Posts Tagged ‘pregnancy’

Antidepressants and Birth Problems

Monday, March 15th, 2010

Taking a popular type of antidepressant during pregnancy may increase the risk for preterm birth, the need for treatment in a neonatal intensive care unit and lower overall health for the baby, according to a new study.

Researchers compared birth outcomes among babies born to 329 women who took selective serotonin reuptake inhibitors (SSRIs) during pregnancy, 4,902 women who had a history of psychiatric illness but did not take SSRIs during pregnancy and 51,770 women with no history of mental illness.

Compared with women who had no history of mental illness, those who took SSRIs during pregnancy gave birth an average of five days earlier and had double the risk for preterm delivery. Babies of mothers who took SSRIs during pregnancy were significantly more likely than infants in the other two groups to have a five-minute Apgar score of seven or lower (seven is the general indicator of good infant health) or to be admitted to the neonatal intensive care unit. Exposure to SSRIs did not affect birth weight or head circumference.

The researchers also found that SSRI-exposed infants admitted to the neonatal intensive care unit had symptoms including seizures, jitteriness, infections, respiratory problems and jaundice that may have been caused by withdrawal from SSRIs or adverse effects from them.

The findings appear in the October issue of Archives of Pediatrics & Adolescent Medicine.

“The study justifies increased awareness to the possible effects of intrauterine exposure to antidepressants,” the researchers concluded. “However, treatment of depression during pregnancy may be warranted, and future studies need to distinguish between individual SSRIs to find the safest medication.”

It’s estimated that more than 10 percent of pregnant women have depression. The authors noted that SSRIs have been shown to cross the placenta and be present in the umbilical cord blood of infants whose mothers took the drugs during pregnancy.

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Paxil Pills Precautions and Contraindications

Monday, December 14th, 2009

Pregnancy. Recent studies have linked Paxil to an increased risk of birth defects, particularly heart defects, when taken during the first trimester of pregnancy. Some of these defects are mild and resolve without intervention, but some may be quite serious. It has also been suggested that exposure to SSRIs during late pregnancy may increase the risk of persistent pulmonary hypertension, a serious lung disorder, in a newborn.

If you are nursing or are pregnant, it is best to discuss the risks and benefits of SSRI therapy with your doctor.

NSAIDs or Aspirin. Use of Paxil with NSAIDs or aspirin may be associated with an increased risk of bleeding.

Liver Disease. Before taking Paxil, tell your doctor if you have impaired liver function. Depending on your condition, your doctor may need to adjust your dose and perform certain tests while on Paxil therapy.

Alcohol. Drinking alcohol with Paxil should be avoided.

This list is not all-inclusive. Other drug interactions should be avoided and medical issues your doctor may need to consider. Be sure to tell your doctor about all medications, including over-the-counter drugs and supplements, you are taking before beginning paroxetine.

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Postpartum Depression

Tuesday, July 14th, 2009

Pregnancy brings about many hormonal shifts. These dramatic shifts can sometimes affect mood. This is commonly known as the “Baby Blues”.

After giving birth, about 30% to 80% of women will experience “baby blues,” feeling mild depression, weepiness, irritability, fatigue and moodiness. These mood changes occur in response to the hormonal changes that follow childbirth and rapidly resolve within hours or days.

About 10% of women, though, will go through postpartum major depression (PMD), experiencing more severe, lasting symptoms. Good self-care and support from family and friends can help many women, although others will require treatment with medication and/or therapy.

Steps you can take to prevent postpartum depression include:

Carve Out Some ‘Me Time’
When you’re a new mom, it’s very easy to become completely focused on the needs of your new baby and forget that you still have your own needs. It’s important to set aside time for yourself, even if it’s just a few quiet moments alone in the bathroom attending to your personal grooming. You’ll feel better for it, and when you feel better, your baby will benefit from it too.

Make Time for Your Partner
With all the excitement and added responsibilities that come with a new baby, it’s easy for parents to lose touch with each other. Even though you are now a family, remember it was your love for your spouse or significant other that brought your child into being. Nurture your relationship just like you nurture your baby. Your partner can be a big support to you, both in caring for the baby and caring for your own emotional needs.

Eat Well
It goes without saying that if you are breastfeeding you should eat well, but even if you aren’t breastfeeding, you should feed yourself well. Nutritional deficiencies can cause depression symptoms and make you too tired to properly care for yourself and the baby.

Get Plenty of Omega-3s
Studies have shown a link between postpartum depression and a dietary deficiency of omega-3 fatty acids. Also, an open trial over an 8-week period showed significant improvement in depression in postpartum women who took omega-3 supplements.

