Today we’ll be exploring postpartum depression, or PPD, a mental illness that can have devastating effects on new mothers, but also affects a sensitive and impressionable population: newborns.
While scientists have struggled to create the perfect medication or form of therapy, there are many new mothers out there who feel none of them work particularly well, and who still suffer. Perhaps there is no need to “create” a cure, maybe the cure has been there all along in the form of psychedelics.
Before the War on Drugs began in America, therapists and scientists alike were learning so much about the relationship between psychedelics and the mind. After the psychedelic boom of the 60’s, their research was buried deep in the catacombs of the scientific community, only to resurface again at the turn of the century.
Since then, SSRIs have lost the sparkle they once had, and those suffering from mental illnesses are yearning for more. As psychedelic research was given another chance, a whole new generation of researchers and therapists began to reinvestigate the therapeutic advantages of psychedelics.
You may be wondering how psychedelics work in the brain. Each psychedelic has a slightly different effect on the brain’s neurotransmitters and blood flow, which can affect our behavior and subjective experience differently.
The research has been done to prove their efficacy in the most common disorders such as depression and anxiety. Now that the groundwork has been laid, we must look at how psychedelics can help the more complex and targeted mental illnesses, such as postpartum depression.
What is Postpartum Depression?
The diagnostic criteria for postpartum depression is very similar to that of major depressive disorder, or MDD, including persistently low mood, feelings of guilt or worthlessness, and suicidal thoughts, with one difference being the effects on the relationship between mother and child.
Even though PPD and MDD have overlapping behavioral similarities, there are major differences happening in the brain. Neural activation patterns of reproductive-related depressive disorders (except for puberty depression) differ from activation patterns observed in MDD (Stickel et al., 2018).
Those with MDD show a heightened amygdala response to negative stimuli, but those with PPD show dampened amygdala response and corticolimbic activity (Chase et al., 2013).
PPD can cause a new mother to reject breastfeeding, feel disconnected to the infant, and in extreme cases have delusions or hallucinations urging them to harm the infant.
The lack of a healthy relationship between mother and child has been shown to cause less enrichment activity and other important interactions which can lead to problems in cognitive, social, emotional or physical development later in life (Paulson et al., 2006).
New mothers often feel the societal pressure to be perfect. The negative stigma attached to medication or not being a good mother can be debilitating. Could this be why so many suffer in silence?
One study found that only 40% of those with PPD in Utah sought professional help, and much less in marginalized populations such as hispanic or emotionally abused women (McGarry, 2009). Healing those with PPD should be a priority, as it can have long-term effects on a whole family, but sometimes it can be difficult to treat.
Current Treatments for Postpartum Depression
Let’s review the current treatment for postpartum depression aside from psychedelics. The most popular medication for mental illnesses are SSRIs, or selective serotonin reuptake inhibitors.
SSRIs are shown to have no effect on the mother-child relationship, which is one of the most important aspects of PPD. While they have been successful for some people, many people are not happy with their results, and over the years their efficacy has been questioned.
What works for some, may not work for others and that is why we need to explore all of our options. If you’re taking an SSRI and are wondering about their relationship to psychedelics, check out our podcast transcript, SSRIs, Antidepressants, and Psilocybin.
Interpersonal psychotherapy is a form of talk therapy that is a popular treatment choice amongst new mothers who typically prefer to not use medication for fear of it’s effects on the baby. It can happen in a group or individual setting, but works best when a partner or family is involved.
Even so, since talk therapy began in the 60’s it has shown a moderate effect that hasn’t changed since. While forms of talk therapy can help mild to moderate forms of PPD, what about more aggressive cases?
The newest form of treatment for postpartum depression is hormone therapy. Many forms of hormone therapy exclude those who are breastfeeding to ensure the baby’s health is not endangered or altered by these hormone medications.
That leaves out an important population of those suffering from PPD. A 2010 literature review by Elizabeth Fitelson and colleagues, found that many of the published research papers on hormone therapy and PPD have lacked a control group.
They have even been financially-backed by pharmaceutical companies, causing their efficacy to be questioned. Brexanolone, a synthetic hormone, is administered intravenously over a 60-hour period.
It has proven to rapidly treat symptoms, but there is no research of it’s effectiveness past a 30-day period. Adverse effects include extreme sedation and loss of consciousness.
A 2021 study conducted by Pirjo Kettunen and colleagues found that hormone therapy using synthetic estrogen was no more effective than a placebo. This brings us back to our question, could a one-time 8 hour trip be more effective and accessible?
