Postpartum Depression: Causes, Symptoms, & When To See A Doctor

Childbirth is typically a period of joy and excitement, but it can also bring on many powerful feelings and emotions you may not expect. Depression following birth is something women may feel due to a myriad of reasons. There are two main forms of depression post-birth- baby blues and postpartum depression. Knowing the symptoms of postpartum depression, when to seek help, and what forms of support are available is vital to your overall well-being.

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What are Baby Blues?

Baby blues are feelings of sadness that women can experience a few days after birth and last up to two weeks. The "baby blues" are experienced by approximately 70-80% of postpartum women. Signs and symptoms can vary from person to person, with each person experiencing one or multiple of them.

What is Postpartum Depression?

If Baby Blue's symptoms persist or intensify, you may be experiencing postpartum depression (PPD). This form of depression is more severe and lasts longer than baby blues. Approximately 10% of women go through PPD, which is a mixture of physical, behavioral, and emotional changes after childbirth.

Baby Blues Symptoms

• Anxiety
• Difficulty sleeping
• Fluctuations in mood
• Bouts of crying
• Sadness
• Trouble concentrating
• Reduced appetite
• Irritability
• Impatience
• Fatigue
• Feeling overwhelmed

The exact cause of baby blues is unknown, but it is thought to be caused by the rapid shift in hormones. One study found that psycho-social factors such as maternal self-esteem and marital status contribute to the intensity of baby blues. Although unpleasant, this postpartum condition is usually temporary and, therefore, not medically treated unless it progresses to postpartum depression.

Postpartum Depression Signs & Symptoms

• Depressed mood
• Severe mood swings
• Excessive crying
• Loss of appetite or excessive eating
• Insomnia or excessive sleep
• Overwhelming fatigue or no energy
• Feeling hopeless, sad, or worthless
• Restlessness
• Feelings of shame or guilt
• Anxiety or panic attacks
• Suicidal thoughts
• Thoughts of self-harm or harming your baby
• Diminished concentration, clear thoughts, or decision making
• Fear you are not a good mother
• Lack of bonding with baby
• Increased irritability and anger
• Reduced pleasure in things you once enjoyed
• Withdraw from family and friends

What Causes Postpartum Depression?

While there is no exact cause of postpartum depression, correlations between hormone changes, social impacts, and psychological factors have been identified. Research also provides evidence that nutrient deficiencies and the autoimmune condition Hashimoto's Thyroiditis are linked to developing PPD.

Hormone Imbalances

Imbalances and interactions between hormones affect the development of PPD. Hormones such as estradiol, progesterone, oxytocin, cortisol, and thyroid hormones are some of the key factors in postpartum complications. For example, after birth, the hormones estrogen and progesterone drop drastically. Progesterone, the most abundant hormone of pregnancy, creates a metabolite called allopregnanolone.

Allopregnanolone helps stabilize mood by reducing anxiety and irritability. Low serum allopregnanolone has been linked to depressive moods. Much like PMS and PMDD, an imbalance of estrogen postpartum can also affect psychological functioning. Research has yet to connect a decline in estrogen as a causative factor of PPD, although estrogen therapy has been shown to be an effective treatment. This is part of the complexity of PPD causation. All current literature indicates that it is multifactorial and not consistently predictive.

Social and Psychological Changes

Many social and psychological changes occur with childbirth, influencing how your body responds, including:

• A lack of support and community.
• Worries about parenting.
• A result of physical changes occurring in your body.
  

Nutrition and Nutrients

Nutrition and micronutrient deficiencies are risk factors for postpartum depression. A study out of Greece documented dietary patterns of 529 women during mid-pregnancy and again at 8-10 weeks postpartum. Results revealed that women consuming more health-conscious dietary foods were about 50% less likely to have high PPD symptoms than women consuming less health-conscious diets.

Omega-3 fatty acids, essential to cardiovascular health and fetal neurological development, have also been shown to play a role in a woman's postpartum symptoms. A study of 52 women revealed that taking 300 milligrams of DHA fish oil during weeks, 24 to 40 of pregnancy significantly reduced PPD symptoms compared to the placebo group.

Micronutrient and mineral deficiencies that contribute to postpartum depression include iron, vitamin D, zinc, and selenium.

Hashimotos Thyroiditis

The presence of Hashimoto antibodies (TPOAb) during and after pregnancy has been shown to increase the risk of developing PPD. This autoimmune condition results from the immune system creating antibodies that attack the thyroid gland. This affects the function of the thyroid gland, causing an underactive thyroid, known as hypothyroidism. Hypothyroidism

Postpartum Thyroiditis

Similar to Hashimoto's, postpartum thyroiditis happens when a woman's thyroid gland becomes inflamed after having a baby. Postpartum thyroiditis affects 5-10% of women in the first year after giving birth. The condition is typically temporary, but it has been shown to correlate with various psychiatric disorders, including depression. Therefore, screening thyroid function in women during and after pregnancy is essential.

