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Part One in a Series: Perinatal Mental Illness for Birth Professionals

Stigma & Prevalence of Perinatal Mental Illness

Part One of this series of posts discusses the experience of public stigma and self-shame around perinatal mental illness. Part Two talks about risk factors and types of perinatal mental illnesses. Part Three about what you can do, Words & Actions that Heal and some resources. I hope you find this a useful addition to your knowledge base as a birth professional.

Woman to Woman Support

As a childbirth professional, how do you help women & families? Lamaze has a wonderfully constructive focus on birth as a normal and healthy process. Lamaze Six Healthy Birth Practices promotes positive empowerment of families. And, it is useful to be aware that the time around birth, pregnancy and postpartum is the time that a woman is most likely to (re) develop a mental illness (Nonacs, 2006).

Childbirth professionals are often the first point of woman-to-woman contact for new moms. Becoming educated about perinatal mood/anxiety disorders and having a list of resources available in your community and online is an effective way to be of help without overstepping your personal, certification or licensure boundaries.

You may be the first person she calls. You can help out by being positively aware, using Words that Heal, and providing a list of contacts in the community and online.

Fear and stigma around “postpartum mental illness”

The mentally ill are dealing with public and self-shame. In the observer, the stereotype of someone who has a mental illness is someone low-functioning, someone who can’t hold a job (Corrigan et al, 2010). Feelings of uneasiness and fear, rather than feelings of compassion bubble up (Corrigan et al, 2010). Think about your own reactions to the words “mental illness.”

So be aware that a mother who is feeling depressed, anxious or fearful is probably experiencing deep self-shame. She probably feels more shame than is expected and associated with a physical illness. She probably has erroneous beliefs about the nature of mental illness.

Some mothers believe they are weak, and “should” be able to control their feelings. Other moms might believe they are bad mothers because they are in such pain, like they are belittling the miracle of their new baby. Others might be afraid to admit the scary thoughts they are having. Yet others believe there is no effective treatment; they think they just can’t get better.

Postpartum mental illness exists on a spectrum. Postpartum mental illness conjures up images of a mom who hurts her children, of courtrooms, of a person who is hearing voices, a home that gets visited by Child Protective Services and a mom who ends up institutionalized (Puryear, 2007). This stereotype is extreme and erroneous, as there are different types of postpartum mental illnesses.

No public stigma? No self-shame? Take a look at these statistics.

The World Health Organization lists depression as one of the top two to four causes of disability (defined as the loss of productive life) worldwide today. Mental illness is more prevalent than many other more publicized illnesses, but as a society we are very quiet about it.

No public stigma? No self-shame? I wonder why is there no nationwide Walk for Depression? What color is the depression ribbon? Why does World Mental Health Day (World Health Organization sponsors this on October 10th ) come and go so quietly? (Well, PsychCentral did have a blog party that day…)

Depression in Women is More Common than Breast Cancer or Stroke (saaay what?)

One in four women suffers depression at some point in her life, and women are more likely to suffer depression during and shortly after pregnancy than at any other time (Nonacs, 2006). Ruta Nonacs, MD (2011), editor-in-chief of Massachusetts General Hospital’s Center of Women’s Mental Health’s website estimates annually in the US, there are about 4 million births, and about 950,000 to 1,000,000 mothers suffer from depression either during or after childbirth every year.

The good news is there are effective treatments for depression and postpartum depression. But the sad fact is less than 25 % of persons affected by depression receive any treatment at all (WHO, 2012). The top barriers to receiving proper treatment are the social stigma associated with mental illness (shame), lack of personal resources and the lack of trained clinicians (WHO, 2012).

So, think about that, only about 25% of those moms actually seek and receive help for perinatal depression. So many women cope all alone, managing their very real emotional pain while at the same time coping with an infant.

According to Postpartum Progress, there are more occurrences of perinatal depression annually than there are breast cancer diagnoses, occurrences of stroke in women, or diagnoses of diabetes. Postpartum Support International says that postnatal depression is the most common complication in childbirth today. Dr. Nonacs (2012) adds there are more occurrences of perinatal depression than pre-term labor or pre-eclampsia.

