The Maine Association of Psychiatric Physicians (MAPP) has developed a Postpartum Depression Project in recognition of the fact that postpartum depression is under-diagnosed and under-treated and can have long-term adverse effects on women and children.  MAPP received a grant from the American Psychiatric Association to provide training programs and easy access to educational materials about postpartum depression throughout the state of Maine.  They now have psychiatrists who provide educational presentations in the form of grand rounds and visits to OB/GYN and other practices.  They have sponsored two large trainings on the topic and have developed patient educational materials and posters.  The are now working to get media coverage of the issue in their state and to develop training sessions for emergency room workers who do crisis evaluations.

"We really emphasize the fact that treatment for the mother is also an early intervention for a child and that early recognition and intervention is most effective for moms," said Dr. P. Lynn Ouellette, an officer of MAPP and chair of MAPP's Postpartum Depression Project. 

Their ultimate goal is to increase the recognition and treatment of mood disorders both during pregnancy and the postpartum period and to encourage collaboration between psychiatry and other healthcare providers. 

Brooke Shields recently received an advocacy award from the Hope for Depression Research Foundation in Manhattan.  At the event, she spoke about her experience with postpartum depression and about the stigma of mental illness.

People magazine covered the event here.  Of interest to me was this bit about her treatment for depression:

"Shields was prescribed medication, though she stopping taking it one point, thinking she didn't need them. 'That was the week I almost did not resist driving my car straight into a wall on the side of the freeway,' she told the crowd. 'My baby was in the back seat and that even pissed me off because I thought she's even ruining this for me. I just wanted to drive into the wall and my friend stayed on the phone with me and made me safely get home.'

She later called her doctor to ask for more help, and was eventually diagnosed with a chemical imbalance. 'I learned what was going on inside my body and what was going on inside my brain,' she said. 'I learned I wasn't doing anything wrong to feel that way. That it was actually out of my control.'  

Two things. 

One, I don't think People magazine got it right when they wrote that Brooke Shields was diagnosed with a chemical imbalance.  People don't get diagnosed with a chemical imbalance.  It's not like there's a test given in your physician's office, like swabbing your throat or having you pee on a stick or something, that tells you whether your neurotransmitters are messed up. 

Shields would have been diagnosed with postpartum depression, which has, as far as we know at this moment, several causes including both genetic, biological and environmental factors.  As Dr. John Grohol at Psych Central has often stated:

"Sorry, mental disorders such as depression and bipolar disorder are not simply 'brain illnesses,' without any significant psychological or social components that must also be treated. They are complex disorders that involve genes, biology, personality, social development, environment, relationships, and a whole lot more in most people. Buying into the simplistic and discredited model of 'brain chemical imbalance' isn’t something that’s beneficial for research or public advocacy or policy."

Does this mean the serotinin or dopamine in your brain aren't involved somehow with your postpartum depression?  No.  Does this mean that there isn't some portion of the illness you're experiencing that is indeed out of your control?  No.  Does this mean it's your fault if your illness isn't biochemical?  No.  But it does mean it's way too simplistic to say you simply have a "chemical imbalance". 

This Just In:  I checked two MDs who are specialists in perinatal mood and anxiety disorders this afternoon just to make sure I'm not making this up and they said what I've written is correct.  There are no consistently identified biomarkers for depression.   There is a test that can be done of cerebrospinal fluid apparently, but it is invasive and not necessarily diagnostic.

In fact, that kind of terminology sometimes frustrates me because in some way I feel it adds to the stigma of mental illness.  Rather than as an evidence-based, medically acceptable diagnosis, I think the term "chemical imbalance" is often used by the media as a sugarcoated, societally acceptable way of referring to depression or postpartum depression. We can't just say we have a mental illness, because that's too hard to prove, supposedly?  Can't be seen on an X-ray?  Too hard for people to believe?  But if we use the phrase "chemical imbalance" then that's acceptable?  That makes it all okay?  I don't know why we have to wordsmith the truth.  I hope someday that stating you have a mental illness like postpartum depression won't require any sort of PR spin.

Now that I got that off my chest, the second thing I wanted to point out is this:  I'm glad to see that Shields spoke so openly about something I hear about quite a lot from moms -- this idea of deciding you should be your own doctor and quit your meds whenever you feel like you don't need them.  Bad idea.  You can see what can happen when you do that, as described by Brooke in the quote above.  Whatever form of treatment you are undergoing, talk with your healthcare provider about whether you should end it, and when and how you should go about doing that.  It's for your own good.

I heard from several readers this week that my post "The Symptoms of Postpartum Depression & Anxiety (In Plain Mama English)" was one of your all-time favorites.  Thanks for that -- it really made my week!  You have no idea how much it inspires me when I hear that!

Interestingly enough, Typepad, the hosting service for my blog, has just launched a feature called "Favorites".  At the bottom of every one of my posts from now on you'll see a little button that says Favorite.  ("Post" is just the blog word for article, FYI.)  If you read a post on Postpartum Progress that you really like, you can click the Favorite button to let me know.  I still love your comments as well, so PLEEEEEEEEASE don't stop writing them because I like hearing from you and getting your feedback.  But you can also click the Favorite button lickety-split if there's something you really like.

Also, there's a new Retweet button at the bottom of every post.  If you are one of those "fringe" people who use Twitter, like me, and would like to Retweet one of my stories, you can click that button as well.

Fun new features.  Thanks Typepad!

Oh, and one other thing.  This Christmas season I'm VERY excited to have a teensy little gift for you.  Nothing big so please know I'm not overselling this.  Can't wait to share it, or them.  Stay tuned.

The Englewood Hospital Medical Center and Northern New Jersey Maternal Child Health Consortium will host "Providing Compassionate Care for Perinatal Loss and Grief" on December 2 from 8am to 3:45pm in Englewood, NJ.  To learn more or to register for the event, click here.

Today is Fight For Preemies Day, hosted by the March of Dimes.  More than 400 bloggers across the country are writing about prematurity, and how important it is for babies to make it full term before they are born.   Why is preterm birth a problem?  Because it can lead to lifelong health problems and sometimes death.

Postpartum Progress is joining in the fight today for good reason.  Prematurity is a relevant subject for people in the perinatal mood and anxiety community, as depression and anxiety during pregnancy can lead to preterm birth, as can antidepressants taken during pregnancy. 

