Postpartum Progress

Are Natural Methods Safer and As Effective When it Comes to Treating Postpartum Depression?

While doing my daily required reading of articles, blog posts, tweets and other assorted media across the web about postpartum depression and related illnesses, I came across a question a while back posted on Mamapedia by a mom with postpartum anxiety.  She was looking for advice on natural treatments because she didn't want to take the Prozac prescribed by her doctor.

She received 22 answers by other mothers, many warning vehemently against taking any medication.  These are some of the things she was told by the moms:

For many people, postpartum anxiety is caused by a deficiency of omega-3s and a lack of coping mechanisms.  Read the book Feeling Good and take omega-3s.

Acupuncture works.

If he is suggesting serotonin imbalance, then speak to your herbologist again. Don't go on medication! You have to take too much time to wean off. There are many things that will help the levels naturally

If you don't want to take Prozac, then ask for something less dramatic. (something less dramatic? huh?)

I highly recommend contacting Dr. ____ who is truly an amazing Chiropractor and Nutritionist and would definitely be able to help you naturally.

Please don't settle for drugs that will be only partially successful in masking your issue and give you the side-effects galore. There are so many safe and effective homeopathic remedies.

I don't know the mom who posed the question.  I don't know if her anxiety is mild or severe.  I don't know whether she has a history of mental illness.  I don't know if she's had suicidal thoughts.  I don't know if she's taken antidepressant medication before and it didn't work or caused unacceptable side effects for her.  I don't know if she's tried therapy.  All I know is that she has received advice from people with no medical training, some of whom have a bias against medication but claim to know what will work to fix her postpartum anxiety. 

To be sure, there were women who responded to the Mamapedia question who I felt had some good suggestions, including reaching out to other moms for support, getting your thyroid checked and getting adequate sleep, nutrition and exercise.  Medicine is not the only answer, and it's not the answer for every person.  But that doesn't mean it's evil incarnate, and that going to your "herbologist" is the right answer for people with moderate to severe perinatal mood and anxiety disorders.

I see this all the time.  Natural is better, right?  You'd think so if you watch Oprah (thereby ensuring I will never be asked to appear on the Oprah Winfrey show) or surf the internet.  But here's what you need to know.  It's not just pharmaceutical companies that have an agenda to sell you their drugs.  There are also lots of people who are trying to sell you their unproven, often untested remedies.

Alternative medicine is highly unregulated and not necessarily any more effective, or safer, than mainstream medicine.  According to the Associated Press in a story this year on alternative medicine:

"Ten years ago the government set out to test herbal and other alternative health remedies to find the ones that work. After spending $2.5 billion, the disappointing answer seems to be that almost none of them do.

Echinacea for colds. Ginkgo biloba for memory. Glucosamine and chondroitin for arthritis. Black cohosh for menopausal hot flashes. Saw palmetto for prostate problems. Shark cartilage for cancer. All proved no better than dummy pills in big studies funded by the National Center for Complementary and Alternative Medicine."

You probably didn't hear about that, because it's not a positive outcome for such a popular concept.  If you were aware, you likely heard proponents argue that the research wasn't conducted correctly.  You were probably told that the fact that many alternative health remedies work no better than placebo is no different than the fact that some prescription medicines are found to work no better than placebo.

Antidepressants, in fact, have been found in certain studies to work no better than placebo.  After reviewing those studies, Dr. Steve Novella, who writes the blog Science-Based Medicine, wrote a great piece about this called "Do Antidepressants Work?  The Effect of Publication Bias". 

"At this time it is premature to conclude that modern antidepressant medications do not work. There is sufficient evidence for efficacy to continue to use medication as part of the overall treatment approach to depression. The current consensus is that therapy is also a critical component of the long term treatment of depression, and therefore looking at the use of medications in isolation may not reflect their actual clinical use. Multiple studies have now shown that combination treatment (medications and therapy) are better than either alone. There is also evidence that medication treatment is more successful when multiple agents are tried in order to find the optimal treatment."

I like Dr. Novella's blog because he gives everybody the "business" if they don't get their science right, whether it's claims made about homeopathy or antidepressants. He explains his belief that the problem with Complementary and Alternative Medicine (CAM) is " ... that they aggressively market CAM as 'harmless' and 'natural.' They point to the warning labels and informed consents associated with science-based medicines as evidence that the alternative must be safer. In reality, many alternative practices are less effective, and can carry serious risks (usually undisclosed to the patient)."

We need more research on what causes postpartum depression and what the most effective methods are to treat it.  This should include looking more closely at alternative forms of treatment, whether it's acupuncture or yoga or light therapy or omega-3s, to make sure that we aren't missing anything.  Unfortunately, there's just not a whole lot of information available on that yet, especially for moms who are breastfeeding.

One interesting piece, the best I've found so far, took a look at the more common natural treatments suggested to women with postpartum depression.  It was published in the Journal of Midwifery and Women's Health in 2004 and looks at both pros and cons. Their conclusion?

"Especially for women with moderate to severe symptoms, complementary and alternative medicine is a complement to conventional treatments, not a replacement for it."

So what should you do?  One of the MDs who writes the blog Denialism suggests the following in his post "There is No Such Thing As Alternative Medicine":

"When someone offers you an 'alternative therapy', ask them what it is an alternative to. Does it work better than something else? Is it safer? How do you know? Why should I believe you?"

Then, talk to your doctor.

Update to this piece:  I think some readers are getting the impression I think alternative treatments are bad.  That's not my point at all.  I simply think we should always look at both sides of any treatment suggested.  Everything has side effects of some sort.  Everything has risks and benefits. Just because a treatment method is "natural" doesn't necessarily mean it is safer or more effective.  That's all.  If you want to try an alternative method, you should.  That's why I report on them here and here whenever research comes out.  I want you to know everything that's available.  You have to make your own choices.

For related articles on this topic, you might want to check out the following blog posts:

Psych Central: Consumer Reports on Antidepressants

Mamapedia: The Postpartum Prozac Roller Coaster

Mayo Clinic: Postpartum Depression and Alternative Treatments

Dr. Shoshana Bennett: Natural and Alternative Treatments for Perinatal Mood Disorders

MGH Center for Women's Mental Health: Fish Oil and Postpartum Depression and Using Omega-3 Fatty Acids to Treat Depression During Pregnancy and Can Estrogen Be Used to Treat Postpartum Depression?

Psych Central: Alternative Practices May Complement Western Medicine 
 

Told It's a 5-Month Wait to See A Psychiatrist? Tips on What to Do Next to Get Help for Postpartum Depression

After I wrote last week about my opinion that women with postpartum depression should try to seek out a specialist for treatment, I heard from a family physician in a major metropolitan city who told me that her patients now need to wait 5 months to get in to see any psychiatrist, not just a specialist.

My perspective comes from being a family physician in [major city].  Right now, in the health system I am in, we are booking into late April and May for a first appointment with a general psychiatrist.  It does take "special clout" to get someone in sooner in my system ... and that's just to see a regular psychiatrist.  As a physician I am someone with that special clout, and it still takes me multiple phone calls, begging, etc., to get a patient in any sooner.  On top of this, my health system just cut psychiatric and counseling services by 30% because it wasn't a money maker, and because leadership determined we were doing more than our fair share here in [major city].  Patients are coming in from other health systems because our wait lists are shorter than average.

If someone has an unrestricted insurance plan (and that's a big "if") or can pay out of pocket (bigger "if") or is willing to drive to the inner city county hospital (many of my patients are not), they may be able to go outside the system and be seen sooner.

I understand that you would want a loved one to get the best care.  But from my perspective I have trouble getting my patients any care at all in a timely fashion.

I appreciated hearing from this doctor about her experience.  Among other things, this email made me think about how awful it is for a mom with postpartum depression or anxiety who has finally gotten the courage to reach out for help only to be told "Sorry.  You'll have to wait."  For months!  I decided I'd ask some healthcare providers I know to provide Postpartum Progress readers with tips on what to do if you want to see a psychiatrist but can't get an appointment.

