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.

Talk therapy works for postpartum depression

A couple of months ago I wrote a piece on light therapy for postpartum depression (PPD). A study released this month shows that talk therapy - with a professional or a mom peer - can help also. This is an important finding, because many women prefer not to take antidepressants when they are breastfeeding.

In this study, the investigators reviewed 10 clinical trials that included nearly 1,000 women. The trials tested psychological and social interventions that included cognitive behavioral therapy (CBT), counseling, and peer support groups facilitated by a health care professional. They found that women who received any of the psychological or social therapies were 30% less likely to have depressive symptoms within one year after giving birth compared to women who received postpartum care as usual. Additionally, peer support groups appeared to be just as effective as formal psychological care, such as CBT, which is great news for moms who can't afford a weekly trip to a therapist.

The study authors additionally noted two key take-home points. First, PPD is treatable, and a wide variety of treatment options is available. Second, social support is critical for moms who are experiencing PPD. Sometimes there is a tendency for new moms to try to pretend all is well, because they're "supposed" to be happy about their new addition. But having support from other women who've experienced PPD can help to normalize the experience and reduce the stigma associated with having a postpartum mood disorder.

So if you or someone you know is experiencing PPD, know there is help. Postpartum Support International is a great resource to find a peer support group in your area. Additionally, Postpartum Progress is a blog written by mom and advocate Katherine Stone, who experienced postpartum obsessive compulsive disorder. She provides a broad array of information on postpartum depression and other mood disorders that readers will find helpful.

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.

Improve depression with exercise

Exercise produces a lot of benefits. It reduces the risk of stroke and heart disease. It lowers the "bad cholestrol" while increasing the "good cholesterol." It helps to reduce blood pressure and maintain a healthy weight. According to research published online this month in Psychosomatic Medicine, exercise is also an effective treatment for depression.

Researchers tested the effectiveness of 4 types of depression treatments: a led exercise regimen, a home exercise program, an antidepressant known as a selective seritonin reuptake inhibitor (SSRI), and a placebo, or a pill that does not contain any medicine. They sorted 202 adults (153 women) with depression into each of the groups and followed them for 4 months.

They found that 41% of all patients no longer met the criteria for major depressive disorder. When they broke the groups down by treatment group, they saw improvements in all 4 groups. Secifically 45% of the led exercise group, 40% of the home-based exercise program, 47% of the antidepressant group, and 31% of the placebo group saw improvements. Interestingly, the rates of improvement were very similar for those in the led exercise group and those taking antidepressants. Further, although participants in the 3 "active" treatment groups (led exercise, home exercise, and antidepressants) had greater improvements than the placebo group, nearly one-third of those in the placebo group still got better. The investigators noted that improvements in depression may be related to factors other than treatment type, such as attention from mental health care providers and monitoring of symptoms.

Per the investigators, it is important to note that this study does not demonstrate that exercise is better than SSRIs for relieving depression. So if you are taking antidepressants, this is not license to stop your medication without first discussing the pros and cons of such a decision with your doctor. However, the study authors d0 note that exercise can increase positive thoughts, enhance self-concept, and change how the body responds to stress, all of which can lead to fewer depressive symptoms. So if you have depression or are prone to a depressed mood, try some exercise - you might see improvements in your mood, as well as other areas of your life.

Pro-Anorexia Websites Bad on All Counts

As lactivists continue to fight for the rights of breastfeeding moms everywhere, my husband over at It's Not a Lecture pointed out that while Facebook is banning photos of breastfeeding moms - and banning the moms themselves in some cases - they continue to let pro-anorexia members mingle and meet using their network. I don't want to get in the middle of a communications debate on this blog - I'll leave that to the PR experts (is that an oxymoron?). However, I do think the timing of this study in the International Journal of Eating Disorders is very interesting.

