Postnatal Depression: The Causes

Joe Bingley Joanne - or Joe - Bingley was a nurse with 20 years experience. She longed for a child and had experienced problems with conceiving, and had at least two known miscarriages. She had also been turned down for both IVF and adoption because she was overweight.

So she was overjoyed to eventually gave birth to a daughter, Emily Jane, in February 2010. However, efforts to breastfeed were not successful and Emily was losing weight. So Joe began to bottle-feed and her daughter started to thrive, but this perceived failure appears to have been the trigger for a severe bout of postnatal depression.

Joe was only sleeping a couple of hours a night, had a 'glazed' look, and expressed the belief that she was a bad mother and that Emily would be better off without her. She repeatedly requested help and felt that her pleas were not being taken seriously. And then, 10 weeks after Emily was born she announced early one morning to her sleepy husband, Chris, that she was going out for a walk and proceeded to throw herself under a train.

An independent report based upon the evidence available concluded that she should have been hospitalised at least 3 days prior to her death and that if this had been done she would probably have made a full recovery.

Her widowed husband, Chris, is now focusing on publicising this issue and de-stigmatising postnatal depression.

So what IS postnatal depression?

Symptoms of postnatal depression

Up to 80% of women suffer with some form of postnatal 'baby blues' with symptoms such as tearfulness, irritability, sleeplessness, headaches, difficulty concentrating, and feelings of isolation - all of which may last for a few days. However, this is not the same as postnatal depression or postpartum depression (PPD), nor is it a precursor to the more serious postnatal psychosis.

According to the MIND report (2006) one in six women are known to be affected by postnatal depression either during pregnancy or following childbirth. Symptoms of PPD can occur anytime in the first year after giving birth and include, but are not limited to, the following:

Feeling low, despondent, and hopeless
Feeling overwhelmed, unable to cope or inadequate
Disrupted sleep patterns including insomnia or sleeping all the time
Loss of appetite – or feeling hungry but not being able to eat
Low or no energy or exhaustion
Feeling empty and lacking pleasure in activities that would normally be enjoyable
Withdrawing socially and having little interest in the outside world
Impaired motor skills such as speaking and writing
Difficulty in concentrating or making decisions
Physical symptoms such as stomach and chest pains, headaches and blurred vision
Feeling anxious or getting panic attacks
Feeling guilty about being a bad mother
Being irritable and hostile towards others
Feeling sad and tearful, crying easily or without reason, and being unable to be comforted
Feeling hostility towards - or a lack of interest in - the baby
Obsessive fears about the baby’s health and/or wellbeing and
Thoughts about death, self-harm, suicide or harming the baby.

Curiously, a small but significant proportion of men also suffer postnatal depression. Men have been shown to experience a drop of a third in their testosterone levels when they become fathers. This is thought to reduce the aggression the man feels and to increase their frustration tolerance in order to protect the baby while they are very vulnerable.

Several factors have been shown to make postnatal depression more likely including:

Being a single parent, being in a poor relationship or the pregnancy being unplanned or unwanted
A previous history of depression, or depression related to a pregnancy
Low socioeconomic status. Women in the lowest income brackets are more than twice as likely to get postnatal depression as those in the highest.
Bottle rather than breast-feeding
Being a smoker
Having low self-esteem
Stresses relating to a lack of social support or childcare
Anxiety and stress relating to life or the pregnancy
Problems with the baby's temperament or health including colic
Being lesbian, bisexual or of African origin.

Furthermore, some of these factors have been shown to be additive.

Postpartum psychosis is less common than postnatal depression and involves a complete break with reality involving thought disturbances, delusions, hallucinations and/or disorganised speech and/or behaviour. Whereas postnatal depression will eventually spontaneously resolve, postpartum psychosis will not and needs intervention.

Given that this problem afflicts one in every six women, many public figures have spoken openly about their experience of postnatal depression as shown below.

