Lifestyle Modifications with an antidepressant effect:

- Exercise - Walking 30-60 min a day, or up to 3-5 hours per week has been shown to work as well as an antidepressant for mild to moderate depression (check with your doctor first if you are considering increasing your exercise)

- Nutrition - A whole foods plant based diet has been shown to decrease depression and increase productivity. Additionally, it decreases the risk of cancer, heart disease, osteoporosis, arthritis, diabetes, and other chronic diseases, and it helps to establish and maintain a healthy body weight. For further information, see the Nutrition section on this page. 

- Rest/Sleep, but not oversleeping - Getting enough sleep when breastfeeding a baby can require some creativity. Ask your partner or other loved one to tend to your baby in the first part of the night and give the first night feed while you sleep through it (ideally with ear plugs and far enough away that you don't waken when the baby does). Research shows that getting enough sleep in the early postpartum period decreases the risk of postpartum depression. If you can't sleep, talk to your doctor. Some non-medication options for sleep include 'CBT for insomnia' (for chronic insomnia), meditation (lots of free apps available), using an ear bud and listening to podcasts - this helps to derail your brain from all its incessant thinking and can help you sleep if ruminating is what keeps you awake. Google TIPP skills by Dr. Marsha Linehan, also Nightmare protocol if you suffer from nightmares. 

- Alcohol - Minimise alcohol to no more than (at most) 1 drink per day. If you are depressed, the ideal amount is none. Alcohol is an excellent depressant, and the risk of death by suicide when under the influence rises astronomically (upwards of 3000% in those with a mood disorder) - even though you may have no intention at all when you are not drinking. If you have difficulty controlling how much you drink, talk to your doctor. You may benefit from a type of therapy called "Motivational Interviewing", and/or from a medication in the short-term that decreases cravings). In Ontario, you can call Dart Ontario for information about all different kinds of treatment centres available.

- Caffeine - Caffeine can increase symptoms of panic and anxiety, so use your judgement to decide if decreasing it or eliminating it might help you feel better.

- Vitamin D 4000 IU from second trimester through to the end of the pregnancy and while breastfeeding is the recommended dose from a large study in 2013 (ref.). You will still need to supplement the baby with Vitamin D drops. There is evidence that all Canadians need to take Vitamin D, although which dose each person needs is not yet clear. Adequate levels of vitamin D have been shown to decrease the risk of depression, autoimmune diseases (thyroid, multiple sclerosis, diabetes, etc), and various types of cancer. Ask your doctor how much you should take.

- Vitamin B12 and iron supplements, if needed. Your doctor will do some screening bloodwork if you are depressed or anxious, to rule out something else causing your symptoms. I usually recommend that the following be checked: CBC-complete blood count, ferritin-iron stores, Vitamin B12, TSH-thyroid stimulating hormone, and blood sugar level. An inadequate RBC folate (folic acid level) can also contribute to depressive symptoms, but if you are pregnant you are likely taking a folic acid supplement. Some people have a genetic mutation that prevents them from being able to get the folate from the blood into the brain, and if this is your case you can take a different form of this vitamin that crosses the blood-brain barrier easily.

- The three behavioural strategies (from CBT) that have an antidepressant effect include:
1) doing something you have been avoiding,
2) doing something that gives you a sense of accomplishment, and
3) doing something for fun/leisure. 

Nutrition

Refer to the following documentaries on Netflix - Plant Pure Nation, What the Health, and Forks over Knives; also the free videos on nutritionfacts.org. If wishing to transition to a more whole foods plant based way of eating, there is lots of help available online, such as the forksoverknives.com website and its "Meal Planner" that gives free recipes, a grocery shopping list, meal preparation tips, etc. Many other websites offer delicious, free whole foods plant based recipes and tips for transitioning to this way of eating.  

Plant-Based Diets for Improved Mood & Productivity
Anti-Inflammatory Diet for Depression
Fish Consumption & Suicide
Fighting the Blues with Greens?

I highly recommend Dr. Michael Greger's year-in-review video presentations that are just over an hour long, but if you want just a taste (no pun intended) of the nutrional research to date so you can live a healthy life, here is an 8 min video summarising "How Not to Die": How Not to Die: An Animated Summary

Psychotherapy

Interpersonal Psychotherapy, or IPT, is the most validated talk therapy in the perinatal population, although Cognitive Behavioural Therapy, or CBT, can also work very well and is easier to source. CBT requires "homework" to be effective, and most of the learning and change occur through doing the homework outside of sessions - it can be difficult for this population to find the time and energy to do the requisite homework. IPT does not require any homework, and the focus is interpersonal - on role transitions (and there are many when people have babies), role conflict (there can be lots of increased relationship conflict when a pregnancy or baby is involved), grief, and lack of a good support network.

Support Network

Call on your supports. Ask for help when you need it, and when it comes to babies, everyone needs it. Don't believe what you see in movies and advertising - these are not real people! Remember the expression: "It takes a village to raise a child", and say "yes please!" when someone offers to help you.

Setting Goals

For help setting goals so that you can increase the likelihood that you will make the changes in your life that you want to make, see NESTS and goal-setting in the following free pdf online: Coping with Depression during Pregnancy and following the Birth. There is also a free 'sister' pdf for anxiety: Coping with Anxiety during Pregnancy and following the Birth.  Many thanks to the Reproductive Mental Health Program team at BC Children's and Women's Hospital for providing this excellent self-help and information tool for free to all.

The 5-minute rule can be helpful in achieving your goals - aim to do the goal for 5 minutes, even 2 minutes if 5 minutes is too long at first, and work your way up to your goal. See NESTS and the goal setting section in the above publication. 

Breathing and Meditation

For anxiety with or without depression, try breathing - here's the scoop: How to Strengthen the Mind-Body Connection.

There are some excellent apps for learning how to meditate. Lots of research is available that proves the health benefits of meditating, including improvement in mood, anxiety, and sleep, and many other physical health benefits. 

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