Monthly Archives: March 2009

The Confusion of Ante-Partum Depression: To Medicate or Not?

Finding yourself faced with depression during pregnancy is a confusing prospect indeed. How do you treat it? Do you tough it out and hope there is no effect on your pregnancy? Or do you risk medication and the potential effects that course may have on your baby as well? In addition, many care-givers are hesitant to medicate a pregnant mother for depression or even worse, are not familiar with ante-partum depression and negate the mother’s concerns over her mental health. If your caregiver brushes aside your concerns as normal pregnancy ups and downs yet you know in your gut it’s more, get a second opinion or ask for a referral to a therapist at the very least.

A recent study by Dr. Katherine Wisner, M.D., M.S., found that continuous exposure to either SSRI or Depression during pregnancy results in pre-term delivery rates in excess of twenty percent while mothers with no exposure to either depression or SSRI over the course of their pregnancy experienced rates of pre-term delivery at six percent or lower. The study looked at 238 women with no, partial, or continuous exposure to either SSRI treatment or depression and compared infant outcomes. They found that exposure to SSRI’s did not increase birth defects or affect infant birth weight but the importance of this study lies within the finding that the pre-term delivery rates were the same with depression exclusive of SSRI treatment, leading the researchers to state that it is “possible that underlying depressive disorder is a factor in preterm birth among women taking SSRIs.” You can read more about this study by clicking here.

“This study adds evidence that depression in pregnancy can negatively affect birth outcome. Although women treated with SSRI’s throughout the pregnancy may experience pre-term birth, the factor causing the problem may in fact be the depression and not the SSRI. More research is needed to tease out what is causing the changes in the uterine environment. As research comes forth, what continues to be clear is that treatment for depression in pregnancy is important. ‘Treatment’ doesn’t necessarily mean medication, but for everyone’s sake the pregnant woman needs to receive a plan for wellness.” Dr. Shoshana Bennett shares when asked about her take on Dr. Wisner’s research.

You may recall a recent study posted also regarding birth weight of infants. The study concluded that Prenatal Depression restricted the fetal growth rate. This study concluded that depressed women had a 13% rate of pre-term delivery as well as a 15% greater incidence of lower birth weight. This study’s results examined cortisol levels to determine risk of pre-term delivery and birth weight prediction, which leads us to another study examining the reliability of cortisol to predict short gestation and low birth weights. The study concluded cortisol levels were indeed a reliable manner in which to predict both.

So what’s a pregnant depressed mama to do?

Throw her hands up in the air?

Scream?

Cry?

Tough it out?

None of the above – she should work in partnership with her doctors to weigh the risks. There are other treatments available for depression and anxiety during pregnancy besides SSRI’s. Therapy is always an option. (Yes, more studies to be quoted ahead) A study examining the effectiveness of a Mindfulness based intervention for pregnant mothers found women receiving the intervention experienced less stress and anxiety during their third trimester and postpartum period. There was no data collected regarding pre-term delivery or birth weight in relation to this particular study.

There’s also a wonderful article at wellpostpartum.com that discusses how cortisol impacts mothers. Included in this article are some terrific (and natural) suggestions on how to keep cortisol at bay.

Alrighty now. You’ve shared your precious studies with us. What about some real life advice? What did YOU do when faced with the Hamlet conundrum of medicating during pregnancy?

I read.

Voraciously.

The two biggest sources of help for me were Karen Kleiman’s What Am I Thinking? Having a Baby After Postpartum Depression and Kornstein/Clayton’s Women’s Mental Health. Karen’s book allowed me to realize my emotions were right on target for a woman facing pregnancy (expected or not) after surviving a PMD episode while Women’s Mental Health laid out the risk factors in a no-nonsense manner. I was convinced to stay on medication after I read my risk for relapse went up by 50% if I discontinued my medication during pregnancy. With my risk factor already 50% higher than women having never experienced a PMD, there was no way I was giving myself a 100% risk of traveling down that road.

I stayed on my medication. I stayed in therapy. I talked to my family and developed a postpartum action plan, spending more time on preparing for my possible fall than for my son’s arrival. And you know what, it paid off big time. I did not experience a PMD the third time around, even though (yes, more studies) having a boy may put you at a higher risk for developing a PMD and the risk for experiencing a PMD after two episodes is almost 100%. I beat the odds and don’t think a day doesn’t go by that I don’t give thanks to God for carrying me through.