Pretty surprising statistics, no?

Any thoughts about why we are mum about maternal mental illness? I’d love to hear your comments.

Do you believe you can be a positive influence regarding maternal mental health? Or do you believe it is too specialized an area in which childbirth professionals to be knowledgeable?

Please share your views below. I love to hear from you!

References

 Corrigan, P.W., Morris, S., Larson,J., Rafacz, J., Wassel, A., Michaels, P., Wilkniss, S., Batia,. K., & Rusch, N. (2010). Self stigma and coming out about one’s mental illness. Journal of Community Psychology, 38(3), 259-275.

Kleiman, K. (2009). Therapy and the postpartum woman. New York: Routledge Press.

Massachusetts General Hospital (2012). Psychiatric disorders during pregnancy. Retrieved March 27, 2012 from http://www.womensmentalhealth.org/specialty-clinics/psychiatric-disorders-during-pregnancy/

 Nonacs, R. (2006). A deeper shade of blue. New York: Simon and Schuster.

 Postpartum Support International (PSI, 2009). Components of care. Seattle: PSI

 Puryear, L. J. (2007). Understanding your moods when you’re expecting. New York: Houghton Mifflin Company.

 World Health Organization (WHO, 2012). Depression. Retrieved March 31, 2012 from http://www.who.int/mental_health/management/depression/definition/en/

Childbirth Education, Continuing Education, Depression, Do No Harm, Evidence Based Medicine, Lamaze Method, Maternal Mental Health, Perinatal Mood Disorders, Postpartum Depression, PTSD , , , , , , ,

  1. April 13th, 2012 at 07:50 | #1

    Thank you for this post. So much needs to be done in this area. Every childbirth educator, doula, and other birth worker needs to be knowledgeable about perinatal mood disorders. At the very least they need to recognize the signs and educate the parents on what to watch for.

    As a postpartum doula I have done research, reading,and attended trainings beyond the requirements of either of my certifications. There is so little help readily available to these moms. Usually the first place moms turn is their Obs and unfortunately many of them have absolutely no training in how to treat ppd.

    More than anything families going through a perinatal mood disorder need encouragement that they are not alone, it’s temporary, and there is help available. It is a specialized area BUT often what’s needed more than anything is a strategy to help the parents get 5 hours of uninterrupted sleep every 24 hours.

    We need more education and public awareness, thank-you.
    Susan

  2. avatar
    Arlene Johnson
    April 13th, 2012 at 08:30 | #2

    Kathy,
    This is an important post. I am glad that you are writing about the stigma associated with mental illnesses. Women and those health care workers caring for them during pregnancy, childbirth and in aftercare need to be educated regarding postpartum depression. NAMI (National Alliance for the Mentally ILL) is working to increase awareness regarding mental Illness. Many local chapters and states are focusing on walks to increase awareness. Another way to increase awareness is to speak to community groups and church groups regarding this issue.

  3. April 13th, 2012 at 08:37 | #3

    Hi Arlene – Thanks so much for your kinds words. I so much agree with your views abt the stigma associated with mental illness. NAMI is a gr8 resource, ty for mentioning them! Massachusetts General Hospital says perinatal mood disorders are the number one complication in pregnancy. But we are silent, why? Thanks, Kathy

  4. April 13th, 2012 at 08:42 | #4

    Hi Susan – I am so glad you wrote in! You are a practicing childbirth educator and doula …and you are letting us know this topic is of interest to you. I was wondering how this would be received. I am so glad you mentioned sleep as a factor in helping parents cope. It is so true. I am a HUGE mombaby advocate, and yet we can help infants sleep and still serve their attachment needs so that moms get some sleep so they can be mentally healthy and cope. (We have a piece written by an infant psychologist about attachment coming up soon), thanks, Kathy

  5. April 13th, 2012 at 09:02 | #5

    One of the reasons we are silent is because many of the survivors when they recover, want to close and lock that chapter and forget it ever happened. There are a few, Postpartum progress for one, who get passionate about helping other women. I facilitate a support group and 99% of my moms move on. 1% continue to invite new mothers and help publicize the group.

