Breastfeeding and Maternal Mood: Exploring a Complex, Bidirectional Relationship

Where Does the Data Come From? If we wanted to design the perfect research study examining the impact of breastfeeding on risk for postpartum depression, we would conduct a randomized controlled trial where, in a group of postpartum mothers, half of the participants would breastfeed exclusively and the other half would bottle feed. But of course, we cannot do that type of study. So when we look at the effects of breastfeeding on mood, we must examine data from observational studies. These are studies where we look at mood in mothers who choose to breastfeed (exclusively or combined with bottle feeding) and in mothers who choose to bottlefeed. It is important to note, however, that these two groups of women are not identical. While many women plan to breastfeed, there are many other factors that play into actually being able to breastfeed for a significant period of time. In these observational studies, the women who breastfeed are often older, more educated, and have higher socioeconomic status compared to women who do not breastfeed. They are also more likely to be married or in stable partnerships and have access to supportive social networks and healthcare environments that support breastfeeding. All of these factors have been associated with lower risk of postpartum depression.Thus, it is not really a fair comparison; many of the factors that are associated with successful breastfeeding are also associated with lower risk of postpartum depression. In other words, it might not be breastfeeding itself that lowers risk for postpartum depression but instead the factors, like adequate resources and social support, that contribute to decreased vulnerability to depression. Breastfeeding and Risk of Postpartum Depression Several lines of evidence indicate that rates of postpartum depression are lower in women who breastfeed. While these studies indicate that breastfeeding is associated with a lower risk for postpartum depression, they do not necessarily indicate that breastfeeding offers protection against or reduces the risk of postpartum depression. Meta-Analysis Findings: The most recent meta-analysis (Alimi et al, 2022) found that mothers who did not exclusively breastfeed were about twice as likely to develop postpartum depression compared to mothers who breastfed exclusively (OR 1.89, 95% CI: 1.50-2.39). Observational Studies: Large cohort analyses and longitudinal studies in diverse populations consistently report that women who breastfeed are less likely to report depressive symptoms during the postpartum period than mothers who formula feed. Acute Impact of Feeding on Mood: In a frequently cited study from Mezzacappa and Katkin, mood ratings were assessed in mothers both before and then after a feeding. Breastfeeding mothers experienced a decrease in negative mood from pre- to post-feeding; in contrast, bottlefeeding mothers experienced a decrease in positive mood from pre- to post-feeding. While these studies suggest that breastfeeding may offer both acute and long-term ameliorating effects on postpartum depression; however, other studies indicate a more complicated relationship between breastfeeding and mood. Impact of Breastfeeding Choices and Experiences on Mood Many studies indicate a bidirectional relationship between breastfeeding and mood, where breastfeeding problems can trigger or contribute to depressive symptoms in the mother and where depressed mood in the mother can lead to breastfeeding difficulties and early cessation. Early breastfeeding experiences can have a significant impact on mood. For example, Watkins and colleagues observed that women who experienced significant breastfeeding pain on the first day were about twice as likely to have depression at two months postpartum (adjusted OR 1.96, 95% CI 1.17-3.29). Rates were even higher among women who were experiencing pain at two weeks postpartum (adjusted OR 2.24, 95% CI 1.18-4.26). While this study demonstrated that breastfeeding pain was associated with increased risk for PPD, the researchers also observed that breastfeeding help appeared to protect women from PPD. With breastfeeding support, there was a reduction in risk of PPD: women with moderate pain (adjusted OR 0.22, 95% CI 0.05-0.94) and those with severe pain (adjusted OR 0.17, 95% CI 0.04-0.75) pain were less likely to experience PPD. In another study, Borrao and colleagues further explored the relationship between breastfeeding intention, initiation, and postpartum depression in participants of the Avon Longitudinal Study of Parents and Children. In this large longitudinal study, the researchers observed that the effect of breastfeeding on PPD differed according to whether women had planned to breastfeed and whether they were able to do so: The lowest risk of PPD was found in women who had planned to breastfeed and were able to do so. The highest risk of PPD was found in women who had planned to breastfeed but were not able to do so. In addition, several studies (Grattan et al 2024, Thompson et al 2023) have observed that perceived pressure to breastfeed was associated with increased symptoms of anxiety, depression, stress, and birth trauma. Mothers who felt pressured to breastfeed — by public health messaging, cultural expectations, or perceived lack of choice in feeding decisions — reported higher levels of distress and a sense of isolation. They experienced the most significant impact on their emotional health when expectations about breastfeeding were not met. The emphasis on “breast is best” and equating successful breastfeeding with good motherhood contributed to feelings of guilt, shame, and inadequacy among those who struggled or felt their choices were unsupported. These effects persisted even after controlling for actual breastfeeding outcomes and prior mental health history. These studies suggest that the effect of breastfeeding on maternal mood is extremely heterogeneous. The information we have underscores the importance of providing expert breastfeeding support to women who intend to breastfeed, and especially to those who are having problems doing so. On the other hand, these studies also emphasize the importance of providing compassionate support for women who do not plan or, for whatever reason, are not able to breastfeed. Impact of Postpartum Depression and Anxiety on Breastfeeding