Natural Supplements for Perinatal Depressed Mood

There have been promising findings, but more studies are needed.

Posted Jul 19, 2019

A significant percentage of women use a variety of CAM approaches during or following childbirth for a range of health and mental health problems, however, relatively few tell their physicians or other health care providers (Hall and Jolly 2014). CAM therapies widely used to treat perinatal depressed mood include S-adenosyl-methionine (SAMe), omega-3 fatty acids, St. John’s wort (Hypericum perforatum), folate and vitamin D.

This blog is offered as a concise review of the evidence for safety and efficacy of natural supplements for treating perinatal depressed mood. In future posts, I will review the evidence for bright light exposure, exercise, acupuncture, and yoga.

S-adenosyl-methionine (SAMe), naturally present in all mammals, is necessary for the synthesis of serotonin and other neurotransmitters involved in mood regulation. SAMe has established antidepressant benefits and is widely used alone or in combination with antidepressants (Papakostas et al 2010; Levkovitz et al 2012).

Although no studies have investigated SAMe for depressed mood during pregnancy, an early study on SAMe in women with post-partum depression reported positive findings (Cerutti et al 1993). Some individuals who take SAME report transient dizziness, upset stomach, or feelings of mild anxiety or irritability.

St. John’s wort (Hypericum perforatum) is a popular herbal supplement used to treat depressed mood. Although research evidence is compelling (Linde et al 2005; Roder, Schaefer and Leucht 2004), it may not be safe to take the supplement during pregnancy, and potentially serious interactions with other medications preclude its safe use in combination with antidepressants and many other medications (Rayburn, Christensen and Gonzalez 2000; Dugoua et al 2006).

Omega-3 essential fatty acids have established antidepressant benefits. Findings of an epidemiologic study suggest that pregnant women who consume less fish may be at increased risk of developing depressed mood postpartum (Strom et al 2009). Placebo-controlled studies report mixed findings on antidepressant benefits of omega-3s in pregnant women (Freeman et al 2008; Makrides et al 2010; Su et al 2008; Kaviani et al 2014).

Omega-3s are important for healthy fetal brain development, are generally safe and cause few adverse effects.

The B vitamin folate is also important for normal fetal development. It has been established that individuals with low serum folate levels are at increased risk of depressed mood (Beydoun et al 2010). Many individuals who do not improve with antidepressants may have abnormally low levels of the enzyme that converts dietary folate into its active form, 5-methyltetrahydrofolate, which is essential for the synthesis of serotonin and other neurotransmitters required for mood regulation.

Two placebo-controlled studies found that daily folate supplementation reduces the risk of depressed mood in pregnancy (Lewis et al 2012; Yan et al 2017).

Vitamin D plays many important roles in health, including healthy brain functioning. Pregnant women with higher vitamin D levels are at reduced risk of developing depressed mood (Williams et al 2016). However, findings of placebo-controlled studies on vitamin D in depressed mood are inconsistent (Spedding 2014; Gowda et al 2015).

Findings of the only placebo-controlled randomized study on vitamin D supplementation in depressed mood during pregnancy reported antidepressant benefits in women who took 2000 IU daily for at least 8 weeks starting in the beginning of the third trimester (Vaziri et al 2016). Prenatal vitamins typically contain 400 IUs of vitamin D, however a daily dose of 2000 IU may be needed to reach serum levels that are effective against depressed mood (Holick et al 2011).

Bottom line

Every person's health is influenced by unique biological, social, and cultural factors. Factors that cause or worsen depressed mood are complex, reflecting the unique social and cultural circumstances, genetic, and other kinds of biological risk factors that affect each person. This is especially true during pregnancy and following childbirth, when a woman’s mental and physical health are influenced by rapidly changing biological factors and social circumstances.

The most appropriate treatment for depressed mood during pregnancy or following childbirth is ideally determined on a case-t- case basis, taking into account each woman's unique history, symptoms, circumstances, and preferences.