The historic passage of the federal health care legislation last week included a provision for a new national postpartum depression (PPD) program. It leaves out the federal screening program so feared by the bill’s opponents, but it includes more money for greater education outreach and more research into this condition. The Melanie Blocker Stokes Mother’s Act passed in watered down form.
Postpartum depression (PPD) is a condition suffered by a minority of women who just gave birth. It is characterized by severe depression and sadness, and often either a lack of interest or even thoughts of harming one’s newborn baby. There is also often the feeling that one will not be a good mother. Postpartum depression may be called the “baby blues,” and sometimes an obstetrician or doctor will minimize the symptoms of this concern by suggesting it is “normal” or something most mothers experience that the woman just needs to “snap out of” or it’ll resolve on its own given time. It may very well indeed, but it may also worsen and like any mental health condition, should be taken seriously.
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Melanie Stokes had all the care that is possible under physicians orders. She still committed suicide probably because her antidepressant mdade her more depressed and suicidal.
The Physicians Desk Reference states that SSRI antidepressants and all antidepressants can cause mania, psychosis, abnormal thinking, paranoia, hostility, etc. These side effects can also appear during withdrawal. Also, these adverse reactions are not listed as Rare but are listed as either Frequent or Infrequent.
Go to http://www.SSRIstories.com where there are over 3,700 cases, with the full media article available, involving 58 cases of postartum homicdes, bizarre murders, suicides, school shootings/incidents [54 of these] and murder-suicides – all of which involve SSRI antidepressants like Prozac, Zoloft, Paxil, etc, . The media article usually tells which SSRI antidepressant the perpetrator was taking or had been using.
There’s a fairly new article that came out, “Gallup, 2010, Bottle feeding stimulates child loss” that hypothesizes if a woman chooses to bottle feed instead of breastfeed it may promote the onset of PPD. The theory suggests that evolutionarily women have developed a response of giving birth and then breastfeeding. By not breastfeeding, the mother’s body assumes the baby did not make it through child birth and goes through “mourning”. It is suggested that this response happens even if the baby is still alive by choosing to bottle feed and may be why so many mothers experience PPD.
It’s all still a theory right now with few studies to back it up; but what is interesting is that low income women have the lowest rates of breastfeeding… and the highest rates of PPD.
And I know that there are some medications that woman cannot breastfeed while taking. I’m not trying to dismiss those women. It would be interesting though to see if just pumping the breast and discarding the milk helps the mother to not have PPD in the first place.
Rosiecee:
You make a good point. SSRI can sometimes cause the depression to worsen or for mania to develop (usually if the patient is actually Bipolar). In fact I noticed what appeared to be a worsening of depression on the SSRI Lexapro. However, once I switched to an antidepressant in another class, my depression got better quickly. Unfortunately there isn’t yet a reliable way to determine what antidepressant will work, which ones will not work and which ones will cause serious side effects for that patient. Everyone has a different theory as to why SSRIs and other antidepressants may increase suicidal thoughts and behavior. One reason could be that the patient has too high of an expectation of the antidepressant. So, when the antidepressant doesn’t work after a couple of weeks or only works slightly (often the patient’ll try 2 or 3 antidepressants before 1 works), the patient get even more depressed and thinks that they “can’t be helped.” Another possible reason is that the patient was suicidal before and only admitted it after start the antidepressant or that the antidepressant made them slightly less depressed so they are able to start planning their suicide. Basically there are a number of different factors and one should be realistic about antidepressants but shouldn’t dismiss all of them just because there are a few rare cases when someone commited suicide on the antidepressant. Actually it’s more likely that they will commit suicide if their depression goes untreated. And lastly, just because a person was prescribed an antidepressant doesn’t mean they were taking it. In Many of these supposed “suicides or homicides caused by antidepressants,” it turns out that there were no detectable antidepressants in the person’s blood.
