Ask the Wellsprings' Experts

How do I treat depression during pregnancy? 

December 2012
Medications and Women's Health
by Allison Kurzman, MD

If you have a psychiatric illness, such as depression or anxiety, you may notice symptom changes or exacerbations during different phases of your reproductive life. Examples of these phases are premenstrual, pregnancy, postpartum and perimenopause. It is important for women to seek out appropriate mental health providers for treatment during these times. This treatment may include counseling and/or medication, depending on your individual circumstances. Before starting or stopping medication, it is important to have a careful discussion of the risks and benefits of taking medication, as well as the risks of untreated symptoms in order to ensure a conscientious and balanced decision in your treatment plan.

What supports are available after experiencing perinatal loss (the loss of a baby during pregnancy, delivery, or after)?

December 2012
Perinatal Loss
By Joey Miller, MSW, LCSW

The death of loved one can be devastating at any time, however, many families who experience the death of a baby during pregnancy, birth, or infancy often experience a double loss. It's not only the loss of all of the hopes and dreams expected for the future, but also the loss of a desired past and all of the memories that can be built over months and years.

Wellsprings Health Associates clinicians are available to provide clinical counseling to individuals, couples and families, but also to offer information; education, and resources on the unique aspects of grief following the death of a baby or young child. Whether the loss follows a miscarriage, stillbirth, or neonatal death, or follows pregnancy termination for prenatal diagnosis or maternal health indications, we are here to provide comprehensive and compassionate care. Other reproductive losses include abortion, unused embryos following fertility treatments, multi-fetal reduction, and adoption. Many of the families we work with eventually make the leap of faith to consider trying again. We are also available to provide support during a subsequent pregnancy, as often this can be as challenging emotionally as the initial raw grief. Our experience and training in the areas of reproductive health allow us to partner with you to explore the very real fears and challenges following loss, but also provide support as you gain courage to continue your journey, never forgetting the past.

What are some effective evidence-based treatments for mood disorders?

December 2012
Cognitive Behavioral Therapy (CBT) and Behavioral Activation (BA)
By Denada Hoxha, Ph.D.

Cognitive Behavioral Therapy (CBT) is a time-limited, structured, present-oriented therapy approach that was originally developed for treatment of depression and has been successfully used in treatment of other diagnoses including anxiety, substance abuse, eating disorders, bipolar, schizophrenia, and personality disorders (AT. Beck, 1967; A.T. Beck & Emery, 1985; A.T. Beck, Wright, Newman, & Liese, 1993; A.T. Beck; Fairburn, 2000; A.T. Beck, Rector, Stolar, & Grant, 2009; Freeman, Davis, & Associates 2004; Fairburn, 2000; Basco & Rush, 1996). According to CST model, our emotional experiences are influenced by our thoughts and behaviors and mental health problems emerge when people demonstrate maladaptive patterns of thinking and behavior. Additionally, from a CBT perspective, there is no one cause of mental health problems. Instead, the interplay among biological vulnerabilities, life stressors, maladaptive thoughts and behaviors, and intense emotional experiences, cause and maintain patients' mental health problems. The goal of CST is to create a structured individualized conceptualization and treatment approach targeting maladaptive thinking and behaviors. CST approaches and techniques are specifically tailored to the needs of the client and goals of therapy include psychoeducation, symptom reduction, and relapse prevention.

Behavioral Activation therapy (BA) was initially used as a therapeutic approach to treat depression but has been adopted and used in treatments of other disorders (Martell, Addis, & Jacobson, 2001; Jacobson, Martell, & Dimidjan, 2011). BA is a focused, brief therapeutic approach that helps patients identify and address environmental sources of their depression. BA is an individualized treatment approach that helps the client and therapist identify and address problems associated with avoidance, goal identification and accomplishment. The primary focus of BA treatment is creating meaningful contextual environments for the individuals that facilitate positive reinforcement through mastery and pleasure while overriding passivity, avoidance, and other secondary problems associated with depression.

How do I know if I have postpartum depression?

December 2012
Understanding Postpartum Depression
by Jennifer Levy, LCPC

The birth of a new baby is often a joyful experience -- greatly anticipated. However, up to 30% of women experience difficulty adjusting to this complex transition in their lives. Post-partum depression is experienced, most commonly, after six to eight weeks of giving birth -- usually following the more expected "baby blues". Short-lived, the baby blues are experienced within a few days postpartum and can last as little as a few hours or up to a few days. Typically, the baby blues are experienced as feeling sad, "down," punctuated with crying and spells of irritability or feeling overwhelmed and frustrated, the baby blues can usually be managed by getting some rest, taking a break and getting needed support from family and friends.

Post-partum depression (PPD)is much more challenging and often strikes women without warning and often without making sense -- that is, postpartum depression affects women both with and without a mental health history, women who had healthy pregnancies and uncomplicated deliveries, as well as women who experienced a difficult pregnancy, labor and delivery. In short, no one is immune. While women suffering from PPD can be been overlooked -- their symptoms going unrecognized by loved ones and medical providers, PPD is better understood today, and more commonly diagnosed than ever before.
How do you know if you are suffering from Post-partum depression? Review the following Postpartum Symptom Check list taken from This is Not What I Expected: Overcoming Postpartum Depression by Karen Kleiman, MSW and Valerie Raskin MD. If you agree with at least four or more of these statements, and these feelings have persisted for at least two or more weeks, you may be suffering from PPD. It's important to trust yourself -- you know better than anyone if your mood, level of day to day functioning and ability to cope has significantly changed since having your baby.

1. I can't shake feeling depressed no matter what I do
2. I cry at least once a day
   
3. I feel sad most or all of the time
4. I can't concentrate
5. I don't enjoy the things that I used to enjoy
6. I have not interest in making love at all, even though my doctor says I'm now physically able to resume sexual relations
7. I can't sleep, even when my baby sleeps
8. I feel like a failure all of the time
9. I have no energy; I am tired all the time
10. I have no appetite and no enjoyment of food (or I am having sugar and carbohydrate cravings and compulsively eating all the time)
11. I can't remember the last time I laughed
12. Every little thing gets on my nerves lately. Sometimes I am even furious at m y baby. Often I am angry with my husband.
13. I feel that the future is hopeless
14. It seems like I will feel this way forever
15. There are times when I feel that it would be better to be dead that to feel this way for one more minute.

If you suspect that you are suffering from PPD we encourage you to see a professional health care provider to assess your symptoms and develop a treatment plan that will best meet your needs and hasten your recovery.