This is a question which does not have a black and white answer, and it is a question that is as much for the society in which we live as it is for healthcare practitioners, families, friends and mothers.  Why?  Because in societies where women have the most support, i.e. paid leave and automatic postnatal health and  household chore support, the incidence of PPD (postpartum depression) is significantly lower.

PPD and PPA (Postpartum Anxiety) are experienced by many women after child birth and yet it’s been little more than a decade that we have been talking about the problem.  We give a lot of credit to Marie   Osmond, who 12 years ago went on the Oprah show and talked about her experience with PPD and shed some light on the issue.  Up until that point, PPD and PPA did not have a face.  It was not something discussed in polite company.  The myth of “happy motherhood and perfect baby” was the picture most of us carried around.  And that picture made it even more difficult for mothers to come forward and get the help that they needed.

When asking the question of PPD as a symptom or disease, several things come to mind:

1.  Exhaustion or Depression: No other normal physiologic body process is as demanding as pregnancy and birth.  Many women go home with a new baby and have other small children and a husband to care for as well.  New babies have intense needs day and night. They require nursing and feeding , lots of body contact and soothing. That means that mother probably won’t be sleeping through the night. Sleep deprivation contributes to negative mental states.   Caring for a family and an infant can render mother exhausted.  If a new mother has had a C-section, she is also recovering from surgery. Treatment for exhaustion is as important as treatment for depression, and it should be noted that exhaustion can mimic many of the symptoms of depression.

2. Nutritional Depletion: A baby’s body is made up entirely of nutrients that are donated by its mother’s body.  The placenta is also made from nutrients donated by mother’s body. The placenta pulls nutrients from a mother’s bloodstream and gives it to the developing fetus.  Nature has it wired that if one is going to do without; it will be the mother for the sake of new life. Some women lose a great deal of blood during childbirth and since blood is made from nutrients, this further depletes a mother’s nutritional reserves.

The research is clear that certain nutritional deficiencies, for example the DHA and EPA  (as from fish oils) can cause depression and moods swings. So can a lack of certain B vitamins.  All postpartum women can benefit from taking a good multiple vitamin and mineral, fish oils and supplementing calcium and magnesium.  Many health care professionals now recommend that mothers stay on their prenatal vitamins for several months after the baby is born.

3.  Community: In the past when extended families lived together or close by, a new mother would be able to have her needs met while she rested for a number of weeks to regain her strength. Women relatives and close neighbors would prepare her families’ meals and they would also help soothe her tender emotions while her body recovered. These days many women no longer have that kind of support. In the 1950s a woman who had just given birth stayed in the maternity ward for an average of 2 weeks, resting and bonding with her newborn. Now she is out of the hospital in 48 hours.

Today there are thousands of web sites started by women who have suffered and survived post partum depression wanting to help other new mothers.  These are communities where women share their fears and stories and share what methods and treatments worked for them.  Mothers who experience PPD and PPA need to know that they are not alone.  These sites provide valuable support, community and information to both mother and her family.

4.  Health overview: In contemplating the question of PPD as symptom or disease, a health overview is crucial.   Hormone testing, adrenal stress index testing, thyroid testing provide information to the health care practitioner which can help decide the best course of treatment for a mother suffering from PPD or PPA.

5.  Drug intervention: Though, we tend to be oriented toward natural remedies, we have always said that there is a time and a place for drugs.  Mothers who are suffering from PPD and PPA may find it difficult to get the immediate relief necessary from natural therapies and will benefit greatly from medication which can get them over the toughest part of PPD and PPA.  Women who suffer from postpartum psychosis often need to be medicated for life. No mother should have to suffer.   If one is doing drug therapy for PPD and PPA , it is hopefully done as part of a holistic plan of diet, exercise, talk therapy and vitamin supplementation.

6.  Meditation: Most new mothers will laugh at the idea that they would have even two minutes to sit and meditate!  They would be right.  That being said, we suggest a “portable meditation” in the form of deep belly breathing.  If you are pushing a stroller, making dinner, sitting down to nurse, or shopping in the grocery store, you can do this.  It is especially helpful when you start to feel anxious.  Take a very deep breath in through the nose…as much air as you can take in…and then let it slowly out through the mouth.  Ten of these deep, slow breaths will lower your blood pressure, slow your heart rate and reduce stress chemicals.  Every new mother should have this technique in her tool box.