Famous postnatal depression sufferers

The medical approach to postnatal depression

Allopathic medicine defines postnatal depression as a psychological or psychiatric problem and treats the symptoms with antidepressant drugs and/or psychotherapy.

This approach is based upon the theory that depression is caused by a deficiency of neurotransmitters and specifically serotonin (the 'feel good' hormone) and noradrenaline (norepinephrine). These neurotransmitters are fundamental to health because they transmit nerve impulses throughout the nervous system, and have a profound effect on mood and self-esteem, in addition to having many other important functions within the body.

In truth, medicine and psychiatry have no idea what mental illness is and they have created an artificial division between the mind (which is assumed to be the brain) and the body. Whereas natural medicine regards depression as a symptom of an underlying disorder and considers that there may be many different causes which are currently all being lumped together under the same heading and treated in a one-size-fits-all way. Whatever the cause, allopathic medicine probably only alleviates the symptom until such time as the body can right itself.

Below are listed just some of the possible causes for postnatal depression.

Serotonin deficiency and PPD

Serotonin is a neurotransmitter produced in the brain that is often referred to as the 'feel good' hormone. In order to synthesise serotonin the brain needs a steady supply of the amino acid tryptophan and vitamin B6.

Most protein foods contain a very small percentage of tryptophan when compared with other amino acids added to which only about 3 percent of the tryptophan consumed is actually converted into serotonin in the brain.

Serotonin is the end result of a series of biochemical steps which convert the tryptophan in the diet into 5 hydroxy-tryptophan (5HTP) and on to serotonin. Each of these steps requires specific nutrients.

Iron and vitamin B3 (niacin) are required to convert tryptophan into 5HTP along with sufficient other B vitamins and magnesium (which is required to convert vitamin B6 into its active form pyridoxyl-5-phosphate or P5P). Without enough 5HTP and P5P available in the brain, serotonin cannot be synthesised at adequate levels.

The adrenal stress hormone cortisol, also causes tryptophan to be converted into kynurenine rather than serotonin. In addition, drinking coffee, smoking, drinking alcohol, and eating chocolate, all promote the release of cortisol and may reduce the amount of serotonin produced.

The antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs) artificially increase the amount of serotonin available to the neurons. However, another kind of postnatal depression can be caused by low levels of noradrenaline (norepinephrine) and this kind of depression will be resistant to - or may actually be made worse by - taking SSRIs.

The depression experienced by women with low serotonin levels is usually accompanied by a great deal of anxiety, whereas that induced by low noradrenaline levels feels like they are in a deep, dark hole. Women with low noradrenaline levels often improve dramatically in response to effective treatment of underlying thyroid and adrenal gland disorders (see below).

Postnatal adrenal gland exhaustion

Our adrenal glands are responsible for producing the stress hormones adrenaline (epinephrine), noradrenaline (norephinephrine), cortisol and dehydroepiandrosterone (DHEA), in addition to oestrogen and aldosterone.

It is estimated that the levels of stress most of us face on a daily basis are now 100 times higher than those faced by our grandparents. Added to which the adrenal glands also have a very high requirement for nutrients including vitamins C and B and most people's diets are now deficient in these essential nutrients.

These factors combine to produce underfunctioning or exhaustion of the adrenal glands and this may be precipitated by the nutritional and physical demands of pregnancy and childbirth. There are also dramatic changes in the balance of hormones after birth (see below) which can also cause the adrenal glands to crash.

In addition, the brain synthesises serotonin and dopamine in line with levels of adrenaline and noradrenaline, so underfunctioning of the adrenal glands may affect the amount of serotonin produced in the brain.

There are several tests that can be used to diagnose adrenal fatigue and effective treatment might include injections of vitamins, ginseng and/or liquorice supplements, specific adrenal support complexes and the use of desiccated bovine adrenal glands. It is also important to allowing enough sleep and rest for the adrenal glands to recover and for the diet to be optimal.

