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A comprehensive approach to prevention and treatment of postpartum depression (PPD) and anxiety disorder after childbirth (EPP)Raffelock Dean DC, L. Ac, CCN, DACBN, DIBAK Hyla Cass, MD 
Postpartum depression (PPD), postpartum anxiety (PPP) have become a national epidemic in the United States, affecting 15% -20% of all mothers, or women about 600.000 to 800.000 per year. (1) It is now estimated that more than 30 million Americans are on antidepressants or antianxiety medications. (2) Most of this 30 million are women who have one or more children. The likelihood of PPD increases with each successive child. (3) The most common medical treatment for postpartum depression are SSRIs (selective serotonin reuptake) antidepressant drugs. Anxiety disorder after birth is most commonly treated by the benzodiazepine family of drugs such as Valium, Ativan, Xanax, and Klonopin. Reuptake inhibitors the combination of serotonin and norepinephrine (SNRIs) are also commonly used in postpartum depression. In the case of postpartum psychosis, antipsychotic drugs that use and are immediately necessary. Many women now have samples of SSRIs, as they are leaving the maternity ward. Most medical sources believe that the PPD is caused by an imbalance of brain chemistry and pharmaceutical intervention is the treatment of choice. While a certain percentage of women PPD sufferers need pharmaceutical assistance, they are much fewer are actually being received. Meta-Recent studies show that this is true. While it is clear that some women with PPD need and benefit of pharmaceutical intervention, our experience is an inclusive approach gives better results. Disorder anxiety after childbirth is mostly treated The most common symptoms of postpartum depression include: 1. Persistent feelings of hopelessness and / or anxiety; Literature in general, outlines several types of postpartum disorders with Special characteristics beyond the typical symptoms of depression. These include: 1. Anxiety disorder after childbirth (EPP). Here, the main symptoms are excessive nervousness, hyper-vigilance, and racing thoughts some cases of panic. Panic attacks are particularly frightening, which often suffer believe they are dying, as they experience shortness of breath, dizziness and chest pounding. 2. Postpartum obsessive-compulsive disorder. Most often, this takes the form of obsessive thoughts or concerns on the infant 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 obsessive thoughts are those in which the mother provides harm your baby in any way. These thoughts are unwanted, intrusive and frightening for the mother. It is important to emphasize that, except in very rare cases of psychosis (see below), these thoughts are not accompanied by any action. However, the mother may be so frightened by his own thoughts that keeps the baby and therefore their neglect. It's terribly difficult for new mothers to recognize that these 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 birth, or because past unresolved trauma-sometimes of a sexual nature-triggered during childbirth. A woman suffering post-traumatic stress disorder may have recurrent memories, dreams or memories of traumatic birth labor. She will be hyper-vigilant and startle easily, and is likely suffering from insomnia, irritability, poor concentration and lethargy. Women who have experienced a particularly traumatic birth often show signs of stress Posttraumatic and PPD. 4. Postpartum psychosis. This is the most extreme and rarest of all postpartum disorders. When this happens, mother loses touch with reality and its symptoms may include extreme for example, disorientation (not knowing who it is), delusional or paranoid thinking and or visual hallucinations hearing. The few, tragic cases where mothers have harmed their children while in a psychotic state have received enormous media attention. As a result, PPD many people mistakenly associated with psychotic symptoms and dangerous behavior. This is another reason why women do not receive help, they want to avoid be labeled with a disorder so stigmatized. Premise item: Brand New Filling a mother after childbirth nutritional reserves has been ignored and must be an integral part of treatment for postpartum depression. Basis Approximation nutrition to PPD No other normal physiological process consumes drains vital nutrients and postnatal over the body of a woman in the process of being pregnant, giving birth and caring for a newborn which may include breastfeeding. The fact that a mother's body donates all the nutrients needed to