Bremner's False Claims about Postpartum DepressionPsychiatrist J. Douglas Bremner has weighed in on the Melanie Blocker Stokes MOTHERS Act, an effort to provide voluntary screenings to pregnant women to help identify postpartum depression before …

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Bremner’s False Claims about Postpartum Depression

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  1. Boy, the propaganda machine this and other sites so gung ho about this LEGISLATION really sickens me! You folks just don’t get it, and I won’t waste my fingers re-explaining it to people who are beyond rigid and inflexible, so my hope is the readers who are gray and moderate will see through the “BS” Dr Grohol exclaims in his post.

    You cannot unilaterally screen for a subjective diagnosis, especially when it involves a life changing event of birth. Don’t believe me, just review the failures moreso than not when politicians start legislating medical care. And if you do not believe some pharma companies are lining up if not already behind this farce of an excuse to responsibly diagnose post partum depression, as Mike Meyers so eloquently said it in his movie, “the monkeys are flying out my butt!”

    Even if 10% of women legitimately display sizeable features of PPD, this demands the other 90% of women being screened? How about you screen first those who show symptoms of questionable concern or legitimate family members speak out independently?

    Nah, that makes too much sense. After all, these are politicians and biased lobbyists behind this agenda, EH !!!!

    Dr Grohol, you may mean well in supporting an issue, but you are way beyond the boundaries in pushing it to be so encompassing. Thank god there are people speaking out against this who are overt examples to why this proposal needs to be scrapped and rewritten at the very least. And if what I read is true about the wife of a NJ congressman being a cause to this legislation with her having PPD for 20 years, that is as absurd as this intention.

    Hey, I am a psychiatrist, I have treated women with legitimate PPD, and advocate for treatment, but NOT THIS WAY!!! Readers, research the whole process to this matter, don’t jump on knee jerk bandwagons that don’t see the forest for the tree.

    Skillsnotpills, board cert psychiatrist

  2. This is a great article. Thank you Dr. Grohol.

    Regarding “skillsnotpills” comment, I’m not sure I understand the sentence as written – “How about you screen first those who show symptoms of questionable concern or legitimate family members speak out independently?” However, I think that many people would agree that any screening of such a common reaction is life-saving, and screening for people who do show symtpoms would be a good first step, and worthy of research. So i guess i agree with you. And I don’t have monkeys flying out of my butt.

  3. Skills, clearly in this case you did not really read the post, because I respond to some of your comment points in the article itself! Screening even for at-risk women is not enough, as the research shows (sorry to argue from what empirical, scientific data we have, and not just opinion or appealing to emotion through individual cases) that we do a less-than-adequate job even with the high at-risk population.

    We wouldn’t even be having this conversation if we were talking about cancer or some other health concern. But since it’s a mental health concern — boom! — it must have some subjective, diabolical meaning.

    I do hope the critics can be a little bit more original, and not so ordinary, this time around.

  4. You know why everyone must be screened? Because of people like me. I was not under any circumstances going to talk to my doctor about how I was feeling but somehow it was easier to take a screening test. I would have committed suicide, possibly taking my children with me had it not been for the fact that I was screened and treated. There is no doubt in my mind that my children would be motherless if I hadn’t had the wonderful doctors and therapist in my corner. You know why they were wonderful? They didn’t force treatment on me. They worked with me and my feelings and beliefs to create the best plan for my individual situation. Medication wasn’t even mentioned until at least a month or two into my treatment and I wasn’t pressured when I initially declined. My Psychiatrist tried things like light and nutrition therapy as well as many other alternative treatments first. She was not a drug pusher by any means. Unfortunately there aren’t a lot of areas of the country that have knowledge about Postpartum Depression to be able to treat and diagnose it effectively. That is what the bill is about…education and research.

    I dare you to look into my children’s eyes and tell them that their mother’s life isn’t worth screening for. Tell them that your paranoid antipharm agenda is more important than them having a mother and even possibly life themselves. If you don’t want to take medication then don’t but leave the rest of us alone!

  5. I am responding to Marcie,
    “I dare you to look into my children’s eyes and tell them that their mother’s life isn’t worth screening for. Tell them that your paranoid antipharm agenda is more important than them having a mother and even possibly life themselves. If you don’t want to take medication then don’t but leave the rest of us alone!”

    OK then, I dare you to look into my children’s eyes and tell them that screening and drugging me and risking my life was worth it. If you want to take drugs fine but leave the rest of us alone – to use your words.

    I dare you to watch this: http://www.youtube.com/watch?v=qnxuw2ufSug

  6. skillsnotpills says “How about you screen first those who show symptoms of questionable concern or legitimate family members speak out independently?”

    I have to wonder how many women with PPD you have treated. First, women with PPD often try to hide their symptoms from their OBs, GPs and pediatricians. I know I did, and none was the wiser. Second, it is rare for family members to contact a woman’s doctor to speak out independently, because much of the time they know something is wrong but have no idea what.

    And when it comes to doctors just observing it and deciding who to screen based on that observation, perhaps you weren’t aware of the following:

    1. Although effective treatment is available, fewer than half of cases of postpartum depression are recognized. (Journal of the American Board of Family Medicine, 2007)

    2. When screening for depression in the health care setting is based on clinical observation alone, 50% of women suffering from depression are missed (Wilen & Mounts, Maternal & Child Health Journal, September 2006)

    3. A study of 888 pediatrician concluded that even during the postpartum period when pediatricians have frequent contact with mothers and babies, pediatricians rarely identify maternal depression through a routine inquiry about symptoms or through family history. (Olson et al, Pediatrics, 2002)

    Oh, and that old saw about propaganda is really getting old. This is legitimate research.

