Postpartum Progress

Study Finds Edinburgh Postnatal Depression Scale Effective For Identifying Women At High Risk for PPD

The Journal of Women's Health reported this week the results of research comparing three screening instruments used to identify women with postpartum depression during the first 6 months after delivery -- the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9) and the Postpartum Depression Screening Scale (PDSS). The study, conducted by the University of Pittsburgh, concluded that administering the EPDS by phone at 6-8 weeks postpartum was an efficient and accurate way to identify women at high risk for PPD.  For more information, click the link above.

NIMH Seeking PPD Study Participants

The National Institutes of Mental Health is continually looking for people in the Maryland/DC/Virginia area to participate in research studies on postpartum depression and related illnesses.  Their studies are currently looking at the role hormones play in PPD.  As Annie Shellswick of NIMH explains:

"Many women have planned for their pregnancies, have a track record of success in life, have no history of depression .... and then, WHAM!  Unanticipated PPD. We think this may be caused by an abnormal sensitivity to a very normal change of hormones that effects a subgroup of women.  We need women to participate in the studies to find the answers."

Please consider participating if you live in the area, because research is so important to identifying the causes and best treatments.   For more information you can call Annie at 301-402-9207 or visit http://patientinfo.nimh.nih.gov/womensdisorders.aspx.

MOTHERS Act Losing Momentum -- Online Petition Needs Your Signature

It's time to talk about the Melanie Blocker Stokes (MBS) MOTHERS Act again.  I know, I know.  We've heard this all before, you're thinking.  I already called my Senator, you're thinking.  I already wrote about this on my blog, you're thinking.  Sheesh!, you may even be thinking.  Well, apparently everything you and I have done so far in support of this bill hasn't been enough. 

As you may know, there are some people who are completely convinced that the MBS MOTHERS Act is a conspiratorial plot by the government to drug pregnant and postpartum women, and it must be STOPPED AT ALL COSTS!!!!!!!!!!!!!!!!  You and I know that's not true.  So we've kind of ignored the negative campaign -- been slightly pissed and sometimes even truly annoyed but gone on with our day because it's silly and we have lots of more important things to worry about than some misguided folks.  But the U.S. Senate can't ignore it when lots and lots and lots of people speak out.  That's how they work, right?  Polls.  When they hear from lots of people on a certain issue, they tend to go in that direction.  Right now our Senators are hearing from a whole host of people who think it's a really bad idea to pass this bill -- a bill that provides funding for increased research into the cause and treatments of postpartum mood disorders, provides better training for healthcare providers and provides for an awareness campaign so that more women will know about these illnesses and realize that they can get help. Those people, bless their hearts, are very vocal and have every right to say what they think. (Tom Cruise must be very pleased.) 

Conversely, those who believe in the MBS MOTHERS Act are not being anywhere near vocal enough. Our Senators are NOT HEARING from enough of those of us who support it.  If this trend continues, this bill will not pass.  What happened to us, and to hundreds of thousands like us, and to our friends and sisters and mothers and girlfriends will keep happening.  Women will continue to think they've gone crazy, never to return to their old selves.  They will continue to live in fear of speaking up and telling someone about it.  They will continue to be afraid to lose their children.  They will continue to suffer, hurting both their health and the health of their children, because they won't get treatment.  Some might even kill themselves, or become so ill they harm their children.  That is unacceptable to me.  Is it acceptable to you?  I started this blog because I was damn well not going to let anybody go through the isolation and terror and ineffective treatment from an untrained doctor that I received.  Don't you feel the same? 

Postpartum Progress readers, and anyone who cares about postpartum mood disorders, I very humbly beg you to complete two very easy assignments:

1.  Click this link and sign this petition to support passage of the MBS MOTHERS Act.  It is as easy as pie.  Thanks to the Depression and Bipolar Support Alliance for getting the petition going.  All you have to do is fill out your name and address and click send, and it will be sent all the proper places.   The petition is also supported by Postpartum Support International.

2.  Forward the petition link to everyone you know and tell them to sign their name to it as well.

We need thousands of people to do this.  Not just a few hundred.  Seriously, thousands.  Please get clicking. And if you have a website, or an organization of proactive women and moms, or a blog, please get your readers/members involved ASAP.

