postpartum depression

RECENT POSTS

Panel Recommends Depression Screening For Women During And After Pregnancy

(Chris Martino/Flickr)

(Chris Martino/Flickr)

On Tuesday the U.S. Preventive Services Task Force released new recommendations on screening for depression in adults, notably calling for depression screening in women both during and after pregnancy.

The recommendations, published in the Journal of the American Medical Association, suggest: “All adults older than 18 years should be routinely screened for depression. This includes pregnant women and new mothers as well as elderly adults.”

Why?

“Depression is among the leading causes of disability in persons 15 years and older,” the task force statement said. “It affects individuals, families, businesses, and society and is common in patients seeking care in the primary care setting. Depression is also common in postpartum and pregnant women and affects not only the woman but her child as well. …The [task force] found convincing evidence that screening improves the accurate identification of adult patients with depression in primary care settings, including pregnant and postpartum women.”

The government-appointed panel found that the harms from such screening are “small to none,” though it did cite potential harm related to drugs frequently prescribed for depression:

The USPSTF found that second-generation antidepressants (mostly selective serotonin reuptake inhibitors [SSRIs]) are associated with some harms, such as an increase in suicidal behaviors in adults aged 18 to 29 years and an increased risk of upper gastrointestinal bleeding in adults older than 70 years, with risk increasing with age; however, the magnitude of these risks is, on average, small. The USPSTF found evidence of potential serious fetal harms from pharmacologic treatment of depression in pregnant women, but the likelihood of these serious harms is low. Therefore, the USPSTF concludes that the overall magnitude of harms is small to moderate.

Nancy Byatt, medical director at the Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms) and an assistant professor of psychiatry and obstetrics and gynecology at UMass Medical School, said the new recommendations “are an incredibly important step to have depression care become a routine part of obstetrical care.”

She added: “Depression in pregnancy is twice as common as diabetes in pregnancy and obstetric providers always screen for diabetes and they have a clear treatment plan. The goal [here] is that women are screened for depression [during pregnancy and postpartum] and they are assessed and treated and this becomes a routine part of care just like diabetes.”

Dr. Ruta Nonacs, who’s in the psychiatry department at Massachusetts General Hospital and editor-in-chief at the MGH Center for Women’s Mental Health, sent her thoughts via email:

In that the USPSTF recommendation recognizes pregnant and postpartum women as a group at high risk for depression, this represents a step in the right direction in terms of ensuring that psychiatric illness in this vulnerable population is identified and appropriately treated. However, there remain significant obstacles to overcome. Research and clinical experience indicate that while pregnant and postpartum women with mood and anxiety disorders can be identified through screening, many women identified in this manner do not seek or are not able to find treatment.

While screening is important, we must also make sure we tend to the construction of a system that provides appropriate follow-up and treatment. Because stigma continues to be significant with regard to mental health issues in mothers and mothers-to-be and because there are concerns regarding the use of medication in pregnant and nursing women, we must make sure that after screening, we help women to access appropriate resources and treaters who have expertise in the treatment of women during pregnancy and the postpartum period.

Continue reading

Related:

Opinion: Why Gut A Program That Truly Helps New Mothers?

pumicehead/flickr

pumicehead/flickr

By Claudia M. Gold, M.D.
Guest Contributor

As any parent knows, caring for an infant is a 24/7 job. Contrary to the idealized “myth of motherhood” — which usually involves a quick, seamless return to pre-pregnancy weight, emotions and all-around functionality — there is no “schedule” to be had. Life has officially turned upside down.

All kinds of research suggest that new moms need help.

But in our culture today, where extended family may be far away, where spouses often return to full-time work almost immediately after the birth, mothers may be very much alone in the task of caring for a new baby. Mother-baby groups have a critical role to play in filling that void.

I have seen these groups in action working as a consultant to the William James College Freedman Center. When mothers feel supported and listened to, extraordinary thing happen: they share experiences not only about the lack of sleep and ability to take a shower, but also fears, anxieties, self-doubt, sadness and even depression. By the end of these groups, many mothers developed powerful, sustaining bonds with each other and interact with their babies with new confidence and joy.

A particularly innovative Massachusetts-based program for mothers is now at risk.

Massachusetts Child Psychiatry Access Project for Moms is a collaboration between the Massachusetts Psychiatry Access Project and MotherWoman, an organization that offers a network of groups as well as training for group leaders and seeks to make these groups available to mothers all across the state.

The program has its roots in a special legislative committee chaired by Representative Ellen Story. While at first the focus of the commission was to implement statewide screening for postpartum depression, it quickly became clear that such a step was meaningless without first having resources in place to help mothers identified by the screening.