Postpartum thyroiditis

Postpartum thyroiditis (PPT) is the development of a transient postnatal thyroid disorder which normally spontaneously resolves within a year. However the problem often recurs after subsequent pregnancies and a quarter of women who have had postnatal thyroid disorders will go on to develop permanent hypothyroidism in the 10 years after giving birth.

One in every 13 women will develop postpartum thyroiditis which is an autoimmune disorder. Up to half of women who test positive for antithyroid antibodies in the first trimester will develop thyroiditis in the postpartum period. In addition to which such women stand a 70% chance of experiencing PPT in subsequent pregnancies.

A quarter of women who tested positive but did not go on to develop PPT during the first pregnancy will develop it during subsequent pregnancies. And for those women that have experienced PPT once, nearly half will go on to experience it in at least one more pregnancy.

Suboptimal maternal thyroid function has serious implications for the developing embryo too - especially in the first trimester. In consideration of this, in 2002 the American Association of Clinical Endocrinologists (AACE) recommended screening all women considering conception and/or all pregnant women in the first trimester for thyroid dysfunction.

Subclinical hypothyroidism (ie: blood tests are returned as being 'normal') and/or the presence of thyroid peroxidase antibodies has been found to be associated with subfertility and infertility, miscarriage, preterm delivery, gestational hypertension during pregnancy, pre-eclampsia, postpartum thyroiditis and postpartum depression.

Effective treatment for PPT may include short term use of thyroxine combined with nutritional support of the thyroid gland using either blends containing the amino acid tyrosine which is the main nutritional precursor for all the thyroid hormones and the mineral iodine, or desiccated bovine thyroid glands to help regenerate the thyroid gland.

The fact that Joe Bingley was overweight, had problems conceiving, had experienced multiple miscarriages and finally had severe postnatal depression may indicate that thyroid problems may have been the root cause of her PPD.

Low progesterone and postpartum depression

Progesterone is so named because it is the pro-gestational hormone, supporting conception, survival of the fertilised egg, maintenance of the endometrium which nourishes the fertilised egg and embryo, and a full-term pregnancy. It also governs the synthesis of the adrenal hormones including adrenaline, nor-adrenaline and cortisol as well as the sex hormones.

At ovulation, progesterone levels rise tenfold from 2-3 mg per day to approximately 22-25 mg per day. This progesterone surge is the source of increased libido at this time. If fertilisation of the egg does not occur within ten or twelve days, progesterone levels fall dramatically triggering the shedding of the endometrium as menstruation.

If the egg is fertilised, the empty egg casing in the ovary (the corpus luteum) starts to produce progesterone until production is taken over by the placenta which secretes an ever increasing supply, reaching 300-400 mg/day during the third trimester - 100X preovulation levels! If progesterone levels drop during the pregnancy or the progesterone receptor sites become blocked then this may result in miscarriage as the endometrium is shed.

After birth, there is a major shut down of progesterone production and this may be associated with the loss of adrenal and thyroid gland function, and the development of postnatal depression. For this reason, some physicians administer high doses of progesterone by injection after birth for 8 days and the woman then uses progesterone pessaries until menstruation resumes.

The results of this therapy can be very dramatic - starting to work within hours and, according to research conducted by the Pope Paul VI Institute in 2004, decreasing symptoms to one quarter of those pre-therapy. Furthermore, 95% of women respond positively which makes this approach far more effective than either psychotherapy or antidepressants and one that some consider should be the first line of approach in the treatment of postpartum depression. Applying a natural progesterone cream to the skin can help to remedy these symptoms.

Progesterone and oestrogen are kept in balance and endocrine disrupting chemicals which mimic oestrogen and bind to oestrogen receptor sites may ultimately be responsible for progesterone deficits. The widespread use of synthetic sex hormones in the contraceptive pill, depot injections and hormone-releasing coils may also be responsible for creating an imbalance.

Also, according to a study at the University of California, Irvine, levels of placental corticotropin-releasing hormone (CRH) during the 25th week of pregnancy were a predictor of the likelihood of developing postpartum depression.