P.S.  In case you're wondering, here is a list of the respected organizations that endorse the Melanie Blocker Stokes MOTHERS Act:

• Postpartum Support International
• Association of Women's Health, Obstetric and Neonatal Nurses
• American College of Obstetricians and Gynecologists
• Children's Defense Fund
• March of Dimes
• American College of Nurse Midwives
• Suicide Prevention Action Network USA
• Mental Health America
• Depression and Bipolar Support Alliance
• National Alliance on Mental Illness
• National Women's Law Center
• National Partnership for Women & Families
• National Council for Community Behavioral Healthcare
• Association of Maternal and Child Health Programs
• American Psychological Association
• American Psychiatric Association
• Postpartum Resource Center of New York

If you would like to add your organization to this illustrious list, please let me know at stonecallis@msn.com.  (They can't all be part of the conspiracy to drug America's moms, can they???)
 

CDC Releases Latest Statistics on PPD Today

Per Miranda Hitti at WebMD, the CDC today issued its latest statistics on postpartum depression, and the figures show that certain groups of women may be at higher risk.  The CDC's report included more than 52,000 new moms in 17 states. The prevalence of self-reported postpartum depression ranged from 11.7% in Maine to 20.4% in New Mexico.  Postpartum depression was more often reported by teenage moms, mothers with less than 12 years of education, Medicaid patients, smokers, victims of physical abuse before or during pregnancy, and women under traumatic or financial stress during pregnancy.  Having a low-birth-weight baby or a baby admitted to a neonatal intensive care unit was also tied to self-reported postpartum depression in most of the 17 states.

The postpartum depression statistics, published in the April 11 edition of the CDC's Morbidity and Mortality Weekly Report, don't separate women who became depressed after giving birth from women who were already depressed before pregnancy.

The CDC urges women to get treatment for postpartum depression for the sake of mother and baby alike.

The CDC also notes that the American College of Obstetricians and Gynecologists recommends that doctors screen all new moms for postpartum depression four to six weeks after birth.

P.S.  Here's a link to the Wall Street Journal's health blog's coverage of the CDC report on postpartum depression.

Postpartum Progress Speaks Out in Full Support of MOTHERS Act

I said I would speak out on the ridiculous campaign being waged through petitions and blogs right now to block passage of the Melanie Blocker Stokes MOTHERS Act ... so here goes (hold on to your hats, folks):

I am truly peeved and disappointed at the breathless, hysterical ranting going on about the MOTHERS Act.  Many of those who oppose it seem to have done LITTLE to NOTHING to inform themselves about the actual bill and the organizations that support it.  Falsehoods are being spread.  Here are some examples:

"A federal bill that is dangerous to mothers and their newborns but being promoted under the guise of ensuring that 'new mothers and their families are educated about postpartum depression, screened for symptoms, and provided with essential services ...'  This is quite simply false ... it will push more mothers onto dangerous antidepressant drugs ..."

"If this bill is passed, any money spent on screening will be a complete waste of tax dollars.  The results will be an INCREASE in the severity and frequency of postpartum depression and an increase in violence and suicide."

"This legislation will ensure that new mothers and their families are also subjected to such treatment as they are screened for symptoms and provided so called 'help' that pushes these new mothers over the edge."

"The bill was originally proposed in response to the death by suicide of Melanie Stokes, a pharmaceutical rep. who took her own life by leaping from a balcony several stories off of the ground. Contrary to popular understanding it was not post-partum depression that killed Melanie, but the numerous antidepressant drugs she was taking ..." 

I'm not sure what algorithm they're using that would indicate that doing more to identify and treat these illnesses would lead to more PPD -- is this the new math they're teaching in schools?  And I have no idea how in good conscience they could spread lies about Melanie Blocker Stokes when her fearless and amazing mother Carol has worked so hard to get legislation like this passed so that other mothers can avoid the pain she has had to endure in losing her daughter. 

Now I know standards dictate that I don't share with you what these people are saying because it somehow gives them a voice.  But I'm blowing up the standards today, because I think my readers need to know exactly what is being said, so that you can be moved to speak up about it and defend the importance of the MOTHERS Act.  (One of the organizations behind this push is CCHR.  CCHR is the Church of Scientology.  Need I say more?)

The Melanie Blocker Stokes MOTHERS Act does NOT recommend drugs or require drugs or endorse drugs.  What is does is the following:

• Encourage the Department of Health and Human Services to coordinate and continue research to expand the understanding of the causes of, and find treatments for, postpartum conditions. 
• Encourage a national public awareness campaign to be administered by HHS to increase awareness and knowledge of postpartum depression and psychosis.
• Encourage HHS to make grants available for projects for the establishment, operation and coordination of systems for the delivery of essential services to individuals with postpartum depression.

