A new article in Time discusses legislation focusing on education and screening of post-partum depression. The Melanie Blocker-Stokes Postpartum Depression Research and Care Act is legislation that is named for a woman who killed herself because of postpartum psychosis. The legislation is to provide funding for research and education efforts in hopes of increasing awareness on the part of healthcare providers and the public about the risks, sometimes deadly, of this common problem. Most are familiar with the Andrea Yates story and the attention surrounding the legislation brings controversy to an issue that is generally treated with pharmaceuticals. Certainly the SSRIs (selective serotonin reuptake inhibitors like Prozac, Zoloft) that are used in the treatment of PPD are not without risks, especially concerning for those women who breastfeed. One has to believe that the drug companies will certainly benefit from the attention since they are looking for any avenue for a new indication for treatment, followed by commercials targeted to new moms (potential patients) who may be feeling overwhelmed by a mild case of “baby blues,” and, of course, let us not forget the increased profit margin, despite the actors’ obvious concern for the mom’s well-being. It never fails to astound me how progesterone deficiency (and estrogen as well) are completely ignored as factors in the development of PPD. Some opponents of this legislation say PPD has nothing to do with pregnancy (and certainly not hormones) but rather a woman’s pre-existing history of anxiety or depression. Of course, the article sites psychologists and not physicians who treat post-partum women so I am not sure they are the best people to give an opinion. The study sited to deny a hormonal link is laughable. Women were given drugs to mimic postpartum hormone decline. Only those women with a previous history of PPD developed mood problems. While women with pre-menstrual dysphoric disorder(PMDD) were excluded, women with PMS were not. Hardly strong scientific validation that there is no hormonal component. How about baseline hormone levels? How about the fact that most women who have hormonal imbalance going into pregnancy, have a higher chance of having problems during and after pregnancy? How about confounding factors like family support structure, Vitamin D and B12 deficiencies (known mood-altering essential nutritional factors), and dietary differences?
Those of us in the hormone arena know that there is a strong correlation between progesterone deficiency and other nutritional and neurotransmitter imbalances and PMS, PMDD and PPD. That these mostly hormonal disorders are virtually treated exclusively as idiopathic mood disorders continues to be discouraging evidence that the pharmaceutical and mainstream medical communities are not interested in hormone balance and wellness, but rather treatment of symptoms with drugs with potentially dangerous side effects. While there is no doubt that brain chemistry is extremely complex, its connection to hormone balance is indisputable, as doctors like Dr. Eric Braverman clearly show. A wholistic approach is always wise. Progesterone is a Pro-Gestational hormone at every stage…you need progesterone to get pregnant, to stay pregnant, to prevent pre-term birth, and to prevent post-partum depression. Although I primarily use salivary hormone testing, I have ordered plenty of serum progesterone levels through the years and there is rarely a normal progesterone level in patients that are not supplemented. Also keep in mind that the range of normal for serum progesterone is usually too low anyway. Since bio-identical progesterone has few side effects compared to synthetic progestins and SSRIs, even those not entirely convinced of its efficacy should utilize it when treating women with PPD. The effect of progesterone can be immediate as outlined by Dr. Thomas Hilgers at Creighton University, the founder of NaPro Technology, progesterone-based protocols for all manner of obstetric and gynecologic disorders. It is Dr. Hilgers observation, and my own, that if one optimizes progesterone levels before and during pregnancy, there is virtually no incidence of post partum depression. Every day in my practice I see women who have suffered needlessly for years because their hormone imbalance was never diagnosed or properly treated. Unfortunately, in the case of postpartum depression, this can be a life or death situation.