Search for tag: "maternal mental health"

This is your brain on hormones. This is your brain off hormones. This is your brain just right. Sounds like Goldilocks? There's a new treatment for postpartum depression that aims to make this better.

About one in seven women will suffer from postpartum depression. This isn't just a couple of days of feeling overwhelmed with the baby blues, something most of us felt in the weeks after a baby is born. This is overwhelming depression and inability to care for oneself and one's newborn. Neuroscientists have always been interested by the effect of sex steroids on the brain, estrogens, progestin, and testosterone. Those of us who practice reproductive endocrinology like me have a particular interest in progesterone and its metabolites, the molecules that the brain makes out of progesterone.

Progesterone and its brain metabolite allopregnanolone seem to make the brain less irritable. And falling progesterone at the end of the menstrual period may have a role in PMS in some vulnerable women. Progesterone is the most abundant hormone in pregnancy and some think that dramatic drop in progesterone after birth may have a role in postpartum depression.

For most women with postpartum depression, it seems to go away in weeks to months, but some women benefit from talk therapy or the usual antidepressants. But that can take weeks for a measurable difference. Until now, the therapies focused on postpartum depression have been based on the same principles and medication as depression that happens to men and women who haven't been recently pregnant. However, looking at the link of falling progesterone and its brain metabolite allopregnanolone, some researchers have wondered if administering allopregnanolone to women with severe postpartum depression who aren't benefiting from regular therapy might be an approach.

A pharmaceutical company has created allopregnanolone in the lab and call it Brexanolone. The research focused on women with severe postpartum depression who are randomized to a 60-hour infusion of Brexanolone or placebo. The women were within six months of giving birth and had experienced depression within a month after delivery. These women were very depressed. Starting out with an average score of 28 out of 30 on a standard depression scale, that's really depressed.

After the infusion, right after the infusion, not weeks later, women who received the Brexanolone had an average score of nine to 10. And women who received placebo had an average score 14. That meant that placebo works which we know from all studies of antidepressants but the Brexanolone worked better. Twice as many women who received the study drug had scores similar to non-depressed women than women who received placebo. The effect lasted for up to 30 days and maybe longer. And this might be enough for other therapies to take hold.

It has some drawbacks. One is that the infusion has to be done in a hospital setting as one in eight women had dizziness and several women temporarily lost consciousness, passed out. The drug itself has an average cost of $34,000 but there may be some ways that insurance or rebates from the drug company might help. And there is the cost of the infusion in the hospital-based monitoring.

The pharmaceutical company is currently studying an oral form of this hormone though they don't call it a hormone. It looks and acts like a naturally occurring hormone allopregnanolone and that's made in the brain, so I call it a hormone.

The most important aspect of those women who had this treatment is that it worked so quickly. We're all concerned that women with postpartum depression get diagnosed, get into treatment, get family support, and get the best therapy. The consequences for the new baby and for the family of a mom who's withdrawn and possibly suicidal is very significant.

So, this therapy isn't necessarily for all women with postpartum depression but for women for whom regular treatment isn't working and who are struggling to care for themselves or their baby. It's an innovative approach and it's good news for the women, their babies, and their families who are struggling at a pivotal time of their lives. So, take care of yourself and your baby. Get help if you need it. There's new stuff on the way. And thanks for joining us on The Scope.

Dr. Jones: Moms are most likely to experience depression in their mid-30s and 40s. Well, is that because it's the time of life, or is it because they're the moms of teens? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care, and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: A recent study of over 2,000 mothers with children from newborns to early adulthood looked at levels of anxiety and depression in these mothers. We all know that post-partum depression is common, affecting about 12% of women who just had a baby. That feeling of being overwhelmed, being inadequate to the job of being a mom. Depression and anxiety is well-described, and clinicians are ever more focused on identifying moms with postpartum depression and helping them get better.

However, what this new study published in the Journal of Developmental Psychology suggests is that moms are more likely to be overwhelmed and depressed when their kids are early teens than when they're newborns. What's going on here and what shall we do about it?

