Your baby is healthy, your nursery is cozy and adorable, your partner and family love you—but there’s one big problem. You are painfully depressed, anxious, and angry, and you’re not sure why. Even worse, you’re scared to share your disturbing feelings and thoughts with anyone. If this describes you, please know that you are not alone. Approximately one in seven new mothers worldwide (about 15 percent) suffers from postpartum depression (PPD). PPD usually begins during the first three months after birth, but it may begin anytime during the first year postpartum.
The excellent news is that PPD and its related disorders are 100 percent treatable! You might have faced depression during pregnancy, or prior to it, but when there is a flare-up following delivery or a continuation of pregnancy depression, this bout of depression is termed PPD. Even if you are already on medication for depression, you might experience breakthrough symptoms postpartum that require a change in treatment. It’s important that you’re under the care of a practitioner who specializes in perinatal mental health, since perinatal depression differs from depression at other times in our lives. Please note that the advice here also applies to mothers with existing depression, from mild to severe, treated with medications or not.
It can be tough to know the difference between normal mood changes after giving birth and the more severe symptoms that require treatment. As moms, new and old, we all have bad days, even bad weeks that leave us feeling down, frustrated, irritated, or helpless. A mild state of the “baby blues” is common after delivery and should be gone by two weeks postpartum. Despite our temporary slumps, with the milder baby blues, there is still a light at the end of the tunnel. But for mothers experiencing PPD, that bright new-baby-light goes off. Low self-esteem and a roller coaster of emotions torture a new mother’s head, heart, and soul, leaving her behavior erratic and often self-destructive.
One mother who knows these feelings all too well is Shoshana Bennett, PhD, widely known as Dr. Shosh. Her journeys through PPD following both of her pregnancies sparked her commitment to helping women all over the globe recover from this disorder. We asked her to share her story and her expertise on the critical role of nutrition and exercise in recovery.
Immediately after I delivered our first baby in 1983, I knew there was something very wrong with me. I became anxious and obsessive—scary thoughts were spinning nonstop in my head about my baby being harmed. I didn’t trust myself to be alone with her, thinking I might be the one to hurt her. I was overwhelmed and frightened. I thought my life was over—there was nothing but doom and gloom. I was a mere shell of the person I had been before the birth.
My ob-gyn at that time did what some unfortunately still do, through no fault of their own, since many ob-gyns don’t know a lot about prenatal or postpartum mood/anxiety disorders. When I exclaimed, “If life’s going to be like this, I don’t want to be here anymore,” he laughed. He told me that all new mothers feel this way, I should go home and do something nice for myself and that feeling would pass. He tried to normalize a serious disorder and dismissed it as the baby blues. If this is normal, I thought, then clearly I’m an inadequate mother and I wasn’t cut out to do this. I was convinced I was a burden to my family, and my husband and baby would be better off without me. I’m quite grateful to still be here—there were a couple of very close calls when I almost took myself out.
When my daughter was two and a half years old, I remember thinking, maybe I can be a mom! I now realize that my chemistry was starting to return to normal. My hair regained its curl, I could see in color again instead of in shades of gray, and I was able to taste my food and enjoy it. We decided to have another baby. Everything went well during my pregnancy, just like the first time, until I delivered. I dropped into the same nightmarish state.
One year into my second life-threatening and undiagnosed postpartum depression, I learned that my condition had a name and there may even be help for it! I vowed to myself at that moment that I would do everything in my power to help other families prevent the devastating effects of this illness. It became my mission to educate all professionals working with pregnant and postpartum parents and the public.
Still coming out of the depression, I started pioneering in Northern California, founded an organization called Postpartum Assistance for Mothers, and became president of California’s state organization. More recently, I served as president of our international organization, Postpartum Support International. The help I never received but desperately needed is what I’ve given to tens of thousands women around the globe.
Along with therapy that empowers new parents to discard the unrealistic expectations of motherhood, a basic plan of action always includes some uninterrupted hours of sleep at night, excellent nutrition, exercise, and emotional and physical support that allow them to nurture themselves. With proper help, postpartum depression is totally treatable and leads to 100 percent wellness—often better than before.
Identifying the symptoms of PPD and distinguishing them from the baby blues is an essential first step. A thyroid imbalance, which affects about 10 percent of postpartum women, can mimic the symptoms of PPD, so it should be ruled out by your doctor as a physiological cause of depression.1 No matter what, every new mom and parent needs support, and the following list should help you determine whether what you’re feeling is “normal” or whether you should seek out a professional.
