Nov
28
2020

Mental Illness and Covid-19

A topic less discussed is mental illness and Covid-19. Covid-19 has been noticeably around us since March of 2020. With the various social distancing and quarantining methods people become more or less isolated emotionally. Social gatherings are outlawed depending on where you live. This helps to interrupt the spread of the virus, but it makes people feel more stressed as their relationships get interrupted.

Symptoms of stress

The CDC sums up that stress during a pandemic can cause the following:

  • Fear of your own health and the health of your loved ones
  • Loss of your job or financial support
  • Changes in eating habits
  • Changes in sleep pattern with lack in concentration
  • Increase in use of tobacco, alcohol or other substance consumption
  • Chronic health problems may deteriorate
  • Worsening of Mental health conditions

The more isolated we are, the more stress we feel. This undermines our stress coping mechanisms, makes us more anxious and more depressed.

Develop coping skills

Taking care of your family and friends may relieve your stress, but it needs to be balanced by taking care of yourself. Although you are physically isolated from others when you are in quarantine, you can stay in contact with others by phone or video chats. This makes you less lonely and isolated.

Take care of yourself. This includes eating well balanced meals, exercising regularly and getting enough sleep. Avoid the consumption of alcohol, tobacco and drugs. Share with a family member or friend how you feel. Maintain friendships through the phone, emails, social media and computer chats. This builds a strong support system for you.

Avoid too much exposure to news stories. Seeing negative stories about Covid-19 over and over again can be undermining, so take a break from the news media. Go for a walk. Take a nap.

Suicide

Sometimes depression can get out of control to the point of driving a person to the brink of suicide. In the US major depression is the leading cause of disability for ages 15-44.  At any given year 16.1 million American adults (about 6.7% of the U.S. population age 18 and older) suffer from major depression. 10.3% of Americans have thought about suicide. If you feel that way, do not act on this impulse. Call 1-800-799-4889. That is the National Suicide Prevention Lifeline & Chat.

Medical literature about the psychological impact of Covid-19

In a July 2020 publication the authors pointed out that Covid-19 infection is a significant psychological stressor. There is the fear of getting the virus and uncertainty about the future. Pre-existing anxiety and depression disorders get accelerated from the stress. In addition, mental disorders like schizophrenia with psychosis may worsen. This may require more antipsychotic medication to control it.

A Kaiser Family Foundation poll found in March 2020 that the Covid-19 pandemic has caused a major impact on US citizens. 45% of respondents said that the pandemic has affected their mental wellbeing significantly. If you are scared, depressed or anxious, you are tense and you have problems falling asleep, you are not alone. You can seek and receive help!

Prevention of mental disease from Covid-19

Here is some practical advice from the World Health Organization.

  • Stay informed.
  • Have a daily routine. Get up and go to sleep at regular times. Eat healthy balanced meals. Exercise regularly. Have your work routine and also find time to rest. Do things that you enjoy.
  • Watch the news only to be informed, but limit news watching to a minimum. This will keep anxiety and depression in check.
  • Stay in contact with close friends by phone and computer technology.
  • Keep your alcohol consumption low. If you did not drink before at all, don’t start drinking in an attempt to deal with boredom, fear, anxiety or social isolation.
  • Take breaks from screen time. This reduces tension.
  • Video games: doing this may relax you for a short time. But longer video game activities can make you tense; you should balance this with the rest of your daily activities.
  • Social media. Use this for honest communication. Keep it brief. If you see misinformation, point out the truth.
  • Helping others: if you can, help others in the community with shopping or other chores.

Treatment for Mental disease from Covid-19

When you notice anxiety, depression or a flare-up of psychotic symptoms from schizophrenia, it is important to see your health professional right away. You may need some counselling. Others may need an antidepressant (for depression) or an adjustment to your antipsychotic medication. Some patients with milder depression or anxiety may benefit from cognitive/behavioral therapy. Most importantly, know that help is available! More info about cognitive therapy for suicide prevention.

