Tuesday, July 28, 2009

Article in The Columbus Dispatch - front page!

We made the Front Page!
Here's the link to the full article: Fearful mothers finding help: Support group, doctors take on depression
Thank you to The Columbus Dispatch and Medical Reporter Misti Crane for providing a quality, well-balanced article about the important issue of maternal mental health. Many thanks, also, to Jobie Krantz and Heidi McAlister for their contributions to the piece. And, most importantly, thank you to our unsung hero, Amy Burt, in leading our vital mom-to-mom support programs!

Sunday, July 26, 2009

Postpartum Depression is Top Priority for New ACOG President

Chicago, IL -- Today Gerald F. Joseph Jr, MD, of Louisiana , became the 60th president of The American College of Obstetricians and Gynecologists (ACOG), based in Washington , DC . During his inaugural speech at ACOG's Annual Clinical Meeting, Dr. Joseph announced that postpartum depression is the theme of his presidential initiative.
"While in an ideal world, the newly delivered mother is at the peak of her reproductive health, with a beautiful child and, ideally, a supportive, loving family, this unfortunately is not always the case," said Dr. Joseph. "Studies show that this is a most vulnerable time for our patients, especially those prone to depression or those with a history of depression." Complicating matters is that the new mother often can't bring herself to admit to any problems or negative emotions due to societal pressures, he said. Instead of asking for help, she may feel guilty for not being 'grateful' or a 'good' mother.
Dr. Joseph explained that the 'baby blues,' which affect as many as 80% of new mothers, usually start early after delivery and spontaneously resolve within a very short period of time. "But what happens when these negative feelings don't resolve and true major depression becomes a part of the process?" he asked. "This can be devastating for the mother, the child, the partner, the family, and the ob-gyn who is caring for her."
There are three areas in particular that need to be addressed, according to Dr. Joseph. "First, we need to determine the true prevalence and incidence of postpartum depression," he said. Because definitions of depression vary among different studies, postpartum depression is estimated to range anywhere from five percent to more than 25 percent, depending on these changing definitions and the diversity of populations studied. "Second, the available screening tools to assess potentially at-risk pregnant women often are imprecise and leave much to be desired. And, finally, we need to develop evidence-based guidelines for ACOG members to screen for postpartum depression."
"We also need to know how ACOG Fellows screen and identify patients suffering from postpartum depression," Dr. Joseph continued. "When do they counsel? How do they treat? Do they refer to other specialists for treatment? What kind of local programs are available for education and support? These are all questions that we need answers to."
In addition, Dr. Joseph said, "Let us hope that this is the year for real, meaningful health care reform. Effective, affordable health care needs to start on the front end with prevention of disease, rather than the acute care on the back end that too many of our citizens receive today. We end up caring for sicker patients and paying much more for expensive acute care rather than the less expensive preventive care. As president, I assure you that ACOG will continue to push for preventive care for all."
Dr. Joseph is a senior consultant in gynecology at the Ochsner Health Center in Covington , LA , and clinical assistant professor of obstetrics and gynecology at Louisiana State University and Tulane University in New Orleans . He has been an ACOG Fellow since 1978. Dr. Joseph has chaired the Committee on Scientific Program and the task forces on Enhancing Practice Satisfaction and District and Section Contributions. He has been a member of ACOG's Executive Board and has served as the Executive Board liaison to the Society for Maternal-Fetal Medicine. Dr. Joseph has served on the committees on Gynecologic Practice, Nominations, Credentials, and Long-Range Planning and on the task forces on Medical Student Recruitment, Nominations Process, and Scope of Practice. He has been a member of the Council of District Chairs, the Grievance Committee's Appeals Panel Committee, and the medical advisory board for pause® magazine.
Dr. Joseph has served in numerous regional leadership positions, including chair of ACOG District VII and the Louisiana Section. He has also served as District VII scientific program chair and as a member of the Missouri Section Advisory Council. Dr. Joseph is past president of the New Orleans Gynecological and Obstetrical Society and the Southeastern Obstetrical and Gynecological Society. He has been active in the Central Association of Obstetricians and Gynecologists for many years, serving as a member of the board of trustees and as vice president.
Dr. Joseph received his medical degree from Tulane University and completed his residency at Louisiana State University in Shreveport .
# # #
The American College of Obstetricians and Gynecologists (ACOG) is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization, ACOG: strongly advocates for quality health care for women; maintains the highest standards of clinical practice and continuing education of its members; promotes patient education; and increases awareness among its members and the public of the changing issues facing women's health care.