Research consistently demonstrates that mothers experiencing depression, whether during pregnancy or in the postpartum period, are at greater risk for breastfeeding difficulties and early cessation of breastfeeding. Studies show that maternal depression is linked with lowered breastfeeding self-efficacy, negative perceptions of breastfeeding, and increased reports of challenges such as latching problems or insufficient milk supply. Women who report depressive symptoms are significantly more likely to discontinue breastfeeding within the first two to four months, even when accounting for factors like socioeconomic status and previous mental health history. These women also express more dissatisfaction and lower confidence in their feeding method, factors that can reinforce breastfeeding challenges and perpetuate depressive symptoms.. Fostering a Collaborative, Respectful Approach While mothers who are able to initiate and sustain breastfeeding often show lower rates of postpartum depression, the relationship between breastfeeding and mood is highly individualized and shaped by an interplay of maternal intention, psychosocial resources, and lived experience. Clinicians should be aware that both breastfeeding challenges and maternal mood disturbances frequently co-occur, and that difficulties with feeding can contribute to or exacerbate depressive symptoms. At the same time, experiencing depression or anxiety during the perinatal period may impact self-efficacy, satisfaction with feeding choices, and duration of breastfeeding. Research demonstrates the importance of timely and effective support: mothers who receive compassionate, practical breastfeeding assistance—especially during periods of pain, frustration, or uncertainty—are less likely to develop depression, while those who feel pressured or unsupported face increased risk fpr distress, anxiety, and depression. Given the bidirectional and nuanced relationship between breastfeeding and mental health, the best approach for clinicians is to provide individualized care that honors the mother’s goals and wishes. This includes routine screening for depression and anxiety, rapid referral to mental health resources when symptoms are identified, and expert lactation consultation for feeding difficulties. For mothers struggling with depression, evidence-based treatments—such as psychotherapy and antidepressant medications —should be initiated without delay. Clinical guidelines recommend that maternal mental health needs should not be sacrificed for feeding goals. Decisions must consider the well-being of both mother and infant. Ultimately, whether a mother breastfeeds exclusively, partially, or not at all, supportive care should prioritize maternal autonomy, minimize guilt or shame, and focus on optimizing both infant nutrition and maternal mental health. Clinicians can foster a therapeutic alliance by listening empathetically, respecting feeding choices, and creating an environment where mothers feel safe to voice concerns and seek help. For those facing barriers to breastfeeding or recovery from depression, collaborative, multidisciplinary support—including access to lactation professionals, behavioral health specialists, social resources, and peer groups—has the potential to improve outcomes for both mother and child. As emerging research and practice guidelines continue to refine our understanding of these complex relationships, clinicians are encouraged to support holistic, evidence-informed care, ensuring that every woman receives the compassion, respect, and individualized guidance she deserves. Ruta Nonacs, MD PhD References: Alimi R, Azmoude E, Moradi M, Zamani M. The association of breastfeeding with a reduced risk of postpartum depression: A systematic review and meta-analysis. Breastfeed Med. 2022 Apr;17(4):290-296. Coo S, García MI, Mira A, Valdés V. The role of perinatal anxiety and depression in breastfeeding practices. Breastfeed Med. 2020 Aug;15(8):495-500. Dessì A, Pianese G, Mureddu P, Fanos V, Bosco A. From breastfeeding to support in mothers’ feeding choices: A key role in the prevention of postpartum depression? Nutrients. 2024 Jul 16;16(14):2285. Grattan RE, London SM, Bueno GE. Perceived pressure to breastfeed negatively impacts postpartum mental health outcomes over time. Psychiatric Research. [Epub ahead of print].Grigoriadis S, Graves L, Peer M, Mamisashvili Z, Park A, Popova A, … Vigod SN. (2021). Breastfeeding and maternal mental health: Systematic review and meta-analysis. Acta Psychiatrica Scandinavica, 143(2), 107–119. Henshaw EJ. Breastfeeding and Postpartum Depression: A Review of Relationships and Potential Mechanisms. Curr Psychiatry Rep. 2023 Dec;25(12):803-808. Hendrix YMGA, van Pampus MG, Hofman A, Henrichs J, van der Horst HE, de Jongh A. Treatment of traumatic birth experience with postpartum early eye movement desensitization and reprocessing therapy: A randomized clinical trial. Am J Obstet Gynecol. 2025 Aug 4; [Epub ahead of print]. Hoff CE, Movva N, Rosen Vollmar AK, Pérez-Escamilla R. Impact of maternal anxiety on breastfeeding outcomes: A systematic review. Adv Nutr. 2019 Sep 1;10(5):816-826. Pope CJ, Mazmanian D. Breastfeeding and postpartum depression: An overview and clinical implications. Arch Womens Ment Health. 2016 Apr;19(2):319-327. Rivi V, Petrilli G, Blom JMC. (2020). Mind the Mother When Considering Breastfeeding. Frontiers in Global Women’s Health, 1. Rodríguez-Gallego I, Vila-Candel R, Corrales-Gutierrez I, Gomez-Baya D, Leon-Larios F. Evaluation of the impact of a midwife-led breastfeeding group intervention on prevention of postpartum depression: A multicentre randomised clinical trial. Nutrients. 2024 Jan 10;16(2):227. Shklarski L, Ner D, Leopold J. Exploring the vital role of lactation support providers in recognizing maternal mental health symptoms. Midwifery. 2025 Jul 27;149:104542. Thompson KA, White JP, Bardone-Cone AM. Associations between pressure to breastfeed and depressive, anxiety, obsessive-compulsive, and eating disorder symptoms among postpartum women. Psych Res. [Epub ahead of print]. Wang Y, Mao K, Chu M, Lu X. Perinatal maternal factors influencing postpartum feeding practices at six weeks. BMC Pregnancy Childbirth. 2024 Jul 30;24(1):514. Watkins S, Meltzer-Brody S, Zolnoun D, Stuebe A. Early breastfeeding experiences and postpartum depression. Obstet Gynecol. 2011 Aug;118(2 Pt 1):214-221.