Postpartum Depression & Integrative CareBy Kimmer Collison-RisMSN, FNP-BC, WOCN, MS CAM

Contributing Factors

There is evidence that metabolic and inflammatory factors play a significant role in the development of Post Partum Depression. -possible factors include low progesterone-inflammation-blood glucose imbalance-Holistic treatment aims to decrease these things that contribute to depression and anxiety.

-Weeping or crying for no reason-Feeling “not like yourself”-Impatience-Irritability-Restlessness-Anxious-Sadness-Mood swings-Difficulty concentrating

-typically begin within a few days following delivery-can last approximately two weeks

Symptoms of “Baby Blues”

• Severe mood swings• Excessive crying• Difficulty bonding with your baby• Withdrawing from family and friends• Change in eating habits• Difficulty sleeping• Overwhelming fatigue• Intense irritability and anger• Feelings of worthlessness or guilt• Difficulty concentrating• Severe anxiety and panic attacks

-More intense, lasting longer than “baby blues”

Postpartum Depression Symptoms

https://www.specificare.com/articles/women-s-health/infertility/female-fertility-booster-taking-control

http://speechfoodie.com/foods-to-increase-progesterone/

12 11/10/2017 Add a footer

https://www.planetnaturopath.com/hormones/how-to-reduce-high-estrogen-levels/

13 11/10/2017 Add a footer

Several complementary interventions may enhance postpartum depression treatment along with the standard treatment.-support minimal medication dosages to treat to

remission.-are used for mild-moderate symptom management and should be considered first-line treatment interventions.--Dietary changes--Adding specific nutritional supplements--increasing exercise

Complimentary Treatments

Support for Complimentary Therapies

Abstract

• Postpartum depression affects an estimated 13% of women who have recently given birth. This article discusses several alternative or complementary therapies that may serve as adjuncts in the treatment of postpartum depression. The intent is to help practitioners better understand the treatments that are available that their clients may be using. Complementary modalities discussed include herbal medicine, dietary supplements, massage, aromatherapy, and acupuncture. Evidence supporting the use of these modalities is reviewed where available, and a list of resources is given in the appendix.

• Weier KM andBeal MW (). Complementary Therapies as Adjuncts in the Treatment of Postpartum Depression. Journal of Midwifery and Women’s Health: Volume 49, Issue 2 March-April 2004 Pages 96–104. http://onlinelibrary.wiley.com/doi/10.1016/j.jmwh.2003.12.013/full

15 11/10/2017 Add a footer

Blood Glucose Levels & Depression

• One factor commonly underlying depression is poor of blood glucose control

• symptoms of poor blood sugar control includes:• fatigue,

• irritability,

• dizziness,

• insomnia,

• excessive sweating (especially at night),

• poor concentration and forgetfulness,

• excessive thirst,

• depression and crying spells,

• digestive disturbances

• blurred vision.

• These often occur before seeing measurable abnormalities in blood glucose; appearing as a decreased sensitivity to insulin (insulin resistance)

16 11/10/2017 Add a footer

Metabolic Disturbance & DepressionAbstract

Problem: Evidence from prospective and cross-sectional studies demonstrates that the presence of diabetes doubles the risk of comorbid depression. This commonly overlooked comorbidity affects more than one quarter of the diabetic population, making its recognition and treatment in diabetic patients clinically relevant.

Methods: PubMed, PsycINFO, and MEDLINE databases were searched (search words: diabetes, depression, metabolic control, hyperglycemia, hypoglycemia) for articles that evaluated outcomes, relationships, and/or management of comorbid depression and diabetes published between 1980 and 2002. This review represents a synthesis of the findings including treatment recommendations.

Results: Concurrent depression is associated with a decrease in metabolic control, poor adherence to medication and diet regimens, a reduction in quality of life, and an increase in health care expenditures. In turn, poor metabolic control may exacerbate depression and diminish response to antidepressant regimens. Psychotherapy and pharmacotherapy are effective in the presence of diabetes; both cognitive behavior therapy and selective serotonin reuptake inhibitors are weight neutral and have been associated with glycemic improvement in some studies.