Although omega-3 fatty acids may be obtained by eating fatty fish – such as mackerel, lake trout, herring, sardines, albacore tuna and salmon – pregnant women should take fish oil supplements instead. Fish are likely to contain contaminants – like mercury and polychlorinated biphenyls – which are harmful to the developing fetus. Studies indicate that fish oil supplements are much less likely to contain these toxic substances, due to the purification that occurs during the manufacturing process.

Sleep as Much as Possible
When your baby requires frequent feedings, it can be difficult to get the rest you need. If you are tired, however, it’s only natural that you are going to feel irritable and depressed. It is very important that you sleep whenever and as long as possible. Take naps when the baby is sleeping, and allow other family members to take over feeding duties, so you can get several hours of uninterrupted sleep. Breastfeeding? Pump milk ahead of time, so it’s available for occasional bottle feedings.

Exercise
There is a growing body of evidence that indicates that exercise can be an effective treatment for depression in the general population. Studies looking specifically at exercise as a treatment for postpartum depression are few, but the results have been promising. Two small randomized controlled trials conducted in Australia, which looked at group stroller walking, found exercise to be a useful adjunct to treatment. In addition, uncontrolled studies and observational evidence suggest that women with postpartum depression can benefit from exercise.

Ask for Help from Your Friends and Family
Not surprisingly, in cultures where it’s expected that family members will pitch in and help, leaving the Mother free to rest and feed the baby, postpartum depression is almost unheard of. If you are fortunate enough to have friends and family offering help, relax and allow them to help.

Seek Out Support from Other Moms
Other mothers can be your best allies when you have a new baby. Not only do they understand exactly what you are feeling, they may have tips and tricks to share for making motherhood more manageable.

Be Realistic in Your Expectations
When you see supermom Angelina Jolie successfully juggling a thriving career, philanthropic work and a growing brood of children, you may feel just a little guilty that you are struggling to balance the addition of just one child to your family. Keep in mind, however, that Angie has a team of nannies to help her. You’re just one person, and it’s only natural that you may feel a bit overwhelmed with the addition of a new baby. Keeping your expectations realistic about what you can and should do will allow you to enjoy your new addition, instead of fretting over your perceived shortcomings.

Don’t Be Afraid to Ask for Professional Help
If self-help measures are not helping and you find yourself experiencing more severe symptoms — such as a lack of interest in your child, suicidal or homicidal feelings, hallucinations or psychotic behavior — do not be afraid to ask for professional help. Postpartum depression is a biologically based illness, not a sign that you are weak or a bad mother, and it can be effectively treated with medications and therapy.

Also, if you have a history of depression, consult your physician about the possibility of taking medication as a preventive measure before you become depressed.

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Acupuncture and Depression in Pregnancy

Monday, June 29th, 2009

Manber and colleagues22 studied the therapeutic effect of acupuncture on pregnant women with depression. The results are particularly interesting. Sixty-one women were randomly assigned to 1 of 3 groups:
1. Acupuncture, in which depressive symptoms were specifically addressed (SPEC) (n = 20)
2. Valid controlled acupuncture, which was not specifically tailored for depression (NSPEC) (n = 21)
3. Massage therapy (MSSG) (n = 20). The treatment consisted of 12 sessions (25 to 30 min each) over an 8-week period.

Patients and the treating acupuncturist were blinded. Patients who responded in the acute phase of treatment continued the same treatment for 10 weeks postpartum. Symptoms were assessed using the Hamilton Rating Scale for Depression-17 and Beck Depression Inventory.

At the end of the acute phase, response rates were significantly higher for the SPEC group (69%) than for the NSPEC group (47%) and for the MSSG group (32%). At postpartum, all groups had a significant reduction in depression symptoms. However, the remission rate was significantly higher in the SPEC group (86%) than in the NSPEC group (50%) and in the MSSG group (67%). The authors suggested that acupuncture may be an effective nonpharmacological treatment for depression during pregnancy.

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More About Postpartum Depresson

Sunday, May 17th, 2009

MGH Center for Women’s Mental Health Seeking Study Participants.

The Massachussetts General Hospital Center for Women’s Mental Health is conducting a new study titled “Escitalopram (Lexapro) for the treatment of postpartum depresson”.  It is a 2-month open label trial of Lexapro for women who have been feeling depressed and anxious since giving birth.  Women would need to be able to go into the Boston office 5 times over a period of 2 months.  If you are between the ages of 18 and 45, gave birth within the past six 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 to participate in this 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.

