Postpartum Progress exists to provide peer-to-peer support. The information on this site is for educational, advocacy purposes only. It is not intended to diagnose or treat any medical or psychological condition. Please consult your health care provider for individual advice regarding your own situation.
"All study participants will receive a referral for treatment and an information pamphlet describing the symptoms of depression and anxiety, possible effects of depression on children and different types of treatments. Randomly assigned participants will also receive a brief, one-session Enhanced Motivation Intervention (EMI). EMI uses special interviewing techniques to identify and resolve a person's concerns about and practical barriers to treatment.
The researchers anticipate that EMI will result in more participants getting treatment for mental disorders compared with the control group. If successful, such interventions would not only benefit the depressed individual, but may improve the well-being of her children as well."
Since it is so hard to keep track of the research coming in almost daily on perinatal mood and anxiety disorders, I've decided to add a research page to Postpartum Progress. You can find it on the right-hand side of your screen underneath "Help Is Here", #5.
I won't be able to list every single piece of research that comes down the pike, but I will put links on that page to the most current, most interesting, most often cited research. I've created categories to try and organize it, such as Genetics & Postpartum Depression, Screening for Postpartum Depression, Risk Factors for Postpartum Depression, etc.
Hope this page is helpful to you should you need to find some specific data. If you know of a study that should be listed there and it isn't, please send me a link at postpartumprogress@gmail.com. And to my brainy, scientific-type, evidence-based medicine readers, if you see a study on there that you don't think is valid, tell me that too and I'll remove it.
A week or so ago I asked you to participate in a research survey over on MedEdPPD. You guys did a great job as they received quite a few responses. Now I've got another one for you. There are actually two versions of this survey, one for providers/clinicians and one for women with postpartum depression. The survey is completely confidential and no identification is required.
A psychiatry research team is planning a study to compare several treatments for women with postpartum depression. Before the study begins, they want to know which treatment options would NOT be acceptable to providers and patients. Once acceptable treatments are determined, the team will begin a study in which participants will be randomly assigned a treatment which will be administered for 8 weeks. Women whose PPD symptoms improve would be provided treatment for an additional 6 months.
Please help out this research team by taking the survey and forwarding it to relevant colleagues and fellow moms.
The survey literally takes just a minute or so. Five quick and easy questions.
If you were reading Twitter on the day this news came out, you might have seen this:
500%!
If you did see any of these headlines, and if you happen to be pregnant and on an antidepressant, then you were probably standing on a ledge somewhere with a loved one trying to talk you down. This is very scary stuff. So let's take a look at the study that led to those headlines and see what all this really means to you.
Notice the risk is for a very specific birth defect of the heart. Not "antidepressants are linked to heart defects" as many headlines read. Notice the increase risk is small, and there's no clear causation like the headlines infer. How much is the risk?
Of all women who give birth, .05% will have a child with a septal heart defect. Of all women who give birth who take a selective serotonin reuptake inhibitor -- a class of antidepressants commonly known as SSRIs -- during the first trimester, .09% will have a child with a septal heart defect.
The researchers also broke the data down further by taking a look at the increase in risk for specific SSRI antidepressants. They found no increase at all in risk for septal heart defects for women taking fluoxetine (Prozac) or paroxetine (Paxil). The risk went up one-half of a percentage point for those taking citalopram (Celexa), and one percentage point for those taking sertraline (Zoloft).
Is there an increase in risk of septal heart defect with certain medications? Yes. Do the researchers know why? No.
"Pederson and colleagues also could not exclude the possibility that something about depression itself, rather than the treatments, accounted for the increase in heart defects."
"Pederson and colleagues noted that variations in compliance or errors in records could have affected the findings. They also acknowledged that previous studies of individual drugs have not consistently identified birth-defect risks associated with SSRIs."
One of the experts I spoke with about this new research said "Unfortunately, statistics are always translated to make the results look as scary as possible, especially in pregnancy. It is called negative framing." In other words, saying there is a five-fold increase in the risk of a birth defect gets much more attention than saying that 99% of women will have a health baby.
"A recent Google search (June 23, 2009) using the keywords 'antidepressants, pregnancy' revealed 1,420,000 results, many describing how 'dangerous/harmful' antidepressants are to take in pregnancy, with many sites warning women not to take antidepressants if they are pregnant. Studies that do not find evidence for harm more often than not are ignored by the media, such as in the recent Vogue article that focused only on studies that reported adverse effects."
Even the Danish researchers agree with that statement as quoted in the WebMD story:
"The bottom line is the risk associated with SSRI use appears to be very small, and this has to be balanced against the very real risk associated with having untreated depression during pregnancy," study researcher Lars H. Pederson of Aarhus University tells WebMD.
This is rarely pointed out. There are risks NO MATTER WHICH DECISION YOU MAKE. Those who are vehemently against anyone taking antidepressants during pregnancy often leave out the fact that there are many risks to the children of women who suffer depression and choose to go untreated during pregnancy.
