By Chaitra Jairaj, Trinity College Dublin
DUBLIN, Oct 11 – Postpartum depression is a significant public health issue, costing the UK economy around £74,000 for a single case according to 2018 research. Postpartum depression, among other symptoms, typically involves the mother feeling ‘disconnected’ — from herself, her infant and her support system.
Current treatment for postpartum depression is largely based on that used in general adult depression. While these treatment options help some women with postpartum depression, they don’t work for all.
A recent review of the therapeutic use of psychedelics such as lysergic acid diethylamide (LSD) and psilocybin (the active agent in ‘magic mushrooms’) suggests they may be useful in treating postpartum depression by improving the mother-infant relationship.
Clinical trials have shown that psilocybin can be safe when used in therapeutic environments alongside appropriate psychedelic therapist support. Psilocybin also shows promise in treating depression in adults, but larger trials are needed before it can be approved.
The symptoms of postpartum depression can include low mood, an inability to feel pleasure, insomnia, poor concentration, and feelings of inadequacy or guilt.
One in five women with postpartum depression think about self-harm, and some have thoughts of harming their infant. In addition to these symptoms, or perhaps because of them, most women with postpartum depression lose confidence in their abilities as a mother.
Current antidepressant drugs are a valuable treatment option for many women with postpartum depression as they can improve mood, but there is no evidence these drugs improve mother-infant bonding.
It is also becoming clear that postpartum depression has some biological differences from general depression, in addition to the added unique aspect of the mother-infant relationship. Treatment options researched specifically for postpartum depression are needed.
The only drug to be internationally approved specifically for postpartum depression is brexanolone. It’s given as an intravenous infusion for over 60 hours in hospital and rapidly improves mood and suicidal thoughts.
Most antidepressants take between two and four weeks to work, and a more rapid improvement is required in some women with postpartum depression.
Psychedelics are thought to work by stimulating receptors in the brain for a chemical messenger known as serotonin, setting off a cascade of effects. Hallucinations are thought to occur partly because the drugs affect the way our brains filter sensory information through the thalamus.
Psychedelics may also affect how different regions of the brain communicate with each other. Ongoing research continues to expand our knowledge of exactly how psychedelics work.
Psilocybin can induce altered states of consciousness through ‘mystical-type experiences’. People have reported feelings of interconnectedness, sacredness, and transcendence of space and time.
Participants in psilocybin trials to treat depression describe a transformation from a pre-psilocybin ‘disconnection’ from the self, others, and the world, to a renewed sense of ‘connectedness’ after psilocybin.
Psilocybin also fosters a sense of openness, self-compassion, and self-acceptance, which is reported to persist for several months. These features may allow a mother with postpartum depression to reconnect with herself, the infant and the people around her, and regain confidence in herself.
However, psilocybin’s effect on postpartum depression is yet to be examined in trials. Major challenges to conducting such trials include the lack of safety data on the use of psilocybin in postpartum women, particularly while breastfeeding.
Any trials in postpartum women will need to either exclude breastfeeding women until there is evidence of its safety in breastfeeding women, or request that women abstain from breastfeeding for some time following psilocybin dosing. Further advances in psilocybin clinical trials for depression will continue to improve our understanding of its effect on postpartum depression.
Postpartum depression can worsen with socioeconomic stress, which is mounting worldwide. Newer treatment options for postpartum depression with a focus on improving the mother-infant relationship are much needed, both for the mother and the infant. Psilocybin may have the potential to fill this gap.
Dr Chaitra Jairaj is a psychiatrist and researcher at Trinity College Dublin.
Article courtesy of 360info.