    How many childbirth education classes include information on preeclampsia and hypertensive disorders which effects 5-8% of births in the U.S.? How many childbirth educators give out information about postpartum depression which effects about 12% of women? (some of them so severely that they are unable to “mother” their babies)

    Would that perinatal mood disorders receive the educational force that breastfeeding, co-sleeping, babywearing, cloth diapering, and several other hot-button topics receive.

    Great topic Kathy. We need more.
    Susan

  6. April 13th, 2012 at 09:22 | #6

    Wow–sobering statistics about woman and depression. Question: How much of the stigma around perinatal depression is attributed to fear of backlash or shame of discussing emotional state with partners?

    Partner support seems to be a huge factor in a woman’s overall emotional and physical health during pregnancy…

  7. April 13th, 2012 at 09:33 | #7

    Hi Linda – great observation….Women/people hide perinatal mental illness as they are afraid that DYFS/CPS may be called and their babies/children taken away. In my work as a volunteer for Postpartum Support International, we do hear abt things like this happening across the country, as we serve all of the US (& internationally). It is shocking how ppl with mental illness are still treated. I think, too , ppl are uneducated abt mental illness..they think it cant be treated. Tx is embarrassing..going to a therapist is thought of as strange, and I think the partners are confused and scared.

  8. April 13th, 2012 at 09:37 | #8

    Thank you so much Kathy for keeping the discussion about depression alive!
    I was surprised too about the high numbers.
    I also want to add to Linda’s points about support that we need more support from work place and from the society in large. I simply don’t understand why we don’t have paid 6 months maternity leave for everybody! Let’s take the added pressure of making a living off the table for these important months. I am absolutely positive that the money will come back threefold!

  9. April 13th, 2012 at 09:39 | #9

    @Susan Breisch
    Hi Susan – Thanks so much for your comments! You sound like you are doing great work, your support group sounds awesome. I run a group in my community, but it does not get alot of attendance. I think women are overwhelmed, many go right back to work. I think u r correct, many just want to forget the major depressive or anxious episode. Mental illness does not feel good and it is difficult to talk about the way we talk about diabetes, say. ty for your observations. Warmly, Kathy

  10. April 13th, 2012 at 09:44 | #10

    @irenesavarese
    Hi Irene – I know, even as mental health professionals, we tend to forget how prevalent mental illness is. Where is the depression ribbon? Its not in our faces so even we forget. And our profession is put back into the shadows as no one wants to admit they are coming to see us! I often feel silenced. I totally agree with you, that US society does not really put a value on family. If we did, we would read the research and use the research as input to our social policies. More maternity leave is better for moms, babies and families. Thanks! Warmly, Kathy

  11. April 13th, 2012 at 14:32 | #11

    Fantastic piece, Kathy. Thank you. I think childbirth organizations could start with position papers. To date, ICEA is ONLY organization training cbes and doulas that has a published position paper on PPMADs.

  12. April 13th, 2012 at 15:58 | #12

    @walker karraa
    Hey Walker – I am honored by your generous enthusiasm! ICEA is actually beginning to take on the PMMI issues? Fantastic! thanks for the information !

  13. April 13th, 2012 at 16:17 | #13

    Useful and thoughtful article. The first paragraph about Lamaze confused me, but then yiou moved right in to topic.

  14. April 13th, 2012 at 16:30 | #14

    Kathy,

    I think that aiming this post at childbirth professionals is hugely important. So often, OBs and other childbirth professionals are the most consistent point of contact for new moms. Simply asking about mental health in an empathic, non-judgmental way can open doors to support and treatment. I hear many women who have experienced PPMADs say that they felt isolated and trapped until someone asked a simple diagnostic question or two. And I think that Linda’s point about partner support is huge as well. Thanks for pulling this information together. I’m looking forward to the rest of the series.

    Warmly,
    Ann

  15. April 13th, 2012 at 17:25 | #15

    @Kathy Morelli
    My pleasure, Kathy…we are all in this together! Yes, ICEA President Elect, Nancy Lantz, announced the position paper at the PSI Washington Conference.

