A New PPD Study - With a Twist

A new study was published this week that provides information about and raises awareness of a largely unrecognized problem - depression in new dads and the impact it has on their parenting.

The study, “Fathers’ Depression Related to Positive and Negative Parenting Behaviors With 1-Year-Old Children,” appears in the April issue of Pediatrics. Researchers analyzed data from 1,746 fathers of 1-year-old children and found that 7% of the fathers were depressed. Further findings show that about 40 percent of the depressed fathers reported spanking their children, versus just 13 percent of fathers who weren't depressed. The depressed fathers were also less likely to report that they regularly read to their child.

One important aspect of this study is that a whopping 77% of the depressed fathers reported having had contact with their child's pediatrician during their child's first year. As a result of this finding, The American Academy of Pediatrics concluded that "visits to the pediatrician may provide an ideal opportunity to discuss specific parenting behaviors and refer depressed fathers for appropriate treatment."

This conclusion is in line with an important project that PHA is undertaking this spring. PHA has created a new poster that calls attention to postpartum depression and anxiety and will be running a "Poster Drive" aimed at ensuring that a large number of pediatricians throughout San Diego display the poster in their offices. This will raise awareness in both providers and patients - mothers and fathers alike - increasing the chances that parental depression can be identified and treated early.

If you would like to support the PHA Poster Drive, through donations or by volunteering to deliver posters, please contact PHA at info@postpartumhealthalliance.org.

More information about the above study can be found on the American Academy of Pediatrics website at http://www.aap.org/.

10 Facts about Postpartum Depression and Anxiety

1. You will recover. You are not alone. Anyone can get postpartum depression or anxiety. It is not your fault. It is not your partner’s fault. PPD is a condition of several causes. The causes and cures are biological, emotional, cognitive, social and spiritual. You may have more stress in one or another of these areas, but full recovery should include all aspects.

2. You need regular breaks from child care. Taking breaks from the intensity of caring for your child(ren) is a necessary part of reducing your stress. It is not a luxury.

3. There is no one thing that will suddenly make PPD go away. In your recovery, you will feel better if you take regular, consistent steps of self-nurturing and accepting support. (Practical, emotional, social, psychological and spiritual).

4. You will feel better if you reach out to understanding people and express your feelings. Women who go through PPD without any support end up incorporating their negative feelings into their self-esteem as mothers. Talking to other women who have recovered from PPD is extremely helpful and effective. It is normal to feel embarrassed about your negative feelings, but it will help to have understanding listeners.

5. On the worst days, make it a rule that you will not evaluate your life. Fill your head with senses and even feelings, but leave out comparisons and judgments about your life, your partner, motherhood, your house, etc.

6. Remedies are individual and need to work for you. Remember, different people need different solutions. This applies to questions of medication, alternative therapies, sleeping arrangements, parenting styles, feeding, and what books you read. Learn what works for you.

7. You will feel better if you get outside regularly. Start small and do more as you feel better.

8. PPD/A goes in cycles. There are good days, bad days, and a lot of gray days. If you stick to a plan of self-care, breaks, support and remedies, you will keep feeling better. Don’t despair when a bad day follows a good day. It’s a natural part of the cycle. When you have a hard day after feeling better, do look at your last few days. Did you get any breaks? Did you overdo it? Stuff your feelings? Did the baby have a growth spurt? Are you expecting your period? Make a change in breastfeeding? Are you experiencing extra stress?

9. PPD does not mean you are a bad mother. Negative feelings about motherhood are a result of PPD, not a cause. When we try to make ourselves match our prenatal fantasies, we usually end up depressed. Instead, you can change your picture of motherhood to be more realistic, flexible and satisfying.

10. Your child came to live with you and needs you to be true to yourself. It is okay to have your feelings, to cry and to feel mad and frustrated and even flat nothingness. But do try and make eye contact and touch your baby. It helps if you can smile but don’t get hung up on smiling when you can’t find one inside. Take breaks when you need breaks – if not before you need one.

Courtesy of Wendy N. Davis, Ph.D.

Call for Proposals

For Professionals: Postpartum Support International is holding its 25th Annual Conference this September in Seattle. PSI is now accepting proposal abstracts. Visit www.postpartum.net for more information.

Did you know...

Postpartum Support International (PSI) hosts free, live phone sessions every week, including Wednesday chats for moms and Monday chats for dads.

During these sessions callers can talk with a PSI expert about resources, symptoms, options and general information about perinatal mood and anxiety disorders. The sessions are facilitated by licensed mental health professionals, are informational only, and open to anyone with questions and concerns.

Visit www.postpartum.net for more information.

Happy New Year

From all of us at Postpartum Health Alliance, we wish you the best for 2011!

Advice from a Mother Who Survived PPD

GET HELP! Talk to someone, anyone, but hopefully reach out to a trained professional.

Get rest when you can. Seek to take care of yourself, even if you feel like you can't lift your head off the pillow. Try to exercise and eat right, take vitamins, and if need be, find a medication that will help through the darkest times. Find the right combination that will work for you.

Try to stay active.

And try to turn any resentment you might have towards your children into a focus for being. See them as a reason to live, a reason to heal.

