Therapy for pregnant women with anxiety offers an alternative to medication
Therapy for pregnant women with anxiety offers an alternative to medication
HAMILTON, Ontario. At a local hospital on a recent Monday, four women, all pregnant or new mothers, were learning how to cope better with their anxiety and depression, no medication is required.
Psychologist Sheryl Green asked participants in her treatment program to share the results of their "behavioral activation" task, a strategy to regularly schedule pleasurable activities and have them do them even if they do not sit with them. The technique can improve the mood.
Mercedes Elmore, 27, pregnant with a girl, told the group that she took the time to send a text message with a friend while her husband and their 8-year-old son were playing video games. Jennifer, mother of Sienna, four months old, left a solo trip to the mall to buy a new outfit for her 30-year dinner. (Jennifer said she was uncomfortable with the use of her last name in this article). Rachel Bakker, 31, a mother of three, had a friend who came to watch television.
Mercedes Elmore shared with the group the results of her "behavioral activation" task, programming activities that give her pleasure. She gave birth to a girl on November 1.
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"It was something to look forward to," said Mrs. Bakker, while her youngest daughter, Winston, five months old, sat on her lap and grabbed a stuffed toy.
The group is part of the treatment program of Dr. Green and her colleagues for perinatal anxiety at St. Joseph's Healthcare Hamilton. It is one of the few, but increasingly numerous psychological therapy programs designed specifically for pregnant and postpartum women struggling with anxiety and depression. They address a critical need. While scientific studies have found that antidepressant medications are safe to use during pregnancy and lactation, there are still some concerns about their impact on babies.
Some doctors encourage women to avoid medications during the perinatal period, especially those patients with mild illness. And many women, even some with severe depression and anxiety disorders, simply refuse to take them during pregnancy or breastfeeding.
Ms. Hodgson has struggled with depression and anxiety for several years. His symptoms increased during his third trimester. "I felt unmotivated, unhappy and worthless," he said.
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For "women who can not or choose not to take medication, you need an alternative," says Dr. Green, an assistant professor in the department of psychiatry and behavioral neuroscience at McMaster University.
In addition, some women who continue taking medications continue to have symptoms: adding psychotherapy to antidepressants may help keep them healthy.
Anxiety disorders and depression are common during pregnancy and the postpartum period. About 13% of women experience. depression during pregnancy. And studies estimate that anywhere from 12% to 39% will have an anxiety disorder. Many women experience both. "Hormones can contribute to worsening mood or anxiety in some women," says Marlene P. Freeman, associate professor of psychiatry at Harvard Medical School. "Pregnancy and postpartum is an important transition in life. There are changes in sleep, stress and worry about having a baby. "
About 10% of pregnant women in the United States receive prescriptions for selective serotonin reuptake inhibitors, the family of antidepressant medications which include Prozac and Zoloft. Studies have found that approximately two-thirds of women with a history of depression who stop their medications during pregnancy will fall.
Rachel Bakker holds her son, Winston. During the session, the women in the treatment program practiced a deep breathing exercise.
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Libby march for The Wall Street Journal
"If you have untreated depression and anxiety disorders during pregnancy, you probably have more exposure to things that are not good for your baby, such as alcohol, smoking or drugs," says Maureen Sayres Van Niel, reproductive psychiatrist in Cambridge. , Massachusetts and president of the Women's Caucus of the American Psychiatric Association. "And it will have an effect on the amount you can attach with your baby."
Depression during pregnancy is related to an increased risk of Preterm birth and lower birth weight in babies High anxiety during pregnancy has been linked to Symptoms of ADHD in children.
The new perinatal programs adapt effective and long-lasting psychological treatments for anxiety and depression. St. Joseph uses cognitive behavioral therapy (CBT), a treatment in which patients are taught to identify useless thoughts, challenge them and replace them with more realistic ones. Researchers at the Washington University School of Medicine in St. Louis are using interpersonal psychotherapy, which focuses on improving relationships as a way to relieve the symptoms of depression, with pregnant patients. The Massachusetts General Hospital and the MGH Institute of Health Professions are studying the use of Cognitive therapy based on mindfulness, which involves yoga and meditation practice, to treat pregnant women with anxiety disorders.
The new programs modify treatments to make them more accessible and relevant for pregnant women and new mothers. They often consist of fewer sessions: the St. Joseph program, for example, meets only six times, while a typical CBT course would include 12 to 18 sessions. Babies are welcome.
