Kyle Stockman

Prof. Jacobson

English 110

29 October 2019

Music Therapy’s Effect On Postpartum Depression

    Postpartum depression is a challenging and extremely problematic condition. According to the American Psychological Association 10% to 20% of new mothers are clinically diagnosed with the disorder every year. Many treatments exist for postpartum depression (PPD) including medications, Psychotherapy, and lifestyle changes. Most mainstream treatments come with side effects or are difficult to obtain.  A lesser known and arguably more effective treatment for the condition is music therapy. Music therapy is a treatment in which music is used to address physical, emotional, cognitive, and social needs of mothers struggling with PPD. Music therapy does not necessarily have to do with singing songs, or playing instruments. It utilizes music in a more abstract sense, such as using the lyrics of a song to help people express themselves or creating a calm and safe atmosphere with sound.  Although there is a lack of widespread research, multiple studies have shown a direct correlation between music therapy and improvements in PPD symptoms. From relieving stress to helping mothers bond with their children, music therapy seems to be an extremely undervalued option in the realm of postpartum depression treatment. This paper will further examine the effects of music therapy on the symptoms of postpartum depression.

    At the moment, music therapy is a relatively niche course of action in the treatment of PPD. Options such as antidepressants and psychotherapy are much more commonly recommended by healthcare professionals for a variety of reasons. Although there is not an extremely large amount of testing around music therapy the studies that do exist almost always implicate positive effects. This being said, “there is insufficient data to suggest that music therapy, as a treatment method, is widely accepted by mothers with PPD.” (Du 15). This is more a result of lack of education and availability of the therapy than preference to other treatments such as pharmaceuticals or psychotherapy. In our current healthcare system insurance does not cover many alternative treatment methods, making them both more expensive than covered options and harder to gain access to. According to Jeannine Mancini of the website Pocketsense, insurance providers often don’t cover alternative types of treatment because they “have not been scientifically proven to be effective in treating medical conditions” (Mancini 1). This absence of understanding and research can be attributed to a significant lack of funding for studies based around alternative medicine, not the fact that they are ineffective. The National Center for Integrative and Complementary Health (NCCIH), which studies the effectiveness of alternative therapies, received a budget of $146.5 million in 2019 (nccih.nih.gov), its highest ever. Alone, the Human Drugs branch of the Food and Drug Administration (FDA) received over $1.8 billion in 2019, which only accounted for 33% of their total budget (FDA.gov). With such a disparity in government funding it becomes obvious why pharmaceuticals are the most commonly prescribed treatment for PPD. This discrepancy is the sign of an acute failure in our healthcare system and government as a whole. 

    Many women are afraid to begin taking antidepressants while breastfeeding for fear that the medication may contaminate their milk and pass into the baby’s system, at the same time for most there appears to be no other option. There are a number of antidepressants such as sertraline (Zoloft) and paroxetine (Paxol) that are considered safe to take while breastfeeding. However, these findings are “not definitive because they are based on very small sample, uncontrolled studies” (Field 1).  Even if they do work, these drugs come with a host of side effects.
For many the question remains, which has a worse impact on the infant, untreated depression or antidepressants? Music therapy provides a way around this question altogether as it has been  shown to “substitute or attenuate the effects of antidepressants” (1). Recently the first drug for PPD was approved by the FDA, according to Pam Belluck of the New York Times. Although the new drug, brexanolone, is very quick acting and effective in comparison to the aforementioned antidepressants, it is extremely expensive and time consuming to receive. The drug is “delivered by infusion over 60 hours” (Belluck 1), all of which the subject must be staying in a hospital for, in case they experience side effects. In addition, one infusion costs a staggering $34,000 not including the two day hospital stay, which is required. The unprecedented price tag alone makes this treatment a completely unfeasible option for basically all women who are not part of the 1%. Music therapy on the other hand is an extremely affordable option. According to Karen Kleiman, a psychotherapist specializing in maternal mental health, music therapy is “cost-effective, easy to implement, and less stigmatizing than other types of therapy” (Fraga 1). Its ability to ease the effects of PPD without any side effects is astonishing. Dr Trudi Seneviratne, chair of the Royal College of Psychiatrists’ Perinatal Faculty, believes that “If rolled out wider, this type of psychosocial intervention could become an additional treatment to what is currently available for mothers struggling with their mental health such as psychotherapy and antidepressants” (Packham 1). The focus moving forward will surely be facilitating ways to improve access to music therapy, and making it a conceivable alternative to other more invasive treatments.

