Category Archives: research

Doctoral Student survey examining Postpartum depression, attachment style and the mother-daughter relationship

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Doctoral candidate Kristi Marshall at Trevecca Nazarene University in Nashville, TN, is studying postpartum depression in new mothers. She is currently seeking 18-40 year old women who are within 1 year of giving birth. A postpartum depression diagnosis is not necessary for participation. Kristi hopes this research will contribute to the understanding and treatment of postpartum mood disorders.

The questionnaires for this study will take about 10 minutes to complete. If you submit your email address you will be entered to win one of several $20 gift cards. You will be eligible if you complete the entire survey by December 31, 2009.
If you have any questions before participating, please contact Kristi at kmarshallcounseling(@)gmail(dot)com.
The questionnaires, with a consent form and instructions, can be accessed by clicking on the following link: Postpartum depression, attachment style and the mother-daughter relationship.

Please feel free to forward this information to other women who might be willing to participate!

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.

Tips on Identifying Reliable Health Information on the Internet

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If you’ve landed here as a result of a Google, Yahoo,  Bing, or other search engine, you already know how many results you can get in mere seconds and even sometimes nano-seconds. Thousands! So you wade through the results hoping for reliable and trustworthy information. Unfortunately, not everything out there is reliable and trustworthy. And even if it is reliable and trustworthy, you should ALWAYS check with a professional prior to implementing or stopping any treatment.

Here are some general tips to help you tell the good from the bad (source: Medical Library Association):

1. Sponsorship
  • Can you easily identify the site sponsor? Sponsorship is important because it helps establish the site as respected and dependable. Does the site list advisory board members or consultants? This may give you further insights on the credibility of information published on the site.
  • The web address itself can provide additional information about the nature of the site and the sponsor’s intent.
    • A government agency has .gov in the address.
    • An educational institution is indicated by .edu in the address.
    • A professional organization such as a scientific or research society will be identified as .org. For example, the American Cancer Society’s website is http://www.cancer.org/.
    • Commercial sites identified by .com will most often identify the sponsor as a company, for example Merck & Co., the pharmaceutical firm.
  • What should you know about .com health sites? Commercial sites may represent a specific company or be sponsored by a company using the web for commercial reasons—to sell products. At the same time, many commercial websites have valuable and credible information. Many hospitals have .com in their address. The site should fully disclose the sponsor of the site, including the identities of commercial and noncommercial organizations that have contributed funding, services, or material to the site.
2. Currency
  • The site should be updated frequently. Health information changes constantly as new information is learned about diseases and treatments through research and patient care. websites should reflect the most up-to-date information.
  • The website should be consistently available, with the date of the latest revision clearly posted. This usually appears at the bottom of the page.
3. Factual information
  • Information should be presented in a clear manner. It should be factual (not opinion) and capable of being verified from a primary information source such as the professional literature, abstracts, or links to other web pages.
  • Information represented as an opinion should be clearly stated and the source should be identified as a qualified professional or organization.
4. Audience
  • The website should clearly state whether the information is intended for the consumer or the health professional.
  • Many health information websites have two different areas – one for consumers, one for professionals. The design of the site should make selection of one area over the other clear to the user.

MLA’s guidelines are an excellent starting point and should be used by anyone searching for Medical information on the internet. Many caregivers will also tell you to not search the web for information, especially if you have a Postpartum Mood Disorder. If you have a question and feel overwhelmed with doing research on your own, get in touch with a Postpartum Support International Coordinator, your midwife, or your doctor, and ask for help in doing research. Sometimes you may come across research or news stories that are not applicable to your situation that may cause triggering thoughts or increase your fear and anxiety without justification.

Another great way to check the reliability of a website is to do so through HONcode. HONcode, Health on the Net certifies websites with healthcare information. Their standards are pretty high and they certify on a random basis once a website has been accepted. (I’m currently working on acheiving this certification for this blog myself). Through HONcode, as a patient/consumer, you can download a toolbar or search directly from their site and will only be given websites that have been approved by them. Click here to learn more about the safety process at HONcode.

I also want to take a moment to mention that a good doctor or advocate will be compassionate, understanding, and work with you regarding your desired route of treatment. Good Caregivers and Advocates are able to stay objective and not allow personal experience to cloud their aid to those who seek their help. This does not dismiss advocates who have specialized knowledge of certain types of treatment however – what I mean by this statement is that if you approach and advocate with a question regarding an Anti-Depressant, they should direct you to research regarding that particular medication and encourage you to also speak with your caregiver. They should NOT bash said medication because they’ve had a bad experience with it. If the caregiver or advocate is not compassionate but instead dismisses or attacks your desired treatment methods, it’s time to find another caregiver or advocate for support.

