Newly updated in 2010, Beyond the Blues contains the current information about risk factors, diagnosis, treatment options, and prevention of mood disorders in pregnancy and postpartum. Included is the most up-to-date research about medication use in pregnancy and in breast milk. Straightforward yet compassionate, it is required reading for all who work with pregnant and postpartum women, as well as for those suffering before or after the baby is born. This book is being used by the US Navy, Spec

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New moms have a lot to be anxious about, and it’s perfectly natural to have some fears during and after pregnancy. The problem is, anxiety can grow, disrupting your daily life and keeping you from enjoying motherhood. The Pregnancy and Postpartum Anxiety Workbook provides proven-effective strategies drawn from cognitive behavioral therapy (CBT) for keeping anxious thoughts at bay and getting back to the productive and positive thinking you’ve been missing. Through a series of easy exercises and

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Overcoming Postpartum Depression & Anxiety

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Think of it in very simple terms. A mother who has a baby should be happy, but instead is mostly sad. The answer most of the time is postpartum depression. In more extreme cases, the mother feels very depressed, alone, and sometimes they don’t automatically feel the natural love they should for their baby.

Postpartum depression is a very common condition. If three fourths of women experience it after giving birth, it is no wonder it has become a popular subject among women, their family members, and doctors. There are a lot of women out there that need help in dealing with the symptoms and emotions of postpartum depression. Most of them have no idea how to overcome it.

Fortunately, there are many ways to overcome postpartum depression. Starting with small steps, a new mother can look forward to feeling whole and “back to her normal self” again. Also remember, depression on any level takes time to overcome. Don’t expect to feel all of the sudden better overnight. It usually takes a few weeks to a few months of conscious effort from the new mother and sometimes even from immediate family members. The level of help to which a new mother with postpartum depression needs is different for every women and her feelings should never be ignored.

First, it is very important that a new mother with postpartum depression takes care of herself. Sleep when the baby is sleeping and enjoy the baby’s sweet company when it is awake. Take a shower, where comfortable clothing, and don’t stress about your body. It will take care of itself in time if your mind is healthy first. It is important that you get ready for each day and be a part of it. Make sure you are interacting on some level with the world or your family members. This, no doubt, will take extra effort since depression has a way of making us exhausted. However, that extra effort will be worth it in the long run. Call in some help from a neighbor, friend, or family if you need to.

Second, talk to someone about it. Since almost 80 percent of new mothers experience postpartum depression on some level, it is no big secret. If you don’t feel you talk talk with your spouse or family, find a postpartum depression support group. The important thing is to make sure your feelings are being heard and that you are being acknowledged in order to get what help you need.

Third, eat a well-balanced diet. Proper nutrition is an important part of getting rid of postpartum depression. Focus on foods high in protein and omega-3 fatty acids. These are foods like nuts, avocados, salmon and other fish, lean meats, and peanut butter. Also make sure you are getting enough fluids. Dehydration can only exacerbate a tired body and mind. Supplements are also important as we don’t often eat enough of the essential vitamins our body needs to balance hormone levels and maintain proper body functions.

Finally, remember again to be a part of the world. Take part in society and get some sunshine on your face. This may take the most effort of all. Having postpartum depression isn’t a condition that makes new mothers want to go out and mingle with friends and family. But if we push ourselves to do so, it can alleviate many emotional symptoms of postpartum depression.

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The symptoms that usually start within the first to twelfth postpartum months vary widely among mothers. A few of the most common are despondency and despair, chronic fatigue, sleeplessness, anxiousness, lack of confidence, loss of sex drive and passion, muscle and joint pains, unhealthy skin, hair and nails, digestive disturbances, bladder problems, heart disease, trouble breathing, and a host of troubling emotions and moods swings. A woman can be puzzled, frustrated, even embarrassed when she reveals symptoms that have plagued her for years. She may have shared her self–observations with doctors only to find that they were not worthy of an acknowledgment or comforting comment from her physician. Any attempt on her part to connect the birth of one of her children with those symptoms may have been met with skepticism or passed over. Yet, she can’t shake the feeling that something about that particular birth began her health decline.

Her observations do have validity and merit. What most mainstream medical practitioners don’t fully take into consideration is that a baby’s body is formed and made entirely of nutrients donated by the mother’s body. Her child’s brain, eyes, muscles, bones, organs, glands, nerves, skin, tissues and fluids are entirely make from the nutrients taken from its mother’s bloodstream via the placenta.

If there is a lack of vital nutrients, the mother’s body is the first one that is deprived because her developing baby is Mother Nature’s priority. All mothers need to consciously replenish their lost nutritional and energetic reserves during the postpartum period. If this isn’t done, they might end up spending the rest of their lives wondering why they “just haven’t felt the same since the baby was born.”

The energy demands of caring for a newborn can further drain and deplete the mother’s nutrient reserves, especially if she is breastfeeding and sleep–deprived. If a woman has lost a great deal of blood while birthing her baby, the need for replenishing the nutritional components of blood is even more critical. Women who undergo Cesarean section also need to restore nutrient reserves; not only have they become mothers, they have had to have major surgery in the process. Women who lose a good deal of blood during the birth process and who don’t replenish key nutrients might experience light–headedness and throbbing headaches, along with extreme fatigue, sleeplessness, anxiety, and depression.

A new mother is also faced with the stress of integrating the intense needs of a new baby into her lifestyle while tending to her mate and perhaps other children and returning to work. All of these responsibilities that women – and those who are cared for by them – have taken for granted for millennia demand high–quality nutrients. Our food supply presently contains only half the nutrients that food contained in the 1940s due to the nutrient depletions in our soil. This fact makes it very difficult, if not impossible, for a mother to fully replenish the nutrient reserves her body donated to make her baby’s body solely from the food she eats. Eating highly refined and processed “junk” foods further depletes vital nutrients, which deepens the need to replenish postnatal nutrients even more.

Every physiologic process in the human body depends upon nutrients. The most important time to consciously replenish postpartum nutrient reserves begins immediately after giving birth and extends to 24 months postpartum. The failure to do this often sets the stage for chronic health problems that may last for decades.

There was a time that women throughout the globe would be given their placenta in some edible form to consume directly postpartum, much like dogs and cats do instinctively. The placenta contains highly concentrated amounts of the nutrients that the mother has lost through giving birth. The fact that eating one’s placenta is now culturally distasteful further supports the need to make a concerted effort to consume the appropriate nutrients and nourishing foods necessary for rebuilding and replenishing the new mother’s donated nutrient reserves. A high potency postnatal nutrient program is now essential to help a postpartum woman replenish her nutrient reserves.

Presently, about 30 million Americans take anti–depressant and anti–anxiety drugs. The majority of these are postpartum women! Women comprise 79% of U.S. citizens on antidepressant drugs. Many doctors prescribe Prozac, Zoloft, Paxil, Celexa, and a host of other anti–depressant drugs before considering whether the mother’s depression, anxiety, fatigue, or lethargy might be caused by postpartum nutrient depletion. All the major brain neurotransmitter chemicals (like serotonin, norepinephrine, epinephrine, dopamine and GABA) that effect mood, energy, and many other physiological process are formed entirely from nutrients! Postpartum nutritional depletion can cause a physiological depression that is far too often misdiagnosed as a mental disease. This is a medical short–sightedness that needs to change. A postnatal nutrient recovery program should be the very first thing a doctor thinks of and prescribes for postpartum women presenting these symptoms; especially with women who have no history of depression, hopelessness, anxiety, insomnia, or fatigue prior to giving birth. Continuing to take a high quality, comprehensive postnatal nutrient program can also help determine if there is truly a need for pharmaceutical antidepressant support or if replenishing nutrients are sufficient.

If one does need and benefits from the assistance of antidepressant drugs, it is still very important to note that these drugs contain no nutrients, so the need to replenish postpartum nutrient reserves still exists and should be addressed. This can also aid and prevent other postpartum health problems. The need for high potency postnatal nutrients is greater now than ever before because the pace of life keeps getting faster, more complex and stressful.