form the body of her baby is too often overlooked when it comes to the medical treatment of PPD. Not only is the placenta literally steal the body of the mother of all key nutrients needed to make the body of a baby but the placenta is formed from nutrients taken from the body of the mother. This is the main reason that many women following childbirth nutritional drainage and nutrient depletion of this syndrome can lead to postpartum depression and anxiety disorder. Other factors contributing to leakage of nutrient reserves of the new mother are blood loss during delivery, sleep deprivation, breastfeeding, returning to work soon and the enormous energy extra that is required to care for a newborn with intense needs. If a pregnant woman or nutrient reserves of the new mother are too low, is much more vulnerable PPD and PPP experience because all the body's normal metabolic processes are totally dependent on nutrients. The preponderance of poor quality drug prenatal vitamins gives a significant boost to the trend of nutrient depletion. Rarely is there is no indication that the body's production of neurotransmitters is completely dependent upon nutritional precursors. (4) Nor are the causes of these nutritional deficiencies precursor discussed. Moreover, the interdependent relationship between hormones and neurotransmitters is rarely taken into account by most physicians to consider treatment for PPD and PPP. The nutritional requirements mitochondrial function, the importance of liver function in the west and the prospects of the East, and some individual nutrients such as Omega 3 fish oils, pharmaGABA, L-theanine, SAM, inositol, magnesium, and St. John's wort may also be helpful in the treatment of PPD and PPP. These are briefly discussed. A comprehensive approach for the treatment of PPD can include nutritional therapies, hormone replacement therapy bio-identical, moderate exercise, a diet of nutrient density, adequate rest, counseling advice /, stress reduction techniques, eliminating caffeine, alcohol and other addictive drugs, and if necessary, intervention pharmaceuticals. Nutritional Neurotransmitter Precursors Serotonin and tryptophan The amino acid L-tryptophan is necessary for the body to produce serotonin. Ninety-five percent of serotonin in the human body occurs in the intestinal tract. Approximately five percent is produced in the brain. Serotonin is produced in the intestinal tract is not available to the brain because serotonin can not cross the blood brain barrier. L-tryptophan also not readily cross the blood-brain barrier and requires a carrier protein for transport into the brain. Consumption of simple sugars of membrane changes cellular neurons in the brain of amino acid selectivity, allowing tryptophan to enter the brain more easily. Therefore, the craving for sweets is often a sign of deficiency of serotonin. Serotonin has been called mood lifting and soothing brain chemicals. inadequate levels of serotonin are related to depression, anxiety, insomnia, irritability and weight gain. Serotonin-mediated depression usually contains an element of anxiety. The Serotonin is considered an inhibitory neurotransmitter. Features include: – The inhibition of glutamate on the excitability of different CNS regions A comparison of the effects of serotonin levels optimal for low serotonin levels reveals the following contrasts: 1) Hope / —— Optimistic depressed Tryptophan becomes its metabolite, 5 – hydroxy-tryptophan (5-HTP) that is then converted into serotonin. Niacin, iron and folic acid are necessary for L-tryptophan converted to 5-HTP. The body also requires pyridoxal 5-phosphate along with 5-HTP to make serotonin. Magnesium and riboflavin (B2) are required for the conversion of pyridoxine (B6) 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 and antidepressant drugs with fewer and milder side effects and most times better tolerated. (5.11) Of Martin Hintz, MD Neuro-Research A number of important factors contributing to lower L-tryptophan levels in many people, especially women In the postpartum period, whose bodies are providing the necessary proteins to form another human body, these are the excessive levels of cortisol, epinephrine, norepinephrine, and dopamine. The proportion of L-tryptophan to other amino acids available in most foods is very low. An excess of cortisol, adrenal gland hormone (a very common problem in psychological stress and physiological states) negatively affects the production of serotonin and the sensitivity of four different ways: 1. Excess cortisol significantly reduced the number of serotonin (5-HT 