Depression and Pregnancy

Weighing The Risks of Treating Antenatal Depression

By Katherine Stone March 8, 2012

There’s a new study out this week, published in the Archives of General Psychiatry, on the effect of taking antidepressants during pregnancy that essentially offers the same result as other studies we’ve reported on here:

Women with untreated depression during pregnancy have a higher risk of having pre-term babies.

Women who take antidepressants during pregnancy for depression have a higher risk of having pre-term babies.

Here was the conclusion of the study as outlined in the abstract:

Untreated maternal depression was associated with slower rates of fetal body and head growth. Pregnant mothers treated with SSRIs had fewer depressive symptoms and their fetuses had no delay in body growth but had delayed head growth and were at increased risk for preterm birth. Further research on the implications of these findings is needed.

It seems this is still a chicken and egg problem — is it something underlying the genetics of depression that leads to pre-term delivery or the medication or both? What should women do? [Read more...]

March 8, 2012 9:12 am Filed Under: Depression and Pregnancy, Postpartum Depression Treatment

Postpartum Depression In the News: On Older Moms, Light Therapy & More

By Katherine Stone October 27, 2011

Here’s the latest news on postpartum depression this week:

A study in the United Kingdom found that postpartum depression is underreported (surprise!). The researchers involved with this study believe that as many as 30% of new mothers in the UK get PPD (or postnatal depression, as it is called there).

A study in Australia finds that older moms (37+) do not face an increased risk of getting postpartum depression. I have heard it cited in the past that older moms have a higher risk, which I always found sort of odd, but this study says that it’s just not the case.

The MGH Center for Women’s Mental Health has published an article on the effectiveness of Light Therapy as a treatment for depression during pregnancy, and whether it can or should be used as an alternative to medication. Check it out.

The awesome Dr. David Rubinow, founder of the University of North Carolina Center for Women’s Mood Disorders, has been elected to the Institute of Medicine, which is one of the nation’s highest honors for those in the fields of health and medicine. So. Damn. Fantastic.

I’ll be in Knoxville tomorrow speaking about postpartum depression at the 14th Annual Fall Psychiatric Symposium. Looking forward to it!!!

October 27, 2011 10:02 am Filed Under: Depression and Pregnancy, Postpartum Depression

Autism and Antidepressants During Pregnancy: On Checking Your Sources

By Katherine Stone October 10, 2011

So this tweet goes out on Twitter today saying that Zoloft causes autism when women take the medication during pregnancy … Mamas start getting nervous. Upset. Understandably so.

As you might imagine, I take immediate notice. What is the source of this? I find the tweet that started it all. It says there’s a link between autism and Zoloft.

The tweet is from Autism Now. Wow. That’s a major organization in Washington DC. It’s the National Resource Center for Autism. Except, wait a minute, Autism Now’s twitter handle is @AutismNowCenter, not @AutismNow. It’s not the credible, nationally-recognized organization that is sending out the tweet. Instead, this account seems to be registered to someone named “Change Agent.” I’m guessing that’s not the person’s real name. Anyway, the account appears to be a straight feed of autism-related news.

Let’s check the link in the tweet that caused the commotion on Twitter this morning. It goes to a site called autism-blog.com, which is apparently a site where anyone can blog about autism. To join and write on this site, all you have to do is enter your email address. The person who wrote this particular story is sandra_8907. Sandra has only posted at the site twice, and both of her posts say the same thing.

[Read more...]

October 10, 2011 12:39 pm Filed Under: Depression and Pregnancy

UNC Opens First Freestanding Inpatient Perinatal Psychiatry Clinic in US

By Katherine Stone August 15, 2011

They already know this, because I talk to them quite a bit, but I couldn’t be more proud of or excited for the wonderful people at the University of North Carolina (UNC) for opening the country’s first freestanding perinatal inpatient psychiatry unit. Hooray! Bravo! Yippee!!!!! What a gift for moms with postpartum depression.

There are other specialized clinics and treatment programs, of course, but this is the first separate unit solely for mothers who need to be hospitalized for perinatal mood and anxiety disorders like severe postpartum depression or postpartum psychosis. In most other places, a woman requiring inpatient treatment will be hospitalized with all other psychiatric patients, without any special services or tools that support her needs as a new mother.

[Read more...]