I always encourage women I come in contact with to weigh their options with their caregivers. To educate themselves and make the best decision possible with the information at hand. Your doctor is on your team and should be willing to listen to your plan and at least consider your requests. If he/she does not respect your wishes, it may be time to find another physician for care during the prenatal period.

I would also encourage you to get a couple of books, the first being Dr. Shosh’s Pregnant on Prozac, in which she examines the relationship of psychiatric medications to pregnancy. It’s a must have resource for mothers facing the decision of psychiatric medication for an existing condition or a newly diagnosed condition. Also pick up a copy of Karen Kleiman’s Therapy & The Postpartum Woman. While this book is ultimately aimed at clinicians and the postpartum woman, pregnant women facing a mood disorder would glean quite a bit from this book as well and may consider gifting it to their caregiver as well, a paying it forward action if you will.

And if you’re interested in complementary or alternative treatment methods that don’t include SSRI’s, a great place to start researching is over at Well Postpartum. Run by Cheryl Jazzar, this blog has just about everything you could ever want to know about alternative care during the Perinatal Period.

The final thought on all of this? Do your homework. Don’t be afraid to ask questions or stand up for yourself (and your child). Above all, make the decision and agree not to second guess yourself or blame any outcome on yourself. As long as you make the best decision with the best information at your fingertips at the time, there is no blame. (And hey, the fact that you’re reading this article right now speaks pretty highly of your motivation to educate yourself!)

No matter how alone you may feel in that dark pit of depression during pregnancy or postpartum, you’re not. There are plenty of other women there with you and there are lots of us reaching our hands down to help you out. All you have to do is reach out and grab.

Sharing the Journey with Ivy Shih Leung

Ivy’s joined the blogging ranks of PPD Survivors recently and I decided to scoop her up for an interview here. She’s been writing some really great stuff over at Ivy’s PPD Blog and is working on a book based on her experience. Check out her blog and enjoy a little slice of her story here!

Tell us about yourself – who is Ivy when she’s not busy being a mom or working?

Hmmmmm……since 3/4 of my life these days revolves around being a mom and working, I have to think a bit on this one. For the past 4 years, I’ve been trying to write a book about my PPD experience. For the past 1-1/2 months I’ve been blogging about my PPD experience, realizing that blogging is an effective means of helping women who are currently suffering from PPD and getting the word out to as many people as possible about PPD in hopes that one day PPD will no longer be so misunderstood, under-diagnosed and under-treated. My motto is: Knowledge is power; information is enabling, and it needs to be shared! Obviously, PPD has shaped my life tremendously. I would like to do more in terms of advocacy and PPD support through telephone support and PPD support groups, as well, but I need to get my book done first.

In terms of what I try to do for fun, I’m a big TV watcher. Nowadays, that’s the cheapest & easiest form of entertainment. I record my favorite TV shows to watch at a convenient time (i.e., after my daughter goes to sleep), like American Idol, Lie to Me, Brothers & Sisters, CSI Miami, Fringe, and Heroes. I try to catch lunch and dinner with friends in NYC a few times a month. I love movies and Broadway musicals, and try to see them as much as I can. I love beaches, shelling, kayaking, and snorkeling in tropical waters. And I love going to craft shows to admire the creativity and talent of artists. I also love to travel, and try to go somewhere different for vacation each year (by plane) and the more exotic the location, the more pictures I take. Last year, my husband and I made it to Athens and Santorini, Greece. I was in photo-op heaven!

You’ve recently joined your voice to increase awareness of PPD. What made you decide to go public with your story?

It was anger of people’s ignorance – those who were my doctors, those whom I’ve talked to and those in the media who say stupid things – that propelled me to write this book. I never would have thought of writing a book had it not been for Tom Cruise’s ignorant ranting that aired on the June 24, 2005 Today Show that “there is no such thing as a chemical imbalance.” I suddenly felt the urge to write a book about my battle with postpartum depression. Rather than just get mad at Tom Cruise’s remarks and sit there and do nothing about it, I decided there weren’t enough people out there telling their personal stories. I would channel all the energy stemming from my anger and do something positive and try to help others. I would tell my story in the hopes of helping and educating as many people as possible about this silent and potentially deadly condition.

I want to reach out to moms currently suffering from PPD. With access to personal stories of PPD survivors, the less alone and ashamed mothers suffering from PPD will feel and the more empowered they will be to seek the help they must get. One of the two things I regret about having PPD is the lost opportunity to bond with my daughter to the fullest extent possible in those months where I was transformed into a different person. The other regret is not having found an understanding individual to help me through the darkest days by assuring me that I wasn’t going crazy, I wasn’t alone and I will get better. Because of this, I want to share my story to give hope to those suffering from PPD and help them feel less alone knowing that there are others who have survived PPD.

