Perinatal Mood Disorders
Michigan Statewide PMD Coalition
3 Hour Training
Objectives:
1.
2.
3.
4.
5.
Differentiate between the Symptoms of the 6 Perinatal Mood Disorders
Describe at least 6 Risk Factors for Perinatal Mood Disorders
Identify recommended Screening Measures for Perinatal Mood Disorders
State at least 3 different Treatment Options for Perinatal Mood Disorders
Describe Resources available to persons interested in Perinatal Mood Disorders
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3
• Mary Taber-Lind, Photographer
Introduction
• 20% of WOMEN and 10% of MEN will experience clinical depression in their lifetime
• PMD occurs in 10-20% of all new mothers who give birth
• One out of every 7-8 mothers
• 400,000 per year reported nation wide
• An estimated 50% of cases go undetected
•PMD knows NO boundaries: it affects all races, all ages, all professions,
all economic status levels. Strong, intelligent women have PMD.
• Often “Missed”: Misunderstood/misdiagnosed/mistreated
•2003 Study- 86% of depressed pregnant mothers did not receive
treatment (stigma, no screening, etc.)
•Gotlib IH, Whiffen VE, Mount JH et al. J Consult Clin Psychol 1989:57:269 Prevalence rates assoc with depression in pregnancy and
postpartum.
• Brown, MA, Slochany JE. Nursin Clin North Am 2004:39:83 Two Overlooked Mood Disorders in Women
•Marcus SM, Flynn HA, Blow FC, et al. Depressive symptoms among pregnant women screened in OB settings. J Womens Health
2003: 12:373
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The Myth
5
The Reality
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Epidemiology of Postpartum Episodes
70
Psychiatric Hospital Admissions per Month
60
50
40
30
20
Pregnancy
10
0
–2 Years
– 1 Year
Childbirth
+1 Year
+2 Years
Kendell RE et al. Br J Psychiatry. 1987;150:662-673.
7
Professional Importance
■ Nursing:
•AWHONN - Association of Women's Health, Obstetric and Neonatal Nurses
Clinical Position Statement
•Best Practice Guidelines - Registered Nurses Association of Ontario.
Interventions for Postpartum Depression. www.rnao.org
■ Physicians:
•American Academy of Family Physicians - 2006 National Congress of Student Members
Resolution #206 adopted for PPD screening
•American College of Obstetricians and Gynecologists – 2015 Clinical guidelines to
screen once perinatal.
•American Academy of Pediatrics – 2010 Established screening guidelines at
well child appointments.
8
PMD Legislation
■ State of New Jersey - Senate Bill 2908
April 2006 - Signed by Governor Corzine
Requires licensed HCPs to provide information and
screening for PMD
Required hospitals and birthing facilities to comply
with screening and education
Similar bills pending in other states
■ Federal Government - Melanie Blocker Stokes PPD Bill /
Mothers ACT - PASSED 2010 Part of the Healthcare
Reform. Allocates 3 Million for research, education and
screening.
■ State of Michigan - Governor declared May 2010, 2015 as
Postpartum Depression Awareness Month. Senate
Resolutions declared in 2011,2012, 2013, 2014
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Maternal Effects- Untreated PMD
■ Poor prenatal behaviors-nutrition, prenatal care, substance abuse
■ Poor parenting behaviors
■ Longer persistence of symptoms
■ Increased risk of PPD with subsequent children
■ Increased risk of relapse
■ Poor pregnancy outcomes: insufficient weight gain, decreased compliance
with prenatal care, premature labor, small for gestational age infant
• Muzik, M., Marcus, S., Heringhausen, J., Flynn, H. Primary Care: Clin in Office Practice 36:1:March 2009 Depression in
childbearing women: When depression complicates pregnancy.
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Effects on Maternal Attitude
•
•
•
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Guilt and anxiety about parenting
Loss of love for baby
Difficulty enjoying baby, negative or disinterested toward baby, less active
interactions, inability or lack of attempt to soothe baby, refusal to look at or hold
baby, hostile expressions
•“I have spent the last 10
years of my career
worrying about the
impact of medications.
I’ve been wrong. I should
have been worrying more
about the impact of the
illness.”
• Nuero Psychiatry Reviews, June 2001
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What about the children?
•“There is significant evidence that
maternal depression can have a negative
impact on the cognitive social and
behavioral development of children,
including infants and toddlers.”
•Linda Chadron, MD, MS, Pediatrics in Review Vol. 24 No. 5 May
2003
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Effects on Infant and Children
■ Poor mother-infant attachment
Irritability, lethargic, poor sleep
■ Language delays
■ Behavioral difficulties
■ Lower cognitive performance
■ Mental health disorders
■ Attention problems
■ Withdrawn/fussy/crying/temper
■ Sleep/feeding/eating disruptions
•Kahn, et al. AJPH 2002:92:1312-1318
•Infant Behav Dev 2004:27:216-229
•Psychiatry 2004:67:63-80
•Bonari et al. Can J Psychiatry 2004:49:726-735
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Dads get Postpartum Depression too!
