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What is Postpartum Depression?

December 7, 2018
postpartum depression, PPD, postpartum naturopath, toronto naturopath, naturopathic doctor toronto

Happiness always follows after the birth of your baby, right?

Nope, not always. 

Postpartum depression (PPD) is a condition that between 7-20% women experience after delivery. Nowadays more light is being shed on PPD because it’s a serious public health issue that affects women, children, and families. Even though the defined postpartum period is between 2-6 weeks after birth, postpartum depression can happen anytime between 2 weeks to 1 year after birth. 

About 7% of women experience a major depressive episode within the first 3 months, but if you factor minor depressive episodes, about 20% of women experience those within the first 3 months. 

Within the 2 week to 1 year time period, women may experience major depressive episodes. And other common symptoms mainly experienced in PDD (when compared to major depressive disorder) are psychomotor agitation (ex. anxiety or nervous excitement) and lethargy. You may also notice exaggerated changes in mood and pre-occupation with your baby’s well-being. Anxiety, ruminative thoughts and panic may also happen too. 

PPD is a little different than postpartum blues and postpartum psychosis:  

  • Postpartum bluesmild dysphoria occurring in the first week after delivery

  • Postpartum psychosisa condition with a rapid onset associated with hallucinations or bizarre delusions, mood impairment swings, disorganized behaviour, and cognitive dominant symptoms, including extreme sadness and loss of interest or pleasure in things previously enjoyed. Usually occurs in conjunction with bipolar disorder. 

Risk Factors of Postpartum Depression

  • Depression or anxiety during pregnancy

  • Depression prior to pregnancy

  • Changes in hormone levels

  • Your age

  • Chronic health problems

  • Psychological stress

  • Lack of social support from friends and relatives

  • History of pregnancy loss

  • Unwanted pregnancy

  • Socioeconomic status

Symptoms of Postpartum Depression

  • Depressed mood or severe mood swings

  • Excessive crying

  • Difficulty bonding with your baby

  • Withdrawing from your family and friends

  • Loss of appetite or eating much more than usual

  • Inability to sleep (insomnia) or sleeping too much

  • Overwhelming fatigue or loss of energy

  • Reduced interest and pleasure in activities you used to enjoy

  • Intense irritability and anger

  • Fear that you’re not a good mother

  • Feelings of worthlessness, shame, guilt or inadequacy

  • Diminished ability to think clearly, concentrate or make decisions

  • Severe anxiety and panic attacks

  • Thoughts of harming yourself or your baby

  • Recurrent thoughts of death or suicide

Criteria for a Major Depressive Episode

At least five of the following nine symptoms in the same 2-week period:

  • Depressed mood

  • Loss of interest or pleasure

  • Change in weight or appetite

  • Insomnia or hypersomnia

  • Psychomotor retardation or agitation

  • Loss of energy or fatigue

  • Feeling worthlessness or guilt

  • Impaired concentration or indecisiveness

  • Recurrent thoughts of death and/or suicidal ideation or attempt 

And also have to meet this criteria:

  • These symptoms cause significant distress or impairment

  • The episode is not attributable to substance abuse or a medical condition

  • The episode is not better explained by a psychotic disorder

  • The patient has never experienced a manic or hypomanic episode

Next Steps

May moms are reluctant to seek help because they’re unable to recognize their own mental health symptoms and accessing care can be difficult. An easy screening tool that will help you determine is PPD is affecting you is the Edinburgh Postnatal Depression Scale. This scale is used by most health practitioners like myself. 

If not treated properly, PPD can affect your overall functioning. While untreated PPD may cause health and developmental problems in your baby – and even affect the whole family. Treatment does not always have to be simply holistic. It may involve medications, and that’s perfectly okay. The important thing is that you’re getting the support that you need and deserve. 

If you prefer to approach PPD from a holistic lens, be sure to check out postpartum depression and Naturopathic Medicine.

References

Horibe M, Hane Y, Abe J et al. Contraceptives as possible risk factors for postpartum depression: A retrospective study of the food and drug administration adverse event reporting system, 2004-2015. Nurs Open. 2018;5(2):131-138. doi:10.1002/nop2.121.

Polmanteer, R., Keefe, R. and Brownstein-Evans, C. (2018). Trauma-informed care with women diagnosed with postpartum depression: a conceptual framework. Social Work in Health Care, pp.1-16.

Schiller, C., Meltzer-Brody, S. and Rubinow, D. (2014). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(01), pp.48-59.

Birth Control and Depression

birth control and depression, toronto naturopath, naturopathic doctor toronto

Over the last couple of years birth control and it’s affect on mood, most commonly depression, has been in the news. Many are left wondering if birth control is safe for women. I’ve assessed a couple of studies, looking at various groups of women to get a better idea of what the research is saying. 

What is depression?

Like most conditions, a person must experience a certain number of symptoms to be diagnosed with a major depressive episode. 

