24h-payday

Don’t Ever Give Up! An Interview with Katherine L Wisner, M.D., M.S. American Women In Science Award Recipient

“Childbirth educators are crucial front-line professionals in providing information to women about their risks for medical complications related to pregnancy and birth, and postpartum depression is a common problem.” – Dr. Katherine L Wisner

Katherine L. Wisner, M.D., M.S., has been involved in clinical work and research since the mid-1980′s. Prior to her medical training, she achieved a Master’s Degree in Nutrition. Dr. Wisner did a pediatrics internship, is board-certified in both adult and child psychiatry, and completed a 3-year postdoctoral training program (NIAAA-funded) in epidemiology. Her major interest area is women’s health across the life cycle with a particular focus on childbearing. In January 2011, Dr. Wisner was chosen as the recipient of AMWA’s Women in Science Award for the year 2011. Dr. Wisner is a Norman and Helen Asher Professor of Psychiatry and Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine.

Most recently, Dr. Wisner and colleagues (2013) published the largest American study to date (N = 10,000) investigating the value of screening for depression in postpartum period (4 to 6 weeks) using the Edinburgh Postnatal Depression Scale (EPDS)1

I know I speak for all in welcoming Dr. Wisner to Science and Sensibility.

_____________

Walker Karraa: Congratulations to you and your colleagues on this most recent JAMA Psychiatry study. The findings have significant implications regarding the value of screening for postpartum mood and anxiety disorders. What role do you think childbirth education has in the area of perinatal mental health?

Dr. Wisner: Childbirth educators are crucial front-line professionals in providing information to women about their risks for medical complications related to pregnancy and birth, and postpartum depression is a common problem.  

WK: Should childbirth educators and doulas be trained to screen for PMADs? 

Dr. Wisner: My answer would be yes, but the controversy in the field is about routine screening – that women with depression can be identified, but getting them to mental health treatment if it exists outside the obstetrical care setting is difficult.  So the counterpoint is– why screen if we don’t have on-site, accessible, acceptable services for mental health?  My opinion is that we ought to work toward this model of integrated care rather than decide not to screen!   I certainly think childbirth educators and doulas can increase education and awareness and are often the first professionals that women call for help, so that group of women who want to and can access care can get the help they need.

WK: How could childbirth education organizations use this study to inform their practices and curriculum?

Dr. Wisner:The study provides evidence that the prevalence of depression is high both during and after pregnancy and evidence that screening is effective in identifying women with major mood disorders.  Women with psychiatric episodes certainly can be assured that they are not alone, which is a common belief of pregnant women and new mothers.  

WK: Due to the prevalence of self-harm ideation in postpartum period found in your study and other studies supporting this alarming rate, and the fact that suicide is the second leading cause of maternal death, how might childbirth education organizations and professionals address this critical problem?

Dr. Wisner:Screening with the EPDS, which has the item 10 self-harm assessment questions, and sensitive exploration of self-harm and suicidal ideation is the primary approach to suicide prevention.  It has to be identified before intervention can occur.  

WK: A remarkable finding in your study was the rate of bipolar disorder among women who had screened positive (10 or higher) on the EPDS. Additionally, among those with unipolar depression, there was high comorbidity for anxiety disorders. What are your thoughts as to how childbirth education might begin to help childbearing women unpack and understand the symptoms of anxiety in prenatal education?

Dr. Wisner: In our study we found that women with depression usually had an anxiety disorder that pre-dated the depressive episodes—this observation is true for women who are not childbearing as well.  Having anxiety or depression as a child or adolescent increases the risk for peripartum episodes.  There are excellent pamphlets and websites about perinatal depression (www.womensmentalhealth.org; www.postpartum.net) which can be used to frame a brief discussion and give to the patient for reference.  This also gives the message that talking about mental health before and during childbearing is an important topic, just like surgical births, anesthesia etc.    

WK: The data you have contributed to science are unsurpassed, yet early in your career many questioned whether postpartum depression was real, and doubted if you would be able to pursue a research career in postpartum mood disorders.

Dr. Wisner: Indeed!

WK: How did you persevere–and particularly in a male-dominated field?

