Following delivery, approximately 13% of new mothers experience a major depressive episode (Wisner et al., 2002). This rate translates to hundreds of thousands of women in the United States each year. This widespread condition affects not only the mother but also the child; numerous studies have documented an adverse effect on children's cognitive and social development from exposure to maternal depression in the first year of life (Hay et al., 2001). Women with a previous history of depression are at a particularly high risk for depression (Wisner et al., 2002). Additional risk factors include conflict with the baby's father, stressful life events and child care stresses. Many women benefit from individual or group psychotherapy (Appleby et al., 1997; O'Hara et al., 2000). Attending weekly therapy sessions, however, is frequently difficult for women who are looking after one or more small children at home. Further, many patients are unable to afford ongoing psychotherapy.
Antidepressants are an additional treatment option for postpartum depression, and several appear to be safe when used during breast-feeding (Burt et al., 2001; Hendrick et al., 2001; Stowe et al., 2000). Nevertheless, many new mothers are reluctant to take medications while nursing because they are concerned about the potential adverse effects on their infant. Further, antidepressants are not universally effective and often produce unacceptable side effects such as reduced libido. Many women look forward to a renewed intimacy with their partners after the pregnancy and prefer not to take medications with such a side effect. Therefore, alternative treatment approaches for postpartum depression merit consideration.
The use of alternative treatments, including acupuncture, homeopathy, herbs, dietary supplements, massage and relaxation techniques, for depression is becoming increasingly widespread (Figure) (Eisenberg et al., 1998; Gallagher et al., 2001; Habek et al., 2002). However, few studies have examined these alternative treatments for depression occurring in the postpartum period.
A recent case report described successful treatment of major depression during pregnancy and following delivery with omega-3 polyunsaturated fatty acids (4 g/day ethyl eicosapentaenoic acid and 2 g/day docosahexaenoic acid). Inadequate levels of omega-3 fatty acids have been associated with depression, including postpartum depression (Hibbeln, 1998; Horrobin and Bennett, 1999; Peet and Horrobin, 2002; Peet et al., 1998), and these fatty acids (e.g., 1 g/day to 4 g/day ethyl eicosapentaenoate) have been used to potentiate the effects of antidepressant medications (Nemets et al., 2002; Peet and Horrobin, 2002).
Omega-3 polyunsaturated fatty acids offer significant health benefits to pregnant and nursing women and their infants. An adequate supply of maternal docosahexanoic acid during pregnancy and nursing is necessary to support the optimal neurological development of the fetus and infant (Birch et al., 2000; Willatts and Forsyth, 2000). Underscoring the importance of maternal dietary supplementation of omega-3 fatty acids, the high fetal demand for these fatty acids can lead to a 50% reduction of the maternal levels (Hornstra, 2000). Research has demonstrated that the risk of preterm labor is reducedin women who consume omega-3 fatty acids during pregnancy (Olsen and Secher, 2002).
The health benefits of these fatty acids continue following delivery. For example, when supplied in infant formula at adequate doses, omega-3 fatty acids improve infant cognitive development and visual acuity (Birch et al., 2000; Willatts and Forsyth, 2000). If the preliminary data on omega-3 fatty acids' positive mood effects are corroborated in larger studies, they will become a safe and healthful treatment option for depression occurring during pregnancy and the postpartum period.
Herbal supplements offer an alternative treatment for depression. Nationwide, the most widely used herbal compound for depression is St. John's wort (Hypericum performatum) (Bilia et al., 2002). The hypericin in this herb is believed to produce its therapeutic effects. Meta-analyses and systematic reviews of clinical trials support the efficacy of St. John's wort in the treatment of depression (Bilia et al., 2002; Gaster and Holroyd, 2000; Kim et al., 1999; Linde et al., 1996). St. John's wort is generally well-tolerated, relatively inexpensive and widely accessible. It is important to keep in mind, however, that the purity and potency of commercially available preparations of St. John's wort may not be what the labels purport. As a result of the Dietary Supplement Health and Education Act of 1994, the U.S. Food and Drug Administration minimally regulates most herbal products sold in the United States.
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