Breast Cancer, Diabetes screening worth it; Postpartum Depression screening not


Earlier this week, I wrote about UK researchers concluding that Postpartum Depression screening was just not cost effective.

Since then, a couple of other studies regarding screening for other conditions have been released.

It seems that screening for Diabetes in primary care qualifies as cost-effective.

And screening for Breast Cancer saves lives despite the habitual over-diagnosis. For every misdiagnosed case, two lives are saved. In fact, the researchers for this study state that approximately 6 women are misdiagnosed and undergo unnecessary treatment for cancer they may never have developed as a result of a false positive at the screening level. In case you were wondering, these researchers are UK based as well.

Hey. Wait.

The researchers from the UK cited over-diagnosis  as one of the reasons formal screening for Postpartum Depression was not cost effective.

And being misdiagnosed with Postpartum Depression does not lead to expensive radiation treatment or other damaging exposures including surgery. At very worst, you may receive a script for an anti-depressant or a referral to a counselor for some talk therapy.

What the….

So lemme get this straight.

Pumping a woman full of radiation and chemotherapy is hunky dory and cost effective EVEN if she doesn’t need it.

But a quick questionnaire to check on mom’s mental health is NOT?

On what planet does this even BEGIN to make sense??

Let’s also discuss this little nugget. For both the Diabetes and Breast Cancer studies, ACTUAL records were used. The Postpartum Study was compromised of 92 “hypothetical” cases.

When did we stop rating the study of actual records? When did researchers stop including the actual risks and ripples of Postpartum Depression? A woman without Postpartum Depression or who is successfully diagnosed, treated, and recovering is more likely to breastfeed in my opinion. And if she’s nursing, she’s protecting herself and her child from – guess what – Diabetes AND Cancer.

So you really want to practice cost-effective healthcare?

SCREEN women after birth. Ensure their stability, support, and positive outcome with life as a new mom. Encourage them to participate in health practices for themselves and their children. Enabling women to make healthier choices reduces the risk of other issues down the road. Screening saves lives when it comes to Postpartum Mood Disorders. It saves mothers, children, and families. It’s not something you skip over because it’s simply not “cost-effective.” Skip screening and cost will simply shift elsewhere – to diabetes care, cancer care, future mental health care for mom or kids, broken families, etc.

It is simply not acceptable to allow new mothers to continue to suffer. Not acceptable at all.

Adrienne Einarson responds to Vogue’s “Pregnant Pause”


On April 29, I posted a piece entitled Thoughts on exploring a “Pregnant PauseFocused on an article appearing in this month’s Vogue magazine, I methodically refuted and balanced the article’s bias against medicating with anti-depressants during pregnancy.

Yesterday morning I woke up to find an email notification regarding a new comment on the piece. The author? None other than Adrienne Einarson, one of the most dedicated researchers in the field of SSRI usage during the prenatal period. Adrienne currently serves as Coordinator for the International Reproductive Psychiatry group at Motherisk in Toronto. She has published several studies in her areas of interest which include psychiatry, nausea and vomiting of pregnancy, and alternative medicine. Her RN specialities include psychiatry and midwifery.

Adrienne’s comment deserves its own post. Her voice deserves to be heard. She states up front that she does not often comment or blog but that the bias of the Vogue article upset her so greatly she felt the need to speak out. This letter has been sent to Vogue but has not received any response as of yet. (I have also submitted my piece directly to Vogue but also have not received a response.) She has granted permission for me to share her letter directly with you.

“I do this because I care about women who have to go through this and if my research can help, I will continue doing it.” ~Adrienne Einarson~

Without further ado, I give you Adrienne Einarson’s response to Vogue’s “Pregnant Pause”:

I am writing to you on behalf of an international group of individuals who are involved with reproductive mental health, as either clinicians, researchers and in some cases both. We would like to voice our concerns regarding your recent piece entitled “Pregnant Pause,” which we felt, did not achieve a balanced perspective on this issue, which was surprising to us, coming as it did from such a highly esteemed publication as Vogue.

We appreciate that you decided to do a piece on this often controversial issue, which can make deciding whether or not to take an antidepressant when pregnant, an extremely complicated decision for both the patient and her health care provider. However, we were very disappointed by the extremely biased approach that you took when writing this article. First of all, the data that you quoted is not as recent as you stated, these studies were published in 2005/2006, they were preliminary and the results have not been confirmed in more recent published papers, which you brushed off as not being important.

