Recent sales of testosterone therapy is associated with excessive sweating
<strong> an integrated approach to prevention and treatment of postpartum depression (PPD) and anxiety after childbirth (EPP)
Raffelock Dean, DC, L. Ac, CCN, DACBN, Diba
Hyla Cass, M. D. postpartum depression (PPD) The anxiety of calving (AFC) has become a national epidemic in the United States, affecting 15% -20% of pregnant women, or about 600,000 to 800,000 women each year. (1) Currently, it is estimated that more than 30 million Americans are antidepressants or antianxiety medications. (2) Most of these 30 million women who have one or more children. The chances of women suffering from PPD successive child. (3) The most common medical treatment for postpartum depression, SSRI drugs (selective inhibitors of serotonin reuptake) antidepressant. Handle the most common anxiety after childbirth benzodiazepine family of drugs as Valium, Ativan, Xanax and Klonopin. reuptake inhibitors and the combination of serotonin and norepinephrine (SNRIs) are also often used for postpartum depression. In the case of postpartum psychosis, antipsychotic drugs used, and needed immediately. Many women now have the pattern of SSRIs, when leaving the maternity ward. Most medical sources believe that PPD is caused by an imbalance of brain chemistry and pharmaceutical intervention in the treatment of choice. While a certain percentage of women suffer from PPD pharmaceuticals need help, they are much less than they actually receive. Recent studies have shown Meta-e to be true. While it is clear that some women with postpartum depression, what we need, and benefit from pharmacological intervention, it is our experience that an integrated approach, which is the best result. Labor often treat anxiety The most common symptoms of postpartum depression include: First Persistent feelings of hopelessness and / or anxiety;
2 Loss of energy and a low daily functioning;
3 Sleep and eating disorders;
4 Inability to focus, concentrate or make decisions; />
indifference and / or resentment toward the baby, seventh
Negative intrusive thoughts and / or obsessive-problems with the most severe cases, this includes the ideas can be dangerous for you and your baby, />
ninth loss of pleasure and appreciation of life, />
The literature describes a variety of post-natal diseases, which have special features beyond the typical symptoms of depression. These include: first Childbirth anxiety (PPP) . Are the main symptoms of excessive anxiety, hypervigilance, racing thoughts, and in some cases even panic. In particular, victims of terrifying panic attack often think they are dying, because they experience shortness of breath, dizziness, pounding in the chest. 2 º obsessive Childbirth compulsive disorder. This is most often in the form of obsessive thoughts, worried about the baby, and must be accompanied by compulsive behavior, and regularly check whether the baby is breathing, constantly washing, the bacteria that protect the baby, what are the type most disturbing obsessive thoughts, which is harmful to the baby’s mother imagines somehow. These thoughts are intrusive, unwanted and frightening for the mother. Importantly, only in extremely rare cases, psychosis (see below), these thoughts are not accompanied by any action. However, the mother is so afraid of their own thoughts, to keep the child, and therefore their forget. It’s terribly difficult for mothers to recognize that such thoughts, and as a result, many suffer from isolation. third PTSD . PTSD can occur in response to real or perceived traumatic birth or a past unresolved trauma of a sexual nature, sometimes driven during labor. A woman who is likely to experience recurring PTSD, memories, dreams and traumatic memories of labor / birth. She’s going to be hyper-alert and easily startled, and are prone to suffer from insomnia, irritability, poor concentration and lethargy. Women who have particularly traumatic births often show symptoms of PTSD, and the PDP. Birth quarter psychosis . This is the most extreme and rarest of all post-natal illness. When this happens, the mother loses touch with reality and its symptoms include extreme confusion (eg do not know who it is), paranoia or delusions and visual or auditory hallucinations. In some tragic cases where mothers of children injured while in a psychotic state that received huge media attention. As a result, many people mistakenly associate the PPD psychotic and dangerous behavior. This is another reason why women can not help, want to prevent a candidate for a stigmatized disease. History of Art: Fully charge new birth mothers nutritional reserves have been largely ignored, and an integral part of treatment for postpartum depression. The Foundations of Nutritional Approach PPD