Dr. Wisner: I got angry that so few data were available to drive care for pregnant and postpartum women and never let go of the importance of obtaining that information.  That motivation was coupled with a real joy in taking care of perinatal women and their beautiful babies!  

WK: Do you think there is still an underlying doubt as to whether postpartum depression (or perinatal mood/anxiety disorders) is real?

Dr. Wisner: Not in academic medicine, and I have not heard anyone say this in about a decade (thankfully!). 

WK: What is your favorite part of the research? Data collection, analysis, or interpretation?

Dr. Wisner: Publishing findings that make a difference in women’s lives, and holding the babies. 

WK: What new trends do you see in research as hopeful signs of progress?  

Dr. Wisner:  The incredible number of young clinicians and investigators who are interested in perinatal mental health.  Also,  our field has been so accepting of interdisciplinary enrichment of research questions.  

WK: What advice would you share with women in research today? 

Dr. Wisner: Network with  your colleagues inside and outside your organization frequently, attend perinatal mental health meetings and don’t ever give up!  

___________

What are your thoughts regarding Dr. Wisner’s expert opinion?   How do you currently address postpartum depression and anxiety in your childbirth classes?  After reading this interview and taking at look at Dr. Wisner’s just published research, might you reconsider how you teach about this important topic or change your approach?  Let us know in the comments section below- Sharon Muza, Community Manager

More about Dr. Wisner

Dr. Wisner’s research has been NIMH funded since she completed her post-doctoral training in 1988. She served on NIMH grant review sections continuously from 1994 to the present. Dr. Wisner completed was a founding member of the NIMH Data Safety and Monitoring Board, and is only the second American to be elected President of the Marce International Society for the study of Childbearing Related Disorders.

Her major interest area is women’s health across the life cycle with a particular focus on childbearing. She is a pioneer in the development of strategies to distinguish the effects (during pregnancy) of mental illness from medications used to treat it (Wisner et al,JAMA 282:1264-1269, 1999; MHR01-60335, Antidepressant Use During Pregnancy).

In recognition of her work, she was a participant in activities related to the FDA Committee to Revise Drug Labeling in Pregnancy and Lactation, a committee member for the National Children’s Study (Stress in Pregnancy), a consultant to the CDC Safe Motherhood Initiative and the Agency for Healthcare Research and Quality Report Perinatal Depression: Prevalence, Screening Accuracy and Screening Outcomes.

Dr. Wisner was elected to membership in the American College of Neuropsychopharmacology in 2005. She received the Dr. Robert L. Thompson Award for Community Service from Healthy Start, Inc., of Pittsburgh in 2006 and the Pennsylvania Perinatal Partnership Service Award in 2007 from the State of Pennsylvania. 

Dr. Wisner was the first American psychiatrist to collect serum from mothers and their breastfed infants for antidepressant quantitation as a technique to monitor possible infant toxicity. She published the only two placebo-controlled randomized drug trials for the prevention of recurrent postpartum depression and showed that a serotonin selective reuptake inhibitor was efficacious.

References 

1.Wisner, K.L., Sit, D., McShea, M. C., Rizzo, D.M., Zoretich, R.A., Hughes, C.L., Eng, H.F., Luther, J.F., Wisneiweski, S. R., Costantino, M.L., Confer, A.L., Moses-Kolko, E.L., Famy, C. S., & Hanusa, B.H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, Published online March 13, 2013. Doi: 10.1001/jamapsychiatry.2013.87

 

Childbirth Education, Depression, Evidence Based Medicine, Guest Posts, Maternal Mental Health, New Research, Perinatal Mood Disorders, Postpartum Depression, PTSD, Research , , , , , , , , ,

  1. April 30th, 2013 at 06:36 | #1

    Nice interview! Thanks for introducing Dr. Wisner to a larger audience! I think that childbirth educators can integrate pmad information into their classes. Here is a link to a useful pocket guide and planning for pmads for childbirth educators http://amzn.to/XnAdlp

  2. April 30th, 2013 at 07:17 | #2

    Excellent interview, Walker, thanks for sharing the work of this well educated and determined researcher.

  3. April 30th, 2013 at 08:44 | #3

    Fantastic interview. Thank you!

