Depression in new mothers may affect up to 20% or more of women who have given birth. Depression can have devastating results on both mother and baby so it is very important that it be diagnosed and treated quickly. Depressed mothers are more likely to stop breastfeeding with negative health effects for both.1
What causes depression?
In the following paper Kathleen Kendall-Tackett2 explains that physical and mental stress can trigger an inflammatory response and this is a key factor in depression. Women who have just given birth are particularly at risk of both physical and mental stress including pain and sleep disturbance. The paper concludes that lowering a mother’s stress and reducing inflammation may prevent or reduce depression.
Breastfeeding and depression
Breastfeeding and exercise have been shown to reduce stress and protect a mother’s mood, however breastfeeding problems including severe nipple pain, can increase the risk of depression and must be looked at promptly. Contact an International Board Certified Lactation Consultant if breastfeeding is painful and see Why Does Breastfeeding Hurt? Breastfeeding protects babies from the harmful effects of their mother’s depression.
Depression and diet
Low levels of essential fatty acids (EFAs) in the diet, especially two known as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), may increase the risk of depression in mothers. These long-chain omega-3 fatty acids (omega-3s) are found in fish and fish-oil products. There is more information in the article below, again by Kathleen Kendall-Tackett.
Other contributing factors
In Mother Food, the author discusses four other common health issues that can contribute to post natal depression; anaemia, low levels of potassium, low blood sugar and low thyroid function, explaining that each of these can lead to exhaustion, irritability, and depression.
Can breastfeeding at night cause depression?
Breastfed babies usually need to feed often during the night and it is a common assumption that breastfeeding mothers sleep less than formula-feeding mothers. Getting enough sleep is important for mental health however recent research has shown that breastfeeding mothers get more sleep. Lack of sleep due to breastfeeding is not therefore thought to be a risk factor for depression (Kendall-Tackett, 2010).
For more ideas about getting enough sleep with your breastfed baby and coping with depression see Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family, LLLI, 2014 especially Chapter 10 Your Own Sleep Needs. There is a book review here.
Anti- inflammatory treatments
Anti- inflammatory treatments can help depression. They include EPA and DHA (omega-3 fats found in cold water fish, see above). Other treatments include cognitive therapy, herbal antidepressants (e.g. St. John’s Wort), and standard antidepressants.
Are antidepressants safe while breastfeeding?
For some mothers antidepressants will be the best choice of treatment. There are several antidepressants that can be used when breastfeeding. As with any drug, there may be a risk of side effects when using antidepressants, but the risk of not treating the depression may be higher still. All the risks and benefits must be carefully weighed up for each mother and baby.
Drugs fact sheet
Antidepressants (postnatal depression) and Breastfeeding is a drugs fact sheet by The Breastfeeding Network in UK which describes levels in breastmilk and potential side effects of many antidepressants for mother or baby:
In her article below Kathleen Kendall-Tackett shares that paroxetine, sertraline and nortriptyline are unlikely to lead to detectable or elevated plasma drug levels in a breastfeeding infant.
breastfeeding infants’ exposure to paroxetine, sertraline and nortriptyline are unlikely to have detectable or elevated plasma drug levels. In contrast, infants exposed to fluoxetine had higher medication levels, especially if they had also been exposed prenatally. Citalopram may lead to elevated levels in some infants, but more data are needed. Although these appear safe for the majority of babies, some adverse effects have been identified through case studies. Therefore, breastfeeding mothers should be advised to watch for any possible signs of adverse reactions including irritability, poor feeding, or uneasy sleep. Premature babies or other with impaired metabolite efficiency should especially be monitored for adverse effects (Weissman et al., 2004).
There are several resources online that discuss drug compatibility with breastfeeding. See Medications and Breastfeeding for links and further information.