Low blood sugar and postnatal depression

Low or poorly controlled blood sugar levels (hypoglycaemia and dysglycaemia respectively) are known to be associated with depression and the dramatic changes in the functioning of the endocrine system at birth may cause compromised insulin production or there may be a blocking of insulin receptor sites on the cells. This can create functional hypoglycaemia where even if blood glucose levels are 'normal', sugar cannot enter the cells.

This produces depression and often results in attempts to remedy the low blood sugar by comfort eating which leads to weight gain. Treatment includes regular, small nutritious meals, eliminating all sugar and processed foods and possibly taking supplements to help support pancreatic function such as chromium or glucose tolerance factor (GTF).

Zinc deficiency and postpartum depression

Trace minerals are now very deficient in our soils due to modern farming methods and then they are further depleted by food refining, processing and preparation. The refining of wheat flour, for example, removes 80% of zinc. And in some areas of the world, zinc deficiency is thought to be responsible for learning disabilities in one-third of children.

Other factors that deplete zinc include stress (this can be physiological such as pregnancy and not necessarily psychological), viral infections, the consumption of sugar, coffee, alcohol and nicotine. In addition, the taking of corticosteroid drugs and/or the contraceptive pill depletes body reserves, and digestive problems such as low stomach acid (which may go undiagnosed) may prevent its absorption.

The levels of the trace minerals copper and zinc tend to be inversely related to one another. The developing foetus has a high requirement for zinc which is required for growth and development. Maternal blood levels of zinc are known to fall by about 30% during pregnancy, and then to decline further during breast-feeding as the mother’s reserves are used up.

Rising maternal copper levels coupled with zinc and vitamin B deficiency make postnatal depression much more likely according to the late orthomolecular medicine practitioner, Dr Carl Pfieffer MD, PhD. He also stated that he had never seen evidence of postnatal depression in patients treated with zinc and vitamin B6.

One Polish study found that the mother's mood postnatally was inversely related to their blood zinc levels and that the mothers who tested positive during pregnancy for mild depressive symptoms also had depleted blood zinc levels.

If you are positive for more than 3 of the following, consider the possibility of zinc deficiency:

Stretch marks
Irritability
Loss of appetite
Poor wound healing
Frequent infections
White spots on 2 or more nails
A baby who has reflux or colic
Poor sense of smell or taste
Pale skin
Acne or greasy skin
Creaky joints and
Hair loss.

Copper toxicity and postpartum depression

In a study by Crayton and Walsh published in the Journal of Trace Elements in Medicine and Biology in 2006, copper levels were found to be significantly higher in women that had a history of postnatal depression compared both to non-depressed women and to depressed women without a history of postnatal depression.

However, in this study it appears to be the balance between copper and zinc that is the key factor, as zinc levels did not differ across the three groups. Excess copper in the brain, is known to alter the balance of dopamine and noradrenaline (norepinephrine), two mood-regulating chemicals.

During pregnancy, a woman’s blood copper levels typically double, normalising again after childbirth. The authors of the study speculate that in women who develop postpartum depression, copper levels fail to normalise possibly because of a genetically determined flaw in the protein that regulates copper levels. Or it may be that as the body's resources are mobilised during pregnancy that copper appears in the circulation from storage or that the hormones of pregnancy cause elevated copper levels in some way.

Magnesium deficiency and postnatal depression

Magnesium serves several extremely important roles in the body. One is that it is involved in the synthesis of steroid and sex hormones. Another is that there is a reciprocal relationship between the macrominerals calcium and magnesium which act as electrolytes in the body with magnesium regulating the passage of calcium ions within neurons controlling nitric oxide production and enabling nerve conduction.

Deficiency of magnesium is well known to produce neuropathologies which could manifest as depression. Again, our diets have become deficient in magnesium with only 16% of the magnesium found in whole wheat remaining in refined flour. The heavy emphasis on eating calcium rich foodstuffs (especially during pregnancy) may also help to create a relative magnesium deficiency. Finally, magnesium deficiency can also be induced by stress hormones.

