Postpartum depression (PPD) is an extremely common disorder that is often pushed behind the scenes due to shame, perceived societal judgment, and the fear of revealing struggles to loved ones.
In fact, it is so common that about one in seven women experiences this condition. Far more persistent and debilitating than the 'baby blues,' PPD can significantly hamper a woman's return to normal function and negatively affect her relationship with her newborn.
Moreover, it can compromise maternal brain responses and behaviors, contributing to a myriad of difficulties. In this article, we discuss what PPD is, what causes it, how lab testing can help manage it, and the different treatments and tools to improve PPD outcomes.
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What is Postpartum Depression?
PPD is a complex mood disorder that can affect women after childbirth. More severe and enduring than the so-called "baby blues"—a term that encompasses the worry, sadness, and fatigue many women encounter after giving birth—PPD can emerge within four weeks post-delivery but may also manifest as late as 30 weeks postpartum (1,2).
The distinctive nature of PPD sets it apart from general depression, with key differences including a neuroendocrine component and changes in reproductive hormones. It arises from shifts in numerous biological and endocrine systems, such as the immune system, the hypothalamic-pituitary-adrenal (HPA) axis, and lactation hormones. The HPA axis, which regulates stress responses and undergoes changes during and after pregnancy, plays a particularly significant role. Additionally, rapid post-delivery shifts in hormones like estradiol and progesterone can trigger depressive symptoms in susceptible women. Lastly, hormones such as oxytocin and prolactin, which are involved in lactation, are crucial in PPD's development, with decreased oxytocin levels linked to depression and difficulties in breastfeeding.
Postpartum Depression Signs & Symptoms
PPD bears a resemblance to other types of depression yet has distinctive symptoms that may include feelings of hopelessness, guilt, worthlessness, irritability, and restlessness. Moreover, women with PPD may experience challenges with concentration, memory, and decision-making, along with a loss of energy, sleeping issues, and changes in appetite. In severe situations, PPD may lead to suicidal ideation or suicide attempts (1,2).
Alongside the emotional difficulties posed by PPD, the physical demands of caring for a newborn can often be overwhelming for many women. The common signs and symptoms of PPD include (1,2):
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Feelings of irritability or restlessness
- Problems with concentration, memory, and decision-making
- Loss of energy or fatigue
- Issues falling asleep or excessive sleep
- Overeating or loss of appetite
- Suicidal ideation or suicide attempts
- Aches or pains that do not improve with treatment
Postpartum Depression Possible Causes
The possible causes of PPD can be grouped into three main categories: biological factors, social factors, and psychological factors.
Biological Factors
Recent scientific findings suggest that biological changes in mothers suffering from PPD could help understand the condition, paving the way for improved treatments and early risk detection before childbirth. One of these biological factors is hormonal change, such as a dramatic drop in estrogen and progesterone levels after childbirth, which might contribute to PPD. Additional contributing factors include autoimmune conditions such as Hashimoto's Thyroiditis, characterized by the presence of antibodies that attack the thyroid gland. Similarly, postpartum thyroiditis, an inflammation of the thyroid gland following childbirth, has been associated with various psychiatric disorders, including depression (1,2).
Social Factors
Social factors play a significant role in PPD, with a lack of social support being a common causative factor. Additionally, domestic violence, including spousal abuse (sexual, physical, or verbal), can also contribute to the development of this condition (1,2).
Psychological Factors
Women with a personal or family history of depression, postpartum depression, or premenstrual dysphoric disorder (PMDD) are at an increased risk of developing PPD. Other risk factors under this category include limited social support, marital or relationship conflict, ambivalence about the pregnancy, pregnancy complications, and the strain of having a baby with special needs or a baby who cries a lot (1,2).
Studies suggest the HPA axis, which is responsible for stress responses, can become hyperactive in those with PPD, which is often accompanied by increased cortisol levels. Furthermore, psychosocial stress during the peripartum period is of significant concern as it may disrupt the usual adaptations of the HPA axis, which can contribute to the onset of PPD.