    Oh, and one other silly claim: “And if what I read is true about the wife of a NJ congressman being a cause to this legislation with her having PPD for 20 years, that is as absurd as this intention.” It’s the former first lady of NJ. She has not had PPD for 20 years. She had it when her children were born.

  7. Mother’s need the MOTHER’S Act. Why?

    Because of ignorant OB’s like my first doc. I went to him at 12wks postpartum, struggling with horrific intrusive thoughts of stabbing my infant. I waited in his office for over an hour to see him, my infant screaming and fussing the entire time. By the time I got into see him I was a mess. Handed him a screening I had taken online with the questions “thoughts of harming yourself or your child” marked yes. Wanted to throw my infant against the wall while at his office just to get some silence!

    What happened?

    Nothing.

    My medical records reflect that I was smiling, happy, well groomed, and clearly not depressed. I got a lecture about how hormones magically re-align at 6wks postpartum so there was no way what I was experiencing could be Postpartum Depression.

    I left a DOCTOR’S office untreated, frustrated, angry, and still struggling with these horrific thoughts and cleaning/hiding potentially harmful items compulsions.

    This spilled over into my second pregnancy, leaving me depressed through my pregnancy, setting me up for one heck of a roller coaster ride once my daughter was born with the unexpected complication of a cleft palate – and NO – no anti-depressants were on board – just plain old deep clinical undiagnosed depression. I wound up hospitalized by the time she was a little over two months old.

    So do I think all new mothers need to be screened? ABSOLUTELY….but it should be done in an informed and consensual manner with an action plan in place for what to do if a mother does screen positive. A plan that respects the mother’s wishes for treatment, much like the one Marcie described.

    I have suffered PPD in an ignorant area of the country. It is what drives me to do what I do now – peer support for new moms, sharing information, and supporting legislation that would enlighten the country and medical profession.

    I am also tired of being judged and accused of not receiving informed consent or choosing to side with Big Pharma. I am BROKE. I have no ties to any pharmaceutical company. I made an informed decision as an intelligent college-educated woman. My approach with moms who come to me for support and guidance is to RESPECT the journey they are on. If they want natural, I am perfectly capable of sending them to people who know about that. If they have questions about medications, I refer them to their physicians and research regarding the efficacy and safety of medications then I (gasp) allow them to MAKE their own decision and SUPPORT whatever that may be…even if I don’t agree with it. It’s called “ethics” and “objectivity.”

    Knowledge is key to reducing stigma.

    Thank you, Dr. Grohol for this post.

  8. Dr. Grohol, you wrote, “Sadly, whether people want to admit it or not, mothers are another “at risk” population. Why? Because society has told mothers time and time again that giving birth is supposed to be a joyous, happy occasion. If you’re depressed after giving birth to a child, there must be something wrong with you.”

    Really – this is why mothers are at risk of PPD, because mothers are told giving birth is supposed to be a happy occasion? Don’t you have a Psy.D.?

    “Don’t draw attention to yourself or your problems. Just try and deal with it, try and take care of the baby, and make it through each day. Mothers don’t know they might have something recognized as postpartum depression, much less that they can talk to someone about these feelings or that there’s treatment — psychotherapy or medication — readily available for it.”

    Really? Mothers don’t know about PPD? Seriously? Because for the past month I have seen about 75 references to PPD on Twitter where PPD is twisted and people say that they have post-whatever-depression.

    Not enough people get diagnosed with depression, eh? Perhaps that’s why one third of pregnant women are on psych drugs at some point during their pregnancy? Perhaps that’s why more people in this country take psych drugs than antibiotics?

    So you’re promoting giving out medication to new mothers – and you don’t see a need to include warnings here with that statement?

  9. Thank you Dr. Grohol–well said, well supported.

    As a survivor, I look at places like Australia with some envy. This is what a friend there said they have there:

    “Post-Natal Depression was discussed considerably at ante-natal classes.

    “At your baby’s 3 month check-up at the maternal child health centre is really a mother’s check-up. The maternal child health nurses have a checklist of questions that they go through with mothers, which is aimed at not only picking up PND indicators, but also other risk factors for mothers – such as isolation, violence in the relationship, etc.

    “We also see the same maternal child health care nurse multiple times in your baby’s first year – an at home visit the day after returning home, a 2 week visit, 4 week visit, 2 month visit, 3 month visit, 4 month visit, then every 2 months until a year.”

    The way it is in my state is after your 6 week check up you are not your OBs patient so much anymore. You are not the pediatrician’s patient, your baby is. You, new mom, don’t seem to matter–just suck it up already.

    As far as I knew, I didn’t have a mental health history prior to my PPD; didn’t have a list of risk factors but who would have known? I didn’t. There was nothing mentioned about “PPD”. I learned that what I had had (including a hospital stay) from Oprah. OHhhhh, it was POSTPARTUM depression, OHHH! What a relief to finally find a name for it, and to talk to others who have had it.

    Why why why let mothers suffer with such a treatable condition???

  10. Dr. Grohol, do you really believe that the reason that women are at risk for PPD is because they are told that birth is a joyous event?

    Do you also believe that there aren’t enough women getting diagnosed with PPD?

    Do you not have a problem promoting medication on your blog, even though you list zero warnings for patients on the risks of drugs?

    One third of women are exposed to psych drugs during pregnancy according to the ACOG. The EPDS triples the number of women diagnosed. Yet you think that “missing” 20% of potential cases of PPD is a sad fact? I’d say that would be a lucky few who women or babies escaping the clutches of potential death, if it were true.

    What’s wrong with women going to the doctor if they want to? Why do you think that the government needs to get involved in marketing a mental disorder? Do you really have so little respect for women that you think they are not capable of making their own decisions about their life and medical treatment?

