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According to Dr Vivette Glover, Director of the Foetal and Neonatal Stress and Research Centre, at any one time during pregnancy, one in every ten women will be depressed and around one in every thirty will be depressed both during pregnancy and the postnatal period (1). It is not yet understood exactly what causes the symptoms associated to depression during and after pregnancy. However, factors such as the large changes that the body undergoes due to the demands of the growing foetus, as well as breastfeeding and potential sleep deprivation, can all play a significant role in how the body deals with stress. It is during this period of time that our bodies require more nourishment from food than ever and it can also be at exactly this time when we perhaps struggle to prioritise nutrition due to lack of energy, loss of appetite or sickness.

Pre and Post-Natal Depression are both complex conditions that can have multifactorial underlying drivers, including genetic and environmental influences. These are currently poorly investigated and the gold standard of treatment is often medication to help stabilise mood. Whilst SSRIs and other types of antidepressants have proven to be helpful for many, they do not address potential causes or drivers of poor mental health and can often mask symptoms. Antidepressants are also not regularly recommended during pregnancy, which is why being more mindful of nutrition and lifestyle habits can be a safer option for you and your baby. There are some natural, evidence-based steps you can take to help support optimal mental wellbeing:

Eat Foods to Support Energy Depletion:

Common issues such as poor sleep during pregnancy and sleep deprivation following the birth can often heighten cravings for stimulants and sugary foods, which may seem like a good option for quick sources of energy, however, these foods can often cause further issues with energy and lead to fatigue and low mood. Eating foods that are high in refined sugar and refined grains such as commercial white bread, pastries, cakes and biscuits, give us an unsustainable source of energy. The brain is a very metabolically active organ; despite it only being 7% of the body’s weight, it can take up to 20% of the body’s metabolic needs (2), meaning that it is very energy hungry. This is why it is important to nourish the brain with foods that are nutrient rich, providing the body the building blocks to produce neurotransmitters, as well as a sustainable source of energy. The best options are fresh, unprocessed foods such as wholegrains (brown bread, brown rice, quinoa, rye and oats), pulses, vegetables, good quality sources of protein (meat, poultry and fish) and healthy fats such as those found in olive oil, coconut oil, avocados and oily fish.

Just like throughout pregnancy, nutritional needs after birth, especially if breastfeeding, are incredibly important. The healthier the diet, the easier it will be to sustain the energy needed to take care of a newborn. Research shows that a breastfeeding mother needs an extra 300-500 calories a day, from food that is rich in the right macro and micronutrients to nourish both mother and baby (3). For example, nutrients such as B vitamins have shown to be important in supporting the mother in ensuring she has enough energy to meet the demands of lactation (4). These nutrients can be found in green leafy vegetables, wholegrains and good sources of animal protein.

Protect yourself from Oxidative Stress:

Oxidative stress refers to a biochemical process that occurs as a result of an accumulative everyday exposure to toxic burdens such as chemicals in cosmetics, furniture, paints, cars, and pollution. Our body has its own way of armouring itself from the damage that exposure to toxins can create through its production of endogenous antioxidants, which is nature’s way of neutralising oxidative stress. Although we have our own production of these wonder molecules, when we are continuously overloaded with toxins in our environment and have problems detoxifying, the liver can become overwhelmed. Research shows that over time oxidative stress can lead to an increase in inflammatory molecules such as cytokines, which have been shown to correlate with depression (5).This is why it is important to have a high intake of nutrients that support the liver in metabolising and removing toxins from the body, as well as regulating the inflammatory response. There are a few things we can change in our diet to support this area, for example eating foods such as the cruciferous family of vegetables which includes kale, cauliflower, broccoli and cabbage. These are particularly effective at supporting the liver in ushering out toxins as they all share an antioxidant compound called indole-3 Carbinol, which plays an important role in liver health (6). In addition, bitter greens such as collard greens, rocket, chicory and swiss chard are also great for supporting the liver’s own antioxidant defence system.

Increase intake of Omega-3 Fatty Acids:

During pregnancy and after pregnancy there is often a concern for the potential depletion of the maternal nutrient reservoir due to the needs of the growing foetus. A nutrient that is particularly important for mental wellbeing and is also essential for the growth of the foetus’s brain, is DHA. This is an omega 3 fatty acid that is found in oily fish and is the primary structural component of brain tissue, as well as playing a crucial role in the maintenance of brain cells and neurotransmitter metabolism (our body can also convert plant sources of omegas 3’s into DHA, such as those found in flaxseeds or chia seeds into DHA, but the conversion can often very poor). Deficiency in this nutrient during pregnancy is common, namely because of lack of seafood intake (the most bioavailable source of DHA) due to poor eating habits and concerns of mercury levels in fish during pregnancy, as well as higher requirements during foetal growth, which can lead to depletion. Due to the role that DHA plays in neurotransmitter metabolism, deficiency in this nutrient has been correlated to symptoms of depression during pregnancy (7). In order, to support your intake of omega 3, aim to have 3 portions of oily fish a week from sources that are low in mercury. These are mainly small fish that have a short life-span such as sardines, mackerel and herring. If you are vegetarian or vegan, although omega 3 is less readily available, it is still possible to get this nutrient from your diet through flax seeds, chia seeds, walnuts and seaweed. If you feel you may not be getting enough through your diet, you may want to consider using a good quality fish oil supplement (or algae based supplement if vegan) as an option. With fish oils, aim to choose a supplement that has been filtered for heavy metals and other pollutants to make sure you’re getting the full benefits of the omega 3 oils.

Exercise and Personalised Nutritional Therapy:

In addition to diet, there are many other things you can also do related to lifestyle, such as stress management through mindfulness (8) or gentle movement such as pre or post natal yoga (9), which have both shown to be incredibly helpful in encouraging mental wellbeing. If you feel you need extra support, personalised nutritional therapy can be very helpful as there can often be other drivers such as nutrient deficiencies and digestive complaints that can play a significant role in mental health and will need to be addressed in a way that is tailored to the individual.

At the Brain Bio Centre, our nutritional therapy clinic, our therapists specialise in mental health and biochemical testing that can provide in-depth information about your own specific needs, so we can create a personalised plan to support your health. For more information, please visit our website: www.brainbiocentre.com. Alternatively, BANT (British Association for Applied Nutrition and Nutritional Therapy), have a large network of therapists you can use to find a therapist suitable for you.
For wider help and information, you might want to contact the PANDAS Foundation, a charity who offer pre and post natal advice and support. They also have a helpline, 0843 28 98 401, open 9am-8pm, 7 days a week.

References:

(1) http://www.pandasfoundation.org.uk/preantenatal-depression/
(2) https://www.scientificamerican.com/article/why-does-the-brain-need-s/
(3) American Academy of Pediatrics. Policy Statement. Breastfeeding and the use of human milk. Pediatrics, March 2012 Sneed SM, Zane C, Thomas MR.
(4) The effects of ascorbic acid, vitamin B6, vitamin B12, and folic acid supplementation on the breast milk and maternal nutritional status of low socioeconomic lactating women. Am J Clin Nutr. 1981 Jul;34(7):1338-46.
(5) http://onlinelibrary.wiley.com/doi/10.1111/imm.12443/pdf
(6) https://www.ncbi.nlm.nih.gov/pubmed/29331880
(7) https://www.ncbi.nlm.nih.gov/pubmed/19289957/
(8) https://www.mindful.org/mindfulness-protects-post-partum-depression
(9) http://journals.sagepub.com/doi/full/10.1177/2156587217715927

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