One in seven moms will experience postpartum depression following the birth of a baby. Hormonal changes associated with giving birth, the stress of caring for a new baby, and lack of a support system can set the stage for this condition. However, it’s possible to alleviate symptoms of postpartum depression—with natural treatments.
Depression and postpartum depression—often abbreviated as PPD—still carry a stigma that hinders optimal prevention and treatment. Unfortunately, most moms who go back to their doctors for postpartum check-ups are given little more than some general mental-health advice and perhaps a prescription for an antidepressant. Read on to learn about the potential causes of PPD, the downside of antidepressants, and nine natural treatments that could help.
Nine Ways to Care for Postpartum Depression with Natural Treatments
If you or a loved one is suffering from PPD or is at risk, natural remedies may be beneficial and can offer powerful alternatives to prescription antidepressants. Many of the remedies I’ll discuss below can also be incorporated before birth, especially for those with a history of depression or postpartum depression.
1. Start Seeing a Psychotherapist
Compared to antidepressant medication, psychotherapy is cost effective, well tolerated, and generally more effective for treating depression, especially in the long term. A meta-analysis and review examined 28 trials and reported that psychotherapy intervention during pregnancy significantly reduced the number of women who developed PPD.
Specifically, mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy have great track records of mitigating postpartum depression.
- Cognitive therapy helps prevent postpartum depression. In pregnant women with a history of depression, MBCT decreased depression relapse compared to other treatments, including antidepressants. MBCT is also a viable treatment option for postpartum depression.
- Cognitive therapy helps treat postpartum depression. In 2018, a meta-analysis reviewed 20 randomized controlled trials that compared the effectiveness of BCT against typical treatment methods (like medication). Women who underwent psychotherapy saw greater improvements in their depression symptoms in both the short and long term than women who received other treatments.
- Cognitive therapy is superior to antidepressant treatment.In one study, MBCT therapy worked better than both SSRI treatment and a combination of SSRI and MBCT treatment. In another study, adding an SSRI to psychotherapy treatment offered no benefit beyond psychotherapy alone.
Unfortunately, a major barrier to getting psychotherapy treatment is the perceived “difficulty” of the process, from researching and finding a therapist to making (and keeping) an appointment. Even under less stressful circumstances, it isn’t always easy to ask for help—but for a new mom experiencing the feelings of hopelessness that accompany PPD, it’s especially challenging. Navigating health insurance, locating a provider, and simply trying to find time to make the necessary phone calls can seem overwhelming.
Before giving up, consider the following:
- Start with baby steps. Break down the process of making an appointment into several steps you can complete over the course of a couple days. For example, first identify providers that fit your criteria, and then set aside a few different blocks of time to call them.
- Bring your baby. If you don’t have someone to watch your baby, many therapists and psychologists are more than willing to see you with baby in tow.
- Give it a few sessions. Don’t ditch your provider after one session. Try a few meetings before deciding if it’s a good fit.
- Stop if it doesn’t feel right. On the other side of the spectrum, don’t be afraid to try a different therapist. You might not click with the first, or even the second, provider. But that’s okay. You’ll find the right person.
- Consider telephone-based or internet-delivered psychotherapy. If leaving the house just isn’t an option, this type of psychotherapy can also be effective.
2. Get Regular Exercise
During the first six to eight weeks after delivery, you should be resting and taking care of yourself and your new baby, especially if you’re recovering from a Caesarian section or other pregnancy complications. But when you get the green light from your healthcare provider, taking up an exercise routine could help reduce the risk of, and even treat, postpartum depression.
In two randomized controlled trials, 12 weeks of an exercise intervention for postpartum women reduced the EPDS score (measure for depression) compared to controls. In another study, moderate exercise five times per week resulted in greater remission rates compared to antidepressant medication. As long as you start off slow and exercise safely, the only side effect of exercise is good health.