I want to reach out and validate the experience of moms who have already suffered from PPD, and encourage them to speak up. The more PPD survivors speak up, the more others will know what PPD is and that it’s a real illness that should be taken seriously. You would think that, of all people, fellow women would be able to empathize with you. But that’s not the case at all. The woman who has never had a child before or who had a perfect pregnancy, delivery and baby tend to be as clueless as men about PPD. Those who have neither experienced PPD firsthand or even secondhand, by way of someone they know and therefore witnessing its devastating effects, cannot understand and empathize with those suffering from PPD. Out of ignorance usually comes pre-conceived notions, or myths, that can’t be farther from the truth. We dispel those myths once and for all.

Finally, I want to reach out to all parents-to-be so they can be knowledgeable about PPD, so that if a new mom succumbs to it, they won’t be totally caught off-guard. When they seek treatment from a doctor, they won’t be at a total disadvantage if the doctor doesn’t spend time to 1) explain to them what is going on so, 2) answer questions she will undoubtedly have, and 3) give reassurance that she is not alone in what she is experiencing and she will be fine, though it takes time for the treatment to be effective.

What was childbirth like for you? Was it what you expected or did things get unexpected and frantic?

I had no expectations of childbirth. I was a bit nervous from not knowing what to expect. All I knew was from what you see on TV and in the movies (i.e., women screaming from pain). Labor and delivery actually went pretty smoothly, which was a tremendous relief. It quickly went downhill from there, though, with the discovery that my placenta would not come out. It turned out to be a rare incident of what they refer to as placenta accreta. Three days after delivery, my doctor had to remove my uterus because the placenta had grown into my uterus. If this weren’t done, I would’ve died. I am absolutely sure that it’s not the traumatic delivery experience itself that caused PPD to rear its head. The following series of events led to my insomnia, the first sign of PPD for me:

  1. negative experience in the hospital-e.g., constant sleep interruptions in the hospital, constant moving from one room to another and changes in hospital staff, multiple attempts to replace IVs in my arms/hands, food deprivation (I only had about 2 meals the whole week I was there….otherwise what I had were ice cubes for the most part, plus an occasional broth or jello), below-par treatment of certain hospital staff, searing pain (felt like someone was burning me) in my abdomen that came & went for 2 days after the surgery
  2. constant sleep interruptions from the noises the baby made throughout the night, plus night feedings
  3. baby’s bad case of eczema and cradle cap
  4. baby’s one week colic

For some Moms, the glow after childbirth simply isn’t there. Instead it gets dark, creepy, and eerie. What was your postpartum journey like?

My childbirth experience was not a glowing, happy experience–at least not until I came out of my PPD fog. And it’s unfortunate that I won’t ever get another crack at this, now that I’m missing a uterus. My experience wasn’t exactly dark, creepy or eerie, either. The 7 days immediately following childbirth were spent in the hospital. It was a negative experience that I try never to think about. You can read more about my hospital experience and my descent into PPD, with insomnia followed by panic attacks at my blog: http://ivysppdblog.wordpress.com. My ignorance about PPD (and my doctors’ ignorance) aggravated my situation. Had I known what PPD was, how to identify risk factors for it, realized that insomnia and panic attacks are symptoms of PPD, and proactively tried to keep risk factors to a minimum (e.g., make sure I got round-the-clock help with the baby and housework), I would not have suffered as badly as I did. Hell, I may not have even suffered from PPD!

What did you find the most helpful in climbing out of the gaping hole of your Postpartum Mood Disorder? What did you learn in the process about yourself?

Firstly, my husband’s love and support (see my response to the next question). Second, Paxil, without which I would not have been able to recover in 4 weeks and get on with enjoying my motherhood experience with my baby. My brain biochemistry was so messed up (due to hormonal changes, delivery complications resulting in a major surgery 3 days after delivery, traumatic one-week hospital stay, constant sleep interruptions throughout the night for a month starting from the time I was in the hospital, sleep deprivation and anxiety), that it’s highly unlikely any other treatment would have cured me as quickly. If I had requested my doctors to test for cortisol levels because my body was undergoing so much stress (“fight or flight” response on overdrive), I’m sure they would have been off the charts (which is probably why I had daily hive breakouts on my arms, legs, butt and mouth…some of them were 2″ long welts).

