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Definitions:

1. Perinatal depression: major and minor episodes during pregnancy (termed antenatal) or within the first 12 months after delivery (termed postpartum or postnatal).
2. Maternal depression: used interchangeably with perinatal depression.

 “Signs and symptoms for perinatal depression are the same as for depression in the general society: depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration.” (3)  Maternal depression is estimated at 12-16% with a high of 20%.

 Are breastfeeding women more at risk for postpartum depression? Yes:

• Women are two to three times more likely to experience depression than men. (3)
• Mood disorders occur in about 20% of United Stated women perinatally. (2)
• Depression during pregnancy (antenatal) peaks during the first trimester while postpartum depression peaks around 12 weeks.
• The benefits of breastfeeding and the health consequences of postpartum depression are well researched. However, the relationship between the two is not well connected. (1)

Research highlights

• For an excellent review of literature regarding post partum depression and the nutrition link, refer to the JADA September 2009 (3).
• A press release dated August 21, 2009 from American Psychiatric Association (APA) and American College of Obstetricians and Gynecologists (ACOG) entitled “Depression During Pregnancy: Treatment Recommendations”  addresses women thinking about getting pregnant, women currently on medication for depression, pregnant and not currently on medication and all pregnant women. However, no mention was made specifically to breastfeeding women. http://www.acog.org/from_home/publications/press_releases/nr08-21-09-1.cfm
• Project Viva followed 1436 pregnant women to assess the impact of prenatal depressive symptoms and high pregnancy-related anxiety relating to prenatal intention to breastfeed and breastfeeding initiation. Their findings reveal “...neither prenatal depressive symptoms or high pregnancy-related anxiety was associated with failure to initiate breastfeeding.” Women with depressive symptoms are less likely to plan to breastfeed but this did not mean the rates were lower in initiation of breastfeeding (2).
• Medline 1966-2007, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) 1982-2007, and Embase 1980-2007 were electronically searched using specific key words. Select specialist journals were also searched by hand. Results “...suggest that women with depressive symptomatology in the early postpartum period may be at increased risk for negative infant-feeding outcome including decreased breastfeeding duration, increased breastfeeding difficulties, and decreased levels of breastfeeding self-efficacy (1).
• Concerns about use of antidepressant medication by breastfeeding women regarding the effects on their infants create obstacles to compliance with treatments (4). 

Websites

1. Postpartum Support International (PSI) 1-800-944-4PPD; http://postpartum.net/ “Founded in 1987 to eliminate denial and ignorance of emotional health related to childbirth.” They have support persons in every state.
2. Support groups for the mother such as La Leche League www.llli.org, church groups, play groups, or a neighbor provide the following:

            a. meeting other women who are or have recovered
            b. provides adult companionship to decrease being alone
            c. creates an identity separate from parenting

Books

1. Breastfeeding: a guide for the medical professional. Ruth Lawrence.
2. Breastfeeding and human lactation. Jan Riordan.
3. The postpartum Survival Guide. Ann Dunnewold and Diane Sanford.
4. Rebounding from Childbirth. Lynn Madsen.
5. A Mother’s Tears: Understanding the Mood Swings that Follow Childbirth. Arlene Huysman.
6. Beyond Birth: What no one ever talks about. Dawn Gruen and Rex Gentry.
7. Laughter and Tears: The Emotional life new mothers. Elizabeth Bing.
8. Overcoming Postpartum Depression and Anxiety. Linda Sebastian.
9. Postpartum Survival Guide: It wasn’t supposed to be like this...Ann Dunnewold & Diane Sanford.
10. Postpartum Psychiatric Illness: A Picture Puzzle. Edited by James Alexander. Hamilton & Patricia Neel Harberger.
11. The Postpartum Husband. Karen Kleiman.
12. This isn’t what I expected. Karen Kleiman.
13. Women’s Moods: What every woman must know about hormones, the brain and emotional health. Deborah Sichel and Jeanne Driscoll.
14. Diapers and Delirium. Jeanne Watson Driscoll.
15. The hidden feelings of motherhood. Jeanne Driscoll.
16. Therapy and the postpartum woman. Karen Kleiman.

Tools to identify depression

• Beck Depression Inventory http://www.ibogaine.desk.nl/graphics/3639b1c_23.pdf
• Center for Epidemiological studies depression scale  http://counsellingresource.com/quizzes/cesd/index.html
• Edinburg Postpartum Depression Scale (EPDS http://www.aap.org/practicingsafety/Toolkit_Resources/Module2/EPDS.pdf

 
References

1. Dennis CL, McQueenK. The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics. 2009 Apr; 123(4). 

2. Fairlie TG, Gillman MW, Rich-Edwards J. High Pregnancy-related anxiety and prenatal depressive symptoms as predictors of intention to breastfeed and breastfeeding initiation. J Womens Health. 2009 Jun 29. http://www.ncbi.nlm.nih.gov/pubmed 

3. Leung BMY, Kaplan BJ. Perinatal Depression: Prevalence, Risks and the Nutrition Link-a Review of the Literature. JADA 2009 September; 109(9): 1566-1575. 

4. Pearlstein T, Howard M, Salisbury A, Slotnick C. Postpartum depression. Am J Obstet Gynecol. 2009 Apr; 200(4): 357-364.

 
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