This week my guest is Kathleen Kendall-Tackett, health psychologist and International Board Certified Lactation Consultant. Kathleen is the author of many books on women's health issues.

She joins us today to talk about how breastfeeding moms can overcome depression naturally. Download the mp3 HERE. Or, read the transcript below.

Carrie: You're back with Carrie at Natural Moms Talk Radio and we are joined this week by our special guest, Kathleen Kendall-Tackett. So, today we are going to talk about some research that you have put together around breastfeeding moms and depression: nutrition and other breastfeeding-friendly ways of handling depression.

First of all, let me just talk a little bit about your background. You're a board certified lactation consultant, a health psychologist. You've written several books on depression and other health topics and one book that I have really enjoyed is The Hidden Feelings of Motherhood.

This is something that is right up your alley, your area of expertise, and I think it's a huge and important issue so I'm going to let you just run with this topic.

Kathleen: Well, there are a couple of areas I want to address. One of the things that I'd like to mention is part of what I'm going to be talking about today is information that I've put together in a journal article that just came out in the International Breastfeeding Journal. I mentioned that because that's something that if people who are listening are interested, that article is free online in its full text form. It's a BioMed Central article, which means anybody can copy it, print it, whatever, and there is no charge for that. That's at the website internationalbreastfeedingjournal.com.

One of the things that we've discovered over the last few years is that inflammation is actually at the heart of depression, that a lot the psychosocial and physical stressors that we know are risk factors for depression. The way that the body reacts to those, it actually increases inflammation.

What that means in terms of practical aspect is that changes the way that we look at depression. One of the things that we've discovered is that a lot of the things that we know work for treating depression also deal with inflammation. They specifically lower inflammation levels.

A good example of that is St John's Wort. They've known for a long time that it's anti-inflammatory, but they didn't realize that that was probably one of the reasons why it worked.

For me, the most exciting part of this is what this means in terms of the omega-3 fatty acids. For a long time we've talked about those, but we didn't really know why they worked. Now, because we understand the mechanism, we can see that the omega-3 fatty acids actually specifically address that inflammation. They actually lower those inflammatory markers that are in the blood.

That's actually one of the reasons why you see things like lower rates of depression in countries that eat a lot of fish, for example. Those are the things that we've discovered and that's actually what's really exciting is because I think it actually have some direct relevance for some of the advice that we give to moms.

Carrie: When you talk about inflammation, it makes me think of illnesses like arthritis and fibromyalgia, which tend to coexist with depression and it's like what came first? The depression or that illness... the chicken or the egg question, but they probably coexist because of that same core issue.

Kathleen: Exactly. Another thing is if you look at a whole list of illnesses, you mentioned two, inflammatory arthritis and fibromyalgia, but there are actually a lot of other diseases that we're discovering are related to inflammation.

Two of the ones that I've been actually really interested in, is looking at heart disease and metabolic syndrome, which is the precursor syndrome to type 2 diabetes. Both of those are actually inflammatory too and both of those are also listed as illnesses that tend to have high rates of depression. Again, we're understanding this process. So, it's not just true for prenatal and peripartum women, but it's actually true across the lifespan.

Here's actually the interesting piece for pregnancy and postpartum though. One of the things we've discovered is that theseinflammation levels naturally rise in the last trimester of pregnancy and one of the reasons I thought that was so interesting is because that's exactly the pattern of depression that we see, that you don't actually see the highest rates of depression after birth, although they're substantial. Where you actually see the higher rates is in that last trimester and that absolutely fits that pattern.

What those proinflammatory cytokines do or those inflammation markers do is that they actually prepare the body for labor. What's intriguing about that is that the same mechanism is actually probably responsible for the link between preterm birth and depression because depression is a risk factor for having a preterm baby. Again, we didn't really understand why.

It's been a pretty robust finding. We've seen it across several studies, but the mechanism we didn't understand. If you have something like depression causing an increase in this inflammation, that's the body's signal that it's time to deliver the baby. One of the markers they specifically look at is specifically right into the cervix so you can see why all of a sudden you've got high levels of that because of depression, why you might see somebody more likely to have a preterm baby.

Carrie: So, what goes wrong there if that inflammation serves a purpose and it is normal and a natural phenomenon? What is it that goes wrong that triggers the depression? Are there other contributing factors?

Kathleen: It's really a matter of too much of a good thing. You can have optimum levels of it that there are certain amounts of what you would expect to see, but you can have too much. That's where actually people get into trouble.

Let's say you are going into the last trimester of pregnancy and so your levels are already elevated, but then you add depression into the mix and it kicks it up into a "too much" category and now all of a sudden it puts you more at risk for depression.

