Postnatal Depression

Postnatal Depression (PND) affects on average 10% of mothers, the range being from 8 - 15%, 26 % having some form of mild depression and 2 in 1,000 postnatal psychosis. 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.

Ÿ Postnatal blues: transient, can occur within the first 2 weeks after delivery,
symptoms include lethargy, crying, anxiety, insomnia, poor appetite and irritability.

Ÿ Postnatal Depression: symptoms are as for the blues but can be more severe
and continue indefinitely without treatment.

Ÿ Postnatal psychosis: hallucinations, delusions, disorganised or catatonic
behaviour. There are a variety of conditions and circumstances that are indicated as predisposing factors or triggers for PND. By identifying those at risk, monitoring of mother before and after the birth many cases of PND can be caught early or avoided. Prognosis is usually positive, most cases seeing recovery in a short time. Postnatal psychosis is much more difficult to treat and, in severe cases, herbal treatment may have to be combined with Western medication, if the mother is suicidal or a danger to the baby. Women who are at increased risk : Ÿ PND is more prevalent among women who have had caesarean births, with a higher rate among those who have had anaesthesia. . Ÿ During pregnancy hormonal levels increase then plummet after delivery, producing a transient hypoactivation of the hypothalamic-pituitary axis that lasts for weeks to months. Cizza et al demonstrated that the suppression of the hypothalamic-pituitary axis is more severe and lasts longer in women who develop postpartum blues or depression. Ÿ Early postpartum anaemia: There is a negative correlation between Hb (Haemoglobin) concentration on postpartum and depressive symptoms. This is also indicated in TCM where a woman is more at risk if there is a pre-existing Blood Deficiency. Ÿ Thyroid levels: Low thyroid functioning is very common after childbirth. The baby's thyroid can produce antibodies against the mother's thyroid which causes it to under-function. Low levels can cause symptoms like depression, e.g. mood swings, fatigue, agitation, insomnia, anxiety. Ÿ Omega 3 oils: The high fetal demand for these fatty acids can lead to a 50% reduction of the maternal levels. Inadequate levels have been associated with PND. Ÿ Hyperemesis Gravidarum: similar to a severe form of morning sickness. Symptoms include loss of greater than 5% of pre-pregnancy body weight,dehydration , production of ketones, nutritional deficiencies, metabolic imbalances, difficulty with daily activities. Women with HG are often more sensitive to hormonal changes, which may be a reason that PND is more prevalent among these women. Ÿ Fatigue as early as 7 days is predictive of depression at Day 28 after birth. TCM and Post-Natal Depression

The predominant patterns associated with PND include: Ÿ Blood deficiency Ÿ Blood deficiency turning into Yin deficiency, or to Blood stasis. A woman is more at risk of PND if there is a pre-existing blood deficiency. Blood deficiency can also be caused by excessive loss of blood during childbirth or may already have been observed in pregnancy. The Heart houses the Mind and governs Blood, when Heart-Blood is deficient it fails to house the Mind giving rise to symptoms such as anxiety, insomnia, pale tongue and palpitations. Other Heart patterns that may be evident are Heart-Yin deficiency (night sweats, agitated, red tongue) or Heart-Blood stasis. Heart-Yin deficiency is often associated with Liver (depression, irritability); and/or Kidney-Yin deficiency (night sweats, loss of libido). Liver-Blood stasis (depression, purple nails) can also be found along with HeartBlood stasis (purple tongue, pain in chest, cyanosis of lips and nails). Pattern 1) Heart-Blood Deficiency Symptoms: include depression, fatigue, anxiety, insomnia, palpitations, poor memory, guilt. Treatment principle: Nourish Blood and Yin, calm the Mind. Tongue: Pale, Thin, may be dry. Pulse: Choppy, Weak on left side. Prescriptions Gui Pi Tang - Tonifies Spleen Qi, Heart Blood and calms the Mind. An Shen Bu Xin Wan - Tonifies Heart Blood, calms Shen, strengthens Heart - Kidney connection. Pattern 2) Heart-Yin Deficiency Symptoms: depression, exhaustion, insomnia, palpitations, mental restlessness, guilt, scanty breast milk, loss of libido, irritability, a feeling of heat in the evening, night-sweating. Treatment principle: Nourish Yin, tonify the Heart, calm the Mind. Tongue: Red without coating, with a Heart crack, red tip. Pulse: thin or thready and rapid, if severe may show floating and empty. Prescriptions Tian Wang Bu Xin Dan - Nourishes Blood and Heart and Kidney Yin, calms the Mind and clears Empty Heat. An Xin Tang - Nourishes Blood, clears Empty Heat harassing the Heart. Gan Mai Da Zao Wan - Tonifies Heart Yin, calms Spirit Pattern 3) Heart-Blood Stasis Symptoms: depression, manic behaviour, cyanotic lips and nails, stabbing pain, aggressive behaviour, delusions, hallucinations, suicidal, destructive thoughts. Treatment Principle: Invigorate Blood, eliminate stasis, calm the Mind, open the Mind's orifices. Tongue: Purple (may show purple spots). Pulse: Wiry, Rapid may be uneven, knotted, or intermittent. Prescriptions Bu Nao Wan - Nourishes Heart Yin, clears Heart Phlegm, tonifies Heart Blood and Qi.