Tuesday, July 14, 2009

Time Magazine: Faulty Article Fails Moms

To the Editors of Time:

Time has done a great disservice to all mothers who are suffering and will suffer from postpartum depression (PPD). In an article called “The Melancholy of Motherhood” journalist Catherine Elton writes a distorted story that no doubt has already begun to confuse and stigmatize women with PPD.

We cannot understand why Time would choose to sensationalize what is a very serious medical issue for hundreds of thousands of women in the United States each year, and to create controversy around the MOTHERS Act, the one and only piece of legislation that would help to systematize support and services that are sorely lacking in so many places throughout our country.

There are several points in the article that concern us:

1. The MOTHERS Act is not “dividing psychologists” as Elton opines. The American Psychological Association, the American Psychiatric Association and the National Association of Social Workers wholeheartedly endorse the MOTHERS Act. In fact, you neglect to mention that much of the medical community supports the bill. It has been publicly endorsed by the March of Dimes, the American College of Obstetricians and Gynecologists, the American College of Nurse Midwives, the National Healthy Mothers Healthy Babies Coalition, and the Association of Women’s Health, Obstetric and Neonatal Nurses, among many others. You didn’t represent any of them in your piece, all of which are highly regarded organizations which have a long record of dedication to the health of both mothers and babies.

2. Elton calls screening controversial and infers it may not even work. Many women will tell you that screening saved their lives, and others who were not screened wish they had been so they could have received treatment sooner. In fact, Elton interviewed at least two such women but they were not represented in the article. Screening for PPD is an effective way to identify women who may have it. Both the sensitivity (misses few sufferers) and specificity (some, but not too many false positives) of the widely-used and validated Edinburgh Postnatal Depression Scale, for instance, is very well-established. We’d be happy to send you multiple, contemporary, highly-regarded studies that support this.

3. Elton states that “… increased screening could lead to an increase in mothers being prescribed psychiatric medication unnecessarily.” First, the MOTHERS Act does not require screening. Second, none of the screening tools for depression were designed to take the place of evaluation by health care professionals, so it is manipulation to suggest that screening alone will yield treatment of any kind or specifically treatment via medication. In a study of large scale universal screening efforts of more than 1000 pregnant and postpartum women, screening for depression did not lead to greater rates of treatment (Yonkers et al., Psychiatric Services, 2009). This is because there are many barriers to treatment, regardless of a positive screen. Additionally, for those who are able and choose to be treated, many women elect methods that don’t include medication (Pearlstein et al., Archives of Women’s Mental Health, 2006).

4. Time should be more careful when discussing the causes of PPD. We were surprised to see such a well-regarded publication misrepresent the results of a small research study that provided evidence to support the idea that a subset of women are more susceptible to hormonal changes as a trigger for depression, such as PPD, by prefacing the results with the unsubstantiated statement that “pregnancy hormones … have little to do with PPD in most cases.” This study showed that for those with a known history of depression, the hormonal changes that occur following delivery may increase one’s risk for developing symptoms during the postpartum period. Yet Elton attempts to use these results to support Michael O’Hara’s overgeneralization that women without prior history of “lots of anxiety and depressive symptoms” (what does this even mean objectively?!) “are unlikely to have problems in the postpartum period – not even close to likely.” Reporting results out of context to support the opinions of a source is appalling.

The fact that women who have had depression or anxiety in the past are more likely to experience PPD is nothing new. This is only one of many risk factors that have been identified. Your article, however, attempted to make a previous history of depression or anxiety the single key to identifying PPD. This will lead women who are ill but who have never been clinically diagnosed or treated for a mental illness to believe they must not have PPD. Many women who suffer will tell you it was the first time they were ever treated for a mental illness and the first time they came to realize they may have suffered from depression or anxiety in the past. You also leave out women who have no history of depression or anxiety but ended up with PPD for other reasons. Perhaps you were not aware, for instance, that diabetes is a risk factor for PPD (Kozhimannil et al., JAMA, 2009), as is thyroiditis. Women who deliver multiples or have babies born with serious health problems also have a higher risk of getting PPD.