We have to remember that these are good things. We don't want it necessarily completely eliminated, but what we want to do is get it back into the range that it's supposed to be in. It's the same thing with stress hormones. Stress hormones are very useful. They are signs basically to protect our lives and get us out of tight situations, but what doesn't seem to work out very well for us is when we have too many of them. It's the same thing with these inflammatory markers.

Again, if you have a lot of things that are making those inflammatory markers rise, you're going to get too much, and then you are increasing the risk of depression. What I think is actually cool, again, it's like I said, to me, all of a sudden this explains why we're seeing the studies that we are with the omega-3 fatty acids. I think it's actually exciting to see this thing we've known for a while, but now we understand why it works.

For me, that means that I think we can even more confident in talking about those with pregnant and postpartum women because so many women in this country are really deficient in those. We just don't naturally eat them very much unless we love fish. A lot of women who are pregnant don't want to eat fish because they're worried about contamination, which I think is a very realistic concern.

Carrie: So, what is your recommendation?

Kathleen: Well, we have several options. There's an organization that I'm sure your listeners are familiar with called the US Pharmacopeia. US Pharmacopeia is actually a group that has grown up to govern the nutraceutical industry. People can voluntarily submit to be evaluated by this organization and then they get a seal that says that their product is what it says it is, it's contaminant-free, etc., etc. The USP has actually certified five different brands of fish oil that are over the counter. There's also the pharmaceutical grade fish oil like Natrol. There's also a vegetarian DHA supplement that it's a number of different forms. It's in prenatal vitamins and a couple of different sources and it's in some food products. Those are a lot of different ways that moms can get safe sources of these essential fatty acids.

One thing I really want to make sure I clarify though is flaxseed is ALA. It's not EPA or DHA and EPA/DHA, the long chain omega-3s are the ones you need for depression. Flaxseed doesn't do anything for depression mainly because our body takes something like ALA, which is the essential fatty acid in flaxseed and it converts it the long chain ones, but it's pretty inefficient. In order to get like 1 mg of DHA, you have to consume 20 mg of ALA. If you eat that much flax, you're not leaving the bathroom. It's not something that's going to be helpful in terms of depression. It doesn't hurt you; it's actually good for you in other ways. It's just it doesn't help with depression. Those are all sources.

Now, if you want specific sources of information, on the New Hampshire Breastfeeding Taskforce website, we actually have not only our postpartum curriculum, but we have handouts for mothers that actually specifically list brands that mothers can use.

The documents are all hyperlinked so you can actually click right to the website for these different products and we don't sell any of these products. We have no financial relationship with any of these groups. That website is nhbreastfeedingtaskforce.org. Those are places that you can go. The US Pharmacopeia is actually really easy, it's usp.org. Both of those sites actually will have a lot of information on specific brands. One of the brands I like and in fact it's the one I take is Nature Made and they sell it at Wal-Mart for like $5 for 100.

Carrie: Really?

Kathleen: Yeah.

Carrie: Wow. That's good to know.

Kathleen: You know, when I was first writing about this, it was depressing because the only brands I felt safe recommending to mothers were those brands that were not cheap. How realistic was it to expect most pregnant or breastfeeding women to go get a pharmaceutical grade fish oil for $65 a crack? I just didn't think that was very realistic and so I felt like here, we have this wonderful resource, but that it was really inaccessible to most mothers and that's not true anymore and I'm actually really excited about that.

Carrie: Yeah, that's great. That's good to know. You addressed the issue of being concerned about eating fish during pregnancy. I was going to ask you about that. What other research have you uncovered in addition to the information about the essential fatty acids?

Kathleen: Well, one of the things that we look at is we were very interested also in the impact of exercise. There have been actually a number of different studies looking specifically at exercise as a treatment for depression.

One of my favorite ones that I always mention whenever I do a talk on this is there was a randomized clinical trial that was conducted at Duke University Medical Center and they've put aerobic exercise head to head with Zoloft.

This is for people with major depression and that's actually one of the reasons why I think the study is so significant because most of the other ones have looked at a mild to moderate depression, but this one actually look at major depression.

What they found is that exercise was as effective as Zoloft for treating major depression in this group. The most exciting stuff actually came later when they looked at relapse rates because the relapse rates were significantly better in the exercise group than they were in the Zoloft group. It was a difference of like 28% versus 51%.

Carrie: That's incredible. It really is.

Kathleen: Yeah. It's exciting too because, again, it's another non-pharmacologic things that moms can try. It doesn't actually take very much. It's about two to three times a week, about 20 to 30 minutes, moderate intensity exercise.

