Is Postpartum Depression an Estrogen Receptor issue?
I recently had Sunita Iyer, ND, LM on my podcast where we talked about Postpartum Depression (PPD). I will summarize some highlights from the podcast
Dr. Iyer practices at Eastside Natural Medicine in Kenmore ,Washington and is a Licensed Midwife and Naturopathic Physician. She is also on faculty in the school of nursing at The University of Washington. I often refer to her and her clinic for pediatric natural medicine care and issues related to the pregnancy process. I am also blessed to share an office space with a gifted fertility focused- East Asian Medical practitioner and acupuncturist Kaira Jorgensen, EAMP, LaC. Between the two of them, I have seen well-supported new parents and babies.
During the podcast, we talked at length how postpartum depression presents differently then classic depression. It presents more as a combination of anxiety, hypervigilance, overwhelm, sadness, and shame rather then a classic depressive episode. She believes that women susceptible to postpartum depression may be experiencing a type of grief or loss ; and framing it this way may lead to a better understanding of the process.
Postpartum depression (PPD) is different then the "baby blues". The latter is a present in 80% of mothers and usually comes on in the first 48 hours after giving birth and soon dissipates. Whereas PPD occurs in up to 11% of mothers and usually lasts many months to years after giving birth. It also can occur in 2% of fathers (we talk about this in the podcast).
PPD was first mentioned in the the March 12, 1955 issue of the British Medical Journal where A.B. Hegarty described postpartum depression as post-puerperal depression. Depression that arises in moms after 6 weeks of giving birth. Then and now, it was thought to be due to the sudden hormone shifts that take place after pregnancy. And more recently this has pointed to the role of estrogen receptor-alpha in PPD.
There are many factors that we dive into during the podcast such as socioeconomic status, babies health, sleep disruption, and familial support. However this article looks at reasons why someone might get PPD under similar circumstances while another person might not.
A recent study showed that genetic DNA methylation biomarkers related to Estradiol sensitivity. TTC9B and HP1BP3 in women with previous mood disorders who became pregnant predicted with 85 percent certainty which women would get PPD. This got me thinking and digging a little deeper.
After pregnancy estrogen is quite low and takes a while to recover. The subtype of estrogen called estradiol has many actions on the brain.
When estradiol (e2) binds to Estrogen-alpha receptors in the brain it acts on dopamine receptors, increases anti-anxiety hormones like GABA and reduces brain inflammation. Estradiol binding also promotes learning and neuroplasticity through its ability to increase Brain Derived Neurotrophic Factor (BDNF). It turns out that the mutations in TTC9B and HP1BP3 are linked to decrease sensitivity to estrogen at the estrogen-alpha receptor level.
So person A and B may have the same low level estrogen; yet the person with decreased receptor function may have worse anxiety, worse mood, and overall poorer executive function. This may be a key link.
It's important for all patients who are in the perinatal period to have an assessment for nutrient status and have key strategies to help with brain inflammation and hormonal balance. No wonder fish oil, healthy thyroid function, healthy iron levels, vitamin D status, and B-vitamin status are so important for the perinatal period.
I use a test like the Nutraeval by Genova to assess for nutrient status, yet before diving into advanced testing new moms should follow up with their ob-gyn, midwife, or pcp to have general blood work done that covers Iron status and Thyroid status. I would suggest having this testing done as soon as possible after child delivery and also each mom should be screened for PPD using the Edinburgh Postnatal Depression questionnaire.
New mom's should not be ashamed or feel guilty about having these feelings. It doesn't mean you are ungrateful or unappreciative of your child; it might mean that your brain doesn't have enough support to deal with a major physiologic shift.