  11. Yes, THANK YOU, Dr. Grohol for your wisdom and ability to see the forest through the trees. We should invite opponents of this bill to think of some other way to speed up the snail’s pace that our country has been moving with respect to public awareness campaigns, as well as education healthcare providers on earlier detection and more accurate diagnoses (and research that will enable this to happen). I had no previously diagnosed mental/mood disorder and yet experienced PPD. Had my OB/GYN screened me for PPD or even bothered to ask me questions to further assess my situation when I told him I had insomnia at 6 weeks postpartum (clear sign we weren’t talking about the blues anymore), instead of merely prescribing me Ambien, I may have been spared the quick decline in my condition and the horrific panic attacks I experienced that left me feeling frightened and completely debilitated. For crying out loud, I couldn’t even take care of the baby my husband and I had tried for so many years to have. I didn’t know what was wrong with me and thought I would never return to my old self again. Hopelessness in the face of depression, if gone untreated, can lead to suicide. It’s frightening to think that was where I might have headed had I not sought help and gotten the medication I needed that brought me to a functioning level within 4 weeks’ time.

  12. Are you claiming there is a stigma (out there somewhere) or are you asserting one? Your words are far from clear.

    Brooke Shields, speaking out, seemed not to accept your pronouncement. And helped many others not to as well.

    No, I do not accept “stigmas,” abet them, validate them, nor pass them on so someone else might. Can you explain why you apparently do?

    Harold A. Maio, retired Mental Health Editor
    khmaio@earthlink.net

  13. THey do a lot of things during pregnancy and birth to screen ALL mothers-most of which we can opt out of. The cream on the baby’s eyes in case I have a veneral disease that could blind her comes to mind. Is that a vast conspiracy?

    The assumption that big pharma is in it for the cash, and that all women are idiot automotons who blindly take pills is insulting. Are you all bothered by being asked about your sleeping habits during your pregnancy? Your eating habits? Where, TRULY, does the harm lie in asking, “Are you feeling ok emotionally?” Where is the harm in screening for mental health as well as physical?

    Women ARE capable Amy-capable of telling doctors they are fine if they are, and capable of walking through a door that may have been opened with some simple questioning.

    I wasn’t screened, by any means. And it risked my life, and my daughter’s because no doctor or nurse could be bothered to look at me and SEE that something was terribly wrong. A lacatation consultant noticed a month later. A month in which I nearly killed myself and my child.

    Closing the door to other women who have suffered, who ARE suffering because YOU believe otherwise…it’s sad and ignorant. Blocking access for other women to help, to therapy, to a doctor noticing…I can’t understand it, and likely never will. Because I have two daughters who might very likely end up where I’ve been, and I shudder at the thought of someone else’s experience guiding the resources available to them.

  14. skillsnotpills, don’t you have some non-existent patients you need to be beating into submission? If you’re really a board-certified psychiatrist, the field is in worse shape than anyone knows….

    Good job, John. These bloggers who pander to the Scientology crowd (and their mentally ill ilk) are simply seeking the spotlight, in my opinion. Shameless self-promotion, at the expensive of accurate information. They’re whipping up the hornets’ nest and taking no responsibility for their actions. Despicable.

  15. Check out Ms. Philo’s connection with the Scientology front’s “Natural News.” As if it’s not obvious she’s mentally unstable. The idea that Time magazine would give her a platform is ridiculous, as if she represents the “other side” of the issue. She sings straight from the Scientology songbook: off-key.

  16. Keep in mind that doug bremner is not a PhD, but a Psychiatrist. I’d use caution before you determine that he is making false claims.

  17. Amy Philo – I’m not clear on your point. Are you saying women aren’t capable of making educated and well-informed treatment decisions if they discover they indeed do have PPD?

    I’m not sure you know this, but one of the major government agencies — the NIH, through the NIMH — not only funds research, but also works to promote and educate the public about mental health issues and its research findings. So the government’s been involved in “marketing” mental disorders for quite a few decades. Why is postpartum depression any different?

  18. Dan – His exact profession shouldn’t matter, as one would hope a psychiatrist, a psychologist, whatever, if they’re a mental health professional and claim to be representing the sum of our research knowledge, works to try and present it somewhat objectively. If he had said, “While the primary risk factors of PPD appear to be having a prior episode of depression or anxiety, research has shown other risk factors as well…”

    But that would weaken his point. Which largely seems to be that since more screenings often result in more people being treated (um, yeah), this particular screening effort is bad. Why? Because some of those people may choose to go on an antidepressant medication, which Bremner philosophically opposes.

    I’d have far more respect for a professional who elaborated a rational, reasoned argument against screenings based upon research data. Sadly, this wasn’t the case here.

  19. To quote a comment:”Even if 10% of women legitimately display sizeable features of PPD, this demands the other 90% of women being screened? How about you screen first those who show symptoms of questionable concern or legitimate family members speak out independently?”

    Doesn’t the latest data show that only 2.5-3.5% of the pregnant population presents with gestational diabetes? Universal screening for that has been in place for many years in each and every OB office in America. 20% of women at real risk for a much more life-threatening and certainly comprising complication like a perinatal mood disorder seems certainly worth the time that it would take to screen using the 3 or 10 question EPDS in order to determine if more evaluation was necessary…yep, that’s it…no prescription pad plunked out- it’s not a diagnostic be all, end all. If women don’t mind being screened with a test that takes more than an hour and requires ingesting an unpleasant liquid and having bloodwork to potentially screen for something they are unlikely to have, and that according to research “no large randomized controlled trials show that screening for and treating gestational diabetes affect perinatal outcomes,” then I can’t imagine many would mind being screened for a couple of minutes for something they have a 1 in 5 chance of experiencing and which has shown to have great affect on perinatal outcome if not diagnosed and treated (with many different options such as therapy, supplements, support, or and or possible medication,etc.). Speak out…if you are a woman let the public, our government officials, and those on both sides of this issue know how you feel about having an OB or pediatrician ask you a few questions about how you are doing emotionally postpartum…it’s your choice if and how you answer.