There is no nefarious undercurrent, no plot by "the man."  The simple point is to continue to look into the causes of postpartum mood disorders, to let people know they exist and to provide better support services for the women who have them and their families.   Period, the end.  Every woman has the choice to decline participation in a screening, and every woman has the choice to look at all of the various treatment options available to her and choose the best one for her, whether it includes medication, therapy, alternative treatments, support groups or some combination thereof. 

Do I agree that we must be careful to only treat those who are ill?  Of course.  Do I agree that we must be careful in the types of treatments that are used, and must recognize the risks of taking certain treatments as well as the risks of not taking them?  Of course.  But I will not allow fearful conspiracy theorists to derail what is most important, which is getting our country's healthcare system to eliminate the stigma of mental illness, recognize the prevalence of postpartum mood disorders, learn more about their cause, allow new mothers who are suffering to feel safe in getting professional help and identify the best and safest treatments possible.

Please add your thoughts.  Scroll to the bottom of this post and look for the comments link to speak out.  C'mon girls - USE YOUR VOICE.

Here are links to other great comments about the opposition and the importance of supporting the MOTHERS Act.  If I've missed your response, let me know and I'll add it to this list.

• Susan Stone, President of PSI - this is so beautifully written - you MUST read it
• Spin Me I Pulsate
• Buoy for Perinatal Blues & Beyond
• Postpartum Perspective
• Unexpected Blessing/Sharing the Journey
• Depression Introspection

Why Universal Screening for PPD is Necessary

I found an excellent article on Health Commentary calling for universal screening for PPD written by Amy Gagliardi, a writer and research based at Yale University.  Check out the whole piece, but here is a highlight:

Wilen and Mounts in their article, Women with Depression – “You Can’t Tell by Looking” suggest that when screening for depression in the health care setting is based on clinical observation alone, 50% of women suffering from depression are missed.  In a study of 888 pediatricians, Olson et al conclude that even during the postpartum period when pediatricians have frequent contact with mothers and babies, pediatricians rarely identify maternal depression through a routine inquiry about symptoms or through family history.  In fact, the most common identification method reported was the physician’s overall impression or the impression in combination with 1 or 2 questions about the mother’s symptoms. Only 4% of the physicians in this study reported using formal diagnostic criteria to identify maternal depression while none reported using a validated screening tool to identify maternal depression. 

Universal screening is a necessary prerequisite towards the identification and treatment of maternal depression and this is not a responsibility specific to any one discipline.  Whether we are discussing perinatal depression, which is depression during pregnancy and the postpartum period, or depression at any time throughout the life course, systematic and universal screening is the most effective way to identify depression.  Of interest is a study which utilized a 2 question screen of mothers during well child visits. One group of mothers received the screen on paper while the other group was screened by means of a scripted interview.  Although both methods were proven to require very little time, the paper screen was verified to be a more effective model.

Study Shows Immigrants Face Higher Risk of PPD in Canada

Immigrants, refugees and women seeking asylum in Canada are four to five times more likely to suffer from postpartum depression than women born there, according to a study published this month in the Canadian Journal of Psychiatry.

"Postpartum depression is more likely to be recognized in Canadian-born moms, but our study shows its much more common in immigrant women and they don't seek help as much as the Canadian women do," said Dr. Donna Stewart, the principle author of the study.

She said the results of the study surprised her, considering a well-documented phenomenon known as the "healthy immigrant effect."

"Immigrants to Canada are much healthier than Canadian-born women, and there have been lots and lots of studies showing that, so from that perspective it did surprise me. From the perspective that it didn't surprise me, as a clinician, I see a lot of foreign-born women who get depression after they have a baby. I also know from the public health nurses that they see them in the community and they're not willing to come and seek services" ...

"We find from the women that there's the stigma of depression, that they're frightened word will get around that they're not good mothers, that their babies might be taken into care. We hear from the health care providers that they're not quite sure what the customs are for these groups, sometimes the language is an impediment, and sometimes they feel that the families don't want these women to seek care."

Stewart said the high incidence of postpartum is largely due to the lack of social support for newly arrived women.

"Their parents are often in their country of origin, their families are back in their country of origin and they may not have had time to make friends here yet. So I think they're very isolated. And I think they often don't know about social services that might be out there, how to meet other moms with young babies, and they also don't know how to access health services very well" ...

She said immigrant social services also need to become better educated, and more aware that when they see new, immigrant moms, that there is a greater risk of postpartum depression and to know some of the services they can be referred to.

"In many countries, depression isn't talked about. So if you have someone coming from one of the far eastern countries, for example, where depression isn't talked about very much and where it's highly stigmatized, the service providers from that background may also not think to ask about it," Stewart said.