  4. April 30th, 2013 at 16:55 | #4

    I am extremely concerned that the focus on screening for postpartum depression using an instrument solely designed for this purpose will miss diagnosis of childbirth-related posttraumatic stress symptoms and full-blown PTSD altogether or will mislabel women experiencing posttraumatic distress as depressed. PTSD symptoms are fairly common–as New Mothers Speak Out found, 18% of women were experiencing symptoms and 9% met the diagnostic criteria for PTSD–and while some symptoms overlap with depression, the treatment differs. Furthermore, on-site mental health services would be of little use to women suffering from childbirth-related emotional trauma because one of the prime protective responses is avoidance of environments and personnel that retrigger traumatic memories.

    I have as well a philosophical issue with making depression the preeminent postpartum mood disorder. Depression centers the problem in the woman, and therefore the cure is centered in her as well. PTSD, however, is centered in the system, and therefore its cure depends on systemic reforms. The incidence of emotional trauma can be minimized by reducing the overuse of cesarean surgery and other painful and invasive treatments, by implementing shared decision-making, and by providing physically and emotionally supportive care. So long as postpartum mood disorders are primarily seen as an issue of depression, little or no attention will be paid to the all too common glaring deficiencies of medical model management in this respect.

  5. April 30th, 2013 at 17:33 | #5

    Let’s not take an article about perinatal depression and turn it into an article about PTSD though. To say that childbirth related PTSD is more important than Postpartum Depression is counterproductive to women with either condition. More screening is needed all around. I agree that PTSD is a serious, under recognize problem, so is perinatal depression. Screening is a first step towards helping women to move towards a healthier, happier place.

  6. avatar
    Gabrielle Kaufman
    April 30th, 2013 at 17:53 | #6

    I applaud Dr. Wisner’s efforts (and Walker Karaa’s for that matter) in helping make maternal depression and anxiety a key part of the discussion of motherhood. It has taken so long for women to finally be willing to risk sharing their feelings of anxiety, sadness and pain for fear of being judged. While screening is not always going to catch every symptom and issue, it is a huge step in the right direction to reducing stigma, helping the mom and in that way, helping the mother/child bond. Very often, there is a trauma that occurs prior to or during delivery. Sometimes these symptoms manifest in anxiety and depression, if screening catches even one of these women and enables her to get help, we are making a big difference. Thank you Dr. Wisner and Walker for spreading the word, and not EVER giving up!

  7. April 30th, 2013 at 18:20 | #7

    In reply to Henci, depression and anxiety are preeminent postpartum mood disorders precisely because those are the illnesses/symptoms that most women with postpartum illness experience. This doesn’t put the any blame on the women for having it.

    And as far as postpartum PTSD goes, there is a lot of talk among perinatal mood and anxiety experts and advocates about PTSD. We share stories about it on my site and consider it very important. Making sure women are identified and screened for postpartum depression and anxiety shouldn’t need to go by the way side simply because we also need to do a better job of identifying postpartum PTSD. You write, “The incidence of emotional trauma can be minimized by reducing the overuse of cesarean surgery and other painful and invasive treatments, by implementing shared decision-making, and by providing physically and emotionally supportive care.” This assumes that most women who have PPD come to it because of stresses they experienced in the childbirth system, and that is not an assumption I’m willing to make.

  8. avatar
    Diane Meyer
    April 30th, 2013 at 18:24 | #8

    Have to wonder about people who use wonderful research such as this as a platform to launch their own personal aggression. Not sure who it is directed at…physicians?…researchers?…the mothers? But seems to be all of them. Henci should take it outside.

  9. April 30th, 2013 at 18:33 | #9

    This is a great article. I am an Australian relationship counsellor and we have had this screening for some time here now. Traditionally couples wait for seven years before they seek help, but I have noticed that since this screening, I am seeing clients earlier in their relationship – and because of that there is more I can do to help. I am trained to know the difference between PTSD and PPD and can refer accordingly. I’m also aware that depression (particularly during the perinatal period) is situational and needs to be addressed and managed within the relationship and wider context. I think screening is a great start and also serves to raise awareness of perinatal issues with both birth professional and parents.