Conclusion: Depression is common in both type 1 and type 2 diabetes and has significant effects on the course and outcome of this medical illness. Conventional antidepressant management strategies are effective and the regimen should be tailored to the individual patient. Enhanced efforts toward good glycemic control may also contribute to improvements in mood and perceptions of well-being.

Lustmana, PJ and Clouse , RE (2005). Depression in diabetic patients: The relationship between mood and glycemic control. Journal of Diabetes and its Complications. Volume 19, Issue 2, March–April 2005, Pages 113-122. Retrieved from http://www.sciencedirect.com/science/article/pii/S1056872704000042.

17 11/10/2017 Add a footer

Complimentary Strategies

-Omega-3 fatty acids-SAMe

-light therapy-folic acid-exercise -cranial electrical stimulation-referral to qualified acupuncturists --for management of antepartum/postpartum illness.

Sam-E

“Sam-E (S-adenosyl methionine) is a natively occurring molecule

involved in the biosynthesis of neurotransmitters, with a long history of use in Europe for treatment of depression, and FDA-approval for over-the-counter use in the US based on more than 40 controlled trials encompassing 24,000 patients. It is well-tolerated without weight gain and sexual side effects, and has some precedent for treatment in pregnant women with liver problems. One study of postpartum depression showed promising treatment effect (Cerutti) and no reports of adverse effects in breastfed infants.”

Omega 3 Essential Fatty Acids

“Omega-3 fatty acids (EPA and DHA fish sources) have demonstrated benefit over placebo for mood support…”(Su, Parker, Freeman, Nemets) “Because of depletion of maternal fatty acids by the fetus during pregnancy and lactation, in addition to insufficient dietary consumption, Omega-3 used at therapeutic doses represents a potential benefit to both the mother and the infant.”

“Folic acid (vitamin B9) supplementation is based on data

demonstrating that deficiency is associated with poor treatment response while augmentation is associated with more rapid and robust effect (Papakostas, Coppen and Bailey). While it has not been studied for monotherapy [standalone use]in perinatal depression, it is recommended to women of reproductive age for prevention of birth defects, and is a reasonable augmentation consideration.”

Folic Acid (B-9)

Depression & Folate Deficiency

Abstract

A relationship between folate and neuropsychiatric disorders has been inferred from clinical observation and from the enhanced understanding of the role of folate in critical brain metabolic pathways. Depressive symptoms are the most common neuropsychiatric manifestation of folate deficiency. Conversely, borderline low or deficient serum or red blood cell folate levels have been detected in 15–38% of adults diagnosed with depressive disorders. Recently, low folate levels have been linked to poorer antidepressant response to selective serotonin reuptake inhibitors. Factors contributing to low serum folate levels among depressed patients as well as the circumstances under which folate and its derivatives may have a role in antidepressant pharmacotherapy must be further clarified.

Alpert JE and Fava M ().Nutrition and Depression: The Role of Folate. Nutrition Reviews: Volume 55, Issue 5 May 1997 Pages 145–149. DOI: 10.1111/j.1753-4887.1997.tb06468.x. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1753-4887.1997.tb06468.x/full

22 11/10/2017 Add a footer

Folate & Fluoxetine StudyAbstract

• BACKGROUND: A consistent finding in major depression has been a low plasma and red cell folate which has also been linked to poor response to antidepressants. The present investigation was designed to investigate whether the co-administration of folic acid would enhance the antidepressant action of fluoxetine.

• METHODS: 127 patients were randomly assigned to receive either 500 microg folic acid or an identical looking placebo in addition to 20 mg fluoxetine daily. All patients met the DSM-III-R criteria for major depression and had a baseline Hamilton Rating Scale (17 item version) score for depression of 20 or more. Baseline and 10-week estimations of plasma folate and homocysteine were carried out.

