Intended for healthcare professionals

Rapid response to:

Practice Practice Pointer

Assessing low mood during pregnancy

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4584 (Published 29 July 2019) Cite this as: BMJ 2019;366:l4584

Rapid Response:

Depression in pregnancy, previous progestogen use, and nutritional deficiencies Re: Assessing low mood during pregnancy

The high incidence of depression, of up to 10% during pregnancy with higher risks for the children, makes depressing reading. Vigod and colleagues recommended (side-effect) prone selective serotonin reuptake inhibitor antidepressant drugs or psychological therapies but they do however refer to one trial of omega-3 supplementation.[1]

A search of PubMed brings up -
171 results for zinc deficiency and depression
141 results for magnesium deficiency and depression
100 results for vitamin B6 deficiency and depression
229 results for vitamin B12 deficiency and depression
462 results for copper and depression
77 results for omega-3 deficiencies and depression
1133 results for progestins and mental depression

Clearly major causes of depression in pregnancy include essential nutrient deficiencies and previous use of progestins which increase depressive mood changes and increase monoamine activity in the brain, blood and endometrium.[2-4] In developed countries most women are given progestogenic hormonal contraceptives from young ages, usually without being monitored for increasingly prevalent essential nutrient deficiencies. Progestogens and oestrogens can lower zinc and increase copper levels (but can lower copper stores) and increase adverse reactions to common food and chemicals, impair liver and pancreatic function, and prevent absorption of essential nutrients during before or pregnancy.[5]

The epidemiology of single drug therapy is fraught with mistakes but it is a mistake to ignore the importance of previous progestogen use and residual multiple essential nutrient imbalances or deficiencies. I spent decades correcting these before conception in couples with histories of "unexplained" infertility or recurrent miscarriages.

1. Vigod SN, Brown LM, Howard LM. Depression in pregnancy. BMJ 2016;352:i1547.
2 Grant EC, Pryse-Davies J. Effect of oral contraceptives on depressive mood changes and on endometrial monoamine oxidase and phosphatases. Br Med J 1968 Sep 28;3(5621):777-80.
3 Robinson DS, Davies JM, Nies A, Ravaris CL, Sylwester D. Relation of Sex and Aging to Monoamine Oxidase Activity of Human Brain, Plasma, and Platelets. Arch Gen Psychiatry 1971;24(6):536-539.
4 Kolla NJ, Chiuccariello L, Wilson AA, Houle S, Links P, Michael Bagby R, McMain S, Kellow C, Patel J, Rekkas PV, Pasricha S, Meyer J. Elevated Monoamine Oxidase-A Distribution Volume in Borderline Personality Disorder Is Associated With Severity Across Mood Symptoms, Suicidality, and Cognition. Biological Psychiatry 2016;79:117-126.
5 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance. J Nutr Environ Med 1998;8(2):105-116.

Competing interests: No competing interests

01 August 2019
Ellen C G Grant
Physician and medical gynaecologist
Retired
Kingston-upon-Thames, UK