Depression, anxiety & mood
Postpartum depression’s silver lining
by Marcy Holmes, Women’s Health Nurse Practitioner
Anyone who has ever had a baby knows that sometimes — or maybe I should say
often — pregnancy and childbirth don’t match the picture-perfect image
we see in the parenting magazines. The most classic instance of this mismatch occurs
when a new mother experiences postpartum depression (PPD), especially when it hits
after she’s had a terrific, even enjoyable pregnancy. But for me, a tale of
a wonderful, happy prenatal experience followed by a bad case of postpartum blues
points to a distinct health issue that might otherwise go unnoticed: a hormonal
imbalance that can resurface or persist all the way through to menopause.
Maybe you’re long past your childbearing years, or maybe you’ve just
had a baby recently. Either way, you should realize that it’s important for
you to pay attention to your postnatal emotions. If you are a new mom who is feeling
blue or depressed, or even if you felt that way when your now-teenage son or daughter
was still in diapers, understand that there are physical circumstances related to
these emotions that are important to recognize, even years later. I’ve had
patients tell me, “I haven’t felt quite right ever since I gave birth,”
long after their child has passed out of babyhood. It only makes sense: if there
was an underlying imbalance before you had a baby that manifested in PPD, it’s
probably still with you even after the PPD resolves. That’s the silver lining
to PPD: it can highlight a hormonal balance problem that you can address before
it starts causing you major difficulties with your menopause transition —
which is especially important if you’re an older mom who might already be
starting perimenopause. Trying to balance your hormones while chasing a toddler
around can be a challenge, to say the least! So let’s talk about what happens
to our hormones postpartum and how PPD can act as a signpost for regaining our hormonal
balance afterward.
It’s not just a “mood” you’re in — our hormones after
pregnancy
As we so often tell our patients at Women to Women, your endocrine system is inextricably
linked with your brain and nervous system. This explains why we are more prone to
problems with mood during hormonal fluctuations. These periods of vulnerability
include puberty (menarche), premenstruation, pregnancy, childbirth, and menopause.
I don’t think many would dispute that having a baby ranks near the top of
that list of hormonal transitions when it comes to how “big” its impact
is in our lives! Mother Nature offers us many wondrous ways to maintain our wellness
through change, but historically, childbirth has been the biggest risk to survival
(never mind wellness!) that a woman may face. The hormonal tides of adolescence,
perimenopause and menopause generally wash over us more gradually than the hormonal
tsunami of childbirth. In today’s world the mother’s survival is not
usually a concern, but the risk of depression and other mood problems does rise
during any one of these times in a woman’s life, especially when she is under
stress of any kind (as most of us are).
Postpartum emotions can make you feel like something is surely wrong. In truth,
your feelings are perfectly natural — in the sense that they reflect the hormonal
changes happening in your body and brain — but that doesn’t mean that
they are optimal for keeping you and your child healthy. In all likelihood, the
message they are conveying is, “Send more support!” And that can mean
both emotional support, help caring for the baby, and most importantly, support
for your physical healing.
If you’re long past your bout with PPD, you may be saying, “NOW you
tell me!” — but bear with me, because it’s still not
too late to benefit from your PPD experience.
What PPD tells us about our hormones
One of the most significant hormones related to PPD is progesterone. During
pregnancy, the level of progesterone in the body is at an all-time high. Progesterone
helps to prevent lactation during pregnancy, and a sudden drop in levels takes place
just before birth to facilitate onset of labor and allow lactation to kick in. For
some women whose depression manifests itself in irritability, poor sleep, and agitated,
restless behavior (these are the women who go down to the basement to clean it when
they feel out of sorts), progesterone has calming effects in the brain, too, and
if you’re one of those, it follows that your mood can change following childbirth,
as it returns to your prepregnant levels around day five. For you and women like
you, progesterone deficiency is an important aspect of PPD.