Functional Medicine Labs to Test for Root Cause of Postpartum Depression
Lab testing for PPD can provide valuable insights into the underlying physiological imbalances that may contribute to the disorder. While there is no single definitive test for PPD, a comprehensive approach that considers various factors can be helpful. Here are some functional medicine labs that may be considered:
Hormone Tests
A comprehensive hormone panel can be helpful since hormonal changes, such as a significant drop in estrogen and progesterone levels post-childbirth, may contribute to PPD. Including a panel that tests for thyroid function is also important to check because of the potential link between thyroiditis and PPD (1).
Micronutrient Tests
This test can be used to identify any nutritional deficiencies that may contribute to PPD. It's important to measure levels of essential nutrients like vitamin D, zinc, selenium, and omega-3 fatty acids. All these are vital for overall health and mental well-being and may play a role in the symptomatologic burden of PPD.
Adrenal Stress Profile
Chronic stress can contribute to the onset of PPD. An adrenal stress profile measures cortisol levels throughout the day, which can provide information about the body's stress response. This could be important to test in cases where an overactive hypothalamic-pituitary-adrenal (HPA) axis may be contributing to the PPD symptoms (8).
Conventional Treatment for Postpartum Depression
The mainstay treatments for PPD include psychotherapy and medications, where the choice of treatment depends on the severity of the condition. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), serve as the primary pharmaceutical intervention for PPD, working by enhancing the brain's serotonin levels to ameliorate mood and diminish depressive symptoms. In cases where SSRIs fall short, alternatives like serotonin-norepinephrine reuptake inhibitors (SNRIs) or mirtazapine may be prescribed (2).
Psychotherapy, particularly cognitive-behavioral therapy (CBT), is another key treatment focused on rectifying negative thought patterns and behaviors contributing to depression. In situations where conventional therapies fail or for mothers worried about exposing their breastfeeding infants to medication, advanced treatments such as transcranial magnetic stimulation (TMS) and intravenous brexanolone can be considered (2).
Functional Medicine Treatment for Postpartum Depression
The functional medicine perspective for treating PPD prioritizes the identification and rectification of underlying physiological imbalances that may be contributing to the condition. Key strategies include dietary enhancements and hormone regulation. Given the possible link between deficiencies in certain nutrients, such as omega-3 fatty acids, B vitamins, and vitamin D, and mood disorders, addressing nutritional gaps forms a crucial part of this approach. This might involve a diet rich in these nutrients or the consideration of targeted supplementation. Additionally, addressing hormonal imbalances, particularly reduced estrogen and progesterone levels often associated with PPD, forms another pillar of functional medicine's approach (5).
The health of the gut microbiota, which plays a significant role in mood regulation via the gut-brain axis, is another aspect considered in functional medicine. A variety of interventions like dietary modifications, probiotics, and others aimed at enhancing gut health can potentially alleviate symptoms of PPD. The practice also recognizes the utility of mind-body therapies like yoga, meditation, and acupuncture, known for their potential to reduce depression symptoms and promote overall health by reducing stress.
Nutrition Considerations for Postpartum Depression
Research has begun to uncover a potential connection between nutrition and PPD. Some studies suggest that micronutrient deficiencies, particularly in vitamin D and certain B vitamins, may be implicated in the development of PPD, signifying the potential importance of a well-balanced diet in managing this condition (5).
Interestingly, the therapeutic benefits of omega-3 fatty acids for PPD have been highlighted, despite the preliminary nature of these studies. Omega-3s are essential fats that offer health advantages for both the mother and the nursing infant. It's also worth noting that research has linked trace minerals such as zinc and selenium to PPD, suggesting a potentially intriguing relationship between these minerals and the disorder.
Observational data demonstrates that adherence to nutrient-dense dietary patterns, similar to the Mediterranean diet, can help protect against PPD symptoms. This diet is characterized by a high intake of vegetables, fruits, nuts, beans, low-fat dairy products, fish, and whole grains. Despite needing more research to pinpoint the precise role of nutrition in PPD, a nutrient-rich diet such as the Mediterranean diet stands as a sound strategy for supporting general health and potentially managing PPD symptoms.