August 15, 2011 7:00 pm Filed Under: Depression and Pregnancy, Postpartum Depression Treatment

Postpartum Depression & Eating Disorders, Pregnancy Depression’s Impact on Babies

By Katherine Stone July 14, 2011

Want to share with you some great stories out this week on postpartum depression and related issues:

The first is from my friend Rita Arens at BlogHer. She wrote an in-depth piece about eating disorders, postpartum depression, and the relation between the two. The article is about research conducted by the University of North Carolina that found that a previous eating disorder can be a risk factor for PPD. Check it out!

The second is from our friends at the MGH Center for Women’s Mental Health and sums up a study on the impact of depression during pregnancy (also called antenatal depression). One finding was that ” … males of mothers who had depression during pregnancy had higher anxiety scores at one year of age than males in the control group. Girls of mothers who had depression during pregnancy had higher oppositional/defiant scores at one year of age than girls in the control group.” This was a small study so (as per usual) the researchers suggest that more research is needed.

Aaaand … I was very excited to see this piece in the Washington Post‘s On Parenting column about postpartum depression and breastfeeding called “It’s Okay if You Don’t Breastfeed”. (It is okay!) Thanks to Jennifer Kogan for the shout-outs to Postpartum Progress, Adrienne Griffen of Postpartum Support Virginia and Lynne McIntyre, DC coordinator for PSI.

Also, Lori at the blog I Can Grow People has just done a 2-part series on the 2-year anniversary of when she spoke up and finally told someone she was struggling with postpartum depression. Part 1 is here and part 2 is here. And our friend Grace also wrote about her experience 2 years ago with PPD in a guest post at Sluiter Nation.

July 14, 2011 3:15 pm Filed Under: Depression and Pregnancy, Postpartum Depression

Pregnancy, Antidepressants & Autism: Is There A Link?

By Katherine Stone July 6, 2011

Yesterday it was widely-reported that a new research study found a link between autism and SSRIs taken by mothers during pregnancy.

SSRIs, if you don’t know, are certain types of antidepressants, and include such name brands as Zoloft, Prozac, Paxil and Luvox. I’ve already heard from some of you with understandable concerns about this news. I know it only adds to the stress all of us experience when making the decision whether and how to be treated with antidepressants if needed during pregnancy.

I reached out to Postpartum Progress Inc. board member Marlene F. Freeman, MD, director of Clinical Services at the MGH Center for Women’s Mental Healthand associate professor of Psychiatry at Harvard University, to help clarify what the study means for us. Here is her response:

“Autism is a very serious condition, and it would be extremely important to know what risk factors are definitely associated with the condition.

A recent article published first online in the Archives of General Psychiatryreported an association between autism and maternal SSRI use during pregnancy. The authors conducted a case controlled study of a Kaiser Permanente database.They found a greater risk of autism spectrum disordersamong children of SSRI users compared to non-usersduring pregnancy.Authors included diagnoses of autism spectrum disorders, maternal lifetime psychiatric diagnoses of mood and anxiety disorders and schizophrenia, and SSRI and other antidepressant prescriptions dispensed during pregnancy in the analyses. Maternal symptoms and burden of illness during pregnancy were not assessed.

The study generates questions for further study, but does not find a cause-and-effect relationship between SSRIs and autism.While previous history of mood and anxiety disorders is factored into the analyses, acute illness during pregnancy is not at all factored in. I believe that this greatly diminishes the value of the article to assess the impact of SSRIsin pregnancy on the risk of autismin children. Current use of SSRIs may be a better indication of acute illness during pregnancy than history of previous diagnoses (as many women will be undertreated during pregnancy due to concerns about fetal exposure, hence leading to a dual exposure of both medication and untreated maternal illness). The possibility that SSRI use may represent acute symptoms or illness is not among the limitationsof the study discussed by its authors. Since the authors state”the combined effect of maternal serotonin transporter geonotype and prenatal stress may contribute to autistic-like behaviors in offspring,” it is disappointing that their study did not control for prenatal maternal stress or burden of illness. Therefore, it is not possible to separate out genetic predisposition and symptoms experienced by mothers during pregnancy — suspected to contribute to risk of autism — from medication exposure in this study.

At this time, we need further research to determine whether maternal anxiety or depression or medication use may increase the risk of autism spectrum disorders, and whether unknown factors associated with maternal mental health conditions or medicine use increase risk. Until risk factors are clearer, women with serious mood and anxiety disorders that do not find relief from non-medication treatments such as psychotherapy should talk about risks/benefits of medicationwith their doctors, and antidepressants are still considered first-line treatment for moderate to severe illness. Women with more mild illness, as before this report, should be encouraged to try psychotherapy first, and perhaps othernon-medication strategies.”