But what’s tricky about progesterone is that it’s not always that the
hormone itself is deficient. Some women are unusually sensitive to fluctuations
in progesterone levels. That means that even if the hormone is at what most would
consider a “normal” level, these women’s bodies and brains respond
as if they’re experiencing abnormally low progesterone. So the answer is not
simply to test whether progesterone is low — we also must assess whether a
woman has a history that points to this kind of sensitivity.
So how do you know if you’re one of those women who is highly sensitive to
fluctuations in progesterone levels? By understanding your own personal reproductive
rhythms. In your menstrual
cycle, progesterone is at its highest after ovulation, then drops off just
before menstruation. Mood changes associated with this drop in progesterone are
similar to those seen in PPD—it’s almost as if PPD is a magnified form of
PMS moods. If you have major mood changes around your menstrual cycle, it could
indicate that you are highly sensitive to changes in your progesterone levels, meaning
you’re more likely to develop PPD. And if any of the above rings a bell —
“This is me!” — then hormonal balance could also become
an issue for you at menopause.
When motherhood and menopause converge
We’ve heard repeatedly that many women 35 and above are becoming mothers for
the first time, often accompanied by a lot of handwringing as to what this influx
of mothers in their late 30s and 40s means for maternal health during and after
pregnancy. We think that concern is overstated, and that women who choose to delay
their families until their 30s or 40s actually have certain advantages over younger
women — particularly when it comes to postpartum depression. A healthy 40-year-old
woman is actually at less risk than some younger mothers for PPD because she is
more likely to have a stable family life and a social support system, not to mention
a stronger sense of self. Mothers in their late 30s and 40s may also have spent
more time planning for motherhood and may be better prepared for the ups and downs
of caring for a newborn. And studies show that women over 35 are more likely to
seek help for depression than younger mothers, so they don’t suffer with it
as long.
The one area where mothers in their 40s have more to think about than younger moms
is their hormonal balance. It’s not unusual for a later-life mom to go straight
to menopause after childbirth without any interlude. If you’re a new mom nearing
(or in) perimenopause, it’s that much more important that you do what you
can to care for your overall health if you’re to avoid PPD, not to mention
limit your menopause symptoms while caring for young children (particularly if you’re
breastfeeding).
So let’s take a look at some things you can do, whether you want to address
PPD right now, or if you’re trying to restore hormonal balance long after
childbirth:
- Think nutrition, nutrition, nutrition. If you’ve just given
birth and are breastfeeding, you may still be taking the prescription prenatal vitamins
offered to pregnant women — and you should absolutely keep taking them! And
consider adding a high-grade omega-3 fatty acid supplement — studies show
it acts as a natural antidepressant. But if you’re not breastfeeding, or if
you’re long past childbirth, then it’s important that you make sure
you get all your key vitamins and minerals. We can’t stress enough how important
a pharmaceutical-grade multivitamin
is as a first step — but it’s not the only step to good nutrition. What
you eat and when you eat it is just as important to restoring your body’s
balance. The suggestions we offer in our article on
eating to support your adrenal glands are just as effective in helping you
to heal the hormonal imbalances uncovered by PPD.
- Include movement into your routine. Most people need some sense
of routine in their life to feel “normal.” If you’ve just given
birth and are feeling blue, it’s not a bad idea to adopt a new regimen for
yourself. Just remember that it needs to be flexible enough to work with baby’s
ever-shifting schedule. Just getting up in the morning, bathing and getting dressed
each day will help you feel better, but the more you can do to move your body, the
better you’ll feel. You can start with gentle exercise that can build and
tone muscle slowly, like yoga, t’ai chi, or walking — these
are relatively easy to include even with a new baby. And do what you can to get
sunshine and fresh air every day!
Even if PPD is far in your past, you may find it helpful to make alterations to
your existing routine geared toward improving your hormonal balance. For example:
If you’re not already into an exercise routine, make an effort to move your
body daily. It doesn’t have to be an ambitious hour-long high-impact aerobics
class! Just going for a walk, gardening, or some other activity will give your health
a boost. Exercise promotes mood-stabilizing hormones and relieves stress —
both important components to regaining hormonal balance.
