Archives for December 2006

15% of New Moms Experience Mental Problems

I'm sure you've all heard by now and all I can say is "Hooray, Hooray, Hooray!!!!!!!!" The new study published in the Journal of the American Medical Association about postpartum mood disorders confirms what so many of us have believed for so long. And just so you know, if 15% of new moms have PPD, that means that 600,000 women in the U.S. alone are experiencing these illnesses every single year. This means there are millions and millions of women like us out there.

From the Associated Press: New moms face increased risks for a variety of mental problems, not just postpartum depression, according to one of the largest studies of psychiatric illness after childbirth.

New dads aren't as vulnerable, probably because they don't experience the same physical and social changes associated with having a baby, the researchers and other experts said.

The study, based on medical records of 2.3 million people over a 30-year period in Denmark, found that the first three months after women have their first baby is riskiest, especially the first few weeks. That's when the tremendous responsibility of caring for a newborn hits home.

During the first 10 to 19 days, new mothers were seven times more likely to be hospitalized with some form of mental illness than women with older infants. Compared with women with no children, new mothers were four times more likely to be hospitalized with mental problems.

New mothers also were more likely than other women to get outpatient psychiatric treatment.

However, new fathers did not have a higher risk of mental problems when compared with fathers of older infants and men without children.

The prevalence of mental disorders was about 1 per 1,000 births for women and just .37 per 1,000 births for men.

The problems included postpartum depression, but also bipolar disorder, with altering periods of depression and mania; schizophrenia and similar disorders; and adjustment disorders, which can include debilitating anxiety.

The study underscores a need for psychiatric screening of all new mothers and treatment for those affected, according to an editorial accompanying the study in Wednesday's Journal of the American Medical Association. [my emphasis]

"Mental health is crucial to a mother's capacity to function optimally, enjoy relationships, prepare for the infant's birth, and cope with the stresses and appreciate the joys of parenthood," the editorial says.

Two of the editorial's three authors reported financial ties to the psychiatric drug industry. The study researchers said they had no financial ties to the industry.

They examined national data on Danish residents from around 1973 to July 2005. About 1.1 million participants became parents during the study.

A total of 1,171 mothers and 658 fathers — none in whom any previous mental health issues had been diagnosed — were hospitalized with a mental disorder after childbirth.

Lead author Trine Munk-Olsen, a researcher at Denmark's University of Aarhus, said similar risks for psychiatric problems likely would affect new parents in other developed nations including the United States. However, differences in screening practices and access to health care might influence whether parents elsewhere are hospitalized, she said.

Physical changes after childbirth might partly explain why women are vulnerable, including fluctuating hormone levels, Munk-Olsen said. These, alone or combined with sleep deprivation and the demands of breast-feeding could trigger mental problems, she said.

Hard data on the number of women worldwide affected by postpartum mental illness are scant, but postpartum depression alone affects about 15 percent of U.S. women.

The condition made headlines last year when actress Brooke Shields acknowledged taking antidepressants after her first child was born — and Tom Cruise publicly criticized her for it.

It also has been cited as a factor in shocking cases of mothers killing their children, including Andrea Yates' drowning of her five children in Texas in 2001.

Dr. Nada Stotland, a psychiatry professor at Rush Medical College in Chicago, said gender differences in postpartum mental illness are not surprising.

Mothers generally bear the brunt of sleep deprivation, and many new mothers are socially isolated or live far from relatives who could provide support, Stotland said.

She said the study likely will provoke mixed reactions.

"There may be people who say, 'My mother raised eight children and she never needed to have mental health care,' and others will say, 'Finally somebody has noticed just how stressful this is and what people go through,"' Stotland said.

Nationally-Recognized Author/Social Worker Karen Kleiman Sounds Off

Karen Kleiman has written an excellent response to the ignorant Ms. Shore on her Postpartum Stress Center blog:

Katherine Stone (and her wonderful Postpartum Progress Blog) has called our attention to the words of Tricia Shore , a writer who, when she isn't stirring up trouble, is a comedian (someone should tell her this isn't funny) who has declared her comments on PPD for all to see. On behalf of women with postpartum depression, I feel compelled to clarify a few things:

It's a shame that so many ill-equipped and opinionated writers have such an expansive audience to whom they can further spread their misconceptions. In the past, when someone found a forum to preach misinformation, it could be dismissed as an isolated aberration or an individual’s distorted interpretation or simply unbridled discourse at a cocktail party.

But today, as we continue to seek or be bombarded by Internet-available information we may or may not want or ask for, sometimes something seeps through cracks. We are then forced to spend what little available time we have wondering why someone actually spent the energy and bandwidth to put forth a particular message. The reason we have to respond is because there is now, more than ever, greater access to these unsupervised communications and more lives potentially impacted.

So I reluctantly confess that I spent superfluous time reflecting on the piece written by Tricia Shore that Katherine so responsibly brought to our attention.

