My Three Shrinks Podcast 29: Suicidal Breast Implants

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This time we recorded inside Clink's place, away from the buses and the birds and the helicoptors. I also did not use the GarageBand filter ("Female Radio") which I usually use to filter out low-volume background noises during silent periods. Let me know your thoughts about how it sounds. We are *thinking* about maybe getting lapel mikes and an inexpensive little mixer to balance out our voices better (any suggestions on products welcomed).

Also, we recorded this last weekend. Since it is a shrink rule that we must take off in August (I swear, they'll kick you out of the APA if you don't), we prerecorded two more podcasts (actually, more like one-and-a-half) which I will dribble out over the next few weeks, but we will return with fresh bloviating blather towards the end of August. (Can't wait? Listen to some old My Three Shrinks.)
July 22, 2007: #29 Suicidal Breast Implants


Topics include:

• Brief discussion about iTunes. We hit #6 in the Medicine section in iTunes last week, thanks in part to KevinMD blogging about our last podcast. We are now getting about 8-9000 podcast downloads per month, which we all find rather amazing. Of course, after the U.S., the country we get the most hits from is China, so we figure there must be Chinese people somewhere trying to learn English from us (big mistake). For the handful of psychiatrists out there (Chinese or otherwise), perhaps we'll release one of those Dummies books about how to make podcasts.
  
  
• "Curbing Nocturnal Binges in Sleep-Related Eating Disorder." Clink talks about this article from Current Psychiatry, about eating in your sleep, particularly after taking Ambien, or zolpidem. Clink read us a related poem:
  
  

  My Grandma had a habit Of chewing in her sleep. She chewed on Grandpa's whiskers, And called it Shredded Wheat.
  

  The article lists weird things people eat in their sleep, including coffee grounds, cat food, and buttered cigarettes (yum!). [I don't think it mentioned eating your own placenta.]
  
  
  
  
• You're Supposed to Get Better. Dinah's post about how to know when you are making progress in therapy, and when to move on. (On the blog, this led to a series of emotional posts and comments about therapy, the power inequity between therapist and patient, and the differences between docs blogging about pts and vice versa. Go here, here, and there to read more.)
  
  
• Archetypewriting.com. Dinah provides an unsolicited (and unpaid) advertisement for this website ("The Fiction Writer's Guide to Psychology") about injecting believable shrinkiness into your fiction, while Clink shows off her new nerdy book (2000 Most Challenging and Obscure Words, by Norman W. Schur) by declaring the word of the day to be hircine.
  
  
• Cosmetic Breast Augmentation and Suicide. Dinah reviews this article from the July issue of AJP, from David B. Sarwer, et al., which finds "Across the six studies, the suicide rate of women who received cosmetic breast implants is approximately twice the expected rate based on estimates of the general population." I guess we need a black box warning on silicone breast implants now. (We had a post a year ago about the Good Breast; this one is obviously the Bad Breast.)
  
  
• Q&A: "Is chronic antidepressant use harmful in the long term?" We don't really do this topic justice, but Dinah refers to a prior post here.
  
  
• Coming up on the next podcast: 3 AJP articles on suicide and depression treatment; federal parity laws; managing agitated patients in your office.
  

I haven't been able to get this song out of my head for the last 2 weeks (prompting me to get the song from iTunes and then buy the CD), so I thought I'd share the infection with everyone: Mr. Blue Sky by Electric Light Orchestra (ELO). For a really cute video of this song, check out CurlyLisa's gang on YouTube.

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Find show notes with links at: http://mythreeshrinks.com/. The address to send us your Q&A's is there, as well. This podcast is available on iTunes (feel free to post a review) or as an RSS feed. You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com. Thank you for listening.

The Good Breast

[posted by dinah]

This one doesn't get a graphic.

From the opinion section of today's New York Times, "About Breastfeeding..."

If you want to start an argument, mention breast-feeding. A two-year federally sponsored campaign caused a rumpus when it compared a mother who fails to breast-feed with a pregnant woman who rides a bucking mechanical bull at a local tavern, or, in one official's formulation, with a woman who smokes while carrying a child. Recently, a Times article on the campaign incited a new debate that kept the report in the paper's most-e-mailed list for days. While we hesitate to stir things up again, it seems as if this is one issue where the middle ground makes the most sense.

The original article, Breast Feed or Else, by Roni Robin, was published on June 13th and states:

Ample scientific evidence supports the contention that breast-fed babies are less vulnerable to acute infectious diseases, including respiratory and gastrointestinal infections, experts say. Some studies also suggest that breast-fed babies are at lower risk for sudden infant death syndrome and serious chronic diseases later in life, including asthma, diabetes, leukemia and some forms of lymphoma, according to the American Academy of Pediatrics.

Both the original article and the opinion piece it inspired discuss some practical reasons women can't breast feed: the logistics of expressing milk at work, or the mother's inability to produce enough milk to nourish her infant.

From a psychiatric standpoint, breastfeeding is a good thing; it helps with the mother's bonding to the infant while creating an environment of closeness, warmth, nourishment, and comfort-- what could be better?

Neither article, however, mentioned what happens when a mother must take medications. The trend is to not only encourage mothers to breastfeed, but to demand it, and now to create the dictate that to not breastfeed is yet one more form of (granted, not yet indictable: sorry Clink and Foo) child abuse. The issue comes up in psychiatry over and over again in the treatment of Post-partum depression. In this condition, the depressed mother is already questioning her competence, she is prone to feelings of guilt, she may be struggling with remorse and distress if there was a separation due to her psychiatric hospitalization, and she may well need to be treated with medications. The last thing she needs is to hear she's harming her infant by not breastfeeding and that her inability to do so is akin to exposing her neonate to cigarette smoke or riding any kind of bucking broncho thingamajiggy.

While one jury's still debating the precise wonders of breastfeeding, another is debating the safety of exposing neonates to psychotropic medications via breast milk. I won't go into those studies here-- most of them look at the immediate effects, or those effects that occur up to age 2 so even if it's found to be safe, the utility of these studies is limited: I want to know how the exposed infants are doing at age 20.

Maybe we will find that early exposure does good things for the infant, maybe it will protect against future episodes of mental illness in a new human being who is already at increased risk (remember, this is my rambling, there is no evidence at all anywhere that this is the case!), maybe we will some day realize that prozac should be in the water supply. In the meantime, however, I'll continue to assume that psychotropic meds might do harmful things to the developing brain. Most of the women I see have stopped nursing before they've crossed my threshold-- it's just been too much to handle in their compromised state. All of them feel guilty. And while I agree that breastfeeding is the ideal, our worlds aren't always ideal or anywhere near it, and I'm left to say that generations of people were raised on formula and people turn out as they will. Zooming asteroids, terrorists, bird flu, and all those known & unknown toxins we drink and breathe, mostly we're just doing the best that we can in a world with no guarantees.


In case I messed up the links:

post partum depression: http://www.womenshealth.gov/faq/postpartum.htm
Breast Feed or Else: http://www.nytimes.com/2006/06/13/health/13brea.html?ex=1151985600&en=4bd49310078f89a1&ei=5087%0A
About Breastfeeding from today's opinion section:http://www.nytimes.com/2006/07/02/opinion/02sun2.html

[Pic per ClinkShrink]