    Here’s some info on gestational diabetes and screening in case you’re interested:
    http://www.aafp.org/afp/20031101/1767.html

  20. This took a bit to complete, so sorry it is long, but it needs to be said:

    After reading the above comments this morning, some of true value and others of just pandering pontification, it seems rather obvious this is a gray issue, and gray issues are not served by black and white pronouncements of legislation. Furthermore, 19 comments in about 12 hours shows there is a lot of passion and concern that relates this is an issue that cannot be summed up with “a bill”. Anyone who is a health care provider should really be stepping back and thinking hard before asking politicians to be setting precedents in health care interventions, because 95% of them have no real backround to be supervising like this!

    It blows me away when colleagues are so quick to ask others without solid credentials to get involved. Sort of like the way managed care crept into health care? But, let’s be honest, and realize that if clinicians did a better job of managing their own, legislation would be few and far between in handling our own affairs.

    To Mr Smith, most of my patients with PPD seem to thank me for not jumping on the meds-first bandwagon this society seems to be riding right into the brick wall up ahead. When I DO offer meds, it seems to go well because the patients are more comfortable with the plan because it is thought out, not thoughtless. Fortunately, being a man, we won’t have to deal with this issue personally, will we sir? I just love it when men want to legislate women’s issues. And, this is said by a man. I won’t touch abortion here, yikes!!!

    Furthermore, Mr Smith, it speaks volumes about you from your “…beating into submission” comment. Whether you believe it or not, I do not take a cookie cutter approach to my patients, so take your rigid and extremist attitude to a place where the monkeys fly. I feel that my approach, the biopsychosocial model to mental health care, is the direction psychiatry should be taking, and not just embracing the quick fix mantra I gather people like you just want in place to ‘correct things’, and not treat the problems.

    As per Dr Grohol, I read your post AGAIN, and do not see how you referenced my position in the post, so I am sorry I did not infer it the way you intended. If you believe that getting OBs involved in diagnosing mental health problems will direct patients into the right care interventions, I have to say, respectfully but harshly as well, you are clueless!

    This is yet another reason why mental health care is declining, because everyone thinks being a psychiatrist or therapist is easy and applicable, and when they screw up the patient, who has to clean up these messes well intended but inadequately trained clinicians create? Yeah, people like me who more often might have helped things progress and not regress. Remember, Dr Grohol, 70% of prescriptions for antidepressants are written by non-psychiatrists, so why is the issue of medicating being beaten around these days?

    Because the public doesn’t know any better, psychiatry as a whole should know better, and those at the front line, PCPs/family docs/OBs/nurse practitioners, don’t have the time or skills to do what is clinically indicated.

    The road to hell is paved with good intentions, this track by this pending bill. I offer this to you clinicians who do daily health care interventions, I’m curious how you feel when you have a negative outcome with a patient, and you felt you did your best. It pains you that it didn’t have a positive endpoint, true? Consider that feeling when you support this bill. Because when it does lead to sizeable negative outcomes, you think the politicians and knee jerk supporters are going to wince and have empathy to those they screwed by not considering all the checks and balances needed for this kind of ‘assessment process’? If you think they will, good luck with your soul.

    I do not want politicians directing medical care in general, and god knows I do not want it involved in mental health care. Who is going to argue that politicians are so supportive and caring about mental health issues as a political body? You think the general air of narcissism and entitlement roaming around the halls of Congress that most politicians possess makes them receptive to a profession that is based on caring for others and being empathetic? And to those who will come at me saying otherwise, it just reinforces why George Carlin so wonderfully summarized in one of his bits why politicians suck, because it is the clueless and uninvested public that votes for them.

    To clinicians reading this and other posts about this issue and mental health care matters as a whole, think about what this legislation is setting as a precedent, because if it passes, it is just another chip away of your inherent rights and responsibilities as providers and advocates. And what a big chunk it will be!

  21. skills – I’m open to data that shows some of yours and other opponents arguments have merit. Surely the federal government has funded (or tried to fund) prior education and screening measures for other health and mental health concerns, no? Yet I scratch my head to find any data that shows such prior efforts have resulted in *more* misery or some sort of mandate to screen (or else!). Show me the data, and I’ll be happy to reconsider my position.

    Lacking data — and since the federal government has previously funded health education and screening initiatives — I honestly don’t see what makes this initiative different. Can you please explain what makes this different than screening for specific health concerns based upon nothing more than gender and age? Do you know how much government money has gone into promoting cancer screening??

  22. It’s funny that a “John Smith” is commenting on here trying to connect me with Scientologists. I’ve said many times on my blog that I have met many Scientologists since I Co-Founded CHAADA.org in 2005 with other psychiatric drug victims. I’ve also linked to CCHR on my website that entire time, and readily talked to and worked with people from any and every mental health watchdog group that I possibly could. It’s no secret that I believe in religious freedom and I have no problem with CCHR or Scientology. John Smith says I am obviously mentally unstable. Mmkay! So now you can diagnose strangers over the internet… without having them fill out a cute little multiple choice questionnaire. Medicine is now branching from the realm of paper and pen tests into the realm of telepathy and blog profiling! What – I’m curious – do you think makes me “obviously” mentally ill John?

    Perhaps instead of screening in doctors’ offices we should just let people like John Smith do a perusal of mommy blogs, an IP trace on their sites and then knock on their doors to offer them drugs.

    My point, Dr. Grohol is not what you wrote, that I don’t think women are capable of making their own decisions, my point is that you write as though you think we aren’t. You wrote that women don’t know they might have something called PPD.

    Implying that the professionals need a way to invade their lives to tell them about it. You seem to think we need a law to make sure that everything possible is done to help women figure out if they have PPD or not. You don’t seem to believe in the ability of women to seek help when they feel the need. This is an invasion into the personal lives of women and families, disease mongering at its worst.

