Hormones and Postpartum Depression

We know childbirth causes one of the most abrupt hormonal changes a woman will ever experience. We know women differ in their sensitivity to reproductive-hormone withdrawal. And one of the first drugs developed specifically for postpartum depression is a neuroactive steroid related to progesterone. Yet the standard discussion of postpartum depression can still sound remarkably similar to the discussion of ordinary major depression.

Postpartum Depression Is Still Depression

New research now links inflammation [1-6], the microbiome [7-10], lacking certain trace nutrients [11-29], and the HPA axis [30-37] to depression. Basically, in natural healthcare we look at the health of the brain. There is a lot of research supporting this idea, but for this article, it is better to just focus on some of the unique aspects of postpartum depression. You can click here to download the free mental health PDF.

But Postpartum Depression Has an Extra Wrinkle

Estrogen and progesterone rise dramatically during pregnancy and then drop sharply after delivery, returning toward prepregnancy levels within days. This doesn’t necessarily cause postpartum depression, but some women do not tolerate this change and become depressed.

I have never been very fond of SSRIs as a treatment for postpartum depression. Most medical websites discuss the hormonal issues but then fall back on SSRIs as the treatment [click here for more information about SSRIs]. If serotonin is an issue, consider the fact that inflammation can drastically lower serotonin levels [click to learn more]. Here are a few things the research suggests are worth discussing with your doctor:

  • The issue isn’t simply “low hormones”; some women appear particularly sensitive to the change in reproductive hormones [38].
  • Ask about hormones, not just antidepressants. Estrogen and progesterone change dramatically after delivery, and research suggests that these hormonal changes may contribute to postpartum depression. Progesterone produces allopregnanolone, a neurosteroid that affects calming GABA signaling in the brain. The importance of that pathway is underscored by the development of allopregnanolone-based treatment specifically for postpartum depression. Estrogen has also shown benefit in a small clinical trial. Hormone treatment is not appropriate for everyone, but these findings make hormone status and hormone-related treatment options reasonable things to discuss with your doctor [39-41].
  • Don’t forget vitamin B6. Your brain needs B6 to make GABA, one of its major calming chemicals. GABA signaling is already under stress from the dramatic hormonal changes following childbirth. Interestingly, one small clinical trial found significantly lower postpartum depression scores in women given B6 during late pregnancy and after delivery [42].

Postpartum Depression and the Thyroid

Thyroid problems can cause depression, and pregnancy and childbirth place unusual demands on thyroid function. Postpartum thyroid problems can also develop after delivery. If you are experiencing postpartum depression, it makes sense to have thyroid function evaluated rather than assuming that every symptom is psychiatric. [Read more about hypothyroidism.]

Iodine, as you know, is necessary for proper thyroid function. One study found that low habitual iodine intake was associated with increased prevalence of perinatal emotional distress and depression [43].

Similarly, selenium (which is also necessary for proper thyroid function) and its connection to depression have been studied. A 2022 systematic review/meta-analysis included 20 studies and 47,164 people. Overall selenium/depression results were mixed, but postpartum depression stood out: higher selenium intake was significantly associated with lower PPD risk. The meta-analysis also found that selenium supplementation significantly reduced depressive symptoms across the intervention studies [44].

The authors of that study pointed out that pregnancy and lactation can increase selenium demands because selenium is transferred to the fetus and secreted in breast milk. They also identified thyroid regulation as one plausible mechanism connecting selenium and depression [44].

Bottom Line

Why would we look at postpartum depression only as a psychiatric problem when childbirth has just produced one of the most dramatic physiological and hormonal changes a woman will ever experience? For some reason, we look at mental health issues differently than we do issues with other organs in the body. The brain is an organ, just like the heart, lungs or liver. Aberrant biochemistry and physiology may cause chest pain if the heart is involved. If the brain is involved it may cause anxiety, depression, or another mental health issue.

This, of course, is complicated by emotional trauma, thought, focus, and a host of other issues, making it a little different than the physiology of other organs. Still, focusing on the health of the brain and nervous system can pay dividends. Related: [Lindsay Clancy’s Prescription Drugs] — a look at the complicated psychiatric drug regimen used in one tragic case of postpartum mental illness.

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