Beyond Blue

Beyond Blue


An Open Letter to Time Magazine About Postpartum Depression

posted by Beyond Blue

I admire my friend and fellow blogger Katherine Stone for being such a warrior in the fight to understand postpartum depression. Whenever controversy surfaces in the media, my first inclination is to run and hide, whereas hers is to get in there and start fighting. She gathered a number of mental health bloggers and advocates to sign the following letter to Time Magazine regarding a recent article called “The Melancholy of Motherhood,” which wasn’t a fair snapshot of postpartum depression. Not according to John Grohol of Psych Central, and not according to the list of other professionals Stone called on to counter this article.

An Open Letter 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, Illinois

Sonia Murdock, co-founder and executive director of the Postpartum Resource Center of New York, 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

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

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

Adrienne Griffen, mother of 3, founder of Postpartum Support Virginia, and mid-Atlantic regional coordinator for Postpartum Support International, Virginia

Heidi Koss-Nobel, MA, mother, psychotherapist, Chairperson of Postpartum Support International of Washington, Washington

George J. Parnham, Attorney at Law, co-founder of the Yates Children Memorial Fund, Texas

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

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

Catherine Connors, mother, author of the Her Bad Motherblog, featured parenting blogger at Beliefnet.com, Maternal Health Editor at BlogHer.com and Partner/Managing Editor at Mamapop.com, Canada

Tonya Fulwider, mother of 2, executive director of Perinatal Outreach & Encouragement, regional coordinator for Postpartum Support International, Ohio

Adrienne Martini, mother of 2, author of Hillbilly Gothic: A Memoir of Madness & Motherhood, New York

Katherine Stone, mother of 2, author of Postpartum Progress, the most widely-read blog in the US on postpartum depression, WebMD 2008 Health Hero, Georgia

Erin Reilly, co-founder of Sound of Silence, Friends of the Postpartum Resource Centerof New York, New York

Jen Stoll, mother of 2, executive director of The Postpartum Resource Center of Kansas, Kansas

Erika Krull, MS, LMHP, mother of 3, mental health counselor, author of the Family Mental Health blog on Psych Central, Nebraska

Wendy N. Davis, Ph.D., mother of 2, psychotherapist & perinatal mood disorders consultant, founding director of Baby Blues Connection, PSI Volunteer Coordinator, Oregon

Therese Borchard, mother of 2, author of the Beyond Blue blog on Beliefnet, author of several books including The Imperfect Mom: Candid Confessions of Mothers Living in the Real World, Maryland

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

Diana Lynn Barnes, Ph.D., mother of 2, award-winning psychotherapist, past president of Postpartum Support International, California

Lauren Hale, mother of 3, author of Sharing the Journeyblog, iVillage Community Leader for Postpartum Depression and Pregnancy & Depression/Mental Illness Message Boards, Georgia

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

Tara Mock, mother of 2, author of the Out of the Valley blog for Christian postpartum depression support

Ivy Shih Leung, mother of 1, author of Ivy’s PPD Blog, New Jersey

Helen Ferguson Crawford, mother of 2, architect, Georgia

Karen Kleiman, MSW, founder and director of The Postpartum Stress Center, author of several books on postpartum depression, Pennsylvania

Joan Mudd, mother, founder of the Jennifer Mudd Houghtaling Postpartum Depression Foundation, Illinois

Susan Dowd Stone, MSW, LCSW, mother of 1, 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

Marcie Ramirez, mother, co-founder of the Maternal Mental Health Task Force of Middle Tennessee, PSI Coordinator of Middle Tennessee, Tennessee

Amber Koter-Puline, mother of 1, author of the Beyond Postpartum blogand Atlanta support group facilitator, Georgia

Amy Tobias, mother, Indiana

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

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

Sara Pollard, RN, BS, Clarian Women’s Health Services, Indiana

Amy Burt, MA, mother of 3, director of operations, Perinatal Outreach & Encouragement for Moms, Ohio Coordinator for Postpartum Support International, Ohio

Diane Ashton, MSW, mother of 2, founder of PPD Support Hawaii, 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

Sara Binkley-Tow, MA, CIMI, CHBE, PCD (DONA), executive director of Moms Bloom, Michigan

Sarah Pond, mother of 1, founder of Mama2Mama and early childhood development facilitator, Canada

Birdie Meyer, mother, president of Postpartum Support International

Della Palacios, mother of 2, Florida

Kimberly Wong, founder and chair of the Perinatal Mental Health Task Force of Los Angeles, California

Visit Katherine’s blog post by clicking here. 