1A) receptors. (12) 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 the maintenance of serotonergic modulation mediated. (16,17) This may be another factor for the participation of insomnia in PPD. Added to the reasons that serotonin deficiencies are increasingly common and contribute to the PPD is an overabundance of stress related catecholamines. Epinephrine, norepinephrine, serotonin, dopamine and serotonin also exhausted because monoamine neurotransmitter is supposed to balance these three monoamine excitatory neurotransmitters. The stress a person experiences more, the body increases production of catecholamines in an attempt to respond to this stress. This requires a body after childbirth to produce even more serotonin – although deficiencies in precursor nutrients can interfere with production. The use of 5-HTP as a precursor of serotonin has important nutritional advantages over tryptophan. 5-HTP easily passes directly through the blood-brain barrier without the need for a carrier protein, allowing easier conversion to serotonin in the brain. Sublingual forms of 5-HTP work faster. The dose varies from 25 mg per day to 300 mg per day or more. A deficiency of vitamin B6 (Pyridoxine), which is required for the synthesis of serotonin are often found in premenopausal female patients with depression. (18) Replacement of B6 cases of deficiency is an important aspect of treatment PPD can increase production of serotonin in the brain. (19) The use of 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 better supplement 5-HTP and pyridoxal 5-phosphate taken together or separately, the completion of a waiting period of two hours. Our clinical experience suggests that be fine to complete together. Many products, including a combination of 5-HTP and the P-5 P are available. There is some controversy over the concurrent use of SSRIs and serotonin nutritional precursors. Companies Pharmaceutical seems adamant about avoiding this and often mentioned the possibility of serotonin syndrome, a dangerous condition usually derived from the combination of serotonin enhancing drugs, especially MAO inhibitors, medications, herbs or nutritional precursors that also enhances the activity of serotonin. The Serotonin syndrome symptoms may include nausea, headache, agitation, diaphoresis, hypertension, tachycardia and hyperthermia that can go 104 F. This seems a remote possibility at best if only used on 5-HTP or the use of 5-HTP in combination with an SSRI medication. (20) SSRIs appear to just to keep serotonin in the synapses of the neuron and reuptake inhibition, but also pulling the nutritional precursors of serotonin in the vesicles port and storage reuptake. In fact, in our clinical experience, many women with PPD do better when taking 5-HTP and P-5 P-together with SSRIs SSRIs alone. Precursor of serotonin deficiencies may be the reason that SSRIs do not work for some, work and then stop working for others, and why it is not unusual for a woman with PPD, we established two or more different SSRIs over time. SSRIs do not give a net increase of serotonin and they need enough serotonin available in order to have enough to re-uptake. Dr. Dean Raffelock-catecholamines table Catecholamines are predominantly energy and state of mind when it occurs at the appropriate levels. Synthesis of catecholamines occurs in the CNS, adrenal medulla and peripheral sympathetic neurons. Norepinephrine and dopamine act primarily as neurotransmitters in the CNS. The adrenaline acts mainly as an adrenal hormone to mobilize energy. Catecholamines affect most organ systems. When levels are excessive, catabolic, and can lead the body to metabolize its own nerve, muscle and bone tissue. Low levels can lead to depression, fatigue and weight gain. Dopamine: Dopamine is the precursor of the catecholamines noradrenaline and found in both the CNS and the adrenal medulla. Its functions include motor function and posture, cognitive function (attention, concentration, working memory and troubleshooting), and feelings of pleasure. Dopamine can act as an inhibitory neurotransmitter or excitatory input in response to afferent signals. Norepinephrine (noradrenaline): CNS norepinephrine mediates regulation of mood, drive, ambition, learning and memory, alertness, arousal and approach. Clinically, there is usually an inverse relationship between norepinephrine (excitatory) and serotonin (inhibitors). When serotonin is low, is too norephinephrine upregulated, resulting in "fight or flight" responses that lead to anxiety and / or panic attacks. Overexpression of norepinephrine in the CNS is clinically