Rupanagunta Gnana Prasoona, Nandave Mukesh, Rawat Divya, Upadhyay Jyoti, Rashid Summya, Ansari Mohd Nazam
Department of Pharmaceutical Sciences, School of Health Sciences and Technology, University of Petroleum and Energy Studies, Energy Acres Campus, Bidholi, Dehradun 248007, Uttarakhand, India.
Department of Pharmacology, Delhi Pharmaceutical Sciences and Research University (DPSRU), MB Road, Pushp Vihar, Sector 3, New Delhi 110017, India.
Saudi Pharm J. 2023 Jul;31(7):1274-1293. doi: 10.1016/j.jsps.2023.05.008. Epub 2023 May 15.
Postpartum depression (PPD) is a challenging psychological disorder faced by 10-30% of mothers across the globe. In India, it occurs among 22% of mothers. Its aetiology and pathophysiology aren't fully understood as of today but multiple theories on the interplay of hormones, neurotransmitters, genetics, epigenetics, nutrients, socio-environmental factors, etc. exist. Nutrients are not only essential for the synthesis of neurotransmitters, but they may also indirectly influence genomic pathways that methylate DNA, and there is evidence for molecular associations between nutritional quality and psychological well-being. Increased behavioural disorders have been attributed to macro- and micronutrient deficiencies, and dietary supplementation has been effective in treating several neuropsychiatric illnesses. Nutritional deficiencies occur frequently in women, especially during pregnancy and breastfeeding. The aim of this study was to perform a comprehensive literature review of evidence-based research in order to identify, gather and summarize existing knowledge on PPD's aetiology, pathophysiology, and the role of nutrients in its prevention as well as management. The possible mechanisms of action of nutrients are also presented here. Study findings show that the risk of depression increases when omega-3 fatty acid levels are low. Both fish oil and folic acid supplements have been used to effectively treat depression. Antidepressant efficacy is lowered by folate insufficiency. Folate, vitamin B12, iron, etc. deficiencies are more prevalent in depressed people than in non-depressed people. Serum cholesterol levels and plasma tryptophan levels are found to be inversely correlated with PPD. Serum vitamin D levels were associated inversely with perinatal depression. These findings highlight the importance of adequate nutrition in the antepartum period. Given that nutritional therapies can be affordable, safe, simple to use, and are typically well-accepted by patients, more focus should be placed on dietary variables in PPD.
产后抑郁症（PPD）是全球10%至30%的母亲面临的一种具有挑战性的心理障碍。在印度，22%的母亲会出现产后抑郁症。其病因和病理生理学至今尚未完全明确，但存在多种关于激素、神经递质、遗传学、表观遗传学、营养物质、社会环境因素等相互作用的理论。营养物质不仅对神经递质的合成至关重要，还可能间接影响使DNA甲基化的基因组途径，并且有证据表明营养质量与心理健康之间存在分子关联。行为障碍的增加被归因于大量营养素和微量营养素的缺乏，膳食补充剂已被证明对治疗多种神经精神疾病有效。营养缺乏在女性中很常见，尤其是在怀孕和哺乳期间。本研究的目的是对循证研究进行全面的文献综述，以识别、收集和总结关于产后抑郁症的病因、病理生理学以及营养物质在其预防和管理中的作用的现有知识。本文还介绍了营养物质可能的作用机制。研究结果表明，当ω-3脂肪酸水平较低时，患抑郁症的风险会增加。鱼油和叶酸补充剂都已被用于有效治疗抑郁症。叶酸不足会降低抗抑郁药的疗效。抑郁症患者中叶酸、维生素B12、铁等缺乏比非抑郁症患者更普遍。血清胆固醇水平和血浆色氨酸水平与产后抑郁症呈负相关。血清维生素D水平与围产期抑郁症呈负相关。这些发现凸显了孕期充足营养的重要性。鉴于营养疗法价格实惠、安全、使用简单且通常为患者所接受，应更多地关注产后抑郁症中的饮食变量。
