5 RESOURCES FOR POSTPARTUM DEPRESSION
Postpartum depression is often undiagnosed, and the results can be fatal. Read here to learn how clinical nutrition can help.
If you’re like many women who work with me, your story is familiar. Most of my clients have challenging hormonal and/or metabolic contributors to PMS, infertility, or postpartum depression, and haven’t been able to get their mojo back. I often wonder, how have they lasted this long without real solutions from their doctors? The answer soon shouts back at me:
These women are warriors.
It may seem like a small thing, depression. It’s a cloud over your day, a fog to wade through, or just a feeling of extreme emotional fatigue. If you aren’t actively considering taking your life, depression might feel like it’s no big deal, or that you don’t need help. You’re strong enough, you can get through it.
EXCEPT…IT DOESN’T GO AWAY.
It gets stronger, or you fatigue more quickly. You don’t see a way out. Your friends don’t get it…they might try to understand, but ultimately you’re left to work through it on your own. Your partner might blame it on lack of sleep, or stress, or finances, but definitely not something for which you need medical attention. And even if you’re present and honest at every postpartum checkup, your midwife or doctor might not catch it if they aren’t looking. Everyone says you’re fine, so…aren’t you?
IT DOESN’T HAVE TO BE THIS WAY.
You just brought a human (or humans!) into the world. You deserve all the support that you need. And if you feel that something isn’t quite right with your mood, I encourage you to advocate for yourself. Seek treatment, get a diagnosis if necessary, do whatever it takes to get help. Clinical nutrition is a vital component of your treatment plan, and I’ve compiled a list of basic nutrition and lifestyle guidelines that will get you started. For further nutrition support, contact a clinical nutritionist (preferably a postpartum specialist) near you.
Omega 3s
Research has repeatedly shown a correlation between low omega3 status during early pregnancy and rates of subsequent PPD. That means that women who have a higher omega3 status in early pregnancy are less likely to experience depression after the birth. Omega3 fats support mood in many people with depression, but the timing during pregnancy is especially important, as it can take weeks to build up sufficient stores for the brand and body.
If you eat fatty fish 2 times per week, your average intake is about 450 mg of omega3 fats per day. But if you suffer from depression, it is likely that your stores of omegas are already depleted, and high dose supplementation is the quickest way to balance it.
Some studies have been done with 1000 mg/day of primarily DHA and shown minimal to no benefits, but higher doses often show more significant improvements. If you’ve experienced PPD before (or are diagnosed with major depressive disorder), I recommend a minimum of 1000 mg balanced source of DHA and EPA, and you may need closer to 4000 mg daily for a short time to bring your levels back up quickly. Here are some of my favorite brands:
This brand is minimally processed, so the dose is lower per softgel. However, the sustainable sourcing and processing means it’s the closest thing to actually eating salmon. The gelatin is also Halal, making it more accessible for diverse dietary requirements.
This brand has high quality standards, and their prenatal blend includes 400 IUs vitamin D. There is also a vegan option, which I only recommend if you are 100% vegan or must avoid gelatin.
This brand creates a minimalist product with easy-to-read labels, which makes dosing less confusing. The gelatin is also bovine-sourced.
Balance Blood Sugar
While it might seem unrelated, low blood sugar can be a big trigger for mood swings and low energy. When you eat a meal that contains a moderate amount of protein, fat, and carbohydrate, AND if your insulin response is normal, you’ll have a moderate lift in blood sugar for severe hours. This elevation provides fuel so you can think, move, heal, and produce breastmilk.
If you don’t have enough elevated blood sugar due to not eating enough, frequently enough, or an overly-zealous insulin response, you won’t have much physical or mental energy. Ironically, the same symptoms can occur when your blood sugar is initially too high due to meal imbalance or insufficient insulin function. The subsequent drop in blood sugar after a significant elevation tends to be quite steep. This is especially common in people with thyroid dysfunction, anemia, high stress, adrenal dysfunction, and elevated cortisol.
FIRST STEPS:
Eat protein, fat, and carbs at every meal and snack. Seems simple, and it is. But this is how your body prefers to digest and create energy, and if you aren’t getting the right fuel, you’re never going to feel great.
NEXT:
Rule out the health conditions listed above with a comprehensive blood panel. Not sure what to ask for? In addition to the CBC and CMP (routine blood work done at a standard physical exam), ask for B12, D, cortisol, HgA1c, progesterone, serotonin, and a full thyroid panel including T3, reverse T3, and anti-thyroglobulin antibodies. There are tons more tests you could run, but those will rule out some major underlying conditions and help you know what to focus on next.
THEN:
Implement everything below, as these factors cause blood sugar fluctuations in addition to other issues.
Micronutrients matter
Your body requires more nutrients for physical healing than any other task. Whether you’re lactating, recovering from a C-section, or just trying to move forward with your new body, you need more nutrients than ever before. That’s why eating regular, balanced meals is so important. If you aren’t able to eat a wide variety of veggies and protein sources, consider taking a high quality multivitamin.
Micronutrients that are especially important for mood:
B6, B9 (FOLATE), AND B12
D3
MAGNESIUM
SELENIUM
ZINC
You may need increased doses of these nutrients, beyond what a multivitamin can provide. However, I do not recommend randomly supplementing large doses of any individual micronutrients unless you have bloodwork showing deficiency or you work with a nutrition professional who can assess your symptoms and make a professional recommendation.