One finding of the study which does raise new concern, across everyone reporting, is that of women taking two or more antidepressants during the first trimester. Of the 400,000 cases that were part of the study, according to Medical News Today, 2,315 (.05%) of unexposed babies had septal heart defects, 12 (.09%) of SSRI exposed babies had septal heart defects, and 4 (2.1%) of babies exposed to more than one type of SSRI in the first trimester had septal heart defects.
"How does Pedersen and colleagues' study contribute to clinicians' and patients' decisions about the use of SSRIs in pregnancy, and how should this be weighed against the risks of non-treatment? The answer remains as before -- if an increased risk for major congenital malformations does exist, this study and others suggest that the absolute risk for the individual pregnant woman is very low. Furthermore, each of the more commonly used drugs in this class has been implicated in at least one study, so it is difficult to conclude that one SSRI is 'safer' than another ... Clinicians and patients need to balance the small risks associated with SSRIs against those associated with undertreatment or no treatment."
The answer remains as before. Talk to your doctor and work together to make the choice that is right for you.
I'm really excited to share with you that the current issue of the Journal of Clinical Psychiatry features a set of commentaries all focused on Perinatal Psychiatry. Read on, because there is a way that you can be a part of an interesting discussion on the treatment of women with perinatal mood and anxiety disorders, and I really want you to participate.
There are 9 commentaries, plus an introduction by Marlene Freeman, MD. Each is a short read and not too full of medical jargon, so for those of you who aren't clinicians I'm pretty sure you will be able to understand what they're saying. (No multilayer perceptrons here.) If you're wondering what a commentary is: Rather than being a paper on the results of a specific piece of research that is published in a medical journal, commentaries are more like op-ed pieces. The writers provide their observations and opinions, citing the research that forms the basis of these ideas. Here's one of the titles to whet your appetite: "Influence of the Media on Women Taking Antidepressants During Pregnancy" by Adrienne Einarson.
You can start posting your responses today in the forums, and later in the month the authors of the commenataries will offer responses to your comments and questions.
Anyone can participate; you don't have to be a doctor or in the psychiatric field. I would encourage all the Warrior Moms out there to read these pieces and share your own opinions or ask questions for clarification. (Just please be sure to be dignified and constructive if you disagree with something.) This is an important way to keep the lines of communication open between the medical field and the patient community. We don't always get to interact in this way so I really encourage you to take advantage of this. And of course the Journal would love to hear from my clinician readers as well!
It is free to participate but you will need to register for a free account in order to do so. Just click on the link in the above paragraph. For each article you can click "full text with forum" and it will allow you to read the piece and comment. The first time you try to do it, you will be asked to join the Net Society Platinum. Fill out the form and you'll be on your way. (Note for the consumers who sign up: for medical school graduation year, I clicked N/A. For profession I clicked other mental health. Once you fill out the initial form and submit it, you will then be taken to a page asking you if you want to subscribe to the Journal. You don't have to. You can scroll down to the bottom to find your name and login. It may ask you one more time if you want to update your profile. Once you're done I'd suggest closing the window and using the link above again, logging in and commenting away.)
Of that, there are a few grants that are related to perinatal mood and anxiety disorders, totalling less than one hundreth of one percent of the $5 billion. I guess it's better than nothing.
One is to research the effect of stress on adolescent pregnancies and perinatal outcomes at Columbia University ($854k).
I could probably already tell you what the affect of stress will be on adolescent pregnancies. You could probably tell me, too. I'm not expecting any surprises on that one, but whatever.
Another, awarded to the Mt. Sinai School of Medicine in New York, is for "Preparation and Patient Education To Reduce Postpartum Depressive Symptoms" ($841k). I'll be interested to see what comes out of that. There's also "Maternal Depression & Early Head Start" ($85k) at Boston University, though I think that's outside of the perinatal period, and "Detection & Care for Depression in the Peripartum" at the University of Pennsylvania ($52k).
Some things you can't change of course. Your ethnicity. Your finances. Your medical history. But other risk factors you have could potentially be positively impacted.
"The authors report that while some factors associated with depressive symptoms in the postpartum period are 'fixed,' such as race and past history of depression, some factors are potentially modifiable, such as level of social support and perceived self-efficacy around caring for an infant. The authors conclude that while more research is required, it is possible that intervening on these modifiable factors before the postpartum period could lessen the severity of depressive symptoms, or prevent their occurrence altogether, particularly among women at higher risk."
Better education. More support for new moms. There you have it.
So a new study came out last week that was ALLOVERtheinternet and Twitter about how Spanish researchers found a way to predict who will get postpartum depression. I saw the articles everywhere, but I waited to write about it because I wanted to understand exactly what the big new idea was before I covered it here.
