Screen New Moms for Postpartum Depression, says American Academy of Pediatrics

Mood changes after giving birth is thought to affect up to 80% of new mothers not only due to hormonal changes, but also because of sleep deprivation and the sudden onset of new and critical responsibilities. However, up to a fourth of women may also experience something more serious – postpartum depression – and the American Academy of Pediatrics stresses to its member pediatricians to begin screening moms at new baby well checks to prevent a host of problems.

Recognize Signs and Symptoms of Postpartum Depression Early

Rates of depression among pregnant and postpartum women are estimated to be between 5 and 25% with the incidence of major depression in the first year after birth being between 1 and almost 7%. According to Marian F. Earls MD and colleagues from the AAP Committee on Psychosocial Aspects of Child and Family Health, this means that more than 400,000 infants are born annually to depressed mothers.
Read: Maternal Affection Provides Lifetime Benefits
Depression in new mothers can cause problems such as delay in maternal-child bonding and an environment that can lead to cognitive and social development problems (ie: behavior problems, anxiety and mood disorders) as early as two months. “The processes for early brain development – neuronal migration, synapse formation and pruning – are responsive to and directed by environment as well as genetics,” write the authors in the November issue of the journal Pediatrics.
Maternal depression can also lead to inappropriate medical care, impaired attention to health and safety concerns, discontinuation of breastfeeding, and most seriously, child abuse and neglect says the committee.
Read: Postpartum Depression is Real for Fathers Too
Although pediatricians may currently lack training to identify postpartum depression, the committee feels that screenings are feasible and can be successful as it may identify at-risk mothers sooner. Infants are seen more often in the first month after birth by a healthcare professional than are postpartum women. In general, babies are seen at 1 week, 2 weeks and one month after birth by a pediatrician, while women usually wait until 6 weeks after giving birth for a follow-up by an obstetrician/gynecologist.
There are also obstacles to be overcome, such as time pressure, inadequate reimbursement, and the need for postpartum screening tools. Pediatricians would also not treat patients under the new model but would provide referrals to mental health professionals, the committee stresses.
Read: Postpartum Depression is Part of Mental Health Awareness
Women and their partners should be on the lookout for the symptoms of postpartum depression, which include loss of appetite, insomnia, intense irritability and anger, feelings of shame or guilt, and withdrawal from family and friends. Women who suffer from postpartum depression should recognize that she is not alone, not at fault, and that the situation will improve. She should seek help as soon as possible from a qualified mental health professional.

