Category Archives: pregnancy

Baby after Postpartum Depression: Tips?

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Postpartum Mood Disorders not only cloud your bonding time with your infant but they also cloud future decisions regarding childbirth.

If they choose to have another child or find themselves unexpectedly pregnant (I’ve done both), Survivor Mamas ready themselves not only for the new baby but for the very real possibility of another brush with a  Postpartum Mood Disorder.

This is one of the biggest questions I get as the Community Leader at iVillage’s Postpartum Depression Message Board.

It’s such a big question that Karen Kleiman has devoted an entire book to it entitled “Having a Baby after Postpartum Depression: What am I thinking?”

One of the wonderful women I’ve come in contact on this journey of mine has recently embarked on trying to conceive another baby. Understandably, she is concerned about experiencing postpartum depression again. She’s blogged about it here. Have any advice for her? Have you had a baby after a Postpartum Mood Disorder and not relapsed? Go show her some love. Don’t forget to leave some tips here too!

Danish research and SSRI use during pregnancy

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An article at medpage.com heralds a new study released September 25, 2009 by Danish researchers. The article carries the sensationalized title “SSRIs in Pregnancy Hike Risk of Heart Defects.”

While the title itself raises eyebrows, the researchers themselves state that they were unable to conclude if the results were because of medication or the underlying depression. Also important to keep in mind is that this research is based on women who had prescriptions filled for SSRIs but does not appear to have checked to see if these women actually took the medication. Instead, they rely on data from a national registry.

“Pedersen and colleagues analyzed national registry data on more than 493,000 births in Denmark from 1996 to 2003. The data included prescriptions filled by mothers-to-be as well as the medical status of their babies at birth.”

And directly from the study:

Our results, however, depend on a correlation between redemptions of prescriptions and drug use. Non-compliance might be a problem for this type of exposure definition and could mask true associations if some of the “exposed” were in fact unexposed.

The most interesting piece to come out of this research is that of the studied SSRI’s, Paxil appeared to have the least risk of septal heart defects. I find this very interesting considering that Paxil is the only SSRI to currently carry a heart defect specific warning.

As with all studies and research, you should always examine all sides and aspects and educate yourself rather than relying on the word of others when making your final decision. Ask yourself if the person presenting the information has your best interest at heart or is merely trying to frighten you with inflated facts and figures. (Click here to read a previous post full of tips on how to find solid medical advice on the web.)

Dr. Shoshana Bennett, author of “Pregnant on Prozac” released this statement regarding this research:

Finally, treatment for the serious and potentially life-threatening illness of prenatal depression (for both mom and therefore baby) is being formally discussed. Fifteen percent of clinically depressed pregnant women try to take their lives – a bit more risky for the baby than mom taking an antidepressant, wouldn’t you say? If the pregnant woman can be non-depressed without a medication, that’s optimal. Some form(s) of treatment, however is essential. If natural and alternative approaches to wellness are not enough, it is regarded by those in the know to be safer for her (and her developing baby) to take an antidepressant than to remain depressed. Depression itself – it is quite clear from the research – crosses the placenta and alters the uterine environment causing negative consequences to the baby. In the latest research there appears to be low (0.9%) chance of a septal heart defect in babies whose mothers had taken certain antidepressants. However, what fear-mongers do not report, is that the researchers themselves could not be sure whether it’s the antidepressant or the underlying depression itself that caused the defect. Women need all relevant information and education about options for treatment during pregnancy so they can make the best decision for themselves and their family. Watch out for alarmists who are not interested in actual data – they are simply invested in promoting fear in women who are at their most vulnerable.

Shoshana Bennett, Ph.D.

http://DrShosh.com

Increased risk was determined by “redemption” of more than one SSRI prescription. Those who redeemed more than one prescription had infants with a higher percentage of septal heart defects. But again this begets the question of whether or not this result lay with the SSRI or the underlying depression/mental illness/stress the mother may have been experiencing in order to receive said prescription.

Bottom line here: Don’t think for a second that becoming a Mom starts at birth. It starts at conception. And we owe ourselves AND our infants the best start possible. This means researching by asking questions and seeking out solid answers. It means finding physicians who will be your co-pilot instead of an uncooperative Auto-Pilot unaware of the pot-holes facing them. It means putting together the best support you can with what you have access to at the time. I happen to agree that a SSRI free pregnancy is absolutely optimal. I also think you should run (not walk) out of any doctor’s office if said doctor is quicker with the script pad than the warm shoulder. But we have to remember that every situation is different. Every person is different and every pregnancy is different. And sometimes we may just have to take medication. It doesn’t make you weaker, it doesn’t make you stupid, and it doesn’t make you a bad mom. And above all, remember that the decision to take or not to take a SSRI during pregnancy is your decision. Make it with an empowered spirit, stick to it, and don’t look back.

