Lyla asks:  Could this theory of inadequate oxytocin be interpreted to mean
that
 moms with depression may have inhibited MER because of insufficient
 ocytocin?
Sounds to me like someone needs to figure out how to do this study....

Do SSRIs normalize oxytocin levels or are they a workaround that
 could relieve the depression symptoms but still leave a mom with
 insuffiecient oxytocin, which could in turn inhibit lactation?
SSRI's work by impacting serotonin uptake.

my understanding is that oxytocin cannot be easily measured with a blood draw
because levels fluctuate so much - is this correct?
Lyla - don't forget about the impact of prolactin on the milk supply.
Remember the findings that women can have strong, intact MER's and still
experience persistent low milk volume.

would a blood draw *while* baby is at breast indicate an accurate oxytocin
reading by which mom's level could be compared to expected levels?
It's not simple to understand all of this physiology stuff, is it?  And to
answer your question about blood draws...it's not simple to measure oxytocin
or prolactin levels.  The timing of the draws for one thing need to be at the
precise time...and, we're not even touching upon the issues of the difference
between blood levels of hormones versus the milk levels of hormones.  At
least we do understand that this hormonal, brain, body (physical) complex
system does center around lactation and symptoms of mood disorders
postpartum.  Now we need to educate the rest of the world that the moms we
meet who need our support are not crazy.  We need to allow them the freedom
to come out of the closets and receive the treatment they so deserve.  Even
the American Psychiatric Association does not yet acknowledge PPD as its own
DSM code.  (DSM code is a diagnostic coding system often necessary for
insurance reimbursement.)  The DSM code used is depression, with the
occurence timing of "during the period postpartum", meaning within 4 weeks of
delivery as a qualifier.  I have a mom I'm presently working with who just
told me that her insurance is refuting her ER visit because of problems with
the DSM coding.  She went to the ER and was treated for anxiety, which is one
of the categories of PPD.  And, guess what we're working on....low milk
volume.  When I first conducted her consult, baby's intake was only 16 cc's
at breast at age of 6 weeks.  Now, 2 weeks later, we're up to exclusive
breast in AM (74 cc's) and continuing to improve total milk volume for later
in the day.
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
Geneva, IL

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