Acupuncture for postpartum depression (PPD) is a treatment that should be considered as a potential modality for those suffering. While many of us have heard of the “baby blues,” it is often for a short timeframe while postpartum depression is one that lasts much longer. Postpartum depression can start shortly before or any time after childbirth, although it is normally between a week and a month after delivery, and symptoms are much more severe than with the “baby blues.” According to the Centers for Disease Control and Prevention (CDC), nationally 1 in 9 women experience symptoms of postpartum depression, and also varies by state & can be as high as 1 in 5 women. This is a condition that is often misunderstood, and also underestimated, many claiming it is “part of having a baby” or that the woman is being “dramatic,” and this couldn’t be further from the truth.
Facts About Postpartum Depression
Postpartum depression is condition that may be mistaken for “baby blues” at first, but the signs & symptoms are much more intense and last longer. This may eventually interfere with the ability to take care of a new baby and handle daily tasks that were once able to be handled. Many new moms go through an emotional phase where they are crying, have mood swings, mild depression, and anger outbursts (“baby blues”). However, these symptoms do not usually last more than a couple of weeks, and if they do that is when it is considered postpartum depression.
Symptoms of postpartum depression:
- Feeling sad, hopeless, overwhelmed
- Crying more often than usual for seemingly no
- Feeling overly anxious/worried
- Feeling moody, restless, irritable
- Oversleeping or not being able to sleep even
when the baby is sleeping
- Trouble concentrating, remembering details
- Physical aches/pains, frequent headaches,
stomach problems, muscle pain
- Eating too much or too little
- Having trouble bonding with the baby
- Consistently doubting the ability to care for the baby
Frequently misinterpreted, postpartum depression is much more than just something that happens when a baby is born, and is not a character flaw or mental weakness. The birth of a baby causes extreme emotional & chemical changes/imbalances within the brain which can cause depression after the birth. There are many contributing factors in postpartum depression, and some of them are actually chemical.
Causes of postpartum depression:
- Emotional factors: this can be caused by any number of things becoming a new parent including sleep deprivation, many new changes in the life of a parent, feeling less attractive, and losing control of one’s life & struggling with identity.
- Physical changes: after giving birth, the levels of hormones progesterone & estrogen quickly and suddenly drop leading to chemical changes in the brain triggering mood swings. Constant sleep deprivation can lead to physical exhaustion which can contribute to symptoms of postpartum depression. Additionally, the thyroid is not producing hormones the way it did before birth which leaves the mother feeling tired and depressed. Other physical changes may be lowered immune system response, changes in metabolism, loos of blood volume, and lower blood pressure.
- Lifestyle changes: new parents are juggling with the sudden feeling of exhaustion, possibly a lack of support from a spouse or partner, and financial adjustments of having a child.
- Genetics: just like with non-pregnancy related depression, some are predisposed to be more at risk of developing postpartum depression than others.
Although there are some standard things to look for when seeing a postpartum depression patient, there are a variety of symptoms involved with postpartum depression which is why, contrary to popular belief, the disorder has been divided into different categories by the medical community. Just like with typical depression not related to pregnancy, the types are divided by strength/length of symptoms, and severity.
Types of postpartum depression:
- Postpartum Blues (referred to as “baby blues”) – The most common form of the postpartum mood disorders, and also the mildest form of postpartum depression occurring within the first few weeks of having a baby, and only lasts a short period of time (typically a couple weeks).
- Postpartum Anxiety – another common mood disorder seen after delivering a baby, this is where the mother is overly anxious and may suffer from paranoid thoughts or obsessive-compulsive behaviors. It often goes undiagnosed because many believe new mothers are naturally anxious, making these symptoms seem “normal.” This is different from other forms of postpartum depression because the symptoms exhibit more anxious behaviors than depressed behaviors such as persistent fears/worries, high stress, and inability to relax. This may also only last for a short period of time, but it can also persist much longer, so it is important to watch for these signs to differentiate postpartum depression and postpartum anxiety.
- Postpartum Obsessive-Compulsive Disorder (OCD) – Postpartum OCD affects 3% – 5% of postpartum women, and is an anxiety mood disorder. Symptoms of this disorder include persistent and unwelcome thoughts usually involving harming or even killing the baby. In this condition however, these thoughts are rarely acted upon as the mother with this disorder is aware of and disgusted by the thoughts. Other symptoms include other compulsive habits such as repetitive changing and cleaning the baby. This is another condition that often is unreported & untreated.
- Postpartum Panic Disorder – this disorder involves extreme levels of anxiety, and occurs in 10% of postpartum women suffering from repeated panic attacks & severe anxiousness. The symptoms of the panic attacks include ones that you would see in a typical panic attack such as shortness of breath, heart palpitations, shortness of breath, and consistent/excessive worry or fear. The fears usually include dying or losing control. This disorder can also potentially indicate thyroid issue or those already with a thyroid issue are at greater risk for this disorder.
