Software used to screen social media photos for depression signs

The images you put up on Instagram could be used to diagnose if you’re depressed,” the Mail Online reports.

Researchers attempted to see if computer-driven image recognition could diagnose depression based on the form and content of people’s posts on Instagram, a social media photo sharing site.

They looked at more than 43,000 images from 166 people, who also completed a survey about their mood.

The researchers found people who reported having a history of depression were more likely to post images that were bluer, darker and less vibrant.

The computer programme was able to correctly identify 70% of the participants with depression, getting it wrong 24% of the time.

These results were compared with a separate independent study, which estimated that GPs only correctly diagnose 42% of cases.

This is a proof of concept study into what is often referred to as “machine learning”, where sophisticated algorithms assess massive amounts of data to see if they can begin to spot patterns in the data that humans can’t.

The researchers suggest social media could become a useful screening tool. But aside from whether the science stacks up, there are ethical and legal implications that would need to be considered before this could happen.

If you’ve been feeling persistently down and hopeless in the last few weeks and no longer take pleasure in things you used to enjoy, you may be depressed. Contact your GP for advice.

Where did the story come from?

The study was carried out by researchers from Harvard University and the University of Vermont, and was funded by the National Science Foundation and the Sackler Scholars Programme in Psychobiology.

It was published in the peer-reviewed journal EPJ Data Science.

There was wide coverage of the story in the media, which was generally accurate – but none highlighted any of the study’s limitations.

The media also failed to point out that although the researchers say their 70% detection rate is better than GPs, the GP detection rate was taken from a study that looked at GPs making a depression diagnosis without using any standard assessments. This means we’re unable to verify the accuracy of this figure.

What kind of research was this?

This case-control study compared the Instagram posts of people who reported a history of depression with the posts of those who did not.

Although this is an interesting concept, this type of study isn’t able to prove cause and effect.

For example, we don’t know whether the individual preferences for colour, mood or genre had changed over time in either group – more people in the depression group may have happened to always prefer the colour blue, for example.

What did the research involve?

The researchers recruited 166 adults aged between 19 and 55 using Amazon’s Mechanical Turk (MTurk) crowdwork platform. This is an online service where participants receive small rewards for taking part in regular surveys or similar tasks.

They completed an online survey about any history of depression and agreed to let researchers have access to their Instagram posts for computer analysis.

A total of 43,950 photos were compared for 71 people with a history of depression and 95 healthy controls.

The researchers chose to measure differences in the following features of Instagram posts:

hue – colour on the spectrum from red (lower hue) to blue/violet (higher hue)
brightness – darker or lighter
vividness – low saturation appears faded, while high saturation is more intense or rich
use of filters to change the colour and tint
presence and number of human faces in each post
number of comments and likes
frequency of posts
They then compared these features between the two groups and ran various computer programmes to see if they could predict who had depression based on 100 of their Instagram posts.

They compared their predictions with those made by GPs using data from a previous independent meta-analysis, which found GPs are able to correctly diagnose 42% of people with depression without using any validated questionnaires or measurements.

The Center for Epidemiologic Studies Depression Scale (CES-D) questionnaire was used as a screening tool for depression.

This uses a scale of 0-60 – it’s generally considered that a score of 16 or more indicates a likely diagnosis of depression. People with a score of 22 or more were excluded from this study.

To see if humans are able to identify factors that computers cannot, the researchers also asked a sample of online users to each rate 20 randomly selected photographs on a scale of 0-5 on the following measurements:

happiness
sadness
interest
likeability
In all, 13,184 images were rated, with each image being rated by at least three people.

What were the basic results?

The computer programme identified 70% of the people with depression. It incorrectly identified 24% of people as having depression who did not.

The results were much less accurate for predicting depression before it had been diagnosed.

According to the computer-generated results, people in the depressed group were more likely to post:

photos that were bluer, darker and less vibrant
photos that generated more comments but fewer likes
more photos
photos with faces
photos without using filters
If they did use filters, they were more likely to use “inkwell”, which converts photos to black and white, whereas the healthy controls were more likely to use “valencia”, which brightens images.

The human responses to the photos found people who were in the depression group were more likely to post sadder and less happy images. Whether the images were likeable or interesting didn’t differ between the groups.

How did the researchers interpret the results?

The researchers concluded: “These findings support the notion that major changes in individual psychology are transmitted in social media use, and can be identified via computational methods.”

They say this early analysis could inform “mental health screening in an increasingly digitalised society”. They acknowledge that further work on the ethical and data privacy aspects would be required.

Conclusion

This study suggests that a computer algorithm could be used to help screen for depression more accurately than GPs – using Instagram images.

But there are several limitations that need to be considered when analysing the results:

As only people with a CES-D score of between 16 and 22 (on a scale of 0-60) were included, this is likely to have ruled out those with moderate to severe depression.
There were a small number of participants.
Selection bias will have skewed the results – it only includes people who like to use Instagram and are willing to allow researchers access to all of their posts.
Many potential participants refused to take further part in the research once they realised they’d have to share their posts.
It relied on self-reporting of depression rather than formal diagnoses.
The data is all from US participants, so may not be generalisable to the UK.
The 100 posts from people with depression were analysed if they were within a year (before and after) of the diagnosis. As we don’t know how long people may have had symptoms for before diagnosis and whether their symptoms had improved, it’s difficult to make any accurate conclusions.
We don’t know their lifelong preferences for colours or genre when posting images.
And, most importantly, the figure quoted that GP diagnostic accuracy was only at 42% was based on meta-analysis of studies where GPs were asked to diagnose depression without using questionnaires, scales or other measurement tools. This doesn’t give a very realistic representation of depression diagnosis in normal clinical practice. As such, it can’t be assumed that this model would be an improvement over standard methods for depression screening or diagnosis.
Though the results of this study are interesting, it’s unclear what benefits or risks may be attached to any future use of screening tools for depression using Instagram or other social media.

If you’re concerned that you’re depressed, it’s best to contact your GP – there are a variety of effective treatments available.

Find the Best Antidepressants

Overview

Depression is a mental health issue that starts most often in early adulthood. It’s also more common in women. However, anyone at any age may deal with depression.

Depression affects your brain, so drugs that work in your brain may prove beneficial. Common antidepressants may help ease your symptoms, but there are many other options as well. Each drug used to treat depression works by balancing certain chemicals in your brain called neurotransmitters. These drugs work in slightly different ways to ease your depression symptoms.

Many common drugs fall into the following drug classes:

selective serotonin reuptake inhibitors (SSRIs)
serotonin and norepinephrine reuptake inhibitors (SNRIs)
tricyclic antidepressants (TCAs)
tetracyclic antidepressant
dopamine reuptake blocker
5-HT1A receptor antagonist
5-HT2 receptor antagonists
5-HT3 receptor antagonist
monoamine oxidase inhibitors (MAOIs)
noradrenergic antagonist
Atypical antidepressants, which don’t fall into these drug classes, and natural treatments such as St. John’s wort are also available.

Read on to learn more about how all of these drugs work and their potential side effects.

SSRIS

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs
Not only do SSRIs help most people with depression, but they also cause fewer side effects than other drugs used to treat this condition. Sexual problems are among the most common side effects of these antidepressants.
SSRIs are the most commonly prescribed class of antidepressants. An imbalance of serotonin may play a role in depression. These drugs fight depression symptoms by decreasing serotonin reuptake in your brain. This effect leaves more serotonin available to work in your brain.

SSRIs include:

sertraline (Zoloft)
fluoxetine (Prozac, Sarafem)
citalopram (Celexa)
escitalopram (Lexapro)
paroxetine (Paxil, Pexeva, Brisdelle)
fluvoxamine (Luvox)
Common side effects of SSRIs include:

nausea
trouble sleeping
nervousness
tremors
sexual problems
Learn more: What you should know about selective serotonin reuptake inhibitors (SSRIs) »

SNRIS

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs help improve serotonin and norepinephrine levels in your brain. This may reduce depression symptoms. These drugs include:

desvenlafaxine (Pristiq, Khedezla)
duloxetine (Cymbalta)
levomilnacipran (Fetzima)
venlafaxine (Effexor XR)
In addition to treating depression, duloxetine may also relieve pain. This is important because chronic pain can lead to depression or make it worse. In some cases, people with depression become more aware of aches and pains. A drug that treats both depression and pain, such as duloxetine, can be helpful to these people.