• RESULTS: Patients receiving folate showed a significant increase in plasma folate. This was less in men than in women. Plasma homocysteine was significantly decreased in women by 20.6%, but there was no significant change in men. Overall there was a significantly greater improvement in the fluoxetine plus folic acid group. This was confined to women where the mean Hamilton Rating Scale score on completion was 6.8 (S.D. 4. 1) in the fluoxetine plus folate group, as compared to 11.7 (S.D. 6. 7) in the fluoxetine plus placebo group (P<0.001).A percentage of 93. 9 of women, who received the folic acid supplement, showed a good response (>50% reduction in score) as compared to 61.1% of women who received placebo supplement (P<0.005). Eight (12.9%) patients in the fluoxetine plus folic acid group reported symptoms possibly or probably related to medication, whereas in the fluoxetine plus placebo group 19 (29.7%) patients reported such symptoms (P<0.05).

• LIMITATIONS AND CONCLUSIONS: Folic acid is a simple method of greatly improving the antidepressant action of fluoxetine and probably other antidepressants. Folic acid should be given in doses sufficient to decrease plasma homocysteine. Men require a higher dose of folic acid to achieve this than women, but more work is required to ascertain the optimum dose of folic acid.

23 11/10/2017 Add a footer

Thirty minutes of exercise on most days is vital treatment for pregnant and postpartum women experiencing mood symptoms and is formally recommended by the American College of Obstetrics and Gynecology. Two studies have demonstrated exercise as a benefit in pregnant and postpartum patients with depression (Koltyn and Schultes, Heh).

Exercise

“Bright light therapy has been substantiated through meta-

analysis as a treatment for seasonal and non-seasonal depression, and has been studied in antenatal and postpartum depression with significant benefit in antenatal studies and limited power to detect benefit in a postpartum study (Oren, Epperson, Corrall). This treatment is typically used for 30-60 minutes daily with a 10,000 lux light source, and would not be appropriate for patients with a personal or family history of Bipolar disorder.”

Bright light Therapy

“With regard to acupuncture, an important study was recently published demonstrating a 63% response rate in pregnant women with major depression, although postpartum data is lacking (Manber)..”

Acupuncture

“Cranial electrical stimulation is a home-use device which acts to

modify electrical activity in the brain to support neuro-transmitter production and alpha wave activity. Although there are no perinatal studies, this modality has been supported by randomized placebo-controlled trials (approximately 20 adequate quality trials) for the treatment of anxiety, insomnia and depression, and represents a low-risk consideration or augmentation strategy for women concerned about the risks of medication exposure..”

Cranial Electrical Stimulation

Depression & Nutrition

Adequate nutrition is needed for countless aspects of brain functioning. Poor diet quality, ubiquitous in the United States, may be a modifiable risk factor for depression. The objective was to review and synthesize the current knowledge of the role of nutrition in depression, and address implications for childbearing-aged women. Poor omega-3 fatty acid status increases the risk of depression. Fish oil and folic acid supplements each have been used to treat depression successfully. Folate deficiency reduces the response to antidepressants. Deficiencies of folate, vitamin B12, iron, zinc, and selenium tend to be more common among depressed than nondepressed persons. Dietary antioxidants have not been studied rigorously in relation to depression. Childbearing-aged women are particularly vulnerable to the adverse effects of poor nutrition on mood because pregnancy and lactation are major nutritional stressors to the body. The depletion of nutrient reserves throughout pregnancy and a lack of recovery postpartum may increase a woman’s risk of depression. Prospective research studies are needed to clarify the role of nutrition in the pathophysiology of depression among childbearing-aged women. Greater attention to nutritional factors in mental health is warranted given that nutrition interventions can be inexpensive, safe, easy to administer, and generally acceptable to patients.

-Bodnar, LM and Wisner, KL (2005). Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry Volume 58, Issue 9, 1 November 2005, Pages 679-685. Retrieved from https://doi.org/10.1016/j.biopsych.2005.05.009.

28 11/10/2017 Add a footer

-Limit caffeine-Avoid sugar & high fructose corn syrup-Limit gluten, GMO, and commercial dairy foods-Avoid eating gluten & dairy products together-Rarely eat animal based dairy milk & cheeses-Avoid processed/fast foods-Avoid Soy and Corn products-Avoid transfats & margarines

Food Matters!!!

