My grandmother died at the age of 61 of complications from postpartum depression.
Upon her death in 1981, my grandmother looked like an elderly woman on the outside. On the inside, her cardiologist said she had the heart of an 80-year-old. I was 12 years old at the time and far too young and inexperienced to realize that her death was rooted in those postpartum days in which she struggled to care for my mother and uncles. Unfortunately, my own experience some 25 years later would allow me to evaluate her life and her death and conclude that she died of complications from early motherhood.
My grandmother had three children and four pregnancies in 6 years and, from all reports, she had a very difficult time coping as a mother. She was exhausted and overwhelmed by motherhood on her best days. On one of her worst days, neighbors observed driving her car on the sidewalk instead of the street, with my young uncle as a passenger. She was institutionalized immediately, as she was one other time. Her doctors gave her what my granddad colorfully termed her I-don’t-give-a-shit pills. When those pills were not sufficient, she was given shock therapy treatments. Shock therapy allowed her to re-enter society and function at a basic level until her next mental breakdown.
What my grandmother did not realize is that shock therapy was effective in part because it changed her brain levels of some key minerals. In 2004 Polish researchers found that shock therapy increases the brain levels of zinc in rats. Low levels of zinc in the brain are associated with depression (Maes 1994; Nowak et al 2005). Likewise, low levels of magnesium in the cerebral-spinal fluid predict suicidal tendencies (Singewald et al. 2004; Banki et al. 1985). People who suffer from depression are also more likely to be deficient in vitamin B-6, vitamin B-12, and folic acid than is the population at large (Hvas et al. 2004; Coppen and Bolander-Gouaille 2005; Fava et al. 1997; Bottinglieri 1990). Shock therapy helped my grandmother function in part because it changed her brain chemistry. While it temporarily changed the mineral levels in her brain, shock therapy did not fix the nutritional deficiencies that caused the depression in the first place.
With the cause of her postpartum depression untreated, my grandmother continued through life developing other degenerative diseases. She developed diabetes and a heart condition, both exacerbated by deficiencies in zinc, magnesium, and B vitamins according to current medical knowledge. Had she treated the cause of her postpartum depression she might still be alive today and, like her husband of those many years who is still alive some 30 years later in the 9th decade of his life, she may have spent many of those years golfing and engaging in other well-deserved recreation.
Women do, indeed, give up a great deal for their children.
We inherit the nutritional stores of our mothers and my mother inherited postpartum depression from my grandmother. As our babies grow inutero they receive our nutrition preferentially, so my mom was first in line for all of the nutrition that my grandmother ingested from sticky buns, canned meat, and canned green beans.
My mother’s nutritional inheritance was not all that she could have hoped for.
My mom’s depression began in her second pregnancy – her pregnancy with me. Her body was taxed with the job of creating a baby and it was beginning to shut down some of its functions. In the late 1960s postpartum depression still did not have a name; my mom just knew that she could not function in her fatigue and poor mental state. She read an article in which the author speculated on whether a large percentage of head-on collisions with semi-trucks were actually suicides. My mom felt suicidal and began to worry that she would be led by her own illness to drive head-on into a semi truck while my sister and I were in the car. Obsessive thoughts of jeopardizing our safety invaded her head in the typical postpartum fashion. She solved the problem by refusing to drive us anywhere.
By two years postpartum, my mother developed a debilitating case of arthritis. She happened upon an article with a diet for arthritis and the diet alleviated her joints. That nutrient-rich diet also helped improve her mental state, likely because the same problem that caused the depression continued unchecked and led to arthritic pain. She was lucky to have found that article which inadvertently improved her depression. She continued on a whole foods diet over the decades and has now outlived her mother by nine years and is a youthful-looking woman about to turn 70. But her change of heart happened only after she had bequeathed her nutritional stores to me.
I became pregnant with my son at the age of 32. The fatigue began in the fifth week of my pregnancy accompanied by some depression symptoms. Major depression began in about the 25th week of my pregnancy. I struggled for two years in pregnancy and then postpartum attempting to avoid medication until I found an amino acid therapy that changed my life. My depression and fatigue disappeared in a miraculous fashion. And while that therapy helped me re-enter society and reach a higher level of functioning, it did not fix the cause of my depression.
Like my mother’s arthritis and my grandmother’s host of medical problems, I continued to feel run down. Inspired simply to feel normal again, I was determined to go back to the basics on my depression research and figure out what keys I had left out – what problem lingered that were still affecting me.
I had a big advantage over my mother and my grandmother in my inquiry. Some decades of research have not only identified the condition called postpartum depression, but since my mom’s struggle in the 1970s, there has been a great deal of medical research on the vitamin and mineral deficiencies that underlie depression. I reviewed the medical literature on depression and, in the process, I got a reality check on some of the common misconceptions that I held.
My recovery even made it possible for me to have a second baby with a depression-free pregnancy.
I can’t be deficient in B-vitamins because I take a B-vitamin supplement and have a good diet.
I took a prenatal vitamin for a year before I became pregnant and throughout breastfeeding. My doctor told me I had signs of B-vitamin deficiencies and, in my depressed state, I did not believe her. When she repeated her concern some two years later I said “Maybe I was deficient back when you mentioned this before, but I cannot be deficient now, my diet is exceptional now.” Of course, she was right and I was wrong.
One key reason I had the host of problems I did is that I was not absorbing my food well. In this case, a B-vitamin tablet or capsule is a poor choice because they can be difficult for your body to absorb. Liquid, sublingual, and nasal spray preparations are better over-the-counter choices. B-vitamin injections are the big guns for severe deficiencies. Any supplement with synthetic folic acid may be a bad choice.