It is unfortunate that the women you quoted in your piece, thought that they had a baby with a heart defect because they took Paxil® and are suffering unnecessary guilt because of it, as if women don’t have enough to feel guilty about already in these complicated times. You acknowledged that there are probably 250,000 pregnant women taking antidepressants in the US, and you must understand before you can make any conclusions, that 1-3% of all pregnancies involve a baby with a birth defect of some kind, whether a woman takes any medications or not and 1/100 babies are born with a heart defect. That is why, researchers who conduct the best quality studies, use a group of exposed women (taking an antidepressant) with a group of unexposed woman (not taking an antidepressant) and compare the rates of adverse events in both groups. The studies that were conducted in this fashion, did not find a difference in the rates of malformations between the groups, including heart defects with Paxil®. Bottom line, if you do the simple math, it is evident that a large number of women would have had a baby with a defect whether they took an antidepressant or not, including the women in your article.

Another disturbing theme that came up several times in the article, is that physicians hand out antidepressants like candy, and physicians in our group were most offended by this statement as they are very careful about prescribing antidepressants and would not give them to someone who not does not require treatment. Every decision is made with great care, all the while weighing the risks/benefits of antidepressant treatment, and especially with pregnant women, ultimately to ensure the best possible outcome for both the baby and the mother.

Finally, and I am sure this was not your intention, several of our group members who are psychiatrists have reported that their pregnant patients have decided to stop taking their antidepressant since they read your article and I will leave you with one example of the damage you may have caused by this highly biased and often inaccurate article.

After reading this article, a woman called her psychiatrist and informed her that she was not going to take her Prozac anymore. She had had no less than seven consultations with psychologists and psychiatrists and all had agreed that she needed to be on medication because of her severe depression and possibility of suicide and concern in the post-partum period. She had finally agreed to go on the medication and at 34 weeks she was doing very well and looking forward to the birth of her baby and then read your article…………

Adrienne Einarson, Coordinator, The International Reproductive Psychiatry group

Sleep patterns of infants with depressed Mothers differs


"sleep like a baby" by peasap @ flickr

"sleep like a baby" by peasap @ flickr

According to a study published today in the May 1 issue of the journal SLEEP, the patterns of sleep differ depending on Mom’s depression or lack there of. The overall amount of sleep seems to be the same but infants with non-depressed mothers sleep longer at night (up to 97 minutes to be precise) and also seem to sleep for longer periods during the day.

Infants of depressed moms seem to wake more often .

Researchers hypothesize that this is related to the stress hormone, cortisol. When mom is pregnant and stressed, more cortisol crosses the placenta. And if you’re depressed postpartum, that plays a role as well.

Now before you freak out and think that your child’s sleep patterns are wrecked for life here, the lead author, Roseanne Armitage, MD, has news for you. The “damage” may be reversible.

“We do think that we could develop a behavioral and environmental intervention to improve entrainment of sleep and circadian rhythms in the high risk infants,” said Armitage. “However, whether it is maternal hormones that “cause” the sleep problems in infants is not yet known. It could genetic, hormonal, or both. Regardless of the cause, they may still be modifiable since brain regulation is very plastic and responsive in childhood.”

If you’d like to read more about this study, click here.

Now, breathe a little sigh of relief. See? the fact that baby isn’t sleeping ISN’T because you’re not doing something right or wrong. It’s not because there’s something wrong with your baby. It’s hormonal. Totally out of your control. I don’t know about you, but I am always able to put things into a better perspective when I understand the explanation behind them.

Frankly, this explains a LOT.

It explains why my first daughter never wanted to sleep for very long and why she wouldn’t sleep a lot at night. It also explains why our second daughter did the same thing. And last but not least, because I did not have PPD with our third, it explains why he’s such an amazing sleeper and has been from the start. Thank GOD it wasn’t me (or baby)! Phew!

Sharing the Journey with Jamie


Meet Jamie. She’s due in June with her second child. Her first brush with Postpartum Depression started during her pregnancy. Jamie felt depressed, upset and confused. Not feeling ready to be a parent, she even felt resentful when the baby moved. She even cried at her first ultrasound – proof that she was indeed pregnant.

Things went from difficult to worse after her first daughter was born. Jamie “cried constantly, was moody, and felt worthless and suicidal at times.” She finally sought help at six months postpartum. It took some time but Jamie was able to deal with the ups and downs of motherhood without wanting to pack her bags and run.

And now, I’m excited to let Jamie speak about her experience in her words. By the way, Jamie blogs too. She found me via 5 Minutes for Mom’s Ultimate Blog Party. You can keep up with her at Melody of a Mom.

Tell us a little about yourself. What do you do when you’re not being a mother or a wife? What fascinates you?

I was a scrapbooker long before I started having kids. My bookshelves hold probably 15 12×12 completed scrapbooks, four of which are full of pictures from my daughter’s first two years of life. Aside from scrapbooking, I enjoy almost anything that has to do with crafting.