However, antidepressants are very helpful for MODERATE-SEVERE cases of depression and should be considered in those and other instances. In fact, most of the research shows that (true) Postpartum depression typically only responds to medication and ECT (the modern, painless, safer version of shock therapy). In fact ECT is considered one of the most effective options in the event that the mother does not improve with antidepressants.
Alice:
That’s an interesting theory. I would like to seem research done on whether breastfeeding can prevent or treat Post-Partum depression. One issue is that many of the antidepressants are counter-indicated d for nursing mothers. So the question remains, should the mother continue to breastfeed in hopes that the depression subsides but take the risk that the depression will worsen or should she stop breastfeeding and take an antidepressant? (especially one that worked before). Difficult questions. Another issue is what a women should do who was depressed during the pregnancy, has a significant history of depression and/or had PPD after her last birth. Now they are recommending that a lot of women who become severely depressed or have significant histories of depression (3 or more major episodes) continue to take antidepressants during pregnancy (ones that are least likely to harm the baby). Definitely a tricky area.
Also, low-income mothers have multiple risk factors for PDD, such as more likely to be a single parent, less able to afford hired help, multiple children, the stress of poverty, more likely to be exposed to violence, etc that could explain their high risk status. Correlation does not equal causation.
I a with Rosiecee on this one. Legislation and funding are worthless (even detrimental) if the doctors prescribing the drugs have no clue what they should be looking for. There is so much emerging research about what causes PPD. It seems that (as many times in the past) the psychological field has just lumped a bunch of separate problems into one diagnosis all related to the trigger and not the actual problem.
For example, emerging research is showing women who have lost a child due to natural causes are more then twice as likely to feel inadequacies as mothers then those who had not lost a child. The figure nearly doubles again when the termination of the pregnancy was by choice. However, “talk therapy” has shown to be far more affective in these cases then medication.
Treating PPD which has psycological causes at its roots is way different then treating PPD with neuological dysfunctions. However to the GP’s “I feel down, a little depressed, I sometimes get so frustrated with the baby, or that I am not a good mom.” all have the same cure. Give them SSRI’s.
I really wish that the FDA would require doctors to stress as they are handing out these drug. They should be required to say, “Now, be forewarned. If you take these drugs, you may end up killing your own child. The chance is slim, but not non-existent.”
Dr. Grohol,
I noticed that you have deleted my post from your blog. Im curious as to why,.. was it your decision, or the decision of your advertisers? Whatever happened to a woman’s right to free speech. If you would like to continue being a respectable psychologist, I suggest you respect the views of all women, but, more importantly, their right to free speech. You are more than welcome to respond to my question privately, you do have my e-mail address
I am going to disagree with other posters. From the article and other reading, there is no proof that taking SSRIs cause suicide. Yes, for young adults it can bring on suicidal thoughts. However, the suicidal thoughts can also happen without taking an SSRIs or because they are not taking one that works for them. SSRIs have a place in treating depression, no matter the etiology. I take SSRIs and they have reduced my suicidal thinking.
Carole,
Antidepressants, carry an FDA Black Box Warning for increased risk of violence and suicide, in Children, teens, and young adults, and a FDA patient medication guide is to be distributed with each prescription filled.
I can assure you, that, the Pharmaceutical Companies would not place this warning in their Direct to Consumer advertising, ie commercials if the suicide and violence affiliated with antidepressants weren’t for real.
Do you disagree with the antidepreesant manufacturer’s and FDA. If so, the stigma of mental illness will remain alive and well
To Lisa and and LOL:
There was ONE study that showed antidepressants might increase suicidual thinking or behavior in teens and young adults. (there were NO suicides). Actually, if you look at the actual study, Effexor, which is not even an SSRI, was the worse in terms of suicidual thinking/behavior. Since then there have been several studies that have cast doubt on this theory. The problem is that the vast majority of people who are on SSRIs and other antidepressants are depressed, most of the time VERY depressed. One of the criteria for major depression is suicidal thoughts and/or actions. It’s very difficult to prove that antidepressants CAUSED that thoughts or actions in the patients. In my earlier post, I mentioned some of the possible explanations as to why this increase in suicidual thoughts or actions might occur.