Translated into plain mama English: They don’t know whether it was the treatment (SSRIs), or the illness for which the mom is being treated (antenatal depression/anxiety, or depression/anxiety she has always had), or some genetic factor in the mom that may be related to both autism and the fact that she is vulnerable to depression/anxiety that led to the incidences of autism in the study. Not to mention the women whose children have an autism spectrum disorder who have none of the above.

The authors of the study themselves suggested caution in how their findings are interpreted (from the Archives of General Psychiatry):

“Our results suggest that prenatal exposure to SSRIs, especially during the first trimester, may modestly increase the risk of ASDs [autism spectrum disorders]. The fraction of cases of ASD that may be attributed to use of antidepressants by the mother during pregnancy is less than 3% in our population, and it is reasonable to conclude that prenatal SSRI exposure is very unlikely to be a major risk factor for ASD. Although these findings indicate that maternal treatment with SSRIs during pregnancy may confer some risk to the fetus with regard to neurodevelopment, this potential risk must be balanced with the risk to the mother or fetus of untreated mental health disorders. We recommend that our findings be considered as preliminary and treated with caution …”

So there you have it. I know many of you had seen this news and I wanted you to get the most balanced information possible.

July 6, 2011 1:22 pm Filed Under: Depression and Pregnancy

MGH Looks At SSRIs during Pregnancy & PPD and Sleep

By Katherine Stone June 14, 2011

The MGH Center for Women's Mental Health has two new stories out that I wanted to point you to:

Postpartum Depression and Poor Sleep Quality Occur Togetherreviews a recent study on sleep quality and sleep efficiency among depressed new moms.

Should SSRIs Be Tapered Prior to Delivery? takes a look at whether lowering the dose of a patient's antidepressant during the last few weeks of pregnancy will prevent neonatal distress.

… and can I just say I'm posting this from a plane? … technology rocks.

June 14, 2011 3:08 pm Filed Under: Depression and Pregnancy

Pregnancy & Depression: Warrior Moms of the Week

By Katherine Stone June 8, 2011

This week, Warrior Moms of the Week is focusing on antenatal depression, or depression in pregnancy. It’s just as common as PPD but is even less talked about, if you can imagine. There are lots of people starting to speak up about this illness, which is very important. It can be very difficult to make decisions about treatment when you are carrying an unborn child, and to go through the experience of everyone wanting to celebrate the upcoming birth while you are miserable. Here are two stories on depression in pregnancy that appeared this week:

Erin Margolin on antenatal depression (depression during pregnancy)

Babble on antenatal depression

You don’t need to feel alone. It can help to see how many others have been through this, and that their stories are similar to yours. For more Warrior Moms stories on antenatal depression, check these out:

On How It Feels to Be Depressed During Pregnancy

The Black Hole of Antenatal Depression

Aunt Becky from Mommy Wants Vodka on Being Depressed & Pregnant

Antenatal Depression: Robbed of the Joy of Pregnancy

How It Feels To Be Depressed When You’re Pregnant

And if you are a survivor of antenatal depression and want people to know they can make it, too, pick up your survivor badge here:

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June 8, 2011 10:30 am Filed Under: Depression and Pregnancy

Molly Shalz: On How It Feels To Be Depressed During Pregnancy

By Katherine Stone May 8, 2011

Dear new mom:

I remember seeing the blue plus sign on the pregnancy test. It was positive. I waited for the happiness. It didn’t come. Instead of happy tears I had a panic attack right there in the bathroom. The sting from the guilt that I felt in that moment has never really gone away.

My first son had just turned one. I had just quit my job two days before. I was on birth control! We wanted another child but the timing. Oh, the timing. Why couldn’t it have happened later when things were more settled? When we were ready? When we could celebrate it and not be riddled with worry about our finances and future?

I will never have those answers. I didn’t choose my son. But that’s okay. He chose me. I know that now.

If you are one of those soon-to-be-moms who stands in the bathroom holding a positive pregnancy test wondering how in the hell you and your tiny impending bundle are going to get through this, let me be the first to tell you … you will.

As a woman who has faced severe depressive episodes due to bipolar II disorder for all of her adult life, I often wondered if the pregnancy hormones and then postpartum depression would push me into my worst mood episode yet.

So I was pleasantly surprised with how truly happy I was during my first pregnancy. Comfortable? No. But happy? Yes, gloriously so.