- Prioritize your health. Busy moms often forget to take time for
themselves, not realizing that when they neglect their health, the whole family
suffers. So make sure you prioritize yourself, as much for their sakes as for your
own. If you’ve been feeling physically out of sorts since childbirth —
even if years have passed — talk to your healthcare practitioner about what’s
been going on. Look at our articles on adrenal
health and fatigue to see if
you recognize a pattern in your life, and take steps to correct these problems.
Above all, don’t feel guilty about taking care of yourself!
- Explore your emotional story. We have previously discussed the
link between stress and health in our articles on
emotions, health and stress. Where PPD is concerned, some of your experiences
as a child might be fueling some of your emotions about being a parent. Were your
own parents loving and present in your life, or were they detached and absent, or
even abusive? Do you feel confident about your capabilities as a mother, or are
you scared, confused, and unsure whether you’ll be able to care for your child?
These factors can affect your physical well-being more than you might imagine, and
if they’re part of your circumstances, consider talking with a therapist or
using emotional healing techniques to address them. Even if your child is no longer
a baby, it’s worthwhile looking at your feelings about being a parent if this
is a source of stress.
Progesterone protocol for PPD
400 mg bioidentical progesterone in divided doses: 100 mg in the a.m., 100 mg
at noon; and 200 mg in the p.m.
We have a reliable compounding pharmacy such as Northern New England Compounding Pharmacy or Women’s International Pharmacy
make this up for our patients as sublingual troches (tro’-keez) or capsules.
The reason we do not use creams is because we need to use higher levels of progesterone
than a cream base can accommodate. We divide the dose to prevent associated fatigue
or “spacey” feelings sometimes associated with a rapid increase in progesterone
levels.
- Consider bioidentical progesterone therapy. When we see women at
our clinic with depression after childbirth, we sometimes check their progesterone
levels; if unusually low, we prescribe a regimen of bioidentical progesterone therapy.
Though there are no controlled studies to date of progesterone in the prevention
or treatment of postpartum depression, at Women to Women we have used prescription-strength
bioidentical progesterone replacement to help women whose levels remain very low
postpartum, to good effect. We will also sometimes use this protocol in women whose
depression shows up in restlessness, sleeplessness, or agitation, even if their
progesterone levels are normal, as these women seem to be unusually sensitive to
hormonal fluctuations. Natural progesterone has a known effect on the GABA receptors
in the brain — the same receptors that opiate drugs (narcotics) bind to. I
will say that this protocol is controversial, so many conventional practitioners
may be unwilling to try it. We and others, however, regularly observe improvement
in these women’s depression and anxiety, and although there have been no large
trials to date that prove its efficacy, we have used this protocol to good effect
many times for many years.
- Reduce inflammation. Inflammation is a key factor in depression,
and studies show that mothers with PPD have higher levels of inflammation. Other
physical and psychosocial stressors — risk factors for depression —
also increase inflammation. Anxiety in first-time mothers, for example, is also
strongly linked with activation of the inflammatory response. So anything you can
do to reduce anxiety and inflammation in your body is a good first step towards
treating or avoiding PPD naturally — and it’s generally good for health
even if you’re long past PPD. One good strategy is to eliminate foods that
cause inflammation, like refined sugar or flour, caffeine, and alcohol. At the same
time, you can increase your intake of nature’s best anxiety-dissolvers and
anti-inflammatories, such as omega-3 fatty acids and safe, gentle herbs (good even
for moms and babes) like chamomile and motherwort. Exercise, cognitive therapy,
and the herbal antidepressant St. John’s wort have also been shown to help
down-regulate inflammation. You have many choices, but for best results, consult
with a professional, particularly if you’re breastfeeding — there are
some herbs that are not necessarily good for your baby and should be avoided until
you wean him or her. (See also our article on
natural anti-inflammatories.)