  10. avatar
    Ann Grauer
    April 30th, 2013 at 18:42 | #10

    Thank you for bringing Dr. Wisner and her important work to the forefront. I have been reading her for awhile but it was nice to “hear” her voice in the interview. I was especially pleased that she spoke of anxiety with depression. I have yet to meet a mom with a PMD where anxiety is not one of the most frustrating factors for the mom. I know that she has much more to say and I am hopeful that she will now be on the radar screens of many more people.

    I read Henci Goer’s remarks with mixed feelings. As a childbirth educator and doula for 25 years I agree that more needs to be done to get information out about what causes PTSD after childbirth and how we can prevent it. We absolutely have to do a better job of minimizing and emotional trauma. I am fully on board with being a part of that.

    However, BOTH issues are worthy and require our time and attention.
    Those who are working in the field of postpartum depression and other perinatal mood disorders deserve our applause and support for not allowing this topic to fall to the wayside.

    I run a perinatal mood disorders support group. It is the only one in the entirety of southeastern Wisconsin. The. Only. One. We have hospitals galore and only one support group for this topic here. As a rule moms are not being screened for PMD’s during pregnancy, after birth or at postpartum checkups. ACOG says it’s not necessary because it affects such a small number of the population (though they think VBAC is far more dangerous, even though a separation of the scar tissue occurs far less often than PMD’s—go figure). Pediatricians don’t want to do any screening because the mother is not their patient (but the mom’s mental health is critical for “their patient” to thrive) and, of course, there is no way to bill for it. Moms see pediatricians more often in the first year of their babies’ lives than they see any other healthcare provider. Many, many missed opportunities.

    I hear all the time, “Why screen. We don’t know where to send those women if they need help”. To my way of thinking, this is unacceptable. We have a responsibility to look at the mother in her entirety—body, mind and spirit. Her health in all areas should be our concern.

    I train birth and postpartum doulas for DONA International. In DONA’s birth and postpartum doula workshops we teach doulas that they must find a referral for this PMD’s and traumatic birth ASAP so that they are not looking in a crisis. And, we give them a self-screening tool for the mother to do herself–in the doula’s presence. We do not want the mother to be alone if she self-actualizes a problem.

    Mothers have been getting the shaft when it comes to mental health for too long. Whether it’s internal or external, they are not getting what the need and deserve. Time has come for us to not discuss which issue is worse. Rather, we need to take our intentions and energies and support mothers in the best way that we can as individuals and as organizations. If we don’t do it, who will.

  11. April 30th, 2013 at 19:19 | #11

    Thank you for bringing awareness about this important issue! As a doula and counselor, I think it is so important to discuss the reality of these conditions with clients. Screening is certainly not a perfect solution nor will it catch all mothers that are suffering. What screening does, is open the opportunity for discussion and to inform the mother and potentially her partner to the signs and symptoms that may indicate a problem.

    PTSD is much more complex that simply changing the system. Many women enter the system with pre-existing mood disorders that they have chosen not to disclose to their provider or partner, placing them in a very vulnerable and risky position. This has much more to do with the stigma around mental health than it does with the system. Some women lack the skills to advocate for themselves or the ability to believe that their voice and opinion is important in a room full of experts.

    If a provider discusses these issues with patients and recognizes perinatal anxiety or depression, the referral to a trained mental health professional can help the client gain the skills to potentially avoid a traumatic birth experience. Postpartum screening can help a provider refer a mother quickly to avoid losing valuable time and harboring negative feelings about her birth and/or motherhood. This is valuable time that can impact the infant as well. Research has clearly shown that the infant in the womb is impacted by the mother’s emotional state and can experience negative consequences including an increased vulnerability to mental health problems. Postpartum, infants whose mothers are experiencing mood disorders are at risk of cognitive, social and emotional delays in their development. These infants are also at increased risk of child abuse and neglect. These are significant consequences for the mother and the baby, the family, the community and society as a whole. While screening is imperfect, it is one of the simplest and most economical tools we currently have available to open up the discussion and allow mothers a safe opportunity to discuss concerns.

    I hope that we will continue to encourage the discussion of perinatal mood disorders without shame or blame to mothers, work towards improved ways to screen and help mothers, and improve the system in which women are currently birthing in. I do not think any of these goals are exclusive and I think that if we try to separate or take sides we will only weaken the position for both sides and ultimately limit what we are able to provide for mothers and babies.