Omega–3 oils are robbed from the mother’s body at a very high rate via the placenta to help form her baby’s brain, eyes, nerves, and cellular membranes. Breast-feeding robs even more Omega 3 oils from a postpartum woman’s body because it is removed from her body to form the milk her body is producing. Many studies show the importance of Omega 3 fish oils to relieve depression, dry skin, thin hair and nails, fatigue and prevent heart disease in postpartum women. Omega 3 oils are an essential ingredient in a good postnatal nutrient program to assist a mother to replenish her nutrient reserves. It is vitally important that the Omega 3 fish oils taken be certified free of heavy metals and PCBs and also contain at least 3 different antioxidants (Vitamin E, Vitamin C, and rosemary oil are best) to prevent these oils from going rancid. Flax oil does not easily convert into DHA and EPA found in fish oils.

All the major nutrients are taken from mother’s body to help form baby’s body. Alpha Lipoic Acid and Coenzyme Q 10 are essential for the body to make energy. Without enough of these two essential nutrients, the energy producing mitochondria in our cells will often make only 2 units of ATP (cellular energy) instead of 38 units of ATP per cycle. These two deficiencies are major causes of postpartum depression, fatigue and mood swings. These two nutrients along with B vitamins, minerals including calcium and magnesium, and the Omega 3 oils are essential nutrients to help a mother replenish her postpartum nutrient reserves and should be included in a good postnatal nutrient formula. Prenatal vitamins do not adequately supply all of the nutrients that new mothers require after bringing new life into this world.

A high quality postnatal nutrient program should be an integral part of the pregnancy recovery program required for all postpartum women to fully replenish their nutrient reserves. This can assist new mothers to not only regain their health and prevent later health problems, but also to allow her the best chance of happily raising her family and having other healthy pregnancies and healthy children if desired.

PPD and PPA (Postpartum Anxiety) are experienced by many women after child birth and yet it’s been little more than a decade that we have been talking about the problem.  We give a lot of credit to Marie   Osmond, who 12 years ago went on the Oprah show and talked about her experience with PPD and shed some light on the issue.  Up until that point, PPD and PPA did not have a face.  It was not something discussed in polite company.  The myth of “happy motherhood and perfect baby” was the picture most of us carried around.  And that picture made it even more difficult for mothers to come forward and get the help that they needed.

When asking the question of PPD as a symptom or disease, several things come to mind:

1.  Exhaustion or Depression: No other normal physiologic body process is as demanding as pregnancy and birth.  Many women go home with a new baby and have other small children and a husband to care for as well.  New babies have intense needs day and night. They require nursing and feeding , lots of body contact and soothing. That means that mother probably won’t be sleeping through the night. Sleep deprivation contributes to negative mental states.   Caring for a family and an infant can render mother exhausted.  If a new mother has had a C-section, she is also recovering from surgery. Treatment for exhaustion is as important as treatment for depression, and it should be noted that exhaustion can mimic many of the symptoms of depression.

2. Nutritional Depletion: A baby’s body is made up entirely of nutrients that are donated by its mother’s body.  The placenta is also made from nutrients donated by mother’s body. The placenta pulls nutrients from a mother’s bloodstream and gives it to the developing fetus.  Nature has it wired that if one is going to do without; it will be the mother for the sake of new life. Some women lose a great deal of blood during childbirth and since blood is made from nutrients, this further depletes a mother’s nutritional reserves.

The research is clear that certain nutritional deficiencies, for example the DHA and EPA  (as from fish oils) can cause depression and moods swings. So can a lack of certain B vitamins.  All postpartum women can benefit from taking a good multiple vitamin and mineral, fish oils and supplementing calcium and magnesium.  Many health care professionals now recommend that mothers stay on their prenatal vitamins for several months after the baby is born.

3.  Community: In the past when extended families lived together or close by, a new mother would be able to have her needs met while she rested for a number of weeks to regain her strength. Women relatives and close neighbors would prepare her families’ meals and they would also help soothe her tender emotions while her body recovered. These days many women no longer have that kind of support. In the 1950s a woman who had just given birth stayed in the maternity ward for an average of 2 weeks, resting and bonding with her newborn. Now she is out of the hospital in 48 hours.

Today there are thousands of web sites started by women who have suffered and survived post partum depression wanting to help other new mothers.  These are communities where women share their fears and stories and share what methods and treatments worked for them.  Mothers who experience PPD and PPA need to know that they are not alone.  These sites provide valuable support, community and information to both mother and her family.

4.  Health overview: In contemplating the question of PPD as symptom or disease, a health overview is crucial.   Hormone testing, adrenal stress index testing, thyroid testing provide information to the health care practitioner which can help decide the best course of treatment for a mother suffering from PPD or PPA.

5.  Drug intervention: Though, we tend to be oriented toward natural remedies, we have always said that there is a time and a place for drugs.  Mothers who are suffering from PPD and PPA may find it difficult to get the immediate relief necessary from natural therapies and will benefit greatly from medication which can get them over the toughest part of PPD and PPA.  Women who suffer from postpartum psychosis often need to be medicated for life. No mother should have to suffer.   If one is doing drug therapy for PPD and PPA , it is hopefully done as part of a holistic plan of diet, exercise, talk therapy and vitamin supplementation.

6.  Meditation: Most new mothers will laugh at the idea that they would have even two minutes to sit and meditate!  They would be right.  That being said, we suggest a “portable meditation” in the form of deep belly breathing.  If you are pushing a stroller, making dinner, sitting down to nurse, or shopping in the grocery store, you can do this.  It is especially helpful when you start to feel anxious.  Take a very deep breath in through the nose…as much air as you can take in…and then let it slowly out through the mouth.  Ten of these deep, slow breaths will lower your blood pressure, slow your heart rate and reduce stress chemicals.  Every new mother should have this technique in her tool box.

7. Exercise: The research is clear that for those who are able, mild to moderate exercise is a mood elevator. Walking with a stroller, yoga, and other beneficial forms of exercise can be very helpful.

So back to the question is PPD a symptom or a disease?  Like we said, this question worthy of contemplation, but it has no simple answer.  In some ways PPD is a symptom of exhaustion and lack of physical and emotional support; in other ways PPD is a disease of depleted brain chemistry.  In some ways PPD is a disease of the culture which still does not understand the PPD process and needs to become more aware of how women are treated in the postpartum phase of motherhood.

In a perfect world, we would wave a magic wand and all new mothers would stay in a birthing center for a few weeks after childbirth; where there were health care professionals to help them learn the coping skills needed to deal with the challenges and demands of mother hood; where mother could truly rest and recuperate; where nutrition dense meals were served ; where dietary supplements were part of the program; fresh air, sunshine and other mothers to talk with.  In a perfect world just this kind of rest and replenishment could lower the incidence and the severity of PPD and PPA.  In a perfect world.  Until then, we need to keep shedding light on PPD and PPA and study methods of care that can best benefit the mother and the family

If you have any questions about this privacy statement, the practices of this site, or your dealings with this Web site, you can contact us.

Dr. Dean and Stephanie Raffelock

http://www.soundformulas.com

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What if my baby isn’t healthy? What if I can’t handle the pain of labor and delivery? What if something goes wrong? What if I’m not a good mother? Along with the excitement and joy of pregnancy and motherhood, most women experience mild anxiety as a natural part of the process. For many women, though, these anxious thoughts become excessive and even debilitating. Many women develop anxiety for the first time or experience an increase in anxiety symptoms during and after pregnancy, yet this is th

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Having a baby is one of the happiest moments in the life of a mother. It can be so thrilling and exciting to have a new baby enter your lives. But it can even be very challenging at times. A woman goes through a lot of changes at physical and emotional levels during pregnancy and child birth.

Such changes can cause a woman to feel sad, afraid, confused and anxious. For many women, such feelings go away after some time. When the feelings go away on their own after some time, it is reffered as ‘baby blues’.

However if feelings persist for a long time, or even get worse, then it would be labeled as pospartum depression. Below are a few signs and symptoms of pospartum depression. A woman may feel all or some of these symptoms.

If these symptoms do not go away or fade away soon then the woman may need medical attention to overcome the problem. It is not advised to neglect this problem for long.

