Source: Field T, et al. Massage and relaxation therapies’ effects on depressed adolescent mothers. Adolescence 1996;31:903-911.
Source: Onozawa K, et al. Infant massage improves mother-infant interaction for mothers with postnatal depression. J Affect Disord 2001;63:201-207.
Comments by Mary L. Hardy, MD
Post-partum depression (PPD) is a relatively uncommon (10-15% of new mothers are affected) but serious outcome of pregnancy that can have adverse consequences for both the mother and the child. Research suggests that PPD can interfere with the establishment of mother-infant bonding and have negative impacts on children’s cognitive and emotional development measurable even after 12 months.1 Conventional therapy includes options such as medication, cognitive behavioral therapy, and social support.2 Although conventional therapy can be very effective, experts are concerned that women may under-represent their symptoms and may be reluctant to seek care because of the risk and stigma of being labeled an unfit mother. Women also are concerned that if they continue to breastfeed while taking antidepressants, exposure of the infant to potent medication is inevitable. Women have been very willing to embrace complementary and alternative medicine (CAM) for other complaints of pregnancy3 and several recent articles have reviewed the evidence for CAM therapies and PPD.4,5 Recently, several interesting articles have examined the possibility of using massage therapy as an adjunctive treatment for PPD.
The first study looks at a group of high-risk patients: teenage mothers.6 Shortly after birth, Field and colleagues enrolled a group of 32 depressed adolescent mothers in a randomized trial comparing massage therapy to a relaxation therapy group. The women in this study were taking no other medication for depression but did have elevated scores on the Beck Depression Inventory. The patients in the massage therapy (MT) group received two half-hour sessions per week for five weeks of a standardized massage routine (total of 10 massages). The subjects receiving relaxation training (RT) spent an equal amount of time in a relaxation group as the massage group, although they practiced a combination of yoga and progressive muscle relaxation.
A number of scales for depression, anxiety, behavior, and mood were recorded on the first and last days of the interventions. Physiological measures, such as pulse and salivary cortisol, also were collected. Although the groups were equivalent at the beginning of the trial, the MT group had significantly lower scores in the measures of anxiety, mood, pulse, and cortisol levels. They also demonstrated greater improvements in stress- related behavior such as restlessness. This study demonstrated both a subject and objective response to the massage intervention, which was greater than the effects observed for the RT groups. Interestingly, the subjects in the RT group complained that they felt less relaxed with their therapy, because they felt that had to work too hard in the group to truly feel relaxed. The age and special circumstances of this group may make generalization difficult, but this is a moderately strong effect for a non-invasive therapy in a generally difficult-to-treat group.
A second study examined the effects of infant massage, performed by depressed mothers, on the mother-infant interaction.7 Post-partum women were screened using the Edinburgh Postnatal Depression Scale (EPDS). Women who scored greater than 13, compatible with a diagnosis of major depression, were offered enrollment in a study comparing the results of a weekly infant-massage class plus a support group to a support group alone. Thirty-four women (an average of nine weeks post-partum) were entered into the trial and randomly assigned to one of the two interventions for five weeks.
The mother’s level of depression and the characteristics of her interaction with her baby were evaluated at the beginning and end of the trial. The EPDS scores of the massage group decreased by 66% and were significantly better (P = 0.03) than the scores for the control group. A great deal of the change occurred even before the intervention began, demonstrating an anticipatory effect of this type of intervention. However, improvement continued, showing a specific effect of this therapy as well. Further, the interactions of the massage group mothers and infants also markedly and consistently improved throughout the trial. One major limitation of this study was the dropout rate in the massage group, reportedly due to the inconvenient scheduling of classes. Despite this, the massage intervention not only seemed to help the mothers’ depression, but also addressed the potential adverse effects depression can have on mother-infant bonding.
For those patients who are unfortunate enough to suffer from depression in what should otherwise be a joyful time, these two studies suggest that massage may be an important adjunctive treatment for PPD. The interventions are non-invasive and non-pharmacological, which is important to many breastfeeding mothers. This therapy should be affordable for many patients, and family members may be taught simple massage techniques. Post-partum programs should include classes in infant massage. If practitioners encourage this low-tech, but compassionate intervention, family members and practitioners may be able to offer tangible support to affected mothers through massage and help ease mothers and babies through a difficult time.
Dr. Hardy, Associate Director, UCLA Center for Dietary Supplement Research: Botanicals Medical Director, Cedars-Sinai Integrative Medicine Program Los Angeles CA, is on the Editorial Advisory Board of Alternative Therapies in Women’s Health.
References
1. Beck CT. The effects of postpartum depression on child development: A meta-analysis. Arch Psychiatric Nurs 1998;12:12-20.
2. Clay EC, Seehusen DA. A review of postpartum depression for the primary care physician. South Med J 2004; 97:157-161.
3. Hollyer T, et al. The use of CAM by women suffering from nausea and vomiting during pregnancy. BMC Complement Altern Med 2002;2:5-10.
4. Weier KM, Beal MW. Complementary therapies as adjuncts in the treatment of postpartum depression. J Midwifery Wom Health 2004;49:96-104.
5. Mantle F. The role of alternative medicine in treating postnatal depression. Compl Ther Nurs Midwifery 2002;8:197-203.
6. Field T, et al. Massage and relaxation therapies’ effects on depressed adolescent mothers. Adolescence 1996;31:903-911.
7. Onozawa K, et al. Infant massage improves mother-infant interaction for mothers with postnatal depression. J Affect Disord 2001;63:201-207.
Hardy ML. Beating the post-baby blues: Massage can help. Altern Ther Women's Health 2004;6(9):70-71.
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