7. Exercise: The research is clear that for those who are able, mild to moderate exercise is a mood elevator. Walking with a stroller, yoga, and other beneficial forms of exercise can be very helpful.

So back to the question is PPD a symptom or a disease?  Like we said, this question worthy of contemplation, but it has no simple answer.  In some ways PPD is a symptom of exhaustion and lack of physical and emotional support; in other ways PPD is a disease of depleted brain chemistry.  In some ways PPD is a disease of the culture which still does not understand the PPD process and needs to become more aware of how women are treated in the postpartum phase of motherhood.

In a perfect world, we would wave a magic wand and all new mothers would stay in a birthing center for a few weeks after childbirth; where there were health care professionals to help them learn the coping skills needed to deal with the challenges and demands of mother hood; where mother could truly rest and recuperate; where nutrition dense meals were served ; where dietary supplements were part of the program; fresh air, sunshine and other mothers to talk with.  In a perfect world just this kind of rest and replenishment could lower the incidence and the severity of PPD and PPA.  In a perfect world.  Until then, we need to keep shedding light on PPD and PPA and study methods of care that can best benefit the mother and the family

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Dr. Dean and Stephanie Raffelock

http://www.soundformulas.com

Sound Medicine, LLC.
3100 Arapahoe Avenue Suite 202
Boulder, CO 80303
Phone: 303-541-9019
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A new kind of electroconvulsive therapy – a treatment for depression – has fewer side effects and is an effective treatment for manic depression. Depression treatment centers throughout Britain and the United States are utilizing “shock” therapy as a treatment.

Electric shock treatment involves a small electrical current sent through the brain. The goal is for the patient to have a seizure. Electric shock treatment was first introduced about 70 years ago after physicians discovered that some people with depression and epilepsy appeared to feel better after treatment. Psychiatrists insist that for the one third of people who do not respond to medication, ECT can prove to be an effective treatment.

The Royal College of Psychiatrists in Britain say that trials comparing ECT with a placebo treatment continue to indicate that patients who had ECT were far more likely to recover, and their recovery time was shorter. The seizure induced by ECT is believed to help by triggering certain brain chemicals like serotonin. One theory is that severe depression is caused by a lack of serotonin. The induced seizure from ECT redirects the serotonin level. There is also research that suggests ECT can stimulate the growth of new blood vessels in targeted areas of the brain.

Despite the benefits of ECT, its popularity faded after tricyclic drugs came on the market. These were followed by SSRIs (selective serotonin reuptake inhibitors) like Prozac. ECT had adverse side effects, including confusion and disorientation after each treatment. Problems with short and long-term memory was also associated with ECT treatment. As a result, the use of ECT in Britain has more than halved over the past 30 years.

The new form of ECT shows promise in reducing or eliminating the side effects. Researchers from Columbia University say that ECT with shorter currents will still result in a seizure but without the side effects. Patients need six to eight treatments, though as many as 12 might be needed. The Columbia University researchers found that remission rates were up to 73 percent with the new ECT treatments.

A larger trial is in progress at the University of New South Wales in Australia. About 180 people are enrolled in the trial.

Dr. Andrew Easton, chair of the Royal College Special Committee for ECT, said that “there is some evidence to show that ultra-brief pulses are effective, with fewer side effects. A recent study has shown that this is only achieved when the treatment is applied to one side of the brain, rather than both.”

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Borderline personality disorder (BPD) is characterized by a consistent pattern of volatile emotionality, unstable relationships, impulsive and self-damaging behaviors (i.e. binge eating, sexual promiscuity, drug abuse), and repeated suicidal gestures. Psychologists who specialize in treating BPD have successfully worked with many individuals diagnosed with BPD, assisting them in building awareness regarding their emotions and decreasing harmful behaviors. However, research suggests that individuals with BPD are at an increased risk for having additional, coexisting psychiatric conditions.

For example, studies have found that between 61% and 87% of individuals diagnosed with BPD also have major depressive disorders. Similar rates have also been found for conditions such as post-traumatic stress disorder, panic disorder, and eating disorders. Due to these high rates of co-occurrence, accurate psychological assessment is extremely important, as it enables an individual to receive appropriate treatment addressing all diagnoses. Thorough psychological assessments with individuals with co-occurring conditions can assist in ensuring that accurate diagnoses translates to the best comprehensive care for the individual.