PPD Survivor Shares her Story for the first time

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On Tuesday, this was a comment left by a mom who had never shared her story with anyone besides her husband (who lived it with her). I emailed her to ask if she would be comfortable with me giving it a post of it’s very own. Her story begins when she is 34 weeks pregnant and continues through to postpartum. I hope you find it as inspiring and as strong as I did…..

This is my first time to share my story in any capacity…. I don’t know if I’m ready, but here goes nothing…

My depression started around 34 weeks into my pregnancy… I had never heard of PPD and I didn’t know what ante partum depression was… I started to realize something was wrong somewhere between 30 – 34 weeks. I’m not afraid of medication, and think of it as an aspirin would be to a headache.

I have had depression and anxiety before so, I somewhat, recognized the signs. I told my husband that I wasn’t quite feeling right, and he encouraged me to speak with my OBGYN. At my next appointment I told my doc that I was worrying excessively, and not feeling quite right. It was really a whole new type of depression for me.. I never could and still have difficulty describing the way I felt. But worry was a BIG concern. The OBGYN said it wasn’t a big concern, and not to worry lots of new mom’s worry a lot.

My husband is a member of the “mind over matter” club. While he, I’ll say, tolerates, my need for meds to get my depression under control, he definitely is one of those, “Just push through it,” kind of people.

I saw my OBGYN on Tuesday, and she prescribed me Prozac, I ended up going to the E.R. on Sunday because I felt very overwhelmed; with what exactly, I do not know… They gave me an Ativan shot, made sure I calmed down and sent me on my way, with no real information. Or possible expectations. I then saw my OBGYN again on Wednesday, explained what had transpired over the weekend, and she prescribed me some Xanax. I felt so horrible that day, that we went straight to the nearest pharmacy and filled the script so I could take one. That Sunday I woke up and I felt worse than I thought I ever could. I told my husband that he had to take me to the E.R. So they could take the baby out so that no harm would come to her, if I did end up harming myself.

I thought this was a completely rational thought process; and was even more distressed when they told me that instead of delivering my baby early, they were sending me to the Nut House. All of this scared my husband to death, not only was he in fear of losing his wife, but that there was a possibility that he could end up without a wife and a child, or raising a baby on his own. And it was definitely one of the two, because the baby could not stay in me anymore.

I think that is when he realized, after two weeks of doctors and E.R. visits, that something was really wrong and a real threat existed not only to my life but to our unborn daughter’s life as well! I went to the psych. ward at a private hospital, where they were fairly knowledgeable about pregnancy related depression. The one thing that is VERY FRUSTRATING in my case, is that, since I was pregnant I was having a OBGYN come in and check on me daily, and since I was high risk (because of a blood disorder) I had a specialist coming to see me daily as well. They kept telling me it would be okay for me to get some Ativan, which had provided tremendous relief at the E.R. Visits, but the psychiatrist that was assigned to me when I arrived, REFUSED to give me anything other than Benadryl and Celexa, neither of which were providing any immediate relief.

As I have learned over the past year and a half since this all occurred, most psych. Wards have limited visitation, and mine was no different. My husband could come to the evening visitation and spend an hour with me. The first few days all I did was cry the whole time he was there. He was so scared. I was breaking his heart and that just made me feel even worse. I really just wanted to give him the baby and leave (you know d-i-e…) I didn’t want to burden him with all of my problems anymore. The thought of me not being around anymore, was the thing that was really bothering him. He got it in those moments.

I got out of the hospital and managed to hold it together until 38 weeks!!! YAY ME!!! When my OBGYN, asked if I wanted to go ahead and deliver, I practically took myself straight to the hospital right then. Coincidentally, I went into labor on my own the day I was scheduled to deliver. My delivery was easy… But there were some complications with my epidural, which lead to added stress. It is the most horrible feeling in the world to think back onto that day and to look at pictures and to know in those moments there was no joy, no love, and no want, for my beautiful, brand new baby girl. You can see the blankness in my face and the fakeness in my smile in all of the pictures… It breaks my heart to think of it. Will she understand, what was wrong with me then? Will she know how much she has ALWAYS been loved and wanted!

