Hope for ending new mothers’ postpartum depression

June 4, 2010

Jennifer Hunter


The nursing that makes your nipples feel as if they’ve been rubbed with sandpaper. The impossibility of finding time for a shower. The wailing each night that interrupts sleep. The struggles to keep the house in order.

For some new mothers, coping with these daily travails is overwhelming. The world becomes dark, very dark, as postpartum depression casts its shadow everywhere.

Catherine Connors had panic attacks even before her first child, Emilia, was born. When Connors was seven months pregnant, the racing of her heart began, along with the fears, the hesitations.

“I even had to abandon parenting classes because they began to spark my anxiety to danger levels,” recalls the former political philosophy teacher at the University of Toronto.

While still pregnant, Connors was referred to a psychiatrist and a nurse practitioner and was prescribed antidepressants, but she didn’t take them for fear of jeopardizing the baby’s health.

Then, after Emelia’s birth 4½ years ago, the depression continued. “I didn’t feel the glow of sunlight with my baby, being blessed-out as I was sitting and rocking her,” says Connors, 40. “I felt like I was supposed to love (her) more. I felt I was a bad mother because I wasn’t doing it right.

No, there wasn’t anything wrong with Connors’ character; she was not a bad mother. It’s just that she was suffering from postpartum depression.

Now, researchers at the Centre for Addiction and Mental Health have fingered a likely culprit — an enzyme that, like a feral Pac-Man, eats up the brain hormones that make us feel good: the serotonin, the dopamine, the norepinephrine.

Dr. Jeffrey Meyer, a psychiatrist who focuses on mood disorders and neurochemical imaging at CAMH (he’s also a professor at the University of Toronto), says that after a woman gives birth, her estrogen level drops dramatically — around 300 per cent. For three or four days, 70 per cent of new mothers get the postpartum blues.

Thirteen per cent of new moms feel bad for longer periods, experiencing sadness, irritability, change in appetite. Then it is called postpartum depression.

According to a paper by Meyer and his team published recently in Archives of General Psychiatry, the cause may be a brain enzyme called monoamine oxidase A (MAO-A). Levels of MAO-A increase dramatically when estrogen levels drop.

The brain researchers were able to isolate the enzyme through the brain-imaging technique positron emission tomography. They compared MAO-A levels in healthy women who were four to six days post partum and 15 age-matched healthy women who had not recently given birth. The new mothers’ levels were 43 per cent higher.

“We began this research as a practical way to prevent postpartum depression,” says Meyer, who believes dietary supplements might be able to restore the chemicals zapped by high MAO-A levels.

Meyer plans a clinical trial in the new year with 150 women to test how the addition of certain amino acids — tryptophan and tyrosine — to a new mother’s diet can help her avoid depression.

“These amino acids cross into the brain and become serotonin, norepinephrine and dopamine,” he explains. And thus they could impede the action of the MAO-A enzyme and keep a mother weathering the first few months of pregnancy depression-free.

Tanya Bruckmueller, 37, who works for Toronto Hydro, remembers a sense of melancholy after her first child, now 2½, was born. “We had three or four really big snowstorms after he was born and leaving the house got really rough. There were dark days and dark nights and I began to feel an overwhelming need to be in the shower by myself and cry.

“I always thought of myself as a strong woman and it was strange to feel like that. I remember my husband saying, ‘We read about this. It’s supposed to be fine.’ ”

Luckily, Bruckmueller’s postpartum blues it left her within a month, evaporating as the spring arrived and she was able to get out more.

Louann Brizendine, author of The Female Brain and a neuropsychiatrist at the University of California, says that a new mother’s brain is rebalancing hormones and that, combined with the stresses of moving into a new female role, can cause the blues. “It’s a whole new life and reality, so feeling rocked by the experience is understandable,” she writes. “Furthermore, postpartum depressive symptoms often remain hidden. Women are ashamed because they are expected to be so happy at the birth of their child.”

Some women are so vulnerable they suffer psychosis, hearing voices or having manic episodes. In 2000, a 37-year-old Toronto doctor, Suzanne Killinger-Johnson, who was being watched 24 hours a day because she suffered from severe postpartum depression, left her house with her 6-month-old son and jumped in front of a subway train (the baby died immediately and she died nine days later in hospital).

Dr. James Swain, a Canadian child psychiatrist who works at the University of Michigan, says some experts believe postpartum depression can affect “between 15 and 40 per cent” of new mothers. “If you have a history of previous depression or post-traumatic stress syndrome or suffer poverty or other kinds of problems,” a 13 per cent incidence is “an understatement.”

A number of physicians welcomed Meyer’s findings. Dr. Meir Steiner, professor emeritus of psychiatry, behavioural neurosciences and obstetrics and gynecology at McMaster University, says he has “great enthusiasm.” He notes that this discovery, along with his own prescription of trying to help at-risk new mothers obtain more sleep, could be the right duo for fighting the terrible pathology of postpartum depression.

Connors has learned that postpartum depression is not much talked about in books about pregnancy and childbirth. “It’s like a dirty secret we’ve put aside,” she says.

After Emelia’s birth, she gave up seeing the psychiatrist and the nurse practitioner. “It’s hard to go to a doctor when you’re feeling so sad,” she says. The depression lasted until Emelia was practically a year old.

Connors knew she might experience this with her second child, Jasper, now 2. And she did. “I am still struggling with it to some extent,” she says. “And I know when my depression is worst for me I am least likely to talk to someone about it.”

One day she found an outlet. Looking on the web for information about postpartum depression she read another woman’s blog and thought, “Wow, it’s another woman writing about it. Someone was saying what I was feeling.”

So Connors, who is an accomplished writer herself, decided to leave her job at U of T and post her own blog, the award-winning “Her Bad Mother.” She also contributes to several others.

Here is what she writes in an entry titled “And the Moon is the Only Light We See:”

“I’ve been struggling with depression. I’m always struggling with depression, in some respects, but it feels harder, these days. My husband asks me if I’m sad, and I tell him no, because depression is different from sadness, but there’s an element of it there.

“. . . I’m more vulnerable to depression when I’m tired. Most people are, I think. Just one reason why new moms are so vulnerable to it. So little sleep, so much stress — it’s a challenging combination…”