Postpartum Depression

The causes for why some women become ill with postnatal depression are numerous. For years scientists have been looking into the responsible factors. Triggers that often also impact each other can include the following:

Psychosocial Factors

Women who have already suffered from postnatal depression following a previous birth have a higher risk to become ill once again. Psychological illnesses before or during pregnancy can also be a trigger.

A traumatic birth experience such as a C-section in place of a natural birth can also trigger postnatal depression. Performance pressure and excessive demands can also lead to depression once daily life with the newborn begins—especially when there is a lack of social support from those around the mother. This especially affects single moms.

Disturbance of the Circadian Rhythm

Research has shown that an impaired circadian rhythm can also be responsible for postnatal depression. This rhythm is a biological rhythm that lasts around 24 hours. Many important processes in our body are controlled by it, such as the production of important hormones and our pain sensitivity.

Our most important circadian rhythm is the sleep-wake cycle that is controlled by the hormone melatonin. Nutrition and exercise are also important factors in order to keep the inner rhythm in balance. But it is exactly during pregnancy and the first few months after birth that this trio—sleep, health nutrition, and exercise—is off kilter.

Of course, it is normal that your sleep is interrupted in the first months of your child’s life. Buy if you are no longer able to sleep in or wake up too early in the morning, then this can affect your physical and mental health negatively. Many studies have already shown a connection between chronic lack of sleep and (postnatal) depression.

Hormonal Imbalance

In hormonal terms, a pregnancy and birth mean a state of exception for the female body. When many hormones such as estrogen, gestagen, progesterone, or human chorionic gonadotropin (also called HCG), are at their absolute peak for around 40 weeks, then these levels drop rapidly again shortly after delivery. Many women react with particular sensitively. This is especially true as many other hormones that are responsible for energy and stable mood or have anxiety-reducing properties are also affected, as well as those that are responsible for the circadian rhythm.

DHEA

A lack of the steroidal hormone dehydroepiandrosterone (DHEA) has many symptoms such as a reduced stress load capacity as well as effects on libido, depressiveness, unrest, and irritability. The importance of this anti-stress hormone that is produced mainly in the adrenal cortex is often underrated—even though it is a building block for many important hormones, including estrogen! Stressful situations, in which the body produces an increased amount of cortisol, appear to reduce DHEA levels at the same time. This interaction is not to be underestimated!

Treatment

Ideal level:
The optimal DHEA-sulfate level lies between 2000-2800 ng/ml.

Dosage:
Level <900 ng/ml: 15-20 mg
900-1200 ng/ml: 5-10 mg
1300-1600 ng/ml: 2,5-5 mg

After four to six weeks, a control after three to four hours of ingestion has proven reliable.

Melatonin

As you have already heard, disturbances of the circadian rhythm are often brought in connection with postnatal depression. The consequence: Chronic sleep disorders can lead to serious health consequences. Your circadian rhythm is best measured through the natural hormone melatonin.

Examinations of women who suffer from postnatal depression have observed that their DLMO (Dim-Light-Melatonin-Onset), i.e. the beginning of their nightly rise of melatonin, is delayed. Therefore, sleep disorders are preprogrammed.

It is also important to observe that the release of melatonin closely interacts with hormones such as estrogen and progesterone. Hormonal balance is an important precondition in order to maintain a healthy circadian rhythm.

Treatment

Combined Hormone Replacement Therapy
To achieve a phase shift, as it is appropriate with DLMO, success has been achieved through customized melatonin and/or light therapy, which allows the rhythm to be reset once again.

For this purpose, the melatonin level is determined through blood, saliva, or urine, and the substitution is then individually proportioned. Important: One must also check for a possible serotonin deficiency that potentially needs to be balanced.

Melatonin Dosage:
Difficulty falling asleep: 1-2 mg of quick releasing melatonin in the evening.

Moderate difficulty falling and staying asleep: 3 mg pulsatile melatonin in the evening.

Estrogen and Progesterone

Estrogen and progesterone are important regulators of our circadian rhythm.

Estrogen levels falling too quickly after birth can lead to unrest and irritability in some women, as well as unstable moods, depression, and sleeplessness.

Progesterone has a similar effect as estrogen: With its soothing and anxiety-reducing properties, it can support the ability to fall and stay asleep during stress, unrest, or anxiety. If it falls drastically after birth, then this can be a contributing factor in postnatal depression.