Postpartum Depression Symptoms:

Feelings of restlessness
Feeling sad or feel like crying
Low energy levels, getting tired easily
Feeling irritable
Unable to sleep well
Unexplained weight loss or weight gain
Don’t feel like eating
Sometimes a woman may indulge in overeating
Lack of interest in the baby, or on the other hand, become overly worried about it
Unable to focus or remember things easily
Not deriving pleasure in anything, including  sex
Being too much worried about hurting the baby

These are some of the common postpartum depression symptoms. One woman may suffer from some of these symptoms while another may suffer from other symptoms from the above list.

PPD may affect women of any age, racial background etc. The exact causes of postpartum depression may not be exactly known. It could be due to hormonal changes in the woman’s body. Or it could be due to low thyroid levels which could happen after giving birth.

If you suffer from any of the above postpartum depression symptoms, no need to get unduly worried. This condition can be treated and cured. However, it is advised not to resort to medication (unless extremely necessary) for treatment of this condition as it could affect breast milk.

Few Tips to Deal with Postpartum Depression Symptoms:

Get good amount of rest.
Try to take a nap when the baby naps.
Talk to your family members.
If needed, consult a doctor.
Avoid spending a lot of time alone.

Postpartum Depression is a form of clinical depression that mostly affects the females. This probably occurs as a response to the overwhelming feeling of childbirth and probably related to hormonal shifts as estrogen, progesterone, and corticotropin-releasing hormone levels in her body decline.

In addition to the overall feeling of sadness, the woman may notice extreme fatigue, inability to stop crying, increased anxiety about the baby’s and her health status, insecurity, psychosomatic symptoms (like nausea, vomiting and diarrhea), and either depressive or manic mood fluctuations.

Low self-esteem may be a major contributor to the occurrence of the disease. A woman do have a high chance of getting it if she has a history of depression, a troubled childhood, stress in the home or work, and lack of effective support people. Sometimes the differences between a woman wanting a pregnancy and her partner not wanting it could trigger the disorder.

Prediction of the occurrence of the depression is difficult especially before birth. It is due to the variety of reactions elicited during birth. But if can be identified, counseling will be beneficial and helpful to prevent the symptoms. For the woman who have not been identified to be at risk for the disorder, it is important to discover the source of the problem immediately as the symptoms develop.

The woman may need further counseling to integrate the experience of childbirth to her life. It is important to identify the problems and allow the creation of solutions to those. For if not, the disorder will persists and may lead to a more advance form of it, Postpartum Psychosis. Postpartum depression treatment also includes the initiation of antidepressant medicines to relieve the symptoms of the disease immediately.

The role of the woman’s partner is highly important to the prevention of this. The support he will be giving is greatly needed to enable the woman to recover emotionally from this overwhelming event. Financial security will also play a big factor to the occurrence of it. If the mother will be anxious to the expenses of having a baby (like the hospital fees, diapers, and infant formula), it is most likely that the mother will think about it and the focus of her attention will be directed to it instead.

The birth of a child is a very important and at the same time, a very stressful event for a mother. A supportive husband and relatives will help her to cope up to the stress that this event will give. For if not, the mother will likely have the disorder; affecting the relationship of both partners and most importantly, the relationship of the mother to her baby and its emotional growth.

Postpartum depression was once thought of as a make believe disorder and was widely discriminated upon. It has only been since the extreme actions of some mother experiencing postpartum depression, that the international community even took serious notice of the issue. That is why programs like this one have been developed and will continue to be developed in the coming years.

Postpartum depression residential treatment training is a series of courses that were developed from a research study conducted at the University of Cambridge, Uk. This study pertaining to the postpartum depression residential treatment training studied the different types of psychological treatments and designed a program suited to best address these needs in new mothers.

There are three main courses of postpartum depression residential treatment training. They are predominantly aimed at doctors to provide them with a set of skills to identify depression and then to treat it. The treatment is centered on a structured, well thought out intervention using techniques and skills acquired from understanding cognitive behavioral theory.

The second phase to postpartum depression residential treatment training is a two-day course that covers the detection of depression and of intervention techniques. Following that is a one-day workshop that also helps in the aiding of detection and of perinatal mood disorders as well as raising general awareness of the issue.  This should have any practitioner ready to handle any postpartum depression case.

There is also a postpartum depression residential treatment for trainers. This is a three-day course that is in large part, designed for those in charge of training primary care workers. This course is an on campus course and is available to adhere to your independent needs.

This postpartum depression residential treatment training has an online presence and you can access their site for more detailed information on course availability. Their website is very informative and has a contact us option so that you may email them your particular needs.
It was once thought of as a make believe disorder and was widely discriminated upon. In recent years it has received international fame through extreme displays of postpartum depression.

This digital document is an article from Family Practice News, published by International Medical News Group on February 15, 2002. The length of the article is 757 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser.

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Title: Treating postpartum depression. (Drugs, Pregnancy, and Lactation).(Brief

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A New Parent’s Guide to Taking Charge of Postpartum DepressionHaving a baby is one of the most dramatic transitions you will ever make, both opening you to the greatest love you can experience and setting in motion a rollercoaster of emotions you never before thought possible. These feelings are affected significantly by psychological and social factors-in fact, studies reveal that nearly as many new fathers as new mothers exhibit symptoms of postpartum depression. Written by a clinical psycholo

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DATELINE:  IRVINE, CA… According to Postpartum Support International, one in eight women suffer from a postpartum mood disorder.  New dads (and veteran dads) should know the difference between the Baby Blues and Postpartum Depression (PPD).  Oftentimes, these disorders go undiagnosed because a new mother’s support system, typically the husband/partner, does not know what to look for and where to go to get help.

Working with more than 200,000 new dads over the past 19 years, Boot Camp for New Dads (bcnd.org), a non-profit orientation program for fathers-to-be, operating in more than 260 hospitals, clinics, schools, fire stations and churches around North America and internationally, advises new fathers to watch for signs of PPD in mom and offers tips on how to recognize it.

Postpartum depression is not selective.  It can affect any woman who is pregnant, has had a baby or who has miscarried.  It’s important that when new mothers begin to experience such symptoms that they get help immediately.  A new mother’s mental health is very important to not only herself but her baby and family.  Get professional help for mom immediately.  Talk to an experienced counselor or your physician. 

Baby blues or postpartum?  Boot Camp for New Dads advises dads of several signs that indicate the more serious PPD:

Self-esteem issues – Mom may have very negative feelings about herself.  She may think she is worthless, unattractive or a bad mother.  If she does feel this way, a simple “pep talk” is not going to help. Constant fatigue – It’s a fact that when the baby arrives, mom probably won’t get as much sleep as she needs.  One of the signs to watch for is constant fatigue, even upon waking.  Fatigue is a symptom of depression. Weight loss or weight gain – Yes, while some moms lose a little of the pregnancy weight within the first few months after birth, other moms stay the same weight.  Significant weight loss from a lack of appetite or weight gain from overeating is sign that something is wrong. Crying often – Mom’s occasional crying is normal as her hormones fluctuate and she has difficulty getting that extra, much needed rest.  But, crying every day and/or more than once a day is a red flag. Disinterest — When mom is not interested in herself, her baby, family or other activities, it’s an indication that something is wrong. Mood swings – Similar to a roller coaster ride, mood swings are extreme changes in mood.  Mom’s joyfulness immediately followed by sadness and despair are not healthy moods.  Being afraid of hurting the baby or herself – If mom is afraid of hurting the baby or herself, get medical attention immediately.

According to Greg Bishop, founder of Boot Camp for New Dads and active Boot Camp coach, “Many new moms experience the baby blues, which can include symptoms of crying and mood swings, restlessness and fatigue that lasts for a few hours to a few weeks after delivery. PPD doesn’t always happen immediately after birth.  It can take hold months after the baby is born and moms usually experience exaggerated symptoms of the baby blues. PPD is a serious condition that can affect any mom – whether she’s just given birth to her first child or fifth.  PPD may be attributed to changes in hormone levels, the stress of a new baby, lack of sleep or a combination of things.  It’s important to know how to recognize the signs of the condition because moms with PPD will not get well without professional help.”

