations. Suspiciousness, withdrawal. May be denial of birth or glorification of baby.
Post Traumatic Stress (1.5% - 6% Moms / OnsetPregnancy through first year) PTS can result from anything that is 'experienced' as life-threatening. Symptoms are: Anxiety, panic, or intrusive thoughts related to specific event (e.g., birth or past trauma.) Recurrent images or nightmares, fears, ruminating, withdrawal and anger. Dissociation and depersonalization.
MAJOR RISK FACTORS
Baby Blues: History of premenstrual depression
Postpartum Depression: 50-80 percent risk if mom had a previous postpartum depression, clinical depression or significant anxiety during pregnancy, personal or family history of depression or anxiety, abrupt weaning, social isolation, poor social support, history of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), mood changes while taking birth contrl pill or fertility medication, thyroid dysfunction.
In an ideal world, when you become pregnant, your doctor or midwife would ask you for a health history to identify whether you are at high risk for Postpartum Depression. And, if needed, test you for nutrient depletion, brain neurotransmitter and hormonal imbalance to identify what kind of nutritional, hormonal or lifestyle and emotional support you will need. They will will have resources available: mental health professionals with postpartum training, contacts at family support agencies and organizations, information about free self-help support groups for pregnant and postpartum families and childbirth educators/Doulas/Mother Coaches to help create postpartum plans for practical and emotional support. In the real world however, that doesn't always happen. This is why we must become our own advocate starting in pregnancy. That way, even if we don't have the perfect practitioner, we can prompt them to provide us with optimum health care now so we don't pay later!
For example: We know now that we can screen for stress hormones at 25 weeks of pregnancy to head off adrenal imbalance, a major factor in postpartum depression because many hormonal imbalances are the direct result of Adrenal insufficiencey. Recently a study (conducted at the University of California, Irvine) suggested that postpartum depression is the result of hormonal imbalances. Is this new information? No, there are countless doctors, books, research that point to hormonal shifts as a factor in postpartum depression. However, this study is the first of its kind to associate CRH (Corticotropin-releasing hormone) with postpartum depression and recommends that a routine blood test be performed around the 25th week of pregnancy in order to assess the risk of developing this condition. And this gives us leverage to request the test when we need it!
The study said that Stress induced hormone release is considered normal when the brain discharges minute amounts of Corticotropin-releasing hormone, or CRH, to help the body cope with stress. During pregnancy, however, the brain could potentially release copious quantities of CRH to help the mother during labor and thereafter drastically reducing the production of this hormone by contrast. This sudden rise and fall of hormonal levels can cause the endocrine system to behave abnormally and create havoc for the mother during the postnatal phase. CRH is also known to trigger a surge of activity in the pituitary and adrenal glands, resulting in an unusually high output of the stress hormone, cortisol. Abnormal levels of stress hormones produced by an endocrine system out of balance can lead to conditions such as anxiety/depression. (see also Hormones 101) Important to note, according to studies, the brains of suicide victims, upon examination, revealed elevated levels of stress hormones.
Mama's are a tricky bunch when we have postpartum depression and many of us won't volunteer to let our doctors, friends and family know what we're going through. In fact, Childbirth Connection's 2008 report found that 3 in 4 mamas with depressive symptoms had not consulted a professional about health problems. This happens for many reasons. Understandably, we're scared and confused and it's hard to articulate everything that's happening. We may not understand our treatment options and fear separation from our babies during treatment. We may be in toxic relationships that don't provide a safe place for us to share what is really going on for us or we are being told it's all in our head and to snap out of it. On a financial front, we may not have the resources to handle healthcare issues. And the list goes on and on. For this reason doctors have the added responsibility of asking the right questions and one of the best ways to do this is with the thoroughly validated screening tools available, such as the Edinburgh Postnatal Depression Scale.
Well informed Doctors know that a mother requires a full 12 months to recover from the rigors of pregnancy and birth and that maternal mood imbalances can occur anywhere in the first year or more. In fact, many new mothers, biological and otherwise, are chronically malnourished. Nutritional deprivation can become part of a vicious cycle of broken sleep patterns, lack of appetite and poor nutrional intake and assimilation.