Firstly, being the mom of teens is much harder than being the mom of a healthy newborn, even if it's your first baby. Babies are moderately predictable. Yes, you get sleepless, but usually you have the tools to figure out what the baby needs and get the job done. There is a very significant hormonal shift after giving birth that can upset the emotional applecart for women.

They're vulnerable, but for most women, the combination of increased awareness, social and psychological help and occasionally, some medicine, gets most women over the hump of postpartum blues in about a year. The baby starts to smile and giggle, you feel more comfortable in your role, and things are still pretty well-defined.

But being the mom of a teen is really hard for many women, and at least a baby will give you a full-on genuine smile once a day. There's no guarantee that an early teen will give you a smile once a month, one that isn't a little twisted with a "Gotcha." They're pushing the boundaries of their bonds with their mom, and it isn't very pretty and it isn't very predictable.

The solutions to their own unhappiness isn't found in a simple checklist. Are they doing drugs? Check. Are they having sex? Check. Are they really going evil places in the Internet? Check. Are they being bullied? Check. Will they even talk to you? Check. Mothers with kids this age have the highest level of stress and loneliness of moms of kids at all ages, and the lowest levels of life satisfaction and fulfillment.

The second possibility is that some of the same hormonal re-wiring of the kids' brain is happening in the moms' brains. The study looked at "well-educated" women who probably didn't have their kids when they were 15 and now they're just 30. More likely, first kid at 25 and now they're about 40. And if they're moms of several teens, they're probably in their mid-40s. Their own hormones are less predictable.

Symptoms of women with PMS are often most prevalent and the most severe in women in their late-30s and early-40s. Our own health may be changing and our relationships may be changing. This is a time of significant stress in marital relationships, and that can add to the loneliness. It's totally unfair that our children are going through very significant mental, physical and social changes at the very time that we're going through our own. In fact, for mothers, "the mid-life crisis" is most likely when their kids are in their early teens.

The third possibility is that this is just part of the biopsychosocial phenomenon called the U-shaped curve of happiness. Studies done all over the world, men and women, rich and poor, highly educated and less educated, millions of people studied show that the levels of happiness are relatively high in the late teens and early 20s, lowest in the 40s, and starting to rise up again about 50, and are the highest in the late 60s to 70s.

Is the U-shaped curved with the bottom of the U of happiness coinciding with the time that most of us have early teens? There are many reasons proposed for this, combined with crazy teens, tough marriage, aging parents, perception there is more good years behind us than ahead of us, and physical aging. The U-shaped curve of happiness is the same for men and women, so it can't be blamed on menopause or pre-menopause.

So what's to do? There are lots of blogs, hotlines for new moms. There are movies and pop stars coming out to talk about their postpartum depression, and it's all the rage. But mid-life moms are on their own, and they don't need to be. The answer of mid-life moms who are tweens who struggle, they share the same similarities with those other new moms. Let's get someone to talk to, someone who's there or has been there. Maybe your mom or sister, or maybe not. Be assured that your friends with the kids of the same age are going through the same things.

Get a group, go out to dinner with your tweenie-mom friends. Giggle a little, reach out to them. You know the kids who are in trouble, more trouble than your own. Reach out and help someone else. Get out of your own head and share with others. Just get out, go for a walk, take an exercise class. Best of all, go for a walk with other tweenie-moms. Many moms had a support group called a playgroup when their kids were little. Now, you should invent a tweenie-moms playgroup for moms to go get out and play.

But sometimes, this won't be enough. If you need more help, and there's no shame in asking for it, healthcare professionals know about this mid-life slump and can help. Women in trouble can get better with therapy, and sometimes a medication can help. It is often a hard time for the kids, the partners, the entire family, but remember, in the event of a sudden loss of cabin pressure, put on your own mask first.

Announcer: If you like what you heard, be sure to get our latest content. Sign up for weekly content updates at thescoperadio.com. This is The Scope, powered by University of Utah Health Sciences.