Scientists Identify Biomarkers in Blood for Mood Disorders

According to today's Washington Post, biomarkers in the blood associated with mood disorders have been identified by Indiana University School of Medicine researchers, who said the finding may change the way bipolar illness is diagnosed and treated.

The researchers analyzed blood samples from 96 patients and found varying levels of the biomarkers in participants with high or low mood states. They also found that concentrations of the biomarkers varied, depending on the severity of depression or mania or a patient's individual experiences.

"This discovery is a major step towards bringing psychiatry on par with other medical specialties that have diagnostic tools to measure disease states and the effectiveness of treatments," study author Dr. Alexander B. Niculescu, an assistant professor of psychiatry, medical neurobiology and neuroscience at the university's School of Medicine Institute of Psychiatric Research, said in a prepared statement.

"Although psychiatrists have been aware that bipolar illness and other psychiatric conditions produced molecular changes in the brain, there was no way to measure those changes while the patient was still living. Blood can now be used as a surrogate tissue to diagnose and assess the severity of the illness," Niculescu said.

He said this line of research could have a major impact on the treatment of a wide range of mood disorders, including postpartum depression, post-traumatic stress disorder and assessments for bereavement interventions.

The study was published in the Feb. 26 online issue of Molecular Psychiatry.

Niculescu and his colleagues are planning a larger study to examine the impact of treatment on these mood disorder biomarkers. They also plan to look for biomarkers associated with other kinds of psychiatric diseases.

Study Says Poorer Moms & African-American Moms More Likely to Suffer PPD

A study of new mothers in Iowa found that poorer mothers were more likely to suffer postpartum depression, as were African-American women.

Forty percent of Iowa mothers with a household income of less than $20,000 suffered from clinically-significant postpartum depression, compared to only 13 percent of new mothers whose household income was $80,000 or more, according to a study of 4,332 women from four Iowa counties.

The study, conducted by U of I psychologist Lisa Segre, was published last April in the journal Social Psychiatry and Psychiatric Epidemiology, the U of I reported Tuesday. Women were surveyed in the late 1990s about 4.6 months after they had given birth.

"Women who are poor already have a lot of stress, ranging from poor living conditions to concerns about paying the bills," Segre said in a news release. "The birth of an infant can represent additional financial and emotional stress, and depression negatively impacts the woman's ability to cope with these already difficult circumstances."

In a second study on race and postpartum emotions in Iowa, Segre found that African-American mothers are more likely than white mothers to experience depressed moods immediately after giving birth, but Latina mothers are less likely to experience depressed moods.

This survey was given to 26,877 English-speaking mothers in maternity wards of Iowa hospitals in 2001 and 2002. The results were published in March 2006 in the Journal of Reproductive and Infant Psychology. Segre said the results may indicate women with strong social support are more resistant to postpartum depression.

Segre and psychology professor Michael O'Hara have worked with Healthy Start in Des Moines to teach caseworkers and nurses to screen new mothers for depression. They are also developing a program of "listening visits," in which a caseworker or nurse listens to mildly- or moderately-depressed mothers talk through their problems.

Segre recently received a five-year grant from the National Institutes of Health to evaluate the effectiveness and acceptability of listening visits in the United States. She will travel to Des Moines to interview participating mothers from Healthy Start before and after their listening visits.

French Study Shows Link to PPD & Having Boys, While China Study Links PPD to Girls

A new research study has been released in France showing that giving birth to boys may raise the risk of severe postpartum depression. (For the full WebMD story, click here.)

From WebMD: " ... the study author himself warns that the results may not apply to U.S. women. 'I believe that it would be dangerous to alarm all U.S. women about [the potential mental health hazards associated with] boys' delivery,' writes Claude de Tychey, PhD, professor of clinical psychology at the Universite Nancy 2 in Nancy Cedex, France ..."

This is interesting, but I wouldn't give it too much thought at this point.  Although I did suffer PPOCD after giving birth to a boy ... Hmmmmm.  Interestingly enough, a different piece of research from China shows that women there are more likely to suffer PPD if they have a girl.   

National Center for Children in Poverty Releases New Policy Brief on Maternal Depression

Project THRIVE a the National Center for Children in Poverty at Columbia University has just released a new policy brief on maternal depression: Reducing Maternal Depression and Its Impact on Young Children: Toward a Responsive Early Childhood Policy Framework.  The policy brief provides an overview of why it is so important to address maternal depression as a central part of the effort to ensure that all young children enter school ready to succeed. It highlights:

• what research says about the impact of maternal depression on young children, particularly infants and toddlers, and how prevalent maternal depression is;
• examples of community and programmatic strategies to reduce maternal depression and prevent negative cognitive, social emotional and behavioral impacts on young children;
• key barriers to focusing more attention to maternal depression in policies to promote healthy early child development and school readiness;
• state efforts to address policy barriers and craft more appropriate policy responses; and
• recommendations

You can download the PDF and read the executive summary here.

