KORN KURATED RESEARCH

5 Ways To Decrease Postpartum Blues and Depression

Postpartum mood disorders, influenced by hormonal shifts and psychosocial factors, can be mitigated through holistic perinatal care and nutritional optimization, emphasizing proactive support for maternal well-being.

In this research review, I focus on postpartum blues, depression, and anxiety, common conditions that occur along a spectrum of experiences following the birth of a child. 

Postpartum blues include symptoms of ​​sad mood, crying spells, anxiety, restlessness, reduced appetite, and irritability. Postpartum depression extends into feelings of disconnection, challenges with bonding, overwhelming worry, doubt, fear, sorrow, rage, and worthlessness, and can lead to suicidality and, rarely, psychosis and homicidality. 

Postpartum psychosis is the severest form characterized by extreme confusion, loss of touch with reality, paranoia, delusions, disorganized thought processes, and hallucinations.

Childhood trauma is a risk factor for postpartum depression, and trauma can also occur during birth to both mother and infant.

The drastic drop in estrogen and progesterone after childbirth contributes to mood changes, which are aggravated by sleep deprivation and lack of social support associated with caring for a newborn infant. 

Fatigue and worry are normal for new mothers. Still, postpartum blues can escalate to depression and anxiety within 6 weeks of birth and lead to feelings that interfere with interpersonal relationships and the mother’s ability to care for her child. The “Blues" tends to occur soon after birth and resolve quickly. Upwards of one in seven women experience postpartum depression.

I begin working with parents before pregnancy to optimize nutritional support and exercise and adjust dietary, nutrient, and herbal needs throughout the cycle to ensure biological and psychological resilience.

Ensuring optimal nutritional and exercise status prior to and during pregnancy helps prevent postpartum blues. A history of premenstrual stress is a risk factor. Supplementing with Borage oil (1000 mg/d), Vitamin B 6 (50-100mg/day), and Magnesium glycinate (200 mg/day), along with exercise, helps alleviate premenstrual stress (see my blog on premenstrual stress). These are safe doses during pregnancy as well.

There is some evidence that a low level of vitamin D is a risk factor in postpartum depression, suggesting both sun exposure and supplemental vitamin D are important to optimize. 

One interesting study on postpartum blues, also called the baby blues, put together a compound protocol combining tryptophan (2 grams at night and tyrosine 10 grams/ during the day, both antidepressant amino acids, and blueberry juice and extract to demonstrate effects.   

Postpartum Depression across countries and cultures

I often wonder about differences in disease categories around the world. Has postpartum blues been with us forever, or has it risen along with the Standard American Diet, sedentism, and lower rates of breastfeeding?

Indeed, one large study found that countries that consumed more sugar-sweetened beverages had higher rates of postpartum depression, with higher seafood, fruits, and fibers associated with lower rates. Women who took probiotics during pregnancy had lower rates of postpartum depression. These findings should not surprise us. 

Physical exercise antepartum also reduces the risk of postpartum depression. One study this year described its benefits of decreased symptoms of postpartum depression and an increase in psychological well-being and quality of life. Breastfeeding appears to reduce postpartum depression and may be among the biggest biological modifiers by increasing oxytocin (the love hormone) and balancing our cortisol and hormone levels.

Fatigue is a risk factor for depression for two years postpartum, which suggests that having extended family and friends provide childcare and household relief is beneficial. The Mexican and South American practice of Cuarentena is a 40-day period during which women are fully attended to, so they only have to care for their infants and not perform other household duties.

Tags: Postpartum blues, postpartum depression, postnatal mental health, postpartum nutrition

Interested in Learning More?

• Course(s): Mental Health Disorders
• Book(s): Natural Woman
• Book(s): Nutrition Essentials For Mental Health

Referenced Research Publications

eClinicalMedicine
2024, April 10
DOI: https://doi.org/10.1016/j.eclinm.2024.102593

Dietary supplement for mood symptoms in early postpartum: a double-blind randomized placebo controlled trial.

Abstract

Background

Postpartum blues (PPB) is a frequent syndrome of sad mood, crying spells, anxiety, restlessness, reduced appetite, and irritability, typically peaking day 5 postpartum. When severe, it greatly increases risk for later postpartum depression. This trial compared a dietary supplement to placebo on PPB severity. The supplement was designed to counter downstream effects of elevated monoamine oxidase A level, implicated in causing PPB.

Methods

Participants recruited by advertisement from the Toronto region completed procedures at CAMH, Canada and/or participants’ homes. Oral supplements or identical appearing relatively inert placebo were administered in randomised, double-blind fashion. Supplement was blueberry juice and extract given four times between nighttime day 3 and morning day 5 postpartum; tryptophan 2 g nighttime day 4 postpartum, and tyrosine 10 g morning day 5 postpartum. On day 5, depressed mood induction procedure (MIP) and postpartum blues were assessed. All data is presented (NCT03296956 closed, clinicaltrials.gov).

