Unfortunately, it’s not uncommon for women to be impacted by either postnatal depression (10-37% of pregnancies) or the more common: postnatal anxiety (27-54% of pregnancies). The good news is that awareness and our understanding of these issues is growing. However, it remains a complicated issue. Some research has also suggested as many as 50% of cases go undiagnosed. (9). Is Chronic Inflammation the key? 

Science still doesn’t have a definitive answer as to how we can prevent it or a single cause for it. That being said, we are understanding more about the many risk factors that can contribute. The good news? This means there are things we can do to potentially reduce the chances we are impacted. In fact, recent research highlights inflammation as one potential risk factor. With some depressed women having levels 40-50% higher! Something that appears to be on the rise in our modern society. We take a look at what, how and most crucially ways you can reduce your own risks of being impacted: 

Postnatal depression: a couple of things to know: 

When we think of Postnatal Depression we probably think of more extreme forms of the ‘baby blues’. Every woman will feel a rollercoaster of emotion after having a baby. That’s normal. It is a combination of massive hormonal swings (crash after the Placental leaves), sleep deprivation and quite dramatic life change! However, postnatal depression is much more significant and often longer lasting….

Some key signs you may have postnatal depression: 

Key signs to watch for (which are often hard to recognise in yourself when you’re in it):

• persistent sadness/low mood
• loss of interest in the world/what’s around you
• persistent lack of energy/tiredness
• trouble sleeping/insomnia/sleepiness during the day
• trouble concentrating/decision making
• loss of appetite or more extreme comfort eating
• agitation, irritability or apathetic
• persistent feelings of guilty/hopelessness and self blame
• indifference/trouble bonding with the baby
• frightening thoughts about harm to the baby
• suicidal/self harm thoughts

However, the less extreme form – postnatal anxiety – can still be debilitating and is often much more common… 

Anxiety can also happen during pregnancy as well as post. This is often characterised by

• intense worrying about the baby’s health
• guilt as well as symptoms like:
• trouble sleeping
• irritability and appetite changes.

The charity Mind has a great list of symptoms here. 

It’s also worth checking out our interview with Dr Natasha who talks in detail about postnatal anxiety and her own experience with it for more. 

Crucial is recognising that both are valid and can have very real consequences on a person experiencing it. 

Are there ways we reduce the chances we get impacted by postnatal depression or anxiety? 

Research has identified some risk factors that can increase the odds that you are impacted.

• unresolved/previous issues with mental health/anxiety
• previous trauma
• lack of support: physically, emotionally and financially
• traumatic birth
• trouble breastfeeding
• Genetics/family history
• Enhanced hormonal sensitivity
• Chronic low level inflammation

Dealing with mental health pre or during pregnancy and asking for help and support are obvious ways to reduce the risks. It is something we are very passionate about. Click here for more of the ‘how to’ with resident expert psychotherapist and women’s mental health specialist Emmy Brummer.  

However – these issues are sometimes not always so easy to ‘fix’. 

The good news is that when it comes to one of the risk factors – chronic inflammation – there are some very powerful ways to combat.

Chronic inflammation and it’s role in postnatal anxiety and depression: 

More recent research suggests that chronic inflammation could play a major role either making us more prone to experiencing postnatal anxiety and depression or to experiencing it: 

What’s chronic inflammation? Think of it as misfiring of the body’s own immune response. It can be caused by many potential things. However nutrient depletion, birth and many other factors in our modern lives can play a big role. 

What is chronic inflammation and where does it come from?

In a nutshell: this is where the body’s defence/immune system is ‘turned-on’ at low level persistently against ‘attack’. The trouble is this can cause damage to the body itself. Think of it like collateral damage….

In fact, we are fast realising that this could be at the root cause of a number of both physical and mental health issues prevalent in our modern lives. 

For a bit more of an in-depth read into how this can impact all stages of conception, pregnancy and development click here. 

But how does inflammation contribute to postnatal depression and anxiety specifically?! 

Of course when you give birth there is naturally ‘trauma’ to the body. Inflammation is the natural response and is actually crucial for healing. Research confirms that post birth inflammation naturally rises (10).

For two reasons: 

One: the body’s natural and necessary response is to try to heal and inflammation is part of this process.