With my second, I waited for those happy feelings. The first trimester went by and my anxiety grew. The second trimester came and the worries and depressed thoughts took over my brain like flies swarm over food in the heat.

I tried to force happiness. When you’re pregnant and your belly reaches the point where it’s obvious to everyone else that a baby will be coming out of you, that’s when everyone starts talking to you about it.

“When are you due?”

“Is it a boy or a girl?”

“Any names in mind?”

I would fake a smile, rub my round belly in that natural motherly way, and answer all their questions. It was my hope that as I heard my own voice it would conjure up that nervous and excitable anticipation that all mothers are supposed to feel. But what came was nothing of the sort.

What all those strangers and friends alike didn’t know was that I was terrified. Terrified of this baby. Terrified of another traumatic birth experience like the one with my first. Terrified by a future that was uncertain for many reasons. Job and income loss. House sitting stale on the market. Husband working six days a week so we didn’t lose everything.

It was all too much. I was mentally and physically exhausted. And not the normal type of pregnancy exhaustion. I wanted to pull the covers over my head and sleep. Sleep through the first, second and third trimester. Sleep through the birth. Sleep through the first month and while we’re at it, maybe the first year.

That’s when I realized . . . I am not just pregnant. I am pregnant and depressed.

True depression. Sadness. Hopelessness. The things no mother-to-be should feel. That was me. I was so ashamed. I kept thinking to myself, Do you know how many women would do anything to be pregnant like you are? Snap out of it!

But now I realize that a pregnant woman who is suffering with depression can no more “snap out of it” than someone who isn’t pregnant and suffering with depression.

That’s when I high-tailed it to my OB’s office and proceeded to break down in tears, unable to muster the courage to talk. The shame of what I was saying enveloped my own words.

“I want to be happy,” I sobbed. “I love my baby and I want so much not to feel like this anymore.”

My doctor looked at me with caring eyes and explained that I am not the first pregnant woman to be depressed. “I see cases of antenatal depression all the time,” she said.

There it was. A miserable diagnosis at a miserable time.

I had been keeping this dirty secret all to myself so as not to offend other people, and come to find out there are other depressed pregnant women out there! All this time I had felt so alone. All this time I had hidden my sadness and there was no reason for it.

My doctor prescribed a very low dosage of medication and talked me through her experience with this drug as it relates to pregnancy and birth. She had seen excellent results in mothers and I trusted her word.

Within three weeks of taking the medication as well as starting up weekly therapy again I started to feel better. I started talking about my baby, thinking about my baby, preparing for the birth. A funny thing happened on the way to wellness and stability. I finally fell in love with the little baby boy inside of me. It’s not that I didn’t love him all along. It just took me awhile to accurately feel those feelings because they were weighed down by depression.

My second son, Brigham Douglas, was born on May 2nd, nearly one year ago as I write this letter. I will never forget the instantaneous bond we shared as our eyes first met. There he was, only seconds old. But he had already taught me more about patience and trust than anyone living on this earth.

If you are pregnant and think you might be depressed, please know you are not alone. Talk to your doctor and trust your instincts. Your baby’s birth day can be joyful too.

Molly Shalzis a working mama to two beautiful boys born 21 months apart. Trying to manage a busy life with two kids under the age of three while also struggling with bipolar disorder. Married to a man made of glue who helps her hold it together. Writer. Traveler. Dreamer. Trying not to trip over tonka trucks. Her blog is called A Day In Mollywood.

Donations to Postpartum Progress can be made here: http://postpartumprogress.org/donate-postpartum-depression-2/

May 8, 2011 9:00 am Filed Under: Depression and Pregnancy, Mother's Day Rally for Mental Health, Warrior Moms

Should This Mom “Tough It Out” With Postpartum Anxiety To Breastfeed Her New Baby?

By Katherine Stone March 21, 2011

Okay Warrior Moms, this pregnant mom and postpartum anxiety survivor wants to know whether she should skip treatment for the second time so she can breastfeed her baby. Please share your thoughts via the comment section.

My second baby is due to arrive fairly soon (scheduled c-section). I had severe postpartum anxiety and moderate postpartum OCD after my child’s birth three years ago even though my first pregnancy was a happy, blissful time and extremely easy.

