Post-weaning depression can be a serious concern for some new mothers

In the months after giving birth in 2015, Katie Brownell braced herself for a seemingly inevitable mental breakdown. She knew that her history of depression and premenstrual mood disorder, a more severe form of premenstrual syndrome (PMS), meant she would be especially vulnerable to postpartum depression.

Her exclusively breastfed baby, Caleb, turned 3 months old, then 6 months old. Brownell remains asymptomatic and breathes a sigh of relief with each milestone.

But then, about seven months after giving birth, when she least expected it, Brownell’s mood plummeted. She had feelings of extreme sadness and worthlessness, had mood swings, and had trouble sleeping at night. Her only real comfort was spending time with Caleb.

Brownell, 38, of Harpers Ferry, W.Va. said: “I was just blindsided. Every day, I wake up and feel like there’s a weight on me. That was the only time in my life I had suicidal thoughts.

Caleb has started eating more solid foods and nursing significantly less. To her surprise, Brownell learned that this weaning could be the cause of her depression.

While postpartum depression is relatively well-researched, with the Food and Drug Administration recently approving a new drug to treat it, a similar condition affects mothers who have recently given birth. called post-weaning depression, there is almost no research dedicated to it. Post-weaning depression occurs during or after cessation of breastfeeding and is thought to be due to the subsequent drop in hormone levels. Symptoms may include anxiety, hopelessness, irritability, and insomnia.

It’s unclear how many women may have or are at risk for post-weaning depression because research is limited.

Verinder Sharma, a professor of psychiatry at Western University, said there have been virtually no large studies on post-weaning depression, in part because we focus so much on postpartum depression. There is a lack of awareness that some women are at risk during the weaning period, not only among the women themselves but also among caregivers.

What post-weaning depression feels like

In 2011, Joanna Goddard suddenly weaned her first son, Toby, within a week. She felt ready to stop breastfeeding and was not worried about any emotional consequences.

It was like being hit by a Mack truck,” said Goddard, 44, founder of Cup of Jo, a women’s lifestyle website based in Brooklyn. I went from being a little nervous and tired, but still doing well, to really being in this fog of sadness.

Unlike Brownell, she had no history of depression. After realizing the connection to weaning, Goddard wrote a blog post about the experience titled The Toughest Two Months of My Life. It became one of her most popular posts with nearly 1,300 comments, including many other mothers who saw themselves in her struggles.

It got a bananas response. I still get emails about it all the time,” Goddard said. After six weeks, her depression suddenly disappeared like a bad waking dream and her period returned the very next day.

Postpartum depression can arise during pregnancy or last up to a year after giving birth, but most commonly begins one to three weeks after giving birth. In the hours after giving birth, levels of hormones like estrogen and progesterone plummet, which can cause depression just as smaller hormonal changes can lead to mood changes associated with PMS. .

Similarly, levels of hormones related to breastfeeding drop when the mother stops breastfeeding. Post-weaning depression is linked to the cessation of breastfeeding, which can occur long after the first year mark rather than pregnancy or childbirth, as is the case with postpartum depression. For example, Brownell experienced another depressive episode at 18 months postpartum, when Caleb was reduced to breastfeeding just once a day.

When you skip meals or stop breastfeeding, your hormones are trying to adapt, says Mary Kimmel, co-director of the Perinatal Psychiatry Program at the University of North Carolina at Chapel Hill. The system needs to find a different balance depending on the situation, and some people are much more sensitive to these changes.

A 2012 study of 42,225 Norwegian women found that mothers who stopped breastfeeding completely or fed solid foods or formula in addition to breastfeeding had higher levels of anxiety and depression by six. month after birth. Additionally, women with elevated baseline levels of anxiety and depression during pregnancy had greater increases in the same symptoms after weaning than women with average baseline levels.

On the other hand, the scientific literature on post-weaning depression is limited to case studies. A 1987 report titled Weaning and Depression: Another Postpartum Complication discussed the harrowing cases of four patients who developed severe depression shortly after they began weaning their children.

A 28-year-old woman, Ms. C, described feeling happy in the first week after giving birth. She began weaning her daughter at 4 months old, preparing to return to work, and said she became anxious, sad and tearful. After she stopped breastfeeding completely, her depression worsened and she had delusions that her poor mothering practices had caused irreparable mental damage to the child. Two months later, convinced that they would be better off without each other, she smothered her baby.

In a 2008 case report, Sharma and his colleagues studied a woman who suffered from depression each time she gave birth and immediately after stopping breastfeeding. She had thoughts of self-harm during the first two episodes, which occurred approximately 8 months after the birth of her first child and 14 months after the birth of her second child, despite no history of suicidal ideation or psychosis.

Hormones and post-weaning depression

The two main hormones involved in breastfeeding help regulate mood, says Wendy Wisner, an International Board Certified Lactation Consultant (IBCLC) based in New York. One is prolactin, which regulates your milk supply and helps you sleep, and then there’s oxytocin, which is released as your milk flows and fills you with love.

Pituitary prolactin secretion increases during pregnancy and increases steadily until birth. After birth, prolactin levels remain high if the mother breastfeeds, which further stimulates milk production. In women who do not breastfeed, prolactin levels return to normal within three to four weeks after giving birth. Many studies have found an association between low plasma prolactin levels and a higher risk of postpartum depression.

Plasma oxytocin levels increase during pregnancy and stimulate uterine contractions during childbirth. After birth, this hormone stimulates the contraction of breast tissue to support lactation. During breastfeeding, oxytocin is released, causing milk to be secreted for the baby to suckle. As a result, breastfeeding mothers have much higher oxytocin levels than non-breastfeeding mothers.

One study found that women felt calmer and less anxious during breastfeeding, when their oxytocin levels were highest. Another observed that mothers’ moods became less negative after breastfeeding rather than bottle-feeding, leading researchers to speculate that the increase in oxytocin during the former acts as a Self-produced antidepressants.

During weaning, both prolactin and oxytocin decrease to pre-pregnancy levels and any protective effect against mood disorders may be lost. Therefore, Wisner recommends weaning slowly, especially for those who are sensitive to hormonal changes like PMS or have a history of depression.

Try skipping a breastfeeding session every few days or even one session a week and see how you feel after skipping each session, says Wisner. Post-weaning depression can happen when you wean very gradually, but it’s more likely to happen when you wean suddenly because your hormones are declining all over.

Other ways to cope include joining a breastfeeding support group, finding a therapist who specializes in women’s mental health issues, or taking medication if necessary.

To help new mothers realize they are not alone, experts say, education about post-weaning depression such as during childbirth or breastfeeding classes during pregnancy is needed.

One hundred percent, knowing that this is something is going to help me, Goddard said. It would change my entire experience.

Do you have questions about human behavior or neuroscience? Email and we may answer it in a future column.

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