After my daughter goes to bed you can find me reading or writing. I am working on a novel (which I hopefully will complete by the time I’m 30!) and I write songs which I hope to have published someday.

What was your first pregnancy like? Was it what you expected? If not, what happened?

My small amount of knowledge about what pregnancy would be like came from TLC’s A Baby Story and the book “What to Expect When You’re Expecting.” So I guess you could say I had no expectations when my pregnancy started, and I was able to take things as they came.

Postpartum Depression can sneak up on the best of us and knock us flat on our backs. Tell us about your experience.

I would say that my postpartum depression started before I even had my daughter (I call it pre-partum depression). There were intermittent periods of time when the prospect of birthing the baby I was carrying seemed depressing and confining, like some kind of cage I was trapped in. One day I’d be excited about all the pink clothes my baby would wear, and the next day I would wish I wasn’t having a baby at all.

After I had my daughter, the depression was severe and constant. I felt like I wasn’t bonding with her…I knew she had needs and I met those needs, but as far as “falling in love,” that just wasn’t happening.

Much of the time I wanted to pack my bags and leave everything behind. I cried a lot, lashed out at my husband and family, and felt very down.

When did you finally seek treatment for your PPD? What made you realize you needed help?

I knew what I was feeling wasn’t healthy, but it took my dad calling me out before I finally went to a doctor to talk about my PPD. One day, after some incident which I can’t remember, my dad said something to the effect of, “Why are you so negative all the time?” I’m not sure why, but that was the moment I decided to try to get some help.

Name three things that made you laugh today.

My daughter and her friend played “Ring Around the Rosie” over and over and over. When they were done, they were so dizzy they fell down all over again!

My best friend just called me on the phone and called me “Stinky Pete.” She’s random, but she always makes me laugh.

Whenever my daughter catches me looking at my belly in the mirror, she says, “Mommy, you’re pregmint.” That never ceases to make me laugh.

What role did family play in your recovery from PPD?

My husband is incredibly supportive. He picked up my slack when I felt like I couldn’t do what needed to be done for our daughter.

How did your husband handle your journey down PPD lane?

He was great. He never made me feel crazy…he supported me as best as he could even though he didn’t understand what I was going through.

You’re currently pregnant with your second child. Do you think things will be different this time? Why? What are you doing to be pro-active this time around?

As soon as I give birth, I am planning on getting back on the same anti-depressants I was on before I was pregnant. Unfortunately this means I won’t be breast feeding, but it does mean I will be able to function normally during my baby’s first weeks, whereas with my daughter I felt like I was just in a depressed daze.

What do you find the most challenging about motherhood? The least?

The most challenging thing about motherhood is making those daily choices in how/when to discipline and wondering how those choices are going to affect my daughter long term.

The easiest thing about motherhood is loving my child unconditionally. Though it took me longer than most mothers to bond with my baby, she is so special to me now. Nothing she could ever do would change the way I feel about her. It’s the same kind of love that God feels for his children, I believe.

Last but not least, what advice would you give an expectant mother (new or experienced) about PMD’s?

It’s better to ask a doctor if what you’re experiencing is normal than to spend any amount of time detached from your newborn. PPD is hard to deal with, but it is fairly easy to get under control once a mother realizes she needs help.

The Confusion of Ante-Partum Depression: To Medicate or Not?


Finding yourself faced with depression during pregnancy is a confusing prospect indeed. How do you treat it? Do you tough it out and hope there is no effect on your pregnancy? Or do you risk medication and the potential effects that course may have on your baby as well? In addition, many care-givers are hesitant to medicate a pregnant mother for depression or even worse, are not familiar with ante-partum depression and negate the mother’s concerns over her mental health. If your caregiver brushes aside your concerns as normal pregnancy ups and downs yet you know in your gut it’s more, get a second opinion or ask for a referral to a therapist at the very least.

A recent study by Dr. Katherine Wisner, M.D., M.S., found that continuous exposure to either SSRI or Depression during pregnancy results in pre-term delivery rates in excess of twenty percent while mothers with no exposure to either depression or SSRI over the course of their pregnancy experienced rates of pre-term delivery at six percent or lower. The study looked at 238 women with no, partial, or continuous exposure to either SSRI treatment or depression and compared infant outcomes. They found that exposure to SSRI’s did not increase birth defects or affect infant birth weight but the importance of this study lies within the finding that the pre-term delivery rates were the same with depression exclusive of SSRI treatment, leading the researchers to state that it is “possible that underlying depressive disorder is a factor in preterm birth among women taking SSRIs.” You can read more about this study by clicking here.