Katherine Stone Alliance

In an effort to reach and educate more men about PPD and what they can do; Boot Camp for New Dads is working with Katherine Stone, a nationally-recognized, award-winning advocate for women with perinatal mood and anxiety disorders, and author of postpartum progress. Boot Camp will be working with Stone in the development of a new section on the bcnd.org website that is dedicated to PPD, as well as collaborating with Postpartum Support International on their website.

Fatherhood Books Serve as a “Play by Play” Guides

Greg Bishop offers strategies from more than 200,000 new dads that have gone through the Boot Camp for New Dads program in both of his books, Crash Course for New Dads:  Tools, Checklists and Cheat Sheets and his first book, Hit the Ground Crawling, which covers work balance, being a dad, caring for a new mom and much more.  Both books are available online at www.DadsAdventure.com.

New Dads Learn What to Expect at Boot Camp Workshops

Dads-to-be will be better equipped to face the challenges and opportunities of fatherhood after attending a Boot Camp “hands on” educational workshop. Men attend the class when they are expecting their first baby, and are joined in the workshop by “veterans” who had previously attended and have returned with their two to four-month-old baby in tow.  They are able to give the dads-to-be a realistic idea of what to do and what to expect when their first baby comes.  For many men attending, it’s their first time holding a baby.

Boot Camp for New Dads        

Now celebrating their 19th year, Boot Camp for New Dads is nationally acclaimed as the “Best Practice” for preparing men to be fathers and has been named a U.S. Navy Model Program.  Boot Camp for New Dads has prepared more than 200,000 men for fatherhood over the years. 

With more than 4.1 million births (National Center for Health Statistics), and approximately 1.5 million men becoming new dads every year, it’s more important than ever for fathers to realize that being a “good provider” is only part of the very central role they have in their children’s lives. 

For more information about Boot Camp for New Dads, visit bcnd.org or to visit Dads Adventure, go to www.Dadsadventure.com.  To arrange an interview with Greg Bishop, please contact sdubin@prworkzone.com, (781) 582-1061.

The exact causes of postpartum depression are unknown,but rapid hormonal changes that accompany pregnancy and delivery may trigger depression. Levels of the hormones estrogen, progesterone, and cortisol fall dramatically within 48 hours after delivery. Women who go on to develop postpartum depression may be more sensitive to these hormonal changes. Postpartum depression (PPD) is a condition that describes a range of physical and emotional changes that many mothers can have after having a baby.

After Pregnancy

Depression after pregnancy is called postpartum depression or peripartum depression. After pregnancy, hormonal changes in a woman’s body may trigger symptoms of depression. During pregnancy, the amount of two female hormones, estrogen and progesterone, in a woman’s body increases greatly. In the first 24 hours after childbirth, the amount of these hormones rapidly drops back down to their normal non-pregnant levels. Researchers think the fast change in hormone levels may lead to depression, just as smaller changes in hormones can affect a woman’s moods before she gets her menstrual period.

Marital/Self-esteem Causes

Marital dissatisfaction is not only a risk factor but may also be a cause for PPD. Mothers who are closer to their spouses/partners are less likely to develop PPD. Some research shows that receiving a daily massage from their partner dramatically reduced the incidence of PPD for some mothers. So clearly a poor marital relationship can play a role in PPD, while a good marital relationship appears to reduce PPD symptoms.

Symptoms

If any of the following symptoms endure for more than two weeks after childbirth, women should seek medical attention:

Feelings of anxiety, guilt, sadness, worthlessness, restlessness or irritability

Sleep disturbances

Lack of interest in social or other activities you previously enjoyed

Lack of feeling or feelings of resentment, anger or fear about motherhood, your partner or your child

The symptoms can range from mild depression to a severe depression with thoughts of ending one’s life (suicide). The disorder should be suspected during its peak (four to six weeks after delivery) in a patient who demonstrates signs and symptoms of clinical depression (feelings of worthlessness and hopelessness, changes in eating and sleeping patterns, irritability, difficulty with motivation, and difficulty getting out of bed in the morning). Additionally, patients may be emotionally detached from the infant and unable to display loving affection towards family members.

Treatment

Psychotherapy for the woman and her family can be very helpful in enhancing coping skills, educating them on caring for a newborn, and providing support. SSRIs are secreted into breast milk, however, in varying amounts. Some studies indicate that paroxetine secretes the least amount of medication into breast milk. Breast-feeding women considering taking an antidepressant should discuss medication choices with their doctor. SSRIs can be given two to three weeks before delivery to patients who had a previous episode to avoid recurrence. Some SSRIs include: fluoxetine(Prozac), paroxetine (Paxil), sertraline(Zoloft), and citalopram(Celexa).

Medical Treatment

Treatment for postpartum depression depends on the form and how severe it is.

Your health care provider may refer you for psychological help and individual or group therapy.

Support groups are helpful.

Marriage counseling may be part of your treatment plan.

It’s important for friends and family to understand the illness so they can help.

Hyla Cass, M.D.

Postpartum depression (PPD) Postpartum Anxiety (PPA) have become a national epidemic in the United States, affecting 15%-20% of all new mothers, or about 600,000-800,000 women annually. (1) It is now estimated that over 30 million Americans are on antidepressant or anti-anxiety medications. (2) The majority of this 30 million are women who have one or more children. The chance of suffering from PPD increases with each successive child. (3)

The most common medical treatment for postpartum depression is SSRI (selective serotonin reuptake inhibitors) antidepressant drugs. Postpartum Anxiety Disorder is most commonly treated by the benzodiazepine family of drugs like Valium, Ativan, Xanax, and Klonopin. Combination reuptake inhibitors for both serotonin and norepinephrine (SNRIs) are also commonly used in postpartum depression. In the case of postpartum psychosis, antipsychotic drugs are used and are immediately necessary. Many women are now given samples of SSRIs as they are leaving the maternity ward. Most medical sources believe that PPD is caused by an imbalance of brain chemistry and that pharmaceutical intervention is the treatment of choice. While a certain percentage of women suffering from PPD do need pharmaceutical assistance, these are far fewer than are actually receiving them. Recent Meta-studies show this to be true.  While it is clear that some women with PPD do need and benefit from pharmaceutical intervention, it is our experience that an integrative approach yields the best results.

Postpartum Anxiety Disorder is mostly treated

The most common Postpartum Depression symptoms  include the following:

1. Persistent feelings of despair and/or anxiety;
2. Loss of energy and low levels of daily functioning;
3. Sleep and eating disturbances;
4. Inability to focus, concentrate or make decisions;
5. Feelings of worthlessness, shame and guilt;
6. Feelings of indifference and/or resentment towards the baby;
7. Intrusive negative thoughts and/or obsessive worries–in the most serious cases, this includes thoughts of harming oneself or the baby;
8. Reduced sex drive;
9. Loss of joy and appreciation for life;
10. Irritability or excessive anger.

The literature generally outlines several types of postpartum disorders that have special features beyond the typical symptoms of depression. These include:

1. Postpartum Anxiety Disorder (PPA). Here, the primary symptoms are excessive nervousness, hyper-vigilance, racing thoughts and in some cases outright panic. Panic attacks are especially frightening–sufferers often believe they are dying, as they experience shortness of breath, dizziness and a pounding chest.

2. Postpartum Obsessive-Compulsive Disorder. Most often, this takes the form of obsessive thoughts or worries about the baby and may be accompanied by compulsive behaviors such as constantly checking if the baby is breathing, constantly washing to protect the baby from germs, etc. The most disturbing type of obsessive thoughts are those in which the mother envisions harming her baby in some way. These thoughts are unwanted, intrusive and terrifying to the mother. It is important to emphasize that, except in extremely rare instance of psychosis (see below), these thoughts are not accompanied by any actions. Nonetheless, the mother may be so frightened by her own thoughts that she avoids the baby and consequently neglects her. It is terribly difficult for new mothers to acknowledge having such thoughts, and as a result, many suffer in isolation.