The human body is fully formed nutrients. All muscles, organs, glands, bones, cells and the liquid is full of nutrients (although environmental toxins). All neurotransmitters, hormones, metabolism and biochemistry of the structures are formed in food. a normal physiological process used by the channel, and several critical nutrients in the body of the woman after delivery, because the process of pregnancy, childbirth and new baby care, which may include breastfeeding. The fact that a mother’s body donates all the nutrients needed to form the baby’s body is too often ignored when the medical treatment of PPD. The placenta is not only rob the body of the mother should take all important nutrients for the baby’s body, but the placenta is formed from nutrients in the body of the mother. This is the main reason why many women in the postpartum nutrition drainage, and this syndrome can lead to nutrient depletion, postpartum depression and anxiety disorder. Other factors contributing to the channel to the nutrient reserves of the new stem blood loss during delivery, lack of sleep, breastfeeding, returning to work early and extra energy is great necessary to ensure children’s needs intensive again. If a pregnant woman or nutrient reserves of the new mother are very low, which is much more sensitive to the experience of PPD and PPA as the body’s normal metabolic processes are totally dependent on nutrients. The preponderance of poor quality drug prenatal vitamins are contributing significantly to the trend of nutrient depletion. It is rarely mentioned that the production of neurotransmitters in the body is completely dependent on the precursors of nutrition. (4), and causes of nutritional deficiencies discussed precursors. Moreover, the interdependent relationship between hormones and neurotransmitters are rarely considered in most physicians to consider treatment with PPD and PPP. The nutritional requirements of mitochondrial function, the importance of the liver in the Western and Eastern perspectives, as well as specific nutrients such as omega 3 fish oil, Pharmagen, L-theanine, magnesium itself, inositol, and St. John’s wort is also a great help in treating PPD and PPA. These are briefly discussed. An integrated approach to the treatment of PPD can be nutritional therapies, hormone replacement therapy bio-identical, moderate exercise, nutritious diet, adequate rest, counseling, psychological support /, techniques stress reduction, elimination of caffeine, alcohol and other addictive drugs, and whether intervention is necessary, pharmaceutical. Dietary neurotransmitter precursors serotonin and tryptophan The amino acid L-tryptophan to serotonin in the body needed. Ninety-five percent of the human body to produce serotonin in the gut. About five percent is produced in the brain. Serotonin produced in the intestinal tract is not available to the brain of serotonin, because they can not penetrate the blood-brain barrier. L-tryptophan is not easy to cross the blood brain barrier, and requires a ferry carrying protein in the brain. Consumption of simple sugars, amino acid changes in the selectivity of the membrane of neurons in the brain, which allows more tryptophan in the brain. Therefore, the desire for sweets is often a sign of a deficiency of serotonin. Serotonin is known as a chemical known to calm and lift the mood in the brain. Inadequate levels of serotonin are linked to depression, anxiety, insomnia, irritability and weight gain. Serotonin-mediated depression usually includes an element of anxiety. Regarded as an inhibitory neurotransmitter serotonin. Its activities include: – inhibits glutamate excitability of different regions of the central nervous system
stimulate GABA receptors on GABA neurons are inhibitory function calls
– appeared to inhibit the catecholamines dopamine, noradrenaline, adrenaline y. Comparison of the effects of low serotonin levels that optimal levels of serotonin are shown in the following contrasts: 1) Esperanza / optimistic ——
Depressed 2) – — —– looking for quiet
3)
irritable benign ——- 4) The impatient patient ———
5) reflective / reflective –
—Impulsive/Reactive 6) Love /
Care offensive ——- 7) being able to concentrate —— short attention span
/> Creative / Prohibited —— focuses scattered
9 carbohydrate intake) — Moderate
excessive carbohydrates 10) a good sleep and memory of — dream dreams insomnia and poor recall converts tryptophan metabolite, 5 – hydroxy-tryptophan (5-HTP), which was moved to serotonin. Niacin, iron, folic acid and L-tryptophan needed to become the 5-HTP. The organization also requires pyridoxal-5-phosphate, in addition to the 5-HTP to produce serotonin. Magnesium and riboflavin (B2) is required to convert pyridoxine (B6) Pyridoxal-5-phosphate. Any such nutrient deficiencies that limit the production of serotonin. Several double blind studies have shown that 5-HTP to be as effective as antidepressant drugs and fewer side effects less severe, and most times better tolerated. (5-11) Martin Hintz, MD Neuro-Research number of important factors contributing to the low level of L-tryptophan many people, especially after birth, women whose bodies can provide the protein needed to form another human body, these include excessive cortisol, epinephrine, norepinephrine and dopamine. Proportion of L-tryptophan to other amino acids available in most foods is very low. An adrenal cortisol excess (a high incidence of psychological stress and physiological state) affects serotonin production and sensitivity in four different ways: First excess cortisol significantly reduced the number of serotonin (5-HT 1A) receptors. (12)
2 Excess cortisol inhibits serotonin receptors. (13, 14)
