BLOG No. TWENTY EIGHT

Welcome back to my blog on anxiety and depression. Today I want to discuss something we have yet to discuss, postpartum depression.

Postpartum depression occurs when hormone levels drop drastically after childbirth. The main culprit is plunging estrogen, but thyroid hormones can also play a role. The sudden change in these hormones can shock the body 10 times more than seeing your grandparents having sex.

And as we have learned in previous blogs, shocks to the body—be it mental or physical—can awaken certain genes, especially anxiety and depression. Of course, not every mother that delivers a baby has postpartum depression. Though about 70% of women get the “baby blues” (emotional changes that last less than two weeks) approximately one in seven women will experience true postpartum depression. This can come on for up to a year after her baby’s birth.

Across the different races (oh my God he used the “R” word!) two things stand out: American Indians have the highest rate of postpartum depression and Asians have the lowest rate. In fact the rate of Asian mothers is less than half of that of American Indians. Does that mean that Asian mothers are tougher than the American Indian mothers? Of course not.

But interestingly, the prevalence of alcoholism in American Indians is twice that of Asians.

And we have learned in previous blogs that alcoholism and D2 dopamine go hand in hand.

So could D2 dopamine have something to do with postpartum depression and anxiety? I believe so. In fact I know so.

(Because there is nothing funny about postpartum depression, I will veer off course for my joke)

A lady goes to her gynecologist. He asks her what kind of problem she is having. She replies, “I have all these postage stamps from Costa Rica in my vagina.” He takes a look and then stands up.

“Those aren’t postage stamps,” he begins. “They are stickers from bananas.”

I remember the first time ever hearing that having a history of postpartum depression was a clinical clue to later diagnosing bipolar disorder. I was attending an educational meeting with a pharmaceutical company, training to lecture family practice providers on recognizing bipolar disorder. One of the greatest minds in psychiatry was giving his lecture on that very subject.

He began to list some of the pertinent facts regarding personal medical and family history that might help make a diagnosis of bipolar disorder.

I about fell out of my chair when he mentioned postpartum depression. Now, does that mean postpartum depression patients are bipolar? Of course not! My experience is that postpartum depression has a strong D2 dopamine component to it and treating only with SSRIs is not going to pull the patient out of the pits of hell.

And of course, the D2 symptoms include being quick to anger, insomnia (made it worse buy a crying baby), racing thoughts, fluctuating mood, and a few others that we have talked about in previous blogs. It should be noted that postpartum depression can even lead to postpartum OCD, postpartum bipolar, and postpartum psychosis. (Please see D2 dopamine medications in the above blogs).

Well I will wrap up on this note: during these troubling times (Covid 19) I tell my patients, “Achieving inner peace is as simple as finishing things you have started.” I guess I should take my own advice and finish off this bottle of Chardonnay. Until next time we talk about more clinical cases, this is Dr. G saying, “Keep the faith”.