“This study adds evidence that depression in pregnancy can negatively affect birth outcome. Although women treated with SSRI’s throughout the pregnancy may experience pre-term birth, the factor causing the problem may in fact be the depression and not the SSRI. More research is needed to tease out what is causing the changes in the uterine environment. As research comes forth, what continues to be clear is that treatment for depression in pregnancy is important. ‘Treatment’ doesn’t necessarily mean medication, but for everyone’s sake the pregnant woman needs to receive a plan for wellness.” Dr. Shoshana Bennett shares when asked about her take on Dr. Wisner’s research.

You may recall a recent study posted also regarding birth weight of infants. The study concluded that Prenatal Depression restricted the fetal growth rate. This study concluded that depressed women had a 13% rate of pre-term delivery as well as a 15% greater incidence of lower birth weight. This study’s results examined cortisol levels to determine risk of pre-term delivery and birth weight prediction, which leads us to another study examining the reliability of cortisol to predict short gestation and low birth weights. The study concluded cortisol levels were indeed a reliable manner in which to predict both.

So what’s a pregnant depressed mama to do?

Throw her hands up in the air?

Scream?

Cry?

Tough it out?

None of the above – she should work in partnership with her doctors to weigh the risks. There are other treatments available for depression and anxiety during pregnancy besides SSRI’s. Therapy is always an option. (Yes, more studies to be quoted ahead) A study examining the effectiveness of a Mindfulness based intervention for pregnant mothers found women receiving the intervention experienced less stress and anxiety during their third trimester and postpartum period. There was no data collected regarding pre-term delivery or birth weight in relation to this particular study.

There’s also a wonderful article at wellpostpartum.com that discusses how cortisol impacts mothers. Included in this article are some terrific (and natural) suggestions on how to keep cortisol at bay.

Alrighty now. You’ve shared your precious studies with us. What about some real life advice? What did YOU do when faced with the Hamlet conundrum of medicating during pregnancy?

I read.

Voraciously.

The two biggest sources of help for me were Karen Kleiman’s What Am I Thinking? Having a Baby After Postpartum Depression and Kornstein/Clayton’s Women’s Mental Health. Karen’s book allowed me to realize my emotions were right on target for a woman facing pregnancy (expected or not) after surviving a PMD episode while Women’s Mental Health laid out the risk factors in a no-nonsense manner. I was convinced to stay on medication after I read my risk for relapse went up by 50% if I discontinued my medication during pregnancy. With my risk factor already 50% higher than women having never experienced a PMD, there was no way I was giving myself a 100% risk of traveling down that road.

I stayed on my medication. I stayed in therapy. I talked to my family and developed a postpartum action plan, spending more time on preparing for my possible fall than for my son’s arrival. And you know what, it paid off big time. I did not experience a PMD the third time around, even though (yes, more studies) having a boy may put you at a higher risk for developing a PMD and the risk for experiencing a PMD after two episodes is almost 100%. I beat the odds and don’t think a day doesn’t go by that I don’t give thanks to God for carrying me through.

I always encourage women I come in contact with to weigh their options with their caregivers. To educate themselves and make the best decision possible with the information at hand. Your doctor is on your team and should be willing to listen to your plan and at least consider your requests. If he/she does not respect your wishes, it may be time to find another physician for care during the prenatal period.

I would also encourage you to get a couple of books, the first being Dr. Shosh’s Pregnant on Prozac, in which she examines the relationship of psychiatric medications to pregnancy. It’s a must have resource for mothers facing the decision of psychiatric medication for an existing condition or a newly diagnosed condition. Also pick up a copy of Karen Kleiman’s Therapy & The Postpartum Woman. While this book is ultimately aimed at clinicians and the postpartum woman, pregnant women facing a mood disorder would glean quite a bit from this book as well and may consider gifting it to their caregiver as well, a paying it forward action if you will.

And if you’re interested in complementary or alternative treatment methods that don’t include SSRI’s, a great place to start researching is over at Well Postpartum. Run by Cheryl Jazzar, this blog has just about everything you could ever want to know about alternative care during the Perinatal Period.

The final thought on all of this? Do your homework. Don’t be afraid to ask questions or stand up for yourself (and your child). Above all, make the decision and agree not to second guess yourself or blame any outcome on yourself. As long as you make the best decision with the best information at your fingertips at the time, there is no blame. (And hey, the fact that you’re reading this article right now speaks pretty highly of your motivation to educate yourself!)

No matter how alone you may feel in that dark pit of depression during pregnancy or postpartum, you’re not. There are plenty of other women there with you and there are lots of us reaching our hands down to help you out. All you have to do is reach out and grab.