This is Part 2 of my Nutrition and Postpartum Depression series. If you're just joining us, please start with Part 1 here!

In Part 1 of this series, we talked about what postpartum depression is and how it is impacted by lifestyle factors like untreated mental illnesses in pregnancy, physical activity, sleep, social isolation, stress, and skin-to-skin care.

Today, we're going to move on to talk about two other important factors: hormones and nutritional factors (including deficiencies and insufficiencies).

​Hormones
A woman’s hormones are constantly in flux, but there is nothing that changes them quite so dramatically and quickly as pregnancy and childbirth. Many different types of hormones are suspected to play a role here, from adrenal hormones (like cortisol) to placental hormones (like the estrogens and progesterone), thyroid hormones, and peptide hormones (like oxytocin and prolactin).

• Levels of the hormones estrogen and progesterone decrease suddenly and dramatically after childbirth. This by itself is linked to changes in mood because of the impacts on serotonin levels, and this is likely one of the causes of the Baby Blues. Estrogen and progesterone levels can take 3-12 months to return to normal after childbirth.
• Thyroid hormone levels increase during pregnancy, and then decrease following childbirth. Sometimes levels can decrease too much postpartum, which can lead to changes in mood, as well.
• Levels of cortisol, a primary stress hormone, are naturally higher in pregnant women, but should start to decrease gradually after childbirth. However, abnormal or excessively high cortisol levels can happen during pregnancy for some women, or can crop up in the postpartum period, maybe due to trauma, stress, sleeplessness—or maybe causing those things.

Hormone balancing is often going to take time, but a lot of the same lifestyle factors we discussed in the first post actually may be able to modify some of these hormone levels. Some important things to consider include:

• Gentle exercise,
• Stress reduction and adequate sleep,
• Keeping an eye on thyroid hormone levels (this is standard to check during pregnancy, but you might want to talk with your doctor about getting it checked if you are already postpartum).
• And consuming a varied diet with adequate levels of the nutrients we need to produce hormones, which we’ll address next.

Nutrients
Everyone is aware that nutrition is exceptionally important in pregnancy—but sometimes we focus on Baby’s nutritional needs (both during pregnancy and after birth) so much that we might forget about our own nutritional needs in the postpartum period.

Of course, if some women are not meeting their increased nutritional needs during pregnancy, they may have lingering deficiencies that persist into the postpartum period. But we also know that there are substantial changes that occur in mom’s nutrient status because of childbirth itself, the healing process, breastfeeding, stopping the prenatal vitamin (as many women do immediately after childbirth), and poorer dietary quality in the struggle that is postpartum life.

Some nutrients that I primarily focus on with my clients are:

• Omega-3s. You hear a lot about DHA, a specific type of omega-3 found in fish oil, during pregnancy because it’s vital for Baby’s brain development and mental health, and many women aren’t getting enough. Supplementing DHA is often necessary, especially when mamas have been told to avoid fish because of concerns about mercury. However, for mom, another type of omega-3 fatty acid called EPA might be missing if we’re just relying on DHA supplements for our omega-3s—and often, again, postpartum women stop these supplements altogether. Both EPA and DHA are important during pregnancy and postpartum, and EPA seems to be a standout nutrient when we’re thinking about preventing postpartum depression.
• Vitamin D. Vitamin D is an incredibly important vitamin and hormone in neurological and mental health. We know that one of the signs of vitamin D deficiency can be low mood, and we also know that it’s important in preventing neuroinflammation and supporting neuroplasticity, which is incredibly important in adjusting to postpartum life!
• Zinc. Higher zinc intake seems to buffer the effects of stress, and is also really helpful in managing the inflammation that happens postpartum!
• Choline. You may know that choline is vital for baby’s brain development, but it’s also essential for brain health in mom, as well. On a population scale, higher dietary choline intake is linked to a lower risk of depression, but we do need more research in pregnancy and postpartum. I don’t recommend going out and taking large doses of choline on a daily basis, but SO MANY women aren’t getting enough (some studies suggest 89% of pregnant women aren’t meeting their choline needs), so this is a really important nutrient for us to be aware of.
• Iron. Iron deficiency can cause symptoms of depression in anyone, and anemia both late in pregnancy and postpartum are associated with postpartum depression. However, if you’re already postpartum, this is one to ask your doctor or dietitian to test with a blood draw before starting a supplement, since overconsuming iron supplements can be problematic.
• Amino acids. Most people know that protein is important for their health and are trying to eat enough of it. However, many people on the Standard American Diet get their protein from lower-quality sources, such as high-fat processed meats and refined grains (which contain significantly less protein than whole grains). Add to that the fact that protein digestion and absorption can be impaired for all sorts of reasons, from gastrointestinal issues to acid-blocking medications to stress, not to mention increased protein needs for wound healing postpartum and possibly for lactation… and you can start to see why I do worry about amino acids, the building blocks of protein, in my clients’ diets. To give one important example, in the early postpartum period, there seems to be an especially high need for tryptophan and tyrosine, and if moms aren’t getting enough, it’s possible they may not make enough of certain mood-stabilizing neurotransmitters like serotonin and dopamine.

