Postpartum and Peripartum Depression: A Chinese Medicine Perspective

Postpartum and peripartum depression affect large numbers of pregnant and postnatal women. Estimates suggest the prevalence rates could be in excess of 20 percent, so these are widespread conditions.

Podcast: Play in new window | Download

Postpartum depression refers to depression symptoms that set in within four weeks of childbirth and persist for months. Peripartum depression is essentially identical to postpartum depression, only the onset of symptoms may begin during pregnancy or up to 12 months following childbirth.

Both conditions are a major cause of concern for the women who experience depression and for larger society, as the health impacts of post and peripartum depression can have fatal consequences for new mothers.

The Devastating Effects of Postpartum and Peripartum Depression

Postpartum and peripartum depression are widely known mental health conditions, but what’s less known is how much of a threat they can be to mother and child. According to multiple studies, one published in Archives of Women’s Mental Health, suicide during pregnancy-related depression accounts for around 20 percent of postpartum deaths. And in the U.S., the maternal mortality rate is higher than it is in all other industrialized countries.

The dangers of postpartum and peripartum depression extend to the child. Various studies link untreated antenatal and postpartum depression to the following newborn complications:

• Higher chance of preterm birth
• Lower birth weight
• Higher incidence rate of febrile illnesses
• Malnutrition
• Emotional and behavioral issues
• Sleeping difficulties
• Language development delays

Responding to the onset of depression symptoms is potentially a matter of life and death for the mother and their child.

What are the Symptoms of Pregnancy-Related Depression and How is it Diagnosed?

Postpartum and peripartum depression present with many symptoms associated with other depressive disorders. They include:

• Mood swings or low mood
• Severe fatigue
• Sleep disturbances
• Panic attacks and severe anxiety
• Withdrawal from friends and family
• Irritability
• Feelings of hopelessness, guilt or shame
• Lack of bonding with baby
• Impaired concentration or decision making ability
• anhedonia (inability to find joy in previous interests)

A milder form of pregnancy-related depression – the “baby blues” – is often confused with postpartum and peripartum depression, but the symptom profile is less severe and fades quickly. In general, the baby blues disappear within a couple of weeks following delivery. Postpartum and peripartum depression may last for many months without treatment.

Diagnosis can be done without testing, though some physicians may call for a thyroid analysis or may test for anemia. These don’t provide definitive proof on their own, and it’s common for doctors to use the patient’s symptom profile to make their diagnosis.

What are the Primary Western Treatments for Postpartum and Peripartum Depression?

Cognitive behavioral therapy (CBT) is a frontline treatment option for pregnancy-related depression and can be implemented proactively for high-risk patients. CBT allows women to present their concerns and anxieties beforehand, which research shows can decrease the risk of developing depression or halt the condition’s progression if delivered early on.

Beyond CBT, antidepressant medications may be prescribed to the mother, but care is needed here. Selective serotonin reuptake inhibitors (SSRIs) are frequently used to treat patients, but a couple SSRIs – fluoxetine and paroxetine – are associated with a higher risk of specific birth defects, including heart and neurological defects. A Danish study also found that SSRI use in pregnant women was associated with a slight, but statistically significant increase in risk of preterm birth and risk of needing a neonatal intensive care unit (NICU) visit.

There’s also uncertainty regarding which medications are safe to take while breastfeeding. The data is lacking in this area, but physicians will generally recommend observing the child and noting any changes in behavior or mood.

In some cases, the mother may already be on antidepressants when they become pregnant (or once they find out they’re pregnant). If there are risks to the child due to adverse effects, this risk is weighed against the risk to the mother if the medication is discontinued. For some patients, the risk of severe depression may be too high to safely remove the antidepressant.

In the end, SSRI use in pregnant women is considered on a case-by-case basis.

How do Chinese Medicine Practitioners Treat Postpartum and Peripartum Depression?

Chinese medicine uses a whole-body philosophy to health, and this extends to the underlying health issues that may drive postpartum and peripartum depression.

Practitioners place emphasis on balancing the body’s life energies – yin, yang and qi being the most prominent. The proper flow of energy from one organ to the next is essential to maintaining organ performance and overall health.

For postpartum and peripartum depression, Chinese medicine centers treatment on the kidneys and spleen. These organs are targeted because they tend to be depleted during pregnancy and childbirth. Specifically, it’s depletion of their yang energy that can leave women vulnerable to depression. Nourishing a developing fetus, undergoing childbirth – along with stress, anxiety and life changes – can all deplete the kidney and spleen yang.

Practitioners also attribute cases of postpartum depression to another cause – the loss of yin energy and blood during delivery. Childbirth is hard on the body and can potentially drain too much substance and yin energy during the process. This can lead to depression symptoms, as well as general fatigue and mood imbalances.

To address these concerns, Chinese medicine practitioners rely on several beneficial botanicals and acupuncture. Some of the most commonly prescribed herbs include:

• Ti Si Zi (Cuscuta) – A neutral herb that is formulated to support both the kidney and spleen Yang.
• Gou Qi Zi (Wolfberry) – Another neutral herb that can tonify the liver and kidney yin energy. It can also tonify the blood.
• Shu Di Huang (Rehmannia root) – A slightly warm herb that is typically used with blood deficiency disorders and can help with tonifying yin.
• Dang Gui (Angelica) – A warm herb with noted effects on tonifying the blood. Dang Gui has long been used for dysmenorrhea and for resolving other menstruation-related symptoms.
• Bai Shao (White Peony) – A slightly cool herb that also tonifies the blood and is also helpful with menstruation. Bai Shao is also recommended for patients with anemia.

Acupuncture treatments also target the spleen, kidney and liver. Acupuncture’s effects on the nervous system and its ability to innervate local nervous tissue means it can regulate energy flow in and out of organs. Many points associated with the kidney and liver channels are found along the legs and abdomen, and these will be incorporated into treatment during acupuncture sessions.

Chinese Medicine Offers Help to Women Suffering with Postpartum and Peripartum Depression

Women suffering from pregnancy-related depression are in a difficult spot. Aside from CBT, western treatments – mainly medication – come with risks that patients may not want to take on, especially if those risks extend to their child.

These women may attempt to push through their depression without treatment, but as we’ve seen, there are serious risks with this approach, too.

To avoid the downsides of drug therapy, an increasing number of pregnant and postpartum women are turning to Chinese medicine to treat their symptoms. When administered by a licensed Houston practitioner, acupuncture and herbal formulations can support better whole-body health, helping ward off the symptoms of postpartum and peripartum depression.