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Breastfeeding & Postpartum Depression

By Tonia Olson, MN, BSN, RN, IBCLC & Angela Bowen, PhD, MEd, BSN, RN

Breastfeeding & Postpartum Depression

Can breastfeeding actually decrease your risk for postpartum depression (PPD)? Can women with PPD safely take antidepressants while nursing? Between 8%-19% of mothers experience depression in the first year after birth. 

Can you sort myth from fact regarding breastfeeding and PPD? Even well-meaning healthcare providers can struggle with these questions if they don’t know the current research.

Myth # 1: Breastfeeding Causes Postpartum Depression

“I don’t understand, she latched well right after the birth, but she hasn’t latched since. I’m worried that I can’t breastfeed. My girlfriend tried to breastfeed and she said it was a really awful experience. She never had enough milk, her baby lost a lot of weight, and her nipples got really sore and were bleeding! She stopped breastfeeding altogether because the whole experience made her feel depressed.” Cassie

The Evidence

Not all women at risk for or currently experiencing depression will find breastfeeding too stressful to maintain, or that it makes their mood worse. While research suggests that struggling with breastfeeding can increase the risk of depression in some women, establishing good breastfeeding actually protects from depression. , In fact, moms with PPD and who stopped breastfeeding early actually described experiencing more depression and anxiety when asked by researchers about their moods. 

Experts believe that the feel-good hormone, oxytocin, which drives the let-down reflex essential to beginning each breastfeeding session, helps moms feel more relaxed and content. Oxytocin also increases attraction between you and your baby, promoting facial recognition and boosting your caregiving and mothering confidence.

Breastfeeding helps you maintain vitamin A-related compounds at levels that are protective against mood disorders, including depression as any excess amounts of these compounds are passed to baby, who receives and uses these nutrients.

Choosing not to breastfeed stops lactation, and in some cases, a mom may have a rush of depressive feelings similar to what a she might experience after the loss of a child, research shows.

In this way, researchers believe breastfeeding helps bolster and protect your moods. In fact, many moms with PPD describe breastfeeding as giving them a significant—if not the only—sense of connection to their babies while dealing with their depression.

If you’re struggling with early breastfeeding recognize that both you and your baby are going through a lot of changes right now. You’re just getting to know each other and everyone’s breastfeeding experience is unique. Breastfeeding can be uncomfortable in the first weeks when your nipples are stretching and your milk is still coming in. If you are stressed, try some of these ideas to practice a comfortable latch:

Undress your baby and cuddle her against your naked chest

Recline and get as comfortable as possible, maximizing skin-to-skin contact

Allow baby to hear your heartbeat, feel your warmth, and smell your milk

Offer her your breasts when she’s relaxed and alert—don’t wait for her hunger cries as she may be too upset and hungry to latch easily

Try nursing baby within the support of a local breastfeeding group to gain knowledge and help from lactation consultants and other nursing moms

Myth # 2: It’s Not Safe to Take Medications for Depression While Breastfeeding

“I don’t know whether I should breastfeed while taking drugs for depression and anxiety. I don’t want the drugs to hurt my baby; I think I will just stop taking my antidepressants.” Rosario

The Evidence

Newer antidepressants transfer in small amounts only into breastmilk and don’t negatively affect your baby. In fact, research shows:

Moms with anxiety may safely take anti-anxiety drugs, like benzodiazepines, while breastfeeding with only a slight increase of sleepiness in some babies

Moms with bipolar disorder can take mood stabilizing drugs such as valproate, phenobarbital, phenytoin and carbamazepine

Experts caution about the use of antipsychotic medications clozapine and olanzapine in women who are very depressed with psychotic symptoms. Still, they suggest that if a mother has safely taken the drug effectively before lactation, she should continue to use that same medication while breastfeeding

Using any medication while breastfeeding is an individual decision. Make this decision with your healthcare provider based on the risks and benefits of taking or stopping a drug during breastfeeding, including those health risks to moms and babies when mom chooses not to nurse or feed baby breastmilk.

Myth # 3: Breastfeeding women are sleep deprived, making them at greater risk for depression

“I want to breastfeed, but we’re thinking of feeding formula at night so that we all get more sleep. I’ve heard that sleep deprivation is a risk for postpartum depression and I worry that my milk just won’t be enough for her” LaToya

The Evidence

There’s an assumption that moms who feed their babies formula get more sleep or free time than moms who breastfeed—but researchers are finding that this is not the case.

While lack of sleep definitely affects anyone’s mood—especially new moms—feeding formula doesn’t improve sleep or mood, particularly because of how it affects the hormone, prolactin, which helps you make milk and sleep.

Prolactin is the primary hormone responsible for milk supply and it also promotes deep sleep in adults, research shows. Because of this, studies report that exclusive breastfeeding actually improves mother’s sleep. One group of researchers found that parents of breastfed infants slept an average of 40-45 minutes longer each night than parents of babies who were fed formula.

That same finding held true compared to moms who mixed breastfeeding with formula feeding as these “combo moms” as they’re commonly called reported fewer hours of sleep, less energy and higher rates of depression.  While it’s true that formula stays in a baby’s tummy longer, this is because it’s more difficult for babies to digest, which can lead to fussiness and even less sleep for everyone!

Just remember that especially in those first few weeks and months, it’s normal for newborns to have fragmented sleep, to need to be fed often at night and to want to be close to you. Babies are brilliant! They nurse often at night because they instinctively know that your prolactin level is highest then.

Most infants need to eat at night and they get up to 20 percent of their nutrition during this time. Studies have shown that breastfeeding mothers, even if they wake up often, actually fall back to sleep quicker than if they were formula feeding.

Remember, this sleep deficit won’t last forever and eventually you and baby will get into a rhythm with breastfeeding, and one day you both will regularly sleep through the night. Meantime, gain support from your partner or a relative who can help you in the first weeks get comfortable with night-time breastfeeding. They can change baby’s diaper, bring baby to you, burp baby and settle her down after feeding so that you don’t feel so alone and so that you can

Tonia Olson, MN, BSN, RN, IBCLC, is a maternal-child nurse and lactation consultant with the Saskatoon Health Region in Saskatoon, Saskatchewan, Canada. Angela Bowen, PhD, MEd, BSN, RN, is associate professor and researcher at the University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

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