For decades, thousands of people in dozens of organizations have fought tirelessly to reduce the stigmatization and ignorance associated with mental health issues and mental disorders. Mental illness is not something you can just “get over,” nor is it an invention of the pharmaceutical companies …

48 Comments to
Postpartum Depression: Real, But Still Stigmatized

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  1. The first time I had a baby, I was almost through with the postpartum depression before I even realized I had it. The second and third times, it became progressively worse.

  2. So anyway, before I was interrupted and rushed to post something, I was going to say that education is critical, especially education that includes solutions.

  3. Having seen two patients today who were referred for post partum depression issues, I see the same theme today as with other patients a lot: a common dynamic. especially with first time moms, is being a single parent and being overwhelmed as with few if any supports. So, is the issue a biochemical matter needing meds, or at least in conjunction with therapy and quick case management access to provide options and access to supports?

    That is what this legislation is not addressing and will not provide the level of funds to have the impact to lessen the consequences of untreated/undertreated post partum-associated depressed features.

    And if anyone dismisses this comment, ask them why.

    they have a pill to sell you, I would be surprised if otherwise. Road to hell, folks!!!

  4. You are my hero, Dr. John Grohol!

  5. Therapyfirst,
    I’m not sure where you’re coming from with your comment, because we talk about the social issues related to PPD all the time. It is not simply a biochemical illness. The options and access to key supports you mention are crucial, and always part of any serious discussion about the treatment of perinatal mood and anxiety disorders. None of that is missing from the text of the Melanie Blocker Stokes MOTHERS Act. There is ZERO language in the bill discussing how the funding will be allotted, and if the experts and fantastic advocates I know have anything to do with it, the issues you talked about will be at the forefront.

  6. Thank you SO much for writing this.

    To further rebut Mr. Philip Dawdy at Furious Seasons I’d like to suggest he educate himself about dear Ms. Charlotte Perkins Gilman. She was one of the first women to speak out about her experience with anxiety and depression after childbirth. Gilman did so by penning The Yellow Wallpaper WAY back in 1898! So no, dear Philip, advocacy for Postpartum Mood Disorders is NOT a phenomenon of the past 10 years. It’s just that our collective voices have finally gotten loud enough, brave enough, and determined enough to garner motivating attention to our cause.

    Where did it get her? She lost her husband and custody of her daughter. BUT her courage in speaking out also changed the view of at least one physician and we can hope maybe even a few more.

    If anyone is interested in reading more about her story, you can do so here: http://tinyurl.com/c67usg.

    Thank you again, Dr. Grohol for your post and your support.

    Warmest,
    Lauren

  7. I have to say I think Ms Stone and other supporters of legislating medical care needs are innocently naive or living in a fantasy place that the average citizen will never see! You really think that asking non-psychiatrists to be the assessors of post partum presentations will make the best effort to get these alleged patients into the best and appropriate care options? Some will, I’ll give you that. But do you think legislation takes into account that treatment takes time, money and energy? No, pharma will lobby that their meds are the easiest and quickest answer, that is what will resonate in politicians’ ears, and the end result will be too many women will be on meds that they may not necessarily need. I may not agree with all that Mr Dawdy writes, but that quote in the post is on the money to me.

    And, as I finished in that last post, why are you dismissing what I say, Ms Stone? You have concrete interests in pharma or other profitting mechanism to this legislation? Some transparency for the average reader, please?

    I see this stuff being on the front line, and I think I have the right to be as critical and tough as I should. You don’t like the challenge and criticism, fine! In the end, it is deeds, not words that define agenda and goals. We will see if this passes if I am right or wrong. The question I ask of you to return to once this is in place for a year or more, did you do right in championing this or do women a disservice, and can you live with yourself if you were wrong. We’ll see who is right, and who may be sad.

    There’s an ironic end to a comment, eh?

  8. Is there an auto-responder with this topic, where if someone disagrees with the resistance to the bill, they are immediately in bed with big pharma, and greedily counting the profits after slamming every mother post partum on medication?

    It’s getting quite old.

    Having a screening process in place would have saved many of us from suffering. I went thru it twice, and neither time was I put on meds. Until I was diagnosed bipolar quite some time after my last pregancy. I had been suffering symptoms of PPD and bipolar all through that pregnancy, not that anyone asked or noticed.

    Dreams of throwing your child through a window 3 days after giving birth to her, and critize then. I suppose it would be better to sit back and do nothing, just to be damn sure no one is on any medication ever.

    And no, I don’t believe medication is the best first answer, even if it is the one thing that has saved MY life.

    Women also gave birth at home, with their families around, but I don’t hear anyone yelling to reinstate that, even if it would also help the problem. But vaginas, and the people attached, they aren’t real people now are they.

  9. I would just politely remind commentators not to disparage other posters here, nor make insinuations about their motivations. We don’t really know one another here, and suggesting that we do, or that we can somehow divine one’s personal motivations from a few words is unwarranted.

    People are not black and white nor are these kinds of issues.

    Legislation that calls for more money for education and information dissemination is hardly “legislating medical care.” It’s that kind of simplifying of these issues that makes people angry, because it’s simply not what this particular piece of legislation is about.

  10. There are people whose ignorance directs them to offer prejudices about many things, generally we argue educating them is the path to take.

    When, however, someone argues there –is– (please note the affirmation) a “stigma” to a mental illness, we join them. It is a peculiar partnership we make with the prejudiced, to become their partners. Why do you suppose, instead of disputing them, we join them?

    When women addressed that pretense with rape they refuted it outright. We assert it. We are strange.

    Harold A. Maio
    khmaio@earthlink.net

  11. While I will genuinely apologize if my comments are disparaging to others, I am really surprised people are so eager to accept that politicians know how to implement diagnosis and treatment. I will go on a search and find out what prior examples are out there (or if other readers have quicker replies, please weigh in) that show how political interference almost always goes awry, even when the best of intentions were intially intended.