 

Jennifer Payne, MD, PhD, co-founder of the Women's Mood Disorders Center at Johns Hopkins, suggests:

First, remember if you are having suicidal thoughts or thoughts of harming your baby, go to the ER. They will help you.  Otherwise, you can seek immediate help from your primary care physician or OB-GYN. They can start medications while you're waiting to see a psychiatrist [should you need them].  Also, call a therapist. They can often see you sooner and if they are concerned may have more direct access to a psychiatrist. Check to see if there are any postpartum depression groups at local hospitals or birthing centers for support. And finally, don't give up.  Keep calling around and ask to be on a call list for cancellations.

Ann Dunnewold, PhD, author of Even June Cleaver Would Forget the Juice Box, says that if you need medication and can't get in to see a psychiatrist, you should talk to your physician:

When a woman already has a good relationship with a physician (such as an OB/GYN, internist, family practitioner or even nurse practitioner), reaching out to that person can be a much quicker route to treatment.  And while psychiatrists may disagree, I've seen that when a woman has a good relationship with her regular care provider, that provider often more readily considers the whole person (i.e. lifestyle issues, other underlying illnesses, etc.)  Many of these care providers also are more comfortable prescribing medication if the mom is seeing a psychologist for therapy who is willing to be part of the treatment team and give feedback.

Diana Lynn Barnes, PsyD, LMFT, and author of The Journey to Parenthood: Myths, Reality & What Really Matters, suggests working with your therapist to try and get an earlier appointment with a psychiatrist:

I find a 5-month wait for a woman with depression unconscionable.  I know for myself that I have developed a close, collegial relationship with a few psychiatrists in my community whom I know specialize in women's reproductive mental health so that when I refer clients I can pretty well know that they will be seen within a few days.  And I leave room in my schedule so that I can see a new patient within 24 hours.

Erika Krull, MS, LMHP, author of the Family Mental Health blog on PsychCentral suggests spending time with other moms for support and considering therapy:

Find a small moms group of some kind -- MOPS, church group, library toddler time with some moms, a little weekly play group, quilting group, PPD support group, whatever.  Something with regularity and other moms so that relationships can develop and there is some level of obligation that gets you going even if you don't feel like going.  That social support is key.  When I didn't know what was wrong with me I happened to already have a habit of attending a young moms church group.  Unbeknownst to me, that was what kept me going until I put the pieces together and got a diagnosis.

Also, getting started with a mental health counselor might be quicker and certainly can help the mom start finding ways to cope with her symptoms.  Just having that listening ear with a professional filter can also help give some direction, keep an eye on worsening symptoms, etc.  Meds work best with therapy, but in some milder cases therapy alone may be enough.

Pec Indman, EdD, MFT, co-author of Beyond the Blues and board member of Postpartum Support International, says it's not unusual for women to be told they'll have to wait a long time to get in to see a psychiatrist, especially those moms without private insurance or those who have medicare/medicaid for only a few months postpartum.  Her suggestion:

Any healthcare provider (OB, family practice, etc) can call the University of Illinois at Chicago Perinatal Depression Project's Toll-Free Consultation Line for Providers at 1-800-573-6121.  It may not be as good as getting the patient in now to see a psychiatrist, but it's better than nothing.  Most OBs, family practice and internal medicine docs treat a lot of anxiety and depression.  They need more information, though, to rule out mania and information about medication during pregnancy and nursing.  That can be provided through consultation with specialists. 

In the meantime, Karen Kleiman, LSW, MSW, author of This Isn't What I Expected: Overcoming Postpartum Depression, suggests making sure you don't have an underlying physical illness that, if treated, would relieve the depression, thereby eliminating your need to see a psychiatrist at all:

Get a physical and rule out some of the conditions that can mimic depression and anxiety symptoms.  Check for thyroid problems, anemia and general blood count.

I thought I'd join in and give you a tip of my own:  If you are having a problem getting timely treatment, or you have issues with insurance or being able to afford treatment, you should consider checking to see whether you are eligible for any clinical trials.  If you find one in your area in which you are willing to paricipate, your treatment and related medical appointments may be free of charge and you'll probably be able to get started right away.  (Yesterday, as it happens, I posted of list of current clinical trials going on around the country!)

And finally, from the family physician who e-mailed me, an exhortation that medical schools need to do better to train all physicians on the identification and treatment of perinatal mood and anxiety disorders:

Training programs in the primary care specialties can and should cover these issues properly.  If these programs could be convinced to do a good job with this (and I think they could be), this would go a lot further toward helping more women, no matter where they live, no matter what insurance, no matter if they have empowerment, no matter if they have clout.

Which meds can be used in pregnancy, in breastfeeding, etc., should not be special knowledge.  It should be normal knowledge.  With 15% of moms getting PPD this is not a special disease.  It's a normal disease.  I want it to be a normal part of training for normal docs that a normal patient can access in a normal way.  Then the specialists will be available to focus on the truly difficult cases.

Treating Treatment-Resistant Postpartum Depression

This week at the Beyond Blue blog, Therese Borchard tackles the topic of treatment-resistant depression.  According to the Mayo Clinic ... 

"With treatment-resistant depression, symptoms — such as feeling sad, hopeless and disinterested in activities — persist despite treatment. Or, your symptoms improve only to keep coming back. Treatment-resistant depression can range from mild to severe, and generally requires trying a number of treatments to find out what works."

A minority of people with depression are treatment resistant, but there are other options to help you recover.  Therese writes about the various alternatives for those people who have serious depression and receive no benefit from therapy, medication and other methods of treatment.  These options include ECT, deep brain stimulation and transcranial magnetic stimulation.  

Also, Therese shares a summary from Johns Hopkins on the various methods of brain stimulation here.

For a fact sheet on brain stimulation therapies from the National Institute of Mental Health, click here.

Do You Really Need a Specialist To Treat Your Postpartum Depression?

I was very happy to see that Parents magazine and CNN.com have covered the specialized inpatient unit for women with severe perinatal mood and anxiety disorders at the University of North Carolina.  Go Dr. Elizabeth Bullard, Dr. Samantha Meltzer-Brody and nurse Chris Raines!!!! 

"Immediately, Meehan-Machos's obstetrician referred her to the University of North Carolina at Chapel Hill (UNC). There, doctors had recently debuted a groundbreaking inpatient psychiatric unit, the first in the nation specifically tailored to women suffering perinatal (prenatal and postpartum) mood disorders. Unlike a general psychiatric unit, it offered:

• A core group of doctors specializing in perinatal issues
• Psychiatrists attuned to medications that wouldn't harm a pregnancy or a nursing newborn
• An unusual policy of allowing children, even babies, on the ward during extended visiting hours
• Mom-only counseling focused on anxiety and bonding"

There aren't near enough specialized programs for women with postpartum anxiety, postpartum depression and postpartum psychosis.  These women have a distinct set of issues and deserve treatment from clinicians who have a lot of experience treating them.  Whether its psychiatrists, psychologists, therapists and social workers who specialize in reproductive psychiatry, special inpatient units like the one at UNC or special outpatient units like the one at Women and Infants Hospital in Rhode island, we need more hospital administrators and healthcare systems to recognize that perinatal mental illness is a public health problem and to create the kinds of services that help new moms and moms-to-be get better as quickly as possible.

I can tell you that when I had postpartum OCD I first went to a psychiatrist that I later came to realize had almost no experience with women with postpartum depression.  After dealing with that for ONE YEAR (argh!) and making little headway, I switched to someone who had trained under specialists in perinatal mood and anxiety disorders.  It was like night and day.  Out came the sun!! 

