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2 Review of 49 studies on breastfeeding and depression Large, recent studies have found that bottle feeding is associated with depression Consistently, breastfeeding across the postpartum period has been associated with a decrease in depressive symptomatology Dennis & McQueen Pediatrics 2009; 123: e376-e751 If I were to eliminate [breastfeeding], I might have no hope of coming through this nightmare. I was hanging on to breastfeeding as my life Brooke Shields, Down Came the Rain, p. 80 2

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5 Norepinephrine Epinephrine Dopamine 5

6 Hypothalamus CRH (CRF) Pituitary ACTH Adrenal cortex Cortisol IL-1β IL-6 TNF-α IFN-γ 6

7 Proinflammatory cytokines rise in last trimester Women s highest risk of depression is in the last trimester Cytokines remain elevated postpartum Depression and anxiety increase the risk for preterm birth 7

8 French prospective study of rate of prematurity 9.7% for depressed women 4% for nondepressed women Dayan et al., Psychosom Med 2006, 68: Increased IL-6, TNF-α in stressed and depressed moms IL-6, IL-8,TNF-α ripens cervix and Levels increase in pre-eclampsia and infection CRH triggers partuition Coussons-Read et al. Psychosom Med 2005, 67:

9 Randomized trial with DHAenriched vs. regular eggs 291 low-income moms in last trimester of pregnancy Increased gestation length by 6 days (+ 2.3) Smuts et al., Obstet Gyn 2003, 101:

10 Women with nipple pain had higher rates of depression than women without pain (38% v. 14%) Moods returned to normal once pain resolved Amir et al., J Psychosom Ob Gyn 1996, 17: % had nipple pain at 5 weeks postpartum 52% reported sore or cracked nipples at 2 months postpartum Mc Govern et al. Ann Fam Med 2006, 4, ; Ansara et al. J Psychosom Ob Gyn 2005, 26:

11 Cytokines are stimulated by Substance P Substance P is a neuropeptide present in pain Cytokines also increase prostaglandin synthesis including cyclooxygenase-2 (Cox-2) Simopoulos J Am Coll Nutr 2002, 21: Patients with MDD or PTSD had significantly more Substance P in their cerebral spinal fluid than healthy controls Levels rose when presented with a labinduced stressor Geracioti et al., Am J Psychiatry 2006, 163:

12 Sleep abnormalities in depressed new mothers Decreased sleep time and reduced REM latency Ross et al., J Psychiatry Neurosci 2005, 30:

13 Sleep disturbances (prolonged sleep latency and REM density) related to more inflammation (higher IL-6) Motivala et al., Psychosom Med 2005, 67: Chronically disturbed sleep increases inflammation (IL- 6, TNF-α) and increases risk of cardiovascular disease and metabolic syndrome Suarez & Goforth, 2008 (in press), In Psychoneuroimmunology of Chronic Disease. American Psychological Assn. 13

14 Study of 133 new mothers & fathers (3 mos postpartum) Questionnaire and actigraphy data 67% EBF, 23% mixed, 10% formula EBF mothers slept 40 minutes longer than mixed feeding mothers Mothers who gave BM slept 47 min longer than mothers who gave formula at night Fathers who gave BM slept 38 min more than fathers who gave formula at night Doan et al. J Perinat Neonat Nurs 2007; 21: Not Getting Enough Sleep Breastfeed Combo Formula 14

15 Depression and trauma compromise sleep quality Kendall-Tackett, Trauma, Violence & Abuse: 8,

16 Adverse Childhood Experiences (ACE) include: Child Sexual Abuse Child Physical Abuse Child Emotional Abuse Witnessing Intimate Partner Violence Parental substance abuse Parental criminal activity Parental mental illness Rates of birth-related PTSD 1.5% to 6% Up to 30% had PTSD symptoms Beck, Nurs Res 2004, 53:

17 Prior depression or trauma primes the stress response More rapid inflammatory response to current stressors Kiecolt-Glaser et al., Psychosom Med 2007, 69: Reduce maternal stress Reduce inflammation 17

18 Breastfeeding protects maternal mood by lowering stress Breastfeeding difficulties can increase inflammation 18

19 Mothers who were both breast- and bottle-feeding (n=28) Breastfeeding decreased negative mood, bottle-feeding decreased positive mood in the same women Mezzacappa & Katkin, Health Psy 2002, 21, Breastfeeding decreased ACTH & cortisol Lower stress response to induced stressor Suckling provided short-term lessening of stress response Heinrichs et al., J Clin Endo Metabol 2001, 86:

20 Breastfeeding downregulates the stress response Directs mother toward milk production, conservation of energy and nurturing behaviors Groër et al., JOGNN 2002, 31: Babies of depressedbreastfeeding mothers had normal EEG patterns Depressed-BF moms touched, stroked and looked at babies more than depressed-non/bf moms Jones et al., Biol Psychology 2004, 67:

21 Study of 139,681 postmenopausal women (Mean age=63) Lifetime history of lactation of more than 12 months related to lower Hypertension Diabetes Hyperlipidemia Cardiovascular disease Schwartz et al. Obstet Gyn 2009; 113: Exercise is an effective treatment for even major depression High-fitness leads to lower inflammatory response to stress Blumenthal et al., Psychosom Med 2007, 69: ; Hamer & Steptoe, Psychosom Med 2007, 69:

22 All treatments for depression lower inflammation 22

23 Polyunsaturated Fatty Acids (PUFAs) Omega-6s Omega-3s Linoleic Acid (LA) Gamma-linolenic Acid (GLA) Alpha-Linolenic Acid (ALA) Arachidonic Acid (AA) Eicosapentaenoic Acid (EPA) Docosahexaenoic Acid (DHA) Wang et al. Agency for Healthcare Research & Quality,

24 Populations with high fish consumption have lower rates Postpartum depression Major depression Bipolar disorder Suicide risk Hibbeln J Affective Disorders 2002, 69: 15-29; Noaghiul et al. Am J Psychi 2003: 160, ; Sublette et al., Am J Psychi 2006:163, ; Tanskanen et al. Psychi Serv 2006: 52, Many pregnant and postpartum women in the U.S., Canada, Europe, Australia, and New Zealand are deficient in EPA/DHA Pregnancy further depletes maternal stores of both Rees et al., Austral NZ J Psychiatry 2005, 39: ; Wang et al. 2004, Agency for Healthcare Research & Quality 24

25 Population study found high Omega-3s related to low IL-1α, IL- 1β, IL-6, TNF-α Opposite true of people low in Omega-3s Ferruchi et al., J Clin Endo Metabol 2006, 91: Students with higher EPA/DHA had a lower inflammatory response to a lab-induced stressor Maes et al., Biol Psychi 2000, 47:

26 St. John s wort Antidepressant constituent is hyperforin Hyperforin is antiinflammatory and reduces proinflammatory cytokines Balch, Prescription for herbal healing, 2002 SSRIs in cardiac patients Inhibited cytokine secretion Lowered C-reactive protein O Brien et al., Brit J Psychiatry 2006, 188:

27 Psychological and physical stress increase inflammation 27

28 Breastfeeding attenuates stress and protects maternal mood Breastfeeding problems increase risk of depression and must be addressed promptly Almost all treatments for depression are breastfeeding compatible 28

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