Mental Illness and Covid-19

Mental Illness and Covid-19

Conclusion

Mental illness and Covid-19 is a huge topic. People definitely have experienced more anxiety and depression since the Covid-19 epidemic. This is because our lifestyle is suddenly restricted. We may have to go through a 14-day quarantine. But we also cannot participate in large gatherings with more than 50 people. Often, we have to wear masks in stores. In areas with high cases of Covid-19 there is also a severe restriction regarding with whom you can visit, leading to feelings of isolation. All of this can lead to mental illness. Essentially there are two ways of coping with this. First, we need to get a routine that makes us more resistant to mental illness. Secondly, if this fails, seek the advice of a health professional right away.

Seek mental illness treatment right away

When you catch mental illness early, it is much easier to treat. Milder cases of depression or anxiety may benefit from cognitive/behavioral therapy. More severe cases often require medication. In this outline I have discussed mental illness during the Covid-19 epidemic. I have not discussed the cases where people came down with Covid-19 coronavirus and got affected in their brain function from the virus. These cases need treatment by a neurologist and psychiatrist, and they are much more complicated.

May
16
2015

Facebook Use And Depression

There has been a recent study that showed that too much time spent on Facebook could have negative effects on your mood. In the most extreme case it could cause depression.

A person who is lonely and spends a lot of time on Facebook will learn about how much fun others have who report about what they have done or achieved. They may also brag about parties they have gone to. But they rarely talk about the times when they are down. When people read about others on Facebook, those who are sensitive or are in a dull mood could get discouraged. As they compare their own lives with those who portray themselves as upbeat people it leaves some with feelings of low self worth, of depression, of isolation and worsening loneliness and isolation. On the other hand, some people do share negative experiences on Facebook. There is the chance that friends can offer encouragement and support, but this is far removed from the personal, close interaction. Even a phone call is more tangible!

We all are subject to feeling blue at times, but a normal blues can turn into depression, which is part of a mental disease.

What is depression?

Depression belongs into the mood disorders. Psychiatrists have found out in the 1970’s and 1980’s that a lack of serotonin, an important brain hormone is associated with depression.

It is a mental condition where the person sees everything negative feels hollowed out and may have a lack of energy. A depressed person sees no way out of their bleak situation; they ruminate about any problems in their lives, but do not have the strength to reason things out and solve their problems. They start having problems falling asleep and sleeping through; their sex live fades due to a lack of sex drive. They are tearful and anxious. There may be a tendency of committing suicide, which is one of the things the psychiatrist will monitor for. In severe cases of depression the suicide potential may be the main reason to commit a person to a psychiatric ward for intensive treatments, either involving antidepressants or using electro convulsive therapy (ECT).

Facebook/depression research

In the Houston University study mentioned at the beginning of this blog it was found that the more hours people spent on Facebook the more depressed they were, at least for men, not so much for women. A second study showed that the more time they spent on Facebook, the more depressive symptoms they had in both sexes. This study found that the depressive symptoms were initiated because of social comparisons between what the Facebook friends did in their lives and how the lives of the subjects of the study were perceived to be. But Mai-Ly Steers, the author, said that “most of our Facebook friends tend to post about the good things that occur in their lives, while leaving out the bad”. The author went on to say: “the act of socially comparing oneself to others is related to long-term destructive emotions“. In plain English: the chronic braggers on Facebook sites are not really doing anything constructive for their friends; they are just on an annoying ego-trip!

If blues turns into depression, it is important to know more about the how depression is treated.

Treatment of depression

Here are the most common treatment modalities.

1. Drug therapy

In mild to moderate depression the caregiver may want to use an anti-depressant drug. It is important to study the side effect of drugs before treatment is even begun. The reason this is important is that the severity of side effects will decide how compliant the patient will be in continuing to take the antidepressant for a period of time. The anti-depressants amitriptyline (Elavil) and imipramine (Tofranil) tend to produce a dry mouth as a side effect. Some people can put up with this, others find it simply too much and they will discontinue treatment, which often can lead to suicide, because the negative thoughts come back when the treatment is stopped. There are newer anti-depressants like fluoxetine (Prozac), but there is a disclaimer that it could bring on suicide in teenagers who are put on this. Discuss the side effects with your physician before you are put on anything. One of the safest mild to moderate anti-depressants is St. John’s wort. This is an ancient herb and a lot is known about it. Side effects are minimal and for this reason it is well tolerated.