•
•
•
•
•
•
•
Virginia Medical School Study 5/10
28,000 New Dads screened - Meta Analysis of 43 published studies
10.4% Scored positive using standardized depression tools (EPDS, CES-D, BDI, etc.)
Tx: Same as for Mom. Couples therapy. Meds. Self Help
Local Resources: Dads Monthly Support group 4th Tuesday
Websites:
www.postpartumdads.org
10.40%
www.postpartumdadsproject.org
89.60%
www.postpartummen.com
www.bootcampfornewdads.org
PSI chat with Dads - First Monday each month at www.postpartum.net
JAMA, Prenatal and Postpartum Depression in Fathers and its Association with Maternal Depression. A Meta-Analysis By James F. Paulson; Sharnail
D. Bazemore
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Mental illness during Pregnancy
■ Pregnancy is not protective
■ Prevalence: 9.4%-12.7%
Prenatal
Mental Illness
12.7%
Wellness
■ Existing psychological disorders either stay the same or worsen during
pregnancy (especially anxiety and OCD)
■ Women with mental illness during pregnancy have
increased risk for Pre-term delivery,
Cesarean Section, Low birth weight, NICU infants
•2003 Study- 86% of depressed pregnant mothers did not receive
treatment (stigma, no screening, etc)
•Whitlock, American Journal of Psychiatry 2007
•Marcus SM, Flynn HA, Blow FC, et al. Depressive symptoms among pregnant women screened in
OB settings. J Womens Health 2003: 12:373
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“Whispers” Artprize 2015 Pam Coven
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Video
“Speak Up When You’re Down”
New Jersey 2007
5 min
Contact nancy.roberts@spectrumhealth
for copies in English and Spanish
Baby Blues
Onset: First 2 – 3 weeks
Prevalence: 50 – 80%
Etiology
• Hormones
• Adjustment period
Subsides in time with support
Possible risk factor for PPD
Symptoms
• Crying, tearfulness
• Fatigue
• Mood swings
• Anxiety
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100
50
0
Baby
Blues
Withou
t Blues
Postpartum Depression
Onset: Anytime in the first year
Prevalence: 10 %– 21.9%
PPD Prevalence
PPD
**Twice the rate of gestational diabetes and gestational hypertension- of which
universal screening for both of these illnesses occurs routinely with ALL
pregnancies
Etiology: A biologic and life stressors illness
Prognosis: Favorable with appropriate treatment
Treatment: Meds, psychotherapy, support, self help
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PMD Symptoms
Depressive mood
Sadness/crying
Anxiety / insecurity
Sleep disturbances
Appetite changes
Poor concentration
Confusion
Irritability
Unable to take care of self /family
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Numerous Losses, ie: self, spontaneity, body
image, sexual, etc.
Isolation
Worthlessness
Shame
Guilt
Anger
“I finally told my husband that he
and my daughter would be better off
without me —that I was not a good
mother or wife. I felt like things were
never going to get better — that I
would never feel happy again”
“…I am going to act as though
everything is fine although I am
terrified of what lies ahead.”
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Postpartum Panic/Anxiety Disorder
Onset: first month
Prevalence: 10-15%
Etiology: unknown
Treatment: meds,
therapy, support
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Symptoms:
Panic attacks
Anxiety
Agitation
Insomnia
Self doubts
Extreme worries
Symptoms of Anxiety/Panic Attacks
•Chest pain
•Muscle tension
•Shortness of breath
•Hot and cold flashes
•Tingling hands and feet
•Extreme worries and fears
•Fear of dying
•Fear of going crazy
•Fear of being alone
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•Faintness
•Irritability- anger and rage
•Feeling trapped
•Racing heartbeat
•Hyperventilating/ Difficulty breathing
•Nausea /Vomiting
•Dizziness
Postpartum Obsessive Compulsive Disorder
Onset: first month
Prevalence: unknown
Etiology: unknown
Treatment: meds, therapy, thought stopping techniques, support
Intrusive thoughts, fears, images
Person cannot control thoughts
The person understands that to act on these thoughts would be wrong
Often misdiagnosed as psychosis
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OCD
■ Intrusive Thoughts: Recurring, persistent and disturbing
thoughts, ideas or images (scary images of accidents,
abuse, harm to self or baby)
■ Hyper vigilant (i.e. can’t sleep for fear that something awful
will happen to baby, constantly checking on baby)
■ Ritual behaviors done to avoid harming baby ( put away knives)
or to create protection for baby ( will not leave the
house)
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Post Traumatic Stress Disorder (PTSD)
Due to Childbirth
Onset: soon after birth
Prevalence: 1.5%-6%
Etiology: birth trauma,
recent or past trauma
Treatment: meds,
counseling-debriefing,
support
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Re-experiencing over and over in one’s mind
(sensations of “being in the trauma” now)
Nightmares/Flashbacks
Increased arousal/anxiety/anger
Emotional numbing/detachment/
isolation
During Delivery: 3 critical concepts
■ Offer good communication- allowing the mother to feel as much in
control of the situation as possible. Fostering trust and offering
choices when possible. Respect the mothers wishes, her dignity
and privacy. Keep them well informed.
