Many of you know that feathers have once again been ruffled by recent opposition to the passage of the MOTHER'S Act. Here's a copy of the bill (Thanks, Susan and Lauren)

Here's TIME Magazine's recent article.

The majority of the debate centers around misunderstandings related to the proposed use of screening procedures and medication.

Today (or tonight EST) Lauren Hale is hosting her featured "Just talkin' Tuesday" where she welcomes comments, both pro and con, of this current debate. Here's the link to her blog.

Check it out.

Then, spread the word and support the passage of the MOTHER'S Act.

PPD Training

Just a reminder that early registration for September's training class will expire July 10th.

If you're interested, please submit your registration form in the next couple of days to get the discounted price. For details, check out the website. And as always, do not hesitate to contact me by phone or email if you have any special concerns.

It's nice to get back to work after our awesome roadtrip to New Orleans. What a ride, highlighted by so many interesting and inspiring people.

While I was away, I received an email from a therapist in Utah who wrote to give me feedback on my book, "Therapy and the Postpartum Woman" and her thoughts on doing this work. She shared her dream of specializing with this population and I was touched by her warm and thoughtful attention to this important work.

Therapists are motivated to do this work for a variety of reasons. I have learned so much from the clinicians who attend our trainings -- about who they are, why they are so committed to this unique client population, why their passion runs so very deep. I've also learned that many enter into this work with a range of emotional readiness. Regardless of their number of years in the field or how much experience they have had in their particular practice, coming face-t0-face with some of the imposing issues specific to this group can be stunning to a clinician unfamiliar with this work.

I have made this post anonymous - feel free to identify yourself if you'd like ;) With her permission, I would like to share her gentle words so other clinicians can ponder this and perhaps, share their own thoughts on the subject:

"I am writing to you today as I have been studying your website and reading your book, Therapy for the Postpartum Woman and felt the strong to express my gratitude. For approximately 8 years I have had a dream of working with women struggling with pregnancy related issues. However, there were no such trainings, clinics or groups that worked specifically with this population. So as a student I gained my education working with women but not specifically postpartum, miscarriage, etc. Now that I am in a position to be starting my own practice, I hope to create such a place for my community.

My expression of gratitude is best described by an experience I had with the Hawaiian ocean. I did my undergraduate work at a university on the north shore of Hawaii. I have always been drawn to water and particularly the ocean. When I first arrived to the island, I ran into the ocean fully clothed, thrilled to be at my new "home." I continued to play in the ocean throughout the days to follow not considering the size of the waves, the strong pull of the current or the rising of the tide. I was very ignorant to the power of the ocean and could have gotten very hurt. Later I met a dear friend who had lived there many years and loved to surf. He sat me down one day on the sand and taught me about the ocean and the more I learned the more respect and caution I exercised. I realized how much I didn't know and the more humility and education I gained, the deeper my love and respect grew for this great body of water. From there on, I approached the ocean very differently, taking into consideration all of the surrounding factors that would make it safe, risky or dangerous to enter.

I feel the same way as I am delving into the waters of postpartum depression. Initially I was jumping in fully clothed with little understanding. Now I am realizing how deep these waters go and how critical it is I become a life long student of learning rather than striving to be an expert who has arrived. The more I am learning the more I realize how much I don't know. Thank you for showing me the respect and spirit necessary to be able to work with this group. I am humbled while excited."

Marital status affects prenatal and postpartum depression

Here's a study I found interesting. "Cohabitation as a strong predicting factor of perinatal depression." (April, 2009, Podolska, Majkowicz, Sipak-Szmigiel, Ronin-Walknowska)

I have to admit at first glance I thought to myself, why are they studying this? What information will this possibly provide us?

But after reading the conclusion, it occurred to me that their results further validates what many of us know to be true and has been documented time and time again: the relationship acts as a foundation for postpartum women and can significantly contribute to how a woman feels after she has a baby.

Their study concluded that the marital status was significantly associated with the presence of prenatal and postpartum depression, specifying that living alone or living together but unmarried both put women at greater risk. Apparently the marital status itself (without measurement of satisfaction) was supportive to some extent. Interesting that co-habitation was a greater risk factor that single motherhood, don't you think?

