Depression During Pregnancy May Warrant Medication

Ground-breaking new guidelines issued by two national physician groups state that while talk therapy alone is considered the best treatment for pregnant women who suffer from depression, in severe cases use of medication is warranted despite potential risk to the developing fetus. Nearly one in four U.S. women experience episodes of depression during pregnancy, 13% of whom are prescribed antidepressant medications. Until now, doctors have lacked coherent professional guidelines to guide pregnant patients in weighing the risks of various treatment procedures for depression during pregnancy.

Based on a study of medical practices between 1999 and 2003, the new guidelines, which were jointly issued by the American Psychiatric Association and the American College of Obstetricians and Gynecologists, stress that talk therapy alone remains the preferred treatment for pregnant women suffering from depression. However, the guidelines go further, stating that in cases of recurrent depression or suicidal inclinations, prescription of antidepressant medication to augment talk therapy should be considered.

The guidelines point out that the danger of limiting treatment for severe depression and under-treating the mother may in certain cases outweigh the risk of subjecting the developing fetus to antidepressant drugs. Babies exposed to antidepressant drugs in the womb can be born prematurely or with low birth weights. Some antidepressants given in late pregnancy can cause more serious, potentially life-threatening problems during the first two weeks of life. The new guidelines, however, recognize the greater risk of poor nutrition and prenatal care that often results from untreated depression and the increased risk to both mother and fetus from possible suicide.

Physicians praised the new guidelines for clearly encouraging obstetricians to screen pregnant patients for signs of depression and for clarifying the role of psychiatrists in caring for pregnant women suffering from depression. “This is a very exciting time in obstetrics and psychiatry, a golden opportunity for us to really make a difference in the lives of women and their children,” UCLA psychiatrist Vivien Burt told the Los Angeles Times.

Physicians from both specialties expect the new guidelines to result in better medical are for women and their unborn children during pregnancy, with obs screening patients for depression and referring those who exhibit symptoms to psychiatrists for treatment.

Why We Cling to Unobtainable Dreams

American Idol has fueled the mega-star dreams of wanna be singers across the country. Yet, as acerbic judge Simon Cowell is quick to point out, many of those dreams are woefully misplaced. The crushing of dreams as impassioned but horribly off-key singers audition season after season makes for dramatic television. We laugh at their folly, wondering how these people can truly believe they have the talent to become professional singers. A new study by psychologists at Ohio State University and the University of Florida published in the current issue of the journal Social Cognition sheds some light on the phenomenon.

Researchers found that people cling to their career dreams with fierce tenacity. Telling someone they lack the skills or knowledge to achieve their goal isn’t enough to shake their belief that they can accomplish their dreams. It takes a clear, often humiliating, demonstration of their lack of ability to convince someone that their dreams are misplaced.

“Most people don’t give up easily on their dreams. They have to be given a graphic picture of what failure will look like if they don’t make it,” study co-author Patrick Carroll, an assistant professor of psychology at OSU-Lima, said in an online article posted on Newswise. “We have a brilliant ability to spin, deflect or outright dismiss undesired evidence that we can’t do something. We try to find reasons to believe.”

It’s a harsh lesson seemingly at odds with the “Dream big! Follow your dreams!” advice that parents use to encourage their children. Shows like American Idol, America’s Got Talent and America’s Next Top Model only fuel our dreams of being “discovered” and catapulted from oblivion to stardom. Idol judge Simon Cowell has often explained that his comments may be cutting, but they’re geared to drag would be stars back to reality. Few make it in the music business, even those with talent.

The problem transcends the entertainment industry. Researchers found that many students harbor unrealistic career dreams, sometimes spending years of fruitless study on career paths for which they lack the ability to succeed. It can be a costly mistake, particularly in today’s uncertain job market.

“Educators are trying to lead students to the most realistic career options,” Carroll said. “You want to encourage students to pursue their dreams, but you don’t want to give them false hope about their abilities and talents.”

Next time: Lessons for parents

More Stress Management Tips

As we have been discussing this week, people use four basic strategies to manage stress. They avoid stressful situations or the people that trigger them. They alter situations they can’t avoid. They adapt to the situation by changing their response. Or they accept the situation so it no longer acts as a stressor. In our last post we offered examples of how to apply these stress-relieving strategies to situations in your own life. We continue those examples today.

• Alter your response. Stand up for yourself and your needs. Deal with problems as they arise; don’t let problems fester and grow. Be assertive in expressing your needs but be willing to compromise to accommodate the needs of others.

• Alter the way you manage time. Allow extra time in your schedule to deal with the unexpected.

• Adapt when stress turns your life upside down. Emphasize the positive. Remember the things you’re thankful for. It helps to focus on the big picture. Ask yourself if it will matter in a week? a month? a year? 10 years? If the answer is no, move on.