A research study published last year found that moms with depression during pregnancy had a higher risk of preterm birth.  As reported on Health.com:

"Depressed moms-to-be are more likely than nondepressed women to have a preterm birth—and the worse their mood, the greater their risk, says a new study published in Human Reproduction. In fact, women in the study who were severely depressed during early pregnancy more than doubled their risk of giving birth to premature babies.

The reasons why aren’t entirely clear, but the researchers don’t think antidepressants are to blame. Only 1.5% of women were taking the drugs during pregnancy, and excluding them from the study didn’t change the results."

On the other hand, a different study from Denmark published this year found, as have other studies, that women who take antidepressants during pregnancy are also at a higher risk of their babies being born prematurely.

Yet another piece of research has found that the risk of preterm birth for those with depression who take SSRIs and those who are depressed and don't receive treatment is about the same.  According to an article from Medscape:

"Pregnant women with major depression have a 1-in-5 risk of preterm delivery, regardless of whether they are taking continuous serotonin-reuptake inhibitors (SSRIs) or receive no treatment for depression.

In a prospective study published online March 16 [2009] in the American Journal of Psychiatry, Katherine L. Wisner, MD, from the University of Pittsburgh Medical Center, in Pennsylvania, report that women who took SSRIs throughout gestation had a preterm birth risk of 21%. Those with continuous untreated depression during pregnancy had a preterm birth risk of 23%. The comparison group of women with neither depression nor SSRI exposure had a preterm birth rate of 6%."

What does all of this mean?  First of all, don't freak out.  This doesn't mean your baby is 100% guaranteed to be born prematurely.  What it does mean is you need to be aware of the potential for preterm birth to occur. If you have depression or anxiety during your pregnancy, whether you receive treatment with medication or are untreated, you need to talk with your doctor about ways to prevent preterm birth.   You need to make sure you are doing everything possible to stay healthy and get the prenatal care you need.  You should consider methods of treatment like psychotherapy.  And it's a good idea to learn the signs of preterm labor.

Finally, if your baby is born prematurely and ends up in the NICU, know that the March of Dimes has great programs to support you.  Visit their website to learn more.

P.S.  I forgot to mention that both my sweet babies were born early.  Jackson at 38 weeks and Madden at 35 weeks. 

After I wrote last week about my opinion that women with postpartum depression should try to seek out a specialist for treatment, I heard from a family physician in a major metropolitan city who told me that her patients now need to wait 5 months to get in to see any psychiatrist, not just a specialist.

My perspective comes from being a family physician in [major city].  Right now, in the health system I am in, we are booking into late April and May for a first appointment with a general psychiatrist.  It does take "special clout" to get someone in sooner in my system ... and that's just to see a regular psychiatrist.  As a physician I am someone with that special clout, and it still takes me multiple phone calls, begging, etc., to get a patient in any sooner.  On top of this, my health system just cut psychiatric and counseling services by 30% because it wasn't a money maker, and because leadership determined we were doing more than our fair share here in [major city].  Patients are coming in from other health systems because our wait lists are shorter than average.

If someone has an unrestricted insurance plan (and that's a big "if") or can pay out of pocket (bigger "if") or is willing to drive to the inner city county hospital (many of my patients are not), they may be able to go outside the system and be seen sooner.

I understand that you would want a loved one to get the best care.  But from my perspective I have trouble getting my patients any care at all in a timely fashion.

I appreciated hearing from this doctor about her experience.  Among other things, this email made me think about how awful it is for a mom with postpartum depression or anxiety who has finally gotten the courage to reach out for help only to be told "Sorry.  You'll have to wait."  For months!  I decided I'd ask some healthcare providers I know to provide Postpartum Progress readers with tips on what to do if you want to see a psychiatrist but can't get an appointment.

Jennifer Payne, MD, PhD, co-founder of the Women's Mood Disorders Center at Johns Hopkins, suggests:

Ann Dunnewold, PhD, author of Even June Cleaver Would Forget the Juice Box, says that if you need medication and can't get in to see a psychiatrist, you should talk to your physician:

When a woman already has a good relationship with a physician (such as an OB/GYN, internist, family practitioner or even nurse practitioner), reaching out to that person can be a much quicker route to treatment.  And while psychiatrists may disagree, I've seen that when a woman has a good relationship with her regular care provider, that provider often more readily considers the whole person (i.e. lifestyle issues, other underlying illnesses, etc.)  Many of these care providers also are more comfortable prescribing medication if the mom is seeing a psychologist for therapy who is willing to be part of the treatment team and give feedback.

Diana Lynn Barnes, PsyD, LMFT, and author of The Journey to Parenthood: Myths, Reality & What Really Matters, suggests working with your therapist to try and get an earlier appointment with a psychiatrist:

I find a 5-month wait for a woman with depression unconscionable.  I know for myself that I have developed a close, collegial relationship with a few psychiatrists in my community whom I know specialize in women's reproductive mental health so that when I refer clients I can pretty well know that they will be seen within a few days.  And I leave room in my schedule so that I can see a new patient within 24 hours.

Erika Krull, MS, LMHP, author of the Family Mental Health blog on PsychCentral suggests spending time with other moms for support and considering therapy:

Find a small moms group of some kind -- MOPS, church group, library toddler time with some moms, a little weekly play group, quilting group, PPD support group, whatever.  Something with regularity and other moms so that relationships can develop and there is some level of obligation that gets you going even if you don't feel like going.  That social support is key.  When I didn't know what was wrong with me I happened to already have a habit of attending a young moms church group.  Unbeknownst to me, that was what kept me going until I put the pieces together and got a diagnosis.

Also, getting started with a mental health counselor might be quicker and certainly can help the mom start finding ways to cope with her symptoms.  Just having that listening ear with a professional filter can also help give some direction, keep an eye on worsening symptoms, etc.  Meds work best with therapy, but in some milder cases therapy alone may be enough.

Pec Indman, EdD, MFT, co-author of Beyond the Blues and board member of Postpartum Support International, says it's not unusual for women to be told they'll have to wait a long time to get in to see a psychiatrist, especially those moms without private insurance or those who have medicare/medicaid for only a few months postpartum.  Her suggestion:

Any healthcare provider (OB, family practice, etc) can call the University of Illinois at Chicago Perinatal Depression Project's Toll-Free Consultation Line for Providers at 1-800-573-6121.  It may not be as good as getting the patient in now to see a psychiatrist, but it's better than nothing.  Most OBs, family practice and internal medicine docs treat a lot of anxiety and depression.  They need more information, though, to rule out mania and information about medication during pregnancy and nursing.  That can be provided through consultation with specialists. 