3 The excess cortisol increases serotonin reuptake. (15)
4 Excess cortisol causes tryptophan oxygenase (A) to metabolize tryptophan to kynurenine, thus will be less of tryptophan to serotonin. (15.16) If your cortisol levels are too low in the amygdala, serotonin has no inhibitory effect on glutamatergic activity, suggesting that cortisol plays an important role in the maintenance of serotonergic modulation is mediated . (16.17) This could be another factor involved in PPD insomnia. joined the reason that serotonin deficiencies are increasingly common, and contributes to the PPD is the excess pressure on catecholamines. Epinephrine, norepinephrine, dopamine and serotonin is also broken, as the neurotransmitters serotonin, monoamine assumed that the balance of the three monoamine neurotransmitters are excitatory. The more stress a person experiences, the more your body increases production of catecholamines in an attempt to respond to this stress. This requires serotonin in the body after childbirth more – despite the deficiencies of nutrients can interfere with the production of precursors. Using 5-HTP dietary precursor of serotonin, tryptophan, a significant advantage. 5-HTP can go directly to the blood-brain barrier without a carrier protein, which facilitates the conversion of serotonin in the brain. Sublingual forms of 5-HTP faster. Varies daily dose of 25 mg to 300 mg / day or more. Vitamin B6 (pyridoxine), which is necessary for the synthesis of serotonin, is commonly found in premenopausal women with depression. (18) the exchange of B6 deficiency is an important aspect of PPD treatment can increase the production of serotonin in the brain. (19) is a metabolite of vitamin B6, pyridoxal-5-phosphate instead of B6 is recommended, especially if the magnesium and / or riboflavin deficiency is suspected or confirmed. There is some debate about whether to supplement 5-HTP-5-phosphate pyridoxal taken together or separately, insisting on a two-hour wait. Clinical experience shows that a good complement. Many products that contain a combination of 5-HTP and the P-5-P is available. There is debate about the concurrent use of SSRIs and the serotonin precursor supply. Pharmaceutical companies seem to insist on how to avoid this, and often mentions the possibility of serotonin syndrome, a dangerous condition is usually caused by a combination of drugs that stimulate serotonin, especially MAO inhibitors, the medicines, herbs, precursors of the diet may improve serotonin activity. Serotonin syndrome symptoms may include nausea, headache, restlessness, sweating, high blood pressure, tachycardia and hyperthermia that can go over 104 F. This seems a remote possibility that it is better to simply use the 5-HTP or 5-HTP with an SSRI. (20) SSRIs, seem to not only maintain the inhibition of serotonin reuptake of neuronal synapses longer, but the pull of the dietary precursor of serotonin, port and storage vesicle reuptake . In fact, our clinical experience, many women PPD better take 5-HTP and the P-5 P-besides taking SSRIs SSRIs alone. Precursor of serotonin deficiencies may be due to the fact that SSRIs do not work with some of the work, and then stops to rest, and why it is not uncommon for a woman to PPD had two or more different prescribed SSRIs time. SSRIs do not give a net increase in serotonin, serotonin, and the need to be sufficient to ensure that, in order reuptake. Dr. Dean-Raffelock catecholamines table catecholamines energizing and mood, especially when it occurs at the appropriate levels. Catecholamine synthesis occurs in the central nervous system, adrenal medulla and peripheral sympathetic neurons. Neurotransmitter dopamine, norepinephrine, and mainly affects the central nervous system. It operates primarily in the adrenal hormone adrenaline to mobilize energy. The effect of catecholamines in most organ systems. When levels are too catabolic metabolism in the body and can lead to its own nerve muscle and bone. Low levels can lead to depression, fatigue and weight gain. Dopamine: Dopamine is a catecholamine precursor of norepinephrine and is found in the central nervous system and adrenal medulla. Tasks include motor function and gait, cognitive functions (attention, concentration, problem solving and working memory), and feelings of pleasure. Dopamine or function of inhibitory neurotransmitter or excitatory in response to incoming afferent signals. norepinephrine (noradrenaline) average CNS norepinephrine mood control, drive, ambition, learning and memory, arousal, alertness and concentration. Clinically, it is often passed between norepinephrine (stimulating) and serotonin (inhibitors). When serotonin is low, norepinephrine may be more “over-regulated, so that the” fight or flight “response that leads to anxiety and / or panic attacks. Overexpression of the central nervous system norepinephrine clinically associated with anxiety, aggression, irritability, mania or bipolar disorder, immunosuppression, and high blood pressure, low norepinephrine associated with atypical depression, with symptoms such as fatigue, hypersomnia, hyperphagia, lethargy and apathy.
(21.22) epinephrine (adrenaline) depends on the synthesis of epinephrine and norepinephrine, epinephrine by methylation in transition.