Project THRIVE is a public policy analysis and education initiative at the National Center for Children in Poverty to promote healthy child development and to provide policy support to the State Early Childhood Comprehensive Systems (ECCS) initiatives funded by the Maternal and Child Health Bureau.

Part of NCCP’s longstanding commitment to promote improved state early childhood policies and practices, the goal of Project THRIVE is to help states strengthen and expand their early childhood systems, paying particular attention to strategies that improve services for those at highest risk and that help reduce disparities in access and quality of care to early childhood health and mental health.

PSI Annual Conference To Be Held in Houston June 4-7

Save the Date!  This year's Postpartum Support International conference will be held in Houston, June 4-7 at the Hilton Americas-Houston.  The event is co-sponsored by the Women's Mental Health Initiative of the Mental Health Association of Greater Houston.  Some of the main speakers include Dr. Margaret Spinelli, Dr. Lucy Puryear, Valerie Plame Wilson and George Parnham.  Registation will begin in March.  I'll be there, and I hope to see you there as well!  For more information, visit www.postpartum.net.

Divergent Views of Male & Female Doctors on Risk Factors for Postpartum Depression

Yesterday, the Society for Women's Health Research (SWHR) released the results of a study on the divergent views of male and female doctors when it comes to women and depression.  Of particular note to the postpartum depression community is this, as reported by Newswise Medical News:

"On the topic of risk factors for postpartum depression, female doctors were considerably more likely to mention difficult or complicated pregnancies or deliveries; lack of support or help with the baby; and difficulty dealing with a newborn, including sickness. In general, female doctors were more likely to attribute a woman’s sense of being overwhelmed as a source of postpartum depression.

'Women doctors, many of whom are mothers themselves, are likely more sensitive to the immense burden that new mothers can place on themselves for the health and care of their new baby,” Jo Parrish [vice president of communications for SWHR] said. “When things go wrong, women can blame themselves, which can lead to sadness or feelings of guilt and contribute to depression. It is an issue about which women need to talk openly and doctors need to be mindful.'"

On the other hand, the report noted that strong majorities of both women and men doctors believe it is safe for women to take medication for depression in the postpartum period and under the right circumstances during pregnancy, opinions not as strongly shared by women in the general population.

And a side note:

The Society of Women's Health Research will be holding an online moderation discussion entitled “Perimenopause and Mood Disorders” onTuesday, January 29, 2008, at 2:00 p.m. EST.  Peter Schmidt, M.D., a clinician and an investigator at the National Institute of Mental Health, will answer questions about mood disorders in the perimenopause period, a time of significant changes in women’s lives that can impact mental health. Sherry Marts, Ph.D., vice president of scientific affairs for the Society, will participate in the discussion to answer questions about the Society's work in this important area. Visit http://www.womenshealthresearch.org and click on "events" for more information.

Research On Maternal Depression & Asthma in Children

New research was released today indicating that children born to mothers with persistent depression or anxiety have an increased risk of developing asthma.

According to U.S. News & World Report, "Canadian researchers report a 25 percent increase in the odds of asthma for children who are exposed to maternal distress from birth to age 7. No such association was found for short-lasting maternal distress, such as postpartum depression."  (note: the highlights are mine)

Since so many media outlets were reporting the association between maternal depression and childhood asthma today, I wanted to make sure all of you saw the sentence I highlighted stating that this does not hold true for postpartum depression.  Y'all don't need anything extra to be worrying about!

Postpartum Depression By The Numbers

Quick, guess which number is higher:  the number of people who sprain their ankle each year or the number of women who experience a postpartum mood disorder?  Actually, it's about equal.  Surprised?

In so many books, articles and news programs, you hear the statistic -- approximately 10 to 15% of women suffer from postpartum mood disorders (PPMDs), including postpartum depression (PPD), postpartum anxiety/OCD and postpartum psychosis.  What bothers me about that statistic is that it holds no meaning for most people, and because of that I think these illnesses get much less funding and attention than so many of the other prevalent illnesses that strike Americans.  As a result, I decided to do a bit of quick, non-scientific research to help people understand the real impact that postpartum depression is having on the women of our country.