■ Provide pain relief- pain is a significant factor in trauma. Offer options
for pain relief: Epidurals, meds, labor support, etc.
■ Provide comfort with the delivery room environment.
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After Birth
■ Ask mother soon after birth if there is
anything they want to know or talk
about regarding their birthing
experience.
■ Allowing expression of their perceptions and
experiences of their birth and the
care they received.
■ Websites and organizations:
www.tabs.org.nz
www.solaceformothers.org
www.ptsdafterchildbirth.org
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Bipolar Disorder
•Often presents with Mania first:
■ Feels great
■ High energy
■ Irritability
■ Decreased need for sleep
■ Feeling “speedy”
■ Easily distracted
■ Mind racing
■ Fast speech
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•85% of bipolar women who go off
their medications during pregnancy
will have a relapse before the end of
their pregnancy .
•Increased potential for
development of psychotic symptoms.
Postpartum Psychosis
Onset: first 1 – 3 weeks ( months)
Prevalence: 1 – 2 per 1000 births or
4,000 per year nationally
Etiology: unknown – 70%
have significant history of mental
illness
5% commit suicide
4% infanticide
Treatment: Inpatient hospitalization
for close observation - a true
psychiatric emergency
Symptoms:
• Delusions
• Hallucinations
• Paranoia
• Loss of reality
• Agitation
• Irrational
statements
• Mania
• Insomnia
Spinelli MG. Am J Psychiatry. 2004;161:1548–1557
Spinelli MG. Am J Psychiatry. 2009;166(4):405-408.
Nonacs R, Cohen LS. J Clin Psychiatry. 1998;59(Suppl 2):34-40
Jones I, Craddock N. Ann Med. 2001;33(4):248-256.
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Risk Factors-Postpartum Psychosis
•
•
•
•
•
•
•
Risk factor
Hospitalization for psychotic episode during the pregnancy.........
Hospitalization for a psychotic episode prior to the pregnancy.....
Any previous psychiatric hospitalization........................................
Previous hospitalization for bipolar mood episode.........................
Baseline population risk ................................................................
Harlow BL. Arch Gen Psychiatry. 2007;64:42-48.
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•
•
•
•
•
Risk factor % that
developed
Postpartum Psychosis
44%
14.5%
9.2%
2.0%
0.07%
“I heard voices while I was in the
shower telling me I should go ahead
and just kill myself.”
“I thought the devil was living inside of
me — that my children would be better
in heaven with God than with me.”
Andrea Yates
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Differentiating between OCD and Psychotic Thoughts
Postpartum OCD
• Thoughts are ego-dystonic
• Disturbed by thoughts
• Avoid objects or being with baby
• Very common disorder
• Low risk of harm to baby
OCD, obsessive-compulsive disorder
Brandes M et al. Arch Womens Ment Health.
2004;7(2):99-110.
Postpartum Psychosis
• Thoughts are ego-syntonic
• Rarely distressed by thoughts
• Do not have avoidant behaviors
• Not common disorder
• High risk of harm to baby
Etiology and Risk Factors
• Biological
• Psychological
• Relationship
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Biological Risk Factors
All normal physical changes of pregnancy
and childbirth
Hormone changes
Brain chemical changes
Thyroid imbalance ( 5-10% during first
postpartum year)
Multiple Births (25%)
Infertility Hx
Family Hx of Mental Illness
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Hx PMS- PMDD (premenstrual
dysphoric disorder)
Personal history of mental
illness (3-4 times the risk)
Hx prenatal depression (33%)
Hx PPD (50-70%)
Complicated pregnancy or delivery
including PTSD
Psychological Risk Factors
Normal psychological
changes that always occur
with childbirth
Unplanned pregnancy:
ambivalence
Expectations of motherhood
Personality characteristics :
“the perfectionist”
Significant Lifestyle changes
first time mothers
Adoptive mothers not excluded
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Unresolved losses:
especially reproductive in
nature: miscarriage,
abortion,infertility, PP
sterilization.
Recent stresses:
illness, divorce,
move, job change, death,
finances
Negative childhood experiences :
Hx abuse, neglect, PTSD
Relationship Risk Factors
Relationship with the significant other/partner/husband
The “Quality “of the partnership
Mothers social support system
Single mothers at higher risk
Quality of relationship with BABY
High Need infant: ill, colic, NNICU
Mothers relationship with OTHER children
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Video
“Healthy Mom, Happy Family”
Postpartum Support International
13 min.
Also in Spanish
2010
Assessment and Identification
Early detection = Early intervention
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Assessment
• Observation: Use our training,
experience, and intuition….
• Her speech? Demeanor? Self care?
Interaction with others?
• Care of infant: Attentiveness to needs?
Interaction? Safety measures?
• Input from Significant Other
• History
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Screening Recommendations:
US Preventive Services Task Force
• 2 Question Screener: (PHQ-2)
•1. “During the past month have you been bothered by feeling down,
depressed or hopeless?”
•2. “During the past month, have you often been bothered by having little
interest or pleasure in doing things that you previously enjoyed?”
•*A window of opportunity exists for screening because this is the time of life
when women are under the care of a healthcare provider and entering
medical systems.