    One of the largest concerns for women suffering from PPD is that treatment may affect the relationship between them and their baby. Treatments such as antidepressants have a long list of side effects which include nausea, increased appetite, weight gain, fatigue, drowsiness, insomnia, dry mouth, blurred vision, constipation, dizziness, agitation, irritability, and anxiety (cite). This is one reason why more and more women are searching for alternatives. There are no known side effects of music therapy. Instead, multiple studies have found that music therapy can “improve physical signs, decrease stress hormones and stabilise vital signs” (Simavli et al. 2) with zero side effects. In the study titled “Shall We Dance? Music As A Port Of Entrance To Maternal-Infant Intersubjectivity In A Context Of Postnatal Depression”, conducted by a group of scientists from Vrije Universiteit Brussel, strong correlations between music therapy and improvements in mother baby intersubjectivity were found. Intersubjectivity being defined “as a state of shared involvement during which mother and infant are responsive to one another” in addressing the same topic or activity (Van Puyvelde 1). This intersubjectivity is key for mothers in order to creating a loving relationship between them as their child. Antidepressants actually work against forming this bond, making mothers more distant and less involved. Increased intersubjectivity in turn becomes one of the greatest contributing factors to improvements in PPD. Not only do studies rooted around music therapy provide evidence of improved relationship between mother and baby, they also show large improvements in hormonal imbalances and anxiety. In a study published by the Journal of Affective Disorders scientists measured anxiety scores of mothers after giving birth on a scale of 1-10. Measurements were taken regarding three separate variables including postpartum anxiety, pain, and satisfaction with childbirth. In all three cases music therapy “decreased…early postpartum depression rate” (Simalvi et al. 2). The study goes on to state that music therapy “has been accepted as a safe, cheap and effective non-pharmacological anxiolytic agent due to its effect on the perception of anxiety and pain” (2). The same conclusion was met in another study, titled “Effects of Music on Postnatal Depression among Postnatal Mothers”, conducted by two Professors of obstetrics in Tamilnadu, India. The study utilized 60 postnatal women, split into two groups of 30. One group acted as a control and the other as the experimental. Music was given to them once daily for 20 minutes. Their depressive levels were measured before and after the therapy. The control group was also measured at the same times. The study showed a substantial decrease in depressive levels after music therapy was employed. In two trials, the mean subject score out of 12 reduced from 8.07 to 5.6 and again from 7.83 to 5.53 (Rajakumari 582). This deviation was deemed a “significant reduction”. The study once again concluded that music therapy showed a definite decrease in PPD symptoms, and that those who did not receive treatments exhibited increases in their depressive scores. In a meta-analysis, an examination of data from a number of independent studies of the same subject, the Journal of Complementary Therapies in Clinical Practice found that “studies have suggested that music therapy is a special language which can affect the brain and emotional system, thus affecting cognitive, linguistic, and athletic ability” (Yang 1). If given more time and money for research, music therapy seems to have a bright future in the treatment of PPD.    

    The most concrete argument against music therapy is that there is not enough concrete evidence to prove or definitively conclude that music therapy is an equally effective alternative to antidepressants or psychotherapy. At the time being this is a truth that cannot be refuted. In most studies regarding music therapy the conclusion notes something to the effect of “only a small number…could be included for analyses; consequently we only can report the effects observed without making generalized assumptions” (Puyvelde 230). Until further funding is provided for inquiry into the efficacy of alternative medicines such as music therapy we will not be able to reach a definitive conclusion. However, hope may be in sight. Erin Seibert a board-certified music therapist says healthcare is moving away from “treating just the symptoms towards integrative medicine” (Seibert). This could mean a transition from utilizing overprescribed medications to embracing lifestyle changes.