  12. April 30th, 2013 at 19:45 | #12

    Great interview, so nice to hear these results and how we can help engage women in conversation about their mental health early and often. In response to Henci’s comment, I agree that it would be problematic to screen for one diagnosis at the risk of missing others, like PTSD. As a clinical psychologist familiar with the EPDS, I know that it asks about symptoms of distress that are common to all the anxiety, mood, and thought disorders we’re concerned about. The screening tool is not a diagnostic tool, rather a tool to let the woman and her care providers know that she is experience distress that deserves to be taken seriously. Follow up with a professional who can do a more careful diagnosis is essential. I believe in using a screening tool even if the only result would be the woman herself gains more awareness of her suffering and can then contemplate getting help.

  13. May 1st, 2013 at 01:05 | #13

    Love this interview and the comments too. Even with disagreement, my strongest reaction is that i am so VERY HAPPY that this dialogue is happening here, right here, with childbirth educators. I do appreciate Henci’s concern and think it’s impt to remember that a screening tool is just that — I’m sure Dr. Wisner would agree (and encourage providers) that the screen does not replace assessment and diagnosis if needed. Reassuringly, in all of the research and conversations I’ve been involved with this year, the issue of anxiety and PTSD is front and center, including those regarding screening in OB settings. As several have said here, the EPDS is only a screen not a diagnosis, and indeed it does pick up the results of anxiety and PTSD, but does no more with them. The person doing the screen should continue the conversation, or refer to somebody who can. Dr. W’s point is excellent about integrated care. The example of such integration is happening right on this site, right here, thank you Walker and S&S.

  14. May 1st, 2013 at 06:31 | #14

    Let’s not split hairs here, Henci. Screening is important!! Any responsible physician will do proper follow up.

    Excellent interview, Walker! I am impressed with your work, as always! More screening is imperative to postpartum health!

  15. May 1st, 2013 at 07:12 | #15

    I wish to chime in again, as I see this topic is sparking alot of dialog. Walker, as I said before, I am so happy that you are bringing Dr. Wisner’s research to a wider audience and that you continue to blog about maternal mental health on Lamaze S&S. To me, we are now beginning to publicly address the mindbody issue of whole care for the whole woman (and family) during pregnancy, birth & postpartum. I agree with Henci that there are many problems in our medical model of care of the birthing woman and we need to keep working towards modifying the medical model to be more compassionate towards birthing women and their families. As a former doula and ongoing CBE, I respect Henci’s lifelong dedication to this issue, and I know her efforts have helped to nudge along the re-emergence of the midwifery model of care for birthing women, a great accomplishment. I also don;t want to minimize the necessity of excellent medical care for women in individual situations. I also want to briefly mention that research supports PTSD can result from necessary and compassionate medical procedures. I worked as a family counselor in a Cancer Center and we had extremely compassionate care but the procedures are emotionally stressful to some. Just saying the relationship of medical procedures & PSTD is complex. As a clinician who works with perinatal mood disorders and trauma, I don’t want to minimize the issues of the other diagnoses such as PPA, PSTD(childbirth onset), postpartum psychosis, or PP-OCD, PP-BIP. Differential diagnosis is achieved by ongoing intake and assessment by a licensed clinician, not by a screening tool. A screening tool is used to identity and refer to a qualified clinician, who can do an ongoing differential diagnosis. And diagnosis can change as more clinical impressions come to light and treatment continues. There is a chapter on the reality of ongoing differential diagnosis in my PMAD pocket guide for childbirth educators. So, I appreciate and see many side to this issue and yet feel we are all working together for mush the same thing, integrated compassionate care for women in the childbearing year and their families. Namaste, my friends.

  16. May 1st, 2013 at 08:36 | #16

    Dear Henci,
    Please share your evidence. You may find the 25 years of studies done by Dr. Wisner and a myriad of scientists do not support your concerns nor your philosophy. I applaud the mental health and childbirth experts who have shared their scholarship, clinical experience and academic understanding of the data here. The EDPS is a self assessment measurement, available for free, with a well-validated done by women themselves…they are self reported answers. By definition, no one screens a woman for depression with the EDPS, she screens herself.
    One could argue that then, your concern is unfounded.