associated with anxiety, aggression, irritability, mania or bipolar disorder, immunosuppression and hypertension, low norepinephrine is associated with depression atypical symptoms of fatigue, hypersomnia, hyperphagia, lethargy and apathy. Epinephrine (adrenaline) epinephrine synthesis depends on norepinephrine becomes epinephrine by methylation. Phase I: the alarm reaction: cortisol adrenaline high / high Phase II: Resistance: high cortisol / low DHEA, variable adrenaline Phase III: Depletion: reduction in cortisol, epinephrine and DHEA A woman suffering from PPD should be closely questioned about their symptoms, SSRIs are routinely given to women have hypoadrenia way that involves the adrenal cortex and / or bone marrow, or low thyroid function (see below). Low glucocorticoid and / or levels of catecholamines can cause symptoms of fatigue, malaise and depression. (24.25) Many women with PPD require pharmaceutical products and / or supplements address nutritional deficiencies in both serotonin and catecholamines. Nutritional therapies for balance of catecholamine: § DL-phenylalanine and tyrosine-L, the amino acid precursor of epinephrine, norepinephrine and dopamine. DL-Phenylalanine also helps increase endorphins, which are in the mood. Many women CP diagnosed with bipolar disorder respond well to high doses of DL-phenylalanine therapy (26), together with the precursors of serotonin and high dose (6 grams per day) omega-3 as fish oils. (27) § L-cysteine, sulfur, iron and folic acid, necessary for the conversion of L-tyrosine L-dopa. § pyridoxal 5-phosphate, necessary for the conversion of L-dopa into dopamine. Copper and vitamin C are required to convert dopamine into norepinephrine. Pridoxal acid-5-phosphate, vitamin B12, and folic acid are required to convert norepinephrine into epinephrine. Gamma-aminobutyric acid (GABA) Inhibitory neurotransmitter GABA is the most important and widespread in the brain. Low levels of GABA are particularly important to look for when anxiety and insomnia included in the display the symptoms of PPD / EPP. GABA is essential for balancing the excitatory neurotransmitters and hormones such as cortisol, epinephrine, norepinephrine and glutamate. Too much excitement without adequate inhibition of GABA can lead to: (28) – Insomnia Working GABA in the clinic is to induce relaxation, tranquility and sleep aid. Where there are glutamate receptors (Powerful excitatory neurons), GABA receptors will close. GABA allows only the most important excitatory signals to pass and cushions or off strange signals with excitement when GABA levels are adequate. Benzodiazepines (Valium, Klonopin, Zanax, Ativan, etc) and pharmaceutical products such as Ambien and sleep Sonata of work on GABA receptors, as moderate consumption of alcohol. L-theanine, lactium (milk peptides), L-glutamine, taurine, and bio-identical progesterone can act as nutraceuticals / hormone agonist GABA. The drug is an inhibitor of GABA reuptake Gabatril as valerian extract. A new product called nutriceutical pharmaGABA seems to yield more effective results than synthetic GABA. From the perspective of Chinese medicine, serotonin and GABA would Yin (relaxing, harmonizing, cooling, nutrition, hydration, inhibitory) and catecholamines would be Yang (energizing, mobilizing, heat, excitement, the drying). In both Eastern and Western perspectives, it is important to balance the opposing groups of chemicals in the brain that equilibrium is established. A woman with PPD which now has more energy, but can not sleep is as unhappy as a woman who can sleep now, but even more lethargic than before treatment. Balance is the key neurotransmitters. Balance of neurotransmitters and hormones is clinically more effective. Hormone-neurotransmitter interactions The relationship between neurotransmitters and hormones in the PPD is often overlooked. The neurotransmitters and neuropeptides are necessary to mediate production hypothalamic releasing hormones, which allows the pituitary gland to properly conduct the orchestra hormone. The hypothalamus is regarded as a key part the midbrain, the 'emotional brain, "so it's no Wonder why the imbalances in the neurotransmitters and hormones may adversely affect emotional states. Thyroid hormones. Catecholamines and thyroid hormones are closely related in many of its functions. L-tyrosine with iodine, is the precursor of thyroglobulin and thyroid hormones T 3 and T-4. A depression without anxiety, with predominant symptoms of exhaustion and difficulty stringing multiple positive thoughts on the whole is more associated with low adrenal (29) and / or