According to the National Center of Health Statistics, there were approximately 4.1 million live births in the United States in 2004.  This statistic does not include fetal losses, including miscarriages and stillbirths.  The National Vital Statistics report indicates that the total number of clinically recognized pregnancies is around 6.4 million.  This is important to know, because all postpartum women are susceptible to PPMDs, regardless of the pregnancy's outcome.

So let's split the difference between the high and low estimates of PPMDs and say that 12.5% of all postpartum women in the US suffer.  This would mean that each year approximately 800,000 women are suffering a serious postpartum mood disorder.  How does that compare with the incidence among women of other major diseases in America?

• Each year approximately the same number of women -- 800,000 -- will get diabetes. (Nat'l Diabetes Information Clearinghouse)
• Each year about 300,000 women suffer a stroke.  (Centers for Disease Control)
• Each year approximately 205,000 women are diagnosed with breast cancer.  (National Cancer Institute)

In fact, more women will suffer from postpartum depression and related illnesses this year than the combined number of new cases for men and women of tuberculosis, leukemia, multiple sclerosis, Parkinson's disease, Alzheimer's disease and epilepsy.  This is not to minimize these other terrible diseases, of course.  I simply want to illustrate just how prevalent postpartum mood disorders are.

Dr. Ruta Nonacs of Massachusetts General Hospital and Harvard Medical School adds, "Postpartum depression is far more common than gestational diabetes.  All women receiving prenatal care are screened for diabetes, but how many pregnant and postpartum women are screened for depression?  PPD is also more common than preterm labor, low birth weight, pre-eclampsia and high blood pressure; in other words, PPD is the most common complication associated with pregnancy and childbirth."

Let me leave you with one last thought:  More women will suffer from a postpartum mood disorder than men will be diagnosed with new cases of impotence (617,715) this year.  Yet you wouldn't know it, considering the overabundance of erectile dysfunction (ED) ads and people falling all over themselves to discuss ED openly.  Why don't PPMDs get the same attention from pharmaceutical companies?  Why doesn't society work as hard to eliminate the stigma of postpartum mental illness?

This really is a big problem, and deserves much more attention that it's getting.

Note:  This article has been revised and updated from a piece I wrote for Postpartum Progress in 2004.  It is crossposted today on BlogHer.

 

Take Part in Online Survey On PPD & C-Sections/VBACs

I have been asked by Tiffani Lawton, RN to let you know about an informal online survey she's doing with a colleague about postpartum depression and C-sections/VBACs.  They have about 65 respondents so far and need 100, so please take part if you can.  Here is the link:   http://survey.constantcontact.com/survey/a07e27mlthufa9s7kth/start

Canadian Researchers Argue For More Gender-Specific Research on Depression & Estrogen

In a study appearing in the October 2007 issue of the journal Biological Research for Nursing, women's health experts from the University of Alberta argue there is an urgent need for carefully designed, gender-specific research to better understand the relationship of female sex hormones to mood states and disorders.

“The reasons for the gender disparity in rates of depression are not completely understood,” says Kathy Hegadoren, the Canada Research Chair in Stress Disorders in Women at the University of Alberta.

“But there is growing evidence that estrogens have powerful effects beyond their role in reproduction—that they play a critical role in mood disorders in women—and this opens new avenues for research into the underlying biological mechanisms and treatment of depression.”

Estrogen can be used to treat various mood disturbances in women—such as perimenopausal, postmenopausal and postpartum depression—but the results of these treatments can be difficult to interpret because researchers are only beginning to recognize the complex interactions among estrogens, serotonin and mood.

“Right now, clinical use of sex-hormone therapies for the treatment of mood disorders is severely hampered by the inability to predict which women would respond well to such therapies,” explains study co-author and U of A nursing professor Gerri Lasiuk.

“Most animal studies looking at the causes of depression have been conducted with male animals and use chronic-stress models, which are assumed to be similar to depression.”

Hegadoren and Lasiuk’s study recognizes that multiple factors may be at play in the development of mood disturbances, with individual, psychosocial and environmental factors interacting in complicated ways to create differential vulnerability in women and men. But they also point out that the link to sex hormones is hard to deny.

“Previous research has found that, before puberty, the rates of mood and anxiety disorders are similar in boys and girls. It’s only after females begin menstrual function that a gender differential in mood disorders manifests itself. This, coupled with the observation that women appear to be especially vulnerable to mood disturbances during times of hormonal flux, certainly lends support to the claim that a relationship exists between sex hormones and mood,” says Hegadoren.

