Oxytocin Concentrations Are Crucial
The causes of postnatal depression are a mesh of physical, hormonal, biochemical, psychological, social, and societal factors. This means that successful treatment will have to take into consideration all these factors and include them in the treatment concept.
Additionally, oxytocin is of great importance during the entire period of pregnancy, birth, and puerperium. A low oxytocin concentration in the last four weeks of the pregnancy seems to be associated with an increased risk of developing symptoms of postpartum depression within the first two weeks after the birth. Good bonding between mother and baby after the birth, such as is standard in certified “baby-friendly hospitals” (www.babyfreundlich.org) increases the concentration of oxytocin. Concentrations of oxytocin as well as prolactin are higher in breastfeeding women; breast feeding therefore reduces the psychological stress reaction (1, 3).
Very few publications consider the difference between non-breastfeeding women and breastfeeding women. Extensive discussions about the influence of hormone imbalances ignore lactation and nature’s potential protective mechanisms owing to high concentrations of prolactin and oxytocin during the breastfeeding period (1, 3).
Breast feeding problems may be an indication of postpartum depression. Hypothyroidism is also associated with severe “baby blues” or fatigue, in addition to reduced lactation, and should therefore also be excluded (1).
With regard to pharmacotherapy, it is worth drawing attention to the 8th edition of Arzneimittel in Schwangerschaft und Stillzeit (2012) by Schaefer et al. It is also worth pointing out that medication-led weaning using prolactin inhibitors can increase depression and should therefore be avoided at all cost. If weaning is necessary physiological weaning without drugs is the preferred option (2).
Gudrun von der Ohe
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Lawrence R: Breastfeeding. A Guide for the Medical Profession. 7th edition Maryland heights, Missouri: Elsevier, Mosby, Inc., 2011.|
|2.||Schaefer C, Spielmann H, Vetter K, Weber-Schöndorfer C: Arzneimittel in Schwangerschaft und Stillzeit. 8th edition. München: Urban und Fischer 2012.|
|3.||Uvnas-Moberg K: The Oxytocin factor: Tapping the hormone of calm, love, and healing. Cambridge: Da Capo Press 2003.|
|4.||Hübner-Liebermann B, Hausner H, Wittmann M: Recognizing and treating peripartum depression. Dtsch Arztebl Int 2012; 109(24): 419–24. VOLLTEXT|