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Postpartum Depression: Diagnosis and Treatment
Postpartum Depression: Diagnosis and Treatment

Manual of Articles Sections 15 - 28
Section 15
Alternative Medical Treatments for Postpartum Psychosis

CEU Question 15 | CEU Test | Table of Contents | Depression
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

In the treatment of postpartum psychosis, contemporary psychiatric practice calls for the use of anti-psychotic medications, and in some cases electroconvulsive (shock) therapy. However, alternative healing modalities may provide complementary means of restoring health. Though not meant to replace hospitalization in a case of acute psychosis, these alternatives may provide relief from the factors that caused the psychotic episode in the first place.

Nutritional Supplements: The Health Research Institute and Pfeiffer Treatment Center (866.504.6076; www.hriptc.org) provides treatment for a variety of mental-health issues through the use of nutritional supplements. A member of the Treatment Center's staff. Judith Bowman, MD, says that the approach to treatment involves reducing the abnormally high levels of serum copper (a dominant feature associated with postpartum depression), but that there are also a number of other factors evaluated in determining the course of treatment, including: blood serum ferritin levels (iron storage), to check for anemia; thyroid function, because the thyroid tells cells how fast to metabolize food; blood histamine levels; and mineral imbalances. Using samples of blood, urine, and hair. Dr. Bowman checks approximately 180 parameters. In cases of postpartum psychosis, high levels of kryptopyrroles — which indicate low levels of zinc and vitamin B6 — signal that serotonin and GABA neurotransmitters are not being produced in adequate amounts. In addition, most postpartum psychosis patients exhibit elevated blood copper, which is associated with elevated norepinephrine levels and can contribute to depression, anxiety, psychosis, or violent behavior.

Some women suffer from an imbalance of good and bad bacteria or an overabundance of yeast, which can cause problems with the absorption of nutrients and minerals in the gastrointestinal tract. Sensitivities to casein (a milk protein) or gluten (from wheat, rye, oats, and barley) can also lead to absorption problems when partially digested pieces of food, called exorphins, leak out of the gut and find their way to neurotransmitter receptor sites in the brain. For the high levels of copper and estrogen common in cases of postpartum psychosis (see sidebar on page 60), the patient is given a metallothionein promoter to lower the level of copper in the blood; the estrogen level then balances out by itself. Because Bowman is unsure whether aggressive nutrient treatment is safe during breastfeeding, she recommends reduced dosages until weaning.

The Pfeiffer Treatment Center works with psychiatrists in a team approach, because they believe there is a place for psychiatric medications. Bowman says that when patients do not respond well to their medications, "once we start their nutritive program, they begin to respond better. We help make their antipsychotics work better, or at least do the job they were designed to do." Nutritional supplements are not fast-acting, but, says Bowman, "one of the faster things we can correct is pyrrole disorder. We can replace [vitamin B6 and zinc] pretty quickly." Bowman adds that patients with pyrrole disorder may see improvement in one to two weeks; other disorders may take two to six months to correct. Dr. Carl C. Pfeiffer's book, Nutrition and Mental Illness, may be a helpful resource.

Homeopathy: Karl Robinson, MD (713.621.3184), uses homeopathic medicines to treat postpartum psychosis and other illnesses. Homeopaths treat what Samuel Hahnemann, the founder of homeopathy, called the "vital force." When the vital force is disturbed, the mind and body begin to manifest symptoms. Robinson explains that "the homeopathic medicines work to correct whatever energetic problem exists in the vital force." When the vital force is in good working order, then "it exerts an all-powerful beneficial effect on the mind, the body, and the spirit…. Our therapy is designed to act on the level of the vital force, which in turn causes the biochemistry to normalize and the psychological anguish to diminish and go away." By treating this deepest level, the whole person is brought back into a state of equilibrium.

In taking a patient's history, the homeopath is looking for unique, and often strange, symptoms that will indicate which homeopathic medicine is appropriate. There is certainly no single "postpartum-depression pill." By examining many factors — including, according to Robinson, "the patient's emotional state. characteristic phrases of speech, and recurrent dreams as well as physical symptoms" — the homeopath determines "which medicine best corresponds To this particular patient. It is an 'individualizing' process." The medicines act instantaneously, but "the effects may take time to manifest." Homeopathy can be used safely during pregnancy and breastfeeding, although, Robinson says, "you can treat with medicine now and then, even a few times a day for a few days, but I wouldn't keep anyone on the medicine for months [during pregnancy]."

Acupuncture: Like homeopathy, acupuncture is an energy treatment that is safe to use during pregnancy and breastfeeding. It is important to find an acupuncturist who has had training in working with pregnant women, because many acupuncture points stimulate the production of the hormone oxytocin. Doctors who are certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) have taken three to five years of training and have passed a board exam. According to Jennifer Meador-Stone, Doctor of Oriental Medicine, LAc, "acupuncture puts the body into a place of homeostasis or balance." While Meador-Stone believes that a patient exhibiting psychotic symptoms should be treated at a hospital, she says that acupuncture can be used to help quickly wean a person off psychiatric medications, and can reduce the side effects caused by those medications.

