September 3, 2019

Postpartum depression is one of the most common pregnancy-related complications, affecting an estimated 20% of new mothers. While treatments including psychotherapy and antidepressant medications have been shown to be effective in reducing symptoms, there can be significant challenges to receiving these treatments. So it’s no wonder that there’s more and more research being done on how to prevent and treat PPD in more accessible ways.

What is postpartum depression?

Postpartum depression is one of the most well known perinatal mood and anxiety disorders that affect women during pregnancy and after childbirth. There’s a wide range of symptoms, including feelings of sadness, worry, anger, or rage; lack of appetite, lethargy, and insomnia. It also can last a long time, with 1 in 4 affected women reporting symptoms lasting at least a year. What causes postpartum depression is related to a number of factors, but the biggest contributor is believed to be fluctuating hormones.

Related: 7 Postpartum Depression Myths Debunked

How is postpartum depression typically treated?

The two main treatments for postpartum depression include psychotherapy (talk therapy) and antidepressants. Psychotherapy involves talking to a mental health professional (a counselor, therapist, psychologist, psychiatrist, or social worker) and treatment for mild cases is typically one session a week for 10-12 weeks. The two methods considered most effective for PPD are Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT). Psychotherapy methods have also recently been shown to be effective for not only treating, but preventing postpartum depression in those with higher likelihood of developing it.

In addition to, or instead of, talk therapy, antidepressant medications may be prescribed. Antidepressants change the chemistry of the brain and may take a few weeks to be effective. Most of these mediations are generally considered safe to use while breastfeeding, but it’s important to have that conversation with a doctor.

Despite the effectiveness of these treatments, studies show that many new mothers either do not receive treatment or are not being treated effectively. There are many barriers to receiving care, including concerns about medication side effects for breastfeeding, stigma, and treatment preferences. As a result, new research is being done on complementary and alternative medicine (CAM) that can be used to treat postpartum depression safely and effectively.

What are some of the alternative ways to prevent or treat PPD?

There have been numerous other studies on complementary and alternative methods for treating and preventing postpartum depression. While the amount of evidence for each method on its own is not overwhelming, some methods show a lot of promise and have little downside.

Singing

A new study was published in the British Journal of Psychiatry this year, which explored the effects of a 10-week community singing program on women with symptoms of PPD. While generally, the symptoms of PPD decrease over time, they decreased much faster for women participating in the singing program. While the study was designed to show that it's singing, and not the community aspect that’s effective, it’s not clear if singing alone is as effective. But singing to your baby is completely free and the great news is that your baby doesn’t care how good you sound. If you want to try a group music class, Music Together offers classes for babies and parents.

Yoga

Studies have shown yoga to be effective for improving symptoms of postpartum depression and prenatal depression (which is a risk factor for PPD). It also improved social anxiety and
PTSD-related intrusions. It doesn’t matter if you’ve taken yoga classes before or not. And while the study used a gentle vinyasa class, you may want to find classes or videos specifically designed for pregnant or postpartum women, to help you avoid movements that cause or worsen diastasis recti. Either way, it’s important to find a certified yoga instructor.

Related: Why do I still look pregnant?

Mindfulness & Meditation

In addition to being part of what makes yoga effective, mindfulness on its own has been shown to be helpful in treating and preventing postpartum depression. There is a technique called Mindfulness-Based Cognitive Therapy (MBCT), which has been tailored to pregnant and postpartum women (referred to as MBCT-PD), and shown to be effective in preventing and treating postpartum depression. However, it’s likely that you don’t have to follow the specific MBCT program. There are a lot of meditation apps to help you get started.

Supplements

Another popular alternative method is dietary supplements. While the studies showing effectiveness have been mixed, there are some supplements that can be added with little risk and general health benefits. Omega-3 fatty acids, folate, and vitamin D show promising results, and are often found in prenatal vitamins anyway, which many women are encouraged to take while breastfeeding. S-adenosyl-methionine (SAMe) is another supplement that has encouraging evidence for effectiveness, but is pretty expensive and might have some GI side effects.

However, it’s smart to be cautious with supplements as dietary supplements are not regulated as strictly by the FDA as “conventional” food and drugs. So that means the risks are higher and the benefits might not be worth it. Also, not all supplements are equally harmless. For example, St. John’s Wort is one popular supplement that not only doesn’t have data to support its effectiveness, but also may not be safe for pregnancy and has potential for drug interactions. As always, when in doubt, talk to your doctor.

Exercise

Physical exercise, even at low-to-moderate intensity, has been shown to decrease symptoms of postpartum depression. It also has a ton of other great health benefits, including better sleep, stress relief, and weight loss, so it’s no wonder that the ACOG recommends it for all new mothers. The official recommendation is for at least 150 minutes of moderate-intensity aerobic activity every week. But you can break that up however you like. For example, you could go for three 10-minute walks every day or do 30-minute workouts on 5 days of the week.

Related: How to build a base for fitness after childbirth

The standard of care for treating postpartum depression is through medication and/or therapy. However, there are a number of alternative treatment options for those looking to either complement these methods or to prevent postpartum depression. These methods like exercise, meditation, and singing are often free or cheap, have little risk, and many additional benefits. In fact, it’s a great idea to add these activities into your routine anyway, and reducing depression symptoms is just the cherry on top.

Sources:

Postpartum Depression Facts. National Institute of Mental Health. Retrieved August 28, 2019 from https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml

Dimidjian, S., & Goodman, S. (2009). Nonpharmacologic intervention and prevention strategies for depression during pregnancy and the postpartum. Clinical obstetrics and gynecology, 52(3), 498–515. doi:10.1097/GRF.0b013e3181b52da6. Retrieved August 29, 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805470/

Fancourt D, Perkins R. Effect of singing interventions on symptoms of postnatal depression: three-arm randomised controlled trial. Br J Psychiatry 2018;212:119–21. Retrieved August 29, 2019 from https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/effect-of-singing-interventions-on-symptoms-of-postnatal-depression-threearm-randomised-controlled-trial/534122E539704BAEAC0824F9FCACC5A8/core-reader

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