You might be asking, “When can a new mom find time to exercise?” It’s a valid question. A sustainable and enjoyable exercise routine is the one you’re most likely to stick with, as adherence to exercise interventions in studies (and in real life) can be quite low. But do what other moms do, and get creative:
- Easiest of all: take a stroller walk with your baby, and pick up the pace as you get your energy back
- Try a Mommy and Me yoga or other exercise class, where babies are part of the routine
- Buy a subscription to postpartum exercise videos you can stream from home
- Dance (safely) with your baby
- Workout during baby’s first nap of the day, to make it a top priority
And remember that before you know it, your baby will be an active toddler—a workout in itself!
3. Use Light Therapy
Our ancestors spent most of their waking hours outdoors, a lifestyle in stark contrast to modern society. Seasonal affective disorder tends to peak during winter, when sunlight exposure bottoms out. Harnessing the mood-improving effects of sunlight, light therapy has been proven effective for treating both seasonal affective disorder and non-seasonal-related depression. In some cases, combining light therapy with antidepressants was no more effective than light therapy alone.
Typically, light therapy involves exposure to a bright light for 10 to 20 minutes per day (to reach about 10,000 lux units of light) in the morning. Light therapy is believed to positively affect mood, sleep, circadian rhythms, and HPA axis activity. Two studies have used bright light as a treatment for perinatal and/or postpartum depression. Both studies demonstrated clinical improvement with light therapy, with up to 75 percent reduction in depression.
Some minor side effects can accompany light therapy, including headache, eye strain, nausea, and agitation, but these effects are mild and usually transient. Critics of light therapy question its efficacy because a proper placebo doesn’t exist—participants will know whether or not they are being exposed to bright light. But even so, does that matter if light therapy yields positive results?
4. Try Acupuncture
Acupuncture also faces criticism for lack of double-blind, placebo-controlled trials. Acupuncture may improve mood by decreasing stress-induced cortisol release. The results of acupuncture for the treatment of depression and postpartum depression are mixed.
In a review of acupuncture for depression, there was no evidence that medication yielded better outcomes than acupuncture.
Generally well tolerated with few side effects, acupuncture from a competent, licensed acupuncturist may be worth pursuing for postpartum depression. However, more robust studies are needed.
5. Start Taking Probiotics
The gut microbiome interacts with and influences the body’s organ and systems, including:
The brain and gut communicate with each other. The vagus nerve, responsible for parasympathetic processes like heart rate, runs from the brain to your visceral organs. In return, gut bacteria produce neurotransmitters that communicate with the brain. Disrupted gut microbiomes have been associated with psychological disorders, including depression and anxiety. Specifically, recent evidence suggests that the microbiota may regulate serotonin synthesis and secretion. In two small studies, the gut bacteria of individuals with depression were shown to have more pro-inflammatory gut bacteria and less anti-inflammatory gut bacteria than control groups.
When administered to mice, the anti-inflammatory probiotic L. rhamnosus reduced corticosterone and anxious and depressive symptoms. In one small human trial, pregnant women who supplemented with L. rhamnosus through six months postpartum reported lower depression and anxiety scores compared to placebo groups, indicating the therapeutic potential of probiotics for postpartum depression.
We know the gut microbiome drastically shifts during pregnancy, and if that shift ventures towards gut dysbiosis, it could predispose certain women to developing PPD. Take care of your gut by consuming bone broth, fermented foods, and kefir or yogurt, if tolerated.
6. Look into Bioidentical Hormone Therapy
After delivery, women experience dramatic drops in progesterone and estrogens, both of which influence activity at the GABA “feel-good” receptor in the brain. Some data suggest that low progesterone following birth is correlated with the baby blues, but other data haven’t supported any clear link between hormone concentrations and postpartum mood.
Bioidentical progesterone treatment may be a viable alternative to traditional antidepressants. Bioidentical progesterone is not chemically identical to the synthetic progestins found in birth control pills, and most obstetricians and gynecologists are unfortunately unfamiliar with the former as a treatment option. In the 1980s, two studies led by Dr. Katharine Dalton demonstrated the effectiveness of bioidentical progesterone for treating PPD, with remission rates of less than 10 percent. Since the 1980s, progesterone therapy for PPD has been widely used by health professionals trained in Natural Procreative (NaPro) Technology, a women’s health initiative that strives to understand and cooperate with a woman’s reproductive and gynecological health. Progesterone can help alleviate some symptoms of depression in as little as one injection almost immediately. Unfortunately, outside of the NaPro literature, further randomized controlled studies using bioidentical treatment for postpartum depression have yet to be published.
