Depression During The Menopausal Transition

The perception that menopause leads to mood disturbances such as depression has a long history. How did these beliefs come about, and are they supported by the scientific literature? This article reviews the theories of menopause and depression, the scientific literature, and the implications of these findings for prevention and treatment. Epidemiologic studies of menopausal status and depression do not provide consistent evidence of an association between the menopausal transition and depression among the general population of women. Depression experienced by women transitioning through menopause may be attributed to factors unrelated to menopause. A subset of women, however, may be more vulnerable to the effects of hormonal changes. For some women, short-term estrogen replacement therapy to relieve vasomotor symptoms may be beneficial, although for others psychotherapy or antidepressants may be more appropriate. Additional research is needed to better understand the association between different stages of the menopausal transition and dysphoric mood or depression, and better identification of women potentially at risk for depression during the menopausal transition.     

Postnatal debriefing: have we thrown the baby out with the bath water?

Postnatal debriefing is offered by 78% of maternity services in the UK despite little evidence from randomised controlled trials (RCTs) that it is effective. RCTs in this area have applied debriefing as a prophylactic to all or high risk women, rather than as a treatment for women who request it. This pragmatic trial therefore evaluated existing postnatal debriefing services that provide debriefing as a treatment for women who request it. Forty-six women who met criterion A for posttraumatic stress disorder (PTSD) and requested debriefing 1.3–72.2 months (median 16 weeks) postpartum completed measures of depression, PTSD, support and negative appraisals of the birth before and one month after debriefing. Women were compared with others who gave birth in the same hospitals during the same time period (n = 34), who met criterion A for PTSD but had not requested debriefing. Results showed PTSD symptoms reduced over time in both groups but greater decreases were observed in women who attended debriefing. Debriefing also led to reduction in negative appraisals but did not affect symptoms of depression. Therefore, results suggest providing debriefing as a treatment to women who request or are referred to it may help to reduce symptoms of PTSD.     

Depressive Thought Content Among Female College Students With Bulimia

The author used a rationalistic cognitive approach to identify typical thought content among female college students with bulimia. The study compared overall depression scores on the Beck Depression Inventoy between women with bulimia and women in a control group and examined differences in specific depression items. Results indicated that women with bulimia are more depressed than are controls and have distorted thoughts regarding body image, self-blame, somatic preoccupation, guilt, and suicidal ideation. By emphasizing competition, perfection, motivation, and attractiveness, the college environment may exacerbate distorted thinking, thus indirectly contributing to the development and maintenance of bulimia. A treatment approach focusing on cognition is proposed.     

Exercise and Depression: A Review of Reviews

There has been considerable research interest in the effects of exercise upon depression outcomes. Recently, health agencies in the United Kingdom (UK) and beyond have made several guidance statements on this issue. Therefore, this review seeks to provide a synthesis of evidence regarding the effectiveness of exercise in the management of depression (including postnatal depression) in adults. Studies were identified by searching PubMed, Medline, Cochrane Library (CENTRAL) and PsychINFO using relevant search terms. The article describes how meta-analyses from peer reviewed journals have reported exercise as treatment for depression is more effective than no treatment, as effective as traditional interventions in some instances, possibly a promising approach to postnatal depression and has equivalent adherence rates to medication. However, reviews have also raised concerns about the methodological quality of trials, possible overestimation of treatment effects and lack of data regarding long term benefits. Based on the available evidence it is concluded that while awaiting further high quality trial evidence it would seem appropriate for exercise to be recommended in combination with other treatments.     

Marital History and Current Marital Satisfaction in Chronic Depression

Marital functioning is an important consideration in the treatment of depression. Although there are several studies of the marriages of depressed individuals, there is little data on the marital lives of those with chronic depression. In this article, we compare the marital history and marital satisfaction in a sample of carefully diagnosed outpatients with chronic depression compared to those with nonchronic depression. The groups were similar in terms of a history of divorce and for the percentage who had ever been married. However, the chronic group had significantly lower levels of marital satisfaction. Increased attention to marital functioning in this group may be beneficial during treatment.     