The warnings are there because of that one study. Also, drug companies don’t want to get sued. Actually, a lot of recent research as shown that the black box warning has a determintal effect because antidepressants actually REDUCE the risk of depression for most people who take them. So, since doctors are less likely to prescribe them now, that’s not good for the patient. I think the warning is also there to remind doctors and patients that they need to FOLLOW-UP on patients on antidepressants.
Lastly, LOL, I would hope the doctor also informs the patient that she has an up to 15% of suicide from depression. Also, I am not saying that therapy isn’t helpful, it is just that in general PPD is chemical in nature and responds best to antidepressants.
Psychologist?
First, Effexor is a “Serotonin-Norpinephrine Reuptake Inhibitor”. It is an “SSRI plus” if you will. If you are simply stating that since it is an SNRI instead of an SSRI, then you are technically accurate, but in an illusive way that misses the point.
Secondly, there are multiple studies where competed suicides occurred while under the influence of SSRI/ SNRI’s. On this very blog sight Dr. Phil Ninan of Whyeth Pharmaceuticals claimed that there was a completed suicide during their testing phase. Do you think they would have picked somebody at risk for suicide to include in these studies? You can find many of the studies here. clinicalstudyresults. Org.
Third, if a drug relies on a person with mental condition to accurately administer their own drug in a precision timely fashion, it is inherently flawed in its logic from the beginning.
Lastly, I got to sit front row and center to watch as suicidal/ homicidal thoughts became part of a personality I had known for 12 years. One where these thoughts never were expressed or uttered. I watched as what should have been a fantastic mother started talking abut uncontrollable urges to harm a 1 yr. old. I personally don’t need to see a study (though I have read 5 in their full complexity) to know that the increase in suicidal possibilities is increased. I was there. There are forums with users and family members alike who have witnessed these and other unhealthy personality changes. One is here. http:/www.topix. net/forum/drug/effexor/TQ4I2UR28DFD3N759. (spaces provided so the comment didn’t have to get moderated)
Many of these patients who report these feelings were never diagnosed with depression. Many were given SSRI/ SNRI’s for minor anxiety, OCD, or to help them quit smoking. The majority of them are prescribed these drugs by GP’s who did not follow the protocol to check for bipolar disorder or alcoholism prior to the prescription.
Stating that “these people were dysfunctional prior to taking the drugs” is a bogus argument. It is asking to “prove a false”. “I say you are crazy. Prove me wrong. But know that anything you say will be considered the words of a crazy person.”
If you are in fact a psychologist, my fear and lowered respect for the field if further confirmed.
I didn’t say SSRIs and other antidepressants are without risk and should be handed out like candy. They need careful monitoring and if possible to be administered by a psychiatrist who first screens them for Bipolar and other disorders. Also, regular follow-up is important. I am just saying that untreated or inadequately treated Major Depression has a much higher chance of causing suicide then antidepressants do. Therefor, since SSRIs and other antidepressants usually DO improve depression in people with Major Depression on the more severe end (not mild depression), they should be considered a viable treatment option. I wasn’t talking about people who have mild anxiety or depression who happen to be taking an SSRI. Yes it is possible to have an adverse reaction. I am not denying that. However it’s possible to have a serious adverse reaction to Asprin or cold medicine.
Whoops. Sorry I meant to say “future psychologist.” I am still a student, but I am echoing opinions of many other psychologists and psychiatrist I’ve had the pleasure of learning and training with. As well as the literature.
PS. By being depressed, you are inherently at risk for suicide. And generally antidepressant trials include people with more severe depression, because these people are most likely to benefit from antidepressants and thus will give the study a higher effectiveness rate.
Future Psychologist,
With all due respect, Id like to know where you obtained your information from, because it is quite clear, that you have no idea what you are talking about.