How Psychedelics Affect PPD Symptoms
Serotonergic psychedelics (LSD, psilocybin, MDMA, DMT, 5-Meo-DMT, mescaline, DOI, ketamine, cannabis) get their name because of their strong association with serotonin 5-HTP receptors in our brain. Serotonin is a neurotransmitter linked to many parts of our subjective life, such as social behavior, mood, and memory.
The oxytocin, dopamine and serotonin systems in our brain interact to shape our complex social behaviors. When one or all of these systems are not functioning properly, different components of motherhood are affected (Grieb & Lonstein, 2022).
Serotonergic drugs may have gotten their name based off of their relationship to serotonin receptors, but they do so much more. For example, psilocybin is known to cause a “reset” in the brain by disrupting its normal, highly organized activity, which causes brain-wide entropy or connectivity (Carhart-Harris et al., 2014).
Although there is currently no clinical research on psilocybin’s “resetting” effects on the neural activity associated with PPD, available research warrants further exploration of the topic, and the prospect is hopeful.
The amygdala regulates our emotional response to salient stimuli, such as how we feel when we see a happy or sad face. The dampened emotional response associated with the lack of amygdala activity is thought to be the cause of hostility towards the infant and decreased maternal sensitivity (Moses-Kolko et al., 2014).
A 2018 study by Leor Roseman and colleagues found that psilocybin increased amygdala response, which allowed depressed patients to work through their emotional responses with psychological support.
Previous research found that SSRIs cause a dampening effect on amygdala activity which may be why they have more success in treating those with MDD opposed to PPD.
MDMA Promotes Interpersonal Bonding
In women with PPD, having a supportive partner has proven to yield great results when in conjunction with other interventions. Taking MDMA together is becoming more common for couples who want to heal their relationships.
MDMA is a stimulant and hallucinogen, and is toxic to fetuses. Therefore it should never be taken when pregnant or breastfeeding, however it may offer a unique way to strengthen a strained relationship between partners.
The effects associated with its healing capabilities are empathy, pleasure and emotional closeness. You may have heard the story of one famous couple: Alexander “Sasha” Shulgin and his wife, Ann Shulgin, authors of Pihkal and Tihkal.
In chapter 27 of Pihkal, Ann tells the story of how Sasha had gotten into one of his “moods”, making him distant and angry towards her. She said she had a theory, and asked if they could ingest MDMA together to see if it helped.
According to Ann, within 40 minutes his face was soft, he was smiling and asked her to come sit on his lap. After their trip, he never held the anger towards her that he used to, and they were able to navigate their relationship with the lightness they had gained during their trip.
Their experience happened decades ago, and now you can find hordes of articles online about MDMA and healing relationships. A trip focused on the strained relationship between partners could be beneficial to a family affected by PPD.
Like serotonergic psychedelics, research for MDMA and PPD is slim and you should always talk to an experienced psychedelic facilitator if you are interested in treating PPD.
(Jairaj & Rucker, 2022)
A Unique Symptom of PPD: The Mother-Child Dyad
Usually, mental illnesses have the biggest impact on the sole person they affect, with regard to close family and friends. PPD is unique in that it directly affects and has a major impact on two people at once, the mother and the child.
To heal those with PPD, we must heal the relationships closest to them. Coined the “love hormone”, oxytocin is a naturally-occurring hormone that facilitates childbirth and also plays a role in social bonding.
There is a positive correlation between maternal oxytocin and heightened sensitivity to infant interactions, which is important because a 2021 study by Friederike Holze and colleagues found that increased oxytocin levels are associated with LSD doses of 200 ug or more in healthy participants.
The Multifaceted Empathy Test (MET) is a computer-assisted test that shows participants 40 pictures of emotionally charged situations and asks them to rate them based on how they felt about the individual in each picture as well as how the pictures made them feel.
By using the MET, Holze and collegues also found that LSD caused a dose-dependent increase in emotional empathy. One of the biggest aspects of psychedelic experiences is a sense of “oneness” or unity, and insights into oneself and relationships with others. The renewed sense of connectedness can be felt towards close friends, family, and even all of humanity.
This unique symptom of psychedelic-use could be extremely helpful in fostering a stronger connection between a mother and child. Interestingly, (Grieb & Lonstein, 2022) found that serotonin metabolism in pro-maternal areas of the brain is higher in postpartum rats than in prepartum or virgin females, and by manipulating these areas they can affect maternal caregiving behaviors.
Clinical trials to study the efficacy of psychedelics in treating PPD are just around the corner, but for now, most of our evidence is from their effects on co-occurring disorders and based on anecdotal data.
