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.

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

• 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.

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.

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.