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Moms And Postpartum Psychosis

Sunday, May 10th, 2009

Warrior Mom and Postpartum Psychosis Survivor: Why It’s Important To Educate Public About Postpartum Psychosis.

Because postpartum psychosis is so rare, we don’t have as many opportunities to hear from women who have gone through it and get their perspective. I was happy to hear from a Warrior Mom who wanted to share some of her experience as well as her thoughts on the ABC “Private Practice” episode that has caused such a ruckus this past week. I appreciate her willingness to share her point of view with us:

“Firstly, I agree it was irresponsible of ABC to request a public service announcement (PSA) about postpartum depression (PPD) from PSI when the show was about postpartum psychosis (PPP). For those who viewed the PSA on the web, it clearly could have created confusion about what PPD is and what PPP is. The PSA should have been about PPP.

Additionally, the segment of the show where Violet [the therapist] tries to comfort the father by speaking about depression creeping up insidiously and then mentions psychosis as though it is something that naturally follows depression also muddles the picture. I can also appreciate how it could frighten mothers experiencing PPD, postpartum anxiety (PPA) or postpartum obsessive-compulsive disorder (PPOCD).

All that being said, as someone who suffered from postpartum psychosis (more specifically, severe postpartum depression with psychotic features) and who has since been able to get help for four PPP-afflicted women, I believe that the show was very accurate in depicting a postpartum psychosis crisis.

Anyone who has experience with PPP (either personally or perhaps through a spouse) would easily identify with the scene of the woman talking to herself or to people only she can see, being excessive in speech while making little to no real sense and laughing inappropriately. The scene where the woman stresses emphatically that she would never harm her baby and that she loves her baby is particularly poignant. In my experience, the afflicted women I dealt with behaved similarly in an effort to communicate that they did not wish or want to do what they felt compelled to do because of their hallucinations, delusions or disorganized thinking (as in the character’s case).

Additionally, I saw Violet’s behavior to be representative of the moronic attitude of some healthcare professionals. In one situation I was involved in, I personally witnessed a nurse trying to involve child services against a woman with postpartum psychosis after we had her admitted to the hospital for treatment. Why she would do this to someone in the process of getting help is beyond me. Imagine the afflicted woman’s horror when, after my assuring her that getting help was the right thing to do, the healthcare professional reported her as unsafe to child protection services.

However, I appreciate that they ["Private Practice"]showed two balanced, level-headed doctors whose views prevailed in letting the mother be with her baby.

Ultimately I thought the show did a remarkably accurate job of presenting how a woman with PPP may behave, the ethical dilemmas healthcare workers face and the right thing for them to do in a situation where a women with PPP is seeking help — all in the 15 minutes they had dedicated to this storyline.

Reading some of the comments posted on Postpartum Progress, I can see that people would have preferred an episode about the more common PPD and I can appreciate that. However, the episode that did air was also necessary in that people need to know that PPP exists, what it may look like, that it can be treated and that even women with PPP are good mothers and can expect to be well again.  All of that goes a long way in making women exhibiting the early symptoms of PPP and their families know that coming forward with such symptoms is the best thing to do toward getting help.

Connected to this is that too many people, include healthcare professionals, don’t know enough about PPP. The perception that PPP is rare is often an excuse to stay ill-informed. This is a dangerous situation that not only led my family to not realize the seriousness of my symptoms, but also resulted in my being consistently sent home by doctors who repeatedly misdiagnosed me — first with PPD, then PPA and even PPOCD.  Sadly, this was also an experience shared by most of the women with PPP I have been able to help.

It is bad enough not to be able to get help when you have PPD, but imagine how it feels to suffer from the symptoms of PPP and consistently be turned away by the very people you are counting on to help you through a dangerous condition.  Perhaps this show will make that kind of behavior happen a little less.”

Thanks HK for feeling comfortable enough to share your feelings.  As someone who has not experienced postpartum psychosis, I appreciate hearing from someone who has a more personal view of what it’s like and what may happen.

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Colorado Community Says No To Postpartum Psychosis Speaker

Saturday, May 9th, 2009

I don’t believe in censorship, including when it comes to the discussion of perinatal mood and anxiety disorders.  There are a lot of people in this community who take the stance that the only way to communicate with you and the community at large about these illnesses is to stay as positive as possible and not scare you with the details.  I totally respect that, and I hope I’ve learned a lot from those people about how to be honest but still careful with my words.