    Since postpartum depression is such a perplexing and complicated disorder there are few treatments, with the exception of a $34,000 injection, that are actually effective for mothers. Antidepressants present an enormous list of red flags even if they are deemed “safe” and psychotherapy comes with stigma and embarrassment, this being its own issue. Music therapy presents a safe, effective, and affordable alternative to these mainstream treatments, yet without further funding there will never be enough evidence to substantiate these claims. The studies that do exist show very promising and consistent results when music therapy has been put to the test. As Erin Seibert states, “there needs to be an expectation in our world of knowing and understanding what music therapy is because of its efficacy in treating people in a variety of situations” (Seibert). The responsibility now lies in the hands of the FDA and our government as a whole to recognize the unadulterated benefits of music therapy as an effective alternative treatment. 

    

Works Cited

American Psychological Association, American Psychological Association, https://www.apa.org/pi/women/resources/reports/postpartum-depression.

Belluck, Pam. “F.D.A. Approves First Drug for Postpartum Depression.” The New York Times, The New York Times, 19 Mar. 2019, https://www.nytimes.com/2019/03/19/health/postpartum-depression-drug.html.

Commissioner, Office of the. “Fact Sheet: FDA at a Glance.” U.S. Food and Drug Administration, FDA, https://www.fda.gov/about-fda/fda-basics/fact-sheet-fda-glance.

Field, Tiffany. “Breastfeeding and Antidepressants.” Infant Behavior and Development, vol. 31, no. 3, 2008, pp. 481–487., doi:10.1016/j.infbeh.2007.12.004.

Fraga, Juli. “During Pregnancy, Anxiety Can Spike. Music Therapy May Help.” The Washington Post, WP Company, 24 Dec. 2018, https://www.washingtonpost.com/national/health-science/during-pregnancy-anxiety-can-spike-music-therapy-may-help/2018/12/21/6ed05726-bdaf-11e8-be70-52bd11fe18af_story.html.

Mancini, Jeannine. “Why Doesn’t Insurance Cover Holistic Medicine?” Pocketsense, 10 Jan. 2019, https://pocketsense.com/doesnt-insurance-cover-holistic-medicine-9707.html.

“NCCIH Funding: Appropriations History.” National Center for Complementary and Integrative Health, U.S. Department of Health and Human Services, 15 Jan. 2019, https://nccih.nih.gov/about/budget/appropriations.htm.

Network, Healthline Medical. “Antidepressant Side Effects: Types, Comparison Chart, and …” Healthline.com, 4 Dec. 2018, https://www.healthline.com/health/antidepressant-side-effects.

Packham, Amy. “How Singing With Babies Can Help Women Recover More …” Huffintonpost.co.uk, 1 Sept. 2018, https://www.huffingtonpost.co.uk/entry/singing-boosts-postnatal-depression_uk_5a535b83e4b01e1a4b176558.

Puyvelde, Martine Van, et al. “Shall We Dance? Music As A Port Of Entrance To Maternal-Infant Intersubjectivity In A Context Of Postnatal Depression.” Infant Mental Health Journal, vol. 35, no. 3, May 2014, pp. 220–232., doi:10.1002/imhj.21431.

Rajakumari, Angel. “Effects of Music on Postnatal Depression among Postnatal Mothers.” International Journal of Science and Research, vol. 4, no. 5, May 2015, pp. 580–584.

Seibert, Erin. “TEDxUSFSP.” TEDxUSFSP. 27 Oct. 2019.

Simavli, Serap, et al. “Effect of Music Therapy during Vaginal Delivery on Postpartum Pain Relief and Mental Health.” Journal of    Affective Disorders, vol. 156, 2014, pp. 194–199., doi:10.1016/j.jad.2013.12.027.

Yang, Wen-Jiao, et al. “The Effectiveness of Music Therapy for Postpartum Depression: A Systematic Review and Meta-   Analysis.” Complementary Therapies in Clinical Practice, vol. 37, 2019, pp. 93–101., doi:10.1016/j.ctcp.2019.09.002.