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How to treat postpartum depression naturally

How to treat postpartum depression naturally

Dr. Erika Krumbeck

Read about Dr. Erika’s personal story about postpartum depression here.

I’m going to talk today a little bit about how to treat postpartum depression naturally, and some things you may want to speak to your doctor about if you think you have postpartum depression or anxiety.

The very first thing we should talk about is some lab work.  So when we talk about treating postpartum depression naturally I really want to know why someone has postpartum depression, and not to just treat it presumptively.  (In other words – is it really postpartum depression?)  So the first thing I want you to talk to your doctor about is getting some basic bloodwork done.

The first thing I like to order is a Complete Blood Count (or “CBC”) to see the size and shape of your red blood cells and white blood cells.  If you have too low of red blood cells (anemia) that can be a frequent cause of fatigue and depression. An add-on test to that would be something called a serum ferritin, which checks the storage form of iron.  This is a much more reliable test than a serum iron because serum iron levels can fluctuate, whereas the ferritin stays relatively the same. If you did have anemia or iron deficiency in pregnancy then this test is even more important (though I think everyone should get checked in postpartum, just in case).

The next thing you should do is have your physician check you for postpartum thyroiditis.  Postpartum thyroiditis occurs in over 5% of women (that’s a lot of women), and remember that the symptoms can mimic depression very closely.  Check out the full blog post about postpartum thyroiditis and postpartum depression.

You should also check your vitamin D if you hadn’t at some point in pregnancy.  The best test for this is 25-OH (hydroxy) vitamin D.

Your checklist for labwork:

  1. A CBC (with differential, to be precise)
  2. A serum ferritin
  3. Thyroid panel (see the full video about thyroiditis to see what I recommend)
  4. 25-OH vitamin D.

Your physician may choose to do a few more tests, too (like a metabolic panel or urinalysis).

The next thing I do for women with postpartum depression is to check their gut.  I’m not totally sure why this is, but I seem to see a lot crossover between gastrointestinal symptoms/abdominal pain and depression and anxiety, which I think is pretty interesting.  So you if have any symptoms like gas, bloating, diarrhea, constipation (or alternating diarrhea and constipation), fatigue or brain fog – these may be symptoms of gut dysbiosis. Dysbiosis is simply the overgrowth of abnormal bacteria.

Pretty interesting – very recently there was a study that came out that reserachers could induce anxiety in mice just by changing their gut flora.  They took the gut flora from anxious mice and put it into normal mice and made them anxious (and vice versa, they took good gut bacteria and fed it to anxious mice and saw that their anxiety decreased).  I think that’s pretty cool.  It is something that naturopaths have been saying for years (decades now!) about the relationship between gut health and mood.

There’s a lot to say about treating healing the gut.  One is definitely removing food allergens.  That is something we need to be a little careful about in the postpartum period because consuming calories –  making sure you have enough calories to maintain lactation to be able to nurse your baby – takes priority over us really healing your gut at this point.  But that said, if you have known food “allergens” (sensitivities) like a gluten sensitivity or a dairy sensitivity this is a good time to check in on those foods and eliminate them whenever you can, as long as you can maintain enough calories to sustain nursing.  (Side note: a true food “allergy” is the anaphylactic kind, most people have food sensitivities. I misspeak a little in the video, and I want to keep my terminology straight!)

The next thing I like to do for folks who do have gastrointestinal complaints is give them very high quality probiotic.  So all high quality probiotics should be somewhere in the thirty and forty dollar range.  If you’re buying a ten dollar probiotic chances are those an organisms aren’t alive anymore and and that’s not such a good thing.  I really like the Klaire Labs brand probiotic (I don’t get any money from endorsing them, though it would be nice if I did!) – they are a little harder to find.  I also like the Culturelle brand probiotic, which you can find most places.

Another thing that I like to do for folks – this can be related to the gut, but is more related to brain chemistry itself – is getting on  a good high quality fish oil as well.  I really like the Pharmax brand – Nordic Naturals and Carlson’s are also pretty good.  (Still don’t get paid to endorse them, though the Nordic Naturals link is through my Amazon account, if you’d like to support this blog.)  I prescribe at least 5 grams per day of combined EPA and DHA.  Normally we think about DHA being great for brain development – which it is – that’s what we give our moms in the prenatal period to make sure the baby’s brain development is good.  It’s important to supplement DHA, but it is actually the EPA component that seems the best for anxiety and depression.  So I want you to get one that has both.  Make sure you speak with you physician about that  – there are a few I’m subtypes and women thatthis is not an appropriate prescription for.

