A Functional Medicine Approach To Postnatal Depression
Postnatal Depression is actually much more common than you may think. Data from the 2010 Australian National Infant Feeding Survey showed that 1 in 7 mothers are diagnosed every year. Hormonal changes associated with giving birth, the stress of caring for a new baby, and lack of a support system can set the stage for this potentially dangerous condition. However, it’s possible to alleviate symptoms of postpartum depression with natural treatments, obviously after being properly assessed and managed by an experienced mental health care professional.
Postnatal Depression is different to the baby blues. The baby blues affect up to 75% of mothers in the first 10 days following birth, but the symptoms — usually mood swings and bouts of crying — are mild and don’t last long. PND lasts much longer and is more deeply felt than the baby blues and can set in at any time during the first year following birth. Women with PND may have trouble connecting with their baby, have doubts about their parenting abilities, develop sleep issues beyond the lack of sleep often associated with newborn care, and may lose interest in activities they used to enjoy (anhedonia).
PND is usually diagnosed through a screening questionnaire, most often the EPDS (Edinburgh Postnatal Depression Scale).
The following symptoms can help you recognise PND in yourself or a loved one:
Feeling sad, hopeless or overwhelmed
Crying more than usual
Worrying or feeling anxious
Feeling irritable or restless
Sleeping too much or too little
Having trouble concentrating
Feeling anger or rage
Losing interest in once-enjoyable activities
Frequent headaches or other body aches
Eating too much or too little
Having trouble bonding with your baby
Doubting your parenting ability
Withdrawing from or avoiding friends and family
“If someone you’re close to is a new mother, listen between the lines. If she says she is completely in love and enjoying every minute, give her the opportunity to open up and share the not-so-good parts of her experience. She might be feeling too guilty to disclose the unpleasant feeling of motherhood upfront.”
Despite these seemingly hard to miss signs, PND isn’t always obvious. To the outside world, a mother may appear perfectly content while suffering on the inside. Many of these symptoms, like worrying or not eating well, are experienced by most mothers of newborns. But PND is far more intense and drawn out. The last symptom on the list— withdrawing from friends and family — is perhaps the most important. Too many stories of PND have ended tragically, and too many times, loved ones said afterward, “I didn’t even know she was suffering.”
If a new mother goes out of her way to physically avoid others — discouraging visitors, not wanting to chat or email, or not leaving home — it’s a bit more apparent that she may have an issue with PND. But often, this “withdrawal” is emotional, not merely physical (and attributed to having a newborn), so it may be easy for a friend or relative to miss and easy for a PND sufferer to hide.
What causes PND?
Low serotonin isn’t always the primary cause of symptoms in PND. Below are the 5 biggest contributors to PND:
Hormonal imbalance
Nutritional Deficiencies — Vitamin D, Iron, EPA/DHA (omega 3 fatty acids)
Stress
Thyroid disease
Inflammation
If you or a loved one is suffering from PND or is at risk, natural remedies may be beneficial and can offer powerful alternatives to prescription antidepressants. I would like to stress that in some cases, the cause of depression is most definitely a biochemical imbalance and antidepressant medication is the best treatment. And if you are taking medication then certainly do not suddenly stop this medication without consulting with your healthcare provider first. Many of the remedies discussed below can be incorporated before birth, especially for those with a history of depression or PND.
9 Ways to Care for Postnatal Depression with Natural Treatments —
1. Start Seeing A Psychotherapist
Compared to antidepressant medication, psychotherapy is cost effective, well tolerated and generally more effective for treating depression, especially in the long term. A meta-analysis and review examined 28 trials and reported that psychotherapy intervention during pregnancy significantly reduced the number of women who developed PND. Specifically, mindfulness-based cognitive therapy (MBCT) and cognitive behavioural therapy (CBT) have great track records of mitigating PND. Unfortunately, a major barrier to getting psychotherapy is the perceived “difficulty” of the process, from researching and finding a therapist to making (and keeping) the appointment. Even under less stressful circumstances, it isn’t always easy to ask for help — but for a mum experiencing feelings of hopelessness that accompany PND, it’s especially challenging. Finding a good GP who will listen with kindness and compassion, for as little as 5 minutes and help a mother find an appropriate psychologist is incredibly important. There are also a number of medicare and non-medicare funding options to help financially for perinatal women.