If you’re a new mom, these additional points apply to you:
- Seek help if you’re currently in PPD or baby blues. The earlier
advice to prioritize your health goes double if you’re actually suffering
from baby blues or PPD right now. This is the hard part about PPD — understanding
that it’s a physical problem that may need medical intervention. There’s
such a stigma associated with any sort of mental illness that many new moms —
even those of us in the healthcare profession who ought to know better! —
hide their symptoms and pretend everything’s okay when it’s really not.
Whether your blues are mild and pass in the first few weeks or it becomes clear
you have something more than the baby blues, don’t think that taking care
of yourself comes second to baby. It is equally important for you to be whole and
healthy to continue being a good mother. If you’re feeling exhausted, overwhelmed,
and teary, don’t wait to seek help. Talk to your healthcare practitioner about
ways to reduce your burden, and heal. And if you have repeated thoughts about harming
yourself or your baby, get help immediately! Your practitioner will understand
that these thoughts are a sign of postpartum depression and can offer you treatment.
Most important, you should not feel embarrassed or ashamed about it — an imbalance
in your hormones doesn’t make you a bad mother!
- Breastfeed to reduce maternal stress. We recommend breastfeeding
for two reasons: it’s been shown to be better for the baby than most formulas
except in unusual situations, but just as important, it’s good for the mother
as well. Breastfeeding can protect Mom’s mental and emotional health because
it lowers stress hormones like cortisol, ACTH, epinephrine and norepinephrine. Women
who nurse also have higher levels of oxytocin, the wonderful “cuddle”
hormone. It often promotes faster weight loss, which can improve a new mother’s
mood as she adjusts to her body’s changed appearance postpartum. And it encourages
Mom to stay well rested and hydrated — you can’t nurse a baby effectively
if you’re always on the go, nor will your milk supply hold up if you don’t
drink enough water.
The flip side is that if you’re having difficulty breastfeeding your baby,
it’s easy to become frustrated and stressed about it, but you don’t
have to try to figure out the problem alone. Most hospitals have lactation consultants
to assist you in learning how to breastfeed effectively (contrary to popular imagination,
it’s not something that every mother knows how to do naturally!), or you can
contact La Leche League
for support. And understand that if breastfeeding becomes a source of stress or
if you’re too deeply depressed to make that effort, it’s okay to formula
feed your baby. Don’t feel you need to always put what’s best for baby
ahead of your own needs, because sometimes doing what you need to do to improve
your health and emotional welfare is more important to the baby’s well-being
than any benefit that might come from breastfeeding.
- Don’t be alone any longer. The simple act of reaching out
to your family, friends and healthcare practitioner for additional support does
wonders. What distinguishes women with the baby blues and postpartum depression
from other forms of depression is that they feel so guilty. The first thing I tell
new mothers concerned about postpartum depression is that an “amplification”
of all our feelings — joy or sadness, sheer bliss or emotional upheaval —
is very common after giving birth, and perfectly natural. And so is needing a tremendous
amount of support — it is never your “fault” for needing more
support through this transition. This is the time when a baby support group —
though it may have seemed a little silly before baby arrived — can really
save your day.
Putting the pieces together
When a woman comes to me with signs of hormonal imbalance, there’s an “Aha!”
moment that comes when she tells me she experienced PPD. Those dark days after childbirth,
whether recent or long past, can become a beacon showing the way to changes that
can transform your health. Even if you’ve come across this information long
after the fact, that’s okay. At Women to Women, we know first-hand that it’s
never “too late” to restore your body’s balance and make a change.
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse–Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at 1-800-798-7902. We're here to listen and help.
We’re always happy to welcome new patients to our medical clinic in Yarmouth, Maine, for those who can make the trip. Click here for information about making an appointment.
Related to this article:
References & further reading on postpartum
depression
Original Publication Date: 07/21/2008
Last Modified:
08/17/2009