Tag Archives: depression treatment

A Secret Sadness: Interview with Dr. Valerie Whiffen

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For information about my book, A Secret Sadness, listen to my podcast interview with psychologists, Dr. Brian Macdonald and Dr. Guiseppe Spezzano.  The interview is published in two parts.  In the first part, we talk about patterns in parent-child relationships that may promote the development of depression later in life.  In the second part, I describe how women’s romantic relationships can lead them to become depressed.  For reviews and other information about my book, please visit www.secretsadness.com.

Those of you who are interested in family relationships and parenting will find lots of valuable information and interviews with other writers and researchers at the website hosted by Drs. Macdonald and Spezzano.

 

The Six Myths of Postpartum Depression

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Myth # 1: Having a Baby Causes Postpartum Depression

The name says it all: “postpartum” depression is brought on by having a baby.  It’s true that women are more likely to be depressed during and following pregnancy than at other times in their lives.  Surveys of women who recently had babies show that about 13% are depressed which is higher than the normal rate for women in their childbearing years.  However, this finding doesn’t mean that they became depressed after giving birth.  Studies that follow women from pregnancy through the postpartum period show that up to 40% of the women who are depressed after childbirth also were depressed while they were pregnant.  At this time, we don’t know how many of these women were depressed before becoming pregnant or what role the pregnancy played in their depression.  At least some of these women will be depressed for reasons unrelated to their pregnancy, such as the death of a family member.

Myth #2: Postpartum Depression is caused by Hormones

Myth #2 follows from Myth #1.  If having a baby causes postpartum depression then postpartum depression must be caused by hormones.  You read it in magazines; you hear it from your doctor.  This is the most persistent – and the least substantiated – of the six myths.  For 50 years researchers have tried to find a link between hormones and postpartum depression.  They’ve looked at the levels of estrogen and progesterone, both in isolation and together.  They’ve looked at the rate at which these hormones return to normal.  They’ve found nothing.  There is not a single piece of evidence to support the myth that hormones cause postpartum depression.

However, the persistence of this myth is impressive.  I’ve had the experience of sitting in my office with a postpartum depressed woman and telling her what I’ve just written only to have her say, “Well, yeah, but I’m feeling really hormonal.”

Myth # 3: Postpartum Depression isn’t the same as Regular Depression

This myth follows from Myth #2.  We know that reproductive hormones don’t cause depression if a woman hasn’t recently been pregnant.  So if postpartum depression is caused by hormones, it must be a different kind of depression.  Some people argue that the symptoms are different; others believe that postpartum depressed women want to hurt their babies.  The media are particularly keen to link postpartum depression and killing one’s baby.

What does the evidence say?  When postpartum depressed women are compared to depressed women who haven’t just had a baby, there are very few differences.  One is that the postpartum women tend to be less severely depressed.  However, the types of symptoms they report and how long their depression lasts are the same.

Another issue is the predictors of postpartum depression.  If this is a different kind of depression then it should be predicted by different factors.  However, the predictors of postpartum depression are identical to the predictors of regular depression: life stress, a lack of social support and a difficult marriage.

In all the ways researchers have thought to look, postpartum depression looks the same as regular depression.

Myth #4: Postpartum Depression doesn’t need to be treated

This myth also follows from Myth #2.  If postpartum depression is due to hormones then the woman just has to wait for her hormones to come back to normal.  Physicians will often assure postpartum depressed women that their depression will get better as time goes on.

This myth is dangerous.  It may be one of the reasons that postpartum depressed women typically don’t receive any form of treatment.  But they should.  Women who are depressed during or after pregnancy are at risk for more depressive episodes, both after the birth of later children and at other times in their lives.  For many women, the postpartum episode is just the first of many.  This finding makes it an important episode to treat because the research shows that every time a woman gets depressed she increases her risk for another depression.

Depression at this point in a woman’s life also can have enduring consequences for her baby and her marriage.  When a new mom is depressed, her baby develops more slowly, cries more often and is less likely to form a secure attachment to her, which can create problems for the child later in life.  Women who experience postpartum depression also are less happily married 5 years later than women who didn’t become depressed.

Myth #5:  Postpartum depression occurs out of the blue to emotionally healthy women

This myth certainly reflects what many women tell me.  However, the impression that they were okay before the baby simply isn’t borne out by the research.  The majority of women who develop postpartum depression have sought help for emotional problems in the past.  The strongest predictors of an episode of postpartum depression are: 1. A previous history of depression and 2. Feeling depressed during pregnancy.

Myth #6: Only women experience Postpartum Depression

Again, this myth follows from Myth #2.  If postpartum depression is due to hormones then there’s no reason to think new fathers will become depressed.  In fact, having a baby is even more disruptive for fathers than it is for mothers, and on average more distressing.  Up to 10% of new dads experience significant levels of anxiety and/or depression.  This rate is 1 in 4 if their wives are depressed.

So what is Postpartum Depression?

If it’s not what the myths say it is, what is it?  The causes of postpartum depression are just as varied as the causes of regular depression.  A woman can become depressed because one of her parents dies, because she loses her job in a bad economy, because she’s all alone in a foreign country.  There are just as many causes of depression as there are individual’s life stories.

