Introduction

Imagine bringing a new life into the world and everyone around you expecting you to be the happiest you have ever been, yet feeling everything but joy. There is a consensus that the postpartum period of having a baby is the best few weeks of your life, feeling like you are living in a wonderful little bubble. However, this is not always the case, with some individuals experiencing postpartum depression (PPD). This is a serious mental health condition diagnosed after birth, that is extremely stigmatised and often diminished as “baby blues”.^{1 2} It is one of the main causes of maternal illness, with it being prevalent in around 10-15% of people assigned female at birth (AFAB) globally.¹ PPD not only has adverse effects on the mothers’ health, but it also severely impacts both the growth and development of the baby, which is why finding different treatments for this type of depression is essential.¹ Currently, a combination of different medications, psychotherapies (i.e., cognitive behavioural therapy), and other forms of therapies is being used to treat PPD, but there could be a new type of treatment. Cannabis is a plant-based drug derived from the dried stems, flowers and leaves of the Cannabis sativa L plant.³ The content of cannabinoids that produce intoxicating effects throughout the body, impacting moods, thoughts and perceptions. In recent years, the use of cannabis for medicinal purposes has increased significantly, and could now potentially be stepping in as a potential treatment for PPD. As a result, this article delves into the latest research exploring whether cannabis is effective in alleviating PPD, together with a deeper dive into PPD itself and cannabis, to shed light on the topic and any questions that remain unanswered. 

Postpartum depression

Postpartum depression (PPD) is a serious and extremely prevalent type of depression that affects more than 1 in 10 people within a year of giving birth in the United Kingdom, according to the NHS. Together with the hormonal, emotional, and psychological changes that women may experience during pregnancy, significant changes also occur in their familial and interpersonal world.⁴ Subsequently, it is not uncommon for new mothers to experience various emotions ranging from joy to sadness. These sad emotions are often described as “baby blues”.⁴ with symptoms lasting up to two weeks post-delivery. However, in more severe cases, new mothers can develop PPD, one of the main causes of maternal illness, which can influence children’s growth and development. PPD not only occurs in the birthing person, but partners, surrogates and adoptive parents.¹ This is because, whilst becoming a parent is a positive life-changing experience, it comes with a lot of new responsibilities, and can be extremely tiring and overwhelming. These factors, together with the physical, emotional, hormonal and financial changes that arise, are all potential risk factors for the development of PPD.

Causes and risks

Whilst the main cause of PPD in individuals is not fully understood, there are a few risk factors that are believed to increase the development of PPD. These include:

• Genetic predisposition: increased likelihood of developing PPD due to the person's genes and family history.
• Psychosocial stressors: These are situations that can occur in a person's life that generate high levels of stress.  
• Hormonal changes occur when hormone levels fluctuate. 

Changes in the level of hormones, including oestrogen and progesterone, coupled with sleep deprivation, are thought to trigger depression in those who are susceptible, potentially causing PPD. 

Symptoms

While symptoms of “baby blues” are milder and people recover quicker, PPD is often longer and has more of a severe impact on the individual's life, in some cases even affecting their ability to return to normal function.⁴ Some of the main symptoms of this condition include:

• Depressed mood
• Persistent feeling of sadness and tearfulness
• Severe mood swings
• Withdrawal from family and your baby
• Insomnia
• Problems concentrating and making decisions
• Tiredness
• Irritated or agitated towards others, including your baby

To be diagnosed with PPD, more than 5 symptoms need to be present for a minimum of two weeks, with most experts including the onset of any symptoms until 12 months postpartum as PPD.⁴ 

Treatment

How PPD can be treated varies on the types and severity of the symptoms.⁵ Treatments may include:

• Antidepressant medication, or mood stabilisers, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Psychological and psychosocial treatments: these include therapies such as interpersonal therapy, cognitive behavioural therapy and partner support

Other non-pharmacological treatments exist as alternatives to standard psychological and medicinal treatments, such as:⁵

• Electroconvulsive therapy (ECT) is a treatment that uses electric current to induce seizures in individuals to alter their brain chemistry. This treatment is used in those who do not respond to antidepressant medication and have severe psychotic symptoms
• Bright light therapy is a non-invasive treatment that uses different wavelengths to mimic natural light, increasing the release of serotonin and improving moods⁶
• Exercise, such as a daily walk

The NHS offers talking therapies as the first line of treatment, which include counselling and behavioural activation. 