Common side effects of SNRIs include:

nausea
drowsiness
fatigue
constipation
dry mouth
TCAS

Tricyclic antidepressants (TCAs)

TCAs are often prescribed when SSRIs or other antidepressants don’t work. It isn’t fully understood how these drugs work to treat depression.

TCAs include:

amitriptyline
amoxapine
clomipramine (Anafranil)
desipramine (Norpramin)
doxepin
imipramine (Tofranil)
nortriptyline (Pamelor)
protriptyline
trimipramine (Surmontil)
Common side effects of TCAs can include:

constipation
dry mouth
fatigue
The more serious side effects of these drugs include:

low blood pressure
irregular heart rate
seizures
Learn more: Tricyclic antidepressants »

TETRACYCLIC ANTIDEPRESSANT

Tetracyclic antidepressant

Maprotiline is used to treat depression and anxiety. It also works by balancing neurotransmitters to ease symptoms of depression.

Common side effects of this drug include:

drowsiness
weakness
lightheadedness
headache
blurry vision
dry mouth
DOPAMINE REUPTAKE BLOCKER

Dopamine reuptake blocker

Bupropion (Wellbutrin, Forfivo, Aplenzin) is a mild dopamine and norepinephrine reuptake blocker. It’s used for depression and seasonal affective disorder. It’s also used in smoking cessation.

Common side effects include:

nausea
vomiting
constipation
dizziness
blurry vision

5-HT1A RECEPTOR ANTAGONIST

5-HT1A receptor antagonist

The drug in this class that’s used to treat depression is called vilazodone (Viibryd). It works by balancing serotonin levels and other neurotransmitters.

This drug is rarely used as a first-line treatment for depression. That means it’s usually only prescribed when other medications didn’t work for you or caused bothersome side effects.

Side effects can include:

nausea
vomiting
trouble sleeping
5-HT2 RECEPTOR ANTAGONISTS

5-HT2 receptor antagonists

Two 5-HT2 receptor antagonists, nefazodone and trazodone (Oleptro), are used to treat depression. These are older drugs. They alter chemicals in your brain to help depression.

Common side effects include:

drowsiness
dizziness
dry mouth
5-HT3 RECEPTOR ANTAGONIST

5-HT3 receptor antagonist

The 5-HT3 receptor antagonist vortioxetine (Brintellix) treats depression by affecting the activity of brain chemicals.

Common side effects include:

sexual problems
nausea

MAOIS

Monoamine oxidase inhibitors (MAOIs)

MAOIs are older drugs that treat depression. They work by stopping the breakdown of norepinephrine, dopamine, and serotonin. They’re more difficult for people to take than most other antidepressants because they interact with prescription drugs, nonprescription drugs, and some foods. They also can’t be combined with stimulants or other antidepressants.

MAOIs include:

MAOIs
MAOIs are rarely a doctor’s first choice of drug to prescribe. They’re often only used as a last resort, after many other drugs have failed to treat your depression.
isocarboxazid (Marplan)
phenelzine (Nardil)
selegiline (Emsam), which comes as a transdermal patch
tranylcypromine (Parnate)
MAOIs also have many side effects. These can include:

nausea
dizziness
drowsiness
trouble sleeping
restlessness
NORADRENERGIC ANTAGONIST

Noradrenergic antagonist

Mirtazapine (Remeron) is used primarily for depression. It alters certain chemicals in your brain to ease depression symptoms.

Common side effects include:

drowsiness
dizziness
weight gain
ATYPICAL MEDICATIONS

Atypical medications

Other depression drugs don’t fall into the typical classes. These are called atypical antidepressants. Depending on your condition, your doctor may prescribe one of these alternatives instead.

For example, olanzapine/fluoxetine (Symbyax) is an atypical antidepressant. It’s used to treat bipolar disorder and major depression that doesn’t respond to other drugs.

Ask your doctor if an alternative drug treatment is a good choice for you. They can tell you more.

Keep reading: Best atypical antipsychotics for treating depression »

NATURAL TREATMENTS

Natural treatments

Safety First
Although these aren’t prescription drugs, you should consult your doctor before using natural treatments for a medical condition such as depression. Natural treatments also carry risks.
You may be interested in natural options to treat your depression. Some people use these treatments instead of drugs, and some use them as an add-on treatment to their antidepressant medication.

St. John’s wort is an herb that some people have tried for depression. According to the National Center of Complementary and Integrative Health, the herb may have mild positive effects, or it may not work any better than placebo. This herb also causes many drug interactions that can be serious.

St. John’s wort interacts with:

antiseizure drugs
birth control pills
warfarin (Coumadin)
prescription antidepressants
Also, certain drugs for depression may not work as well if you take them with St. John’s wort.

The supplement S-adenosyl-L-methionine (SAMe) is another natural option that some people have tried to ease their depression symptoms. SAMe may help treat joint pain, but there’s not much support to show that it helps with depression. This treatment can also interact with prescription drugs.

Get more info: Is St. John’s wort safe? »

TAKEAWAY

Talk with your doctor

Drugs are only part of your depression treatment. Talk with your doctor about steps you can take, such as lifestyle changes or changes in your diet, that can help ease your depression and help your medication to work its best.
– Susan J. Bliss, RPh, MBA

When it comes to treating depression, what works for one person may not work for another. Finding the right drug for your depression can take time.

If you start taking medication for your depression, allow time for trial and error. According to the Mayo Clinic, it can take at least six weeks for an antidepressant to work fully.

Ask your doctor how long it should take for your medication to work. If your symptoms of depression haven’t improved by then, talk to your doctor. They may suggest another medication that may be more effective in relieving your depression.

What Medications Help to Treat Depression?

Depression Medications List

SSRIs
SNRIs
TCAs
Tetracyclic antidepressant
Dopamine reuptake blocker
5-HT1A receptor antagonist
5-HT2 receptor antagonists
5-HT3 receptor antagonist
MAOIs
Noradrenergic antagonist
Atypical medications
Natural treatments
Takeaway
Overview

Depression is a mental health issue that starts most often in early adulthood. It’s also more common in women. However, anyone at any age may deal with depression.

Depression affects your brain, so drugs that work in your brain may prove beneficial. Common antidepressants may help ease your symptoms, but there are many other options as well. Each drug used to treat depression works by balancing certain chemicals in your brain called neurotransmitters. These drugs work in slightly different ways to ease your depression symptoms.

Many common drugs fall into the following drug classes:

selective serotonin reuptake inhibitors (SSRIs)
serotonin and norepinephrine reuptake inhibitors (SNRIs)
tricyclic antidepressants (TCAs)
tetracyclic antidepressant
dopamine reuptake blocker
5-HT1A receptor antagonist
5-HT2 receptor antagonists
5-HT3 receptor antagonist
monoamine oxidase inhibitors (MAOIs)
noradrenergic antagonist
Atypical antidepressants, which don’t fall into these drug classes, and natural treatments such as St. John’s wort are also available.

Read on to learn more about how all of these drugs work and their potential side effects.

SSRIS

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs
Not only do SSRIs help most people with depression, but they also cause fewer side effects than other drugs used to treat this condition. Sexual problems are among the most common side effects of these antidepressants.
SSRIs are the most commonly prescribed class of antidepressants. An imbalance of serotonin may play a role in depression. These drugs fight depression symptoms by decreasing serotonin reuptake in your brain. This effect leaves more serotonin available to work in your brain.

SSRIs include:

sertraline (Zoloft)
fluoxetine (Prozac, Sarafem)
citalopram (Celexa)
escitalopram (Lexapro)
paroxetine (Paxil, Pexeva, Brisdelle)
fluvoxamine (Luvox)
Common side effects of SSRIs include:

nausea
trouble sleeping
nervousness
tremors
sexual problems
Learn more: What you should know about selective serotonin reuptake inhibitors (SSRIs) »

SNRIS

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs help improve serotonin and norepinephrine levels in your brain. This may reduce depression symptoms. These drugs include:

desvenlafaxine (Pristiq, Khedezla)
duloxetine (Cymbalta)
levomilnacipran (Fetzima)
venlafaxine (Effexor XR)
In addition to treating depression, duloxetine may also relieve pain. This is important because chronic pain can lead to depression or make it worse. In some cases, people with depression become more aware of aches and pains. A drug that treats both depression and pain, such as duloxetine, can be helpful to these people.

