I was asked to write about the connection between postpartum depression and thyroid dysfunction. Read on with the understanding that severe depression or any postpartum depression must be addressed with your doctor. This article is not meant to diagnose or treat depression and is based on my own story. PERIOD. With love, Jenn
If you are a new mom or soon-to-be new mama, one condition that's probably of concern to you is Postpartum Depression (PPD). It's a scary condition because PPD can be debilitating but remember, MOST mothers do not get PPD. Also, with proper care, you will be all right. My reason for writing this blog isn't so much about PPD though. It's about your thyroid and it's possible connection to your postpartum mood. It's meant to inform you of a condition you might otherwise not know about, but now that you know, this info can save you years of struggle, overwhelm, and unhappiness.
Though most mamas get the Baby Blues in the week or two following childbirth due to the rush of hormones in their system (and an enormous lack of sleep!), some mamas can't come out of the blues. These moms become very withdrawn, don't connect with their baby, and are very, very depressed. If this is you, then please ask for help. Immediately.
For others though, your depression may be there but much milder. It's something you can convince yourself out of when friends visit the baby or your in-laws bring over dinner, but the next day it's still there...sort of an overall sadness mixed with great fatigue. And, like PPD, the depression lingers well beyond the 7-14 day Baby Blues.
If we were to put our post-pregnancy mood on a spectrum, we could have the Baby Blues at one end and PPD at the other end. Somewhere in between could be "Thyroid Disorders ".
Within this area would be one condition known as Postpartum Thyroiditis (PT), which is having an inflamed thyroid, lasts about a year after childbirth, and begins with hyperthyroidism swinging to hypothyroidism. This condition rights itself for 50% of the women who have it, while the other 50% end up with lasting Hypothyroidism. Your mood with PT could begin with anxiety or just feeling like you're on constant overdrive and your weight falls off, but then your metabolism might slow down and your mood is of great fatigue and also, depression.
Another condition, mid-spectrum, the one I believe I most likely had, was an under active thyroid condition and/or present thyroid antibodies, prior to even becoming pregnant. This condition would absolutely NOT right itself within one year. And it's called Hashimoto's Thyroiditis.
Let's back up a bit and speak for a minute about research. According to some research, the prevalence of Postpartum Thyroiditis, having an inflamed thyroid gland the year following pregnancy, is low.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395948/)
However, according to this research here, Postpartum Thyroiditis is actually pretty common. (https://academic.oup.com/jcem/article/87/9/4042/2846380/Postpartum-Thyroiditis)
Also according to research, the connection between Postpartum Depression and Thyroid Disease is also low, meaning that studies show a connection-- but fewer Postpartum cases have both PPD and Thyroiditis. ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395948/) However, that same study also claims that wider studies should be done regarding thyroid and PPD.
And then there's this, according to the New England Journal of Medicine, "A careful history taking and a physical examination are warranted in all women with postpartum depression. Thyroid function should be assessed, since both hypothyroidism and hyperthyroidism are more frequent during the postpartum period and may contribute to mood changes."
Confusing? Of course it is! As has been my experience with the medical community and my thyroid, and my clients' thyroids, for years. On top of that, many doctors either don't know to test, OR they test for only TSH which is an outdated, unreliable test, OR they are using outdated lab numbers which means most of us go home undiagnosed.
As both a woman with Hashimoto's Thyroiditis and a Holistic Health Coach specializing in Thyroid, in my OPINION, it would be beneficial to have your thyroid properly checked before, during (doctors are more routinely testing during pregnancy) and post pregnancy. Not only does insufficient thyroid affect fertility, and not only is thyroid hormone crucial to fetal development, insufficient thyroid hormone can easily show up symptomatically as depression. SO, when the initial 7 days of Baby Blues don't subside, it's time to not only ask your nurse about PPD but request a full thyroid panel as well. I wish I had.
I was diagnosed with Hashi's in my late 30's, after years of searching for answers. When I look back on the years prior, there are multiple signs that I MAY have been suffering from an under active thyroid. Though I was never actually diagnosed with Postpartum Depression (PPD), I did suffer from bouts of depression and was finally given an antidepressant. I firmly believe now, knowing what I know, that I was suffering from an under active thyroid all along. Regarding my span of seven pregnancy years, the following are possible connections between my Hashimoto's and my condition:
My Hashimoto's was quite possibly the reason why getting pregnant with my first child took so long.
Or, it may have been a reaction to pregnancy -- meaning the stress of pregnancy was the final trigger contributing to my Hashimoto's.
It was very likely the reason I had a very low production of breast milk and my milk was not "creamy and fatty" but "watery and blue".
It could have been the reason for the insomnia I suffered from after baby #2, insomnia that lasted for twelve years.
My dysfunctional thyroid may have contributed to my miscarriage and the debilitating depression and fatigue I felt following that sad day. Baby or no baby, the hormones are still there.
It most likely was the reason I was placed on antidepressants prior to becoming pregnant with my third daughter when I confided in my doctor how I just always felt "flat", and so fatigued, yet had a quick temper that seemed to be spiraling out of control. She diagnosed me with depression. If only she had checked my thyroid.
