If you searched the internet this very minute, you’d think it was very clear what causes postpartum depression and how to treat it. I saw one website this morning about how you can use “therapeutic gemstones” to treat PPD, and another yesterday where someone said, as matter of factly as possible, that PPD is caused by a drop in progesterone and all you need is progesterone cream to fix it.
Hmmm. Interesting. Because last week I spent several days with the top scientists, researchers and physicians across the world when it comes to postpartum depression, and not a single one of them mentioned therapeutic gemstones or progesterone cream as the be-all-end-all cure for PPD. No one has all the answers, least of all the snake oil salesmen on the internet.
My key learning from attending the annual conference of the Marce Society and Postpartum Support International was that there are a lot of people using much larger brains than mine to try to figure this stuff out. They are trying to understand the genetic components of perinatal mood and anxiety disorders, the social components, the impacts (both good and bad) of current treatments, how to provide better services to moms who suffer, and how one day we might prevent PPD and in the meantime have more targeted, safe and effective treatment methods. Having met them, I feel good about where we are headed, though at the same time it is clear we need many more specialists and A LOT MORE FUNDING.
I was happy to see such a diverse range of topics presented on everything from mindfulness-based therapy to post-adoption depression to eating disorders in the postpartum period. I was also pleased to see so many trying to figure out ways to reach mothers where they are — mothers who have no interest in being anywhere near a mental health professional but who need help — to get them treatment, whether it’s in their homes or at the supermarket. I heard from several who felt that another key takeaway of the meeting was that early childhood trauma seemed to be a major risk factor for PPD (raising hand here).
There was one particularly energetic discussion after a presentation on the new Diagnostic Statistical Manual, the DSM5, which doctors use to make mental health diagnoses. A representative of the team working on the topic of postpartum depression explained that the new DSM will state that the diagnosis of “depression with postpartum onset” can be made if PPD symptoms appear in the first four weeks postpartum. She said there just wasn’t enough scientific evidence to say that the diagnosis should be made if symptoms appear in the first 4 months, or 6 months, or 12 months or whatever.
As you might imagine, I had to call BS on that, so I stood up in front of the entire group to speak my mind. Anyone who works with women who suffer knows that many women don’t present with symptoms, or at least ask for help, until much later than 4 weeks postpartum. In fact, most sufferers don’t. Doctors who follow the 4-week rule will tell patients who come in at 8 months postpartum seeking help that they don’t have PPD and send them away. I GUARANTEE IT. The DSM5 process is not over yet, so there is still time to change their minds. If you’d like to tell the DSM5 team what you think of this BIG MISTAKE, register and comment here. Since there won’t be a new DSM for a long time after this one, you need to speak now or hold your peace. Just make sure you make a reasoned argument — they’re not going to pay any attention to what you have to say otherwise.
Near the end of the Marce/PSI conference, my brain began to ache from all the talk of serotonergic neurons, corticotropin, methylation and basilar dendrites. It was the good kind of ache though, like the kind you get after a good workout. Some exciting things are coming soon. In the meantime, don’t listen to someone who tells you they have all the answers. Instead, talk to your doctor. I highly doubt he or she will recommend therapeutic gemstones.
My mind is boggling at the 4-week rule. First off, most mothers with uneventful deliveries won't be back to their doctors until six weeks. So what the heck? You'd see a huge drop in "diagnosed" PPD with that rule. Ridiculous.
Off to register and comment.
(I can't find where to comment on the other site.)
Interesting. Comments on that website are now closed. Instead, email your comments to:
Ellen Frank franke@upmc.edu
Kimberly Yonkers kimberly.yonkers@yale.edu
Thank you for speaking up at the conference. As you know, I didn't seek help until my baby was almost a year old when I was reeling from the zombie-like, disconnected existence of the previous months. In fact, I didn't have the presence of mind to even entertain the idea that I was depressed/maladjusted. Whenever I did, I could recognize that something was "off" but the moments of clarity quickly passed. It took my husband finally saying "I think you should talk to somebody" for me to even start to try to help myself. And all of this with what I thought at the time to be an intimate knowledge of postpartum mood disorders and depression as a whole. I'd even written about post-adoption depression. Imagine that!
Yeah, we need to change the language and the existing "markers." And PRONTO!
Also, while I welcome more research on biological causes of PMD, I hope no one forgets that there are non-biological factors as well. I never got treatment for my PPD, so I'll never know to what extent my problem was biological, but I'm sure that social and psychological factors were the greater part by far. I know from my own experience and from anecdata from others that a leading factor in PMD is pressure to conform to unrealistically high standards of mothering. In this day and age of sanctimommy and the mommyblog, and aggressive promotion of exclusive breastfeeding, "baby wearing," etc., many new mothers are going feel overwhelming pressure to adhere to these dogmas. This is setting up new mothers to feel like failures for no reason other than that they didn't live up to someone else's "one true faith" about motherhood. We should certainly be studing biological factors, but never ignore the psycho-social factors.
Anyone who has had PPD or good old depression for that matter (I have had both) know 4-week old is not only BS but simply criminal. People who have not been affected by mental health issues have no idea what we have gone/go through. Depression is a disease, it is a broken soul. It would not occur to anybody to ask a patient to come back in 4 weeks to see if a leg was actually broken! It's not because you cannot see it that it does not hurt.
I agree that dogma and motherhood perfectionism adds to the pressure and can definitely impact mental health. I can tell you that the psycho-social factors seem to be being studied in depth as well.
Before we dismiss hormones as being implicated in postpartum depression I would suggest people get tested. It's quite simple. When I was tested 4 months postpartum, I was producing 2% of the progesterone needed. A progesterone cream, prescribed by my doctor, helped. It was certainly not a cure. However, progesterone is needed for anxiety reduction and the symptoms of progesterone deficiency are widespread after delivery, most commonly hair loss.
I didn't dismiss hormones as being implicated in PPD. What I suggested was that progesterone cream is not the single cure for PPD, as you state above. I find though, that some people who found progesterone cream helped them will tell everyone else that it's THE answer. There is no "THE answer" for PPD, other than making sure you go get help.