Two: there is naturally some suppression of the body’s immune response to maintain pregnancy (anti-inflammatory cytokines). This reverses after birth. (10).

The trouble is when this is ‘too much’ or when there is an over response: 

There is speculation that when inflammation is excessive or persistent (or even coming from our modern lifestyles) research has shown it can contribute to issues with mental health. Click here for much more. 

If inflammation is normal and part of healing what’s the issue? 

As always it is about the extent. Not too much, not too little. At the right time!

The more inflammatory cytokines circling the body (these are signals for the immune system) the greater the potential risk of negative impact to neurotransmitters. Think Serotonin, Dopamine etc which play a role in our mood.

It has also been shown to impact hormone levels and the HPA axis which is closely tied to our mood and response to stress. 

In fact, we have discovered that these cytokines DO cross the blood/brain barrier and impact our mood. Which is partly why you feel down when you’re unwell. Click here for more. 

40-50% more inflammation for people with depression?! 

Research (2) has shown that ‘levels of inflammation can be 40-50% higher in depressed people than their non depressed counterparts.’

We used to think that depression caused chronic inflammation. However, we now know that it can be the reverse as well. Proinflammatory cytokines can cause symptoms like:

• alteration in sleep/appetite
• mood disorders
• impact on energy levels
• impact on libido
• impact on desire to socialise

‘The relationship between inflammation and depression appears to be bidirectional: inflammation increases the risk of depression and depression increases inflammation.’ (2)

In English: yes, trauma to the body (including birth) can potentially cause and heighten the risk of depression and anxiety. If your immune system is ‘over reacting’ this to can cause issues with mood, depression and anxiety. 

So how can we reduce the risk of chronic inflammation in the body? 

The good news is that there are a lot of things you can do to reduce the risk of ‘out of control inflammation’ in the body. The other thing to remember is that pregnancy takes a lot out of the body. Often when a baby arrives we focus so much on them and not enough on ourselves. It is important to support the body and help it do its job in the best way possible. Postnatally is the time we need to replenish the body’s nutrients and give an extra level of support:

We will focus on the main elements research suggests can help:

• Omega 3 fatty acids (DHA/EPA)
• Vitamin D
• Iodine (Thyroid support)
• Folate/B12
• Sleep (yes, this one may be trickier: but shouldn’t be minimised)
• Exercise
• Anti-inflammatory foods
• Focus on gut health

Omega 3: a tool in the fight against postnatal depression, anxiety and chronic inflammation? 

DHA/EPA which are long chain polyunsaturated fatty acids (aka. Omega 3s) have been growing in prominence as proven anti-inflammatories in the body. They are mainly found in fatty fish and certain algae. 

Research has shown that: ‘EPA/DHA supplementation has been shown to reduce levels of key inflammatory cytokines.’ (1) 

How?

They appear to work by:

• impacting the pathway that forms these pro inflammatory cytokines
• competing with molecules that form cytokines
• regulating the production, function and metabolism of certain neurotransmitters 

In fact, the research has been so compelling that the American Psychiatric Association recommended in 2006 that doctors consider monitoring and supplementing Omega 3 levels during treatment of mood disorders. (1) 

Why we miss out given our modern lifestyles:

The other key thing to know is that 80% of the population do not get the required amount of EPA/DHA.  (5)

We also know that there tend to be imbalances in Omega 6 vs Omega 3 in our modern diets. The reason being we have many more Omega 6 fats in processed foods and cooked oils which make up more of the Western diets. In fact in some cases research has shown instead of having a ratio of 2:1/3:1 Omega 6: Omega 3 we are getting as much as 15:1 to 17:1 (2). 

So, how much do we need? 

Getting enough during pregnancy is key for both mother and baby. This is important for brain development and a healthy pregnancy. Click here for more. 

When it comes to fighting inflammation and risks to mood – we know it is best to start during pregnancy as well as ensure you have a steady supply postnatally, particularly if you’re breastfeeding. 

Why?

During the last trimester, research (2) has shown that babies will accumulate on average 67mg/day of DHA. The average intake for mothers in the West is 15mg/day. Because babies need DHA for brain and vision development, women’s bodies will preferentially divert DHA to the baby and will deplete maternal stores. (2) 

The current recommended minimum dose is 200-400mg/day. 

