Postpartum Depression

• What is it?
• Causes of Postpartum Depression
• Symptoms
• Conventional Medical Option Treatments
• Vitamins, Supplements and Herbs
• Diet
• References

What is it?
Postpartum depression can occur, at any time, during the first few months after childbirth. It can also affect women after a miscarriage or an abortion.

According to the National Institute of Mental Health, roughly 10% of pregnancies result in postpartum depression. [1] Yet other studies claim the incidence of postpartum is much higher (i.e., 50 -85% of all pregnancies). Keep in mind that this illness has just recently come into the forefront of public awareness.

Mood changes are common after having a baby. The Mayo Clinic makes a distinction between the "baby blues" and postpartum depression. While the baby blues may last a few days or weeks, (crying one minute, and happy the next) postpartum depression lasts much longer with much more intense symptoms, "eventually interfering with your ability to care for your baby and handle other daily tasks." [2]

Postpartum depression is a serious illness. If your depression lasts for more then a week or two, it may require the assistance of your family doctor.

A Warning: In the most severest of cases, postparum depression can lead to postpartum psychosis. This requires immediate medical intervention.

Causes of Postpartum Depression
Though there is no single cause of postpartum depression, the following situations can contribute to this condition:

• decrease of insulin after childbirth, which reduces serotonin levels in the brain [3]
• dramatic declines in both estrogen and progesterone levels [4]
• exhaustion (late night feedings, interupted sleep cycles, career demands, etc)
• feeling unattractive
• maritial stress, as well as lack of spousal, and/or family support

Symptoms
Women suffering with postpartum depression can experience varying degrees of any or all of the following symptoms:

• frequent bouts of crying
• feelings of hopelessness
• feelings of unworthiness
• lack of interest in your baby or
• thoughts of harming the baby (in severe postpartum and/or postpartum phychosis)
• poor concentration
• suicidal thoughts (in severe postpartum and/or postpartum phychosis)

Conventional Medical Option Treatments
Conventional medical treatment options for postpartum may include one or any combination of the following:

• antidepressants
• counseling
• hormone therapy

Vitamins, Supplements and Herbs

• omega-3: Many studies suggests that omega-3 polyunsaturated fatty acids have beneficial effects on major depression. [5] In addition, an ecological study suggests that the omega-3 polyunsaturated fatty acid, docosahexaenoic acid, may have etiological importance in postpartum depression. A cross-national study was conducted that compared prevalence rates for postpartum depression with the docosahexaenoic acid content in mothers' milk and seafood consumption rates in published reports from 23 countries. Reesults showed that lower prevalence rates of postpartum depression were significantly associated with both high concentrations of docosahexaenoic in mothers' milk (r = -0.84) and greater seafood consumption (r = -0.81). [6]
• multivitamins: It should go without saying, that women, especially new mothers, need to ensure their diet is healthy and adequate. Whole foods and lots of liquid are essential to regain, and maintain one's strength, especially, with a new baby on board. Do your best to STAY AWAY from as much processed foods as possible. Processed foods are just that, foods that are processed. They offer little nutrient value, albeit many empty calories.If there is doubt that you are meeting your daily nutritional needs, discuss this with your healthcare provider. He/she may recommend you add a quality multivitamin supplement to your daily regimine.
• l-tryptophan or 5-HTP: An essential amino acid, l-tryptophan is used by the brain to produce the neurotransmitter, serotonin.[7] Most researchers believe that an imbalance of this neurotransmitter leads to depression.
• riboflavin also known as B2: "...riboflavin consumption in the third quartile was independently related to a decreased risk of postpartum depression." [8]
• calcium: A study was done "to determine the effect of calcium carbonate on the prevention of PPD, women from Portland, Oregon, and Albuquerque, New Mexico, participated in a randomized, double-blind, placebo-controlled trial for the prevention of preeclampsia and completed the EPDS at 6 and 12 weeks postpartum (44). At 6 weeks, the proportion of EPDS scores > 14 was 11% (16/150) for the calcium group from Portland and 18% (26/143) for the placebo group. The proportions from Albuquerque were 24% (10/42) vs 21% (8/39) (P > 0.05). At 12 weeks, only 5.7% (7/123) of the calcium group had an EPDS score >14, compared with 15.3% (19/124) of the placebo recipients (P = 0.01). The results demonstrate that oral calcium supplementation reduced the point prevalence of PPD significantly at 12 weeks and marginally at 6 weeks." [9]
• St. John's Wort: There have been several studies that used this herb to determine its effectiveness in postpartum depression; however, there is a woeful lack of evidence to suggest any beneficial use. We list it here only because there are many instances of online advertisements that claim the opposite of results gleaned from clinical trials.