• Adapt your response to situations beyond your control. Don’t hyperventilate when traffic snarls; enjoy the opportunity to groove to your favorite tunes.

• Adapt your expectations. Show perfectionism the door. Trying to meet impossible standards is a sure path to failure. Be reasonable in the expectations you set for yourself and others.

• Accept what you can’t control, such as the way other people behave. Instead, control your response.

• Accept that life has its ups and downs. Take responsibility for mistakes you make along the way and learn from them. Consider life a continual opportunity for personal growth.

Stress Management Strategies

Between family, home and work, our lives are hectic, complicated and demanding. Stress seems to be a constant companion. We may not be able to avoid stress, but we can learn to manage it more effectively. The first step to decreasing stress is to realize that you are in control of your life. You have the power to decrease your stress levels.

In our last post we suggested keeping a journal to help pinpoint the particular stressors that plague your life and determine how you respond to those stressors. To eliminate stress, you can either change the situation or change your reaction to it using four basic management strategies: avoid, alter, adapt or accept. Below you’ll find examples describing how these stress-relieving strategies can be applied to better reduce the stress in your life.

• Avoid activities that cause you stress. Learn to say “no” in your personal and professional life. Know what your limits are and refuse to accept additional responsibilities that may push you over those limits. Life is short and full of choices. Make a conscious decision to spend your time on things that are important to you and that make you happy.

• Avoid people that add stress to your life. If you can’t change the relationship dynamics, spend less time with the person or end the relationship.

• Avoid stressful situations. If the news makes you anxious, turn off the TV. If traffic is your hot button, change your travel route. If discussing religion sends your blood pressure soaring, leave the conversation.

• Avoid over-scheduling. Prioritize your “to do” list into things that must be done today, things that should be done but can pushed into the future, and things that are not essential. Move less important items to the bottom of the list or eliminate them.

• Life changes and your priorities should change with it. Periodically assess your activities and purge things you do only out of obligation or habit. Concentrate on activities that keep you and your family happy and safe. Eliminate things that are no longer important or that no longer fit your lifestyle.

• Alter situations you can’t avoid. If something or someone upsets you, don’t hide your feelings and let resentment build; express your feelings politely and respectfully.

More Stress Management Tips on Friday.

Combating Dangerous Pattern Perceptions

Perceiving patterns where none exist, a psychological phenomenon called pattern perception, is a mental coping mechanism used by many people to combat uncertainty when events spin their lives out of control (see our June 10 post). It’s a phenomenon that’s on the rise in these times of economic uncertainty where rising unemployment, catastrophic investment losses, mortgage foreclosures, and a host of other worrisome factors have shattered people’s faith in their ability to control their future.

That loss of control generates an extreme anxiety that can impel people to create and act on connections and associations between innocuous, unrelated events, according to research published in the journal Science. In a series of experiments conducted by Jennifer Whitson of the University of Texas-Austin McCombs School of Business and Adam Galinsky of Northwestern University’s Kellogg School of Management, researchers found that people can trick themselves into seeing nefarious conspiracies behind government pronouncements or business announcements.

Structure and order have a calming effect on our psyches while chaos generates anxiety that can lead to panic or depression. The desire for order can become so overwhelming that people fantasize connections between events to bring order to a world that they feel has become dangerously chaotic.

“Feelings of control are so important to people that a lack of control is inherently threatening,” Galinsky explained. “While some misperceptions can be bad or lead one astray, they’re extremely common and most likely satisfy a deep and enduring psychological need.”

The danger comes when people believe in or act on the imaginary patterns they have created. Illusory stock market trends can lead to poor investment decisions and increased financial anxiety. Imagined conspiracies between co-workers can increase job stress to intolerable levels. Delusional thinking can cause marital stress and jeopardize personal relationships. Fantasized government agendas can lead to paranoia and panic.

Exerting phantom control over chaotic events in our lives through pattern perception can hide a very real need for psychiatric help in coping with anxiety, panic disorders or depression. The combination of cognitive-behavioral therapy and psychodynamic therapy practiced by Atlanta psychiatrist Dr. Tracey Marks is effective in helping people find healthy ways to cope with and mitigate the uncertainties that pervade life today without resorting to harmful pattern perception.

Can Brain Scans Detect Lies?

Brain scans are opening new avenues in science, including forensic psychiatry. Functional magnetic resonance imaging (fMRI) is being used to discover new insights into how the brain works and what makes people tick. By studying which areas of the brain “light up” on MRI images, researchers are uncovering differences in how men and women communicate and process information that may lead to stronger relationships at home and more effective relationships in the workplace. Scientists are using MRI research to explore new paths of treating drug, alcohol and nicotine addiction. Recent studies in Europe indicate that brain scans may some day replace lie detector tests in the courtroom.

