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HAMILTON, Ontario – In a local hospital recently on Monday, four women, all pregnant or new mothers, have learned to better manage their anxiety and depression – unnecessary medications.
Psychologist Sheryl Green asked participants in her treatment program to share the results of their "behavioral activation" assignments, a strategy of regularly scheduling enjoyable activities and encouraging them to do so even if you do not feel comfortable. at the height. The technique can improve the mood.
Mercedes Elmore, 27 years old and pregnant with a girl, told the group that she had taken the time to text with a friend while her husband and 8-year-old son were playing video games. Jennifer, Sienna's four-month-old mother, is rushed to make a solo trip to the mall to buy a new outfit for her 30-year dinner. (Jennifer said that she did not feel comfortable with using her last name in this article.) Rachel Bakker, 31, a mother of three, come a friend to watch TV.
Mercedes Elmore shared with the group the results of her "behavioral activation" assignments, organizing fun activities. She gave birth to a baby girl on November 1st.
Photo:
Libby March for the Wall Street Journal
"It was something to be hoped for," said Ms. Bakker, while her youngest child, Winston, five months old, was sitting on her lap and was holding a little stuffed chick.
The group is part of the perinatal anxiety treatment program by Dr. Green and his colleagues at St. Joseph's Healthcare in Hamilton. This is one of many but more and more psychological therapy programs specifically designed for pregnant women and postpartum women experiencing anxiety and depression. They respond to a critical need. Although scientific studies have generally shown that antidepressants are safe during pregnancy and breastfeeding, their impact on babies is still a concern.
Some doctors encourage women to avoid drugs during the perinatal period, especially patients with mild illness. And many women, even some with severe depression and anxiety disorders, simply refuse to take them during pregnancy or breastfeeding.
Ms. Hodgson battled depression and anxiety for many years. His symptoms increased during his third trimester. "I felt unmotivated, unhappy and worthless," she said.
Photo:
Libby March for the Wall Street Journal
For "women who can not or do not want to take medication, it takes an alternative," says Dr. Green, an assistant professor in the Department of Psychiatry and Behavioral Neuroscience at McMaster University.
In addition, some women who continue to take medication continue to experience symptoms: Adding psychotherapy to antidepressants could help keep them healthy.
Anxiety disorders and depression are common during pregnancy and the postpartum period. About 13% of women experience depression during pregnancy. And studies estimate that between 12% and 39% of them will have an anxiety disorder. Many women experience both. "Hormones can contribute to worsening moods or anxiety in some women," says Marlene P. Freeman, associate professor of psychiatry at Harvard Medical School. "Pregnancy and the postpartum are a major transition in life. There are changes in sleep, stress and worry about having a baby. "
In the United States, approximately 10% of pregnant women receive prescriptions for selective serotonin reuptake inhibitors, the family of antidepressants including Prozac and Zoloft. Studies have shown that about two-thirds of women with a history of depression who stop taking their medication during pregnancy will relapse.
Rachel Bakker is holding her son, Winston. During the session, women participating in the treatment program performed a deep breathing exercise.
Photo:
Libby March for the Wall Street Journal
"If you have depression and anxiety disorders during pregnancy, you are at risk, such as alcohol, smoking or drugs, such as alcohol, tobacco or drugs," says Maureen Sayres Van Niel, a reproductive psychiatrist in Cambridge. , Mass. And Chair of the Women's Caucus of the American Psychiatric Association. "And that will have an effect on how much you can attach with your baby."
Depression during pregnancy is linked to an increased risk of preterm birth and low birth weight in babies. High anxiety during pregnancy has been associated with symptoms of ADHD in children.
New perinatal programs are adapting effective and long-lasting psychological treatments for anxiety and depression. St. Joseph's uses Cognitive Behavior Therapy (CBT), a treatment that teaches patients to identify unnecessary thoughts, challenge them, and replace them with more realistic thoughts. Researchers at the University of Washington School of Medicine in St. Louis use interpersonal psychotherapy, which aims to improve relationships as a way to relieve the symptoms of depression in pregnant women. Massachusetts General Hospital and the Institute of Health Professions at the General Health Hospital are investigating the use of mindfulness-based cognitive therapy, which involves yoga and the practice of meditation, to treat women pregnant with anxiety disorders.
The new programs modify treatments to make them more accessible and suitable for pregnant women and new mothers. They often consist of fewer sessions: the St. Joseph's program, for example, meets only six times, whereas a typical CBT program would consist of 12 to 18 sessions. Babies are welcome.