    On the panel presentation, I was lucky to moderate, Nancy read the board’s approved paper on Postpartum Emotional Disorders. Historical! Also, I have been impressed by their working WITH mental health professionals to revise current curriculum, and create their new postpartum doula curriculum. They have partnered with PSI, and really reached out to sister organizations to integrate evidence-based research and information for their educators, doulas, and families.Also, they are is making a concerted effort to include material on PPMAD in journal, newsletter, and blog. The volunteer who runs their blog came to PSI Conference in Seattle and went through the wonderful 2 day certification training. I am encouraged to see ICEA begin this!

    Public position papers are such essential tools for advancement of comprehensive support of childbearing women. I hope that other birth and doula organizations will follow suit. Serving the whole woman can only benefit the whole community.

  16. April 13th, 2012 at 17:34 | #16

    @Walker Karraa
    Wow, impressive! You are in the thick of it!

  17. April 13th, 2012 at 17:37 | #17

    @Ann Becker-Schutte, Ph.D.
    Hi Ann – Thanks for your good points! Yes, ppl feel so isolated and ashamed. I think sometimes women are afraid to say something to their doctors…some docs are great, others not so informed, or of course, they are very busy too. In my work at PSI, I am so saddened by the stories I hear abt how women are treated. M/b its the cohort, as they need to call a warmline for support, but some stories are so disrespectful and actually dangerous.

  18. April 13th, 2012 at 17:38 | #18

    Hi Janna – TY for the feedback! Love the input! Warmly, Kathy

  19. April 13th, 2012 at 18:55 | #19

    I know that as a new mom with my first child, I might have been diagnosable as having PPD, but I did not consider it “depression” because I felt fine every time I got a few hours of uninterrupted sleep. But if that only happens a handful of times in the first 5 or 6 months of babyhood, the experience is pretty much that of depression. I resisted being diagnosed with PPD because I actually experienced it as a way people were inclined to write off my need for sleep, or try to medicate me and send me back into the every-2-hours nursing trenches. I made it through with a very supportive husband and the tincture of time, and was lucky enough to have a better sleeper the second time. But I think that the generic materials in doctors’ offices needs to be revised, to take into consideration the psychological impact of the physical demands of new motherhood. I really resented having it suggested that I was having a problem with hormones, when it was so clear to me it was a problem with exhaustion. I like seeing several people in these comments listing “get mom some sleep” as a treatment modality, and I would encourage more of it.

  20. April 13th, 2012 at 19:04 | #20

    @Lara
    Hi Lara – Right on! I commend you for stating that you suffered from PPD. You have stated so many things I feel strongly about, I am unhappy with solely the “hormonal” explanation as well. There are many factors colliding at the time of birth, including the past history of mental illness, marital relationship strains etc. (My next post covers this.) I love that “get more sleep” suggestion. I am in love with mom-baby attachment philosophy, but I do think there are ways that in a healthy family dynamic, all family members’ needs can be taken into consideration.

  21. April 13th, 2012 at 21:13 | #21

    I think the stereotype of a mentally ill person is what keeps so many of us silent for fear of being viewed as underfunctioning, unstable, or weak. I am not a childbirth educator, but as a woman who has experienced depression and as a mother of an almost one-year-old happily attached son, there are three ways I could see a childbirth educator being of invaluable service: 1. Offer a high quality referral. Especially if you are in the thick of mental illness, finding an effective mental health professional can be a gargantuan task. You could even go the extra mile and ask your contact to be in touch with the woman (with her knowledge/permission of course) so she doesn’t have to go through the effort. 2. Share your experience if you have encountered mental illness. What better way to make women comfortable coming to you if they are having trouble? 3. Be nonjudgmental and evidence-based in discussions that arise around treatment options–including sleep, talk therapy, medication, etc. There are so many treatment options, and finding the right combo requires patience and an open mind.