Co-habitation may, in some instances, indicate ambivalence? Or lack of commitment? Or insufficient support? Or fear of something that may be unsettling.

Or, I could be completely off base.


Reference: Ginekol Pol. 2009 Apr;80(4):280-4

Postpartum Depression Clinical Training

Attention fellow clinicians

We had another wonderful training this weekend joined by clinicians from two of my favorite places, Indiana and St Louis, Mo. (I guess, and hope, I will never outgrow my Midwest roots and affinity!)

It was an especially cozy group of fabulously passionate women who are committed to furthering their study and becoming experts in the treatment of postpartum depression. It is, as most of you already know, my very favorite thing to do. I am honored to work so closely and intimately with such dedicated clinicians.

To those of you who attended, do not hesitate to contact me if you need anything. And to those of you who are interested in attending, our next training session will be in September, 2009. Please check our website for details.

PPD screening in pediatric offices

Clinicians note:

A new study published in the May issue of PEDIATRICS looked at the issue of screening for postpartum depression at pediatric well-visits.

It was carried out at an adolescent-oriented maternity clinic and it's interesting to note that the providers were electronically cued when they opened the electronic file of a patient who had scored >10 on the EPDS indicating that they could be re-screened. (I want one of those!)

Prevalence went down when the rescreened at 4 months but increased at 6 months therefore the recommendation put forth from this study was that rescreening at the 6 months well-visit would be most beneficial.

Conclusion:

"Screening 2 months after delivery detects most mothers who become depressed during the first 6 postpartum months, and screening at the 6-month well-child visit is preferable to screening at the 4-month visit."

Antidepressants and breast cancer recurrence

Please take note of this not-so-good news about some antidepressants and breast cancer recurrence rates:

As reported in the Wall Street Journal in an articled titled "Some Antidepressants Cut Tamoxifen's Effectiveness - Study" by Jennifer Corbett Dooren, the use of some antidepressants can double the breast cancer recurrence rate.

Apparently some antidepressants, which are prescribed for depression and also prescribed for hot flashes (which can be a side effect of the drug Tamoxifen), are considered to be CYP2D6 inhibitors which means they can chemically interfere with active ingredient in Tamoxifen.

Here are some excerpts:

"Some antidepressants such as Paxil, Prozac and Zoloft are considered moderate-to-potent CYP2D6 inhibitors while antidepressants like Celexa, Lexapro and Luvox are considered weaker inhibitors."

"We've known that these CYP2D6 inhibitor drugs block the activation of tamoxifen chemically, but this is the first time there's evidence that these drugs are putting women at much higher risk for recurrent breast cancer," said Robert Epstein, Medco's chief medical officer and one of the study researchers."

"Researchers then did a separate analysis of women on antidepressants and found those taking Paxil, Prozac or Zoloft had a breast cancer recurrence rate of 16%, or more than double the rate of women on tamoxifen only."

"Women taking antidepressants considered to be low CYP2D6 inhibitors like Celexa, Lexapro and luvox and tamoxifen had an 8% breast cancer recurrence rate, which researchers said didn't translate into an increased breast cancer recurrence rate."

Click here for article.

PPD Training

There are now a couple of available spots in our June PPD training since two folks are moving to the September class so if anyone is interested in a last minute registration, be sure to let me know and I'll save a spot for you! Or you can click here to register.

Media Alert!

ABC News is looking for a participant who is willing to talk TONIGHT for their show tomorrow. They are covering the subject of substance abuse and new mothers and are looking for women who stopped drinking during pregnancy but resumed drinking after the baby was born (either in moderation or binge drinking). They are aware of the sensitive nature of this topic and would put you in shadow if that is preferred.

Anyone who is interested should contact Cathy at Cathy.A.Becker@abc.com as soon as possible.

With so much current attention being placed on screening practices, it's interesting to take note of what's working and what isn't working. A recent (May, 2009) study published by BJOG, An International Journal of Obstetrics and Gynecology is titled: "Is it clinically and cost effective to screen for postnatal depression: a systematic review of controlled clinical trials and economic evidence."

