Postpartum Depression

Having a baby is an emotional period, with so much to deal with. Depression is not one of the things that a new mother would expect.

Postpartum depression is defined as a mood disorder that begins after childbirth and lasts up to eight weeks (with some extending to a year).

Baby blues is a mild attack of depression that happens in the first week after birth. The new mother feels anxious, irritable, and tearful, with frequent mood changes. This does not interfere with her ability to take care of her baby and usually resolves spontaneously within days.
In postpartum depression (PPD), the mother feels that she is unable to care for her baby with more severe symptoms of depression.
Postpartum psychosis is the most severe form of PPD; it is relatively rare with symptoms of agitation, confusion, delusion and hallucination.

Symptoms of Postpartum Depression

Anxiety
Changes in appetite
Difficulty in concentration
Fatigue
Frequent crying
Intense worrying about baby
Loss of interest
Mood swings
Withdrawal from family friends and activity
In severe cases, thoughts of suicide or infanticide can be present.

Causes of Postpartum Depression

The exact cause of postpartum depression is unknown, but the rapid hormonal changes which accompany pregnancy and delivery may trigger it.

At the beginning of pregnancy, progesterone is produced from the corpus luteum in the ovary, then starting from the seventh week of pregnancy the placenta produces high amounts of the progesterone hormone (about ten fold more than pre-pregnancy state), which helps to relax the uterus and prepare the mammary gland for lactation.

After the delivery of the baby and expulsion of the placenta, the level of progesterone drops markedly returning to the pre-pregnancy level [1, 2]. This dramatic change in hormone levels may trigger the mood changes experienced in postpartum depression [3-5]. In some studies, metabolites of progesterone have been found to be lower in women with postnatal depression [2]. Therefore progesterone supplementation may help control the depression that is sometimes experienced after giving birth.

Treatment of Postpartum Depression

Progesterone supplementation. The dose should be adjusted according to follow-up tests and improvement in symptom severity.
5-hydroxytryptophan (5HTP) [6-8]
Zinc [9]
Support from family and partner

References

1.         Gilbert Evans, S.E., et al., 3alpha-reduced neuroactive steroids and their precursors during pregnancy and the postpartum period. Gynecol Endocrinol, 2005. 21(5): p. 268-79.
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2.         Nappi, R.E., et al., Serum allopregnanolone in women with postpartum "blues". Obstet Gynecol, 2001. 97(1): p. 77-80.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11152912
3.         Harris, B., et al., Maternity blues and major endocrine changes: Cardiff puerperal mood and hormone study II. Bmj, 1994. 308(6934): p. 949-53.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8173402
4.         Chang, J., Y. Zhang, and L. Cui, [Impact of placental hormone withdrawal on postpartum depression]. Zhonghua Fu Chan Ke Za Zhi, 1995. 30(6): p. 342-4.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7555367
5.         Bloch, M., et al., Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry, 2000. 157(6): p. 924-30.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10831472
6.         Bailara, K.M., et al., Decreased brain tryptophan availability as a partial determinant of post-partum blues. Psychoneuroendocrinology, 2006. 31(3): p. 407-13.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16303256
7.         Kohl, C., et al., Measurement of tryptophan, kynurenine and neopterin in women with and without postpartum blues. J Affect Disord, 2005. 86(2-3): p. 135-42.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15935232
8.         Nakajima, T., Y. Kudo, and Z. Kaneko, Clinical evaluation of 5-hydroxy-L-tryptophan as an antidepressant drug. Folia Psychiatr Neurol Jpn, 1978. 32(2): p. 223-30.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=307522
9.         Wojcik, J., et al., Antepartum/postpartum depressive symptoms and serum zinc and magnesium levels. Pharmacol Rep, 2006. 58(4): p. 571-6.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16963806