How to prevent postpartum depression?

Many new moms struggle to enjoy their little bundle of joy. They are haunted by feelings of insecurity and even stress.

Professor Tzachi Ein-Dor from the School of Psychology. Ivchera of Reichman University and Gal Levin, an M.S. in clinical psychology and biofeedback trainer, are hopeful in this regard. At least that’s their current target.

As part of Levine’s doctoral work under Prof. Ein-Dor, they have collected the most recent and groundbreaking research in this area and combined it into a model that, for the first time, links the causes of postpartum depression to symptoms, allowing for personalized treatment. and even prevention.

“This model is groundbreaking because it manages to explain what has not yet been achieved – the diversity of symptoms of postpartum depression, why some women develop it and others do not, and how genes and previous life events influence this variability. ‘ Levine explains.

According to the model, three systems are involved in the process: immune, stress, and oxytocin. “When these systems are out of balance, we see symptoms that characterize postpartum depression. Each of these individually can cause depression to some extent, and when they all occur together, it’s a kind of “perfect storm” leading to more severe symptoms. ” explains Levin.

To better understand this process, Lewin compares our mental state to a plant: “It needs a certain amount of sun, water, and soil to grow, but if it is exposed to direct, hot sun all day, it will wither; the roots will sink in. In the same way, we need different things in certain amounts and up to a certain limit. For example, a certain amount of stress is necessary for us to react – if a lion is chasing us in the savannah, we want to be stressed and run – but too much stress brings the system out. out of balance and hinders the development of an organism, be it a plant or a person.

The first and most obvious question is: what motivates two men to delve into an area that traditionally belongs to women, and in fact even they often avoid participation or discussion. “I have four children,” says Professor Ein-Dor.

“I’ve also had two miscarriages and a stillbirth in the past, so I’ve been subject to miscarriages and stillbirths and pregnancies where everything went smoothly, but then came the severe experiences known as postpartum depression – and it’s worth it.” noting that these feelings occur not only in women who have given birth, but also in men. Although it is reported that women suffer twice as often from postpartum depression, considering that about 35,000 women in Israel experience postpartum depression every year, this is a significant number.

Levine says that his interest in the subject began when his wife became pregnant. “I have a master’s degree in child psychology, so it was inevitable for me to deal with this – not to mention that everyone wants their partner to be happy and minimize the likelihood of her developing depressive symptoms as much as possible.”

What is the real difference between regular depression and postpartum depression?
Levin: “Firstly, it is important to clarify that this is not just depression after childbirth, but around childbirth. It can develop in the last months of pregnancy, and may even appear several months after childbirth.

In terms of symptoms, we see the same symptoms as regular depression, such as an inability to enjoy things, a lot of negative thoughts, even about death, and possibly even attempts at self-harm. But in addition, there are symptoms associated with the added small and cute creature, such as rejection, reduced desire to interact with the baby.

“While theoretically, and I hope not, depression can be experienced alone, by definition it involves the helpless family and the child,” adds Professor Ein-Dor.

“Therefore, the impact of perinatal depression is much greater, and in severe cases, untreated depression can even lead to death, either as a result of the desperation of the mother or the lack of care for the child. In addition, as we have already mentioned, it has an incredible prevalence.”

Despite the large number of cases, perinatal depression is still underdiagnosed. “Many times it is confused with the phenomenon called “baby blues”, which is a kind of disappointment after childbirth,” explains Levin. “It’s also a whole family of disorders. Some women have certain symptoms, others have others, and this also complicates the identification itself and, of course, treatment.

Following the model and its conclusions, Professor Ein-Dor compares the development of a depression with an accident at a nuclear reactor. “The reactor is based on elements that push to create steam to generate electricity, but there must also be restraints in the process, such as anti-reaction materials to help calm down, or water that circulates to cool.

As long as the reactor works well, we know how to make electricity and nothing happens. The problem starts when the process gets out of balance, and then we have Chernobyl and radioactive poisoning.”

And is pressure relief achieved with medication?
“This may be in the form of drugs, but we also know what inhibitors exist and how they work – through body contact, breastfeeding or social support, a hormone called oxytocin is released, which was once called “love.” hormone. This hormone can inhibit both the stress system and the immune system.

For example, due to events such as an emergency caesarean section, which we know can contribute to postpartum depression, a woman avoids meeting people or holding a baby because it hurts, and then she not only survives labor, which is stressful event, it also does not use one of the main inhibitors of the process, and then starts a cycle that poisons the internal nuclear reactor that we have, which can eventually lead to a “Chernobyl” event.

At first glance, it may seem that early detection and treatment will greatly improve the situation and nip depression in the bud, but even with treatment and professional guidance, symptoms can persist and even worsen. According to Levin, this is the result of treatment that does not adequately fit the specific situation.

“The model helps not only at the diagnostic level, but also in treatment. Currently, all medications focus on the end of the process, but this end point may not be accurate. If you understand the whole path, you can intervene along the way in a more precise and correct way depending on the person. Today we hear about personalized medicines, and this is exactly what can be customized with a few simple questions. Later, in a larger project , which Professor Ein Dor will initiate, this can be achieved with a simple saliva test, and then we even save those questions, the answers to which may be biased.

“And then we can get an interpretation a few months before the depression hits,” adds Professor Ein-Dor.

How it works?
Levine: “We know that we get our genes from our parents and we have DNA that stays the same until we die, but there is a mechanism in DNA called epigenetics that knows which genes will be expressed and which will not.

Today, based on saliva, we can get the epigenetic profile of a person, his genetics and the interaction between them. For example, we can see if they had life events that triggered an epigenetic signature, how it affects the DNA they were born with, and based on that, determine whether that person will be more or less prone to depression.

“So, let’s say two people experience the same life events, such as the death of a loved one: I would be able to tell with a relatively high probability from the genetic and epigenetic profile which one of them is more likely to experience postpartum depression after this event, as well as which of the mechanisms we discussed – stress, the immune system, the absence of inhibitors.

Also, I can tell that some medications will be more effective for this person than others because his stress system is very active compared to his immune system, or vice versa.”

So the ultimate goal of every couple planning a pregnancy is preliminary genetic and epigenetic testing in an attempt to prevent depression?
Professor Ein-Dor: “Yes. Getting a genetic test now is not expensive, it’s not intrusive, and almost every couple gets it done today – so all it takes is an education to understand, just like if I had a predisposition to diabetes in my family. I know that I need to be more careful and control myself. It’s the same idea: if there is a potential that I am at risk for something, then preventive medicine costs several times more than any treatment I would do after this. the goal is not to experience it. Do not carry this with a child. Do not participate in this event.