I realize that not everyone has access to specialists.  It is my wish that one day every woman will, no matter in which corner of this country (or any other) she lives.  It is my personal opinion, though, that seeing a specialist in the best case scenario for women trying to get well.  If it's a friend of mine, a relative, a neighbor or my own daughter, I'm going to fight like hell to find a specialist to help her. 

I'm just saying.

Update:

I received the following comment to this post and I'd like to share it so that it isn't missed.

"With reimbursement of mental healthcare as poor as it is, there are not (and may never be) even enough regular psychiatrists to go around, much less psychiatrists who treat only patients with perinatal issues.  If we have special clout and extra connections we may be successful in getting our friend, relative or neighbor in to see a specialist (as long as she lives in a major metropolitan area and has good insurance, of course).  But the vast majority of people aren't so well connected.  We need to make sure not to alienate non-specialists.  OBs, family physicians, midwives etc. can and should be trained well enough to treat straightforward perinatal mood disorders.  And if general psychiatrists are unable to successfully treat the more complicated cases, I don't think the solution is just to hope and wait for more postpartum specialists.  The solution is to insist that general Psychiatric training programs adequately address these common and important conditions."

Thank you for your comment.  I understand what you are saying.  It is true that we are sorely lacking in this country when it comes to having enough psychiatrists to go around, especially in rural areas.  I do not think, though, that you need any particular clout when it comes to seeing a specialist.  Insurance, perhaps, but not clout.  When I was sick I had zero clout.  When I finally got tired of being treated by someone who didn't know what they were doing the only thing I did have was empowerment.  The courage to demand more for myself and my health and to ask around and ask around and not give up until I found someone with more training than the average doc on these illnesses (which doesn't take much actually, because as you rightly point out, the current med school training is inadequate).  There are many healthcare providers from various disciplines who have taken the time to learn more, get CEUs, attend a conference or go to a PSI training.  These are the people I think women should try and see.  

Additionally, I know that many of the specialists in this field do consults and confer with women's personal physicians to discuss care for perinatal mood and anxiety disorders.  They are aware that, because this specialty is so unique, their expertise is needed both inside and outside of their "neighborhoods".  

And finally, I would never suggest women who are suffering wait and hope until we have every specialist we need.  I hope that's not how it came across in my post.  Thankfully, with organizations like Postpartum Support International, women don't have to.  They can connect with one of more than 100 trained volunteers spread out across our country in every state who can offer information on healthcare providers in the vicinity who can help. 

3. Women's Mental Health Treatment Programs & Specialists, US, Canada & Australia

The following are links to some of the hospitals and clinics in the United States, as well as other countries included at the bottom of this page, that have specialized programs to treat women with perinatal mood and anxiety disorders. 

How do I decide which programs are listed here?  These organizations are specifically geared toward women with perinatal mood and anxiety disorders.  They are well-rounded, offering treatment, hosting support groups and conducting research into these illnesses.  Their clinicians are focused squarely on treating women with these kinds of illnesses.  If you think your hospital or university's program should be included in this list, email me at postpartumprogress@gmail.com. 

(Note: This list is in alphabetical order by state.  Specialized programs outside of the United States are listed at the bottom. This list does not serve to endorse any particular program.)

Arizona: Women's Mental Health Program at the University of Arizona, Tucson

California:  UCLA Women's Life Center Los Angeles, Dr. Lori Altshuler and Dr. Vivien Burt at UCLA Women's Life Center; El Camino Hospital Maternal Outreach Mood Services, Mountain View, CA, Kristina Peterson, MFT

Colorado:  Postpartum Depression Intervention Program at The Kempe Center, Denver, Dr. Brian Stafford

Connecticut:  Yale Program for Women's Reproductive Behavioral Health, Dr. Cynthia Neill Epperson

Georgia: Emory Women's Mental Health Program, Atlanta, Dr. Zachary Stowe, Dr. Jeffrey Newport, Dr. Toby Goldsmith

Illinois:  University of Illinois at Chicago Perinatal Mental Health Project, Chicago, Dr. Laura Miller; Advocate Good Samaritan Hospital Perinatal Depression Support Services, Oak Brook, Dr. Diane Semprevivo

Iowa: Iowa Depression & Clinical Research Center, Iowa City, IA, Dr. Michael O'Hara and Dr. Scott Stuart

Kentucky: University of Louisville Women's Mental Health Program, Louisville, Dr. Joyce Spurgeon, Sheila Ward CNM

Massachusetts: Massachusetts General Hospital's Center for Women's Mental Health, Boston, Dr. Lee Cohen, Dr. Ruta Nonacs, Dr. Marlene Freeman, Dr. Adele Viguera

Maryland: Johns Hopkins Women's Mood Disorders Center, Baltimore, MD, Dr. Jennifer Payne, Dr. Karen Swartz

Michigan: University of Michigan Perinatal Mood Disorders Team, Ann Arbor, MI, Dr. Sheila Marcus, Dr. Heather Flynn, Dr. Maria Muzik, Dr. Juan Lopez, Kate Bullard, LMSW

Minnesota: Hennepin Women's Mental Health Program, Minneapolis, Dr. Helen Kim

New York: Payne Whitney Women's Program at Weill Cornell, New York, Dr. Margaret Altemus; New York University Reproductive Psychiatry, New York, Dr. Shari Lusskin; the Women's Mental Health Consortium, New York, Dr. Catherine Birndorff; Columbia University Women's Program, New York, Dr. Eileen Kavanagh

North Carolina:  University of North Carolina Center for Women's Mood Disorders, Chapel Hill, NC, Dr. David Rubinow, Dr. Samantha Meltzer-Brody, Dr. Elizabeth Bullard, Chris Raines RN

Pennsylvania: Women's Behavioral HealthCARE at the Western Psychiatric Institute & Clinic of the University of Pittsburgh Medical Center, Pittsburgh, Dr. Katherine Wisner; Penn Center for Women's Behavioral Wellness, Dr. Deborah Kim

Rhode Island: Women & Infants Hospital Day Program, Providence, RI, Dr. Margaret Howard

Texas: The Menninger Clinic/Baylor College of Medicine, Houston, Dr. Lucy Puryear; UT Southwestern Women's Mental Health Center, Dallas, Dr. Neysa Johnson, Dr. Anna Brandon, Dr. Geetha Shivakumar

CANADA

Reproductive Mental Health Program at St. Paul's Hospital and BC Women's, Vancouver, Dr. Shaila Misri

Perinatal Mental Health Program at Mt. Sinai Hospital, Toronto, Dr. Ariel Dalfen

AUSTRALIA

Perth Clinic Mother Baby Program, Perth

Royal Women's Hospital Centre for Women's Mental Health, Victoria

This site complies to the HONcode standard for trustworthy health information: verify here.

Updated List of Specialized Treatment Programs for Postpartum Depression

This week I have updated the list of specialized treatment programs at hospitals and universities around the country for women with perinatal mood and anxiety disorders, which can be found here.

The University of Louisville Women's Mental Health Program, the University of Michigan Perinatal Mood Disorders Program, the Women's Health Consortium program in NYC, the Columbia University Women's Program, the Penn Center for Women's Behavioral Wellness and UT Southwestern's Women's Mental Health Center have all been added. 

A big thank you to the hospitals and universities who have recognized women's reproductive psychiatry as a mental health issue important enough to deserve a specialized program with trained individuals who can provide some of the best support and treatment around to the women who need it.

If you know of another program that should be on the list, email me at postpartumprogress@gmail.com and I'll take a look.

Dance Therapy for Postpartum Depression

One of the people I met at the PSI conference this summer was Gabrielle Kaufman, one of the PSI coordinators for Southern California.  One of the things we discussed was dance therapy.  I had never heard of dance therapy, and was intrigued to find out more about what it is and how it might be used to help women with perinatal mood and anxiety disorders.  Gabrielle was kind enough to write the following article to enlighten us:

"When Rachel was deeply depressed after the birth of her baby girl, she didn't know what to do.  In desperation and with her husband's encouragement, she reached out for help.  Her OB/GYN referred her to a specialist in postpartum depression.  When this specialist spoke to Rachel, she gave monosyllabic answers.  Her baby sat alone in the baby carrier and Rachel stated, 'I don't want to be her mother.'  When traditional talk therapy didn't seem enough to penetrate her sadness, her doctor thought to refer her to a dance/movement therapist.