3. Post-traumatic Stress Disorder. PTSD can occur in response to a real or perceived traumatic childbirth or because of unresolved past trauma–sometimes sexual in nature–triggered during childbirth. A woman who experiences PTSD is likely to have recurring, memories, dreams or even flashbacks of the traumatic labor/birth. She will be hyper-vigilant and startle easily, and will likely suffer from sleeplessness, irritability, poor concentration and apathy. Women who have experienced a particularly traumatic childbirth often show symptoms of both PTSD and PPD.

4. Postpartum Psychosis. This is the most extreme and rarest of all postpartum disorders. When it occurs, the mother loses touch with reality and her symptoms may include extreme disorientation (e.g., not knowing who she is), delusional or paranoid thinking, and visual or auditory hallucinations. The few, tragic cases where mothers have harmed their children while in a psychotic state have received enormous media attention. As a result, many people inaccurately associate PPD with psychotic symptoms and dangerous behavior. This constitutes yet another reason why women fail to get help–they want to avoid being labeled with such a stigmatized disorder.

Article Premise: Fully Replenishing a New Mother’s Postpartum Nutritional Reserves Has Been Largely Ignored and Should  be An Integral Part of Treating Postpartum Depression.

Foundations of A Nutritional Approach to PPD
The human body is entirely formed from nutrients. Every muscle, organ, gland, bone, cell, and fluid is composed entirely of nutrients (environmental toxins notwithstanding). All of the neurotransmitters, hormones, biochemical structures, and metabolic pathways are formed from nutrients.

No other normal physiological process uses up and drains more vital nutrients from a postnatal woman’s body than the process of being pregnant, giving birth, and caring for a new infant which may include breastfeeding. The fact that a mother’s body donates all the nutrients required to form her baby’s body is too often overlooked when it comes to the medical treatment of PPD. Not only does the placenta literally rob the mother’s body of all the key nutrients required to make a baby’s body, but the placenta itself is formed from nutrients taken from the mother’s body. This is the main reason that many postpartum women become nutritional drained and this nutrient depletion syndrome can lead to postpartum depression and anxiety disorder.

Other factors that may contribute to a drain of a new mother’s nutrient reserves are loss of blood during the birth process, sleep deprivation, breastfeeding, returning to work too soon, and the immense extra energy required to take care of a new infant with intense needs. If a pregnant woman’s or new mother’s nutrient reserves are too low, she is much more vulnerable to experiencing PPD and PPA because all of the body’s normal metabolic processes are entirely dependent upon nutrients. The preponderance of extremely poor quality pharmaceutical prenatal vitamins significantly adds to the tendency of nutrient depletion.

Rarely is there is any mention that the body’s production of neurotransmitters is completely dependent upon their nutritional precursors. (4) Nor are the causes of these nutritional precursor deficiencies discussed. Additionally, the interdependent relationship between hormones and neurotransmitters is rarely taken into consideration by most physicians when considering treatment for PPD and PPA. The nutritional requirements of mitochondrial function, the importance of liver function from Western and Eastern perspectives, and some individual nutrients like Omega 3 fish oils, pharmaGABA, L-theanine, SAMe, inositol, magnesium, and the herb St. John’s Wort can also be of great assistance in treating PPD and PPA. These will be briefly discussed.

An integrative approach to treating PPD may include nutritional therapies, bio-identical hormone replacement, moderate exercise, a nutrient dense diet, proper rest, psychological counseling/support, stress reduction techniques, elimination of caffeine, alcohol and other addictive drugs, and if needed, pharmaceutical intervention.

Neurotransmitter Nutritional Precursors

Serotonin and Tryptophan

The amino acid L-Tryptophan is required for the body to produce serotonin. Ninety-five percent of the serotonin in the human body is produced in the intestinal tract. Approximately five percent is produced in the brain. The serotonin produced in the intestinal tract is unavailable to the brain because serotonin cannot pass through the blood- brain barrier. L-Tryptophan also does not easily pass through the blood-brain barrier and requires a carrier protein to ferry it into the brain. The consumption of simple sugars changes brain neuron cell membrane amino acid selectivity, allowing tryptophan to enter the brain more easily. Hence, the craving of sweets is often a sign of serotonin deficiency.

Serotonin has been referred to as the brain’s mood elevating and tranquilizing chemical. Inadequate serotonin levels are linked with depression, anxiety, insomnia, irritability, and weight gain. Serotonin mediated depression usually contains an element of anxiety. Serotonin is considered an inhibitory neurotransmitter. Its functions include:

- Inhibiting Glutamate excitability over diverse regions of the CNS
-Stimulating its own receptors on GABA neurons prompting GABA to perform its inhibitory function
- Inhibiting the release of the Catecholamines: Dopamine, Norepinephrine, and Epinephrine.

A comparison of the effects of optimal serotonin levels to low serotonin levels to reveals the following contrasts:

1) Hopeful/optimistic—————-Depressed
2) Calm—————————Anxious
3) Good-natured——————–Irritable
4) Patient————————–Impatient
5) Reflective/ thoughtful————–Impulsive/Reactive
6) Loving /Caring——————–Abusive
7) Able to concentrate—————-Short attention span
Creative/focused——————Blocked/scattered
9) Moderate carbohydrate intake——–Excessive carbohydrate intake
10) Good sleep and dream recall——–Insomnia and poor dream recall

Tryptophan is converted to its metabolite, 5- Hydroxy-Tryptophan (5-HTP) which is then converted to serotonin. Niacin, iron, and folic acid are required for L-Tryptophan to be converted into 5-HTP. The body also requires pyridoxal-5-phosphate along with 5-HTP in order to produce serotonin. Magnesium and riboflavin (B2) are required for the conversion of pyridoxine (B6) into pyridoxal-5-phosphate. Deficiencies in any of these nutrients can limit the production of serotonin. Numerous double-blind studies have shown 5-HTP to be as effective as antidepressant drugs with fewer and milder side effects and most times better tolerated. (5-11)

From Martin Hintz, M.D. –Neuro Research

 A number of significant factors contribute to low L-Tryptophan levels in many people, especially postpartum women whose bodies are providing the proteins needed to form another human body, these include excessive levels of cortisol, epinephrine, norepinephrine, and dopamine. The ratio of L-tryptophan to other amino acids available in most foods is quite low.

An overabundance of the adrenal gland hormone cortisol (a very common occurrence in stressful psychological and physiologic states) adversely affects serotonin production and sensitivity in four different ways:

1. Excess cortisol significantly decreases the number of serotonin (5-HT1A) receptor sites. (12)
2. Excess cortisol suppresses serotonin receptors. (13, 14)
3. Excess cortisol increases serotonin reuptake. (15)
4. Excess cortisol, causes tryptophan oxygenase (TO) to metabolize tryptophan into kynurenine, leaving less tryptophan to become serotonin. (15,16)

If cortisol levels are too low in the amygdala, serotonin no longer has an Inhibitory effect on Glutamatergic activity, suggesting that cortisol plays a key role in maintaining Serotonergic-mediated modulation. (16,17) This may be another factor involving insomnia in PPD.

Added to the reasons that serotonin deficiencies are growing more common and contributing to PPD is a stress-related overabundance of the catecholamines. Epinephrine, norepinephrine, and dopamine also deplete serotonin because the inhibitory monoamine neurotransmitter serotonin is supposed to balance these three excitatory monoamine neurotransmitters. The more stress a person experiences, the more the body increases the production of the catecholamines in an attempt to respond to this stress. This requires a postpartum body to produce even more serotonin – though deficiencies in nutrient precursors may interfere with its production.

The use of 5-HTP as a nutritional precursor to serotonin has significant advantages over tryptophan. 5-HTP easily passes directly through the blood-brain barrier without the need for a carrier protein, allowing for an easier conversion into serotonin in the brain. Sublingual forms of 5-HTP work more quickly. Dosage varies from 25 mg per day to 300 mg per day or more.

A deficiency of vitamin B6 (pyridoxine), which is required for serotonin synthesis, is often found in premenopausal female patients with depression. (18) Replacing B6 in cases of deficiency is an important aspect of PPD treatment that may enhance serotonin production in the brain. (19) The use of the vitamin B6 metabolite, pyridoxal-5-phosphate, instead of B6 is suggested especially when magnesium and/or riboflavin deficiencies are suspected or confirmed. There is some controversy whether it is best to supplement 5-HTP and pyridoxal-5-phosphate together or take them separately, adhering to a two-hour wait period. Our clinical experience indicates that it fine to supplement them together. Many products including a combination of 5-HTP and P-5-P are available.