Researchers investigated the mental and emotional effects of three types of websites on 235 college women: a pro-anorexia website, a women's fashion website, and a home decor website. They found that compared to women who viewed the fashion and home decor sites, women who viewed the pro-anorexia site were more likely to feel negative emotions, to have poor social self-esteem, and to not feel confident about their appearance after 25 minutes of navigating the site. They also were more likely to feel heavy, to want to exercise more, to think about their weight, and to compare themselves to images of thin women on the site. Essentially, women who viewed the pro-anaorexia site felt worse about themselves, worse about their bodies, and worse about their appearance.

I don't know if the folks at Facebook care about the research. I do know the unfortunate reality is that young women looking for "pro-ana" friends don't need Facebook to find each other. There are plenty of pro-ana websites with chat room capabilities on the web - and you can access many of them without even registering. Ultimately, I think it's up to parents to protect their daughters: monitor what they access on the internet and on social media sites, and perhaps more importantly, love them and instill in them a sense of worth and self-confidence. Also know if, despite your best efforts, they develop the disease, there is help.

Depression more damaging to daily health than other common conditions

After today's headline about the increase in suicide rates among teen girls, new research on the effects of depression on daily health status should come as no surprise.

In a study published in this week's Lancet, researchers examined the effects of depression on everyday health status for 245,404 people living in 60 countries in all regions of the world who participated in the World Health Organization's World Health Survey. They defined everyday health as encompassing several domains, including general health, vision, mobility, self care, pain/discomfort, sleep/energy, emotional processes, and thinking processes. In addition to studying the effect of depression on health status, the researchers also studied and compared the effects of four chronic health conditions on health status: angina, arthritis, asthma, and diabetes.

Several significant findings emerged from this research. First, people who had depression AND one of the four chronic health conditions had significantly worse daily health than people who had depression alone or one of the four conditions alone. Second, people who had angina, arthritis, asthma, or diabetes were significantly more likely to be depressed than people who did not have one of these conditions. Third, women had worse daily health than men. Finally, depression contributed to poor daily health more so than any of the other chronic health conditions. These findings were consistent even across different countries with different demographic characteristics.

This study demonstrates that depression continues to be a public health problem that needs greater attention not only in the United States, but around the world. Unfortunately, much of our lack of attention to this important health issue reflects the stigma associated with mental health problems in our society. If there is an upside to this research, it is that women with chronic health conditions should be aware they are at greater risk for developing depression. If you think you may have symptoms of depression, talk to your health care provider when you see her for your chronic health condition. She should be able to diagnose and treat your depression if necessary, or refer you to someone who can.

Light treatment for postpartum depression

If one good thing came from Tom Cruise's public insult of Brooke Shields - and the cadre of new mothers who have taken antidepressants for postpartum depression (PPD) - it's that people started paying attention to a disorder that is often hidden because of fear and stigma.

Postpartum depression is characterized by any of the following symptoms over a 2-week period or more within the first year after delivery: restlessness, irritability, sadness, hopelessness, feeling overwhelmed, crying a lot, having little energy or motivation, appetite changes, sleep disturbances, difficulty focusing, remembering or making decisions, feeling worthless or guilty, loss of interest in pleasurable activities, withdrawal from friends and family, headaches, chest paints, heart palpitations, hyperventilation, not having interest in the baby, and thoughts of hurting the baby or oneself. There are a number of contributing causes of PPD. These include rapid changes in hormonal levels (specifically progesterone and estrogen) after delivery, low thyroid levels, exhaustion from delivery, broken sleep patterns, feeling overwhelmed by parenting responsibilities, doubting one's ability to be a "good" mother, stress resulting from changes at work and home, feeling a loss of one's pre-pregnancy identity, having less free time, and having less control over time.

The two most common treatments for PPD are talk therapy and antidepressants. Findings from a study released this month, however, show that light therapy may be a promising new treatment, especially for women who refuse medication because they are breastfeeding or simply do not like the idea of taking medicine. Light therapy involves exposure to specific wavelengths of light, or very bright full-spectrum light, for a prescribed amount of time. It has been used successfully to treat a variety of conditions, including acne, seasonal affective disorder, and non-seasonal depression.

