Postpartum Progress

Miami Herald Covers Issue of Antidepressants During Pregnancy

Kudos to reporter Sherry Rauh and the Miami Herald for doing a nicely balanced article on depression during pregnancy and the treatment options.  There are risks either way, and it is important to work with your ob/gyn to make the best decision for YOU.

Many Women Not Comfortable Seeking Postpartum Depression Help From Their OB/GYN

We talk a lot about screening and treatment for women with postpartum depression, but there's always the question of which healthcare professional will do it.  Most often, it is the OB/GYN that women reach out to for help, which is why this new study in the Archives of Women's Health conducted by researchers from the University of Pennsylvania is worth consideration.  They took a look at women's views on getting depression help from OB/GYNs. 

"Among the 225 women in the study, more than half receiving gynecologic care (59%) and nearly a third of women who received prenatal care (29%) stated they would not seek help from their OB/GYN for depression."

Those who said they would not seek help from their OB/GYN if they developed postpartum depression had two major beliefs that prevented them from doing so:  1)  An OB/GYN is the wrong doctor for depression care and 2) OB/GYN is not a good setting for depression care. 

Other research out this week (some of which I can hardly understand but will report to you anyway):

• The Journal of Psychoneuroendocrinology (yes, that's a word apparently) published a study about the relation between leptin levels in the body and postpartum depression.
• The Journal of Obstetrics & Gynecology published a study about the risk factors for post-traumatic disorder in pregnant women, finding that women with PTSD during their first pregnancy were more likely to have suffered childhood abuse, to be African-American, living in higher crime areas, living in poverty, to be suffering depression and anxiety as well, and to have sought mental health treatment in the past.
• From the British Journal of Midwifery, a study on the risk factors for depression and anxiety during pregnancy (antenatal or antepartum depression).

ACOG & APA Issue Guidelines For Treatment of Depression During Pregnancy

The American College of Obstetricians and Gynecologists, in partnership with the American Psychiatric Association, has just issued specific direction and guidelines on the use of antidepressants during pregnancy.  They must be congratulated for their clear understanding of the nuances of treatment for depression during pregnancy, and for acknowledging that there is no one right answer to this situation as some would have you believe. 

"This is a report intended to reach out to psychiatrists as well as obstetrician-gynecologists," said Dr. Kimberly Yonkers [the report's author, who is from both the Department of Psychiatry and the Department of OB/GYN at Yale University]. "We developed algorithms which I think reflect the fact that there are multiple issues to consider and [that] there should be no knee-jerk response in managing a woman who is depressed and pregnant or contemplating pregnancy. Psychiatric history and a woman's preference are among the important features that should be taken into consideration."

In a nutshell, ACOG and the APA recommend that those with mild depression who are pregnant may be better served trying psychotherapy and seeing if that will relieve their symptoms.  Women with severe depression or those who have a history of depression or psychosis, however, should remain on their medication during pregnancy.  And of course, all pregnant women or those who are thinking about becoming pregnant should discuss their specific situation with their doctors.  Here are just a couple of the common scenarios the report offers along with recommendations to doctors and patients as to how to proceed:

Pregnant Women Currently on Medication for Depression

• After a consultation between their psychiatrist and obstetrician/gynecologist (to discuss risks), psychiatrically stable women who prefer to stay on medication may be able to do so.
• For those who want to discontinue medication and are not experiencing symptoms, tapering and discontinuation may be attempted. However, women with a history of recurrent depression are at a high risk for relapse.
• Those with recurrent depression or symptoms despite their medication may benefit from psychotherapy to replace or augment medication.
• Women with severe depression should remain on medication. If a patient refuses, alternative treatment and monitoring should be in place, preferably before discontinuation.

Pregnant Women Not Currently on Medication for Depression

• For those who want to avoid antidepressant medication, psychotherapy may be beneficial.
• For those who prefer taking medication, risks and benefits of treatment choices should be evaluated and discussed.

If you have access to the September issue of the journal Obstetrics & Gynecology, you can read the entire report here.  It will also appear in the September/October issue of General Hospital Psychiatry. 

Surprisingly, this report has been covered fairly well thus far by the mainstream media.  ABCNews.com did a good piece that included quotes from Dr. Lucy Puryear and Dr. Ruta Nonacs.   Nice job by ABC with a story on Good Morning America as well.  And here is coverage from Medscape and Medical News Today.  The Wall Street Journal Health Blog chose to go with a story angle about ECT for some odd reason.  Will keep you posted if I see more on this ...

For more from Postpartum Progress on depression during pregnancy, also called antepartum depression, click here.

Mayo Clinic Weighs In on Antidepressants During Pregnancy

Here's a section from the highly-respected Mayo Clinic on the issue of antidepressants and safety during pregnancy.  (Note: there are two pages, so don't miss the second page.)  It is a well-balanced piece that discusses the pros and cons.  Here's their conclusion, which is exactly what I've tried to put forth here at Postpartum Progress:

"If you have depression and are pregnant or thinking about getting pregnant, consult your doctor.  Sometimes mild depression can be managed with support groups, counseling or other therapies.  If your depression is severe or you have a recent history of depression, the risk of relapse may be greater than the risks associated with antidepressants.

It's not an easy decision.  As researchers continue to learn more about antidepressants, the risks and benefits of taking the drugs during pregnancy must be weighed carefully on a case-by-case basis.  Work with your doctor to make an informed choice that gives you -- and your baby -- the best chance for long-term health."