This was my husband’s first baby, but my second. I have a, now 10 y.o., daughter from a previous relationship, so I had been through the nursing and diapering and everything before. I was uncertain of myself because of my depression and anxiety, but I knew what I was doing automatically. My husband second guessed everything I did. He questioned my positioning of the baby while nursing, and was convinced that she was not getting any milk, despite the fact that the nurses had told him multiple times that everything was going fine. As one would assume this only compounded the problem I was dealing with.

A couple of days out of the hospital and other than the epidural complication I thought I was feeling much better! I look back now and think that the depression was just masked by the Vicodin they were giving me for pain after the delivery. I probably had about a weeks worth of Vicodin, and within a few days after that, I was back in the E.R. I won’t go into all of the how I was feeling… But I ended up back in the psych. Ward.

Telling my husband the second time felt easier to me… With the flawed logic of depression, It seemed very simple. I leave (aka die) and then he doesn’t have to worry about me, he now has his child, life will be easier without me… Yada yada yada… The same visitation schedule existed, naturally, I had just been there little less than a month before… My husband came to all the visitations and brought our daughters. (the first time I lied to the oldest about where I was, she still doesn’t really know why I was there either time) again, in the moment, he was understanding, apologetic, and sympathetic. He just wanted me to do what ever I need to do to get better, and come home to our family.

We had tough decisions to make. Since I was nursing, and since I had the same psychiatrist that I had had previously, she was equally unwilling to provide me with any REAL meds, until I agreed to stop nursing ( as I type that, I think I hate her for that!) Up until the point in which I agreed, I pumped and dumped, my milk every few hours in my room there in the ward. That too was heartbreaking, but I was finally at a point mentally where I knew I had to get better and go home, and without me at home, there wouldn’t be breast milk anyway! So I stopped pumping and finally got some relief!!!

When I first came home my husband was great!!!! He did the laundry without being asked, he made sure there were meals for everyone, he helped out with our new daughter a lot. But as time passed and things have gotten better his back to his same old self. Mind over matter. He really does spend a lot of time wondering what the hell is wrong with me.

I’m glad to report, that I’m now doing great, as long and I don’t have to talk about the time around my daughter’s birth, (this post has resulted in the need to take some Ativan!) And you don’t talk to me about having another baby, which my husband definitely wants to do, and I’m not so sure I can handle it… I can’t even type out what happened to me without having a panic attack!!!! But for the most part I’m GREAT! ;o) I’m down to 30 mg of Cymbalta a day, and Ativan as needed (which is rare!). We are working on weaning off the Cymbalta, but I’m in no hurry! I want to be well and I want to be here with my family.

I’m looking forward to sharing this post with my husband. I think I have stated fairly well, what I will need him to do better next time. I have also printed of a “Me First” letter (got it from a post on a PPD site) and will be well armed if we decide to have another baby! I wish my husband had a better understanding of depression. I which he could remember how VERY REAL everything we went through during our daughter’s birth was. Maybe then he would have more compassion for my now fleeting struggles, and be WELL prepared for the next time!

Low Omega-3 Fatty Acid Intake from Fish correlates with High Levels of Depressive Symptoms in Pregnancy

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Published in the July issue of the Journal Epidemiology, researchers put to the test the relationship between fish intake and depression based on the observation that “Although common in western countries, depression appears to be virtually absent in countries with high seafood intake.” (Abstract, High Levels of Depressive Symptoms in Pregnancy with Low Omega-3 Fatty Acid Intake from Fish)

The researchers collected data from women as they progressed in their pregnancy during 1991-1992. At 32 weeks, the women then completed a questionnaire which included symptoms of depression as well as a food frequency questionnaire from which the amount of Omega-3 Fatty acid from fish was calculated.

The results? Both adjusted and unadjusted analyses showed that lower maternal intake of omega-3 from fish was associated with high levels of depressive symptoms.

So just how much fish do you have to eat in order to achieve these results? Women consuming more than 1.5g of Omega-3 from seafood vs. those consuming none were less likely to have depressive symptoms. And how much fish equals 1.5g of Omega-3 fatty acids? FDA guidelines suggest women and children eat up to 12 oz of fish per week. Some of the healthier fish to eat (in order to avoid mercury build-up) are: Anchovies, Catfish, Crab, Herring, Mackerel, Mussels, Wild Salmon (Alaskan), Sardines, and Whitefish (source: Fish Intake During Pregnancy, Dietriffic.com)

What if you don’t like fish? You can take a supplement and there are non-fish sources of Omega 3 such as walnut, kiwi-fruit, flax seeds, pecans, hempseed, hazel nuts, and butternuts. Eggs and milk from grass fed chickens and cows are also higher in levels of Omega-3 fatty acids than other eggs and milk. But remember this particular study dealt specifically with Omega-3 from fish.

