Pregnancy depression and flu: a bad combination

January 13, 2010 by  
Filed under DEPRESSION

Raging hormones. Morning sickness. Add to that depression. Then top it up with the flu. What you get is a nasty cocktail of symptoms and complications.

Researcher s at the Ohio State University report that pregnant women who are suffering from more than your usual dose of baby blues –e.g. severe pregnancy depression – are more likely to suffer from severe flu symptoms than “less depressed” pregnant women.

The immune system of pregnant women is naturally weakened to accommodate the growing fetus. However, the study findings suggest that the immune system of depressed pregnant women is even more problematic, e.g. is not functioning typically, a dysfunction can be dangerous when it encounters infections such as the flu bug.

There is a well-established mind-body connection in people under chronic stress and depression. Pregnancy can be a stressful period, yet the mind-body connection during gestation is not well studied event.

According to Lisa Christian, an assistant professor of psychiatry:

“Our basic starting question was, do those same relationships between depression and immune function hold during pregnancy? And these studies suggest that they do. We see immune dysregulation during pregnancy due to stress and depression.”

Does having the flu shot help?

The researchers looked at 22 pregnant women who received the seasonal flu shot. The study participants were tested for inflammatory biomarkers in the blood before and after vaccination and completed questionnaires that asses depressive symptoms. In particular, post-vaccination blood samples were tested for macrophage migration inhibitory factor or MIF, which is a protein that promotes inflammation. The results of the study show

  • Depressive symptoms and perceived were significantly more evident in women who were unhappy about their pregnancies, and in those less social support and more frequent hostile social interactions.
  • Those women with stronger depressive symptoms had higher MIF levels in the blood after vaccination indicating a stronger biological reaction to the seasonal flu vaccine compared to women who were not depressed.
  • The inflammatory responses to the flu shot do no harm, are mild, and typically go away within a few days but is indicative of the immune response when the actual infection strikes.

Research studies have shown that pregnancy suppresses certain functions of the immune system to prevent rejection of the fetus and to protect the fetus from inflammation that accompanies fevers and other illnesses. Excess inflammation during pregnancy, however, has been associated to increased risk of preterm birth and preeclampsia or gestational hypertension.

The study findings support the recommendations that pregnant women should get vaccinated against the flu. However, flu shots be it the seasonal or the H1N1 flu, are viewed with skepticism. Only about 12 to 13% of pregnant women in the US opt for flu vaccination.

Sleepless and depressed: postpartum depression

July 15, 2009 by  
Filed under DEPRESSION

motherly_lovePostpartum depression (PPD): only mothers have the bad luck of going through such an ordeal. Fortunately, in most cases, PPD is not permanent but rather reversible. Tell me about it. I’ve had it myself – an extended one actually because I had twins. A case of a double dose of stress perhaps?

Anyway, many hypotheses have been put forward as to what causes depression in postpartum women. Latest research suggests that sleep disturbances may play a key role in PPD. In a study of 2,830 Norwegian mothers, the following results were reported:

  • 60% of the participating women admitted to be suffering from sleep deprivation. Of these, 16.5 suffered from depressive symptoms.
  • 21% of women with PPD reported to have been already depressed during pregnancy.
  • 46% of those with PPD reported to have had at least 1 episode of depression before getting pregnant.
  • Average nightly sleep duration was reported to be 6.5 hours.
  • Sleep efficiency was 73%.

It seems that PPD is not only due to poor sleep quality but to a history of depression before and during pregnancy. Other factors such as a bad relationship and stressful life events may also play a role. However, tiredness and lack of sleep can aggravate the depressive symptoms. The association between depression and poor sleep was observe to set in about four months after delivery.

Experts find it is important to find out whether the depression causes the sleep disturbances or whether it is the tiredness that causes the depression. To complete the vicious cycle, babies of moms with PPD also tend to suffer from sleep disturbances from age two weeks to six months, according to another research.

According to lead researcher of the Norwegian study Dr. Karen Dørheim, psychiatrist at Stavanger University Hospital in Norway,

“It is important to ask a new mother suffering from tiredness about how poor sleep affects her daytime functioning and whether there are other factors in her life that may contribute to her lack of energy. There are also helpful depression screening questionnaires that can be completed during a consultation. Doctors and other health workers should provide an opportunity for postpartum women to discuss difficult feelings.”

In addition, the researchers also looked at the factors that affect sleep quality in postpartum moms and they’ve identified the following to cause poor sleep quality:

  • depression
  • history of sleep problems
  • having a younger or male infant
  • being a first time mother
  • not exclusively breastfeeding

Postpartum sleep quality seems to be better when the baby sleeps in another room.