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Heather

posted July 15, 2009 at 2:52 pm


Some points of my own:
Oddly enough, the woman writing the response to the TIMES article didn’t seem to notice that BOTH Amy Philo AND Melanie Blocker-Stokes had been treated for PPD with psychiatric treatments. And BOTH had adverse reactions, one ending in suicide, while the other woman (Philo) was strong enough to recognize and save her life by getting OFF of the treatments. And adverse reactions to psychiatric treatment is NOT, in fact, rare at all. More people have died in psychiatric institutions than all major wars combined!
Also, where is the biological/chemical proof of the existence of PPD? No matter how you argue the matter, there is no physical evidence that the “disease” exists.
ALSO, Diabetes and Thyroiditis can cause symptoms of depression. But think about it – ANY disease will cause symptoms of depression. Who do you know, who has gotten a flu and been happy about it?
THINK, PEOPLE, THINK. Use your chemically imbalanced brain and think about the consequences of such a broad, general bill that will spend large amounts of money on research for a problem that doesn’t PHYSICALLY EXIST.



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Steven Y. Park

posted July 15, 2009 at 5:48 pm


I read the Time article and your entire letter, and and I’m still not sure which way to go. Being a physician as well as being a husband of a wife that did suffer from PPD in the past, I can see both sides of the coin.
My wife and I have a different take on PPD, and here is our story:
After the birth of our first son Jonas (10 years ago), Kathy was severely depressed for one year. Not to the point where she had to get professional help, but that year was very difficulty for everyone. After our second son Devin was born (6 years ago), she wasn’t as bad from a PPD standpoint, but she was always dizzy and lightheaded, and had trouble performing routine tasks. At one point her right arm went numb and was seen by multiple doctors who couldn’t help her. One thought she was having a stroke, and was told to go to the ER. Eventually, after about 4 months, it slowly went away.
A few months later, Kathy just happened to mention that the resolution of her symptoms coincided with her returning to her pre-pregnancy weight. The same for the first pregnancy (she had gained a lot more the first time). At this moment, I had a EUREKA moment that eventually lead to the writing and publication of my book, Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired.
All the pieces fell into place: Kathy’s father has known obstructive sleep apnea. Kathy snored mildly during her third trimesters. I had recently read papers about pregnant women being treated for pre-eclampsia successfully with CPAP, which is usually used for obstructive sleep apnea. Gaining weight increases your chances of developing sleep apnea. A new condition called upper airway resistance syndrome (UARS) was described, which is a precursor/variation of sleep apnea where young, thin people have frequent microscopic obstructions and arousals, preventing deep efficient sleep. These people also had much higher rates of anxiety, depression, chronic fatigue, hypothyroidism, irritable bowel symptoms, cold hands, headaches, and more. They are always “light sleepers.”
Most importantly, progesterone increases dramatically during pregnancy. Progesterone is also an upper airway muscle dilator: It stimulates and stiffens your throat muscles, especially the tongue. When pregnant, with all the weight gain, you would expect sleep apnea to increase (in some cases, it does, which can aggravate pre-eclampsia or glucose intolerance). But higher levels of progesterone act as a protective factor. The problem occurs just after delivery. Progesterone drops, but the weight gain persists. The throat is more narrow due to enlarged fat cells, but there’s no progesterone stimulation of the tongue and throat muscles.
It makes sense that women who are prone to PPD also have a previous history of anxiety or depression, since by definition, they are never able to sleep efficiently. They normally prefer not to or absolutely can’t sleep on their backs, since this is when the tongue falls back the most due to gravity, and when in deep sleep, due to muscle relaxation, the tongue can obstruct, causing immediate obstruction and arousal. This inefficient sleep causes a low-grade physiologic stress response, which heightens the senses, leading to a wide range of symptoms like being chronically tired no matter how long you sleep, being irritable, or intolerant of certain odors, scents, or sounds.
In almost every situation, one or both parents snore heavily, and have one of the complications of untreated obstructive sleep apnea, such as depression, diabetes, hypertension, heart disease, heart attack, or stroke.
I’m not minimizing all the great research and knowledge base about PPD. My explanation is only a different perspective, based on what we know about modern human’s inability to breathe properly at night while sleeping. I explain in much more detail the reasons for this in my book.
Knowing what we now, and by implementing certain simple concepts, Kathy had a much better post-partum experience after Brennan was born 5 months ago. Kathy was expecting the worst, delivering at the age of 40. She’s not completely back to normal, but she’s feeling much better than her last two pregnancies at this point.
I think the Time article misses the point by segregating women into susceptible and non-susceptible groups. In real life, everyone is one a continuum, and I think all of us can agree that this is a real and serious problem that doctors, mothers and the general lay public must pay more attention to.
Steven Y. Park, M.D.
http://www.doctorstevenpark.com



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sheila

posted July 16, 2009 at 8:07 am


I had 2 children, one in 2000 and one in 2003, I suffered PPD and some psychosis with the first, I tried to kill myself while my parent had my daughter, but they didnt realize I had thyroiditis in the form of graves disease accompanying my PPD (I was diagnosed depressed and also bipolar at different times in my life). Thyroiditis can cause mental health like symptoms makingme one huge mess, as educated as I am I couldnt tell you simple math or who the president was, I was too confused. They thought at the mental ward, when my hair was falling out and I was losing weight from stress, and then they rush me to take a radioactive iodine tablet (they were going to send me to ECT”S!). many mistakes were made but I recovered in a year and when I had my 2nd child, I had both problems again and knew better how to cope, but still lost another year of rasing my kids. sad.



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