-Increase nutrient dense foods-Drink plenty of fresh filtered water-Eat small frequent protein snacks-Use grass fed butter & coconut oil-Add nuts and seeds (high in Omega 3 EFAs)-Consume small frequent amounts of fruit & veggies-Add beans to soups, stews, stirfrys-try making crockpot soups, stews, freezer meals loaded w/whole foods

Food Matters!

Nutritional Deficiency & Depression

CalciumAverage diet contains 40 to

50% of RDA*

Brittle nails, cramps, delusions, depression, insomnia, irritability,

osteoporosis, palpitations, peridontal disease, rickets, tooth decay

Copper75% of diets deficient; average

diet contains 50% of RDA*

Anemia, arterial damage, depression, diarrhea, fatigue, fragile bones, hair

loss, hyperthyroidism, weakness

35 11/10/2017 Add a footer

IronMost common mineral

deficiency

Anemia, brittle nails, confusion, constipation, depression, dizziness,

fatigue, headaches, inflamed tongue, mouth lesions

Niacin Commonly deficient in elderly

Bad breath, canker sores, confusion, depression, dermatitis, diarrhea,

emotional instability, fatigue, irritability, loss of appetite, memory

impairment, muscle weakness, nausea, skin eruptions and inflammation

Pantothenic acid

(B5)

Average elderly diet

contains 60% of RDA*

Abdominal pains, burning feet, depression, eczema, fatigue, hair loss,

immune impairment, insomnia, irritability, low blood pressure, muscle

spasms, nausea, poor coordination

Nutritional Deficiency & Depression

Potassium Commonly deficient in elderly

Acne, constipation, depression, edema, excessive water consumption, fatigue,

glucose intolerance, high cholesterol levels, insomnia, mental impairment, muscle

weakness, nervousness, poor reflexes

Pyridoxine

(B6)

71% of male and 90% of female

diets deficient

Acne, anemia, arthritis, eye inflammation, depression, dizziness, facial oiliness,

fatigue, impaired wound healing, irritability, loss of appetite, loss of hair, mouth lesions,

nausea

36 11/10/2017 Add a footer

Riboflavin Deficient in 30% of elderly Britons

Blurred vision, cataracts, depression, dermatitis, dizziness, hair loss, inflamed eyes,

mouth lesions, nervousness, neurological symptoms (numbness, loss of sensation,

"electric shock" sensations), seizures. sensitivity to light, sleepiness, weakness

Vitamin B-

12

Serum levels low in 25% of hospital

patients

Anemia, constipation, depression, dizziness, fatigue, intestinal disturbances,

headaches, irritability, loss of vibration sensation, low stomach acid, mental

disturbances, moodiness, mouth lesions, numbness, spinal cord degeneration

Vitamin C 20 to 50% of diets deficientBleeding gums, depression, easy bruising, impaired wound healing, irritability, joint

pains, loose teeth, malaise, tiredness.

Zinc 68% of diets deficient

Acne, amnesia, apathy, brittle nails, delayed sexual maturity, depression, diarrhea,

eczema, fatigue, growth impairment, hair loss, high cholesterol levels, immune

impairment, impotence, irritability, lethargy, loss of appetite, loss of sense of taste, low

stomach acid, male infertility, memory impairment, night blindness, paranoia, white

spots on nails, wound healing impairment

(Source: Total Wellness by Joseph Pizzorno, ND )

Steps to reduce inflammation

• By reducing chronic inflammation — also known as low-grade or systemic inflammation — you may be able to boost your defense against several major diseases.

• 1. Omega 3 EFA’s

• 2. Tumeric & Ginger

• 3. Yoga- People who regularly practice yoga may have reduced levels of interleukin-6 (a marker of inflammation), according to a 2010 study of 50 women. Analyzing blood samples from the participants, researchers observed that those who practiced yoga had 41 percent lower levels of interleukin-6 than those who didn't practice yoga.

