Guest Post – Postpartum Depression

Pregnancy, child birth, and the postpartum period place high demands on a woman’s physical, emotional, and spiritual health. Although welcoming a new life into the world comes with strong feelings of happiness, the postpartum period is a fragile time during which many women struggle with depression.

In this article, naturopathic doctor and CCNM clinic resident, Lauren Quinn, looks at the difference between postpartum ‘baby blues’ and postpartum depression, and ways to prevent postpartum depression.

There are ups and downs during the postpartum period. Lack of sleep, initiation of breastfeeding, variable support networks, hormonal changes, and physical symptoms after birth can all take a toll on a mother’s mood.

Postpartum blues
During the postpartum period there is a shift in hormones; estrogen & progesterone levels drop and prolactin levels rise. Postpartum blues can affect up to 75% of mothers, and the onset is usually within the first 3-5 days postpartum and can last for 24-48 hours. Symptoms include: anxiety, mood swings, fatigue, and feeling tearful and overwhelmed. There is no treatment required for the baby blues; however, support, nutrition, and rest will assist with coping with these changes.1

Postpartum depression (PPD)
In Canada, the prevalence of major postpartum depression is 8.69%, while that of minor/major (moderate) PPD is 8.49%. Symptoms typically appear by 2-4 weeks postpartum, and are longer lasting and more severe than the baby blues. Symptoms can be the same as any other depressive episode and can include: anxiety about infant, guilt, insomnia, severe fatigue, and inability to care for self or family. Some risk factors for developing PPD are a prior history of depression, lack of social support, adolescent mothers, and mothers who experience high levels of stress during pregnancy.1

Stress and Inflammation:
Preventing and treating postpartum depression should include decreasing stress and inflammation. Research in the area of psychoneuroimmunology is investigating the relationship between stress, inflammation, and depression; mental and/or physical stress can lead to increased inflammation which is a major underlying risk factor for depression. Pro-inflammatory cytokines increase during the final trimester of pregnancy, and they increase even more when affected by sleep disturbances, pain, and other stressors in the postpartum period.2

Lifestyle support:
1) Breastfeeding
Successful breastfeeding has been shown to be associated with more positive mood and decreased stress.3 Initiation of lactation and having infants properly latch can be very a challenging for new mothers. Seeking out some of the following resources during pregnancy could be a helpful way to prepare for breastfeeding:
-Dr. Jack Neman- Dr. Newman is a medical doctor who runs the International Breastfeeding Clinic in Toronto. He has a book called Dr. Jack Newman’s Guide to Breastfeeding, handouts and resources on the website http://www.nbci.ca, as well as a Facebook group (Dr. Jack Newman) for online support.
-Lactation Consultant- Find a board certified lactation consultant for hands-on clinical support with breastfeeding, and any breastfeeding-related problems.
-La Leche League- A mother-to-mother support group set up in cities all around the world. Visit http://www.groups.LLLC.ca to find one close to you.

2) Exercise
Exercise can be a helpful way to decrease depressive symptoms postpartum.4 Meeting up with other mothers to walk while pushing a stroller, or finding a mom-and-baby yoga class can be ways for new mom’s to get out, socialize, and get some exercise with baby in-tow.

3) Infant massage classes
Postpartum depression can negatively impact the mother-infant relationship. Infant massage classes have been shown to facilitate mother-infant interaction, and decrease depression scores in mother’s with postpartum depression.5 Infant massages are not only great for bonding, but can be a calming addition to bed-time routine.

Nutritional support:
The link between nutrient deficiencies and mood has been reported for folate, vitamin B12, calcium, iron, selenium, zinc, and omega-3 fatty acids. Several studies have reported inadequate intake of omega-3s, folate, B vitamins, iron, and calcium in pregnant women.6 Combine that with the fact that pregnancy and lactation are major nutritional stressors on the body, it makes sense to utilize nutrition in the prevention of postpartum depression.7
1) Fish oil
Omega-3 fatty acids, including intake during the perinatal period, can help decrease pro-inflammatory cytokines, thus decreasing the risk for depression.2,8 A combined EPA/DHA supplement (with at least 400mg/day DHA) is best to help support mom’s mood, and also ensure baby is getting the proper fatty acids for brain and vision development.

