#PTonICE Daily Show – Monday, December 4th, 2023 – Postpartum depression, part 3: treatment, support, and resources

In today’s episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick as she wraps up her series on postpartum depression. In this episode, she will focus on first line of defense treatment for PPD including including medication, psychotherapy and exercise. As well as how to support someone with PPD as a friend or healthcare provider. She concludes with some important resources for emotional and mental health support that are free and extremely helpful to share with someone who is postpartum.

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Hello and welcome PT on ICE. My name is April Dominick. I am part of the faculty for the ICE pelvic division. And today’s topic is all things treatment support strategies and helpful resources for postpartum depression. This is the final episode in my three part series on postpartum depression. So I am excited to dive in. But first I wanted to remind everyone of our array of course offerings in our pelvic division. Our first few live courses of 2024 are in Raleigh, North Carolina. That’s going to be January 13th and 14th. And then Hendersonville, Tennessee, January 27th and 28th. And let’s not forget about our not one, but two online eight-week course offerings. The level one cohort is going to start January 9th, while our brand new level two advanced concepts course will take place April 30th. If you’ve got someone asking you for some gift ideas or asking you to let them get you a birthday present, if you have a winner birthday, then have them help you out with some courses for ICE. That would be such a great gift of learning. And you can head over to ptonice.com to secure your seat in one or all three of those offerings, which is what is needed for our brand new ice pelvic certification.

All right, let’s dive in today to the treatment section of postpartum depression. So one of the most common ways to treat postpartum depression is with antidepressants and psychotherapy. For those who are lactating, the conversation may include discussing the benefits of breastfeeding and known risks of antidepressant use during lactation. A lot of folks have concerns with the side effects that can occur when starting antidepressants. These concerns are totally valid and really excellent questions to bring up with their physician. For some, not being on the medication and leaving symptoms left untreated from a medical management standpoint could be just as risky in terms of their mental health and emotional health as well. For those who are concerned about the interactions that breastfeeding would have with antidepressants, or for those who would not prefer to take antidepressants, Psychotherapy is actually the first line of treatment. When looking for a mental health provider, we want to remind our clients, if possible, you want to find one that lists some sort of training in or special specialization of perinatal health as they will be really well-versed in the unique challenges that a postpartum individual faces. 

Now, Let’s talk about a treatment that is within our PT scope of practice, and that’s going to be exercise. So exercise is a great alternative or supplement to treating postpartum depression. Now, as a postpartum person, finding time to exercise while caring for a newborn, as well as taking care of the rest of life’s demands, including chores or a job, That can be incredibly difficult and is a huge barrier for many to either return to or begin exercise in the postpartum period. When I was searching on the American College of Obstetrician and Gynecologist website, just seeing what all they have in terms of resources and recommendations, they didn’t really have exercise as readily mentioned on their main pages when they were discussing how to address postpartum depression symptoms. And rather, they had like the medication and the mental health therapy, which was the greater focus, which is wild given that it Exercise is an excellent treatment offering that’s conservative, it’s generally accessible, and non-pharmacological. Not to mention, some of the forms of exercise can be cost-effective. And this may be a gap that we as rehab providers can remind our physician colleagues on the latest research that we know about of the effects of exercise and depression. and reminding them that, hey, we’re those musculoskeletal experts in your community, and we are willing and able to help guide their clients in starting or continuing exercise, as we know, improving the postpartum individual’s physical well-being and directly supports their mental health and well-being.