Carrie: Does it matter what kind? Does it have to be aerobic?

Kathleen: It doesn't have to be aerobic. It can be strength training, you get the same effects. Again, thinking about realistically what moms can do in terms of what they can squeeze into their day, I think we sometimes set the bar so high that moms can't possibly do it, but for most moms I think actually trying to squeeze in 20-minute walks a couple of times a week is realistic. I think that that's exciting.

Some stuff that actually has just come out within the last month or so has specifically looked exercise and these inflammatory markers. The findings have been mixed and I think part of it has to do with looking at intensity of exercise. If you do too much, it can actually go the opposite way. It actually increases inflammation, but it's that moderate amount that seems to be the good amount in terms of not only controlling that inflammation, but it also controls stress. It makes people feel less stressed and I think anybody who exercises regularly knows that. They are having a really bad day, they go and they take a walk or something like that and they feel better.

Carrie: At the gym where I work out, sometimes I'll see women and they say, "Why are you here? You don't need to lose weight," and I'll say, "I come here because it keeps me sane. I have four children and I have to come here to work out my stress."

Kathleen: You're absolutely right and you know what? The research actually does support exactly what your experience has been, that you go and you feel better. That's a really good reason to do it for a lot of people.

Carrie: Yeah and it's self-sustaining as you do it and you feel that benefit, the more you want to do it. The hard thing is for a person who is depressed. It's getting them to that point that is very difficult.

Kathleen: Oh, it absolutely is hard. I do a lot of teaching for healthcare providers and one of the things I always say is, "Look, this year, you're gonna have to do some teambuilding stuff because this is gonna be the absolute last thing [depressed] people feel like doing."

Carrie: Right. Yeah, very true.

Kathleen: I'll never forget. I was speaking at a conference in Lake Michigan and there was this gal and she looked like this Amazon standing there. She's like 6 feet, very Nordic-looking and holding this 3-year-old on her hip like it was nothing in terms of like weight and stuff versus a lot of us would be crushed by that weight. She's like, "What can we do to get these mothers to exercise?" It was very clear for her that that was never a problem.

Before I could even say anything, another mother in the audience said, "You know, I have chronic fatigue syndrome. I have six children and it's just you've put it much more realistic face on why it's hard for some mothers to do this." Again, like I said, I don't think this gal ever had a problem not exercising, but for a lot of moms, especially moms who weren't necessarily exercisers before, this is going to be something that's going to be a little bit of a stretch, but I think if they can understand what the benefits are and try to think how can we make this happen for you, what are some things that we can do to help you with this, some ways your family can help. I think a lot of moms actually could probably work it in, but they're going to need some support in doing it.

Carrie: Yeah, absolutely. When it comes to breastfeeding and depression, tell us a little bit about what research has uncovered how babies who are breastfed actually do better (when their mothers are depressed) than if they are not breastfed. Do you want to share some about that?

Kathleen: I think that that's been a really important finding because we have a fairly large body of evidence that tells us that babies of mothers who are depressed have difficulties. There are lots of things that modify that: if the baby has a non-depressed adult to interact with, if the mother has a higher level of education, all of these things can lessen that effect, but it is important for us to really be realistic about the fact that there are some negative impacts of having a mom who is depressed.

One of the things that this one study looked at, the first one they really looked at whether breastfeeding made a difference, all these other studies and there has been just dozens and dozens of them never really looked at that believe it or not. I think partly it's just the way that the field is. They don't really consider breastfeeding in the psychological impact, but this one study did it. This is done in Florida.

What they did is they compared four groups of women, women who were depressed and who were either breast- or bottle-feeding and women who were not depressed and either breast- or bottle-feeding, so a total of four groups. What they specifically were looking for was this brainwave pattern called right frontal asymmetry, which is less important to know than the fact that it's a pattern that tends to show up in chronically depressed adults.

It was basically a measure, a physiological measure of depression in the babies. That's something that people have observed. They look at the babies and they say, "Well, these babies looked depressed," but you can't obviously use that as a research thing because it's fairly subjective. Somebody just looked at them and say, "Well, they looked depressed." They were trying to find some other objective physical criteria that satisfy that.

Anyway, what happened in the study is when they looked at these babies, what they found is that the mothers who were breastfeeding but depressed, their babies looked normal, that the breastfeeding was protecting those babies. One of the things that they have speculated on why is they have observed the moms and the babies together and they found that the depressed breastfeeding mothers couldn't disengage from the baby. It's built into the breastfeeding relationship.