Misinformed but well meaning Doctors may have been taught that postpartum mood imbalnce only happens within the first 3 months. If your Doctor says this to you and refuses to test your hormones and treat you holistically (Mind, Body, Spirit), it's time to find someone who can. Doctors of Functional medicine, Midwives and OBGYN's and Physician Assistants who also specialize in Postpartum Mood Disorders will be a great place to start.
According to Penny Simkin, a leader in the childbirth education movement, Postpartum recovery has taken place when the following items below have been accomplished. I have added a few in pink that I believe are important (For More Info Check Out Our Self Nurturing Plan Page):
Maternal physical factors relating to pregnancy and childbirth are normal or nearly so, such as: all incisions or lacerations have been healed; involution is complete; feeding - breast or bottle - is well established; adequate sleep is occurring regularly; and all physiological systems are functioning well. Mothers should be receiving optimal nutrition, exercising regularly, practicing self-care and nurturing and taking part in activities that provide spiritual upliftment and joy.
Maternal psychosocial factors are normal, or nearly so, such as: support system is adequate and functioning well; relationships with father/partner and extended family are positive; mother's emotional state is normal and stable; mother-infant attachment indicators are positive; and mother is ready and able to resume some pre-pregnancy interests and activities.
Infant development and temperament factors are healthy and normal. The infant is: thriving physically; responsive to parents' attention; suckling well; consolable, sooth-able; able to give cues to indicate some needs; and is successfully integrated into the family."
A Natural Guide to Pregnancy and Postpartum Health by Dean Raffelock, D.C., Robert Runtree, M.D., and Virginia Hopkins and Melissa Block
Postpartum Recovery and Adjustment: A Definition (handout), Penny Simkin, 2000
I'm Listening: A Guide to Supporting Postpartum Families, Jane I. Honikman, M.S.
Depression may be expressed in any number of ways such as increased irritability and dissatisfaction, withdrawal from others, crying spells, moodiness, nervousness, anxiety, unwillingness to get out of bed in the morning, tiredness, insomnia, headaches, muscle aches and pains and/or palpitations. Depression may also be expressed through "sudden" anger and aggressive behavior.
Depression has become so widespread, particularly in the U.S., that Europeans call this country the "Prozac Nation". It is very common for those with symptoms of depression to turn to antidepressants. It is not unusual for women to experience mild depression before or during menses, after childbirth or through peri/menopausal years.
In Traditional Chinese Medicine (TCM), there are actual physiological causes for depression that can be treated and improved. Thus, it is important to determine and correct the root cause of depression. While there are many patterns and causes for depression like hormone imbalance, deficient Kidney chi due to chronic stress, pregnancy and childbirth, in TCM, the most common is stagnant Liver Qi. Just as a tree spreads out freely in all directions, so does the Liver promote unrestrained and regular movement of Qi and Blood throughout the body. In its ideal state, Qi flows smoothly and disperses and circulates freely. When imbalanced, its flow is irregular and Qi doesn't flow smoothly, evenly or in the right directions. This can occur in anyone - male, female, young, or old - but because the Liver is so intimately involved with women's monthly cycles, menstruating women tend to experience it more often (this is probably why more women feel depressed). When Liver Qi stagnates, it has far-reaching effects, many of which co-exist with depression: pain and distension in the ribs, breasts and lower abdomen, moveable or fixed cysts, fibroids and other lumps in the abdomen and breasts with little to extreme stabbing pain; irregular menstruation, dysmenorrhea or amenchronic diarrhea, abdominal distension, loss of appetite, or jaundice.
Smooth Liver Qi harmonizes emotions with the Mind by keeping a happy state, sensitivity, ability to reason, an even disposition and a sense of ease. Thus, obstructed Liver Qi adversely affects emotions, causing emotional swings, irritability, frustration and depression. It also triggers pain in chest or under ribs, sighing, a feeling of a "lump" in the throat and PMS symptoms.
