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A Case of Postpartum Depression in “The Yellow Wallpaper” , Part 2

© Charleen Merced

Research shows that two endocrine systems, the hypothalamic-pituitary-adrenal (HPA) axis and the hypothalamic-pituitary-ovarian (HPO) axis are important in the regulation of sex hormones. The HPA axis is important in regulating the stress hormone, cortisol, which upon activation by stress factors "has an inhibitory effect on the reproductive system" (Barrio and Burt 3). The hypothalamus secretes the corticotropin-releasing hormone (CRH). Cortisol secreted from the adrenal cortex inhibits estrogen and progesterone biosynthesis and estradiol actions (principal estrogen formed by the placenta during pregnancy ). The estrogen hormone stimulates the HPA axis by inducing CRH synthesis and cortisol-binding globulin secretion. Low estrogen levels lead to low CHR plasma levels which might be indirectly associated with the menstrual cycle. The assumption is that "the abrupt post delivery decreases in estradiol, progesterone, CRH, ACTH and cortisol levels lead to a significantly increased risk for the development of postnatal psychiatric disturbances" (Barrio and Burt 3) like postpartum depression.

Besides body changes there are many risk factors that have an association with the onset of PPD. A woman who has previously suffered from depression or depression like symptoms or other mental illnesses (e.g. bipolar disorder), (Clay and Seehunsen 158) has an increased probability that she will get PPD. Other risk factors include stress, being a young or a single mother, lack of social support or help with the baby, financial or marital trouble, low confidence and self-esteem (NMHA) . PPD appears to be a result from a combination of body, mind and, lifestyle factors.

In "The Yellow Wallpaper", the protagonist is given phosphates . Today there are many treatments for PPD and it is necessary most of the time. There are several available pharmacological and nonpharmacological options which include: counseling and support groups, antidepressants, hormone therapy (MayoClinic.com). Antidepressants may alleviate the symptoms of PPD but, should be combined with counseling to explore the issues that led to the depression (if factors other than body changes were also involved). Social adjustment issues addressed during interpersonal psychotherapy may also be useful in treatment. It is advisable to avoid caffeine, as it may produce anxiety and mood changes (NMHA), and also alters the sleep cycle and can contribute to worsening the symptoms of depression (Barrio and Burt 4).

Many research studies have established a relationship between low levels of serotonin and depression. The studies have observed that depressed people tend to have low serotonin levels in their cerebrospinal fluid and brain tissues. Pharmacologial options should then focus on restoring serotonin levels by targeting the serotonin transports. Appropriate antidepressant drugs are selective serotonin-reuptake inhibitors (serotonergic agent) which have the least side effects. These inhibitors "work by altering the function of neurons that release serotonin by blocking the reuptake of serotonin back into the cell" (Byrd 1). Thus, "the level of serotonin activity is increased in any part of the nervous system that uses this neurotransmitter as a chemical signal between cells" (Byrd 1). Examples of these types of drugs are fluoxetine and venlafaxine.

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