improvements, an enhanced sense of well-being, and observed increases in plasma serotonin concentrations.

A 2007 review of the literature identified a total of two small, randomized controlled trials of pram (baby carriage) walking in postnatal mothers, both of which reported significant benefit (Armstrong and Edwards, 2003, 2004; Daley, Macarthur, and Winter, 2007). However, the authors were not able to control for the confounding influence of concurrent medications. A variety of other uncontrolled or observational studies for postpartum depression have reported similar positive preliminary findings.

Yoga

Yoga consists of a complex system of spiritual, moral, and physical practices aimed at raising self-awareness (Pilkington, Rampes, and Richardson, 2006). It has been studied for the treatment of depression. Five randomized controlled trials evaluating the efficacy of yoga in the treatment of depression were identified in a systematic review (Pilkington et al., 2005). Different forms of yoga were used. All trials reported positive findings, but poor study quality limited the usefulness of their results. Yoga is a particularly interesting therapy during pregnancy and the postpartum period, given the other physical and emotional symptoms women experience (such as back pain, anxiety) at this time. Yoga programs for perinatal women are widely available throughout the country, and further research of this intervention appears warranted.

Acupuncture

Acupuncture has been used in China and other Asian countries for thousands of years. Acupuncture is generally safe, and studies suggest that it may be an effective treatment for psychological problems, including depression (Weier and Beal, 2004). A Cochrane review that examined the efficacy of acupuncture for depression included seven trials: five trials compared acupuncture with medication, and two trials compared acupuncture with a wait-list control of sham acupuncture (Smith and Hay, 2005). There was no evidence that medication was better than acupuncture in reducing the severity of depression or in improving depression. Given the small sample sizes and poor quality of the studies, the authors concluded that there was insufficient evidence to determine the efficacy of acupuncture compared with medication for depression. There are no randomized trials evaluating the use of acupuncture for depression during pregnancy or for postpartum depression.

Other therapies, such as aromatherapy, massage therapy, and reflexol-



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