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ACOG: Screening for PMD
• May 2015
• ACOG (The American College of Obstetricians and
Gynecologists)
• New Committee Opinion Report Published!
• Finally!
• http://m.acog.org/Resources-And-Publications/CommitteeOpinions/Committee-on-Obstetric-Practice/Screening-forPerinatal-Depression?IsMobileSet=true
• Replaces the Feb 2010 report
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PMD Screening Tools
■ Edinburgh Postnatal Questionnaire (EPDS) by Cox
■ Postpartum Depression Screening Tool (PDSS) by Cheryl Beck
Western Psychological Services 310-478-2061 www.wpspublish.com
■ Patient Health Questionnaire (PHQ-9) by Spitzer
Linked to DSM- www.pfizer.com/phq-9
■ Postpartum Depression Checklist (PDC) by C. Beck – Identifies 11 symptoms
■ Beck Depression Inventory (BDI) by A. Beck - 21 items, self report, 3 versions
■ Others for clinical depression:
CES-D Center for Epidemiologic Studies/Depression
MHI-5 Mental Health Inventory
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Edinburgh Postnatal Depression Scale
EPDS
• Brief - 10 questions
• Easily read and understandable - 6th grade reading level
• Self administered : 2-4 minutes to complete
• Published in 20 languages and used internationally
• No cost - unless for electronic documentation
• Can be used both prenatal or postpartum
• Validated by research –Reliable
Sensitivity: 78%
Specificity 99%
• In use since 1987
• Explores mood symptoms in PP period and less physical and somatic
symptoms
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Edinburgh
Postnatal
Depression
Scale
46
Interpretation of the EPDS score
■ A score of 12 or more suggests further assessment for intervention to take place
■ Confirmation requires 2 consecutive scores of 12 or more separated by 2 weeks
plus a professional interview/assessment.
■ Always intervene with #10 question if marked positive
■ Other Languages at: http://bit.ly/1xb0N4o
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Research on EPDS Last Question
•
•
•
•
11% marked a score of 12 or more, of which 40% of these endorsed last question.
14% were on meds. 20% had prior suicide attempt.
8 % under care of a psychiatrist
More frequently endorsed by non Caucasian with Asian /Hispanic highest
6 themes: 0.8% had an actual suicide plan
57% reporting fleeting thought of suicide but would never act on it
16% reported in past (not last 7 days)
10% denied marking last question when asked
2 % said it was marked by mistake
12% misunderstood the question (language barrier, a dream, etc)
Kim, Jo. University of Chicago Pritzker School of Medicine, 2015
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Diagnostics: DSM-V Criteria
Uses same criteria as for non-pregnant.
PPD is not listed as a separate diagnosis, however the DSM-V has a postpartum
onset specifier within 4 weeks of delivery. (Although studies show onset can occur
much later in the PP period)
Five (or more) symptoms present in the same 2 week period:
1. Depressed mood most of the day
2. Diminished interest or pleasure in activities
3. Significant weight loss or weight gain
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive guilt
8. Diminished ability to think or concentrate
9. Recurrent thoughts of death or suicidal ideation
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Risk Assessment Screening
Performed at many hospitals in Michigan using the
Spectrum Health Postpartum Depression Risk Questionnaire.
The self administered PMD Risk Questionnaire AND Edinburgh is completed by mother
within first 12 hours after birth
If High Risk - The staff/RN/MSW provides education, creates a PMD plan with patient and
family, and initiates follow up screening and /or phone call.
35% Screen at High Risk at Spectrum Health. Other hospitals report similar findings.
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Postpartum
Depression
Risk
Questionnaire
Key Questions to ask
•“How are things a home?”
•“Are you sleeping OK when the baby sleeps?”
•“Any changes in your appetite?”
•“Are you experiencing anxiety or panic?”
•“Are you afraid to be alone with your baby?”
•“Do you feel more irritable or angry than usual?”
•“Are you afraid you might lose control?”
•“Are you worried about the way you feel right now”
•“Are you afraid of any thoughts you are having?”
•“Does your partner know how you are feeling?”
•“Do you ever have thoughts about hurting yourself or the baby?”
•“Is there anything you are afraid to tell me but think I should know?
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Red Flags: Mothers may reply…
•“I have not slept at all in 48 hours or more”
•“I have lost a lot of weight without trying to “
•“I do not feel loving towards my baby and can’t even go through the
motions to take care of him/her”
•“I feel like such a bad mother”
•“I am afraid I might harm myself in order to escape this pain”
•“I am afraid I might actually do something to hurt the baby”
•“I hear sounds or voices when no one is around”
•“I feel that my thoughts are not my own or that they are totally out of my
control’
•“Maybe I should have never become a mother, I think I may have made
a mistake”
•Always use Clinical Judgement
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Tips for Professional and Family
■ Do not assume that if she looks good, she is fine.
■ Do not assume this will get better on its own.
■ Do encourage her to get a comprehensive evaluation if you are
concerned.
■ Do take her concerns seriously.
■ Do let her know you are available if she needs you and inform
her of support resources for PPD.
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Why don’t mothers seek treatment?