In what might, at first glance, be a not-so-popular posture, I must admit that I agree with her opening opinion which raises a concern of my own: Has our media-soaked attention to a devastating illness, somehow diminished its worthiness in the medical and mental health community? Is there so much hype surrounding postpartum depression that in addition to promoting much needed awareness to this underdiagnosed illness, it might actually dilute the impact and sabotage our own efforts?

I hope not.

Those of us who treat this illness know only too well how excruciatingly painful and potentially deadly it is. Quite frankly, we should not be the least bit influenced by the misguided insights of a bystander who claims to have a worthwhile opinion. But for the sake of those who have been disturbed by this very well-written commentary, and on behalf of women who struggle with postpartum depression, let me do my best to respond to some of her specific points with a few of my own opinions:

–Postpartum depression does not make strong women appear weak. It makes strong women sick.

–Claiming that Brooke is "prostituting", Oprah is "enabling" and Mary Jo is "victimized" is inflammatory and simply unmerited.

–"Little pills that supposedly cure depression" can save lives and improve the quality of life. This is not a belief, it is evidence-based information that may or may not be significant to Ms. Shore or anyone she loves.

–Breastfeeding may indeed facilitate a pre-pregnant hormonal state. Breastfeeding may also be contraindicated if a woman is sick and unable to adequately care for herself and/or her baby. Breastfeeding can be associated with increased fatigue, depletion of personal resources and guilt that renders a mother virtually frozen with ambivalence. Pressuring a woman to breastfeed when she is in the throes of a major depressive episode and feeling suicidal can have catastrophic consequences.

–If a woman is fortunate enough to be surrounded by family and friends to "help hormones return to normal", she is likely to feel less isolated, less agitated and far more comforted. The presence of her loving family and friends cannot, however, prevent nor treat a major depressive episode.

–She makes a good point regarding the thyroid and it's worth repeating by one of the "supposed experts" who understands and treats women with postpartum depression: Before a definitive diagnosis of postpartum depression is made, depression caused by medical conditions such as thyroid dysfunction or anemia must always be ruled out.

–It’s okay for her to be skeptical about our mental health industry. She should be. We all should be. Women who are sick should be especially skeptical about misdiagnoses, mistreatment and misinformation. No one should be prescribed medication if they do not need it. And no one should question the use of medication by someone who does.

–"I even wanted to be a social worker… my plans have changed about becoming a social worker…"

This point, Ms. Shore, is very good news for all of us.

Sheer perfection!

Another Great Piece from MomSquawk about PPD

The following is a great post called "The Shame of Postpartum Depression" written by Momma Steph over at MomSquawk:

According to an article in Psychiatric Times, postpartum depression and psychosis are often missed by practitioners. Around 10-15% of new mothers will be diagnosed with postpartum depression (not to be confused with “baby blues”, which affects around 80%), and less than 1% of new mothers reportedly experience postpartum psychosis.

But postpartum depression may be more prevalent than thought, because women are reluctant to reveal the symptoms, Dr. [Phillip J.] Resnick said. Fearing of falling short of society’s ideal of motherhood, women may hold back from telling their husbands. And many fear that if they tell a doctor or social worker about their depression, their baby might be taken away, he said.

Gee… women who are blindsided by postpartum mental disorders aren’t likely to fill anyone in voluntarily? YA THINK?! “You know, honey, I can’t seem to stop obsessing about putting the baby in the dishwasher. Isn’t that odd? I guess we should get takeout. Why are you looking at me like that?”

I wonder if other undiagnosed women got hit with PPD as I did – in such a bizarre and scary fashion that it didn’t even occur to me that I’d been hit. I thought women with PPD hated their babies, or cried all the time, or didn’t feel like leaving the house. I loved my baby fiercely, didn’t cry much at all, and didn’t at all shy away from leaving the house – many evenings I headed down the road, clutching the baby, making a beeline for my husband’s office, if only to intercept him partway through his walk home and hand off our spawn so that I’d know he was safe. Safe from the dishwasher.

Had I known that intrusive thoughts are a fairly common symptom of PPD, I probably would have told someone. And I’m certain that the obsessions would have been much less severe, more easily laughed off and dismissed. As it was, I just thought I was going crazy, and that admitting it would make it worse, and might cost me my child. So I decided to just use all my mental strength to keep it together. And I made a pact with myself that if I ever found myself in real danger of harming the baby, I’d kill myself first, as a pre-emptive move.

Yes, the unclouded bliss of new motherhood, indeed!

Some facts on infanticide, from the article:

About 40% of mothers with postpartum depression have thoughts about killing their child, Dr. Resnick said. And for depressed mothers of “colicky” babies-babies not soothed even when fed, changed, and held-that figure climbs to 70%, he said.

Of the mothers whose depression develops into psychosis, as it did with Yates, about 4% will harm their children if the psychosis is not treated, Dr. Resnick said.