    By the way, I think I have been fairly transparent to my reasons for being so vocal for my opposition, and yet I read just generalities by others. Why can’t people just reply that they have “such and such investment” as a clinician or experienced patient or other reasonable cause so readers can truly see why people are speaking out so strongly about this issue.

    Otherwise, to come across as murky or vague does legitimately raise questions to the intent of supporting this legislation. What I sense is an ulterior motive has validity until proven wrong.

    A fair request. Hopefully respected and replied to. Sorry I am so harsh about this, but I am tired of intrusions by others (politicians here)who really have no business being involved in the first place!

    Hello out there, remember how managed care got involved due to ERISA? Is that something to wake up clinicians who have been screwed by legislation?

    Or perhaps some people aren’t practicing clinical care these days, just in ivory towers or speaking at seminars. Some of us involved at these sites read here to use info to help patients!!!

    Your “12 reasons what patients learned from therapy” post was quite well received by colleagues, so if I am going to refer readers here, I don’t want to look bad by association, as many do not like this issue with legislating treatment interventions.

    I hope this perspective is at least heard.

  12. you know if mothers give natural childbirth and didn’t get loaded up with SYNTHETIC hormones the natural hormone Oxytocin is released and allows for normal bonding and makes the mother feel HIGH!! And HAPPY…we mess with nature it messes with us.

    See the documentary The Business of Being Born—beautiful movie.

    I’m super heavy into the loss of natural childbirth being a big part of the escalating mental health crisis…

    that being said, there is no denying mothers and fathers, for that matter, need support early on and should get it, but legislating screening that encourages drugging is not the way to go.

    most of the people opposed to this bill have horror stories of the drugs causing havoc and once they got off them they felt much better…these are women who suffered from the TREATMENT.

    how many women will be told of the risks of SSRIs?? If it’s anything like the rest of psychiatry most won’t be told.

  13. If ONLY I had been given the tiniest bit of information about the possibility of “PPD” I could have avoided SO MUCH pain for me and my family. Maybe I’d also have avoided a stay in the psych ward as well.

    It took FIVE years before I heard the entire phrase “Postpartum Depression”. When I finally had the phrase and looked it up, it fit me like a painted-on glove. I had risk factors (previous miscarriage, for one) and could so easily have been identified as possibly at risk for a perinatal mood disorder. And educated about such. But noooo, I got the “school of very hard knocks” education in PPD.

    Thank you Dr. Grohol for sharing your understanding views. You’re definitely one of the good (and informed) guys.

  14. (Therapyfirst) and Gianna, You had me at “The Business of Being Born” and I was nodding along at all your comments-until this:

    “…there is no denying mothers and fathers…need support early on and should get it, but legislating screening that encourages drugging is not the way to go.”

    I encourage you and all opponents to get to know about the work of postpartum advocates. Whole organizations were founded on the idea of increased social support. Some of these fine organizations are criticized today while their agenda has not changed!

    Find out what they actually do and stop reacting to what you imagine they do.

    For over ten years I have advocated for non-pharmacological approaches to PMADs AND I support The MOTHERS Act. As an advocate, I know the climate of support focuses on non-pharm approaches first. If the opposition really understood this point, they would happily become advocates themeselves and spend their energy creating solutions.

    We could actually work together! We know the system is not perfect, but if there were more talented, passionate people out there willing to make a difference how much further along would we be?

    Of course women need informed consent when they use any medication. It IS tragic that there are tragic outcomes for some. Together we could find ways to minimize these outcomes or eliminate them through education and the use of alternative methods- which are, by the way, FASTER and CHEAPER.

    The truth is: some women want and need meds and respond well to meds and many more do not fit into this category. I’m thankful women are treated in many different ways and I will continue to advocate for balance.

  15. Cheryl you suffer at the hands of indiscriminate psychiatry and maybe you’d understand why we fear this. Most places, most often WON’T offer drug alternatives…even if it’s in writing.

    AD’s are handed out like candy everywhere—the myth still being they are safe. If and when I can feel assured that TRUE INFORMED CONSENT would be practiced and options offered and education on the value of natural childbirth and breastfeeding is routine, then sure I’ll get on board. But I don’t buy for a minute that any of that is in place to happen right now.

  16. therapyfirst,

    I’m not at all dismissing what you say. I apologize sincerely that I made you feel dismissed. What I was trying to do was respond to your concerns about medication being advocated over other types of supports. Perhaps I wasn’t clear in trying to indicate that I agree with you that PPD is not 100% biochemical — there are social risk factors for the illness, including poor relationships, lack of support in caring for the baby, past and/or current abuse, major life traumas, economic stressors. The people who advocate for this bill are believers in creating the type of supports needed that we hope might one day prevent some women from getting ill in the first place.

    I’m not sure how I’ve come across as murky or vague. I’ve never been anything but transparent. To be clear, I make no money off of my blog whatsoever. I’m a full-time VOLUNTEER advocate, just so that you know where I’m coming from. My investment in this is as an experienced patient, and also as someone who has spoken to hundreds upon hundreds of women who’ve gone through it.

  17. Thank you Dr. Grohol for this post on behalf of women who have suffered from and/or currently suffering from a perinatal mood disorder.

    Had I known what to look out for in terms of PPD, my (one and unfortunately only) experience following childbirth would have been so, so different. I have no regrets except that I survived my experience a stronger and much more knowledgeable person. My eyes are wide open. I see how everyone is unique and their experiences are all different. Instead of attacking each other, why can’t we find ways to work together (thank you Cheryl for your comments)?!

    I’ve only been blogging for 2-1/2 mos now and I have to say thank you to the tireless efforts of Katherine Stone and others to help other women. I am already tired of writing the same things over & over. Mandatory screening is not written into the bill. I realize that there are those who are completely skeptical that this bill doesn’t automatically mean meds (these folks have every right to feel that way from their own negative experiences). However, let’s not let our hatred of meds get in the way of the big picture here, which is the need to help mothers in this society. We’ve been silent for way too long. There is critical need for early intervention (e.g., public awareness, info availability, stopping the myths and stigma, increased support services). I believe that, without this legislation, improvements in 1) public perception toward moms with PPD, 2) research efforts to improve existing treatment options and ability to detect PPD earlier and thus minimize the impact on mothers, 3) availability of support services, and 4) quality of care by medical/mental health practitioners will continue to crawl at a snail’s pace like it’s done for centuries…..and at what cost?

