hypericum and Depression--Postpartum

Complementary and alternative medicine therapies are increasingly sought out by people with psychiatric disorders. In this chapter, we review the evidence for several commonly used CAM therapies (i.e. omega-3 fatty acids, folate, S-adenosyl-methionine, St John's Wort, bright light therapy, exercise, massage, and acupuncture) in the treatment of perinatal depression. A number of these treatments may be reasonable to consider for women during pregnancy or postpartum, but the safety and efficacy of these relative to standard treatments must still be systematically determined. Evidence-based use of complementary and alternative medicine therapies treatments for perinatal depression is discussed. Adequately powered systematic studies are necessary to determine the role of complementary and alternative medicine therapies in the treatment of perinatal depression.

Topics: Acupuncture Therapy; Complementary Therapies; Depression; Depression, Postpartum; Dietary Supplements; Exercise; Fatty Acids, Omega-3; Female; Folic Acid; Humans; Hypericum; Massage; Mothers; Peripartum Period; Phototherapy; Pregnancy; S-Adenosylmethionine

Perinatal Major Depressive Disorder (MDD) is common and poses particular treatment dilemmas. Complementary and Alternative Medicine (CAM) treatments are widely used, accessible, and understudied for well-defined psychiatric indications. Women are more likely than men to both suffer from MDD and use CAM.. A PubMed/Medline search was conducted to assess the evidence base for commonly utilized CAM treatments, MDD, and perinatal depression.. Among CAM treatments, omega-3 fatty acids have received the most specific study in terms of epidemiological, preclinical, and clinical research for perinatal depression. Three randomized placebo-controlled trials have been conducted in which investigators assessed omega-3 fatty acids vs. placebo for perinatal depression, with conflicting results. CAM interventions that can be easily added to a treatment plan with little risk and general health benefits for most women include omega-3 fatty acids, exercise, and folate, although data are insufficient at this time to recommend any of these as monotherapy for perinatal depression. S-adenosyl-methionine (SAMe) and bright light therapy may be reasonable to consider based on the evidence in MDD. St. John's Wort requires further study with regard to safety in pregnancy, and drug interactions can be a potential problem.. Further study is required to elucidate the role of CAM treatments for perinatal depression, and the clinical context of perinatal depression requires safe, effective, and accessible treatment options.

Topics: Acupuncture Therapy; Complementary Therapies; Depression, Postpartum; Depressive Disorder, Major; Fatty Acids, Omega-3; Female; Herbal Medicine; Humans; Hypericum; Phototherapy; Phytotherapy; Plant Extracts; Pregnancy; Pregnancy Complications; S-Adenosylmethionine

The use of complementary and alternative therapies for depression is an issue of growing interest for practitioners who care for women. Postpartum depression is a serious and debilitating illness that affects many women, their infants, and families. Often, women do not report feelings of sadness or depression to their health care providers due to stigma. Some women have multiple concerns in using prescription drugs, especially if they are breastfeeding their infants. In addition, more women are educating themselves about the potential side and adverse effects of prescriptions drugs and are exploring complementary and alternative therapies. With the availability of information from multiple sources, whether accurate or not, women may be using these therapies inappropriately. Two major concerns in using complementary and alternative therapies are the purity and safety of the herbs and herbal formulations and the potential lack of communication between the client and health care provider.

Topics: Complementary Therapies; Depression, Postpartum; Female; Herb-Drug Interactions; Humans; Hypericum; Lactation; Medicine, Ayurvedic; Medicine, Chinese Traditional; Phytotherapy; Plant Preparations; Pregnancy; Safety

Both doctors and patients often treat postnatal depression with herbal preparations derived from St. John's wort. Because these preparations are available to patients as "natural" over-the-counter drugs for depression, they are popularly assumed to be safe. However, no systematic information exists regarding treatment of postnatal depression, infant's safety or pharmacokinetics of hypericum constituents in human breast milk or infant plasma. A mother with post-natal depression was admitted at our service. Her pharmacist had recommended taking a St. John's wort preparation three times a day (Jarsin 300, Lichtwer Pharma AG, Berlin, Germany). Four breast-milk samples (fore and hind milk) during an 18-hour period were analyzed to measure concentration of hypericin and hyperforin. Only hyperforin is excreted into breast milk at a low level, hyperforin and hypericin (two major active components) were below the lower limit of quantification (BLQ: below lower limit of quantification, LQ hypericin: 0.20 ng/ml, LQ hyperforin: 0.50 ng/ml) in this infant's plasma. No side effects were seen in the mother or infant. Before recommending St John's wort for the treatment of depression to women who breastfeed, long-term studies of outcome in infants are needed.

Topics: Adult; Breast Feeding; Depression, Postpartum; Female; Humans; Hypericum; Phytotherapy; Plant Preparations