Katherine Stone

is the founder & editor of Postpartum Progress. She was named one of the ten most influential mom bloggers of 2011, a WebMD Health Hero and one of the top 25 parent bloggers using social media for social good. She also writes the Fierce Blog, and a parenting column for Disney's Babble.com.

News From the Los Angeles County Perinatal Mental Health Task Force

By May 22, 2013 Comments
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Sharing news from the Los Angeles County Perinatal Mental Health Task Force. Here are just a few things they’d love for you to do before May — Maternal Mental Health Month — is over …

1. Watch and share this Public Service Announcement. The “Speak Up When You’re Down” Public Service Announcement features women and men who have been affected by maternal depression. Please share with your family and friends and/or post on your website or blog.

2. Register for the Bringing Light into Motherhood Two-Day Certification Training. The Los Angeles County Perinatal Mental Health Task Force is offering a two-day advanced professional training on maternal mental health. The training will take place on Monday July 29th – Tuesday July 30th in Los Angeles, CA. The total cost of the training is $195 and includes 9 Continuing Education Credits for RNs, 12 Continuing Education Credits for LMFTs and LCSWs, a Bringing Light to Motherhood toolkit, informational handouts, breakfast and lunch.

3. Make a donation, Receive Greeting Cards. All individuals who make a donation of $30 or more to the Los Angeles County Perinatal Mental Health Task Force between April 15 – May 30, 2013 will receive a package of 6 beautifully Mother’s Day-themed greeting cards. Each card has been designed by a child who’s mother experienced maternal depression. Donations will support programs that directly help women with perinatal mood and anxiety disorders.

4 Join the conversation. Throughout the month of May we will be using Twitter and Facebook to raise awareness about resources available to treat perinatal depression. Please join our social media outreach efforts by following the Los Angeles County Perinatal Mental Health Task Force on Twitter @SpeakUpWhenDown and becoming our Fan on Facebook and sharing the information we post throughout this month!

 

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May 22, 2013 9:05 am Filed Under: Postpartum Depression

Researchers Find Genes That Predict Postpartum Depression

By May 21, 2013 Comments
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epigeneticsPostpartum depression is really a combo-pack of nature and nurture, rather than what we have thought of as solely a “chemical imbalance.” Part of the cause of PPD is likely your genes, and part of the cause is likely what type of trauma, stress or environmental changes you have experienced that has caused certain of your genes to be expressed differently.

You aren’t born with one set of genes that never change, believe it or not. We know this thanks to the science of epigenetics. Epigenetics is the study of chemical reactions that switch parts of your genome off and on at strategic times and locations and what causes those chemical reactions to occur. As explained in easy to understand terms by The Week, your “… genes aren’t a fixed, predetermined program simply passed from one generation to the next. Instead, genes can be turned on and off by experiences and environment.”

Johns Hopkins has released the results of a small study this morning that they say shows two particular gene alterations that highly predict PPD. As described in their news release, “Johns Hopkins researchers say they have discovered specific chemical alterations in two genes that, when present during pregnancy, reliably predict whether a woman will develop postpartum depression. The epigenetic modifications, which alter the way genes function without changing the underlying DNA sequence, can apparently be detected in the blood of pregnant women during any trimester, potentially providing a simple way to foretell depression in the weeks after giving birth, and an opportunity to intervene before symptoms become debilitating.”

The genes in question?  TTC9B and HP1BP3, which appear to be highly reactive to changes in estrogen levels. The idea is that some of us have brains that may be much more reactive to changes in estrogen during pregnancies than others, which may be why some of us get postpartum depression while others don’t.

Lead study author Zachary Kaminsky, PhD, explains, “The researchers noticed that women who developed postpartum depression exhibited stronger epigenetic changes in those genes that are most responsive to estrogen, suggesting that these women are more sensitive to the hormone’s effects. Specifically, two genes were most highly correlated with the development of postpartum depression. TTC9B and HP1BP3 predicted with 85 percent certainty which women became ill.”