Some controversy exists regarding the simultaneous use of SSRIs and serotonin nutritional precursors. The pharmaceutical companies seem adamant about avoiding this and often mention the possibility of Serotonin Syndrome, a dangerous condition generally brought about by combining serotonin enhancing medications, especially MAO inhibitors, with medications, herbs, or nutritional precursors that also enhance serotonin activity. Symptoms of serotonin syndrome may include nausea, headache, agitation, diaphoresis, hypertension, tachycardia, and hyperthermia that can go over 104 F. This appears a remote possibility at best when just using 5-HTP or using 5-HTP in combination with one SSRI medication. (20)

SSRIs appear to not only keep serotonin in the neuron synapses longer by inhibiting reuptake, but also by pulling the nutritional precursors for serotonin from the storage vesicles and reuptake ports. In fact, in our clinical experience, many women with PPD do better when taking 5-HTP and P-5-P along with their SSRIs than taking SSRIs alone. Serotonin precursor deficiencies may be the reason that SSRIs don’t work for some, work and then stop working for others, and why it is not unusual for a woman with PPD to have been prescribed two or more different SSRIs over time. The SSRIs do not give a net increase of serotonin so they need enough available serotonin in order to have enough to re-uptake.

Dr. Dean Raffelock- catacholamine chart

The catecholamines are predominantly energizing and mood elevating when produced at appropriate levels. Synthesis of the catecholamines occurs in the CNS, adrenal medulla, and peripheral sympathetic neurons. Norepinephrine and dopamine act primarily as neurotransmitters in the CNS. Epinephrine acts primarily as an adrenal hormone to mobilize energy.

The catecholamines influence most organ systems. When levels are excessive they are catabolic and can lead to the body metabolizing its own nerve, muscle and bone tissue. Low levels can lead to depression, fatigue, and weight gain.

Dopamine: Dopamine is the catecholamine precursor for norepinephrine and is found both in the CNS and adrenal medulla. Its functions include motor function and posture, cognitive function (attention, focus, working memory and problem solving), and pleasure sensations. Dopamine can act either as an inhibitory or excitatory neurotransmitter in response to incoming afferent signals.

Norepinephrine (noradrenaline): CNS norepinephrine mediates mood regulation, drive, ambition, learning and memory, alertness, arousal and focus. Clinically, there is often an inverse relationship between norepinephrine (excitatory) and serotonin (inhibitory). When serotonin is low, norephinephrine may be over-upregulated, resulting in “fight or flight” responses leading to anxiety and/or panic attacks. Over-expression of CNS norepinephrine is clinically associated with anxiety, aggression, irritability, mania or bipolar disease, immune suppression, and hypertension; low norepinephrine is associated with atypical depression, with symptoms of fatigue, hypersomnia, hyperphagia, lethargy and apathy.
(21,22)

Epinephrine (adrenaline): Epinephrine synthesis is dependent upon norepinephrine being converted into epinephrine by methylation.
Hans Selye (1974) described the three phase s of the “General Adaptation Syndrome” to stress (23):

Phase I: Alarm reaction: high epinephrine/high cortisol

Phase II: Resistance: high cortisol/low DHEA, variable epinephrine

Phase III: Exhaustion: depletion of cortisol, epinephrine and DHEA
Adrenal exhaustion is a major factor in depression related to chronic or severe stress.

A woman suffering from PPD should be closely questioned about her symptoms; SSRIs are routinely given to women who have functional hypoadrenia involving the adrenal cortex and/or medulla, or low thyroid function (discussed below). Low glucocorticoid and/or catecholamine levels can cause the symptoms of fatigue, malaise, and depression. (24,25)

Many women with PPD require pharmaceuticals and/or nutriceuticals that address deficiencies in both serotonin and the catecholamines. Nutritional therapies for catecholamine balance include:

§ DL-phenylalanine and L-tyrosine, the amino acid precursors for epinephrine, norepinephrine, and dopamine. DL-phenylalanine also helps to increase endorphins, which are mood-elevating. Many PP women diagnosed with bipolar disorder will respond well to high dose DL-phenylalanine therapy (26), along with serotonin precursors and high-dose (6 grams per day) omega-3 fatty acids in the form of fish oils. (27)

§ L-cysteine, sulfur, iron, and folate, required for conversion of L-tyrosine into L-dopa.

§ Pyridoxal-5-phosphate, required for the conversion of L-dopa into dopamine. Copper and vitamin C are required to convert dopamine into norepinephrine. Pridoxal-5-phosphate, B12, and folic acid are required to convert norepinephrine into epinephrine.

Gamma-Aminobutyric Acid (GABA)

GABA is the most important and widespread inhibitory neurotransmitter in the brain. Low levels of GABA are particularly important to look for when anxiety and insomnia are included in the symptom display of PPD/PPA. GABA is essential for balancing excitatory neurotransmitters and hormones such as cortisol, epinephrine, norepinephrine, and glutamate. Too much excitation without adequate GABA inhibition can lead to: (28)

- Insomnia
- Restlessness
- Irritability
- Anxiety
- Panic Attacks
- Seizures

GABA’s job clinically is to induce relaxation, calmness and aid sleep. Where there are glutamate receptors (powerful excitatory neurons), there will be GABA receptors nearby. GABA allows only the most important excitatory signals to pass by and dampens or quenches extraneous excitatory signals when GABA levels are adequate.

Benzodiazapines (Valium, Klonopin, Zanax, Ativan, etc.) and sleep pharmaceuticals like Ambien and Sonata work on GABA receptors, as does moderate alcohol consumption. L-theanine, lactium (milk peptides), L- glutamine, taurine, and bio-identical progesterone can act as nutraceutical/hormonal GABA agonists. The drug Gabatril is a GABA re-uptake inhibitor as is Valerian extract. A newer nutriceutical product called pharmaGABA seems to yield more effective results than synthetic GABA.

From a Chinese Medicine perspective, serotonin and GABA would be Yin (relaxing, harmonizing, cooling, nurturing, moisturizing, inhibitory) and the catecholamines would be Yang (energizing, mobilizing, warming, excitatory, drying). From both Eastern and Western perspectives, it is important to balance these opposing groups of brain chemicals to obtain balance. A woman with PPD who now has more energy but can’t sleep is just as unhappy as a woman who now can sleep but who is even more lethargic than before treatment.

Balancing neurotransmitters is key. Balancing neurotransmitters and hormones is clinically even more effective.

Hormone-Neurotransmitter Interactions

The relationship between neurotransmitters and hormones in PPD is often overlooked. Neurotransmitters and neuropeptides are required in order to mediate hypothalamic production of releasing hormones, enabling the pituitary gland to properly conduct the hormonal orchestra. The hypothalamus is considered a key part of the mid-brain, the “emotional brain,” so there is little wonder why imbalances in neurotransmitters and hormones can adversely affect emotional states.

Thyroid hormones. The catecholamines and thyroid hormones are closely related in many of their functions. L-tyrosine, along with iodine, is the precursor for thyroglobulin and thyroid hormones T-3 and T-4. A depression with no anxiety, with the predominant symptoms of exhaustion and difficulty stringing multiple positive thoughts together, is most often associated with low adrenal (29) and/or thyroid function (30-32) and generally doesn’t respond well to SSRIs or serotonin nutritional precursor therapy.