2. Cognitive therapy and behavioral therapy

These two forms of psychological intervention strategies have been found to be very useful to help depressed patients to normalize their thinking.

It is in the area of “self-talk” that patients learn how to reprogram their internal thoughts. They learn to use their cognitive thoughts to intervene when they get caught in negative, stereotype thought patterns or negative generalizations (“I always do everything wrong” etc.). You learn how to use rational questioning to expose generalizations: “are you really always wrong? Tell me the last time you were successful in something!” This way the generalization of “always” being wrong is put into the right context.

3. Electroconvulsive therapy

For more severe depression admission to a psychiatric ward in a hospital equipped for psychiatric patients may be required. The psychiatrist who is involved in these cases needs to observe the patient closely and determine the suicide risk. Some patients are put on special psychiatric monitoring involving psychiatric nurses that frequently talk to the patient and monitor the suicide risk. Some patients will respond fairly well to anti-depressant therapy combined with cognitive therapy, behavioral therapy or both. If the patient does not respond adequately to this treatment approach, the psychiatrist may recommend a brief course of unilateral ECT treatments.

They are more gentle than the bilateral ECT treatments. Memory loss that was a big issue with bilateral ECT treatments is not so much an issue any more with unilateral ECT treatments. One of the advantages with ECT treatments is that after 6 to 9 such treatments there is often an impressive response of depression where the suicidal risk gets overcome. Other treatment modalities like anti-depressant therapy and cognitive/behavioral therapy will then guide the patient to a full recovery from depression.

Bipolar disorder, a special form of depression

In the past bipolar disorder was termed “manic/depressive illness”. This can be inherited, and certain triggering factors can suddenly bring on a manic phase where the person is hyperactive, has racing thoughts and behaves in weird ways. But on other occasions the same person may present with strong depressive symptoms including suicidal thoughts and behaviors. These patients need to be brought to the attention of a psychiatrist right away, because untreated they may do harm to themselves (suicide) or they may do harm to others. Sadly it is often not recognized by police or firefighters if a person presents with psychiatric symptoms. Some of these cases make news headlines when police responds by firing shots, but the underlying mental disease is often not detected and treated. As fast as patients with bipolar disorder can flare up with their symptoms, they can also calm down and regain their normal controlled condition very rapidly as well. Often a person in a manic state is sleep deprived and when relaxed with a major tranquilizer drug, they fall into a deep prolonged sleep from which they wake up with much of their manic symptoms having resolved. If the psychiatrist now decides to put them on a simple mineral, called lithium carbonate, as a maintenance therapy, the mood fluctuations may never come back. The person stays equal tempered and you would not think that they could ever have needed psychiatric intervention.

Facebook and mental disease

I like to come back to the topic of this blog, namely what influence the social media and in particular Facebook has on mental illness.

We all have certain needs that we may or may not be aware of and that need to be met. Abraham Maslow, an American psychologist has taught about this many years ago. I like to simplify these needs and point out four of these basic needs as follows: we have a need for self worth, a need for autonomy, a need to belong and a need for love. If any of those needs is not met, we will feel hurt inside and our thinking may get disbalanced. Once we are on a negative internal spin and there are no friends that help us see things in perspective, this could grow into depression as found in the study discussed in the beginning of this blog. When a semi-depressed person reads some of the upbeat communications on Facebook, comparing oneself to others, it can lead to a feeling that they do not belong to this upbeat group, but they are left out. They may feel that they are not loved and the need of self worth is undermined. It is easy to see how one’s self-talk could get into a negative spin and the mood would be spiraling downwards toward depression. It depends on how emotionally stable the person is who reads these Facebook entries. An emotionally robust person will be able to reason within oneself that people tend to show the rosy part of them on Facebook. They may also limit Facebook time and contact some of their friends and meet them in person rather than only by computer or texting. The electronic world can be a lonely experience. There is no substitute for personal touch, talking, listening and interacting with real people, and this is still one of the valuable tools of preventing mental illness. But if depression or other mental illness sets in, contact your family doctor to get a referral to a psychologist or psychiatrist.

