Can stopping breastfeeding cause postpartum depression?

Stopping Breastfeeding and Postpartum Depression

Stopping breastfeeding can increase the risk of postpartum depression, particularly in women who already have elevated symptoms of anxiety and depression during pregnancy. 1

Hormonal Mechanisms

Breastfeeding cessation leads to significant hormonal changes that may contribute to mood disturbances:

• Prolactin changes: Women who develop postpartum depression have significantly lower plasma prolactin levels than non-depressed mothers 2. Prolactin has anxiolytic (anxiety-reducing) properties and contributes to stress-buffering effects during lactation 3.

• Oxytocin fluctuations: Lower oxytocin levels are associated with postpartum depression symptoms 3. Breastfeeding stimulates oxytocin release, and cessation removes this protective mechanism 4.

• Hormonal withdrawal: The sudden drop in prolactin and oxytocin following breastfeeding cessation may trigger system dysregulation in vulnerable women 3, 4.

Risk Assessment

The risk of developing depression after stopping breastfeeding is particularly high for:

• Women with pre-existing high levels of anxiety and depression during pregnancy 1
• Women with a history of mood disorders 5
• Women with genetic predispositions that may influence sensitivity to hormonal fluctuations 5

Evidence Strength

Research shows a bidirectional relationship between breastfeeding and postpartum depression:

• Breastfeeding cessation is predictive of an increase in postpartum anxiety and depression symptoms (β 0.11; 95% CI 0.09-0.14) 1
• This effect is multiplicative in women who already had high anxiety and depression during pregnancy 1
• Women who breastfeed have significantly lower depression scores than those who don't 2

Clinical Implications

For women stopping breastfeeding:

1. Monitor mood changes: Be vigilant for emerging symptoms of depression or anxiety
2. Gradual weaning: When possible, tapering breastfeeding gradually may help minimize abrupt hormonal shifts
3. Support systems: Ensure adequate emotional and practical support during the weaning process
4. Early intervention: Address any mood symptoms promptly to prevent progression to more severe depression

Common Pitfalls to Avoid

• Overlooking the risk: Post-weaning depression is often undiagnosed and understudied 6
• Dismissing mild symptoms: Even subclinical symptoms after weaning warrant attention
• Focusing only on hormones: Both psychological and physiological factors mediate the relationship between breastfeeding cessation and depression 4
• Neglecting women with pre-existing risk: Those with prior depression history or prenatal depression symptoms need closer monitoring during weaning 1, 2

While individual responses to weaning vary considerably, the evidence clearly shows that stopping breastfeeding can trigger or worsen postpartum depression symptoms, particularly in vulnerable women. Healthcare providers should recognize this risk and provide appropriate monitoring and support during the weaning process.