Depression Medication Linked to Gestational Hypertension

Currently SSRI’s (selective serotonin reuptake inhibitors) are commonly prescribed during pregnancy for those who have been previously responsive to SSRI’s and those who have severe depression or anxiety. A March 2009 study in the American Journal of Psychiatry reported increased incidence of gestational hypertension and preeclampsia in women who took SSRI’s during the last trimester of pregnancy.

Should pregnant women take depression medications? This is a complicated question and requires an individual assessment of the woman’s needs. The risks of taking depression medication have to be weighed against the risks of not taking it. We know that some drugs can cause birth defects especially if taken during the first trimester. Some babies experience medication withdrawal after birth if their mothers took antidepressants during pregnancy. On the other hand, we also know that untreated depression during pregnancy carries its own risk to the baby such as preterm labor, smaller head size and lower birth weight. Also, babies born to untreated, anxious, depressed mothers are more difficult to soothe and may have slowed motor development.

So what’s a woman to do? I tend to be on the conservative side of the spectrum with regards to avoiding medication if at all possible, especially during the first trimester when the baby’s organs are forming. However, I think the general trend has been to use SSRI’s even in mild cases of depression. There are definitely women who cannot continue the rest of their pregnancy off depression medication without putting their life and the life of their unborn baby at risk. In general the findings seen in this study should make us give more consideration as to which women should continue on depression medication throughout their pregnancy and which ones should continue off depression medication and be monitored closely.

Depression Twice as Likely to Strike Women

Women are twice as likely as men to suffer major depression, according to a new report released by the U.S. Department of Health and Human Services. Analyzing the most recent research on women’s mental health issues, the report, Action Steps for Improving Women’s Mental Health, examines the role gender plans in treating and coping with mental illness issues such as depression, anxiety, and post traumatic stress disorder brought on by trauma and violence.

Analysis discovered that not only are women twice as likely as men to suffer depression, but women suffer anxiety disorders at a rate two to three times greater than men. Women are also at far greater risk than men for post traumatic stress disorder, a discovery that could significantly impact the treatment of female war veterans returning from Iraq and Afghanistan. In fact, the study found that any history of violence, trauma or abuse increased a woman’s risk of developing depression, post traumatic stress disorder, anxiety and panic disorders. It also increased the tendency to engage in risky behaviors.

In a press release, Acting Surgeon General Dr. Steven Galson said, “Mental illness is often incorrectly perceived as a weakness, which prevents women from recognizing the signs and symptoms and seeking treatment. In order to reduce stigma, we need to encourage open, honest conversations.”

Depression, anxiety, panic disorders, and post traumatic stress disorder are treatable conditions. In a key finding, the federal report found that family and interpersonal relationships in a woman’s life not only play a significant role in a woman’s ability to cope with and recover from mental illness, but that strong, positive relationships offer women some modicum of protection from mental illness.

In an effort to encourage dialog about women’s mental health issues and address stigmatizing misconceptions about mental illness, the U.S. Office of Women’s Health (OWH) has produced a free, downloadable booklet to educate women about steps they can take to improve their health and reduce their risk for many diseases, including depression, anxiety, panic disorders, and post traumatic stress disorder. Click here to download the free OWH consumer booklet Women’s Mental Health: What It Means to You.

Women’s Sleep Habits Linked to Mood

When mom doesn’t get enough sleep, the whole family suffers. In women, there’s a definite connection between sleep and mood. Worry, stress and anxiety can interfere with sleep, and sleep problems can increase depression and anxiety symptoms. According to a 2007 National Sleep Foundation study on women’s sleep habits, the relationship between sleep and mood is bi-directional. More than half of the women surveyed in the NSF poll said they had felt unhappy, sad or depressed in the past month, and one-third (36%) had felt hopeless about the future. Most reported problems sleeping, and 40% had been diagnosed with a sleep disorder.

Biology affects a woman’s sleep habits. The NSF study analyzed sleep patterns at each stage of a woman’s life:

• Menstruation. Menstruating women slept longest, averaging 7 hours, 32 minutes of shut-eye; however, 67% reported insomnia several nights a week. One-third experienced sleep problems during their cycle.
• Pregnancy. Women got more sleep during pregnancy than at any other time — approximately 8 hours, 14 minutes per night — although 84% complained of insomnia several nights a week and 30% said they never got a good night’s sleep.
• Post Partum. Women slept least — an average 7 hours, 46 minutes — after childbirth. Nearly half (47%) reported never getting a good night’s sleep, and 84% experienced chronic insomnia, 90% related to child care. Two in every 10 women experienced post partum blues or depression.
• Perimenopausal. During menopausal transition, women got the least amount of sleep (7 hours, 12 minutes). More than half (59%) reported insomnia a few nights each week; and 43% experienced a sleep disorder, hot flashes or night sweats that interfered with sleep.
• Postmenopausal. Postmenopausal women slept an average 7 hours, 19 minutes but had the highest incidence of sleep disorders (50%) and insomnia (61%). Forty-one percent used a sleep aid several nights a week.