Facebook Use And Depression

Facebook Use And Depression

Conclusion

Mental illness still has a stigma from the past. However, now we know that the symptoms of mental disease are just due to a disbalance of brain hormones that can be rebalanced through the treatment protocols mentioned above. Facebook can have a negative influence on the development of mental illness, because the basic needs mentioned above are unmet or even are being undermined, which in turn tends to make mental symptoms worse. The solution to this is to limit Facebook time, to meet real people and share all of the feelings with them and listen to their feelings as well. This human interaction tends to stabilize our mental well-being. It is also important to realize when professional help is needed and to seek it.

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Mar
22
2014

Protect Yourself From Radioactivity

Even though the Chernobyl catastrophe was bad enough, it appears now the 2011 Fukushima Daiichi nuclear power plant catastrophe was 7 to 10 times worse in terms of worldwide radioactive pollution. Even as late as Feb. 20, 2014 there was a new report of further radioactive water spill into the Pacific Ocean.

It is important that you start thinking about preparing yourself to cope with radioactive pollution.

In this blog I will briefly review the history of several radiation disasters in various parts of the world and will mention how coping mechanisms with radiation were fortuitously developed. Finally, I will summarize what you can do to reduce any damage to your health that is caused by radiation leaks.

History of the first nuclear bombs with radioactive fallout in 1945

On Aug. 9, 1945 the second atomic bomb was dropped on Nagasaki, Japan. Dr. Akizuki  worked at the St. Francis Hospital (Uragami Daiichi Hospital), about one mile from the epicenter. He and a staff of 20 were serving at this hospital that looked after 70 tuberculosis patients.

Miraculously all of the staff and most of the patients survived because of a vegetarian diet, which consisted of uncontaminated brown rice, fermented foods, sea algae and vegetables. Dr. Akizuki did not allow sweets of any kind. Salt was allowed as the main condiment. Everybody was fed at least one helping of a soup with fermented soy and seaweed in it (wakame miso soup). Other investigators have confirmed that in a mouse model miso soup has radio protective effects.

The staff and the patients of another hospital also one mile form the epicenter were not so lucky. Almost 100% of them died. They were not on the strict miso/seaweed diet without sugar and sweets.

Protect Yourself From Radioactivity

Protect Yourself From Radioactivity

The experience with Chernobyl

Perhaps the best way to start reviewing the Chernobyl disaster of April 26,1986 is by looking at how children fared who had been directly exposed to the radiation spill from this disaster. As this link shows about 7 million people living in the nearby area were exposed to the highest radiation exposure ever since the atomic age. The children of this population have experienced a 2,400 % increase in thyroid cancers, a 100 % increase of cancers and leukemia and a 200% increase of breast cancer. There were about 800,000 men who risked their lives when working on containing the radiation spill. 25,000 of these men have died and 70,000 are disabled. 20% of the deaths (5000 men) were due to suicide. Here is a report for those who like more details about the health consequences as a result of the Chernobyl disaster. Here are more questions and answers regarding the Chernobyl disaster.

The question is whether a similar accident could happen with any of the other nuclear power reactors. This link explains that such an accident can “only happen in a reactor operating with a Positive Temperature Effect combined with a Positive Steam Effect, and built without a containment structure to mitigate the potential atmospheric effects of a worst-case reactor accident.” It goes on to say that only the reactor in Chernobyl was this type of a reactor, the RBMK series made by the former USSR. The link above goes on to say: “All other reactors for the production of electricity, including all those in America, operate on natural Negative Temperature and Negative Steam Effects, and are encased in air-tight multi-layered containments, the integrity of which rivals that of Egypt’s pyramids.” It ends with this rather strong statement: “This being understood, it is entirely correct to say that an accident like the one that occurred at Chernobyl in 1986, will never happen anywhere else.” The same website reports in another section about the Fukushima disaster, without mentioning that this should not have happened. Nobody could have predicted the forces of nature (a double whammy of an earth quake of the magnitude 9 on the Richter scale, followed by a horrendous tsunami), which destroyed part of the nuclear power plant. From the literature it is not clear whether the government went through any major efforts to provide chelating agents, Prussian Blue and iodine salts to the affected population either in Chernobyl or in Fukushima to minimize the radiation effects from the radioactive emissions.

Part of the problem in Chernobyl was at the time that this all happened behind the iron curtain and that there was a news blackout, which only gradually improved after 1989. In Japan the problem was severe denial and underreporting on behalf of the Japanese government.