Cannabis 

Cannabis is a plant-based drug derived from the Cannabis sativa L plant,³ which contains over 125 different types of chemicals, which are known as cannabinoids. It is a widely used psychoactive substance amongst the general public, but also during pregnancy. Depending on the type of cannabinoid present, which includes delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), cannabis can be used for different purposes, both recreational and medicinal. Within recent years, claims of cannabis’ therapeutic benefits have increased, contributing to the legalisation of the drug in several different countries.⁷ A large area of research has focused on the potential health benefits this drug could have on depression. Evidence has suggested that the use of cannabis can lead to the onset of depression. Having depression may also increase the frequency of using cannabis.⁸ Some of the various ways in which it is thought to positively impact individuals include:

• Endocannabinoid system (ECS): cannabis is thought to react with the ECS, a system which is involved in regulating sleep, mood and emotions. The active compounds in cannabis, such as THC and CBD, interact with specific receptors in the ECS, reducing depressive symptoms and helping to positively control moods.⁹ 
• Reduces anxiety: certain types of cannabis, especially those containing high levels of CBD, have been shown to produce calming effects and reduce anxiety, which often accompanies depression. 
• Reduces stress: cannabis can create a more relaxed state by acting on the ECS, together with other neurotransmitter systems, such as serotonin. This helps to manage stress, which can trigger depression. 

Use of cannabis for postpartum depression

While the relationship between cannabis use and depression has been extensively studied, the research on the use of cannabis for PPD is limited. The drawbacks, such as side effects, use reluctance, and cost-benefit ratio associated, have influenced a search for alternative treatment options.⁷ With this in mind, the recent findings on the possible therapeutic benefits of cannabis, especially with general depression, have led to this being a potential new option. Research that contributes to its efficacy for PPD includes:

• Anxiety: Some studies have shown cannabis to be effective for controlling anxiety disorders, which often go hand-in-hand with depression. However, the number of individuals with PPD was not specified in these studies, so the direct effect on PPD remains unclear⁷
• Sleep: Sleep disorders are not uncommon in those with PPD, which is why there has been an attempt to study the role cannabis plays in insomnia. Analyses have shown CBD, an active chemical found in cannabis, significantly improve sleep quality and reduce nightmares in those with PPD¹⁰
• Mother and child bonding: Detachment from their baby is often observed in mothers with PPD. This attachment can often be improved during breastfeeding, helping to alleviate the feeling of guilt that may accompany this detachment. However, the use of cannabis can interfere with this, as its safety when breastfeeding remains questionable. Research has shown that moderate amounts of cannabis are secreted in breastmilk, which can have significant harmful effects on the child¹¹

Despite the evidence mentioned above, the role and efficacy of cannabis use in PPD remain largely understudied. In addition, many of the studies carried out were self-reported with small sample sizes,  which potentially present certain biases. Therefore, there remains insufficient evidence to support the efficacy of using cannabis as a treatment option for PPD.⁷  

Summary

Postpartum depression is a type of depression that affects parents after childbirth, impacting around 10-15% of individuals globally. Unlike “baby blues”, which are more commonly experienced following childbirth, PPD involves more severe and long-lasting symptoms which can have detrimental effects. Some of the main symptoms that can be observed include severe mood swings, long-term sadness, insomnia and withdrawal from both the baby and those around them. The exact causes of this type of depression remain unclear, but there are certain factors that can contribute towards its manifestation, which include hormonal changes, psychosocial stressors and genetic predisposition.

PPD not only affects the birthing parent, but can also impact surrogates, adoptive parents and partners, due to the life-changing event of bringing a child into the world. Current treatments for PPD vary based on symptom severity and include antidepressant medications like SSRIs, psychological therapies such as cognitive behavioural therapy (CBT), and partner support. Additionally, alternative non-pharmacological treatments are being used, including electroconvulsive therapy (ECT), bright light therapy, and regular exercise. The article also explores cannabis as a potential treatment for PPD, due to its recently gained attention for its medicinal properties and positive effects for treating general depression.

However, despite its potential role in alleviating PPD symptoms being studied, there is insufficient evidence due to the properties of the studies carried out, including small sample sizes and bias, to support the benefits of cannabis for PPD.