Before giving up, consider the following:
Start with baby steps
Bring your baby to appointments
Give it a few sessions
Stop if it doesn’t feel right
If you don’t click with the first (or second) therapist, try a different one — you’ll eventually find the right person
Consider telephone-based or internet delivered therapy
2. Get Regular Exercise
During the first 6-12 weeks after delivery, you should be resting and taking care of yourself and your new baby, especially if you’re recovering from a C-section or other pregnancy complications. But once you get the green light from your healthcare provider, taking up regular exercise could help reduce the risk of, and even treat, PND. It doesn’t have to be strenuous exercise, and in fact that could be detrimental for your nervous system if you are depleted, stressed and exhausted. Walking just fast enough that having a conversation is difficult is perfectly good exercise and can be done with a friend or fellow mum. You might be asking, “when can a new mum find time to exercise?” and it’s a valid question. A sustainable and enjoyable exercise routine is the one you’re most likely to stick with and it might require you to get creative:
Easiest of all — take a stroller walk with your baby, pick up the pace and add in some hills as you get your energy back
Try a mum and bubs yoga or pilates class, where babies are part of the routine
Buy a subscription to postpartum exercise videos you can stream from home
Dance (safely) with your baby
Workout during baby’s first nap of the day, to make it a top priority
And remember...before you know it, your baby will be an active toddler — a workout in itself!
3. Use Light Therapy
Our ancestors spent most of their waking hours outdoors, a lifestyle in stark contrast to modern society. Seasonal affective disorder tends to peak during winter, when sunlight exposure bottoms out. Harnessing the mood-improving effects of sunlight, light therapy has been proven effective for treating both seasonal affective disorder and non-seasonal related depression. Typically, light therapy involves exposure to a bright light for 10 - 20 minutes per day in the morning. Light therapy is believed to positively affect mood, sleep, circadian rhythms and HPA axis activity (modulating stress). Two studies have used bright light as a treatment for perinatal and/or postnatal depression. Both studies demonstrated clinical improvement with light therapy, with up to 75% reduction in depression.
4. Try Acupuncture
It may improve mood by decreasing stress-induced cortisol release. The results of acupuncture for the treatment of depression and PND are mixed. Generally well tolerated with few side effects, acupuncture from a competent, licenced practitioner may be worth pursuing for PND, however, more robust studies are needed.
5. Start Consuming Pre and Probiotics
The gut microbiome interacts with and influences the body’s organs and systems, including the brain. The brain and gut communicate with each other. The vagus nerve, responsible for parasympathetic processes like heart rate, runs from the brain to your visceral organs. In return, gut bacteria produce neurotransmitters (such as serotonin) that communicate with the brain. Disrupted gut microbiomes have been associated with psychological disorders such as depression and anxiety. We know the gut microbiome drastically shifts during pregnancy, and if that shift ventures towards gut dysbiosis, it could predispose certain women to developing PND. Take care of your gut by consuming bone broth, fermented foods, and kefir or yoghurt, if tolerated and seek advice from your healthcare professional to see if supplemental probiotics are right for you.