Treatment

Individual Hormone Replacement Therapy
Through a “physical hormone replacement therapy,” the correct balance of estrogen and progesterone can be restored. To do this, human-physiological estrogen through 17ß-Estradiol is individually customized in the form of a gel, patch, or cream. The advantage: This dosage form requires only minimal estrogen dosage for maximum results.

Progesterone is also administered physiologically and capsule form is preferred. An individually customized dosage is recommended. In the case of severe anxiety or panic attacks, a dosage of 100 mg progesterone over the course of four to 12 hours has proven effective. If you suffer from stress-induced sleep disturbances, then 100 to 300 mg of progesterone can render efficient aid when taken in the evening.

Thyroid Hormones

After birth, thyroid subfunction, as well as hyperfunction, can lead to anxiety, panic attacks, unrest, depression, and cognitive impairment in new mothers. However, it is much more common in the realm of postnatal depression that a subfunction (hypothyroidism) is present, often only several months after birth.

If the thyroid can no longer produce thyroxin and triiodothyronine in sufficient amounts, important metabolic processes are affected, usually functioning more slowly. In addition to those listed above, a lack of drive and weight gain are additional typical side effects.

Treatment

After determining the TSH level in the blood, ideally in combination with T3 and T4 levels, a possible subfunction can be compensated for through individual hormone substitution.

Serotonin

Serotonin is our endogenous happiness hormone that lifts our mood. It has long been recognized that a lack of serotonin is often responsible for sleep disturbances, depression, lack of drive, or fatigue. In other words: severe exhaustion.

If too little serotonin is produced, then a snowball effect is also put into play: Since the night hormone melatonin is produced in the evening from serotonin, serotonin deficiency can also lead to a lack of melatonin and also to sleep disorders. Serotonin also influences numerous functions in the central nervous system such as emotions, pain perception, and also sleep-wake behavior.

Important in this context: A deficiency in DHEA or progesterone can also often lead to a lack of serotonin! A large drop in estrogen levels can impact serotonin levels, as well as chronic stress.

Treatment

Ideal Level:
The ideal normal level of serotonin lies at 200 ng/ml (around 120-480 ng/ml).

Besides defining serotonin levels, the levels of estrogen, progesterone, and DHEA should also be taken into account.

Dosage:
Serotonin cannot be absorbed by the body in and of itself, which is why the precursors of 5HTP and/or tryptophan must be administered, which are then converted to serotonin in the body.

Light Depression: 200-300 mg quick releasing 5HTP in the morning

Medium Depression: 50 mg quick-releasing 5HTP plus 250 mg delayed tryptophan in the morning and again at noon if necessary.

An initial control has proven reliable after four to six weeks.

Talking helps

Turn to your doctor or midwife at the first signs of postnatal depression. You can figure out with their help what type of psychotherapeutic treatment is best suited for you.

Have your hormone levels tested

If your body is producing too little of certain hormones after birth such as melatonin, estrogen, progesterone, or serotonin, then this can have serious consequences for your health. Testing your hormone levels and subsequent tailored medication can help you find your inner balance again quickly so that you can fully enjoy the time with your baby.

Let yourself be treated for the well-being of your child

The first years of life are an especially important time for your child. If postnatal depression is not treated, then this can have serious consequences for your child, including developmental delays or emotional and cognitive deficits. Your mother-child relationship can also be limited permanently.

Take care to have a regulated rhythm

Not only is the regulated rhythm of your child important, but you should also pay attention to eat regularly. Don’t forget to get some exercise outdoors in nature; a walk with the stroller also supplies your child with an important dose of fresh air. After such an activity both of you will sleep better. Give it a try!

Take time to rest

Think about it: In your baby’s first year of life, you especially need a lot of energy. If possible, plan for daily deliberate times of rest, such as when your child is sleeping. The household can wait. It is more important that you regain your strength and energy!

Let yourself have a time-out

Particularly in the first months of life, you are there for your baby around the clock as a new mother, so there is hardly any time for a trip to the salon, for hobbies, or even for meeting with friends. At first glance, regularly having one or two hours to yourself seems like an impossible luxury for many women. But this short “vacation” is enormously important for you. You can also ask family or friends for help. You’ll see it is worth it! After a short time-out, you will find yourself full of energy again.

Look for social contacts

Meet with family and friends, and make new connections with other new mothers. The exchange with other people will do you and your child some good.

Reading Suggestions:

Shields, Brooke. Down Came the Rain: My Journey Through Postpartum Depression. Christa Incorporated 2005.

Helpful Links:

Office of Women’s Health 

Depression After Delivery