Obviously, there are a lot of factors to consider here. Diversity in the diet and a balanced, mindful lifestyle can make a big difference in both risk and ability to manage postpartum depression. But there are even MORE factors to consider here.

In our next post, we'll talk about the gut microbiome and inflammation, and how these two factors can play into postpartum depression--and then we'll try to wrap all these bits and pieces of information up into an actionable, doable package.

If you're comfortable sharing with this community, I'd love to hear from you in the comments. Have you ever struggled with postpartum depression, or are you struggling now? What was the most important step you took to help manage your symptoms? 

Postpartum depression is shockingly common for how infrequently it actually gets talked about. Sure, we’ve all done the screening questionnaires in the hospital, and those are very important. But many women are shamed into feeling that the way they feel is a sign that they are bad mothers or that something is wrong with their ability to love their babies.

But more than one in 10 women experience postpartum depression. It’s the most common postpartum mood disorder—and if you’re wondering why there even is a most common postpartum mood disorder, why this is such a sensitive time period in a woman’s life, I hope to partially answer that question in this series.

But also, along with telling you about why postpartum is SO HARD (you already knew it was, I’m just going to give you even more reasons why it’s hard), my goal is also to give you hope—that maybe there is more you can do about it, more that is actually within your locus of control, than you might have thought.

What is postpartum depression?
Postpartum depression is a depressive episode that occurs during pregnancy or within a year of giving birth. The symptoms in general are a lot like those of major depressive disorder (MDD), but these symptoms will look different, and perhaps in some cases more pronounced, because of the context in which they are occurring. Common symptoms include difficulty with self-care, changes in appetite, sleep, energy, motivation, and concentration, low self-esteem, guilt, and feelings of worthlessness. In some cases, women may also experience suicidal thoughts or thoughts of harming baby.​

Unlike the “baby blues” (which are experienced by up to 85% of women postpartum), postpartum depression is much more debilitating, lasts much longer, has a much more substantial impact on a woman’s ability to care for herself and for baby, and requires treatment. It’s so important that women recognize that care is available, and that they don’t have to “go it alone.”

Screening for postpartum depression
If you’re thinking that some of these symptoms sound familiar and want to dig a little deeper, a lot of physicians, psychologists, psychiatrists, and OB-GYNs use a screening form called the PHQ-9. You can take it on your own and bring it to your next appointment to discuss with your provider.

Why postpartum?
The period from conception to childbirth to the months following the birth (or loss) of a baby is filled with change—lifestyle changes, hormonal changes, inflammatory changes, dietary changes, and microbiome changes, just to name a few. This is an incredibly sensitive period in a woman’s life, including her physical, mental, and spiritual life.

Some of these factors are easy to understand but difficult to address. Some are difficult to understand in layman’s terms and still difficult to address. There’s nothing really easy about mental health in general. But we’ll start today by zooming in on some of the specifics, and then end by zooming out to what implementation of these specifics might look like in simple but broad sweeps.

