In Part 1, I reviewed strategies for supporting postpartum mood in all women. After all, the leading risk for postpartum depression is having given birth! If you didn’t see Part 1, take a look at the suggestions there for a happy postpartum transition. Here in Part 2 I want to share drug and supplement options for women with specific risks for postpartum mood challenges. Risk factors include prenatal depression, prior postpartum depression, poor social support, economic and relationship stressors, and medical illness. Cesarean birth may be a risk factor as well.

Very little research is performed in populations of postpartum women, especially regarding drug and supplement use. This is not likely to change in my lifetime or yours. New mothers and health care providers will continue to struggle with questions about safety and effectiveness without conclusive answers. Many conventional health care providers are unfamiliar and uncomfortable with non-pharmaceutical strategies. You may wish to consult a midwife, naturopathic doctor, or integrative medicine provider if you have questions about these options.

Below are a handful of choices that may reasonably be considered for women at risk for postpartum mood disturbance. This list is not exhaustive, and it is based in a Western approach which reflects my own background as a midwife and herbalist. Please note that some of these options are not appropriate for women with bipolar disorder. Self-treatment for an established condition is not advised. As always, get professional help right away if you think you’re depressed.

1. Essential fatty acids

Omega 3 fatty acids decrease inflammation in the body and protect cardiovascular and brain health. The evidence to date supports their ability to improve mood. Essential fatty acids are often used with prescription antidepressants, and may enhance the effects of these drugs. An omega 3 fish oil supplement containing DHA and EPA is usually recommended at 1 to 3 grams daily. Eating salmon, tuna, trout, and other cold water fish provides the body with these same essentials.

2. Adaptogens

Adaptogens are herbs that enhance nonspecific resistance and improve the stress response. Adaptogens have been studied extensively over decades in Europe and Asia, and particularly in Russia. These herbs are official in the pharmacopeias of many nations. Adaptogens are intended to be taken over long periods of time (weeks or months). While they should not be used during pregnancy, many are compatible with breastfeeding, including those listed here.

• Ashwagandha (Withania somnifera): An Ayurvedic staple, this herb also has a history with Western herbalists who know it as winter cherry, a relative of the tomato plant. This is my adaptogen pick for new mothers who are prone to anxiety and trouble sleeping. It is slightly sedative and pain-relieving. The powdered root can be purchased in bulk and mixed into yogurt, smoothies, or applesauce. It’s inexpensive and nutritional.
• Eleuthero (Eleutherococcus senticosus): Supports immunity and mental and physical stamina. Eleuthero is a gentle yet strong herb that works best over time, like all adaptogens. It is traditionally chosen for people who are recovering from illness or injury, feeling fatigued or “washed up”. That makes it a nice choice for postpartum recovery.
• Rhodiola (Rhodiola rosea): An adaptogen with a long record of use in Russia and Scandinavia, this is one of my all-time favorite herbs in any category. Rhodiola has no significant side effects or interactions with other herbs or drugs. Known for boosting stamina and tolerance to stress, recent studies suggest antidepressant effects as well. Improves daytime alertness and nighttime sleep.

Not sure if an adaptogen is really working? Try it for 6 to 8 weeks, then stop taking it and see how you feel over a few weeks time. The beauty of adaptogens is that they act subtly, helping you feel like the better version of yourself. You don’t know you’ll miss them until you give them up.

3. St John’s Wort

St John’s Wort (Hypericum perforatum) is the most studied herbal antidepressant in the Western world. Effects are comparable to prescription antidepressants for mild to moderate depression. The best postpartum application of this herb (in my opinion) is as a preventive for mothers at risk. A standardized preparation should be chosen. Unfortunately, the use of St John’s Wort is limited by interactions with many prescription drugs. High doses can lead to sun sensitivity. SJW should not be used by those with bipolar disorder or severe depression. An oil infused with fresh St John’s Wort herb can be applied topically to wounds, including perineal tears and trauma in the new mother.

4. SSRIs

Selective serotonin reuptake inhibitors are the most commonly prescribed category of antidepressant. This group of drugs includes Prozac, Zoloft, and many others. SSRIs are relatively safer than other prescription options for breastfeeding mothers and babies. They are often taken preventively in women with a history of depression, postpartum or otherwise. Many women are reluctant to use an SSRI due to concerns about side effects or infant exposure. While I understand their hesitation, as a clinician I strongly support the treatment of postpartum depression by the method that is safest and most effective for any given woman. Often this will mean an SSRI, taken for a minimum of several months. The consequences of not treating depression are too serious to ignore. And although I reserved these drugs as my final list item, you will probably find that your doctor begins with them when you have The Talk about postpartum mood. Lucky for you, you’ll already know the alternatives.

Stay happy, stay healthy!