Reward and Risk: My Decision to Stay On An SSRI During Pregnancy

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postpartum depression medicationNearly two years to the day after my overdue diagnosis of postpartum depression and anxiety, I found myself pregnant and still on an SSRI antidepressant. We had been trying; I had done my research, consulted my OB and my Pediatrician for their thoughts on wether or not I should taper off of my medication prior to becoming pregnant again. They both agreed that the risk was outweighed by the reward-a healthy me was the best way to guarantee a healthy baby in the long term. When I specifically asked my pediatrician about the increased risk in heart and lung defects, she stated that we could handle it on the back end, IF it needed to be handled.

Fast forward three weeks. To our complete surprise, we discovered we were expecting not one baby, but two. Fast forward a few more weeks, a lot of tears, panic, a couple of therapy sessions, and dozens of honest conversations with my husband, doctors, and some other Warrior Moms later, and I had decided that the best thing for me and my babies was to remain on my Celexa until the third trimester of the pregnancy.

SSRI antidepressants do cross the placental barrier during pregnancy. This means that the fetus will be exposed to the medication while in utero. My doctor suggested that I wean off of the medication during the third trimester because some babies exhibit “‘withdrawal’ symptoms such as breathing problems, jitteriness, irritability, trouble feeding, or hypoglycemia (Psych Central, 2006).” However, she stressed that many of these symptoms, specifically irritability and trouble feeding, are normal for newborns and would likely be hard to discriminate from the normal behavior of newborn twins. [Read more...]

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Depression Is the Leading Cause of Disease Burden For Women Worldwide

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International Day of the GirlI’ve said it before. Postpartum depression exists all over the world, despite what some people might have you believe.

I also believe 1 in 5 women get postpartum depression worldwide. That’s 20%, which is a hell of a lot of women. Not the oft-quoted 10%, or 15%, but TWENTY PERCENT.

And yesterday, for World Mental Health Day, the World Health Organization (WHO) reiterated that. In their media note to mark the 20th anniversary of World Mental Health Day, they specifically mentioned postpartum depression, which I thought was fantastic:

“Depression results from a complex interaction of social, psychological and biological factors. There is a relationship between depression and physical health, for example cardiovascular disease can lead to depression and vice versa. Up to one in five women who give birth experience postpartum depression.”

In a 2012 paper on depression, the WHO states, “While depression is the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males (WHO, 2008). In fact, depression is the leading cause of disease burden for women in both high-income and low- and middle-income countries (WHO, 2008).” Let me repeat that: Depression is the leading cause of disease burden for women. Not diabetes. Not hypertension. Not heart disease. Not chronic obstructive pulmonary disease (COPD.) Depression. And yet, almost half of the world’s population lives in a country where, on average, there is one psychiatrist or less for every 200,000 people. There are no services. There is no help. Can you imagine?

Postpartum depression cannot be ignored. So many of the people I talk to who are carrying out maternal child health programs around the world tell me those programs do not include provisions to assess and support a new mother’s mental health. This has got to change.

And it’s not only women and PPD we should be concerned about. Today is International Day of the Girl. Much of the focus of this event is on issues — important ones — of equality, child marriage, sex trafficking and access to education.  But did you know the WHO found the leading cause of disease burden among adolescents age 10-19 across the world is depression, too?

Let’s make sure our girls grow up healthy and strong in body and mind. Let’s make mental health a priority instead of an afterthought.

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Postpartum Depression Statistics: One in Five

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postpartum depression statisticsI’ve been saying for years that I believe more women in the US get postpartum depression than the oft-quoted “1 in 8.” That postpartum depression statistic is based on data from the CDC that found a range of anywhere from 11 to 20% of moms get PPD.  Most people like to say it’s 10% or, if they’re really adventurous, 15%. I know one expert who, after saying to the powers that be that he believed the numbers were higher, was told not to get hysterical. Sound familiar, ladies?

The truth is that people aren’t really tracking the numbers as closely as they should here. Good postpartum depression statistics are hard to come by. There is the information from the CDC, which looked at only a handful of states and at only self-reported cases. Given what we now know about how untreated postpartum depression affects both mother and child, I hope to see measurement being ramped up.