“I never let others know how bad I felt. I was so afraid people would think I
was crazy and take my baby away.”
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PMD and Treatment
•PMD Education
•Family support
•Social support / Support Groups
• Self Help
•Counseling / Therapy - Cognitive behavioral and Interpersonal therapy
•Medications
56
Self-Care Treatment Options
Education: Books, Journals, Videos, Websites, Resources
Exercise “Activity or Movement” ( Yoga, Tai Chi, Stroller Exercises, etc)
Sleep / Rest
Nutrition (High protein, Limit sugar and caffeine)
Vitamins (Prenatals, Vit. B Complex, Vit. D3, Omega 3 Fatty Acids)
Social and Family Support
Journaling
Keep expectations realistic
Postpone major life changes
Prayer and Spiritual Healing
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Other Treatment Options
Hormonal replacement – Controversial - Estrogen/Progesterone creams, injections, etc
Complementary Alternative Medicine (CAM) Treatment:
Light Therapy, Massage Therapy, Infant massage, Hypnosis, Acupuncture, etc
Mindfulness, Meditation, Relaxation, Stress Reduction
Herbal -St Johns Wort ,SamE, etc
Homeopathy, Naturopathy
Placenta Ingestion
TMS – Transcranial Magnetic Stimulation
ECT – Electro Convulsive Therapy
Barnes PM et al. Natl Health Stat Report. 2008;(12):1-23;
Eisenberg DM et al.JAMA. 1998;280(18): 1569-1575;
Nahin RL et al. Natl Health Stat Report. 2009;(18):1-14.
58
Psychotherapy Approaches
Cognitive Behavioral Therapy (CBT)
Thought or symptom based methods
Interpersonal Psychotherapy (IPT)
Grief, Role Transitions, Interpersonal Disputes, Interpersonal Deficits
Couples Therapy
Group Therapy
EEG Biofeedback / EMDR
Aaron Beck, Founder of CBT
O’Hara, Interpersonal Psychotherapy Manual for PPD, 1993
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PMD and Pharmacology
• During Pregnancy
• During Lactation
• During postpartum without lactation
60
“There is no perfect decision, and no
decision is risk free. Patients need to
know about the risk of exposure to
medications and they need to know
about the risk of untreated disease.”
Massachusetts General –Center for Women’s Mental HealthLee Cohen MD, Nuero Psychiatry Reviews June 2001
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Two Choices: Risk/Benefit Analysis
•
Expose the baby/fetus to medication during pregnancy or lactation
•
Expose the baby/fetus to the adverse effects of untreated depression in the
mother
62
Medication
■ Use the medication that Mom has taken in past with good results (if possible)
■ Start on lowest dosage and increase gradually every 5-7 days (if possible)
■ Use the safest medications possible (review the research and categories)
■ A plan of action needs discussion between patient and provider during the
pregnancy for the upcoming year.
■ Most advise to continue meds 6-12 months after patient begins to feel better, then
discontinue slowly as provider monitors.
63
Breastfeeding and PMD
■ Assessment of the mothers perception of
the breastfeeding experience and
her own expectations
■ It may be the ONLY thing that she feels
good about
■ Do not tell her to automatically discontinue
breastfeeding if taking meds
■ Give her permission to follow her instincts
■ Support the mother whatever her
decision, to avoid guilt and shame
■ If SHE chooses to wean, do NOT let her
wean abruptly (slowly over 2-3
weeks)
64
Considerations
■ Balance the benefits of breastfeeding with the risks of the drug
■ The risk/ benefit assessment is case-specific
■ Observe the infants behavior. Inform the Pediatrician.
American Academy of Pediatrics Policy Statement
65
Medication Resources
■ Zachary Stowe, MD- Women's Mental Health Program, Emory University
www.emorywomensprogram.org
■ Lee Cohen, MD-Center for Women’s Health, Massachusetts General Hospital
www.womensmentalhealth.org
■ Thomas Hale, PhD. - “Medication and Mother’s Milk”
www.iberastfeeding.com
www.neonatal.ttuhsc.edu/lact
■ www.ibreastfeeding.com An online pharmacy subscription
■ www.motherrisk.org Valuable info about meds during pregnancy and lactation
■ Mother To Baby: Medications and More During Pregnancy and Breastfeeding
OTIS: Organization of Teratology Information Specialists
www.mothertobaby.org
LactMed - www.toxnet.nim.nih.gov
www.bmj.com/content/351/bmj.h3190 - SSRI safety study
66
Cultural Perspectives
•
•
•
•
67
One universal denominator: Social Support is THE most significant factor across all
cultures
Use of alternative words in lieu of “Depression and Anxiety”
May use “stress” and “sadness”, etc instead
All cultures have customs and traditions for families and women who give birth.
Sometime barriers, such as distant family units, can lend to isolation difficulties for
new mothers.