In a published study, these Spanish researchers say they've figured out a way to predict 80% of postpartum depression cases, a method they say has higher accuracy than any other. As reported at US News & World Report:
"Early diagnosis of postnatal [or, postpartum] depression would make it possible to intervene to prevent it from developing among women at risk," Salvador Tortajada, a researcher at the Polytechnic University of Valencia and lead author of a new study on the methodology, said in a news release from the Scientific Information and News Service in Spain.
Per Psych Central, the researchers used artificial neural networks and extracted a series of risk factors highlighted in previous studies (stuff we already knew about):
the amount of social support for the mother
prior psychiatric problems in the family
emotional changes during the birth
neuroticism (a tendency to be less emotionally stable and more affected by stress than the average person)
genetic variations in the serotonin transporter gene (genes with high levels of expression lead to an increased risk of developing the illness)
I read as many of the stories online about this as I could find. They all pretty much parroted the press release from Spain but it was difficult to find much more than that. None of them had a link to the study. None of them explained to me how this method can or will be implemented in the real world. None of them explained how, once these women are identified, we can ensure they receive the proper treatment.
A multilayer perceptron is a feedfoward artificial neural network model that maps sets of input data onto a set of appropriate output.
Sorry. I don't speak Russian.
An artificial neural network is a mathematical model that tries to simulate the structure or functional aspects of biological neural networks. They can be used to model complex relationships between inputs and outputs or to find patterns in data. Feedforward refers to giving pre-feedback to a person or an organization from which you are expecting feedback.
Wha?
Are you lost? Me too.
Tell me more, you say? I can't. The article costs $25 euros and I just don't have $40 right now to spend on it. Besides which, I doubt I'd be able to understand a darn thing the paper says.
One thing I thought was odd, though:
They say they've discovered two protection factors that reduce the risk of getting postpartum depression - age (the older the woman the lower her chances), and whether or not a woman has worked during pregnancy (which reduces the risk). That seems strange to me, since I've known so many women who had PPD who waited until they were in their 30s or later to have kids, and so many women to who had PPD who had careers before they had them.
"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 participating women -- most of them first-time mothers in their 30s -- had a wide range of suicidal thinking, as the study examined the phenomenon of suicidality and its relationship to maternal mood, perceptions and mother-infant interactions ...
Seventeen of the 32 participants (53 percent) comprised the high suicidality group and the study found that those women were experiencing more sleeping and eating problems along with greater severity in overall struggles attributable to postpartum depression ...
Researchers also found that most of the women in the highly suicidal group held jobs before becoming mothers - a significant life changing experience where they left behind their working identify in a predictable and controlled environment where they felt competent, to the unpredictability of caring for a newborn. This dramatic change could have been enough to catapult them into severe postpartum depression."
The study offers ideas on how to assist these mothers in having more structured interactions with their babies. The authors suggest that the treatment of PPD should include working with the mother and child together.
Poor sleep after childbirth appears to be increase the risk of postpartum depression, according to findings published in the journal Sleep ...
Dr. Dorheim's group studied 2830 women who delivered at Stavanger University Hospital between October 2005 and September 2006.
The women reported that they slept an average of 6.5 hours per night. After adjusting the data for other significant depression risk factors -- including previous sleep problems, being a first-time mother, not exclusively breast-feeding, having a young infant or having a male infant, and stressful life events -- poor sleep was still associated with depression ...
"Women with postpartum depression may also benefit from treatment of sleep problems," she added.
Amen. One of the best "treatments" for sleep problems is that new moms are allowed to get at least 5 hours of uninterrupted sleep each night. The way we did that was that I would get up with the baby until 1 or 2 in the morning, and then my husband would take over after that. We'd go to bed early, and each of us would get a good solid stretch of sleep. You can also do a one or two nights on/one or two nights off plan. It can really help save your life. Sleep is SO important to mental and physical health, especially when you've just had a baby. Just because you have a newborn doesn't mean you're not allowed to get any sleep.
The University of Nevada Las Vegas Maternal Health Lab is currently conducting an internet-based survey on postpartum mental health and is seeking 500 postpartum women who have had a child within the last year and are at least 18 years old to participate. The survey is completely anonymous and takes approximately 30 minutes to complete. If you meet the criteria and would like to participate, please go to www.maternalhealthlab.com and click the Postpartum Moms link.
A new study presented at the annual meeting of the Endocrine Society shows that postpartum anxiety can lead to a delayed onset of puberty in daughters.
The study, conducted on mice by researchers in New Zealand, found that low levels of prolactin in early pregnancy causes postpartum anxiety. (Maybe that's what was wrong with me.) Puberty was delayed in the daughters even if they weren't raised by their birth mothers.
According to Newswise, late puberty in humans is linked to shortened height and psychological problems that can persist into adulthood.