Clinicians who are interested in program development or private practice should take note that although the formal screening practices (Edinburgh) did seem to be associated in lower EPDS scores, the authors note it is unclear what is a result of the screening component and what was resulting from the "enhanced care" and other interventions because of the positive EPDS screen.

We've noticed this is our clinical work, that screening is only as effective as the "screener", the environment and actions that both precede and follow the screening itself.

There is another new study confirming that support during the prenatal and postpartum period decreases the risk of postpartum depression. In the study, "Prenatal Social Support, Postnatal Social Support, and Postpartum Depression", the group from the Department of Obstetrics and Gynecology, University of Ottawa, Canada

In their conclusion: the risk of postpartum depression is higher with lower or lack of social support.

Keep in mind, having the social support is part of the equation. Accessing it, making use of it, and asking for help is another part.

Reference: Ann Epidemiol. 2009 May 12. [Epub ahead of print]Click here to read
Prenatal Social Support, Postnatal Social Support, and Postpartum Depression.
Xie RH, He G, Koszycki D, Walker M, Wen SW.

A new study, "The Influence of Birth Experience on Postpartum Depression: A Follow-up Study" by Michelle Bland at Missouri Western State University, set out to determine the impact a woman's birth experience has on postpartum depression.

The purpose was to determine whether a woman's birth experience, control of the birth process, and place of birth (operating room, delivery room, or home) are related to the emergence of postpartum depression. The researcher hypothesized:

"a) the more control a woman has (or feels she has) over her birth experience, the less apt she is to suffer from postpartum depression
b) the more satisfied a woman is with her birth experience, the less likely she is to suffer from postpartum depression
c) the less invasive the birth experience, the more the woman will feel in control, and the more satisfied she is likely to be. Thus, it was predicted that the lowest incidence and severity of postpartum depression would occur in the home birth sample, and the caesarean group would have the highest incidence and severity of depression."

Much of what they found was consistent with current literature as well as their predicted outcomes. The incidence and degree of depression was found to be associated with the place and type of delivery, as well as the perceived level of control over the birth experience, and the level of satisfaction.

The women who delivered at home were found to have the lowest rates of depression, have felt the most control over their birth experience, and were the most satisfied.

Although the women with C-sections were found to report the least control over their birth experiences, the data regarding their depression levels were inconclusive.

Here's a link to the article.

Katherine Stone at Postpartum Progress has brought attention to some wonderful news in the medical world regarding PPD awareness. In a press release, it was announced that the new president of the American College of Obstetricians and Gynecologists (ACOG), Dr. Gerald Joseph, Jr. intends to make postpartum depression his "top priority."

In his speech, Dr. Josephs beautifully articulates some of the current sticking points and clarifies what needs attention in the medical community. He acknowledges that their are huge ranges and inconsistencies in the literature regarding prevalence, screening and referral practices. This is so phenomenal that he is highlighting these areas of concern and hopefully, docs all over will respond with precise care and attention to their patients.

Here's the press release.

Lauren Hale has written a compelling piece on her blog: Sharing the Journey in response to a recent article in Vogue called "Pregnant Pause" which looks at the complex issue of taking antidepressants during pregnancy.

Here's a link to article in vogue to which she responded.

Lauren is a strong PPD advocate and articulate voice on behalf of women and families who struggle with depression during and after pregnancy. Please take the time to read her very thoughtful and well-researched post.

Very nice job, Lauren. ;)
And thanks, Katherine, for the heads up.

Wishing everyone an early Happy Mother's Day!
Find something wonderful, and then,
surround yourself with it.....

I spent a lovely couple of days in Long Island speaking to a group of passionate and dedicated professionals in our field. Adelphi University sponsored the training program and as always, I was thrilled to be surrounded by such great energy. I met a number of fabulous women as well as some special familiar faces I hadn't seen in a while and that always feels good.

As promised, here is the link to the STEP-PPD program (Support and Training to Enhance Primary Care for Postpartum Depression).

It's a great tool, be sure to check it out.

Stay tuned to this blog for ongoing educational and therapeutic tidbits that should be helpful to your clinical practice...And again, thanks to all for a memorable training experience.