Interviewer: If you're feeling a little bit overwhelmed with your newborn, it's totally natural because it's hard having a newborn. We're going to find out exactly what that means, and hopefully reassure you coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Sonia Van Hala is with University of Utah Health Care and one of things she likes to reassure her patients about is when you have a newborn, it's hard. It's difficult. And you find that your patients come in and they think that they are inadequate in some way because it is hard. Tell me a little bit about that.

Dr. Van Hala: Babies are remarkable in so many ways, and especially remarkable in how they really turn your world upside down and you're trying to figure out, how do I right things? The biggest thing that parents are challenged with is when things aren't going according to their expectations. We talk a lot about this as we're approaching the delivery date. I deliver babies as well. Just in being flexible and thinking about what's reality going to look like.

The arenas that I see the big challenges happening are in breastfeeding. When breastfeeding is hard either because of too little milk, too much milk, difficulty with the latch. Just having to work really hard at it, so breastfeeding is a common concern.

Also sleep deprivation. Trying to figure out how to manage with not a full nights worth of sleep. I think one of the big things with that is, just trying to not do too much because if you expect to carry on with your regular life while you're figuring out how to have a newborn, well that's a bit too much at that time. You can postpone those other things until a later time. Focus on your newborn first.

Interviewer: Take it easy on yourself.

Dr. Van Hala: Take it easy on yourself. Then, the third issue would be the fussy baby. There are a lot of really unfussy babies out there. When you see them you think "Oh, that's just lovely" and that's really hard when your baby is not one of them. I know because I had two fussy babies myself. So I really have a lot of heartfelt empathy for those parents who come in concerned about the baby that just cries a lot.

For those parents I say bring your child in as many times as you need, if you are worried about something medical going on. So that your doctor can check your child to make sure your child is well and there is nothing that's being missed.

Also know that babies do cry. The range of temperaments between babies is quite broad and it's very normal. The other really important piece is, it's temporary. So your baby will eventually stop crying and you will eventually have a good relationship with your child.

Interviewer: You said early on that parents come in with expectations about what's it's going to be like having a newborn. What are some of the expectations that they have that aren't quite in tune with reality and I think these answers should be something like, when a parent hears it they're like, "Oh, that's me. I'm expecting too much, maybe I should be more over here."

Dr. Van Hala: I think it falls into some of the arenas I just mentioned regarding feeding, temperament, sleep. Also, your emotional response to that. It's pretty common for parents to, especially moms, who are tired, who are trying to breastfeed, and do all this new stuff, to feel overwhelmed, to maybe not feel so delighted to be with their child all the time and then have guilt surrounding that.

Interviewer: Because what good mother would not want to be around their child all the time? Right? Isn't that the expectation?

Dr. Van Hala: Right, right and then they judge themselves and get down on themselves. You know what? That is totally normal, but I really encourage my moms to just be easy on themselves. Recognize this is a hard job and they will make it through it and they will have a good relationship with their child when they get through it. Sometimes people are worried about the quality of time that they're spending with their child when they are not feeling as positive as they had hoped they would be.

Interviewer: But that time is just the same to the child.

Dr. Van Hala: It is.

Interviewer: All that other stuff is our internal thing.

Dr. Van Hala: Yes, that's exactly right.

Interviewer: What about parents that see other parents on Facebook and think "Their life's is so perfect."

Dr. Van Hala: Yeah, Facebook.

Interviewer: Just judging yourself against other parents and how other parents experience are going and not knowing the whole story. Does that happen a lot?

Dr. Van Hala: Absolutely. Well I think it's common and popular to post the good and fun things in our life. We don't want to be posting all the stuff that's sort of a downer. That can be a disservice to parents with a newborn. If all they're seeing is these positive images, and then they're looking at themselves and saying "That's not me, what's wrong?" When really, there's nothing is wrong. Their experience is normal. It's also temporary

Interviewer: What's that last piece of advice you'd have for a parent that is struggling with these things. Just be sweet to yourselves?