Prognosis
Excellent
When…. the appropriate diagnosis and treatment occurs
The sooner this occurs, the sooner mom recovers
68
PMD Resources
•Referral Listings
•Organizations
•Websites
•Books
•Journals
•Videos
•Curriculums
69
Key PMD Organizations
•
Postpartum Support International (PSI)
www.postpartum.net
(805) 967-7636
•
The Marce’ Society- International
www.marcesociety.com
70
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PSI Michigan Coordinators
• West Michigan:
Nancy Roberts - Spectrum Health and Pine Rest
616-391-1771 / 616-391-5000
nancy.roberts@spectrumhealth.org
nancy.roberts@pinerest.org
• South East Michigan: Kelly Ryan - Beaumont Hospital
Parenting Program 248-898-3234
kelly.ryan@beaumont.org
• Northeast Michigan: Shurkela Mason - Flint 810- 853- 9795
shurkelamason@yahoo.com
• Southwest Michigan: Polly Vega – Battle Creek 269- 964-5868
vegap@trinity-health.org
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Michigan PMD Support Groups
Battle Creek
(269) 964-5868 Phone support
Bay City (989) 894-6980 Phone support
Cadillac Mercy
(231) 876-7277
Flint
(810) 853-9795
Grand Rapids
(616) 391-1771, (616) 391-5000
Grand Haven
(616) 847-5512
Lansing
(517) 363-8775
Muskegon
(231) 773-6624
Traverse City
(231) 947-2255
Detroit Area
(586) 372-6120 Tree of Hope Foundation
Sterling Heights, St. Clair Shores, Troy, Farmington Hills
Zeeland
(616) 741-3790
As of 2016-Subject to change
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Pine Rest
Mother and Baby Day Program
• Grand Rapids
• Partial Hospitalization Program- 9 am to 3 pm M-F
• 68th St Pine Rest Main Campus - VanAndel Building
• Pregnant and Postpartum up to 3 years postpartum
• Voluntary Admission
• Self Referral, Provider Referral, Agency Referral
• Private Insurance and Medicaid accepted
• Nursery and Nursery Attendant on site
• Group and Individual PMD Therapy and Education
• Psychiatrist Evaluation on Day 1
• Usual stay averages 5 days
• Aftercare Discharge Plan and Phone follow up support
Contact: 1-844-MOM-HOPE or 1-844-666-4673
www.pinerest.org/mother-baby-postpartum-depression-treatment
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Pine Rest levels of care
(*needs a trained clinician and can be difficult to assess)
Outpatient
Partial
Inpatient
Increased depressive or
anxiety symptoms
Loss of function in daily
tasks, thoughts of not
wanting to care for infant
or be with infant
Suicidal thoughts, can’t be
safe without being with
someone 24/7
Can function in work/daily
living tasks
Waiting for 1x a week
therapy is not enough
Psychosis (hearing voices,
seeing things, feels
everything is connected or
has special mission)
Meeting 1-2x a week with
a therapist helps alleviate
the stress
Suicidal thoughts but no
intent and has support
system
Loss of function, worsened
anxiety or depression that
affects ability to eat/sleep
or function
Michigan Statewide PMD Coalition
•
•
•
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Founded 2013
www.mipmdcoalition.org
PMD Providers listing in 10 regions
Recruiting members- Currently 100 members
Quarterly meetings
Funding PMD projects
Trainings/Education
Goals
Contact Information for
Michigan Statewide PMD Coalition
Nancy Roberts
nancy.roberts@spectrum-health.org
nancy.roberts@pinerest.org
616-391-2561
616-391-1771
Spectrum Health Healthier Communities
665 Seward Ave NW
Grand Rapids, MI 49504
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Other Michigan PMD Coalitions
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Kent County - Healthy Kent 2020
Contact Barb Hawkins-Palmer
barb.hawkins-palmer@kentcountymi.gov
616-632-7281
• Lakeshore PMD Coalition – Ottawa and Muskegon Co.
Contact Laura Bronold
lbronod@noch.org
616-847-5512
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Program Development Toolkit for
Perinatal Mood Disorders
Step by Step process for organizations who wish to create a PMD program
55 distributed throughout US
Contact nancy.roberts@spectrumhealth.org 616-391-1771
www.spectrumhealth.org/ppd-toolkit
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Tree of Hope Foundation
www.treeofhopefoundation.org
Contact Pam Moffitt
pmoffitt@treeofhopefoundation.org
(586) 879-9374
Books- A few good choices
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Postpartum Depression for Dummies – by Shoshanna Bennett. (2006)
Pregnant on Prozac – Shoshanna Bennett. (2009)
Beyond the Blues – A Guide to Understanding and Treating Prenatal and Postpartum
Depression – by Shoshana Bennett, PhD., Pec Indman. (2005). Also in Spanish
Therapy and the Postpartum Woman - Karen Kleinan. (2008)
This Isn’t What I Expected – by Karen Kleinan, Valerie Raskin. (1994)
Postpartum Survival Guide – by Ann Dunnewold, PhD , Diane G. Sanford, PhD. (1994)
The Mother-to- Mother Postpartum Depression Support Book – by Sandra Poulin (2006)
Postpartum Husband: Practical Solutions for Living with Postpartum Depression by Karen
Kleinman, (2003)
Women’s Moods – What Every Woman Must Know about Hormones, the Brain and
Emotional Health – by Deb Sichel, MD , Jeanne Driscoll, MS, RN. (1999).