thyroid function (30-32) and generally does not respond well to SSRIs or precursor of serotonin nutritional therapy. It is well known that low thyroid function can cause depression and physiological fatigue. Dar T3 induces an increase in serotonin, and in animals with hypothyroidism, the synthesis of serotonin is reduced. (33) T3 seems to desensitize presynaptic serotonin autoreceptors. (34) However, the peak day of TSH, observed during the circadian rhythm physiology, is serotonin dependent. (35) Thyroid function and serotonin function are interdependent, both clinically and biochemically. optimal performance depends on optimal thyroid levels of serotonin. optimal balance of serotonin depends on thyroid function optimal. TSH increase depends on adequate stimulation of serotonin hypothalamic TRH, allowing an increase in TSH. (36) Suppressed TSH can now be represented better low serotonin states that any real assessment of thyroid function truth. The thyroid hormone triiodothyronine (T3) increases and accelerates the effects of antidepressant drugs. Fluoxetine + T3 are better in desensitizing 5-HT autoreceptors hypothalamus than one. (37-39) Estrogen: A growing body of evidence points to the importance of estrogen on serotonergic function. (40) Estrogen inhibits the reuptake of serotonin. (41.42) Estrogen treatment has been shown to improve so selective serotonin (5-HT 1A-mediated) responses in the hippocampus (43,44) Estrogen increases the activity of cooking 5-HT (serotonin) neurons in both male and female rats. (45,46) In summary, estrogen appears to be the nature SSRIs. At present, there is much controversy in relation to estrogen HRT. The HERS and WHI studies have raised the dispute without making the important distinction between estrogen and bio-identical pharmaceutically altered, nor is any distinction between progesterone and progestins. The clinician is encouraged to be well versed in the art in terms of risks versus benefits of HRT. Many PPD women can benefit from low doses of estrogen bio-identical HRT if indicated and the potential benefits outweigh the risks. Progesterone: Bio-identical progesterone has an effect anti-depressant/anti-anxiety known. During pregnancy, the placenta produces large amounts of progesterone, increasing levels often blood levels before pregnancy. Post-partum, this resource has suddenly gone, along with its soothing effects on the nervous system of the mother. bio-identical progesterone can be very useful for women with PPD with anxiety and insomnia. Using PharmaGABA and progesterone bio-identical at the same time often very useful to relieve anxiety and sleep problems. DHEA: DHEA increases the activity of serotonin neurons. (51) also DHEA increases dopamine and norepinephrine synthesis via tyrosine hydroxylase mRNA. (52) Because of this, DHEA may be useful in some forms of PPD. DHEA inhibits GABA and thus an antagonist of GABA. (53) Clinically, if the use of DHEA causes insomnia and irritability, it's likely that the patient is poor and that GABA must be addressed before proceeding to complete the DHEA. Testosterone: increased firing of raphe serotonergic neurons in the area, increasing mood. (54) Mitochondrial function of Lab-Ion Metametrix Group Brochure inefficient mitochondrial function may limit the production of ATP, the less energy and contribute to the physiological cause or depression. More 90% of total cellular oxygen consumption is used as fuel for mitochondrial metabolism. Mitochondria must transfer a large number of electrons to produce energy. Mitochondrial dysfunction can affect all organ systems, including neurons and glands. Dietary fats, carbohydrates and proteins all must be converted into acetyl coenzyme A (acetyl CoA) before entering the Krebs cycle and electron transport chain. Nutritional precursors for fatty acid 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, alpha-lipoic acid required for carbohydrates and proteins to enter the Krebs cycle in mitochondria. Within the Krebs cycle, cysteine and iron are necessary to convert cis-aconitate to isocitrate. Niacin, magnesium and manganese are required to convert isocitrate into alpha-ketoglutarate. The amino acids glutamine, histidine, arginine, glycine and proline are necessary to form alpha-ketoglutarate. Thiamine, riboflavin, niacin, pantothenic acid, acid and alpha lipoic acid are required to convert alpha-ketoglutarate to succinyl-CoA. The amino acids isoleucine, valine, methionine, and are required to form succinyl-CoA. Magnesium is required to convert succinyl-CoA to succinate. Riboflavin is needed to convert succinate to