  17. May 1st, 2013 at 08:46 | #17

    Lastly, I believe that this discussion is evidence of the growth in childbirth educator knowledge and that the tide has indeed turned. Childbirth education is now aware of PMADs, and no longer comfortable dismissing, ignoring, or remaining ignorant of the evidence and need of their clients to have access to perinatal mental health education, resources, and support. My hope is that those who stay rigidly positioned against this progress will join the future of the field, learn the science, and apply some sensibility.
    Happy Mental Health Awareness Month!

  18. May 1st, 2013 at 08:58 | #18

    EPDS…auto type on phone!

  19. avatar
    Ann Jamison
    May 1st, 2013 at 10:34 | #19

    Really enjoyed reading this interview. As a coordinator with PSI, a survivor of PPD (and yes, PTSD too), I’d like to share my own thoughts here.

    First of all, I do not believe that PTSD is a systemic disease while PPD is an individual disease. Postpartum-depression and anxiety is often exacerbated by women having to make devastating choices that revolve around unpaid maternity leave (if any leave is available at all), limited childcare options, low or non-existent access to mental health resources, and by race and socioeconomic status. In fact, poverty is a huge risk factor for developing PMDs. Screening for PPD does certainly focus on what an individual is experiencing. However, I don’t think for one second that the conversation about PPD misses the point that our society simply does not do enough to support mothers.

    As for PTSD, it is absolutely true that women can be deeply traumatized in childbirth. And yes, we need a much more respectful system that respects women’s bodies and choices. However, I’m concerned that what we’re saying here is that the only way to eradicate PTSD in childbirth is to change the system. That is a very narrow view. For example, I run a birth trauma support group in SouthCentral Wisconsin. I see mothers who are traumatized by their too-fast vaginal births at home. I see mothers who had what most in the natural childbirth camp would call “dream birth,” who were unprepared for the pain and were left wondering why their births felt scary and bewildering instead of empowering.

    My point here is to challenge the notion that PPD is individual and PTSD is systemic. I don’t believe that’s an accurate view. In addition, I’m still not sure what the problem is with screening in general. If the concern is that screening tools will misdiagnose, I think it’s important to keep in mind that these are not diagnostic tools. These are screens that identify those that should see someone for a more formal evaluation. I would rather see screening be done to get women pointed toward mental health resources (which we need to increase, yes) rather than have nothing because we’re conflating diagnosis with risk assessment.

  20. avatar
    Christine Morton
    May 1st, 2013 at 13:19 | #20

    I have long shared Henci’s concern about what I perceived to be an emphasis in maternal mental health advocacy on depression as a condition embedded in women’s hormones/bodies that is ‘fixable’ by big pharma (and therefore a billable clinical encounter). I too worried that women’s emotional responses to their birth experience, including PTSD, would be labeled as pathological, when in most circumstances, for most people, such responses are very NORMAL. While there is a lot still to be done to improve systems of care so that women are treated with dignity and compassion, and to bring the birth experience into the discourses of PMAD researchers/ maternal mental health advocates, I also think that dialogue such as is happening here is critical in bringing new information and perspectives to everyone at the table. I’m heartened by the recognition among maternal health advocates that the EPDS is merely a screening tool–the first and NOT the last step– in the process of validating women’s mental health issues, seeking an appropriate diagnosis, and finding appropriate treatment with a trained professional. We have to start somewhere, usually where we ARE. The etiologies of PTSD, or depression, or other mood/anxiety disorders, are likely multi-factorial, making it hard to pick out one piece of the problem as the particular domain of one group and thus identify an easy solution.

    When Henci writes, “PTSD, however, is centered in the system, and therefore its cure depends on systemic reforms” – I’m sure she didn’t mean to imply that for any individual woman with PTSD the only cure is to fix the system! And she is right in that the system needs work!