Related to bioidentical progesterone, allopregnanolone, a naturally occurring metabolite of progesterone, has been studied in two clinical trials for PPD treatment. Much like bioidentical progesterone, allopregnanolone showed rapid mood-boosting effects after just one drug infusion. As these trials were very recent, in 2017 and 2018, I am intrigued at the prospect of a fast-acting, more natural option for postpartum depression.
7. Get More Sleep and Rest
More than one-third of American adults admit to not getting enough sleep, and I would bet that number is even higher among new moms. Large meta-analyses have found associations between sleep disturbances and depression in both the general adult population and in postpartum moms. Sleep depression and depression can create a vicious cycle, as each contributes to the other.
Getting enough sleep can seem impossible for new moms, especially in modern Western societies where women have less support than in previous generations. Sleeping when the baby sleeps is not always an option, but aim for it whenever possible.
If you are breastfeeding, not on any medications with drowsy side effects, and a nonsmoker, co-sleeping and side-lying nursing might be good options that offer more sleep. Despite what mainstream organizations want to claim, co-sleeping can be safely done. Check out the La Leche League’s Safe Sleep Seven to find out how to create a safe sleeping environment for you and your baby.
8. Try Supplementing with St. John’s Wort
Many natural health communities tout St. John’s wort as a beneficial treatment for depression, as the herb has been shown to have mood-boosting activity at the serotonin and “feel-good” GABA receptors. In double-blind, placebo-controlled trials, St. John’s wort often performs better than antidepressant medications at reducing depression symptoms, with up to 10 times fewer reported side effects. Of note, St. John’s wort should not be taken concurrently with SSRIs, nor should it be combined with light therapy because it may increase the body’s sensitivity to light.
However, if you are breastfeeding, St. John’s wort might not be the best choice. Even though it is found in breastmilk at “undetectable to low levels,” breastfeeding infants whose mothers supplemented with St. John’s wort had higher instances of drowsiness, colic, and lethargy.
Talk with your provider about other supplements that might be useful for postpartum depression:
- Sam-e, which may be especially helpful for women with MTHFR mutations
- Vitamin D
9. Set Up a Personal Support Network
Being a new mom can be isolating. In other cultures, women are surrounded and cared for by other women and moms after giving birth. In modern Western societies, extended family often lives far away, and the concept of a “village” helping to raise children is disappearing. Couple that isolation with inadequate parental leave policies and poor sleep, and you have a recipe for depression. Ideally, a postpartum woman would have an extensive support network from friends and family, a generous amount of worry-free leave from her job, and multiple home visits from a medical practitioner as she recovers and adjusts to her new life. (And that’s how it is in many countries around the globe—but not in the United States.)
Most American women only have one checkup four to six weeks after giving birth, although the American College of Obstetricians and Gynecologists now recommends that postpartum care be an ongoing process with multiple follow-up appointments. See if your provider is willing to follow a more holistic care model, which would include:
- Multiple follow-ups post-birth
- Blood work to monitor nutritional stores (beyond iron) and hormone statuses both during and after pregnancy
- Full thyroid blood panel during and after pregnancy
- Physical therapy referral, if needed for pelvic floor dysfunction or diastasis recti (separation of the abdominal muscles)
- Mental health referral, if needed
If you are pregnant, set up a support system as best you can before birth. Here are a few tips to help you get started:
- Accept any and all offers of help. Have a list ready for errands that friends and family can run or chores they can do.
- Have a freezer meal baby shower. Get everyone together to help you prep dozens of nutrient-dense meals and snacks so you won’t be tempted to eat easily accessible processed foods.
- Begin a meditation practice. The Headspace app can help you get started.
- Identify nearby lactation consultants for support if you plan to breastfeed.