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.

Breastfeeding is better for babies AND moms - so why is it discouraged?

As if it weren't enough that Applebee's in Lexington pushed a mom out of their restaurant for breastfeeding her baby in a back corner booth. (So much for that Kentucky law that states breastfeeding in public is legal. Of course, why we need laws for this I'm unclear, but that's for another post).

Now the federal government has toned down its ads to promote breastfeeding. You read correctly, toned down its ads, even though media relations experts advised them against softening the ads, because they wouldn't increase breastfeeding. I mean, why would the federal government want to increase breastfeeding rates? Who cares about the study published this year by the Agency for Healthcare Research and Quality (yes, an agency of the federal government) that showed breastfeeding contributes to good infant AND maternal health? According to this AHRQ study, children who are breastfed get fewer ear and respiratory infections, GI illnesses, and skin rashes. They're also less likely to have asthma, obesity, type 1 and 2 diabetes, and childhood leukemia, and less likely to die from sudden infant death syndrome (SIDS).

As for moms - women who breastfed were less likely to have type 2 diabetes, breast cancer, and ovarian cancer. Conversely, women who stopped breastfeeding early (before 6 months) or never breastfed at all were more likely to have postpartum depression.

So why are we spending money on an ad campaign for breastfeeding that will essentially have no effect on a mother's decision to breastfeed? Talk to your neighborhood pharmaceutical company - apparently it was the infant formula/pharmaceutical lobby that got the Department of Health and Human Services to tone down its ads, because they need to keep those revenues up. And not just in infancy mind you. They want to make sure kids keep needing their prescriptions well into childhood to take care of the asthma, ear infections, and diabetes they develop.

Are we really making health policy based on an industry that does better when people are unhealthy? I say nurse-in at Applebee's today - big PHRMA tomorrow.

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.