Findings

Between January 2019 and December 2022, participants took supplement (n = 51) or placebo (n = 52). There was no significant effect on primary outcome MIP on visual analogue scale for depressed mood (mean difference = −0.39 mm, 95% CI: −6.42 to 5.65 mm). Stein Maternity Blues scores, exploratory PPB measure, was lower in the active group (effect size 0.62; median, interquartile range (IQR): active 2.00 (IQR 1, 4); placebo 4.00 (IQR 1.5, 6); regression with general linear model, supplement effect, β coefficient = −1.50 (95%: CI −2.60, −0.40), p = 0.008; effect of CES-D crying category before supplement, p = 0.03–0.00000023). Twenty-six and 40 different adverse events occurred within 25% and 42% of supplement and placebo cases respectively (Chi-Square, p = 0.06).

Interpretation

The primary outcome was negative for effect on depressed mood induction, however the supplement moderately reduced PPB.

Funding

CAMH/Exeltis.

Reference

Meyer, J. H., Wang, Z., Santhirakumar, A., Dowlati, Y., Docteur, N., Shoaib, A., Purnava, J., Wang, Y., Wang, W., Chen, S., Husain, M. I., Wijeyeratne, R. S., Reeyaz, H., Baena-Tan, C., Koshimori, Y., Nasser, Z. & Sit, V. (2024). Dietary supplement for mood symptoms in early postpartum: a double-blind randomized placebo controlled trial. EClinicalMedicine, 102593. https://doi.org/10.1016/j.eclinm.2024.102593

Archives of Women's Mental Health
2020, October 10
DOI: 10.1007/s00737-020-01066-4

The Impact of Childhood Trauma on Psychological Interventions for Depression During Pregnancy and Postpartum: A Systematic Review

Abstract

Background:

Women who have experienced childhood trauma (CT) are at increased risk for depression during pregnancy and postpartum, increased pregnancy complications, and adverse child outcomes. There are effective psychotherapeutic interventions to treat depression during pregnancy and postpartum, yet there is a paucity of literature on the impact of CT on treatment outcomes. This review aims to determine whether and how maternal CT history affects the outcomes of psychological interventions for depression during pregnancy and postpartum.

Methods:

PubMed, PsycINFO, and Cochrane Library searches were conducted to identify papers on psychological interventions designed to treat depression during pregnancy and postpartum in women with CT.

Results:

Seven manuscripts, describing six studies, met the inclusion criteria (N=1,234). Three studies utilized core principles of Interpersonal Psychotherapy (IPT). Two studies investigated interventions based on Cognitive-Behavioral Therapy (CBT). One study was based on a psychoeducation component. Results suggest that IPT-based interventions are beneficial for women with CT. The evidence regarding CBT-based interventions is less conclusive.

Limitations:

This review is written in light of the paucity of research addressing the question systematically. The Childhood Trauma Questionnaire (CTQ) was the main measure used to assess CT. Trauma related to accidents, illness, and political violence were not included. The results are only applicable to interventions based on either IPT or CBT and cannot be generalized to other forms of psychotherapy.

Conclusions:

Psychotherapeutic interventions are beneficial for depressed women with history of CT during pregnancy and postpartum; however, further systematic research is needed.

Reference

Reuveni, I., Lauria, M., Monk, C., & Werner, E. (2021). The impact of childhood trauma on psychological interventions for depression during pregnancy and postpartum: a systematic review. Archives of women's mental health, 24(3), 367–380. https://doi.org/10.1007/s00737-020-01066-4

Heliyon
2024, January 29
DOI: 10.1016/j.heliyon.2024.e25455

The effects of yoga-based interventions on postnatal mental health and well-being: A systematic review

Abstract

Background: The postnatal period is a critical time for maternal mental health, presenting unique challenges and vulnerabilities. Identifying effective and accessible strategies to improve postnatal mental health and well-being is therefore crucial and could have substantial benefits for both mothers and babies, alongside broader implications for healthcare systems. Yoga is a potential intervention that has demonstrated notable benefits; however, a gap exists in systematically evaluating the existing literature on postnatal yoga-based interventions. This systematic review addresses this, aiming to comprehensively assess the impact of postnatal yoga on maternal mental health and well-being.

Methods: Six databases were searched using keywords "yoga", "yogic", "postnatal", "postpartum", "perinatal", "maternal", "mother*". Articles were considered if they were quantitative and evaluated a yoga or yoga-based intervention in postnatal samples. Study outcomes were extracted and synthesised descriptively. A quality assessment of studies was also conducted.

Findings: Of the 383 non-duplicated records that were identified, nine met criteria for full-text review. Only 6 met the inclusion criteria and so were included in the review. Across the 6 studies within this review, data from 377 adult women were included and looked at the outcomes of women in the USA, Northern Ireland, Taiwan and Turkey. The findings of the studies suggest that taking part in postnatal yoga is associated with decreased symptoms of depression, an increase in psychological well-being and quality of life.