• 4. Anti-inflammatory diet

• 5. Eliminate inflammatory lifestyle factors: stress and poor diet, chronic inflammation occurs when the immune system continually releases those inflammatory chemicals -- even when there are no foreign invaders to fight off.

38 11/10/2017 Add a footer

39 11/10/2017 Add a footer

Vitamin C

• Ascorbic acid (vitamin C) is a cofactor required for the function of several hydroxylases and monooxygenases. It is not synthesized in humans and some other animal species and has to be provided by diet or pharmacologic means. Its absence is responsible for scurvy, a condition related in its initial phases to a defective synthesis of collagen by the reduced function of prolylhydroxylase and production of collagen polypeptides lacking hydroxyproline, therefore, they are unable to assemble into stable triple-helical collagen molecules. In fibroblast cultures, vitamin C also stimulates collagen production by increasing the steady-state level of mRNA of collagen types I and III through enhanced transcription and prolonged half-life of the transcripts

• Nusgens, Humbert, Rougier, Colige, Haftek, Lambert, Richard, Creidi and Lapière. (2000).

42 11/10/2017 Add a footer

43 11/10/2017 Add a footer

Flaxseed• Obtain ground milled kind; whole which has fiber coating that is

indigestible ends up "just passing through “

• Contains soluble fiber, which clears out cholesterol and healthy fat

• Known to reduce high blood pressure

• reduces inflammation

• Contains omega-3 fatty acids approx. 2500mg of Omega 3 fatty acids, 650mg of Omega 6 fatty acids, ratio is 4/1

• has laxative properties

• 2 T only has 70 calories

• Omega 3 fatty acids are essential as your body doesn't make them

• lowers calories and fat

• 3 T ground flax equals 1 T fat

• 2 T flax w/1 T of water equals 1 T fat (serving size =1 T )

44 11/10/2017 Add a footer

Coconut Oil• high in vitamins, minerals and antioxidants,

• rich in fiber which helps you feel full, contributes to regulate bowels

• easily digested as it doesn't require any pancreatic enzymes to digest the foods and absorb the nutrients

• less burden on the digestive system as it contains medium chain fatty acids your body is able to digest easier than saturated fats (long chain) cheese, meats, dairy

• considered antifungal, antiviral, and antibacterial

• helps w/autoimmune disorders

• contains fatty acids (3)

• provides anti-bacterial benefits

• coconut doesn't increase cholesterol, triglycerides or risk for heart disease

• promotes absorption of other nutrients

• promotes digestive healing

• suffering from chronic pain, inflammation, bloating, gas, diarhea, symptoms

• medium chain sent to liver for energy

• long chain sent to liver by a long route (which contribute to stored fat)

• coconut water helps replace electrolytes, sodium & potassium

• heat stable at very high temps

• cook, bake, fry in extra virgin state

• don't buy hydrogenated choice

45 11/10/2017 Add a footer

Magnesium and Depression

Summary

• Major depression is a mood disorder characterized by a sense of inadequacy, despondency, decreased activity, pessimism, anhedonia and sadness where these symptoms severely disrupt and adversely affect the person’s life, sometimes to such an extent that suicide is attempted or results. Antidepressant drugs are not always effective and some have been accused of causing an increased number of suicides particularly in young people. Magnesium deficiency is well known to produce neuropathologies. Only 16% of the magnesium found in whole wheat remains in refined flour, and magnesium has been removed from most drinking water supplies, setting a stage for human magnesium deficiency. Magnesium ions regulate calcium ion flow in neuronal calcium channels, helping to regulate neuronal nitric oxide production. In magnesium deficiency, neuronal requirements for magnesium may not be met, causing neuronal damage which could manifest as depression. Magnesium treatment is hypothesized to be effective in treating major depression resulting from intraneuronal magnesium deficits. These magnesium ion neuronal deficits may be induced by stress hormones, excessive dietary calcium as well as dietary deficiencies of magnesium. Case histories are presented showing rapid recovery (less than 7 days) from major depression using 125–300 mg of magnesium (as glycinate and taurinate) with each meal and at bedtime. Magnesium was found usually effective for treatment of depression in general use. Related and accompanying mental illnesses in these case histories including traumatic brain injury, headache, suicidal ideation, anxiety, irritability, insomnia, postpartum depression, cocaine, alcohol and tobacco abuse, hypersensitivity to calcium, short-term memory loss and IQ loss were also benefited. Dietary deficiencies of magnesium, coupled with excess calcium and stress may cause many cases of other related symptoms including agitation, anxiety, irritability, confusion, asthenia, sleeplessness, headache, delirium, hallucinations and hyperexcitability, with each of these having been previously documented. The possibility that magnesium deficiency is the cause of most major depression and related mental health problems including IQ loss and addiction is enormously important to public health and is recommended for immediate further study. Fortifying refined grain and drinking water with biologically available magnesium to pre-twentieth century levels is recommended.