Goiania accident involving radioactive cesium-137 in Brazil

On September 13, 1987 two fellows illegally entered an abandoned private radiation treatment hospital in Goiania where a radiation unit containing cesium-137 had been used for treating cancer patients. They stole the radiation head thinking that it might  be valuable scrap metal that they could sell. They managed to sell it to a junkyard owner, Devair Ferreira.

Having a lack of insight that the radiation head would contain radioactive cesium-137, which was emanating ionizing radiation, Devair proceeded to probe for a precious metal with a screwdriver. As the details in the Wikipedia link show, shortly after a total of 112,000 people were screened for potential radiation exposure. There were 4 deaths including the junkyard owner’s wife, and his 6-year old daughter. He himself survived the incident. 249 people were significantly contaminated with cesium-137 and 1000 people had received a dose twice the amount of the yearly background radiation. 20 patients developed radiation sickness and required treatment. As this link shows the Brazilian authorities arranged treatments for  patients who had proven contact with cesium-137 with 10 Grams of Prussian Blue daily, which reduced the effective radiation exposure by 70%. This was the reason for the relatively low mortality and disability rates from this serious accident.

The Fukushima experience

Fast-forward to the latest disaster that has made clear how an earthquake of the magnitude of 9 on the Richter scale followed by an enormous tsunami in combination could lead to the Fukushima disaster in Japan. Following the catastrophe on March 11, 2011 there have been several leaks of radioactive material into the ocean, which are described here.

Dr. John Apsley II also pointed out that with the explosions in Fukushima there were also significant releases of radioactive pollution into the stratosphere that subsequently traveled around the globe. He has made it his ambition to help people minimize radiation exposure from nuclear accidents such as Fukushima.

The initial denial of the Japanese authorities caused a problem of assessing the true significance of the Fukushima incident.

As mentioned in the introduction to this blog there are still ongoing releases of radioactive material, which will eventually work their way into the oceans and into the atmosphere. Dr. Apsley II describes in detail in his book that there were 29 radioactive elements that were released into the air and into water, the main ones being Cesium-137 (and 134) Iodine-131, Plutonium-238 and 239, Strontium-89 and 90 and Uranium-234 and 238. As the body takes up these radioactive elements, they have different organ preferences and they metabolize differently so that each of them causes a certain disease pattern. Radioactive Iodine for instance causes thyroid disease and thyroid cancer, while radioactive Plutonium is causing leukemia, heart disease, lung and breast cancer, several childhood cancers and infant mortality. There is a wave of radioactive cesium-137 coming across the Pacific Ocean that will start to show on the west coast of Alaska, Canada and the US mainland by 2015 and stay peaked until 2020 and beyond.

Ref. 1 points out that it is difficult to know the real concentration of the radioactivity in the water and in the radioactive rain over the US and Canada, as government agency measurements were kept hidden or were falsified. However the author comes to the conclusion in comparing various reference sources that the radiological leak and impact of the Fukushima crisis was and is about 7-fold to 10-fold bigger than that of Chernobyl.

Depending on what story you believe, the fear mongering or the more balanced reasoning arguing that there is enough water in the ocean to significantly dilute the amount of spilled radioactivity, you may or may not eat the sushi on the West coast.

With all this noise it is unclear whether the local population made use of the simple method of chelation at home using miso soup and uncontaminated seaweed. One would hope so. But did they know that it is only effective in combination with a strict diet without sugar and starchy foods?

Protection from radioactive fallout

This brings us to toxicity studies and simple ways of how to protect you from radiation in the environment. First, you need to know how radioactive materials can enter your body. Most nuclides (that is another name for radioactive compounds) enter the body through contaminated food via the gut where they are absorbed into your blood. You can inhale gases like gaseous radioactive Iodine or Radon. Cesium, which has now leaked into the Pacific Ocean can be absorbed through your skin when you walk on a beach that is contaminated with radioactive Cesium-137 containing ocean water. Cesium-137 has a half-life of 30 years meaning that after 30 years it still emits 50% of today’s gamma rays (these are strong X-rays). The biological half-life of Cesium-137 in the body is 110 days. But we do not want this stuff in our bodies causing free radicals to destroy our body cells. So we need effective methods to remove radionuclides.