Symptoms begin the first week and should be gone by two to three weeks following delivery. If these mild symptoms haven’t ended by then, or if they intensify, contact a psychologist or other health practitioner who specializes in perinatal mental health. This professional should give you a thorough assessment and a wellness strategy.
• Crying for no apparent reason
• Lack of concentration
• Feeling stressed out
• Difficulty sleeping at night
PPD can appear immediately after delivery and anytime up to one year postpartum. The feelings are more intense than baby blues and they can get in the way of normal feelings and functioning. If you identify with any of the following feelings or have other symptoms getting in your way, please find a health-care practitioner who specializes in perinatal mental health.
• Sadness
• Difficulty sleeping at night
• Irritability or anger
• Feeling overwhelmed
• Fatigue and exhaustion
• Loss of interest in sex
• Lack of joy in life
• Feelings of shame, guilt, or hopelessness
• Anxiety
• Difficulty bonding with your baby
• Withdrawal from family and friends
A rare but serious condition that almost always develops within the first month after delivery. If you experience any of these symptoms, get help immediately.
• Confusion or disorientation
• Thoughts about needing to hurt yourself
• Seeing or hearing things that others don’t (hallucinations)
• Speech that doesn’t make sense to others
• Paranoia
• Obsessing about death (including of your baby)
• Feeling that you don’t need much sleep
Maintaining a well-balanced diet and taking supplements postpartum is essential for both your physical and mental health. From vitamins and minerals to healthy fats and lean proteins—your diet has a huge impact on your strength, stamina, ability to produce breast milk, and solid emotional well-being.
• Take a daily multivitamin with minerals to make sure that you are getting all the essential nutrients your body and brain need. Talk to your doctor or care team about your specific needs. Additional supplements may be required to make sure your body is not lacking any vital nutrients that could affect your emotional health.
• Do not diet if you are suffering from PPD. Depriving your body of nutrients is detrimental to recovery.
• If you’ve lost your appetite and can’t manage to eat three meals a day, nibble foods throughout the day.
• Consume lots of protein, ideally at least 60 grams per day. High-protein foods will help prevent your blood sugar level from rising; keeping it steady is important for balancing your moods.
• Eat complex carbohydrates, such as whole grains, fruits, and vegetables. These slow-releasing sugars are the type your brain likes, especially if it is struggling with depression.
• Avoid refined carbohydrates as much as possible. A box of chocolates may be fleetingly pleasurable, but the sugar high and crash that follow can send your blood sugar levels and emotions into a tailspin. Keep these foods out of the house. If you want a cookie, buy a single, delicious cookie, not a whole bag.
• Stay well hydrated with water. Aim for at least 8 to 10 glasses a day, particularly when exercising, or if you suffer from panic attacks. Dehydration can exacerbate anxiety.
• Try to avoid caffeine; it won’t aggravate depression but may increase anxiety.
• Avoid alcohol, which is a depressant.
• Get exercise, ideally outdoors. Even a walk will make a difference.
• Get plenty of sleep. Naps are great, too.
Are there any special nutrients to combat depression?
Yes, there certainly are.2 In tandem with other treatments, the foods you eat and supplements you take can have a positive effect. Here are some of the top nutrients, why they matter, and where you can find them.
• Chromium to bust sugar cravings.3 Aim for about 45 micrograms daily. Chromium helps stabilize serotonin, a neurotransmitter that affects anger, aggression, mood, sleep, and other brain functions. A drop in serotonin levels can trigger sugar cravings. It is found in meat, poultry, broccoli, spinach, romaine lettuce, peanuts, potatoes, whole grains, and apples.
• Iron to combat fatigue:4 Aim for at least 9 milligrams per day. Iron can be severely depleted during pregnancy and breastfeeding. Talk to your care team to see if you’re getting enough (see here for iron sources).
• DHA to alleviate depression:5 Get plenty of serotonin-raising DHA omega-3 fatty acids (at least 300 milligrams of DHA) during pregnancy and postpartum from fish or supplements. DHA omega-3s are proven to help alleviate and prevent depression, in general, not just during pregnancy and postpartum. If you are breastfeeding, they are critical for your baby’s brain development, too. And if you’re not breastfeeding, speak with your pediatrician about adding a liquid omega-3 supplement to the infant formula. See here for more information on omega-3 supplements.