  22. April 13th, 2012 at 22:42 | #22

    @Melissa
    Hi Melissa – thanks for your candid remarks. It takes alot of guts to come out and say you suffered a depression. I love your open-ness abt suggestions for childbirth educators, having a high quality referral and helping to place that important call. I think you are correct, just knowing some down to earth, competent therapists in the community to refer to is a giant help. It can be confusing trying to find someone you feel comfortable with. That’s why it is important for therapists to be visible, to have websites, to come out of their offices…so ppl can get a feel for them and get the guts to call. ty, K

  23. April 14th, 2012 at 06:00 | #23

    @Kathy Morelli
    Kathy, thank you so much for starting this discussion! We need to keep it going. I love the comments that are being made.

    I’m not a “medical” professional so I have to be very careful in how I present things to clients, but helping them get sleep is always my starting point. Sadly there are many mental health practitioners who don’t have a good grasp of perinatal mood disorders. So many of them seem to be fixated on using medications. Medications have their place but they are not an across the board easy fix. Many times I have seen them make things worse due to the side effects.

    Love your suggestions Kathy.

  24. April 14th, 2012 at 08:25 | #24

    I actually did not mean to state that I suffered from PPD. I meant to say that going without 3 hours of sleep in a row for months made me miserable and almost non-functional. I guess the fact that many women can do this without being quite as miserable means that my experience counts as illness? So should we diagnose medical residents who are miserable after too many nights of call as having Residency Depression, and treat the ones who can’t handle it? In that case, I believe we decided to reform the system at least somewhat (though it was for the sake of patient safety more than medical resident health). I know there’s not an obvious way to “reform” infant care, especially if you are committed to breastfeeding. But I feel like the emphasis on diagnosing illness makes the problem a problem of the individual, rather than a problem of social structure. Many of my friends solved the structural problem by bottle feeding and assigning their husbands to one of the night-time feedings. The approach to mental well-being in the materials I encountered in my doctors’ offices were not nearly as helpful as my mother, who affirmed my experience (“Yes, it’s unbelievably exhausting and can be miserable, but you’ll get through it, and you’ll be glad you kept at the breastfeeding”). And also the support from the moms’ group I gathered; hearing a friend tell me that parenting an infant was much harder than running an internal medicine ward was validation of my own struggle. The questionnaires in my doctors’ offices put my suffering in the category of “exceptional problem probably because of hormones” rather than “legitimate suffering from incredibly demanding vocation during these months.”

    I do not mean that PPD should not be diagnosed, treated, respected, etc., as appropriate. But if you do not want to irritate and alienate women like me, there needs to be more recognition of the incredible demands of early infant care (especially if the baby needs to be comforted more frequently than average, etc.). Less “candy coating” of the total breastfeeding experience would be helpful, too. My breastfeeding books had good practical advice, but none recognized just how challenging the demands of full-time breastfeeding can be. I would have experienced less discouraging feelings and had fewer doubts about my self-worth if someone had said, “yes, this is kind of like deciding to climb Everest, and it may push you to your limits, but you can make it, and here’s sources of help if you feel you are faltering.”
    @Kathy Morelli

  25. April 14th, 2012 at 09:00 | #25

    @Lara
    Hi Lara – Oh Please excuse me…I misunderstood! Caring for an infant is very hard work, absolutely….(and I dont mention breastfeeding in my article). Actually, that is a great topic for another blog post, maybe you’d like to write a guest post? One book comes to mind, which is a compilation of interviews of women’s experiences as new mothers. It is called Why Didn’t Anyone Tell Me? There are quite a few other books about women’s experiences…email me if you’d like some other titles. I agree with you that our social structure is not truly supportive of families and in general, there is not adequate maternity leave, and our social support structure has changed, But I do not see where I said in my article anywhere that I was diagnosing overwhelmed tired mothers as persons with depression. Depression is a scary word. Thank you for your comments! Warmly, Kathy

  26. April 14th, 2012 at 09:08 | #26

    @Susan Breisch
    Hi Susan -
    Thanks so much for your comments. I absolutely believe that meds s/b used carefully. Sleep is a great balm, and heals much suffering. Being a mother is hard work and you are so wise to be supportive of new moms. I think mental illness is difficult to talk abt as it looks alot like other things in life, and sometimes it is by degrees, on a continuum, and it doesn’t always need to be treated with medication. But an intractable depression, sometimes needs medication.