Apparently Stowe made approximately $250,000 from his relationship with Glaxo. The paper reports that Stowe has been reprimanded and told he must eliminate all conflicts related to current federal grants. "In a statement, the school said Stowe had informed it of 'previously unreported activities and has disclosed his failure to abide by Emory policies.'"
This is very disappointing. It calls into question his research, regardless of whether it was or was not affected by this relationship. Is it possible to separate church and state and have federally-funded research that completely bars any additional funding from pharmaceutical companies? What is the issue with the cost of research or the amount that researchers are getting paid that makes them seek additional funding from sources that could compromise their work? Can't we ensure that people are paid well enough in their jobs that they don't need to seek this kind of questionable funding elsewhere? Ugh.
No matter how many he times he may say that this didn't affect his research results, it won't help because this damages his credibility, at least in the public arena. No matter how much good work he may have done. That is why this is so awful.
"About 13 percent of women suffer from the anxiety, hopelessness, desolation, and fatigue of postpartum depression (PPD) for the first 3 to 12 months of their children's lives. Yet, primary care physicians fail to recognize more than half of PPD cases, despite the availability of depression screening tools that can expedite diagnosis and treatment. Some women and clinicians may confuse PPD with "baby blues," which occur in more than 80 percent of mothers. However, baby blues begin within hours or days of delivery, are characterized by major mood swings rather than consistent depressive symptoms, and typically disappear 2 to 4 weeks postpartum.
While baby blues and minor depressive symptoms often clear spontaneously, PPD is a persistent form of major depression that develops within the first 2 to 6 months postpartum. Untreated PPD can devastate the mother (who loses her energy or joy in parenting), her child (who often has delayed psychological and cognitive development), and her family (with twice the risk of divorce within 2 years postpartum). In extreme cases, PPD can result in suicide and infanticide. Timely diagnosis and treatment of PPD can interrupt these cycles before damage to mother, child, and family become irreparable, explains Barbara P. Yawn, M.D., M.Sc., of the Olmsted Medical Center and University of Minnesota."
The National Research Council and Institute of Medicine of the National Academies are releasing a report at a public briefing on Wednesday, June 10 called "Depression in Parents, Parenting and Children: Opportunities to Improve Identification, Treatment and Prevention". The report will be released via a press conference at 1pm EST at the National Press Club in Washington DC.
It explores the interaction of depressed parents, parenting practices and its impact on children as well as strategies to promote effective interventions for widespread implementation in different service settings for diverse populations of families. The briefing will include the committee's recommendations for improving the quality of care for depressed adults and their children. The study was funded by the Annie E. Casey Foundation, the California Endowment, the Robert Wood Johnson Foundation, the U.S. Health Resources and Services Administration, and the U.S. Substance Abuse and Mental Health Services Administration.
Participants in the press conference will include William Beardslee of Children's Hospital in Boston, Frank Putnam of Cincinnati Children's Hospital Medical Center and Mareasa Isaacs of the National Alliance of Multi-Ethnic Behavioral Health Associations.
The briefing will be audiowebcast for those who cannot attend. Both the webcast link and the form for submitting questions via email will become available at the time of the event at http://national-academies.org.
I wonder whether this report will just reinforce the need for the Melanie Blocker Stokes MOTHERS Act ...
"Not only can postpartum depression interfere with a new mother's ability to care for her newborn, it can be confusing and misunderstood by the woman and her family," Rupp said. "My colleagues and I will be investigating whether oxytocin, a hormone that reduces the physiological stress response and promotes social bonding, buffers new mothers against depression through its influences on their neural responsiveness to stress, and whether this process is disrupted in some way in women suffering from postpartum depression."
The mechanism for altered neural responsiveness in the postpartum period may involve oxytocin, which also occurs at higher levels in new mothers. It is hypothesized that this makes the new mother less affected, generally, by negative stressors from the outside world, but more responsive to her infant.
The study will involve three groups of women -- new mothers who are not depressed, new mothers with PPD, and women who have never given birth. Using fMRI technology, Rupp and her colleagues will compare brain activity in the three groups in response to a series of images. Some of the women will also receive an oxytocin nasal spray. The study results will provide a better understanding of brain activity in women with postpartum depression, and the role of oxytocin in the early stages of motherhood.
I missed out on telling you about a lot of study results and articles that have come out in the last several weeks while I was getting ready for the Mother's Day Rally for Moms' Mental Health. So here goes ...
"Thus, all things considered, on the basis of the findings from the methodologically sound and rigorous study of Wisner et al. and the evidence available from long-term studies, this author thinks that the risk of untreated major depression outweighs the risk of effects of SSRI treatment on neonatal outcomes."
Findings of the study, conducted by U-M sleep expert Roseanne Armitage, Ph.D., are significant because they show that sleep and biological rhythms disturbances persist at least through the first eight months of life in the infants of depressed mothers.
