New moms who have particular difficulty breastfeeding may be at greater risk of postpartum depression, a new study suggests.
The findings, reported in the August Obstetrics & Gynaecology, do not prove that breastfeeding problems cause depression. But researchers say that new mothers and their doctors should be aware that the two can go hand-in-hand.
Out of nearly 2,600 mothers who had ever breastfed, slightly less than 8% screened positive for major depression two months after giving birth.
And that risk was higher among women who either had severe breast pain or generally disliked breastfeeding during their baby's first weeks of life.
Hormonal factors could be responsible for depression
Whether the breastfeeding difficulties are to blame is not clear, said lead researcher Stephanie Watkins of the University of North Carolina, Chapel Hill.
A limit of the study, she told Reuters Health, is that there was no information on whether mothers had suffered depression during pregnancy. So it could be that women who were already depressed had a tougher time with breastfeeding.
"Everything is harder when you're depressed," said co-author Dr Alison Stuebe, also from UNC. "It may be that some women were depressed during pregnancy, and that made breastfeeding harder."
On the other hand, she said in an interview, it's possible that underlying hormonal factors contribute to both breastfeeding issues and depression, and the researchers are doing further studies to look into that question.
Early problems in breastfeeding could be a sign
Whatever the reasons for the connection, they said the main message is that early breastfeeding problems could serve as a warning sign of postpartum depression in some women.
The American College of Obstetricians and Gynaecologists (ACOG) says there is not enough evidence to support routinely screening all new mothers for postpartum depression. On the other hand, ACOG also says depression screening can benefit new mothers and their families and should be strongly considered.
Focusing screening on women with risk factors for postpartum depression could be the best route, Dr Stuebe noted. "And our study suggests that these breastfeeding difficulties may be a risk factor," she said.
The findings are based on 2,586 US women who took part in a larger study of infant feeding practices. All had breastfed and answered questions on their experiences with it in the first few weeks.
Mothers who liked breastfeeding less likely to suffer depression
The women were then screened for depression when their babies were two months old.
Overall, among women who screened positive, 35% had severe breast pain in the early weeks of breastfeeding, compared to 22% of women who did not screen positive for depression.
After adjustment for factors such as age, education and race, severe breast pain was linked to a doubling in the odds of postpartum depression.
Similarly, mothers who disliked breastfeeding in the first week were 42% more likely to later screen positive for postpartum depression compared to mothers who liked it.
Postpartum depression is not frequent
None of that means that women who dislike breastfeeding are destined for depression, Dr Stuebe stressed.
But, she said, women and doctors should be aware that the two things can run together, and that some women who feel breastfeeding is painful or too difficult may actually have depression.
According to ACOG, the so-called baby blues – where mothers feel anxious, sad or irritable in the days after delivery are very common. True postpartum depression is less frequent, affecting about 10% of new mothers.
Antidepressant medication is often recommended, but support groups or other non-drug options may also help, according to ACOG.
(Reuters Health, July 2011)