fumarate. The amino acids tyrosine and phenylalanine are required to form fumarate. Niacin is needed to convert malate to oxaloacetate. All these nutrients are needed to produce 36 units of ATP per molecule of acetyl-CoA in the Krebs cycle. A deficiency important part of any of these essential nutrients can cause mitochondrial dysfunction and contribute to fatigue and depression. Niacin and coenzyme Q10 are required for oxidative phosphorylation (electron transport chain, ETC.) Normally, the ETC produces another 3 units of ATP in mitochondria, in addition to the Krebs cycle 36. A deficiency in any of these can also reduce ATP production and contribute to a physiological depression. Mitochondrial dysfunction is often overlooked in the treatment of PPD. A study of postpartum women showed that a comprehensive program of post-natal nutrients, including many of the cycle Krebs / nutrients oxidative phosphorylation, relieved symptoms postpartum including many of mild to moderate PPD. Liver Detoxification NUTRITION: A Functional Approach-Jeffrey Bland, Ph.D For many centuries, Chinese medicine is dysfunction related to the liver meridian anger, irritability and depression. From this perspective, repressed anger often leads to depression. Concepts such as increased heat Liver and Liver Qi stagnation is used to describe how defective liver function can dramatically alter the meridian of emotional states. When the flow of electrons within a meridian is up or down-regulated, the person in charge of organs through this meridian will become dis-eased. Many professionals Chinese medicine are taught to consider the liver the seat "emotional body" because of this strong correlation of liver dysfunction with emotions negative. In the East the term "hot liver" is used to describe someone who has anger problems. The use of English depressed "for describe one who is irritable. From the standpoint of Western medicine, most physicians are aware of how a first alcoholic liver cirrhosis can cause irritability and finally depression. In the last two decades much more information has surfaced in connection with phase one and phase two liver detoxification pathways. These pathways contribute greatly to the body's ability to excrete toxic exogenous and endogenous chemicals. Environmental toxin levels (xenobiotics) are ever increasing and requires that the liver plays an important role in their excretion. Added to this burden of detoxification are the internal production of stress hormones more and other body chemicals requiring excretion. All these chemicals require that the liver has the proper nutrients to facilitate their excretion. The first phase consists of liver detoxification of oxidation, reduction, or hydrolysis. The cytochrome P450 mixed function oxidases to make the most important function beginning of detoxification of 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, carotene, vitamin C, bioflavonoids, flavonoids, vitamin E, selenium, copper, zinc, manganese, CoQ10, and nutrient content in thiols, Pycnogenol, and silymarin. Phase II involves the liver detoxification pathways of conjugation in hepatocytes. Amino conjugation acid (Binding) of toxins requires glycine, taurine, glutamine, ornithine and arginine. Sulfation requires amino acids containing sulfur or elemental sulfur. The sulfation is necessary to break down and combined estrogen, DHEA, thyroxine, cortisol, catecholamines, melatonin, ethanol, bile acids, tyramine, cholecystekinin, cerebrosides and others. Glucuronidation requires magnesium and B6 to break down estrogen, 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. conjugation glutathione helps detoxify heavy metals and numerous xenobiotics. Glutathione requires glutamate, glycine, cysteine and N-acetyl-o-cysteine plus selenium and vitamin C for their formation. Acetylation, another detoxification pathway, requires B2, B5, molybdenum, and vitamin C to make your turns function.Sulfoxidation toxic sulfite to sulfate molecules usable. Mothers in the U.S. have a high toxic load as evidenced by the levels of toxins in breast milk. (55) If the liver is overloaded and unable to perform its many tasks of detoxification, this may contribute to PPD. Omega-3 deficiencies fatty acid and PPD A deficiency of omega-3 fatty acids have been linked with depression. (56-59) Numerous studies have demonstrated the efficacy of supplements fish oil depression. (60.61) The human brain is 60% fat. The quality of the fats that make the neurons significantly influence the function including cerebral moods. A relative deficiency of omega-3 fatty flexibility 