And let go of the anger. Under the anger is a lot of pain, but you have to peel away those layers before true healing can begin.

Remember you're not alone. Ever.

Finally, accept it. It took me a LONG time to accept that PPD invaded my life. That it changed my being. It changed who I was, who I am and why I'm here. Once you start to see light, once you start to let go and find some strength again, begin to understand that even in your darkest hour, there are things that happened that were good. Pull from those moments. Recreate the happiness PPD tried to take away. Remember the first smiles, the first steps, the first tooth, and know that once the cloud has been lifted, those memories are once again yours and no one or no disease can take those away.

Recovery from PPD long and bittersweet. Those nice memories don't come easy and you have to dig deep to find them. But they do become a defense against PPD when it tries to creep back in.

And it takes time. The scar will be there. While I no longer have PPD, I still have the scar and it will be with me forever. The key is not letting it win, not letting it debilitate you and your family, to not let it take away any more memories or minutes from your life.

Taking Medication While Pregnant - A Psychiatrist's Thoughts

One of the most common questions I am asked in my psychiatry practice is, “Is it safe to keep taking my antidepressant/antianxiety medicine during pregnancy?” The answer to this involves looking at the risk of medicine use in pregnancy, the risk of depression/anxiety in pregnancy, and the benefit of the medicine. It’s also somewhat unique to each woman, based on her history of depression or anxiety.

My job is not to convince women to stay on medicine. That is a decision that is between the woman and her doctor (ideally with her partner’s input as well). However, the assumption is often made that medicines are always “bad” to continue in pregnancy, when the reality is that depression and anxiety can also be “bad.” If a woman decides to stop a medicine, I always hope that this is an informed decision (ie, she has talked with her doctor and learned about the risks and benefits), not one made out of fear. After she stops the medicine, she should still be seen by a mental health provider, even if only once a month, so that she has someone to check in with in case she starts having symptoms again. Many times this is a therapist or a psychiatrist. Hopefully, if symptoms are caught early, she can improve her depression or anxiety in therapy and avoid needing to restart the medicine (if that is her choice).

But, and this is a big BUT: this should be an informed decision, not a scared decision.

In my clinic I often see the following situation: a woman has 1, 2 or more depressive episodes in her life and is doing well on medication (and hopefully with therapy as well). She decides to start trying to get pregnant, and stops her medicine. Or, she waits until she is pregnant, and then stops as soon as the pink line turns up. She feels okay for the first few weeks or months of pregnancy, but the depression or anxiety gradually returns until it is worse than before. Now the woman feels like a failure because “pregnant women are supposed to be happy” and she is not.

Most of these women haven’t told their doctor who gave them the medicine that they stopped, and then they start seeing an OB or midwife, who only asks the woman “What medicines are you taking now?” rather than “What medicines were you taking before getting pregnant?” Because no one else knows that the woman has a history of depression or anxiety, or was on medicine in the recent past, it takes much longer for her to get help and feel better. Some women spend their entire pregnancies feeling terrible, and only after delivery does someone say, “I think you have postpartum depression.” The truth is that the “postpartum depression” started during pregnancy.

The problem with this scenario is that, even though the woman was doing really well before getting pregnant, once she stops the medicine she is at increased risk of becoming depressed or anxious again. A study done at Harvard in 2005 showed this very clearly: they followed 200 women with depression who were feeling good (not depressed) for at least 3 months before getting pregnant. Once the women were pregnant, the researchers watched to see who stopped or continued their medicine, and then who got depressed again. They found:

• 68% of women who stopped their antidepressant medicine at the beginning of pregnancy became depressed again during pregnancy
• 21% of women who continued their medicine also became depressed

Women are at much higher risk of becoming depressed again if they stopped their medicine. The bad news, however, is that even those women who continued their medicine were at high risk of depression.

So, what should women do?

1. Talk to the doctor who prescribed your medicine, and let him or her know you are pregnant or trying to become pregnant. Ask about the risks of taking the medicine in pregnancy, and about what to do if you start feeling depressed or anxious again during pregnancy.
2. Let your partner know that you are on medicine for depression or anxiety, if you think he will be supportive and helpful in making a decision about what to do.
3. Get information about the medicine you are on and the risk of depression or anxiety in pregnancy. A great resource is California Teratogen Information Service: ctispregnancy.org/factsheets, or get more detailed information by calling for a free phone consult at 1-800-532-3749.
4. Tell your prenatal care provider that you are/were taking a medicine for depression or anxiety.
5. If you don’t feel comfortable asking the doctor who gave you the medicine, or if she or he does not know the answers to your questions, find someone who does. (See our provider directory at postpartumhealthalliance.org)
6. If you stop the medicine, make sure that you are monitoring your mood, and ideally working with a therapist or doctor to prevent depression or anxiety from coming back.

Most importantly: Do not try to do this alone. Getting help does not mean you are a failure, it just means that someone else is in it with you.

Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, Suri R, Burt VK, Hendrick V, Reminick AM, Loughead A, Vitonis AF, Stowe ZN. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 295(5):499-507, 2006.

Katie Hirst, MD is the Education Coordinator for the Postpartum Health Alliance and the Director of the Maternal Mental Health Clinic at University of California, San Diego.