Because of the link between sleep and mood, psychiatric treatment that addresses both issues through cognitive-behavioral therapy and psychodynamic therapy can be most effective. A board-certified psychiatrist like Dr. Tracey Marks with considerable experience treating sleep disorders can help you find workable and lasting solutions to sleep better and enjoy life more.

What is Generalized Anxiety Disorder?

A plain English term for this would be a worrywart. This is more than concern about a specific issue such as whether you child will return home from Iraq. People with this disorder tend to worry about most things. There is usually something at the forefront of their minds that they are worried about. If that issue resolves, the next issue moves up in the cue. Other symptoms are feeling edgy, having trouble relaxing, irritability and feeling afraid that something bad will happen (even if you are not clear on what the bad thing can be).

Some people can learn to control their worry or engage in self-talk that lessen their concerns. Others may need medication such as antidepressants especially if their symptoms interfere with their work or home life.

Routine Depression Screening Advised for Teens

With more than two million U.S. teens affected by depression, an influential medical panel is urging physicians to routinely screen their teen patients for depression. According to the U.S. Preventive Services Task Force, a government-appointed blue-ribbon group of medical experts that sets health guidelines for doctors on a wide range of health issues, most depressed teens struggle with their condition undiagnosed and untreated. The task force’s recommendations, which exceed teen depression screening guidelines suggested by the American Academy of Pediatrics’, were published in the April issue of the journal Pediatrics.

Evidence suggests that teen depression can be accurately diagnosed in primary-care settings with the aid of simple but detailed questionnaires. Because routine school/sports physicals, illness and injury send most teens to their primary-care doctor several times a year, the task force believes that increased screening by primary-care physicians has the greatest potential to dramatically increase the number of teens receiving help for depression. An estimated 6 percent of U.S. teens suffer from clinical depression that requires psychotherapy and, in some cases, medication.

Teen depression can lead to social isolation, persistent sadness, school problems, and even suicide. Screening for early detection and treatment is crucial to improving symptoms and helping teens cope, the panel said. While other medical groups have recommended screening high risk teens, the panel experts recommend screening all teens at least once a year. “You will miss a lot if you only screen high-risk groups,” Dr. Ned Calonge, task force chairman and chief medical officer for Colorado’s Department of Public Health and Environment told the Associated Press.

The teen years are a time of volatile emotions, individualization, separation from family, and boomeranging self-confidence that can quickly spiral down into depression. With families always on the go, teens’ natural emphasis on spending more time with their friends, and the normal teen desire for privacy, parents can often miss early signs of depression. Teens, too, can be adept at hiding depressive feelings and suicidal thoughts from their families and friends. However, simple questionnaires that focus on depression indicators — mood, anxiety, appetite, drinking, substance abuse — have proven remarkably accurate in helping physicians diagnose teen depression.

In light of highly publicized links between antidepressants and teen suicide, Calonge stressed that the panel is not promoting drug treatment alone. The panel specifically recommends routine depression only when psychotherapy is readily available to immediately help teen patients.

More Sleep Can Improve ADHD Symptoms

A common behavior disorder that affects 8% to 10% of U.S. school-aged children, ADHD – attention deficit hyperactivity disorder — has been linked to children’s failure to get enough sleep. In a new study (see our April 29 post), researchers at the University of Helsinki in Finland found that children who typically received less than 7.7 hours of sleep per night were significantly more likely to develop ADHD than children who slept longer. The study is the first to pinpoint length of sleep alone as a source of behavioral symptoms.

Interestingly, the study found that parents regularly over-reported the amount of sleep their children received compared to objectively measured results, suggesting both that most parents are unaware of their children’s actual wake-sleep cycles or that a “social desirability bias” promotes over-reporting. Despite such discrepancies, study results clearly found a direct, measurable, causal link between short sleep cycles and increased symptoms of ADHD.

“Even though we hypothesized that sleep duration would affect behavioral symptoms, we were somewhat surprised that the effect was so very, very clear,” principal researcher Dr. E. Juulia Paavonen told Medscape Psychiatry in an April 28, 2009, online article about the study.