Results indicate that infants born to mothers with depression had significant sleep disturbances compared to low-risk infants. The high-risk group, those with moms suffering postpartum depression, took up to 2 hours more to settle for night time sleep, woke up more often and had more daytime sleep than infants who were born to mothers without depression at two weeks and 30 weeks postpartum.
“We think we may have identified a vulnerability in the initial entrainment of sleep and circadian rhythms that may elevate the risk for these children to develop later depression,” Armitage says. “Our task now is to determine if it is modifiable. Can we reverse the effects and reduce the risk of developing later depression by enriching sleep and circadian rhythms in infancy? ”
The Northwestern University Stress and Depression Laboratory is conducting research on the risk factors for postpartum depression. They are looking for study participants in the Chicago area who are pregnant, in the second trimester and have depression but are not on antidepressants. Compensation is $140 for two visits in addition to $20 for each visit to cover parking and transportation. For more information, please contact 312-926-7510 or NUsadlab@gmail.com.
The Massachussetts General Hospital Center for Women's Mental Health is conducting a new study titled "Escitalopram (Lexapro) for the treatment of postpartum depresson". It is a 2-month open label trial of Lexapro for women who have been feeling depressed and anxious since giving birth. Women would need to be able to go into the Boston office 5 times over a period of 2 months. If you are between the ages of 18 and 45, gave birth within the past six months, began to feel depressed and anxious within 3 months of giving birth, are not currently taking an antidepressant and are not breastfeeding, you may be eligible to participate in this research study evaluating how an FDA-approved antidepressant helps treat depression after childbirth. Women who participate will receive study medication and evaluations of their mood at no cost and will be compensated up to $150 over the course of the 8-week study. For information call 617-724-6989 or email kdonovan8@partners.org.
A study came out yesterday confirming that women who have multiples are at a higher risk for postpartum depression. This new study, conducted at Johns Hopkins and appearing in the journal Pediatrics, found that these mothers are actually have a 43% higher risk. What we still don't know for sure is why. As reported on MedPage Today:
"[The researchers] said their work was limited in identifying mechanisms for the increased risk of depressive symptoms among mothers of multiple births because of a lack of data on psychosocial covariates of maternal depression such as spousal support and marital relationship.
The researchers said, too, that little documentation is available regarding hormonal changes and dysregulation in women associated with multiple births. They were also not able to factor infertility treatments into the analysis.
Although we do know that infertility puts moms in a higher risk category for PPD as well.
The study found that a higher proportion of Hispanic and Asian women participated on the Internet compared to the in-person study. (Interesting!) It also found that the PDSS had excellent "internal consistencies and construct validity", which I think means it was very effective no matter how it was administered. The Internet sample also reported more risk for major postpartum depression (PPD) compared to the community sample (23% vs. 12%). They concluded that the Internet is a viable and feasible tool to screen for PPD.
I just love this place! I'll be adding this study to the speech I give on how women with perinatal mood and anxiety disorders use the Internet. If you're interested in having me speak at your event, let me know! (Plug. Plug. Plug.)
According to the Materna & Child Health Bureau, the perinatal depression initiative was launched to increase the number of women who sought treatment, increase the number of providers who recognized the signs and symptoms and provide screenings. The Yale researchers, according to the abstract, found that "universal screening and support for treatment referral by paraprofessionals did not reduce the overall rates of depressive symptoms of perinatal women who received care at publicly funded obstetrical clinics." They suggest that future screenings should engage women more severely affected by these disorders. From what I can tell, but I can't be sure, they didn't use the Edinburgh Postnatal Depression Screening Scale to identify the women, so I'm wondering if the screening tool was part of the problem. Just curious. I'd like to know more about this.
Someone out there who loves me and who has a subscription to Psychiatric Services could be a real hero and send me the full texts. ;-)
For you researchers out there, NARSAD is accepting applications for the Independent Investigator Award in Mental Illness Research. The deadline is March 2. The applications are for investigators seeking support during the critical period between initiative of research and the receipt of sustained funding. The program provides a 2-year award of up to $50,000 per year to scientists at the associate professor level or equivalent who are clearly independent and have won national competitive support as a principal investigator. The program is intended to facilitate innovative research opportunities.
Perinatal anxiety — unhealthy distress experienced during or soon after pregnancy — is the subject of a major new study being conducted by psychologists at the University of North Carolina at Chapel Hill and Florida State University.
“We call perinatal anxiety the hidden disorder,” said Jonathan Abramowitz, Ph.D., co-principal investigator for the study, associate professor of psychology and director of the Anxiety Disorders Clinic in UNC’s College of Arts and Sciences.
“About 60 to 70 percent of new mothers and fathers have these kinds of thoughts,” he said. “It’s normal to think these things, dismiss them and move on. But when you can’t control your thoughts, or they interfere with your sleep, your health or your ability to care for your baby, then you may need help.”