In the meantime, Karen Kleiman, LSW, MSW, author of This Isn't What I Expected: Overcoming Postpartum Depression, suggests making sure you don't have an underlying physical illness that, if treated, would relieve the depression, thereby eliminating your need to see a psychiatrist at all:

Get a physical and rule out some of the conditions that can mimic depression and anxiety symptoms.  Check for thyroid problems, anemia and general blood count.

I thought I'd join in and give you a tip of my own:  If you are having a problem getting timely treatment, or you have issues with insurance or being able to afford treatment, you should consider checking to see whether you are eligible for any clinical trials.  If you find one in your area in which you are willing to paricipate, your treatment and related medical appointments may be free of charge and you'll probably be able to get started right away.  (Yesterday, as it happens, I posted of list of current clinical trials going on around the country!)

And finally, from the family physician who e-mailed me, an exhortation that medical schools need to do better to train all physicians on the identification and treatment of perinatal mood and anxiety disorders:

Training programs in the primary care specialties can and should cover these issues properly.  If these programs could be convinced to do a good job with this (and I think they could be), this would go a lot further toward helping more women, no matter where they live, no matter what insurance, no matter if they have empowerment, no matter if they have clout.

Which meds can be used in pregnancy, in breastfeeding, etc., should not be special knowledge.  It should be normal knowledge.  With 15% of moms getting PPD this is not a special disease.  It's a normal disease.  I want it to be a normal part of training for normal docs that a normal patient can access in a normal way.  Then the specialists will be available to focus on the truly difficult cases.

It's Postnatal Depression Week down under in Australia.  (For the uninitiated, postnatal depression is the "Queen's English" term for postpartum depression.) 

Beyondblue, the national depression initiative in Australia, conducted a survey to find out what Australians think about postnatal depression.  As reported by the Sydney Morning Herald:

"Most Australians mistakenly believe suffering depression is a normal part of pregnancy.

Researchers at the nation's depression initiative beyondblue are worried women experiencing antenatal or postnatal depression will be reluctant to get help if most people think it is part and parcel of motherhood.

Of the 733 men and women surveyed, more than half believe it is normal for women to feel depressed during pregnancy.

One quarter of respondents think postnatal depression does not require treatment and will go away on its own."

Beyondblue is working to ensure women realize that postnatal depression is a real illness that doesn't just go away without help, and also to make sure that women with these illnesses are identified by their physicians.  Australia's ABC Network reports that "... planning has begun for doctors across Australia to routinely screen women for depression during and after pregnancy.  Beyondblue psychologist Nicole Highet says New South Wales and Western Australia have already started routine screening and the program is set to be expanded nationwide."

Massachusetts General Hospital's Center for Women's Mental Health is conducting two clinical trials that may be of interest:

Bipolar Disorder in Pregnancy:  If you are pregnant and diagnosed with bipolar disorder (or manic depression), you may be eligible for this research study.  Participants meet with research coordinators and psychiatrists who specialize in bipolar illness during pregnancy.  For more information, contact Rachel at 617-726-2912 or skfowler@partners.org.

Escitalopram (Lexapro) for the Treatment of Postpartum Depression:  If you are between the ages of 18 and 45 , gave birth within the past 6 months, began to feel depressed and anxious within 3 months of giving birth, are not currently taking an antidepressant and are not breastfeeding, you may be eligible for a research study evaluating how an FDA-approved antidepressant helps treat depression after childbirth.  Women who participate will receive study medication and evaluations of their mood at no cost, and will be compensated up to $150 over the course of the 8-week study.  For information, call 617-724-6989 or email sdconnors@partners.org.

Here are some other clinical trials in which you may be eligible to participate:

Effectiveness of Sertraline Alone and Interpersonal Psychotherapy Alone in Treating Postpartum Depression (Iowa and Rhode Island)

The Role of Hormones in Postpartum Mood Disorders (DC area)

Identification and Therapy of Postpartum Depression (Pittsburgh, Pennsylvania area)

Clinical Trial of Estrogen for Postpartum Depression (Washington DC area)

Effectiveness of a Web-Based Prevention Program for Postpartum Depression (San Francisco area)

Does Fish Oil Prevent Depression in Pregnancy and Postpartum (Ann Arbor, Michigan)

Perinatal Depression Treatment in a Pediatric Setting (Rochester, NY)

Translating Research into Practice for Postpartum Depression (Rochester, Minnesota)

Depression Prevention for Women on Public Assistance (Rhode Island)

A Comparison of Antidepressant Treatment on Women With and Without Postpartum Onset of Major Depressive Disorder (New Haven, Connecticut)

What does it feel like to have postpartum depression or postpartum anxiety?  What are the symptoms?  How do you know when you have it? 

I thought we'd have a talk today about the signs of postpartum depression and anxiety, and we'd do it in "plain mama English".  We won't use words like hypomania or dysthymia or suicidality or psychomotor agitation.  We will use the words we hear in our heads when we think about what the hell is happening to us ...

When you read the lists below, keep in mind a few very important things: 

1. You may not be experiencing all of the symptoms below or even most of them.  Postpartum depression and anxiety are not "one-size-fits-all" illnesses.  Your experience may be focused on just a few of the following symptoms and you may not have others at all.  For instance, some women with postpartum depression are sad and crying all the time, whereas others don't experience the sadness but are instead very angry and irritable.
   
2. Many people have a feeling like the ones listed below every now and then.  For a day, or maybe two.  We all have bad days.  Postpartum depression and anxiety are not bad days.  Women with postpartum depression or anxiety have symptoms like these most or all of the time, for a period of at least 2 weeks, and these symptoms interfere with their ability to function on a daily basis.
   
3. Postpartum depression and anxiety are sometimes "comorbid".  This means you can have a bit of both, or all of both.  If you have symptoms on both lists, that's not out of the ordinary. 

Okay.  Here we go. 

You may have postpartum depression if you have had a baby within the last 12 months and are experiencing some of these symptoms:

• You feel overwhelmed.  Not like "hey, this new mom thing is hard."  More like "I can't do this and I'm never going to be able to do this."  You feel like you just can't handle being a mother.  In fact, you may be wondering whether you should have become a mother in the first place.
  
