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.

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.

STIGMA: Keeping Mental Health Problems on the QT

When I used to practice therapy in an outpatient psychiatric unit of an inner city hospital I co-managed patients with a psychiatrist who would further evaluate and medicate clients as needed. Most of my clients were very distressed when the physician side of the team recommended an antidepressant, anti-anxiolytic, or other medication in conjunction with talk therapy. I would have the same conversation with different patients every time:

ME: If you had diabetes would you feel embarrassed about taking insulin?
CLIENT: No.
ME: Well think of (fill in disorder here) as if it were diabetes. Both conditions have biologic origins that can be helped by medication.

Despite my best attempts, this conversation made very few patients feel better about their diagnosis or its treatment.

It's been over 10 years since I first entered the mental health field, and I'm amazed that little has changed when it comes to the stigma associated with mental health problems, despite the educational campaigns of the federal government and NAMI. This is especially true in rural areas and smaller communities where mental health professionals are scarce and residents so tight knit that folks are afraid if someone sees their car parked in front of the mental health clinic, everyone will know they have a mental health problem before day's end. Unfortunately, this means that rather than seek proper treatment for mental health problems, people self-medicate through the use of alcohol and drugs.

My colleague and I recently published a paper in the Journal of Affective Disorders looking at the percentage of folks who have both a mental (e.g., depression, anxiety, bipolar) and substance use (drug and alcohol abuse and dependence) disorder. While we found no differences between rural and urban folks in terms of the prevalence rates of these disorders, we did find that rural residents were less likely to seek treatment for their disorders than urban folks. We wondered: Is anonymity the key to seeking mental health treatment?

This may be why there is a burgeoning of online communities for folks with mental health problems. This is great in the sense that folks can readily access information and "talk" to people with similar disorders. However, I wonder how stigma is perpetuated by communities who don't share experiences face-to-face. Are we encouraging people with mental health problems to seek support behind a screen name?