Based on the understanding that the body and mind are interrelated, dance/movement therapy is defined as the psychotherapeutic use of movement to further the emotional, cognitive, physical and social integration of an individual.  The dance/movement therapist's goal was to help Rachel "move" toward health and connect with her baby girl Sophie.

So what did they do?  A dance/movement therapist has training much like a traditional verbal therapist, but has additional tools in her belt.  With an understanding of movement assessment, the dance/movement therapist can begin to help the client interpret her behaviors and initiate a shift.  The process of bonding with a newborn is a very physical one.  By simply encouraging the mother to hold her baby and rock with her, movement can begin a journey toward connection.  The rocking rhythm is soothing to both the mother and the baby, and the closeness of touch can be healing for both as well. 

The therapist may mirror the client in an effort to meet the mother in her depression, or she may be a model mother by encouraging her client to 'move' her depression.  Sometimes the therapist might bring out scarves for her client to use.  She might invite the client to 'hide' from her baby and return, 'peek-a-boo'.  This process is one in which the mother can regain control and initiate her relationship with her baby.  We know that the bond a mother forms with her baby early on makes a profound impact on the lifetime development of her child.  As much of this attunement is non-verbal, dance/movement therapy can be an ideal intervention.

These days, Rachel finds herself putting on music and dancing with Sophie.  It was through the formation of an intimate bond with her baby that Rachel was able to connect to parenting.  At times she still struggles and has moments of sadness, but by continuing to see her dance/movement therapist and her doctor, Rachel feels more prepared to engage in the dance of motherhood.  To find out more about dance/movement therapy, visit the American Dance Therapy Association at www.adta.org."

Six Things That Can Affect How Quickly You'll Recover from Postpartum Depression

There is probably no question I am asked more often by moms suffering from perinatal mood or anxiety disorders than "How long will it take for me to get better?"  Suffering moms are seeking the exact date when the box will be delivered to their door with their old self inside of it.

"Is it 4 months?  6 months?  I heard so-and-so got better by 5 months postpartum, and I'm 10 months postpartum and I'm still miserable, so does this mean I'm a lost cause?"

I actually looked this up in my library of PPD books, and searched online, and couldn't find a single citation of the exact amount of time it takes to recover from postpartum depression and related illnesses.  That's because there isn't one!  There are many different variables affecting how long it takes each person to get better.

This installment of the Postpartum Progress Six Things series will address six things that can affect your length of recovery from postpartum depression and other mental illnesses related to childbirth.  I am hopeful that, armed with this information, you will be able to have a smoother road to recovery.

1.  How long did you suffer from PPD before you reached out for treatment?

Most moms with postpartum depression will fully recover, especially if the illness is diagnosed and treated early.  It stands to reason that the longer you wait to get help, the longer it may take for you to get better.  Recent research found that the rapid remission of depressive symptoms is the most important predictor for the favorable long-term outcome of a depressive episode.  (Scadoczky et al, Journal of Affective Disorders, 2004)  In simpler words, the quicker you are treated, and the more effective the treatment is, the better result.  Why wait to reach out for help when it may only prolong your misery?

2.  How severe is your illness?

The more severe your symptoms, the longer it may take for you to get better.  A 2002 study found that more severe depression was associated with a decreased likelihood of early recovery.  (Meyers et al, Archives of General Psychiatry, 2002)  NOTICE, that doesn't say decreased likelihood of recovery, just decreased likelihood of early recovery.

3.  How effective is the treatment you have been using?

Some women receive treatment that isn't particularly effective, so their illness doesn't resolve.  There are a variety of reasons why this might be the case.  There are different kinds of therapies (cognitive behavioral therapy, dialectical behavioral therapy, interpersonal therapy, group therapy, etc.), and different kinds of medications (serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclics, antipsychotics, etc.), different kinds of alternative methods (light therapy, exercise, etc.) and even different kinds of support groups (new mom groups, PPD groups that allow moms to bring their babies, PPD groups that don't allow babies, freewheeling groups and groups with specific agendas at each meeting).  It has been proved time and time again that, in the arena of mental health, what works for one person does not always work for another. 

In the book "This Isn't What I Expected", Karen Kleiman writes "If you haven't met your goals or if you are actually getting worse instead of better, it is time to consider a change in treatment or a consultation ..."  If what you've been doing isn't working, work with your healthcare professional to try something different.  Don't give up.

By the way, some people actually have treatment-resistant depression.  According to the Mayo Clinic, you may have treatment-depression if standard treatments don't help much or don't help at all.  It can be caused by significant emotional stress, not taking medications exactly as prescribed, or other underlying health problems you may have like thyroid disorder, heart problems or substance abuse.  Another possibility, if you happen to be on meds, is that your body metabolizes medication more quickly or more slowly than most people.  The Mayo Clinic states that you should make sure you're being treated by a mental health professional (not just your regular doctor), be patient and be willing to try different methods of treatment.  This may include different types of therapy, different medications, trying a sleep and exercise program, or newer treatments like vagus nerve stimulation or trans-cranial magnetic stimulation.

4.  How effective is the doctor or therapist you are working with?

We sometimes make the mistake of assuming the people in the "white coats" know more than we do, so we go along and don't speak up for ourselves when we know we aren't getting better despite following the treatment recommendations.  It could be that the doctor you're working with has limited knowledge and experience in the area of perinatal mental health, and has already tried whatever method they know how to use.  If you're in therapy, perhaps the method they are using just doesn't work for you or fit your personality.  If you're on medication, perhaps they've given you a sub-therapeutic dose, or something that has side effects that are hindering you, or something that flat out doesn't work for you.  This may be because they aren't psychiatric specialists, or because they don't know enough about the medications.  Or, perhaps you are in a support group that just doesn't make you feel comfortable or supported. 

You MUSTspeak up about how you're feeling and how the treatment plan you are on is, or is not, affecting your symptoms.  You must talk about how you feel in the doctor's or therapist's office and whether you feel you are being heard and understood.  If the healthcare professional you're working with isn't willing to try something else or isn't willing to listen to you, there is another out there who will.  Again, Kleiman writes "Treatment failure is not necessarily the fault of the therapist [or doctor].  'Good' therapists often need to change treatment modalities or consider new options when [the treatment] doesn't have the desired outcome."

Sometimes, though, you may have just gone to the wrong person.  That's okay.  You have every right to make a change.  If you are looking for specialists in the treatment of perinatal mood and anxiety disorders, you can click here, here and here.

5.  What is your current life situation and how may it be affecting your recovery?

Getting professional help is crucial, but your doctor or therapist can't come home with you and ensure that your environment is the right one for recovery.  If you are in a situation where the people around you are not supportive this may well slow down your process.  If your partner, for instance, doesn't believe postpartum depression or anxiety or psychosis are real, or isn't willing to help you get the right amount of sleep or give you help around the house, the resulting stress of that can make it harder for you to get better.  A study on the role of support from family and friends in recovery from major depression found that emotional support is significantly associated with depression outcome.  (Nasser, Acta Scandinavia Psyciatrica, 2004) 

As much as you can, reach out to those who are supportive when you need to talk.  Ask your most reliable and encouraging family members or friends to pitch in, or maybe reach out to a local moms group or PPD support group for help.  If you can't find local help, you can at least find virtual emotional support from people who know what you're going through here at Postpartum Progress or at places like the Online PPD Support Group or Postpartum Support International.

