Intended for healthcare professionals

Rapid response to:


Psychosocial and psychological interventions for prevention of postnatal depression: systematic review

BMJ 2005; 331 doi: (Published 30 June 2005) Cite this as: BMJ 2005;331:15

Rapid Response:

Postnatal depression and low zinc and high copper levels

An obvious easily treatable cause of postnatal depression, common
nutritional deficiencies especially of zinc and fish oils, has not been
mentioned in the responses to the article on psychosocial and
psychological interventions by Cindy- Lee Dennis.1

In contrast, Bodnar and Wisner write that child bearing-aged women
are particularly vulnerable to the adverse effects of poor nutrition on
mood because pregnancy and lactation are major nutritional stressors to
the body.2 They believe that depletion of nutrient reserves throughout
pregnancy and a lack of recovery postpartum may increase a woman's risk of
depression. They also write that greater attention to nutritional factors
in mental health is warranted given that nutrition interventions can be
inexpensive, safe, easy to administer, and generally acceptable to

Wojcik and others demonstrated a relationship between the severity of
depressive symptoms and decreased serum zinc concentrations in postpartum

Following observations of a possible association between elevated
serum copper levels and post-partum depression, Crayton and Walsh found
copper levels were significantly higher in women with a history of post-
partum depression compared both to non-depressed women and to depressed
women without a history of post-partum depression. The mean serum copper
level of 78 women with a history of post-partum depression was 131+/-
39microg/dL compared with 111+/-25microg/dL in 148 women without such a
history, and 106+/-20microg/dL in non-depressed controls (p<_0.001. p="p"/> Increases in progesterone and oestrogen levels during pregnancy raise
copper and lower zinc concentrations and I do not know why this is usually
ignored. I have seen patients with high copper (up to 263 microg/L) and
low zinc concentrations who have postnatal depression and premenstrual
psychotic feelings.

I am concerned that many pregnant women take nutritional supplements
containing 1mg or more of copper daily and continue to take these high
doses after childbirth. High doses of copper are common in several
multivitamin and mineral supplement combinations recommended for use in
pregnancy by companies selling such products.

1 Cindy- Lee Dennis. Psychosocial and psychological intervention for
prevention of postnatal depression: systematic review. BMJ 2005; 331:15.

2 Bodnar LM, Wisner KL. Nutrition and depression: implications for
improving mental health among childbearing-aged women. Biol Psychiatry.

3 Crayton JW, Walsh WJ. Elevated serum copper levels in women with a
history of post-partum depression. J Trace Elem Med Biol. 2007;21:17-21.

4 Wójcik J, Dudek D, Schlegel-Zawadzka M, Grabowska M, et al.
Antepartum/postpartum depressive symptoms and serum zinc and magnesium
levels. Pharmacol Rep. 2006;58: 571-6.

Competing interests:
None declared

Competing interests: No competing interests

21 August 2008
Ellen CG Grant
physician and medical gynaecologist
Kingston-upon-Thames, KT2 7JU