    How many more mothers (and families) must suffer before people realize that something must be done to help mothers (and families) in this country?

  18. While I support the Melanie Blocker Stokes MOTHERS Act, I do wonder if it will lead to anything more then labeling rather then the very outcomes we would wish. Can we reasonably expect that a system in “shambles” according to the members of the President’s New Freedom Commission of Mental Health and recently given a D grade by NAMI will naturally foster preferred outcomes? Does it merely engender outcomes reflecting its long standing inadequacies?

    There is something disheartening when persons are given the message – identify, reach out and recover – given that most fail to receive (1,2, 3) the optimal care associated with the favorable outcomes frequently cited as the norm. Perhaps things will be different this time if the words and deeds intersect but based on previous initiatives, legislation, and the like may be unlikely.

    (1)The Quality of Care for Depressive and Anxiety Disorders in the United States, Alexander S. Young, MD, MSHS; Ruth Klap, PhD; Cathy D. Sherbourne, PhD; Kenneth B. Wells, MD, MPH
    Arch Gen Psychiatry. 2001;58:55-61.

    (2) Recent Care of Common Mental Disorders in the United States Prevalence and Conformance with Evidence-Based Recommendations, Philip S Wang, MD, DrPH, Patricia Berglund, MBA, and Ronald C Kessler, PhD.J Gen Intern Med. 2000 May; 15(5): 284–292.

    (3) Mental Illness Said to Affect One-Quarter of Americans; NIH Report Cites Problems With Adequate Treatment; A Debate Over Definitions. Leila Abboud. Wall Street Journal. (Eastern edition). New York, N.Y.: Jun 7, 2005. pg. D.1

  19. A few comments if allowed:

    First, I appreciate Ms Stone’s reply, so I have a better understanding of her perspective. Make no mistake I am nothing less than a full supporter of women accessing treatment for Post Partum Depression, as much as any other illness, and there should be zero tolerance of anything less.

    I am not clear to Joe’s comments about the President’s New Freedom Commission of Mental Health, is this a Bush or Obama intiative? Nonetheless, let me make one statement that may attract disagreement, but it is based on the history of what politicians are about: the mental health care community, based on clinicians, patients, families of patients, and invested other parties, are not seen as a strong enough lobby to gain attention and support of politicians. And the main reason is, the majority of mental health patients do not vote, therefore, they do not count to our alleged representatives both locally and nationally. Therefore, what sparse efforts we have seen offered by politicians in the past decades is superficial and fluff until proven otherwise. One strong exception was the Surgeon General’s report on mental health care issues while Clinton was still in office, but that is the only one I can think of at the moment.

    Face it, you want to make an impact on improving mental health care in this country, you have to vote, vote for people who are interested in representing you, and not tolerate incumbents who are only invested in themselves and their cronies.

    The current crop of politicians, the few exceptions aside, will only continue myths, misperceptions, and stigmas as long as they stay in office. Don’t believe me, just review their records regarding mental health opinions and actions.

    Sorry I am cynical and jaded. 20 years of seeing the same old garbage year in and out wears you out!

    Deeds, not just words. And post partum issues are just the tip of the iceberg of what are the mental health care needs in this “sea” of our culture.

  20. I wanted to thank you so much. Thank you for your voice of support. Thank you thank you thank you. I continue to discover more about the effects of my PPD and PMDD.

    We need more light on this and we need the stigma to change.

    Thank you!

  21. John M. Grohol, Psy.D. – The best blogger in the field of mental health, hands down!

    Forgive this little detour into philosophy, but this discussion illustrates a HUGE problem in the field that, until properly addressed, will continue to generate the illusory division between the “Pro-education, pro-information, pro-evidence-based-treatment” camp, and the “Anti- Big Pharma” camp.

    The confusion, frustration, and feelings of being misunderstood (“Wait a minute, that’s not what I mean at all!”) reflect the basic confused theoretical framework underlying the fields of psychiatry and psychology. The notion that chemical imbalances or “brain diseases” cause psychological problems is so embedded in our discourse it’s taken for granted. The whole language of “disease,” “disorder,” “diagnosis,” and “treatment” presupposes it. So, despite our best efforts to talk the “bio-psycho-social” talk, all that stuff ends up sounding a lot like lip-service when, come on now, we all know that it basically comes down to the brain! The disease model takes a partial truth (namely, that ALL subjective experience correlates with some pattern of neurological/biological activity), ignores several other partial truths (like that life experiences can and do shape the structure and function of the brain), and arrives at a badly distorted way of understanding and dealing with the very real problems affecting people.

    This distorted framework is what’s muddling this discussion on post-partum depression (in my opinion). In fact, it doesn’t matter what disorder we’re talking about, the same issues will pop up again and again.

    NO ONE is against education, the dissemination of information, and the practice of evidence-based approaches. NO ONE! But how do we decide what kind of information gets disseminated? How do we decide what a “real” disorder is? How do we decide what research to conduct, how to interpret the results, and what research to ignore?

    Everyone agrees that:
    • The experiences reported by suffering people are REAL.
    • Psychological problems are REAL.
    • People experiencing psychological problems should be helped, and helped using the BEST available approaches which cause the LEAST HARM possible.
    • People should be educated and informed about the BEST approaches available to deal with psychological problems.
    • The pharmaceutical industry should NOT dictate what gets included in diagnostic manuals, treatment guidelines, university research agendas, college courses, or the general public’s ideas about the nature of psychological problems.
    • The pharmaceutical industry HAS had an undue influence on all of the above.

