Mood Disorders during Pregnancy Linked to Postpartum Depression

There's a lot of societal pressure to be excited about being pregnant. One popular depiction of this pressure is the Sex and the City episode where Miranda finds out the sex of her baby. She later tells Carrie how she "faked her ultrasound" - meaning she faked a big, happy smile when the sonographer said, "Congratulations!! It's a boy!"

Miranda never gets characterized as having a mood disorder during pregnancy. But for women who do experience depression or anxiety while pregnant, the excitement of pending motherhood can be dulled by the pain of sadness or worry that permeates each day. Unfortunately, a large number of women experience mood disorders during pregnancy. A study published this month in Obstetrics and Gynecology revealed that 54% of pregnant women experienced anxiety and 37.1% experienced depression. Further, women who experienced anxiety or depression during pregnancy were up to four times as likely to experience postpartum depression.

That's no small number - and it suggests that we have a lot of work to do if we want to help women who experience mood disorders during and after pregnancy. The Mom’s Opportunity to Access Help, Education, Research, and Support for Postpartum Depression (MOTHERS) Act is a bill currently pending in Congress that has the potential to increase women's access to screening and help for postpartum depression. This recent research only highlights the importance of this legislation. We need to do more so that moms get the help they need when they need it.

Meditation: It does a mind-body good

For those of us who meditate, we know it works. It calms the mind, brings clarity and focus, and helps to ease the effects of challenges in our lives. Some folks are skeptical about "all that mind-body" stuff, and they're not going to be swayed by personal opinion. So it's really nice when research backs you up and says, Yep, it's not all in your head. This stuff really works.

Where is this great evidence, you ask? The National Academy of Sciences (which, by the way, is the adviser to the U.S. on science, engineering, and medicine) publishes a weekly rag. In the most recent edition there was a study on meditation. And how it works. And not just for long-time practitioners.

The researchers enrolled 80 Chinese college students into their study. They randomly assigned 40 students to a test group and 40 to a comparison group. They taught the test group a form of meditation known as integrative body-mind training, which incorporates meditation and mindfulness work. The group practiced for 5 days 20 minutes at a time. The comparison group was taught a relaxation technique, which they also practiced for 20 minutes daily over 5 days. Before and after the 5-day training, the students were given a variety of tests to examine their emotional states and concentration abilities.

They found that compared to the relaxation group, the meditation group had less anxiety, fatigue, depression, and anger. They also showed decreases in stress and increases in their immune response. All in 5 days. 100 minutes. With no previous training.

You too can receive the benefits of meditation. There are a host of guided meditation CDs that can get you started (just check out your favorite book store or Amazon). A practice called yoga nidra is one of my favorites. And you don't have to spend a lot of time. Just 20 minutes a day to be on your way to less stress and greater relaxation. Sounds too good to be true, huh? But it isn't.

Panic attacks possibly linked to heart disease and death

If you've ever had a panic attack, this headline may not surprise you. Many of the symptoms of panic attacks can mimic a heart attack: racing heart, chest pain, sweating, nausea, dizziness, and shortness of breath. These symptoms usually peak within 10 minutes, and they can be accompanied by fear of leaving home. Approximately 1 in 75 people experience panic disorder, and it is more common in women than men.

Researchers investigated the relationship between panic attacks and heart disease in a study of nearly 3,400 postmenopausal women. They found that women who had experienced a panic attack in the previous 6 months were four times as likely to have heart disease, and three times as likely to have a stroke. These women also were 75% more likely to die from heart attacks and stroke.

If you are in this population of women (i.e., a postmenopausal women who has been diagnosed with panic disorder or who has experienced panic attacks), these findings may seem worrisome. However, it is important to note (as the investigators do) that the number of women who actually had an event (i.e., heart attack, heart-related disease, or stroke) was extremely small - only 81 women, or 2.5% of the those studied. Still, it is something to discuss with your doctor, who may recommend additional tests to evaluate your heart and vascular health.

Meantime, also know there is treatment for panic disorder. Anti-anxiety medications and cognitive behavioral therapy can help to alleviate the symptoms and improve your quality of life.

PMS: You are what you eat - or something like that

Periods are bad enough without adding premenstrual agonies to the front end. You know what I'm talking about - the bloating, breast tenderness, irritability, fatigue, acne, crying spells, anxiety, and food cravings (chocolate, salt, both - do I hear chocolate covered pretzels anyone?) that occur a week or so before your period arrives.