What am I thinking? Having a Baby After Postpartum Depression – by Karen Kleiman. (2005)
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DVDs -A few good choices
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Postpartum Depression: Speak up When You're Down – New Jersey 5 min 1-609-2924043
Recognizing and Treating Postpartum Depression: A Practitioner’s Guide – (2005) 44
min. www.Injoyvideos.com 1-800-326-2082
Healthy Mom, Happy Family – Postpartum Support International (2010) 13 min Also
Spanish
Postpartum Couples-Postpartum Mood Disorders: The Couple’s Experience – by
Christina Hibbert (2002) 33 min www.postpartumcouples.com
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Professional books-A few good choices
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Medications and Mothers Milk – by Dr. Thomas W. Hale. 12th edition (2010)
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Perinatal Mental Health- A Guide to the Edinburgh Postnatal Depression Scale
– by John Cox and Jeni Holden. (2003) Includes the scale in 20 languages
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Postpartum Depression: A Comprehensive Approach for Nurses – by Kathleen
A. Kendall-Tackett. (1993)
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Postpartum Psychiatric Illness: A Picture Puzzle – by Dr. James Hamilton and
Patricia Neel Harberger. (1992)
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Screening for Perinatal Depression – by Henshaw and Elliott
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(2005)
Professional Contact Hours
•www.step-ppd.com
•www.nursingcenter.com/ceconnection
•www.netCE.com
•www.Ce4Less.com Independent Study for the book
Therapy and the Postpartum Woman
As of 2016-Subject to change
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Spanish PMD Resources
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www.postpartumdepressionhelp.com Beyond the Blues Mas Alla de la Melancolia,
contiene la informacion mas reciente para las mujeres que sufren de problemas
temperamentales y depresivos durante y despues del embarazo.
www.perinatalweb.org Wisconsin Perinatal Foundation pamphlets
www.noodlesoup.com “Rompiendo el Silencio” (Breaking the Silence) pamphlets
Speak Up When You’re Down DVD- 5 min - Kent Co PMD Coalition
Healthy Mom, Happy Family video – Postpartum.net
www.inprf.org.mx.?es dificilser Mujer? Una guia sobre depresion
Ma. Asuncon Lara Cantu ISBN 968-860-545-X
www.state.nj.us Search Postpartum Depression New Jersey
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References
•Aditi Mehta, MD; Sandeep Sheth, MD; Postpartum Depression: How to Recognize and Treat This Common Condition
Medscape Psychiatry& Mental Health, Expert Column, Posted 04/24/2006
•Altshuler 96, Andersson L et al. Am J Obstet Gynecol 2003; 189:148-152
•Bettes, B. A. (1988). Maternal Depression and Motherese: Temporal and Intonational Features. Child Development, 59, 10891096.
•Bonari et al. Can J Psychiatry 2004; 49(11): 726-35;
•Breznitz, Z., & Friedman, S. L. (1988). Toddlers' Concentration: Does Maternal Depression Make A Difference? J. Child.
Psychol. Psychiat., 29(3), 267-279.
•Campbell, S. B., Cohn, J. F., & Meyers, T. (1995). Depression in First-Time Mothers: Mother-Infant Interaction and
Depression Chronicity. Developmental Psychobiology, 31(3), 349-357.
•Chrousos, G. P., & Gold, P. W. (1992). The concepts of stress and stress system disordres, overview of psysical and
behavioral homeostasis. JAMA, 267(9), 1244-1252.
•Chaudron, et al.; Detection of Postpartum Depressive Symptoms by Screening at Well-Child Visits, PEDIATRICS Vol. 113
No. 3 March 2004, pp. 551-558
•Cohen LS, et al. CNS Spectr 2004; 9:298-16;
•Cohen et al, JAMA 2006 295(5) 499-507;
•Corral, et al.; Am J Psychiatry 157:303-304, February 2000, Bright Light Therapy’s Effect on Postpartum Depression
•Cox, J.L., et al. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. British
Journal of Psychiatry. 1987; 150:782-786.
•Dawson, G., Frey, K., Panagiotides, H., Yamada, E., Hessl, D., & Osterling, J. (1999). Infants of depressed mothers exhibit
atypical frontal electrical brain activity during interactions with mother and with a familiar nondepressed adult. Child
Development, 70(5), 1058-1066.
•Dawson, G., Frey, K., Self, J., Panagiotides, H., Hessl, D., Yamada, E., & Rinaldi, J. (1999). Frontal brain electical activity in
infants of depressed and nondepressed mothers: Rrelation to variations in infant behavior. Development and
Psychopathology, 11, 589-605.
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References (cont.)
•Einarson A., et al. J Psychiatry Neuroscience 2001; 26:44-48
•Field et al. Depression & Anxiety 2003;17(3): 140-15;
•Field, T., Pickens, J., Fox, N., Nawrocki, T., & Gonzalez, J. (1995). Vagal tone in infants of depressed mothers.
Development and Psychopathology, 7, 227-231.