Here we have a report from a Psychedelic Passage survey respondent who used half a tab of LSD (approx. 50ug) to heal from the emotional trauma of a miscarriage, with no preparation other than going in with an open mind.
“I did mirror work and I remember seeing my belly grow in the mirror and then shrink down. I remember crying very hard after that, realizing I had been pregnant and now I wasn’t. The reality of it hit me hard.
I just kept repeating the phrase in my head. I was pregnant and now I’m not. I must have cried for half an hour. I realized I had repressed so much and I badly needed to stare the facts in the face, and feel the full extent of the grief. My husband was next to me helpless and held me.
I realized that my grief is mine alone to go through, and not something he will ever be able to understand, and that this is okay. Then, I thought about grief, and what it meant.
I realized that grief is something we choose to hold onto because if we let it go, we let go of our remaining link to the thing we love and lost. I talked it over with my mom on the phone who knew I was tripping. She suffers greatly from grief and I wanted to share my insights with her.
She said the insight was helpful, and helped her be more kind to herself with her own grief. Then, I felt elated and relieved, and I took a walk in nature until I finally came down from the high.”
–Anonymous survey respondent
Another anonymous report from Romper explained her experience taking psychedelic mushrooms to help her postpartum depression:
“Since my mushroom trip, I have fallen in love with the world more completely. My rebooted brain is chemically different than it was before.
A single trip didn’t ‘cure’ my depression, but it did leave me with an undeniable sense of goodwill and peace to rely on during any difficult moments of my day or week. When I look out the window, play with Joel, or take a walk, I see more beauty than before.” –Anonymous Romper respondent
Breastfeeding and Child Care
One of the biggest reasons people are hesitant to use psychedelics to treat PPD is because it is very common for new mothers to be breastfeeding, meaning whatever they ingest can get passed on to their baby.
Research is seldom because it is unethical to put a baby at risk just for results, however the same can be said about SSRI’s. Many people will tell you that SSRIs are completely safe to take while pregnant and breastfeeding.
However, the long-term effects of SSRIs on babies are largely unknown because of the lack of long-term and follow up research (Tuccori et al., 2009).
Women deciding to start or continue SSRI use while breastfeeding are asked to evaluate the severity of the mother and infant’s exposure to mood symptoms and weigh it against the risks of the infant being exposed to antidepressants. The same should be considered when thinking about psychedelic-assisted therapy.
Unlike SSRIs, psychedelics offer the option of a one-time trip that can have lasting psychological effects with short-term physical effects. Because of this, it is possible for a new mother to store a few days’ supply of drug-free breastmilk for the baby to have during and after the trip.
In a narrative review published this year, authors Chaitra Jairaj and James J Rucker collected extremely helpful information on breast milk and psilocybin. 48 hours after oral ingestion only 0.0016% of psilocin, the active metabolite in psilocybin, is detected in plasma.
Breast milk is more acidic than plasma, and that causes it to attract weak bases. Psilocin is acidic, with a pH of 5.2, meaning it is less likely to pass into breast milk, however more research needs to be done to know the exact relationship between psilocybin and breast milk.
Without proper clinical research investigating psychedelics and PPD, it is still reasonable to speculate based on the available research on each topic and the anecdotal evidence for a relationship between them.
We know that psychedelics can positively affect the same areas of the brain that cause PPD symptoms, and that in the right setting they can have lasting positive effects on subjective feelings and mood.
We always recommend proper preparation before a psychedelic session. Part of this is instituting safety protocols such as being in a physically safe environment, being mentally fit at the time of your trip, having a trusted trip sitter, and in this case a babysitter is a must as well.
Psychedelics do have a special way of rooting out the most pertinent problems, as we saw in anecdotal reports. However in clinical research, the most significant results happened in conjunction with preparation and integration.
This means that we can’t expect to “pop a pill” and make everything okay. Setting intentions before a psychedelic experience can make your problem more tangible, so that you can metaphorically hold it in your hand during your trip, examine it, transform it, or gain clarity from it.
After your trip, it is equally important to take what you’ve learned and weave it into your life so that you can continue to reap the benefits of your trip, long after it’s done.
If you are suffering from postpartum depression we want you to know you are never alone, and that help is closer than you think. Is psychedelic-assisted therapy the answer?
Only you can decide, but at Psychedelic Passage, we are here to support you on your healing journey in any way that we can. If you have questions or need guidance please don’t hesitate to reach out to our psychedelic facilitators.
We know finding help can seem impossible, and we want to make it accessible to everyone. So, if your psychedelic curiosities aren’t yet satiated, head on over to our resources page for more informative articles like this one.