In some cases, such anxiety results in panic attacks (perinatal panic disorder). In the most serious cases, parents may become obsessed with senseless, intrusive negative thoughts which they can’t seem to control no matter how hard they try, Abramowitz said (pregnancy and postpartum OCD). “They may begin to worry about all kinds of things: What if the baby dies during sleep? What if I lose control and harm the baby? What if I do something terrible to the baby? Worse, they may feel scared and confused about what these thoughts mean — fearful that they will act on these obsessional thoughts.”
The researchers in this study will be looking at how effective cognitive behavioral therapy (CBT) is in treating perinatal anxiety. All participants in the six-week study will receive helpful childbirth counseling as part of free weekly prenatal classes. Half of the participants will receive elements of CBT as well. Those who complete the study will also receive a modest fee at the end. First-time pregnant women over the age of 18, and their partners, can learn more and complete a screening questionnaire online at www.babyprepstudy.com.
For the study, the researchers examined medical claims data from more than 11,000 pregnant women enrolled in New Jersey's Medicaid program from July 2004 to September 2006. The data covered six months before to one year after the women gave birth.
"What our study found is pregnant women and new mothers with diabetes have nearly double the chance of experiencing postpartum depression compared with those without diabetes," said Harvard Medical School's Katy Backes Kozhimannil, one of the study's authors. This link remained consistent across all types of diabetes, including type 1, type 2 and gestational diabetes, which develops during pregnancy.
The researchers caution that these findings do not establish that diabetes causes postpartum depression, only that the two are related.
What to take away from this study: If you have any form of diabetes and are pregnant or plan to become, you should talk to your doctor about ways to prevent or plan for perinatal depression. You should also know that not every woman who has diabetes gets postpartum depression.
They found that the incidence of psychotic illness peaks immediately following a first childbirth, and almost 50% of the cases of postpartum psychosis were women without any previous psychiatric hospitalization.
They also found that, among women without any previous psychiatric hospitalization, those who had their babies at the age of 35 or older had a higher risk of getting postpartum psychosis.
Additionally, they found that most of the psychosis cases appeared in the first month after chilbirth, with 32% of the cases being hospitalized within 7 days after birth, and 59% hospitalized within 14 days, reinforcing the fact that postpartum psychosis usually has sudden onset.
I agree with Dr. Grohol's assessments, but I believe there is another significant contributing factor to the lack of screenings: Many docs don't have psychiatric resources available to offer a patient should her screening test indicate the need for professional treatment.
This story from last week in the St. Cloud Times points out a problem we have around the country: a lack of mental health professionals that is leading people to long waits or no treatment at all. We have even fewer healthcare providers with any kind of training or experience treating women with perinatal mood and anxiety disorders.
"Angela Broska-Smith is a clinician at St. Cloud Hospital's Recovery Plus who suffers from anxiety. She had to go to a primary care physician for medication.
'I had postpartum depression, and I started using medication that had been prescribed for pain ... and things got worse and worse until I ended up in a substance abuse program,' said Broska-Smith, who formerly worked at Lutheran Social Service.
She is worried others who struggle with mental health issues can't afford the time off, or the expense of travel, to find an available psychiatrist."
"We found a hormone that is produced by the placenta during pregnancy that is a good predictor of postpartum depression," says lead author Ilona Yim, a psychologist at the University of California in Irvine. Using blood tests to measure this hormone might one day help doctors identify mothers-to-be at risk for postpartum depression (PPD) ...
Yim and her colleagues followed 100 pregnant women in southern California throughout their pregnancies and for approximately nine weeks after their babies were born.
The researchers at five intervals tested their subjects' blood levels of placental corticotropin-releasing hormone (pCRH), a hormone that normally climbs during pregnancy to prepare the body for birth and that they suspected might be linked to PPD.
About nine weeks after each woman delivered, the scientists asked each one to complete a survey on whether she had any PPD symptoms. The researchers discovered that the women who developed PPD all had a surge of pCRH on or around their 25th week of pregnancy; 75 percent of the 16 women identified with the condition had more than 56.86 picograms per milliliter of pCRH in their blood compared with only 24 percent of those who did not develop PPD.
Yim says she's optimistic that further research may confirm her findings and that pCRH may one day be used to predict postpartum depression."
It would be supremely fantastic if we could just take a blood test, find out we are at high risk for PPD, start whatever treatment program is indicated before PPD ever arises and prevent the damn nightmare from occurring in the first place. Prevention, prevention, prevention!
Some preliminary research presented at the Society for Maternal-Fetal Medicine meeting found that female victims of domestic violence have a 40% increased risk of developing postpartum depression, a cross-sectional study showed.
Those who suffered intimate partner violence in the form of physical or sexual abuse or stalking as an adult were significantly more likely to develop postpartum depression than women who did not experience any abuse. Women who said they were physically or sexually abused as a child also had a higher risk of postpartum depression, according to Matt Garabedian, MD, MPH, a maternal-fetal medicine fellow at the University of Kentucky in Lexington.