    We also need to acknowledge that the current system inflicts emotional damages on the health care clinicians (obstetricians, nurses, midwives) who work within it, and to acknowledge the work that many maternity care clinicians are doing within their organizations to address these issues (as well as the problems of overtreatment and lack of effective treatment for women with pregnancy/birth complications) at this very moment. Every group of professionals involved in the care of pregnant women needs to own their part of the issue, and work to improve services and care that they have control/jurisdiction over. But every group also needs to reach ACROSS organizational and professional lines with helping hands and open hearts, in recognition of the fact that “we ALL have work to do”. Pointing fingers at other groups as the locus of the problem works against building effective coalitions based on trust and mutual respect. I think it’s only through effective coalitions among strong and healthy ORGANIZATIONS that true systemic change can happen. That means we have to muddle through as individuals, with our limited and partial perspectives and work together to create something bigger than any one of us can do alone.

  21. May 1st, 2013 at 13:50 | #21

    Even with exposure to trauma, depression remains the number one symptom and has been shown to impact PTB, LBW, low APGAR scores, etc. What is noted in Dr. Wisner’s current study of 10,000 women is important. Of those who screened positive with score higher than 10 on EPDS: 68.5% had unipolar depression–most of which (65.0%) were recurrent episodes. Wisner et al., (2013) “Consistent with epidemiologic studies, most of the screen postpartum women (91.1%) had primary mood disorders. Also consistent is the finding that the most common diagnoses identified were unipolar depressive disorders, with the overwhelming majority being Major Depressive Disorder” (p. E6).

    Other findings:
    46% had anxiety disorders, from which 10.5% had Posttraumatic stress. This demonstrates that EPDS does in fact pick up PTSD because the symptoms of PTSD are predominantly symptoms of depression)

    22.6% had bipolar disorders. For a screening instrument NOT designed to pick up bipolar disorders, this number is alarmingly high.

    Moreover, suicidal ideation was a significant finding with a rate of 3.2%.
    As it is the largest American population to have undergone screening with the EPDS, I encourage everyone to read the study. It is linked in article.

  22. May 1st, 2013 at 14:12 | #22

    And Christine…thanks for input. I feel comfortable saying that the pre eminent researcher in the field of perinatal mood and anxiety disorders agree to do an interview for Lamaze is the reach across you suggest. Just as Nancy Byatt, Cheryl Beck, Louise Howard, Vivette Glover, Michael Lu have agreed to do with me for Lamaze. Where is the reach from Lamaze?

  23. May 1st, 2013 at 17:21 | #23

    From http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml
    What illnesses often co-exist with depression?

    Other illnesses may come on before depression, cause it, or be a consequence of it. But depression and other illnesses interact differently in different people. In any case, co-occurring illnesses need to be diagnosed and treated.

    Anxiety disorders, such as post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder, often accompany depression.3,4 PTSD can occur after a person experiences a terrifying event or ordeal, such as a violent assault, a natural disaster, an accident, terrorism or military combat. People experiencing PTSD are especially prone to having co-existing depression.

    In a National Institute of Mental Health (NIMH)-funded study, researchers found that more than 40 percent of people with PTSD also had depression 4 months after the traumatic event.5

    Alcohol and other substance abuse or dependence may also co-exist with depression. Research shows that mood disorders and substance abuse commonly occur together.6

    Depression also may occur with other serious medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson’s disease. People who have depression along with another medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have co-existing depression.7 Treating the depression can also help improve the outcome of treating the co-occurring illness.8

  24. May 1st, 2013 at 17:23 | #24

    What causes depression? Research indicates that depressive illnesses are disorders of the brain.http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml

    Most likely, depression is caused by a combination of genetic, biological, environmental, and psychological factors.

    Depressive illnesses are disorders of the brain. Longstanding theories about depression suggest that important neurotransmitters—chemicals that brain cells use to communicate—are out of balance in depression. But it has been difficult to prove this.

    Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain involved in mood, thinking, sleep, appetite, and behavior appear different. But these images do not reveal why the depression has occurred. They also cannot be used to diagnose depression.

    Some types of depression tend to run in families. However, depression can occur in people without family histories of depression too.9 Scientists are studying certain genes that may make some people more prone to depression. Some genetics research indicates that risk for depression results from the influence of several genes acting together with environmental or other factors.10 In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Other depressive episodes may occur with or without an obvious trigger.

  1. May 3rd, 2013 at 08:20 | #1