By reviewing the history above, we already have learnt of two effective ways to remove such radionuclides: Miso soup with seaweed in Nagasaki; and Prussian Blue in Brazil. Prussian Blue works on eliminating the radioactive Cesium-137 before it is absorbed from the gut into the blood. It disappears from the body with bowel movements and also in the urine. However, it should only be taken, when there is proven food contamination with Cesium-137 as it can seriously affect your potassium levels, which could cause serious side effects to your heart. A physician knowledgeable in the use of Prussian Blue can monitor your potassium levels and follow you along.

In comparison to that it is easy to implement dietary habits as was done in Nagasaki:  miso soup and seaweed can be consumed without any side effects. So, why is it important to avoid sugar and starchy foods? The reason is that sugar oxidizes your cholesterol and any tissue it comes in contact with. It also causes the pancreas to overproduce insulin, which causes an inflammatory reaction. Cesium-137 also causes an extreme inflammation in your body, because of the free radicals that are caused from the gamma radiation of cells. Add to this a situation where there is a fire burning inside of your body (inflammation from sugar and starch consumption) and you have a recipe for disaster, comparing it to dumping gasoline into a fire. Inflammation is amplified ,and the radioactive Cesium-137 causes havoc in your system. You quench the fire when you do not eat sugar and starch and you give it an extra dousing by taking chelating agents (miso soup with seaweed), which removes the radioactive Cesium-137. The successful outcome of Dr. Akizuki’s treatments in his hospital in Nagasaki speaks volumes.

There are a number of other useful antioxidants like melatonin, vitamin C, and glutathione. Co-Q10 supports the mitochondria and protects cholesterol from being oxidized. But other substances are also useful. Cabbage contains isothiocyanates that will bind radionuclides before they are even absorbed from the gut. Edible clays, like calcium bentonite works similar to Prussian Blue, but it also supplies extra calcium for the body. For further details consult Ref. 1, which contains a lot more details.

Conclusion

The surprising twist for me when I researched this topic was the fact that what is good for your heart, what prevents Alzheimer’s disease and what helps you to live longer also helps you to cope with processing and eliminating radioactive pollutants. When we adopt a healthier lifestyle now, we are at the same time preparing ourselves for the worst nuclear pollution.

More information on vitamins, minerals and supplements: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/vitamins-minerals-supplements/

Reference

1. Dr. John W. Apsley II : “Fukushima Meltdown & Modern Radiation: Protecting Ourselves and Our Future Generations” © 2011. Temet Nosce Publications, Sammamish, WA 98075

Last edited Nov. 7, 2014

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Aug
17
2013

Postpartum Depression

Recently there has been a lot of publicity around the topic of postpartum depression (PPD). Typically the reports originate from a case where depression led to catastrophic consequences. It is sad that it often takes a tragedy before a problem like this is publicly more acknowledged. But sadly reports are often one-sided and are missing vital information about preexisting risk factors that are frequently not picked up by the family doctor. There is often denial on behalf of the mother and family, the mother is getting no support from support groups, even though there are such groups. And swift treatment that would be available is often not given. The results are finally making headlines. Once a mother is desperate and deeply depressed (“psychotic depression”) she is capable of killing the baby, herself and others who are close. PPD affects 15% of mothers (Ref.1); a small percentage of them may have postpartum psychosis, which is the most severe form of PPD.

Risk factors for postpartum depression

In Ref. 1 several risk factors are reviewed that can lead to postpartum depression. For instance, a history of a major depressive episode or anxiety attacks during the pregnancy has been found among mothers who developed PPD. However, there may also have been a history of dysphoria (intense feeling of discontent) before her periods in the past; stressful events during the pregnancy or right after birth. Often there is poor social support or a marital conflict. Other factors are low income, young maternal age or immigrant status with deprivation. A lack of support from the partner can also be a major factor.

Up to 85% of women experience postpartum blues within the first 10 days after the delivery of the baby. Symptoms such as mood swings, fatigue, confusion, tearfulness, mild elation and irritability are common during these initial days following her delivery. Progesterone levels following delivery are decreased for at least one month, sometimes up to 3 months. This leads to sleep problems (insomnia), which coupled with the baby crying in the middle of the night causes more sleep disruption. Abnormal brain wave pattern have been documented on women following the birth of a child.