I will give you an example, GSK, the manufacturer of paxil had conducted 9 placebo controlled clinical trials of paxil in the child and adolescent population, that they had submitted to FDA for approval. All 9 studies were negative, and did not meet FDA’s standard for approval in the pediatric population. All 9 studies, failed to demonstrate efficay. In these studies children became violent, suicidal, psychotic, self-mutilated, and suffered from medical damage. You wouldnt know this, because your not a DR.
Im curious, where are you being educated, I suggest you take a course in Pharmacology and drug safety. FDA’s website is a good start.
Being ignorant, and ill informed, places your patients lives in danger.
By the way, more people suffer and die from the side effects of antidepressants then they do aspirin, that was a poor and irresponsible comparison. Your not a Dr., and heck, you are not even a psychologist, you are a student.
It’s obvious that writing on this website would be about the same as attending a convention of pharmaceutical sales reps disputing whether antidepressants cause suicide. In fact there are numerous studies and thousands upon thousands of reports of such to the FDA. Google serotonin syndrome and look at the symptoms. As for the people who truly care about women they are nowhere to be found among those who pushed for the bill’s passage. Because if they did care about women then they would care about all the moms who are committing suicide and homicide and losing babies to SIDS, birth defects, stillbirth and miscarriage caused by psychiatric drugs. Have a nice life, drug pushing “disease” mongerers, we’ll be busy warning moms to stay as far away from you as humanly possible. For their babies’ sake. http://tinyurl.com/IndiVid
Sincerely,
Amy Philo
Zoloft Survivor
http://www.youtube.com/amyphilo
I would like to restate and add to the above post.
First, “Psychologist”, please forgive my defensive posture. I would explain that I saw a woman that was kind, compassionate, committed, dedicated, and very loving dwindle into an aggressive, violent, suicidal, negative person a few short weeks after taking Zoloft. She had shown signs of mild OCD, anxiety, and occasionally contempt towards her father in the 10 years I had known her. Every one of these symptoms were magnified many fold after being one Zoloft. Then she was switched to Prozac. Everything heightened to another level. Then within 3 months she entered a state where every possible symptom of manic behavior was embodied. There is nobody around her who wasn’t shocked by this behavior. However, I am sure you are right. I am just a layman and probably missing some kind of crucial bit of information. Maybe it wasn’t the drugs that changed her personality. I am at a loss for understanding what seemed to happen overnight, during a time that should have been the high point in our relationship. My TPJ has been on overload for more then a year now. So far, in talking to a few hundred people from all walks of emotional status that had this happen, the only thing in common is that they had SSRI’s newly introduced into their systems.
That said, what frustrates me about treating PPD with antidepressants is the often the spouses are not brought into the fold. They are not informed about what kind of changes may occur as a result of the introduction of SSRI’s. Life is a change enough when a new child enters the relationship. A little heads up and communication with the family of the patient would improve the treatment. As I understand it, no patient has ever walked into their general practitioners office (or their therapist’s office for that fact) and said, “You know doc I feel bad because I feel great. I have increased my alcohol consumption. I am spending money I don’t have. I can’t stop having extra marital affairs. I am so happy that I am lashing out against my family and spouse and I know it is my fault. Sometimes I want to just shake my child. I really don’t care about anything but making me happy.” So where is the physician going to get input like this? Say it was a dormant dysfunction for years. Is this really the outcome that is hoped for by these drugs? PPD mother is morphed into a manic personality?
You are reading the words of a guy who saw these very damaging and hurtful events unfold in front of him and instead of turning angry and reciprocating the madness, I stopped and ask, “why did this happen?” As the legal and medical fields entered this situation, all of them seemed to want to protect her right to act that way. A way that is indisputably unhealthy for her, and defiantly unhealthy for our child to be exposed to.
Again, forgive my reprehensions. Since this all went down a year ago, I have had 3 friends have children. All three mothers were offered an SSRI in the first 3 months after their childbirth.
