Monday, April 18, 2011

The Truth about Post-Partum Depression

   In regard to the issue of post-partum depression, the United States Department of Health and Human Services’ Office of Women’s Health states: Depression after childbirth is called postpartum depression. Hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen and progesterone increase greatly. In the first 24 hours after childbirth, hormone levels quickly return to normal. Researchers think the big change in hormone levels may lead to depression. This is much like the way smaller hormone changes can affect a woman’s moods before she gets her period.
   Levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food. Low levels of thyroid hormones can cause symptoms of depression. A simple blood test can tell if this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine.1

   According to the government’s own information, researchers think the big change in hormone levels may lead to depression.  The truth is that there is no way for them to be able to prove this.  Low levels of thyroid hormone, known as an underactive thyroid can be determined by a simple blood test and receiving proper medication can have the effect of reducing symptoms of depression.  The fact that a simple blood test can be performed means that an underactive thyroid is a recognized medical condition with a biological basis.  This is not true when it comes to post-partum depression.

  There is no objective medical test that can be performed to determine if a woman is suffering from post-partum depression.  This same United States government website lists some of the possible symptoms of post-partum depression including: tiredness after delivery, tired from a lack of sleep or broken sleep, feeling overwhelmed with a new baby, doubts about one’s ability to be a good mother, stress from changes in home or work routines, unrealistic need to be a perfect mother, loss of a feeling of who one is after having a baby, feeling less attractive, and a lack of free time.

   Given the fact that childbirth has a very dramatic impact on the human body, it is hard to imagine that any woman would not feel tired after delivering a child.  The major fluctuations in her hormones can cause a woman to experience either a lack of sleep or broken sleep for a certain period of time.  Is there any woman who does not feel overwhelmed, at times, by virtue of the fact that she has a new baby?  This child has changed her life forever.  This new mother will no longer have the free time which she had prior to getting pregnant or giving birth; this is a normal result of childbearing. 

   Since children do not arrive with a manual, it is normal for a mother to have doubts about her ability to be a good mother.  Even if one is raised in a loving household with caring and attentive parents, no one has any idea what kind of parent they will be until they are in a situation where they become a parent.

   Parents instinctively want the best for their child.  This child is completely dependent upon his or her parents for every aspect of their daily survival.  Wanting to be the best mother for her child is not an indication that a woman is suffering from a mental disorder, but an indication of the fact that she adjusting to her new role as a mother.  While it is true that there is no such a thing as a “perfect” parent, the desire to want to do everything extremely well for one’s child is normal.  
   How can one give birth to a new child and not experience changes in their home or work routine?  While it might be easier for women with multiple children to adjust more easily to such changes following the birth of their first child, the first time mother will have to readjust various aspects of her daily life now that she has a child.  She may have to cut back on her time at work or postpone other things which she was involved with prior to giving birth until such time as she is able to develop a more stable routine.

    A loss of a sense of who one is after having a child seems quite natural as well.  This woman, who was once a single, independent human being, has now become someone’s mother.  The fluctuation in her hormone levels can easily account for the fact that she is experiencing a sense of loss of identity as well as feeling unattractive.  Weight gain during pregnancy, a normal experience, can contribute to a sense of feeling unattractive and this new mother can benefit herself by using her time with a new child both as a bonding experience as well as remaining active in order to help reduce whatever weight she may have gained.

   Performing an on-line search of the phrase “post-partum depression”, the first website found was actually a site sponsored by Pfizer Pharmaceuticals, Inc., maker of the drug Pristiq.2  Any woman wanting to find out more information about whether or not she has post-partum depression could click on and she is immediately sent to the website which is nothing more than an advertisement for an anti-depressant medication. 

    The Mayo Clinic in Rochester, MN also has link on their website dealing with post-partum depression.  When one clicks on the website that person is immediately presented with an enormous advertisement for Pristiq on the right side of the page.3 WebMD has a page available regarding this issue as well.  Not surprisingly, this page “emedicinehealth” contains two rather large advertisements for Pristiq. 

     How do these drugs, like Pristiq work?  This information should be readily available to the patients through the product information pamphlet which accompanies the medication. How the drug works is known as the “Mechanism of Action”.  Antibiotics, for example, are designed to impact the cellular activity of bacteria by either inhibit it’s grow of killing it outright. However, when it comes to psychotropic drugs, the very packet contained with the medication itself says that the method of action is “unknown”. 

   A major problem is that while these psychotropic medications may decrease the depression it also decreases the joy, which means that these drugs are minimizing what it means to be a human being in an effort to manage the depression.  Instead of working to resolve the underlying issue at the heart of the depression, these medications are simply making these patients numb. Their emotions have almost “flat-lined” which is not a sign of a healthy mental state. 

