Breastfeeding problems tied to moms' depression

NEW YORK (Reuters Health) - New moms who have particular difficulty breastfeeding may be at greater risk of postpartum depression, a new study suggests.

The findings, reported in the journal Obstetrics & Gynecology, do not prove that breastfeeding problems are the cause of depression symptoms. But researchers say that new mothers and their doctors should be aware that the two can go hand-in-hand.

The study found that of nearly 2,600 mothers who had ever breastfed, just less than eight percent 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.

Whether the breastfeeding difficulties are to blame is not clear, according to lead researcher Stephanie Watkins, an epidemiologist at 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 Dr. Alison Stuebe, an obstetrician/gynecologist at UNC who also worked on the study. “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. Stuebe and her colleagues are doing further studies to look into that question.

Whatever the reasons for the connection, the researchers said the main message is that early breastfeeding problems could serve as a warning sign of postpartum depression in some women.

Both Watkins and Stuebe suggested that new moms talk with their doctor about any breastfeeding problems they are having. And doctors, they said, might think about screening those women for postpartum depression.

The American College of Obstetricians and Gynecologists (ACOG) says there is not enough evidence to support routinely screening all new mothers for postpartum depression. (The major downside of any medical screening is that it can lead to over-diagnosis, and treatment of people who do not need it.)

On the other hand, ACOG also says that 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, Stuebe noted. “And our study suggests that this (breastfeeding difficulties) may be a risk factor,” she said.

The findings are based on 2,586 U.S. 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.

The women were then screened for depression when their babies were two months old.

Overall, women who screened positive were more likely to have had severe breast pain in the early weeks of breastfeeding. During week one, 35 percent did, versus 22 percent of women who did not screen positive for depression.

When the researchers accounted for other factors -- like women’s 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 percent more likely to later screen positive for postpartum depression, compared with women who said they liked it.

None of that means that women who dislike breastfeeding are destined for depression, 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 percent of new mothers.

Some symptoms include strong feelings of sadness, anxiety or helplessness that do not improve after about a week and start to interfere with daily life.

As for treatment, some doctors might recommend an antidepressant medication (which is generally considered safe during breastfeeding). But support groups or other non-drug options may also help, according to ACOG.

SOURCE: Obstetrics & Gynecology, August 2011.