When to See a Doctor

If symptoms persist beyond two weeks, your coping mechanisms and ability to function are altered, or you have thoughts of harming yourself or your child, you should seek care with your primary healthcare provider or OB/GYN.

Attending postpartum visits between 4-6 weeks and 12 weeks is vital for your overall health. During these visits, your doctor will screen for depression and any complications from childbirth. It also allows you to discuss any concerns you may have.

Functional Medicine Labs to Test for Root Cause of Postpartum Depression

The following functional medicine testing options are quite helpful for understanding the root cause of postpartum depression:

Hormone Panel

A hormone panel that includes sex hormones estrogen and progesterone, along with cortisol, is warranted in women with PPD symptoms or at risk for PDD based on other confounding factors.  The results of this test can help practitioners with a more individualized approach to treatment.

Omega-3 Index

This test looks at fatty acid status, including Omega-3 markers: alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA).

Micronutrient testing

During pregnancy, women may benefit from micronutrient testing to see if any deficiencies correlated to PPD are present. Individual Vitamin D testing and Iron testing would also provide beneficial information for therapeutic input.

Thyroid testing

A complete thyroid panel, including Anti-TPO, would show if there are antibodies to the thyroid gland. If Anti-TPO is present, other thyroid markers could be off as well. Another way to screen for autoimmunity is to do an Antinuclear Antibody (ANA) test.

Functional Medicine Treatment for Postpartum Depression

A functional medicine approach to treatment consists of nutrition, herbs, supplements, and other lifestyle changes, as you will see below:

Nutrition

A whole-food diet emphasizing high-quality vegetables, fruit, fish, legumes, and grains could aid in treating postpartum depression. This list of healthy foods is also helpful to overall postpartum wellness. *note this list discusses gluten-containing grains. If a patient has anti-TPO antibodies, it's imperative to exclude gluten from the diet.

Herbs & Supplements

Herbs and supplements are very beneficial. However, make sure to always work with a qualified professional before taking the follow recommendations, especially if you are also breastfeeding.

Melissa Officinalis

Melissa Officinalis, also known as Lemon Balm, is an effective botanical used in treating baby blues. Lemon balm is a sedative herb commonly used to treat stress, anxiety, and depression.

Omega-3

Omega-3 fatty acids have promising results in reducing PPD symptoms. One of the best ways to get Omega-3s is by eating wild-caught fish like Salmon, Mackerel, Tuna, and Trout. Plant sources of ALA, such as flaxseed, chia seed, and walnuts, can also provide the necessary nutrients. There are great fatty acid supplements on the market, but it is always best to consult your practitioner for individualized recommendations.

Micronutrients

Prenatal vitamins provide nutrients for a healthy pregnancy and fetal development and the necessary nutrients that are usually low in postpartum depression. If you are concerned about your micronutrient levels, discuss with your provider the possibility of micronutrient testing for an individualized approach.

Lifestyle Changes

Postpartum is a time of incredible life changes. Here are some recommendations to help with this transition:

Community

Finding a support group during the difficulties of postpartum can help build relationships with others going through a similar situation. Whether it is a group of friends or a local community group, building trusting relationships can help your journey through postpartum and beyond. Many cities have groups for new mothers, which can be found via social media searches (i.e., Denver Mom's Group).

Therapy

Speaking with a professional can help you navigate your feelings and provide coping mechanisms. The first line of therapy recommended is Interpersonal Therapy. This form of treatment works on attachments and interactions within your environment, with the primary goal being to improve the quality of interpersonal relationships and social functioning. Cognitive Behavioral Therapy is also commonly utilized for PPD.

Sunlight Exposure

One study evaluated the amount of sunlight exposure and the risk for postpartum depression. The results revealed that women with fewer daylight hours in the last trimester of pregnancy had an overall 35% risk of developing PPD. The recommendation went on to say that women should be encouraged to get frequent sunlight exposure to enhance their vitamin D levels (a risk factor for PPD).

Sleep

Sleep disturbances are common in postpartum. Women are encouraged to get adequate sleep to help the body recover after birth. Due to the demands of caring for themselves or the new child, sleep may be impacted. Research shows that sleep deprivation was associated with higher depressive symptoms seven months postpartum. Speaking to your doctor during follow-up visits is important in addressing this early on.

It's important to know that it is okay to ask for help. If you have a support group that can give you some alone time to nap or decompress, take advantage of that. Care.com offers in-home nanny support services and housekeeping to provide support during this time. Some daycare centers also offer drop-in options.

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Summary

Postpartum depression is a common condition affecting 1 in 10 women. Although there is no exact cause, it is important to be aware of risk factors. Awareness of how you engage with others after birth while also becoming in tune with your own body is essential for detecting the signs and symptoms of postpartum depression. If you have symptoms associated with PPD, reaching out to your doctor for proper evaluation and testing, along with nutrition, adjunctive support groups, and therapy, can provide the best outcome in overcoming this condition.