Post Partum Depression Breakthrough

Many women will say that being pregnant was the 'best they felt'. Women will quote that they had a 'feeling as great as after a run, or a rush of good news." It is that soaring endorphin feeling that can be duplicated in some people by food, and others by other strategies that are not necessarily as healthily. Gynecologists are likely to say this is due to hormonal effects of pregnancy on the brain. Psychologists might argue that the effects are due to the fulfillment feelings that one has when being pregnant. There is no doubt there is actually a wide range of feelings among women, but one thing seems to be a constant. That is that certain hormone levels, made only when a woman is pregnant, will rise. Taking advantabe of this a group at University of North Carolina (UNC) at Chapel Hill and director of the Perinatal Psychiatry Program at the UNC Center for Women's Mood Disorders has begun using allopregnanolone, a metabolite of progesterone, in which" dosing replicates soaring levels of the hormone that occur during the height of pregnancy, appears to lead to rapid improvement of symptoms of severe postpartum depression", as reported at The findings were presented here at the American Society of Clinical Pharmacology (ASCP) 2017 Annual Meeting.


Results of an open-label phase 2 study show that following 60-hour intravenous administration of the new and still experimental drug, known as brexanolone, the majority of patients experienced significant improvement in depressive symptoms. The improvement began at 24 hours and was sustained at 30 days.
"The rapid onset of response, the robust treatment effect size and durability of the response we are seeing with this treatment are quite different from anything else available for postpartum depression," said Samantha Meltzer-Brody, MD, MPH, an associate professor in the Department of Psychiatry at the

Baby Blues is Not Post Partum Depression

The "baby blues" usually begins right after delivery, may be the worst in the first days at home with baby, and are often described as feeling a bit on edge, irritable or sad, and essentially go away without treatment. Postpartum depression is significant, you worry too much about the baby, have trouble concentrating and enjoying motherhood and may even get so difficult moms with this much depression think of killing themselves so they will not harm the baby. It is essentially clinical depression that will respond to the treatments we use for depression during pregnancy, and many of the medications are safe during breastfeeding as well. It is unfortunately very common, some studies say 1/5 women can experience postpartum depression.Actual postpartum psychosis is very rare and very serious. It can be difficult to diagnose. Poor sleep, mood swings and temporary improvement make it harder to diagnose. Thinking can become so disordered if not treated these patients may harm their infant. Essentially recovering post delivery means taking care of your inner self as well as your physical self, and it's definitely a topic to gab with your gyno about. 

Diagnosis is Not Necessarily Complicated

Women can be stressed and tired without being depressed after having a baby, but baby blues, postpartum depression, and postpartum psychosis are three diagnoses that may need serious attention from your health care provider to get a formal definition. Essentially, without belaboring the point, it is being depressed, after you have your baby. American Psychiatric Association: Diagnostic and statistical manual of mental disorders (DSM-5) classifies and defines disorders. Obstetricians are trained to screen for Post partum Depression. However, DSM-5 does not recognize postpartum depression as a separate diagnosis; rather, patients must meet the criteria for a major depressive episode and the criteria for the peripartum-onset specifier. The definition is therefore a major depressive episode with an onset in pregnancy or within 4 weeks of delivery.The DSM-5 criteria for a major depressive episode are as follows:
a) Five or more out of 9 symptoms (including at least one of depressed mood and loss of interest or pleasure) in the same 2-week period. Each of these symptoms represents a change from previous functioning, and needs to be present nearly every day. In the post partum period many risk factors come together, and regardless of the formal definition, it's critically important to get treated.

This was covered in the press a couple of years ago and hasn't changed much.  NYT article notes that these feeling actually begin in pregnancy, not just post partum. And not just for women who have had poor outcomes in pregnancy such as miscarriage or stillbirth. Oddly the current formal categories of psychiatric diagnosis do not recognize postpartum depression as being anything other than depression.

Nutrition is Helpful 

 

Rapid, Sustained Improvement

In preclinical animal studies, allopregnanolone, an endogenous neuroactive steroid, has been associated with rapid behavioral changes. Following childbirth, levels of allopregnanolone plummet, leading to speculation that it plays a role in postpartum depression. To test the theory, the dose of brexanolone, an injectable agent, was designed to mimic the levels of exposure to allopregnanolone that are typical in the third trimester of pregnancy. And they found this medication worked very well, and may actually represent a breakthrough in therapy.

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