Dr. Van Hala: Yes, absolutely. Be kind to yourself. Gentle, loving, kindness. Right? Also seek a support network, people who can help you out and reach out to them and do ask for help. A lot of people just don't feel comfortable asking for help, do. People want to help and they're not going to know your needs unless you speak up.

Also, important to mention, if you're feeling really down and low, you're just feeling like can't pull out it and you're not having the happiness, do check in with your doctor. Make sure you're not dealing with having postpartum depression. That's a real entity and it does affect your health, and the health of your child, and the health of your relationships. Seek support from your friends your family and also your physician.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Dr. Jones: Your baby smiles and her whole little face lights up, but you can't smile back. What's wrong? Is it the baby blues or something more serious? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care and we're talking about postpartum depression today on The Scope.

Announcer: Covering all aspects of women's health. This is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: The birth of a child rewires a woman's brain for maternal behavior. There are huge shifts in the hormonal environment from pregnancy to the postpartum state, breastfeeding turns on the bonding hormone, oxytocin, and adds some sleep deprivation in a world turned upside down and it's no wonder that women can experience a roller coaster of emotions. What are the baby blues and what is postpartum depression, and what can a woman do, and her family do to get help?

Well, let's start with the baby blues. Seventy-five to 80% of new moms experience some emotional upheavals in the first couple of weeks after the birth of a child. It's common. It's hard to do research on new moms. No prospective randomized trials, and we don't have any great animal models for the baby blues, rats. But we do know that a big change in pregnancy hormones and a drop in the levels of endorphins that got a woman through her labor and delivery might be part of the reason that women experience the following: weeping and bursting into tears, sudden mood swings, anxiousness and hypersensitivity to criticism . . . who would criticize a new mom, anyway? Low sprits and irritability, poor concentration, and indecisiveness, feeling unbonded with the baby.

I remember wondering when my new baby's mother was going to show up, myself. The baby blues happened in the first couple of weeks after delivery and don't last more than a couple of weeks, often just a few days. This is the time where family should be around helping the new mom get settled and get as much rest as possible with the new baby. Women without family or partner support may struggle and good news is that it happens to most women and it gets better in about a week or so.

When is the time that baby blues is possibly postpartum depression? If the anxiety and sadness continue the first couple of weeks and gets worse, this is more likely postpartum depression. Postpartum depression affects 8 to 15% of women, about one in eight. The symptoms are similar to depression, in general, overwhelming fatigue or loss of energy, severe mood swings, withdrawing from family and friends, reduced interest in activities you used to enjoy, feelings of worthlessness, shame, guilt or inadequacy. This list makes me sad just to say it out loud.

Where baby blues are common and short-lived, postpartum could go on for months and it should be recognized and treated for the sake of the mom and the baby. The women who experience postpartum depression may not even know what's happening. Families and partners need to be aware that the new mom's in trouble. Treatment is very helpful and can include talk therapy with a psychological therapist and medication can be important. Women who realize they don't feel well emotionally should call their doctors or midwives, or pediatricians and they can be referred appropriately.

There's one other postpartum psychological problem that is a medical emergency. Postpartum psychosis is very rare but serious disease that can develop within the early weeks after childbirth that's marked by a loss of contact with reality. Women may have hallucinations, hearing or seeing things that aren't real that say bad things about them or their baby, they may have delusions about themselves or their babies that are paranoid or irrational, they may show extreme agitation or anxiety, they may have thoughts of harming themselves or their babies.

This is a devastating condition for the new mom and the family and needs immediate medical care. New mom showing these problems should be brought to the medical care right away and often need to be hospitalized to protect themselves and their babies. The good news is that we're better at recognizing and treating women with postpartum mood disorders. We need to get the word out so that women and their families, that it's okay to ask for help, and they can feel better. So let's all go smile and talk to that little baby and thanks for joining us on The Scope.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.