• You feel guilty because you believe you should be handling new motherhood better than this.  You feel like your baby deserves better.  You worry whether your baby can tell that you feel so bad, or that you are crying so much, or that you don't feel the happiness or connection that you thought you would.  You may wonder whether your baby would be better off without you.
  
• You don't feel bonded to your baby.  You're not having that mythical mommy bliss that you see on TV or read about in magazines. 
  
• You can't understand why this is happening.  You are very confused and scared.
  
• You feel irritated or angry.  You have no patience.  Everything annoys you.  You feel resentment toward your baby, or your partner, or your friends who don't have babies.  You feel out-of-control rage. 
  
• You feel nothing.  Emptiness.  You are just going through the motions. 
  
• You feel sadness to the depths of your soul.  You can't stop crying, even when there's no real reason to be crying.
  
• You feel hopeless, like this situation will never ever get better.  You feel weak and defective.  You feel like a failure. 
  
• You can't bring yourself to eat, or perhaps the only thing that makes you feel better is eating.
  
• You can't sleep when the baby sleeps, nor can you sleep at any other time.  Or maybe you can fall asleep, but you wake up in the middle of the night and can't go back to sleep no matter how tired you are.  Or maybe all you can do is sleep and you can't seem to stay awake to get the most basic things done.  Whichever it is, your sleeping is completely screwed up, and it's not just because you have a newborn.
  
• You can't concentrate.  You can't focus.  You can't think of the words you want to say.  You can't remember what you were supposed to do.  You can't make a decision.  You feel like you're in a fog.
  
• You feel disconnected.  You feel strangely apart from everyone for some reason, like there's an invisible wall between you and the rest of the world.
  
• Maybe you're doing everything right.  You are exercising.  You are taking your vitamins.  You have a healthy spirituality.  You do yoga.  You're thinking "Why can't I just get over this?"   You feel like you should be able to snap out of it, but you can't.
  
• You might be having thoughts of running away and leaving your family behind.  Or you've thought of driving off the road, or taking too many pills, or finding some other way to end this misery.  Or you may have thoughts of harming others.
  
• You know something is wrong.  You may not know you have a perinatal mood or anxiety disorder, but you know the way you are feeling is NOT right.  You think you've "gone crazy".
  
• You are afraid that this is your new reality and that you've lost the "old you" forever.
  
• You are afraid that if you reach out for help people will judge you.  Or that your baby will be taken away. 

You may have postpartum anxiety or OCD if you have had a baby within the last 12 months and are experiencing some of these symptoms:

• Your thoughts are racing.  You can't quiet your mind.  You can't settle down.  You can't relax.
  
• You feel like you have to be doing something at all times.  Cleaning bottles.  Cleaning baby clothes.  Cleaning the house.  Doing work.  Entertaining the baby.  Checking on the baby. 
  
• You are worried.  Really worried.  All. The. Time.  Am I doing this right?  Will my husband come home from his trip?  Will the baby wake up?  Is the baby eating enough?  Is there something wrong with the baby that I'm missing?  No matter what anyone says to reassure you it doesn't help. 
  
• You may be having disturbing thoughts.  Thoughts that you've never had before.  Thoughts that make you wonder whether you aren't the person you thought you were.  They fly into your head unwanted and you know they aren't right, that this isn't the real you, but they terrify you and they won't go away.  These thoughts may start with the words "What if ..."
  
• You are afraid to be alone with your baby because of the thoughts.  You are also afraid of things in your house that could potentially cause harm, like kitchen knives or stairs, and you avoid them like the plague. 
  
• You have to check things constantly.  Did I lock the door?  Did I lock the car?  Did I turn off the oven?  Is the baby breathing?
  
• You may be having physical symptoms like stomach cramps or headaches, shakiness or nausea.  You might even have panic attacks.
  
• You feel like a captive animal, pacing back and forth in a cage.  Restless.  On edge.
  
• You can't eat.  You have no appetite.
  
• You can't sleep.  You are so, so tired, but you can't sleep.
  
• You feel a sense of dread all the time, like something terrible is going to happen.
  
• You know something is wrong.  You may not know you have a perinatal mood or anxiety disorder, but you know the way you are feeling is NOT right.  You think you've "gone crazy".
  
• You are afraid that this is your new reality and that you've lost the "old you" forever.
  
• You are afraid that if you reach out for help people will judge you.  Or that your baby will be taken away. 

Now that you've gone through these lists are you thinking "How the heck does this lady know me? Is there a hidden camera in here?"  Nope.  What this should tell you is that you are NOT alone and you are NOT a freak and you are NOT highly unusual.  If you are having these feelings and symptoms then it is possible you are experiencing a common disorder that 15 to 20% of new mothers have, and it is completely treatable.  Just reach out for help.  There are people who've seen all of this before and know exactly what is happening and how to help you.  They won't be shocked by what you have to say or what you are thinking.  There are also women going through this who you can meet with and talk to.

If you are pregnant and are having symptoms similar to those listed above, you should know that you aren't unusual either.  You may have antepartum depression or anxiety, which are just as common but occur during the nine months of pregnancy. 

Oh, and it's a good idea to speak with your physician to get a physical so that you can rule out other illnesses that may be causing your depression or anxiety symptoms, such as an underlying thyroid problem.

One last thing:  If you are having moments where it seems like you can see or hear things no one else does, if you are feeling paranoid as if others are out to get you, if you are feeling that you or your baby are somehow related to the devil or God in some way, or if you are having thoughts of harming yourself or others, it's important to reach out for help right now.  These symptoms require immediate attention as they could be signs of postpartum psychosis or severe postpartum depression.  If you have these symptoms, your illness has the potential to take over and lead you to do things that you wouldn't normally do.  In order to avoid that it is important to reach out for help right away so that trained professionals can help you get stabilized and healthy.

This week at the Beyond Blue blog, Therese Borchard tackles the topic of treatment-resistant depression.  According to the Mayo Clinic ... 

"With treatment-resistant depression, symptoms — such as feeling sad, hopeless and disinterested in activities — persist despite treatment. Or, your symptoms improve only to keep coming back. Treatment-resistant depression can range from mild to severe, and generally requires trying a number of treatments to find out what works."

A minority of people with depression are treatment resistant, but there are other options to help you recover.  Therese writes about the various alternatives for those people who have serious depression and receive no benefit from therapy, medication and other methods of treatment.  These options include ECT, deep brain stimulation and transcranial magnetic stimulation.  