Thinking ahead: complexity of expectations and the transition to parenthood

This study examined the integrative complexity of thinking in individuals making the transition to parenthood, and the relationship between complexity and adjustment during this period. Sixty-nine couples were interviewed 3 months before their babies were born, and 6 months after the birth. The prenatal interview focussed on individuals' expectations about what it would be like being a parent; the postnatal interview focussed on individuals' actual experiences as parents. In addition, participants completed measures of depression, self-esteem, and marital satisfaction after each interview, and a measure of stress after the 6-month postnatal interview. Both men and women demonstrated a significant increase in the complexity of their thinking from the prenatal to the postnatal interview, with women demonstrating higher levels of complexity at both times. In addition, women with more complex expectations demonstrated better adjustment after their babies were born than did women with simpler expectations; these results were not obtained for men. Results are discussed with regard to the way in which thinking about the self changes as one negotiates major life transitions, and the way in which complex thinking can help counter some of the stresses that individuals may experience at these times.     

Critical Factors Associated with Early Postpartum Depression among Turkish Women

The main objective of this study was to examine the associated factors of the early postpartum depression, in a Turkish sample of 151 postnatal women. Besides positive and negative affect and marital adjustment measures, demographic and labor related variables, which may affect the postpartum depression, were also included into the study. To reveal the critical factors associated with the early postnatal depressive mood, a regression analysis was conducted. After controlling for the variance accounted for by age and number of children, negative affect and marital maladjustment measures were found to be significant associates of postpartum depression. These findings are discussed in the light of the literature.This work has been supported by the Turkish Academy of Sciences, in the framework of the Young Scientist Award Program. (TG-TUBA-GEBIP/2002-1-11).     

Screening for and Preventing Perinatal Depression

New York City (NYC) public hospitals recently mandated that all pregnant women be screened for depression, but no funds were allocated for screening or care coordination/treatment, and research suggests that unfunded mandates are not likely to be successful. To address this, we implemented an on-site depression prevention intervention (NYC ROSE) for positive depression screens among pregnant, mostly Black and Hispanic, lower-income women in one public hospital. In this paper, we used Aarons’ implementation model to describe the successes and challenges of screening and intervention. Patient tracking sheets and electronic medical records were abstracted. Key informant interviews and an informal focus group were conducted, and staff observations were reviewed; common implementation themes were identified and fit into Aarons’ model. We found that a lack of funding and staff training, which led to minimal psychoeducation for patients, were outer context factors that may have made depression screening difficult, screening results unreliable, and NYC ROSE enrollment challenging. Although leadership agreed to implement NYC ROSE, early involvement of all levels of staff and patients would have better informed important inner context factors, like workflow and logistical/practical challenges. There was also a mismatch between the treatment model and the population being served; patients often lived too far away to receive additional services on site, and economic issues were often a higher priority than mental health services. Screening and interventions for perinatal depression are essential for optimal family health, and a detailed, thoughtful and funded approach can help ensure effectiveness of such efforts.     

A Psychoeducational Approach to Hypochondriasis: Background,Content, and Practice Guidelines

Patients suffering from health anxiety are difficult to engage in a psychological treatment, although it has now been empirically established that cognitive behavioral treatments are beneficial for many of these patients. A first important step is to change their orientation from a biomedical to a biopsychosocial perspective. One way of promoting this change is to provide focused psychoeducation. A number of studies have shown that group psychoeducation for patients with health anxiety results in a reduction in anxious concerns, depression, and medical services utilization. The purpose of this paper is to describe the background, content, and implementation of a brief course entitled “Coping With Health Anxiety.” The empirical support as well as the potentially active ingredients of this approach are discussed.     

