Most people have a general understanding of the fact that your hormones can impact your mood. However, what may not be widely understood is the level at which your hormones impact your mood and mental health. Perinatal mood disorders, such as postpartum depression (PPD) and postpartum anxiety (PPA), are common mood disorders that are largely due to fluctuations in hormones that result in changing levels of serotonin and other neurotransmitters that play a crucial role in your mood and mental health. This interplay between hormones and neurotransmitters can increase a person’s risk of developing PPA and PPD.
What are neurotransmitters?
Dopamine and serotonin are two common neurotransmitters in the brain that are responsible for how we regulate feelings of pleasure, our motivation levels, and our behavior. More specifically, dopamine is primarily responsible for how we receive and respond to pleasure, the way we learn, and the way we respond to aversive stimuli in the environment. When there’s dysfunction in the dopamine regulation system, psychiatric conditions like addiction can develop.
The role of serotonin is not as clearly understood as dopamine. What is known, however, is that serotonin plays a role in our mood and feelings of depression, our levels of sleep and wakefulness, and our behavioral inhibition, which refers to our temperament, the ability to feel and manage emotional distress, and the way we respond to unknown environments.
What are hormones?
Estrogen is an important steroid sex hormone that plays a key role in the development of women; men have estrogen but at much smaller levels than women. Estrogen is responsible for female development including:
- The menstrual cycle
- Breast development
- Growth of pubic hair
- Sexual desire (libido)
- Bone health
- Brain health
- Skin health
Too much or too little estrogen can result in many physical and emotional problems including:
- Mood disorders including depression and anxiety
- The development of fibroids
- Weight gain
- Trouble sleeping
- Irregular menstrual cycles
Progesterone is another steroid hormone that is primarily responsible for preparing the uterus for potential pregnancy after a female ovulates. Like estrogen, abnormal levels of progesterone can lead to health problems.
Potential problems that can occur as a result of too little progesterone include:
- Abnormal menstrual cycles
- Risk of miscarriage or pre-term delivery
- Difficulty conceiving
- Abdominal pain during pregnancy
- Spotting during pregnancy
- Abnormal uterine bleeding
It is important to note that too little progesterone can lead to the body creating too much estrogen, which can result in:
- Weight gain
- Gallbladder issues
- Lowered sex drive
How do hormones and neurotransmitters impact one another?
There is a strong interplay between steroid sex hormones and neurotransmitters. Estrogen and progesterone are transported throughout the body by various neurotransmitters like dopamine and estrogen and synthesized in the brain and peripheral glands. Changes in estrogen and progesterone can increase or decrease levels of serotonin and dopamine in the brain, which can lead to mood and cognitive changes. Studies show that women who are experiencing sex hormone fluctuations are at an increased risk for developing various mood disorders such as postpartum depression, premenstrual dysphoric disorder, and perimenopausal depression. Additionally, their cognitive processing, memory, and decision-making skills are influenced by changes in estrogen and progesterone levels.
When estrogen and progesterone levels are high, like during a woman’s menstrual cycle, increased verbal abilities are observed and when the levels of sex hormones are low, it can result in memory deficits. During a transitional stage of a woman’s life, such as starting menstruation to becoming pregnant to entering menopause, levels of estrogen and progesterone change significantly, which increases their risk for developing certain psychiatric and mood disorders.
Perinatal mood disorders
Perinatal mood disorders are any form of depression or anxiety that occurs during pregnancy, shortly after giving birth, or within one year after giving birth. Common perinatal mood disorders include postpartum depression (PPD) and postpartum anxiety (PPA). As discussed previously, changes in sex steroid hormones like progesterone and estrogen influence levels of serotonin and dopamine, which are neurotransmitters responsible for feelings of pleasure, cognitive processing, and motivation levels, among other things.
Risk factors for PPD and PPA
During pregnancy and the postpartum period, hormone levels change drastically. During pregnancy, estrogen and progesterone are at the highest levels they will be, and then almost immediately after birth, they drop significantly. As we know, changes in sex steroid hormones impact the neurotransmitters in the brain which increases the risk for a pregnant or postpartum female to develop mood and psychiatric disorders during this period of life.
Several factors impact your vulnerability to developing perinatal mood disorders as well as impact the type and severity of symptoms. Factors such as genetics, family history of PPD or PPA, your support system, and the way your body handles stress and hormones can impact the development and severity of perinatal mood disorders.