Pregnancy and childbirth are a huge physical, metabolic, and psychological challenge. Magnesium is important to muscle contraction and the powerful and prolonged contractions of labour will consume vast amounts of magnesium. The production of stress hormones may also compound this problem further exacerbating any deficiency.

Recoveries of less than 7 days from major depression have been demonstrated using 500–1,200 mg of magnesium per day.

Other nutritional deficiencies implicated in PPD

The fact is that a deficiency of any single nutrient can alter brain function leading to depression and the mother's body has just raided all its resources to make a small human being and so has been under the greatest nutrient stress of her life.

"Even in the absence of laboratory validation of nutritional deficiencies, numerous studies utilising rigorous scientific designs have demonstrated impressive benefits from nutritional supplementation."

Dr Melvin Werbach MD

Other nutrient deficiencies which have been implicated in PPT include:

Omega oil deficiency Omega 3 oils are critical to brain function as they form an important component of the cell membrane and help to regulate the passage of all molecules in to and out of the cell. Again, almost everyone is thought to have become deficient in omega 3 oils in recent decades due to dietary changes. The mother's brain may become massively depleted of omega-3 fatty acids during pregnancy when the brain of the foetus is developing quickly - or may be depleted further during breastfeeding.

B vitamin deficiency Some of the most common deficiencies found in depressed individuals are folic acid, riboflavin, vitamin B12 and vitamin B6. Supplementing these B vitamins can result in dramatic improvements in mood. Taking the contraceptive pill is also known to deplete vitamin B6 which is essential in the manufacture of serotonin.

S adenosyl methionine deficiency S adenosyl methionine or SAM is a methyl donor which is important in the synthesis of brain compounds including neurotransmitters. Supplementing folic acid increases SAM.

Antidepressants and postnatal depression

Allopathic medicine treats postpartum depression symptomatically mostly using selective serotonin reuptake inhibitors (SSRIs) including Prozac, Zoloft, and Paxil. These drugs work by preventing the reuptake of the neurotransmitter serotonin in the synapses between nerve cells thus artificially elevating their levels in the brain. They also draw serotonin out of storage in the brain cells into the synapses.

Even where the depression is related to low neurotransmitter levels in the brain, the underlying cause is often a deficiency of the nutritional precursors that the body needs to make these neurotransmitters. So this approach depletes the body's reserves of serotonin and the serotonin precursors are used up more rapidly making the underlying deficiency worse.

Overstimulation of the neurons may also result in permanent brain damage or the downregulation of serotonin receptors thus compounding the original problem. SSRIs may also create dangerously low levels of the neurotransmitter dopamine in some people.

All of which means that once the woman has started to take antidepressants it can be difficult to wean off unless the underlying problems are addressed concurrently.

The other issue for the new mother is that whatever pharmaceutical drugs they take will be passed to the baby in the breast milk and appear to concentrate in the baby's brain. Some studies have linked the maternal use of Prozac to colic in nursing infants. And a baby with colic can push an already stressed mother to breaking point.

Some mothers choose to take antidepressants and bottle feed their babies. But this can deprive the baby of their intended nutrition and also deprives the mother of the oxytocin release associated with breastfeeding which calms her and aids bonding with her baby. This can in turn worsen the depression.

SSRIs can bring feelings of numbness, and of separateness from others and common side-effects include nausea, drowsiness, insomnia, sexual dysfunction, headaches, trembling, digestive problems and agitation. SSRI drugs also seem to disinhibit some people resulting in violence, suicide and the mother potentially harming her baby.

Many experts, including the psychiatrists and authors Joseph Glenmullen, M.D., and Peter R. Breggin, M.D., think that SSRIs are overprescribed and that their dangers are dramatically downplayed.

Their use needs to be tapered off gradually with the guidance of a knowledgeable physician. And the SSRIs may take weeks to take effect so they are not the immediate fix some imagine.

