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469098080Both postpartum blues (PPB) and then the more significant postpartum depression (PPD) occur within the first days-12 months postpartum. In women who have a more severe version of PPB, they are at about a 23% risk of PPD vs. those without severe PPB who have a 6% risk of PPD. PPB affects about 75% of women during the postpartum days 4-6 and typically peaks on day 5 and then resolves within about 10 days. Most of the definitions and criteria of PPD describe an occurrence within the first 1-12 months postpartum and with an overall occurrence of 13%. This peak of PPB on day 5 is hormonally related to the several hundredfold drop in estrogens and the fiftyfold decline in progesterone levels. Another change that is implicated in PPD is the elevation in monoamine oxidase A (MAO-A) levels, which is likely related to the decline in the estrogens and the inverse relationship between the two. Other possible mechanisms include reductions in GABA levels and increased serotonin transporter levels. MAO-A levels are associated with major depressive disorders, depression mood states and higher risk for depressive disorders.

Prevention strategies seem to be an ideal approach given that severe PPB increases the onset of PPD. The current study focused on a nutritional supplement program to address at least one component of the neurobiology of PPB, and the hypothesis that a dietary supplement would counter the elevation in MAO-A levels and thus make a woman less vulnerable to PPB.

A dietary supplementation program was given that included 2 gm/day of tryptophan, 10 gm/day of tyrosine blueberry juice and blueberry extract. Tryptophan was given in the evening of postpartum day 4 and tyrosine was given the morning of day 5. The blueberry extract powder was given in sachets containing 1 gm of powder and was added to the blueberry juice. Blueberry juice was packaged in 280 mL bottles. It is not clear from the paper, how may days or which days the blueberry was given.

Tryptophan and tyrosine are monoamine precursor amino acids and the blueberry juice was included due to anti-oxidant effects. One group (n=21) received the dietary supplement and the control group (n-20) received no supplement.

Results: The severity of PPB was based on the elevation in depressed mood following a protocol to induce sad mood. There was a significant induction of depressed mood in the control group and no effect in the supplement group resulting in the conclusion that the supplement countered the elevation of MAO-A activity immediately postpartum and made the women less vulnerable to depressed mood during the peak of PPB.

Commentary: The combination of the tryptophan/tyrosine/blueberry extract with blueberry juice almost completely eliminated the vulnerability to depressed mood during the peak period of PPB at an effect size of 2.9 which is about a tenfold greater effect than for other interventions I am familiar with.

Most practitioners may not be experienced with using doses of tryptophan and tyrosine that are this high, especially postpartum. But remember, these doses were each given only once. In addition to that, these specific doses had been previously shown to significantly elevate free tryptophan and free tyrosine in plasma, to be well tolerated, and not to increase total tryptophan and total tyrosine in breast milk. If a pregnant and now postpartum woman is on prescription anti-depressants, I cannot vouch for the safety of this protocol, although hopefully, she would not need it because her depression was being well managed already. The benefits vs. risks of prescription anti-depressants during pregnancy and lactation is another topic, that should be studied and evaluated closely with careful decision making and optimal integrative holistic health care.

Reference: Dowlati Y, Ravindran A, Segal Z, et al. Selective dietary supplementation in early postpartum is associated with high resilience against depressed mood. PNAS.org Feb 2017

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