Additional risk factors include:
- Having a prior history of anxiety or depression
- Having depression during pregnancy
- Having a negative attitude about the pregnancy
- Experiencing gender disappointment
- Low self-esteem and feelings of inadequacy about your ability to parent your baby
- Having a history of sexual abuse or trauma
- Having multiple children at home
- Having a high-risk pregnancy
- Wanting to have a vaginal birth but having to have a C-section
- Not breastfeeding
- Having a history of severe PMS
- Being of young age when you become pregnant and give birth
- Having higher blood sugar levels during pregnancy
- Having a diet high in carbohydrates
- Having a thyroid disorder
- Low social and emotional support
- Experiencing domestic violence during pregnancy
- Financial hardship and low economic status
- Being unemployed
Fortunately, perinatal mood disorders are temporary and largely associated with the perinatal period of life. Furthermore, you can take steps to reduce your risk of developing PPD or PPA.
Protective factors against PPA or PPD
Studies show that certain factors can reduce your vulnerability to developing perinatal mood disorders which are referred to as protective factors. However, it is important to note that you can still develop PPA or PPD even when the protective factors are present.
Protective factors include:
- Having a low-risk pregnancy
- Taking time to prepare for the delivery by taking birthing classes
- Having an epidural during childbirth
- Breastfeeding immediately after childbirth
- Breastfeeding for 3-4 months postpartum
- Giving birth between the ages of 31-35 years old
- Feeling confident in your ability to care for and parent your baby
- Eating foods high in protein and low in carbohydrates
- Being financially stable
- Having a stable career
- Completing high school and higher education
- Having a strong support system
- Having a supportive partner and being able to make decisions at home
It is important to highlight the importance of lifestyle factors in reducing or increasing your risk for perinatal mood disorders. For example, studies show that having a diet that is high in fruits, vegetables, dairy, legumes, seafood, and olive oil can reduce your risk for postpartum depression by 50%. Additionally, maintaining healthy levels of zinc can reduce your risk for PPD. Maintaining healthy levels of vitamins B6 and B2 can reduce your risk for PPD.
Talk to your doctor if you think you may have a zinc or vitamin B deficiency. Always consult with your doctor before making any medication or lifestyle changes, especially if you are pregnant or nursing.
Symptoms of perinatal mood disorders
Mood changes are common for many women during pregnancy and the postpartum period. If you or someone you love may be experiencing perinatal mood disorders, there are signs you can look out for.
Common symptoms of perinatal mood disorders include:
- Mood swings including extreme highs and lows
- Feelings of sadness
- Feelings of overwhelm and/or anxiety
- Anhedonia (loss of joy in once-enjoyable activities)
- Excessive worry (about your baby)
- Hallucinations (seeing or hearing things that don’t exist)
- Intrusive thoughts (scary thoughts about your baby being harmed)
- Thoughts of harming your baby
- Changes in sleep
- Appetite changes
- Feelings of worthlessness, guilt, or inadequacy
If you notice any of these changes in a loved one, help is available to them. Talk to your loved one from a place of compassion and concern and discuss your concerns with them. Remind them that you are there to support them, that they are not alone, and that treatment options are available.
It’s important to understand that perinatal mood disorders aren’t your fault and the symptoms will not last forever. However, you can take steps to manage and reduce the symptoms of perinatal mood disorders. You don’t have to suffer in silence. PPD occurs in 6%-20% of postpartum women. Talk to your doctor or mental health professional if you are experiencing symptoms of PPD or PPA. Your doctor or mental health professional will work with you to create a customized treatment plan that can address your symptoms.
Your treatment plan can include services like psychotherapy, medication, and ancillary services. If medication is part of your treatment plan, WellRx can help you save money on both brand name and generic prescription medications.
Jacquelyn Buffo began writing at the age of 10 when she won a county-wide essay contest explaining why her mother is worth her weight in gold. Since that time, she has written for several newspapers and a health and wellness blog. Her education and experience is in mental health and addiction. She is a licensed counselor and currently provides therapeutic services on an outpatient basis. Her counseling and substance abuse experience includes inpatient residential, in-home, and early recovery counseling. She is a certified addiction specialist and is working on obtaining her certification in Dialectical Behavioral Therapy. She also specializes in working with pregnant and post-partum women and has received advanced training on women's health.
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