It is well known that low thyroid function can cause physiologic depression and fatigue. Giving T3 induces a rise in serotonin, and in animals with hypothyroidism, serotonin synthesis is reduced. (33) T3 appears to desensitize presynaptic Serotonin autoreceptors. (34) Conversely, the diurnal peak of TSH, observed during the physiological circadian rhythm, is serotoninergic dependent. (35)

Thyroid function and serotonin function are interdependent both clinically and bio-chemically. Optimal thyroid function is dependent on optimal serotonin levels. Optimal serotonin balance is dependent on optimal thyroid function. TSH increase is dependent on adequate serotonin stimulation of hypothalamic TRH, allowing TSH to rise. (36) Suppressed TSH currently may more appropriately represent low serotonin states than any real assessment of true thyroid function. The thyroid hormone triiodothyronine (T3) augments and accelerates the effects of antidepressant drugs. Fluoxetine + T3 are better at desensitizing 5-HT hypothalamic autoreceptors than either alone. (37-39)

Estrogen: A growing body of evidence points to estrogen’s importance in serotonergic function. (40) Estrogen inhibits serotonin reuptake. (41,42) Estrogen treatment is shown to selectively enhance serotonin (5-HT1A-mediated) responses in the hippocampus (43,44) Estrogen increased the firing activity of 5-HT (serotonin) neurons in both male and female rats. (45,46) In short, estrogen appears to be nature’s SSRI.

Presently, there is a great deal of controversy regarding estrogen HRT. The HERS study and WHI studies have stirred the controversy without making the important distinction between bio-identical and pharmaceutically altered estrogens; neither is any distinction made between progesterone and progestins. The clinician is encouraged to become very well versed in this area regarding risks versus benefits of HRT. Many women with PPD can benefit from low-dose bio-identical estrogen HRT if indicated and potential benefits outweigh risks.

Progesterone: Bio-identical progesterone has a known anti-depressant/anti-anxiety effect. Throughout pregnancy, the placenta produces copious amounts of progesterone, increasing blood levels to many times pre-pregnancy levels. Post-partum, this supply is suddenly gone, along with its soothing effects on the mother’s nervous system.
Allopregnanolone is synthesized by the reduction of progesterone via the enzymes 5-reductase and 3-hydroxysteroid dehydrogenase (3-HSD). Allopregnanolone is one of the most potent known modulators of GABA receptors. (47,48) Allopregnanolone has behavioral and biochemical characteristics similar to ethanol, barbiturates, and benzodiazepines. (49,50)

Bio-identical progesterone can be very helpful for women with PPD with anxiety and insomnia. Using the  PharmaGABA and bio-identical progesterone simultaneously is often very helpful to relieve anxiety and sleep issues.

DHEA: DHEA increases the firing activity of serotonin neurons. (51) DHEA also increases dopamine and norepinephrine synthesis via mRNA for tyrosine hydroxylase. (52) Because of this, DHEA can be helpful in some forms of PPD. DHEA also inhibits GABA and is therefore a GABA antagonist. (53) Clinically, if the use of DHEA causes insomnia and irritability, most likely the patient is GABA deficient and this should be addressed before continuing to supplement DHEA.

Testosterone: increases serotonergic neuron firing in the raphe area, increasing mood. (54)

Mitochondrial Function

from Metametrix Lab- Ion Panel Booklet

Inefficient mitochondrial function can limit ATP production, lower energy and contribute to or cause physiological depression. More than 90% of all cellular oxygen consumption is used to fuel mitochondrial metabolism. Mitochondria must transfer huge numbers of electrons to produce energy. Mitochondrial dysfunction can affect all organ systems, including neurons and glands.

Dietary fats, carbohydrates , and proteins all need to be converted into acetyl-coenzyme A (acetyl CoA) before entering the Krebs cycle and electron transport chain. The nutritional precursors required for fatty acids, glycerol, and cholesterol to enter the Krebs cycle and generate ATP are riboflavin (B2), L-carnitine, niacin, and biotin. Thiamin (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), biotin, and alpha-lipoic acid are required for carbohydrates and proteins to enter the Krebs cycle in the mitochondria.

Within the Krebs cycle, cysteine and iron are needed to convert cis-aconitate to isocitrate. Niacin, magnesium, and manganese are required to convert isocitrate into alpha-ketoglutarate. The amino acids glutamine, histidine, arginine, proline and glycine are needed to form alpha-ketoglutarate. Thiamin, riboflavin, niacin, pantothenic acid, and alpha lipoic acid, are needed to convert alpha-ketoglutarate into succinyl-CoA. The amino acids isoleucine, valine, and methionine are needed to form succinyl-CoA. Magnesium is required to convert succinyl-CoA into succinate. Riboflavin is required to convert succinate into fumarate. The amino acids tyrosine and phenylalanine are needed to form fumarate. Niacin is required to convert malate into oxaloacetate.

All these nutrients are required to produce 36 units of ATP per molecule of acetyl CoA in the Krebs cycle. A significant deficiency of any of these key nutrients can cause mitochondrial dysfunction and contribute to fatigue and depression.

Niacin and coenzyme Q10 are required for oxidative phosphorylation (electron transport chain, or ETC). Normally, the ETC produces another 3 units of ATP in the mitochondria in addition to the Krebs cycle’s 36. A significant deficiency in either of these can also reduce ATP production and contribute to a physiologic depression.

Mitochondrial dysfunction is often overlooked in the treatment of PPD. A study done with postpartum women showed that a comprehensive postnatal nutrient program, including many of the Krebs cycle/oxidative phosphorylation nutrients, relieved many postpartum symptoms including mild to moderate PPD.

Liver Detoxification

NUTRITION: A FUNCTIONAL APPROACH-Jeffrey Bland, Ph.D

For many centuries, Chinese medicine has correlated liver meridian dysfunction with anger, irritability, and depression. From this perspective, suppressed anger often leads to depression. Concepts such as rising liver heat and stagnant liver Qi are used to depict how faulty liver meridian function could dramatically affect emotional states. When the flow of electrons within a meridian is up or down-regulated, the organ dependant upon that meridian will become dis-eased. Many practitioners of Chinese medicine are taught to consider the liver the “seat of the emotional body” because of this strong correlation of liver dysfunction with negative emotions.

In the Orient the term “hot liver” is used to depict someone who has anger issues. The English use the “liverish” to describe one who is irritable. From a Western medicine point of view, most clinicians are aware how an alcoholic’s liver cirrhosis can first cause irritability and eventually depression.

In the past two decades much more information has come to light regarding phase one and phase two liver detoxification pathways. These pathways greatly contribute to the body’s ability to excrete exogenous and endogenous toxic chemicals. Environmental toxin levels (xenobiotics) are ever on the rise and require that the liver play a very important role in their excretion.

Added to this burden of detoxification are the internal production of increased stress hormones and other body chemicals that require excretion. All of these chemicals require that the liver have adequate nutrients to facilitate their excretion.

Phase one liver detoxification consists of oxidation, reduction, or hydrolysis. The cytochrome P450 system mixed function oxidases perform the most important beginning function of detoxifying these exogenous and endogenous toxins. Phase I liver detoxification requires an adequate supply of nutrients, enzymes, and antioxidants. This list includes riboflavin, niacin, pyridoxine, folic acid, cobalamin, glutathione, phospholipids, carotenes, vitamin C, bioflavonoids, flavonoids, vitamin E, selenium, copper, zinc, manganese, CoQ10, and nutrients contained in thiols, pycnogenol, and silymarin.

Phase II liver detoxification consists of conjugation pathways in the hepatocytes. Amino acid conjugation (binding) of toxins requires glycine, taurine, glutamine, ornithine, and arginine. Sulfation requires sulfur-bearing amino acids or elemental sulfur. Sulfation is required to break down and package estrogens, DHEA, thyroxine, cortisol, catecholamines, melatonin, ethyl alcohol, bile acids, tyramine, cholecystekinin, cerebrosides and others. Glucuronidation requires magnesium and B6 to break down estrogens, other steroids, melatonin, and many xenobiotics.

Methylation requires B12, B6, and folic acid to break down and eliminate catecholamines, histamine, and many drugs and xenobiotics. Glutathione conjugation helps to detoxify heavy metals and numerous xenobiotics. Glutathione requires glutamate, glycine, and cysteine or N-acetyl-cysteine plus selenium and vitamin C for its formation. Acetylation, another detoxification pathway, requires B2, B5, molybdenum, and vitamin C in order to do its function.Sulfoxidation transforms toxic sulfite molecules into usable sulfates.

Mothers in the U.S have a high toxic burden that is evidenced by the levels of toxins in mother’s milk. (55) If the liver is too burdened and unable to perform its many tasks of detoxification, this may contribute to PPD.

