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Postpartum Depression (PPD)
Postpartum depression (PPD) is a major depressive episode occurring during pregnancy or within the first year after childbirth. In the setting of PPD a woman will have persistent symptoms, which would include but not be limited to: depressed mood, anxiety, sleep disturbance and/or feeling of being overwhelmed. A true PPD will result "significant functional impairment", ie: a woman will not be able to function well in her day-to-day activities.
PPD is not the same as the “Baby Blues” which is when symptoms are present for only a few days or one to two week. The American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the U.S. Preventive Services Task Force all recommend that postpartum women be screened for depression with one of several validated standardized screening tools and offered treatment if indicated. One such standardized screening tool for PPD is called the "Edinburgh Postnatal Depression Scale (EPDS) ". Click the button below and see Handout #17 for a downloadable pdf file of the EPDS that includes the scoring system or you can do an online assessment here.
How is Postpartum Depression diagnosed?
Screening... Screening... Screening...
According to the American College of Obstetricians and Gynecologists, standardized screening should be preformed at least once during pregnancy, and again during the early postpartum period. Whereas, the American Academy of Pediatrics recommends screening at the well child visits for the first 6 mos (at 1moth, 2 months, 4 months, and 6-months).
Risk Factors:
According to the American Academy of Family Physicians (AAFP) key risk factors are:
Psychiatric and psychological factors:
- History of depression
- Comorbid anxiety
- History of physical or sexual abuse
Social and economic factors:
- Lack of social support
- Lack of financial support
- Low socioeconomic status
- Ongoing stressful life events
Pregnancy and birth-related factors:
- Unplanned or undesired pregnancy
- Traumatic birth
- Breastfeeding difficulties
- Adolescent pregnancy
Medical factors:
- Preexisting diabetes mellitus or gestational diabetes
What are NaPro Treatments for Postpartum Depression?
One of the best and most effective NaPro Treatments is our protocols for managing Postpartum Depression and Anxiety. Women just LOVE how quickly they respond to this treatment.
We use bioidentical (micronized) progesterone, which can be given either via injection, orally, or even vaginally. We will have a dialogue first, during which time I will provide education regarding the pros and cons of using the different formulations.
My personal preference is to use injectable progesterone:
- Just one injection of 200 mg of progesterone is often sufficient to make a woman feel better.
- If you feel there is still room for improvement, you can take another injection of 100 mg of progesterone every other day for up to five more doses.
- After a total of six injections, you will have the option to meet with me again to discuss additional treatment if you feel a need. Most often a second visit is not needed.
- I will ask that you have someone designated to inject you. Some providers allow their patients to inject themselves. However, I prefer you do not do this.
If you don't like to take shots... or you don't have some to inject you... no problem!
- We can start with oral progesterone 200 mg taken once daily right before bedtime.
- You will continue this for up to two weeks.
- After two weeks, you will have the option to meet with me again to discuss additional treatment if you feel a need. Most often a second visit is not needed.
- During your TeleHealth visit, I will provide you with additional information and education.
Yes! Progesterone supplementation is safe even if you are breastfeeding your baby.
I prefer to order your progesterone solution from use Kubat's Compounding Pharmacy.
11107 Mill Valley Rd. Omaha, Nebraska, 68154.
Ph: (402) 558-2474; FAX: (402) 561-1252.
Kubat's is one of the few pharmacies who will provide you with an injectable solution that is 100mg/ml. Thus, we can minimize the number of injections you will need to take. Additionally,
the pharmacists there are exceptionally well-versed in providing progesterone for Napro Protocols. After I call in the Rx, a pharmacist will call you to discuss cost and you will confirm you wish to move forward. Kubat's also offers expedited shipping.
Please view the FREEDOM TO TEACH INSTRUCTIONAL VIDEO. Injections should be administered in the upper-outer quadrant of the buttocks (shown in the video) and you should always alternate sides.
Common side effects of the injections are:
- Tender lumps/bumps
- Soreness itching and/or mild bruising at the injection site
Here are a few tips to avoid these common side effects:
- Prior to injecting, hold the vial of progesterone solution in your closed hand to help the solution become slightly less viscous (thick).
- Inject the solution SLOWLY over a full TWO minutes. Always set a timer. The slower the solution is injected, but less likely you will form tender lumps and bumps.
- Apply a heating pad to the site for about 5-10 minutes after the injection has been given. ** Note: never apply a heating pad prior to giving the injection.
- Always inject in the AM if possible, and gently massage the area as much as possible throughout the day. Move around as much as possible, as both the massage and movement will help disseminate the solution more effectively, minimizing the chance of forming tender lumps/bumps.
Please download the handout entitled, "St. Paul VI Progesterone Injection Instructions & Landmarks" posted below. We will be reviewing this handout together during your Telehealth visits.
Information about Bioidentical Progesterone:
Again, only bioidentical hormones supplementation is offered. Bioidentical progesterone can be purchased through a retail pharmacy (eg: CVS, Walgreens, Walmart, etc... it is called "micronized progesterone" as a generic, also known as "Prometrium". Pts can also purchase this via a compounded pharmacy (cash pay only). This medication is generally well-tolerated. Some common side effects are quite pleasant, eg: you may feel more relaxed or sleepy and your might find your mood may improves. Some more unpleasant side effects may be: next-day fatigue, nausea, headaches, or dizziness. Most often the unpleasant side effects can be easily managed by taking the medication right before you lay your head down on the pillow and/or changing to a compounded formulation. Please know prometrium and generic progesterone capsules contain peanut oil, so you CANNOT take this if you have a peanut allergy.
Sometimes the Prometrium or generic micronized progesterone that is purchased will include a package insert which will "warn" of possible birth defects. However, this warning refers to progesterone substitutes that are often prescribed in oral contraception pills, not the bioidentical progesterone we are prescribing. NaPro providers, who were trained at the St. Paul VI Institute, have been safely prescribing micronized progesterone to many, many women to support pregnancies for over 35 yrs and they have not encountered problems.
If the oral medication is not strong enough or if the side effects are bothersome, we can try a vaginal suppository. This will be prescribed for you by a specialty pharmacy called a "compounding pharmacy". You can see a list of compounding pharmacies by viewing Handout #21 here.