Also, Therese shares a summary from Johns Hopkins on the various methods of brain stimulation here.

For a fact sheet on brain stimulation therapies from the National Institute of Mental Health, click here.

Yesterday the National Institute of Mental Health announced it awarded a challenge grant to Judy Garber, PhD, of Vanderbilt University to develop and test a method encouraging depressed mothers to follow treatment recommendations.  

"All study participants will receive a referral for treatment and an information pamphlet describing the symptoms of depression and anxiety, possible effects of depression on children and different types of treatments.  Randomly assigned participants will also receive a brief, one-session Enhanced Motivation Intervention (EMI).  EMI uses special interviewing techniques to identify and resolve a person's concerns about and practical barriers to treatment.

The researchers anticipate that EMI will result in more participants getting treatment for mental disorders compared with the control group.  If successful, such interventions would not only benefit the depressed individual, but may improve the well-being of her children as well."

I was very pleased to be able to meet Heather Turgeon, MFT, at the Postpartum Support International annual conference this summer.  Heather just wrote a piece on her Science of Kids column at Babble.com on postpartum OCD, an illness for which I have a special place in my heart.  This is a very well-written piece that explores what postpartum obsessive-compulsive disorder is like and how it's different from postpartum psychosis.  Go check it out.

P.S.  I'm especially excited that one of the people she interviewed for the piece is Dr. Merrill Sparago, awesome psychiatrist and all-around great guy! 

The columnists at the Wall Street Journal's working parents column, The Juggle, took on the topic of whether to take antidepressants during pregnancy with a column called "Medication During Pregnancy: A Vexing Dilemma". 

The column covers the normal back and forth that all of us go through when trying to make the decision on medication during pregnancy.  What I found most interesting, though, were the comments.  You can see some of the stigma that exists and how uninformed some people are.  The following comments stuck out to me the most:

"PPD is temporary depression. Anyone who is clinically depressed is different. You may be clinically depressed and don’t know it, get PPD which triggers your depression tendencies and it becomes long term due to the trigger.  I think we need to be very very careful how we use the terminology due to confusion with the actual illnesss and the opposite of temporarily being down and out."

"Go back to work and put the kid in daycare and PPD will go away. It's a phase, its not clinical depression."

Aha!  Postpartum depression isn't real depression.  It's make-believe depression! 

Real geniuses, those two. 

Since it is so hard to keep track of the research coming in almost daily on perinatal mood and anxiety disorders, I've decided to add a research page to Postpartum Progress.  You can find it on the right-hand side of your screen underneath "Help Is Here", #5. 

I won't be able to list every single piece of research that comes down the pike, but I will put links on that page to the most current, most interesting, most often cited research.  I've created categories to try and organize it, such as Genetics & Postpartum Depression, Screening for Postpartum Depression, Risk Factors for Postpartum Depression, etc.

Hope this page is helpful to you should you need to find some specific data.  If you know of a study that should be listed there and it isn't, please send me a link at postpartumprogress@gmail.com.  And to my brainy, scientific-type, evidence-based medicine readers, if you see a study on there that you don't think is valid, tell me that too and I'll remove it.

Amber Koter-Puline, author of the Beyond Postpartum blog, is featured in a new video on WebMD about postpartum depression.  Check it out!  Great job Amber!

This is a poignant post from Tamra at Surprisingly Sane, who is recognizing her one-year "anniversary" of suffering from postpartum depression.  She starts out describing what last November was like ...

"I can’t remember last November.  I have no recollection of celebrating the holidays or what I bought everyone for Christmas.  Did I get anyone gifts?  Did I even get my own kids something from St. Nicholas?  Maybe someone pulled out a camera with proof that I was breathing through that time, but it sure wasn’t me."

And then she describes how she feels now ...

"The fact that I am sitting at my kitchen table next to an open window filled with blue skies and sunlight in the gorgeous city of Seattle, Washington a year later is proof to me that there simply MUST be a God, He/She MUST love me, and for whatever reason… my life MUST be worth living.

I believe that now.

A year ago, I couldn’t."

So glad you are well Tamra.

A young man named Robert Enke, the goalkeeper for Germany's national soccer team, killed himself by jumping in front of a train this week.  Just awful.

When writing about his suicide on Psych Central, Christine Stapleton wrote the following:

"Sit down, close your eyes and imagine – if you can – what it would feel like if you suffered from a reviled illness and believed that your child would be taken from you if word of your illness got out."

No need for guided imagery here, Christine.  We don't need to close our eyes and imagine.  The women who read this blog feel like that right now, or felt like that when they were sick with perinatal mood and anxiety disorders.  It's our greatest fear to lose our children, though most often unfounded.  She goes on ...

"People with cancer or heart disease or diabetes do not have these worries. They can focus on getting well. But not people with mental illnesses."

Stigma sucks.  There's no excuse for it.  God bless Robert Enke.

Susan Stone, chair of the President's Advisory Council of Postpartum Support International and blogger at Perinatal Pro, reports that today at George Washington University in Washington DC, First Lady Michelle Obama and Dr. Jill Biden will contribute opening remarks to the official introduction of Service Nation volunteer partnerships. Service Nation is an organization devoted to increasing volunteer efforts among civilians, non-profits and other entities in communities across the United States.

Among the organizations included in the presentation are two devoting specific attention to postpartum mood disorders: Postpartum Support International, the worlds largest organization devoted to the eradication of perinatal mood disorders, and Give an Hour, a non profit established by Dr. Barbara Van Dalen to encourage mental health practitioners to donate a weekly hour of professional service to military families. Both are volunteer organizations.

As Susan states, "PSI’s inclusion brings more consistent visibility to our issue along with a level of exposure and awareness that will help spread our mantra, 'You are not alone, you are not to blame and with help, you will be well'."

Very cool.

Update:  Here's a photograph of Susan on the stage with First Lady Michelle Obama.  She's on the right with the rose-colored jacket. 

Let's face it: postpartum depression is a bummer of a subject.  So are postpartum OCD, postpartum psychosis, intrusive thoughts, mental illness ... shall I go on?  These things are real and they can't be ignored, but they're not gleeful things to discuss.  Necessary but not exactly fun.