Omega-3 Fatty Acid Deficiencies and PPD

A deficiency of omega-3 fatty acids has been linked with depression. (56-59) Numerous studies have demonstrated the efficacy of fish oil supplementation in depression. (60,61)

The human brain is 60% fat. The quality of fats that compose neurons significantly influence brain function including moods. A relative deficiency of flexible omega-3 fatty acids compared to the more rigid omega-6, saturated, and cis-trans fatty acids impairs the function of cell membranes and their ability to selectively allow passage of molecules in and out of neurons. The brain is composed of and uses more fatty acids than any other body structure. DHA – referred to by Allport as the “queen of fats” (62) – is responsible for the fastest cellular movements. As the primary structural and cognitive fat of the brain, DHA also affects moods.

A developing fetus’ brain, nerves, eyes, skin, and cellular membranes all require omega-3 oils, especially DHA. The placenta selectively removes omega-3 oils from the mother’s blood stream via the placenta often leaving the mother significantly deficient in these essential oils. (63,64). The recommended dose for omega-3 fish oils when treating PPD is 6-12 grams per day.

Hypericum perforatum (St. John’s Wort):

Over twenty-five double-blind studies have shown the herb St. John’s Wort to produce as good or better results compared to SSRI drugs with significantly fewer side effects. (65-71) In Germany, where hypericum is a prescription drug and covered by insurance, over 20,000,000 take this herb for depression. One of the benefits of taking St. John’s Wort is an increase of serotonin. (72)

SAMe (S-adenosylmethione):

SAMe is a methyl donor in the production of monamines, neurotransmitters, and phospholipids such as phosphatidylserine and phosphatidylcholine. SAMe serves as a precursor for glutathione, coenzyme A, cysteine, taurine, and other essential compounds. SAMe is involved in converting methionine into sulfur and is important in homocysteine metabolism.

When compared with other antidepressants, SAMe tend to work faster and more effectively with virtually no negative side effects. In fact, SAMe has beneficial side effects including improved cognition, slowing of the aging process, improved joint function and less pain, and liver protection. (73)

Normally the brain synthesizes adequate SAMe from the amino acid methionine. Supplementing SAMe in depressed patients increases serotonin and dopamine levels, improves membrane fluidity, and improves the binding of neurotransmitters to receptor sites (74,75). Numerous double-blind studies demonstrate the efficacy of SAMe for depression. (76-78) The suggested dose of SAMe to treat depression ranges from 400-1600 mg a day.

Inositol

Depressed patients have lower brain levels of inositol. (79) Inositol is useful in maintaining healthy serotonin metabolism, and by doing so helps treat many conditions like depression, agoraphobia, panic disorder (80-82), and obsessive compulsive disorder (83).
Research shows that taking 6-12 grams of inositol per day for 4 weeks significantly improves mood and reduces the severity of depression. (84-86) Inositol can be safely used with antidepressant medications. (87)

L-Theanine

L-theanine is known to increase levels of GABA and has an anti-anxiety effect as well as improving cognitive function. (88) L-theanine may also normalize dopamine levels which are often depleted by various stresses. (89) L-theanine significantly reverses glutamate-induced toxicity. (90)

Integrating High Quality, High Potency Prenatal and Postnatal Nutrient Systems into Preventing and Treating Postpartum Depression and Anxiety 

Clinically it is imperative that higher quality, higher potency, more comprehensive prenatal an postnatal nutrient systems be utilized in the treatment and prevention of postpartum depression. It is common knowledge in many 3rd world countries that the postpartum recovery period is 24 months because this is the amount of time women are told to wait between pregnancies to replenish their bodies and avoid many postnatal health problems. These women have more community and extended family support too which significantly reduces the incidence of PPD.

Most prenatal vitamin supplements are inadequate to fully supply developing baby and mother with the potency and quality of nutrients required to fuel pregnancy and the postpartum periods. These are highly nutrient dependent process.
A randomized, double-blind, placebo-controlled clinical trial done on a comprehensive postnatal nutrient program called After Baby Boost showed excellent results, improving 14 common postpartum symptoms including postpartum depression, anxiety, insomnia and mood swings. Parameters measured were breast tenderness, concentration, cramping, depression, dizziness, fatigue, headaches, insomnia, irritability, joint inflammation and pain, mood swings, nervousness, palpitations, sweating, temperature changes (hot or cold), vaginal dryness, and water retention.

After Baby Boost contains high-potency vitamins and minerals including CoQ10, alpha lipoic acid, 2 grams of fish oils with 3 antioxidants to prevent rancidity, and nighttime minerals (calcium and magnesium citrate). The placebo used was a leading prenatal vitamin.

After Baby Boost significantly outperformed the prenatal vitamin in all 14 symptom categories, indicating that most postpartum women require more comprehensive, higher potency nutrient replenishment than prenatal vitamins provide. (91)

Obstetricians rarely stress the importance of a high-quality, nutrient dense diet. Nor do they prescribe high quality prenatal vitamins.  Women are often told, “you are eating for two now, so eat whatever you want.” In actuality, only 300 extra calories are needed per day during pregnancy. It is important that these be nutrient-dense calories. Unrestricted eating of carbohydrates contributes to obesity and can contribute to metabolic diseases including physiologic depression and even, diabetes of pregnancy.

Integrative PPD Treatment

It is hoped that the reader becomes more aware of this simple concept: A baby’s body is entirely composed of the nutrients donated by its mother’s body. Because all physiologic processes and chemicals (neurotransmitters, hormones, metabolic pathways, etc.) are nutrient dependent, nutritional deficiencies can often be the fundamental cause of PPD. While antidepressant drugs are necessary for some, the longer-term solution often requires a well-thought-out integrative approach that includes (1) replenishing nutritional reserves through dietary supplements,(2) psychotherapy and/or  childbirth/PTSD therapies such as EMDR, (3)adequate sleep (often very difficult with a new infant), (4) moderate exercise, (5) deep belly breathing/meditation, (6) community support, (6) a nutrient dense diet, and (7) drug therapy when necessary

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It is estimated that 80 percent of all women experience some form of postpartum depression after giving birth. It does not usually kick in until at least three days after giving birth and can last for a few short weeks or up to six months. It is normal to experience some weepiness, tiredness, restlessness and a general feeling of grouchiness during the weeks following birth. Mild female depression does not interfere with the mother’s ability to care for the newborn child.

The feelings may kind of sneak up on the postpartum woman. At the hospital, the nurses and doctors are there to help out and the high of just giving birth keeps a woman going strong. When the woman and her new baby go home it can be overwhelming and the first signs of depression may start up. The new mother may not recognize the signs for what they are and write them off as hormones or attribute the feelings to exhaustion.

It is important every new mother knows that feeling a little overwhelmed is normal. Depression after pregnancy is also normal to an extent. Hormones are fluctuating all over the place trying to get back in line after giving birth. There is a lot of responsibility and if the woman does not have the support of her loved ones or the child’s father it can be very tough to cope with.

If a woman experiences pregnancy depression a doctor will monitor her closely for several months after giving birth. The depression may dissipate after giving birth or may continue to fester and become dangerous to mother and baby. Pregnancy depression is common for those who are carrying an unwanted pregnancy or have experienced some traumatic event during the pregnancy.

Female depression problems are more prevalent in those who have a substance abuse problem. Addictions are commonly related to unresolved depression issues. It is important for a woman to seek treatment for the depression in order to successfully kick any addictions she may have.

Women who have experienced depression before will most likely need to remain under the care of their physician for several months to monitor the depression. Postpartum depression does go away eventually, and it can be treated with prescription drugs. The medicines are safe to use while the new mother is breast feeding. A history of female depression in the family increases the risk of postpartum depression as well.

It is important for women to ask for help when they need it. Postpartum depression is nothing to be ashamed of. Hospitals and doctors are talking to the partner’s more about what signs they should be watching for in their loved one who has just given birth. This is very helpful to the new mom because she really may not be able to comprehend the feelings are not normal. A partner should be as supportive as possible and keep in mind that this will pass with a little patience.

Nice Ocean Beach Waves for Relieving Maternal Postpartum Depression, Anxiety