The next think I’d like to talk about is getting folks on a really good quality multivitamin.  I use the Thorne brand here in my office (still no affiliation).  I know I’m talking about brands a lot, and that is because it seems that brand do matter when it comes to efficacy.  At the least, I have found that switching folks from a low (Costco) or even medium quality (Good Food Store) brand to Thorne/Pharmax, etc, it makes a big difference.  (Read more here about why picking a high quality multivitamin is so important.)

Make sure to keep taking your prenatal vitamin all the way through postpartum – for as long as you are nursing your child (and possibly longer).  Remember that if you’re nursing your little one is sucking all those nutrients out of you via your breast milk.  That’s why taking a good quality prenatal vitamin and fish oil is so important – if you are losing important fats and nutrients it can contribute to fatigue and depression.  Sometimes women just don’t have enough B vitamins to get through the day.

Speaking of B vitamins – that’s the next thing I like to do for folks.  If the regular prenatal vitamin isn’t quite enough, or if you are feeling really fatigued or stressed out, you can start on a basic B vitamin.  This one is a bit trickier to say who should do what and how much to take.  It’s a bit more personalized – B vitamins definitely aren’t for everyone, andand and there’s some safety data that’s lacking for certain B vitamins and certain doses in the postpartum period in lactation.  Check with your physician about that one as well.

I should also mention that exercise is probably the best thing that you can do for yourself in the postpartum period to prevent depression or to treat depression.  There is tons and tons research on how important and really effective exercise is in improving depression.  There are even research studies that compare exercise to SSRI’s and anti-depressants.  Exercise inevitably wins!  That is really neat.

I know that can be really difficult for a lot of women in the postpartum period to exercise. You’re tired, you’re stressed out, you’re really really busy – but it’s really important to make sure you get outside in at least take your little one for a walk every day at least 30 minutes.   You will notice your mood improves pretty significantly.

Make sure you get exposure to good bright light during the day if you can. If you live in the Pacific Northwest’s or Alaska or some of those gray areas of the country, I do recommend getting one of those broad spectrum lightboxes (like a Happy Lite) those can be really helpful for for seasonal affective disorder (SAD) patients that are really sensitive to light.

Finally,  the very last thing that you can speak with your physician about if all of these other things haven’t been quite enough… And I know these things seem really basic – but I’ll be honest, in about half or more than half of cases in my practice, just the things I have mentioned so far have really turned a lot of women around.  The last thing you can consider speaking with your physician about is getting a prescription for progesterone.  In pregnancy progesterone levels are really really high. Progesterone actually acts on the GABA receptor in the brain – which means that it acts like Valium in the brain.  So you can imagine why you normally feel pretty happy in pregnancy (well, maybe not so great otherwise, but usually mood is pretty good).  In the postpartum period there is a very sudden drop in progesterone and for a lot of women that can really trigger some severe depression and anxiety.  Because – that vallium is taken away!

So what we can do for some women who are experiencing very severe depression or anxiety is to replace progesterone for a time so that we can more closely control the weaning off of progesterone.  That would be 100 to 200 milligrams of oral micronized progesterone, also known as Prometrium.  It is a peanut oil product, which is very frustrating, so if you are allergic or sensitive to peanuts it may not be appropriate for you.  Once again, it can be very helpful for some women, but you have to talk to your doctor about that one – it is not perfect for everyone.

I’ve got lots more tricks up my sleeve for postpartum depression anxiety treatment.  Usually it involves a lot of evaluation of women.  I am looking out for further food allergies and sensitivities, I check nutrient balance and look at diet, make sure folks are getting enough protein, and lots of other lifestyle factors.  I will speak a little bit more about those in future episodes.

I hope you enjoyed this!  Please comment under this blog post if you have any other questions or need clarification.

In HOPE and good health,

Dr. Erika

Treating postpartum depression naturally

photo credit: Pink Sherbet Photography via photopin cc


  • Maheen Ahmed
    December 19, 2013 at 11:33 pm

    I love the information being provided in this article. You need the most effective techniques and approach to help the human body heal itself naturally and that can be achieved by simply pushing the mind in moving out
    of the way and activating the parasympathetic nervous system. Learn more about it http://www.howtoOvercomeAnxiety.org

  • Carrie
    January 3, 2014 at 11:07 pm

    Really great post. Thank you.

  • Elizabeth
    May 5, 2014 at 8:10 am

    I’m struggling with PPA. I started seeing a therapist, and started to walk 45 min every day. Everyone wants me on antidepressants, but I already suffer from insomnia (take ambien and .25 xanax to sleep) and the antidepressants I’ve tried make me be UP ALL NIGHT even with the ambien, etc. The sleeplessness is making my anxiety WORSE!!! I am exclusively breastfeeding. My therapist says there is only so much she can so if I don’t take the drugs. I don’t know what to do. Please help.