    I know very well that NIMH promotes screening. As Tom Coburn has pointed out, most of what is in the bill is already being done in some form – except that it has been voluntary so far for women, until New Jersey passed a mandatory screening law.

    We’re opposed to the expansion of drugging of mothers with a government go-ahead at a time when psychiatric drugs have been exposed for being extraordinarily dangerous. Rather than creating a new market for them we need to be finding alternatives to them for women in need and making women aware of the medwatch data. Did you see the video link I posted above with baby Matthew’s memorial video? He died after two hours of life because his mom took Effexor. This is being expanded by the perinatal drugging promoters who promote the bill.

    What you and your allies don’t want to talk about are the risks of available treatments. Our coalition opposes dangerous psychotropic drugs being given to pregnant and nursing women and we promote the concept of informed consent for anyone unfortunate enough to be accepting a psychotropic drug prescription.

    You have a gigantic Abilify ad on your site.

    You think PPD is underdiagnosed and that this justifies mass screening.

    We say PPD is overdiagnosed and overdrugged. I doubt that you would ever say there is overdrugging, but I could be wrong. I don’t ordinarily follow your drug blog. So maybe you have admitted that pregnant and nursing mothers are overmedicated, somewhere at some point in time.

  23. Thordora doesn’t seem to understand the concept of forced psychiatric treatment.

    http://www.netpowwow.com/unite011109/ppdcriminals.htm

    Now I haven’t personally talked to Maxine Garcia or Yolanda Iyube so I have no idea if they are connected to, Natural News or CCHR or Scientology. Perhaps John Smith has a justification for the police escorting them from their doctor’s office and home respectively after calling a PPD hotline? Maybe it was their marital status, or their marital relationship, or their self esteem, or their pregnancy depression, or perhaps they walked outside to meet the police two fisting beer bottles while holding the baby in a sling? I don’t know.

    The Star-Ledger (Newark, New Jersey)

    December 9, 2007 Sunday

    Promised lifeline for new moms falls short
    Postpartum depression law called a disappointment so far

    BYLINE: SUSAN K. LIVIO, STAR-LEDGER STAFF

    A `HORRIBLE’ RESPONSE

    Maxine Garcia of Sayreville says that when she asked for help she got a response that left her stunned. Police officers and rescue squad workers arrived unannounced at her home last year, an hour after she called the hotline to say she was six months pregnant and “depressed out of my mind.” According to the police report, Garcia threatened to hurt herself, but she denies it. She and her two children were forced to go to the emergency room. “I felt like I had no rights,” Garcia said. “I really just needed someone to talk to.”

    Yolanda Iyube of Franklin in Somerset County says she confided to her gynecologist two years ago she was consumed with scary thoughts about her baby dying violently. Before she left the office, a police-escorted social worker took her to the emergency room. “They brought me in a police car to the hospital. It was horrible – everyone was looking at me like I had committed a crime.”

    Venis said such responses can discourage women with postpartum depression from seeking help.

    …When the law took effect, there was an initial reluctance from physicians treating new mothers – a fear that “we won’t be able to discharge anyone from the hospital,” said Edward Wolf, vice chairman of the Department of Obstetrics and Gynecology at Saint Barnabas Medical Center in Livingston.

    Wolf said the law added responsibilities for obstetricians already vulnerable to malpractice lawsuits. He said there was a fear of “I am going to get this thrown on my lap without help.”

  24. Bremner has responded on his blog:

    http://www.beforeyoutakethatpill.com/

    but his comments are closed/broken, so I will reply here.

    First, he spends half his defense talking about something I didn’t even mention in my blog post, something about Wisner’s conflicts of interest. I said nothing about Wisner nor her conflicts of interest. Everyone has conflicts of interest, even Bremner (who also says he doesn’t profit off of his book — an astonishing claim given that his book has been on sale for more than a year and a half).

    He then cherry picks a single research article to respond to, completely ignoring the other studies. That’s fine, but then he mis-reports(?) the findings of the Ross et al. study. He claims:

    However a perusal of Ross et al shows that a history of childhood abuse is not in fact a factor, rather only abuse during pregnancy.

    That’s simply not true and I’ll attach the study to the above reference (in the article) so you can download the PDF and read it yourself. The researchers identified 8 abuse studies, 7 of which found a positive risk effect for PPD. And it’s not just abuse, but simply something like witnessing violence in the past (Stevens et al., 2002).

    Again, this is a far cry from the claim that *only* depression and anxiety are risk factors for PPD. The research clearly shows otherwise.

    I can only imagine that since Bremner is an accomplished researcher, he’s being a bit disingenuous about the research literature on risk factors and PPD. Which only goes to show you that biases exist even in respected researchers, especially when they are promoting their own personal agendas (e.g., fighting against a single type of treatment that he dislikes).

  25. skillsnotpills: You said “most of my patients with PPD seem to thank me for not jumping on the meds-first bandwagon this society seems to be riding right into the brick wall up ahead. When I DO offer meds, it seems to go well because the patients are more comfortable with the plan because it is thought out, not thoughtless.” Thank you. That is just the kind of treatment women deserve. I think women need to be offered a variety of options with clear information on the risks and benefits of each. Medication should not be the only answer nor should it always be the first answer. It’s nice to hear that you take such a considered approach.

  26. over here (UK) all women are screened a few times for depression after the birth. However even screening is not 100% accurate, I suffered depression all the way through my pregnancy and after birth (I still have it now, 5 years on) although this is long-term depression, not post natal depression, it is so easy to cover up this illness. Mothers need more reassurance their child is safe and nobody will take them away if they admit they feel like killing themselves. Any woman who undergoes a birth involving complications or an emergency C-section should be thoroughly screened too.