•Field, T., Healy, B., Goldstein, S., & Guthertz, M. (1990). Behavior-State Matching and Synchrony in Mother-Infant
Interactions of Nondepressed Versus Depressed Dyads. Developmental Psychology, 26(1), 7-14.Francis & Meaney, 1999
•Gjerdingen, Dwenda, The Effectiveness of Various Postpartum Depression Treatments and the Impact of Antidepressant
Drugs on Nursing Infants. Journal of the American Board of Family Practice, 2004
•Goldsmith, D. F., & Rogoff, B. (1997). Mothers' and Toddlers' Coordinated Joint Focus of Attention: Variations with
Maternal Dysphoric Symptoms. Developmental Psychology, 33(1), 113-119.
•Honikman, Jane; I'm Listening: A Guide to Supporting Postpartum Families, Postpartum Support International
•Hostetter, et al. Biol Psychiatry 2000; 48:1032-34;
•Jones, N. A., Field, T., Davalos, M., & Pickens, J. (1997). EEG stability in infants/children of depressed mothers. Child
Psychiatry and Human Development, 28(2), 59-70.
•Jones, N. A., Field, T., Fox, N. A., Lundy, B. L., & Davalos, M. (1997). EEG activation in 1-month-old infants of depressed
mothers. Development and psychopathology, 9, 491-505.
•Kendell RE et al. Br J Psychiatry. 1987;150:662-673
•Kim et al. Br J Clin Pharmacol. 2006; 61 (2): 155-63
•Llewellyn 97
•Logsdon DNS, Social Support to Childbearing Women: What Are the Rules?, ARNP Journal of Obstetric, Gynecologic,
Neonatal Nursing Vol. 34 Issue 6 Page 754 November 2005;
•Logsdon, M.C. (2000). Social Support for Pregnant and Postpartum Women. AWHONN
•Marcus SM et al. J Womens Health 2003; 12:373-80;
•Milberger, S., Biederman, J., Faraone, S. V., Chen, L., & Jones, J. (1996). Is maternal smoking during pregnancy a risk
factor for attention deficit hyperactivity disorder in children? american Journal of Psychiatry, 153, 1138-1142.
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References (cont.)
•Monk, C. (2001). Stress and Mood Disorders During Pregnancy: Implications for Child Development. Psychiatric
Quarterly, 72(4), 347-357.Moses-Kolko EL et al. JAMA 2005; 293: 2372-2383
•O’Connor et al. Br J Psychiatry 2002; 80: 502-8
•O’Connor et al. J Child Psychol Psychiatry 2003; 44(7): 1025-36
•Olds,D., Robinson,J., O'Brien,R., Luckey,D., Pettit,L., Henderson,C., Ng,R., Sheff,K., Korfmacher,J., Hiatt,S. & Talmi,A.
(2002) Home Visiting by Paraprofessionals and by Nurses: A Randomized, Controlled Trial
•Orr ST et al. Pediatric & Perinatal Epidemiology 2000; 14:309-13
•Porges, S. W. (1992). Vagal Tone: A Physiological marker of Stress Vulnerability. Pediatrics, 90(3), 498-504.
•Portales, A. L., Roosevelt, J. A., Lee, H. B., & Porges, S. W. (1992). Infant Vagal tone predicts 3 year child behavior
problems. Infant Behavior & Development, 15, 636.
•Stein, A., Gath, D. H., Bucher, J., Bond, A., Day, A., & Cooper, P. J. (1991). The Relationship between Post-natal
Depression and Mother-Child Interaction. British Journal of Psychiatry, 158, 46-52.
•Stewart DE. CMAJ 2006; 174(3):302-303;
•Teixeira Fisk & Glover. BMJ 1999; 318(7177): 153-7;
•Van den Bergh et al. Neuroscience & Biobehavioral Reviews 2005; 29(2): 237-58
•Van Den Bergh et al. Neurosci Biobehav Rev 2005; 29(2): 237-58.
•Van Den Bergh & Marcoen. Child Dev 2004 Jul-Aug;75(4):1085-97.
•Wadhwa, P. D., Sandman, C. A., & Garite, T. A. (2001). The neurobiology of stress in human pregnancy: implications for
prematurity and development of the fetal central nervous system. In J. A. Russell (Ed.), Progress in Brain Research (Vol.
133, pp. 131-142): Elsevier Science.
•Wisner KL, Gelenberg AJ, Leonard H, Zarin D, Frank E. Pharmacologic treatment of depression during pregnancy.JAMA.
1999 Oct 6;282(13):1264-9. Review.17.
•Wisner KL, Findling RL, Perel JM. Paroxetine in breast milk. Am J Psychiatry. 2001 Jan;158(1):144-5. No abstract
available.18.
•Wisner KL, Zarin DA, Holmboe ES, Appelbaum PS, Gelenberg AJ, Leonard HL, Frank E. Risk-benefit decision making
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A Challenge to Participants
Health Care Providers
Office nurse
Childbirth educator
Labor and delivery nurse
Mother-baby nurse
Neonatal nurse
Lactation consultants
Medical social worker - Care management
Home visiting nurse
Help line telephone nurse
All Others…
90
YOU can make a difference!
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