But then, around 7 months postpartum, at a time when she least expected it, Brownell’s mood took a sharp downturn. She had overwhelming feelings of sadness and worthlessness, drastic mood swings and trouble sleeping at night. Her only real comfort was spending time with Caleb.
“I was just blindsided,” said Brownell, 38, of Harpers Ferry, W.Va. “Every day, I woke up and felt like there was a weight on me. That was the only time in my life when I’ve been suicidal.”
Caleb had started eating more solid foods and nursing considerably less. Much to her surprise, Brownell learned that this weaning was the likely cause of her depression.
While postpartum depression is relatively well studied, with the Food and Drug Administration recently approving a new drug for its treatment, a similar condition that affects new mothers — known as postweaning depression — has almost no research dedicated to it. Postweaning depression occurs during or after the cessation of breastfeeding and is thought to result from a subsequent drop in hormone levels. Symptoms can include anxiety, hopelessness, irritability and insomnia.
It is unclear how many women may have or be at risk of postweaning depression because research is limited.
“There are almost no large studies on postweaning depression, in part because we are focused so much on postpartum depression,” said Verinder Sharma, professor of psychiatry at Western University. “There is a lack of awareness that some women are at risk during the weaning period, not only amongst the women themselves but also the caregivers.”
In 2011, Joanna Goddard abruptly weaned her first son, Toby, within a week. She felt ready to stop breastfeeding and wasn’t worried about any emotional consequences.
“It was like I had been hit by a Mack truck,” said Goddard, 44, founder of Cup of Jo, the women’s lifestyle site based in Brooklyn. “I went from being a little anxious and tired, but doing well, to really deep in this fog of sadness.”
Unlike Brownell, she had no history of depression. After realizing the connection to weaning, Goddard wrote a blog post about the experience, titled “The Hardest Two Months of My Life.” It became one of her most popular posts with nearly 1,300 comments, many from other moms who saw themselves in her struggle.
“It got a bananas response. I still get emails about it all the time,” Goddard said. After six weeks, her depression suddenly lifted — “like waking up a from a bad dream” — and her period returned the very next day.
Postpartum depression can arise during pregnancy or up to a year after giving birth, but it most commonly starts one to three weeks after delivery. In the hours after childbirth, levels of hormones such as estrogen and progesterone sharply decrease, which can trigger depression in the same way that smaller hormonal changes may lead to PMS-related shifts in mood.
Similarly, levels of the hormones associated with breastfeeding fall as a mother stops nursing. Postweaning depression is linked to breastfeeding cessation — which can happen long after the one-year mark — rather than pregnancy or childbirth, as is the case with postpartum depression. Brownell, for instance, experienced another depressive episode at 18 months postpartum, when Caleb dropped to only one feeding per day.
“As you are dropping feeds or stopping breastfeeding, your hormones are trying to readapt,” said Mary Kimmel, co-director of the Perinatal Psychiatry Program at the University of North Carolina at Chapel Hill. “The system needs to find a different balance depending on the situation, and some people are much more sensitive to these changes.”
A 2012 study of 42,225 Norwegian women found that mothers who had stopped breastfeeding entirely or were giving solid food or formula in addition to breastfeeding had higher levels of anxiety and depression at six months postpartum. In addition, women who had elevated levels of baseline anxiety and depression during pregnancy experienced larger increases in those same symptoms after weaning compared with those with average baseline levels.
Otherwise, the scientific literature on postweaning depression is limited to case studies. A 1987 report titled “Weaning and Depression: Another Postpartum Complication” discusses the harrowing cases of four patients who developed episodes of major depression shortly after they had begun to wean their infants.
One 28-year-old woman, “Ms. C,” described feeling happy during the first week postpartum. She began weaning her daughter at 4 months old, in anticipation of returning to work, and mentioned becoming “anxious, sad, and tearful.” After stopping breastfeeding completely, her depression worsened, and she had delusions that “her poor mothering had caused the child irreparable emotional damage.” Two months later, convinced that they would be “better off” without each other, she suffocated her baby.
In a 2008 case report, Sharma and his colleague studied a woman who became depressed each time she gave birth and immediately following the cessation of breastfeeding. She had thoughts of self-harm during the first two episodes, which occurred around eight months after the birth of her first child and 14 months after the birth of her second child, despite having no history of suicidal ideation or psychiatric disturbance.
Hormones and postweaning depression
“The two main hormones associated with breastfeeding help regulate mood,” said Wendy Wisner, an international board certified lactation consultant (IBCLC) based in New York. “One is prolactin, which regulates your milk supply and helps you sleep, and then there’s oxytocin, which is released when the milk lets down and floods you with love.”
Secretion of prolactin by the pituitary gland increases during pregnancy, rising steadily until delivery. After birth, prolactin levels remain high if the mother is breastfeeding, which further stimulates milk production. In non-breastfeeding women, prolactin levels return to normal within three to four weeks postpartum. Multiple studies have uncovered an association between low plasma prolactin levels and a greater risk of postpartum depression.
Plasma levels of oxytocin increase during pregnancy and stimulate uterine contractions in childbirth. After delivery, the hormone stimulates contractions of breast tissue to aid in lactation. During breastfeeding, oxytocin secretion causes the milk to release so the baby can feed. As a result, breastfeeding mothers have much more elevated levels of oxytocin compared with non-breastfeeding mothers.
One study found that women felt calm and less anxious during breastfeeding, when their oxytocin levels were highest. Another observed that a mother’s mood becomes less negative after breastfeeding as opposed to bottle-feeding, leading the researchers to speculate that the surge of oxytocin during the former acts as a self-produced “antidepressant.”
During the weaning process, both prolactin and oxytocin drop to pre-pregnancy levels, and any protective effects against mood disturbances may be lost. As a result, Wisner recommends weaning slowly, especially for those who are sensitive to hormonal changes such as PMS or have a history of depression.
“Try dropping a breastfeeding session every few days or even one session a week, and see how you feel after each session is dropped,” Wisner said. “Postweaning depression can happen when you wean very gradually, but it’s more likely to happen when you wean suddenly because your hormones are crashing all over the place.”
Other ways to cope include joining a breastfeeding support group, finding a therapist who specializes in women’s mental health issues or taking medication, if necessary.
To help new mothers realize that they aren’t alone, education around postweaning depression — such as during childbirth or breastfeeding classes during pregnancy — is needed, the experts said.
“One hundred percent, knowing that this was a thing would have helped me,” Goddard said. “It would have transformed my whole experience.”
Do you have a question about human behavior or neuroscience? Email BrainMatters@washpost.com and we may answer it in a future column.
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