Yes, Spouses and other (adult) family members should be included in the treatment. And GPs shouldn’t be prescribing SSRIs and other antidepressants if they can’t provide accurate follow-up and don’t know enough about the possible side effects. Both psychiatrists I’ve been too (and I hope all of them) insist that you come in 1-2 weeks after starting a new drug and that you call them immediately if you start to have side effects. Spouses, therapists, etc should also be on the look out for mania or worsening depression or other new psychiatric symptoms. Still, unfortunately still happen. When faced with a severely depressed woman, I think GPs want to help so they prescribe the drugs. Also, in some communities psychiatrists are scarce and a lot of people won’t see one for a variety of reasons.
To Lisa,
I am not a doctor, nor do I ever intend to prescribe medication. That should be the job of highly trained professionals who can make since of the risk-benefit ratio. Once again, I am not saying that antidepressants, SSRIs included, are without risk. They are not. However Major depression itself carries a 10-15% chance of suicide. As well as a significant risk of psychosis, mania (then it becomes Bipolar Disorder), suicide attempts, substance abuse, etc. Yes, as with pregnant woman, prescribing psychoactive drugs to children, should be done with create caution and only if the depression is severe enough to warrant it. Only Prozac is approved for depression in kids. Not Paxil. This is a good article that summarizes the suicide & antidepressant link:http://149.142.238.229/pgxlab/docs/nrd0205-licinio-final.pdf
I would recommend you read it or other scientific literature about the topic (not a random website or anecdotal evidence)
I thought they had PPD figured out back when I had it in 1989. When a woman is pregnant the placenta takes over a great majority of the production of estrogen. When she has the baby, the body has to shift back to the regular way of producing estrogen. There is usually a lag which produces the regular “baby blues”, but if the body does not figure it out it progresses through severe depression to psychosis. This happened to me. My doctor did not help at all. He prescribed Prozac. 20/20 had a special on it. After watching it, I asked my doctor to give me topical estrogen cream. The problem was cleared up in one day.
Future psychologist.
What “should” happen and what does happen are two completely different things. Now my child is another statistic, my wife is off her rocker, and I am feeling the loss akin to loosing a spouse to death (only worse because I have to send my daughter away with this new personality). The result will cost me many thousands of dollars throughout the rest of my life through direct and indirect cost related to the divorce. Worst of all, I desire to be a good dad and a good parent, but I will have reduced access to my daughter at least in these crucial formative years. So what “should happen” is of little consolation to me. Until protocols can be enforced, these drugs are doing more harm then good.
Nothing embodies this more then me sitting in my GP’s office. He knows my wife personally as he works in the same hospital. His wife delivered our baby. H knows how close we were and often talked to her. After 5 mins of my explanation as to what happened, he said, “it sounds like she might be bipolar and misperceive. 20 mins of me describing the hell I had been through, he looks at me and says, “you sound depressed. I am going to prescribe you an antidepressant.” I said, “Doc haven’t you listened to a word I said? How do you know that I am not bipolar? Who in my family are you going to talk to about any negative behavioral changes?”
LOL:
You and your wife need to see a psychiatrist. GPs don’t usually have skills and time available to treat a mental health problem properly. Some do it properly, others think SSRIs should be handed out like candy. I hope you have access to a psychiatrist.
You are right, the FDA can’t enforce what GPs do (only what drug companies do). Therefore, it is really important for patients to be active consumers when it comes to mental health problems, especially. For example, I would never go to a GP and ask them to prescribe me an antidepressant or otherwise treat my depression (if I had it). Unless I got really desperate and wanted a refill on one that I had already been on with success. For that, I go to a psychiatrist and even then I don’t agree to take something unless I thoroughly researched it first and agreed it would be effective. I also talk it over with other knowledge people, like my psychologist.
Unfortunately, I am a psychology student who knows what proper mental health care looks like and knows where to get accurate information about a drug. I hope that when I get my degree I can help others become empowered about their mental healthcare, so they don’t fall for a drug companies “misleading” ads or receive inadequate if not downright dangerous care from an doctor.
Sally-
There are multiple reasons why a new mother would be depressed and not just one way to treat it. It could be entirely hormonal, like in your case, or their could be multiple factors, such the extreme stress or an underlying tendency towards depression.