I don't get a chance to talk a lot about happiness here.  I talk more about finding one's way back to it.  Postpartum Progress is sort of a stop along the way to happinessland.  You just left the twin cities of Darkness and Misery and now you're here in Postpartum Progress and on the way to full recovery with a final destination of Happy Momville.  You can't see where you're going because Happy Momville is a little bit of a ride from Darkness and Misery and nobody gave you a precise map, but I've made the journey and I know for a fact that Happy Momville can be reached and in fact is a pretty cool place to be.  You'll see.

Today I happened upon an interview that Gretchen Rubin of the Happiness Project just conducted with "momblogger" Liz Gumbiner who writes Mom-101.  It's such a basic discussion, yet an important one in that Rubin asks questions that we rarely ask ourselves but should:  What makes you happy?  What detracts from your happiness?  How do you give yourself a happiness boost? 

Is it ridiculous to even bring up the subject of happiness on this blog?  I'm not sure.  Thinking back to when I suffered from postpartum OCD I can't say I felt much happiness whatsoever during that time.  There were a few "decent moments."  I can't think of a word to describe those times, fleeting moments where I glimpsed that maybe I could love my son and maybe he could love me.  (What's a word to describe the wide open space between misery and bliss?)  I probably would have wanted to PUNCH someone who tried to talk to me about happiness during that time.  

Concerned person: Katherine, how could you give yourself a happiness boost right now?

Katherine: Are you kidding?  F*&#k you.  (Pow.)

if someone had wanted to talk to me about recovery, though, or being healthy, or getting back to the old me, I think I would have been open to it.  Aren't those words -- recovery, health, being me, renewal, healing -- synonyms for happiness, or at least things that can lead to it?

Even if the word "happiness" is anathema to you right now, you can admit that it is truly where you want to be.  You want to get back to your own specific brand of happiness, your own version of what being contented in life means.  And even though you have no control over your genetics, your brain chemistry, unsupportive people who may be around you, and some of the other things that might have led you to this crappy place called Darkness and Misery, you are empowered to take steps to fix the situation.  

In fact you've already taken steps to fix the situation, perhaps without knowing it.  You've identified the problem that has stopped you in your tracks.  That's why you are here, reading this blog.   And now that you are finding out what is wrong you are also finding out what you can do to turn things around.  You are finding out that what is happening to you is temporary.  You are finding out who to talk to and where to get the help you need and who is dedicated to supporting you through this.

You're on the road to the h-word.  We just won't call it that. 

I was very happy to see that Parents magazine and CNN.com have covered the specialized inpatient unit for women with severe perinatal mood and anxiety disorders at the University of North Carolina.  Go Dr. Elizabeth Bullard, Dr. Samantha Meltzer-Brody and nurse Chris Raines!!!! 

"Immediately, Meehan-Machos's obstetrician referred her to the University of North Carolina at Chapel Hill (UNC). There, doctors had recently debuted a groundbreaking inpatient psychiatric unit, the first in the nation specifically tailored to women suffering perinatal (prenatal and postpartum) mood disorders. Unlike a general psychiatric unit, it offered:

• A core group of doctors specializing in perinatal issues
  
• Psychiatrists attuned to medications that wouldn't harm a pregnancy or a nursing newborn
  
• An unusual policy of allowing children, even babies, on the ward during extended visiting hours
  
• Mom-only counseling focused on anxiety and bonding"

There aren't near enough specialized programs for women with postpartum anxiety, postpartum depression and postpartum psychosis.  These women have a distinct set of issues and deserve treatment from clinicians who have a lot of experience treating them.  Whether its psychiatrists, psychologists, therapists and social workers who specialize in reproductive psychiatry, special inpatient units like the one at UNC or special outpatient units like the one at Women and Infants Hospital in Rhode island, we need more hospital administrators and healthcare systems to recognize that perinatal mental illness is a public health problem and to create the kinds of services that help new moms and moms-to-be get better as quickly as possible.

I can tell you that when I had postpartum OCD I first went to a psychiatrist that I later came to realize had almost no experience with women with postpartum depression.  After dealing with that for ONE YEAR (argh!) and making little headway, I switched to someone who had trained under specialists in perinatal mood and anxiety disorders.  It was like night and day.  Out came the sun!! 

I realize that not everyone has access to specialists.  It is my wish that one day every woman will, no matter in which corner of this country (or any other) she lives.  It is my personal opinion, though, that seeing a specialist in the best case scenario for women trying to get well.  If it's a friend of mine, a relative, a neighbor or my own daughter, I'm going to fight like hell to find a specialist to help her. 

I'm just saying.

Update:

I received the following comment to this post and I'd like to share it so that it isn't missed.

"With reimbursement of mental healthcare as poor as it is, there are not (and may never be) even enough regular psychiatrists to go around, much less psychiatrists who treat only patients with perinatal issues.  If we have special clout and extra connections we may be successful in getting our friend, relative or neighbor in to see a specialist (as long as she lives in a major metropolitan area and has good insurance, of course).  But the vast majority of people aren't so well connected.  We need to make sure not to alienate non-specialists.  OBs, family physicians, midwives etc. can and should be trained well enough to treat straightforward perinatal mood disorders.  And if general psychiatrists are unable to successfully treat the more complicated cases, I don't think the solution is just to hope and wait for more postpartum specialists.  The solution is to insist that general Psychiatric training programs adequately address these common and important conditions."

Thank you for your comment.  I understand what you are saying.  It is true that we are sorely lacking in this country when it comes to having enough psychiatrists to go around, especially in rural areas.  I do not think, though, that you need any particular clout when it comes to seeing a specialist.  Insurance, perhaps, but not clout.  When I was sick I had zero clout.  When I finally got tired of being treated by someone who didn't know what they were doing the only thing I did have was empowerment.  The courage to demand more for myself and my health and to ask around and ask around and not give up until I found someone with more training than the average doc on these illnesses (which doesn't take much actually, because as you rightly point out, the current med school training is inadequate).  There are many healthcare providers from various disciplines who have taken the time to learn more, get CEUs, attend a conference or go to a PSI training.  These are the people I think women should try and see.  

Additionally, I know that many of the specialists in this field do consults and confer with women's personal physicians to discuss care for perinatal mood and anxiety disorders.  They are aware that, because this specialty is so unique, their expertise is needed both inside and outside of their "neighborhoods".  

And finally, I would never suggest women who are suffering wait and hope until we have every specialist we need.  I hope that's not how it came across in my post.  Thankfully, with organizations like Postpartum Support International, women don't have to.  They can connect with one of more than 100 trained volunteers spread out across our country in every state who can offer information on healthcare providers in the vicinity who can help. 

