Having a baby can be an exciting and rewarding time in a mother's life. Emotions run strong, and feelings often encompass immense joy and love. However, childbirth can also be an overwhelming event, as life is on the brink of a significant change for both the mother and the entire family. Feelings of doubt, worry, sadness, or even symptoms resembling depression may emerge, and a considerable percentage of new moms experience what is known as postpartum blues.
Postpartum depression, on the other hand, is a much more serious but still common condition, affecting approximately 15% of mothers. It is the most prevalent complication of delivery, surpassing even pre-term delivery and gestational diabetes in frequency. Symptoms can range from mild to severe, with the more extreme cases causing debilitating and long-lasting effects.
Having a strong support system during these challenging times is crucial, and treatment options may include psychotherapy and traditional anti-depressant medications. Unfortunately, antidepressants may not always be effective or can be associated with side effects that are difficult to tolerate, especially for a new nursing mom.
Ketamine infusion therapy emerges as an attractive option for postpartum depression due to its safety and robust efficacy. Moreover, ketamine acts rapidly within hours, unlike other antidepressants that typically have a delayed onset of 3 to 4 weeks. Today, we will review postpartum depression and discuss the use of ketamine infusion therapy as a treatment option for this common and challenging condition that affects our beloved mothers.
Postpartum depression is a type of depression that affects new mothers with symptoms similar to major depressive disorder including:
Postpartum depression symptoms typically arise within weeks after delivery, but approximately 50% of mothers may experience symptoms even before or during delivery. The duration of postpartum depression can extend up to a year after delivery, with symptoms sometimes lingering even longer.
It is crucial to distinguish between postpartum depression and postpartum blues. Mothers with postpartum blues may experience feelings of anxiety, sadness, worry, or even bouts of crying. These symptoms may begin before childbirth and can last for weeks after delivery. Postpartum blues are usually self-limiting, though still quite common, affecting approximately 50 to 75% of new moms.
The most significant risk factors for postpartum depression are having a previous history of postpartum depression and a personal or family history of major depressive disorder. For mothers who have experienced postpartum depression before, the risk of developing it again in subsequent pregnancies increases by approximately 30%. Other risk factors for postpartum depression include:
• Young age, <25
• Single marital status
• Breast-feeding difficulties
• Poor social support
• Stressful life events such as marital conflicts
• Prior psychiatric illnesses or issues such as anxiety, exposure to domestic violence, and abuse
• Poor prenatal health or pregnancy related health issues such as gestational diabetes, hypertension, and infection
The underlying cause of postpartum depression remains unknown, but there appears to be a strong association with genetics and hormones. Additionally, researchers have discovered structural abnormalities in the brain and abnormal levels of neurotransmitters, the chemical signaling molecules, in mothers suffering from this condition. Hormonal fluctuations, including estrogen, cortisol, melatonin, oxytocin, and thyroid hormones, may play a role in causing havoc, stress, and ultimately leading to depressive symptoms.
We strongly believe that all expecting mothers should undergo careful screening for postpartum depression. Screening can be initiated with the assistance of various healthcare providers, including primary care physicians, obstetricians, gynecologists, and pediatricians. The most widely used screening assessment for postpartum women regarding major depression is the self-report, 10-item Edinburgh Postnatal Depression Scale.
Psychotherapy is the recommended first-line treatment for postpartum depression, especially in cases of mild to moderate severity. When psychotherapy is not available or proves ineffective, other options include antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors, bupropion, and mirtazapine.
While many clinicians consider antidepressants to be safe for breastfeeding mothers, it's important to note that medications taken by the mother can be secreted into the breast milk, potentially exposing the newborn to these medications. Deciding to take antidepressants while breastfeeding should be a carefully considered decision made after discussing potential risks, benefits, and alternative options with your healthcare provider.
Ketamine has been widely used as an anesthetic medication for over 50 years. It is considered safe, fast-acting, and has minimal interactions or contraindications. During the actual delivery process, ketamine can be employed to reduce the risk of postpartum depression. A double-blind, randomized clinical trial published in the Journal of Medicine and Life, which focused on women undergoing scheduled caesarian deliveries, demonstrated that a single dose of ketamine significantly decreased the rate of developing postpartum depression.
Following delivery, ketamine infusion therapy emerges as an attractive option for preventing or treating postpartum depression due to its high effectiveness and safety for both the mother and newborn. Ketamine exhibits an impressive 70% response rate for depression, and when combined with psychotherapy, response rates are even higher. The onset of its antidepressant effects occurs within hours, and it lacks the side effects commonly associated with traditional antidepressants, such as weight gain, changes in libido, sleep disturbances, and mood alterations. Additionally, there is no risk of physiological dependence or withdrawal. Just six infusions over the course of 2 to 6 weeks can lead to a dramatic improvement in symptoms or even complete relief from depression.
Published in July of 2022, Wolfson et al. conducted a study and found that breast milk contained low concentrations of ketamine and its metabolites. However, these concentrations rapidly declined within several hours after dosing. Based on their findings, they concluded that resuming breastfeeding for lactating mothers is safe. The predicted exposure levels from this study showed that the low exposure to the infant would not have clinically relevant effects in breast-fed infants.
The half-life of ketamine is approximately three hours, which means that ketamine is completely cleared from the system on the same day of an infusion. As mentioned earlier, ketamine is commonly used as an anesthetic, including its safe use during childbirth. The dose of ketamine used in ketamine infusion therapy for postpartum depression is significantly lower than the dosage used during anesthesia, allowing the medicine to be cleared from the system rapidly.
To exercise caution, we recommend that mothers pump and discard their breast milk for one day after infusions. Preparing beforehand by storing milk for this post-infusion period can help ensure the safety of the breastfed infants.
This blog post provides a comprehensive overview of postpartum depression, its symptoms, risk factors, and treatment options. Postpartum depression affects approximately 15% of mothers and is the most prevalent complication after delivery. Psychotherapy is recommended as the first-line treatment, but when not available or effective, antidepressants like SSRIs can be considered. Ketamine infusion therapy has emerged as a promising option due to its rapid and safe efficacy, with a response rate of about 70%. Studies show low concentrations of ketamine and metabolites in breast milk, supporting the safe resumption of breastfeeding. However, caution is advised, and mothers are recommended to pump and discard breast milk for one day after infusions. Overall, early screening and a comprehensive treatment approach can help alleviate the challenges posed by postpartum depression for both mothers and families.
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