- Postpartum Post-Traumatic Stress Disorder (PTSD)– the symptoms of this unique form of postpartum depression is the result of real or perceived threat to the mother usually occurring during childbirth or shortly after. The traumas that encompass postpartum PTSD may include birth complications, unplanned C-sections, the baby being sent to the NICU, or injuries other women have suffered during delivery. Symptoms of postpartum PTSD include avoiding trauma triggers, anxiety/panic attacks, difficulty sleeping, reliving the trauma in flashbacks or memories, irritability, and feeling detached from reality. Women who may have suffered other past traumas may be at a greater risk to develop postpartum PTSD, and those who suffer from it feel a strong sense of shame, guilt, and self-blame regarding their feelings of the trauma.
- Postpartum Psychosis – this is the most serious form of postpartum depression, and it is extremely rare. Only 1-2 mothers out of 1,000 childbirths will develop postpartum psychosis, and begins usually within the first few weeks after giving birth. Symptoms of this disorder include hallucinations, hyperactivity, confusion, extreme agitation, delusional thoughts, mania, paranoia, and poor judgement. The manic behaviors of a woman with bipolar disorder are comparable to a woman with postpartum psychosis. This condition causes the woman to be unaware of their actions & behaviors, and therefore are at a serious risk for suicide or infanticide. Immediate treatment and potentially hospitalization are vital with this condition.
A study in 2012 showed a correlation with the amygdala in the brain with increased anxiety in mothers. A meta-analysis in 2017 with imaging scans of the brain show changes in the basal ganglia structure located in the midbrain as well as altered connectivity in multiple prefrontal cortexes and the amygdala. Another study recently done in February of 2020, showed that the estrogen withdrawal from giving birth reduced the hippocampal glucocorticoid receptor (GR) which exhibited depression/anxiety-like behavior.
If left untreated, postpartum depression can cause problems within all members of the family:
if left untreated the depression can last months or years and could develop
into a chronic disorder. This then increases a woman’s risk of future episodes
of major depression.
postpartum depression, much like typical depression, can have a ripple effect
bringing emotional strain for all that are close to a new baby. Sometimes
called paternal postpartum depression, those who have a history of depression,
have relationship problems, or struggling financially are most at risk. This
can have a negative effect on relationships and child development the same way
as mothers can.
- Children: for children of mothers (or fathers) who have untreated postpartum depression they are more likely to have emotional or behavioral problems such as sleeping or eating difficulties, delays in language development, and excessive crying.
While there is still much to be learned about postpartum depression, and the research regarding its effects on the brain are in their infancy, there are many studies out there (and studies to come) showing its impact on the brain.
Acupuncture for Postpartum Depression
Acupuncture is a great addition to any new or expectant mother’s self-care routine, before and especially in the days after giving birth. As we know, giving birth puts the biggest strain on a woman’s essence or jing, and we as providers also know it is difficult to replace. Women who have postpartum depression in TCM terms are extremely blood deficient. Throughout the pregnancy, the blood volume is nearly doubled so as to support the baby, however postpartum is a different story. Childbirth and nursing deplete the bodies blood and fluid, and when those levels are low, TCM identifies birth as Liver Blood, Heart Blood, or Yin deficiency manifesting in the standard symptoms listed above in postpartum depression. Acupuncture treatment allows the body’s natural hormonal balance to be restored in a much shorter period of time.
As practitioners, it is important to make note of any subtle changes in the patient’s physiology and presentation of symptoms to reveal the underlying imbalances responsible for the persons postpartum depression. Being able to get to the root cause, and treat it explains why acupuncture works effectively for preventative care for postpartum depression. These small imbalances in a patient can be caught & corrected before they have a chance to intensify to the point of having serious symptoms.
Acupuncture works for postpartum depression:
- Promotes relaxation & reduces stress – acupuncture calms the nervous system as well as the mind and body by lowering the blood pressure, promoting healthy circulation, and mitigating the release of stress hormones.
- Heal from the physical birthing process – being a beautifully intense experience, women use a large amount of blood and qi to both create and birth the child.
- Restore balance to the body – once we look at the underlying patterns and root cause of the postpartum depression, we can create a unique diagnosis for the patient thus allowing us to lessen the root symptoms allowing the body to heal and prepare for parenthood.
- Time for self-care – acupuncture allows for time to implement self-care. Restoring homeostasis to the body is essential in a new mother’s journey and for her well-being.
In addition to all of these, there are specific acupuncture points that are most helpful as well as TCM dietary therapy that is immensely useful for women healing from birth and/or postpartum depression.
Acupuncture Points & Herbs for Postpartum Depression
Treatment plans for postpartum depression usually consist of daily herbal medicine coupled with weekly acupuncture visits, and depending on the TCM diagnosis, and may require more than once a week for treatments. Getting other healthcare providers on board with the patient’s treatment plan is also very important, depending on the severity of the case and the patient’s needs for adjunctive treatment.
Acupuncture points for postpartum depression:
- ST36 – Leg Three Li – Zusanli – located 3 cun below ST35 one finger width lateral from the anterior border of the tibia. This point benefits blood production, ST qi, and source qi as well as psychological/emotional disorders.