MGH: Using New Research to Inform Treatment Decisions During Pregnancy

The Massachusetts General Hospital Center for Women's Mental Health posted a new piece today called "Using New Research to Inform Treatment Decisions During Pregnancy: A Case Report".   I would imagine this could be very helpful to practicing physicians looking for guidance when it comes to psychiatric meds during pregnancy, so check it out MDs. 

Postpartum Progress' "Six Things" Series

If you hadn't noticed it yet, I've created a new series called Six Things.  You can find it on the left of your screen, directly underneath my picture. (Found it?  Good.) 

I decided to develop these documents as a "quick and dirty" way to let people know what I believe are some important things to understand about perinatal mood and anxiety disorders, which include depression and anxiety during pregnancy and in the 12 months postpartum.  These are brief Word documents that you can quickly download. 

If you or someone you know has time to read nothing else, hopefully these Six Things lists will help give you and those who care for you some clarity as you grapple with these illnesses.  These, of course, aren't the only six things you need to know.  You may have another six you'd like to share.  (If so, email me at stonecallis@msn.com). 

So far I've created a Six Things for Moms and Moms-To-Be, and a Six Things for Healthcare Professionals.  There will be more to come ...

Bumps In the Road: Warrior Mom Stories

So last week my kids were on Winter Break.  Did you have Winter Break when you were a kid?  I don't recall Winter Break, or Spring Break, or anything other than school and summer.  And why is it that the kids get a break?   I think grownups should get a break.  Thankfully, my parents have a house up in the mountains of North Carolina and we were able to take a free trip up there and go hiking and snow tubing.  The scenery is just beautiful and very reinvigorating. 

In the meantime, Warrior Moms from here and there are writing about their experience with perinatal mood and anxiety disorders.

Lauren at Sharing the Journey writes "A Little Slice of ... Normal?" about what it's like to be recovered.

Ivy at Ivy's PPD Blog writes about bad doctors, and shares the letter she wrote to hers.

Amy at Smelling God writes about how much perinatal mood and anxiety disorders hurt and why she chooses to speak out publicly about her experience.

Jill at Owner of the Band writes about her diagnosis of antepartum depression, or depression during pregnancy.

The mom at C Shell talks about her experience with postpartum psychosis and her fear it will come back any minute.

Strollerderby Readers Discuss Antepartum Depression

Check out the conversation between moms at Strollerderby about antepartum depression:  http://babble.com/CS/blogs/strollerderby/archive/2007/08/10/antepartum-depression-not-every-pregnant-woman-glows.aspx   There is quite a lot of sharing and support going on.  Great work, ladies. 

Calling All Warrior Moms

Hey ladies (and you gents lurking out there)!  2008 has nearly come to an end.  I've accomplished almost NONE of the things I wanted to, as usual, because there's just too much to do and nowhere near enough time.  But that's okay.  I still got a lot of other things done that I'm pleased with.  We just can't do it all, can we? 

Here's what I need to hear from you -- what do you want to see in Postpartum Progress in 2009?  Are there some new features you wish we had here?  Some functionality that you'd like to see improved or added?  Some information that you think is missing?  This site can't exist and remain fresh and helpful without your feedback.  

Are you are reader from another country who wishes there was more information specific to your culture and area?  Are you a sufferer of an illness on the spectrum that you feel doesn't get enough attention and want to see more info?  Are you a family member or friend who has ideas about how to better enlist your help when your loved ones are ill?   Are you a healthcare professional that wants to share best pratices?  Bring it on!

Please, please comment below or send me an email at stonecallis@msn.com.   If you don't share your thoughts and ideas, than I'll never know how I could have made Postpartum Progress more helpful to the people who need support and comfort ...

Dr. Shari Lusskin Interviewed on Oprah & Friends Radio with Dr. Oz

Dr. Shari Lusskin just appeared on the Oprah & Friends network on XM (and now Sirius as well) Radio on Dr. Mehmet Oz's show.  This is just fantastic.  What great exposure, and I'm so glad it was Dr. Lusskin who is one very smart cookie, a true expert and a great representative for all of us.  On the web page I've linked to above there is basic information, and then you can click a tab to listen to the 8-minute interview.  One topic of conversation was the issue of taking medication when pregnant.  

My only disappointment is that the interview was so brief, as I think the entire listening audience would benefit from further discussion. 

Postpartum Depression & Anxiety: The Waiting Is the Hardest Part

I can't tell you how many women I've spoken to lately who are worried and upset by the setbacks they experience while recovering from perinatal mood and anxiety disorders.  They have a string of good days and think they're finally getting better, and then they have a terrible day and feel that all is lost.  It's heartbreaking.

I know exactly how they feel.  I can remember starting to feel better after beginning my treatment.  I'd have a few good days and begin to glimpse peace.  I'd feel like I was turning the corner.  I'd have a sliver of hope, for goodness sake.  And then -- SLAM! -- the sadness, anxiety, misery and guilt would flood back over me.  I'd think to myself, "Of course.  How could I have been so foolish?  I knew I'd never get better.  I'll never be me again."  I'd be crushed with disappointment, and angry for even thinking I could ever get back to my old self.

I did get better, though.  In fact, I'd venture to say that the me who came out of my experience with postpartum OCD is even better than the me who went in.   It took a while, but that's the deal unfortunately.  Recovery from these illnesses is a process.  I wish it was like bronchitis or strep throat:  Call doctor.  Go to appointment.  Get prescription.  Take 1 pill twice a day with food.  10 days later, all better.  It isn't.  It can be scary to hear that, but it's better to know what to expect so that you can be patient with yourself.   

