January 10th, 2012
I found the following study published in today’s edition of the Journal of Human Lactation quite interesting.
Depressive Symptoms During Pregnancy and the Concentration of Fatty Acids in Breast Milk.
The scientists examined whether there was an association between depressive symptoms during pregnancy and breast milk fatty acid concentrations. It turns out that the more depressed a woman was during pregnancy (at 20 weeks) the less fatty acids she had in her breast milk.
Lactation and a mom’s ability (as well as choice) to breast feed her newborn have repeatedly been shown to be associated with postpartum depression, but this is the first study to suggests some of this might be observable and possibly determined antepartum (that is, during pregnancy).
While a very interesting step forward, even after reading the study I wondered to what extent socioeconomic status (e.g. poverty and nutrition) and/or genetic factors play in this relationship.
December 8th, 2011
Mothers and babies can instantly synchronize their hearts just by smiling at each other.
I’m going to find the actual paper and offer some comments once I read it. But if true, fascinating on so many levels.
You can see the lay publication here
November 29th, 2011
I found this article lacking of many necessary points. Unfortunately there is too much misinformation about c-sections, the numbers, and the increased rate of their utilization to save the life of mother and/or fetus who would have otherwise died or suffered severe consequences. There’s also a good amount of data demonstrating that markers for depression often precede the need for c-sections. That is, a woman who is depressed, or has biological markers indicating that she is headed for depression (changes in DHEA level) more frequently require c-sections. A causality dilemma at its finest.
Rates of C-sections and postpartum posttraumatic stress disorder on the rise
August 1st, 2011
NPR posted an interesting report today and I have to agree with much of it.
But as someone who lectures on postpartum depression regularly, it never ceases to amaze me how many practitioners have only the slightest understanding of mood changes in the postpartum period.
It’s not just stigma, we do need to do a better job at educating those practitioners in the front lines.
July 28th, 2011
Given the approximate annual U.S. birth rate of 4,000,000, an estimated 600,000 women would be expected to suffer from a clinically significant postpartum depression every year. One big question is how many of these cases are severe enough to require hospitalization? A number of these sorts of studies have been conducted and published in the past, but in other contries such as Denmark where there are large medical registries – but also quite different social support systems. These sorts of databases simply don’t exist in the United States. A few years ago I joined up with some brilliant epidemiologists to see if we could determine the rate of severe postpartum depression in the State of New York. It required years of seeking government approval (linking fetal health to mothers, birth records to hospitalizations, etc.) and then once approved an intense amount of work correctly linking the people and newborns within the databases. This work was recently published in the prestigious journal Annals of Epidemiology.
A link to the article can be found here.
E-mail me if you’d like a copy of the manuscript.
July 27th, 2011
Postpartum depression is a potentially catastrophic condition that follows pregnancy, affecting both the mother and the newborn. Contemporary diagnostic nosology (a fancy word for how we classify diseases and psychiatric disorders) considers postpartum depression to be a “specifier” of a major depressive disorder. What this means is that, clinically speaking, postpartum depression is just major depression. The “specifier” refers to the fact that postpartum depression is a major depression that occurs specifically within the first 4 weeks after childbirth. Think about this for a second, if you’re a woman who becomes depressed 4 weeks and 1 day postpartum, you’re NOT technically postpartum depressed, your just depressed. Never mind that study after study has demonstrated that rates of affective disorders (i.e., depression) after childbirth peak between 2-3 months postpartum, or that your OB/GYN considers the postpartum period to be 12 months after delivery, or that hospitalizations for mood disorders after childbirth are heightened for at least 2 YEARS after delivery (e-mail me if you want any of the references). Simply put, the current classification of postpartum depression is wrong. So should we care? YES!
While postpartum depression may be behaviorally similar in presentation to major depression in many ways, specific differences in the clinical presentation of postpartum depression have also been identified. Recently a number of investigators have suggested that the diagnosis of postpartum depression at times appears more consistent with a Bipolar II type disorder, which is characterized by recurrent episodes of depression and episodes of hypomania. Notably, the reported prevalence of postpartum hypomania is nearly equal that of postpartum depression (10-20%), however the current classification of postpartum depression does not even recognize hypomania as a significant clinical feature in the postpartum period. Indeed, because there remains a folk assumption that women are expected to be exhilarated if not euphoric with their newborns, such behavior might not be considered clinically significant to the new mother or clinician. Problem? You betcha.
Because giving the wrong treatment a woman who is predisposed to a hypomanic or manic episode can have catastrophic consequences.
July 26th, 2011
Postpartum depression (PPD) is an important and potentially catastrophic condition that frequently follows pregnancy affecting the mother and the newborn. With a reported prevalence between 13-22% PPD, the most common complication of childbearing, remains under-diagnosed and under-treated, in part because controversy still exists about how to best characterize the depression that occurs in the postpartum period. While behaviorally similar in presentation to major depression in many ways, specific differences in the clinical presentation of PPD have been identified. As a result, its classification as a specifier of major depression in the DSM-IV-TR continues to be questioned.
As I wrote some time ago, there is a growing and often contradictory, imaging literature that has only begun to demonstrate the complexity of depression. Indeed, there is no one type of depression – It comes in many flavors (unipolar and bipolar, agitated and retarded). These different types of depression result in a variety of changes in each of the important regions involved in emotion, cognition and behavior (e.g. prefrontal, limbic, or striatal areas). Put more simply, some people with depression sleep too much while others have difficulty sleeping. Similarly, while some people eat too much when they are depressed, others lose significant amounts of weight. Thus, as a clinical researcher, I have come to the conclusion that simply calling something “postpartum depression” is inadequate. We need to do better and I believe as researchers we can.
In my next post, I’ll begin detail some of the differences between MDD and PPD.
April 19th, 2010
A productive few weeks, despite a few slowdowns caused by the flu. We presented at the American Academy of Neurology, The New York Academy of Medicine (TMII symposium) and today at the Cognitive Neuroscience Society in beautiful Montreal.
In addition, a link to our new paper can be found here. If you do not have access to the journal but would like a copy please e-mail me.
April 2nd, 2010
While I wait for my next patient and continue to catch up on some of the comments and e-mails I received during the absence, I stumbled across this report from ABC News.
Wonder what sort of mood disturbance might occur after this?
April 1st, 2010
First, I want to say thank you for all of the wonderful comments I’ve received over the last few weeks. I promise to respond to each and every one of them.
In the time away we’ve finished what I believe to be a novel and important study that I believe will help shed light on what’s going wrong in the brains of women with postpartum depression. What I mean by this is, what the disorder looks like in comparison to other psychiatric disorders such as major depression and how may be the best way to treat it. Very very exciting and I wanted to get some of those initial papers into peer review.
We’ve also had a paper reviewed, re-edited, accepted and now in press. Once I get word that the paper is released, whcih should be in the next week, I can post it here. This paper focuses on what may be the best pre-pregancy predictors of postpartum depression. The goal will be to develop an intervention and see if we can prevent PPD before the baby is even delivered.
Finally, during the break some of our work has been selected as a 2010 significant advance by the American Academy of Neurology. As a result we’ve wanted to be very careful with this data and make sure we get it 100% right. That concept should probably be saved for another discussion. But needless to say, this is a HUGE honor and one we take very seriously. Again, once it’s presented in a few weeks (they get first announcement rights), I can post it here.
So, I’ll get to the comments over the next few days and back to writing.