Postpartum Depression (PPD)

What is postpartum depression?

Symptoms of postpartum depression

Consequences of postpartum depression

Causes of postpartum depression

Risk factors for postpartum depression

Prevention / remedies / treatment / recovery from postpartum depression

References

What is postpartum depression?

Postpartum depression (PPD, Postnatal Depression) is a form of clinical depression that sometimes affects women after childbirth. Studies (2) estimate that between 5% and 30% of women are affected, but lack of a clear definition of PPD and how to measure it mean that its incidence is not clear. PPD affects women in the first few months after childbirth, and can last as long as a year (1). New fathers can also suffer a form of PPD, with one study estimating that between 1% and 26% of men are affected (2).

Symptoms of postpartum depression

• Anxiety, hopelessness, emptiness, feeling overwhelmed, frustration, guilt, feeling inadequate, irritability, low self-esteem, panic attacks, sadness, social withdrawal, cannot be comforted, no longer feels pleasure.
• Crying episodes.
• Exhaustion, fatigue, low energy.
• Eating pattern changes.
• Low libido.
• Sleep pattern changes and insomnia.
• Impaired speech and writing.

Consequences of postpartum depression

Aside from the obvious unpleasant effects of the above symptoms, PPD can have severe consequences for the infant's health and development. Months two through six in an infant's life are very important because it is at this time that the baby develops some social interaction and cognitive skills. Parent-infant interaction is essential because it builds the infant's connection not only with the mother, but other people as well. This is the riskiest developmental time for the child. PPD or lack of interaction with the mother can can result in diminished parent-infant communication and poor results in other measures of infant performance, with lifelong consequences

Causes of postpartum depression

• Mis-directed anticipation. The new mother had a goal, the new baby. From a hormonal (dopamine) point of view, it is far healthier for the new mother to enjoy the journey - the pregnancy, the delivery, the new infant, and life continuing. Focus on the journey, enjoying each moment of it. If instead there is a goal and an end point, it will inevitably turn out to be disappointing.
• The new mother may be re-experiencing the lack of bonding that she suffered as an infant. When she was a newborn her own mother did not cherish and care for her. The daughter is now exhibiting the same behaviour as her mother. A professional therapist and some honest conversation can start to remedy the problem.
• Massive hormonal changes occur during pregnancy, at the onset of birth, and immediately post-delivery. The most important imbalance is usually insufficient progesterone.
• Depression - a history or tendency to be depressed (either before or during the pregnancy).
• Poor nutrition. Insufficient Omega-3 fatty acids, protein, vitamins (particularly from the B group), minerals and wholesome nutrient-dense food. Consuming a high level of processed foods, low-fat food, and high-sugar, refined food.
• Insufficient sleep. Sleep is a brain detox process
• Pyroluria.
• The physical stresses of birth.
• During pregnancy, the level of copper in the woman's body goes up. Copper is a healthy and essential mineral. It is crucial that the foetus gets sufficient copper. Without enough copper, development of the brain, organs and bones may be abnormal, and underweight birth is likely. Copper is so important that the foetus takes priority over the mother if there is not enough copper in her body. So the mother is at high risk of copper deficiency if she does not have enough copper in her diet. In some cases of postpartum depression, after delivery copper levels do not normalise. A copper-rich diet is essential both during and after pregnancy. It is also important to eat a mineral-rich diet, particularly with zinc sufficiency.

Risk factors for postpartum depression

• Major risk - Mental state, attitude and emotions (predisposition to be depressed). The new mother's own mother did not cherish and care for her. The new mother is at risk of exhibiting the same behaviour she received from her mother.
• Major risk - Father's level of involvement during pregnancy and with the new child.
• Major risk - The state of the relationship between the mother and the father.
• Life stress and anxiety.
• Social support (lack of support from family, friends).
• Unwanted or unplanned pregnancy.
• Disruption to needs and relationships (not getting sexual, support, connection and other needs fulfilled).
• Single parent.
• Living a modern western lifestyle, rather than a traditional lifestyle.
• Low socioeconomic status (lack of control of major decisions especially work, living in a less desirable place and circumstances, feeling unwanted and un-needed, low income).
• Postpartum exhaustion is caused by sleep deprivation in the days and weeks after giving birth. Parents whose babies have severe colic or other medical causes of sleep upset, or temperament problems causing a disrupted sleep schedule are most at risk.
• Low self-esteem.
• Chronic stress from childcare.
• Bottle feeding rather than breast feeding.
• Smoking.

Prevention / remedies / treatment / recovery from postpartum depression

It is important that the mother trusts her intuition about how she is feeling and communicates with the father / significant other, a close friend, and her doctor or health practitioner. Early identification and intervention improves the long-term outcome for most women. The mother and those around her need to address the Causes and Risk factors detailed above. She needs support, a good diet, and help with getting normal sleep.

The new mother may need to deal with issues concerning her own mother, and whether she was cherished and cared for. The new mother is likely to exhibit the same behaviour she received from her mother.

Before pregnancy, a healthy woman produces about 20 mg of progesterone each day. During pregnancy, it goes up by twenty times to 400 mg per day. The level of estrogen in her body also rises, but not to the same extent. The placenta is responsible for the huge increase in progesterone after about week ten of the pregnancy, when it takes over progesterone production from the ovaries. Progesterone level peaks during the third trimester. Most women feel great at this time, they are said to "nest" and "bloom". They enjoy clear thinking and confidence, and good enthusiasm and energy levels. At the birth of the child and the passing of the placenta, her progesterone blood level falls dramatically. Remember that in a non-pregnant woman, the ovaries produce progesterone immediately after ovulation. Breast feeding naturally inhibits ovulation, so her progesterone level remains very low.

Most women feel baby blues / maternity blues / second day blues at this time. It is quite common. Symptoms typically last from a few hours to several days. She may feel tearful, irritable, sleepless, isolated, and have brain fog or a headache. These blues are short lived and not the same thing as PPD.

It is interesting to note that many female animals eat their placenta immediately after birth. The placenta is rich in progesterone, as well as containing a treasure trove of other nutrients. In China, most maternity hospitals sell fresh human placenta to the public. I have a Chinese friend who buys a small peice when she feels she needs a tonic, and cooks it in her kitchen.

Copper sufficiency.

Zinc may be useful, see Causes of postpartum depression above.

It makes sense that the addition of natural progesterone at this time will assist the new mother. I am NOT suggesting the animal's solution! A progesterone skin cream is the most effective remedy. It is essential that she uses a high quality bio-identical progesterone and not an analog look-alike such as progestin or progestagen. Remember that the progesterone will be expressed in her milk and taken on by the infant. We are merely trying to imitate nature rather than introducing any pharmaceutical medications to the mother and her new baby. Bio-identical natural progesterone does not interfere with her breast milk and offers a far more reassuring treatment than antidepressants or medication. Using progesterone cream post pregnancy minimises the degree of hormonal shift that takes place after the birth. In more severe cases of PPD a high-dose natural progesterone cream treatment is usually only required for a few months. We recommend combining it with professional counselling, a support group, and addressing the Risk Factors discussed above. The results will be invaluable to both the mother and her child.

References

1. Post Partum Depression. Canadian Mental Health Association. 13 June 2010

2. Paulson James F. Focusing on depression in expectant and new fathers: prenatal and postpartum depression not limited to mothers. 6 February 2010. Psychiatry Times 2010;27(2).