We all start out with more bad days than good, or perhaps even all bad days.  Then you have a few good ones here and there.  Then you start having more good days than bad.  Then one day you realize you've had only good days, for a long time, and you have this slow and cautious realization that maybe the sun has come out for good.

In the meantime, don't let bad days define you or defeat you.  It's okay to have them, and to feel the bad feelings.  Just don't let them convince you that the progress you've made up 'til now is gone.  You're still moving forward, even on bad days.  Just continue to do the things you need to do to take care of yourself.   

There is one thing you can do to help your recovery process along:  Don't take it over as though you are a healthcare provider.  The first time you feel better, don't decide to quit your meds (if you're taking them) cold turkey, or quit seeing your therapist (if you're seeing one) cold turkey, or quit asking for help or taking care of yourself or following whatever method of treatment you and your doctor have decided to follow.  This could impede your progress.  I know lots of people who decide they know better than their healthcare providers, and so they start making decisions as to what they should and shouldn't be doing without the counsel of trained professionals.  I don't think that's a good idea. 

If you feel like the professional you're working with isn't helping you or hearing you, that's different.  It's okay to go out and find another one.  But if you like the one you're with, don't ignore your physician's advice just because you've started feeling better, or because you've bought into the false belief that you should be over this by now, or because you've bought into the false belief that you should be able to get over this all on your own.  There is no set timetable for recovering from perinatal mood and anxiety disorders. And there is no law of nature that states that you're a better person if you can get over it all by yourself.  No one can get through life on their own without help, regardless of whether they're ill or not.  We all need support at some point.  It just happens to be your turn.

In the meantime, try and accept that you're moving in the right direction, even if you have a bad day.  Try and find inspiration and patience in your faith, or in music and literature, or in nature, or in speaking with women who have long since recovered, who know how you're feeling and who know you can get better. 

We know how hard it is to wait for the clouds to lift.  We know that there are ups and downs, and that it can take a while.  We'll wait with you.  You're worth it. 

Preterm Birth Twice As Likely for Depressed Pregnant Women

A new study published in the Oxford University Press journal Human Reproduction finds that depressed pregnant women have twice the risk of preterm delivery than pregnant women with no symptoms of depression.  The study was conducted by the Kaiser Permanente Division of Research. 

The study found that pregnant women with symptoms of depression have an increased risk of preterm delivery, and that the risk grows with the severity of the depressive symptoms. These findings also provide preliminary evidence that social and reproductive risk factors, obesity, and stressful events may exacerbate the depression-preterm delivery link, according to the researchers.

Because the majority of the women in the study did not use anti-depressants, the research provides a clear look at the link between depression and preterm delivery.

The study -- which is among the first to examine depression and pre-term delivery in a representative and diverse population in the United States -- looked at 791 pregnant Kaiser Permanente members in San Francisco city and county from October 1996 through October 1998.

"Preterm delivery is the leading cause of infant mortality, and yet we don't know what causes it. What we do know is that a healthy pregnancy requires a healthy placenta, and that placental function is influenced by hormones, which are in turn influenced by the brain," said lead author Dr. De-Kun Li, a reproductive and perinatal epidemiologist at Kaiser Permanente's Division of Research in Oakland.

"This study adds to emerging evidence that depression during early pregnancy may interfere with the neuroendocrine pathways and subsequently placental function. The placenta and neuroendocrine functions play an important role in maintaining the health of a pregnancy and determining the onset of labor," Li explained.

In addition to being the leading cause of infant mortality and morbidity, preterm delivery is also the leading medical expenditure for infants, with estimated annual cost of about $26 billion in the United States alone. Presently, other than a prior history of preterm delivery and some pregnancy complications, very little is known for its risk factors and origins.

See more about this, and coping with depression during pregnancy, online at U.S. News & World Report.

Will PPD Be on the Rise Due to Economic Downturn?

According to a study just released by the American Psychological Association, the Wall Street downturn has begun to impact the health of Americans.  As reported by USA Today, "Finances now overshadow the more typical daily stressors of work and relationships; 46% report being worried about providing for their family's basic needs."  What's worse, the poll finds that women are more significantly impacted than men.

We already know that financial troubles are a risk factor for antepartum and postpartum depression and anxiety.  So one has to wonder, given the current economic turmoil, whether we will see an uptick in the number of women with these illnesses.  I imagine that we might, and it would be good for healthcare providers to be aware of this.

Infertility & Depression from MGH

Here is an interesting article from Massachusetts General Hospital's Center for Women's Health on infertility and depression and why they may be linked.

Study Finds Antepartum Depression Contributes to Developmental Delays

A study conducted by the Centre for Child and Adolescent Health at the University of the West of England indicates that some of the harmful effects on early child development attributed to postpartum depression may be caused partly by antepartum depression, or depression during pregnancy.

"It is widely acknowledged that postnatal (postpartum) depression has a negative impact on child development but this is the first study that has demonstrated that the children of women who experience low mood during pregnancy are also at risk," said Deave.

Deave and colleagues found that persistent depression in the mother during pregnancy increased the odds of developmental delay in the son or daughter by 50 percent.  This study, they say, adds to "increasing evidence that the mother's mood during pregnancy is important" and that any persistent depression during pregnancy has the potential to raise the risk for developmental delay in childhood.