5. The language used in the article frustratingly minimizes the devastation that PPD can cause. Such phrases as “the melancholy of motherhood” and “still, there is no denying that the postpartum period is a difficult one for many women” almost brush PPD off as a blue funk or a trying transition time for new moms. This signifies a clear lack of understanding about the seriousness of this illness that somewhere between 10 and 20% of women around the world suffer. PPD impacts a mother’s ability to function on a daily basis. It is not a difficult period. Elton asks, “Does PPD screening identify cases of real depression or simply contribute to the potentially dangerous medicalization of motherhood?” It is no more medicalizing motherhood to identify and treat PPD than it is to identify and treat gestational diabetes, which is universally screened for and occurs in only 3.5% of mothers.

As Time reported in June, the National Academies fully endorses screening for parental depression and believes it is crucial, while also emphasizing that screening is not helpful unless there is effective follow up and treatment tied to it. Supporters of the MOTHERS Act share that belief. Although effective treatment is available, fewer than half of cases of postpartum depression are recognized (Gjerdingen et al., Journal of the American Board of Family Medicine, 2007). Even fewer of those women ever receive treatment of any kind.

We are terribly sorry about the experience of the one mother quoted in your article, which happens on rare occasions, but we believe that the MOTHERS Act would actually go a long way to prevent what happened to her. What this bill actually funds is research, education and awareness. If these pieces are put in place, women, families and medical professionals will be better educated to prevent false positives from screening. A well-trained and educated physician will know to refer the patient on to a specialist who can inform her of various treatment options and monitor her to ensure the treatment she chooses is effective. A woman who has been made fully aware of the kind of services she should receive and the risks and benefits of the treatments available to her will be able to make the best choice for herself and her family.

Time focused on one potential but unlikely consequence of the MOTHERS Act rather than the actual content of the bill and why it is so sorely needed. We are deeply disappointed.

Sincerely,

Mary Jo Codey, mother of 2, former first Lady of New Jersey, kindergarten teacher, New Jersey
Carol Blocker, mother of Melanie Blocker Stokes (http://www.melaniesbattle.org/), Illinois (carolblocker@aol.com)

Sonia Murdock, co-founder and executive director of the Postpartum Resource Center of New York (http://www/. postpartumny.org), past president of PSI, New York

Cheryl Beck, DNSc, CNM, FAAN, mother of 2, Board of Trustees Distinguished Professor at the University of Connecticut School of Nursing, co-author of the American Journal of Nursing 2006 Book of the Year award, Postpartum Mood and Anxiety Disorders: A Clinician’s Guide, Connecticut (Cheryl.beck@uconn.edu)

Amy D. Gagliardi, mother of 4, Director of a Perinatal Health Clinic at a Federally Qualified Health Center, writer, researcher and chair of the Woman's Health Sub-Committee of Connecticut's Medicaid Managed Care Council, Connecticut (amyd.gagliardi@gmail.com)

Valerie Plame Wilson, mother of 2, author of Fair Game, New Mexico

Adrienne Griffen, mother of 3, founder of Postpartum Support Virginia (http://postpartumva.org/), and mid-Atlantic regional coordinator for Postpartum Support International, Virginia (Adrienne.griffin@gmail.com)

Heidi Koss-Nobel, MA, mother, psychotherapist, Chairperson of Postpartum Support International of Washington (http://www.ppmdsupport.com/), Washington (heidikossnobel@comcast.net)

George J. Parnham, Attorney at Law, co-founder of the Yates Children Memorial Fund, Texas (georgeparnham@aol.com)

Ann Dunnewold, Ph.D., mother of 2, licensed psychologist, author of Even June Cleaver Would Forget the Juice Box, past president of Postpartum Support International, Texas (ann@anndunnewold.com)

Diane G. Sanford, Ph.D., internationally-recognized expert on pregnancy and postpartum emotional health, medical advisory board member on Babycenter.com, adjunct associate professor at the St. Louis University School of Public Health, Missouri (ssanford7@earthlink.net)
Tonya Fulwider, mother of 2, executive director of Perinatal Outreach & Encouragement (http://www.poemonline.org/), regional coordinator for Postpartum Support International, Ohio (tonya@poemonline.org)