Common side effects of SNRIs include:

nausea
drowsiness
fatigue
constipation
dry mouth

TCAS

Tricyclic antidepressants (TCAs)

TCAs are often prescribed when SSRIs or other antidepressants don’t work. It isn’t fully understood how these drugs work to treat depression.

TCAs include:

amitriptyline
amoxapine
clomipramine (Anafranil)
desipramine (Norpramin)
doxepin
imipramine (Tofranil)
nortriptyline (Pamelor)
protriptyline
trimipramine (Surmontil)
Common side effects of TCAs can include:

constipation
dry mouth
fatigue
The more serious side effects of these drugs include:

low blood pressure
irregular heart rate
seizures
Learn more: Tricyclic antidepressants »

TETRACYCLIC ANTIDEPRESSANT

Tetracyclic antidepressant

Maprotiline is used to treat depression and anxiety. It also works by balancing neurotransmitters to ease symptoms of depression.

Common side effects of this drug include:

drowsiness
weakness
lightheadedness
headache
blurry vision
dry mouth
DOPAMINE REUPTAKE BLOCKER

Dopamine reuptake blocker

Bupropion (Wellbutrin, Forfivo, Aplenzin) is a mild dopamine and norepinephrine reuptake blocker. It’s used for depression and seasonal affective disorder. It’s also used in smoking cessation.

Common side effects include:

nausea
vomiting
constipation
dizziness
blurry vision

5-HT1A RECEPTOR ANTAGONIST

5-HT1A receptor antagonist

The drug in this class that’s used to treat depression is called vilazodone (Viibryd). It works by balancing serotonin levels and other neurotransmitters.

This drug is rarely used as a first-line treatment for depression. That means it’s usually only prescribed when other medications didn’t work for you or caused bothersome side effects.

Side effects can include:

nausea
vomiting
trouble sleeping
5-HT2 RECEPTOR ANTAGONISTS

5-HT2 receptor antagonists

Two 5-HT2 receptor antagonists, nefazodone and trazodone (Oleptro), are used to treat depression. These are older drugs. They alter chemicals in your brain to help depression.

Common side effects include:

drowsiness
dizziness
dry mouth
5-HT3 RECEPTOR ANTAGONIST

5-HT3 receptor antagonist

The 5-HT3 receptor antagonist vortioxetine (Brintellix) treats depression by affecting the activity of brain chemicals.

Common side effects include:

sexual problems
nausea

MAOIS

Monoamine oxidase inhibitors (MAOIs)

MAOIs are older drugs that treat depression. They work by stopping the breakdown of norepinephrine, dopamine, and serotonin. They’re more difficult for people to take than most other antidepressants because they interact with prescription drugs, nonprescription drugs, and some foods. They also can’t be combined with stimulants or other antidepressants.

MAOIs include:

MAOIs
MAOIs are rarely a doctor’s first choice of drug to prescribe. They’re often only used as a last resort, after many other drugs have failed to treat your depression.
isocarboxazid (Marplan)
phenelzine (Nardil)
selegiline (Emsam), which comes as a transdermal patch
tranylcypromine (Parnate)
MAOIs also have many side effects. These can include:

nausea
dizziness
drowsiness
trouble sleeping
restlessness
NORADRENERGIC ANTAGONIST

Noradrenergic antagonist

Mirtazapine (Remeron) is used primarily for depression. It alters certain chemicals in your brain to ease depression symptoms.

Common side effects include:

drowsiness
dizziness
weight gain
ATYPICAL MEDICATIONS

Atypical medications

Other depression drugs don’t fall into the typical classes. These are called atypical antidepressants. Depending on your condition, your doctor may prescribe one of these alternatives instead.

For example, olanzapine/fluoxetine (Symbyax) is an atypical antidepressant. It’s used to treat bipolar disorder and major depression that doesn’t respond to other drugs.

Ask your doctor if an alternative drug treatment is a good choice for you. They can tell you more.

Keep reading: Best atypical antipsychotics for treating depression »

NATURAL TREATMENTS

Natural treatments

Safety First
Although these aren’t prescription drugs, you should consult your doctor before using natural treatments for a medical condition such as depression. Natural treatments also carry risks.
You may be interested in natural options to treat your depression. Some people use these treatments instead of drugs, and some use them as an add-on treatment to their antidepressant medication.

St. John’s wort is an herb that some people have tried for depression. According to the National Center of Complementary and Integrative Health, the herb may have mild positive effects, or it may not work any better than placebo. This herb also causes many drug interactions that can be serious.

St. John’s wort interacts with:

antiseizure drugs
birth control pills
warfarin (Coumadin)
prescription antidepressants
Also, certain drugs for depression may not work as well if you take them with St. John’s wort.

The supplement S-adenosyl-L-methionine (SAMe) is another natural option that some people have tried to ease their depression symptoms. SAMe may help treat joint pain, but there’s not much support to show that it helps with depression. This treatment can also interact with prescription drugs.

Get more info: Is St. John’s wort safe? »

TAKEAWAY

Talk with your doctor

Drugs are only part of your depression treatment. Talk with your doctor about steps you can take, such as lifestyle changes or changes in your diet, that can help ease your depression and help your medication to work its best.
– Susan J. Bliss, RPh, MBA

When it comes to treating depression, what works for one person may not work for another. Finding the right drug for your depression can take time.

If you start taking medication for your depression, allow time for trial and error. According to the Mayo Clinic, it can take at least six weeks for an antidepressant to work fully.

Ask your doctor how long it should take for your medication to work. If your symptoms of depression haven’t improved by then, talk to your doctor. They may suggest another medication that may be more effective in relieving your depression.

Can My Depression Affect My Child?

Study: Depression During Pregnancy Increases a Child’s Risk of Mood Disorders

A population-based study shows that the children of women who experience depression during pregnancy are 1.5 times more likely to be depressed themselves as teens.

Depression is believed to have a genetic link, but a new study suggests a mother’s mental health while pregnant can affect her child even more directly.

Research published in the journal JAMA Psychiatry suggests that women who experience depression during pregnancy give their children an increased risk of depression as adults.

Rebecca M. Pearson, Ph.D., of the University of Bristol in the U.K., and her colleagues used data from more than 4,500 patients and their children in a community-based study. The researchers concluded that children born to depressed mothers were, on average, 1.5 times more likely to be depressed at 18 years old.

While shared genetic risk is one potential explanation, Pearson said the physiological consequences of depression experienced by the mother can pass through the placenta and may influence the fetus’ brain development.

“At an individual level the risks are very small. Having said this, these differences are meaningful at a population level,” Pearson told Healthline.

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Depression and Pregnancy

Prenatal depression affects about 10 to 15 percent of women and is as common as postnatal depression, more commonly called postpartum depression.

While pregnant women often feel surges of emotion due to hormonal changes, more serious mood changes may be related to depression. These symptoms include feelings of sadness, hopelessness, or being overwhelmed, excessive crying, having no energy, losing interest in once pleasurable activities, or withdrawing from friends.

Know the Warning Signs of Depression

Researchers say the monitoring and protections that are in place for postpartum depression are not there for women with prenatal depression.

“We really don’t want to scare pregnant women or make them feel guilty,” Pearson said. “Nonetheless, the message is to prioritize your own mental state and seek help early in pregnancy if you are feeling low, both for your own sake and for your baby.”

Seeking Help for Depression During Pregnancy

Researchers say their findings have important implications for the nature and timing of interventions to prevent depression in children of depressed mothers.

“In particular, the findings suggest that treating depression in pregnancy, irrespective of background, may be most effective,” the study concludes.

Treatments like cognitive behavioral therapy—a kind of talk therapy—have been shown to help women with depression without the risk of side effects that comes with some psychoactive medications.

Explore Depression Medications and Their Side Effects

“Health professionals should be aware and ready to support women,” Pearson said. “Depression during pregnancy is important in its own right and not just because it may continue after birth.”

Dealing with Postpartum Depression

Everything You Need to Know About Postpartum Depression

Part 1 of 17

What is postpartum depression?

 

You’ve probably heard of the “baby blues.” That’s because it’s quite common for new mothers to feel a little sad, worried, or fatigued. As many as 80 percent of mothers have these feelings for a week or two following childbirth. It’s completely normal and usually fades in a few weeks.

While some of the symptoms sound the same, postpartum depression is different from the baby blues.