Center for Women's Mental Health: Cognitive Therapy Vs. Medication In the Treatment of Depression

Here's a link to a very helpful post at the Center for Women's Mental Health Blog about cognitive therapy vs. medication in the treatment of depression.  This is a great argument for the use of therapy, which I believe in strongly, and should be a relief to those of you who would rather not take medication.  A trained therapist can really help you to work through all of the bad feelings you experience when going through a postpartum mood disorder.  It makes a big impact when you have someone help you understand where your thinking has gone awry and help you get back on the right path.   

Study Suggests New Moms' Mental & Physical Health Be Monitored Past 6 Weeks, But Who Will Do It?

A new study in the November/December 2007 issue of the Annals of Family Medicine takes a much-needed look at the postpartum health of working mothers.  The study looked at moms who return to the workplace 11 weeks after childbirth and found that they continue to need evaluation of their fatigue levels and mental and physical symptoms beyond the normal 6-week postpartum checkup.

"At 11 weeks postpartum these employed mothers continued to experience several childbirth-related symptoms, indicating a need for ongoing rest and recovery. Postpartum evaluations should include screening for anxiety and depression and evaluation of fatigue and other physical symptoms, including those related to job stress."

The study recommended that women showing continued symptoms should receive counsel on strategies to decrease job stress and increase social support at work and home, and that physicians should talk with them about the possible need for intermittent leave under the Family and Medical Leave Act to help them manage symptoms.

One of the most fascinating comments was this, from Pat McGovern, PhD, MPH at the School of Public Health at the University of Minnesota in Minneapolis, and her colleagues who wrote the study:

"The traditional medical perspective of the postpartum period refers to the time after childbirth that is required for the reproductive organs to return to their nonpregnant state, a process that takes approximately 6 weeks. Many physicians perceive this time as one requiring little assistance other than the recommended single postpartum visit ..."

All new mothers know this is true but I don't think I've ever seen it stated so plainly.  Our healthcare professionals are essentially focused on making sure our uteruses (or is it "uteri"?) are in working order ... but the rest of us?  Not so much. 

Dr. Laurie Barclay writes on Medscape.com:

"Because of the increased prevalence in the workplace of mothers with infants, greater understanding of factors that could improve postpartum health and facilitate return to work is greatly needed. Recovery from childbirth and successful return to work may be affected by personal factors such as preexisting health status, parity, breast-feeding, and social support from family and friends; as well as work-related factors including the timing of return to work, job stress, and support in the workplace."

Honestly, I think the results of this study apply equally to women who don't go back to work.  All new mothers suffer a compounding list of stresses that make it difficult to cope with daily responsibilities, and there is no specific group of healthcare professionals who has taken on the task of monitoring our whole health.   

Which group of clinicians will make sure women are properly evaluated and counseled?  The study specifically cites the need for screening new moms for anxiety and depression, but who will do it?  At the moment, no group of doctors taken on the job of providing that safety net.  I sometimes wonder whether they're all hoping someone else will step up to the plate so they can be relieved of the duty.  Sure, there are pockets of doctors and nurses in different places throughout the country who have recognized the importance of paying more attention to the health of new moms over a more extended period of time, but as a general rule many ignore it, and I wonder if some of the larger physicians' groups aren't actually against it.

The OB/GYNs are concerned with taking responsibility for the process of pregnancy and childbirth.  The pediatricians are primarily focused on the health of the baby.  Your primary care physician may not see you for months unless you come down with the flu, so they may never know if you're having problems.  They all say they don't have time, they don't have the proper training, they aren't reimbursed for it, they worry about the legal ramifications, etc.  And they're right on all those points.  Yet mental health screenings and treatment remain completely necessary if we care about having healthy mothers in this country. 

New moms are just not very likely to wander by the office of a mental health professional and drop in to say hello.  These people are specialists, for whom you generally need a referral.  We need a comprehensive nationwide process to get mothers mental healthcare if they need it, where the doctors responsible for screening and referral have buy-in and there is a clear line of sight.  Somebody is going to HAVE to take responsibility for this, so we need to work together to begin developing workable solutions.  Hopefully the MOTHERS Act will help to address this when it is passed, and it becomes federal law that all women are screened for postpartum depression and anxiety.  Notice I sad when, not if.

(crossposted at BlogHer.com)

Study Highlights Disconnect Between Perceptions of Women and Doctors on Postpartum Depression

A fascinating piece of research has just come out from the Society for Women's Health Research that highlights that vast differences of opinion between women and physicians on the use of medication to treat depression during and after pregnancy, as well as women's lack of understanding of the risk factors for postpartum depression:

Only 10 percent of women think it is safe for women to take medication for depression while they are pregnant, compared to 68 percent of doctors, according to a new survey of women and physicians released today by the Society for Women’s Health Research. Even after pregnancy, in the postpartum period, only half of women think it is safe for women to take medication for depression, compared to 97 percent of doctors.

