Showing posts with label depression. Show all posts
Showing posts with label depression. Show all posts

September 2, 2008

New postpartum depression scale may be effective in screening new moms

Researchers in Denver just announced that simply by asking three simple questions, doctors can tell whether or not a new mom may be suffering from postpartum depression.  This new three question screening process is basically a sub-scale of the traditional Edinburgh Postpartum Depression Scale that is commonly used.  Instead of asking a boat load of questions to a new mom who is most likely completely sleep-deprived, stressed, distracted and has an attention span of a toddler, this new scale contains only these three yes/no questions:

1) I have blamed myself unnecessarily when things went wrong.
2) I have felt scared or panicky for not very good reason.
3) I have been anxious or worried for not very good reason.

Apparently, in the study, this shorter PPD depression scale identified 16% more mothers as being depressed than the longer, Edinburgh questionnaire.

Personally, I see merit in the study and am so glad that PPD is receiving this kind of attention to detail.  However, had I taken the above test, I would not have been diagnosed, as my symptoms were all physical (mainly GI-related) and I had no idea that I felt anxious or scared or panicky.  I just wondered why I couldn't stop vomiting or feeling nauseous or dizzy all the time.

Much still needs to be done to educate our medical providers on just what the symptoms of depression are and how to more effectively reach those who are have so deeply fallen into a dark place that they are unable to seek help.

To read a complete article on the study, please visit EmpowHer, the world's greatest health site for women!



March 21, 2008

Scientific American's solid article on postpartum depression epidemic

There's an extremely comprehensive article on PPD on the Scientific American web site, including data from a number of current PPD-related studies from around the world. The article, written by Katja Gaschler, includes an in-depth look at the impact of PPD on the nascent bond between a mother and her baby.

Here's an excerpt:
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"The consequences of depression inevitably reach beyond the mother. In a fog of sadness, a mother often lacks the emotional energy to relate appropriately to her baby. Overwhelming grief prevents her from properly perceiving a child’s smiles, cries, gestures and other attempts to communicate with her. Getting no response from mom, the child quits trying to relate to her. Thus, three-month-old infants of depressed mothers look at their mothers less often and show fewer signs of positive emotion than do babies of mentally healthy moms.

"In fact, infants of depressed mothers display something akin to learned helplessness, a phenomenon University of Pennsylvania psychologist Martin E. P. Seligman and his colleagues described in the 1960s. In Seligman’s experiments, an animal would conclude that a situation was hopeless after repeatedly failing to overcome it—and then remain passive even when it could effect change. A similar passivity characterizes depression. “Sometimes the infants mirror their mother’s depressive behavior,” Reck says.

"Such reciprocal withdrawal can start to fray the critical emotional bond between mother and child, especially if the depression occurs early in the baby’s life. Other work has shown that infants develop essential social skills in months two through six, building relationships with their mothers as well as other people. In a 2006 study of 101 new mothers, psychiatrist Eva Moeh­ler, Reck and their Heidelberg colleagues found that maternal depression strongly diminished the quality of a mother’s bond with her child at two weeks, six weeks and four months postpartum—but not at 14 months. Thus, depression during the first few months after birth may be particularly perilous for a child’s social development."
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So .... in addition to treating a woman for PPD, it's equally important to treat the relationship that she has with her baby as well. Apparently, there are some really ground-breaking therapies happening around the world, such as at the Clinic for General Psychiatry in Heidelberg, Germany. This personally fills me with so much hope. How great to know about the good work being done out there!! Here's another excerpt:

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"Tabea, a mother in her early thirties whose depression was severe enough to warrant hospitalization for several weeks after she gave birth, is still having difficulty interacting with her four-month-old son. At the Heidelberg clinic, a psychologist asks Tabea (which is not her real name) to sit in front of a video camera with her baby. Tabea speaks loudly to him. She raises her eyebrows and laughs. Her infant makes eye contact, and a smile flits across his face. His mother feels reinforced. But then the infant turns his head away. And Tabea says, “Well, what’s the matter now? Sulking again, are we? Did mommy leave you by yourself too long?” Tabea feels guilty for having had to leave her baby to be treated for depression.

