Ask the Doctor: Postpartum Depression

Q.
Three months ago I gave birth to my first child, a beautiful baby girl. Ever since, I’ve felt extremely tired all the time, plus I frequently get very moody, depressed, and irritable. My ob-gyn wants me to take an antidepressant, but I would rather avoid medication. Suggestions?

A. Rather than rushing to treat your symptoms with medication, it would be more appropriate to first do some testing to make sure no underlying nutritional or endocrine problems need correcting. If you haven’t already done so, you should start with a blood test for anemia. Anemia after childbirth can be caused by deficiencies of iron and/or B vitamins, especially folic acid, B12, and B6. These deficiencies are usually corrected by taking a standard prenatal vitamin-mineral supplement. However, at least 25 percent of women have a genetic condition that increases their need for folic acid. For that reason, I recommend measuring your blood levels of homocysteine, an amino acid that increases when there is a deficiency of folic acid. A test for levels of methylmalonic acid, which increases with vitamin B12 deficiency, may also prove useful. Studies have shown that people with depression tend to have elevated levels of homocysteine along with low levels of folic acid, vitamin B12, and vitamin B6.
I also recommend having your blood sugar tested to make sure you don’t have diabetes or reactive hypoglycemia. You can test your blood sugar at home by using one of the handheld glucometers available at most drug stores. If your blood sugar is bouncing up and down, that can certainly drain your energy and make you feel irritable, even if the levels aren’t high or low enough to qualify as an official disease. The best way to stabilize blood sugar is to eat frequent small meals with lots of fiber and protein.
You should definitely get a complete test for thyroid hormone levels, including anti-thyroid antibodies. Thyroid disorders (both hyper- and hypo-) from autoimmune thyroiditis are very common in the postpartum period, affecting up to 10 percent of new mothers. If these are normal, I would recommend an adrenal hormone analysis, which measures salivary levels of cortisol throughout the day and evening. The cumulative physical and emotional stress of pregnancy and childbirth, followed by the 24-hour job of caring for a helpless infant is enough to strain anyone’s adrenal glands, so it’s not unusual to find problems with cortisol production.
In addition to correcting any abnormalities that might turn up with this testing, I strongly recommend taking a fish oil supplement that is high in DHA (docosahexaenoic acid). Studies have shown that pregnant and postpartum women tend to be depleted of the omega-3 fatty acids found in fish oil, especially DHA. Restoring DHA to normal levels can improve mood and—via breast milk—enhance brain function in the baby. A good target dose is 1,200 to 2,400 mg of DHA and 250 to 500 mg EPA a day.
I find two herbs—eleuthero (Eleutherococcus senticosus) and roseroot (Rhodiola rosea)—particularly helpful for women in your situation. Eleuthero is sometimes called Siberian ginseng because of its long history of use in Siberia for treating fatigue and low stamina and stimulating the immune system. It is particularly useful for normalizing cortisol and regulating high and low blood sugar levels. A typical dose is 250 to 500 mg daily. Roseroot has been used for hundreds of years in Siberia, Scandinavia, and Europe to increase energy and enhance resistance to stress. These effects have been confirmed in numerous animal studies. The herb also appears to have antidepressant properties. The usual dose is 200 to 600 mg daily.

Robert Rountree, MD, has practiced alternative and complementary medicine for 22 years.