    I’ve personally worked with hundreds of people who have suffered greatly from psychological problems. I know their suffering is real. But that doesn’t mean I have to buy into the notion that they have a disease. I’ve seen many helped by medication, even people who would fall apart completely without it. But that still doesn’t support the notion that people have diseases and that those diseases are being “treated” by the meds.

    Until psychology and psychiatry have a sensible, comprehensive theoretical framework (and this can’t happen when the DSM, NAMI, and leading academic researchers are unduly influenced by Big Pharma) we will fall into the same ruts again and again.

    Wow! That was a rambling, woefully unclear post! To sum up: Great blog, great discussion, and philosophy is important!

  22. You write that among other things the legislation will have the effect of:

    “Requiring the Secretary of HHS to conduct a study on the benefits of screening for postpartum depression and postpartum psychosis.”

    Whoah, there, shouldn’t there have been some study already conducted to determine if screening is beneficial before making screening mandatory?

    How con you recommend something that hasn’t been determined to be helpful(not a rhetorical question)?

    My experience is similar to that of Bob D. who writes:

    “I’ve personally worked with hundreds of people who have suffered greatly from psychological problems. I know their suffering is real. But that doesn’t mean I have to buy into the notion that they have a disease. I’ve seen many helped by medication, even people who would fall apart completely without it. But that still doesn’t support the notion that people have diseases and that those diseases are being “treated” by the meds.

    Until psychology and psychiatry have a sensible, comprehensive theoretical framework (and this can’t happen when the DSM, NAMI, and leading academic researchers are unduly influenced by Big Pharma) we will fall into the same ruts again and again.”

    I couldn’t have said it better myself.

    Though I must confess I also agree with TherapyFirst who writes:

    “… I see the same theme today as with other patients a lot: a common dynamic. especially with first time moms, is being a single parent and being overwhelmed as with few if any supports. So, is the issue a biochemical matter needing meds, or at least in conjunction with therapy and quick case management access to provide options and access to supports?”

    I don’t like the idea of making women who fail a screening being forced to pay for therapy or even case management, god forbid for meds. And since even those who believe in screenings understand that the most egregious cases are the ones not picked up in screenings, uh, like Andrea Yates, why don’t we pass umbrella legislation providing financial support for childcare and food and prenatal care for women and children, all women and children. That is something Charlotta Perkins Gilman would have wanted – not this sexist, degrading stigmatizing, that by the way makes institutionalization more likely than in Perkins day and of course robs, with it’s stigma, the mother of custody rights to her child. The road to hell indeed…

  23. Government backed and pharma lobbied, just makes a person wonder what drugs will be promoted by PCPs and Ob/GYN’s.

    There are women who could end up on meds for no reason, just like over-zealous doctors who medicate children for “bipolar”.

    No one here denies that PDD is not a real event in a woman’s life, but just because it happens to some it doesn’t mean ALL.

    As a mom of 3 w/out any post partum issues, I am against anyone assuming I will, especially the government and pharma! give me a break, like these programs run smoothly?

  24. Let’s see if we can even fathom this delicate issue for a moment, while attempting to get past the obvious conflicts of interest involved here with “Psych Central”?

    Does government have a right or even an obligation to intercede on a said person’s HIPPA protected Health Care Rights and Choices?

    Our Constitution and Bill of Rights may tend to point us in a completely other direction in relation to individual’s rights and self determination in these deeply personal matters as in this case related to PPD.

    If government is going to mandate intrusion upon personal liberties and choose {since you are talking “Women’s Rights” here; shall we add abortion into the foray as it relates to choice also}. The privacy issues alone make this bad legislation in fact.

    I would say personally, they (The Government) better have stronger evidence and reasoning than an unconfirmed 10-20% incidence ratio, and some form of impending, looming, or emergency health crisis to build that “Mother’s Act” case upon quite frankly.

    If you’re running ads for Big Pharma on a site for profit as “Psych Central” without doubt does; and then you take a stance that appears on the surface and without much debate would benefit those Advertised Interest. Then just maybe those opinions could be and should be seen as less than independent or free from being influenced by those stating them.

    Ironic that this opinion that John M. Grohol, Psy.D. made here falls pretty much directly in line with those of the Pharmaceutical Industries take on this issue. Is that just a coincidental, or some serious food for thought to be added into this conversation?

    We all should know by now what is going on concerning the bad science, tainted studies, poorly ran clinical trials, criminal activities, and undue influence, and as added bonus thrown into the mix, that these drugs side effects and consequences that even our own FDA has taken a back seat to as it relates to the Pharmaceutical Industry and it’s scandalous activities.

    Independent evaluation -vs. – conflict of interest! Psych Central – vs. – Furious Seasons!

    That argument and difference of opinions should be weighed in the light of this dialogue, or it means nothing more than continued Pharma Peddling and propaganda for dollars. Thus in reality, it would be no argument after all.

    Please be aware that those opposition voices that were once called anti-medicine, anti-psychiatry, and even “Scientologist” to discredit their validity; are now becoming no longer a fringe element of distraction; but quickly becoming the majority voice among those who truly advocate, are involved with, and are living with altered mental constitutions or conditions.

    The “Mother’s Act” is bad politics, bad law, bad policy, and bad for America!

  25. @RU… Really? Wow. You leave me speechless with your logical rhetoric (guilt by association, an oldie but goodie).

    My record is out there since 1995 for all to see; I don’t hide my conflicts, nor my extensive calling out of the pharma industry in this very same blog when they behave badly. Suggesting that influences my opinion shows how little you’ve actually read here on Psych Central, which is too bad, because you’re missing a great deal of the nuance.

    And I suppose that’s the point, folks. Issues are not black and white. You can have legitimate concerns about the MOTHERs Act. But you’ll do your argument a great deal of good if you make some reasonable points about what specifically is bad about the act or what your specific concerns are (based upon the actual language of the Act, not someone’s interpretation of it).

  26. @Sally… Just another part of the misinformation campaign about the MOTHERS act.