In order to actually digest and use those micronutrients, you need a functioning microbiome in your gut. It is well-established that people with depression have altered gut microbiota and that certain strains can be effective at improving symptoms. This is partly because your gut and brain are closely connected, and also because a healthy microbiome allows you to digest your nutrients completely. Here are some strains shown to help depression:
Lactobacillus helveticus R0052 and Bifidobacterium longum - 30 days of supplementation improved depression and anxiety scores.
L. acidophilus, L. casei, and B. bifidum - 8 weeks of supplementation showed improved depression scores and insulin resistance.
Support Sleep
As you probably know, sleep deprivation can play a huge factor in mood stabilization. And yet, many moms operate under sleep deprivation for months or years because their kids keep them up at night.
It’s impossible to get perfect sleep with a newborn. But it’s crucial for you to create a healthy sleep environment and routine so that the sleep you do get is as helpful as possible. Rather than say this aspect of self-care is impossible, seek to change where you can.
THE PERFECT SLEEP ENVIRONMENT
Imagine a peaceful room free of debris, screens, and unnecessary light. The cool temperature makes you want to relax, and the bed itself is cozy and inviting. In this space, there are no distractions from sleep. Alarm clocks, phones, nightlights, streetlights and noise are blocked or minimized to create as much room for good sleep as possible. Start small if you need to, and gradually shift your bedroom into something that feels like a haven from the world. The more you can relax in there, the better your sleep quality will be.
THE PERFECT SLEEP ROUTINE
Obviously, this will depend on your kid(s) and their sleep routines.
SIDE NOTE - IF YOU’RE STRUGGLING TO ESTABLISH SLEEP ROUTINES FOR YOUR INFANT OR SMALL CHILD, I HIGHLY RECOMMEND WORKING WITH A SLEEP CONSULTANT SUCH AS ASHLEY AT HEAVEN SENT SLEEP. SHE’S A WIZARD.
The perfect sleep routine for you is one that will allow you to feel human and sane with minimal work. Here’s a quick way to figure out when you need to start getting ready for bed:
Pick a day to time yourself doing all the things that must be done daily before bed. Here’s an example: kid(s) to bed, 30 minutes of alone time (it’s important!), evening snack with significant other, finish laundry, wash face, brush teeth, dress for bed, crash. Avoid unnecessary tasks like reading the mail, or anything you wouldn’t want to do every single day.
Count 8-10 hours backwards from when your kid(s) typically wake up in the morning. I say 8-10 because you know there will be interruptions in your sleep, so plan for them and allow time to go back to sleep.
Then add on the time it takes you to do your evening routine. That’s how many hours before wake-up you need to start getting ready for bed. It might be 6pm! If you have an alternative work schedule, you’ll need to shift things around (and you may benefit from hiring a sleep consultant for yourself!).
This probably seems unrealistic or daunting to implement. But if you’re depressed, everything else can wait a little. You need to sleep. Ask for help from family and friends so you can take care of yourself.
Screen for Triggers and Trauma
Try to identify any triggers that might have led to your current state. Were you feeling anxious or moody before or during pregnancy? If so, you may have had an underlying mood issue that became exacerbated due to the significant hormone shifts during pregnancy and childbirth.
Did you experience any birth trauma, such as choices made without your consent, a physically difficult labor, or an emergency cesarean? If so, consider the fact that your brain has created new neural pathways in response to that trauma, and that may be why you feel so different. Trauma can create a whole new “personality,” but it may actually be a diagnosable condition with specific medical treatment available. Birth trauma can take years to process, and you need guidance to do so safely.
Whether you suspect a specific trigger or are completely baffled as to why you feel this way, you deserve adequate care. Schedule a visit to your PCP and seek trauma-informed mental health care from a therapist.
Summary and Further Support
These tips are really just the basics in treating postpartum depression, but they can make a huge difference for many people. If you’ve gotten this far, you’re taking health seriously. Please seek medical help so you can get well. You’re not alone, and you are wanted in this world. If you are experiencing distress and would benefit from community support, seek help from a local postpartum support group. If you are considering self-harm or harm to your child(ren) or spouse, use one of the below resources:
National Suicide Prevention Lifeline: 1-800-273-8255
Suicide Prevention Hotline: 1-800-SUICIDE
National Postpartum Depression Warmline: 1-800-PPD-MOMS
Have you experienced postpartum depression? I’d love to hear from you! Please comment below.
WARMLY,
~ Sarah
REFERENCES:
Akkasheh, G., Kashani-Poor, Z., Tajabadi-Ebrahimi, M., Jafari, P., Akbari, H., Taghizadeh, M., Esmailizadeh, A. (2016). Clinical and metabolic response to probiotic administration in patients with major depressive disorder: A randomized, double-blind, placebo-controlled trial. Nutrition, 32 (3), 315-320.
Messaudi, M., Lalonde, R., Violle, N., Javelot, H., Desor, D., Nejdi, A., . . . Cazaubiel, J. M. (2011). Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium long R0175) in rats and human subjects. The British Journal of Nutrition, 105 (5), 755-764. Miyaoka, T., Wake, R., Furuya, M., Naseribafrouei, A., Hestad, K., Aversina, E., Sekelja, M., Linlokken, A., Wilson, R., Rudi, K.