• B12 for energy:6 Aim for at least 2.8 milligrams per day of B12, which is needed to convert amino acids into serotonin and dopamine, two important neurotransmitters linked to depression and low energy. Animal products, fortified breakfast cereals, and brewer’s yeast are good sources.
• Folate for energy and mental health:7 Raising your daily folate intake to at least 600 micrograms has been associated with increased energy and mental clarity. Studies show that 15 to 38 percent of adults with depressive disorders have low levels of B vitamins, including folate. This B vitamin is also believed to enhance the effects of antidepressant medications (see here for folate sources).
• B6 for mood balance:8 Aim for 2.0 mg daily. This vitamin helps conduct the neurotransmitters responsible for balancing your moods. Consume B6 from poultry, fish, eggs, whole grains, and nuts, and thiamine from whole grains, brewer’s yeast, lean pork, legumes, nuts, and seeds.
• Vitamin D to ward off depression:9 Adequate vitamin D from the sun can help alleviate feelings of depression, but it might not be enough. It’s a good idea to get your Vitamin D level checked. There is an inverse relationship with vitamin D levels and depression. People with low levels of vitamin D have more depression, and those with higher D tend to have less. At least 500 mcg or 200 IU are recommended.
How can exercise can help reduce depression?
Exercise is an important part of any PPD recovery plan. One of the best reasons to exercise is that it elevates serotonin and dopamine, and it releases endorphins, or happy hormones. Ironically, during a bout of depression, when you most need those happy chemicals, getting exercise can be extremely difficult due to lack of energy and motivation. Go easy, and remember your body is still recovering. Dr. Shosh suggests doing whatever you can. If all you can do is walk from the living room to the kitchen on a given day, fine. If you can walk outside only far enough to get your mail, that’s okay. It may be hard to imagine being this paralyzed by depression, but some women are. If it helps, ask a support person to be your buddy for a walk around the block. Here are some tips to help you start exercising after your doctor gives you clearance.
• Try to take a walk outside every day. Ten minutes is a good start, ideally work up to 30 minutes. Sunshine can be an added serotonin booster.
• If a walk outside sounds overwhelming, do some body stretches that can help relieve tension and stress. If you’re sitting a lot, stand up every 20 minutes to get the blood flowing.
• Even if your mobility is restricted due to doctor’s orders, certain breathing exercises can oxygenate your brain and help your moods.
• Stay well hydrated, particularly if you’re breastfeeding.
• Take lots of breaks, and don’t push yourself too hard. If a woman is experiencing a panic disorder, she should avoid overly strenuous exercise because it may cause an adrenaline surge, which could spark a panic attack.
• Yoga is an excellent stress reducer.
Does sleep affect depression?
Catch your zzz’s at night and whenever you can. Easier said than done, especially if you have a baby who does not sleep through the night. Sleep deprivation can rob mothers of melatonin, a naturally occurring hormone vital to the regulation of circadian rhythms, and it can reduce serotonin. Low levels of either of these brain chemicals may cause depression, anxiety, and other negative feelings. Finding a sleep schedule that works for you and your baby is the best advice. A few hours of uninterrupted nighttime sleep a few nights a week will propel PPD recovery, and without it, recovery will be harder. Throw out the myths of motherhood, such as, “I’m the mother, so the responsibility of nighttime care is all on me.” Allow your baby to bond with Daddy, Gramma, or another trusted adult during those hours so you can recover. You can provide a bottle in case your baby needs to feed while you’re sleeping. Everyone benefits this way. Solicit help with child care or chores whenever you can.
If you are at the breaking point of requiring medication to sleep (or you want to avoid getting to that point) and want to try a natural option first, Dr. Shosh suggests getting a pair of low blue light glasses, available online at www.lowbluelights.com. In the spectrum of light, blue light suppresses melatonin and keeps you awake. These special lenses are designed to block out 95 percent of blue light. Wearing them 2 to 3 hours before bedtime can start the flow of natural melatonin in the brain.
Bottom line: PPD is totally treatable and in many cases preventable. It’s important to recognize emotional and physical symptoms and to embrace nutrition, exercise, and regular emotional support to greatly minimize the severity of PPD and possibly even to completely avoid it. You’re an amazing mom. With proper help from a health-care practitioner who specializes in perinatal mental health, you will succeed, and be on your happy way!