Furthermore, most of us take B-vitamins as part of a multi-vitamin regimen. However, B-vitamins are best taken on an empty stomach whereas multi-vitamin supplements usually recommend that the capsule or tablet be taken with food. Thus the B-vitamin supplement practices that most of us follow may be inadequate for those of us who need it most.
And while we may have a healthy intake of B-vitamins in our diet, our body may need more still. B-vitamins are critical in making babies and milk for those babies, but beyond the nutritional demands of our children, our environment essentially depletes us of our B-vitamins everyday. The liver uses a host of nutrients, including B-6, B-12, and folic acid to detoxify and flush out the everyday toxins we ingest, inhale, or absorb each day (Yang and Yoo 1991; Campbell and Hayes 1974). If we face toxic overload, we also likely are using up more B-vitamins than we are ingesting.
Be diligent in adding B-vitamins to your diet. If need be, your doctor can do a plasma homocysteine test for deficiencies in B-12 and folic acid and a plasma P5P test for B-6.
I can’t be mineral deficient because my blood panel was normal.
The lab that my primary care provider uses has a host of blood work it can provide. To test mineral levels, the lab only provides red blood cell levels for magnesium and whole blood levels other minerals. The problem is that these tests are not adequate according to the medical literature.
A magnesium red blood cell count can have high false negative rates – your red blood cell count would look adequate even if your body is deficient in magnesium. A magnesium loading test or a blood ionic magnesium test are more accepted in the literature.
For other minerals, the red blood cell test (erythrocyte) is a reasonable test to reduce your chances of a false negative test. This test is available at Metametrix Clinical Laboratory, Genova Diagnostics, and Doctor’s Data.
Magnesium or zinc (or name your favorite mineral here) cannot be the cause of my depression because I tried a supplement and I was still depressed.
Researchers have known for decades that zinc deficiencies are correlated with depression and that increased zinc levels in the brain can improve the depressed state of the patient. However, zinc is not used as a therapy because it would take months for zinc levels in the brain to increase with a diet change or with supplementation (Frederickson 1989). Zinc therapy takes too long to use in acute states of depression. You might try a supplement but because it takes so long to be effective, it is hard to evaluate its effectiveness unless you have changed nothing else in your lifestyle. Blood work is a far more effective measure and it avoids the trial-and-error process and the possibilities with ending up toxic in some of these minerals.
Furthermore, not all forms of a mineral supplement are equal. Magnesium oxide is a form of magnesium that is cheap to produce, widely available in the marketplace, and one of the least effective forms you can take. Better choices for magnesium are magnesium citrate, malate, and glycinate. Amino-acid chelate forms of zinc are also good choices.
My Omega-3 intake is high – I eat fish and it’s in my multivitamin.
In the last trimester of pregnancy, babies need a great deal of DHA (an Omega-3 fatty acid) for their developing brain. Their needs for DHA continue while breastfeeding. If we do not have adequate DHA in our diet, our body will draw on our body stores for DHA. As we become depleted, depression sets in.
The problem with relying on dietary forms of Omega-3 fatty acids is that they are largely disappearing. Animals on their natural diets tend to have high levels of Omega-3s in their flesh because their natural diets are rich in Omega-3s. As they eat those Omega-3-rich foods, their bodies use the fat to build their cells, just as our bodies use them to build our own cells. But as cattle are fed corn and other such convenience foods, they lose their own dietary source of Omega-3s and, thus, have no Omega-3s to build the cells in their bodies. Not only are their bodies less healthy, their flesh is less healthy to consume. Fish would be a good source of Omega-3s if they were not polluted with mercury and the topic of government warnings for pregnant women.
Further, do not count on a multivitamin supplement to provide you with sufficient Omega-3s if you are depressed. In Andrew Stoll’s book on Omega-3s and depression The Omega Connection, Stoll suggests that four grams of EPA a day have been therapeutic for depression. Most studies of Omega-3s have focused on EPA rather than DHA, so it is doubly difficult to know exactly what dosage is most effective for postpartum women. Stoll reminds us that on their traditional diet, Intuits eat upwards of 15 grams of EPA a day even though research studies do not tend to use doses that high. Your Omega-3 capsule will have a small fraction of that amount.
Take a look at your favorite multi-vitamin and see if it has Omega-3 in it. If it does, it likely has a few hundred milligrams of EPA and you would have to take 12 or more doses a day to meet Stoll’s suggestion of 4 grams for depression. Don’t take those 12 doses a day of your multi-vitamin because you will be taking too much of some of the other ingredients. Find an Omega-3 supplement with higher dosage levels.
I cannot try nutrition therapy because I am on antidepressant medication.
In the medical literature, there are clinical trials where nutritional supplementation is used in conjunction with antidepressant therapy. Researchers are finding that nutritional therapy augments antidepressant therapy:
- Supplemental B-12 helps improve depression outcomes for patients on medication (Coppen and Bolander-Gouaille 2005).
- Medication is more effective taken with folic acid (Fava et al. 1997, Godfrey et al. 1990, Procter 1991)
- In a double-blind and placebo controlled study, patients felt better after 6 weeks if they were taking zinc supplements along with their medication (Nowak et al. 2003).
- Controlled trials of Omega-3 fatty acids combine antidepressant medication with Omega-3s for improved results (Su et al., 2003 Nemets et al. 2002; Peet et al. 2002).
Work with your doctor to determine your needs. Medication may get you through a rough patch and it may even save your life, but it will not fix the cause of your depression.
Medication may be your chosen survival tool for the short-term. Nutrition is a survival tool for the long-term.
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Amanda Rose, Ph.D., lives on five acres in the Sequoia National Forest with her two sons, the second of whom was born to a depression-free pregnancy. She works with her mother Jeanie on the Traditional Foods website providing nutritious recipes and food science and health tidbits.