Postpartum depression is a lot more powerful and lasts longer. It follows about 15 percent of births, in first-time moms and those who’ve given birth before. It can cause severe mood swings, exhaustion, and a sense of hopelessness. The intensity of those feelings can make it difficult to care for your baby or yourself.

Postpartum depression shouldn’t be taken lightly. It’s a serious disorder, but it can be overcome through treatment.

Part 2 of 17

What are the symptoms of postpartum depression?

Although it’s normal to feel moody or fatigued after having a baby, postpartum depression goes well beyond that. Its symptoms are severe and can interfere with your ability to function.

Symptoms of postpartum depression vary person to person and even day to day. If you have postpartum depression, chances are you’re familiar with several of these indicators:

You feel sad or cry a lot, even when you don’t know why.
You’re exhausted, but you can’t sleep.
You sleep too much.
You can’t stop eating, or you aren’t interested in food at all.
You have various unexplained aches, pains, or illnesses.
You don’t know why you’re irritable, anxious, or angry.
Your moods change suddenly and without warning.
You feel out of control.
You have difficulty remembering things.
You can’t concentrate or make simple decisions.
You have no interest in things you used to enjoy.
You feel disconnected from your baby and wonder why you’re not filled with joy like you thought you’d be.
Everything feels overwhelming and hopeless.
You feel worthless and guilty about your feelings.
You feel like you can’t open up to anyone because they’ll think you’re a bad mother or take your baby, so you withdraw.
You want to escape from everyone and everything.
You have intrusive thoughts about harming yourself or your baby.
Your friends and family may notice that you’re withdrawing from them and from social activities or that you just don’t seem like yourself.

Symptoms are most likely to start within a few weeks of delivery. Sometimes, postpartum depression doesn’t surface until months later. Symptoms may let up for a day or two and then return. Without treatment, symptoms may continue to worsen.

Part 3 of 17

Treatment for postpartum depression

If you have symptoms of postpartum depression, you should see your doctor as soon as possible so that you can get started on treatment.

There are two main treatments for postpartum depression: medication and therapy. Either one can be used alone, but they may be more effective when used together. It’s also important to make some healthy choices in your daily routine.

It may take a few tries to find out what treatment works for you. Keep open communication with your doctor.

Medication

Antidepressants have a direct effect on the brain. They alter the chemicals that regulate mood. They won’t work right away, though. It can take several weeks of taking the medication before you notice a difference in your mood.

Some people have side effects while taking antidepressants. These may include fatigue, decreased sex drive, and dizziness. If side effects seem to be making your symptoms worse, tell your doctor right away.

Some antidepressants are safe to take if you’re breastfeeding, but others may not be. Be sure to tell your doctor if you breastfeed.

If your estrogen levels are low, your doctor may recommend hormone therapy.

Therapy

A psychiatrist, psychologist, or other mental health professional can provide counseling. Therapy can help you make sense of destructive thoughts and offer strategies for working through them.

Self-care

This part of treatment may be a little more difficult than it sounds. Practicing self-care means cutting yourself some slack.

You shouldn’t attempt to shoulder more responsibility than you can handle. Others may not instinctively know what you need, so it’s important to tell them. Take some “me time,” but don’t isolate yourself. Consider joining a support group for new mothers.

Alcohol is a depressant, so you should steer clear of it. Instead, give your body every opportunity to heal. Eat a well-balanced diet and get some exercise each day, even if it’s only a walk around the neighborhood.

Treatment helps most women feel better within six months, though it can take longer.

Part 4 of 17

Are there natural remedies for postpartum depression?

Postpartum depression is serious and not something you should attempt to treat without a doctor’s input.

Along with medical treatment, natural remedies such as exercise and getting the right amount of sleep can help improve symptoms. Massage, meditation, and other mindfulness practices may help you feel better. Maintain a diet high in nutrients, but low in processed foods. If you’re not getting the nutrients you need in your diet, ask your doctor to recommend the right dietary supplements.

Supplements

Herbal remedies may be appealing. However, the U.S. Food and Drug Administration (FDA) doesn’t regulate dietary supplements in the same way they regulate medications. The agency monitors supplements for safety, but it doesn’t evaluate the validity of health claims.

Also, natural supplements can still interact with medications and cause problems. Tell your doctor or pharmacist about all the supplements you take and in what amounts, even if they seem harmless. Many things you ingest can end up in your breast milk, which is another reason to keep your doctor informed.

St. John’s wort is an herb some people use to treat depression. According to March of Dimes, there’s simply not enough research to know if this supplement is safe for treating postpartum depression.

There’s some evidence that a lack of omega-3 fatty acids may be associated with postpartum depression. However, there’s not enough research to know if taking omega-3 supplements would improve symptoms.

Learn more about natural remedies for postpartum depression »

Part 5 of 17

What causes postpartum depression?

The exact cause isn’t clear, but there are some factors that may contribute to postpartum depression. Postpartum depression may be triggered by a combination of physical changes and emotional stressors.

Physical factors

One of the biggest physical changes after giving birth involves hormones. While you’re pregnant, your levels of estrogen and progesterone are higher than usual. Within hours of giving birth, hormone levels drop back to their previous state. This abrupt change may lead to depression.

Some other physical factors may include:

low thyroid hormone levels
sleep deprivation
inadequate diet
underlying medical conditions
drug and alcohol misuse
Emotional factors

You may be more likely to develop postpartum depression if you’ve had a mood disorder in the past or if mood disorders run in your family.

Emotional stressors may include:

recent divorce or death of a loved one
you or your child having serious health problems
social isolation
financial burdens
lack of support

Part 6 of 17

Postpartum depression facts and statistics

Depression vs. the blues

About 80 percent of mothers have the baby blues in the weeks following childbirth. In contrast, a large-scale 2013 study found that just 14 percent of mothers screened positive for depression. Of those women, 19.3 percent thought about harming themselves and 22.6 percent had previously undiagnosed bipolar disorder.

Risk factors

The study found that women who had depression were more likely to be:

younger
less educated
publicly insured
African-American
Onset

The study authors also found by conducting home visits or phone interviews with 973 women that:

26.5 percent had onset of depression before pregnancy
33.4 percent started having symptoms during pregnancy
40.1 percent noticed symptoms after childbirth
Getting help

According to the nonprofit Postpartum Progress, only about 15 percent of women with postpartum depression get professional help. In addition, these figures represent only women who had live births. They don’t include postpartum depression in women who miscarried or whose babies were stillborn. That means the actual incidence of postpartum depression might be higher than we think.

Other statistics

Postpartum anxiety is common, affecting more than 1 in 6 women following childbirth. Among first-time mothers, the rate is 1 in 5.
Suicide is said to be the reason for about 20 percent of postpartum deaths. It’s the second most common cause of death in postpartum women.
Postpartum OCD is fairly rare. About 1 to 3 in 100 childbearing women are affected.
Postpartum psychosis is rare, affecting 1 to 2 per 1,000 women after childbirth.
It’s estimated that up to 25 percent of fathers experience depression in the first year postpartum.
Going beyond the first year postpartum, a 2010 study found that 39 percent of mothers and 21 percent of fathers had an episode of depression by the time their child was 12 years old.
Part 7 of 17

Where to find support for postpartum depression

First, consult with your OB-GYN to address your physical symptoms. If you’re interested, your doctor can refer you to a therapist or other local resources. Your local hospital is another good place to get referrals.

You might feel more comfortable reaching out to others who’ve been through the same thing. They understand what you’re feeling and can offer nonjudgmental support. Consider joining a group for new mothers. Some of them may also be living with depression, anxiety, or postpartum depression.

These organizations can help guide you to the appropriate resources:

Postpartum Depression Support Groups in the U.S. and Canada: This is a comprehensive list of support groups around the United States (by state) and Canada.
Postpartum Education for Parents at 805-564-3888: Trained volunteers answer the “warmline” 24/7 to provide support.
Postpartum Progress: This organization has information and support for pregnant women and new moms who have postpartum depression and anxiety.
Postpartum Support International at 800-944-4PPD (800-944-4773): This resource offers education, online support, and information about local resources.
If you don’t like one support system, it’s okay to try another. Keep trying until you find the help you need.

