Understanding Postpartum Depression

For mother’s in the Foxboro area experiencing post-partum depression, here is some information that may help you determine if you should seek professional attention. Hormonal changes, as well as stress and lifestyle changes that follow childbirth, can cause mood disturbances. Sometimes, however, this is more severe than just the “baby blues.” Postpartum depression occurs in some women after having a baby, although studies vary widely in the reported prevalence of postpartum depression—anywhere from 5% to 25% of women may experience postpartum depression, which is primarily characterized by the onset of depressive symptoms within the first year after giving birth. Telltale signs include:

·         Sadness

·         Hopelessness

·         Low self-esteem

·         Sleep disturbances

·         Appetite disturbances

·         Feelings of emptiness

·         Inability to be consoled or comforted

·         Social withdrawal

·         Low energy

In postpartum depression, these feelings are often tied to ideas of inability to take care of the baby or feelings of inadequacy as a mother. This often facilitates inappropriate feelings of guilt and self-blame, furthering the depression. Postpartum depression persists for weeks or months, and is not simply a routine mood swing. It generally does not resolve on its own without medical attention.

Causes of Postpartum Depression

Doctors and researchers of the Boston area are still unclear as to what causes postpartum depression, although there are several viable hypotheses. Some scientists have suggested that postpartum depression may arise from depleted vitamins or hormonal changes; however, trials of hormone treatment have not been successful in alleviating the depression, and some of the studies failed to find a demonstrable correlation between hormones and depression. Although hormones may play a role in the etiology of postpartum depression in Boston, they are not likely to be the sole cause. Another complicating factor is that sometimes fathers can also develop postpartum depression, despite not undergoing the same hormonal changes. Another possible cause would be the profound and often stressful lifestyle changes that come with a newborn baby; however, some women experience postpartum depression in their most recent pregnancy without having had it in previous pregnancies.

Although the exact causes of postpartum depression still remain unclear, research has identified some risk factors that may predispose a woman toward being more susceptible to postpartum depression. These risk factors include:

·         Psychological or physiological trauma associated with the birth itself

·         Elevated levels of prolactin, a hormone that plays a role in milk production

·         Depletion of oxytocin, an important hormone implicated in social bonding

·         A prior history of depression

·         Low self-esteem

·         Prenatal depression or anxiety

·         Life stress, including stress related to childcare

·         Unwanted or unplanned pregnancy

·         Low socioeconomic status

It should be noted that although these factors are correlated with postpartum depression, a definite causal relation has yet to be established. Etiologically, postpartum depression is still somewhat a mystery.

Preventing and Treating Postpartum Depression in Boston

For most women in Boston and across the nation who struggle with postpartum depression, early intervention is a key factor in ensuring a good prognosis. Many physicians feel that women who may be at risk should be screened so that psychosocial interventions, namely psychotherapy, can be provided. The Edinburgh Postnatal Depression Scale is a 10-item questionnaire often used by clinicians. Physicians also recommend optimal nutrition during pregnancy and after giving birth, although no causal link has been demonstrated between nutritional problems and postpartum depression.

Treatment for postpartum depression occasionally includes medications but is often more focused on psychotherapeutic modalities. Cognitive behavioral therapy, CBT, is a common method for managing the condition, and has been shown to be equally as effective as the antidepressant fluoxetine (Prozac), without the side effects. Although research into electroencephalographic correlates of postpartum depression has not yet been undertaken, it remains hypothetically possible that someday neurofeedback therapy could be proven to have efficacy for treating postpartum depression. If you reside in the Foxboro area and would like to schedule a consultation with your local BrainCore clinic to discuss your options call 1-844-BRAIN-ON (272-4666) or visit our website today!

What is Complex PTSD?