6.  What have you been doing to follow your treatment plan and take care of yourself?

In the end, no doctor can make you show up for appointments.  Therapy will fail if you don't open up to your therapist and aren't willing to try some of the coping techniques your counselor suggests you try.  No medication will work if you don't take it.  No support group will help if you don't attend.  Poor sleep and lack of nutrition can prevent anybody from being healthy.  Remember that you need to take a key role in your recovery process.  I know it's hard.  I know you feel like crap.  I also know that you can dig deep down and do this.  Taking care of yourself and making your health a priority is the best gift you can give to both you and your baby.

One final note:  Once  you start to feel better, and you will, the Mayo Clinic suggests that "It's important to continue treatment after you begin to feel better ... Stopping treatment too early may only lead to a relapse."

Depression Treatment Reduces Risk To Family Members

NPR just did a story on how depression in a family can increase the risk of any one member of the famimly getting depression or anxiety as well.  It's a nice piece that reminds us that we must reach out for treatment not only for ourselves, but to benefit our loved ones as well.

"Parents with depression can reduce the risk to their children by getting treatment."

One method of treatment this article recommends is family therapy and support groups.

"What we've found works well is participant support groups," says Peter Ashenden, head of Depression and Bipolar Support Alliance. "People get to meet other individuals with the same or similar experiences," he says, and families can see how other families have coped.

You can find support groups for perinatal mood and anxiety disorders here and here.   These groups are a great way to get started down the road to recovery.

 

New Zealand Study Finds Online Therapy As Effective As Face-To-Face Therapy

I did a story yesterday about online therapy, and then wouldn't you know it, a piece of research comes out on the very same subject.

Researchers at the University of New South Wales and St. Vincent's Hospital in New Zealand found that online treatment was as effective as face-to-face therapy for such mental illnesses as anxiety, social phobias and depression.  Here are some highlights as reported by Science Alert in Australia:

A paper outlining the results of the latest generalized anxiety disorder (GAD) trial appears next month in the Australian and New Zealand Journal of Psychiatry.

The researchers say the initial pilot investigations were so successful participants are now being sought for new, larger trials of the Worry and Shyness programs. The clinic expects to have treated more than 1,200 people in online trials by the end of the year.

"Dr. [Nick] Titov said the results achieved by all three programs - which involved simple online lessons, regular emails and online discussion forums - surprised everyone involved.

'After completing the various programs, more than 70 per cent of participants diagnosed with generalised anxiety disorder no longer met that diagnostic criteria. In the Shyness program 85 per cent of participants recorded good improvement in their scores on measures of social phobia, and more than a third of depressed patients no longer met the criteria to be diagnosed as clinically depressed,' Dr Titov said.

While the internet programs may never completely replace face-to-face therapies, they have the potential to significantly enhance the capacity of existing services ...

'Only 35 per cent of people with anxiety or depression seek treatment over a 12 month period, and only one in 10 sees a psychologist,' he said. 'Internet-based programs may play an important role in increasing those numbers.'

The researchers said it was still unclear why the internet programs were so effective.

The researchers also argue that the online sessions are cheaper than traditional treatments, and required much less time from clinicians.

Some questions I have:  Were the participants getting any other types of treatment or just online therapy?  How did they measure compliance -- how many of the participants actually completed all the sessions they were supposed to?  How severe were the illnesses of the participants -- did people with severe depression or anxiety recover have the same recovery rate as people with mild to moderate depression or anxiety?  How many other studies are that reflect the same or a similar outcome?

I'm interested in learning more about this because it would be great to have a treatment option that works for those moms or moms-to-be that don't have access to face-to-face therapy because of their location or for some other reason ... stay tuned ...
 

Can Online Therapy Help You?

In many corners of this country and others, there is a serious lack of access to trained and competent psychiatric professionals.  I can tell you to go get help, but if there isn't any, what are you supposed to do?  One emerging option that you may wish to consider is online therapy. 

ABC News recently did a story on a study conducted in Britain and published in the journal Lancet that found that online behavioral therapy conducted via instant messaging was effective.  

"The investigators said online [cognitive behavioral therapy] may actually enhance the therapeutic effect of psychotherapy because written expression gives patients the opportunity to reflect, and a transcript of each session is available for review."

Psych Central also recently reported on a study that found online therapy was helpful in treating insomnia.  And Dr. Kathleen Young wrote in her blog about another study, conducted in Australia, that found online therapy to be helpful.  (Note:  I am unaware of any study results currently available on the impact of online therapy specifically on postpartum depression sufferers, although I believe some are underway.)

This is still a fairly new form of treatment, so I think it is really important for you to do your homework before choosing to go this route.  Dr. Young offers a list of things to consider before starting online therapy, such as making sure you have a way to contact the therapist in case the technology fails, and making sure that the online therapist clearly identifies his or her credentials and, if possible, offers you some way to verify those credentials through a licensing board or other trusted organization.  The website Metanoia also offers a good list of four things you should think about before you proceed with internet therapy.  They point out the fact that you must be comfortable writing expressively and descriptively, and you must be willing to reveal things about yourself to the therapist so that this person may help you.

The Online Therapy Institute created a list of ethical guidelines that includes things like ensuring secure and encrypted communications with them so that your privacy is protected and offering you informed consent on the advantages and disadvantages of using online therapy.  Dr. John Grohol at Psych Central has also developed a series on best practices in e-therapy that you may find helpful.

Finally, keep in mind that this form of therapy may not be covered by insurance.

Here's another story on this topic from CNN this week.

 

For more on psychotherapy as a treatment for postpartum depression, click here.

News Roundup on Antidepressants, Online Treatment & More

There are lots of interesting articles, tidbits and posts online by the cast of characters I like to read, and I want to share some of them with you here:

Therese Borchard at Beyond Blue: Do Antidepressants Dull Emotions?

Therese Borchard at Beyond Blue:  How Would the Dalai Lama Treat A Mood Disorder?

Lauren Hale at Sharing the Journey:  Adrienne Einarson Responds to Vogue's "Pregnant Pause" Article

John Grohol at Psych Central:  No Significant Relationship Between Violent Crime & Mental Illness

John Grohol at Psych Central:  Online Treatment for Depression

No Judgment Allowed When It Comes to PPD Treatment: What Saves One Woman May Not Save Another

I just saw this as I'm trying to catch up on my reading of the Beyond Blue blog, and I thought it was really fantastic.  I hope she doesn't sue me (it wouldn't be worth it Therese, I have no money!), but I'm going to "reprint" a lot of it here, because it is SO worth reading:

Two days ago, at my doctor's visit, I ended up crying, again, as I talked about my resentment toward those people in my life who took advantage of my suicidal days as an opportunity to push their philosophies about the Law of Attraction [she's referring to that book that Oprah promoted]. They scared me by saying "You are losing your personality to medication," and "Medicine is today's biggest industry--It's a conspiracy, and you are the guinea pig." They very strongly encouraged me to go off all of my meds, to center myself, and look to the light. They performed Reiki on me.

And they told me, as I sobbed: "You are a weak person if you have to rely on medication. It's a shame you weren't stronger."

I believed them for a very long time. Too long. And so whenever I hear someone sound like them, I have to put my hands in my ears and yell this message:

1.) Depression is a legitimate brain disease, as legitimate as cancer, arthritis, diabetes, and dementia. For the medical reports and explanations, read Peter Kramer's "Against Depression." Or read my post "Depression Is a Brain Disease."

2.) I have seen what happens when people who have mood disorders don't take accountability for their illnesses--what happens when they rely soley on positive thinking and visualization techniques: their family members have to pick up the pieces and do all of the responsibilities that the person has neglected because he/she won't take medication, or is in denial. Or they take their own lives. At the age of 16, I saw that too (my Godmother, a bipolar, took her life then.)

3.) I am holistic in my approach. I engage body, mind, and spirit in my recovery more than you know. I think about my brain at every meal, conversation, and work out.I pray. I meditate. I take fish-oil capsules. I exercise like Lance Armstrong. I get outside. I use a light lamp. I get regular sleep. I keep a gratitude journal. I try to do charity.

