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Thursday, May 5, 2011

Pregnant Ladies, Put Your Lotus Hands Up (and Find Supportive People)

“You aren’t taking antidepressants, are you?!” Apparently, Mom read my blog post on effects of stress during pregnancy, and was naturally over-concerned. You see, she heard news antidepressants may cause birth defects. Though I'm lucky to be an expectant mom who is neither depressed or taking meds, I can sure say I feel more vulnerable to depression and anxiety while I'm pregnant.

Looking into it, I see the news has been somewhat alarmist. In actuality the case for prenatal antidepressant use is complicated, and most doctors aren't recommending their depressed patients stop taking antidepressants while pregnant (of course they factor in the severity of the depression and wishes of the patient). My own physician, Dr. Tina Leung at Palo Alto Medical Foundation, says about 30-40% of her patients will stop taking antidepressants when they become pregnant.

Admittedly, I can see why. If the recent research discussed here has some truth, then antidepressants might lead to a greater risk of heart defects and pulmonary hypertension for the fetus. Worthy of mention too is the debate going on about whether antidepressant use can increase risks of spontaneous abortions. A London group recently asked the key question if the case against prenatal antidepressants is compelling enough to stop it altogether, and they cite a 2010 Swedish study confirming the hypertension and cardiac defect risks associated with some serotonin reuptake inhibitors (Paxil seems to be the worse on several accounts, and my doctor says she always switches her pregnant patients to a different antidepressant).

What mother wouldn't want to be super cautious about taking antidepressants in the face of such potential risks?! The reason many doctors are encouraging patients to stick with their meds is that the research is far from conclusive. The negative effects show up in some studies and not in others. The studies certainly don’t look at the long-term effects, nor are conducted as properly controlled clinical trials to begin with. Plus in many cases, the effect is very small (e.g. pulmonary hypertension in infants happens at a certain rate regardless of whether the mom is taking antidepressants, and the increase in risk is slight). So it seems right to say "don't throw out the pills just yet" (or properly dispose of them, rather) unless you and your doctor come up with a very good backup plan.

What do doctors have in their treatment toolkit if a mom-to-be is depressed or anxious and wants off the meds? First off, no one should make a rash decision about their treatment, nor should they stop taking their medications without a good support network, including a physician capable of weighing the benefits and risks of different treatments plans, a point made here already. The risks of prenatal depression are serious and potentially life threatening for all involved, in addition to the risks of pre-term births and transgenerational effects discussed before.

Doctors Expand Their Toolkit for Depression Treatments

Listen, I understand physicians can’t go around recommending treatments if the effectiveness isn’t adequately studied, and when it comes to alternative therapies, most aren’t backed by hard evidence. Meditation and Mindfulness-Based Cognitive Therapy (MBCT) are becoming exceptions, and some clinical circles now accept them as treatments equally as effective as antidepressants for depression.

In some areas, like the Bay Area where I live, there’s a wealth of meditation programs linked to hospitals such as Stanford and UCSF, and many more within the community. The most widely offered meditation class in a clinical setting is Mindfulness Based Stress Reduction (MBSR), and this directory lets you search for practitioners in your state. If you’re interested in Buddhism, “insight meditation” can be useful as well, and this link lists outside resources, including insight meditation groups across the world. Though meditation can also be learned from books, I see from my own experience that healing is greatly supported when connected within a community. This is especially important for newbies to meditation. It’s not uncommon to become overwhelmed by negative emotions when attempting to sit with them.

Overall, I can't emphasize enough the importance of support networks during depression, but I know how being social so often feels like the last thing you want. Connect with supportive people anyway. Make it a priority to find them.

Choices and "Alternative" Roads to Wellness

The power of choice is a critical consideration in the way depression and anxiety can worsen into a debilitating disease. This is not to say depression is a choice! It certainly isn't, and always has a very real biological basis. Yet consider how the choices we make every day, every moment can have huge effects on our well-being and susceptibility. For example, I’ve been keeping my promise made a few weeks ago to be in bed by 10pm, and I’m finding my ability to regulate stress the next day is greatly improved. The small choices we make of which thoughts and actions we give power to and which ones we shift away from ripple throughout our lives in very significant ways. This is where MBCT is very useful, in addition to life coaching. They both support you in focusing on thoughts worth thinking and actions worth taking for yourself.

Even neglecting to seriously educate yourself about depression/anxiety/mania and all possible treatments is a choice. I struggled with one long major depressive episode (in the form of bipolar II) 10-12 years ago, and initially I simply refused to believe that mental illness could affect me. Though all the signs were there, I buried my head in and dug deeper for about 8 months in 1999 before starting to get help. Ironic, considering that at the time I was actively conducting research on the nervous system as a PhD student, as if by studying the brain I would somehow be immune from any illness related to it.

Based on my experience, I’m a huge supporter of meditation as a treatment for depression and bipolar II. I’ve been well and drug free for 10 years. I also found cognitive therapy, yoga, exercise, and friendship very helpful, in addition to compassionate talk therapy (NOT psychoanalysis). I’m genuinely curious to hear from you ways you’ve successfully healed during times of mental struggle. Dietary changes? Acupuncture? Prayer? Religious fellowship? Taking on a challenge, like a 100 mile bike ride?
Namaste' ya’ll

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