The Daily Observer London Desk: Reporter- John Furner
A major new research paper that advises women to swap medication for exercise to treat postpartum depression has sparked outrage among women’s health experts.
The newly published analysis, by researchers at the China University of Geosciences, claims to prove doing exercise like running at least twice a week is more effective than traditional treatments.
Antidepressants and psychological therapies are the approved remedies for the condition, shown in multiple studies to offer benefits.
The condition – which affects around 10 million American women – has strong links to suicide after childbirth.
Suicide is the leading cause of death in the postpartum period, according to studies.
Former Victoria’s Secret model Chrissy Teigen admitted to suffering postpartum depression after the birth of her first child, saying the months following childbirth were a ‘sad existence’
Doctors have criticised the makeup and the conclusions of the new study, accusing the authors of underestimating the severity of the condition.
Dr Nicole Cirino, a Texas-based psychiatrist who specializes in treating pre- and post-partum women, told that to propose an exercise plan to a postpartum woman as a treatment would be unreasonable.
She said: ‘They’d look at you like you were crazy, like, hey, I just delivered a baby. I’m on bedrest.’
She added that to a new mother, ‘that’s a last thing on my mind right now with all the things I need to do to care for this young child or thinking about going back to work.’
Symptoms of postpartum depression can be debilitating, including thoughts of harming oneself or others, persistent sadness, loss of energy, and feelings of worthlessness.
Dr Ian Bennett, an obstetrician and maternal health expert at the University of Washington, told: ‘Exercise is not going to be sufficient for managing the more severe depression.
‘We need to make sure that we’re using stronger therapeutics for people in that situation.’
She said: ‘Suicide, due to postnatal mental illness, including postnatal depression, is one of the leading causes of death of women in the year after birth.
Women who suffer from postpartum depression often experience sadness, hopelessness, emptiness and depression
‘Postnatal depression is a serious illness that often requires treatment using medication and talking therapies.
‘Whilst exercise is good for health and for some people with depression, it is vital that postpartum women get this very serious condition diagnosed and obtain the correct evidence based treatment for them, from a health care professional.
Well-known figures to suffer the condition include model and influencer Chrissy Teigen and the late Princess Diana.
In 2020, Teigen admitted that she experienced a ‘flatline of life’ after the birth of her first child, Luna.
Meanwhile, the ‘people’s princess’ revealed to the BBC that she had experienced postpartum depression following the birth of her first child, Prince William.
For the latest research, scientists in China analyzed 26 studies, including nearly 2,900 pregnant and postpartum women aged 18 and up.
They concluded: ‘The efficacy of aerobic exercise in preventing and treating postpartum depression is significant compared to standard care.
‘The optimal prescribed exercise volume for intervention comprises a frequency of three to four exercise sessions per week, moderate intensity (35 to 45 minutes).’
Dancing was the most effective exercise, with nearly 87 percent of those who did it reporting an improvement in their symptoms, followed by 73 percent of swimmers and 54 percent of people who ran, walked, and biked.
Exercise is known to have antidepressant effects and is almost always recommended to people suffering from depression and anxiety.
But experts believe that to recommend this as a frontline treatment for severe PPD undercuts the severity of the condition and need for therapy and medications.
They reached their conclusion based on several academic and scientific papers from five databases. The study had notable limitations, though.
Dr Cirino said: ‘There’s an awful lot we do not know about the women in this trial that responded to the exercise regimen. So that’s I think one of the limitations – it’s not a US based study, it’s a meta analysis, it’s not new literature.
‘And it could be a lot of compounding factors that could impact the improvement in depression, that we’re not necessarily recorded or asked about, such as are they on medicines, medical problems, their socioeconomic status, etc.’
Princess Diana was public about her struggle with postpartum depression during a 1995 interview
Previous research has shown that psychotherapy and antidepressant medications, particularly SSRIs, are more effective than physical activity alone at improving postpartum depression symptoms.
For instance, researchers from the University of Minnesota, Brown University, and the Teachers College Columbia University reported in 2021: ‘It is possible that exercise alone is not enough to impact depression but if combined with a wellness intervention, it can impact depression.’
And psychiatrists from the Medical University of South Carolina said: ‘Women with mild-to-moderate depressive symptoms in the postpartum period should be offered psychotherapy as a first line treatment option. Among women with moderate to severe depression, antidepressant medication and therapy are recommended.’
The authors of the current study, published in the journal PLOS One, admit the research does not offer a ‘conclusive determination’ about ‘which specific exercise’ women with the condition should do.
They also say their findings do not necessarily represent what would be true for the entire maternal population.
In addition, any benefits would depend widely on the frequency and intensity of exercise, they say.
Dr Bennett added: ‘We shouldn’t be discounting studies about the preventive ability of exercise, for developing depression, and for the treatment of mild to moderate depression.
‘But I would be very skeptical of a study that said that the aerobic exercise alone was adequate for treating those folks with severe depression and risk of suicide.’
When women receive adequate medication for their PPD, their babies can benefit too. Researchers from King’s College London analysed data from over 61,000 mothers and their children.
Of the mothers, 8,671 were diagnosed with postnatal depression and 177 of these received SSRI treatment.
Analysis revealed the children whose mums had been given SSRIS were less likely to have behavioural difficulties and exhibit antisocial behaviour when they were five years old.