  27. John G. wrote: “We wouldn’t even be having this conversation if we were talking about cancer or some other health concern. But since it’s a mental health concern — boom! — it must have some subjective, diabolical meaning.”

    ——
    Well, I’m glad that you see the logic of the Mothers Act.

    When it came to Rebecca Riley, however, you were virtually calling for that treating psychiatrist’s head (I could be wrong, but I think you removed that story in the RR series….good.) Another headline (and story) remains, however, in which you definitely attribute that poor child’s death to early diagnosis and psychotropic medication, not to the depraved actions of the obviously mentally ill parents. http://tinyurl.com/mr8zjs

    So, I don’t know how you can be accused of towing any Pharma line. That’s just the throwaway line from people who can’t process larger issues and go for the easy attack. Pfft to them.

    In both cases, biology matters and facts matter. And for those who don’t understand what “screening” means, you should learn.

    My only concern with the Mothers Act is that it is too narrowly focused on depression, specifically PPD. Conservatively, 10 million adults in the U.S. have ADHD, but only one tenth know that they do, and only a fraction of those are pursuing treatment. Presumably, half of those 10 million are women. (And again, that is an extremely conservative estimate.)

    We also know that untreated ADHD is associated with higher rates of unplanned and unwanted pregnancies (for this reason, ADHD rates are high among adoptive children).

    Even women with ADHD who want the children aren’t always prepared, cognitively or emotionally, for the reality. This is part of the ADHD symptomatology: not anticipating consequences and then being shocked by them. Women with resources and support get the help they need to deal with the transition to motherhood (or the addition of another child), if not always to pursue an ADHD diagnosis and treatment. But other women are left to their own devices.

    Given that ADHD is 76 heritable, odds are good that these women with ADHD will have children with ADHD. Some of these children will display early manifestations of symptoms in the form of “fussiness,” difficulties with sleep, colic and food allergies, sensitivities to touch (meaning they will, for example, be overstimulated by cuddling and will cry, in essence rejecting the mothers). This is tough on any mother, much less a mother with ADHD — who doesn’t know she has it.

    (By the way, children with ADHD are @46 times more likely to have a mother with ADHD than are children in who don’t have ADHD.)

    Too often, women with ADHD are diagnosed with and treated for depression and anxiety — sometimes for decades. That’s because less-than-astute clinicians don’t know how to rule out the untreated ADHD that might be causing the depression and anxiety. I imagine a variant of this is also true with PPD.

    I, too, worry about medications used in these cases, because treating ADHD with anti-depressants alone can intensify ADHD symptoms. (For a different reason, there’s also a risk with bi-polar disorder.) It would make more sense to me to screen new mothers for all mental illness, because if they go in looking for PPD or depression, well, you know what they say about a hammer and everything looking like a nail.

    Moreover, I would like to see new fathers screened as well. The fact is, the arrival of a baby into the relationship can be extremely destabilizing for men with undetected/untreated mental illness. (Some experts say this is why the most common cause of death among pregnant women is murder by their partners.) Then, too, some women do not realize that their babies’ fathers are mentally ill until the baby arrives and they are suddenly expected to “step up to the plate.” This alone can create symptoms that resemble PPD.

    Overly focusing on mothers and PPD or depression seems a real danger here. The problem isn’t medication or the Internet-based self-medicating-with-opposition crowd’s favorite boogie man, Big Pharma. The problem is poorly trained clinicians who do not know how to screen for a wide variety of mental illness and often treat the wrong thing. We have them to thank, in my opinion, for the medication backlash.

    Gina Pera, author
    Is It You, Me, or Adult A.D.D.?
    Stopping the Roller Coaster When Someone You Love Has Attention Deficit Disorder
    Winner: ForeWord Magazine’s Psychology Book of the Year

  28. Is there any evidence that screening for mental illnesses leads to that treatment which could foster successful outcomes? If so, what are the long term outcomes for persons who have been screened pursuant to any screening initiative? More specifically, are there studies for PPD screenings which relate the outcomes realized?

  29. It’s a little silly, though, to impugn Doug Bremner’s motives because he wrote a book, for petesake. (As if anyone but the Dr. Phil types and other “celebrities” make money on the books they write.)

    The title of his book, Before You Take That Pill, seems to have drawn the anti-medication, anti-psychiatry crowd to his blog. But I suspect none of them has actually read the book. It’s about all sorts of medication, including Vioxx and those for diabetes, and it contains some useful information. Not the usual shrill anti-pharma diatribe.

  30. Gina — Good point, and I didn’t mean to impugn Bremner for writing a book. I haven’t read it, so I can’t comment on its value, but it sounds like it might be worth picking up a copy, thanks.

  31. To those who contend that the mentally ill always know they are mentally ill, that flies entirely in the face of all that we know about anosognosia and the denial of illness. Mental illness can — and often does — limit accurate perception of self and others. It’s just a fact.

  32. As Dr. Bremner likes to point out on his blog, you can get a used copy, John, for $.01. :-)

  33. Katherine Stone- Until recently, I had been a resident of New Jersey.. born and raised.. It is true that Mary Jo Codey is the former first lady of NJ, and not a Congressma’s wife. It is also true that Mary Jo publicly states she had been diagnosed w/postpartum depression after the birth of her first son. And according to Mary Jo, through press interviews, has stated that she continues to be treated for PPD. That she continues to take daily “medications” plural.

    Mary Jo has also stated, publicly, in the Newark Starledger that she rcved ECT, and had been overmedicated by her physician and had to be hospitalized. Pretty frightening dont you think.

    Would you please explain the rationale of screening for PTSD while a young woman is in active labor.. “during a contraction”

    Mary Jo does nothing for free, and Senator Codey doesnt have the Salary to be paying for her
    expenses, id like to know who is. Id also like to know who foots the bill for your hotel, food and travel.

