Dietary Supplement Kit May Head Off Postpartum Blues

Megan Brooks

March 14, 2017

A dietary supplement kit containing tryptophan, tyrosine, and blueberry juice/extract appears to markedly reduce vulnerability to postpartum blues (PPB), a new open-label study suggests.

"The supplement taken on days 3 to 5 post partum had a very strong effect on preventing sad mood in postpartum," Dr Jeffrey Meyer, head of the neuroimaging program in mood and anxiety at the Center for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Canada, told Medscape Medical News.

The study was published online March 13 in the Proceedings of the National Academy of Sciences.

Elevated MAO-A

PPB is a subclinical syndrome of low mood and emotional lability often associated with fatigue, insomnia, poor appetite, and anxiety. It is common, affecting roughly 75% of women during postpartum days 4 to 6. It typically peaks on day 5 and resolves within 10 days. Severe PPB is a strong risk factor for later clinical postpartum depression.

In a prior study, as reported by Medscape Medical News, Dr Meyer's group showed that during the first postpartum week, when PPB tends to occur, women experience a dramatic increase in the binding of monoamine oxidase A (MAO-A) in key areas of the brain that affect mood.

They designed the dietary supplement kit to compensate for this temporary increase in MAO-A levels in the brain. It consists of 2 g of L-tryptophan, 10 g of L-tyrosine, and blueberry juice and extract.

"These specific dosages of L-tryptophan and L-tyrosine have been shown to significantly elevate free tryptophan and free tyrosine in plasma and to be well tolerated, but not to increase total tryptophan and total tyrosine in breast milk," the authors write.

Tryptophan, which also may help initiate sleep, was given in the evening of postpartum day 4, and tyrosine was given on the morning of day 5, along with the blueberry juice/extract drink. The blueberry drink was also given on the night of postpartum day 3 and the morning of postpartum day 4.

Large Effect Size

Forty one healthy women completed the study protocol; 21 received the dietary supplement intervention, and 20 received no intervention (control). PPB severity was quantitated by the elevation in depressed mood on a visual analogue scale (VAS) following a sad mood induction procedure (MIP) on day 5 post partum.

"Our measurement focused on postpartum day 5 because this is the peak point of depression, mood lability, and PPB severity. It is also the time point with the most robust elevation in MAO-A levels throughout the brain, including affect-modulating brain regions, in the early postpartum period," the researchers explain.

Following the MIP, an increase in depressed mood was observed in the control group; this increase was markedly attenuated in the group that received the supplement, with a "large" effect size of 2.9. Depressed mood, as measured on the VAS, increased by 43.85 mm after the MIP in the control group but by only 0.05 mm in the group that received the supplement.

There was also an increase in depressed mood on the Profile of Mood States (POMS) after the MIP in the control group. This increase was attenuated by administration of the supplement in the treatment group. After the MIP, the POMS depression score increased by 8.95 in the control participants and decreased by −0.05 in the group that received the supplement. The supplement was well tolerated by all women; no adverse effects were reported.

"The main strength of this trial is its large effect size of 2.9. However, given that we conducted the first investigation of this supplement in humans with an open trial, the contribution of placebo should be considered in the context of effect size from other interventions for PPB," the researchers note.

They also point out that although the supplement kit was developed to counter elevated MAO-A levels, it is possible that other mechanisms were responsible for the observed effects.

"For example, tryptophan is well known to improve sleep through reducing sleep latency, and tyrosine is known to increase resilience against stressful events," they write.

Dr Meyer said a double-blind study that tests the dietary supplement kit in PPB is set to get underway shortly. "We'd also like to research its effect in preventing clinical-level postpartum depression," he said.

Interpret With Caution

In an interview with Medscape Medical News, Caroline Apovian, MD, professor of medicine, diabetes, endocrinology, and pediatrics, Boston University School of Medicine, who was not involved in the study, urged caution in interpreting the findings.

The major flaw of the study is that the control group did not receive a placebo, she said.

"What I think would happen is that if the control group got a placebo that they didn't know was a placebo, they would report the same thing as the intervention group. With depressive symptoms, a placebo effect is very strong," said Dr Apovian, who is director of the Nutrition and Weight Management Center at Boston Medical Center.

"I think there is not a lot that you can conclude from this kind of study," she said, noting that a double-blind, randomized controlled trial is clearly needed. "The good news is that these dietary supplements have a low risk, but I wouldn't go blasting away and say this is a cure [for postpartum blues]."

This research received project support from the Canadian Institutes of Health Research through the Canada Research Chair in Neurochemistry of Major Depressive Disorder, the Leslois Shaw Foundation, and the Campbell Family Mental Health Research Institute. First author Yekta Dowlati, PhD, is developing natural health products to overcome a high MAO-A state in the early postpartum period. Dr Meyer is developing natural health products to treat high-risk states for major depressive episode and is listed as the inventor on a patent application for this dietary supplement. Dr Meyer has received operating grant funding for other studies from Eli Lilly, GlaxoSmithKline, Bristol-Myers Squibb, Lundbeck, SK Life Science, and Johnson & Johnson/Janssen in the past 5 years and has served as a consultant for all of these companies with the exception of of Johnson & Johnson, as well as for Sepracor, Trius Therapeutics, and Mylan Inc.

Proc Natl Acad Sci. Published online March 13, 2017. Abstract

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