    There is no language in the Act that mandates mandatory screenings for mothers for postpartum depression. It’s good FUD, and it makes for a bigger blogger controversy, but it’s simply not in the Act’s language. And then the followup about all the bad things that will supposedly happen to mothers who fail these illusionary screenings is also more FUD.

    I’m all for debating an Act’s merits on its, well, merits. But not on conjecture and lies that appear nowhere in the language of the Act itself.

    As for psychology and psychiatry having a more established and practical theoretical framework? Absolutely, that would be desirable. So would an affordable healthcare system in the U.S. I don’t see either coming anytime soon, however, so we have to work with the systems we have today (no matter how limited or limiting they may be).

  27. Why stop there? Let’s screen everyone.

    I don’t appreciate the intrusion and would decline participation in the screening.

  28. http://dissidentvoice.org/2009/04/mothers-act-bad-movie-rerun/

    By Evelyn Pringle

    “Pregnant women and nursing mothers are rarely told that antidepressants take anywhere from three to six weeks to work, if they work at all. “We know that the natural history of depression means that many patients will improve within weeks whether treated or not,” says Dr David Healy, author of Let Them Eat Prozac.

    “The overwhelming majority of women who are prescribed antidepressants are at little or no risk for suicide or other adverse outcomes from their nervous state,” he points out

    “Treatment runs the risk of stigmatizing the person,” he says, “as well as giving them problems that they didn’t have to being with.”

  29. Mothers Act: Bad Movie Rerun
    by Evelyn Pringle / April 15th, 2009

    Pregnant women and nursing mothers are rarely told that antidepressants take anywhere from three to six weeks to work, if they work at all. “We know that the natural history of depression means that many patients will improve within weeks whether treated or not,” says Dr David Healy, author of Let Them Eat Prozac.

    “The overwhelming majority of women who are prescribed antidepressants are at little or no risk for suicide or other adverse outcomes from their nervous state,” he points out

    “Treatment runs the risk of stigmatizing the person,” he says, “as well as giving them problems that they didn’t have to being with.”

  30. I doubt Dr Grohol or Ms Stone would agree this is an example equivalent to this pending legislation, but I offer it anyway, and it is related since it involves women: HPV vaccination. Are people aware that at least two states made this mandatory after it came out, although last I heard it was retracted and returned to voluntary status, but doesn’t that bother people that an alleged intervention became a “ward of the state” and an intrusion into adolescents’ own choices? And, don’t argue for one second that the manufacturer was not in some way behind the scenes in pushing for more universal consideration, even if not directly involved in the mandating situations.

    I will say this in Dr Grohol’s defense about the commentary at Furious Seasons regarding this matter, some people are taking this further than I believe it should go. I agree that you (Dr G)have said your share of negative comments about meds here, and I have voiced my support you post such comments. All I can say is, we run the risk of guilt by association, so running psychotropic ads does cloud the agenda for some. I would offer you consider caution in being associated with some of the companies who are less than savory these days, like Astra Zeneca as one example. A gentleman’s bet they would make a play for an indication with Seroquel for P.P. Depression if this legislation passed? The seasoned players to this matter would not hesitate to agree with me!

    Just an opinion.

  31. RU Conflicted -
    RU speaking from personal experience with PPD? Your philosophizing doesn’t do much good here when so many women suffer from these illnesses each & every year.

    Claire/Sally -
    Screening isn’t mandated by this bill. Even if it were a person has THE RIGHT to turn it down. It’s only meant to help, not harm, just in case because the occurrence rate is, after all, fairly high (1 out of 8 moms). Just because you haven’t suffered from a postpartum mood disorder doesn’t mean you should speak on behalf of all that do or may at some point.

  32. This is what it says: “C) SCREENING AND REFERRAL- A State that receives a grant or contract under subsection (a)(1) shall ensure that new mothers, during visits to a physician, certified nurse midwife, certified midwife, nurse, or licensed healthcare professional who is licensed or certified by the State, within the first year after the birth of their child, are offered screenings for postpartum conditions by using the Edinburgh Postnatal Depression Scale (EPDS), or other appropriate tests.”

    You’re right it says “offered.” Are they going to say, “Would you like to be screened for a mental disorder?” I doubt it. Those states that receive the grants will screen new mothers. I doubt seriously that it will be presented as completely optional.

  33. Screening isn’t mandatory, huh, below is the language from the proposed legislation itself.

    Section 502(C) SCREENING AND REFERRAL- A State that receives a grant or contract under subsection (a)(1) shall ensure that new mothers, during visits to a physician, certified nurse midwife, certified midwife, nurse, or licensed healthcare professional who is licensed or certified by the State, within the first year after the birth of their child, are offered screenings for postpartum conditions by using the Edinburgh Postnatal Depression Scale (EPDS), or other appropriate tests. If the results of such screening provide warning signs for postpartum conditions, the new mother shall be referred to an appropriate mental healthcare provider.

    Wonder what happens to those mothers who refuse screenings? Social services called in? It’s a de facto mandate.

    What about the women who have warning signs and can’t afford an “appropriate mental healthcare provider?”

    I’m not sure I get why we’re recommending this when the legislation itself states that there’s no research to indicate screening is helpful. As for education, it reminds me of the one about the team of psychiatrists who go to Zimbabwe to interview the kids dying of cholera from drinking contaminated water to see if these kids have mood disorders…the entire epidemic of cholera could be ended by shipping in water for less cost than sending psychiatrists to interview the victims. Road to hell folks…

  34. We read the language differently.

    It clearly uses the verb “offered.” Offering something to someone clearly denotes they have the opportunity to accept your offer, or decline it. When I see my doctor with a complaint, he often makes me offers… “Well, would you like us to do a blood test and see if that shows anything?” I can say yes, I can say no. He doesn’t commit me if I decline.

    Perhaps I’m naive (and I’ll grant you that’s a possibility), but when a law says something will be offered to patients, I take it for face value that it’s something a patent can make use of if they so choose.