"But it is normal for infants to turn away after a social interaction. That is how they regulate stimuli. It is not, as Tabea sees it, a personal affront or a sign that she is a bad mother. Nevertheless, Tabea’s misinterpretation of her baby’s actions can prompt a vicious cycle in which the child’s apparent rejection hurts Tabea, making her feel insecure and sad, which in turn has a negative effect on the baby.

"The therapist’s job is to break that cycle, large­ly by correcting a mother’s misimpressions and emphasizing what she has done well. Tabea’s wide-open eyes, for example, signaled that she was paying attention to her child. The psychologist points out that Tabea’s expressive face and melodious speech are similarly appropriate and helpful. Then she encourages Tabea to wait for her child to take the initiative, which will be her signal to respond.

"Some hospitals have mother-infant treatment centers for postpartum depression so that the mother can remain with her infant during treatment. There hospital personnel help the mother feed, diaper and bathe her child while also providing behavior therapy. Fathers can play an important part, too. Assuming he is not depressed, a father can significantly ameliorate the effects of a mother’s depression by building a close relationship with his son or daughter.

"Meanwhile a mother can take steps to ease her emotional burden by asking for help from family and friends, sleeping more, spending time with her spouse, getting out of the house and putting less pressure on herself. In the end, most mothers who receive adequate treatment—often a combination of psychotherapy, medication and self-help—usually recover completely within about two months of starting treatment, according to psychiatrist Ricardo J. Fernandez of Prince­ton Family Care Associates in New Jersey. Some mothers even emerge from their cloud of sadness with a new sense of clarity. As one mother said of her depression, 'It gave me the impetus to change my life.'"
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I just love that last quote. I can totally relate to that "new sense of clarity" feeling that comes from rising up from the pit of despair. There is actually so much positive that you can take away from overcoming a devastating nightmare such as PPD. And it's gratifying to know that there are those in the scientific community who are working hard to contribute to what has truly become an epidemic among mothers.

March 16, 2008

Story of a mom who survived PPD

There's an article that ran recently in The Santa Clarita Valley Signal that I think everyone should read about a mom named Tracy who went through PPD and successfully came out the other side.

Here's an excerpt that I especially found valuable:

Prevention is Key
Since screening for depression is rarely done on pregnant women, knowing your own risk factors and taking care of yourself both before and after your baby is born are key ingredients to avoiding PPD in the first place.

"It's a shame that we screen pregnant women for Down's Syndrome, but we don't screen for depression, even though it's much more common," said Diana Barnes, Psy.D., a licensed marriage and family therapist specializing in the assessment and treatment of postpartum illness.

Those at higher risk of developing PPD include women with a personal or family history of PPD or other mood disorders, as well as those who have significant mood changes around their menstrual cycle, and women undergoing fertility treatment.

"If you had one episode of PPD already, the risk of having a subsequent episode during a different pregnancy is 75 percent," Barnes warned. "If you have been treated for depression or anxiety in the past, you are at risk."

Barnes added that if you develop depression while you are still pregnant, like Tracy did, your risk is even higher of being depressed after the baby is born as well.

Though many women have these risk factors, Barnes cautions against panic. Just because you are at risk does not mean you will develop PPD, but being aware of the possibility means that if you do develop it, you will be able to nip it in the bud that much sooner.

"Awareness is key," said Barnes. "Women should educate themselves and their families during their pregnancy."Barnes also encourages women to slow the pace of their lives before and after a baby is born. Don't try to change houses, jobs, or make other major life changes.

"Try to keep things status quo for at least one year postpartum," she said. "Women often put too much stress on themselves around pregnancy time, which is not good. We underestimate how big a change we are going through, and overestimate what we can handle. Other cultures make a much more sacred space for women to be pregnant, and we don't, but we should."

Get Help and SupportTo help yourself get well if you are in the throes of PPD, experts advise that you not be afraid to ask for help, and accept as much as you can.

Since getting enough sleep is important for recovery, Barnes suggests bringing someone in to your home who can get up at night with the baby if necessary. Tracy chose to hire a nanny, but you can also call on your spouse, a friend, or a family member as well.