The program at St. Joseph's is covered by the universal health insurance system of Canada and is free for participants.
Katelyn Hodgson, one of the program's participants, has struggled with depression and anxiety for several years. The antidepressants helped relieve her symptoms, but she stopped taking the medication as soon as she found out that she was pregnant with her daughter Frances, who is passing by Frankie, who is now four months old. "I was just worried [the medication] I was going to go after her and I did not know what I would do, "said the 27-year-old public relations and social media manager.
But her symptoms increased during her third trimester, and Mrs. Hodgson went back to taking the medication. "I felt unmotivated, unhappy and worthless. "I did not understand how I could feel so bad when something so big was happening," he said. Mrs. Hodgson stopped taking the medication again, worried that Frankie would expose herself through her breast milk. St. Joseph's perinatal program began when Frankie was two months old. Her anxiety "is less intrusive now," she says.
During the St. Joseph program, women learn to identify and change their "thinking errors," those catastrophic thoughts that can fuel depression and anxiety (for example, if someone else holds my baby, she will get sick). They learn to put them on trial, noting tangible evidence for and against thoughts. They are also taught to change the behaviors that can fuel anxiety, such as spending hours online investigating labor and delivery complications. Each week, women receive homework to practice new skills.
On that recent Monday, Dr. Green's colleague, psychologist Eleanor Donegan, led the women in a deep breathing exercise. "It's just a message to your brain to slow down and relax a little," said Dr. Donegan. The women closed their eyes and the room was silent except for the occasional sounds and murmurs of Frankie and Winston.
In a small pilot study Of the program published in 2015 in the Archives of Women's Mental Health, in which 10 women participated without a control group, the treatment led to a statistically significant reduction in the symptoms of anxiety and depression. Dr. Green and her colleagues are finishing a larger randomized controlled trial.
Ms. Elmore has found that strategies to change thinking errors are particularly useful. She has seen a psychiatrist for several years for generalized anxiety disorder and post-traumatic stress disorder, but she has always resisted medication. With this pregnancy, her anxiety increased.
"At first, I was worried about miscarriage. As time passed and I arrived at 20 weeks, I worry that she was born dead, "said Mrs. Elmore, an early childhood educator, now, when she gets anxious," look at the evidence of that anxious thought. and the evidence against him, "he said." I find myself thinking about more balanced thoughts. "Mrs. Elmore gave birth to a girl on Thursday.
Ms. Hodgson said that perhaps the greatest benefit of the San Jose program was the validation and support she received from the other women. "It makes you feel like there are other people who are fighting just as well and that's fine," he said. "We can find a way to overcome it."
How safe are antidepressants during pregnancy?
There is a solid body of research that tries to answer this question, but the results of the study come into conflict. And some of the risks attributed to the use of selective serotonin reuptake inhibitors, or SSRIs, are similar to those found in children exposed to their mother's psychiatric illness. Therefore, it can be difficult to distinguish between the effects of the medication and the impact of the disease.
Some studies found that babies whose mothers took antidepressants during pregnancy were more likely to have born prematurely and in low birth weight. But babies exposed to their mother's depression in the womb face these same risks. Some studies found an increased risk of heart defects and neural tube defects among babies whose mothers took SSRIs. But others, particularly recent researchBabies exposed to SSRI are not more likely to have heart defects than children born to women who did not take medication.
The long-term impact of exposure to antidepressants is not clear either. Some studies reported an increased risk of autism Y ADHD in children exposed to medications, while others did not find a link. Some research found an association between a mother's SSRI use during pregnancy and Problems of language and behavior in their children.. Other studies found there is no such association.
There is some concern that children exposed to antidepressants in the womb may be at increased risk of depression later on. A great study of nearly 65,000 women published in 2016 in the Journal of the American Academy of Psychiatry for Children and Adolescents, they found that adolescents whose mothers took certain antidepressants while pregnant were more than four times more likely to become depressed at age 15, compared with Children whose mothers had psychiatric disorders but did not take medication during pregnancy.
"We never want women to take any medication they do not need during pregnancy and breastfeeding," said Marlene P. Freeman, associate professor of psychiatry at Harvard Medical School. "SSRI antidepressants are among the best studied drugs in pregnancy and lactation. The medication for many women is really necessary to stay well. "
Write to Andrea Petersen in andrea.petersen@wsj.com
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