Chapter 30: Postpartum Depression: Evaluation and Treatment

Hilgers TW

Postpartum Mental Health

Chapter 30: Postpartum Depression: Evaluation and Treatment

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 369-380, 2004

RRM Academy Synopsis

Most postpartum depression episodes treated with progesterone improved

Most postpartum depression episodes treated with progesterone improved markedly or moderately in a two-phase study of 50 women. A textbook chapter reports the study. The chapter proposes that the drop in progesterone after birth may contribute in a subgroup of women and lists earlier premenstrual syndrome as a risk factor.

Key Findings

The chapter reports postpartum mood disorders in nearly 40 percent (or more) of women, and psychiatric hospitalization risk in the first three months postpartum seven times that of other periods.
Risk factors include a history of premenstrual syndrome or postpartum depression, personal psychiatric history, mood disorder, and genetic vulnerability. Studies cited relate mood after delivery to withdrawal of natural progesterone.
In 21 women with postpartum depression, progesterone in pregnancy ran higher than in normal controls, significant only in the first 12 weeks. A larger fall after delivery could contribute.
The study enrolled 20 women with 23 episodes in its first phase and 30 women in its second, 53 episodes of postpartum depression in 50 women.
Among the 53 episodes, most showed marked or moderate improvement; in the second phase, average symptom counts fell significantly.

RRM Context

Restorative reproductive medicine looks for the hormonal change behind a symptom before choosing a treatment. Hormone levels shift sharply at delivery, and the months after birth belong to the same reproductive lifespan that restorative care follows. NaProTECHNOLOGY, developed by Dr. Thomas W. Hilgers, brings its hormone-based evaluation into that period. A history of premenstrual syndrome is known before a pregnancy begins. A clinician can therefore anticipate postpartum mood changes early and read them against the woman's own cycle history, which connects each stage of her reproductive life.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter reviews the definition, incidence, proposed causes and conventional treatment of postpartum depression (PPD) and distinguishes it from postpartum psychosis (PPP). Among proposed causes, the chapter discusses the withdrawal of progesterone and its metabolites after delivery and reports that women with PPD at the Pope Paul VI Institute had higher progesterone levels during pregnancy than controls, a difference that was statistically significant only in the first 12 weeks. Hilgers then reports an open-ended study without a control population, conducted in two phases, in which women with PPD were treated with progesterone and the results were most dramatic with intramuscular injection. The chapter presents a clinical worksheet and treatment protocol developed from this work and states that further study with a randomized, double-blind design is needed.

Topics

Postpartum › Mental Health › Postpartum Depression · Reproductive Endocrinology › Ovarian Hormones › Progesterone · Therapeutics › Hormonal Agents › Progesterone and Progestins

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 30: Postpartum Depression: Evaluation and Treatment

Most postpartum depression episodes treated with progesterone improved

Key Findings

RRM Context

Abstract

Topics

By this author

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