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  Tendency Toward Postpartum Depression  
 
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Contributing risk factors | Recommendations

 

After having a baby, many women have mood swings. One minute they feel happy, the next minute they start to cry. They may feel a little depressed, have a hard time concentrating, lose their appetite or find that they can't sleep well even when the baby is asleep. These symptoms usually start about 2 to 4 days after delivery and may last for several days.

If you are a new mother and have any of these symptoms, or have had them in the past, you are amongst the 70 to 80% of women who get what is called the "baby blues". "The blues" are considered a normal part of early motherhood and usually go away within 10 days of the delivery. However, some women have worse symptoms or symptoms that last longer. This is called postpartum depression.
What is postpartum depression?
Instead of this relatively mild sadness and anxiety, about 10% of new mothers develop a more troubling condition called postpartum depression. Postpartum depression lasts longer, is more intense, and often requires counseling and treatment. Postpartum depression can occur after any birth, not just the first. Here are some symptoms of postpartum depression:

  • Postpartum blues that don't go away after 2 weeks
  • Strong feelings of depression and anger that begin to surface 1 to 2 months after childbirth
  • Loss of interest in things that used to bring pleasure in life
  • Less energy and motivation to do things
  • Marked changes in appetite
  • A hard time falling asleep or staying asleep or sleeping more than usual
  • Increased crying or tearfulness
  • Feelings of sadness, doubt, guilt, helplessness, or hopelessness that seem to increase with each week and begin to disrupt a woman's normal functioning. The woman may not be able to care for herself or her baby. She may have trouble handling her usual responsibilities at home or on the job.
  • Feeling restless, irritable or anxious (for example being frightened of being left alone in the house with the baby)
  • Unexplained weight loss or gain
  • Having thoughts about hurting yourself, including suicide
  • Fear of harming the baby. These feelings are almost never acted on by women with postpartum depression, but they can be very frightening and may lead to guilty feelings, which only make the depression worse
  • Extreme concern and worry about the baby, or lack of interest in or feelings for the baby. Feeling unable to love the infant or rest of the family.
Although many women get depressed right after childbirth, some women don't feel "down" until several weeks or months later. Depression that occurs within 6 months of childbirth may be postpartum depression.

Who gets postpartum depression?
Postpartum depression is more likely if you had any of the following:
  • Previous postpartum depression or another psychiatric condition not related to pregnancy
  • Severe premenstrual syndrome (PMS)
  • A difficult marriage or lack of supportive partner
  • Few family members or friends to talk to or depend on
  • Stressful life events during the pregnancy or after the childbirth.
Why do women get postpartum depression?
There are many causes. Hormone levels change during pregnancy and right after childbirth. Those hormone changes may produce chemical changes in the brain that play a part in causing depression.

Low thyroid functioning is very common in women after childbirth. The baby's thyroid can produce antibodies against the mother's thyroid causing hypothyroidism. This may be one of the chief causes of postpartum depression and weight gain.

Long chain polyunsaturated omega 3 fatty acid deficiency may contribute to depressive symptoms in alcoholism, multiple sclerosis and postpartum depression. Adequate long chain polyunsaturated fatty acids, particularly docosahexaenoic acid (DHA), may reduce the incidence of depression just as omega 3 fatty acids may reduce the incidence of coronary heart disease.

In studying 20 healthy primiparous women (women bearing their first child) without significant health or psychiatric problems, a significant connection between reduced serum cholesterol levels and depressive symptoms postpartum was found.

How long does postpartum depression last?
It's hard to say. Some women feel better within a few weeks, but others feel depressed or "not themselves" for many months. Women who have more severe symptoms of depression or who have had depression in the past may take longer to get well. Just remember that help is available and that you can get better.

What kinds of treatments help with postpartum depression?
Postpartum depression is treated much like any other depression. Support, counseling ("talk therapy") and medicines can help. If you take an antidepressant medicine, it will go into your breast milk. Talk to your doctor about the risks of taking an antidepressant while nursing. Your doctor can decide which medicine you can use while nursing your baby.