How to Use Postpartum Progress

You may be a new Warrior Mom who has just found Postpartum Progress, or someone who has been reading for a while but wants to learn about the various resources available in this blog.  You may have just been diagnosed, or be worried that you may have postpartum depression or a related illness.  Or, you may be a pediatrician, obstetrician, social worker or other clinician who works with moms and moms-to-be.  This blog is for all of you, and this page will help you find your way around.

Postpartum Progress is a blog about postpartum depression and related illnesses intended to provide hope and comfort to the women who suffer, as well as the people who care for them (family, friends, healthcare providers).  It features news, the latest research, a list of support groups around the country, stories from moms and fellow sufferers, and links to major support organizations and treatment programs. 

Below is an outline of some of Postpartum Progress' key features.

For Moms-to-Be & New Moms:

If you have been diagnosed, or think you may be suffering, from postpartum depression, postpartum anxiety, postpartum OCD, postpartum panic disorder, postpartum PTSD, postpartum psychosis or antepartum anxiety or depression, welcome.  I'm really glad to meet you.  I hope you will find a kindred spirit in this blog.

I cover every illness in the perinatal mood and anxiety disorder spectrum, so no matter what you're going through I hope you can find something here that gives you knowledge and comfort.

The "Help Is Here" section (on the right hand side of your screen, underneath the "Welcome" section) includes several important resources: 

• the "What's Wrong With Me?" description of all perinatal mood and anxiety disorders, including risk factors and symptoms
• a list of support groups around the U.S. and Canada
• a list of perinatal mood and anxiety disorder treatment programs in the U.S. and Canada, and
• a list of state and national organizations that offer a wide variety of local resources, services and information.  All of these may be helpful to you on your journey to recovery.  (Please note:  Many of these organizations and groups have "postpartum" or "postpartum depression" in the name, but that doesn't mean they don't serve women with other illnesses.  In fact, they are usually knowledgable of all illnesses across the spectrum and offer support services to everyone.  It's just that postpartum depression is the most widely known of all the illnesses, so that's the name they use.   The proper term for the entire spectrum is "perinatal mood and anxiety disorders" -- that pretty much covers us all.)

Surviving & Thriving Mothers Photo Album -- This fabulous photo album can be found on the right hand side of the home page screen, directly underneath "Help is Here" and above Readers' Favorites.  It features photos of women who have survived perinatal mood and anxiety disorders and their children.  I hope it serves as an inspiration to everyone going through one of these illness by showing that, with treatment, you can be a happy and healthy mom.  I look forward to adding your photo as well.  If you'd like to participate, email me a jpeg to stonecallis@msn.com, along with info on which illness you suffered, what year, and in which state you live.  I use only your first name and last initial.

If you're looking for specific information on a particular topic related to perinatal mood and anxiety disorders, check out the Categories section further down on the left of your screen.  We cover it all here, from Birth Trauma and Breastfeeding to Infertility and Intrusive Thoughts and everything in between.

The Readers' Favorites section (further down on the right hand side of your screen) includes links to the most popular posts I've ever written, based on reader feedback.  These were the ones that struck a nerve or have been most helpful or comforting.  I hope you'll feel the same way about them. 

Read Up (even further down on the right hand side) features a wide variety of books on our illnesses.  If you click on the book, it will take you directly to Amazon.com where you can learn about it, read reviews, and purchase it if you so choose.

As many moms do, you are also welcome to email me if you want to reach out, at stonecallis@msn.com.

For Healthcare Pros:

If you look in the Help Is Here section on the right hand side, you'll see a link to the Tools for Professionals page with a bit of helpful info specifically for you.  Check it out.  Plus, nearly every week I'm posting info on new research and on events that may be of interest to you.  To find them, scroll down the left hand side of Postpartum Progress until you see the Categories section. 
Some categories that may be of particular interest to clinicians:  Research, Obstetricians, Pediatricians, Effects on Children, Screening and Education & Training. 

If you are hospital that has created a special PPD program, someone with a support group or event related to perinatal mood and anxiety disorders, or a researcher looking for participants or announcing research results, please send your news to postpartumprogress@gmail.com so that we can cover it here.

For everyone:

I've created a series called Six Things.  You can find it on the left of your screen, directly underneath my picture.  These brief Microsoft Word documents are a "quick and dirty" way to let people know what I believe are some important things to understand about perinatal mood and anxiety disorders, which include depression and anxiety during pregnancy and in the 12 months postpartum.  If you or someone you know has time to read nothing else, hopefully these Six Things lists will help give you and those who care for you some clarity as you grapple with these illnesses.   

You can Search the entire blog with the search function (powered by Ligit).  It is on the left side of the blog, directly under the subscriber box.  Just type in the topic you're looking for (just like you would if you were searching on Google), and click search and it will take you to a list of posts from Postpartum Progress about that topic.

Home Delivery (on the left hand side, underneath Six Things) allows you to be a regular subscriber to Postpartum Progress.  Just enter your email address and click "Subscribe me!", and you're a subscriber via Feedblitz.  What does this mean?  In the morning, you will receive an email in your inbox with links to each post that I have written the previous day.  This way you always know what's going on without having to remember to visit the Postpartum Progress site every day.  FYI -- I have never, EVER shared the list of subscribers with anyone, so you won't be receiving unwanted email from anyone else.  Also, if you should ever decide you don't want to receive the emails any more, you can easily unsubscribe.

The Listed On section (further down on the left) is simply a list of some of the places on the web that feature Postpartum Progress or have highly ranked it among all internet health sites.  I'm very proud of those associations and happy to display my "blog bling".