Still, at my core I’m a no-nonsense chick.  I don’t want to feel like I’m being treated like a baby.  I still feel that if I had had a more realistic understanding of what was happening to me when I had postpartum OCD I would have reached out for help even sooner.  So I’m biased in that I want the truth for msyelf, and I want the truth for society, because that’s the only way for all of us to be fully informed and for women who are suffering to be identified and treated.

Society, on the other hand, doesn’t like too much of the truth when it comes to perinatal mood and anxiety disorders, perhaps because it conflicts with the myth of perfect motherhood.  Any picture that doesn’t look like serene and happy “mom-ness” just does not compute.

An extreme case of this is the current situation in Colorado.  The Mental Health America chapter in Pueblo invited Rebekah Amaya, a mom who killed her two children in 2003 while suffering from postpartum psychosis, to speak at one of their monthly meetings.  After three doctors testified that Amaya was insane at the time of the crime, the judge in her case found her unfit to stand trial and she was committed to the Colorado Mental Health Institute.  Recently that judge found her well enough to have supervised leave from the hospital, which I assume is what would have allowed her to attend the MHA meeting and discuss postpartum psychosis.  According to KKTV, the CBS affiliate in Pueblo, the community reacted so negatively that MHA canceled her appearance.

I understand the reaction.  The insanity defense is often misused, so people are very distrustful of it.  Additionally, those who have never “lost their minds” are fully convinced that it is not possible to do so.  They don’t believe anyone could ever not be in control of their thoughts.  And then there’s the loss of those two beautiful children, which of course can never be made right, no matter how long someone spends in an institution.  The Pueblo Chieftain reports that even the family of Amaya is vehemently against her speaking.

Maybe she wasn’t the right person to speak.  I don’t know.  I certainly don’t know the details of her case, and I’m not excusing what happened.  I just wonder whether the appearance might have led to a poignant discussion about the very rare but extreme consequences that can occur when people don’t recognize that a woman is suffering from severe PPD or postpartum psychosis and she doesn’t receive treatment.

Could Pueblo still use this opportunity to do some good by educating people on perinatal mood and anxiety disorders?  After all, not talking about these things doesn’t make them go away.

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Postpartum Depression Treatment and Recovery

Tuesday, May 5th, 2009

As I mentioned earlier, all of these illnesses are completely treatable.  It is important to reach out to a healthcare professional to discuss your situation and your symptoms and get an official diagnosis.  Then you can work together with these people to identify the best treatment plan.  Treatment might include therapy and/or medication, as well as things like attending support groups and getting the right nutrition and exercise.  It is best not to delay reaching out for help, because research shows that both you and your baby’s health (both physical and emotional) can be negatively affected by these illnesses.  Your deserve having your joy restored, and your baby deserves a healthy mom.  Please keep reading Postpartum Progress for more information daily on what is happening in the world of PMADs.

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Antepartum Depression and Anxiety

Monday, May 4th, 2009

Women can also fall ill with PMADs during pregnancy.  The symptoms of antepartum depression and anxiety are just like those of their postpartum counterparts, as are the risk factors.  It’s important to point out that many women who end up with antepartum depression were people who were already being treated for depression and have relapsed because either they chose or their OB/GYNs directed them to go off their antidepressant medication during the pregnancy.

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Postpartum Psychosis

Friday, May 1st, 2009

The most serious of all PMADs, affecting less than 1% of new mothers, is Postpartum Psychosis.  This illness usually comes on suddenly, most often in the first 2 to 4 weeks after birth, but sometimes even before mom and baby have left the hospital.  There are several key symptoms to look for, and one or all may be present:

* Hallucinations, where you see or hear things other can’t
* Delusions, which often involve feeling as through you are being controlled by an outside power (sometimes involving angels or demons)
* Periods of confusion, memory loss and/or difficulty communicating
* Feeling paranoid, as though others are out to get you
* Feeling manic or hyperactive
* Difficulty sleeping or feeling like you don’t need to sleep
* Extreme agitation

The problem with postpartum psychosis is that the women who experience it usually think their thoughts make perfect sense and do not believe they are ill, which is one of the reasons this illness is so dangerous.  Women with postpartum psychosis may feel that they need and want to act on their thoughts and are not upset by them.  This is caused by the illness and is not their fault.  That is why there is a danger that they may harm themselves or others.  If you have these symptoms, or you have a loved one who is experiencing them, it is important to seek medical help immediately.  Research shows that one key risk factor for postpartum psychosis is a history of type 1 or type 2 bipolar disorder.  New moms with diagnosed or undiagnosed bipolar disorder, or whose family members have bipolar disorder, have the highest risk of getting postpartum psychosis.  Also, if you have had a previous psychotic episode you are at greater risk.

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