Suicide prevention
If you think someone is at immediate risk of self-harm or hurting another person:
Call 911 or your local emergency number.
Stay with the person until help arrives.
Remove any guns, knives, medications, or other things that may cause harm.
Listen, but don’t judge, argue, threaten, or yell.
If you think someone is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.
Sources: National Suicide Prevention Lifeline • Substance Abuse and Mental Health Services Administration
Part 8 of 17

How to deal with postpartum depression: 4 tips

After you consult with your doctor, there are a few other things you can do to deal with postpartum depression.

1. Communicate

You may be tempted to keep your feelings to yourself, especially if you’re a naturally reserved person. But it might be helpful to talk things over with someone you trust. You may find out that you’re not alone and that others are willing to listen.

2. Fight isolation

Remaining in seclusion with your feelings can feed into depression. It’s not necessary to have a whirlwind social life, but do try to maintain your closest relationships. It can help you feel connected.

If you’re comfortable in a group setting, you can join a depression support group or a group specifically for new moms. If you’ve stopped participating in previously enjoyable group activities, try them again to see if it helps. Being in a group can help you focus on other things and relieve stress.

3. Cut back on chores

If you’re not up to chores and errands, let them go. Use your energy to take care of basic needs for you and your baby. If at all possible, enlist the help of family and friends.

4. Rest and relax

Both your body and your spirit need a good night’s sleep. If your baby doesn’t sleep for long periods, get someone to take a shift so you can sleep. If you have trouble drifting off, try a hot bath, a good book, or whatever helps you relax. Meditation and massage may help ease tension and help you fall asleep.

Learn more about how to deal with postpartum depression »

Part 9 of 17

Medications for postpartum depression

Selective serotonin reuptake inhibitors

Paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft) are selective serotonin reuptake inhibitors (SSRIs). They’re the most commonly used antidepressants. These drugs affect serotonin, a chemical in the brain that regulates mood. They generally have fewer side effects than other antidepressants.

Atypical antidepressants

These newer antidepressants also target several neurotransmitters in the brain. Duloxetine (Cymbalta) and venlafaxine (Effexor) are examples of atypical antidepressants.

Tricyclic antidepressants and monoamine oxidase inhibitors

These older antidepressants affect neurotransmitters in the brain. They tend to produce side effects and are not usually prescribed unless all other options haven’t worked.

Antidepressant side effects and considerations

All antidepressants can cause side effects, such as:

dry mouth
nausea
dizziness
headaches
insomnia
restlessness
fatigue
weight gain
perspiration
diarrhea
constipation
decreased sex drive
anxiety
tremors
Antidepressants often take several weeks to start working, so patience is required. They must be taken exactly as prescribed, without skipping doses. You’ll start with the smallest dose, but your doctor can increase the dosage a little at a time if it’s not working. It may take some trial and error to find the best medication and the right dosage for you. While taking antidepressants, you’ll need to see your doctor regularly.

If you’re taking a high dose or take antidepressants for a long time, you may have to taper off when you’re ready to stop. Stopping suddenly can increase side effects.

Hormone therapy

Hormone therapy may be an option if your estrogen levels are down. Side effects of hormone therapy may include:

weight changes
breast pain or tenderness
nausea and vomiting
Hormone therapy can also increase your risk of developing certain cancers.

Before taking any medication or hormone therapy, tell your doctor if you’re breastfeeding. Some of these medications can be passed to your baby through breast milk.

Part 10 of 17

What is severe postpartum depression?

Without treatment, postpartum depression can get progressively worse. It’s most dangerous when it leads to thoughts of harming yourself or others. Once these thoughts begin to occur, medical intervention is necessary.

Signs of severe postpartum depression include:

hallucinations, or seeing, hearing, smelling, or feeling things that aren’t really there
delusions, or having irrational beliefs, placing too much importance on insignificant things, or feeling persecuted
disorientation, confusion, and talking nonsense
strange or erratic behavior
rage or violent actions
suicidal thoughts or attempted suicide
thoughts of harming your baby
These are all signs that you need emergency medical treatment. Hospitalization may be necessary. Severe postpartum depression may be life-threatening, but it can be treated successfully.

Part 11 of 17

What are the risk factors for postpartum depression?

Any new mother can develop postpartum depression regardless of age, ethnicity, or how many children she has.

These things might increase your risk:

previous depression or other mood disorder
family history of depression
serious health problems
recent stress, such as a divorce, death, or serious illness of a loved one
unwanted or difficult pregnancy
having twins, triplets, or other multiples
having your baby born prematurely or with health problems
being in an abusive relationship
isolation or lack of emotional support
poor diet
drug or alcohol misuse
sleep deprivation and exhaustion
If you have some of these risk factors, talk to your doctor as soon as you notice symptoms. Postpartum depression can increase your risk of substance abuse or of harming yourself or your baby.

Part 12 of 17

Postpartum depression prevention

Absolute prevention isn’t really possible. Still, some factors can make you more prone to postpartum depression, so you may be able to do a few things to reduce your risk.

Firstly, be proactive. During pregnancy, tell your doctor if:

you’ve had a previous episode of postpartum depression
you’ve ever had major depression or another mood disorder
you currently have symptoms of depression
Your doctor may be able to prescribe the appropriate therapy and make recommendations in advance.

You may also be able to reduce your chances of developing postpartum depression by following these tips:

Get your support system in place before your baby is born.
Make an action plan and write it down. Include contact information for your doctor, local support services, and a family member or friend you can confide in.
Have an arrangement for childcare in place so you can take a break. If symptoms appear, you’ll know exactly what to do.
Maintain a healthy diet and try to get some exercise every day.
Don’t withdraw from activities you enjoy and try to get plenty of sleep.
Keep the lines of communication open with loved ones.
A new baby in the house changes family dynamics and alters sleep patterns. You don’t have to be perfect, so go easy on yourself. Report symptoms to your doctor right away. Early treatment can help you recover faster.

Part 13 of 17

What is postpartum psychosis?

The most severe form of postpartum depression is postpartum psychosis. Postpartum psychosis is a rare occurrence. When it does happen, it’s usually within the first few weeks after delivery. Psychosis is more likely if you have a history of mood disorders.

Psychosis means you’re no longer grounded in reality. Postpartum psychosis is rare. When it does happen, it’s usually within the first few weeks after you’ve given birth. Often, postpartum psychosis is associated with bipolar illness.

The earliest symptoms are restlessness, irritability, and insomnia. These could easily be overlooked as baby blues or even sleep deprivation.

Hallucinations and delusions are also common symptoms that include seeing, hearing, smelling, and feeling things that seem real, but aren’t. For example, you could hear a voice telling you to harm your baby or feel that your skin is crawling with bugs.

Delusions are irrational or grandiose ideas or feelings of persecution despite evidence to the contrary. For example, you may believe people are plotting against you. Delusions can also revolve around your baby.

Other symptoms include:

nonsensical chatter, confusion, and disorientation
feelings of rage for no apparent reason
erratic or violent behavior, such as throwing things, breaking things, and lashing out at people around you
rapidly shifting moods
preoccupation with death that might include suicidal thoughts or suicide attempt
intrusive thoughts about your baby, such as blaming your baby for the way you feel or wishing they would go away
Postpartum psychosis is a severe, life-threatening emergency. The risk of hurting yourself or your baby is real. If you or someone close to you exhibits these symptoms after giving birth, seek immediate medical attention. Postpartum psychosis is treatable. It usually requires hospitalization and antipsychotic medication.

Learn more about postpartum psychosis »

Part 14 of 17

How is postpartum psychosis treated?

Several medications are used to treat psychosis. They may be used alone or in combination and include:

mood stabilizers
antidepressants
antipsychotics
These medications can help control your symptoms and keep you stabilized. If they don’t, another option is electroconvulsive therapy (ECT). ECT uses electrical currents to trigger chemical changes in the brain. It’s usually well-tolerated and can be effective in treating postpartum psychosis.

Once you’re stabilized, your doctors may recommend that you consult with a therapist who can help you work through your feelings.

Treatment should continue even after you’ve been discharged from the hospital. As you recover, your medications may need some adjusting.

If you also have bipolar or another mental health disorder, you’ll need to continue to follow your treatment plan for that health issue as well.

Part 15 of 17

Postpartum anxiety

Postpartum depression gets more attention, but postpartum anxiety is more common. It affects more than 1 in 6 women after childbirth.

It’s normal to feel a little stressed or worried when you bring a new baby into your home. Sometimes, those feelings cause anxiety that interferes with everyday life.