Only 1 in 500 mothers after birth develop what physicians call “postpartum psychosis”, which is a recognized psychiatric emergency.  The symptoms here are extreme mood swings with confusion, poor judgment, disordered thoughts (“delusions”), paranoia (where they think that someone is after them or it is the baby’s fault that they feel that way). Erratic behavior and impaired functioning are also part of this symptom complex. It is this state that needs to be monitored in a psychiatric unit as it is associated with a high suicide and homicide rate. A psychiatrist with experience in treating PPD needs to treat the patient.

Urbanization leads to a lack of support, which is particularly devastating to new mothers who need all the support they can get. This is reflected in a higher percentage of PPD in urban areas versus the percentage of PPD in more rural areas where there is more family support.

 

Postpartum Depression

Postpartum Depression

Hormone changes with postpartum depression

Some people would say that they couldn’t understand why a woman who just had a baby would not be happy and content. Most women are, but if the stress from the pregnancy and from childbearing were too much for the system, there is a point where the hormones are no longer balanced and the coping mechanisms are undermined.

Serotonin concentrations in the brain of women during pregnancy are kept at a higher level due to higher estrogen levels that slow down the degradation of serotonin. Serotonin is the brain hormone that makes you feel good. Estrogens and progesterone are very high during the pregnancy, but this changes right after the baby’s delivery and during the time of recovery in the first few days and weeks. Studies have shown that there was a 15% higher thyroid autoantibody rate in postpartum depression patients when compared to non-depressed postpartum mothers. This was weakly associated with postpartum depression and was responding favorably to thyroid replacement therapy. Progesterone levels were much lower in depressed and nondepressed patients following delivery because with the delivery the placental source of natural progesterone was removed. In a group of patients where progesterone was replaced, no significant improvement of PPD was observed, but they did not explain whether the progesterone replacement was done with bioidentical hormones or synthetic hormones.

Dr. Michael Platt described a case of a postpartum woman who was hypothyroid as well (Ref.2). She responded to hormone replacement with thyroid hormones and progesterone by shedding 60 pounds (she always had a weight problem) over 10 months changing from a size 20 to a size 4. She was able to wean herself off the anti-depressants. In breast feeding women this could be a significant difference as women on bioidentical progesterone can breast feed and will positively influence their breast fed child’s brain development (brain cells have a lot of progesterone receptors, which are stimulated by progesterone).

A recent Canadian study involving pregnant women and women after delivery of their babies showed that there was a significant drop of progesterone levels in saliva samples for several weeks, particularly with breast feeding. The authors explained that the lack of ovulation with a lack of progesterone synthesis in the ovaries was responsible for this. It takes several weeks for most women to regain regular menstrual cycles. It would follow from this that there is room for bioidentical progesterone replacement in the first few months of the postpartum period until the ovaries have resumed their normal cyclical hormone activity.

Conventional treatment for postpartum depression

With baby blues the symptoms are much less severe (compared to PPD) and are starting 2 to 3 days after childbirth, resolving spontaneously within 10 days after delivery. PPD occurs within 3 months following delivery and responds to treatment with antidepressants and psychotherapy such as cognitive behavioral therapy.  Breast feeding needs to be stopped, as it is known that metabolites of the antidepressants end up in breast milk. Typically, a less toxic antidepressant is used like paroxetine (Paxil), otherwise citalopram (Celexa), and fluoxetine (Prozac). In the rare cases where PPD is so severe that psychotic symptoms are present (postpartum psychosis) hospitalization is mandatory (Ref.3). Some of these cases may require electroconvulsive therapy (ECT) and/or lithium treatment for mood stabilization. Thyroid hormone therapy has also shown a beneficial effect in treating antidepressant-resistant cases of PPD (Ref.4).

Alternative treatment of postpartum depression

Although review texts of the treatment of PPD mention that estrogen replacement in postnatal women with PPD was beneficial, there is a warning that this could cause blood clots and anticoagulant measures would have to be combined with this to prevent deep vein thrombosis; suggestions for progesterone replacement were mentioned, which is a treatment modality where blood clots are no danger, but formal trials have not been done, so it is being ignored by most medical professionals. Here is forum of women who have taken postpartum progesterone with positive effects.