Depression in bypass patients: non-drug treatments work

June 24, 2009 by  
Filed under DEPRESSION

depression2It is a known fact -surgery may mend the body but it may also depress the mind. This is especially true with heart surgery. It is estimated that 1 in every 5 patients who underwent coronary artery bypass graft (CABG) surgery suffer from major depression. Many others may suffer from milder forms of depression. However, it is also a known fact that negative feelings are bad for the heart, thus creating a vicious cycle that delays recovery and reduces quality of life.

According to researchers at the Washington University School of Medicine

“Depression around the time of surgery predicts postoperative complications, longer physical and emotional recovery, worse quality of life and increased rates of cardiac events and mortality [death].”

Thus, the researchers conducted a study which involved 123 CABG patients who developed depressive symptoms within one year of surgery. The patients were randomly assigned to three groups, namely:

The depressive symptoms were monitored before the therapies, at 3, 6, and 9 months.

The study results show that the two non-drug treatments helped in resolving the depressive symptoms better compared to standard care.

The percentage of patients who experienced depression remission are:

  • 71% of patients in the cognitive behavior therapy group
  • 57% of patients in the supportive stress management group
  • 33% of patients in the usual care group

Cognitive behavior therapy seems to be the best strategy, not only against cardiac surgery-related depression but also secondary psychological outcomes, such as anxiety, hopelessness, and perceived stress. Supportive stress management also showed some benefits against depression, “but it had smaller and less durable effects than cognitive behavior therapy.” In comparison, current standard care is not seem to be that effective in resolving depressive symptoms among CABG patients. A previous study has shown that although the medical needs of heart patients are usually met by standard care, there are non-medical needs that usually go unmet but are nevertheless just as important in clinical outcomes.

In fact, the American Heart Association (AHA) issued a science advisory this year recommending routine screening for depression in cardiac patients.

Is prolonged grief a mental disorder?

June 1, 2009 by  
Filed under DEPRESSION

Resource post for June

heart_of_daisiesIt can happen to anybody – losing a loved one – a child, a partner/spouse, a sibling, a parent. We grieve because grief is an extension of our capacity to love as human beings. But after some time we have to move on and carry on with our lives. The intensity of grief lessens, the pain starts to heal. But what if it doesn’t?

There are cases when grief just wouldn’t go away and remains unresolved for months, and even years. This what experts call Prolonged Grief Disorder (PGD) or Complicated Grief.

Symptoms

It seems that PGD is a form of depression associated with bereavement. The feelings of grief of people with PGD extend six months or longer after the bereavement (“separation distress”) and can manifest in cognitive, emotional and behavioural Symptoms.

According to the Grief-Healing Support Group, PGD is characterized by the following symptoms:

Those suffering from PGD become socially withdrawn and suffer not only from poor mental but also physical health outcomes.

Incidencedepression2

Studies have shown that 10 to 15% of people who have experienced bereavement suffer from PGD, and become severely depressed or even suicidal. In African Americans, the incidence pf PGD is even higher – up to 21%.

Therapies

It has only been recently that PGD was recognized as a psychiatric disorder in its own right. With it came also possible therapies and treatments that can help the patients. There are those who believe, however, that grief shouldn’t be “medicalized” or “labelled as a disorder.”

The table below gives an overview of the treatment strategies for PGD (source: www.grief-healing-support.com):

Treatment Strategies

Learning to be mindful Buddhist teachings and meditations talk of mindfulness and how we can pay attention to our life in the moment, with intention and without judgement. Echhart Tolle teaches us to have a pain free life by living fully in the present –The Power of Now – a guide to spiritual enlightenment
Managing Stress Managing the fight-or-flight response. As we have to deal with one of life’s greatest stress events we are aslo encountering other grief related as well as normal life stressful events and situations
Solving Problems A simple yet structured approach to identifying issues, searching for options and working on possible solutions
Setting Goals Even at times of great pain there are things we may want or need to achieve in life. It may be to reduce our current levels of pain, or to become financially secure
Managing Emotions and Anger We may feel that our emotional responses are out of our control. However, there are some strategies we can use to control emotions and make life easier for ourselves and for others
Relaxation Techniques Some of these ideas may help you to relax. How relaxed are you at the moment? What is your mind doing? Where are your thoughts? What is your body doing?
Dealing with Conflict There are different levels and degrees of conflict. The grief period is a time of mixed and difficult emotions, consequently we may become more susceptible to conflict situations
Scheduling Enjoyable activities We have just lost someone very close to us, perhaps our partner or companion. It is important that we now schedule to do something that will bring us joy and fill some of the space
Improving Sleep A good sleeping pattern is crucial for normal healthy functioning. Are you getting adequate and restful sleep?
Understanding Anxiety A feeling of dread, fear, or worry. We all experience anxiety at some time or another, but when anxiety becomes too severe it can interfere with everyday functioning

 Remember, it is normal to grieve but when grief becomes prolonged and rules your life, then it’s time to seek professional help.depression

 

Photo credit: stock.xchng

Fighting depression with exercise

May 12, 2009 by  
Filed under DEPRESSION

happy-timesMany children and adolescents suffer from clinical depression. That is why experts have recently come up with guidelines that recommended routine screening for depression in the younger segment of the population. The guidelines also recommended psychotherapy or psychotropic drugs or both in the management of clinical depression in adolescents. But aren’t there other ways – especially non-pharmacological approaches to manage depression?