Common symptoms include episodes of hyperventilation and panic attacks. Hyperventilation occurs when you breathe so quickly and deeply that you run low on carbon dioxide. This can leave you feeling as though you can’t catch your breath.

Panic attacks can mimic symptoms of a heart attack. The symptoms include:

pounding heartbeat
chest pain
sweating
shortness of breath
Other symptoms of postpartum anxiety include:

excessive worry, even about inconsequential matters
being unable to sleep because of worry
running the same problems over in your mind, even though they’ve been solved or aren’t important
poor concentration due to worry
overprotecting your baby due to constant worry about what could go wrong
worrying about or imagining you have various illnesses
You can have anxiety and depression together, making it difficult to figure out what’s going on without a doctor’s help.

While postpartum anxiety may go away on its own, it could also worsen. It’s a good idea to talk to your doctor. Anxiety can be treated with antianxiety medications and therapy.

Learn more about postpartum anxiety »

Part 16 of 17

Postpartum OCD

You likely want to raise your baby in a healthy environment, and you might feel pressure to have everything perfect. Those aren’t unusual thoughts for a new mom. But the pressure can sometimes blossom into obsessive-compulsive disorder (OCD).

Postpartum OCD isn’t very common. About 1 to 3 percent of childbearing women develop OCD. It usually starts within a week of delivery.

Obsessions could be about anything, but they’re likely to focus on the baby’s safety. For example, you might worry about your baby dying during the night or that you’ll drop them.

If you have postpartum OCD, you might engage in ritualistic behaviors related to those thoughts. These are a few examples:

repetitive organizing, cleaning, and obsessing over germs that may come in contact with your baby
repeatedly checking on your baby during the night, even though you did so recently
mental compulsions, such as constantly praying for your baby’s safety
rituals such as counting or touching something a certain way, thinking it will prevent bad things from happening
spending a lot of time researching your or your baby’s health
You may not be able to control these behaviors. If you have symptoms of postpartum OCD that don’t go away within a few weeks, see your doctor.

Postpartum OCD can be treated with therapy alone or with antidepressant medication.

Part 17 of 17

Postpartum depression in men

It’s not uncommon for new fathers to have the blues on occasion. As with new mothers, these feelings are normal in men and tend to fade away as everyone makes the transition.

Men can also develop a type of postpartum depression, called paternal postnatal depression.

Symptoms and prevalence

Symptoms of depression are similar in men and women, but they may come on more gradually in fathers. That can make them harder to recognize. New fathers also don’t have follow-up exams with doctors like new mothers do, so depression can go unnoticed. There’s also less information and fewer systems in place to help new fathers cope with these feelings.

Men are less likely to report symptoms of depression, but estimates say up to 25 percentof fathers have feelings of depression in the first year postpartum. First-time fathers tend to have a higher level of anxiety in the weeks following a birth.

Causes

There haven’t been many studies into the causes of postpartum depression in men. Researchers theorize it may have something to do with changes in testosterone and other hormone levels. It may be related to lack of sleep, stress, and the changing family dynamics.

Risk factors

Fathers may be at higher risk of postpartum depression if their partner has depression.

Another risk factor is having previous depression or other mood disorder. If that’s the case, you should talk to your doctor before the baby is born. Mention any signs of depression, however small.

Treatment

Fathers should also try to get a support system in place. This could involve arranging for childcare, joining a depression support group, or spending time out with friends.

Like new mothers, new fathers need to maintain a nutritious diet, exercise daily, and get plenty of rest. If your symptoms of depression don’t clear up or are severe, you should see your doctor for a proper diagnosis.

Depression can be treated with antidepressant medications, either alone or with therapy. In cases where both parents show signs of depression, couples counseling or family counseling may be good options.

Depression and Pregnancy

Overview

Postpartum depression—the depression that occurs in new mothers after their baby’s born — may be better known, but mood disorders during the pregnancy itself are more common in pregnant women than experts once thought.

There’s a collective term now for prenatal depression before the baby’s born and postpartum depression after the baby’s born — perinatal depression.

CAUSES

Causes and prevalence

Pregnancy can be one of the happiest times in a woman’s life. But it can also play havoc with hormones and create plenty of stress.

It was once believed that pregnancy protected a woman from emotional disorders, but that turned out to be a myth. Plus, in recent years, there’s been a great deal of media focus on postpartum depression. That may be why it took some time for word to get out that the combination of biological and emotional factors in moms-to-be may lead to anxiety and depression.

Now those symptoms may lead to a diagnosis of perinatal depression. It’s estimated that between 10 and 20 percent of women develop some type of pregnancy-related mood disorder. Plus, about 1 in 20 women in the U.S. will experience a major depressive disorder (MDD) while they’re pregnant.

PERINATAL DEPRESSION

Symptoms of perinatal depression

Normal pregnancy shares some symptoms and signs of depression. For instance, with either, you’re likely to be tired, have some insomnia, experience emotional changes, and gain weight. That means your pregnancy can mask any symptoms of depression.

To help you recognize depression during pregnancy, it’s worth talking with your doctor about any of these symptoms:

frequent crying or weepiness
trouble sleeping not because of frequent urination
fatigue or low energy
changes in appetite
loss of enjoyment in once pleasurable activities
increased anxiety
trouble feeling connected to your developing baby (called poor fetal attachment)
If you had depression before pregnancy, your symptoms may be more significant during it than they were before.

BABY BLUES

Symptoms of the ‘Baby Blues’

As many as 80 percent of women are affected by what is known as the “baby blues.”

During pregnancy, your levels of estrogen and progesterone rise dramatically. They’re needed to help your uterus expand and to sustain the placenta. These hormones are also associated with mood.

Within 48 hours after your baby’s arrived, the levels of both hormones plummet drastically. Many researchers believe this “postpartum hormonal crash” causes the baby blues.

For about 1 or 2 weeks after your baby’s born, you may have symptoms of the baby blues. They usually go away after that. Until then, you may feel especially:

irritable
anxious
frustrated
overwhelmed
likely to have rapid mood changes (elation one moment, weeping the next)
exhausted
sleepy, like you want to sleep all the time (hypersomnia)
unable to sleep (insomnia)
POSTPARTUM DEPRESSION

Symptoms of postpartum depression

Experts think the same plunge of estrogen and progesterone after delivering a baby may make some women more susceptible to postpartum depression. Postpartum depression affects between 10 and 20 percent of new mothers.

One difference between the baby blues and postpartum depression is duration. Symptoms of postpartum depression last for more than 2 weeks after your baby’s born. They include feeling:

overwhelmed
intensely anxious
weepy or like you’re crying all the time
irritable or angry
sad all the time
extremely tired and without energy
worthless, hopeless, or guilty
like you want to sleep or eat more or less than you usually do
unable to concentrate or forgetful
intensely worried about your baby
uninterested in your newborn or doing things you used to enjoy
headachy or pain in your chest or like you can’t catch your breath (hyperventilate)
POSTPARTUM PSYCHOSIS

Symptoms of postpartum psychosis

A more severe form of postpartum depression is called postpartum psychosis. It is an extremely rare condition that affects between 1and 2 women per 1,000.

Common symptoms of postpartum psychosis include:

either auditory or visual hallucinations
delusions, which is believing something that isn’t true
suicidal thoughts
thoughts about harming your baby
Postpartum psychosis is an extremely serious condition. It requires immediate emergency care. A mother may be hospitalized for her own safety as well as her baby’s.

TREATMENT

Treatment

The methods used to treat perinatal depression are the same ones used for other types of depression. The good news is that success rates are typically much higher for perinatal depression. Between 80 and 90 percent of pregnant women and new moms are helped by medications, talk therapy, or a combination of drugs and talk therapy.

Medications

Antidepressant drugs are the most common treatment for perinatal depression. Doctors especially prescribe selective serotonin reuptake inhibitors (SSRIs). You and your doctor may talk about taking an antidepressant while you’re pregnancy, after your child’s born, or both.

Several studies, both in the U.S. and the U.K., have determined that SSRIs are generally safe for pregnant women and nursing mothers. There’s currently no evidence that antidepressant drugs have long-term harmful effects on a child when taken during pregnancy. However, there is a chance of drug withdrawal reactions in newborns that may include jitteriness or irritability. In rare cases, there’s a risk of seizures.