I haven’t been on any medication during this pregnancy, and it’s been much tougher than the first. I’ve had a lot of anxiety and difficulty sleeping throughout. And there has been a lot of external stress too. We bought a new house and my husband lost his job. Not long after that, we found out I was pregnant. (We wanted a second baby, but I’d immediately declared when he lost his job that we should stop trying. It turns out that I was already pregnant– proving God has a fun sense of humor.) For someone who ls naturally anxious even when I’m on medication, these changes were big triggers for me.

I’ve felt myself getting worse and worse as my due date approached, and I made an appointment with my psychiatrist. When I met with her on Friday, she immediately saw that I was suffering from anxiety and depression. She recommended that I go back on medication immediately after the new baby’s birth to prevent a repeat of the postpartum anxiety and OCD I had last time. But the problem is that the mix of drugs that worked for me last time are not safe for breastfeeding.

After my first child’s birth I took a medication that was considered safe for breastfeeding. It helped me function, but I didn’t start feeling better until I stopped breastfeeding at 3 months and switched to a different medication. It took about a year of working with my psychiatrist to find what worked the best.Now I have to decide if I want to start with the “safe” medication again and attempt to breastfeed this new baby or start with the mix that worked after much trial and error last time even if it means putting the baby on formula immediately. I’m conflicted because I really truly hated breastfeeding last time but also want to do what’s best for the baby. And I’m also not ready to deal with the criticism mothers face for formula-feeding.

Last time, I took off six months from work, so I was able to survive the sleep deprivation and demands of breastfeeding for the first three months even though I hated every moment of it. This time, I’m not able to take off time since I’m running my own business and have clients and other demands, but will have help from my husband and a nanny.

Still I’m not sure I can put the baby on formula from day one even if it’s to take medication that helps me. I live in an area that is dominated by breastfeeding mommies. I got crap last time for quitting breastfeeding and switching to formula at three months, and I’m already hearing judgmental comments from the mommies about how I’m going back to work nearly immediately. These women often say things to me like “I don’t know how you do it” in reference to my work. I feel like they are questioning my ability as a mother when they make “how do you do it” comments because they follow-up by telling me how busy they are being a mom. The implication is that I “do it” by neglecting my responsibilities as a mother.

I’m too polite to tell them that my not-quite 3 year old is quite healthy and happy. Heck…he’s already potty-trained and reading and even says please and thank you consistently and plays so nicely with other kids. He even helps clean-up his toys. And he’s loving and has a great sense of humor. Clearly I’m doing something right.

But I just don’t know if I can deal with the comments and the negativity from just about everyone I know (with the exception of my own parents, mother-in-law and husband) for not breastfeeding at all. At least last time, I was able to say that I stopped breastfeeding due to mastitis, and that shut up most (but not all) of them. But if I never nurse, I’ll face a lot of criticism both behind my back and to my face. I’m not exactly open with people about postpartum anxiety/OCD, and I look happy and healthy to people that know me. They’ll probably speculate that I’m one of those mothers who formula feeds because she’s so career obsessed and wants the nanny to parent her child.

I’m just not sure if I can deal with the hurtful comments, and I don’t want to tell anyone that I’m not breastfeeding because I need medication. Most of all, I’m resentful that moms have to justify formula-feeding and that “breast is best” messaging makes total strangers feel empowered to shoot you dirty looks in the park if you pull out a bottle.

The best thing for me would be to formula-feed and take the more effective medication, but I’m holding a prescription for the “safe” med right now and feel the pressure to “tough it out” for my baby. I know that med will help me function, but I do worry that I’m delaying feeling completely better by not taking the more effective (for me) meds immediately. And I’ve already had a tough time this whole pregnancy because I chose to do it without any medicine since I was too worried about harm to the baby. I’m ready to feel happy again, but I think the constant criticism about formula would be just as harmful to recovery as taking a less-effective medicine.

So how do other moms with postpartum depression justify their decision to formula feed from birth if they do not feel comfortable disclosing that they have a medical reason? I don’t exactly want to share my mental health issues with friends and acquaintances. But would anything else shut them up? Even my friend’s husbands are big breastfeeding advocates and say things like “I’m so glad my wife quit her job as a partner at a major law firm because breastfeeding is such a big accomplishment and sacrifice. Isn’t she so amazing? I wouldn’t want to be with someone who would put their interests above the health and well-being of our baby.” (They haven’t used those exact words, but it’s an accurate summary of the conversation.)

What do you think, ladies?

For more resources, try Which Psychiatric Medications Are Safe During Breastfeeding?

March 21, 2011 10:12 am Filed Under: Breastfeeding, Depression and Pregnancy