  34. Gina,… WoW, promoting a book I see.

  35. John,I have purchased and read Dr. Bremner’s book, very informative and an easy read. His chapters on psyche meds was quite weak though.

  36. Lisa — I don’t really travel. I’d like to — maybe to the islands … So no one is footing the bill as I’m not going anywhere. If I were going somewhere, I’d be paying for it.

    And no one pays for my blog but me. Personally. With money my husband makes because I don’t work so that I can do my blog and be a stay-at-home mom. I know it’s hard to believe that someone could just do work because they are passionate about it, but that’s the deal. If you’d like to turn me into some sort of conspiracy, you’re too late. Others have beat you to it.

  37. Katherine Stone is a paid speaker for pharma front groups funded by Pfizer, and made $5800 doing this, over $300 for each one hour talk on “perinatal mood disorders.”

    http://momsandmeds.wordpress.com/2009/06/02/pharmapaysmasupporters/

    “Just so you have whatever data it is you need in your records, I did a total of 16 speaking events in 2008 and made a total of $5800. I had no idea the grant was for $20,000 as they never told me the amount of the grant they received — you have more info on that than I did. I’m sure the organization that supported these events has put it to good use to help serve the community.” – comment by Katherine Stone

    To quote my original blog entry at the above link:

    Including Nemeroff’s pharma income (as he was head of the AFSP and SPAN-merged group), but not including the pharmaceutical payments to leading psychiatric researchers who received money awards, consulted or acted as paid speakers for conferences in this list (e.g. John Rush, Joseph Beiderman etc.), the unknown amount of money given to any more recently added groups, including the National Healthy Mothers Healthy Babies Coalition which is sponsored by Wyeth, Glaxo, J&J, Merck, and Sanofi Pasteur, or money to Screening for Mental Health which conducts mental health screening, the total dollar amount from this summary is: $13,095,010. This is using the lowest dollar amounts in the dollar range for the donations disclosed without an exact amont. If the larger dollar amounts in the dollar ranges are used from the inexact donation amounts, the total increases to $16,487,497.

    This does not include money awards from Eli Lilly to PSI’s Mary Jo Codey, Margaret Spinelli or Diana Barnes. This does not include payments to PSI’s Shari Lusskin from the four pharmaceutical companies she works for as a paid speaker. This does not include the undisclosed millions given to NAMI by the numerous other pharmaceutical companies (NAMI’s main foundation receives 56% of its funding from pHARMa). It’s possible that there is more money lurking under there, but who knows? It’s impossible to know what else might be undisclosed, or how many of the members of these groups who donate money to them privately have vested interests in pHARMa.

    If my math is off I will be glad to correct it.

    The dollar amounts were taken from the following excerpt from Evelyn Pringle’s “Just Say No To The MOTHERS Act” article:

    Big Pharma funds Mothers Act supporters

    Read more on that blog.

    I think pharma might be hiring in the Bahamas.

  38. I hate to see you defend yourself against such spurious attacks, Katherine. It’s not that the people who make such attacks trouble themselves to read your blog and to perceive your intentions accurately. Such deliberations are beyond them.

    People who have not one mirror neuron in their brains distrust those who do; it is simply a foreign concept to them. The fact that they see craven motives behind every advocate or volunteer speaks more to what motivates them than what motivates those whom they criticize.

  39. I think screening is a good process to add for women’s healthcare after giving birth. Screenings offer information and an opportunity to learn more about one’s self. A woman has free choice to decide what to do about such information. A referral to a qualified mental health provider should be provided.

    This is no different from any other referral for a medical condition that a woman might receive from her doctor. She is still free to find her own referral or use the referral provided or do nothing.

    A woman could be referred to a specialist after a mamography. She might have her own specialist in mind or she can choose to do nothing.

    A qualified mental health provider’s services can offer a new mom support and coping skills, assist with getting the woman’s family involved. Getting such assistance does not equal medication. Lots of people are helped by mental health providers without the use of medication.

    Some posters have indicated that they were screened and then forced on meds that caused greater distress. That is terrible and sounds like a case of malpractice.

    A screening provides information. A qualified mental health provider provides treatment options. The woman is free to choose.

    Knowledge is power.

  40. Amy Philo’s attack is a logical fallacy called “poisoning the well:”

    http://www.nizkor.org/features/fallacies/poisoning-the-well.html

    A logical fallacy occurs when your opponent doesn’t want to debate the issues (government funding of voluntary postpartum depression information and screenings), and instead wants to attack the person making the argument.

    By associating your opponent with a perceived negative (“Oh, look, she took pharma money!”), you hope to stifle legitimate debate.

    We don’t allow ad hominem or personal attacks here. So I suggest that if you want to engage in such, you go elsewhere for your enjoyment.

    If, however, you actually want to talk about the issue at hand — a researcher’s selective summary of what some of the research shows on this issue — you’re welcomed to continue posting.

  41. So, just wondering, does this “lack of insight” that is a “fact” apply to ALL mentally ill women, or just the mentally ill women who disagree with you?

  42. kimbriel – Interesting. Nobody mentioned a “lack of insight.” What are you responding to?

  43. Katherine Stone admitted at one time on her blog that she was taking 5 different antidepressants and 2 antipsychotics (according to Evelyn Pringle). Why did she remove this fact if she is so certain this was an effective way to treat PPD and what deleterious effects must such a cocktail have on her parenting skills? I hope she saw the error of her ways and is on a much smaller cocktail now. Ivy Shih-Leung admits to having taken Ambien which leads very quickly to rebound insomnia and panic attacks yet she is certain she had underlying PPD — how does she really know once Ambien is in the picture since her symptoms were precisely those associated with Ambien dependency and intra-day withdrawal? What I object to here is not that postpartum issues aren’t real — of course they are — people do have emotional issues and need support after giving birth to a child especially if it is a complicated pregnancy or birth using fertility drugs or having a Cesarean. What I object to is the ignorance this avid group of Mothers’ Act supporters shows about treatments they have had themselves and/or endorse for others. I object to the fact that they do not admit that if in fact you go to a medical professional for postpartum problems this is the main option you are going to be offered and that professionals are operating in a vacuum with incomplete knowledge about how the drugs work and how to recognize and treat adverse effects. This is not “free choice” if the consent is misinformed which I can assure you it most certainly is.