The study found the lowest risk of developing ADHD symptoms among children who regularly received an average night’s sleep characterized by at least 7.7 to 9.4 hours of uninterrupted sleep per night. Parents who are able to help their children establish and maintain adequate sleep cycles of 8 to 10 hours of uninterrupted sleep per night may be able to significantly reduce their children’s risk of developing ADHD. In children who already exhibit symptoms of the disorder, maintaining adequate sleep patterns may help to control and/or alleviate symptoms, researchers believe. In an independent European study, lengthening children’s sleep cycles by just 30 minutes per night was found to significantly improve cognitive and attention behavior with observable improvement exhibited in less than one week.

Here are some things parents can do to help their children get the sleep they need:

• Establish a regular bedtime.
• Decrease activity about 30 minutes before bedtime.
• Ban TVs, video games and other over-stimulating activities from the bedroom.
• The bedroom should be comfortable — well ventilated and slightly cool with a nightlight.
• Establish a soothing bedtime routine — bath, brushing teeth, toileting, story time, prayers.

ADHD Linked to Lack of Sleep in Kids

Lack of sleep in children increases their risk of developing attention deficit hyperactivity disorder (ADHD), according to new research published in the April 27, 2009 online edition of Pediatrics. In a study of 7- and 8-year-olds conducted by researchers at the University of Helsinki in Finland, children who received less than 7.7 hours of sleep per night were at significantly increased risk of developing hyperactive/inattentive disorders compared to children who slept longer. The Finish study is the first to identify length of sleep alone as a source of behavioral difficulties.

“There is a large amount of literature linking sleeping difficulties to behavioral symptoms,” principal researcher E. Juulia Paavonen, M.D., Ph.D. told Medscape Psychiatry in an April 28, 2009, online article about the study. “However, this study shows short sleep duration itself is related to behavioral symptoms, independent of sleeping difficulties.”

The study provides a potential key for the treatment of rising attention and cognitive performance issues among U.S. children. As many as one-third of American children do not receive an adequate amount of sleep.  While previous studies have indicated a probable link between sleep disorders, such as sleep apnea, and the behavioral symptoms associated with ADHD, none of those studies included behavioral assessments. The Finish study is the first to specifically assess the effects of sleep length on behavioral issues in children and show a definite causal effect between lack of sleep and decreased attention span and cognitive performance.

The study evaluated the sleep habits and duration of 280 boys and girls with a mean age of 8.1 years. Assisted by the children’s parents, sleep journals logged when children went to bed, woke up and were allowed to leave their beds over seven-day intervals. Problems such as illness that could affect sleep quality were also recorded. Hyperactivity, impulsivity and inattention symptoms were evaluated using the maternal ratings from the ADHD Rating Scale. Socioeconomic status, parental education and other demographic data were also considered. The majority of the test group (80.7%) were categorized as average sleepers, getting 7.7 to 9.4 hours of sleep per night. Short sleepers (9.3%) received less than 7.7 hours of sleep, while long sleepers (10%) got more than 9.4 hours of sleep.

Next time: Study recommendations: What parents can do.

Night Owls Stay More Alert Longer

Each person has an internal biological clock that determines his own personal sleep/wake cycle. Called circadian rhythm, your individual 24-hour clock determines whether you’re an early riser or a night owl (see our April 24 post). Interestingly, new research conducted by researchers in Brussels, Belgium indicates that people who wake later in the morning, 9 a.m. as opposed to 5 or 6 a.m., remain more alert for longer periods during the day, even if they turn in early.

In tests comparing the sleep cycles of early birds and night owls, MRI brain scans were taken to measure brain activity at different times throughout the day and night. Night owls were slower than early risers to exhibit sleep pressure (the urge to sleep) as the day progressed, remaining alert for one to two hours longer per day than early risers. Eventually though, the study found that night owls paid a price for their late hours. Out of synch with society’s daily schedule (children, school, job schedules, etc.), night owls tended to rack up a sleep deficit as the week progressed, requiring additional sleep on the weekends to recover.

Similar studies in the U.S. have shown that teenagers who typically prefer staying up late and sleeping in might do better in school if the school day started later and went longer. Some school districts are considering switching high school schedules to accommodate teenage circadian rhythms. In recent trials, starting high school classes at 9 a.m. and ending at 5 p.m. to 6 p.m. resulted in more alert students and improved academic performance.

While the exact role of sleep is still under debate, director of the Belgium study, Philippe Peigneux, professor of clinical neuropsychology at the Free University of Brussels explained in an article posted to The Why? Files website that researchers are convinced that an activity at which you spend fully one-third to one-quarter of your life — sleep — must have multiple functions critical to the health of mind and body. “When you fall asleep, you are not conscious of the external world, but sleep helps restore your ability to be alert the next day. Sleep is believed to be important for thermal regulation and memory consolidation, and many other functions,” he said. Continuing research will determine what other roles sleep plays in good health.

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