You can also check out the following blog, Rebuild from Depression, for additional sources and information regarding Omega-3 fatty acid sources.

I have been taking Omega 3/6/9 for quite some time now as part of my regular routine. I can tell when I forget to take my supplement as well. (So can my husband!) Make sure you talk to your physician before adding a supplement to your routine though. Also discuss adding more fish to your diet as well to make sure it fits with your particular situation.

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Adrienne Einarson responds to Vogue’s “Pregnant Pause”

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On April 29, I posted a piece entitled Thoughts on exploring a “Pregnant Pause” Focused on an article appearing in this month’s Vogue magazine, I methodically refuted and balanced the article’s bias against medicating with anti-depressants during pregnancy.

Yesterday morning I woke up to find an email notification regarding a new comment on the piece. The author? None other than Adrienne Einarson, one of the most dedicated researchers in the field of SSRI usage during the prenatal period. Adrienne currently serves as Coordinator for the International Reproductive Psychiatry group at Motherisk in Toronto. She has published several studies in her areas of interest which include psychiatry, nausea and vomiting of pregnancy, and alternative medicine. Her RN specialities include psychiatry and midwifery.

Adrienne’s comment deserves its own post. Her voice deserves to be heard. She states up front that she does not often comment or blog but that the bias of the Vogue article upset her so greatly she felt the need to speak out. This letter has been sent to Vogue but has not received any response as of yet. (I have also submitted my piece directly to Vogue but also have not received a response.) She has granted permission for me to share her letter directly with you.

“I do this because I care about women who have to go through this and if my research can help, I will continue doing it.” ~Adrienne Einarson~

Without further ado, I give you Adrienne Einarson’s response to Vogue’s “Pregnant Pause”:

I am writing to you on behalf of an international group of individuals who are involved with reproductive mental health, as either clinicians, researchers and in some cases both. We would like to voice our concerns regarding your recent piece entitled “Pregnant Pause,” which we felt, did not achieve a balanced perspective on this issue, which was surprising to us, coming as it did from such a highly esteemed publication as Vogue.

We appreciate that you decided to do a piece on this often controversial issue, which can make deciding whether or not to take an antidepressant when pregnant, an extremely complicated decision for both the patient and her health care provider. However, we were very disappointed by the extremely biased approach that you took when writing this article. First of all, the data that you quoted is not as recent as you stated, these studies were published in 2005/2006, they were preliminary and the results have not been confirmed in more recent published papers, which you brushed off as not being important.

It is unfortunate that the women you quoted in your piece, thought that they had a baby with a heart defect because they took Paxil® and are suffering unnecessary guilt because of it, as if women don’t have enough to feel guilty about already in these complicated times. You acknowledged that there are probably 250,000 pregnant women taking antidepressants in the US, and you must understand before you can make any conclusions, that 1-3% of all pregnancies involve a baby with a birth defect of some kind, whether a woman takes any medications or not and 1/100 babies are born with a heart defect. That is why, researchers who conduct the best quality studies, use a group of exposed women (taking an antidepressant) with a group of unexposed woman (not taking an antidepressant) and compare the rates of adverse events in both groups. The studies that were conducted in this fashion, did not find a difference in the rates of malformations between the groups, including heart defects with Paxil®. Bottom line, if you do the simple math, it is evident that a large number of women would have had a baby with a defect whether they took an antidepressant or not, including the women in your article.

Another disturbing theme that came up several times in the article, is that physicians hand out antidepressants like candy, and physicians in our group were most offended by this statement as they are very careful about prescribing antidepressants and would not give them to someone who not does not require treatment. Every decision is made with great care, all the while weighing the risks/benefits of antidepressant treatment, and especially with pregnant women, ultimately to ensure the best possible outcome for both the baby and the mother.

Finally, and I am sure this was not your intention, several of our group members who are psychiatrists have reported that their pregnant patients have decided to stop taking their antidepressant since they read your article and I will leave you with one example of the damage you may have caused by this highly biased and often inaccurate article.

After reading this article, a woman called her psychiatrist and informed her that she was not going to take her Prozac anymore. She had had no less than seven consultations with psychologists and psychiatrists and all had agreed that she needed to be on medication because of her severe depression and possibility of suicide and concern in the post-partum period. She had finally agreed to go on the medication and at 34 weeks she was doing very well and looking forward to the birth of her baby and then read your article…………

Adrienne Einarson, Coordinator, The International Reproductive Psychiatry group