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 the passage of molecules in and out of neurons. The brain is made and used more fatty acids than any body structure. DHA – Allport referred to as the "queen of fats (62) – is responsible for the fastest moving cells. As the primary structural fat and cognitive brain, DHA also affects mood. The brain of a developing fetus, nerves, eyes, skin and cell membranes require omega-3 oils, especially DHA. The placenta selectively eliminated omega-3 oils in the bloodstream of the mother through the placenta from mother often leaving significantly deficient in these essential oils. (63,64). The recommended dose of omega-3 fish oils in the treatment of PPD is 6-12 grams per day. Hypericum perforatum (St. John's wort): More than twenty-five double-blind studies have shown the herb herb San Juan to produce results as good or better compared with SSRI drugs with less side effects. (1965-1971) in Germany, where hypericum is a prescription drug and covered by insurance, more than 20 million taking this herb for depression. One of the benefits of taking St. John's wort is an increase of serotonin. (72) SAM (S-adenosylmethione): SAM is a methyl donor in the production of monamines, neurotransmitters and phospholipids such as phosphatidylserine and phosphatidylcholine. SAM serves as a precursor of glutathione, coenzyme A, cysteine, taurine and other essential compounds. SAM is involved in the conversion of methionine sulfur and it is important in the metabolism of homocysteine. Compared with other antidepressants, SAMe tend to work faster and more efficiently, practically no negative side effects. In fact, SAM has ancillary benefits, including improved cognition, slowing the aging process, improves function articulate and less pain, and liver protection. (73) Normally, the brain synthesizes the appropriate SAM on the amino acid methionine. To supplement SAM in depressed patients increases serotonin and dopamine levels, improves membrane fluidity and improves the binding of neurotransmitters to receptors (74,75). Numerous double-blind studies demonstrating the effectiveness of SAMe for depression. (76-78) The suggested dose of SAMe for the treatment of depression ranges 400-1600 mg daily. Inositol Depressed patients have lower levels of brain inositol. (79) Inositol is helpful to maintain healthy serotonin metabolism, and in so doing helps treat many conditions such as depression, agoraphobia, panic disorder (80-82), and obsessive compulsive disorder (83). L-theanine L-theanine is known to increase GABA levels and has an anti-anxiety, and improve cognitive function. (88) L-theanine may also normalize the levels of dopamine, which are often depleted by various stresses. (89) L-theanine significantly reverses toxicity induced by glutamate. (90) The integration of high quality, high potency prenatal and postnatal Systems Nutrients in Prevention and Treatment of postpartum depression and anxiety Clinically, it is imperative that higher quality, greater power, plus a comprehensive prenatal postnatal nutrient systems for use in the treatment and prevention of postpartum depression. It is common knowledge in many 3rd world countries that the recovery period after birth is 24 months since this is the amount of time that women told to wait between pregnancies and to replenish their bodies and prevent many health problems after childbirth. These women have more support from the community and extended family also significantly reduces the incidence of PPD. Most prenatal vitamin supplements are not sufficient to fully supply baby development and the mother with the power and quality of nutrients needed to nourish the pregnancy and the postpartum period. These nutrients are highly dependent process. After Baby Boost contains high potency vitamins and minerals including CoQ10, alpha lipoic acid, 2 grams of fish oils with three antioxidants to prevent rancidity, night and minerals (calcium and magnesium citrate). The placebo used was a prenatal vitamin leader. After a decisive impetus to the infant exceeded prenatal vitamins in all 14 categories of symptoms, indicating that the majority of postpartum women require more comprehensive, more powerful replacement of nutrients that provide prenatal vitamins. (91) Obstetricians seldom emphasize the importance of a high quality, nutrient dense diet. Neither prescribing high quality prenatal vitamins. Women often say, "You're eating for two now, so eat whatever you want." Currently, only 300 Additional calories are needed per day during pregnancy. It is important that these calories are rich in