Chiropractic: Using blood tests and vitamin and mineral supplements. Brian McGuckin, DC, DABCI, focuses on the nutritional side of postpartum mood disorders. "What we tend to forget is that the nervous system, the immune system, and the hormone system work together." First, he looks into the causes of exhaustion and depression: lack of iron, magnesium, vitamin B, or antioxidants. Last on his list is a hormone imbalance. "Ninety-nine percent of this is purely nutritional. The person was usually anemic during pregnancy, and after the birth, the body cannot compensate anymore. There's a huge mineral demand" during pregnancy. McGuckin asserts that prenatal vitamins are not enough to prevent some women from developing perinatal mood disorders, such as postpartum depression. "The idea behind prenatal vitamins was that everyone was going to eat a picture-perfect diet, and the prenatal vitamins were just there to prevent birth defects, But it's a busy world, fast food does exist, and nutritional requirements can become compromised. When you become too weak in the process, that's when things start to fall apart."

Self-Care: According to Kathleen Kendall-Tackett, PhD, IBCLC, postpartum depression can be eased by use of an "adjunct treatment to help the body heal itself, but not necessarily as primary treatment. With psychosis, medications are necessary to stabilize symptoms. After that, adjunct treatments can help prevent another episode. That would be the safest course."

If a woman has experienced a traumatic birth, or previous sexual abuse, posttraumatic stress disorder may be a factor. "Medications and counseling can help here too. But EPA and DMA, the long-chain omega-3 (fatty acids], are showing promise as adjunct treatments for trauma," says Kendall-Tackett.

Exercise, too can benefit depressed women. Exercise might be hard to implement in cases of acute psychosis, but once a patient is stabilized, exercise is "a good thing to put in place because often there's co-occurring depression," says Kendall-Tackett. "Depression can trigger another psychotic episode. If someone is depressed, they're vulnerable, so it's important to treat that co-occurring depression. For someone with mania, before things get spun out of control, [exercise] might be a way to taper off some of that excess energy, and then get the adjunct treatments in place to keep it from going into a full-blown manic episode."

Sleep deprivation is another aspect of psychosis. Severe insomnia is common, "Not sleeping for several days is the red-flag symptom for psychosis," warns Kendall-Tackett. "Being depressed affects your sleep, but not sleeping also makes you more depressed. Unfortunately, they feed into each other and you get into this bad cycle." A woman who is not able to sleep at all should see her doctor immediately.

Kendall-Tackett encourages mothers who want to continue breastfeeding to do so, even through a psychotic episode. To facilitate breastfeeding, she advises: "Mothers need a supportive environment, where mom and the baby can stay together but the baby is safe. Mothers and their care providers also need to know about which medications are compatible with breastfeeding." The best resource for that is Dr. Thomas W, Male's book, Medications and Mothers' Milk. Birdie Gunyon Meyer, RN, MA, CLC, coordinator of the Perinatal Mood Disorders Program at Clarian Health Women's Services in Indianapolis, Indiana, advocates self-care: "getting enough sleep, eating a balanced diet, getting some kind of exercise (like a walk) every day, doing something just for yourself (like getting a massage), and taking time off work." In addition to medication, Meyer encourages members of her postpartum support groups to try "yoga, stretching, prayer, meditation, massage therapy, aromatherapy, journaling, bubble baths, music, watching a sunset, and saving major decisions for later." She emphasizes "eating foods that are healthy for you, including six to eight glasses of water per day, and avoiding junk food and anything high in sugar. In addition, a good multivitamin and vitamin B complex and omega-3 fish oils might be helpful." Light therapy is used to treat depression. Meyer also recommends going outside every day and staring into the sky (don't look directly into the sun), and, as helpful adjunct therapies to consider, counseling and support groups.

Though not meant to replace hospitalization in a case of acute psychosis, these alternatives may provide relief from the factors that caused the psychotic episode in the first place.
- Alternative Treatments For Postpartum Mood Disorders; Mothering; May/Jun2007, Issue 142

Challenges in Diagnosing and Treating Postpartum
Blues, Depression and Psychosis

- Lewis, C. A., Bers, A. D., Malard, S. D., and Dawson, G. A. Challenges in Diagnosing and Treating Postpartum Blues, Depression and Psychosis. The Alabama Counseling Association Journal, 36(1). p. 5-14.

Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socio-economic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 225 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress.” You will not be required to provide us with these Journaling Activities.

Personal Reflection Exercise #1
The preceding section contained information regarding various alternative medical treatments for postpartum depression and psychosis.  Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Blum, L. D., Horenstein, A., Carper, M. M., Stange, J. P., Cohen, J. N., Doyle, A., & Smith, V. (2021). A new instrument to assess counterdependency, evaluated in the context of postpartum depression. Psychoanalytic Psychology, 38(1), 49–57.

Brandão, T., Brites, R., Pires, M., Hipólito, J., & Nunes, O. (2019). Anxiety, depression, dyadic adjustment, and attachment to the fetus in pregnancy: Actor–partner interdependence mediation analysis. Journal of Family Psychology, 33(3), 294–303.

Cao, H., Zhou, N., Leerkes, E. M., & Su, J. (2021). The etiology of maternal postpartum depressive symptoms: Childhood emotional maltreatment, couple relationship satisfaction, and genes. Journal of Family Psychology, 35(1), 44–56.

Online Continuing Education QUESTION 15
What are five categories of alternative treatment for postpartum depression and psychosis mentioned in this article? Record the letter of the correct answer the CEU Test.

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Postpartum Depression: Diagnosis and Treatment

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