Dr. Katherina Dalton published a trial involving 30 PPD patients with a positive response rate of 95% when treated with natural progesterone.

Before treatment patients were suffering from an average of 7.57 symptoms, after the treatment only 2.1 symptoms remained. (Figures with details regarding this study can be found under the above link).

There are many uncontrolled observations like this where natural progesterone creams are incorporated into a holistic approach to treating PPD. Dr. Mercola describes here how useful natural progesterone therapy can be. He also cautions that it should be taken cyclically to mimic nature’s biorhythm to allow progesterone receptors to recover in between treatments.

There are many websites that have useful information about natural progesterone cream treatment for PPD, such as this.

Conclusion

It is common sense that a woman may need natural progesterone following a delivery, because she just got rid of her placenta, which was a virtual progesterone factory protecting her body and the baby’s brain all throughout the pregnancy. Even if a woman decides to only use natural progesterone in a cyclical fashion for 3 to 6 months, the majority of women would not experience the baby blues or PPD. When regular menstrual cycles have been re established, the patient’s own ovarian progesterone production has resumed and progesterone cream is no longer needed until after the birth of  the next child or at the arrival of menopause. Medicine is full of examples where common sense was applied for effective treatment options despite missing randomized studies.

Natural progesterone treatment of PPD is one such example, where intuitively it was tried and it worked in many patients. Whether or not a randomized trial has been done does not concern the progesterone receptors (they just do not like the synthetic versions of progesterone, as they block the receptors leading to progesterone deficiency!).  Natural progesterone treatment can also be combined with traditional treatments of PPD.

More information on postpartum depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/postpartum-depression/

References

1.Teri Pearlstein, MD, Margaret Howard, PhD, Amy Salisbury, PhD and Caron Zlotnick, PhD: “Postpartum depression” : American Journal of Obstetrics and Gynecology – Volume 200, Issue 4 (April 2009)

2. Dr. Michael E. Platt: The Miracle of Bio-Identical Hormones; 2nd edition, © 2007 Clancy Lane Publishing, Rancho Mirage, Ca/USA (p.53-55).

3. Bope & Kellerman: Conn’s Current Therapy 2013, 1st ed.© 2012 Saunders

4. Jacobson: Psychiatric Secrets, 2nd ed. © 2001 Hanley and Belfus

Last edited Nov. 7, 2014

Aug
01
2005

Cognitive Therapy Useful For Suicide Prevention

A prospective study was done involving 120 adults over 18 months with evaluations at 1, 3, 6, 12, and 18 months involving patients who had attempted to commit suicide before entering the study. The purpose of the study was to find out whether cognitive therapy could make a difference in the suicide or suicide attempt rate in the months following an attempt. Several parameters were measured using scales of hopelessness, symptom of depression, frequency of suicidal thoughts and recording repeat suicidal attempts.

The results showed that there was a significant difference between the regular treatment group and the group where cognitive therapy was given. The subsequent suicide attempt rate in the regular treatment group was 1.97-fold higher than in the cognitive therapy group over the 18 months treatment and observation period. 76% of the cognitive therapy treated group did not attempt to commit suicide again (free of repeat suicide attempt), whereas in the regular treatment group this figure was down to 58%. At 6, 12 and 18 moths a depression assessment showed that the cognitive therapy group had a significantly lower (meaning “better”) score than the regular treatment group. This was also reflected in the statistics showing a 50% less likely rate of repeat suicide attempts in the cognitive therapy group. Feelings of hopelessness were also significantly lower in the cognitive therapy group, but interestingly enough there was no significant difference between suicidal thoughts in the cognitive therapy group versus the regular treatment group.

Cognitive Therapy Useful For Suicide Prevention

Cognitive Therapy Useful For Suicide Prevention

The authors came to the conclusion that cognitive therapy is an effective treatment modality, which helps preventing further suicide attempts, in patients who recently have attempted to commit a suicide.

More info on suicide and suicide prevention: http://nethealthbook.com/mental-illness-mental-disorders/suicide-suicide-prevention/

Reference: JAMA. 2005;294:563-570

Last edited October 29, 2014