There has been a lot written in the popular media about easing PMS symptoms through changes in diet, such as consuming less caffeine and sodium and increasing vitamin B intake. But a study published in the Journal of Women's Health actually looked at what proportion of the participants' diets consisted of what kinds of foods (e.g., fats, carbs, fiber) and how these proportions related to their premenstrual symptoms. The study consisted of 3,302 ethnically diverse women who participated in SWAN (Study of Women's Health Across the Nation). They did find some relationships between what women ate and how they felt. But you may be surprised by the results (I sure was).

Fat intake was associated with fewer premenstrual cravings and less bloating (potato chips okay). Caffeine was associated with more anxiety and mood changes (pumpkin spice latte from Starbuck's not okay). Alcohol consumption was associated with less anxiety and mood changes (glass of red wine okay), but more headaches (or maybe not okay). Fiber was associated with more breast pain (bran muffin maybe not okay, I'm still not sure about this one - see below).

Perhaps more important than the dietary findings, they found certain subgroups of women experienced PMS differently. Perimenopausal women reported significantly more premenstrual symptoms than premenopausal women. Additionally, women with depression reported more PMS symptoms, especially anxiety and mood changes. Conversely, 0lder women reported less anxiety, mood changes, and back pain. Finally, overweight and obese women reported more cravings and bloating than normal weight women.

Is there a dietary moral here? The authors of the study say no. With the exception of caffeine, most of the dietary relationships were in the opposite direction - that is, fat and alcohol were actually associated with fewer symptoms, not more. Additionally, I would add there are other benefits of fiber intake that may outweigh the monthly nuisance of breast pain (although I'm not someone who experiences breast pain, so I might be convinced otherwise). They also didn't time their study to measure food intake and then track subsequent symptoms in the same 2-week period. Had they done this, they might have identified some different relationships between food and symptoms. Perhaps the more important part of this study is the identification of subgroups of women who are at higher risk for PMS symptoms, namely perimenopausal women, overweight women, and women with depression. If you are in one of these subgroups and you experience PMS, talk to your health care provider about ways to alleviate your symptoms.

Is work getting you down?

My colleague and I have done a bit of research on job quality and mental health, so this study caught my attention - especially since it's a study of folks born around the same time I was.

Researchers studied over 800 employed men and women born between 1972 and 1973 in New Zealand. They looked at the stress these folks experienced at work, including psychological job demands (e.g., work load and time pressures), physical job demands (e.g., heavy lifting and work hazards), control over what work gets done and when, and social support from colleagues and supervisors. They also examined their mental health - specifically anxiety and depression.

After adjusting their calculations for income level, a history of a mental health disorder in adolescence, having a generally negative personality, and other job stressors, they found that women who reported having high psychological job demands were 75% more likely to have depression or anxiety than female workers with low psychological job demands. In fact, when they analyzed the data over time, they found that high demand jobs were linked to new cases of depression and anxiety in workers without any history of either disorder prior to entering the labor force.

Most people who work experience job stress at one point or another. However, it's clear from this study that strategies for reducing stress are in order. Yoga, meditation, and breath work are great tools that I use. And anything that gets your heart pumping and gives your head a rest is always good. You also may want to talk to your supervisor about ways to minimize job stress, such as getting more help with job responsibilities or adjusting deadlines if possible. This can help to reduce your risk for depression and anxiety and improve your quality of life and well-being.

Om Sweet Om

As a long-time yoga practitioner and instructor, I am always interested in new research on the benefits of yoga practice. Two recent studies suggest that yoga can both boost your mood and improve your migraines.

In one recent study, researchers compared the effects of one hour of reading to one hour of practicing yoga on brain functioning. They found the yoga practitioners had a 27% increase in GABA levels, while the readers experienced no change. GABA is the primary inhibitory neurotransmitter in the central nervous system, and low levels of GABA are associated with mood disorders, including depression, anxiety, and manic-depression (bipolar).

In a randomized controlled trial of yoga versus self-care for migraine sufferers, the patients who were randomly assigned to yoga showed significant improvements over those assigned to self-care in headache intensity, frequency, and pain levels. The yoga practitioners also had significant reductions in symptoms of anxiety and depression and use of migraine medications compared to those in the self-care group.

Other research suggests that yoga can improve quality of life in breast cancer patients, decrease seizure activity in individuals with drug-resistant epilepsy, improve gastrointestinal symptoms in adolescents with irritable bowel syndrome, and improve chronic lower back pain. Sound too good to be true? Learn more and judge for yourself. Meanwhile I'll keep doing my sun salutations. Namaste.