In this series of articles, we’ll cover lifestyle factors, hormones, nutrients, inflammation, and the gut microbiome in a deep dive into preventing postpartum depression and promoting postpartum mental well-being.

Lifestyle factors
We’ll start with the lifestyle factors, because in some ways these are the most important—and in some ways also the most challenging to address.

• Untreated mental illness during pregnancy. Many women stop psychiatric medications when they become pregnant because of fear of the impact on Baby. While the impacts of many psychiatric medications in pregnancy aren’t completely understood, this is a really important conversation to have with a trained mental health professional such as a psychiatrist so that you can fully understand the risks and benefits involved. If you do choose to stop your meds, it’s vital that you replace the medication with something (therapy, for example). Allowing mental illness to go untreated during pregnancy and breastfeeding has the potential to cause much greater harm to both you and your baby over the long term.
• Physical activity! We also know that physical activity is incredibly important both during pregnancy and in the postpartum period, though of course tailoring exercise to your physical ability with an eye toward safety is of utmost importance. Most of all, just remembering the healing potential that movement has both physically and psychologically. There is a lot of very solid evidence that physical activity is protective against depression, and that it has powerful antidepressant effect! According to a 2023 review looking at exercise and mental health, pregnant and postpartum women were actually some of the groups to see the largest reduction in mental health symptoms from engaging in exercise. Higher intensity exercise seemed to have the greatest benefit for reducing depression and anxiety, but ALL types of physical activity were beneficial, including walking, Pilates and yoga (which are often great for some of the physical issues women are dealing with postpartum, as well).
• Sleep. Sleep is one of the most challenging areas to address, especially on your own. When you have a tiny baby who needs you constantly, you need support from others to be able to get rest. You need to feel safe, and you need to know that your rest is an absolute priority when it comes to your own health AND the health of your baby.
• Social isolation. We all know this is really difficult to avoid in the haze of postpartum life, but research shows that the more isolated a woman is postpartum, the higher her risk of postpartum depression. This is another thing that we obviously can’t do on our own—but if you feel that you don’t have the level of social support you need, during pregnancy is a great time to start seeking out support groups, cultivating friendships, and becoming part of a community.
• Stress. Stress obviously has a tendency to ramp up pretty dramatically in the period just before and for several months (or years) after the birth of a child. If you’re stressed, there’s nothing that stresses you out more than hearing that you need to stop being stressed because it’s harming your health. I plan to do a whole article on this in the future, but I want you to hear me for a moment on this here: stress is not always bad. You do not have to live a fully anxiety-free life in order to be healthy or even to prevent postpartum depression. Stress can actually be a remarkably positive thing when it has 1) a purpose and 2) an end. Like inflammation, when stress becomes chronic, generalized, and purposeless, that’s where it harms us. Do you know how to complete the stress cycle? To recognize when the purpose of a particular anxiety has passed, metabolize it, and get back to steady, calm, and stable?
• Skin-to-skin time with Baby. Thankfully, this is a much more common practice in hospitals and birthing centers today, but it hasn’t always been, and it certainly still isn’t accessible to everyone, especially in cases of traumatic or emergency births. However, when it’s possible, skin-to-skin care is hugely important for Baby’s health as well as for your health. Studies on postpartum depression risk have shown that mom is significantly more likely to deal with postpartum mood disorders if she is not given the skin-to-skin time she needs with her baby, activating that oxytocin release and reducing stress and anxiety. Whether you’re due next week or you had the baby three months ago, it’s not too early or too late to start thinking about what this might look like for you. It’s not too late to reap some big benefits from the power of touch.

No one is going to have all of these things all the time in perfect balance. But if there is a specific item in the list that you know is a real struggle for you, maybe that's the growth area to focus on first--even if the only thing you can actually do is share with someone else that you need their help and support.

In the next couple of posts (Part 2 and Part 3), we'll cover hormone changes, nutritional changes, changes in the gut microbiome, and inflammation, and how these factors can also have significant implications for postpartum mental health. 

In the meantime, let me know how I can support you in your journey. Postpartum is hard! But it's easier together.