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Causes and treatment of Postpartum Depression

What causes postpartum depression?

Women who have been depressed in the past are more likely to end up with PPD, and women who have had PPD with previous pregnancies have a 70 percent chance of having it again. Those with marital problems, abusive spouses, substance abuse problems, or a lack of social support are more likely to have PPD. Many experts feel that these factors are enough to explain the PPD phenomenon.

Other researchers believe that there is a biological mechanism at work. Fluctuations in hormones, including thyroid hormone, cortisol, prolactin, progesterone, and estrogen, can strongly influence a woman's emotional state. There is nothing like the transition from late-term pregnancy to new motherhood to toss one's hormones into complete disarray. Changes in brain levels of the neurotransmitters serotonin and norepinephrine also take place soon after a woman gives birth, and these changes are thought to be very important contributors to PPD as well. Deficiencies of the amino acids, vitamins, and minerals that form these neurotransmitters can severely limit the ability of the brain and nervous system to make them.

The scientific consensus is that PPD is multifactorial, which means that all of the above variables – hormonal, psychological, and neurochemical – come into play. We believe that all of these factors share one important and commonly overlooked characteristic: The balance of each of these systems relies upon proper nutrition. If the nutritional building blocks that the body needs to make hormones, neurotransmitters, and other mood-altering body chemicals are not present in adequate amounts, mood and physical health can both be compromised.

Medical treatment for postpartum depression

As is the case with depression unrelated to pregnancy, mood-altering drugs and psychotherapy are conventional medicine's treatments of choice for PPD. While talking to a trusted friend or psychotherapist is often helpful, the usefulness of the drugs most often prescribed for women with PPD has not yet been proven. Most physicians treat PPD with various psychiatric drugs that, in effect, trick the brain into thinking it has more neurotransmitters than it actually does – specifically, that levels of one or both of two very important brain neurotransmitters, serotonin and norepinephrine, have been increased. Serotonin and norepinephrine are fundamental to a healthy body because they carry nerve signals and messages throughout the brain and the rest of the nervous system. They have a profound effect on mood and self-esteem, as well as on many other important functions within the body. A deficiency of these neurotransmitters can lead to depression, anxiety, insomnia, anger, obesity, and a host of other serious ailments.

In the vast majority of cases of PPD, the real cause of low levels of serotonin or norepinephrine in the brain is a deficiency of the nutritional precursors that the body needs to make these neurotransmitters. Interestingly, not only do the psychiatric drugs most commonly prescribed for PPD not increase serotonin and neroepinephrine levels, but they actually cause the body's reserves of the nutritional precursors needed to produce them to be used up more rapidly, worsening the state of nutritional deficiency. This is probably why it is so difficult for so many people to go off these drugs. It is not unusual for doctors to hear that a person had a very good initial experience with one of these drugs but that, as time passed, the good feelings wore off and higher doses and/or different medications were needed.

The most common class of drugs physicians prescribe for PPD is known as selective serotonin reuptake inhibitors, or SSRIs, the best-known of which is fluoxetine (Prozac). Other medications in this category include citalopram (Celexa), paroxetine (Paxil), and sertraline (Zoloft). These agents act by keeping serotonin in the brain's synapses (the spaces between nerve cells) for a longer period of time. They also pull serotonin out of the "serotonin stores" in the brain cells and pull it into the synapses. However, as we learn so tragically from time to time when we hear of mothers on medication for PPD who harm or even kill their children, these drugs don't always work. In fact, they fail to work over the long term at least one-third of the time. SSRIs speed up the rate at which serotonin is used up in the brain. If you drive a car at a high rate of speed, it uses up more gas and you have to fill up the tank more often. Similarly, if you speed up the rate at which the brain uses up serotonin by taking SSRIs you will need to replace the nutritional precursors more rapidly.

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