It’s understandable that mothers are concerned about any their infants being at risk for side effects. So many women opt for other treatments instead of antidepressants.

Talk Therapy and Alternative Treatments

Talk therapy has proven very effective for perinatal depression.

A few alternative treatments have also shown great promise helping women with perinatal depression. They include massage and especially acupuncture. For acupuncture, a specialist inserts small needles at specific parts of the body. A recent Stanford University study found that 63 percent of women who received a depression-specific form of acupuncture responded well.

Make note that prolonged depression may be more harmful to a mother and her child than the side effects of any treatments or medications. Family and friends should encourage early assessment and care.

If you notice signs of depression during or after your pregnancy, talk to your doctor about all of your treatment options. You and your doctor can work together to make an informed decision about a treatment that’s best for you and your baby.

PREVENTION

Preventing perinatal depression

Studies have found that mothers who breastfeed for at least 3 continuous months have less incidence and severity of postpartum depression.

Perimenopausal Depression

Perimenopausal Depression

Perimenopause, the transition women go through prior to menopause, causes abnormal periods, erratic fluctuations in hormone levels, insomnia and, for many women, unpleasant hot flashes. It has also been linked to depression according to several studies.

In a pair of studies published in the Archives of General Psychiatry, researchers found that women in perimenopause are twice as likely to be diagnosed with major depressive disorder (MDD) and four times as likely to develop depressive symptoms than those who haven’t yet entered this hormonal transition. The studies found that women with the greatest frequency of hot flashes reported the most significant depressive symptoms.

Women who haven’t given birth and those who have taken antidepressant medications are at a higher risk for depression as well.

Risk Factors for Perimenopausal Depression

Although some studies show that fluctuating levels of the female hormone estradiol are one predictor of depression, there are several other factors that may account for perimenopausal depression.

One interesting finding from a Seattle-based study in 2008 published in the journal Menopause found that women with no prior history of depression were four times as likely to develop depression as a result of perimenopause than previously-depressed women. Hot flashes and their impact on sleep patterns were also implicated in the study.

In contrast to prior studies, new research shows that changing levels of the female hormone estrogen have little impact on perimenopausal depression. This may explain why hormone replacement therapies have little impact on overall depression (although it provides some relief for more severe depression, perhaps because it helps with hot flashes).

Stressful life events such as divorce, job loss, or the death of a parent are common occurrences for women in this stage of life and may also trigger depression.

Several other factors have been linked to perimenopausal depression including:

  • a family history of depression
  • a prior history of sexual abuse
  • negative feelings about aging and menopause
  • severe menopausal symptoms
  • a sedentary lifestyle
  • smoking
  • social isolation
  • low self-esteem
  • disappointment in not being able to have any more children (or any children)

Symptoms of Perimenopausal Depression

Major depressive disorder is a serious condition that requires treatment.

Symptoms of the disorder may include fatigue and lack of energy, slowed cognitive function, inattentiveness, a lack of interest in once-enjoyable activities, and feelings of worthlessness, hopelessness or helplessness.

Other symptoms related to perimenopausal depression may include:

  • mood swings
  • irritability
  • crying for no reason or tearfulness
  • heightened anxiety
  • profound despair
  • sleep problems related to hot flashes or night sweats

Depression and Its Effect on Perimenopause

Perimenopause and depression have a complex relationship.

Not only can the effects of perimenopause cause depression, a 2003 study found that depression itself may lead to early-onset perimenopause. The study, published in the Archives of General Psychiatry found that women with “significant symptoms of depression in their late 30s and early 40s” were more likely to enter perimenopause before their 45th birthday than women who hadn’t experienced depressive symptoms.

Research was inconclusive whether early perimenopause led to early menopause or if it simply resulted in an extended period of perimenopause.

Lower estrogen levels during both phases are associated with other health risks including impaired cognitive functioning, heart attack, and stroke. Women using antidepressants were three times as likely to enter perimenopause early than those who weren’t according to the study.

The Other Side of Antidepressants and Perimenopause

Although antidepressants are linked to an earlier onset of perimenopausal depression, they also help relieve one of its most uncomfortable symptoms.

A 2011 study published in the Journal of the American Medical Association found that the selective serotonin re-uptake inhibitor (SSRI) escitalopram (Lexapro) reduced both the severity of hot flashes and also released their occurrence by half when compared to a placebo. The study found Lexapro to be three times as effective at relieving depressive symptoms than hormone replacement therapy.

Additionally, only 31 percent of the women who received hormone replacement therapy reported relief for their hot flashes compared with 56 percent of the women who took the antidepressant alone. This is good news for women concerned about the 2004 Women’s Health Initiative study which found hormone replacement therapy raises the risk of heart attack and stroke.

It is still unknown why escitalopram works, but the findings reported no “serious adverse effects” on women participating in the study. However, antidepressants may have their own side effects including dizziness, insomnia, fatigue, and stomach problems.

Climate Change Already Causing Suicides In India As Crops Fail

Climate change has already caused more than 59,000 suicides in India over the last 30 years, according to estimates in a study published today in the Proceedings of the National Academy of Sciences (PNAS) that suggests failing harvests that push farmers into poverty are likely the key culprits.

UC Berkeley researcher Tamma Carleton discovered that warming a single day by 1 degree Celsius (1.8 degrees Fahrenheit) during India’s agricultural growing season leads to roughly 65 suicides across the country, whenever that day’s temperature is above 20 degrees Celsius (68 degrees Fahrenheit). Warming a day by 5 degrees Celsius has five times that effect.

While high temperatures and low rainfall during the growing season substantially impact annual suicide rates, similar events have no effect on suicide rates during the off-season, when few crops are grown, implicating agriculture as the critical link.

This study helps explain India’s evolving suicide epidemic, where suicide rates have nearly doubled since 1980 and claim more than 130,000 lives each year. Carleton’s results indicate that 7 percent of this upward trend can be attributed to warming that has been linked to human activity.

Soaring temperatures, despair

More than 75 percent of the world’s suicides are believed to occur in developing countries, with one-fifth of those in India alone. But there has been little hard evidence to help explain why poor populations are so at risk.

“It was both shocking and heartbreaking to see that thousands of people face such bleak conditions that they are driven to harm themselves,” Carleton says. “But learning that the desperation is economic means that we can do something about this. The right policies could save thousands.”

The study demonstrates that warming — forecast to reach 3 degrees Celsius by 2050 — is already taking a toll on Indian society. Using methods that she developed in a previous paper published in the journal Science, Carleton projects that today’s suicide rate will only rise as temperatures continue to warm.

Optimists often suggest that society will adapt to warming. But Carleton searched for evidence that communities acclimatize to high temperatures, or become more resilient as they get richer, and found none in the data.

“Without interventions that help families adapt to a warmer climate, it’s likely we will see a rising number of lives lost to suicide as climate change worsens in India,” Carleton says.

Carleton, a doctoral fellow at UC Berkeley’s Global Policy Laboratory and a Ph.D. candidate in agriculture and resource economics, says she hopes her work will help people better understand the human cost of climate change, as well as inform suicide prevention policy in India and other developing countries.

“The tragedy is unfolding today. This is not a problem for future generations. This is our problem, right now,” she says.

Which policies will help prevent suicide?

Debate about solutions to the country’s high and rising suicide rate is contentious and has centered around lowering economic risks for farmers. In response, the Indian government established a $1.3 billion crop insurance plan aimed at reducing the suicide rate but it is unknown if that will be sufficient or effective.

“Public dialogue has focused on a narrative in which crop failures increase farmer debt, and cause some farmers to commit suicide. Until now, there was no data to support this claim,” says Carleton.

More than half of India’s working population is employed in rain-dependent agriculture, long known to be sensitive to climate fluctuations such as unpredictable monsoon rains, scorching heat waves, and drought. A third of India’s workers already earn below the international poverty line.

This study’s findings indicate that protecting these workers from major economic shortfalls during these events, through policies like crop insurance or improvements in rural credit markets, may help to rein in a rising suicide rate.

Impacts beyond agriculture

Heat drives crop loss, Carleton contends, which can cause ripple effects throughout the Indian economy as poor harvests drive up food prices, shrink agricultural jobs and draw on household savings. During these times, it appears that a staggering number of people, often male heads of household, turn to suicide.

Carleton tested the links between climate change, crop yields and suicide by pairing the numbers for India’s reported suicides in each of its 32 states between 1967 and 2013, using a dataset prepared by the Indian National Crime Records Bureau, along with statistics on India’s crop yields, and high-resolution climate data.