Instead of using the physical indicators of anxiety — changes in pulse, blood pressure and respiration — measured by a polygraph, fMRIs purport to show whether an individual is lying by which areas of the brain show increased activity. According to an article in Scientific American some entrepreneurs are already trying to capitalize on this, as yet, unproven science. Cephos in Massachusetts and No Lie MRI in California claim to be able to predict with 90% or better accuracy if someone is lying. One firm even advertises its services for “risk reduction in dating.” However, neuroscientists and legal scholars doubt the company’s accuracy claims, saying the science  is too new and unproven.

A 2007 article in the American Journal of Law and Medicine by researchers at Stanford University that analyzed existing research on the subject concluded that current studies has failed to prove the validity of fMRIs as a lie detector “at any accuracy level.” Article authors criticized the small number of studies, the failure to replicate results and the fact the most studies focused on groups and not individuals. Concern was also expressed about assumptions being made about MRI results. Scientific consensus has yet to be reached on what illumination of various parts of the brain indicates.

Opinion is divided on when or even if our understanding of how the brain operates will ever be precise enough to consider MRIs dependable courtroom evidence. However, the possibilities are so intriguing that new research is already being funded. The MacArthur Foundation has donated $10 million to a three-year pilot Law and Neuroscience Project to assess how fMRIs and other neuroscience discoveries could affect the law. The day may come when polygraphs are replaced by MRIs.

Army Suicides Increase Each Year

The US Army recently released the statistics for 2008 of numbers of army suicides. Since 2004 the numbers have been increasing to now 128 active duty soldiers and 43 non-active duty soldiers. These 2008 numbers correspond to a suicide rate of 20 per 100,000 personnel. If you look at the suicide rate of the US population, it works out to roughly 19.2 per 100,000 people in 2005. Here are the numbers for the past five years.

These figures do not include soldiers who left service, however the Department of Veterans Affairs reported 254 suicides of veterans across all military services between 2001 and 2005. The Army has responded to the increase in suicide with suicide prevention training programs. They also developed a Battlemind program which helps prepare soldiers for the psychological stresses of combat. The Army has recently focused on decreasing the stigma of mental health problems with the hope that more soldiers will seek help when needed.

Although the numbers of army suicides don’t seem to vary much from the overall suicide rate for civilians in the US, it is still disturbing that the numbers continue to increase each year to nearly double from 2004. Additionally, it’s bad enough to lose soldiers in combat to enemy actions, but it seems worse to lose soldiers to suicide. What’s happening? Are they becoming so hopeless that death seems to be the only relief? Are they being exposed to images or experiences that they don’t think they can live with?

The National Institute of Mental Health is underway to research this issue. Hopefully they will be able to develop ways to reduce the risk of these suicides so that our soldiers can return home safely.

Fame, Money, Beauty Don’t Bring Happiness

It turns out that those oft sought goals in life — fame, wealth and beauty — don’t bring happiness and can, in fact, make life miserable. That’s the finding of a new study by three researchers at the University of Rochester in New York that was reported this week on ScienceDaily online.

“People understand that it’s important to pursue goals in their lives, and they believe that attaining these goals (fame, wealth, beauty) will have positive consequences,” said study author Edward Deci, professor of psychology at the University of Rochester. However, he noted that the study disproved that belief. “Even though our culture puts a strong emphasis on attaining wealth and fame, pursuing these goals does not contribute to having a satisfying life,” Deci said. “The things that make your life happy are growing as an individual, having loving relationships, and contributing to your community.”

The study tracked recent university graduates using in-depth psychological surveys to gauge satisfaction, self-esteem, anxiety, stress and positive/negative emotions. Goals were evaluated as intrinsic such as developing deep, personal relationships or extrinsic such as attaining personal wealth.  Identical surveys were administered 12 and 24 months after college graduation, a critical development stage for young adults who have finally left the safety net of home and university to make their own way in the world.

While the study confirmed earlier research that commitment to a goal increases an individual’s success in achieving that goal, it broke new ground in analyzing the relationship between goals and happiness. The study found that the content of the goal, not the desire to achieve it, most affected happiness. Achieving materialistic and image-related goals actually generated negative emotions like shame and anger and produced anxiety symptoms including headaches and stomachaches. The greatest satisfaction came from the achievement of intrinsic goals such as personal growth, building relationships, improving the community and physical fitness that met the basic psychological needs of autonomy, competence and relatedness.

While study authors emphasized the need for further study over broader population groups, they did suggest that the emphasis on extrinsic pursuits — career building, long work hours, possession acquisition, etc. — that is typical of the educated, post-collegiate, young adults may lead to general feelings of dissatisfaction with life. Young people may be happier if they place less emphasis on career pursuits and greater emphasis on psychologically nourishing experiences such as spending time with friends and family or pursuing personal interests.

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