    • Ellie
      June 4, 2014 at 8:42 am

      @Elizabeth. I have had great luck with using essential oils to treat insomnia and PPA. These are natural and without the bad side effects of pharmaceutical medications. Just make sure you get a good quality essential oil as there are many cheap versions out there. If you want more info on which oils to use, I’d be happy to help.

        • Christa
          March 22, 2016 at 4:20 pm

          Is it ok to bathe in a diluted essential oil bath of chamomile lavender & frankensense its diluted with soy bean oil
          It’s says online those 3 oils are safe for nursing but safe to add drops to a bath?

  • Suzanne
    September 5, 2014 at 6:37 pm

    Hi dr. Erika, thank you for this blog post. The supplements are helping me immensely and I’m thankful for the advice. I do have a few questions:first, have you received feedback that the Thorne prenatals cause nausea? I’m 6 months postpartum and often have a feeling that I’m about to loose my lunch! Also the iron causes constipation and I’m wondering if another set of their multi’s might be better. Lastly, have any of your moms with PP anxiety have panic attacks? I’m thinking I’m having these along with the anxiety and wondering if the supplements are enough or if you’d recomend something else. Thanks!

      • Suzanne
        September 11, 2014 at 1:04 pm

        Thanks . I have had my thyroid checked, vitamin D, and adrenals and all came back normal. Good news but I’m still not exactly sure what’s going on. However, I feel so so much better since I started taking the supplements you recommend and eating more protein. In fact, most of my symptoms are gone unless I wait to long between meals and crash. One last question, do you still recommend the New Chapter prenatals that are listed on your vitamins blog post? I noticed a lot of negative feedback on amazon because the company was sold to a big corporation (I think Proctor and Gamble). The claim is that the formula has or will be changed. Could be unfounded…

  • Lauren
    October 14, 2014 at 6:19 pm

    Thank you for such a great post! I’m 8 months PP and struggling a bit with PPA. Will look into these tests! Could you please recommend a B vitamin? I also seem to do better with increasing my magnesium but would also like a recommendation on brand(s) since I’m not always in the mood for the ‘Calm’ drink. I am still taking new chapter prenatals.

  • Andrea
    January 8, 2015 at 6:48 pm

    Hi there.

    I wanted to take a Norvegian kelp supplement for iodine but because I am breastfeeding am wondering if there is another option. I have not eaten salt for over ten years, am vegetarian and do not drink cow milk. I want to get some iodine in my system.


  • Lexie
    May 19, 2015 at 10:48 am

    I am on Zoloft for severe PPA and OCD. I have two weeks out of the month that I feel overall good, but about 10 days out of the month I can barely get out of bed from crying so much and so many scary thoughts. I am on the Mirena birth control and after having it put in is when things seemed to get way worse! Should I be off birth control for a while. Also can I take these supplements while on Zoloft? It’s just hard feeling amazing half the month and horrible the other half!

  • Kate
    June 23, 2015 at 10:27 am

    I have been diagnosed with Hashimotos Thyroid Disease. My doctor increased my medicine throughout my pregnancy by about 80 mcg. I suffered with PPA off and on after my first child was born for about a year. I breastfed for about a year and a half. It was more severe in the beginning when they were trying to balance my thyroid postpartum and when I weaned. I feel like the symptoms disappeared completely when I got pregnant the second time. Is there something specific I should look for after my second child is born (besides thyroid)? I will ask my endo to screen for the deficiencies you spoke about in your video. Thank you for the great information!

  • Lata
    July 30, 2015 at 12:19 pm

    I suffer from ppd.My symptoms are that I don’t have any interest in anything even in life.My psychiatrist tried all types of antidepressants but nothing is working on me.I feel so hopeless.I wanted to ask if my body heal itself naturally if time is given.

  • sarah
    July 31, 2015 at 11:18 pm

    even if your vit D levels were good in pregnancy, still have them checked post partum.

    at 7 months pregnant my levels were at 54. i just got bloodwork back (my son is 12 months) and my levels plummeted to 27!!!!!!!!! and i almost didn’t request the test, on the same premise as the author – assuming i was fine due to the level at 7 months.

