Showing posts with label depression. Show all posts
Showing posts with label depression. Show all posts

Wednesday, July 1, 2009

Poor sleep is independently associated with depression in postpartum women

Contact: Kelly Wagner
kwagner@aasmnet.org
708-492-0930
American Academy of Sleep Medicine
Poor sleep is independently associated with depression in postpartum women

Sleep may act as a moderator between risk factors for depression and the onset of depression in women vulnerable to sleep changes during the postpartum period

Westchester, Ill. — A study in the July 1 issue of the journal SLEEP suggests that postpartum depression may aggravate an already impaired sleep quality, as experiencing difficulties with sleep is a symptom of depression. Twenty-one percent of depressed postpartum women included in the study reported having also been depressed during pregnancy and 46 percent reported at least one previous depressive episode prior to conception, suggesting that new mothers diagnosed with postpartum depression are not merely reporting symptoms of chronic sleep deprivation.

Results indicate that two months after delivery, poor sleep was associated with depression when adjusted for other significant risk factors, such as poor partner relationship, previous depression, depression during pregnancy and stressful life events. Sleep disturbances and subjective sleep quality were the aspects of sleep most strongly associated with depression. Overall, nearly 60 percent of the postpartum women experienced poor global sleep quality, and 16.5 percent had depressive symptoms.

According to lead author Karen Dørheim, MD, PhD, psychiatrist at Stavanger University Hospital in Norway, depression after delivery is often not identified by new mothers, whereas tiredness and lack of sleep are common complaints. These symptoms may be attributed to poor sleep, but the tiredness could also be caused by depression.

"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," said Dørhei. "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."

Data were collected between October 2005 and September 2006 from 2,830 women who gave birth to a live child at Stavanger University Hospital in Norway. Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) and depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). The mean self-reported nightly sleep duration was 6.5 hours, and sleep efficiency was 73 percent. The mean age of the mothers at the time of reply was 30 years, and the mean age of the infants was 8.4 weeks.

Depression, previous sleep problems, being a first time mother, not exclusively breastfeeding or having a younger or male infant were factors associated with poor postpartum sleep quality. Better maternal sleep was associated with the baby sleeping in a different room.

According to authors, the first three months after delivery are characterized by continually changing sleep parameters. Women who are tired during this period may attribute this to poor sleep, but the tiredness could alternatively be caused by depression; thus talking about sleep problems may provide an entry point for also discussing the woman's overall well-being. Individual women may react differently to shorter sleep duration and lower sleep efficiency during the postpartum period, and that the sleep of women with a history of depression may be more sensitive to the psychobiological (hormonal, immunological, psychological and social) changes associated with childbirth.

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SLEEP is the official journal of the Associated Professional Sleep Societies, LLC (APSS), a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The APSS publishes original findings in areas pertaining to sleep and circadian rhythms. SLEEP, a peer-reviewed scientific and medical journal, publishes 12 regular issues and 1 issue comprised of the abstracts presented at the SLEEP Meeting of the APSS.

For a copy of the study, "Sleep and Depression in Postpartum Women: A Population-Based Study," or to arrange an interview with the study's author, please contact Kelly Wagner, AASM public relations coordinator, at (708) 492-0930, ext. 9331, or kwagner@aasmnet.org.

AASM is a professional membership organization dedicated to the advancement of sleep medicine and sleep-related research. As the national accrediting body for sleep disorders centers and laboratories for sleep related breathing disorders, the AASM promotes the highest standards of patient care. The organization serves its members and advances the field of sleep health care by setting the clinical standards for the field of sleep medicine, advocating for recognition, diagnosis and treatment of sleep disorders, educating professionals dedicated to providing optimal sleep health care and fostering the development and application of scientific knowledge.

Tuesday, June 30, 2009

Depression: A dark and dangerous place

By WALKER MEADE Correspondent

Published: Tuesday, June 30, 2009 at 1:00 a.m.
Last Modified: Monday, June 29, 2009 at 4:10 p.m.

Can't remember when you last had a good night's sleep? Been feeling edgy and short-tempered? Cry sometimes while you're making lunch? Feel that everything that matters is somehow out of your control?

Click to enlarge
MANY FACES OF DEPRESSION
Major depressive disorder is a combination of symptoms that interfere with your ability to work, sleep, study, eat and enjoy once–pleasurable activities. Major depression is disabling and may occur only once in a person’s lifetime, but more often, it recurs throughout life.

Dysthymic disorder lasts two years or longer but its severe symptoms may not disable but can prevent you from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.

There are other forms of depression that can develop because of unique circumstances, such as the present economic recession. Not all scientists agree on how to define these forms of depression.

They include:

Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations and delusions.

Postpartum depression, which is diagnosed if a new mother develops a major depressive episode within one month after delivery. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.

Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight.

Bipolar disorder is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changes — from extreme highs to extreme lows.

—National Institute for Mental Health

You may be on the slippery slope to depression. And if you don't do something about it, your world may become a very, very dark place.

