Science and Research Forutn

NAPROTECHNOLOGY AND POSTPARTUM DEPRESSION: A CLINICAL ASSESSMENT OF THE THERAPEUTIC EFFECTS OF PROGESTERONE Postpartum depression is a somewhat controversial condition. It has been suggested that seven to twelve percent of women following childbirth will have relevant depressive disorders by six weeks following delivery. Attention has been focused on the role of unwanted pregnancies, major marital difficulties, other situational aspects or long-standing problems as important etiological factors in this condition. However, not much attention has been placed on the role of hormonal changes and subsequent hormonal treatment. Katarina Dalton, over many years of working with premenstrual syndrome, noticed that postpartum depression responds to progesterone treatment. In our work with the NaProTechnologyTMapplications of progesterone in premenstrual syndrome, there was a natural interest in using progesterone for the treatment of postpartum depression as well. This study is a report of 15patients who experienced postpartum depression and who were treated subsequently with progesterone. These patients range in age from 27 to 41 with a mean of32.4. They had a mean gravidity of 4.5 (with a range of2 through 10) and parity of3.3 (with a range of I through 6) and previous miscarriage of 1.4 (with a range of 0 to four). Eleven out of thirteen patients in which information was available had a previous history of premenstrual syndrome and eight out of twelve had a history of previous postpartum depression. Some of these occurred following miscarriage. The most common symptoms observed in our patients with postpartum depression were depression, anxiety/panic disorder, uncontrollable crying, fatigue, insomnia, suicidal thoughts, poor appetite, night sweats, shaking and a "freezing" sensation along with some lesser symptoms of feeling wired, mind racing, hot flashes, strange thoughts, rapid heartbeat and nausea. These patients were all treated with progesterone using different programs of treatment. This latter factor was due to the lack of knowledge of the exact doses to use and the routes of administration that might be best. Some were treated during pregnancy with progesterone along with being treated postpartum. Intramuscular, oral and/or vaginal progesterone were all used at various doses. From this, basic results could be observed and a program for improved management could be elicited. In these 15patients, there were 18 episodes that were treated. Fifteen of these (83.4%) had either excellent (n=12, 66.7%) or very good outcomes (n=3, 16.7%) and three had minimal improvement-outcomes (17.6 percent). In each of the three cases of minimal improvement, the patients had had previous severe episodes of postpartum psychosis and/or the entry for the use of progesterone occurred several weeks after the beginning of symptoms prior to treatment. In other cases, where treatment was initiated early and aggressively, these symptoms were alleviated with excellent or very good results in all cases. In studying these cases there are a number of treatment factors that have been identified. First of all, the use of progesterone for the treatment of postpartum depression and anxiety is dramatic when used early in the symptom complex. We had patients telling us that "This is a miracle," "Feeling great," "Feeling considerably better," "I cannot believe how good I feel within two hours of the progesterone injection." Secondly, there is a significant history of premenstrual syndrome and previous episodes of postpartum depression that occurred in our population with postpartum depression. If those can be identified in advance of pregnancy and treated appropriately, the anticipated difficulties with postpartum depression can be significantly reduced. Thirdly, if one has knowledge of premenstrual syndrome or postpartum depression in previous history following either a full term delivery or miscarriage then treatment during the pregnancy with progesterone can help considerably to decrease the recurrence of postpartum depression. Fourthly, the results with progesterone treatment are most dramatic with the use of intramuscular progesterone. The treating physician must be willing to titrate that dose against the occurrence of the patient's symptoms. On many occasions we have had patients tell us that the symptoms disappear within minutes or hours following the injection of progesterone. Oral progesterone and vaginal progesterone also have a role but only as supplements to intramuscular progesterone.