New Therapies Show Promise For Vascular Depression

Researchers see new treatments on the horizon for a type of depression related to blood vessels that affects the elderly, and have discovered why some elderly people fail to respond to current medications. In other studies, scientists urge caution regarding use of antipsychotics (usually for schizophrenia or other psychosis) in this and other populations to minimize metabolic, heart, and stroke risks.
The scientists spoke today at a press conference involving speakers from two symposia sponsored by National Institute of Mental Health (NIMH), a part of the National Institutes of Health, during the American Psychiatric Association Annual Meeting here.
"Mental health practitioners and patients should be aware of the relationship between vascular problems and depression, and should understand the value of preventing vascular changes that might lead to difficult-to-treat depressions, for example through early recognition and treatment of high blood pressure" says John Newcomer, MD, of Washington University in St. Louis.
Drugs Show Promise for Vascular Depression
New treatment possibilities are being explored for vascular depression, a recently recognized type of depression that usually develops in patients older than age 60 and is associated with loss of blood supply to the brain. This condition is a serious problem for elderly patients and highly effective treatments have yet to be developed, but several research teams now report progress in understanding and treating this condition.
George Alexopoulos, MD* of the Weill Cornell Medical College in White Plains, NY, and his colleagues, are investigating the specific brain abnormalities linked to blood vessel problems. Using a new magnetic resonance imaging technique called diffusion tensor imaging, Alexopoulos and his team have found that, in late life depression, higher blood pressure readings are linked to tiny white matter abnormalities, mainly in the brain’s frontal lobes and in subcortical areas. Some of these structural abnormalities were linked to impairment in specific frontal lobe functions.
The researchers are also studying the brain abnormalities preventing depressed older patients from responding to antidepressant medication. In a study of 112 elderly patients with major depression treated with the antidepressant citalopram, they found that patients were less likely to recover from their depression if they had cardiovascular disease or performed poorly on a ‘response inhibition’ task testing an aspect of cognition requiring frontal lobe function. This timed task asks a person to suppress the reading of a word (e.g., the word red) and identify the color of ink by which the word is written (e.g., blue). In a subsequent study of 48 depressed older patients treated with the antidepressant escitalopram, which is more potent than citalopram, Alexopoulos and his colleagues showed, for the first time, that patients who failed to achieve remission had more of the tiny structural abnormalities in several areas of frontal lobe and in subcortical structures compared with those who got well.
"With further refinement, the findings may improve physicians’ ability to predict who will fail to respond to antidepressants," Alexopoulos says. "Such patients may need close follow-up and different treatments such as psychotherapy or novel medications. Second, our findings can be used in the development of new treatments for those who do not respond to classical antidepressants."
Alexopoulos is now working to pinpoint activation and processing abnormalities in frontal and subcortical brain structures that predict failure to respond to antidepressants. He is studying how parts of the frontal lobe are activated when depressed patients perform cognitive tasks known to engage this area. "Preliminary findings show that depressed older patients cannot activate these frontal lobe parts as efficiently as non-depressed older adults," Alexopoulos, says.
Stimulation Therapy Tested for Vascular Depression
In other treatment strategies, Robert Robinson, MD, a professor of psychiatry at the University of Iowa, and his colleagues have found for the first time that vascular depression can be effectively treated with repetitive transcranial magnetic stimulation (rTMS), an experimental technique that also has been tested in other psychiatric disorders.
Among 92 depressed people with an average of three prior treatment failures, the researchers found that rTMS produced better remission rates than those associated with standard medication treatment. They also found that increasing the number of magnetic pulses delivered significantly improved remission rates. "These findings suggest that this new method of treatment may be particularly useful for these late life onset depressions and that even greater response rates might be achieved by utilizing more pulses of magnetic stimulation," Robinson says. The findings of this study were published in the March 2008 issue of the Archives of General Psychiatry.
The study participants had clinical or imaging evidence indicating lack of blood flow in the brain, and had failed to respond to standard treatments for depression. They were given either 12,000 or 18,000 pulses of rTMS or a sham (inactive) treatment over a two-week period. Neither the patient nor the examiner knew if the treatment was actual rTMS or sham, thus removing any possible bias. Improvement of depression was documented by scores on the Hamilton Depression Scale. The next step in this research is to determine precisely how many magnetic stimulations will achieve the maximum response among patients with vascular depression.

Studying Antidepressant Use Among Children, Adolescents With Mental Illness

Are antidepressants effective as treatments for mentally ill children and adolescents? Are they harmful? These questions have been the topic of immense public debate and are of considerable public health importance.
To learn more about the role of antidepressants in the treatment of children and adolescents living with mental illnesses, the Child and Adolescent Psychiatry Trials Network (CAPTN) is launching the first independently funded large-scale safety registry to track antidepressant use among youth.
The goal of the Antidepressant Safety in Kids (ASK) study is to determine factors that may help doctors better understand the risks and benefits associated with using antidepressant medications as part of a young person’s treatment plan. It will seek to answer, "Which treatment is most effective for which child?"
"It is of considerable public health importance that we address the long-term safety and effectiveness of medications used in the care of mentally ill youth. This work marks an important step toward understanding the usefulness of antidepressant medications in children and adolescents," said John March, M.D., chief of child and adolescent psychiatry at Duke University and lead investigator on CAPTN. "My hope is to repeat the success of networks established for other common illnesses, such as heart disease and cancer, to determine the effect of psychotropic medications on patient outcomes."
Funded through a grant from the National Institute of Mental Health to the Duke Clinical Research Institute in cooperation with the American Academy of Child and Adolescent Psychiatry (AACAP), CAPTN is an innovative practical clinical trials network of 200 practicing child and adolescent psychiatrists throughout the United States and Canada.
The first study to be conducted under the CAPTN umbrella is ASK, a prospective longitudinal cohort study of 2,420 children and adolescents with a depressive disorder, anxiety disorder, obsessive-compulsive disorder or eating disorder. The study participants will be prescribed either a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI). While these two classes of medications are widely used among adults and prescribed to approximately two to three percent of American children, questions have arisen about potential adverse events, especially suicidal events, associated with use of these medications. Through ASK, information will be collected about the safety, tolerability, effectiveness and potential benefits of these medications.