I welcome comments on the posts I write.  Just click on the little "comments" link that can be found at the bottom of each post and let me know what you think, or if you disagree, or have a different idea.  And if you have a news tip or story idea, please email me at stonecallis@msn.com.  It is important to note that all commenters on this site are by default considered as non-medical professionals.  If you are a health professional and decide to offer medical information as a commenter, your status as a medical professional must be identified.  If you do make any medical claims, you must offer references or links to material(s) that would support those claims.  It is the policy of Postpartum Progress that all commenters behave at all times with respect and honesty. 

If for some reason you want to learn a little more about me, Katherine Stone, click on the About link and you'll probably get more info than you ever needed to know.  It's underneath my picture.  Just remember, I am not a healthcare professional.  I am simply a mom who has been through this.  Nothing on this site constitutes medical advice.  Postpartum Progress exists to provide peer support.

Again, I hope you find Postpartum Progress helpful and I'm really glad you are here.  God bless you.

P.S.  The Swiper, No Swiping! section (a reference to Dora the Explorer for those of you who don't know) on the left hand side of the blog is a reminder that Postpartum Progress has a creative commons copyright.  You may reprint the original content in this blog with permission, but it must not be altered in any way, and must be attributed to Postpartum Progress/Katherine Stone at http://postpartumprogress.typepad.com.

updated March 10, 2009

New Research on Risk Factors for Postpartum Depression

The Washington Post reported Monday that a new study in the Archives of General Psychiatry suggests that age, marital status, health status, stressful life events and history of traumatic experiences were all significantly associated with higher risk of psychiatric disorders in pregnant and postpartum women.

Overall, however, they found pregnancy itself is not associated with increased risk of the most common mental disorders. They did identify that women with a particularly high prevalence of psychiatric disorders, included those aged 18 to 25, living without a partner, widowed, separated, divorced or never married, and those who experienced pregnancy complications or stressful life events.

"Given the critical importance of this life period for mothers and their offspring, urgent action is needed to increase detection and treatment of psychiatric disorders among pregnant and postpartum women in the United States," the researchers wrote.

Urgent action indeed! 

Here is a link to the postpartum depression study in the Archives of General Psychiatry.

Available Journal Articles on Perinatal Mood Disorders

The Archives of Women's Health just published a study by Lee Cohen, Zach Stowe, Lori Altshuler and others on a screening scale for antepartum depression, or depression during pregnancy.  From Springerlink:

"There are currently no validated clinician-rated scales that assess for depression specifically during pregnancy. We sought to develop a brief, convenient screening tool to identify depression in pregnant women in the community setting. Prospective mood data using the 28-item Hamilton Depression Rating Scale (HDRS) were collected monthly in 196 pregnant women with a history of a major depressive disorder. These data were analyzed to delineate those HDRS items associated (elevated) with normal pregnancy vs. those indicative of a pregnant woman meeting diagnostic criteria for a major depressive episode. Endorsement of symptoms on seven items of the HDRS were highly predictive of having a major depressive episode during pregnancy. We present a well-validated, brief scale to screen pregnant women for clinical depression. Whether this study will generalize to women who do not have a history of major depression remains to be studied."

So there you have it.  I'm not exactly sure what all of that means, but what I did find out is that the Archives of Women's Health has several different studies/journal articles available for purchase on SpringerLink which should be of interest to clinicians, including:

• Desired assistance versus care received for postpartum depression: access to care differences by race
• An audit of pregnant women with severe mental illness referred during the first 2 years of a new perinatal mental health service
• The Edinburgh Postnatal Depression Scale detects but does not distinguish anxiety disorders from depression in mothers of infants
• The relationship between women's attachment style and perinatal mood disturbance: implications for screening and treatment
• Pregnant women’s cortisol is elevated with anxiety and depression — but only when comorbid

Also:

• from Current Psychiatry: Postpartum depression - What to tell patients who breastfeed
• from the Journal of Women's Health:  Screening for Depression in the Postpartum Period: A Comparison of Three Instruments
• from the British Journal of Psychiatry: Duration of antidepressant use during pregnancy and risk of major congenital malformations

More Mommy Bloggers Share Their PPD Stories

Here is a link to the Becoming Me blog where a mom opens up to share her story about antepartum and postpartum depression. 

And another GREAT PPD story from the Dig Your Toes In blog ... here is a highlight:

For me, PPD looked (looks) like this:

• Feeling off.  Just off.
• Feeling disconnected–from my life, from my kids, from my husband
• Feeling like I’m in a ‘fog.’
• Lacking joy.  Lacking joy in being a Mom, in little things that I normally love, in life in general.
• Guilt, guilt, and more guilt. 
• Just feeling down
• Having my ‘default’ attitude be negative and pessimistic rather than fairly optimistic
• Wanting to run away.  To sleep, to hide, to curl up in a ball.
• Shrinking when my children cried.
• Inability to focus
• “Escaping” often.  To the computer, to phone calls, to books, to anything to get me out of my ‘real life’ and my feelings.
• Snapping at my children very, very easily
• Feeling overwhelmed all the time
• Feeling like no matter what I just couldn’t get it all together.

And a link to the Unfolding... blog and another story about PPD.

Depression More Common in Women with High Risk Pregnancies

Here is a link to story fom the Center for Women's Mental Health blog on how common antepartum depression is in women with high risk pregnancies.