    The Act does not say what will happen if someone declines the government-mandated “offer.” Since there’s no language in the Act for recriminations or consequences for declining the offer, the Act itself does not mandate any type of screenings. It just directs that they be made available for those who want them.

    So just to be clear, I too would be against forced or mandated screenings for anyone. All of us should have the right to decline any medical or psychological advice or orders, as we do today.

  35. Dr. Grohol,

    Thanks for your response:

    “As for psychology and psychiatry having a more established and practical theoretical framework? Absolutely, that would be desirable. So would an affordable healthcare system in the U.S. I don’t see either coming anytime soon, however, so we have to work with the systems we have today (no matter how limited or limiting they may be).”

    I agree that we have to work within the current healthcare system, but do you really believe we also HAVE to work within the current theoretical framework? There are several integrative psychological theories out there—do a google search and take your pick! Or better yet, give us an explicit statement of your own theoretical framework. I have no doubt you hold an integrative, balanced perspective–it’s implicit in your blog. That’s why I’ve been reading it for years!

    We don’t have to work within the same old limiting philosophy of mental health. It’s a way of thinking and understanding, not a bureaucratic system we have to adapt to. We don’t tell patients, “I’m sorry, but you’ll just have work with those same limiting thought patterns.”

    I challenge you to write a post briefly outlining your theoretical orientation/philosophy of psychology. I bet you could do it in ten minutes. I triple-dog-dare you!

  36. Clearly your surface reading of the bill is reasonable, however, it’s not realistic and is in fact naive. Unexpected results of legislation are all around us. The entire 401k debacle for instance.

    There’s a real danger declining will be seen as proof positive of having the condition. And this is psychiatry we’re talking about. Remember those offered a chance to take their meds get forced if they refuse. And be honest, if a woman declines a screening, Grohol, what will you or an “activist” like Ivy think. Should this woman be allowed to keep her child? The offer is a part of the screening.

    Also, it concerns me that in spite of all the crowing about how this is feminist bill designed to help women and remove stigma from women who murder their children (uh such stigma should remain), there’s no language about helping women in the bill. The language is anti women rhetoric about protecting society including children from people (all of whom by definition are women).

    From Section 2(12)

    “Untreated, postpartum depression impacts society through its effect on the infant’s physical and psychological and cognitive development, child abuse, neglect or death of the infant or other siblings, and the disruption of the family.”

    The language is the antithesis of what is supports are billing it as.

  37. @Bob… I’d be happy to do so (and will take you up on that offer sometime in early May as I’m heading out of the office for awhile), but you also illustrate the problem nicely — if there are dozens of alternative theoretical approaches, how do we choose from so many? How come none of them have risen to the top, if they are so clearly better than the system we use today? Certainly if all clinicians tomorrow said, “I will no longer use anything but X,” I don’t see how we could go wrong…

    @Sally… I believe reasonable people can disagree with the intent of the bill, and what its current wording means (or does not mean). We all live with unintended consequences of too much government in our everyday lives, so I very much understand where you’re coming from. And certainly you have historical precedence in terms of psychiatry and forced treatment (ala TAC).

    But just as I can refuse any medical procedure today without recrimination, I am assuming the same is true of this screening. Typically a federal agency would need to publish rules after a bill like this is passed with the details of implementing the act. At that time, we would have more solid grounds on which to debate this point (if, indeed, such rules called for some type of action if a person refused the screening; I have seen no indication from any government official or agency that that would be the case).

  38. I wonder, and this might be incorrect, if the description the screening is included simply to provide a definition about what would be researched. Not describing any sort of mandate of any sort (which ought to be clear that it is not by now).

    Just a thought.

    Also, I don’t often hear a lot of controversy about being checked at the Dr office every time with the blood pressure cuff and I’m asked to step on the scale. Those would certainly be two opportunities for Drs to write a mile long regimen of dietitian appts, blood pressure meds, meds known to have weight loss effect, etc.

    I’m not saying this is a 1:1 comparison, but I also don’t hear tons of controversy about how this pads the Dr and pharm company’s pockets. It’s considered “best practice”, and I imagine you could refuse to be checked in that manner, you could refuse to go to the doctor at all.

    Really, HHS is quite busy with the child removal cases they’ve got pretty much everywhere. In my state, there has been a push to reduce the number of kids in foster care/out of the home. I doubt that HHS workers would be really excited to hear that because of 10 answers on a questionnaire, their caseload is going to triple from all the baby removals they’ll be involved in.

    YES – some HHS workers go overboard, just like employees from all sorts of professions. But it just isn’t practical to assume that’s how this would go because of one piece of legislation.

    Don’t screen just because of some who have serious problems? (this might have been from another post) I am glad many women have great postpartum experiences. Every woman who’s had PPD or some form of major problem after childbirth has wished that too. Unfortunately, some of us, who are just as worth the attention, have been left out to dry by that perspective.

    Dr’s who know their patients well can use this tool judiciously like all other tools at their disposal. If you seriously don’t trust your Dr, find a different one. Not all Dr’s are good Drs, doesn’t mean many aren’t great.

    Some doctors won’t screen just because they’re too busy. There are probably 100 other conditions that they are encouraged to screen for as it is. It simply can’t be done the way things are set up now.

    I could be told I have a heart murmur and be put on meds, and I might never know the difference. My Dr could probably fake that and get away with it if I never went anywhere for a second opinion. But I have a Dr I trust. she’s never done something that I’ve felt suspicious of. I hardly take medication and only do things I think are justified. She can’t mandate that I do it or else. Even if I had a life-threatening disease, she can’t force something into my body or take my kids because of it. I could choose to forgo my my meds and quit seeing her.

    If this passes, in all likelihood, we’ll probably be lucky to see research outcomes in a few years. Practical use would trickle down slowly at best.

  39. John,

    I wish that it were true that today you, or I, could refuse any medical procedure you or I want to refuse without recrimination, but it’s not, and, as you point out, this is more so in psychiatry than in other areas of the law.