  27. April 14th, 2012 at 10:08 | #27

    You are right, Kathy, you did not frame it that way. I am reflecting on a much broader popular/medical discourse of PPD. What is unfortunate is that our popular culture and much of the material produced for doctors’ offices takes an all-or-nothing approach. Either you have PPD, or you should be fine. Where I was living at the time of my first birth, PPD did not actually seem stigmatized, and my peers seemed comfortable diagnosing themselves (and their friends) with it. So it often became a replacement for social support and feminist awareness of the demands of new motherhood. Even a way to say, “why don’t you stop complaining and go get some medication?” I would love to see a truly integrated approach, where new mothers who are struggling are offered affirmation, social support, and one-on-one care for conditions (physical or mental) which may be triggered or exacerbated by pregnancy, birth and infant care. The doctors’ office questionnaires, as they stand, just don’t cut it. Part of the problem, I think, is that the way we slice care into isolated segments, doctors are only trying to slice off their piece (PPD, which counts as “illness,” which is what they treat). So if you “test” negative for PPD, as far as they are concerned, you are fine. I suspect there are many, many borderline experiences, like mine, where what I really needed was general social support to mitigate my “symptoms,” until my body had a chance to rest enough to heal itself. And even for women who may need greater levels of medical support and intervention, the social support might go a long way toward mitigating the immediate distress.

  28. April 14th, 2012 at 16:50 | #28

    @Lara
    Hi Lara – Thanks so much for your compassionate, integrated approach. I think that we agree on alot of things. You expressed your thoughts very well, and I absolutely hope that we are on the way towards more support for families, in general, rather than pathologizing people’s distress. But it is sad to me to see the safety cut rather than strengthened. I meant my post to raise awareness of the possibility of mental illness, rather than cut a deep swath and say every mom who is feeling exhausted and sad b/c of lack of sleep needs s diagnosis. That is certainly not o my intention at all. We all have enuf to deal with as far as stereotypes, expectations, etc..My philosophy is to try to be of service to women & families. You have a valid perspective and I really meant it when I said let’s talk guest post. I am Blog Manager only for April, so the best way to contact me w/b via my own websites. Even if you wrote it for inclusion in May, I am thinking the next manager w/b interested. Warmly, Kathy

  29. April 15th, 2012 at 10:55 | #29

    Truly useful and important post. And I agree with the comments about aiming this information at doctors, nurses, doulas, lactation consultant and others who care for pregnant women and post partum women. I think we would make a lot of progress if these professional not only asked the diagnostic questions but also did so in a way that invited the actual real answer. I think a lot of women as you have noted are ashamed and do not always talk about what is going on. Folks need to be trained not only in what to ask but also how to ask.
    Great information. Keep up the good work. Best, Allison

  30. April 16th, 2012 at 11:52 | #30

    Kathy,

    This is a very important conversation that you have started.
    The stigma of mental illness and the self-blame, shame and sense of hopelessness that often accompanies peripartum mood and anxiety disorders, can be such huge barriers to seeking help.

    I know that you said that you will be sharing resources in part 3, so forgive me if I am jumping the gun, but here is a link to the Edinburgh Postnatal Depression Scale for birth professionals to use for screening purposes. http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf

    Thanks for your efforts to educate birth professionals and the public about the need to address the mental health needs of postpartum women.

    Best wishes,
    Andrea

  31. April 16th, 2012 at 16:22 | #31

    Hi Andrea – Thanks so much for your reply. The stigma surrounding all mental illness runs very deep, as mental health professionals know….and thanks for sharing those resource, you are not jumping the gun! Join the conversation with your knowledge! It is all about coming together and sharing! thank you!

