HOW STRESS AND POOR NUTRITION CAN CAUSE POSTPARTUM DEPRESSION
by Dean Raffelock, DC, DIBAK, DACBN, CCN, Dipl. Ac.

Dr. Dean Raffelock is a chiropractor, a diplomate in acupuncture and applied kinesiology, and a certified clinical nutritionis in Boulder, CO.. He is also the lead author of A Natural Guide to Pregnancy and Postpartum Health: The first book by doctors that really addresses pregnancy recovery (Avery, 2003). This article was excerpted from that book.

Most cases of postpartum depression (PPD) can be very effectively treated with a combination of progesterone, nutritional and adrenal support, and in some cases, thyroid supplementation. However, conventional medicine persists in treating women who have PPD, or even the milder version, “baby blues,” with drugs and psychotherapy. 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 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 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.

Post Partum Depression and Brain Chemical Imbalance

In the vast majority of cases of PPD that are related to low serotonin or norepinephrine levels in the brain (vs. a hormonal imbalance), the underlying cause 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 norepinephrine 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.

The most common class of drugs that physicians prescribe for PPD are 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 synapses (the spaces between nerve cells) in the brain for a longer period of time. They also pull serotonin out of the &quo;serotonin stores” in the brain cells and put 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.

Post Partum Depression and Stress
Why are so many people apparently suffering the effects of low serotonin levels? Serotonin and a group of neurotransmitters called the catecholamines—adrenaline (epinephrine), noradrenaline (norepinephrine), and dopamine—which are predominantly made by the adrenal glands—work together and need to be in balance within the nervous system. As the general level of stress with which we live has gone up, our adrenal glands have been induced to make more catecholamines. The brain then is faced with the need to make more serotonin to maintain a proper balance. It is estimated that the level of stress most of us face on a daily basis is 100 times higher than that faced by our grandparents. The world keeps getting more complicated, and our nervous systems keep trying to adapt. We have reached a point where many people's brains are having trouble making enough serotonin to match the levels of adrenal catecholamines required to cope with life.

Post Partum Depression and Nutrition

There are a number of other factors that make it more difficult for our brains to produce enough serotonin. The brain needs a steady supply of the amino acid tryptophan and vitamin B6 to make serotonin. Proteins in foods contain a very small percentage of tryptophan as compared with other amino acids. Only about three percent of the tryptophan in food is actually converted into serotonin in the brain.

The production of serotonin does not take place in a single step, but is a complicated biochemical process, and each of the steps along the way requires specific nutrients. Your body must have enough iron and vitamin B3 (niacin) to convert tryptophan into a compound known as 5-hydroxy-L-tryptophan (5-HTP) and enough other B vitamins plus the mineral magnesium to convert vitamin B6 to pyridoxyl-5-phosphate (P5P), the active form of this vitamin. Without enough 5-HTP and P5P available in the brain, serotonin can not be made at adequate levels. Doctors cannot simply give their patients serotonin to take orally or intravenously because it does not pass through the blood-brain barrier. The only way that the brain can get serotonin is to make it from the specific nutritional precursors available to it at the time.
The adrenal hormone cortisol, which is produced in response to stress, converts trytophan into a chemical called kynurenine, which cannot be converted into serotonin. If you drink coffee, smoke cigarettes, drink alcohol, eat chocolate, take diet pills, or just have a lot of stress in your life—and what mother doesn't?—your body may produce too much cortisol, increasing the tryptophan that is converted to kynurenine and limiting the amount available to produce serotonin.

Antidepressants and Nursing

The safety of SSRIs for the babies of nursing mothers has not been proven. Some studies have linked the maternal use of Prozac to colic in nursing infants. A baby with colic can push the most even-tempered mother over the edge. For this reason alone, giving such a drug to a mom with PPD doesn't seem like the best way to support her recovery. While studies have shown that little or no drug circulates in a baby's bloodstream, others that have looked at the concentrations of the drug in babies' brain tissue have found much higher levels. Nothing is known about the possible harm this can do to a newborn.

Some mothers choose to take the drugs and not to nurse. This deprives their babies of the most perfect food they can be given, and deprives both mother and child of the important bonding that comes with breastfeeding. Mothers with PPD who miss out on the bonding experience of breastfeeding may end up feeling even more distant from their babies.

Side Effects of SSRI Drugs

One potential side effect of SSRIs is a feeling of numbness, of separateness from others. Feeling numb does tend to blunt depression, but it may do so at the expense of a new mother's feelings of intimacy with her baby. Other common side effects of SSRIs include nausea, sleepiness, insomnia, sexual dysfunction, headaches, trembling, indigestion, abdominal pain, and nervousness. SSRI drugs also seem to lift normal inhibitions against violence and suicide in some people, and thus may even play a part in enabling an overwrought woman to commit one of the worst crimes imaginable—causing serious harm to her child.

Many experts, including Harvard University psychiatrist and author Joseph Glenmullen, M.D., and Peter R. Breggin, M.D., psychiatrist, author, and director of the nonprofit International Center for the Study of Psychiatry and Psychology (ICSPP), warn that SSRIs are overprescribed and that their dangers are drastically underplayed.

Dr. Glenmullen's book, Prozac Backlash (Simon & Schuster, 2000), warns that SSRIs can cause symptoms similar to those of Parkinson's disease—including facial and body tics and muscle spasms that may persist even after the drug is discontinued—in at least 10 percent of those who use them. This finding implies that SSRIs may create dangerously low levels of the neurotransmitter dopamine in some people. Moreover, the long-term effects of Prozac and similar drugs are not known, but some studies indicate that permanent brain damage could occur because the constant artificial elevation of serotonin eventually burns out receptor sites in the brain.
Never stop using SSRIs abruptly, as this can cause serious withdrawal symptoms. Taper off gradually with the guidance of a knowledgeable physician, hopefully one who is experienced in giving you increasing amounts of the nutritional precursors as you wean off the drugs.

Depression and Serotonin

Many women suffer from a kind of depression that results not at all from low brain serotonin levels but from low levels of norepinephrine. Increasing serotonin levels with drugs does not help this kind of depression. On the contrary, it often makes people even more tired and depressed. Women with low serotonin levels tend to have a great deal of anxiety, while women with low norepinephrine levels feel like they fell into a deep, dark hole and just cannot muster the energy to get out. People with low norepinephrine levels are often dramatically helped by restoring normal thyroid and adrenal gland function. Tyrosine (along with the mineral iodine) is also the main nutritional precursor for all the thyroid hormones.

I believe that the vast majority of cases of PPD can be prevented and/or treated successfully without resorting to drugs that may harm you and your baby.