6. Look Into Bioidentical Hormone Therapy
After delivery, women experience dramatic drops in progesterone and estrogens, both of which influence activity at the GABA “feel good” receptor in the brain. Some data suggest that low progesterone following birth is correlated with the baby blues, but other data haven’t supported any clear link between hormone concentrations and postpartum mood. Bioidentical progesterone is not chemically identical to the synthetic progestins found in birth control pills and many conventional doctors will not be familiar with bioidentical hormone therapy. Related to bioidentical progesterone, allopregnanolone, a naturally occurring metabolite of progesterone, has been studied in 2 clinical trials for PND treatment. Much like bioidentical progesterone, allopregnanolone showed rapid mood-boosting effects after just one drug infusion. As these trials were very recent, in 2017 and 2018, it will be interesting to see what develops in this field in the future.
7. Get More Sleep And Rest
A large proportion of the population admit to not getting enough sleep and most likely that number would be even higher for new mums. Large meta-analyses have found associations between sleep disturbances and depression in both the general adult population and in postnatal mums. Sleep deprivation and depression can create a vicious cycle, as each contributes to the other. Getting enough sleep can seem impossible for new mums, especially in modern western society where women have less support than in previous generations. Sleeping when the baby sleeps is not always an option (especially if you have other children), but aim for it whenever possible. If you are breastfeeding, not on any medications with drowsy side effects and a non-smoker, co-sleeping and side-lying nursing might be good options that offer more sleep. Co-sleeping can be done safely. If you are unable to sleep, resting is next best — get horizontal on the couch or in a hammock for at least 5 minutes every day. Meditate, listen to some music or read a book… anything that relaxes you is good.
8. Investigate St Johns Wort And Other Natural Remedies
Many natural health communities tout St John’s Wort as a beneficial treatment for depression, as the herb has been shown to have mood-boosting activity at the serotonin and “feel good” GABA receptors. In double blind, placebo-controlled trials, St John’s Wort often performs better than antidepressant medications at reducing depression symptoms, with up to 10 times fewer side effects. Of note, St John’s Wort should not be taken concurrently with SSRIs, nor should it be combined with light therapy because it may increase the body’s sensitivity to light. However, if you are breastfeeding, St John’s Wort might not be the best choice. Even though it is found in breastmilk at “undetectable to low levels”, breastfeeding infants whose mothers supplemented with SJW had a higher incidence of drowsiness, colic and lethargy. Talk with your healthcare provider about other supplements that might be useful for PND such as, Vitamin D and consult your naturopath to ensure maximum suitability of certain antidepressant herbs such as Motherwort, Rhodiola, Saffron and Chamomile.
9. Set Up A Personal Support Network
This final point is probably the most important because being a new mum can be isolating. In other cultures, women are surrounded and cared for by other women and mothers after giving birth. In modern western societies, extended families often live far away, and the concept of a “village” helping to raise children is disappearing. Couple that isolation with inadequate parental leave policies and poor sleep and you have a recipe for depression. Ideally, a postpartum woman would have an extensive support network from friends and family, a generous amount of worry-free leave from her job, and multiple home visits from a medical practitioner as she recovers and adjusts to her new life. Most women only have one check up six weeks after giving birth, although the American College of Obstetricians and Gynaecologists now recommends that postpartum care be an ongoing process with multiple follow-up appointments.
See if your GP is willing to follow a more holistic care model which would include:
Multiple follow-ups post birth
Blood tests to monitor nutritional stores (beyond iron) and hormone statuses both during and after pregnancy
Full thyroid blood panel during and after pregnancy
Physiotherapy referral, if needed for pelvic floor dysfunction or diastasis recti (separation of the abdominal muscles)
Mental health referral if needed
If you are pregnant, set up a support system as best you can before birth. Here are a few tips to help you get started:
Accept any and all offers of help
Have a freezer meal baby shower
Set up a meal train for food delivery in the early weeks after baby is born
Begin a meditation practice
Identify nearby lactation consultants for support (The Australian Breastfeeding Association has a hotline you can call 24/7)
In conclusion, I want to assure you that if you (or a loved one) are suffering from postnatal depression, you are not alone. I urge you to please speak with your GP immediately about these and other options available for you to get help.
Yours in health,
Camilla x