Yoga and Postpartum DepressionUnderstanding the efficacy of Hatha yoga as a form of complementary therapy in the treatment of postpartum depression

Anna Burke – Spring 2017NURS-5510

What is Postpartum Depression (PPD)?• A depressive episode occurring in the months after

childbirth• Affects up to 13%, or more, of women• The risk of PPD doubles for women living in poverty• Additional risk factors:

– History of depression– Depression and/or anxiety during pregnancy– Poor social supports– Conflict with partner during pregnancy

(Newland & Parade, 2016, p. 4-6)

Effects of Untreated PPD on the Infant & Child• PPD is associated with:

– Undesirable parenting behaviors including hostility, low sensitivity and warmth, caregiving difficulty and negative perception of infant (Newland & Parade, 2016, p. 6).

• Children are at risk for:– Difficult temperament, insecure attachment and poor physical development

(Newland & Parade, 2016, p. 6).– Emotional and behavioral problems, poor social competence and poor adjustment

in the school setting (O’Connor et al., 2016, p. 389).– Prolonged infant crying, infant colic, increased infant cortisol levels, and decreased

intelligence and language skills (Deligiannidis & Freeman, 2012, p. 442).

Therapy Options• According to the Mayo Clinic (2015), traditional therapy for

PPD includes psychotherapy and antidepressants.• Complementary and alternative medicine (CAM) therapies

are popular in the United States and are used more frequently by women than men (Deligiannidis & Freeman, 2012, p. 441).• Yoga is a complementary therapy in the treatment of PPD.

What is Yoga?• Hatha Yoga is the most

common form of Yoga in the United States. It is a physical yoga practice emphasizing three components: breath, physical poses and meditation (Buttner et al. 2014, p. 95).• Considered one of the top ten

complementary and alternative medicine (CAM) therapies for adults with depression (Buttner et al. 2014, p. 95).

What Does Yoga Practice Entail?• Hatha yoga (most common form)

– The yoga student assumes a variety of physical poses which put the joints and muscles through a full range of motion

– Breathing is regulated in synchrony with the poses– Emphasis on meditation to achieve a focused mind

Harvard Men’s Health Watch (2015)

Yoga’s Physiologic Effects

• Yoga during pregnancy– Women who practiced yoga while pregnant had lower cortisol

levels on days of practice and fewer PPD symptoms than a control group (Bershadsky et al, 2014, p. 110).

• Yoga for the general population– Research suggests that yoga practice can decrease immune-

based inflammatory patterns, lower systolic and diastolic blood pressure, lower heart rate, and improve insulin and glucose regulation (Cohen 2015, p. 107).

Psychological Effects of Yoga

• Yoga postpartum– Women who practiced yoga postpartum improved at a

significantly faster rate on measures of depression, anxiety, well-being and health-related quality of life than a control group who did not practice yoga (Buttner et al., 2014, p. 97).

• Yoga for the general population– Individuals who practice yoga may experience improved physical

functioning, mental health, and symptom control, reduced fatigue, and improvements in sleep disturbances (Cohen 2015, p. 106).

Why Does Yoga Work?• Yoga transforms an individual’s stress response– Cohen (2015) suggests that

the many physiological and psychological benefits that result from yoga practice can be attributed to a person learning to change how they respond to stress (p. 107).

Frequency of Practice• There is no literature which dictates the amount and frequency of

time one must spend practicing yoga to achieve maximum benefit in regards to treating postpartum depression.

• Buttner et al. (2015) designed a study which asked postpartum women to practice yoga three times a week, in two 1-hour formal classes and one 30 minute DVD-guided home session (p. 96).

• The average participant in the Buttner et al. (2015) study attended 11.46 out of 16 classes in an 8 week period, with 78% performing a 30 minute DVD-guided home session at least once every two weeks (p. 96).

• The Buttner et al. (2015) study concluded that women in the yoga group vs. the control group experienced significantly greater improvement across multiple dimensions of mental health (p. 97).

General Feasibility• Yoga is considered a low risk therapy and gives the

postpartum woman a sense of control over her emotional and physical well-being (Buttner et al., 2014, p. 94).• Easily accessible

• Local yoga studios• Classes in many fitness center• DVDs for home use available on Amazon• YouTube video classes

Potential Barriers • Doubts about the efficacy of yoga in treating PPD• Denial of PPD symptoms

– “I’m fine.”• Pain and healing

– Many women are instructed by their health care providers to avoid physical activity immediately following cesarean section or traumatic tearing of perineum.

• Time constraints– Mothers may be the sole caregiver or feel like they cannot take time

away from caring for their infants to attend a formal yoga class.

What Can Healthcare Providers Do?• Screen postpartum patients for PPD

– Screening a pregnant or postpartum patient for PPD, even without providing a subsequent intervention, reduces the prevalence of depression and increases remission and treatment response (O’Connor et al., 2016, p. 398).

• Prescribe pharmacological interventions and recommend psychotherapy as appropriate.• Encourage use of complementary therapy, including yoga,

for treatment of PPD.• Let women know they are not alone in how they are

feeling. • Follow up!

References•Bershadsky, S., Trumpfheller, L., Kimble, H. B., Pipaloff, D., & Yim, I. S. (2014). The effect of prenatal Hatha yoga on affect, cortisol and depressive symptoms. Complementary Therapies in Clinical Practice, 20(2), 106-113. doi:10.1016/j.ctcp.2014.01.002.•Buttner, M. M., Brock, R. L., O'Hara, M. W., & Stuart, S. (2015). Efficacy of yoga for depressed postpartum women: A randomized controlled trial. Complementary Therapies in Clinical Practice, 21(2), 94-100. doi:10.1016/j.ctcp.2015.03.003.•Cohen, L. (2015). Yoga with a capital y: the benefits of yoga as a lifestyle intervention. Alternative & Complementary Therapies, 21(3), 106-110. doi:10.1089/act.2015.29004.lc.•Deligiannidis, K., & Freeman, M. (2010). Complementary and alternative medicine for the treatment of depressive disorders in women. Psychiatric Clinics Of North America, 33(2), 441-463. doi:10.1016/j.psc.2010.01.002.•Mayo Clinic Staff (2015). Postpartum depression: treatments and drugs. Retrieved from http://www.mayoclinic.org/diseases-conditions/postpartum-depression/basics/treatment/con-20029130.•Newland, R. P., & Parade, S. H. (2016). Screening and treatment of postpartum depression: Impact on children and families. Brown University Child & Adolescent Behavior Letter, 32(1), 1-6. doi:10.1002/cbl.30092.•O'Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016). Primary care screening for and treatment of depression in pregnant and postpartum women: Evidence report and systematic review for the US Preventive Services Task Force. JAMA: Journal Of The American Medical Association, 315(4), 388-406. doi:10.1001/jama.2015.18948•Yoga offers range of health benefits. (2015). Harvard Men's Health Watch, 19(11), 5.