Adrienne Martini, mother of 2, author of Hillbilly Gothic: A Memoir of Madness & Motherhood, New York (amartini@stny.rr.com)

Katherine Stone, mother of 2, author of the most widely-read blog in the US on postpartum depression (http://postpartumprogress.typepad.com/), WebMD 2008 Health Hero, Georgia (stonecallis@msn.com)

Erin Reilly, co-founder of Sound of Silence, Friends of the Postpartum Resource Center (http://www.soundsofsilencefoundation.org/) of New York, New York

Jen Stoll, mother of 2, executive director of The Postpartum Resource Center of Kansas (http://kansasppd.org/), Kansas (jen.stoll@gmail.com)

Erika Krull, MS, LMHP, mother of 3, mental health counselor, author of the Family Mental Health blog on Psych Central (http://blogs.psychcentral.com/family/), Nebraska (elkrull@yahoo.com)

Wendy N. Davis, Ph.D., mother of 2, psychotherapist & perinatal mood disorders consultant, founding director of Baby Blues Connection (http://www.babybluesconnection.org/), PSI Volunteer Coordinator, Oregon (wdavis@postpartum.net)

Therese Borchard, mother of 2, author of the Beyond Blue blog on Beliefnet (http://blog.beliefnet.com/beyondblue/), author of several books including The Imperfect Mom: Candid Confessions of Mothers Living in the Real World, Maryland (therese@thereseborchard.com)

Carol Peindl, RN, MSN, CNS, psychotherapist/nurse for the Prenatal and Postpartum Center of the Carolinas, PSI coordinator for the state of North Carolina, North Carolina (cpeindl@roadrunner.com)

Diana Lynn Barnes, Ph.D., mother of 2, award-winning psychotherapist, past president of Postpartum Support International, California (dbarnes@postpartumhealth.com)

Lauren Hale, mother of 3, author of Sharing the Journey blog (http://unexpectedblessing.wordpress.com/), iVillage Community Leader for Postpartum Depression and Pregnancy & Depression/Mental Illness Message Boards, Georgia (lauren.hale@ppdacceptance.org)

Pec Indman, PA, EdD, MFT, mother of 2, psychotherapist, co-author of Beyond the Blues, A Guide to Understanding and Treating Prenatal and Postpartum Depression, Education and Training Chair of Postpartum Support International, expert panelist for the Maternal and Child Health Bureau/HRSA, California (pec@beyondtheblues.com)

Tara Mock, mother of 2, author of the Out of the Valley blog for Christian postpartum depression support (tara@outofthevalley.org)

Ivy Shih Leung, mother of 1, author of Ivy's PPD Blog (http://ivysppdblog.wordpress.com/), New Jersey

Helen Ferguson Crawford, mother of 2, architect, Georgia (hcrawford@lasarchitect.com)

Karen Kleiman, MSW, founder and director of The Postpartum Stress Center (http://www.postpartumstress.com/), author of several books on postpartum depression, Pennsylvania (kkleiman@aol.com)

Catherine Connors, mother, author of the Her Bad Mother blog (http://www.badladies.blogspot.com/), Canada (herbadmother@gmail.com)

Joan Mudd, mother, founder of the Jennifer Mudd Houghtaling Postpartum Depression Foundation (http://www.ppdchicago.org/), Illinois (joanmudd@comcast.net)

Susan Dowd Stone, MSW, LCSW, NJHSS Certified Perinatal Mood Disorders Instructor, Public Reviewer for the National Institutes of Mental Health, author and Adjunct Lecturer at the Silver School of Social Work at New York University, New Jersey (Susanstonelcsw@aol.com)

Marcie Ramirez, mother, PSI Coordinator of Middle Tennessee, Tennessee

Amber Koter-Puline, mother of 1, author of the Beyond Postpartum Blog (http://www.atlantappdmom.blogspot.com/) and Atlanta support group facilitator, Georgia (amberkoter@aol.com)

Amy Tobias, mother, Indiana (atobias@tobiasofc.com)

Kimmelin Hull, PA-C, LCCE, mother of three, director of Pregnancy to Parenthood and author of A Dozen Invisible Pieces and Other Confessions of Motherhood, Montana (kmh@pregnancytoparenthood.org)