    Also, the bill places an unfair burden upon poor women and their families.

    The language here explains why:

    The bill reads in part:

    “The causes of postpartum depression are complex and unknown at this time; however, contributing factors include: a steep and rapid drop in hormone levels after childbirth; difficulty during labor or pregnancy; a premature birth; a miscarriage; feeling overwhelmed, uncertain, frustrated or anxious about one’s new role as a mother; a lack of support from one’s spouse, friends or family; marital strife; stressful events in life such as death of a loved one, financial problems, or physical or mental abuse; a family history of depression or mood disorders; a previous history of major depression or anxiety; or a prior postpartum depression.

    (8) Postpartum depression is a treatable disorder if promptly diagnosed by a trained provider and attended to with a personalized regimen of care including social support, therapy, medication, and when necessary hospitalization.

    (9) All too often postpartum depression goes undiagnosed or untreated due to the social stigma surrounding depression and mental illness, the romanticization of motherhood, the new mother’s inability to self-diagnose her condition, the new mother’s shame or embarrassment over discussing her depression so near to the birth of her child, the lack of understanding in society and the medical community of the complexity of postpartum depression, and economic pressures placed on hospitals and providers.”

    Lack of social support, financial problems, premature birth are all much more prevalent in people with less financial power, i.e. the poor, and these are the same women who have the least power when choosing a physician. As I’m sure you’re aware, with the current ob/gyn shortage in our nation, even further limited by those that accept medicaid or medicare, a poor woman does as she’s told by her doctor, having no choice and this bill ends up ordering women to seek non-existent services, when this “disease” tends to be an upper class “problem” to begin with.

  40. Sally,
    You may seem like you’re defending women’s interests by being so anti Mothers Act. You are, among other anti-pharma or anti-screening or anti-infringement on people’s rights, strangely enough trying to stand in the way of potential improvements for women who have or will have at some point a perinatal mood disorder. If you had one, you may be singing a different tune right now.

  41. There are a variety of reasons people oppose the MOTHERS Act, and for the record I am not anti-pharm. I don’t support it for other reasons.

    First, I support medical research. If there is a need for post partum depression research then conduct it like every other research study. Get a separate informed consent document. Submit the research project to the IRB. This doesn’t require a special law.

    Second, as others have pointed out who knows if this will even help. Many of those with post partum depression/psychosis who have been in the news WERE being treated. Perhaps it was the treatment that made things worse? We don’t know. Would it have made a difference if they were treated earlier? We don’t know.

    Third, Sally makes a good point about the referrals. All fine and good if you have health insurance. What about those who don’t? Where do they go? Onto a waiting list for community mental health care? When will they be seen and by whom? The type of care those without resources receive is pitiful, and this needs to be addressed before people are referred to bad care.

    Fourth, I don’t (and there are other women who feel the same way) want to be approached to fill out a a survey where someone who probably isn’t even a mental health professional decides I need psych treatment. How can they (a nurse, etc) make that determination based on a 10 question survey that is asked when I am emotional from just having had a baby?

    Fifth, I do believe this will lead to women who are simply dealing with temporary hormone issues onto medication they don’t need.

    Sixth, there are other ways of educating women about post partum depression without passing a law like this. Most of the women I know are already well aware of what post partum depression is.

  42. Now that I see the comments are being taken today, and read others are having this problem, hope Dr Grohol finds out the problem with comments not being accepted. Onwards to this post:

    Claire’s above comments are right on the money! We don’t need legislation, we need education and destigmatizing by good public relations by all involved: providers, patients, families, and other invested parties. Screening forms have limited applicability, and let me remind these good intended souls promoting this legislation about one simple fact that Claire alluded to as well: it takes were I work these days at least 6 to 12 weeks to get an appointment with a private psych doc, and while maybe a bit sooner at the community mental health clinic I work at, still at least 2 to 4 weeks. So, you as an OB MD or Pediatrician or internist are just going to tell the patient to see a psych MD? No, they are going to prescribe to the patient the latest, greatest med that the reps have been pushing in their offices, and some of these patients will be inappropriately medicated. Again, don’t believe me, just talk to these docs who see straightforward depression without pregnancy involved these days.

    This is a set up folks, well intended or not. Dr Grohol and Ms Stone I am sure want the best for people who need it, however it is not by this method it will do best in the end.

    By the way, Sally, I appreciate the support. Hope the next issue we are congruent on as well.

    If on the East Coast, have a nice weekend outside! Not that I don’t wish well elsewhere, but it looks nice on the left side of the US this weekend, hope for you at other areas too!

    therapyfirst, board cert psych MD

  43. I suffered from postpartum depression with both of my children. In fact, it was so severe and I was so despondent and disillusioned that I filed for and was granted a divorce from my husband in the postpartum period and have no recollection of doing it. That is the nature of this disease. I was to the point that I was told not to be alone with my children for fear I’d kill them. PPD is nothing to joke about or take lightly whatsoever. It is a physical and mental illness that needs treatment. I am completely insulted that an obstetrician would block this act. His medical license should be repealed. What a jerk.

  44. Claire,
    While most of your friends are aware of what PPD is, that does not mean that everyone else knows and can recognize symptoms for themselves and seek help earlier rather than later. Though my experience was 4 yrs ago, I highly doubt the majority of the population has been enlightened. When I talk to people I know I get this glazed look, like whatever. They don’t want to hear about it. So, those like you and therapyfirst that are so opposed to the bill…what would you propose to do? Would you like to take the lead on educating the public? It takes more than a few people here & there in communities. Sure, there’s some momentum, but we’re talking years–maybe a good decade at minimum–before there is progress to really speak of.

  45. Vowing to defeat this pharma push act that will cause harm and devastation while increasing pharma profit.

    Most groups supporting it take pharma money.

    Thanks to Dr. Coburn

  46. Presently there is a case in the Utah court of Appeals May 2009.
    The civil case was in Logan, Utah. It is about a women who delivered twins, and at the same time adopted a child from Asia. As most of us mothers know that have suffered post partim depression, you are for the most part unaware that you are suffering from it.