So what do we know about the effects of exercise in general on depression? Exercise helps to increase levels of endogenous endorphins and opioids, all of which have positive effects on mental health. And the team from Singh et al published a paper in 2023 on an overview of systematic reviews on physical activity for improving depression. they found that physical activity had medium effects on depression compared to usual care. So specifically, they suggested that aerobic resistance and yoga exercise was the most beneficial and exercise with higher intensity was associated with greater improvements. And then there was another study that was published in September of 2023, and this one was by Zhao et al. And they aimed to determine the association between seven lifestyle factors and lots of other body functions to see what their impact was on depression. They studied data from 290,000 individuals across nine years, with about 13% of those individuals developing depression. We love that length of time for data collection. Some of the seven healthy lifestyle factors that they found were associated with a lower risk of depression were healthy sleep, about seven to nine hours, that reduced the risk of depression by 22%. Frequent social connection that reduced the risk of depression by 18%. it was the frequent social connection was the most protective against recurrent depressive disorder. And then the other two of the seven healthy lifestyle factors was regular physical activity that reduced depression risk by 14% and then low to moderate sedentary behavior. When it comes to our postpartum population, we have to recognize that seven to nine hours of sleep is extremely unrealistic for most, but we can offer suggestions for improving the quality of that sleep, curating the best environment with maybe the control of limited noise. Can we make the room colder when we are going down for two to three hours, start to nap, uh, darker, uh, light or like less light and then cooler temperatures. Um, So those were some of the studies that looked at the effects of exercise and lifestyle behaviors on depression overall. What about the role of exercise in prevention and treatment of the postpartum population with depression? A little more niche. When it comes to aerobic exercise, there was a qualitative systematic review from 2023 by Xu et al. And it actually just came out last week. And it was studying the efficacy of aerobic exercise in preventing and treating postpartum depression. They found that compared to standard care, aerobic exercise, particularly 30 to 45 minutes of moderate intensity, three to four sessions a week, had a significant effect in treating postpartum depression with a greater emphasis on prevention. Many of the studies we have on exercise effects on postpartum depression, look at aerobic exercise. But what about resistance training? So in a study by Le Chemin et al. from 2019, the group examined the influence of resistance training in women during postpartum depression. They found that compared to a stretch-based program, those who engaged in resistance training reported a significant decrease in their depressive symptoms four months postpartum. compared to when they measured immediately postpartum. We also have data from our very own ICE faculty, Dr. Christina Prevett, who did a study that looked at the impact of heavy resistance training on pregnancy and postpartum health outcomes. And compared to the national averages, those who lifted heavy showed lower rates of perinatal mood disorders as well. So there’s quite a bit of heterogeneity in the method sections of these studies that these systematic reviews are looking at when it comes to exercise and depression. This makes it difficult to specify any sort of intensity or specific type of exercise or timing frequency domain for what is best practice, what is most effective for using exercise to help with reducing depression. The SHU article was one of the first that I had run across giving a specific time and frequency domain for exercise in the postpartum depression period. It would be interesting if researchers could look at the effects of exercise alone, as many of the studies look at the combination of the treatment of psychotherapy, medication, and exercise. I’d also be curious about, hey, does it matter the specific time that someone returns to exercise postpartum. As in, is it most effective if someone returns to movement within two weeks, four weeks, six weeks? What makes the most difference? So while we’re waiting for more dialed-in research in the clinic, If you’re going to create a program or suggest a rehab EMOM for someone with postpartum depression, make sure that you’re including a mix of aerobic exercise, resistance training, and mobility, as well as some sort of reconnecting with their breath and body, just to help tap into that downregulation of the nervous system and hit those preliminary time guidelines from Shu et al. of 30 to 45 minutes, three to four sessions a week. So to sum up treatment, while there are multiple options to address postpartum depression currently, our first treatment approach is usually a combination of the treatments of antidepressants, psychotherapy, and exercise. So that was treatment.

Now I want to talk about how do you support someone who has postpartum depression as a rehab provider or a friend. Overall, validation, education, and reassurance and psychosocial support go a long way in helping someone experiencing postpartum depression. Making the new mom feel taken care of. Everyone has shifted focus to the baby, so how about asking how the mother is doing, checking in with their needs or whoever the postpartum person is. So there are so many ways to support a new parent and these are just going to be a few suggestions for how providers or friends and family can support that person. As a friend and provider, highlighting and celebrating the wins is key. Small, big. How they have made a huge impact on caring for their child and supporting their family. How their baby needs them, the postpartum person, to be consoled and that that person is able to console the baby and how they are learning what their baby needs are and recognizing the needs for comfort, for food, for diaper changes. As a friend, if you’re looking for a way to help them that may not have as high a financial ticket as some other ways that folks can help, offering to drive the postpartum person to their appointments or to sit in the stay with a baby so they can get out of the house or get in some exercise without being interrupted by the baby waking up. Or as a friend, offering to help them with some chores. Bonus, you’d get some quality time together. And then another option as a friend is just communication. A simple message can make someone’s day offering consistent check-ins, text messages, phone calls, FaceTime, snail mails. You can share something funny about what you just experienced or maybe you just thought of them and wanted to share that with them. As a provider, brainstorming with the postpartum person, how they can ask for help from their support system and help offload their mental and physical demands. Um, maybe they could create a meal train or ask, um, friends to set up a grocery delivery or, uh, ask for some gift cards to a favorite restaurant or self care services like physical therapy, um, a massage, a facial or a haircut or a babysitter. Obviously those come with a little bit higher price tag, but just options to, um, suggest for the, uh, postpartum person to tap into their support network. And then as a provider, reviewing and sharing some resources with the client that are particular to postpartum depression, such as phone support lines, community groups, or even providing them with some postpartum depression related pamphlets so that if it’s a hard conversation that they don’t want to have, then they could read it on their own time.