Sylvia Lasalandra-Frodella, mother of 1, Constituent Relations for the former First Lady of New Jersey Mary Jo Codey, author of A Daughter’s Touch, New Jersey

Lisa Jeli, mother of 1, California

Susan McRoberts, mother of 3, author of The Lifter of My Head: How God Sustained Me Through Postpartum Depression (suemcroberts@mac.com)

Sara Pollard, RN, BS, Clarian Women’s Health Services, Indiana (spollar2@clarian.org)

Amy Burt, MA, mother of 3, director of operations, Perinatal Outreach & Encouragement for Moms (http://www.poemonline.org/), Ohio Coordinator for Postpartum Support International, Ohio

Diane Ashton, MSW, mother of 2, founder of PPD Support Hawaii (http://www.ppdsupporthi.org/), Hawaii

Laurel R. Spence, MS, PA-C, mother of 3, Assistant Professor, Baylor College of Medicine, clinical physician assistant, Women’s Specialists of Houston, Yates’ Children Memorial Fund/Women’s Mental Health Initiative advisory council member, speaker’s bureau Mental Health America – Houston and Postpartum Support International member, Texas (lspence@bcm.tmc.edu)

Tuesday, July 7, 2009

Recovering...from a bad day

Everyone has bad days once in a while. But plain old bad days aren't so simple once you've experienced a mood disorder. When you've suffered from depression, anxiety, etc., and have had a period of many bad days, the part-of-life down days carry a whole different meaning.

What if I'm slipping back down again? What will I do? These worries can make a plain 'ol crappy day much worse.

So we must prepare.

Melissa McCreery, PhD, ACC, a Psychologist and Life and Wellness Coach, has written an excellent piece, "How to Recover from a Bad Day." She writes:

Bad days are a part of life. We all have them. No matter how many yoga classes you attend or how smoothly your life runs, you'll run up against one sooner or later. The secret to thriving is learning how to move forward in spite of bad days, not aiming to never have one (although minimizing their frequency is a good thing).

Here are some tips for dusting yourself off and getting back on track after a bad day happens:

Do you have permission to have a bad day? Make sure that your inner-perfectionist (the one who requires all-or-nothing success) isn't running your show. Are you knee-deep in self-blame or guilt for things that may have contributed to your bad day (or for the way you reacted to it)? As long as you are busy beating yourself up, you won't be able to move on. Why not try on the idea that an occasional bad day is simply to be expected? It doesn't mean you failed; it means it's time to implement the "bad day plan."

Are you ready to move on, and what will you need to let go of to do so? This is an important question. Are you ready to move on from your bad day, or do you need it to continue for a little while longer? If you are busy beating yourself up, or feeling miserable, or drowning your sorrows, or feeling indignant and victimized, you're not ready to stop having a bad day yet. What do you need to let go of in order to start to shift into a different space? Anger, hurt, frustration, and negativity are all common answers.

What do you want to move on TO? How do you want things to be? How do you want to feel? What do you want your mindset or mental attitude to be? Your posture? Your facial expressions? Take a look in the mirror and make sure you aren't still carrying your bad day with you -- it's amazing how often we do this.

What helps you feel grounded? An important step in moving on from a bad day is connecting with the present and letting go of the past. What helps you to be really present in THIS moment -- completely here and alive? For some people, deep breathing or physical activity helps. Some people like to journal or spend quiet time alone. Take some time to get centered and to set your intention for how you want to BE in the present moment and into the future.

What kind thing can you do for yourself? This is what we do for others who are having a bad day. What can you do for yourself? (And no, a pint of ice cream doesn't count.) Can you call a friend or rent a movie? Pick a flower from your yard? Schedule a massage or a long bath or buy some new nail polish? Bad day recovery days are prime times for self-care.

What's one thing you can commit to that is a positive action? It doesn't need to be big. Pick one small step or action that signifies that you are moving in a positive direction. Do a good deed or a short workout or clean out one drawer. You'll know the action that fits. Your goal is to take the first step toward getting on a more positive track, and when that's done, take the next one.



www.poemonline.org

August meeting correction

Our Saturday meeting in August has been changed to the 15th - not the 8th, as previously posted. Same time, same place.

Thanks!