  32. avatar
    Walker Karraa, MFA, MA, CD
    April 17th, 2012 at 08:27 | #32

    I am wondering about the boards on Lamaze, DONA, CAPPA and their interest in position papers on PPMADs. And the EDPS is a great self-assessment tool, but childbirth educators and doulas deserve practical training in feeling comfortable understanding it and getting through discomfort of actually going over it with a client. Most importantly, birth professionals deserve access to referrals of GOOD care providers, including psychiatric hospitalization resources, in their area. We need to be able to walk a client, or her partner/family member through the process to getting to help.

    I have sat with partners and gone through the PSI website BEFORE the birth to find local resources, facts, and information for them.

    And let’s note the recurrence rate with PPMAD is HUGE! If you have a student or client with a previous experience of PPMAD, or PPP (postpartum psychosis) their chance of developing it in subsequent birth is three times greater.

    Thanks again, Kathy

  33. April 20th, 2012 at 12:04 | #33

    Hi Walker – thank you so much for your interest and educated input! Part Three is about supportive measures you can take…take care, Kathy

  34. April 22nd, 2012 at 10:40 | #34

    Hi Kathy,
    Once again, a very informative post. I love the idea of a walk for depression or a ribbon. The statistics about the incidence of perinatal mental illness and the percentage of women who seek help are very sad. Thanks for your work to raise awareness.
    Best,
    Carolyn

  35. April 23rd, 2012 at 11:14 | #35

    Antidepressants and other psychiatric medicines are one of the most common calls we receive via our free counseling service at 866-626-6847, and many women struggle with the decision to continue their medications during pregnancy and breastfeeding. There are a number of medicines and they have varying amounts of pregnancy information. OTIS is a free service to help provide information on these medicines during pregnancy and breastfeeding. When making decisions about treatment, it is also important to remember that avoiding medications is not the “no risk” decision. Our fact sheet discusses this at http://www.otispregnancy.org/files/depression.pdf

    Studies have reported higher rates of miscarriage, low birth weight, and babies who are small-for-gestational age when depression is left untreated in pregnancy. Pre-eclampsia is a serious form of high blood pressure that can cause life-threatening complications for mother and baby. A study found that the risk of pre-eclampsia in pregnant women suffering from depression was more than double the general population risk. In addition, stopping your medication could lead to a return of your symptoms of depression, called a relapse. One study found that women who stopped their medications for major depression had a five times greater risk of relapse during pregnancy compared to pregnant women who stayed on their medications. Restarting the antidepressant medicine lowered the chance of a relapse, but it did not completely prevent the relapse in all cases. A relapse of depression during pregnancy could increase the risk of pregnancy complications. If you or someone you know would like to discuss her particular situation, please feel free to contact us at 1-866-626-OTIS (6847) from anywhere in North America.

  36. April 24th, 2012 at 09:48 | #36

    @Mara, Teratogen Counselor @ The Organization of Teratology Information Specialists
    Hi Mara – Thanks for sharing the OTIS pregnancy information. Your site is one I share as a resource to my clients all the time. Invaluable information and support. Psychotrophic drugs are very complex and there is alot of research been done out there, so it is a specialty area. Great resource for women and families. OTIS will be in Part Three for resource recommendations..thanks, Kathy

  37. May 14th, 2012 at 18:35 | #37

    Kathy, thank you so much for talking about this issue. It’s one of those taboo topics that makes even mental health professionals nervous. I hate the language of “mental illness.” I realize it is what we have to work with but it seems so limiting for so many people – especially when it comes to mood and anxiety related to perinatal issues. It’s frustrating.

    I appreciate you taking the time and making the effort to expand the conversation beyond the stereotypical one that tends to find its way into the mainstream media.

  38. May 15th, 2012 at 05:12 | #38

    Hi Tamara – Thanks for your kind words. The language around mental illness is not so easy for me either, and that’s what we do for a living! So I wanted to bring it out and call it what it is …a mental illness.
    But I also want to mention that I don’t believe people are their diagnoses, that it is so much more. Also, not everyone who feels sad around postpartum has a diagnosis, fatigue and adjustment is a big part of the transition to parenthood as well. But then there are those who do need the professional help. No stigma? No shame? I had much shame during my postpartum depression. Much.

  1. April 20th, 2012 at 11:09 | #1