    The crazy part of this story in Utah, is that the judge, Stantion Taylor ignored the fact that the mother suffered from PPD and actually called it a “chemical imbalanced” when in fact it is a hormonal imbalance. So even a judge who presided over the case was not educated on PPD yet he continued to preside and never educated himself as to the effect it can have on a mother especially one who gave birth to twins.

    Interesting enough, it was a child custody battle. I was sent the link as in Utah you can actually hear the oral arguments. The mother was appealing to the Utah court of appeals. Seems the adoption agency took their child that they adopted from Asia, and this same adoption agency owners were indicted and convicted of federal crimes. The adoption agency was called Focus on Children, The owners are or were I should say Scott and Karen Banks. I googled them and WOW, what losers. Seems they ran a corrupt adoption agency that bartered Samoan children for food stuffs.

    So the mother who suffered PPD was looking for respite care and these loser adoption agency owners were looking to take the child from them and then they wanted to keep the child. The oral arguments talks about these Scott and Karen Banks people and their probation and some other adopted kids that they adopted but did not keep them in their home, and there was one child who was severly neglected in their home.

    For all woment who have suffered from post partim depression, we should be outraged by this judge in Logan, Utah who ignored this fact and called it a “chemical problem”. It is truely unbelivable that in this year 2009, such a judge would sit at a

  47. sue

    I heard of this strange case too. It is in Utah, Dahhhhh…

    I read that there were so many judges. I have a friend who lives in Cache Valley where there was a trial but that the judge who did the trial was really old and retired. That he said in his judgement that Post Partim Depression was in fact a chemical thing.

    I got a divorce. it took over five years and I had one judge. I am thinking that the people in Utah, which is also the adoption warehouse state dragged this out, with all those judges. Utah is not a fair in courts. LDS families are favored. There is a group of us following this story. The owners of the adoption agency had their own agenda. We read all that stuff that they did in Western Samoa. How could they be good parents let alone decent role models to children.
    Utah needs to catch up with the real world. Educate the judges and get the Book of Mormon out of the courts.

  48. Since I am a Major Contributor to our federal Tax System,… Id like to know one thing. How much is thise lame possibly unconstitutional piece of legislation going to cost me?

  49. How about we stop the AFP screening too? It only helps a few, yet many women worry and don’t even understand what it is for. Plus it is often inaccurate.
    And amniocentisis is invasive and dangerous. Plus, wouldn’t a positive screening for Downs Syndrome almost certainly either encourage an abortion or cause the woman lots of stress? Can you imagine the damage of a false positive?
    Actually results of Sonogram/Ultrasounds and even the doppler heart monitor all can cause emotional stress and be inaccurate.
    Why don’t we stop those screenings? Surely they lead to negative outcomes at times.
    And mammograms too, there are now people advocating that we don’t offer screenings for breast cancer until 50 because it “probably” does not save a large % of lives.
    As for me:
    My AFP was wrong.
    My sonogram/ultrasound was wrong and I was told to consider “selective reduction” (which would have KILLED one or both of my perfectly healthy identical twins)based on the misdiagnosis.
    And the doppler heart monitor test was wrong – a few times.
    Yet, in the very same office, I was not offered screening for postpartum mood disorders in spite of being very upset. I had postpartum psychosis and depression.
    Then, at my first routine mammo (offered at age 40), an aggressive invasive cancer was discovered. I now have a second chance. Had I waited until 50 it would have almost certainly been too late. I did not have any known risk factors – so if it had not been offered, if it had been up to me to request it… I would not have.
    Screenings are not perfect — BUT — they SHOULD be offered and available –PARTICULARLY when something is stigmatized. And if it takes a law to get doctors to OFFER to screen for this disorder – first diagnosed by HIPPOCRATES (yes, it is not new and a careful review of historical literature and documents shows that) – than we should have a law requiring it.
    I’m not sure what change those who oppose the MOTHERS Act WOULD seek. (Although on other websites I’ve seen posts supporting the BANNING of pharmaceuticals for mental illness.) It is hard to imagine, given the terrible experiences some relate, that they wish to keep things as they are. I’d like to know what change they seek and what they are doing to effect that change. Seriously. Maybe we can find a meeting of the minds.
    Also, in the interest of full disclosure: I DO NOT receive money from Big Pharma. I, like others PSI volunteers, give lots of my own time JUST to help other mothers BECAUSE right now, we volunteers are a PRIMARY resource for moms with postpartum mood disorders. PSI is the largest and most active grass-roots, volunteer organization offering social support to new moms (as well as education and raising awareness). It is funded by — wait for it….
    ……
    ……
    Mothers and fathers (and some sisters and brothers)who care enough to help struggling mothers and their families.

  50. I went through a terrible bout with PPD several years ago.
    This harrowing experience, along with my eventual recovery, inspired me to try to help others who are going through difficult experiences with their health. To that end, I now produce and host a radio show called Wellness TalkRadio. Each week I interview an expert, with the goal of helping others through the advice provided on the show. You may listen to some of my interviews at http://www.wellnesstalkradio.com

    My company also produces live video broadcasts that – like my radio show — are dedicated to helping people solve their health issues. On January 16th, our broadcast, which will be available live over the Internet, will feature clinical psychologist, Dr. Shoshana Bennett, author of Beyond the Blues: Prenatal and Postpartum Depression, a Treatment Manual. In this live video seminar, Dr. Bennett will cover many issues regarding surviving Postpartum Depression, as well as ways to get support and recover. She will take questions via phone and email – and will be geared toward both parents and practitioners.

    I hope that you and your blog visitors will be able to join us. You can go to http://drshoshlive.eventbrite.com/ for more information. And please feel free to email or call me, as well. My contact information is below.

    Kris Costello
    http://www.wellnesstalkradio.com
    kris@wellnesstalkradio.com
    805 717 0795

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