If a future blood test can identify those women who have a  high risk for PPD, then we can do a lot to help prevent it or at least reduce its severity and length, by educating them and their families in advance and creating a safety net that could start immediate, effective treatment at the first sign of symptoms.

A larger study is needed — this one included only 51 pregnant women. Meantime, this research is very exciting.

This study is published in the  May 21 issue of the journal Molecular Psychiatry.

Photo credit: © rolffimages – Fotolia.com

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May 21, 2013 11:36 am Filed Under: Postpartum Depression, Postpartum Depression Research

What The New DSM-V Says About Postpartum Depression & Psychosis

By May 21, 2013 Comments
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DSM 5The new Diagnostic Statistical Manual — the DSM-V — has officially been released by the American Psychiatric Association. So what does it say about postpartum depression?

Not what I thought it would. In the DSM-IV, to diagnose Major Depressive Disorder with Postpartum Onset, symptoms needed to appear in the first 4-6 weeks. As you know, many moms don’t recognize postpartum depression symptoms until much later in the first year. It’s my belief that this has led to moms going to see their docs and being told they couldn’t have PPD because it was too late.

My understanding was that in the new DSM-V,  that would change. To make the qualification for Major Depressive Disorder with Postpartum Onset, symptoms could appear any time in the first four months. Others have said the discussion leading up to revisions of the DSM also revolved around extending it to as far as six months.

Yet yesterday I got a copy of the new pages (pg. 186 and 187) and it still says 4 weeks. So frustrating.

With peripartum onset: This specifier can be applied to the current or, if full criteria are not currently met for a major depressive episode, most recent episode of major depression if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery.

The DSM does now recognize antenatal depression, since the listing has changed from a postpartum onset specifier to a peripartum onset specifier.

The DSM-V also offers a detailed note on using the Major Depressive Disorder with Peripartum Onset diagnosis:

Note: Mood episodes can have their onset either during pregnancy or postpartum. Although the estimates differ according to the period of follow-up after delivery, between 3% and 6% of women will experience the onset of a major depressive episode during pregnancy or in the weeks or months following delivery.

What the heck made them decide on that low number? 3%? Y’all must be kidding. It’s more like 10-15%.

Fifty percent of “postpartum” major depressive episodes actually begin prior to delivery. Thus, these episodes are referred to collectively as peripartum episodes. Women with peripartum major depressive episodes often have severe anxiety and even panic attacks.

Good. Great points to have added about antenatal depression and about the anxious nature of postpartum depression.

Prospective studies have demonstrated that mood and anxiety symptoms during pregnancy, as well as the “baby blues,” increase the risk for a postpartum major depressive episode.

Peripartum-onset mood episodes can present either with or without psychotic features. Infanticide is most often associated with postpartum psychotic episodes that are characterized by command hallucinations to kill the infant or delusions that the infant is possessed, but psychotic symptoms can also occur in severe postpartum mood episodes without such specific delusions or hallucinations.

Postpartum mood (major depressive or manic) episodes with psychotic features appear to occur in from 1 in 500 to 1 in 1000 deliveries and may be more common in primiparous women.

Primiparous means first pregnancy.

The risk of postpartum episodes with psychotic features is particularly increased for women with prior postpartum mood episodes but is also elevated for those with a prior history of depressive or bipolar disorder (especially bipolar 1 disorder) and those with a family history of bipolar disorders.

Once a woman has had a postpartum episode with psychotic features, the risk of recurrence with each subsequent delivery is between 30 and 50%. Postpartum episodes must be differentiated from delirium occurring in the postpartum period, which is distinguished by a fluctuating level of awareness or attention. The postpartum period is unique with respect to the degree of neuroendocrine alterations and psychosocial adjustments, the potential impact of breast-feeding on treatment planning, and the long-term implications of a history of postpartum mood disorder on subsequent family planning.

There you have it. What do you think about the new postpartum depression listing?

Photo credit and citation: American Psychiatric Association

 

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May 21, 2013 9:38 am Filed Under: Postpartum Depression, Postpartum Psychosis