Finally, according to a study conducted by Appleby et al (1997), counselling proved as effective as antidepressant therapy over a 12 week period.

Suggestions for postnatal depression

Most of us are malnourished and this becomes particularly critical when trying to get pregnant, during the pregnancy and after the birth when the mother has to continue nourishing herself and her child. Consider the following suggestions.

Eat sufficient protein It is important to consume enough high quality animal protein to rebuild the body and to produce breast milk so make sure you include a portion of meat, fish, eggs or cheese at every mealtime or snack. You might want to consider including a protein shake in addition to protein consumed at meals.

Stay hydrated It is particularly important to maintain hydration levels if you are breastfeeding and it is suggested that nursing mothers drink ten tall glasses of water every day.

Avoid alcohol Alcohol is also best avoided for a variety of reasons including causing dehydration, making any depression worse and being passed to the baby in the breast milk.

Reduce caffeine and sugar consumption High caffeine and sugar intakes are associated with higher rates of depression and are best avoided.

Stabilise your blood sugar levels Eliminate sugar and refined foods and eat small amounts of complex carbohydrates such as whole grains regularly.

Avoid low fat diets Strict low fat diets have been linked to feelings of depression and even suicide (Nutrition Review, April 2000).

Eat and supplement omega 3 oils Include plenty of oily fish, nuts, seeds, grass fed meat, and eggs from chickens fed on high omega 3 seeds in addition to supplementing omega 3 oils throughout pregnancy and breastfeeding.

Supplement a multivitamin/mineral Take a high quality multi especially formulated for preconception, pregnancy and/or breastfeeding.

Increase your zinc intake Especially if you identified with several of the zinc deficiency symptoms listed above. Good dietary sources of zinc include lean meat, poultry, fish, organ meats and whole grain bread. Supplement zinc at about 25 mg per day.

Increase your B vitamins Rich sources of B vitamins include brewer's yeast, wholegrains, green leafy vegetables, beans and wheat germ. In addition to which you may want to take a vitamin B complex supplement (containing around 50 to 100mg of the major B vitamins) and possibly 800mcg of folic acid and 88mcg vitamin B12 day (take together).

Increase your magnesium intake Magnesium rich foods include seeds, nuts, beans, dark green leafy vegetables and seafood. Supplement magnesium as glycine or taurine 125 mg with each meal and before bedtime.

Eat tryptophan-containing foods Foods that contain tryptophan (the serotonin precursor) include turkey, cottage cheese, eggs, lobster, mung beans, tofu, bananas, pineapple, spinach, asparagus, and sunflower and flaxseeds and their oils and/or supplement 5HTP.

Exercise and fresh air Do not underestimate the curative value of daylight and gentle exercise.

Consistent/healthy sleep patterns Try to go to bed at the same time every night and if you need to take a nap during the day.

Finally, postnatal depression is a physiological and psychological crisis and as such, requires serious, timely and meaningful intervention. If you need help, make sure that you ask.

Further resources

For more about postnatal depression please see the Joe Bingley Memorial Foundation website.

For related videos refer to What's Wrong With Psychiatry, Psychiatry: No Science, No Cures, Difference Between Medical Disease & Psychiatric Disorder, and Natural Mood Enhancer or for podcasts listen to Tryptophan and Your Health listed under Supplements and Nutrition and Is Depression Overdiagnosed? listed under Fatigue Syndromes and Toxicity in the Audio hub.

Postnatal depression: Article summary

This article looks at the recent tragic suicide of Joanne Bingley while suffering with severe postnatal depression. Whilst the allopathic medical world treats depression using antidepressants, the naturopathic world regards depression as a symptom of a variety of toxicities, deficiencies and hormonal disorders and seeks to identify and treat the underlying cause. The most common likely causes are detailed along with restorative treatment options.

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The Natural Recovery Plan Newsletter December 2011 Issue 24. Copyright Alison Adams 2011. All rights reserved
Alison Adams Dentist, Naturopath, Author and Online Health Coach www.thenaturalrecoveryplan.com