2009 has been a great year here at Postpartum Progress and I just wanted to take a look back at some of the cool things that have happened here and all that YOU have accomplished ...   

We started Six Things, an ongoing series of easily digestible lists of six things to know about perinatal mood and anxiety disorders if one has time to read nothing else.  The first Six Things articles included "Six Things Every New Mom Should Know About Postpartum Depression", "Six Things You Should Avoid if You Have Postpartum Depression or Anxiety" and "Six Things That Can Affect How Quickly You'll Recover from Postpartum Depression".  There will be more to come in this series in 2010!

We held the first annual Mother's Day Rally for Moms' Mental Health.  This event featured 24 hours straight of female authors and bloggers writing about the importance of the emotional health of mothers.  Some of the participants included Vicki Glembocki of Oprah.com's Blunt Force Mama, Catherine Connors of Her Bad Mother, Lauren Hale of Sharing the Journey, Deb Arora of Missives from Suburbia, and Therese Borchard of Beliefnet.com's Beyond Blue. We'll be doing it again next year, so if you have an interest in being a featured author, let me know!

We spoke out assertively against unbalanced or misleading coverage of perinatal mood and anxiety disorders in the media, especially when it came to the Time magazine article on screening and the Mother's Act and ABC's "Private Practice" episode.  Many of you wrote your own letters and articles in addition to speaking out on Postpartum Progress.

You signed DBSA's petition to support the Mothers' Act and added your name to Susan Stone's list of individuals and organizations who endorse its passage.  (You can still add your name if you haven't already!)

You sent in your pictures so that the Surviving & Thriving Mothers Photo Album now features more than 60 photos of recovered, happy and healthy moms and their children.  Your participation in this album helps fight stigma and serves as a symbol of hope to those who are currently suffering.  If you haven't sent your picture in yet, please do!  I hear from women who say your pictures are very inspirational to them. 

I'm so proud of what happens here and the community you've helped create by becoming regular readers, sending in news tips, commenting on stories, sharing your opinions, updating the support groups list and adding your photos to the Surviving & Thriving Mothers Photo Album.  Postpartum Progress wouldn't succeed without this great community of survivors, clinicians, advocates and current "patients".  Thanks for your bravery in speaking out.  Please keep up the good work, and keep your news, ideas and photos coming in 2010!! 

A week or so ago I asked you to participate in a research survey over on MedEdPPD.  You guys did a great job as they received quite a few responses.  Now I've got another one for you.  There are actually two versions of this survey, one for providers/clinicians and one for women with postpartum depression.  The survey is completely confidential and no identification is required.

A psychiatry research team is planning a study to compare several treatments for women with postpartum depression.  Before the study begins, they want to know which treatment options would NOT be acceptable to providers and patients.  Once acceptable treatments are determined, the team will begin a study in which participants will be randomly assigned a treatment which will be administered for 8 weeks.  Women whose PPD symptoms improve would be provided treatment for an additional 6 months.

Please help out this research team by taking the survey and forwarding it to relevant colleagues and fellow moms.

The survey literally takes just a minute or so.  Five quick and easy questions. 

If you're a mom or mom-to-be, take this survey.

If you're a provider, take this survey.

The following are links to some of the hospitals and clinics in the United States, as well as other countries included at the bottom of this page, that have specialized programs to treat women with perinatal mood and anxiety disorders. 

How do I decide which programs are listed here?  These organizations are specifically geared toward women with perinatal mood and anxiety disorders.  They are well-rounded, offering treatment, hosting support groups and conducting research into these illnesses.  Their clinicians are focused squarely on treating women with these kinds of illnesses.  If you think your hospital or university's program should be included in this list, email me at postpartumprogress@gmail.com. 

(Note: This list is in alphabetical order by state.  Specialized programs outside of the United States are listed at the bottom. This list does not serve to endorse any particular program.)

Arizona: Women's Mental Health Program at the University of Arizona, Tucson

California:  UCLA Women's Life Center Los Angeles, Dr. Lori Altshuler and Dr. Vivien Burt at UCLA Women's Life Center; El Camino Hospital Maternal Outreach Mood Services, Mountain View, CA, Kristina Peterson, MFT

Colorado:  Postpartum Depression Intervention Program at The Kempe Center, Denver, Dr. Brian Stafford

Connecticut:  Yale Program for Women's Reproductive Behavioral Health, Dr. Cynthia Neill Epperson

Georgia: Emory Women's Mental Health Program, Atlanta, Dr. Zachary Stowe, Dr. Jeffrey Newport, Dr. Toby Goldsmith

Illinois:  University of Illinois at Chicago Perinatal Mental Health Project, Chicago, Dr. Laura Miller; Advocate Good Samaritan Hospital Perinatal Depression Support Services, Oak Brook, Dr. Diane Semprevivo

Iowa: Iowa Depression & Clinical Research Center, Iowa City, IA, Dr. Michael O'Hara and Dr. Scott Stuart

Kentucky: University of Louisville Women's Mental Health Program, Louisville, Dr. Joyce Spurgeon, Sheila Ward CNM

Massachusetts: Massachusetts General Hospital's Center for Women's Mental Health, Boston, Dr. Lee Cohen, Dr. Ruta Nonacs, Dr. Marlene Freeman, Dr. Adele Viguera

Maryland: Johns Hopkins Women's Mood Disorders Center, Baltimore, MD, Dr. Jennifer Payne, Dr. Karen Swartz

Michigan: University of Michigan Perinatal Mood Disorders Team, Ann Arbor, MI, Dr. Sheila Marcus, Dr. Heather Flynn, Dr. Maria Muzik, Dr. Juan Lopez, Kate Bullard, LMSW

Minnesota: Hennepin Women's Mental Health Program, Minneapolis, Dr. Helen Kim

New York: Payne Whitney Women's Program at Weill Cornell, New York, Dr. Margaret Altemus; New York University Reproductive Psychiatry, New York, Dr. Shari Lusskin; the Women's Mental Health Consortium, New York, Dr. Catherine Birndorff; Columbia University Women's Program, New York, Dr. Eileen Kavanagh

North Carolina:  University of North Carolina Center for Women's Mood Disorders, Chapel Hill, NC, Dr. David Rubinow, Dr. Samantha Meltzer-Brody, Dr. Elizabeth Bullard, Chris Raines RN