To isolate the types of climate shocks that damage crops, Carleton focused on temperature and rainfall during June through September, a critical period for crop productivity that is based on the average arrival and departure dates of India’s summer monsoon.

She cautions that her estimates of temperature-linked suicides are probably too low, because deaths in general are underreported in India and because until 2014, national law held that attempted suicide was a criminal offense, further discouraging reporting.

Carleton was a Rhodes Scholar at Oxford University and is a recipient of the Science to Achieve Results Fellowship awarded by the U.S. Environmental Protection Agency.

Holiday Depression

Holiday Depression

Holidays are supposed to be a time of joy and celebration, but for some people they are anything but.

Depression may occur at any time of the year, but the stress and anxiety during the months of November and December may cause even those who are usually content to experience loneliness and a lack of fulfillment.

Why Is Depression So Common During the Holidays?

There are several reasons why you may develop depression during the holidays:

Social Isolation

Social isolation is one of the biggest predictors of depression, especially during the holidays.

Some people may have a small social circle or a lack opportunities for socialization. People who have feelings of disconnectedness often avoid social interactions at holiday time. Unfortunately, withdrawing often makes the feelings of loneliness and symptoms of depression worse.

These individuals may see other people spending time with friends and family, and ask themselves, “Why can’t that be me?” or “Why is everyone else so much happier than I am?”

One of the best ways to deal with social isolation is to reach out to friends or family for support. You can also try talking to a therapist. They can help you figure out where your feelings come from and develop solutions to overcome them.

Grieving During the Holidays

Some people may be keenly aware of the loss of a loved one during the holiday season. Here are several ways to stave off the holiday blues that may descend at this time:

Begin a New Tradition

Try planning a family outing or vacation, instead of spending the holidays at home.

Don’t Give In to Holiday Pressures

Feel free to leave an event if you aren’t comfortable. Be willing to tell others, “I’m not up for this right now.”

Volunteer

Helping others can also be very helpful for you, too. For example, you might try:

working at a soup kitchen
organizing a gift drive
helping your neighbor with a yard or house task
Get Back to Nature

Going for a walk in the park or the woods helps many people relax and feel better when they are feeling overwhelmed.

Major Depressive Disorder with Seasonal Pattern

Major depressive disorder with seasonal pattern is a type of recurrent depression that is caused by the seasons changing. Many people with this disorder develop depression symptoms during the fall, and continue to feel sad throughout the winter. Most people stop having symptoms during the spring and summer. However, some people experience seasonal depression during the spring and summer.

This disorder is treated with light therapy, antidepressants, and talk therapy.

Dealing with Holiday Depression

Talk to your doctor if you are feeling sad for long periods of time. They can refer you to a mental health specialist. If your feelings of sadness during the holidays are accompanied by suicidal thoughts, do one of the following immediately:

Call 911.
Go immediately to a hospital emergency room.
Contact the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).
You can improve your mood by practicing self-care during the holidays. Eat a healthy diet, and maintain a regular sleep pattern and exercise program. According to the kept Primary Care Companion to the Journal of Clinical Psychiatry, as little as 30-minutes of cardiovascular exercise can provide an immediate mood boost similar to the effects of an antidepressant medication. Joining a support group where you talk to people with similar experiences to yours can also help.

Depression in the LGBT Community

Depression in the LGBT Population

Part 1 of 6

Overview

Depression is one of the most common mental disorders in the United States. It affects an estimated 15.7 million adults and 2.8 million adolescents in the United States, according to the National Institute of Mental Health.

Depression affects LGBT people at higher rates than the heterosexual population, and LGBT youths are more likely than heterosexual students to report high levels of drug use and feelings of depression. According to the Centers for Disease Control and Prevention (CDC), suicide is the third leading cause of death among people age 10 to 24 in the United States. Lesbian, gay, and bisexual youths in grades 7-12 are twice as likely to attempt suicide than their heterosexual peers.

Part 2 of 6

Statistics about LGBT youth at school

Adolescence is a difficult time for many young people and can be especially challenging for LGBT youth. Negative attitudes and cultural stigmas put LGBT youth at a higher risk for bullying, teasing, and physical violence than their heterosexual peers.

The Gay, Lesbian & Straight Education Network (GLSEN) released a report in 2013 on LGBT youth that states the following:

Fifty-five percent of LGBT youth feel unsafe at school because of their sexual orientation, and 37 percent feel unsafe because of their gender expression.
Seventy-four percent of LGBT youth were verbally harassed because of their sexual orientation, and 55 percent were verbally harassed because of their gender expression.
Sixteen percent were physically assaulted, either punched, kicked, or injured with a weapon, because of their sexual orientation, and 11 percent of them experienced this type of assault because of their gender expression.
A hostile school environment affects a student’s performance in school and their mental health. LGBT students who experience victimization and discrimination typically have worse grades and don’t perform as well academically.

Part 3 of 6

Home life for LGBT youth

Challenges for many LGBT youth don’t stop when the school bell rings. How a parent responds to their LGBT teen can have a tremendous impact on their child’s current and future mental and physical health. Many parents react negatively upon learning that their teen is LGBT and may even throw them out of the house, while other LGBT teens run away from home due to conflict or stress with their parents. Because of this, LGBT youth are also at a greater risk for homelessness than heterosexual youth.

The True Colors Fund states that 1.6 million youths experience homelessness every year and that 40 percent of homeless youths identify as LGBT. This number is even more astounding considering that LGBT youths make up only 7 percent of the youth population. Homeless youths are at a greater risk for discrimination, victimization, and mental health issues than those who aren’t homeless.

According to the CDC, stresses experienced by LGBT youth put them at a greater risk for mental health problems and other health risks than heterosexual youths. These health risks include:

behaviors that contribute to violence, such as carrying a weapon or getting in fights
behaviors that contribute to unintentional injuries, such as driving without a seatbelt or driving drunk
tobacco, alcohol, or other drug use
risky sexual behaviors, such as not using birth control
depression
suicide or suicide attempts
Part 4 of 6

LGBT adults

This study suggests that lesbian, gay, and bisexual adults also have higher rates of mood and anxiety disorders and are at a higher risk for suicidal behavior than heterosexual adults. Depression in lesbian, gay, and bisexual adults is usually rooted in discrimination and victimization from childhood and adolescence. Research on transgender people is still lacking.

Some research aims to study depression in older gay men. It examines cognitive behavioral therapy, its benefits, and how effective it is for gay men over the age of 60.

Part 5 of 6

Support

Support can begin in childhood and adolescence. It’s important that LGBT youths have support, both in school and at home. LGBT youths should feel comfortable and safe in environments that are socially, emotionally, and physically supportive.

School

Resources to support LGBT teens are still lacking in a lot of schools, but school climate and attitudes toward LGBT youths has improved over the years, according to GLSEN.

The GLSEN report also states that LGBT youths who have access to support do better in school. Schools can do a number of things to make the environment safer and more supportive of LGBT youth, including:

implementing clear policies against discrimination and harassment
fostering support groups, such as gay-straight alliances, and other student clubs
implementing LGBT topics as part of the curriculum
having a supportive staff
Home

Parents should be willing to talk openly with their teen about any problems they’re having at home or school and be watchful for signs of bullying or violence. Parents should:

talk
listen
be supportive
be proactive
stay involved in their teen’s life
Resources

Many resources are available online for LGBT youth, including the:

True Colors Fund
It Gets Better Project
CDC
American Psychological Association
Youth Resource
Human Rights Campaign
Part 6 of 6

Takeaway

Adolescence is a challenging time, and may be even more challenging for LGBT youths because of their sexual orientation or gender identity. They have an increased risk of being discriminated against and harassed, and also an increased risk of physical and mental health issues.

It’s important to remember that you aren’t alone. Attitudes and the social climate toward LGBT people continue to improve, and many resources are available to help LGBT youths and adults face challenges.

Suicide prevention
If you think someone is at immediate risk of self-harm or hurting another person:
Call 911 or your local emergency number.
Stay with the person until help arrives.
Remove any guns, knives, medications, or other things that may cause harm.
Listen, but don’t judge, argue, threaten, or yell.
If you think someone is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.
Sources: National Suicide Prevention Lifeline • Substance Abuse and Mental Health Services Administration