Primary care screening and risk factors for postnatal depression in Zimbabwe: A scoping review of literature

Postnatal depression (PND) exerts a significant burden on the global public health system, globally affecting approximately 10 to 20% of women. Despite the recently reported high prevalence of PND in Zimbabwe, it is rarely diagnosed or appropriately managed in primary care settings. This review scopes evidence on PND from studies on screening for PND and the associated risk factors conducted in Zimbabwe over the past 20 years. We searched electronic databases for published articles and checked reference lists of studies relating to depression among women in Zimbabwe. We used the following key words: postnatal, depression, women, screening, risk-factors, and Zimbabwe. A total of 14 studies were retrieved as follows: postnatal depression (4), postnatal mental disorders (1), mental disorders among pregnant women (1), and depression and women in general (8). Reported prevalence of PND ranged from 16% to 34.2%. Studies on PND enrolled women from urban and peri-urban settings. Significant risk factors for PND identified among women in Zimbabwe included multi parity, having a spouse who was older than 35years, poorer relations with spouses or partners, having had experienced an adverse event, being unemployed, and having had experienced intimate partner violence. Psychosocial factors are implicated in PND occurrence among Zimbabwean women. There is need to explore the burden of PND among rural communities.     

Interpersonal factors and perinatal depressive symptomatology in a low-income Latina sample

Interpersonal factors are among the risk factors that predispose women to experiencing mood disturbances during the childbearing years. This study investigates the trajectory of change in depressive symptomatology over the course of the perinatal period as related to interpersonal risk factors (marital quality and social support) in a sample of 69 low-income, mostly immigrant Latina mothers at high and low risk for depression. We found a significant linear change in depressive symptomatology from baseline (pregnancy) through the postpartum period. This decline was steeper for high-risk women who reported high levels of social support compared with those who reported low levels of social support. In addition, a greater decline in depressive symptom scores was found for women who reported better postnatal marital quality, irrespective of risk group status. The results suggest the importance of considering marital quality and social support in estimations of risk for depression. These findings also have implications for targeting social support and marital quality in preventive interventions for perinatal depression in Latinas.     

Post natal depression,the mother's conflict and parent – infant psychotherapy

This paper sets out to consider a psychodynamic approach to postnatal depression. In particular, it examines the advantages of psychodynamic parent?–?infant psychotherapy both as a treatment model, and also as a way of thinking that can help to formulate a theory of the postnatal period. An illustration is provided in the clinical account of the therapy of a couple and their nine-week-old infant. The author draws on this example, and on findings from psychoanalytic theory, infancy research, evolutionary biology and anthropology to suggest an integrated understanding of the postnatal state of mind and its challenges.     

A randomized clinical trial of a brief, problem-focused couple therapy for depression

The aim of this study was to evaluate a brief couple therapy for depression targeted for mildly discordant or nondiscordant couples struggling with the negative impact of depression. Subjects included women with major depression or dysthymia who had husbands without clinical depression. Thirty-five couples were randomly assigned to the 5-week intervention (n = 18) or a waitlist control group (n = 17), and followed up 1 and 3 months later. Results showed a significant effect of treatment in reducing women's depressive symptoms, with 67% of women improved and 40% to 47% recovered at follow-up, compared to only 17% improved and 8% recovered among women in the control group. Treatment was also effective in secondarily improving women's marital satisfaction, reducing husbands' levels of psychological distress and depression-specific burden, and improving both partners' understanding and acceptance of depression. The treatment was implemented in five 2-hour sessions, representing an efficient, cost-effective approach. Findings support the growing utility of brief, problem-focused couple interventions that simultaneously target depression, relational functioning, and psychological distress experienced by the loved ones of depressed persons.     