 Five or more of the following symptoms must be present on most days for at least 2 weeks

  • Depressed mood*

  • Diminished interest or pleasure*

  • Significant weight loss or weight gain

  • Insomnia or hypersomnia

  • Psychomotor agitation or impairment

  • Fatigue or loss of energy

  • Feelings of worthlessness or excessive guilt

  • Decreased ability to think, concentrate, or ability to be decisive

  • Recurrent thoughts of death/suicide, or a suicide attempt

*One of these symptoms MUST be present

Select Populations & Birth Control

Adult Women 

A study conducted in Sweden (Zethraeus, 2017), looked at the effects of a combined pill (150 mg of levonorgestrel and 30 mg of ethinylestradiol) on general well being and depression in women aged 18-35. Compared to the placebo group, there was no difference in anxiety, depressed mood, general health. However, there WAS a significant reduction in in general well-being in women who used a levonorgestrel-containing OC, compared to women taking the placebo. 

Postpartum Women

A study by Horibe analyzed the connection between postpartum depression, drugs, and reported adverse events. They found that levonorgestrel was the top drug reported in connection with postpartum depression. This was followed by other progestins: etonogrestrol and drospirenone (further down in the list). The authors concluded that contraceptives or intrauterine devices with progestin might convey risk for postpartum depression.

With this in mind, I believe that postpartum women should be aware of the risk of depression with many of the pharmaceuticals they may taking during that first postpartum year. Moreover, it’s important to have these conversations with their doctors of what may happen, and what the next steps would be. Currently progestin-only contraception is considered first-line therapy for breastfeeding women. Estrogen-containing contraceptives are not started until breastfeeding is stopped as it may decrease milk supply. 

Adolescents

A groundbreaking study (looking at over a million women!) in 2016 by Skovlund, looked to investigate if hormonal contraception is associated with antidepressant use and a depression diagnosis. They ended up finding that adolescents (15 to 19 years) using hormonal contraception are more sensitive than older women (20 to 34 years old). when it came to getting a diagnosis of depression or using antidepressants. This effect was seen in both the combination pill as well as progestin-only pills (which was more predominant). The study also indicated that the incidence of depression and use of antidepressants decreased with age. 

For teens considering taking birth control, I would ask yourself why this might be. What is the outcome you are hoping to achieve? There are two conditions in which girls are given birth control as a treatment: endometriosis and acne (usually resulting from PCOS).

If you are experiencing heavy and painful periods (where you are unable on some days to go to school), talk to your medical doctor about endometriosis and if it’s a possibility. If you are experiencing acne, hair growth in places usually seen in males, and even irregular periods, talk to your doctor about PCOS as a possible explanation.  

Women with Bipolar Disorder and Depression

The study by Pagano aimed to look at the safety of contraception in women with depression and/or bipolar disorder. This was a meta analysis which looked at 6 studies that met their specific inclusion criteria. They found that oral contraception, levonorgestrel-releasing IUD and the depo shot, were not associated with worse clinical outcomes of depression or bipolar disorder in women who already had this condition. 

A couple things to note about this review: there was no 
standard definition or assessment of depressive and bipolar disorders or symptoms across studies, and the use of depression medication was unknown in three of the six studies. 

Final Thoughts on Birth Control and Depression

Overall, while there’s no clear cut answer on whether birth control causes depression – these studies still give you an idea of what the risk might be. Here are a couple of questions to think about if you’re considering taking birth control:

  • Why do you want to take birth control?

  • Are you considering birth control because of painful periods or ‘regulating’ your cycle?

  • Are you considering birth control because you want to prevent a pregnancy?

  • Are you willing to live with side effects (ie. a decreased quality of life)?

  • Are you an adolescent?

  • Have you given birth within the past year? 

While there isn’t a naturopathic alternative to birth control (I’m talking about supplements, not the fertility awareness method), it’s necessary to dive deeper into why you may be considering this option. This may also have you wondering what’s going on in your body and if you can help support it in other ways – perhaps with the assistance of Naturopathic Doctor as well!

If you found this information helpful, check out my handy chart of the nutritional deficiencies caused by the pill!

References

Zethraeus N, Dreber A, Ranehill E et al. A first-choice combined oral contraceptive influences general well-being in healthy women: a double-blind, randomized, placebo-controlled trial. Fertil Steril. 2017;107(5):1238-1245. doi:10.1016/j.fertnstert.2017.02.120.

Horibe M, Hane Y, Abe J et al. Contraceptives as possible risk factors for postpartum depression: A retrospective study of the food and drug administration adverse event reporting system, 2004-2015. Nurs Open. 2018;5(2):131-138. doi:10.1002/nop2.121.

Pagano H, Zapata L, Berry-Bibee E, Nanda K, Curtis K. Safety of hormonal contraception and intrauterine devices among women with depressive and bipolar disorders: a systematic review. Contraception. 2016;94(6):641-649. doi:10.1016/j.contraception.2016.06.012.

Worly B, Gur T, Schaffir J. The relationship between progestin hormonal contraception and depression: a systematic review. Contraception. 2018. doi:10.1016/j.contraception.2018.01.010.