Hans Selye (1974) describes the three phases and the syndrome of “general adaptation to stress (23): I phase: alarm reaction, a high adrenaline / high cortisol Phase II: Resistance: high cortisol / DHEA is low, variable adrenaline Phase III: Fatigue: exhaustion of cortisol, epinephrine and DHEA
adrenal fatigue is an important factor in depression with chronic stress or serious. Women who suffer from PPD should be carefully questioned about symptoms, SSRIs are routinely given to women participating in the adrenal cortex hypoadrenia functional and / or marrow, or low thyroid function ( see below). Under glucocorticoids and / or catecholamine levels can cause symptoms of fatigue, malaise and depression. (24.25) Many women PPD necessary medications and / or nutraceutical to correct deficiencies in both serotonin and catecholamines. catecholamine balance in nutritional therapies are: § DL-phenylalanine and L-tyrosine, an amino acid precursor of epinephrine, norepinephrine and dopamine. DL-phenylalanine also helps increase endorphins, which are state of mind. PP Many women diagnosed with bipolar disorder respond well to high-dose therapy with DL-phenylalanine (26), and the precursors of serotonin and high dose (6 grams / day) in the form of omega- 3 in fish oil. (27) § L-cysteine, sulfur, iron and folic acid, needed for the conversion of L-tyrosine to L-dopa. § pyridoxal-5-phosphate necessary for the conversion of L-dopa into dopamine. Copper and vitamin C is needed to convert dopamine to norepinephrine. Pridoxal-5-phosphate, vitamin B12 and folic acid required to convert norepinephrine into epinephrine. gamma-aminobutyric acid (GABA) inhibitory neurotransmitter GABA is the most important and widespread in the brain. The low level of GABA is particularly important to consider when anxiety and insomnia is also included to show the symptoms of PPD / PPA. GABA is essential to counteract the excitatory neurotransmitters and hormones such as cortisol, epinephrine, norepinephrine and glutamate. Without much excitement, inhibition of GABA can lead to case: (28) – Insomnia
–
Anxiety – />
– Panic attacks
– spasm GABA function clinically, to induce relaxation, calm and dream aid. When glutamate receptor (strong excitatory neurons), GABA receptors will not be in the neighborhood. GABA allows only the most important excitation signals to pass and attenuate the stimulant to external signals or eclipse, when the GABA level < ! - NextPage -> right. Benzodiazepines (Valium, Klonopin, Zanax, Ativan, etc), and sleep, work in a pharmacy Ambien Sonata GABA receptors, and moderate consumption alcohol. L-theanine, lactium (milk peptides), L-glutamine, taurine, and bio-identical progesterone can act nutraceuticals / hormone agonist GABA. The drug is an inhibitor of GABA reuptake Gabatril valerian extract. A new nutraceutical product called Pharmagen seems better performance than the GABA synthetic results. a point of view of Chinese medicine, serotonin and GABA could be the yin (quiet, alignment, cooling, nourishing, moisturizing, anti ) and catecholamines Yang (energizing, mobilizing, warming, stimulating, drying). Both views east and west, it is important to balance the opposing groups to obtain balance brain chemicals. A woman who is PPD now has more energy, but can not sleep so miserable as a woman who has been unable to sleep, but still sluggish than before treatment. Balance is a key neurotransmitter. balance of neurotransmitters and hormones are clinically effective . Hormone-neurotransmitter interactions relationship between neurotransmitters and hormones in the PPD is often overlooked. The neurotransmitters and neuropeptides are necessary to mediate the release of hormones from the hypothalamus as Proper performance of the orchestra pituitary hormones. The hypothalamus is considered a key part of the midbrain, the “emotional brain”, so no wonder why inequalities neurotransmitters and hormones may adversely affect the emotional states. Thyroid hormone . Catecholamines and thyroid hormones are closely linked with many functions. L-tyrosine and iodine, a precursor of thyroglobulin and thyroid hormones and T-3 T-4. Depression is not anxiety, the primary symptoms of fatigue and the difficulty of linking a series of positive thoughts, especially low adrenal (29) and / or thyroid (30-32), and usually do not respond well to SSRIs or precursor of serotonin nutritional therapy. It is well known that low thyroid can cause depression and physiological fatigue. Ensures that the T3-induced increase in serotonin, and hypothyroid animals, the reduction serotonin synthesis. (33) T3 seems to desensitize presynaptic serotonin autoreceptors. (34) By contrast, the daily peak of TSH observed during the normal circadian rhythm of serotonin dependent. (35) thyroid function serotonin function among both clinical and biochemical criteria. For optimal thyroid function depends on the optimal levels of