That is where MCPAP for Moms comes in to play. In collaboration with William James INTERFACE referral service, when a mother is struggling, she can find support that is available close to home and right away. When a new mother feels alone, scared and overwhelmed, a three-month- or even a three-week-wait is unacceptable. She needs help today.

MCPAP for Moms offers a unique constellation of services: it offers toolkits and training for primary care clinicians — obstetricians, pediatricians and family practitioners, many of whom now do not know where to turn when they see a mom struggling with postpartum depression and/or anxiety. Second, it helps mothers connect with help — individual clinicians experienced in treating perinatal emotional complications as well as groups — right away. And last, MotherWoman has a growing network of support groups and trainings for group leaders so that the service can extend throughout the state. So, it’s a whole safety net that involves many things.

“I was so overwhelmed and stressed as a new mom that I didn’t know what to do and felt like a failure. Without MCPAP for Moms I don’t know where I would be today,” said one postpartum mom, Amanda Martin. “I am so grateful for them helping me get the help I needed to feel better for me and for my family.” Continue reading

Falling Into The Postpartum Mood Disorder Abyss: A Personal Story

By Deb Wachenheim
Guest Contributor

Over the past two days, The New York Times published a series of articles about postpartum depression and other related mood disorders. The first article looked at the science and policy on this topic and highlights a few women’s stories.

Today’s article is about my sister, Cindy Wachenheim, who took her own life in March of 2013 after struggling for six months with postpartum mood disorders. I say mood disorders because it was not just depression (and the fact that there are other postpartum mood disorders in addition to postpartum depression was something about which I was previously completely unaware). She had extreme anxiety about, and obsession with, her baby’s health and she was depressed because she believed she caused him to have serious health problems. Also, according to what I have been told by experts, she may have been psychotic: she was so convinced that something was seriously wrong with her baby — despite doctors telling her otherwise — that she strapped him to her chest when she jumped out of her apartment window, believing, I can only assume, that this was what was best for him. Thank goodness, he survived and is thriving.

Beyond what is written in the article, I think it is important to give more detail and information on some resources and policy activities in Massachusetts, in the hope that this could possibly help others who are facing similar struggles. As is mentioned in the article, I reached out to Cindy’s son’s pediatrician after Cindy had gone to see her multiple times about her concerns.

Pediatricians are key to screening for postpartum mood disorders and making referrals for needed treatment. Most women see their OB a few weeks after giving birth and if everything seems okay at that point then they are sent on their way until the following year’s annual exam.

However, woman bring their infants to see the pediatrician many times over that first year. It is pediatricians who could notice if something seems to not be right with the mother. Continue reading

Postpartum Depression’s Lingering Toll

Postpartum depression can make you feel, quite frankly, insane.

juliedos/flickr

juliedos/flickr

Psychosis, PTSD and other serious mental illnesses have been linked to that fraught post-childbirth period. (According to the group Postpartum Support International 15-20 percent of pregnant women and new mothers will experience a maternal mental health disorder.)

Most recently, of course, Miriam Carey, a 34-year old dental hygienist, rammed her car — with her one-year old baby inside — into police barricades near the White House. We don’t know exactly what was going in in Carey’s brain — maybe she had a previous mental illness, maybe she was taking medication for it.

Whatever happened, one thing is certain: having a baby changes your brain. And under stress, those changes can be negative and long-lasting.

New research on mother rats found that exposure to chronic stress early in life (in this case an unfamiliar male intruder) “not only impairs a mother’s ability to care for her own children but can also negatively impact her daughter’s ability to provide maternal care to future offspring.”

Here are more details from the the Tufts University Cummings School of Veterinary Medicine news release:

A different male rat was placed in the cage of the first-generation mothers and their newly born pups for an hour a day for 15 days. Consistent with previous research, the lactating mother rats responded to the stress of the intruder with depressed maternal care, impaired lactation, and increased anxiety. The pups of these mothers were also exposed to the conflict between their mothers and the male intruders.

After reaching maturation, second-generation females were mated and compared to a control group where neither the mother nor the pups had been exposed to a male intruder. The second generation mothers that experienced the early life stress also displayed depressed maternal care, impaired lactation, and increased anxiety. There were also changes to hormone levels: an increase in the stress hormone corticosterone, and decreases in oxytocin, prolactin (important to both maternal behavior and lactation) and estradiol.

I asked study author Ben Nephew, an assistant professor in the department of biomedical sciences at Tufts’ Cummings School of Veterinary Medicine, about the research, Continue reading