If you have given birth recently and are feeling sad, blue, anxious, irritable, tired or have any of the other symptoms mentioned here, remember that many other women have had the same experience. You're not "losing your mind" or "going crazy" and you shouldn't feel that you just have to suffer. Here are some things you can do that other mothers with postpartum depression have found helpful:
  • Find someone to talk to and tell that person about your feelings.
  • Get in touch with people who can help you with child care, household chores and errands. This social support network will help you find time for yourself so you can rest.
  • Find time to do something for yourself, even if it's only 15 minutes a day. Try reading, exercising (walking is good for you and easy to do), taking a bath or meditating.
  • Keep a diary. Every day, write down your emotions and feelings as a way of "letting it all out." Once you begin to feel better, you can go back and reread your diary. This will help you see how much better you are.
  • Even if you can only get one thing done in any given day, this is a step in the right direction. There may be days when you can't get anything done. Try not to get angry with yourself when this happens.
  • It's OK to feel overwhelmed. Childbirth brings many changes, and parenting is challenging. When you're not feeling like yourself, these changes can seem like too much to cope with.
  • You're not expected to be a "supermom". Be honest about how much you can do, and ask other people to help you.
  • Find a support group in your area or contact an organization that can put you in touch with people near you who have experience with postpartum depression.
  • Talk with your doctor about how you feel. He or she may offer counseling and/or treatments that can help.
Feeling depressed doesn't mean that you're a bad person, that you did something wrong or that you necessarily brought this on yourself.

References:
(1) "Dietary Polyunsaturated Fatty Acids and Depression: When Cholesterol Does Not Satisfy", Hibbeln, Joseph R. and Salem, Norman, Jr., American Journal of Clinical Nutrition, 1995;62: pp.1-9.
(2) "Rapid Decrease of Serum Cholesterol Concentration and Postpartum Depression," Ploeckinger, Barbara, et al, British Medical Journal, September 14, 1996;313: p.664.
 

 
 

Risk factors for Tendency Toward Postpartum Depression:
 
 
Environment / Toxicity  Copper Toxicity
 Persons with elevated copper are prone to tinnitus and postpartum depression.
 
 

Recommendations for Tendency Toward Postpartum Depression:
 
 
Amino Acid / Protein  Tryptophan / 5 HTP
 Tryptophan at 1 to 3gm per day can be used to treat a variety of depression syndromes. It is especially effective when treating depression which is accompanied by insomnia. Depression associated with menstrual cycles and postpartum depression sometimes respond very well to tryptophan supplementation. Postpartum women usually have high estrogen levels and it has been found that high estrogens increase the conversion of tryptophan to niacin. Progesterone and hydrocortisone decrease its conversion. Women on birth control pills, when given vitamin B6 and tryptophan, generally tend to metabolize tryptophan more normally.

Habits

  Sunlight / Light Exposure
 ScienceDaily (Nov. 14, 2007) Scientists at John Carroll University, working in its Lighting Innovations Institute, have developed an affordable accessory that appears to reduce the symptoms of ADHD. Their discovery also has also been shown to improve sleep patterns among people who have difficulty falling asleep. The John Carroll researchers have created glasses designed to block blue light, therefore altering a person's circadian rhythm, which leads to improvement in ADHD symptoms and sleep disorders.

How the Glasses Work

The individual puts on the glasses a couple of hours ahead of bedtime, advancing the circadian rhythm. The special glasses block the blue rays that cause a delay in the start of the flow of melatonin, the sleep hormone. Normally, melatonin flow doesn't begin until after the individual goes into darkness.

Studies indicate that promoting the earlier release of melatonin results in a marked decline of ADHD symptoms. Major uses of the blue-blocking glasses include: providing better sleep, avoiding postpartum depression, preventing Seasonal Affective Disorder and reducing the risk of cancer.

An alternative to the glasses has also been developed in the form of night lights and light bulbs with coatings that block the blue light. Instead of wearing the glasses, an individual may simply turn off ordinary lights and, instead, turn on the ones with filters that remove the blue rays. The night light is a convenient "plug-in" device. The cost of the items ranges from approximately $5 for light bulbs and night lights to $40-$60 for glasses.

Hormone

Not recommended:
  Melatonin
 On the basis of theoretical ideas about how melatonin works, some authorities specifically recommend against using it for depression, schizophrenia, autoimmune diseases and other serious illnesses, and in pregnant or nursing women.