Although complex post traumatic stress syndrome (C-PTSD) is not yet formally recognized as a diagnostic designation, a case is being made in the psychiatric community for the recognition of this disorder as distinct from the currently defined form of PTSD. PTSD, as it is currently defined and diagnosed in Mansfield and elsewhere, is a result of exposure to acute trauma. It often occurs in individuals who have either witnessed or experienced tragedies, such as combat, a violent death, assault, or a natural disaster. C-PTSD is distinct from PTSD in that complex PTSD results from repeated trauma. It often develops as a result of prolonged sexual, physical, verbal, or emotional abuse. It can also occur in people who have survived a long-term hostage situation.

Causes of Complex PTSD

Whereas traditional PTSD is associated with acute psychological trauma, complex PTSD results from prolonged and systematic trauma exposure. Complex PTSD is often associated with relational abuse, such as spousal or child abuse. One of the distinguishing characteristics of C-PTSD, as opposed to “simple” PTSD, is the presence of disorders and problems with interpersonal attachment. Attachment in individuals who suffer from complex PTSD tends to take a pervasive insecure or disorganized form.

Diagnostic Criteria for Complex PTSD

The Centre for Addiction and Mental Health (CAMH) has put forth a potential set of diagnostic guidelines for complex PTSD:

I.                    Alteration in Regulation of Affect and Impulses

a.       Affect regulation

b.      Modulation of anger

c.       Self-destructive behavior

d.      Suicidal preoccupation

e.      Difficulty modulating sexual involvement

f.        Excessive risk-taking

II.                  Alterations in Attention or Consciousness

a.       Amnesia

b.      Transient dissociative episodes and depersonalization

III.                Alterations in Self-Perception

a.       Ineffectiveness

b.      Permanent damage

c.       Guilt and responsibility

d.      Shame

e.      Nobody can understand

f.        Minimizing

IV.                Alterations in Relationships with Others

a.       Inability to trust

b.      Revictimization

c.       Victimizing others

V.                  Somatization

a.       Problems with the digestive system

b.      Chronic pain

c.       Cardiopulmonary symptoms

d.      Conversion symptoms

e.      Sexual symptoms

VI.                Alterations in Systems of Meaning

a.       Despair or hopelessness

b.      Loss of previously sustaining beliefs

Many researchers advocate differences in diagnostic criteria for children versus adults. In this conceptualization of complex PTSD, the disorder is further divided into an adult symptom cluster and a childhood symptoms cluster.

A child and adolescent symptom cluster for complex PTSD would encompass the following domains:

·         Attachment

·         Biology

·         Affect or emotional dysregulation

·         Dissociation

·         Behavioral control

·         Cognition

·         Self-concept

An adult symptom cluster for complex PTSD symptoms would include:

·         Difficulty regulating emotions

·         Variations in consciousness, including psychogenic amnesia, dissociation, or intrusive flashbacks of traumatic episodes

·         Changes in self-perception, often involving a chronic sense of helplessness, along with irrational self-blame and feelings of shame and guilt

·         Varying changes in perception of the person perpetrating the abuse; this may involve attributing too much power to that person, being preoccupied with revenge, or even idealizing that person

·         Alterations in relationships with others; this may take the form of isolation and withdrawal, inability to trust, or reliance on the idea of a “rescuer”

·         Loss of faith or overwhelming sense of despair

Treating Complex PTSD

As with diagnostic criteria for complex PTSD, researchers advocate differences in treatment approaches in children versus in adults, in order to account for differences between childhood and adult reactions to and results of trauma. Some of the principles and guidelines that have been proposed for treating complex PTSD in children include:

·         Identifying and assessing current threats to the child’s safety and well-being

·         Relational and strength based diagnosis and treatment

·         Treatment aimed toward enhancing the child’s self-regulatory abilities to improve their coping abilities

·          Determine when and how it is appropriate to fully address traumatic memories

·         Preventing and managing psychosocial crises and ongoing relational issues

In adults, complex PTSD researchers have proposed six core components for treatment:

·         Safety

·         Self-regulation

·         Self-reflective information processing

·         Integration of traumatic experiences

·         Relational engagement

·         Positive affect engagement

St. John’s Wort: An Herbal Remedy for Milder Forms of Depression

Depression

Although Major Depressive Disorder can be very severe and debilitating, there are also milder forms of depression. “Dysthymia” is a disorder related to depression, but with a milder degree of emotional disturbance; “minor depressive disorder” is another label sometimes used for individuals whose depression is to a less extreme extent, or who meet some but not all of the criteria for being diagnosed with Major Depressive Disorder. Clinical depression is usually treated with a combination of psychotherapy and antidepressant medications. Although antidepressants can be quite effective for treating the symptoms of depression, they also have a range of potentially negative side-effects. For less intense cases of depression, some evidence suggests that St. John’s Wort may be effective in lieu of prescription antidepressants like Zoloft or Lexapro. 

What is St. John’s Wort? 

St. John’s Wort, also known as Hypericum perforatum, is a flowering plant native to Europe. Historically, it has been used as a medicinal herb. Modern research supports the hypothesis that St. John’s Wort may be quite effective for depression. In some studies, it has been shown not only to be superior to a placebo, but to be equally as effective as standard SSRIs like Zoloft. Like SSRIs, which work by inhibiting reuptake of the neurotransmitter serotonin, St. John’s Wort is thought to have its effects by inhibiting serotonin reuptake. Reuptake inhibition increases the available amount of serotonin, a neurotransmitter used in communication between brain cells that is strongly involved in processes involving mood regulation. 

What Makes St. John’s Wort Effective for Depression? 

St. John’s Wort contains numerous chemical compounds. There are two main chemicals that are thought to be tied to the herb’s effect on mood regulation.

·         Hyperforin is a chemical that acts as a reuptake inhibitor for a class of neuro-chemically important compounds called “monoamines”, including serotonin, norepinephrine, dopamine, GABA, and glutamate.

·         Hypericin is another active component found in St. Jon’s Wort that is implicated in its efficacy for treating depression. Along with hyperforin, it helps to give the plant effects similar to MAOI inhibitors, an older form of antidepressant medication.

  

Are Any Risks and Side Effects Associated with St. John’s Wort? 

St. John’s Wort has relatively few side effects, although you should always consult with your physician before beginning any medicine, herb, or supplement. Studies have found it to be less problematic than commercial SSRIs such as Zoloft and Prozac in terms of negative side effects, although the following effects can occur when taking St. John’s Wort:

·         Difficulty sleeping

·         Unusually vivid dreams

·         Stomach upset

·         Fatigue

·         Skin rash

·         Heightened sensitivity to light

Although it has fewer side effects than most depression medications, chemicals contained in St. John’s Wort can interact with other drugs. You should NOT take St. John’s Wort if you are taking one of the following medications:

·         Alprazolam (Xanax). St. John’s Wort can cause the body to excrete the active components of Xanax more quickly, possibly decreasing its effectiveness.

·         Aminolevulinic acid. Both this medicine and St. John’s Wort can increase your sensitivity to sunlight and increase your risk of sunburn.

·         Amitryptaline (Elavil). As with Xanax, St. John’s Wort can cause the body to break this medicine down more quickly, decreasing its effectiveness.

·         Birth control pills. These pills usually contain estrogen; St. John’s Wort can make the body break the estrogen down more quickly.

·         Cyclosporine may have reduced effectiveness when combined with St. John’s Wort.

·         Digoxin may be less effective with St. John’s Wort.

·         Fenfluramine works on serotonin, so if it is taken with St. John’s Wort it can cause there to be too much serotonin, which causes anxiety and nausea.

·         Many antidepressants, especially SSRIs like Celexa, Zoloft, Prozac, and Lexapro, should not be combined with St John’s Wort, in order to avoid too much serotonin.

This is only a partial list of drugs that St. John’s Wort can interact with. If you are considering trying Saint John’s Wort for mild to moderate depression, you should talk to your doctor beforehand to assess the risks of interactions with other medications.

St. John’s Wort is very safe overall, and produces few side effects. Clinical studies have indicated that for mild to moderate depression, it may be as effective as many antidepressants--- without the negative side effects. 

NEUROFEEDBACK FOR DEPRESSION