In addition, finding other mothers suffering from PPD or a support group that caters to women with PPD can be a lifesaver during the most difficult moments.

"Support groups are excellent," Barnes said. "When you have PPD you feel that no one could feel as bad as you, but when you are sitting across the room from someone who gets what you are going through, there is nothing as good as that. You have less of a sense of isolation, and it can make you feel more hopeful."

Barnes recommends finding a group that specifically deals with mothers with PPD, as opposed to a general "new mothers" club, since moms with PPD are going through an entirely different experience of motherhood than those not suffering from it.

August 23, 2007

So what's up with our access to anti-depressants?

A woman e-mailed me this morning after reading my last post and said that she's really suffering and needs to see a psychiatrist. She gave birth to her baby after a very traumatic delivery about 6 weeks ago and she's been experiencing some troubling OCD symptoms, like obsessive hand-washing. The problem is that she has no insurance and limited funds, so when she called a psychiatrist that she found in her phone book and was told that it would cost her $225 an hour to see him, she gave up. So I started researching free and low-cost psychiatric resources in her state when this comment appeared on my blog from Moxie Mom:

"I wonder if the inconsistency stems from the availability of seeing a shrink that is affordable since many, many, people have terrible health care. It's much easier for a women to see her PCP (primary care physician) than it might be to see a shrink in that case. Of course, I agree with all of your comments: a shrink would be the best choice. Believe it or not, I have pretty good health care but I see a psychologist and get my drugs from my PCP. All the real psychiatrists wouldn't call me back, even after I left several messages. I called 5 of them. Talk about an eye-opener. Seems to me, all levels of health care providers need to start stepping up their game and thinking outside their box."

Moxie Mom's comment really made me think. I know that in my city, Phoenix, there are very, very few psychiatrists and when you actually find one who happens to be taking new patients, the wait could be as long as 3-6 months. It's ridiculous. There's no way a woman suffering from PPD, not to mention her baby, can wait that long. I could rant about this for hours....

But I still had to figure out how to help this poor woman with no health insurance.... so I'll rant about the general lack of psychiatric care later. I did find a state-funded mental health program in her state that had several psychiatric clinics spread throughout her county. At the clinics, she would be able to have access to either a psychiatrist or a psychiatric nurse practitioner to receive medication if necessary, and also a psychologist for talk therapy. If she qualified all of the services and meds would be free, but even if she didn't qualify financially, she would still receive everything at a 40-60% discount compared to private practices.

That was encouraging and I hope to hear back from her after she finds the support she needs. Moxie Mom, thanks for sharing your thoughts!

August 21, 2007

I have postpartum depression and need some Zoloft!

So I was chatting last night with a young woman who has a 9-month-old baby and is suffering from postpartum depression. She asked me where to go to get a "good" anti-depressant. She's been going to her OB who has prescribed Lexapro but so far the Lexapro isn't working for her. Before that, she went to her primary care physician who had her taking Paxil for a while, which also didn't work.

What amazes me here is the fact that neither of these doctors should be prescribing an anti-depressant to this woman who is obviously suffering. I mean, when you need medication for your heart, you go to a heart doctor/cardiologist. When you need medication for your brain, you go to (you guessed it) a brain doctor.

Why are so many women getting their anti-depressants from doctors like gynecologists, obstetricians, internists, etc??? Why are we messing around with our brains??? Would you go to a foot doctor if you're suffering from an ulcer? I think there are so many misconceptions about anti-depressants and it has gotten to where they are way too commonly prescribed -- and by any kind of doctor.

So I suggested that this young mother try to go see a psychiatrist so that she'll have the opportunity to get on the right anti-depressant or mood stabilizer or combination of medications, not to mention the correct dosage level for her. She'd never thought about going to see a psychiatrist or even a psychiatric nurse practitioner. None of her doctors had mentioned this option to her. I just don't understand why doctors who are obviously not specialized in the area of the brain feel that they can prescribe brain meds.

Taking a brain medication is a big deal -- not to be handled lightly.