Article published June 28, 2001

Regional News
Postpartum misery tied to crash in hormone levels

BY JENNI LAIDMAN
BLADE SCIENCE WRITER

Two to four weeks after the baby arrives, Mom goes cold turkey.

For 10 to 15 percent of all new mothers, the withdrawal pains are enormous. What follows is full-scale depression. The deeply desired baby becomes a source of anxiety, an overwhelming burden. Insomnia plagues her. Hopelessness colors the days.

Chances are, the new mother didn’t even know her brain had grown accustomed to the rising tide of pregnancy hormones. But when the flood of estrogen and progesterone that made her body baby-ready ended abruptly, she found out. The hard way.

Laura Allegoet came crashing down not long after her twins were born 41/2 years ago.

"There was probably a period of a couple weeks where I couldn’t even touch the kids. It wasn’t that I thought it was going to hurt them. I just couldn’t touch them.’’ The only person the Brighton, Mich., woman thought about hurting was herself.

For one-tenth of 1 percent of all women - one or two in 1,000 - the hormonal crash that follows delivery will turn into something even worse, postpartum psychosis - the chief suspect in the case last week of a Houston woman who allegedly killed her five children. Experts say such psychotic episodes are rare, and occur in women at risk for what psychiatrist call "bipolar disorders" - yesterday’s manic-depressive illness.

But postpartum depression is a separate disorder, frequently undiagnosed, with potentially severe consequences for the mother and her child.

Both illnesses have their roots in the chemistry of the brain.

Dr. Sheila Marcus, a psychology professor and clinician at the University of Michigan Medical School, said the key culprits in postpartum depression are the usual suspects in any depression: serotonin, norepinephrine, and dopamine.

"Those are the three neurochemicals most implicated in depressive disorders. The reason they are effected postpartum, we think, is that estrogen and progesterone come crashing down from levels one-thousandfold of normal,’’ she said.

"Something about the rapidly changing hormonal milieu, sleep deprivation, and a family or personal history of depression can lead to postpartum depression,’’ Dr. Marcus said.

The neurochemical suspects in depression are among the brain’s messenger molecules. Between neurons are gaps where signals are sent and received. When one neuron squirts serotonin into the gap, it can signal the next neuron to fire or stop firing. When serotonin is in short supply, for example, depression can result.

Estrogen and progesterone don’t carry messages. Yet it’s clear they have a say in mood, perhaps modulating the effects of the main players.

"We know hormones literally go everywhere in the body. We have receptors [where hormones can interact with cells] for hormones everywhere in the body, including the brain,’’ said Dr. Katherine L. Wisner, a professor of psychiatry at the University of Louisville in Kentucky.

A study conducted in 1995 demonstrated a cause-and-effect connection between the decline of pregnancy hormones and postpartum depression, Dr. Wisner said. Nonpregnant women were put on a hormone regimen that mimicked pregnancy. Women with a previous history of postpartum depression grew depressed when the artificial pregnancy was ended by hormonal removal.

"We actually don’t fully understand it,’’ Dr. Marcus said. "Interestingly, before girls start menstruating at the age of 12, and after they are finished at menopause, the depression playing field is sort of level,’’ she said. That is, males and females are equally subject to depression. During the years of menses, depression disproportionately troubles women.

Mrs. Allegoet’s depression took her completely by surprise.

"We thought it was baby blues,’’ she said. "I wasn’t sleeping. I’d be exhausted, but I wasn’t sleeping. I had real high anxiety. We thought it was just, ‘Oh, you’re overwhelmed, you have twins,’’’ she said.

Suicidal thoughts finally drove her to tell her obstetrician about her distress. He referred her to a counselor who specializes in postpartum depression. She was hospitalized for three days and put on antidepressants and, for a short time, anti-anxiety medication.

"I would say it took me a good four weeks after that until I was pretty much having good days most of the time,’’ she said.

Some scientists believe postpartum depression could be a remnant of our evolutionary past.

Dr. Edward Hagen, a post-doctoral researcher at Institute for Theoretical Biology in Berlin, Germany, said during human’s long history as hunter-gatherers, the high cost of caring for a new baby was weighed against the availability of food, the health of the mother, the health of the infant, and the toll an additional child would take on existing children.

In that kind of calculus, mothers sometimes opted to neglect, abandon, or kill their children, he said.

Dr. Hagen said high rates of infanticide in traditional cultures testify to this. When the demands of food gathering add to the strain of lactation, with its high caloric requirements, infanticide can be a solution.

This is the heritage that shaped us, he said.

"Our psychology was built to deal with the circumstances that human mothers faced over evolutionary time. If mothers are getting cues that circumstances are not propitious for a new child, she may experience very negative feelings,’’ he said.

Dr. Hagen notes that one of the biggest predictors of postpartum depression is lack of social support, he said.

Indeed, experts see the highest levels of postpartum depression among single mothers.

"We’ve looked at 3,500 women during pregnancy and postpartum, and the demographic that showed up most was lack of social or marital support. Single women had more of a problem,’’ Dr. Marcus said.

Other factors in postpartum depression included a history of psychosocial problems, poor health, a family or personal history of postpartum depression, and alcohol use during pregnancy.

Mrs. Allegoet and her husband Steve were living far from family when she had her twins. But her mother and mother-in-law pitched in when depression hit. Still, she was back in Michigan when her youngest was born two years ago. This time, though, she was prepared for the depression, taking an anti-depressant during pregnancy, and increasing the dose when her mood finally faltered.

"Fortunately my family was very supportive,’’ she said. "But I think it was hard for most people to understand. Having always wanted to have children, and being so excited, it was just a shocker to have this happen. You just don’t expect it.’’