  44. Never mind, John. It’s another one of those red herrings — hijack someone’s words by setting up a false dichotomy.

    False dichotomy, poisoning the well, straw man…..overusing these tools of obfuscation ought to be diagnostic of something.

  45. Let’s look at the defenses of scoundrels, shall we?

    Raise an issue or promote a cause that really is more gray, or is really less legitimate than claimed, and have ‘facts’ and questionable empirical evidence that is, in the end, refutable when closely examined. Then, do not give those with legitimate concerns a fair chance to review the data or have equal time to rebut. Then it begins:

    1. Attack your opponent as being irrelevant and not supporting an issue that has merit, or claim the opponent is denying those who allegedly could benefit because the scoundrel says so and raised the matter first.

    2. Once the opponents do in fact have positions of merit, then project, as the scoundrel is in fact guilty of doing, onto the opponent and blur the issues to obscure who is really guilty of inappropriate behaviors or unreasonable basis.

    3. Once the opponent has shown he/she/group is not guilty of such false accusations, then the scoundrel will muddy the waters with spurious details that could give some merit to what the opponent has in fact raised, but in the end still claims the original intent has more pros than cons.

    4. If the original pursuit still has too much to lose for the scoundrel, then try to bring on others who mistakenly buy into the scoundrel’s porous claims to try to legitimize the agenda.

    4a. If the pursuit is a lost cause by now, the scoundrel will try to minimize the original claim and redirect the agenda, or try to slip out as best undetected, usually sloughing the baggage onto someone who had innocently come on board early on in the process.

    5. Once the facts and goals are clearly understood and realized by the masses, the opponent is somewhat vindicated, but usually muddied and bruised.

    The cost of pursuing the truth. No good deed goes unpunished. This is my epitaph.

    Note I am not saying this directed to Dr Grohol, but I do feel this issue has qualities of this process as started by others, maybe with some true, responsible intent, but now very muddied.

    Transparency, folks, and deeds speak louder than words. What defines healthy and appropriate intent. Or, as the business model also says, Buyer Beware! I now leave having said my peace and piece on this issue, as I agree with a blogger who earlier this PM advised me this issue is too emotional to maintain levelheadedness, as I have been guilty of today. But, legislating this issue is wrong, and as someone on the front line of post partum depression, I do know what I am talking about.

    Hopefully, and ironically, sanity will prevail.

  46. Honesty and Integrity can go a long way, it is also good for the soul.

    Dr. Grohol, $5800.00 is considered by many as chump change. I would have respected and appreciated being told the truth. Katherine brought the criticism onto herself, and that’s a shame.

    Full disclosure on my part:
    I have never accepted any financial support for the trips I made to D.C. in regards to the safety and efficacy of antidepressants in children and adolescents, the importance of patient medication guides and testifying before Congress.

    I did however receive from CCHR a beautiful, spray of funeral flowers. I had been extremely close to my mother-in-law who had passed away in 2005. CCHR’s act of Sympathy was very much appreciated.When one is grieving the loss of a loved, you really dont care about another’s religion, just their act of kindness.

  47. Dr. Grohl, I never attacked Katherine Stone. I corrected her when she replied to Lisa’s question. If you don’t want someone to point out a conflict of interest, that makes your blog lose a lot of credibility. Perhaps you believe that the Senate investigation for undisclosed conflicts of interest of psychiatrists who are on the take from pharma is inappropriate? If so, I would point again to the large ad for Abilify above. I am not sure if you have any control over this on your blog or not.

    To say that I don’t want to debate the issues is ridiculous. I have provided sources of information that discredit many of your arguments.

    The only logical fallacy going on anywhere is the poor reasoning by you and a few others would be the repeated insistence that everything taking place in psychiatric treatment is voluntary and benign. Ignore the fact of women being arrested and incarcerated for seeking help, which deters women from seeking treatment in the first place. Being safe to seek help is something that you supposedly want women to feel. Yet you allow attacks and stigmatizing of “mentally ill” people in this thread.

    Dr. Grohol your comments are getting a little bit silly. I suggest you reread my comments and the others as you have so carefully done with your literature review.

  48. I also noticed that Brooke Shields name was mentioned here. What I find fascinating is that Brooke herself admitted publicly, in her book that while in the abrupt withdrawal of Paxil she had thoughts of crashing her car into a brick wall with her baby in the rear seat. She had gone back to her Dr., who then advised her not to stop paxil cold turkey. The Dr. should have told her about the dangers of stopping paxil cold turkey when he wrote the prescription. Brooke also admitted to the Today show that withdrawing from paxil was horrible.

    I encourage folks to visit http://www.ssristories.com. Their are over 3100 hundred casses of antidepressant horror stories. Do these stories relate to a causal role,.. no. but it sure does get one thinking!!

  49. Dr. Grohol, Gina Pera did mention it, in her comment above. I’ll re-quote for you:

    “To those who contend that the mentally ill always know they are mentally ill, that flies entirely in the face of all that we know about anosognosia and the denial of illness. Mental illness can — and often does — limit accurate perception of self and others. It’s just a fact.”

  50. And, so I’m not obfuscating, lest I be diagnosed with something for it … she did not use the phrase “lack of insight”… but rather the word anosognosia, of which “lack of insight” is one definition.

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