First, "it is terribly important that you know if your sense of discouragement and demoralization is a clinical or real depression," says Sarasota psychiatrist Dr. Robert Mignone. "People can also be demoralized, which is different from depression. In depression, day in and day out, it's a dark and rainy place. Demoralization, on the other hand, doesn't necessarily have a continued loss of sleep, appetite, focus or concentration. It's more a sense of despair and loss of meaning and purpose."

Major depression, which affects about 8 percent of the population and tends to run in families, is treatable with antidepressants, says Mignone. Other depressive disorders may respond to tranquilizers, but will not respond to antidepressants.

Major depression is "the big gun," Mignone says. "If you come down a notch, you have an adjustment reaction with depressive symptoms. If a hurricane hits and takes your house, you may have a situational depression. It comes on immediately and is exquisitely related to the event. It will tend to run a course, especially for people who have strong support, faith and other resources that they can mobilize. It will diminish within four to six weeks. For people who are not resilient or can't bounce back, it will become an ongoing stress."

Mignone believes that the incidence of situational depression has increased since the economic downturn and so have other kinds of acting out.

"Drinking has increased. Suicidal thinking and attempts have increased. Anxiety has remarkably increased," he says. "I not only read about these things, but see them in my own practice. Our current economic situation is clearly not like a hurricane or a fire. It is ongoing and has no certain end. The fallout directly affects all of us."

Because the current situation is very socially destructive, we need to understand that we can't change the fact of what we are going through, but we can change our response. "The financial crisis is not changing our emotional state. We are doing that," he says. "You don't look to the facts to get a handle, you look to yourself. You find a way to get a handle on the situation. I think when we are delivered an emotional blow we are designed to heal. Even when no intervention is given, most of us will heal over time. Healing wants to happen."

Miriam Lacher, the manager of referral development at Sarasota Memorial Hospital's Bayside Center for Behavioral Health, says that although total patient volume is down because people can't afford to come to the center, the diagnostic profile of people with depression-related problems is up.

"What we are seeing are people who are profoundly depressed who are looking for some way to find something that can be back in their control," she says. "We now see people at Bayside that we have not seen before. We had a gentleman ... who attempted suicide. He had never had any mental illness but he lost everything in the market and could not figure out how he was going to sustain himself because this was his retirement."

What can we do to help?

When we see a friend or family member begin to withdraw, there are things we can do to intervene. "We must be more mindful of people in our lives and be aware if they change their daily routines, the way they interact, the things they say, or they allow their personal hygiene to deteriorate," says Lacher. "We are our brother's keeper after all. People just cannot pull themselves up by their bootstraps. We need to say, 'Hey, there is something not right here. Can you talk to me? And if you can't, then let's go get some help.' "

The primary breadwinner in a family is likely to have more symptoms of depression, says Lacher, "because when the world is out of control, it is not just about them, but about the people who depend upon them." Depression in a family also profoundly affects children. "If children are upset, or angry or depressed, you often see acting-out behavior," says Vicki Klein, a clinical social worker in Sarasota. "Children don't have the skills to express themselves with words, so they act their emotions out. They may pick on other children, they may turn it inward on themselves and become withdrawn and have trouble sleeping. They are not likely to discuss these things. "As a parent you would want to have them express what they feel with words and you may have to give them the words," she says. "You might say something like 'It looks like you're sad' and get them to talk about that."

Sometimes, just the act of talking problems out with a therapist can help get people on the road to recovery. "People heal in the very act of sharing what it is that they are struggling with," says Lacher. "You must have a genuine trusting relationship with a patient in order for them to change and take a different path in life. You have to hear the client, hear what their struggles are, validate those struggles, believe that they are struggling before they begin to make changes. Because then you can begin to work with the patient so that they can begin to see if there aren't other ways to perceive what can happen next. You want to see what they are thinking about and not just responding to the emotional part of the problem."

When should you get help?

But how do you know when your emotional problems have gotten so serious that you should reach out for professional help?

The important thing is to be able to "read" yourself -- to know what you are feeling. "Symptoms reach thresholds," Mignone says. "You get to a place where you realize you are not your old self. And, by and large, when the pain gets too much, you will go for help, whether it is a physical problem or an emotional one. Sometimes a patient's inability to function becomes so apparent it can't be denied. They get negative reports at work. A spouse or friend says, 'What's the matter. You're just not yourself.' There is a symptomatic expression of illness that either the patient recognizes or other people do."

There is no point in living in pain when the condition you think is hopeless is not, when the suffering you think will never end can be overcome because of the advances in treatment available to you now.

"If you have no resources and need professional guidance, you will find the churches in Sarasota County a great help," says Mignone. "They will often have an active counseling service where you can get some help. And there are services like Jewish Children & Family Service that can and will help out."

This story appeared in print on page E10

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Monday, June 29, 2009

How to recognize the warning signs of suicide

By DAVE FOPAY, Staff Writer
dfopay@jg-tc.com

Someone feeling pushed to the brink, perhaps thinking things are so bad they can’t get better, needs to hear that they can improve, “even if at the moment you don’t believe it,” Linda Weiss says.