This is why education and screening are so important. I’m a well-read person, I pored over all the pregnancy books I could get my hands on, but nothing prepared me to recognize PPD. For me, bad thoughts = Andrea Yates. My only available coping mechanism (so I believed) was denial.

I’m praying that the MOTHERS Act gets out of committee and onto the floor of Congress. Its stated purpose:

To ensure that new mothers and their families are educated about postpartum depression, screened for symptoms, and provided with essential services, and to increase research at the National Institutes of Health on postpartum depression.

I had great healthcare, by all obvious standards, and I was in the dark about the signs of postpartum depression. How many other women are uninformed? How many mothers and babies are at risk?

If and when the legislation makes its way onto the floor, we should be ready for idiotic hissy fits like this: “PPD is made up by whiney mothers and screening is a grand conspiracy by the patriarchy” essay (link courtesy of Katherine at Postpartum Progress). Debate over the proposed law is one thing. But denying the existence of PPD, and further shaming women who may be suffering from it by calling them weak, is unconscionable.

Postpartum Women Respond to Ignorant Writer

Regarding my post yesterday about that insulting woman who wrote a very uninformed piece about postpartum depression, Postpartum Progress reader Sandra Wolf, M.A. LMFT, wrote a great response:

Here is the e-mail I sent this self-righteous you-know-what:

I just read your article and I have to say that I am appalled by your level of ignorance and non-compassion for your fellow women. I am so happy you never experienced postpartum depression. No woman should ever have to experience that and that is precisely why it is extremely important that women be screened for this disease. Yes, Virginia, it is indeed a disease. I was absolutely overjoyed and over the moon when I discovered I was pregnant with my son. But, not once did my OB/GYN during my pregnancy ask me how my mood was (which, looking back was mildly depressed throughout the pregnancy despite my initial elation at discovering I was pregnant), or ask me if I had a history of previous depression, or ask me if I have a familial history of depression. If she had, then I could have been notified I was in a high-risk group for developing postpartum depression. After the birth, I knew something did not feel right. And despite my trying to tell people something was wro ng, I was dismissed and told it was just the "baby blues", even after the initial 2 week period when "baby blues" should have subsided. I didn’t tell ANYONE about the thoughts I had of harming my baby, even though I knew in my heart I would never do it…that is the defining difference by the way between a mother experiencing psychosis who will likely kill her infant when having such thoughts and a mother who simply has OCD and depression and is appalled and terrified of having such thoughts. I didn’t tell anyone precisely because I was frightened someone would take my child away from me and my husband. Had I could have been assured that I would have been helped rather than judged negatively or harshly or labeled as "evil", I would have spoken up and therefore not have had to suffer for as long as I did (6 months before I finally sought help). That is why I think it is extremely important for women to be screened and specifically asked about possible symptoms of this disorder. If you don’t have it, which fortunately, the majority of women do not, great for you! However, if you fall within the 10-20% of women who do experience such symptoms, then you should not have to worry about others trying to silence you due to their fear and ignorance. This disorder is VERY TREATABLE. There is MORE THAN ONE successful means of treatment and each woman should decide with a professional upon the level of treatment that will work best for her. Not everyone needs medication, but for those who do, then so be it if it means a WELL mother! If you are such a proponent of motherhood and children, then you should realize a WELL mother is what is best for a child, not a mother suffering in silence, afraid to speak up about her experience for fear of being chastised by women like you! As for your tirade about breastfeeding being the best "medicine", that is not always the case. I breastfed my son for 13 months, and y et, I STILL suffered from postpartum depression! And no, the mental health profession is not seeking to "brainwash" people as you suggest…I am a Licensed Marriage & Family Therapist, and not ONCE did it occur to me that I was suffering from postpartum depression, though I did know something felt terribly wrong and not right. I didn’t realize this is what I was suffering from because no Dr. bothered to screen me for it and it wasn’t taught when I was in graduate school. I would come home and cry after spending an afternoon with my best friend who would state to me that her son was "the joy of her life". I cried from the depths of my soul because I so DESPERATELY wanted to feel that for my son, but I didn’t and I couldn’t understand why or what was wrong with me. Lucky for me, once I sought therapy and became well again, I have subsequently discovered what that feeling is like as I can now say assuredly that my son IS the joy and love of my life! Unfortunately, this disorder ROBBED me from feeling that for most of the first year of his life and I ache thinking I can never go back and change that for him. But now, after having received treatment, I can feel assured that he knows what it feels like to have a WELL mohter now who takes pride in being his Mama! But, when I was experiencing this disorder, I never dared say a word for fear of coming across people with small, judgemental minds like yourself. Shame on you!…You seem to tout yourself as a Christian….aren’t Christians supposed to feel compassion for others, even when their experiences are not the same as yours or fall along your way of thinking??!!! At least that was what I was taught growing up in a religious school for 12 years!