Researchers at the Medical College of Georgia looked at the effect of exercise on depressive kids. The participants were 207 weight children aged 7 to 11 years old. The participants were tested for depressive symptoms using the Reynolds Child Depression scale as well as the Self-Perception Profile for Children, a test which measures childrens’ perception of themselves before (at baseline) and after the study. The children were randomly assigned to three different physical exercise regime which lasted for 13 weeks

  • Group one: a “low-dose” exercise group which was physically active20 minutes each day
  • Group two: a “high-dose” exercise group which was physically active for 40 minutes each day
  • Group three: a control group which consisted of sedentary children.

Exercises consisted of activities which were fun but maximized for intensity and designed so that the participants’ heart rates exceeded more than 150 beats per minute.

The study results showed that depressive symptoms improved significantly with increasing exercise time even though no noticeable weight increase was observed. It seems that exercise has a positive impact on the children’s self-esteem. However, this positive effect was only observable in white but black participants.

Physical activity has been shown to greatly help in managing depression in adults. In patients who suffered from stroke or cardiac events, exercise helps in improving health outcomes. In patients with primarily clinical depression, exercise leads to release of the hormone endorphin which induces positive feeling. The study results here suggest that physical exercise can positively affect children’s self-worth should therefore be considered as intervention against depressive symptoms.

This is very relevant considering the results of another study last year which showed that American children take more psychotropic medications that their counterpart in Western Europe. Comparing the US with two European countries, the annual prevalence of use of psychotropic medications is:

  • US  – 6.7%
  • The Netherlands – 2.9%
  • Germany – 2.0%

The most common of these psychotropic drugs were antidepressants and stimulants and there was a tendency for multiple drug therapy among US kids. There is some indication that Europeans tend to use alternative ways of managing depression – including exercise.

The depressive brain: it’s in the family

April 14, 2009 by  
Filed under DEPRESSION

brain_001The depressive brain is structurally different compared to a non-depresssive brain. And it seems to run in the family. This is reported by scientists at Columbia University. Those with a family history of depression have brains which are, on average, 28% thinner in the area of the right cortex compared to those with out familial history of depression. This difference seems to be evident long before depressive symptoms, if ever, come up. The cortex is the outermost layer of the brain and this thinning of the cortex is also somewhat similar to those observed in patients with schizophrenia or Alzheimer’s disease.

According to Dr. Peter Bradley, lead researcher:

The greater the anatomical differences seen in patients, on average, the more severe were their symptoms of cognitive impairment. Subjects who showed cortical thinning in the left hemisphere of the brain went on to develop the hallmark symptoms of clinical depression or anxiety.

The most common symptom of depression is sadness. However, it goes far beyond than just feeling down or having the blues. Researchers have long identified that clinical depression comes with a wide range of neurological and cognitive problems including:

  • Problems with concentration
  • Problems with visual memory
  • Failure to pick up on social and emotional stimuli

These symptoms cannot be attributed to emotional and psychological problems alone. The current study published in the Proceedings of the National Academy of Sciences, indicate that there is a physiological and anatomical side to depression.

The study looked at the brains of 131 people using functional magnetic resonance imaging (fMRI) technique. The study participants were aged 6 to 54 years old “who were biological descendants (children or grandchildren) of individuals identified as having either moderate to severe, recurrent, and functionally debilitating depression or as having no lifetime history of depression.” The cortical thinning was observed to correlate well with severity of depression and the symptoms listed above.

The findings suggest that the cognitive problems may not be due to depression but may actually be the cause of the depressive symptoms. The thinning of the right cortical region suggest that an individual is at risk of developing depressive symptoms. If the thinning spreads to the left cortex, the cognitive weakness can lead to full-blown depression.

“…the cortical thinning in the right hemisphere produces disturbances in arousal, attention, and memory for social stimuli, which in turn may increase the risk of developing depressive illness.” The findings may have some major implication in the screening for depression. When signs of right cortical thinning are detected early, certain therapies can be used to help patients compensate for their cognitive problems and thus minimize depressive symptoms.

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.