Congress Wants More Money Spent on Research for Postpartum Depression

The US House of Representatives passed a bill (H.R.20) that encourages NIH to spend more money on PPD, recognizing it as an underfunded area of research.

Rep. Bobby Rush (D-IL) has been pushing this bill for 5 years or so (in honor of Melanie Stokes). (He needs to work on his blog.)

This is a really great effort. The bill goes to the Senate now. Let both of your Senators know how you feel about this bill.

Postpartum Depression and Eating One's Own Placenta

Okay, this is a new one on me. USA Today has a story on placentophagy, which is believed by some to help prevent postpartum depression.

"French's midwife offered her an unusual remedy: She suggested the expectant mother ingest her own placenta as a means of allaying postpartum depression. The temporary organ was saved, dried and emulsified, then placed in gelatin capsules and taken by the mother in the months after the birth in December 2004.

'Before I actually did it, my friends thought it was weird,' says French, 29, of Spokane, Wash., whose fifth child is due in August. 'But when they saw how fast I recovered from my birth and they knew my history, they thought it was pretty neat. Now I have a lot of friends planning to do it.' "

An expert quoted in the article noted the absence of evidence that this practice is effective.

A well-known psychiatrist in Langley, Virginia, suggests eating it "fried with liver and onions and a nice Chianti."

Nine Months And Counting....And Counting...

I started this post as an email to Midwife With A Knife to help her with her talk about perinatal psychiatric issues. It got long enough that I decided to turn it into a blog post instead. I see Dinah is also working on her part of MWAK's homework and it's a good one. Here goes.

Last November I went to an excellent CME lecture on perinatal OCD. I thought this would be a nice change from the usual maternity-associated illnesses like post-partum depression and psychosis.

First of all, obessive-compulsive disorder is an anxiety disorder characterized by obsessions or compulsions that are time consuming or interfere with social or occupational functioning.

Obessions are anxiety-producing thoughts, impulses or images that are excessive and beyond the range of normal worry about real-life problems. Sufferers usually recognize that they are irrational, and often try to ignore or suppress them. The most common types of obsessions are contamination obsessions followed by obsessions about aggression or the need for exactness.

Compulsions are urges to perform repetitive behaviors or mental acts. They usually happen in response to obsessions and are aimed at reducing distress or preventing some unpleasant event. The most common types of compulsions are checking rituals followed by cleaning or washing. There can also be mental compulsions (repeating words or numbers, counting or reciting prayers.)

The prevalence of OCD is about 1 in 50 people (2.3% of adults). The gender ratio is 1:1 male/female. The prevalence of perinatal OCD is 0.2 to 3.7%. Eighteen percent of new cases occur during the postpartum and 6% during pregnancy. Most women with pre-existing OCD have no change in symptoms with pregnancy, but one-third may have worsening or a change in symptom presentation.

The types of obsessions in perinatal OCD are different than in non-postpartum OCD. Postpartum obsessions are more likely to involve contamination fears or fears of violence (eg. intrusive thoughts to poke the baby's "soft spot", putting the baby in the microwave) than non-postpartum OCD. Patterns of compulsions are also different---postpartum OCD is more likely to involve checking, washing and cleaning rituals. Some OCD patients have been known to call their daycare multiple times a day to neutralize their obsessions.

About half of women with post-partum depression have co-existing OCD, but the OCD is less likely to be diagnosed because of patient concealment and embarrassment. And yes, fathers can get it too.

Treatment usually involves cognitive-behavioral therapy sometimes combined with medication. For the Ob-Gyn crowd, this would be the time to refer. Dinah is writing a good post about meds in the peripartum, so I'll leave that to her.

Hope this helps.

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]

[Roy] Tom Knows Psychiatry!

[Guest blogger here, Roy]: I don't know how many of you watch Keith "keep your knees loose" Olbermann's Countdown on MSNBC, but he tends to deliver news with an edge. For example, every night he has a segment titled, "Worst Person in the World." I think a recent one was about Phillip Winikoff, a 76yo man in a white lab coat going door-to-door saying that he was from the health department providing free, in-home screening breast exams. What a boob! [sorry--I can't resist a bad pun]

Keith Olbermann has recently focussed his lens on Tom Cruise. Before Mr. Cruise and Katie Holmes had their baby, Suri, this week, Keith was pondering whether he required Katie to have a "silent birth", as prescribed by his, umm, religion. My understanding is that the newborn must experience extreme quiet -- no touching, no noise -- for some period of time, I guess to let it chill out... you know, provide a little stress innoculation to protect it from future psychopathology, lest it be taken advantage of by unscrupulous psychiatric quacks who would push mind-altering drugs on to the would-be maladjusted, unsuspecting, little alien Thetan channeler, rather than the much more appropriate method of clearing one's bad karma by being audited by a specially trained, well, auditor, who uses some high-tech E-meter device to slowly but surely remove each and every last of the two-thousand-some galactic Thetan spirits which inhabit each of us when we are born. ::taking a deep breath::

Where am I going with this? Oh, yeah. Keith Olbermann pointed out that little Suri just happens to have been born on the same date that Brooke Shield's baby was born. You may recall that Mr. Cruise ridiculed Ms. Shields for seeking treatment for her postpartum depression, rather than handling it his way. Mr. Olbermann wondered what will happen if Ms. Shields also develops a postpartum depression (up to 10% of women develop postpartum depression after giving birth). We can guess she won't take medication or see a psychiatrist. I figure Tom will treat her. After all, he knows Psychiatry. Then, "Doctor" Phillip Winikoff can provide him a free examination.