nutrients. Unrestricted carbohydrate consumption contributes to obesity and may contribute to metabolic diseases such as depression and even physiological, diabetes in pregnancy. PPD Integrative Treatment It is hoped that the reader becomes more aware of this simple concept: The body of a baby is exclusively composed of nutrients donated by her mother's body. Due that all physiological processes and chemicals (neurotransmitters, hormones, metabolic pathways, etc.) are responsible nutrients, nutritional deficiencies often may be the root cause of PPD. While antidepressant medications are necessary for some, the long-term solution often requires a well thought-inclusive approach out including (a) the replacement of nutritional reserves through dietary supplements, (2) psychotherapy and / or delivery / PTSD and EMDR therapy, (3) sleep enough (often very difficult with a child again), (4) moderate exercise, (5) deep abdominal breathing or meditation, (6) community support, (6) a diet of nutrient density, and (7) pharmacological treatment as necessary REFERENCES 1. Gaynes BN, Gavin N, S Meltzer-Brady, et al. "Perinatal depression: prevalence, screening accuracy, and the results of the evaluation" Agency for Healthcare Research and Quality, U.S. Department Health and Human Services, Rockville, MD: AHRQ Publication # 05-E006-2, February 2005. 2. 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Fux "Inositol treatment of obsessive-compulsive disorder," Am J Psychiatry 153 (9): 1219-1221. 84. Colodny L, Hoffman RL. "The Inositol-clinical applications for exogenous use", Altern Med Rev 1998; 3 (6) :432-47. 85. Levine J, et al. "Double-blind, controlled of inositol treatment of depression," Am J Psychiatry 1995; 152 (5) :792-794. 86. J. Levine "Controlled trials of inositol in psychiatry," Eur Neuropsychopharmacol 1997, 7 (2) :147-55. 87. Levine J, et al. "The combination of inositol and reuptake inhibitors of serotonin in the treatment of depression. "Biol Psychiatry 1999, 45 (3): 270-273. 88. Nathan PJ, et al. "The neuropharmacology of L-theanine (N-ethyl-L-glutamine): a possible neuroprotective and cognitive enhancing agent," Journal of Herbal Pharmacotherapy Innovations in Clinical and Applied Evidence-Based Herbal Medicinal 2006, 6 (2). 89. R. Mason "200 mg of Zen; waves L-theanine increases alpha promotes relaxation of alert, "Alternative and Complementary Therapies 2001 April 7:91-95. 90. Nagasawa K, et al. "Possible involvement of the group I mGluRs in neuroprotective effect of theanine, "Biochem Biophys Res Commun. July 16, 2004, 320 (1) :116-22. 91. Blum J et al. "A clinical trial randomized double-blind investigation fourteen symptoms postpartum After Baby Boost compare comprehensive system of postnatal nutrition leads a prenatal vitamin vs. a placebo. " About the Author Dr. Dean Raffelock D.C., L. Ac., CCN, DACBN, DIBAK has been a clinical nutritionist since 1977. He is Vice President of Research and Development for www.soundformulas.com , a nutritional company dedicated to helping pregnant and postpartum women receive optimal nutrition before, during, and after giving birth. He is the formulator of After Baby Boost™ the world’s first and only clinically tested comprehensive, postnatal 3 bottle nutrient designed to help new mothers fully replenish the nutrients donated to form their baby’s body. He is also the formulator of Before Baby Boost™, the world’s first truly comprehensive 3 bottle prenatal vitamin system. He is the lead author of the book A Natural Guide to Pregnancy and Postpartum Health (Avery, 2003). He is President of Sound Formulations, LLC-a consulting company that formulates and manufactures nutritional products for numerous nutriceutical companies. Dr. Raffelock has a multi-disciplinary practice in Boulder, Colorado and may be reached at DrDeanR@soundformulas.com , Soundformulations@gmail.com.
Hyla Cass, M.D. is a board-certified psychiatrist, former Assistant Clinical Professor of Psychiatry at UCLA School of Medicine, and author of several books, including Natural Highs, 8 Weeks to Vibrant Health, and Supplement Your Prescription. A member of the Medical Advisory Board of the Health Sciences Institute and Taste for Life Magazine, she is also Associate Editor of Total Health and served on the board of California Citizens for Health. Dr. Cass has also served as president of Vitamin Relief USA (www.vrusa.org). She has a clinical practice of integrative medicine and psychiatry in Pacific Palisades, CA. For more information, see her website: www.drcass.com. Alpha Rev – Colder Months
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