A few days after giving birth, 50-85 percent of women (depending on your source) suffer from various degrees of postpartum depression (PPD). The symptoms include one or more of the following: crying, impatience, insomnia, impatience, irritability, loneliness, mood swings, restlessness and sadness.
Delivery, Depression and Advice
Doctors and scientists have known that following delivery, women have huge drops in estrogen levels. Feeling emotional after significant hormonal fluctuations was to be expected. Unflattering physical changes, the reduction of intimacy with their partners, and concern for their infants further increases the odds of having down days and blue moods. The basic advice for mild PPD, aka "the baby blues," was to eat a healthy diet, get enough sleep, exercise regularly and join some type of support group. Many considered it a psychosocial condition.
The Monoamine Connection
Monoamines are neurotransmitters derived in part from the amino acids tryptophan and tyrosine. Monoamine oxidase (MAO) is an enzyme found on the periphery of the mitochondria that breaks down monoamines. There are two subtypes of MAO - A and B.
In a PET scan study, researchers compared the brains of 17 normal and 17 depressed volunteers.1 Using specific biomarkers given prior to scanning, the scientists were able to measure MAO-A levels in the brain. They found that those with depression had 34 percent more MAO-A than their non-depressed counterparts. Furthermore, the elevations were present in all brain structures.
The results prompted another experiment that compared 15 women who were four to six days postpartum with 15 controls.2 MAO-A levels were again measured by PET scans following the infusion of the same radiotracer employed previously. The data showed postpartum women had 43 percent more MAO-A than the controls.
Linking Depression With Giving Birth
The two studies above showed that depressed people and new mothers both have an elevation of the same enzyme that breaks down monoamines. Two of the monoamines targeted by MAO-A are serotonin and melatonin. Lower levels of serotonin can cause or amplify depression. Melatonin reductions decrease the quality of sleep - and there's no secret how a poor night's sleep affects our state of mind, patience, mood and emotions. The identification of this neurobiological link proved the purely psychosocial model of PPD was incorrect. The authors hoped their findings would help develop therapeutic interventions "compatible with breast-feeding." Reading between the lines, this implies a preference for solutions based on nutritional rather than controlled substances.
Clinical Management
There are two potential ways to manage the postpartum depression problem - increase monoamine levels or reduce MAO-A levels. The authors stated that monoamine precursors in the form of nutritional supplements are a promising area of future study and even suggested tryptophan and tyrosine as potential therapeutic agents. I expect nutritional supplements (such as resveratrol) that inhibit MAO-A will also be studied.
That said, although it may be tempting for clinicians to recommend products with tryptophan, tyrosine or resveratrol to women who have just given birth, current recommendations are to avoid all three until there is evidence supporting their safety.3 Thankfully, there is an equal absence of evidence suggesting they are harmful during nursing.
In the meantime, while we err on the side of caution regarding supplemental forms of these nutrients, we can make dietary recommendations. Foods high in tryptophan include fish, beef, pork, lamb, poultry, eggs and soy products (protein, flour, tofu and beans). The best sources of tyrosine are soy products, eggs and peanuts. Foods rich in resveratrol include purple grape juice, purple and red grapes, peanuts and peanut butter. Finally, in case you're wondering, red wine is high in resveratrol - but the current limit of one to two glasses a week (not a day) during nursing will not provide enough resveratrol.
So, while we wait for research on supplements to help postpartum symptoms, advising women to have five servings a day of tryptophan-, tyrosine- and resveratrol-rich foods for (at least) two weeks after giving birth may help control their unwanted biochemical roller-coaster rides.
References
- Meyer JH, Ginovart N, Boovariwala A, et al. Elevated monamine oxidase A levels in the brain: an explanation for the monoamine imbalance of major depression. Arch Gen Psychiatry, Nov 2006;63(11):1209-16.
- Sacher J, Wilson AA, Houle S, et al. Elevated brain monoamine oxidase a binding in the early postpartum period. Arch Gen Psychiatry, May 2010;67(5):468-74.
- Hendler SS, Rorvik D, eds. PDR for Nutritional Supplements (2nd Edition). Montvale: PDR Network, 2008;373,378,545.
Click here for previous articles by G. Douglas Andersen, DC, DACBSP, CCN.