Pregnancy could have triggered my Hashimoto's. (Pregnancy is a known trigger for Hashimoto's and other autoimmune diseases.) Or, maybe my dysfunctional thyroid triggered the infertility, low milk production, insomnia, fatigue, and depression. I won't ever know definitively, because I was never properly tested.
Until much too late.
I know you want, more than anything, to enjoy your baby and motherhood. Yet, some of you, us, have a harder time with it. And, it's so difficult to pinpoint why or to even admit it.
We think, "I must just be tired...I am so, so tired." Or, "This is just temporary, I will figure it out." Or, "Why am I the only one of my friends who doesn't want to leave the house, have friends stop by, or even talk to anyone? Why would I rather just sleep?" Most likely we tell ourselves, "I am fine, no really I'm fine, everything is fine!"
Things really aren't fine though, are they?
I'm not an expert in PPD or PT. This information is really just to put that bug in your ear. To let you know there are reasons for depression at ANY point in your life and you just have to get to the root cause. As a holistic health coach, certified in Thyroid Disease, I understand how the symptoms of Hypothyroidism/Hashimoto's* can be overlooked by doctors. I can imagine, when it comes to new moms, they just chalk it all up to:
-- new moms are expected to be tired
-- new moms have a hard time losing weight
-- new moms just aren't ready to have sex
-- new moms aren't really depressed they are just overwhelmed
-- new moms experience hair loss, dry skin, acne, low libido, and brain fog because their hormones just need to rebalance and they don't get enough sleep
-- new moms have digestive issues becasue they just don't eat right
-- new moms CAN lose their baby weight, they just have to eat less and exercise more.
Symptoms are simply ... ignored. This is why it takes so long to get a diagnosis.
So, what does a new mother do? How does she tell the difference between Baby Blues and Postpartum Depression and Thyroiditis? SHE SPEAKS UP.
Tell your husband, your friends, your mother. Talk about it. Ask you doctor, and especially your kind nurses, to help you keep and eye on you. And get tested. Rule out the thyroid and go from there. But do NOT just keep your thoughts to yourself. Please. SPEAK UP.
If your ARE diagnosed with PPD, here is an article by Dr. Josh Axe citing fish oil, acupuncture and exercise to combat PPD. (https://draxe.com/postpartum-depression/) Also, check out Dr. Anna Cabeca who has discussed that progesterone, which drops when we stop ovulating, may help as well.
I would add, all moms, as a rule, need to take extra care to nurture themselves. Follow these simple rules:
1. Eat real, whole foods, especially plants. This is no time to diet. Your hormones are made from the food we eat!
2. Prioritize 5-10 minutes of YOU TIME every day. Whether it's an epsom salt bath or sitting ALONE on your porch, or reading, or taking a walk, or driving ALONE with the windows down and radio blasting!
3. Connect -- yes you need alone time, but connection is a great healing tool. Visit with friends, call you sister, and talk, a lot, with your husband. Just like you did seven days ago, remember? Before the baby was born?
4. Don't forget who you are. Motherhood doesn't have to change who you are, it expands you. Remember what lights you up and keep doing it as often as you can.
If you are blue or depressed, enlist your family and friends to help make this happen.
If you think you may have a thyroid problem and want to receive proper testing, read my blog first. And check out my symptom checklist.
I'll leave you with this story, for ALL new moms, that happened in the very early days after the birth of my first daughter.
I was bonding with my baby, yes. I was out and about the first week, just a little bit, yes. But one afternoon, I was sitting in bed, hadn't showered for a couple days, and was completely topless because I was connected to the worst contraption ever -- a breast pump! As it sucked and churned and "mooed" - in those days that's the sound they made, really! -- I sat there, staring off into space.
Suddenly my friend, Tricia, appeared in my bedroom door. ("Really mom?" I thought, "Couldn't you have warned me?" ) She came in smiling about having met Baby Olivia downstairs and "Isn't she wonderful?" and "How are you, Jenn?"
I slowly moved to cover myself, hardly caring about the partial nudity because, well, my boobs weren't boobs anymore, they were machines (not very productive ones but still) I looked at Tricia and asked, "Why didn't you tell me it would be so hard?"
Tricia burst into tears! And then ran over to hug me.
After an hour of crying and talking and laughing, too, we swore to each other that when other women and moms asked, we would be honest. And we made my sister and other friends swear to do the same.
Motherhood is AMAZING. And it's hard. And it's messy. And it's beautiful. And it's hard, again. But the best way to get through the hard parts? Talk about them. Share. You will find you are not alone. And, you and your baby will survive, your hubby/partner too. Just ask for help when it feels too big. OK?
Jenn Krusinski is a Certified Transformational NutritionTM Coach with a specialty in Thyroid and women with Hashimoto's. She wholeheartedly believes that health is not just about what you are doing but who you are being. Today, more than ever, Jenn knows that women are even more important to our families, our communities and our world. So let's get them healthy! She helps women get back to themselves -- find their joy, their spark, their voice and their vitality, by eating, living and being real.