“This survey shows a tremendous disconnect between doctors’ beliefs about managing depression and the perceptions held by women,” said Sherry Marts, Ph.D., vice president of scientific affairs for the Society, a Washington, D.C., based advocacy organization. “The health care community needs to do a better job communicating with women about depression. We need to carefully explain the full range of treatment options for mood disorders and the pros and cons of taking medications during pregnancy and after pregnancy so that women can make better informed choices.”

African American women and women 18-34 in the survey were even more likely than others to say that it is not safe to take depression medications during pregnancy or the postpartum period.

“Many pregnant and postpartum women falsely think that depressive symptoms, and even clinical depression, are part of the normal experiences of being pregnant and delivering a baby,” said Kimberly Yonkers, M.D., an associate professor of psychiatry and obstetrics and gynecology at the Yale University School of Medicine in New Haven, Conn. “Moreover, they often assume that these symptoms will spontaneously go away when that is not always the case. There are a range of treatments available to women and we need to get the message out and encourage depressed women to access care for their emotional symptoms.”

The survey also revealed that women underestimate, compared to doctors, their risk for depression at specific life stages where they undergo a hormonal transition. The gap is largest for perimenopause and menopause. Only 47.5 percent of women thought perimenopause is a time of heightened risk for depression, compared to 83.2 percent of doctors. Even fewer women, 39.5 percent said menopause presents unique depression risks, while 77.8 percent of doctors noted this time of risk. Women’s recognition of depression risk at puberty and in postpartum was better.

“Women’s bodies undergo changes in hormone levels during key life cycle transitions from puberty to menopause,” said Marts. “Most women navigate these transitions with minimal mood disturbances, but some women experience mood disorders such as depression or bipolar disorder. We need more research to understand the underlying mechanisms in the brain where mood disorders are triggered by hormone changes. Women need to be aware of this issue and talk to their health care providers about their individual risk factors, warning signs and treatment options if needed.”

When asked about the major symptoms of depression, women focused on emotional symptoms and most neglected to mention the physical symptoms that can accompany depression, such as trouble sleeping, fatigue, changes in appetite or pain. Only 38.2 percent of women noted at least one physical symptom that can be a sign of depression, compared to 86.4 percent of doctors.

Regarding risk factors for postpartum depression, less than one percent of women mentioned family history, previous depression problems or genetics as a risk factor, compared to more than half (53.8 percent) of doctors.

The survey of 1,000 U.S. women 18 and older was conducted through a national telephone omnibus survey, Oct. 4-14, 2007, and the results are weighted to be representative of the total population. The survey of doctors took place Oct. 11-17, 2007, via the Internet. Both surveys were conducted by International Communications Research (ICR) of Media, Pa. The margin of error for the full women’s survey is plus or minus 3.1 percent. It is 4.4 percent for the survey of doctors, which included family practitioners, general practitioners and internal medicine specialists. Support for the survey was provided to the Society by Novartis through an educational grant.

Participants Needed for Online Survey On New Postpartum Distress Scale

Karen Kleiman has sent out the following information on research she is conducting into a new postpartum distress scale.  She needs participants who have babies up to 12 months old to complete a survey (Bummer - I can't participate!).  If you meet this criteria, I hope you'll take the survey.  The link to it is below:

As many of you know, I have been collaborating with a research team at the University of Pennsylvania School of Medicine who have expertise in postpartum distress and scale design. We have performed an initial statistical analysis on a new postpartum distress scale.

At this stage, we would like to re-test our proposed scale items, along with established measures, such as the Edinburgh Postpartum Depression Scale (EPDS).

We need approximately 100 postpartum women (with babies up to 12-months old) to complete this phase of the study. I am hoping that you will post a link to the questionnaire, which is offered online, for your members or your clients, to help us further validate this measure.

The survey will probably only be up for a month or so.

Click here to participate.

Study on Transcranial Magnetic Stimulation As Treatment for Postpartum Depression

Here's a link to a story in the St. Louis Post-Dispatch about a study currently taking place in St. Louis using transcranial magnetic stimulation to treat postpartum depression.  The link has information for those who live in the area and might wish to participate in the research.

Talk Therapy Works For Postpartum Depression

Here's a link to Leigh Ann Simmons' blog Women's Health Matters -- she writes about a new study indicating that talk therapy works to treat postpartum depression.  I think talking it out, whether in therapy or in a support group, is a key part of recovery and for some people may work to treat the illness without meds. 

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