That being said, the research does suggest certain patterns.  The typical woman who experiences postpartum depression is unhappy in her romantic relationship and may fear that her partner does not love her.  She feels unsupported by him.  Perhaps her partner does not help out around the house or with taking care of other children.  Outsiders may see her partner as indifferent to her.  These factors induce depression at any point in a woman’s life.  When women are unable to have close and harmonious relationships with the people who are most important to them, they feel bad.  I believe this is especially true when a woman is pregnant or has just had a child because the baby is a tangible sign of her commitment to her partner, and she is sensitive to any indication that this commitment is not shared.

There is a reason that women who’ve just had babies are more likely than other women to experience depression – it just has nothing to do with hormones.

The Diagnosis of Depression: What your Physician doesn’t know

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A recent article in Canada’s Globe and Mail newspaper reported that doctors misdiagnose about 20% of their patients’ illnesses. Wow. If physicians misdiagnose this many physical illnesses, I wondered how accurate they can be when it comes to emotional problems like depression.

As it turns out: not very.

In 2007, a physician named Cepolu looked at the results of 36 studies that had examined physicians’ diagnoses of patients who mental health professionals agreed were depressed. 75% of the physicians were family doctors, while the rest worked in hospitals where they might encounter depression, such as emergency rooms and internal medicine. The results of the single studies were compiled in what statisticians call a “meta-analysis.” The results of the meta-analysis showed that the physicians accurately detected depression 42% of the time. Although the detection rate has improved over the past 15 years, more recent studies show that only 1 in 2 depressed patients is accurately identified.

Physician misdiagnosis is a problem because the first person people normally talk to when they feel bad is their family doctor.

Why is physicians’ diagnosis of depression inaccurate? Patients are partly responsible: they tend to report physical symptoms of depression, such as insomnia, rather than the emotional symptoms, such as feelings of sadness. The way patients present the problem may lead their physician to look for physical causes rather than emotional ones. Even physicians who are knowledgeable about depression may be reluctant to ask about emotional symptoms for fear of upsetting their patients or getting a defensive reaction.

Physicians also tend to think of depression as a purely biological problem, which leads them to be poorly informed about the social causes of depression, which I discuss in my book A Secret Sadness. For instance, life stress is strongly associated with the onset of an episode of depression. Most individuals who experience depression had something very bad happen to them within the month prior to the onset of their depression, particularly a loss, such as the end of a relationship. If a physician is knowledgeable about the social context in which depression occurs, they will take this information into account when considering diagnoses. For example, insomnia in a patient who also tells the physician that his marriage has just ended should be more indicative of depression than insomnia that occurs in the absence of major life stress.

Similarly, a person who had a difficult childhood or who has recently experienced a traumatic event is at increased risk for depression.  If physicians don’t know about the connection between depression and negative life events, both contemporary and historical, they’re unlikely to take these risk factors into account when making a diagnosis.

Another strong predictor of depression is past history. A woman who has been depressed previously is at 40 times the risk of another episode when she experiences life stress.  If a physician doesn’t know the patient’s history of depression, she or he may be unlikely to consider this diagnosis when a woman reports physical symptoms of depression.

The advice in the Globe and Mail article is clear: when you’re trying to get an accurate diagnosis, you’re your own best advocate. If you think you’re depressed, read as much as you can about the symptoms of depression. Then if you strongly suspect you are depressed, read as much as you can about treatments. Many people – and most physicians – think the most effective treatment for depression is antidepressants, but their effectiveness may be due to a placebo effect, as described in a recent 60 Minutes report.  A placebo effect means that the act of taking the medication makes people feel better, not the drug itself.  Both psychological treatments and regular, aerobic exercise have been shown by research to be just as effective as antidepressants. While antidepressants only work as long as you take them, psychotherapy teaches you new life skills and exercise gets you in shape.

In Canada, if you think you’re depressed, the only reason to consult a physician is to get a prescription for an antidepressant. You don’t need a physician’s referral to see a psychologist or counsellor unless your extended health care plan requires a referral to reimburse your treatment.

If you think you’re depressed and you want to try antidepressants, tell your family physician about the specific symptoms you know may indicate you’re depressed. If he or she doesn’t raise depression as a possible diagnosis, ask questions: What else could be causing my insomnia? Is it possible I’m depressed?

To help get you started, here are 14 symptoms of depression:

• Feeling sad or crying easily
• Feeling numb or flat
• Feeling angry or easily irritated
• Feeling you no longer enjoy things as much as you once did

AND

• Not wanting to see people, even friends and family
• Feeling that everything is an effort or lacking motivation
• Feeling tired all the time or having to nap to get through the day
• Sleep problems; either you sleep too much or you wake up after a few hours and can’t get back to sleep
• Appetite problems, either you want to eat all the time or you’re never hungry
• Difficulty concentrating or making decisions
• Feeling critical of yourself for your faults or weaknesses
• Blaming yourself, even for things you know rationally aren’t your fault
• Feeling pessimistic about the future
• Feeling that you’ve failed or are a loser

If you feel any of the first 4 symptoms on a regular basis, that is, at least a few days a week, and 3 or more of the remaining symptoms, you may be depressed. If you consult a physician, don’t forget to talk about the emotional symptoms as well as the physical ones. A licensed psychologist also is qualified to diagnose depression.

© 2012 Valerie Whiffen