4.) The most irresponsible thing for me to do right now for my family would be for me to go off my meds. I have seen what happens when I do. So part of the reason I stay on, and not experiment with weaning is because I love them. I love them so much that I will take my meds, even if I don't want to.

Please. Don't say things like you just did. If you only knew how hurt I still am by those who utter similar words to my face, at my lowest point, you would take them back. At least I hope you would. Support those who face mental illness head on, and don't hide behind empty feel-good philosophies."

Wow, Therese.  You are one powerful Warrior Mom.  

Do you know how many women I hear from who call me when they're now 8 or 9 months postpartum, or even at a year, sobbing, wondering what they've done wrong?  They've figured out by now that they have postpartum depression, or something akin to it, and they know that if they could just exercise more, or find a better brand of vitamin, or maybe get even closer to God, or think happy thoughts that it would all get better.  If they just did one more thing, or worked a little bit harder, this would all go away.  They're convinced this is all their fault because they're obviously not doing it right, even though they've been trying like crazy for months on end and it hasn't worked.  They've been made to feel that certain treatment choices are simply off limits because others look down upon them.  How much of that suffering could be eliminated if these moms had felt safer trying something different rather than continuing to bang their heads against the wall?

I think it's important to inform yourself of all the things that help to make your brain work better and to do them, as long as you yourself are comfortable with them.  It's YOUR decision and no one else's.  If you find a treatment method that works for you, whatever it is, I SAY AMEN SISTER!  But if your illness keeps going, and going, and going, don't be afraid to try something else just because it's not what others think is right.

I happen to take Flaxseed oil capsules.  I have started exercising 4-5 times a week.  Do I like exercising?  No, not a big fan.  Am I doing it to lose weight?  No, because now that I'm turning 40 my metabolism has stopped and I can't lose weight for the life of me.  (UGH!)  I do it because I can literally feel it releasing stress.  I could get 4 to 5 more hours of work done a week instead of exercising -- time that I could really use working.  But instead I'm exercising because it's crucial for my brain.  I could also get up early, or go to bed even later than I already do, to get everything done that I'd like to.  But NOPE, won't do that either.  Sleep is like oxygen and I'm making sure I get enough. I go to church and my faith happens to help me.  I have supportive family and friends.  Therapy has been great for me.  I also believe that meds worked for me and I'm glad I took them, and, horror of horrors, continue to take them for my OCD.  I've made my own decisions and I'm comfortable with them.  These things have worked for me.  But who cares what has worked for me?  What matters is what works for you.

There will be people who will tell you "this works for everyone".  I've heard:

• "[Insert antidepressant brand here] saved me!"

• "Stopping breastfeeding saved me!" or conversely "Continuing to breastfeed saved me!"

"Eating my baby's placenta saved me!" (I swear I'm not kidding on that one.)

"Thyroid treatment saved me!"

"My support group saved me!"

"[Insert doctor's/therapist's name here] saved me!"

"Progesterone cream saved me!"

It may have indeed saved them.  But it doesn't mean it will save you. What I have done, or your best friend did, or your mom's coworker did won't necessarily save you.  I haven't come upon anything yet for the treatment of perinatal mood and anxiety disorders that works the exact same way and has the exact same impact on everyone.  Each of us is different from the next, and there are simply too many variables -- your genetics, your family life, your doctor's/therapist's personality/approach/expertise/bedside manner, how severe your illness is, your family history, your general health, your economic situation.  That is why you have to find trusted, experienced professionals to help you sort this out based on YOU and only YOU.  And you have to do your own research and educate yourself.  And keep in mind that, for many people, it takes more than one course of action to get better -- you may need to make sure you're taking care of yourself in a variety of ways and not relying on one magic "whatever" to make you better.

It is awful that people judge, and quite ridiculous actually.  DO NOT JUDGE.  You have NO PLACE.  Don't prevent women from getting whatever kind of help it is they need to get back to being themselves again.

MGH: Using New Research to Inform Treatment Decisions During Pregnancy

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

How To Decide Whether To Take Meds for Depression or Anxiety During Pregnancy

So you have a history of depression (or anxiety or bipolar disorder) and you're trying to decide whether to have a child or not.  OR you've gotten pregnant and now have depression (or anxiety or bipolar disorder) during your pregnancy, maybe even for the first time in your life.  OR you are pregnant and you're feeling fine but you've had antepartum or postpartum depression (or anxiety) with a previous child and you want to prevent it from happening again. 

Let's say you happen to know (from reading Postpartum Progress!) that research shows that the rate of relapse for women with depression who are taken off their medication while pregnant is 50 to 75%.  You also already know that babies whose moms suffer untreated depression while pregnant are negatively affected, including having a higher risk of being born pre-term and with low birthweight.  On the other hand, you're worried about the risks of taking medications while you are pregnant.  You've read about conflicting studies and you're not sure what they mean.  You're starting to realize there is no 100% safe choice either way.  So what the hell should you do?!

Most of us feel like we're damned if we do take medication to treat or prevent depression or anxiety and we're damned if we don't take medication to treat or prevent our depression or anxiety. 

You can freak out about it and make yourself sick over it.  I've been there.  It is no doubt a scary decision to make and one that I've had to make myself.  But I'd like to suggest a different approach ... a Warrior Mom approach, if you will.

As a Warrior Mom, you're going to talk it over carefully with your psychiatrist and your OB/GYN and come up with a plan that makes the most sense for you as an individual.  Your plan may include therapy, support groups, medication, nutrition, and/or exercise ... there are lots of options.  What you need is a healthcare professional who has knowledge and experience, who is measured and balanced, and who can have an intelligent discussion with you about your unique history and situation. 

If you have a doctor who hands out antidepressants like candy and doesn't talk to you about the risks, get another doctor.  If you have a doctor who refuses to allow anyone to take medication during pregnancy and doesn't understand the risks to you and your baby of untreated mental illness during pregnancy, get another doctor.  If the healthcare professional you're going to is an extremist on either end, they're not fully informed and that's not fair to you.  At minimum, you can have your doctor consult with another who has more expertise on these issues.  Then you can make a decision.

The next step is to remind yourself that this will be only ONE of a million decisions you will make about your children that may (or may not!) deeply affect them.  We make choices every day that can change our children's lives, in big ways and small, for better or worse.  Do we breastfeed or don't we?  Do we send them to daycare or do we stay at home with them?  How much television?  Public school or private?  City, suburbs or country?  Do we sign them up for this sport or that one, this art class or that one, or do we sign them up for nothing at all?  Do we let them spend the night or not?  What's the right curfew?  Do we stand our ground or give them a break?  Give them birth control or tell them to abstain?  Do we let them go on that trip, borrow the car, wear that outfit or get that nose ring?  There are no 100% safe answers to any of these questions.  What you decide, based on your circumstances, may be very different than what I decide.

We can't run off and hide, much as we might like.  As parents, or parents-to-be, we have to decide.  So we do the best we can each day.  All you can do is try and make the best decision for yourself and your family on each of these issues, including the important issue of how to tackle mental illness and pregnancy. 

For more on this, read this great article from Brain Child magazine called "Between Depression And a Hard Place" by Anna Blackmon Moore on how she made the decision whether to take an SSRI during pregnancy, the resources she used, and the varying feedback she got from different doctors. 

And this piece from Heather Armstrong at the very famous blog Dooce about her decision.  And this post from me about my decision.

Also, these pieces, one from the New England Journal of Medicine called "Use of Selective Serotonin Reuptake Inhibitors [SSRIs or antidepressants] In Pregnancy & The Risk of Birth Defects" and this helpful piece from Dr. David Schatz at CTIS.  And this from the Mayo Clinic.