The University of Las Vegas Maternal Health Lab, under the guidance of Dr. Chandler Marrs, is conducting two internet-based surveys on postpartum mental health and parenting. They need YOUR participation. Each survey is completely anonymous and takes 15-30 minutes to complete. Data from these surveys will be used to develop postpartum mental health assessment scales for new moms and evaluate parenting stress in new dads.
They need 500 postpartum women and their partners, who have had children within the last year and who are 18 years and older to complete the survey. Please go to www.maternalhealth.lab and click either the Postpartum Moms or Postpartum Dads links to take part.
Please share this with anyone you think may be interested in participating.
A group of undergraduate psychology students at the University of Mary Washington are conducting an online survey on the level of women's knowledge about postpartum depression.
"We believe this is important research as studies have shown that the amount of knowledge that women have about Postpartum Depression can greatly impact the likelihood that those who are afflicted will seek help."
Click here to participate. It is open to all women, not just those who have had PPD.
"Mothers who received this support were at half the risk of depressive symptoms 12 weeks after delivery," says study leader Cindy-Lee Dennis, PhD, Canada research chair in perinatal community health at the University of Toronto ...
The study included 701 women at risk of postpartum depression. Half got standard postnatal care and half got peer support. With standard care, 25% of the mothers had significant depressive symptoms 12 weeks after delivery. About half as many women who got peer support -- 14% -- had such symptoms.
After an extensive review of existing research, Dennis saw that efforts to prevent postpartum depression were most effective if begun soon after a woman gives birth -- and if they were home based.
But that's a problem: In Canada, as in the U.S., it's uncommon for health care workers to routinely visit families at home once they and their babies leave the hospital.
Dennis' solution: Recruit women who overcame postpartum depression, give them very brief training, and have them make regular telephone calls to at-risk women from two to 12 weeks after they gave birth.
"So we recruited mothers from the community who felt they had themselves experienced postpartum depression, so they know what it is like," Dennis tells WebMD. "Mothers are more willing to disclose their feelings to another mother who knows what it is like than to a doctor or nurse."
Training of the peers was intentionally brief.
"You don't want to overtrain them and make them paraprofessionals -- that would change the dynamics of the relationship," Dennis says. "We mostly talked with them about how to establish a relationship over the telephone and how to provide support. And we taught them how to identify depression so they could refer depressed women to professional care."
The peer support was intended not to replace professional help, but to serve as a link between communities and the health system.
I think it's just fantastic that a free and non-medical intervention can be of such help. If you're looking for a support group, you can go to the PSI Resources page or stop by the support group list here at Postpartum Progress. PSI's warm line is 1-800-944-4PPD.
I don't know. I think I'd put this in the category of "Did they really need to spend money on research to figure this out??" I suppose I shouldn't be a pain in the butt about it, but it feels obvious. Anyway, ignore me and read on:
Sleep deprivation can hamper a mother's ability to care for her infant, as judgment and concentration decline. Sleep-deprived mothers also may inadvertently compromise their infants' sleep quality because infants often adopt their mothers' circadian sleep rhythms.
All new mothers experience some sleep loss following childbirth, as their estrogen and progesterone hormone levels plunge. They typically spend 20 percent more of the day awake than average during the first six weeks postpartum. Postpartum women wake more frequently and have less dream sleep than non-postpartum women, with women in their first month postpartum spending only 81 percent of their time in bed actually sleeping. Neurotransmitters that influence sleep quality also affect mood, raising sleep-deprived mothers' risk for depression ...
Study author Bobbie Posmontier of Drexel University compared sleep patterns of 46 postpartum women, half with symptoms of PPD and half without. Sleep patterns were monitored for seven consecutive days. Results showed that mothers suffering from PPD took longer to fall asleep and slept for shorter periods. The worse their sleep quality, the worse their depression.
Posmontier recommends clinicians treating women for PPD to address the importance of adequate sleep. 'Mothers can develop a plan to have other family members help care for the baby at night,' she said. 'They also should practice good sleep hygiene. That includes going to bed at the same time every night, avoiding naps and steering clear of caffeine, exercise, nicotine and alcohol within four hours of bedtime.'"
I completely agree with the issue of sleep management for any new mom, but especially those moms who have a perinatal mood or anxiety disorder. My husband and I had a plan: I stayed up with the baby two nights in a row, and he stayed up with the baby the next two nights while I slept in a room without the monitor. And yes, he had a job to go to in the morning. But he sacrificed so that our whole family could be healthy as soon as possible. Let me tell you, a full night's sleep does a lot for your ability to cope. Husbands out there: You can balk now if you want to, and not stay up to help with the baby. But if you do, you may pay for it later with a completely incapacitated wife. Remember, the vow reads "in sickness and in health."
"About 60% of whites with symptoms of depression had received treatment in the past year, compared to only 41% of blacks and about a third of Asians and Latinos, in one new study, published in the November issue of Psychiatric Services ...