Supplements & Herbs for Postpartum Depression
Research into the role of supplements and herbs in supporting mental health, especially concerning PPD, is still ongoing. While some show promise, their effectiveness and safety need to be established more conclusively. Omega-3 fatty acids have shown potential for enhancing mental health and may positively impact PPD. These can be sourced either through fish oil supplements or from fatty fish like salmon and sardines. Vitamin B6 is another supplement that has been linked to the prevention of PPD. For patients with concurrent postpartum thyroiditis, supplements such as ginger or ashwagandha may help to rebalance thyroid hormones. Ashwagandha is also a great choice for general PPD patients as it has been shown to reduce general stress levels (4).
Complementary and Integrative Medicine
Many nonpharmacological treatments are sought as alternatives or adjuncts to standard treatments for PPD. Concerns such as potential effects on breastfeeding, access to care, the stigma associated with mental illness treatment, limited effectiveness of standard treatments, or personal beliefs may contribute to this pursuit (20).
Electroconvulsive Therapy (ECT)
ECT is considered for depressed postpartum women who do not respond to antidepressant medication or who have severe or psychotic symptoms. One small study reported a 100% remission rate among five women receiving ECT for treatment-resistant PPD. ECT's use in PPD does not differ substantially from its use in major depression, but breastfeeding women may need to time their sessions to minimize milk contamination from anesthetic agents (20).
Bright Light Therapy
Bright light therapy has shown effectiveness in treating nonseasonal depression and presents minimal known risks to the fetus or nursing infant. However, current data on its effectiveness in the postpartum population is limited, necessitating further research to clarify its therapeutic potential in PPD (20).
Acupuncture and Massage
Acupuncture, a traditional Chinese practice of inserting and manipulating needles into various points on the body, has been investigated for depression treatment with mixed results. Although no data exists on its use in postnatal depression, a pilot study comparing targeted acupuncture with non-targeted acupuncture and massage found the former significantly reduced depressive symptoms in pregnant women (20).
Massage therapy, in various forms, has been examined for treating perinatal depression, with studies showing potential benefits such as improved sleep patterns, interactions, crying, and lower cortisol levels in infants. However, the effectiveness of massage as a PPD treatment remains inconclusive due to inconsistent research findings and limited long-term follow-up (20).
Stress Reduction
Several therapeutic approaches can be effective for stress reduction in PPD patients. Interpersonal therapy (IPT) and cognitive behavioral therapy (CBT) have both demonstrated success in reducing depressive symptoms. Group IPT may also provide increased social support and reduce PPD stigma. Mindfulness meditation has also been shown to be a beneficial tool for managing stress and enhancing coping mechanisms in this population (20).
Exercise
Research supports exercise as a management strategy for mild-to-moderate depression. Home-based exercise programs have shown a reduction in depression rating scales in PPD women, and moderate-intensity activities, like "pram pushing," are recommended. However, some studies did not find significant changes in depression between treatment and control groups (20).
Lifestyle Changes
Lifestyle adjustments can play a crucial role in managing PPD. It's essential to prioritize adequate sleep, as sleep deprivation can elevate depressive symptoms even seven months postpartum. Additionally, frequent sunlight exposure is encouraged, particularly to boost vitamin D levels, given the link between limited daylight exposure during the last pregnancy trimester and higher PPD risk. Therapeutic approaches, such as interpersonal therapy and cognitive behavioral therapy, which concentrate on improving social functioning and interpersonal relationships, can be beneficial. Lastly, fostering supportive community relationships, either through local mom groups or other support networks, can provide a sense of understanding and shared experience, offering significant relief for those navigating PPD (1,20).
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Summary
In summary, postpartum depression is a complex mood disorder affecting women after childbirth, impacting not only their own mental health but also their ability to care for and bond with their newborn. The condition, often more severe than 'baby blues,' manifests through symptoms of hopelessness, guilt, irritability, and difficulties in concentration, memory, and decision-making. PPD is linked to a combination of biological, social, and psychological factors, including hormonal changes after childbirth, lack of social support, and a history of depression. While conventional treatments like psychotherapy and medications are commonly used, there's a growing interest in functional medicine approaches that focus on identifying and rectifying underlying physiological imbalances through methods such as dietary and lifestyle modifications.
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