Integrative and Holistic approach to treating postpartum depression. Symptoms can be reduced with a combination of medications, dietary adjustments, supplements, and lifestyle changes.

1. Postpartum
Depression &
Integrative Care
By Kimmer Collison-Ris
MSN, FNP-BC,WOCN, MS CAM

3. 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.

4. -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”

5. • 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

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

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

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

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14. 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
ComplimentaryTreatments

15. Support for ComplimentaryTherapies
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
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16. 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)
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17. Metabolic Disturbance & Depression
Abstract
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.
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18. 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.

19. 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.”

20. 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.”

21. “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)

22. 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
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23. Folate & Fluoxetine Study
Abstract
• 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).
• LIMITATIONSAND 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.
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24. 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

25. “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 lightTherapy

26. “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

27. “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

28. 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 PsychiatryVolume 58, Issue 9, 1 November 2005, Pages 679-685. Retrieved from
https://doi.org/10.1016/j.biopsych.2005.05.009.
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29. -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!!!

34. -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!

35. Nutritional Deficiency & Depression
Calcium
Average diet contains 40 to
50% of RDA*
Brittle nails, cramps, delusions, depression, insomnia, irritability,
osteoporosis, palpitations, peridontal disease, rickets, tooth decay
Copper
75% of diets deficient; average
diet contains 50% of RDA*
Anemia, arterial damage, depression, diarrhea, fatigue, fragile bones, hair
loss, hyperthyroidism, weakness
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Iron
Most 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

36. 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
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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 deficient
Bleeding 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:TotalWellness by Joseph Pizzorno, ND )

38. 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.
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42. 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).
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44. 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
• 2T only has 70 calories
• Omega 3 fatty acids are essential as your body doesn't make them
• lowers calories and fat
• 3T ground flax equals 1T fat
• 2T flax w/1T of water equals 1T fat (serving size =1T )
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45. 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
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48. 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 HypothesesVolume 67, Issue 2,
2006, Pages 362-370. Retrieved from https://doi.org/10.1016/j.mehy.2006.01.047
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51. 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
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55. 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'sWort 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
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56. B12 and Depression
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B-Vitamin Rich Foods

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62. 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

63. •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!

64. • 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

65. 1. Scary movies
-worsens anxiety and depression
2. Being too busy or overscheduled
-worsens symptoms, prevents self-care, rest & regeneration
3. NegativeThoughts
-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
6Things to Worsen Symptoms

66. 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 PsychiatryVolume 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 HypothesesVolume 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 & HowToTreat 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). ComplementaryTherapies as Adjuncts in theTreatment 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
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