Key conclusions: Yoga-based interventions may offer a promising and effective intervention for maternal mental health and well-being. However, due to the limited number of studies, and a lack of consistency in study design and measures, more high-quality research is required to establish these effects and explore the potential benefits on other aspects of maternal well-being and infant outcomes.

Reference

Munns, L., Spark, N., Crossland, A., & Preston, C. (2024). The effects of yoga-based interventions on postnatal mental health and well-being: A systematic review. Heliyon, 10(3), e25455. https://doi.org/10.1016/j.heliyon.2024.e25455

Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine
2017, July 27
DOI: 10.1089/bfm.2016.0213

Associations Between Postpartum Depression, Breastfeeding, and Oxytocin Levels in Latina Mothers

Abstract

Background: Postpartum depression (PPD), often comorbid with anxiety, is the leading medical complication among new mothers. Latinas have elevated risk of PPD, which has been associated with early breastfeeding cessation. Lower plasma oxytocin (OT) levels have also been associated with PPD in non-Latinas. This pilot study explores associations between PPD, anxiety, breastfeeding, and OT in Latinas.

Materials and methods: Thirty-four Latinas were enrolled during their third trimester of pregnancy and followed through 8 weeks postpartum. Demographic data were collected at enrollment. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at each time point (third trimester of pregnancy, 4 and 8 weeks postpartum). The Spielberger State-Trait Anxiety Inventory (STAI) was administered postpartum and EPDS anxiety subscale was used to assess anxiety at each time point. Breastfeeding status was assessed at 4 and 8 weeks postpartum. At 8 weeks, OT was collected before, during, and after a 10-minute breast/bottle feeding session from 28 women who completed the procedures. Descriptive statistics are provided and comparisons by mood and breastfeeding status were conducted. Analyses of variance were used to explore associations between PPD, anxiety, breastfeeding status, and OT.

Results: Just under one-third of women were depressed at enrollment. Prenatal depression, PPD, and anxiety were significantly associated with early breastfeeding cessation (i.e., stopped breastfeeding before 2 months) (p < 0.05). There was a significant interaction between early breastfeeding cessation and depression status on OT at 8 weeks postpartum (p < 0.05).

Conclusions: Lower levels of OT were observed in women who had PPD at 8 weeks and who had stopped breastfeeding their infant by 8 weeks postpartum. Future studies should investigate the short- and long-term effects of lower OT levels and early breastfeeding cessation on maternal and child well-being.

Reference

Lara-Cinisomo, S., McKenney, K., Di Florio, A., & Meltzer-Brody, S. (2017). Associations Between Postpartum Depression, Breastfeeding, and Oxytocin Levels in Latina Mothers. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine, 12(7), 436–442. https://doi.org/10.1089/bfm.2016.0213

Frontiers in psychiatry
2023, July 15
DOI: 10.3389/fpsyt.2023.1193490

Nutritional factors and cross-national postpartum depression prevalence: an updated meta-analysis and meta-regression of 412 studies from 46 countries.

Abstract

Background

Postpartum depression (PPD) is the most common complication associated with childbirth and can lead to adverse outcomes for both mothers and their children. A previous meta-analysis found that PPD prevalence varies widely across countries. One potential underexplored contributor to this cross-national variation in PPD is diet, which contributes to mental health and varies significantly around the world. Here, we sought to update the global and national estimates of PPD prevalence using systematic review and meta-analysis. Further, we examined whether cross-national variation in PPD prevalence is associated with cross-national variation in diet using meta-regression.

Methods

To estimate national rates of PPD prevalence, we conducted an updated systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale between 2016–2021 and combined our findings with a previous meta-analysis of articles published between 1985–2015. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To examine dietary predictors, we extracted data on sugar-sweetened beverage, fruit, vegetable, total fiber, yogurt, and seafood consumption from the Global Dietary Database. Random effects meta-regression was used to test whether between-country and within-country variation in dietary factors predicted variation in PPD prevalence, controlling for economic and methodological variables.

Results

412 studies of 792,055 women from 46 countries were identified. The global pooled prevalence of PPD was 19.18% (95% confidence interval: 18.02 to 20.34%), ranging from 3% in Singapore to 44% in South Africa. Countries that consumed more sugar-sweetened beverages (SSBs) had higher rates of PPD (Coef. = 0.325, p = 0.044, CI:0.010–0.680); Moreover, in years when higher rates of sugar-sweetened beverages were consumed in a country, there were correspondingly higher rates of PPD in that country (Coef. = 0.129, p = 0.026, CI: 0.016–0.242).

Conclusion

The global prevalence of PPD is greater than previous calculations, and drastically varies by country. Sugar-sweetened beverage consumption explained some of the national variation in PPD prevalence.

Reference

Fish-Williamson, A., & Hahn-Holbrook, J. (2023). Nutritional factors and cross-national postpartum depression prevalence: an updated meta-analysis and meta-regression of 412 studies from 46 countries. Frontiers in psychiatry, 14, 1193490. https://doi.org/10.3389/fpsyt.2023.1193490