Nobody knows exactly why minorities receive less treatment for depression. The Harvard researchers speculate that blacks, Latinos and Asians may mistrust mental health care workers, feel more stigma linked to emotional problems or lack the insurance or funds needed for treatment ..."
Those of you who are aware of great programs out there for underserved communities, please reach out to me. I want to write about the work people are doing to help women with perinatal mood and anxiety disorders who are economically disadvantaged, those without insurance, those who speak English as a second language, etc.
The paper also reported that a separate study has found that as many as 17,000 late-onset cases of postpartum depression go undetected each year in Britain. The results are due to be published in the Bipolar Disorders journal.
They are seeking participants who have symptoms of postpartum depression. Participants are offered a free 12-week treatment and will be seen by a psychiatrist or a treatment therapist and may be compensated up to $205. For information about the Treatment Study for Women with Postpartum Depression, please contact Sarah Sullivan, research assistant, at (401) 274-1122, extension 7052, at (401) 369-6908, or at sasullivan@wihri.org.
A small study in England published in the journal Family Practice finds that women with postnatal (aka postpartum) depression have negative views toward antidepressants. Only over the course of the illness, through time and contact with others including health professionals did their views change. The study concluded that doctors should assess women's concerns about meds prior to prescribing them and should provide regular follow-up for women on medication.
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.
The first will explore the benefits of treating PPD with estrogen. Women who think they might currently be depressed and have given birth within the last 6 months are encouraged to participate. Women participating in this study may help to advance a treatment that could alleviate their own symptoms and may someday lead to a new standard of care for postpartum depression.
The second study is for women with a history of PPD. Healthy individuals without a history of postpartum depression are also needed to serve as controls. Participants in this study will go through a “simulated” pregnancy by taking a course of hormones that mimic the experience of pregnancy in an abbreviated time frame. Participants will be evaluated and monitored for signs of depression. This will help researchers determine how and to what extent fluctuating levels of hormones during pregnancy can influence mood and behavior.
The women in this study will learn whether they may experience PPD following a future pregnancy. Women who are interested in participating in the trial or who would like more information should contact NIMH at (301) 496-9576.
"As more women opt to wait until they are older to have children, and by association be more likely to have a caesarean section delivery, these results are important because they could provide better understanding of the basic neurophysiology and psychology of parent-infant attachment," said Dr. James Swain, one of the study's authors.
IMPORTANT: As was noted in the article on this study on WebMD, "Don't panic or think you did the wrong thing by having a C-section because it may be that these differences are just in the initial phases and it may take the oxytocin awhile to build up after a C-section delivery. Or maybe C-section moms may make up for it later with normal cuddling and hugging and nursing," Swain says.
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.
A new site was launched earlier this year by the National Library of Medicine to provide consumers with the latest information on significant topics in women's health research. I didn't even know there was a National Library of Medicine. These nice people have created a one-stop resource so that you won't have to visit a variety of websites, including PubMed, MedlinePlus and ClinicalTrials.gov, to get the research info you're looking for. The Women's Health Resources site can be found at http://sis.nlm.nih.gov/outreach/womenshealthoverview.html. Here's the specific women's mental health section: http://sis.nlm.nih.gov/outreach/womenshealthtopicsnlm.html#b011.
Cheryl Jazzar has shared with me that Kathleen Kendall-Tackett and Thomas Hale, in conjunction with the Texas Tech University Health Sciences Center, are conducting a new online survey about mothers' sleep and fatigue. The study is open to all mothers with babies 0-12 months old. They would like to include breastfeeding and non-breastfeeding women, as well as women of all ethnicities and income levels. They hope to document:
Where and how much babies sleep
Whether mothers who breastfeed and co-sleep are more or less tired than mothers who don't
Whether mothers tell their friends, relatives and healthcare providers where their babies sleep
If there are ethnic group differences in where babies sleep
The role of depression, psychological trauma and difficult birth in mother's ongoing daytime fatigue
The online questionnaire takes 20 to 30 minutes to complete and is confidential. Click here to participate: http://neonatal.ttuhsc.edu/lact
A reminder that any woman who gives birth at Magee-Womens Hospital in Pittsburgh can participate in a five-year, $2.5 million study funded by the National Institute of Mental Health, the only large-scale research screening program in the country.
Mothers who score more than 10 points on a postnatal depression screening scale are eligible for home visits and referrals to mental health and other support services, according to Dr. Katherine Wisner, director of the Women's Behavioral HealthCARE program at Western Psychiatric Institute and Clinic and a leader of the study, which has served nearly 5,000 women since its inception two years ago.
How This Site Can Help You This is the most widely-read blog in the U.S. on depression & anxiety during pregnancy & postpartum. It is aimed at women who suffer & the professionals who care for them. To learn about the resources available here, click the link above.
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