Eby, GA and Eby, KL (2006). Rapid recovery from major depression using magnesium treatment. Medical Hypotheses Volume 67, Issue 2, 2006, Pages 362-370. Retrieved from https://doi.org/10.1016/j.mehy.2006.01.047

48 11/10/2017 Add a footer

Progesterone Rich Foods & Herbs

Food

• Eggs (Yolk contains the most)

• Dairy: cheese & milk

• Chicken

• Zinc Rich foods• Shellfish

• Turkey (hormone free)

• Red meats “ “

• B6 Rich foods• Walnuts

• Organic whole grains

Herbs

• Macca root powder • An adaptogen which helps manage

stress

• Tumeric

• Thyme

• Oregano

51 11/10/2017 Add a footer

52 11/10/2017 Add a footer

53 11/10/2017 Add a footer

54 11/10/2017 Add a footer

Dietary Supplements & Mental Health

Abstract

Dietary supplement use has increased during the past decade. Epidemiologic studies suggest that patients turn to dietary supplements because of a reluctance to take prescription medications or a lack of satisfaction with the results. They often perceive dietary supplements to be a safer or more natural alternative. Patients with mental health conditions, including depression, anxiety, and sleep disorders, are among those who use dietary supplements. St. John's Wort is used to treat depression. Clinical studies comparing dietary supplements with low-dose antidepressants (maprotiline, amitriptyline, or imipramine at 75 mg/day) or high-dose antidepressants (imipramine at 150 mg/day) find no significant difference between treatments. Kava kava is used to treat anxiety. Clinical trials demonstrate it to be superior to placebo, and roughly equivalent to oxazepam 15 mg/day or bromazepam 9 mg/day. Agents discussed for use in sleep disorders include melatonin, valerian, 5-hydroxytryptamine, catnip, chamomile, gotu kola, hops, L-tryptophan, lavender, passionflower, skullcap, and valerian. Familiarity with the evidence for use and the possible resulting risks can help health professionals to guide patient decisions regarding use of dietary supplements.

Cauffield JS , and Forbes HJ (1999). Dietary supplements used in the treatment of depression, anxiety, and sleep disorders. Lippincott's Primary Care Practice [01 May 1999, 3(3):290-304]. Retrieved fro http://europepmc.org/abstract/med/10711131m

55 11/10/2017 Add a footer

B12 and Depression

56 11/10/2017 Add a footer

58 11/10/2017 Add a footer

B-Vitamin Rich Foods

60 11/10/2017 Add a footer

A holistic treatment plan also incorporates:-dietary changes to increase progesterone-dietary changes to decrease inflammation-dietary changes to increase low folate-dietary changes to balance thyroid levels-relaxation exercises-Rest-breathwork-exercise-light therapy-acupuncture -cranial electrical stimulation

Holistic Health Plan

•Take care of your body-eat healthier, avoiding processed foods, sugar, bread, & dairy-rest when the baby rests-try prolong walks with your baby in a stroller or carrier•Set aside personal time for yourself•Set realistic goals. -pace yourself, don’t feel you have to “do it all”-be willing to leave some dishes and toys on the floor •Talk about it-find a friend who will listen-seek out a therapist-talk to your healthcare provider

Lifestyle changes relieve symptoms!