As well, the Liver is associated with the Ethereal Soul (Hun) in TCM, the part of us that dreams, plans, envisions, creates and imagines. If the Ethereal Soul is unsettled, Mind (Shen) is cut off from the Universal Mind, resulting in a lack of direction in life, feelings of aimlessness, and unrealized dreams and plans. Such "isolation" leads to moodiness, sudden outbursts of anger or aggression and depression.
At first signs of depression, physicaly move your body - this is the most efficient way to move stagnant Qi and change emotions. Do whatever is easiest and most satisfying - walk, run, dance, pound pillows, garden or do yoga, Qi Gong or something similar. A half an hour is ideal but you should feel noticeably better after five or ten minutes. Moving in nature is even better, as nature is powerfully healing.
In general, daily exercise is beneficial for preventing and treating depression, as it keeps Liver Qi healthy and stimulates production of endorphins, natural mood-elevating chemicals.
And if you are angry know that anger is energy so it must be expressed and released in healthy ways. Bottled up it can morph into anxiety and acute panic attacks that can be dibilitating. If you are feeling anxious, angry frustrated and resentful, move, cry, scream, clean up the kitchen, unload old drawers/closets, or run around the block -express and release anger energy in healthy ways.
Since stagnant Qi results from any long-term suppressed or repressed emotions, it is important to discover their underlying causes and outlets. Do not repress or stuff emotions, as this creates more depression and anxiety. Take time to explore your feelings with a spiritual counselor/therapist. Journal write, as this unloads repressed feelings, moving energy and inviting insights, solutions and ideas that may help sort through painful emotions and clarify decisions. Go on a retreat, take time off and explore what is not working in our life so you can come up with a plan for change. Identify stressful factors in your home and work environments and modify them. Put energy into creative outlets since creativity opens doors to your subconscious mind, allowing energy to flow again. It doesn't have to be a big project, simple activities as decorating or gardening or singing is beneficial. Any form of appropriate self-expression moves stagnant Qi.
To relieve depression, it is extremely important to refine your diet by eliminating depression-causing foods and including stagnation-moving ones. Foods that congest Qi are, unfortunately, very prevalent in the Western Diet. Eliminate: fried, greasy and fatty foods, nuts and nut butters, avocados, cheese and dairy, chips of all kinds, turkey and red meats, alcohol, caffeinated foods and drinks (coffee, black tea, mate, cocoa, colas and chocolate) and recreational drugs. Beneficial decongesting and Liver-aiding foods include vegetables, lemons, dark leafy greens such as kale, collards, dandelion, mustard, beet and other bitter foods.
Lastly, reflect on your lifestyle habits and balance them as appropriate. Excessive activity, sex, or exercise deplete Qi, as do keeping late bedtimes (after 11 PM), working at jobs one doesn't like, overworking physically and mentally, and insufficient activity. To rebalance the Liver, go to bed before 11pm at the latest, get plenty of physical exercise, find enjoyable and fulfilling work and jobs and alternate work with rest and play. Regularity of habits regulates Liver Qi.
Examples of herbs that regulate Liver Qi, moving stagnation and easing depression include vitex, citrus (tangerine peel, both the ripe and unripe fruit of the bitter orange), cyperus (sedge root), sandalwood, Chinese chive, rose petals, mint, lemon balm and cumin, as well as the Chines herbs bupleurum and saussurea.
To release postpartum depression and acute anxiety I first had my hormones and blood tested and found out I needed progesterone cream and iron. I then turned to an integrated therapist at www.breakingfreemedical.com for 90 minute therapy/bodywork to release the pain on a cellular level and move out of an abusive relationship. I eliminated bad food and ate whole foods and greens and drank plenty of clean ionized high alkaline water fromwww.beyondo2.com. To help provide the necessary precursers for healthy neurohormonal chemistry I drank aminio acid protein shakes and took Coenzyme Bcomplex supplements during the day, Calcium magnesium at night to help me sleep and deer placenta, Women's Jing and Bupleurum and Peony fromwww.dragonherbs.com to balance liver and hormones.
How do you handle Depression and anxiety?