I recently reached out to both the CDC and the National Institute of Mental Health to find out how many women die of suicide in the first year postpartum in the US, and where suicide ranks among the leading causes of maternal death here. And you know what? No one had any idea, because they haven’t tracked it. They will now, hopefully, since I made so much noise about finding out. (MUCH gratitude goes to Kathleen O’Leary, head of the women’s program at NIMH, et al, for really making a concerted effort to look into this for me.)

A study came out this week from the Australian Institute for Health and Welfare which surveyed 29,000 mothers and found that one in five said they had postpartum depression, or postnatal depression as it’s called there.  One in five. Could the numbers be that large here in the US? There’s no reason to believe they’d be much different.

One in five.

One. In. Five.

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How Many Women Get Postpartum Depression? The Statistics on PPD

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postpartum depression statisticsQuick, guess which number is higher: the number of people who sprain an ankle each year, the number of people who have a stroke, or the number of women who experience postpartum depression?

PPD. Surprised?

In so many books, articles and news programs, you hear the statistic — approximately 10 to 15% of women suffer from postpartum mood disorders (PPMDs), including postpartum depression (PPD), postpartum anxiety/OCD and postpartum psychosis. What bothers me about that statistic is that it holds no meaning for most people, and because of that I think these illnesses get much less funding and attention than so many of the other prevalent illnesses that strike Americans. As a result, I decided to do a bit of quick, non-scientific research to look at the real numbers and to help people understand the real impact that postpartum depression is having on the women of our country.

There were approximately 4.3 million live births in the United States in 2007. This statistic does not include fetal losses, including miscarriages and stillbirths. The National Vital Statistics Report indicates that the total number of clinically recognized pregnancies is around 6.4 million. This is important to know, because all postpartum women are susceptible to postpartum depression, regardless of the pregnancy’s outcome.

So let’s split the difference between the high (20%) and low estimates of PPD (11%) and say that an average of 15% of all postpartum women in the US suffer, as the CDC reported in its 2008 PRAMS research. And let’s use the number of clinically recognized pregnancies and not live births. This would mean that each year approximately 950,000 women are suffering postpartum depression.

BUT, did you know the CDC’s research only reflected self-reported cases of postpartum depression? How many women do you think did not mention they had PPD out of fear or shame? Should we increase the estimate of sufferers to 17% or 20%?

ALSO, these numbers don’t take into account women who may have suffered other perinatal mood and anxiety disorders like PPOCD or postpartum psychosis. Should that make the numbers go even higher?

I’d argue that the average number of new mothers who experience perinatal mood and anxiety disorders is more likely in the 20% range, which would mean around 1.3 million annually.

How does that compare with the incidence among women of other major diseases in America?

In fact, more mothers will suffer from postpartum depression and related illnesses this year than the combined number of new cases for both sexes of tuberculosis, leukemia, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease and epilepsy. This is not to minimize these other terrible diseases, of course. I simply want to illustrate just how prevalent postpartum mood & anxiety disorders are.

Dr. Ruta Nonacs of Massachusetts General Hospital and Harvard Medical School adds, “Postpartum depression is far more common than gestational diabetes. All women receiving prenatal care are screened for diabetes, but how many pregnant and postpartum women are screened for depression? PPD is also more common than preterm labor, low birth weight, pre-eclampsia and high blood pressure; in other words, PPD is the most common complication associated with pregnancy and childbirth.”

Let me leave you with one last thought: More moms will suffer from PPD than men will be diagnosed with new cases of impotence (approx. 600,000) this year. Yet you wouldn’t know it, considering the overabundance of erectile dysfunction (ED) ads and people falling all over themselves to discuss ED openly. Why doesn’t PPD get the same attention from pharmaceutical companies?

Why doesn’t society work as hard to eliminate the stigma of PPD? Why aren’t more corporations and foundations concerned about PPD and supporting awareness campaigns?

This really is a big problem, and deserves much more attention than it’s getting.


Photo credit: ©Andres Rodriguez – Fotolia

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