Severe problems and depression that can lead people to consider ending their lives are usually accompanied by warning signs family and friends can look for, said Weiss, director of the Mattoon-based Regional Behavioral Health Network. The network operates a 24-hour crisis telephone line that’s not only for people who are thinking about suicide but also for people who are concerned that someone else might be, she explained.

“Suicide is a permanent solution to a temporary problem,” Weiss said. “It may end your emotional suffering but it doesn’t end the problem. There is help out there.”

There are several warning signs professionals say might mean that someone’s thinking about suicide. Weiss said some of the major ones are hopelessness or “somebody saying, ‘Why bother?’,” any mention of suicide or that things would be better without them and significant symptoms of depression.

Anybody can “just be down” because of something such as another person’s death or loss of a job, Weiss said, but the level of depression for someone who’s suicidal isn’t “typical to a situation.” It can include loss of interest in things a person normally enjoys and especially needs attention if it lasts two weeks or more, she said.

Along with contacting a professional “if there’s any hint at all” that someone’s thinking about suicide, Weiss said those concerned should talk to the person as bluntly as they feel comfortable, and that includes asking directly about suicide.

“Asking somebody about it is not going to put the thought in their head,” Weiss said.

In recent weeks, the area has seen some dramatic or unusual suicides and attempts, including on June 8 when a rural Charleston woman jumped off a bridge onto Interstate 57 north of Mattoon but lived. Just days before, a Charleston police officer shot and killed himself at his home and about a week before that, a Mattoon man shot himself to death at a friend’s home in Bushton after a police pursuit.

More drastic acts usually indicate that “they’ve made their mind up that they do want to be dead” and they choose the method because they’re not likely to be stopped, Weiss said. Someone might also have access to a gun but not pills for an overdose, for example, she added.

Weiss also said law enforcement is one of the high-risk occupations for suicide because of the stress that comes with the job and the access to weapons. One local police officer said he “absolutely” agrees with that and his department offers programs to help deal with it.

“A lot of the time, we see the worst in people,” said Lt. Tad Freezeland of the Coles County Sheriff’s Department. “Sometimes, police officers can get dragged down by that.”

Freezeland also said he’s probably dealt with about 100 instances during his 16 years in law enforcement where someone attempted suicide. Those include times trying to talk the person out of it, he said, and that’s when he tries to mention those who care about the person and to make that person realize suicide’s not the answer.

“We’re there to help them,” he said. “We’re there to de-escalate their thoughts.”

Freezeland echoed Weiss in saying that if someone’s intent on suicide “they’re going to do it.” He also agreed that it’s best if others know and recognize the warning signs because usually by the time police arrive “it’s too late.”

The Regional Behavior Health Network crisis line is averaging about 320 calls per month this year, a few more than last year and continuing an increase the program’s seen each year since it began in 2004. Weiss said that could be because people are more aware of the service and because of “the state of affairs,” namely the poor economy.

“There are more people under stress,” she said.

The emergency room at Sarah Bush Lincoln Health Center deals with people who’ve tried to kill themselves but also frequently encounters people thinking about it, said Joseph Burton, the hospital’s emergency department medical director. As many as six people walk in each day with mental illness problems, most considering suicide, and it’s “getting busier,” he said.

Some can be admitted to the hospital, but for people who don’t meet the criteria for that, they mostly have to be referred to an agency and are left to make the contact themselves, he added. That’s a situation he called a “silent crisis” in mental health care.

“They need something in between going home and being admitted,” Burton said.

Contact Dave Fopay at dfopay@jg-tc.com or 238-6858.

Sunday, June 28, 2009

Mental Health Help is at Hand

Mental health help is at hand
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By MICHELLE BEARDEN | The Tampa Tribune

Published: June 27, 2009

What happened to Mike Hailey could happen to anyone, says Scott Barnett, executive director of Mental Health America of Greater Tampa Bay.

Untreated depression can lead to substance abuse, alienation from family and friends, poor decisions, physical problems and suicide.

"If you're running a high fever, you'd seek medical help," he says. "It works the same way with mental health. You need to treat it before it gets worse."

That can range from talk therapy to medications, Barnett says. But the important thing is not to ignore the symptoms. Anyone suffering from severe depression without a specific cause, such as a death of a loved one, needs to seek professional help.

"Too often people think it's a character flaw to ask for help," he says.

Barnett, who manages his depression through prescription medication, offers these tips:

If the way you are feeling is not normal for you, then something not normal is probably happening.

You have a right to feel better. Pursue your rights.

Find a person you can be open with. Dial 211 for help reaching crisis centers in Tampa and St. Petersburg or go to www.mhagreatertampabay
.org for information.

More than 20 percent of Americans will have mental health problems in their lifetime. You are not alone.

"My own experience is that when I make it known I have clinical depression, I usually make at least one new friend," Barnett says. "So, it is well worth it."

Hailey is sharing his story to groups in the hope of helping others. To contact him or to learn more about New Day Church, call (813) 681-8239 or go to www.newdayministries.org.