UCSF Hosting PPD Lecture & Training March 26-27

The University of California San Francisco, Community Medical Centers and the March of Dimes will be hosting "Shouldn't I Be Happy? What Everyone Needs to Know About Depression and Anxiety During Pregnancy and the Early Mothering Years" on March 26th at the UCSF Fresno Center.  The event will feature Dr.Shaila Misri, one of the leading reproductive psychiatrists in North America and founder and director of Reproductive Mental Health at St. Paul's Hospital and BC Women's Hospital in Vancouver, Canada. A training session will be held the following day from 8am to 2pm.  CME and CEUs are available.  Registration for the lecture is $20, and $30 for the training.  For more information, call 559-499-6532 or email shissong@fresno.ucsf.edu.

Sportscaster in Philly Shares Her Story of Antepartum Depression

Leslie Gudel, a sportscaster in Philadelphia (the first female sports anchor in Philly!!), was kind enough to send me her story about experiencing antepartum depression, which was first published in Philadelphia magazine in July of 2006 and written by Vicki Glembocki.  This is a great story for those of you looking for a kindred spirit when it comes to depression during pregnancy:

Leslie Gudel was 13 weeks pregnant with her second child. It was a Friday. She was sitting on the couch in her living room in Berwyn, watching her 14-month-old daughter Kendall toddle around and jump up and down, goading her mom to play with her. But Gudel couldn’t even think about playing. All she could think was Please sleep. Please lie down with Mommy. Please let Mommy sleep.

Wanting to sleep wasn’t so unusual; she’d been exhausted during her first pregnancy, too. But not like this. Gudel, now 40, wanted to sleep all the time. All the time. In fact, she really didn’t want to do anything else. She didn’t want to wake up in the morning. She didn’t want to talk to people, which posed quite a problem at Comcast SportsNet, where she worked as an anchor, going on the air every night at 6:30, needing to appear together and peppy and commanding whether she was tired or not. But all she wanted to do was sleep. And cry. And fight with her husband Jamie, who, when he left the house for work that morning, dressed in his state trooper gear, turned to her, utterly confused by her behavior, and said, “You don’t even like me. You have no interest in me at all. You don’t like me.”

Gudel had to do something. This wasn’t just pregnancy hormones knocking her out of whack, as she’d been trying to convince herself for weeks. This wasn’t a momentary dip in her mood. Pregnancy wasn’t supposed to be like this. She was supposed to be thrilled. On top of the world. Glowing. This wasn’t normal. She decided to pack up Kendall and head to the Shore for the night. Get a hotel room. Walk the beach. Sort this out. She could get over this. She could conquer it just as she had conquered everything her whole life, the way she played sports, mentally psyching herself up to run faster, to row farther, to win. She would just put her mind to it, figure it out, beat it down.

But before she called Jamie and told him where she was going, she decided to try one more thing. She turned on her computer, linked to Google, typed in “pregnancy and depression.” Omigod, she thought, as she scanned the results on the screen. One in five women experienced depression during pregnancy. (Why wasn’t there any discussion of this in What to Expect When You’re Expecting?) Gudel had almost all the symptoms — lack of motivation and focus, excessive fatigue, general malaise, though no thoughts about hurting herself or anyone else. At least, not yet.

She called her doctor right away.

“You have antepartum depression,” said Wendy Manko, her ob-gyn at Women for Women at Main Line Health. Firmly. Without hesitation, as though she’d had this call many times before. Because she had. At least 10 percent of the patients in her practice show signs of depression when they’re pregnant. And Manko had suffered from antepartum depression herself.

Of course, all women are at high risk for depression — twice as likely to get it as men — so why wouldn’t it sneak up during pregnancy, just as it does after? It was probably Brooke Shields and her book, Down Came the Rain: My Journey Through Postpartum Depression, as well as her public war in 2005 with Tom “Mr. Anti-Antidepressants” Cruise, that got everyone seriously talking about motherhood and postpartum depression, which actually doesn’t affect any more women than the antepartum type. But antepartum has been largely ignored. Until recently, most physicians simply dismissed any signs of emotional upheaval during pregnancy, which could be anything from severe impatience to loss of appetite to suicidal thoughts, and could be caused by anything from hormones to a history of depression to just feeling ugly and fat. Of course, as with all depression, the line between what’s expected as a part of life and what’s beyond expected is fuzzy.

“Doctors would say, ‘Everyone cries,’” explains Manko’s colleague Karen Kleiman, the executive director of the Postpartum Stress Center in Rosemont. “It’s almost patronizing.” And patients would be left wondering what was normal and what wasn’t, and how bad they had to feel before someone decided they needed help.

Apparently, Leslie Gudel was feeling bad enough. Manko called in a prescription: 50 milligrams a day of Zoloft, an antidepressant that, as a selective serotonin re-uptake inhibitor (SSRI), was considered safest for pregnant women and their babies, though there’s no definitive evidence that any antidepressants are totally risk-free, given that it’s difficult to conduct studies on pregnant women. The Zoloft didn’t kick in right away. The following week, when Gudel and her husband went to a friend’s wedding in Avalon, she sat next to another pregnant woman, a good friend of hers who was as glowing as glowing could be. Gudel couldn’t help but think I hate you right now. Her doctor had warned her it would probably take three or four weeks to get the full effect of the Zoloft. Even so, and despite the wedding incident, she already felt like a huge weight had been lifted off her shoulders. So did Jamie. Depression — that was something they could identify with. Something they could understand. Something that could be treated. And it was. Within a few weeks, Gudel felt like herself again.