What happens sometimes in depression is that moms sometimes stop interacting with their babies and it's very easy in a culture that doesn't think it's bad to leave a baby in a car seat all day, it's very easy to just disengage from your baby, prop up a bottle and never even look at or touch or talk to your baby if you're feeling depressed. With breastfeeding, you can't really do that, so even if you're not maybe as interactive as you normally would be, you can't completely disengage. You still have to look at your baby and you're going to be touching your baby.

Within that relationship, a lot of times you're talking, so even though it might be less than you would normally do, you still are there and that's actually what seemed to make the difference for these babies. I thought that was actually a very important study.

I was speaking to a peer counselor down in New York City and she works with a mostly Latina population. She comes from that culture herself. She told me in her culture, she says a lot of the moms don't want to breastfeed if they're depressed because they're feeling like they're giving the depression to the baby. She said, "Well, what do I say to them?" So, I showed her the study and she said, "Oh, I think I could tell them that." It actually is just the opposite, that it's actually protecting the baby.

We also note that breastfeeding, when it's going well, seems to actually also protect maternal mood. It's not to say that if you're breastfeeding, you're not going to be depressed, but you have a lower risk of it. I think part of it has to do with the fact that you're interrupting that stress response. That's the thing that seems to trigger this physiological reaction. They've actually found that moms have this nice little stress buffer right after they breastfeed their babies and it's for about half an hour. So, when they exposed these moms to a stress like in the laboratory, they found that the moms didn't physiologically react like they would have if they just had breastfed their babies.

Breastfeeding provides this nice little cushion for moms... and moms talk about that. They sit down and nurse their babies and they feel much better. There does seem to actually be some physiological correlates of that, which is cool because one of the things that was concerning us as a breastfeeding taskforce is there is some stuff in the field right now talking about how breastfeeding is a risk factor for depression. "Well, moms can breastfeed if they absolutely must..."

What we were trying to argue was that we want the field to be more affirmative towards breastfeeding and say, "Look, there are some times when it's not only not a risk factor, but it actually can be the vehicle back to health for the moms." It's definitely worth preserving. Now, this is if breastfeeding is going well. If it's not going well, then it can become a risk factor for depression. If you've got somebody who's got a lot of nipple pain or something like that, that can trigger depression.

I think part of the reason why we see some of the research results we have is they don't differentiate anybody who is breastfeeding whether it's going well or not, but I think even with that you're seeing at least a mild protective effect. I think if you pulled out the women whose breastfeeding experiences weren't going well and just look at the ones who were, I think you would see the overall. It's actually a fairly significant protective aspect, so I think that's something at least to tell moms.

Now, there are going to be moms always that maybe just way too overwhelmed to even have their breastfeeding and we need to respect that, but I meet a lot of moms who are told to wean their babies because they're depressed and they say, "This is the only thing that's going well for me." It's for those moms that I think we need to stand up and say, "Now, wait a second. Maybe this is something we can keep."

Carrie: Yeah, education is so important in that. In addition, they have to understand that if they are already breastfeeding that weaning the baby may bring a host of other problems that they can't foresee. For instance, digestive problems in the baby that causes a lot of crying.

Kathleen: Oh, yeah. That's huge.

Carrie: So, that can add to their stress load.

Kathleen: I can't tell you the number of moms I know who have experienced that. Overall, the majority won't, but there is a significant number of moms whose babies are very allergic and then what are they going to do? They're stuck on these really expensive $70 a day formulas because they can't tolerate anything else. I think, again, it's something we don't want to discourage lightly.

We always have to be conscious of what the mom wants to do and we certainly can never force anybody to breastfeed, but I think sometimes we've swung the other way and a lot of times we're saying, "Well, maybe if we just wean the baby would be better," and then these poor moms get into it and discover that it's made things at least more complication and that's not a good thing.

Carrie: Well, thank you so much for coming on the show and sharing this very important information with our listeners. I really appreciate it.

Kathleen: Well, I'm happy to do it. One other site I'd like to mention is we have a site that we've also listed a lot of this information on is breastfeedingmadesimple.com. I've got quite a few of the articles, I've got a depression page and I've also got a page for women who are abuse survivors. A lot of the things we've talked about, I've actually got papers and stuff on there that moms can take a look at.

Carrie: Okay, great. Thank you for mentioning that.

Kathleen: Well, I thought that might be helpful. Thank you very much for having me on your show.

Carrie: Oh, you're quite welcome.

More resources and information:

Kathleen's books:

Depression in New Mothers

The Hidden Feelings of Motherhood

Breastfeeding Made Simple

The Well Ordered Home

more of Kathleen's books

Natural remedies for depression:

Nordic Naturals Fish Oil - this is my personal favorite, it doesn't have a strong fishy taste.