   Pristiq, for example, a popular post-partum depression medication, has several alarming side effects including: allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives), irregular heartbeat or pulse, low blood pressure (dizziness, weakness), high blood pressure (severe headache, blurred vision), chills or fever, unusual bleeding or bruising, rash or hives, Suicidal Ideation, Headache, tremor, nervousness, or anxiety; difficulty concentrating, constipation, nausea, diarrhea, dry mouth, or changes in appetite or weight, weakness, increased sweating, sleeping or insomnia, decreased sex drive, impotence, or difficulty having an orgasm while at the same time it’s mechanism of action, like all psychotropic drugs is “unknown”. 4 The side effects listed above and not an exhaustive list, but simply several of those mentioned. These are some very powerful side effects and one has to begin to wonder at what point is this actually managing the disease rather than making the patient worse? 5

     Pfizer’s own website states: As with any medication, you may experience side effects while taking PRISTIQ. In clinical studies, the most common side effect with PRISTIQ was nausea. It was generally mild to moderate and occurred most frequently during the first week of treatment. Other side effects included dizziness, sweating, constipation, and decreased appetite. In general, side effects occurred most frequently during the first week of treatment in clinical studies. These are not all the possible side effects of PRISTIQ (see Important Safety Information). In clinical studies of the recommended 50-mg dose, the percentage of people who stopped taking PRISTIQ due to side effects was similar to placebo (sugar pill).6  These potential side effects are far fewer and much more benign that the potential side effects listed elsewhere.

   Senator Robert Menendez (D-NJ) introduced S. 1375 into the 110th Congress in 1997 which is known as the `Mom's Opportunity to Access Health, Education, Research, and Support for Postpartum Depression Act' or the `MOTHERS Act”. This bill is designed to establish Federal grants to provide for post-partum education and screening programs.

   The screening program recommended is the Edinburgh Postnatal Depression Scale (EPDS).  The EPDS was developed for screening postpartum women in outpatient, home visiting settings, or at the 6 –8 week postpartum examination. It has been utilized among numerous populations including U.S. women and Spanish speaking women in other countries. The EPDS consists of 10 questions. The test can usually be completed in less than 5 minutes. Responses are scored 0, 1, 2, or 3 according to increased severity of the symptom. Items marked with an asterisk (*) are reverse scored (i.e., 3, 2, 1, and 0). The total score is determined by adding together the scores for each of the 10 items. Validation studies have utilized various threshold scores in determining which women were positive and in need of referral. Cut-off scores ranged from 9 to 13 points. Therefore, to err on safety’s side, a woman scoring 9 or more points or indicating any suicidal ideation – that is she scores 1 or higher on question #10 – should be referred immediately for follow-up. Even if a woman scores less than 9, if the clinician feels the client is suffering from depression, an appropriate referral should be made. The EPDS is only a screening tool. It does not diagnose depression – that is done by appropriately licensed health care personnel. Users may reproduce the scale without permission providing the copyright is respected by quoting the names of the authors, title and the source of the paper in all reproduced copies.
Instructions for Users
1. The mother is asked to underline 1 of 4 possible responses that comes the closest to how she has been feeling the previous 7 days.
2. All 10 items must be completed.
3. Care should be taken to avoid the possibility of the mother discussing her answers with others.
4. The mother should complete the scale herself, unless she has limited English or has difficulty with reading. 7

    This questionnaire is given to women within seven days after giving birth.  Given the fact that this woman is undergoing a major hormonal change in her body it should come as no surprise that she might answer “yes” to Question 8, for example, which states, “I have felt sad or miserable”.  Both the questions and the answers are completely subjective.  Depending upon how her hormones are effecting her at the time she takes this screen test, this new mother can be determined to be suffering for a major depressive disorder by the person providing the screening and placed on an anti-depressant, when, in reality, her answers were based upon a fluctuation in her hormones and if this same test were administered twenty four hours later her results could be completely different.

   S. 1375 calls for research into the history and causes of post-partum depression as well as epidemiological studies to determine the impact of this problem on members of different racial and/or ethnic groups.  It also provides funding for clinical research for the development and evaluation of new treatments for postpartum conditions, including new biological agents.  Since post-partum depression cannot be determined by any scientific test, such as a blood test, the only possible “biological agent” that can be developed would be a new psychotropic medication.  

   This legislation was referred to the Senate Committee on Health, Education, Labor, and Pensions in 1997 and as of April 18, 2011 it has not been voted on by either the Senate or House of Representatives.  While it is commendable that Senator Menendez and his colleagues have taken an interest in women’s health issues and would like to offer assistance to those who are struggling with post-partum depression, the fact is that most, if not all, of the symptoms are either dramatically reduced or disappear entirely as a result of the woman becoming more comfortable with motherhood.  

   It is unconscionable that what have been understood to be normal human emotions for centuries are now classified as psychiatric disorders.  Changes in mood, temperament, and emotions are normal human experiences.  Providing someone with a drug in order to help them manage these “problems” actually makes us less human in the process.  We no longer have to deal with our emotions and engage in normal human interaction by going to a friend or loved one and expressing how we feel and thereby nurturing our relationship with that person, instead we can now take a pill which will not be able to cure the problem and may actually make the person worse.

                                                   End Notes

     1)    Depression During and After Pregnancy
5)    Jeremiah R. Grosse “The Truth About Mental Illness”

1 comment:

Rowena said...

A high heart beat, low thyroid, and sometimes a tight chest. I exercise hard and often which has been affected by the racing heart. I think I need to back off the dose of bovine supplements .