Also, you can check out the following books:  Pregnant on Prozac by Shoshanna Bennett, Pregnancy Blues by Shaila Misri and What Am I Thinking? by Karen Kleiman.  I haven't had the chance to read Shoshanna's or Shaila's books yet, but I know they cover this topic in detail.  I have read Karen's, and as with all her other books, it's very helpful.

Peer Support Prevents Depressive Symptoms in Moms At Risk for PPD

WebMD reported yesterday on a Canadian study published in medical journal BMJ concluding that phone calls from volunteer mothers who overcame postpartum depression prevent depressive symptoms in at-risk mothers.  This is such an amazing testament to the power of speaking up, and to the volunteers all over the world who create and maintain support groups and answer warm lines.

"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.

Most Effective Treatment for Depression: Therapy & Meds

Psych Central has reported on a new study released in the Journal of Consulting & Clinical Psychology that finds that a combination of psychotherapy and medication is usually "the best possible treatment option for depression (acute or chronic) for nearly everyone.  If you're only doing one or the other, you're likely not going to get well as quickly, it's that simple."

Manber and colleagues (2008) re-examined previous data on 656 patients with chronic depression to see who would get to remission first. Remission in depression research is simply when a person’s depression score on a commonly used depression quiz (the Hamilton) falls below a certain number.

People who had scores of less than 26 on the Hamilton fared best with the combination treatment — 40% of them attained ‘full remission’ within the 12 week study period. So in just 3 months of combined treatment, your depressive feelings could be significantly decreased.

To read the entire article, click here.  I'm not at all surprised by the results of this study.  We don't know exactly what causes depression.  It may be a combination of both physical and social factors.  A "one-two punch" of medication to help improve the physical processes of the body in some way and therapy to help you work through personal issues makes perfect sense to me as the best way to recover. 

Depression and The Medication vs. No Medication Camps

This is an EXCELLENT, EXCELLENT piece from Therese Borchard at BeliefNet about taking medication for mental illness and all those arguing against it.  I think this is a MUST read.  She writes about James Gordon, author of "Unstuck," who talks about how drugs aren't necessary to treat depression in an interview with Newsweek.

"I have no doubt Gordon's techniques work for those struggling with mild and moderate depression. My doctor confirmed that. Alternative therapies are wonderful for folks with uncomplicated mood disorders. Maybe I wouldn't need meds if I was in that camp.

But I'm not. What I have is serious, and even Gordon didn't sound all that convincing when Newsweek's Anne Underwood asked him, 'And for severe depression?'

His response: 'That's harder to work with. That's where we need studies.'"

Thanks Therese.  Right on girl.  I hate how judgmental people are about medication.  What I know is that it worked for me.  Let me repeat:  It. Worked. For. Me.    I know lots of people for whom it works.  There are others who don't need it.  That's fine.  Stop judging, world.  Just stop it.

P.S.  Here's Dr. John Grohol from Psych Central's response to Therese's piece

Mayo Clinic Presents Research on Genotyping for Treatment-Resistant Depression

Last week at the annual meeting of the Royal College of Psychiatrists in London, research conducted by the Mayo Clinic was presented on genetic blood tests for people who do not respond well to antidepressants.  From Medical News Today:

"Four out of 10 people with depression have a genetic abnormality that prevents them responding to anti-depressant medication.  The research showed that a quarter of those with a genetic abnormality produce a liver enzyme that either stops Prozac working or causes unpleasant side-effects.

Since 2003, the Mayo Clinic has offered genotyping to patients who either report significant side-effects to antidepressants or have no response."

The article stated that genotyping for depression has become widely known in the USA following publication of the autobiography "Mommies Cry Too" by Carolyn Brink in 2006. (I actually don't agree with that statement -- I don't think many health organizations are doing that type of genotyping at all.)  Brink was diagnosed with severe postpartum depression shortly after the birth of her first child. But her treatment with three different antidepressants made the depression worse and led to suicidal feelings. She says the Mayo Clinic saved her life when the genotyping test showed that the antidepressant medication she was taking became toxic in her bloodstream due to her low metabolism rate for this type of medication.  To learn more about Carolyn Brink, go here.

I'm curious to hear back from some of the experts who read this blog (you know you're out there) about their thoughts on genotyping for treatment-resistant depression.

Straight Talk About Hospitalization & Postpartum Depression

One area I don't like to talk about is hospitalization.  I don't know why.  It's like the ultimate embarrassment for me or something that at one point I had to be hospitalized in a mental hospital (UGH!) for depression.  It was only for a few days, but it's one thing of which I have to say I still feel slightly ashamed.  If our society considered mental illness a physical illness, then of course I wouldn't be ashamed, because there is nothing at all wrong with being sick and having to go to the hospital.  But you and I both know that's not the way people think when it comes to "mental institutions."  Nonetheless, I can't let that stop me from talking openly to you about a type of treatment that some women with postpartum mood disorders must experience, so here goes ...

The truth is, if we are a danger to ourselves or others we need to be hospitalized.  Period.  I wish there were another way, a better solution, but as far as I know there isn't.   I got to a point where I thought I might kill myself.  And so, that's where I was sent.  The minute I got there and saw what was coming I completely changed my mind about killing myself, of course.  I told them very articulately that I was all better and there was no need to move forward.  (Stop the train, I want to get off!)  But once the proverbial cat is out of the bag you can't put it back in. 

Here's what you should know:  Mental hospitals aren't a treat.  It can feel like being in jail.  Once you are in you can't just get out any old time you want.  At least not for 48 hours or so.  You don't have access to all of your things because they take them away from you to make sure there's nothing dangerous or illegal in them. You don't have free access to the people you love, except during limited visiting hours.  The decor is sorely lacking.  The food stinks.  The beds are lumpy.  You don't even have the right to go to the bathroom at any time without permission.  I remember at one point being in the cafeteria trying to eat the awful food and I needed to pay a visit to the facilities.  They wouldn't let me, because they couldn't leave my group and couldn't let me leave the cafeteria alone.  I was humiliated and infuriated.  "I'm a competent grownup!  How dare you tell me I can't go to the bathroom!  What happened to basic human dignity??!!"  They were unimpressed by my reaction, and I had to wait.  Also, I was in the general adult ward, with men and women in all sorts of mental states -- addicts, schizophrenics, people suffering from depression or bipolar disorder -- and I was scared.  The truth is no one would choose to hang out with a group of people she doesn't trust to make safe choices.  But be all of that as it may, it was the exact right place for me. 

I truly benefited from being in that hospital at that moment.  Once we get over the thinking that we are somehow better, special and different from the rest of the people in the "asylum", it can be a profound experience.  First, they took care of me and helped me become stable.  I was in a crisis and they helped me out of it.  Second, I was humbled and made to understand via circumstance that we are all one step away from losing our minds no matter where we come from or how much money we make or what we look like or what job we have or how competent we've been up 'til now.  Third, I learned that severely mentally ill people are still people, and I became very empathetic to their plight.  I remember watching a man who stood in the corner all day brushing himself off and found out it was because he thought there were snakes on him.  Another young man curiously kept cutting the eyes out of pictures of people in magazines.  Only later did I notice he had been taping them up surreptitiously in strategic places throughout the ward -- in the leaves of the ficus tree, on the wall clock, in the plastic floral wreath covered in a layer of dust.  The eyes watched me wherever I went.  I imagined what those two men, and some of the others, might have been like as innocent, happy children with no inkling of what was to come in their lives.   Could they help the situation they were in now?  Maybe, maybe not.  I went from a state of fear to one of wonder and to one of caring about these people and hoping for their well-being.   