- HT7 – Spirit Gate – Shen Men – located at the wrist crease on the radial side of the flexor carpi ulnaris tendon, between the ulna and the pisiform bones. This point is good for emotional & psychological issues, tonifies deficiencies of HT qi, blood, yin & yang.
- P6 – Inner Pass – Nei Guan – located 2 cun above the wrist crease between the tendons of palmaris longus and flexor capri radialis. This point benefits the heart, calms the mind. It is helpful for insomnia and/or other spirit disorders of excess or deficient nature, mania, nervousness, stress, and poor memory.
- SP6 – Three Yin Intersection – Sanyinjiao – located 3 cun above the tip of the medial malleolus on the posterior border of the tibia. This point benefits blood production, ST qi, source qi, and many anxiety related emotions.
- GV20 – Hundred Convergences – Bai Hui – located 5 cun posterior to the AHL. This point is where the mind is housed, and yang channels gather. Useful for associated area with emotions, memory, behavior, and yang energy imbalances.
- EX-HN1 – God’s Cleverness – Sishencong – located at a group of 4 points, at the vertex, 1 cun posterior, anterior and lateral to GV20. This is also where the mind is housed, and yang channels gather. It is useful for pacifying the mind and calming the spirit, and also serves issues with memory or thinking when combined with GV20.
- LV3 – Great Surge – Tai Chong – located on the dorsum of the foot in a depression distal to the junctions of the 1st and 2nd metatarsal bones. This point regulates qi, blood, and yin. It is a calming point used for anger, irritability, insomnia, and anxiety as well as resolving any stagnation.
Along with useful points, it is important that individuals with postpartum depression eat foods that nourish the kidneys (home to a woman’s jing), and the liver as it has to process & eliminate all the excess hormones throughout the body after birth.
Foods that nourish the kidneys & liver:
- Black beans
- Black sesame seeds
- Dandelion & Nettles (which can easily be
found in tea form) to boost iron & calcium
- Milk thistle to support the liver
Postpartum herbal formulas are also, as we know, helpful as they replenish micronutrients, enhance circulation, boost cellular metabolism, and promote tissue repair, which is an integral part of postpartum depression care.
Postpartum depression herbal formulas:
- Xiao Yao Wan – Free & Easy Wanderer – its job is to primarily harmonize, and then also regulate the liver & spleen. It is useful in the case of postpartum depression for anxiety, depression, loss of motivation, fatigue, bloating, and breast distention. Contraindications being to use with caution during pregnancy.
- Dang Gui Jian Zhong Tang – Decoction to Construct the Middle – its job is to nourish, invigorate, and harmonize the blood. In the case of postpartum depression, it is helpful with a wide variety of its symptoms such as insomnia, fatigue, night crying, irritability, and postpartum emaciation/weakness.
- Qing Hun San – Clear the Hun – its job is to tonify the heart qi and calm the spirit. In the case of postpartum depression, it is helpful with depression, irritability, mood swings, low spirits, palpitations, fatigue, and lower back ache.
As always, it is important to consider the patients individual set of circumstances, especially other medications they may be taking in conjunction with acupuncture/herbal therapy.
Acupuncture Can Help Postpartum Depression
In the United States alone, approximately 70% – 80% of women will experience, at a minimum, the “baby blues,” and many will experience postpartum depression that goes undiagnosed, unrecognized, and untreated. The reported rate of postpartum depression among new mothers is 10% – 20%, and with approximately 4 million live births occurring each year, that equates to almost 600,000 postpartum depression diagnoses. It is important to note that these numbers only include live births, and many women who have stillbirths or miscarry experience postpartum depression as well, and medical experts believe that the rate of postpartum depression could be at least twice as much as what is actually reported & diagnosed.
Acupuncture treatment should be a part of the mother’s life from the start of pregnancy, and preferably beforehand. Proper treatment protocol would be to make postpartum care an ongoing process rather than a single encounter. The woman and/or family member should receive guidance through the pregnancy with development of a postpartum care plan that addresses the transition to parenthood for all. Ideally, the woman should have contact with her acupuncturist throughout, but definitely within the first 3 weeks postpartum to assess her mental and physical state after childbirth and prevent any possible postpartum depression symptoms from manifesting further or at all.
Studies show that acupuncture allows patients to regain their natural hormonal balance in a shorter time than those not treated with acupuncture, and is also at least as effective as standard medicines given for postpartum depression. A study in both 2014 & 2018 showed acupuncture to be as effective as fluoxetine in the treatment of postpartum depression, and a study in 2019 showed acupuncture to be effective at improving the symptoms of postpartum depression.
Having postpartum depression does not make someone a bad person or mother. It is a very real scientific condition that needs further study. As healthcare and technology advances, more studies and neuroimaging come up as we become increasingly aware of this very real health concern within new mothers and fathers. Acupuncture and TCM providers can truly be a big help along the way.
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