I learned a couple things about myself as a result of my PPD experience. Firstly, I’ve never been depressed before (I’ve always wondered whether I had been previously). Second, I emerged on the other side of the dark tunnel a survivor and a much stronger and smarter person than before. I realize that my calling is now to help educate others about PPD. I would like to help prevent other mothers from going through what I went through. I wouldn’t have realized this calling had I not suffered the way I did.

How did your husband handle your PPD experience? Did it affect your marriage?

He handled my PPD experience like the trooper that he is. He was there for me EVERY step of the way. I never even had to ask him for help. Though he didn’t really know how to comfort me on those really, really dark days where I just wanted to wither up and vanish into thin air, he did all he could to listen to me, give me hugs, come home from work early whenever a panic attack was setting in, and help with the baby, housework and cleaning–on top of having a full-time job. It wasn’t just a heck of an awful experience for me, it was really tough on my husband as well. He became physically and emotionally drained and didn’t have many people he could turn to for advice. This experience showed me how lucky I am to have him for a husband and how lucky my daughter is to have him for her daddy, and how strong our relationship is to have survived what we both went through.

At your blog, you make reference to a book you’re in the process of wrapping up. Where are you in this process and has it been helpful to write it all down?

If during my high school and college years and even up until before I had the baby, someone had told me I’d be writing a book one day, I would’ve laughed at them. I’ve never even kept a diary. It definitely takes life-altering experiences to motivate you to do something that you think might make a difference in someone else’s life. My husband thought writing a book was an excellent idea, and would certainly be a great outlet for my feelings. I’ve been working on my book for the past four years and plan to finish in the next few months. Writing the book has been such a therapeutic experience.

Name three things that made you laugh today.

Though there were definitely more than three things that made me laugh today, the primary ones that come to mind: 1) my daughter makes me laugh in delight and amazement each and every day in terms of some of the words/phrases she uses; 2) my daughter (again – but why would that surprise you) and the way she loves to dance; and 3) I have to admit that I watched the movie “The Shaggy Dog” (starring Tim Allen) with my daughter and I cracked up throughout the movie. Great comic relief after a long day at work!

What do you find the most challenging about parenting? The Least?

I’m not sure if other parents would agree, but just having to think of ways to stimulate her intellectually, socially and athletically is challenging for me. After all, as a parent, I am responsible for her future and I only get one shot at it. The least challenging is loving her…it comes naturally.

Last but not least, let’s say you have just one chance to provide some advice to an expectant mother (new or experienced) about Postpartum Mood Disorders. What would you tell her?

PPD is the #1 complication of childbirth, with 1 out of 8 mothers experiencing it. You wouldn’t know it, though, because most mothers keep their experiences to themselves. Knowledge about PPD & adequate social support to enable mom to get the rest she needs postpartum are CRITICAL! The more knowledgeable and prepared a mom is for situations that can reduce risk factors for PPD-getting adequate social support is just one example-the better off she will be. No woman is completely immune from PPD after having a baby. With the right combination of risk factors and stressors, any woman-even you-could end up suffering from it.

Prayer Request

I’ve had a reader contact me with a prayer request.

She’s been reading for awhile now and has experienced OCD with two pregnancies.

This past January the OCD came back with a vengeance and she’s fighting back with medication.

She shared with me the following:

I’m not in a good place and I wondered if you could pray for me.  I just started back on medication a week ago.  My husband says I’m getting better but I don’t see it.  I’m putting my faith in God but at times I can’t picture that I can ever get back to my vivacious self that I used to be.  Everything is hard right now, sleeping, driving, some days I look at the clock and can’t believe I’ve made it another hour.

If you could send up a prayer or two for her, I know it’d mean the world to her.

Thanks.

Pennsylvania Hospital Encourages Quiet Bonding Time for new parents

"Mom and baby" by justhiggy @ flickr

"Mom and baby" by justhiggy @ flickr

Mount Nittany Medical Center has instituted a new policy – Quiet Bonding Time for new parents between 1:00p.m. and 3:00p.m. Visitors are allowed but encouraged to respect the wishes of new parents wishing to take advantage of this bonding time. They are also required to place their cell phones on vibrate and use low talking voices. Non-urgent care is also placed on a hold during these hours.You can read the article for more information here.

I think this is a wonderful idea and hope more and more hospitals implement this practice in their Maternity wings. Not only is there a ton of research extolling the importance of Mom and Baby having time to themselves to bond but if new parents are given the chance to see the difference it makes prior to heading home, maybe more parents will realize that it’s ok to say no to visitors during those all important first weeks home. And let’s also remember that new moms who aren’t as fatigued are less likely to experience postpartum depression as well.