June 15, 2014 | New York Times | by Pam Belluck

‘Thinking of Ways to Harm Her’
New Findings on Timing and Range of Maternal Mental Illness

Postpartum depression isn’t always postpartum. It isn’t even always depression. A fast-growing body of research is changing the very definition of maternal mental illness, showing that it is more common and varied than previously thought.

Scientists say new findings contradict the longstanding view that symptoms begin only within a few weeks after childbirth. In fact, depression often begins during pregnancy, researchers say, and can develop any time in the first year after a baby is born.

As public awareness has grown, often spiking after a mother kills herself or her baby, a dozen states, including Illinois, New Jersey, Texas and Virginia, have passed laws encouraging screening, education and treatment, and New York and others are considering action. The federal Affordable Care Act contains provisions to increase research, diagnosis and care for maternal mental illness.

Sometimes cases are mild, resolving themselves without treatment. But a large analysis of 30 studies estimated that about a fifth of women had an episode of depression in the year after giving birth, about half of them with serious symptoms.  Continue reading the main story.... 

JUNE 16, 2014 |New York Times | Pam Belluck
Second of Two Articles

After Baby, an Unraveling
Mother's Mind:  A Case Study in Maternal Mental Illness

Cindy Wachenheim was someone people didn’t think they had to worry about. She was a levelheaded lawyer working for the State Supreme Court, a favorite aunt who got down on the floor to play with her nieces and nephews, and, finally, in her 40s, the mother she had long dreamed of becoming.

But when her baby was a few months old, she became obsessed with the idea that she had caused him irrevocable brain damage. Nothing could shake her from that certainty, not even repeated assurances from doctors that he was normal.

“I love him so much, but it’s obviously a terrible kind of love,” she agonized in a 13-page handwritten note. “It’s a love where I can’t bear knowing he is going to suffer physically and mentally/emotionally for much of his life.”   Read the whole article here.

May 2014 | Out From the Shadows | by Diana Price

Healthcare providers, mental health professionals, and affected families around the country are working hard to shine light on perinatal mood and anxiety disorders.

Six weeks after Ivy Shih Leung delivered her daughter,she was hit with crippling insomnia despite, as she terms it, “mind-numbing exhaustion.” A traumatic birthing experience had resulted in the removal of her uterus and required consistent blood work and procedures that prohibited her from sleeping in the hospital; once home, Ivy became anxious as she faced caring for her newborn, who developed colic, eczema, and cradle cap in those first weeks.  

Ivy’s OB/GYN prescribed Ambien® (zolpidem) to help her sleep, but her health continued to deteriorate. “Within a couple of weeks, I developed full-blown panic attacks that scared me into thinking that something was seriously wrong with me, that I might never return to my old self again, and that I may not even make it through alive,” Ivy says. In addition, she says she experienced a loss of appetite and weight loss and lost interest in most of the activities that had brought her pleasure. “I felt completely debilitated and had difficulty thinking, concentrating, and making decisions. I felt disoriented and in a haze—I turned into a shell of a person.”

Definition and Causes of PMAD 
It wasn’t until a month after she developed insomnia and two weeks after her panic attacks began that Ivy was diagnosed with postpartum depression (PPD), one of a variety of perinatal mood and anxiety disorders (PMAD). Though a majority of women (about 80 percent) will experience normal changes in mood during pregnancy and following childbirth, which might include feeling overwhelmed, tearful, tired, and full of emotion (sometimes referred to as the “baby blues” when it occurs postpartum), about 15 to 20 percent of women will develop depression or anxiety that is more significant.(1)

Emily Dossett, MD, MTS, a psychiatrist in private practice in Pasadena, California, and the founder and director of the Maternal Wellness Clinic at the Los Angeles County + University of Southern California (LAC + USC) Medical Center, specializes in women’s health, specifically mood disorders. Dr. Dossett says that PMAD—which includes mood and anxiety disorders that arise during pregnancy as well as postpartum up to about a year, including depression, anxiety, obsessive compulsive disorder, bipolar disorder, postpartum post-traumatic stress disorder, and postpartum psychosis—is more common than many people think.

“Anxiety and depression among pregnant and postpartum women is not rare—current statistics [which reflect only self-reported cases] mean that a busy OB/GYN who is seeing 20 to 30 patients a day potentially sees 5 to 8 patients a day who are dealing with this. That’s a lot.” According to Dr. Dossett, mood disorders and depression among pregnant and postpartum women can be the result of both biological and psychological factors. “Women’s estrogen and progesterone levels climb steadily during the course of pregnancy, and then within the first 24 hours of delivery they drop precipitously—estrogen levels can drop 95 to 98 percent in the 24 hours after delivery; these changes are likely one cause, though we can’t pinpoint a specific estrogen level that causes the problem.”

Thyroid abnormalities can also play a role, Dr. Dossett says, and research is ongoing around the impact of inflammation occurring in the body during this time that could affect the immune system and be linked to mood disorders. The impact of sleep deprivation is also considered a major factor. Beyond the biological causes, the most significant risk factor for PMAD is a personal or family history of mood or anxiety disorders. The chances are especially high, Dr. Dossett says, if a woman is symptomatic during pregnancy. Additional risk factors include a lack of social support, a poor marital relationship, a medically complicated pregnancy, a history of trauma or abuse, loss of or separation from one’s own mother, financial stress, a traumatic labor or delivery, an infant’s medical challenges, and substance abuse.

All of these factors can play a role during what is, in general, a period of major change, Dr. Dossett says: “Women undergo an enormous transition in identity wherein all the different expectations you put on yourself and your own experiences of being mothered, whether good or bad, come to the forefront. There’s a lot of psychological upheaval.”

In retrospect Ivy believes that had her OB/GYN been more aware of the signs of PPD and had screened her to determine if some of the symptoms she was experiencing were indicative of something more than insomnia, she could have received appropriate care much sooner: “My OB/GYN completely overlooked the fact that insomnia at six weeks is a clear sign of PPD. Had I been properly diagnosed at that point, I could have been spared my painful ordeal.”  Read the rest of the article with references right here.  

  1. Pregnancy and Postpartum Mental Health. Postpartum Support International website. Available at: March 25, 2014.
  1. Wisner KL, Sit DKY, McShea MC, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 2013;70(5):490-98. doi:10.1001/jamapsychiatry.

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