Lab Tests/Rule-Outs

  Test Thyroid Function
  Test for Estrogens
  Test Copper Levels

Nutrient

  DHA (docosahexaenoic acid)
 US scientists found low levels of omega-3 fatty acids, especially DHA, in mother's milk and in the red blood cells of women with postpartum depression. The difference was significant compared to those without depression. The reason for this finding was related to low intake of fatty fish such as salmon and herring containing large amounts of DHA. [Hibbeln JR., Seafood consumption, the DHA content of mother's milk and prevalence rates of postpartum depression: J Affective Disorders 2001]

Breast milk remains the primary source of DHA for the baby and a mother's brain the primary source of DHA for the milk. Researchers found significant variations in breast-milk DHA levels around the world. The lowest concentrations were found in vegan and American mothers, and the highest in mothers who ate fish regularly. [NOAA technical memorandum, NMFS-SEFSC-367, NIH meeting on omega-3 fatty acid research, May 12, 1994]

  TMG (Tri-methyl-glycine) / SAMe
 TMG or SAMe may be superior to methionine for the treatment of depression. It may be especially useful in treating postpartum depression and depression associated with drug withdrawal.

Vitamins

  Vitamin Folic Acid
 When postpartum depression occurs with megaloblastic anemia, the depression many times responds extremely well to folate supplementation.
 
 


KEY
Strong or generally accepted link
May do some good
Likely to help
Highly recommended
May have adverse consequences







GLOSSARY

Antibody:  A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.

Anxiety:  Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.

Cholesterol:  A waxy, fat-like substance manufactured in the liver and found in all tissues, it facilitates the transport and absorption of fatty acids. In foods, only animal products contain cholesterol. An excess of cholesterol in the bloodstream can contribute to the development of atherosclerosis.

Copper:  An essential mineral that is a component of several important enzymes in the body and is essential to good health. Copper is found in all body tissues. Copper deficiency leads to a variety of abnormalities, including anemia, skeletal defects, degeneration of the nervous system, reproductive failure, pronounced cardiovascular lesions, elevated blood cholesterol, impaired immunity and defects in the pigmentation and structure of hair. Copper is involved in iron incorporation into hemoglobin. It is also involved with vitamin C in the formation of collagen and the proper functioning in central nervous system. More than a dozen enzymes have been found to contain copper. The best studied are superoxide dismutase (SOD), cytochrome C oxidase, catalase, dopamine hydroxylase, uricase, tryptophan dioxygenase, lecithinase and other monoamine and diamine oxidases.

DHA:  Docosahexanoic Acid. A metabolite of the omega-3 fatty acid alpha-linolenic acid.

Fatty Acids:  Chemical chains of carbon, hydrogen, and oxygen atoms that are part of a fat (lipid) and are the major component of triglycerides. Depending on the number and arrangement of these atoms, fatty acids are classified as either saturated, polyunsaturated, or monounsaturated. They are nutritional substances found in nature which include cholesterol, prostaglandins, and stearic, palmitic, linoleic, linolenic, eicosapentanoic (EPA), and decohexanoic acids. Important nutritional lipids include lecithin, choline, gamma-linoleic acid, and inositol.

Hormones:  Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.

Hypothyroidism:  Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.

Multiple Sclerosis:  Demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord, manifested by loss of normal neurological functions, e.g., muscle weakness, loss of vision, and mood alterations.

Polyunsaturated:  Polyunsaturated fats or oils. Originate from vegetables and are liquid at room temperature. These oils are a good source of the unsaturated fatty acids. They include flaxseed with added vitamin B6 (pyridoxine), sunflower oil, safflower oil, and primrose oil.

Postpartum:  After childbirth.

Postpartum Depression:  The "baby blues" are a very frequent and completely normal consequence of childbirth, usually wearing off soon afterwards as hormonal and psychological systems get back to normal. Postpartum depression is a less common but severe depression that begins in the weeks following delivery. It impairs the ability of the mother to care for the child and fall in love with it. This makes her feel even more depressed and inadequate thinking that she can not be a good mother. At the extreme, postpartum depression may lead to dangerous delusions (for example, thinking the baby is in some way deformed or cursed) or hallucinations (that may command violent acts). This can occasionally result in a tragic episode of suicide and/or infanticide.

Premenstrual Syndrome:  PMS consists of various physical and/or emotional symptoms that occur in the second half of the menstrual cycle, after ovulation. The symptoms begin about midcycle, are generally the most intense during the last seven days before menstruation and include: acne; backache; bloating; fatigue; headache; sore breasts; changes in sexual desire; depression; difficulty concentrating; difficulty handling stress; irritability; tearfulness.

Serum:  The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.

Thyroid:  Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.

Tinnitus:  A sensation of noise (ringing or roaring) that is caused by a bodily condition and can usually only be heard by the person affected.