Had Gudel called Dr. Manko this past spring instead of in 2005, however, her treatment might not have been so clear-cut. So far this year, two studies have challenged the safety of SSRI drugs for pregnant women. One says that almost a third of babies suffer through a couple days of withdrawal — fast breathing, jitteriness. The other says that taking SSRIs late in the third trimester may increase the risk of a newborn developing pulmonary hypertension, a severe, life-threatening lung disease — though the risk is still less than one percent.

“For the past several months, we’ve been looking at each other, asking ‘Now what do we do?’” says Nancy Roberts, chair of obstetrics and gynecology for Main Line Health. But she’s advising her staffers to do what they’ve always done: thoroughly research their patients’ health, find out if they have a history of depression, counsel them about their choices. Of course, ob-gyns aren’t experts in diagnosing and treating mental illness, which is why physicians at Main Line Health refer questionable patients to mental health professionals for evaluation.

“Obs often miss it,” says Karen Kleiman. “They’re not asking the right questions, because they don’t know what to ask, and moms aren’t telling them.” Conversely, she says, “Some obs are handing out Zoloft like it’s candy.” Kleiman thinks of antidepressants as a last resort (unless the patient is suicidal: “Then we don’t wait five minutes”). She and her staff will meet with the entire family, will try talk therapy, will try hypnosis. But in the end, she’s just as concerned about the fetus being exposed to depression as to antidepressants. Depression can cause premature labor or a low birth weight. Plus, pregnant women who are depressed don’t sleep well, don’t eat well, don’t take care of themselves — and all of that can, of course, adversely affect the baby’s development.

On October 5, 2005, at 8:25 in the morning, Leslie Gudel gave birth to a nine-pound, eight-ounce baby boy. They named him James Chase. He was perfectly healthy, a dream baby, happy all the time. Gudel stayed on the Zoloft for a while to ward off any postpartum, then started weaning herself off the drug when Chase was about seven weeks old — around the time she had drinks with her friend Gail Harrington, who’d given birth to her daughter Kira a month before.

“I was so depressed when I was pregnant this time,” Gudel told her.

“Me too.”

“You too?” Gudel asked. “I went on Zoloft.”

“Me too,” Harrington said, as surprised as she’d been in the doctor’s office a year before when she discovered that, yes, women have an increased risk of depression during pregnancy. Harrington was thinking she was going to have this great, happy experience when she was pregnant. Everyone expected her to have a smile on her face all the time. God forbid she would complain.

But Gudel wasn’t surprised. She was used to it by then. It seemed like everyone she confided in had experienced depression in one way or another; they were all on antidepressants or knew someone who was. No. What surprised Gudel — what continues to surprise her — was the response she got, again and again, when she explained her condition to friends and family: No one knew that antepartum depression even existed.

Postpartum Progress Opens Up To Guest Authors

Would you like to be a guest author on Postpartum Progress in 2008?  I have decided to open the blog up to some additional voices this year, as Postpartum Progress continues to grow. 

I've thought about doing this in the past, but haven't done it because I've been nervous about offending people if I edit them or choose not to use their articles.  But I've decided to ty and get over that for the sake of diversity.

You can submit your stories/articles to me at stonecallis@msn.com anytime throughout the year.  Here is how I will make choices about what will and won't appear on the blog:

1) Stories should run no more than 700 words.  I try to keep all my blog posts fairly short and easy to digest.

2) The article must be 100% relevant to Postpartum Progress and its readers, meaning it should be focused on postpartum mood disorders (postpartum depression, postpartum psychosis, postpartum OCD/anxiety, postpartum PTSD) or antepartum mood disorders.  As a reminder, Postpartum Progress is written to SUPPORT the women who have suffered or will suffer, and for their families and friends and those who treat them.

3) I will not run any article in which the writer is attempting to sell their product or service.  No shilling.  I will make an exception, however, for published authors of books focused on PPD and related-disorders if they would like to share an excerpt of their book of which they are particularly proud.

4) I will not run any article where I feel the story has already been done many times on Postpartum Progress, so it would help you to be very familiar with the site.  The subject should be a new and fresh take on the issues surrounding PPD and related disorders.

5) I welcome personal stories of people's experiences with PPD as long as they are fairly concise and well-written.  I also welcome brief summations from people who have been able to attend conferences or roundtables or other events that I have not been able to attend, as long as there is some interesting, newsy nugget of info that came out of the event.  And I welcome stories about newly published research as long as it comes from a highly-regarded source.

I hope this makes sense to everyone.  You will, of course, be credited as a guest author for your story, and should you have a blog or website I will be happy to link to it in your article.  I will try and respond back to each person who submits an article to either let you know that it will appear and when, or to let you know why I don't plan to use it.  If I don't reply back it may be because I get too overwhelmed.

Clinical Trial of Light Treatment for Antepartum Depression

This is a link to new and ongoing clinical trial which provides light treatments for depression during pregnancy at Yale University, Columbia University, and the University of Pittsburgh.

Results Out on Kaiser Permanente Study on Depression Before, During & After Pregnancy

According to a new study from Kaiser Permanente, more than one in seven women are depressed in the nine months before pregnancy, during their pregnancy, or in the nine months after giving birth.  Highlights from an article on the study on WebMD:

The new research expands on information already known about depression after childbirth.  "People have known for quite a while that postpartum depression is a serious, sometimes devastating event," says researcher Evelyn Whitlock, MD, MPH, senior investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. "One of the things we were able to do is look across the spectrum -- nine months before pregnancy, the nine months of pregnancy, and the nine months postpartum. I think this is the first study to do that" ...