serotonin. optimal balance depends on serotonin optimal thyroid function. TSH-dependent increase of hypothalamic TRH stimulate serotonin appropriate to allow an increase in TSH. (36) reduces TSH is more appropriate now represents the low serotonin states as true a real assessment of thyroid function. Thyroid hormones triiodothyronine (T3) increases and accelerates the effect of antidepressant drugs. Fluoxetine + T3 better than the desensitization of 5-HT autoreceptors in the hypothalamus, which alone. (pp. 37-39) estrogen: More and more evidence suggests the importance of estrogen on serotonergic function. (40) Estrogen inhibits the reuptake of serotonin. (41,42) demonstrated a selective estrogen therapy increases serotonin (5-HT 1A-mediated) responses in the hippocampus (43,44 ), estrogen increases the firing activity of 5-HT (serotonin) neurons in male and female. (45.46) Briefly, estrogen appears to be a native of SSRIs. At present there is great debate on estrogen replacement therapy. The WHI and the HERS study stirred a debate without a significant difference in the change in medicine and bio-identical estrogens, nor any distinction between progesterone and progestins. The doctor recommended that This area is very well aware of the risks versus benefits of HRT. PPD, many women can benefit from hormone replacement therapy low dose of estrogen bio-identical, it is reasonable and possible benefits outweigh the risks. progesterone : bio-identical progesterone is a known anti-depressant/anti-anxiety effect. During pregnancy, the placenta produces large amounts of progesterone in the blood increases, often to pre-pregnancy . postnatal supply suddenly disappeared and the calming effect of the nervous system of the mother.
allopregnanolone is synthesized through the reduction of the enzyme 5-reductase, progesterone and 3-hydroxysteroid dehydrogenase (3-HSD) . allopregnanolone is one of the strongest known GABA receptor modulator. (47.48) THP in behavioral and biochemical characteristics similar to ethanol, barbiturates and benzodiazepines. (49.50) bio-identical progesterone can be very useful for women in the PPD for anxiety and insomnia. Pharmagen and use of bio-identical progesterone at the same time is often very useful for problems of anxiety and sleep. DHEA : DHEA increases the discharge activity of serotonin neurons. (51) DHEA increases the synthesis of norepinephrine and dopamine by tyrosine hydroxylase mRNA. (52) Thus, DHEA may be useful in certain forms of PDP. DHEA inhibits GABA, and therefore GABA antagonist. (53) Clinically, the use of DHEA causes of insomnia and irritability, the patient is likely to be deficient GABA, and this must be addressed before additional DHEA. Testosterone : increased firing of serotonin neurons in the raphe area, the mood improves. (54) mitochondrial function Metametrix Ion-Group Laboratory of brochures waste mitochondrial function limits ATP production, less energy and contribute or cause a physiological depression. Over 90% of mitochondrial oxygen metabolism of the fuel cell . A large number of mitochondria for electron transfer to produce energy. The mitochondria can affect all organ systems, including neurons and glands. fats, carbohydrates and proteins have to convert acetyl-coenzyme A (acetyl-CoA), before the Krebs cycle and electron transport chain. The nutritional precursors needed for fatty acids, glycerol, and cholesterol in the Krebs cycle and generate ATP riboflavin (B2), L-carnitine, niacin and biotin. Thiamin (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), biotin and alpha lipoic acid is necessary for protein and carbohydrates in the Krebs cycle in mitochondria. within the Krebs cycle, cysteine and iron needed to convert cis-aconitate to isocitrate. The niacin, magnesium, manganese, and the need to convert isocitrate to alpha-ketoglutarate. The amino acids glutamine, histidine, arginine , proline and glycine are necessary to form alpha-ketoglutarate. The thiamine, riboflavin, niacin, pantothenic acid and alpha lipoic acid, you must convert alpha-ketoglutarate to succinyl-CoA reductase. Isoleucine Valine, methionine, and are necessary to form succinyl-CoA reductase. Magnesium is needed to convert succinate to succinyl-CoA reductase. Riboflavin is needed to convert succinate to fumarate. The amino acids tyrosine and phenylalanine are needed to form fumarate. Niacin is needed to convert oxaloacetate malate. All these nutrients you need 36 units of ATP is a molecule of acetyl-CoA in the Krebs cycle. A severe deficiency of any of these essential nutrients can cause mitochondrial dysfunction and contribute to fatigue and depression. niacin coenzyme Q10 and the need for oxidative phosphorylation (electron transport chain or ETC). Normally, the ETC has produced a 3 units of ATP in mitochondria, the Krebs cycle-36 significant deficit while reducing production
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