So, if you aren’t able to eat the recommended 1-2 portions of fatty fish per week it is well worth discussing a supplement with your doctor. 

Can Vitamin D play a role helping reduce the chance of postnatal depression, anxiety and chronic inflammation?

Did you know Vitamin D acts as a neuroactive hormone?! There are Vitamin D receptors widely distributed through the brain. (6) 

Whilst we don’t have definitive answers; research is increasingly showing a link between Vitamin D (getting enough) and a functioning immune system. Amongst other things. Click here for more.

In fact, a systematic review and meta-analysis of observational studies involving nearly 32,000 non-pregnant adults found low vitamin D levels to be significantly associated with clinical diagnoses of depression [13].

There are studies showing how Vitamin D shifts the body’s production of crucial elements of the immune system: T Lymphocytes. Lower levels of these have been implicated in depression (1) So, once again the role of the immune system not functioning as it should comes into play.

How much vitamin D do we need?

The American Academy of Pediatrics recommends 200 iu/day for the first two months postnatally. (4) Although, one randomised clinical trial showed that supplementation with as much as 2000 iu/day during pregnancy reduced the risk of antenatal depression. (8). 

Not getting enough during pregnancy has even been linked to the development of ADHD in kids (ie. not getting enough). Click here for more. 

It’s important to get your levels checked if in doubt and discuss the right dosage for you with your doctor before starting a supplement. Making sure your body has enough during pregnancy, recovery from birth and breastfeeding is always a good idea. Click here for more. 

Iodine and thyroid support: another risk factor in postnatal depression? Other ways to combat inflammation:  

Iodine is crucial for the Thyroid and associated hormones. During pregnancy our needs go up by around 50%. (5). It is also crucial for the healthy development of a baby’s brain. 

Thyroid hormones have been implicated in postpartum depression. (9, 10) Fish and shellfish are the main dietary source as they receive it from algae.  

The average European intake is 85-88 micrograms/day vs the recommended 150 micrograms. (5). Click here for much more.  

If in doubt, ask for your levels to be checked and chat to your doctor about support. 

Folate/B12 and postnatal depression and anxiety:

Finally. Keeping our digestive system healthy has been shown to keep the body’s immune system in check. Click here for much more. 

References: 

1.Ellsworth-Bowers ER, Corwin EJ: Nutrition and the psychoneuroimmunology of postpartum depression: Cambridge University Press: Vol 25: June 2012. 

2. Kendall-Tackett K: A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health: International Breastfeeding Journal: March 2007

3. Maes M, Lin A, Ombelet W: Immune activation in the early puerperium is related to postpartum anxiety and depressive symptoms: Psychoneuroendocrinology: Feb 2000, (25): 121-137

4. Picciano MF, McGuire MK: Use of dietary supplements by pregnant and lactating women in North America: American Journal of Clinical Nutrition. 

5. Moon JS: Nutritional Management of breastfeeding infants for the prevention of common nutrient deficiencies and excesses: Korean Journal of Paediatrics: 2011; 54(7): 282-286

References:

6. Williams JA, Romero V, Clinton C: Vitamin D levels and perinatal depressive symptoms in women at risk: a secondary analysis of the mothers, omega-3, and mental health study: BMC Pregnancy and Childbirth:  2016: 16: 203

7. Trujilo J, Costa Vieira M: A systematic review of the associations between maternal nutritional biomarkers and depression and/or anxiety during pregnancy and postpartum: Journal of Affective Disorders: May 2018. 

8. Aghajafari F, Letourneau N: Vitamin D Deficiency and Antenatal and Postpartum Depression: A Systematic Review: Nutrients: 2018 Apr 12; 10 (4):

9. Payne J, Maguire J: Pathophysiological Mechanisms Implicated in Postpartum Depression: Frontiers Neuroendocrinology 2019: Jan; 52; 165-180. 

10. Edler Schiller C, Meltzer-Brody S: The Role of Reproductive Hormones in Postpartum Depression: CNS Spectrum 2015: 20 (1); 48-59

11. Rechenberg K, Humphries D: Nutritional Intervention in Depression and Perinatal Depression: Yale Journal of Biology and Medicine: 2013. 

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