So I’ll go over some resources now and put them in the caption for you to reference. That is my cat. She is joining and also wants to hear the resources. So the first one is the Postpartum Support International website. It is one of the best resources overall that I’ve encountered. It is good in that it is going to be helpful for connecting folks with local resources in their region, offering emotional support during pregnancy and postpartum. with online support groups and they also have live phone sessions every Wednesday and I think they’re capped at about 15 to 20 people. They also have perinatal trained medication providers or therapists or community groups and tons of blogs with others sharing their stories and so Folks can also use the Postpartum Support International’s directory of trained perinatal mental health providers on folks who are specialized in postpartum anxiety, postpartum depression, and they have a director specifically for those humans, which I think is awesome. The next resource is the National Maternal Mental Health Hotline. They provide free conventional support confidential support resources and referrals from professional counselors to help pregnant and postpartum individuals facing mental health challenges. And this is also available 24-7. They also have interpreter services that are available in multiple language, which is huge. The third resource is the 988 Suicide and Crisis Lifeline. It provides free and confidential emotional support to help people in suicidal crisis or emotional distress. This is also available 24-7 and individuals can call, they can chat, or look up all the different educational information on their website. The fourth resource is the Postpartum Progress website. It is just chock full of information on the postpartum period in general, with a big section on postpartum depression, They have a provider list, including a black mental health provider list. And, uh, one of their extras was a Spotify playlist, uh, called warrior moms, which I love the strength and energy behind that. And then finally another, um, uh, resource, which is on the ACOG website. Uh, it is an infographic on anxiety and they do a beautiful job of, um, pretty much going through all of my, uh, podcast series, but for anxiety. about the prevalence, what is postpartum anxiety, and what are some treatment methods, what are some resources, just kind of sharing information because it’s helpful to know that other folks are going through the same thing and that there’s help out there. This pamphlet is a great idea to put up in the clinic, put up in bathroom stalls, maybe even have on your clinic website, but making one for postpartum depression. So we as PTs, we are perfectly positioned to help break the silence of folks with postpartum depression who may also be unaware that they’re even dealing with this condition. We can make a difference in these clients’ lives. Combined with educating ourselves, we need to be educating the birthing individuals, their support system on what postpartum depression looks like and ways to prevent it. then actually informing the individual on a number of treatment strategies available to them, including the combination of medication that is right for them, psychosocial mental health therapies, or alternative therapies like aerobic or resistance training exercise, whichever of those treatment strategies makes sense to them. And of course, speaking with their medical provider for the medication and psychotherapy piece. Oftentimes finding the right care support and gradually adding in movement, physical movement, aiming for good quality sleep, which is so tricky with this population and addressing nutrition can be huge steps in treatment of postpartum depression. But there’s so much more. The essential pieces are asking someone about their current ecosystem in their postpartum world, allowing them space to share the tough things and knowing when to refer out for postpartum depression. as well as encouraging them different ways that they can lean on their support system or offering them the free resources such as the support groups or hotlines I talked about. And those are available in the caption. So treatment for postpartum depression, remember it’s not a one size fits all. And individual specific situations, their preferences, they all have to be taken into account. If you miss the other two episodes in this series that go over the prevalence, risk factors, how to screen and what to say to someone who you suspect has postpartum depression, check out episode number 1553 and number 1572 to learn more. And thank you so much for your time and attention today. And I hope you find some brightness in your day. And as a bonus, if you have anyone who is recently postpartum, send them a warm message and let them know that you are thinking about them. Take care, everyone.

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