I have family members of women with postpartum depression or psychosis reach out to me to tell me their sister or daughter has been hospitalized and that it's absolutely the WRONG place for her.  "She doesn't belong with those other people.  She's not crazy.  She's just not doing well."  I completely understand what they mean.  It's the wrong place for everyone.  Wouldn't we all like to go recuperate from wanting to kill ourselves in Tahiti?  Don't they have a "Mental Health Weekend" 3-day package at the Ritz?  That would be lovely but that's not how it works.  So I tell them I know it seems like a mistake, but it's actually the exact right place for her at that moment.  I tell you that if it's what you have to do to restore your sanity and return home a more healthy mother to your baby, just do it.  Suck it up and do it.  No matter how yucky it is, you will live.  And you might be a better person for it.

   

Scaremongering, Risk & Postpartum Depression

I wanted to share this quote from an email sent to me by a woman in the UK who suffers from depression.  It is so well put, and represents how a lot of us feel when it comes to taking medication:

[I was pleased with the] intelligent discussion on your Blog about the risk-benefit of antidepressants, amidst the relentless tide of scaremongering from "big pharma sponsored" psychiatrists warning people that they will inevitably relapse into bad mental health if we discontinue our medication and the scaremongering from "litigation sponsored" lawyers frightening us to death about inevitable child defects. There is nothing inevitable in life & people manage risks as well as they can.

Agreed.

Can Estrogen Be Used to Treat PPD?

Here's a link to a very helpful post on the efficacy of estrogen in treating postpartum mood disorders.  It's written by Dr. Ruta Nonacs of Massachusetts General Hospital and Harvard Medical School.

Clinical Trial of Light Treatment for Antepartum Depression

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

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 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. 

Women's Health Matters Blog Covers Light Therapy

This is a nice post from the blog Women's Health Matters, written by Dr. Leigh Ann Simmons, about light therapy as a potential for treating PPD.

Top Women's Postpartum Mood Disorder Treatment/Research Programs in the U.S. and Canada

I have created a new page, which you can find to the left of your screen underneath the "Pages" link, that features a list of the top treatment and research programs in the United States and Canada for postpartum mood disorders.  I have compiled the list from my own research, so it reflects my opinion, of course, but I have to say I think it is pretty accurate.  For those women who need care and live in the vicinity of the hospitals and clinics where these programs are located, you are very fortunate to have the opportunity to be treated by people who truly specialize in our illnesses.   I will add additional programs to this resource whenever appropriate.  Here is the link to the page: http://postpartumprogress.typepad.com/weblog/major-womens-mental-healt.html

The programs featured include:

Emory Women's Mental Health Program, Atlanta, Dr. Zachary Stowe & Dr. Jeffrey Newport

Massachusetts General Hospital's Center for Women's Mental Health, Boston, Dr. Lee Cohen, Dr. Ruta Nonacs

Payne Whitney Women's Program at Weill Cornell, New York, Dr. Catherine Birndorff

New York University Reproductive Psychiatry, New York, Dr. Shari Lusskin

Yale Program for Women's Reproductive Behavioral Health, Dr. Cynthia Neill Epperson

University of Illinois at Chicago Perinatal Mental Health Project, Chicago, Dr. Laura Miller

UCLA Women's Life Center, Los Angeles, Dr. Vivien Burt

Women's Behavioral HealthCARE at the Western Psychiatric Institute & Clinic of the University of Pittsburgh Medical Center, Pittsburgh, Dr. Katherine Wisner

Reproductive Mental Health Program at St. Paul's Hospital and BC Women's, Vancouver, Dr. Shaila Misri

Iowa Depression & Clinical Research Center, Iowa City, Dr. Michael O'Hara and Dr. Scott Stuart

Women's Mental Health Program at the University of Arizona, Tucson, Dr. Marlene Freeman

Reluctance to take Meds: What If It Was Diabetes or High Blood Pressure Instead?

I get so many comments and questions from women who want to know how to get over postpartum depression without taking medication.  I'm NOT judging them or questioning their reluctance one bit, because truthfully I didn't want to take medication either.  But all these concerns have led me to wonder what our reluctance really is.  As I said in an email to one of these women earlier today, if I was diagnosed with diabetes I wouldn't think twice about taking medication prescribed to me.  If I was told by my doctor that I had high cholesterol or high blood pressure, I'd take the medication prescribed to me.  Sure, I'd need to change my lifestyle as well to address the underlying problems causing the high blood pressure or cholesterol -- I'd exercise more, I'd eat better, I'd develop better coping mechanisms for stress -- but I'd also take the medication to address the current crisis until my other activities kicked in and my blood levels were safe enough that I could discontinue the meds.   

Isn't it the SAME THING with postpartum mood disorders?  Aren't meds ok to help resolve the immediate crisis, while at the same time we can use exercise and/or talk therapy and support gropups and whatever else works to resolve any contributing underlying factors and to recover and get back to our old selves?  And when we do recover, we can reduce them until it's okay to stop taking them altogether. 

It seems to me that psychiatric medication, where appropriate and prescribed by an experienced professional, is simply addressing a physical medical crisis.  Our bodies don't differentiate between psychiatric illnesses and other physical illnesses.  Only society does.  It's society, and the damn insurance companies, that make us feel like psychiatric illnesses are some how different and highly questionable.   Who the hell is some insurance person to tell me how many damn doctor visits I'm allowed to have to get better from postpartum depression?  Are you kidding?  ... sorry ... it just incenses me that we're given hard limits on what treatment we can have to get better as if (wink, wink) we're probably not really sick in the first place, now are we??

Anyway, I'm sure there are people who have recovered from postpartum mood disorders without taking medication.  And I say more power to them, seriously.  Potentially, through continued research into various hormones and brain chemicals and genes and levels of various things in our blood we may get to a point where there is a more direct treatment for these illnesses which may or may not involve medication.  Until then, I can only tell you that I, myself, would not have recovered without the medication I took.  As Oprah says, that's one thing I know for sure.

P.S.  On the same topic, click here to go over to The Perinatal Project blog to read about some recommended changes in the way mental illnesses are covered by insurance.

Transcranial Magnetic Stimulation a Potential Treatment for PPD

My inbox is flooded, flooded, flooded with stories on PPD, including more and more stories on research and new discoveries, which is so exciting.  Today I'll share with you a story from KSDK-TV in St. Louis, Missouri.  But you have to PROMISE to keep in mind, there are no magic bullets yet to fix PPMDs, and there are no complete answers as to what causes it.  We can't say for sure whether the following treatment will really work for everyone, or what long-term side effects it may cause:

"Local doctors may be on the verge of a breakthrough for women who suffer from postpartum depression.

It's a treatment that doesn't even require new moms to take a pill. Doctors are using magnets to stimulate the brains of moms who are depressed after giving birth.

It's still in the testing phase, but it's helped Erin White so much, she wishes she had talked about her depression much sooner.

Every day for the past four weeks, she's had her brain stimulated by a magnet. The hope is the treatments will loosen the grip of her postpartum depression.

'I waited almost five months to say something and I kept thinking well maybe I'm just overwhelmed maybe I just need to get used to my new schedule,' said White.

The treatment is called transcranial magnetic stimulation. Discovered by accident, it actually changes the physiology of the brain and improves the mood.

So how does it work?

'The fact is, we don't know,' said Dr. Keith Garcia, a psychiatrist at Washington University School of Medicine.

But the preliminary findings of this research are promising. Magnetic stimulation of the brain does appear to be working in women with PPD.

'So far I think the findings are going to be pretty positive. In major depression it seems to be an effective treatment,' said Garcia.

Candidates for the study are carefully screened. Those selected get 40-minute treatments, five days a week for a month.

White said it's been time well spent and urges other new moms struggling with depression to reach out for help.

'Don't be embarrassed get help as soon as possible and that way you can enjoy your baby as much as you can!' said White.

Besides a tapping feeling, some women may also get a slight headache following treatment, but side effects are said to be minor.

Postpartum depression affects 15 percent of women who deliver babies. Symptoms include poor mood, lack of sleep, appetite, and concentration.

For more information, call Washington University's Volunteer for Health Office at 314-362-1000."