• Ask for Help! •Eat healthy whole foods & avoid processed foods• Eat small frequent snacks of protein –stabilize blood sugars-Add nutritional supplements-Rest more & sleep with the baby• Go outside in nature• Get small amounts of frequent exercise• Give yourself permission to be less than perfect•Talk about your feelings-Try Essential oil blends

Basic Plan

1. Scary movies-worsens anxiety and depression

2. Being too busy or overscheduled-worsens symptoms, prevents self-care, rest & regeneration

3. Negative Thoughts-enhances downward spiral

4. Unsupportive People-enhances negative thoughts, depression, isolation

5. Self-diagnosing-depression is complex requiring professional help

6. Putting off getting help-can be life threatening if left-untreated

6 Things to Worsen Symptoms

Citations• Alpert JE and Fava M (1997).Nutrition and Depression: The Role of Folate. Nutrition Reviews: Volume 55, Issue 5 May 1997 Pages

145–149. DOI: 10.1111/j.1753-4887.1997.tb06468.x. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1753-4887.1997.tb06468.x/full

• Bodnar, LM and Wisner, KL (2005). Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry Volume 58, Issue 9, 1 November 2005, Pages 679-685. Retrieved from https://doi.org/10.1016/j.biopsych.2005.05.009.

• Cauffield JS , and Forbes HJ (1999). Dietary supplements used in the treatment of depression, anxiety, and sleep disorders. Lippincott's Primary Care Practice [01 May 1999, 3(3):290-304]. Retrieved fro http://europepmc.org/abstract/med/10711131m

• Coppen , BJ. (2000). Enhancement of the antidepressant action of fluoxetine by folic acid: a randomised, placebo controlled trial. J Affect Disord. 2000 Nov;60(2):121-30.

• Eby, GA and Eby, KL (2006). Rapid recovery from major depression using magnesium treatment. Medical Hypotheses Volume 67, Issue 2, 2006, Pages 362-370. Retrieved from https://doi.org/10.1016/j.mehy.2006.01.047

• Nusgens BV, HumbertP, Rougier A, Colige AC, Haftek M, Lambert CA, Richard A, Creidi P and Lapière CM. (2000). Topically Applied Vitamin C Enhances the mRNA Level of Collagens I and III, Their Processing Enzymes and Tissue Inhibitor of Matrix Metalloproteinase 1 in the Human Dermis. Journal of Investigative Dermatology (2001) 116, 853–859; doi:10.1046/j.0022-202x.2001.01362.x. Retrieved from http://www.nature.com/jid/journal/v116/n6/abs/5601085a.html.

• Lustmana, PJ and Clouse , RE (2005). Depression in diabetic patients: The relationship between mood and glycemic control. Journal of Diabetes and its Complications. Volume 19, Issue 2, March–April 2005, Pages 113-122. Retrieved from http://www.sciencedirect.com/science/article/pii/S1056872704000042.

• “Natural Remedies for postpartum depression” retrieve from https://www.healthline.com/health/.../natural-remedies-for-postpartum-depression

• Postpartum progress. Retrieved from http://www.postpartumprogress.com/the-best-complementary-alternative-medicine-treatment-options-postpartum-depression

• Postpartum Depression: What Causes It & How To Treat It Holistically (2017). Retrieved from https://www.mindbodygreen.com/0-12045/postpartum-depression-what-causes-it-how-to-treat-it-holistically.html

• http://www.modernalternativepregnancy.com/2016/04/04/10-ways-treat-postpartum-depression-naturally/

• Weier KM and Beal MW (2003). Complementary Therapies as Adjuncts in the Treatment of Postpartum Depression. Journal of Midwifery and Women’s Health: Volume 49, Issue 2 March-April 2004 Pages 96–104. http://onlinelibrary.wiley.com/doi/10.1016/j.jmwh.2003.12.013/full

66 11/10/2017 Add a footer