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  • Review

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    Licensee OA Publishing London 2013. Creative Commons Attribution Licence (CC-BY)

    F : Brogan K. Putting theory into preliminary practice: neuroin lammatory models of postpartum depression. OA Alternative Medicine 2013 May 01;1(2):12.

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    AbstractIntroductionUnderstanding of underlying risk, predisposing factors and effective treatments with high-safety pro ile for breastfeeding mothers with postpar-tum depression continues to evolve. As investigation into neuroin lamma-tory models of depression becomes more the focus of mainstream medi-cine, research into pathological patterns of immune adaptation in late pregnancy and postpartum has begun to emerge in the literature. Alternatives to medication are highly sought after by this patient popula-tion, and natural agents such as pro-biotics, melatonin and tryptophan, omega-3 fatty acids, folate, curcumin and behavioural interventions such as dietary modi ication, exercise, mindfulness meditation, and cranial electrical stimulation present appeal-ing considerations. In lammatory lifestyle factors, appropriate diagnos-tics and environmental modi ication are addressed. This article discusses neuroin lammatory models of post-partum depression.ConclusionAlthough exercise, relaxation response and targeted supplementa-tion of the postpartum patient with anti-in lammatory nutrients (such as turmeric, probiotics, folate, omega-3s and melatonin) have not been for-mally studied, they hold promise for low-risk, potentially high-yield inter-ventions of bene it to the mother and the infant.

    IntroductionAs with the rising incidence of mental illness and associated disability, post-partum depression rates continue to escalate, commanding the attention of providers who care for women of reproductive age. There is an urgent need to investigate the underlying con-tributors and aetiologies of postpar-tum depression, anxiety and psychosis and to create practice algorithms that guide clinicians in the process of rul-ing out alternative explanations for a patients postpartum psychiatric com-plaints and considering non-pharma-ceutical interventions. Treatment data on antidepressant, mood stabilizer, benzodiazepine and antipsychotic medications in lactating women and in the postpartum population gener-ally are lacking, as are longitudinal data. To support this exploration, this article will discuss current theories proclaiming in lammation as a driver of postpartum symptomatology, address proposed biomedical screen-ing for new-onset postpartum mood and anxiety symptoms and discuss as of yet theoretical applications of life-style changes and nutrients that could be applied to buffer in lammatory responses and considered as preven-tive strategies.

    DiscussionThe author has referenced some of its own studies in this review. These ref-erenced studies have been conducted in accordance with the Declaration of Helsinki (1964) and the protocols of these studies have been approved by the relevant ethics committees related to the institution in which they were performed. All human sub-jects in these referenced studies gave informed consent to participate in these studies.

    Beyond chemical imbalancesTodays pregnancies are not those of our ancestors. We have ever-in lating incidences of maternal and infant mortality and morbidity, par-ticularly in America. The changes in chronic illness in our paediatric population cannot be accounted for by Mendelian genetics, and we must look to our environment for its role in adverse epigenetic effects. Todays mother-to-be suffers from a toxic burden through everyday exposures, and there is reason to believe that these largely unstudied exposures are cumulative in their risk. Additives such as dyes and preservatives in pre-natal vitamins, metals and adjuvants in vaccines1 and industrial chemi-cal exposures through cosmetics, furniture, paints, cars, and pollution all bioaccumulate in the very top of the food chain, the foetus. These fac-tors conspire to modulate endocrine and immune responses while simul-taneously rendering the body less capable of managing and supporting metabolic processes of detoxi ication. This is known as oxidative stress, or the inability of the products of aero-bic respiration to be effectively neu-tralized by endogenous antioxidant agents prior to causing damage to cellular machinery and membranes.

    What are these toxins?Environmental toxic exposures include pesticides, most notably glyphosate; industrial chemicals such as polybrominated diphenyl ether (PDBE) lame retardants, pthalates, bisphenol A (BPA); neurotoxic met-als such as mercury and aluminium; and carcinogens such as dioxins. With 80,000 registered agents in the Toxic Substances Inventory, a mere 200 have been studied for human safety

    Putting theory into preliminary practice: neuroinfl ammatory models of postpartum depression

    K Brogan*

    *Corresponding authorEmail: drbrogan@kellybroganmd.com

    New York University/Bellevue Hospital Center, 280 Madison Avenue, Suite 702, New York, NY 10016, USA

  • Page 2 of 7

    Review

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    Licensee OA Publishing London 2013. Creative Commons Attribution Licence (CC-BY)

    F : Brogan K. Putting theory into preliminary practice: neuroin lammatory models of postpartum depression. OA Alternative Medicine 2013 May 01;1(2):12.

    parameters. An important case series supported by the Environmental Working Group and the Red Cross examined umbilical cords, identi-fying 287 toxic chemicals, 217 of which are known neurotoxins. PDBE and BPA have been associated with adverse cognitive, endocrine and motor outcomes in children2, and while ubiquitous, may represent a modi iable exposure in our immedi-ate environment.

    Between the years 1948 and 1971, treatment of pregnant women treated with a synthetic oestrogen, diethyl-stilbestrol (DES), demonstrated epigenetically driven reproductive effects two generations later, leading to its ban in 1971. Similarly, Skinner et al. have looked at germ cell inher-itance of chronic disease phenotypes (tumours, kidney disease, immune dysfunction) in fourth-generation rats born of pesticide-exposed ances-tors3, demonstrating that these non-DNA-sequence-related phenotypes could be passed down. This research serves to sound the alarm on under-studied environmental toxins and their role in consideration of preg-nancy exposures.

    A recent report on the poten-tial harm associated with the most ubiquitously applied pesticide, glypho-sate, typically applied to roundup-ready genetically modi ied crops (soy, corn, sugar beets etc.) discusses the potential role of this chemical in depleting tryptophan and altering gut lora functioning related to the pesticides bactericidal effects on gut microbiota4. Alteration of microbes in gut ecology may have deleterious effects independent of the depletion of this essential amino acid. The role of healthy gut microbial balance will be discussed in the following, but the integrity of colonic enterocytes rely on healthy balance of bacteria and fungi for nutrient absorption, vitamin production and immune protection.

    These exposures may be driving in lammatory responses and per-turbations of the antenatal immune

    system in ways that deleteriously affect the foetus and put the mother at greater risk for postpartum mood pathology.

    The greatest defence compromisedThe experience of pregnancy is one that draws heavily on a womans native nutrient stores and involves luctuations in hormone levels and

    immunologic parameters. The ana-bolic state of pregnancy demands a synergy of nutrients not only to nourish the growing foetus but also to support the tissues of reproduc-tion (mammary, placental) and metabolism. Some theorize that the relative de iciencies of certain criti-cal nutrients may make some women more vulnerable to postpartum psy-chiatric symptoms. A study of preg-nant American women found that the majority were consuming below recommended amounts of iron, zinc, calcium, magnesium, folate and vita-mins D and E5 and that selenium sup-plementation may protect against the development of postpartum depression6.

    In addition, elements of our modern diet, including high sugar (fructose) content and trans fats rendered from heat-labile