Xiao Tiao Jing Tang - Deficient Blood that is rebelling upwards to harass the Heart causing post-natal psychosis. Bai Zi Yang Xin Wan - Nourishes Heart Yin and Blood, calms Shen, resolves heart Phlegm, disperses heat in upper burner. Herbs to Nourish Blood Long Yan Rou (Longan Berry) - Supplements the Heart, calms the Shen, nourishes Blood, tonifies Spleen. Sweet flavour, warm energy. Organs: Heart, Spleen. Dang Gui - Nourishes, moves and builds Blood. Sweet flavour, warm energy. Organs: Heart, Liver, Spleen. Shou Di Huang (Prepared) Rehmannia - Nourishes Blood. Sweet flavour, warm energy. Organs: Heart, Liver, Kidney. Herbs to Nourish Yin Bai-He (Lily Bulb) - Quiets Heart, calms the Shen, nourishes Yin. Sweet flavour, cold energy. Organs: Heart and Lung. Tian Men Dong (Ophiopogon) - Removes heat, resolves phlegm, nourishes Yin. Sweet and bitter flavour, mild, cold energy. Organs: Heart, Lung, Kidney. Cardiotonic Tranquillisers: reduce fright, palpitations, insomnia, caused by weakness of the Heart, Blood and Liver Yin. Mild nature, used to treat a weak constitution. Bo Zi Ren (Biota Seed) - Tranquillises heart, calms spirit. Sweet and pungent flavour, neutral energy. Organs: Heart, Liver, Kidney Suan Zao Ren (Zizyphus) - Calms Heart and spirit, reinforces Yin. Sweet and sour flavour, neutral energy. Organs: Heart, Spleen, Liver, Gall bladder Yuan Zhi (Polygala) - Tranquillises Spirit, removes phlegm, used to open the mind's orifices. Pungent and bitter flavour, warm energy. Organs: Lung, Heart, Kidney. He Huan Pi (Albizzia Bark) - Relieves Depression, used to open the mind's orifices. Sweet flavour, neutral property. Organs: Heart, Spleen, Lung. Settling Tranquillisers: Help to calm, generally used in a firm constitution. Mu-Li (Oyster Shell) - Tranquillises spirit, subdues exuberance of Liver Yang. Salty and astringent, mild, cold energy. Organs: Liver, Gallbladder, Kidney. Long Chi (Dragon Teeth) - Tranquillises spirit and mind. Fright, manic-depression. Astringent, cool energy. Long Gu (Dragon Bone) - Tranquillises mind, tranquillises and nourishes Spirit, moves Qi stagnation in Heart, subdues exuberance of Liver Yang. Sweet and astringent, neutral energy. Organs: Heart, Liver, Kidney.
Acknowledgements

Ÿ Catherine Roca, National Institute of Mental Health, National Institutes of Health (NIH). Ÿ Hendrick V, Altshuler LL, Suri R: Hormonal changes in the postpartum and implications
for postpartum depression. UCLA Neuropsychiatric Institute and Hospital.

Ÿ Ahokas A, Kaukoranta J, Wahlbeck K, Aito M: Estrogen deficiency in severe postpartum Ÿ Ÿ Ÿ Ÿ
depression: successful treatment with sublingual physiologic 17beta-estradiol. Michelle A. Bland: The effect of birth experience on postpartum depression. Nonacs R, Cohen LS: Postpartum mood disorders: diagnosis and treatment guidelines. Perinatal and Reproductive Psychiatry Clinical Research Program, Department of Psychiatry, Massachusetts General Hospital. Corwin EJ, Murray-Kolb LE, Beard JL: Low haemoglobin level as a risk factor for postpartum depression.

Ÿ Giovanni Maciocia: Post-Natal Depression drawn from Wu Qian’s "Golden Mirror of
Medicine" (Yi Zong Jin Jian, 1742).

Ÿ Most of the mentioned research documents are to be found on www.medscape.com, a very useful site. Sonya Oldham, Dip.C.H, MURHP, Dip A&P Massage, VTEC.