Plasma cortisol, free and total tryptophan were determined in 71 subjects on 8 occasions between 36 weeks gestation and 6 weeks post-partum. Affect was measured by rating scales and clinical interview. Twenty-eight subjects were judged to have experienced post-partum 'blues'. Seasonal variation occurred in the incidence of 'blues' and in cortisol and free tryptophan levels. Puerperally-depressed mood was correlated with high cortisol at 38 weeks irrespective of season. Free tryptophan was reduced in 'blues' subjects but only at the time of year when free tryptophan was normally high. Total tryptophan was low antenatally; a rapid rise on days 1 and 2 post-partum was superimposed on a slower return to normal. This initial peak was clearly absent in 37 per cent of subjects. Its absence was significantly related to occurrence of post-partum 'blues' and of complaints of depression in the ensuing 6 months. This finding is discussed in relation to the possible occurrence of an occult disturbance of tryptophan handling in subjects susceptible to depression.
The interrelationships of 'blues' and later postpartum depression with a number of biochemical, medical, and psychosocial variables have been examined in 52 subjects. The two syndromes shared only an impressive association with a prior history of gynaecological problems. Puerperal 'blues' was characterised in addition by associations with primiparity, tearfulness during pregnancy, and reduced plasma total tryptophan in the early puerperium. Depressive symptomatology up to nine months postpartum was related to an excess of male births and to an altered pattern of decline of non-esterified fatty acids immediately postpartum. In each case, the 'risk' variables were statistically independent and combined linearly. Stepwise discriminant analysis successfully discriminated 'blues' and depression from their respective non-cases. 'Blues and postpartum depression were only weakly related and, apart from gynaecological history, each was associated with separate and independent causative factors.
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