Researchers in Canada studied the effects of light therapy on 15 women who had a diagnosis of PPD but who were not taking antidepressants. The women were assigned to one of two treatment groups: 30 minutes of daily light exposure between 7AM and 9AM using a 10,000-lux bright light or 30 minutes of daily light exposure between 7AM and 9AM using a 600-lux red light. After 6 weeks of light therapy, both groups of women showed significant reductions in their depressive symptoms, with an average of 49% improvement. Additionally two women (one in each group) experienced a complete remission, or absence of PPD symptoms.

While these findings are encouraging, this study followed a small number of patients, and the authors acknowledge that more work needs to be done to determine whether this approach is as useful for PPD as it is for seasonal affective disorder. Additionally, none of the patients were suicidal, so nothing can be said about how light therapy might work for women with more severe symptoms. However, the upside is that more treatment options offer women more control over how their depression is managed, which can improve the ability to cope with the disorder.

If you are interested in learning more about light therapy, the Mayo Clinic has a nice piece with information about the risks and benefits. You also can talk to your doctor or mental health care provider about whether light therapy may be worth a try.

What you think about your depression affects how you cope

When you are diagnosed with a mental health problem such as depression, one issue you have to face is how to deal with the diagnosis. Research suggests that women generally use what's called "emotion-focused coping," which includes crying, dwelling on the causes and implications of their depression (aka ruminating), and seeking support from others. (Versus men who cope by distracting themselves with hobbies, sports, alcohol, and drugs.)

A study published this month shows that people's emotional reactions to their depression diagnosis affect how they cope. Researchers interviewed 189 patients (133 women) in a primary care clinic who were taking antidepressants. They found women who believed their depression would have a greater negative impact on their lives used more maladaptive coping strategies, such as blaming themselves, ruminating about their illness, and disengaging from others. On the other hand, women who perceived they had some control over their depression and who believed their depression was caused by an identifiable stressor (such as relationship or job difficulties) used more active coping strategies, such as planning, acceptance, problem-solving, reframing the illness positively, and religious/spiritual supports.

Why do coping strategies matter? The researchers suggest that maladaptive coping may actually worsen depressive symptoms, while active coping may help to lessen them. Further, women in particular may benefit from strategies that increase their active coping skills and improve their sense of control over their disorder.

If you have been diagnosed with depression, it may be helpful to talk to your mental health care provider about how the diagnosis has affected you emotionally. You also may ask your provider to give you more detailed information about your depression, such as: how long you can expect to have symptoms, whether the symptoms will wax and wane or decrease gradually over time, how the symptoms will affect you in the short- and long-term, how the treatment will affect you short-term and over time, and how long your provider expects you will need treatment. The answers to these questions will vary for different people, and also can vary for the same person for different depressive episodes, depending on the severity of the episode. Having open and clear communication with your provider can assist you in developing a sense of control over your depression and help you to manage your illness constructively as you heal.

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.

ATTENTION MOMS: GOT STRESS?

Well, duh, you say. Just the fact that you are a mom means you have stress. It's also not news to you that more stress means worse mental health. However, researchers have found that the source of your stress matters. Using nationally representative data, these researchers identified three key predictors of poor mental health:

(1) lack of support, including nobody to provide you emotional help with parenting or give you a break when you need it;

(2) spending too much time with your child. That's right too much time - moms who think they don't spend enough time with their kids don't experience the same negative mental health effects; and

(3) difficulty paying for child care. Other financial difficulties, such as trouble paying for medical care or supplies for the child, lack of health insurance for the child, and missed or delayed health care for the child did not produce the same negative mental effects.

Further, these authors found that having more than one stressor exponentially increased the likelihood that moms experience poor mental health. Moms with two or more stressors were nearly 12 times as likely to have poor mental health compared to moms with no stressors (apparently these women exist, but I have yet to meet them).

So what does this all mean for moms out there? It means get help when you need it - ask your partner, your family, your friends. It means there really is too much time with your child and not enough time for yourself, so don't feel guilty about taking me-time when you need it. (Recall the last flight you took....first put the oxygen mask on yourself, then help children and disabled passengers.) It means as a society we need to do a much better job of helping working moms with childcare strategies they feel good about. Co-op (pdf) anyone?