The American Journal of Psychiatry just published (May, 2009) an editorial written by Barbara Parry, MD, director of research at the Women's Mood Disorder Clinic at the University of California:

Assessing Risk and Benefit: To Treat or Not to Treat Major Depression During Pregnancy with Antidepressant Medication.

It is a great article, summarizing the available research with explores this important dilemma, Dr. Parry cites work that studied the impact of maternal depression on the pregnancy versus the impact of pharmacologic treatment on the pregnancy. Most of the studies have focused on neonatal outcome.

The author concludes with this important take-home point:

"...this author thinks that the risk of untreated major depression outweighs the risk of effects of SSRI treatment on neonatal outcomes. We need to consider not just short-term, but also long-term, consequences of our decisions. In addition to focusing on the child, the clinician needs to consider the risk of untreated major depression in the mother. These risks include exacerbation or recurrence of her underlying psychiatric illness, which can have adverse effects on her morbidity and mortality and can impair not only her functioning, but that of her family and other children under her care."

Click here to read the article.

Reference: Am J Psychiatry 166:512-514, May 2009

How great is this??? Our magnificent Katherine Stone, from Postpartum Progress, is organizing a Mother's Day Rally on Sunday May 10, 2009.

She has gathered some impressive names :) from across the blogsphere who will each contribute a "letter to mothers" throughout the day. Every hour, for 24 hours, a new message will be posted providing readers with an ongoing wealth of creative expression on behalf of all mothers.

Keep an eye out for it on her blog. Should be fun and inspirational. Thanks, Katherine.

The Hudson Perinatal Consortium, Inc. and New Jersey Department of Health and Senior Services are sponsoring a training event on May 27, 2009.

"On the Front Line of Perinatal Mood Disorders:
Practical Strategies for Health care and Social Service Providers"

Date: Wednesday, May 27, 2009
Time: 8am-4pm

Location: Pines Manor

2085 Rt. 27 (Lincoln Highway)
Edison, NJ 08817

Susan Dowd Stone, MSW and Margaret Spinelli, MD will be among the esteemed speakers. Mary Jo Codey will moderate a panel presentation

Click here to register and/or download their brochure.

Read this post by Susan Dowd Stone and listen carefully to the inspirational and important words of a passionate advocate.

Then call your senator.

There are so many women counting on this.

Today, we are reminded to act in favor of the Melanie Blocker Stokes MOTHERS Act.

If you haven't already done so, please take the time to follow up with these actions so we can make sure our voices are heard. Everyone reading these blogs knows how important this is!

Here's the bill. (Thanks, Katherine)

Susan Dowd Stone has helped make this easy by providing links so please call your Senator in support of S324.

And don't forget to add your name to the petition that is set to be presented to U.S. Senators the week of Mother's Day. Do it now.

U.S Senator Robert Menendez from New Jersey has put his stamp on this widespread effort:

"Postpartum Depression is a condition that is not only more widespread than most realize but also more debilitating than most realize. We need to make sure these mothers are fully supported and informed, rather than scared and alone. Working together with a nationwide community of mothers, we are so close to enacting this important legislation into law. What we need is an intense dose of public pressure. This Blog Day helps reinforce the type of grassroots movement that will increase the pressure that is needed, and I commend the participants. I invite mothers, fathers and anyone else who believes we need to better support those with postpartum depression to contact their Senators and urge them to vocally support S.324."

Per Adrienne Griffen from PSI Virgina :

Hello, all

The early registration deadline for the PPD conference May 7-8 at the National Institute of Mental Health has been extended until April 15. We have extended the deadline because we were able to add CEUs for psychologists and therapists (along with social workers) to the event.

Please read this, posted by Susan-Dowd Stone:

A Father's Story of Losing His Daughter

Pennsylvania Resource Now Online

The Pennsylvania Perinatal Partnership is a great resource for clinicians and consumers in Pennsylvania is now available online.

They have a nice summary of the Mother's Act here.

As well as a comprehensive list of resources divided into three categories: 1) community resources 2) provider resources and 3) mother resources. Check it out.