Pennsylvania: Women's Behavioral HealthCARE at the Western Psychiatric Institute & Clinic of the University of Pittsburgh Medical Center, Pittsburgh, Dr. Katherine Wisner; Penn Center for Women's Behavioral Wellness, Dr. Deborah Kim

Rhode Island: Women & Infants Hospital Day Program, Providence, RI, Dr. Margaret Howard

Texas: The Menninger Clinic/Baylor College of Medicine, Houston, Dr. Lucy Puryear; UT Southwestern Women's Mental Health Center, Dallas, Dr. Neysa Johnson, Dr. Anna Brandon, Dr. Geetha Shivakumar

CANADA

Reproductive Mental Health Program at St. Paul's Hospital and BC Women's, Vancouver, Dr. Shaila Misri

Perinatal Mental Health Program at Mt. Sinai Hospital, Toronto, Dr. Ariel Dalfen

AUSTRALIA

Perth Clinic Mother Baby Program, Perth

Royal Women's Hospital Centre for Women's Mental Health, Victoria

This site complies to the HONcode standard for trustworthy health information: verify here.

Many women with postpartum depression who want to reach out for professional help aren't sure if therapy is even covered by their insurance, and many who do have coverage find it can be quite limited.  The New York Times' Patient Money columnist Lesley Alderman has written a much-needed column on how to make the most of your mental health insurance benefits.  She offers great tips, especially in light of the fact that the Mental Health Parity Law is about to take effect in January.  You might find that the benefits your insurance company offers for mental health care have been improved.  Check out her column to learn more.

Note:  She says her next column will cover how to get mental health care if you don't have insurance.  I will let you know about it when it's published.

The March of Dimes is hosting Fight For Preemies Day on November 17.  Premature birth is a health crisis that jeopardizes the lives and health of nearly half-million babies each year. It is the #1 killer of newborns and can lead to lifelong disabilities.  November 17 is dedicated to raising awareness of the crisis of premature birth. The March of Dimes invites you to get involved.  You can:• Learn about premature birth at marchofdimes.com/fightforpreemies• Put a badge on your blog during November, Prematurity Awareness Month®• On November 17, blog for a baby you love and to help others

Premature birth is a concern for women with antepartum depression (depression during pregnancy).  Research shows that preterm birth is twice as likely to occur for women who suffer from depression during pregnancy.  Studies have also found that antidepressants may cause premature birth.  We need more research funding so that we can get a better idea of how to prevent premature birth among pregnant women who suffer from depression, whether they are taking meds or not taking them.

You can join in this event at Bloggers Unite and at the March of Dimes site.

The Des Moines Register reports that Heidi Anfinson, who drowned her 2-week-old child in 1998 while allegedly suffering from postpartum psychosis, is now headed back to jail. 

Anfinson had been granted a new trial after being imprisoned for nine years of her original sentence of 50 years for second-degree murder.  She had been out for jail for about a year. 

"The [Iowa] Supreme Court threw out her conviction at a second trial, held in 2000, because her attorney at the time, Bill Kutmus, failed to raise compelling evidence of severe postpartum depression, or psychosis. Anfinson, and some legal experts nationally, had hoped a new trial would put a spotlight on postpartum psychosis, which has become a more recognized legal defense since her son died."

Her new lawyer had planned to present evidence that she was suffering from postpartum psychosis at the time of the infanticide.  Anfinson waived her right to that new trial, however, reportedly out of fear that a jury would again find her guilty.  She plead guilty to child endangerment in a plea deal with the prosecutors.

It is still unclear how long her new prison sentence will be.  While the judge sentenced her again to 50 years, the Iowa Parole Board could allow her to be released for time served, according to the Register.

"Judge Rosenberg, who presided over Anfinson's post-conviction case, noted that he had no choice under the plea agreement but to sentence Anfinson to prison.'Although this is a tragic incident beyond description ... the court believes (Anfinson) is no further threat to public safety,' he said. 'We often like to think of things in black and white. But often, it is the gray that is the truth.'Many of Anfinson's supporters cried as she was ushered out in handcuffs.Mike Anfinson said he has never stopped loving his wife, or admiring her strength, or thinking she was not to blame for the death of their only child."

Thanks to those of you who visited Organized Wisdom and nominated Postpartum Progress as a top resource for information on postpartum depression.  We now have 14 nominations and are leading the pack.  You can still nominate Postpartum Progress or any other site you feel is a great resource on perinatal mood and anxiety disorders!  I nominated PSI and the MGH Center for Women's Mental Health.

Also, remember last week when I said this?

Just found out Postpartum Progress is listed at #55 of the top 100 Family Blogs on Technorati.  Technorati tracks millions of blogs all around the world, so that's pretty awesome.  Now we just need to get on the top 100 Health list ...

I spoke too soon.  We're on the top 100 Health Blogs list at Technorati now too!  As of today we are #14, though that will fluctuate.  Weehoo!   World of Psychology is on there as well -- go DocJohnG! 

I've been busy redoing the Postpartum Progress Blogroll this week.  I've taken off blogs that no longer exist or that haven't been updated in quite a while, and tried to add a few more.  Since I've added some that weren't on the blogroll before, you should definitely check it out.  You'll mainly see blogs written by mommas who are currently going through (or are survivors of) postpartum depression or related illnesses.  They include (but are not limited to):

Unexpected Blessing

Dooce:  this is linked to her posts on depression and postpartum depression

Ivy's PPD Blog

Atlanta PPD Mom

Pretty Swell Mama

Laughing Through The Chaos

Mood-Disordered Mama

Life with PPD

Sophie in the Moonlight

Go Erin Go

Surprisingly Sane

His Boys Can Swim

Ohana

Postpartum Dads Project: for dads whose wives/partners are suffering

Dig Toes In

TheMommyblog.net

The Smiling Mask

The Mommy-Muse Blog

Oh, and since my mind is crammed with too much data, I know there are people I've inadvertently left off the list.  If you think you are one of those people, let me know at postpartumprogress@gmail.com.   Please note that I generally only list writers who've written at least a couple of times about PPD and related topics, as they can serve as a great resource to those who suffer. (Oh, and make sure you check the list first before you fire off an email about how you're not on it!)

Oh, and I hope you'll add Postpartum Progress to your blogroll too!  Pweez?! as my daughter would say ...

Psych Central has released its list of the top 10 bipolar blogs for 2009, as written by Sandra Kiume.  Go check them out!