Can breastfeeding trigger PPD?

Postpartum depression (PPD) is a serious mental health condition that can affect new mothers after childbirth. PPD causes feelings of extreme sadness, anxiety, fatigue, and hopelessness. For some women, the experience of breastfeeding can exacerbate the symptoms of PPD.

What is Postpartum Depression?

Postpartum depression is a mood disorder that can affect women after they give birth. Symptoms usually start within the first few weeks after delivery, but may begin later up to a year after birth. PPD is estimated to impact 1 in 9 new mothers.

Common symptoms of PPD include:

• Depressed mood or severe mood swings
• Excessive crying
• Difficulty bonding with the baby
• Withdrawing from family and friends
• Loss of appetite or eating much more than usual
• Inability to sleep or sleeping too much
• Overwhelming fatigue or loss of energy
• Reduced interest and pleasure in activities
• Intense irritability and anger
• Fear that you’re not a good mother
• Hopelessness
• Feelings of worthlessness, shame, guilt or inadequacy
• Diminished ability to think clearly, concentrate or make decisions
• Restlessness
• Severe anxiety and panic attacks
• Thoughts of harming yourself or your baby
• Recurrent thoughts of death or suicide

Untreated, PPD can last for months or longer. Postpartum psychosis, a related condition that can occur shortly after childbirth, can cause hallucinations and delusions and requires urgent treatment.

Risk Factors for Postpartum Depression

There are a number of factors that can increase a woman’s risk of developing postpartum depression, including:

• Hormonal changes. Levels of estrogen and progesterone decrease sharply after delivery. This change may contribute to postpartum mood disorders.
• History of depression. Women with a personal or family history of depression are more likely to experience PPD.
• Stress. Stressful life events during pregnancy, trauma, and relationship problems increase risk.
• Difficult delivery or pregnancy complications. Emergency C-sections, premature births, and health issues can contribute to PPD.
• Emotional issues with body image. Struggling to accept bodily changes after pregnancy signals increased risk.
• Fatigue. The exhaustion of caring for a newborn makes some moms more vulnerable.
• Lack of social support. Isolation or unavailability of family and friends to help out.
• Anxiety. High levels of anxiety in pregnancy or after delivery.
• Previous mental health issues. A history of depression, PTSD, anxiety disorders or eating disorders.
• Substance abuse. Using alcohol, opioids or illicit drugs is linked with higher risk.
• Financial stress. Money concerns or poverty can contribute to PPD.

While these risk factors are associated with increased rates of PPD, postpartum depression can affect any new mother – even those without any known risk factors.

Can Breastfeeding Trigger Postpartum Depression?

For some women, the experience and challenges surrounding breastfeeding may exacerbate postpartum depression and anxiety:

• Difficulty breastfeeding. Problems like low milk supply, latch issues, nipple pain or thrush can be very distressing and worsen feelings of inadequacy.
• Physical discomfort. Sore nipples, engorgement, blocked ducts, mastitis and other complications add stress.
• Lack of sleep. Frequent overnight nursing can lead to exhaustion that compounds mood disorders.
• Pressure to breastfeed. Feeling forced to nurse even when struggling with it can contribute to PPD.
• Pumping difficulties. Problems pumping and storing breast milk create additional obstacles.
• Social isolation. Breastfeeding can make it harder to leave the house which may worsen loneliness.
• Bonding issues. Challenges with breastfeeding may inhibit emotional attachment and bonding.
• Unrealistic expectations. Cultural messaging that breastfeeding should always be easy and joyful sets moms up for distress.
• Hormonal shifts. Changes in prolactin, oxytocin and other hormones during lactation are linked with mood disorders for some.
• Identity struggles. Difficulties breastfeeding may lead to feelings of failure and lowered self-esteem.

However, it’s important to keep in mind that while breastfeeding struggles can exacerbate postpartum depression, they do not directly cause it. PPD is understood to be caused by complex interactions between reproductive hormones, genetics, emotional adjustment and social circumstances.

Breastfeeding Rates and Postpartum Depression

Some studies have found an association between breastfeeding and lower rates of postpartum depression. However, there are a few important caveats:

• Women who breastfeed may have greater social support from lactation consultants, parenting groups and friends. This community connection may help prevent PPD.
• Mothers who are facing significant mental health challenges early on are less likely to initiate or sustain breastfeeding.
• The choice to formula feed may stem from pre-existing risk factors for PPD like trauma, anxiety or lack of support.
• The data is correlational. Breastfeeding does not seem to directly cause lower rates of PPD.

Overall, while breastfeeding may be protective for some women, mothers who formula feed are not inherently at higher risk for postpartum depression. PPD is complex with no single cause.

Getting Help for Postpartum Depression

If you are experiencing symptoms of postpartum depression, help is available. Here are some steps you can take:

1. Talk to your doctor. Describe your symptoms and be open about your emotional state.
2. See a mental health professional. A therapist can provide support and help create a treatment plan.
3. Consider medication. Your doctor may prescribe antidepressants to ease your symptoms.
4. Join a support group. Connecting with others experiencing PPD can help you feel less alone.
5. Lean on loved ones. Don’t isolate yourself – allow family and friends to support you.
6. Prioritize self-care. Take time for yourself when possible. Do things you enjoy.
7. Consider other therapies. Exercise, meditation, journaling and other activities can help.

With compassionate professional help and social support, most mothers are able to overcome postpartum depression and feel like themselves again. Don’t hesitate to reach out.

Tips for Coping with Breastfeeding Difficulties

Here are some tips that may help you manage breastfeeding challenges and lower the stress:

• Seek assistance from a lactation consultant. They can assess any issues and provide guidance.
• Join a breastfeeding support group. Connecting with other moms can help you feel encouraged.
• Limit visitors and commitments. Focus on rest, recovery and bonding with baby.
• Accept formula supplementation. Combination feeding can take the pressure off.
• Set small breastfeeding goals. Don’t expect perfection, just gradual progress.
• Practice self-care daily. Take moments for yourself when possible.
• Discuss your concerns with your doctor. They may have suggestions to make it easier.
• Avoid comparing yourself to others. Every mother’s journey is different.
• Remember fed is best. Your baby needs a healthy, happy mom most of all.

Breastfeeding can be difficult, but with support it can often get better over time. If it becomes unmanageable, stopping breastfeeding may be the best option for your mental health.

When to Stop Breastfeeding

There are a few situations where it is medically advised to stop breastfeeding:

• You have breast or nipple infections that are not resolving.
• You develop a breast abscess or mastitis that does not improve with antibiotics.
• You are undergoing chemotherapy or taking certain prescription medications that are unsafe while breastfeeding.
• You have HIV or active, untreated tuberculosis.

Outside of those medical indications, deciding when to stop comes down to a personal choice between you and your doctor. If breastfeeding is severely complicating your recovery or mental health, it may be time to switch to formula. Do not feel guilty – fed is best.

In Summary

Postpartum depression is a complex condition caused by biological, social and emotional factors. While breastfeeding difficulties do not directly cause PPD, they can contribute by:

• Increasing sleep deprivation and exhaustion.
• Creating physical discomfort and pain.
• Heightening feelings of failure and hopelessness.
• Worsening isolation and loneliness.
• Making bonding and attachment with baby more challenging.

If you are experiencing symptoms of postpartum depression, reach out for professional help right away. There are many effective treatments available. Leaning on loved ones, prioritizing self-care, and finding support from other moms can also make a big difference.

While breastfeeding may not be right for every woman, fed and nurtured by a healthy, caring mother is what is best for baby. If you are struggling with breastfeeding, know that formula is a perfectly valid option. Your mental health matters.