Breastfeeding and post-partum depression: A possible cure, a possible cause

The Pediatric Insider

© 2014 Roy Benaroch, MD

An August, 2014 British study comes to two seemingly opposite conclusions: in some women, breastfeeding can protect against depression; while in other women breastfeeding seems to increase the risk of depression. It all depends on what mom’s intentions had been.

The study is complicated, and has a lot of tables—but they’ve kindly made it open-access, so you can read it yourself in detail (click the Download PDF button after the link, above.) Briefly, researchers looked at about 14,000 births, and tracked measures of mental health during pregnancy and periodically afterwards. They also tracked whether women tried or didn’t try to breastfeed, and how long breastfeeding continued. And, they kept track of what women had said their intentions to breastfeed had been prior to delivery. Results were corrected for things like socioeconomic factors and the health of the baby, since we know those have a big effect on the risk of post-partum depression.

The women who didn’t intend to breastfeed, and didn’t end up breastfeeding, were used as the comparison group, and the relative risks of post-partum depression were determined. What they found was fascinating:

Among women who intended to breastfeed, and who did in fact successfully breast feed, the risk of depression was cut in half. This effect was strongest for longer-duration nursing. The authors postulate that the beneficial effect of nursing in this group was conveyed by hormonal factors released during nursing.

Unfortunately, those positive hormonal factors were not seen in all women. Among women who had planned to breastfeed, but were in fact unable to nurse sucessfully, the risk of depression more than doubled. Most women who try to nurse find nursing a successful experience, but women who don’t meet their own expectations seem especially vulnerable to depression.

And: among women who didn’t plan to breastfeed, but did in fact end up breastfeeding anyway, the risk of depression was also increased. Perhaps these women, who hadn’t wanted or planned to nurse, felt bullied or coerced into nursing?

The obstetric and pediatric communities are fully in support of breastfeeding, which offers medical and psychological advantages to most women and their babies. But we need to acknowledge that nursing can be difficult, and that women who don’t nurse are still capable, good moms—they don’t need scorn or dirty looks when they use baby formula. It’s a shame that moms who are providing love, nurturing, and good nutrition though a bottle may be at higher risk of depression. We can do better than this.

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4 Comments on “Breastfeeding and post-partum depression: A possible cure, a possible cause”

  1. Rachel Says:

    Thank you for this. I fell in the category of wanting to but being unsuccessful in breastfeeding my twins and fell into a fairly deep and painful depression which was focused almost exclusively on what I perceived as my being a total failure as a mother because I was unable to provide “the best” for my kids.

    The “breast is best” message is EVERYWHERE and I could not escape it. I got it in every baby book I read, at every baby class I attended, at every pediatrician visit, and every time I opened can of formula. There were no post-partum support groups for me because I did not breastfeed (the post-partum support group was billed as a “breastfeeding class” even though I know from mom friends who attended it that it was mainly a support class for new mothers where a variety of topics were discussed – not just breastfeeding). I attended a ‘baby and me’ class when my kids were six months old and I had to hear the instructor telling all the moms who were breastfeeding “great job – you’re doing the best for your baby” and then basically ignoring me. This was in 2008 when a “study” that said that formula feeding costs the US billions of dollars in health and other costs came out and was reported rabidly in every news outlet. So, now not only was I a terrible mother because my kids were going to be dumb, overweight, asthmatic and rashy, I was partly to blame for downturn in the economy. No wonder I was depressed.

    Luckily, I came to my senses when I saw my kids growing up to be healthy, happy, smart, and loving. However, I do still get angry when I think about how much energy and emotion I wasted beating myself up over breastfeeding. Obviously, it was my fault for allowing myself to be being sucked into the vortex of guilt and depression – but it is also the fault of our society which has created an environment in which a new mother (sleep deprived, hormonal and in the midst of a huge life change) is subjected to such intense pressure and criticism over something that is, in the long (and short) run, so relatively unimportant. We CAN do better than this.

    In any case, I didn’t read the study but I question the conclusion that the decrease in PPD with women who wanted to and did breastfeed having lower incidence of PPD being due to hormones. If this is the case, wouldn’t the women who breastfeed despite not wanting to have a lower incidence of PPD as well?

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  2. Alexis Says:

    Discussing this on my FB page after stumbling across some old but interesting research on low supply and my pithy comment is “Yes!” So many comments like, “I felt like I was failing my child,” or even “2 years later I tear up when I think about our nursing struggles.” Clearly there is a lot of emotional energy built up around successful nursing that when it doesn’t turn out as planned, it’s a huge letdown.

    ~5-15% of nursing Moms will struggle with low-supply – a not insubstantial number. Yet people are stunned when they run into this problem because it’s not one that is often discussed. They arm-wrestle with supplements, medical grade pumps, etc. trying desperately to squeeze more milk out of their breasts, which may or may not be up to the tasks.

    I’m not sure how to strike a balance here but I feel that prior to birth we need to introduce the idea that, physically, not everybody will be capable of doing this and that’s OK. Again I know this is challenging because you have so many people who give up too quickly so it’s a fine balance between the two extremes (self-flagellation and feelings of failure vs. giving up on day 3 because you’re convinced it’s not working).

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  3. Dr. Roy Says:

    Alexis, I try to (1) be honest, and (2) look at the whole health of the whole mom-baby dyad. It’s not just about breasts and nursing (in terms of the influence on overall health, compared to hundreds of other choices and responsibilities, nursing is a comparatively minor contribution.)

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  4. Dr. Roy Says:

    “In any case, I didn’t read the study but I question the conclusion that the decrease in PPD with women who wanted to and did breastfeed having lower incidence of PPD being due to hormones. If this is the case, wouldn’t the women who breastfeed despite not wanting to have a lower incidence of PPD as well?”

    I agree– the “hormone” conclusion was the authors’ speculation, not mine. Perhaps what influences the rate of PPD isn’t so much nursing versus not nursing, but only one’s mindset or attitude or feelings about nursing? If that is true then perhaps the simplistic “breast is best” message isn’t helping.

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