2) Vitamin D
Low vitamin D levels during pregnancy can increase the risk for developing low mood and depressive symptoms during the postpartum period.9 Supplementing with at least 1,000 IU of vitamin D per day during pregnancy and the postpartum period can help in achieving adequate levels.

3) Tryptophan
The amino acid tryptophan is a precursor to the neurotransmitter serotonin, and decreased serotonin levels are associated with depression. There is a transient decrease in tryptophan during the postpartum period which could contribute to low mood.10 The most common sources of tryptophan are protein-based foods such as nuts, seeds, tofu, cheese, red meat, chicken, turkey, beans, lentils, and eggs. A whole foods diet with lots of veggies and fruit, along with plentiful intake of these protein-rich foods, can help support mood.

4) Iron
A combination of increased need for iron during pregnancy and blood-loss during birth can put new mother’s at risk for anemia. The recommended daily allowance of iron for pregnant women is 27mg/day, and that for breastfeeding women is 9mg/day. It is important to have iron levels checked because postpartum anemia is associated with increased fatigue, emotional instability, and depression.11,12

Thyroid
Testing thyroid function and treating accordingly is something that should not be overlooked in new mom’s, as there is a positive association between decreased thyroid function at delivery and depressive symptoms at 6 months postpartum.13

Additional naturopathic therapies can be used to address the cause of the issue, as well as to help alleviate the symptoms associated with low mood and depression. These include, but are not limited to the following modalities: lifestyle and nutritional support, nutraceutical supplement, botanical medicine, and acupuncture.14 It is important to have a thorough assessment done by your healthcare provider, and this article should not replace the advice of your naturopathic doctor or family physician.

References:
1. Lanes et al. Prevalence and characteristics of Postpartum Depression symptomatology among Canadian women: a cross-sectional study. BMC Public Health. (2011); 11: 302.
2. Kendall- Tackett, Kathleen. A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. International Breastfeeding Journal. 2007; 2: 6.
3. Groer MW. Differences between exclusive breastfeeders, formula-feeders, and controls: a study of stress, mood, and endocrine variables. Biol Res Nurs. 2005; 7(2): 106-17.
4. Armstrong and Edwards. The effects of exercise and social support on mothers reporting depressive symptoms: A pilot randomized controlled trial. International journal of mental health nursing. 2003; 12: 130-138.
5. Onozawa K et al. Infant massage improves mother-infant interaction for mothers with postnatal depression. J Affect Disord. 2001; 63(1-3): 201-207.
6. Leung BM and Kaplan BJ. Perinatal depression: prevalence, risks, and the nutrition link–a review of the literature. Journal of the American Dietetic Association. 2009; 109(9): 1566-1575.
7. Bodnar and Wisner. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biologyical Psychiatry. 2005; 58(9): 679-685.
8. De Vriese et al. Lowered serum n-3 polyunsaturated fatty acid (PUFA) levels predict the occurrence of postpartum depression: further evidence that lowered n-PUFAs are related to major depression. Life Sciences. 2003; 73(25): 31831-3187.
9. Robinson et al. Low maternal serum vitamin D during pregnancy and the risk for postpartum depression symptoms. Archives Women’s mental health. 2014; 17(3): 213-219.
10. Bailara et al. Decreased brain tryptophan availability as a partial determinant of post-partum blues. Psychoneuroendocrinology. 2006; 31(3): 407-413.
11. Milman N. Postpartum anemia I: definition, prevalence, causes, and consequences. Annals of Hematology. 2011; 90(11): 1247-1253.
12. Albacar et al. An association between plasma ferritin concentrations measured 48 h after delivery and postpartum depression. Journal of affective disorders. 2011; 131(1-3): 136-142.
13. Sylven et al. Thyroid function tests at delivery and risk for postpartum depressive symptoms. Psychoneuroendocrinology. 2013; 38(7): 1007-1013.
14. Manber et al. Acupuncture: a promising treatment for depression during pregnancy. Journal of affective disorders. (2004)l 83(1): 89-95.

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thepeartree

Integrative Health Centre