Diet
As previously mentioned, women, especially new mothers, need to ensure their diet is healthy and adequate.

Diets rich in the supplements listed above, are a good starting point for the new mother. If you are nursing, please speak with your healthcare provider regarding additional caloric intake. As a rule of thumb, studies have shown that most lactating mothers maintain their own bodily needs, as well as a good supply of breast milk when consuming between 1800 - 2200 calories per day. However, this figure may differ from woman to woman.

And finally, the use of mild to moderate exercise in treating all types of depression cannot be overstated. Exercise releases what are known as endorphines. A recent study found that exercise works at least as well as Zoloft, a popular antidepressant drug, in treating depression. [10]

Try to accomplish as much of your exercise outdoors as possible. Prevention magazine calls fresh air, "The simple way to boost brainpower, improve health, and feel great!" [11]

References

[1] National Institute of Mental Health, Office of Communications and Public Liaison, fax communication to OWH, 6/22/01

[2] Mayo Foundation for Medical Education and Research, Postpartum Depression, June 7, 2008, Website Source: http://www.mayoclinic.com/health/postpartum-depression/DS00546/DSECTION=symptoms

[4] Victoria Hendrick, M.D., Lori L. Altshuler, M.D., and Rita Suri, M.D. Hormonal Changes in the Postpartum and Implications for Postpartum Depression 1998 Psychosomatics 39:93-101, April 1998 [Review] Website Source: http://psy.psychiatryonline.org/cgi/content/full/39/2/93

[5] Severus WE, Littman AB, Stoll AL. Omega-3 fatty acids, homocystiene, and the increased risk of cardiovascular mortality in major depression. Harvard Rev Psychiatry 2001;9:280-293

[6] Hibbeln JR. Seafood consumption, the DHA content of mothers' milk and prevalence rates of postpartum depression: A cross-national, ecological analysis. J Affect Disord 2002;69:15-29.

[7] van Praag HM, Lemus C. Monoamine precursors in the treatment of psychiatric disorders. Nutrition and the Brain, vol. 7, eds. RJ Wurtman, JJ Wurtman. New York: Raven Press, 1986 [review]

[8] Miyake Y, Sasaki S, Tanaka K, et. al. Dietary folate and vitamins B12, B6, and B2 intake and the risk of postpartum depression in Japan: the Osaka Maternal and Child Health Study. J Affect Disord. 2006 Nov;96(1-2):133-8. Epub 2006 Jul 11. Department of Public Health, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Fukuoka, Japan. miyake-y@fukuoka-u.ac.jp Website Source: http://www.ncbi.nlm.nih.gov/pubmed/16815556

[9] Cindy-Lee E Dennis, RN, PhD Assistant Professor, Faculty of Nursing, University of Toronto, Toronto, Ontario. Preventing Postpartum Depression Part I: A Review of Biological Interventions

[10] James A. Blumenthal, Michael A. Babyak, Kathleen A. Moore, W. Edward Craighead, Steve Herman, Parinda Khatri, Robert Waugh, Melissa A. Napolitano, Leslie M. Forman, Mark Appelbaum, P., Murali Doraiswamy, K., Ranga Krishnan. Effects of Exercise Training on Older Patients With Major Depression. Archives of Internal Medicine, October 25, 1999.

[11] Prevention Magazine Online The Fresh-Air Fix The simple way to boost brainpower, improve health, and feel great? Spend time outside written by Sarah Mahoney Website Source: http://www.prevention.com/health/health/healthy-living/fresh-air-can-help-your-brain/article/3bf9b3eb1f463110VgnVCM20000012281eac____/ Sourced: 03/11/10