The study, with an accompanying editorial urging more research, is published in the October issue of the American Journal of Psychiatry.

Whitlock and her colleagues evaluated 4,398 women, all members of the Kaiser Permanente HMO, who had given birth between 1998 and 2001.

Before pregnancy, 8.7% were identified as depressed by their health care providers; 6.9% were classified as depressed during the pregnancy, and 10.4% were depressed in the nine months after delivery. In all, 15.4%, or more than one in seven of the women, were depressed during at least one of the three periods.

About half of the women who had postpartum depression also were depressed before the pregnancy occurred or during pregnancy. More than half of those depressed before pregnancy became depressed during the pregnancy, suggesting the condition is not temporary or relieved by getting pregnant or by giving birth.

Whitlock also found that 93.4% of those with pregnancy-related depression had seen a mental health provider and/or gotten antidepressants. About 77% of women took an antidepressant before becoming pregnant, 67% during pregnancy, and 82% after giving birth. Since the study, reports of possible side effects of antidepressant use during pregnancy, including lung problems and heart problems in newborns, have been published. As a result, doctors emphasize that a careful evaluation of the risks and benefits is crucial before deciding on an antidepressant during pregnancy ...

Boston Globe Covers Antepartum Depression

At the Postpartum Support International conference, I was reminded over and over that ours is a spectrum disorder.  In a spectrum disorder the symptoms and characteristics can present themselves in a wide variety of combinations, from mild to severe.  As many of you know, you can experience postpartum depression, postpartum anxiety, postpartum obsessive compulsive disorder and postpartum psychosis.  One size does NOT fit all. 

One area that has gotten less focus, but is now beginning to get more attention, is antepartum depression, or depression during pregnancy.  Click here for a link to a good story on this by Jody Santos in the Boston Globe.

Depression During Pregnancy

Thanks to Katherine Cruise for sending me the link to this article in USA Today a few days ago about depression during pregnancy:  http://www.usatoday.com/news/health/2006-03-12-depression-pregnancy_x.htm

In terms of taking meds during pregnancy, I can only share my own experience.  As you know, I was on Cymbalta during pregnancy.  My daughter did not develop any heart defects or lung defects as far as I know, and she did not experience withdrawal.  She seems like a perfectly healthy and happy 1-week old.

This, of course, doesn't guarantee your outcome.  Each person and their situation is different.  It's important to talk to your doctor. 

Study busts pregnant and happy myth

I got this news from CNN.com yesterday: Study busts pregnant and happy myth. I give it to you here, now, verbatim:

CHICAGO, Illinois (AP) -- Pregnant women who stop taking antidepressants run a high risk of slipping back into depression, a study found, busting the myth that the surge of hormones during pregnancy keeps mothers-to-be happy and glowing.

The study offers new information but no clear answers for expectant mothers who must balance the risk of medications harming the fetus against the danger of untreated depression.

"It's important that patients not assume that the hormones of pregnancy are going to protect them from the types of problems they've had with mood previously," said study co-author Dr. Lee Cohen of Massachusetts General Hospital.

The study does not deal with postpartum depression -- the depression that sets in after delivery, and is often blamed on hormonal changes. The research looks only at depression during pregnancy, a condition far less understood.

No one knows how many pregnant women are on antidepressants, but it is safe to say millions of women of childbearing age take them. Medco Health Solutions estimates 8.4 million American women ages 20 to 44 take antidepressants.

Other research has shown risks to the fetus, including possible heart defects, from antidepressant use during pregnancy.

Researchers followed 201 pregnant women with histories of major depression who were taking drugs such as Prozac, Zoloft, Effexor and Paxil.

Because of ethical concerns, the researchers did not randomly assign the women to either stop or continue medication. Instead, the women decided what to do, then researchers watched what happened.

Sixty-eight percent of those who stopped taking antidepressants slipped into depression. They were five times more likely to suffer a relapse than the women who continued on drugs.

But staying on antidepressants did not shield expectant mothers from depression entirely; 26 percent of those who continued drug treatment became depressed anyway.

Dr. Katherine Wisner of the University of Pittsburgh School of Medicine said the study makes an important contribution by quantifying the risk of relapse. She was not involved in the study but does similar work.

"I was taught in my residency that women don't get depressed during pregnancy," said Wisner, who was a psychiatry resident in the early 1980s. But "I had patients who were depressed. I asked my supervisor, 'You mean I'm really not seeing patients who are depressed?"'

The study appears in Wednesday's Journal of the American Medical Association and was funded by the National Institute of Mental Health. Two of the co-authors declared in the paper that they have financial ties to several antidepressant manufacturers.

Other researchers have shown that antidepressant use during the last three months of pregnancy can make newborns jittery and irritable, and sometimes can cause them serious breathing problems. In addition, the Food and Drug Administration has warned that Paxil may be linked to fetal heart defects when taken during the first three months of pregnancy.

Dr. Peter Kramer, author of "Listening to Prozac" and "Against Depression," said the study provides information that can help women and doctors decide what to do.

"Ideally, everyone would like to go through pregnancy off all medication," Kramer said. "But these are serious issues, and both decisions can be justified."

Kramer suggested some women might want to get off antidepressants but schedule more psychotherapy while pregnant.

Copyright 2006 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

Tag: postpartum depression, PPD research