Treatment for Psychosomatic Blindness Among Cambodian Refugee Women

A number of older Cambodian women came to the attention of the authors because of their overrepresentation among a larger group of people who exhibited functional or psychosomatic blindness: visual loss with no physiologic basis. Myriad problems are faced by the psychosomatically blind Cambodian refugee, including war-based trauma, improper diagnosis resulting in denial of claims of disability, and feelings of severe depression and isolation. It was our intention to design and test an intervention program for the 150 psychosomatically blind Cambodian women whom we have seen over a four year period. Working with fifteen of these clients, we wished to test the relative effectiveness of two different treatments in reducing psychological distress and improving well-being and visual acuity: (1)Skills in living group: treatment consisted of group sessions designed to teach minimal skills such as using the telephone and public transportation; and (2) Therapy group: treatment consisted of group therapy conducted by a Cambodian therapist. Both treatment modalities were designed to be culturally relevant, implemented by Cambodians and in the Khmer language. Extensive pre and post-treatment interviews were conducted to assess level of visual acuity, psychological and physiological functioning and experiential background. Comparison of pre and post measures showed significantly better perceived well-being and improved visual acuity in the treatment groups as compared to the control group. Such findings may be beneficial in reducing psychological distress and improving vision.     

„Cognitive Behavioral Analysis System of Psychotherapy“

There are a number of evidence-based methods of psychotherapy for the treatment of depression but most treatment approaches have shown low or moderate success in the subgroup of chronic depression (duration >?2 years) as compared to episodic depression. This could be related to a higher rate of early trauma and specific deficits in cognitive and interpersonal functioning within this group of patients. James McCullough has developed a psychotherapeutic approach known as cognitive behavioral analysis system of psychotherapy (CBASP) specifically for chronic depression to overcome these deficits. In CBASP early negative experiences are associated with current interpersonal problems and a systematic relearning process is initiated. The approach integrates behavioral, cognitive and interpersonal strategies. The CBASP approach is empirically supported by study results and has shown to be effective in both inpatient and outpatient settings. This article presents the development of the approach and therapeutic strategies as well as techniques of CBASP are described.     

Tailoring treatment of depression for women across the reproductive lifecycle: the importance of pregnancy, vasomotor symptoms, and other estrogen-related events in psychopharmacology

Compared with men, women are at increased risk of depression, especially at several reproductive-related lifecycle points. This may be partially due to changing levels of estrogen, a hormone that can affect levels of neurotransmitters and neural proteins. As estrogen levels vary throughout the lifespan, risk of depression in women also varies, and not all treatments are appropriate or effective at all times. In adolescence, onset of depression may be associated with onset of puberty, but treating underage girls with antidepressants can risk suicidality. In females of childbearing age, mood disturbances associated with menstrual cycles signal a risk for later full-blown major depressive disorder. In depressed pregnant and postpartum women, risks of treatment versus risks of nontreatment are intricate and require case-by-case evaluation. In perimenopause, vasomotor symptoms may be harbingers of oncoming depression and also may signal the presence of dysregulated hormones and neurotransmitters. Relieving vasomotor symptoms may be a necessary dimension of treating depression. In postmenopause, response to selected antidepressants may depend on whether the patient is also taking hormone-replacement therapy. To attain optimal outcomes, modern psychopharmacologists must tailor treatment of depression to a woman's reproductive stage of life.     

Difficulties in the Treatment of Depression During Pregnancy and Postpartum Depression

Treatment with women who become depressed during pregnancy or who develop postpartum depression can be challenging. In certain cases where women have a poor parental representation rooted in a negative relationship with their own mothers, a powerful resistance emerges and can take the form of abandoning the treatment. For women who have a history of abandonment by one of the parents, this particular aspect of the relationship may be repeated. In others, where there is a great deal of anger towards the parent, in spite of conscious wishes to be different, there is an identification with this negative parental image; the new mother feels herself to be a bad mother and flees the treatment as a way to protect the baby. Biological as well as psychological factors present during pregnancy and postpartum depression, as well as the impact of the mother’s depression on the developing infant are described and clinical vignettes are provided to illustrate the main points.