  • Christa
    March 10, 2016 at 2:15 pm

    I got insomnia as soon as my daughter slept through the night at 6w pp. I went 5 nights with out sleep. I am now on Zoloft and that cured the GOING TO SLEEP insomnia
    But now I wake multiple times a night and barely get 4 hours total. I exclusively breastfeed. Is Progesterone safe while BF? I’m going on MON to a PCP going to request a full screening including hormones HELP PLEASE
    I feel crazy with no sleep as I should 🙁

  • Christa
    March 18, 2016 at 12:47 pm

    I had my levels done. They said my 0.5 is normal for being post partum. I was on the pill from 18-29 and then got preg 2x very easily one miscarriage one healthy preg. Is 0.5 low/normal? I live in PA & I’m so sick of no medical doctor taking me seriously about my insomnia. They just upped my Zoloft like come on! I hate meds if they truly are not needed

    • Christa
      March 18, 2016 at 12:50 pm

      Progesterone is 0.5

  • Christa
    March 18, 2016 at 2:26 pm

    Thank you so much for making me feel validated. I had SEVERE anxiety once she hit 6w old. It was so scary that I didn’t know how to cope. Luckily the Zoloft helped but I know antidepressants & sleep pills are not the way to go. I watched your video on PPD healing. I’ll apply what I learned. I think I need to convince someone to write me a script for Progesterone

  • Janelle
    March 23, 2016 at 1:35 pm

    My friend is going to her Dr because she’s hearing voices that aren’t there and they said she had postpartum pshycosis do you have any recomendations for what i could have her ask her dr. She lost her dog sinxe highschool, her grandma died and she got demoted from her pisition at her job shed given like 12 years of her life to plus her babies dad had to go to a treatment center all in the same month of december only a month after her baby was born. She has gone above and beyond still caring for her baby although she will hold him all day instead of taking care of herself but hes still fussy and shes getting frustrated over it.

      • Christa
        March 25, 2016 at 2:22 pm

        Will the mini pill helps someone with low levels of Progesterone. I’m starting birth control tomorrow (the mini pill

          • Christa
            April 9, 2016 at 10:03 am

            So I didn’t take the pill
            But my period returned
            And now I feel better?
            Sleeping more too!

  • Therese
    May 7, 2016 at 6:30 pm

    Hi! Thanks for such a thorough article. How long do you find it takes to increase ferritin levels with supplements? My ferritin was 10 (!!!) and I’m taking supplements now, but I’m wondering how long it will take to see a difference. Also, is it possible to have low progesterone even if I’m having regular ovulating cycles every month? Finally, can extended breastfeeding (I still nurse my 23 month old once a day) affect progesterone levels?


  • Cynthia
    May 22, 2016 at 2:39 pm

    Hi, can low ferritin cause symptoms of lack of concentration, short of breath, shakiness or tremors especially when moving around, rapid pulse when waking up, anxiety and panic attacks? I had a severe postpartum hemorage 10 weeks ago. I have not felt well since and just a week ago my dr discovered that my ferritin was at 15 while my other blood work was in normal ranges with the exception of my thyroid falling just in range of being hyper. I had an ultrasound on the thyroid and also a blood test for antibodies and that checked out fine. I just wanted to know if a low ferritin level could be the cause of my distress and why. I started supplementation with iron a week ago and feel like I may have improved a little, but it is hard to tell. Have you seen other women with low ferritin and symptoms like mine? Also did they improve with supplementation? I have never experienced postpartum anxiety before this birth[#5), but I had never had a hemorage like I did this time. Thanks!

  • Bethany Geary
    October 15, 2016 at 10:08 pm

    Hi I was prescribed Zoloft and I absolutely hate it. I have taken it for 2 days and it makes me feel insane. I want to try all natural things to pull me out of this anxiety and depression I feel. Before having my Son I have never experienced depression or anxiety. I was always so happy. My Son is 14 months old and it seems like each month I’m getting worse. A few months back I was told my vitamin d3 and b12 (I think b12) were really low. Could this be why I have been feheling so down? After having my Son I felt drained for months and months. By 3 month pp I started getting anxiety. I dealt with anxiety for a few months then depression hit me. I am ready to be 100% again. I have been looking at life as a chore instead of being my happy go lucky self. My doctor is no help. Please share some advice with me. My doctors answer is anti-depressants.

  • Sheba Bridges
    April 18, 2017 at 11:08 pm

    I really like your post. I have had no luck at all. I had my daughter in August of 2015 and ever since Im totally off. I thought depression was sadness, I’m not sad, I don’t feel anything. 0 excitement for crafting, 0 excitement for cooking, 0 excitement for vacation, I mean I remember so I try to act that way with 0 anything, well actually that’s not true I do feel board. I can’t remember things at all, my husband use to say he hated my memory cuz it got him in trouble, I can’t remember now. I have panic attacks when I leave the house as well. I hope this works. But what I really hope is I care enough to do it, like I said I doneed feel anything and I don’t have drive. Thanks

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