The St. Joseph's program is covered by Canada's universal health insurance system and is free for participants.
Katelyn Hodgson, one of the participants in the program, has been suffering from depression and anxiety for several years. Antidepressants helped her relieve her symptoms, but she stopped taking this medication as soon as she learned that she was pregnant with her daughter Frances, who goes to Frankie's house, today. four months old. "I was just worried [the medication] I was going to see her and I did not know what it would do, "said the 27-year-old social media and public relations officer.
But her symptoms increased during her third trimester and Mrs. Hodgson resumed treatment. "I felt unmotivated, unhappy and worthless. I did not understand how I could feel so bad when something as big was happening, "she said. Mrs. Hodgson stopped taking the medication again, fearing that Frankie might be exposed to it through breast milk. She started the St. Joseph Perinatal Program at two months old. Her anxiety "is less intrusive now," she says.
During the St. Joseph program, women learn to identify and modify their "thought errors", these catastrophic thoughts that can fuel depression and anxiety (if another person holds my baby in his arms, she will fall ill , for example). They learn to judge them by writing tangible evidence for and against their thoughts. They are also taught to modify behaviors that may fuel anxiety, such as spending hours online looking for complications during labor and delivery. Every week, women have homework to put the new skills into practice.
Recently, on Monday, Dr. Green's colleague, psychologist Eleanor Donegan, led the women to a deep breathing exercise. "It's just a message to your brain to slow down and relax a bit," Dr. Donegan said. The women closed their eyes and the room was silent, except for the occasional slaps of Frankie and Winston.
In a small pilot study of the program published in 2015 in the Archives of Women's Mental Health and involving 10 women without a control group, the treatment resulted in a statistically significant reduction in symptoms of anxiety and depression. Dr. Green and her colleagues complete a larger randomized controlled trial.
Ms. Elmore has found strategies to change particularly useful thought errors. She consulted a psychiatrist for several years for generalized anxiety disorder and post-traumatic stress disorder, but she has always resisted medication. With this pregnancy, her anxiety increased.
"At first, I was afraid of miscarriage. Over time and after 20 weeks, I'm afraid she's stillborn, "said Mrs. Elmore, early childhood educator. Now, when she is anxious, she "examines the evidence of this worried thought and evidence against her," she said. "I find myself thinking in a more balanced way." Ms. Elmore gave birth to a baby girl on Thursday.
Ms. Hodgson said that the main benefit of St. Joseph's was to validate and receive support from other women. "It gives the impression that other people are struggling just as much and that's acceptable," she said. "We can find a way to get through."
How safe are antidepressants during pregnancy?
Many studies attempt to answer this question, but the results of the studies are contradictory. And some of the risks attributed to the use of selective serotonin reuptake inhibitors, or SSRIs, are similar to those seen in children exposed to their mother's psychiatric illness. It may be difficult to distinguish between the effects of the drug and the impact of the disease.
Some studies have shown that babies whose mothers took antidepressants during pregnancy were more likely to be born prematurely and weigh less at birth. But babies exposed to the depression of their mother in utero are exposed to the same risks. Some studies have revealed a higher risk of heart abnormalities and neural tube defects in babies whose mothers were taking SSRIs. But others, particularly more recent research, have found that babies exposed to SSRIs are no more likely to have heart defects than children of women who do not take medication.
The long-term impact of antidepressant exposure is not clear either. Some studies have shown an increased risk of autism and ADHD in children exposed to drugs, while others have found no connection. Some research has found a link between a mother's use of SSRIs during pregnancy and language and behavioral problems in her children. Other studies have not revealed any association of this type.
There is concern that children exposed to anti-depressants in utero may have a higher risk of depression later. An extensive study of nearly 65,000 women published in 2016 in the Journal of the American Academy of Child and Adolescent Psychiatry found that adolescent girls whose mothers took certain antidepressants during the Pregnancy was four times more likely to become depressed by the age of 15, compared to children whose mothers had psychiatric disorders but did not take the drugs during pregnancy.
"We never want women to take medications they do not need during pregnancy and breastfeeding," said Marlene P. Freeman, associate professor of psychiatry at Harvard Medical School. "SSRI antidepressants are among the best studied drugs during pregnancy and breastfeeding. To stay healthy, many women need medicine. "
Write to Andrea Petersen at [email protected]
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