As a Postpartum Support International Coordinator myself, I work very hard to support the journey the mother is on and the treatment route that best fits with her personal philosophy. I encourage the involvement of professionals – including her OB or midwife, a psychiatrist, and a therapist. I also encourage Mom to take time for herself, something we all forget to do from time to time, but is very important for our mental well-being.

So please remember to:

Thoroughly check the source of the information you are reading online using the above guidelines from the Medical Library Association as well as searching via HONcode for your information.

Double-check any information regarding starting treatment or stopping treatment with your professional caregiver prior to implementation.

Make sure your caregiver respects your opinion regarding your body. (You are of course, your #1 expert in this area!) If he/she fails to respect you, although it may be difficult, find another caregiver who DOES respect you!

Take time for yourself as you heal.

Dr. Zachary Stowe reprimanded by Emory

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Dr. Zachary Stowe, a well-known researcher in the field of anti-depressant usage during pregnancy and postpartum, has been disciplined by Emory University for failing to disclose a conflict of interest while conducting research using a NIH grant during 2007 and 2008. Dr. Charles Nemeroff, also of Emory, was also found to have existing conflicts while conducting research just a few months ago.

These disheartening discoveries are becoming too commonplace. What’s happened to honest, decent morals? What’s happened to working for the greater good instead of the not-so-almighty dollar?

I must say that my initial reaction was one of very deep disappointment as this is all unfolding in my own backyard. Emory is one of the most well known resources for Postpartum support here in Georgia. Without Emory, there’s not much left to the support and knowledge of Postpartum Mood Disorders and their treatment here. (Trust me, I’ve worked to find one!)

I sincerely hope both Dr. Nemeroff and Dr. Stowe have learned important lessons through all of this. I also hope other researchers will realize the importance of honesty when disclosing relationships during research.

The public deserves un-biased data when it comes to our health. Has that even become too much to ask for?

Postpartum Anxiety Delays Puberty in Offspring

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In another study with mice, researchers have discovered that a low level of Prolactin in early pregnancy translates to a delay in puberty. The results were revealed yesterday at The Endocrine Society’s 91st Annual Meeting in Washington, D.C.

The most interesting aspect of this research was the discovery that regardless of environment (ie, raised by an anxious mouse or non-anxious mouse), the offspring of the “anxious” mice still experienced a delay of puberty when raised by a controlled non-anxious mother.

Here’s a snippet of the press release:

Women have an increased rate of anxiety during pregnancy and for 2 years after giving birth, said the study’s lead author, Caroline Larsen, PhD, a postdoctoral fellow at the University of Otago in Dunedin, New Zealand.

“Postpartum anxiety disorders are poorly understood and difficult to treat,” Larsen said. “There is growing evidence that untreated anxiety disorder during pregnancy may contribute to premature birth and also can have major and lasting adverse effects on the infant’s development and behavior.”

Prolactin is a hormone that may protect against anxiety. Recently Larsen and her co-workers found that mice with induced low levels of prolactin in early pregnancy displayed substantial anxiety after they gave birth. Because the researchers also noted that daughters of the anxious mothers had delayed onset of puberty, they conducted the current study to learn what causes this late physical transition to sexual maturation.

Daughters of female mice made anxious by low prolactin were raised either by their birth mother or by a mouse who was not anxious (control mother). Another group consisted of daughters of nonanxious mice, and these mice were raised by either a control mother or an anxious mother. There were at least six mice in each of the four groups. The researchers determined onset of puberty by examining when the vagina opened and noting the time of first estrus (equivalent to the first menstrual cycle in humans).

“Remarkably, puberty was still delayed even if the daughters of anxious mothers were raised by nonanxious mice,” Larsen said. “And delayed puberty also occurred in daughters born to nonanxious mothers who were raised by anxious mothers.”

This result demonstrates that hormonal changes in early pregnancy, as well as changes in maternal behavior caused by these hormone changes, can alter brain development in the offspring and delay puberty, she explained. Larsen believes that their work, with further study, may translate to people.

“Finding the hormonal mechanisms that trigger the timing of puberty in mice may help identify potential targets for the prevention and treatment of delayed or early puberty in humans,” she said.

Late puberty in humans is linked to shortened height and psychological problems that can persist into adulthood.