Research suggests that teens may become addicted and relapse more easily than adults because their developing brains are more motivated by drug-related cues. Adolescent rats given cocaine were more likely than adults to prefer the place where they got it from, indicating higher sensitivity to drug-associated environments.

Further research showed that people with personality disorder and emotional disorders (i.e., depression, anxiety, and phobias) experience their emotions in similar ways. In essence, they enter a downward spiral in which they cannot accept an initial negative emotion; they try to get rid of the emotion; and they have trouble regulating and letting go of the emotion. Dr. Janetzke combines several techniques to help clients to build coping skills in order to accept, let go of and move on from their negative emotions.

After extinguishing the drug-linked preference, a small reinstating dose rekindled that preference, but only in the adolescent rats. These results reinforce previous evidence that teen brains get stuck on drug-related stimuli more easily than adult brains and are most likely to become addicted. Cortical remodeling, how it associates reward cues to consequences, and drug exposure during adolescence may produce drug-linked associations that are extremely difficult to change, reduce, or extinguish. Adolescent addicts may require atypical strategies for drug abuse intervention such as longer treatment and substituting with different rewards such as exercise or music.

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Researchers have been investigating whether cognitive impairments in bipolar disorder are the result of psychotropic medication or the illness itself. Results indicated deficits involving memory, processing rewards, and sensitivity to negative feedback. All of these limitations present difficulties for bipolar patients in making decisions and adapting to situations which contribute to high-risk behaviors. The data indicated that these deficits represent an effect of the illness itself and are not due to mood-stabilizing medication. This clarification should reassure patients to continue utilizing the benefits of mood-stabilizing medication without concern over harmful cognitive side effects. Optimal treatment involves monitoring and managing symptoms by a psychologist who is trained in the treatment of bipolar disorder and clinical psychopharmacology. One type of specialized psychological treatment of Bipolar disorder is Interpersonal Social Rhythm Therapy (IPSRT). IPSRT is an intervention designed specifically for bipolar patients which involves teaching them how to prevent manic and depressive episodes by stabilizing their sleep/wake cycles and daily routines.  Current interpersonal problem areas are also identified in IPSRT and addressed to provide additional stability.  In addition to IPSRT, neuropsychological assessment and cognitive retraining also can assist in reducing the effects of neurocognitive impairments on overall functioning.

Some patients with bipolar disorder also have demonstrated poor psychosocial adjustment, for example unemployment and a lack of reliable friends and quality leisure activities. Poor psychosocial adjustment is associated with low quality of life and increased risk of suicide. Psychologists continue examine this crucial area of psychological functioning to improve patient care.

Insight on Psychosocial Functioning in Bipolar Disorder

Executive functioning involves abilities to generate strategic approaches to problems, monitor and planning behaviors, and revise strategies to behaviors that are no longer appropriate. Executive functioning and insight are strongly related to psychosocial adjustment and are often impaired in patients with bipolar disorder.

Insight involves awareness of current psychiatric symptoms, awareness of the presence of psychiatric disorders, and awareness of the achieved effect of treatment.  In bipolar disorder, the relationship between poor insight and poorer psychosocial adjustment is likely accounted for by neurocognitive deficits. These deficits are exacerbated by multiple manic and depressive episodes. Thus, managing episodes through medication and psychotherapy is critical in preventing future neurocognitive deterioration.

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Relationships are the most important and indispensable parts of every individual’s life. Relationships go bad when one person or both people in the relationship no longer feel happy in the situation they are. When people start to feel that they are not happy in the relationship, it shows that it is the beginning of the relationship failing. There are a huge number of reasons why a person might feel unsatisfied within a relationship. But whether this becomes an end of the relationship or results in some positive changes by both the partners depends largely on how the couple reacts to this situation.

A relationship that no longer pleases both the partners, has reached a stage where there is a need for major changes and in some cases a break up or a divorce in inevitable. At times the reason for relationships failing is the lack of action and initiative on the part of the couple. To put it in a simple language, when obvious issues and problems are not looked into, the relationship begin to become cold.

Relationships go bad when one partner in the relationship is unhappy or has changed his or hers behavior. Other problems that can easily lead to a relationship going bad include infidelity, addiction issues, money problems, and any other reasons that might add strain into a relationship. While some couples manage to stay together during rough times, some couples don’t hold on to their relationships and the relationships turn bad.

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