Postpartum depression (PPD) is defined as depressive symptoms that last for at least 2 weeks and interferes with a mother’s ability to function in her activities of daily living (Moldenhauer, 2020). The onset tends to be gradual over the first 3 months after birth, in contrast to the “Baby Blues” which are milder symptoms of mood disturbance that come on suddenly and dissipate within the first 2 weeks after the birth of the infant (Moldenhauer, 2020). PPD affects approximately 10-15% of pregnant women and is of great concern especially in severe cases where the mother has suicidal ideation and there is the potential of harm to the baby (Brummelte, 2016) (Harrison-Hohner J, 2001) (Moldenhauer, 2020).
The exact cause of postpartum depression remains unknown although a history of depressive episodes, hormonal changes, sleep deprivation, and genetic susceptibility increases a woman’s risk (Moldenhauer, 2020). There are many other known risk factors such as preterm births, stress, low income, lack of social support, trauma, and more (Rahman, 2018) (Dennis CL, 2007) (Moldenhauer, 2020). Unfortunately, many of these are not directly modifiable risk factors and the consequences of postpartum depression can be quite severe, not only for the mother but also for the infant.
One of the most direct impacts of postpartum depression is the lack of bonding and attachment of the mother and the infant (Brummelte, 2016). This can have some serious downstream effects for the child such as health issues and developmental disabilities later in life (Abdollahi, 2017). Some research has shown that a child’s emotional state, social life, and cognition can be negatively impacted by the mother’s postpartum depression, which is amplified and highly associated with the chronicity and recurrence of the condition. This affects the mother primarily, and the child subsequently, but also the family unit as a whole.
Conventional treatments for postpartum depression are the same as with major depressive disorder, where psychotherapy is recommended for more minor cases and antidepressants for more severe cases. The typical first-line antidepressant treatment is selective serotonin reuptake inhibitors (SSRIs) but the safety and efficacy are not well-researched in this population (Molyneaux E, 2014).
Since PPD is common, with lots of risk factors, dire consequences, and lack of safe and effective treatment options, the best approach becomes prevention through the use of natural protective factors. Some simple, yet effective, preventive strategies that have proven beneficial in research include educating the mother as well as her significant other/partner, conducting at-home visits in the postpartum phase, phone support and interpersonal psychotherapy (Dennis, Psychosocial and psychological interventions for preventing postpartum depression, 2013). The most important aspect really is early identification and that is best done by educating the mother and the family unit to detect the early signs and symptoms of PPD. This also means that regular screening in the postpartum phase should be common practice for most healthcare practitioners and should become routine at check-up visits.
Naturopathic medicine can further support a mother mired by depressive symptoms with supplementation to ensure adequate nutritional status for mother and baby. One study showed that women who supplemented with 2g of calcium daily from week 11 to week 21 of gestation, had a decreased risk of depression at 12 weeks postpartum after the birth of their first child (Harrison-Hohner J, 2001). From a nutrition standpoint, pregnant women should be encouraged to consume foods that are high in calcium, such as dark leafy greens, broccoli, and almonds, throughout their pregnancy to ensure they are meeting their increased daily requirements and preventing potential nutritional deficiencies. Supplementation can also be used if deemed necessary. Another study found a similar trend with omega-3 essential fatty acids. This study was conducted with obese pregnant women diagnosed with major depressive disorder (MDD) (Su KP, 2008). These women were supplementing with 2,200mg of EPA and 1,200 mg of DHA for 8 weeks and saw a decrease in depressive scores on validated scales (Su KP, 2008). The best natural source of omega-3s is fatty oily fish. Pregnant women, however, have to be careful with their seafood consumption, due to the potential of consuming high levels of toxins such as mercury. Well-sourced fish oil can offer great nutritional and therapeutic benefits to these women while remaining safe and effective for both mother and child.
Another great recommendation for pregnant and postpartum women is to go for daily outdoor walks, especially during peak daylight hours. Some research has shown an increase in PPD risk with winter births, or women who go through their last trimester during the darker months (Smith, 2018). Natural light exposure is vital for pregnant women, for a multitude of reasons, but is likely associated with vitamin D levels. Supporting a pregnant woman with adequate vitamin D levels and preventing a deficiency of this nutrient is important. Light exposure can also help to suppress melatonin during the day regulate the sleep-wake cycle, which in turn may help with the sleep disturbances that are both a risk factor of PPD and a symptom (Smith, 2018).
Lastly, hormonal changes play a very important role. This may seem a bit harder to manipulate as a risk factor, as hormonal changes are a normal transition through pregnancy and birth. In particular, oxytocin often referred to as the “love hormone” is vitally important for the bonding of the mother and her newborn. A disruption of the oxytocin system in the brain can increase symptoms of anxiety, depression, and stress, as well as pain and inflammation (Wdowin, 2016). Trauma and stressful life events can decrease levels of oxytocin. The therapeutic benefits of oxytocin are far-reaching as they calm and soothe the mother and help to nurture infants to be more relaxed, energetic and interactive children. Oxytocin can be leveraged therapeutically with vitamin C and probiotics, but levels are also naturally enhanced with simple practices such as gratitude, exercise, massage, hugging, and sex (Wdowin, 2016).
As Rahman put it, “a child’s birth is supposed to be a significant happy moment in a women’s life as she embraces motherhood” and we should leverage these natural protective factors to the best of our ability to prevent postpartum depression from overshadowing this beautiful moment and relationship between mother and child (Rahman, 2018).
Abdollahi, F. A. (2017). Postpartum Depression Effect on Child Health and Development. Acta Medica Iranica, 55(2):109-114.
Brummelte, S. G. (2016). Postpartum depression: Etiology, treatment and consequences for maternal care. Hormones and Behavior, 153-166.
Dennis CL, R. L. (2007). Psychosocial and psychological interventions for treating antenatal depression (Review). Cochrane Database of Systematic Reviews, 1-18.
Dennis, C.-L. D. (2013). Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression. Cochrane Database of Systematic Reviews, 1-40.
Dennis, C.-L. D. (2013). Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews, 1-158.
Harrison-Hohner J, C. S. (2001). Prenatal calcium supplementation and postpartum depression: an ancillary study to a randomized trial of calcium for prevention of preeclampsia. Arch Women's Ment Health , 3:141-146.
1. Moldenhauer, J. (2020, May). Postpartum Depression. Retrieved from Merck Manual - Professional Version.
Molyneaux E, H. L. (2014). Antidepressant treatment for postnatal depression (Review). Cochrane Database of Systematic Reviews, 1-54.
Rahman, I. Y. (2018). Postpartum depression—It’s time to pay attention. Asian Journal of Psychiatry, 111.
Smith, N. (2018, November 13). Postpartum Depression Risk May Increase with Winter Births. Retrieved from Naturopathic Doctor News and Review: ndnr.com/naturopathic-news/postpartum-depression-risk-may-increase-with-winter-births/
Su KP, H. S. (2008). Omega-3 Fatty Acids for Major Depressive Disorder During Pregnancy: Results From a Randomized, Double-Blind, Placebo-Controlled Trial. J Clin Psychiatry , 69(4):644-51.
Tani F, C. V. (2016). Maternal social support, quality of birth experience, and postpartum depression in primiparous women. The Journal of Maternal-Fetal & Neonatal Medicine, 1-4.
Wdowin, H. (2016, February 9). The Healing Power of Love: The Hormone, Oxytocin. Retrieved from Naturopathic Doctor News and Review: ndnr.com/neurology/the-healing-power-of-love-the-hormone-oxytocin