Skovlund C, Mørch L, Kessing L, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154. doi:10.1001/jamapsychiatry.2016.2387.

Mom Squad with Lindsay Forsey (Tenth Moon Mothercare)

September 5, 2017
mom squad, tenth moon mothercare, naturopath toronto, toronto naturopath

A few months ago, I stumbled across Tenth Moon Mothercare on Instagram and fell down the rabbit hole. It’s a company that promotes self care for mom in the postpartum period and covers all aspects of discomforts after childbirth! While I don’t have a baby registry (nor a baby), when that time comes this package is going to be first on my list! Blend up a bulletproof coffee and learn why Lindsay of Tenth Moon Mothercare cares so much about your postpartum experience, and why you should too!

What inspired you to start this company?

Let’s face it: in most of Western culture, nearly all attention falls to preparing for and caring for our babies. A new mom’s wellbeing is so often overlooked, but the reality is that it’s absolutely essential to the wellbeing of her family, and her newborn. (That’s not just my opinion; there are studies that prove it.)  

Tenth Moon Mothercare is Canada’s first postnatal care package company. In different cultures around the world, there are beautiful traditions of mothering the mother and making sure that women are taken care of so that they’re best able to thrive and care for their newborn. I find this hugely inspiring and want to create a new tradition of care for moms in Canada.

My postpartum experience with my first baby was nothing like what I had imagined. I’d ended up having an emergency caesarean and found myself physical and emotionally depleted in a way I didn’t know was possible. Even though I was a doula, I was prepared for how challenging new motherhood would be. I had tons of support from my husband and my mum, and I remember thinking, “How would I possibly be surviving right now without this encouragement and care?” A few months later, the idea for Tenth Moon started to blossom. I started making small care packages for friends, and getting requests from friends of friends. Eventually I began connecting with suppliers and fine-tuning the details and I was seven months pregnant with my second baby with I officially launched Tenth Moon Mothercare.

The business is and always has been about maternal health and wellness, with a vision to change the way we think about postpartum care in Canada. The heart-warming feedback I get from women who receive Tenth Moon packages is an amazing source of inspiration for me now.

What was your favourite product to create?

I love all of the products in our packages, but when it comes to “creation” I’d say my favourite is our Yummy Mama granola. It’s addictively delicious. It’s packed with nutrient-dense organic oats, pumpkin and sunflower seeds, coconut and pecans, and toasted in maple syrup. Oats and pecans are considered galactagogues, or foods that help to promote a healthy breastmilk supply, so it’s perfect for nursing moms. But even if someone isn’t breastfeeding, for whatever reason, it’s a super nutritious, easy snack that’s yummy any time of the day or night. Our mamas love it.   

Which of your packages is the most popular?

Tenth Moon Essentials is our most popular. It includes our Herbal Sitz Bath, Lavender Mineral Soak, Organic Raspberry Leaf Tea, Yummy Mama Organic Granola, Organic Coconut Oil and Shoosha Rescue Nipple Balm. The Essentials are included in all of our bigger packages as well.

What’s the first thing you do every morning to start your day off right?

My day pretty much always starts with my youngest daughter crawling into our bed for snuggles around 6.30 a.m. Her big sis isn’t an early riser, but she and I have a morning cuddle, too, when she wakes up. We talk about our dreams, if we can remember them. Aside from that, I start the week with sunrise yoga at 6.30 a.m. every Monday.   

What’s your favourite self-care practice?

I try to keep it simple with self-care. For the past few months I’ve been listening to a yoga nidra mediation at bedtime. I love it, because it requires me to do nothing and helps me to fall asleep with a calm mind, rather than rethinking the zillion items on my to-do list.   

What’s the best advice you’ve ever received?

I’ve done a lot of travelling and spent a few years living abroad in different places. In my early twenties, when I was getting ready to leave on my first epic backpacking adventure, my mum gave me a card with this quote by Henry David Thoreau on it:

“Go confidently in the direction of your dreams. Live the life you’ve imagined.”

It meant so much to me to receive that from her at the time, and I’m still living my life that way. (Thanks, Mum!!)  

What’s your personal or professional motto?

No official motto, but I do love listening to the super quirky 80s one-hit-wonder Break My Stride by Matthew Wilder when I’m working, whether it’s a personal project or Tenth Moon Mothercare.  

Nobody’s gonna break my stride/

Nobody’s gonna slow me down/

Oh, no. I’ve got to keep on moving/

The video features dancers in sparkly green leotards, for extra inspiration. If you’ve ever heard this song before it’ll likely be stuck in your head for the rest of the day. I hope that’s a good thing! 

How can moms connect with you?

Website:  tenthmoonmothercare.com
Facebook:  tenthmoonmothercare
Instagram:  @tenthmoonmothercare

On your way out

Join Mom Squad’s Facebook Group AND sign up here to receive the official monthly Mom Squad newsletter!

Other #MomSquad members: Angelique Montano-Bresolin, Olivia Scobie, Beth Yarzab, Stephanie Kishimoto, Rhondda Smiley