Depression During Pregnancy Regaining Control – Part 7

Depression During Pregnancy: Consequences of Becoming the best mom that I can – Re-grounding self and regaining control.

Re-grounding self and regaining control describes the consequences of the strategies undertaken in confining the threat. All women had undergone counseling; ten took antidepressant medication during pregnancy, five commenced antidepressant medication within two months of delivering, and one woman delayed commencing antidepressant medication until she had weaned her baby.

Three women elected not to use antidepressants at anytime during the pre- and postpartum periods. The properties of this category are: Being in a better place and Knowing self.

Being in a better place

As a result of counseling, medication, or a combination of both, most of the women felt that they had arrived at a better place. Life still had moments of being "up and down" but, there were "far less bad days than there are good days". One woman, who managed her depression with a combination of counseling and antidepressant medication said:

I'm in a much better place now than I was before even becoming pregnant. I still have ups and downs, but my ability to deal with some of the things that are
triggers for me, is much better. (#18).

Another woman, who had received counseling, but remained medication-free during the obstetric and postpartum periods, explained how she was feeling:

For me I know it's slowly going. I do get depressed sometimes. I still do get angry, exasperated. I still haven't regained my full patience. It will take work, and that's what I believe – understand, it's a work in progress. It's like building a beautiful couture dress, it takes time. It's a work of art. It takes time. You are the art piece, and you are just slowly, you know, getting primped up. (#17).

Knowing self
All women felt that they had learned about the self and were regaining control of their life. Many felt confident that they were better able to recognize their needs, what triggered their moods, and that they could identify ways and means to ensure that those needs were met:

There's so much more to juggle. When you come home, you be [come] a wife, you be [come] a mother, and ... something, one time or another has got to give, you can't always be catching the ball. You need to take a break to recharge. I think that's important, sometimes we just forget to recharge. (#3).

Some women felt that having had depression and attended to its management, that they had undergone a "growing experience". One woman expressed this sentiment as:

I learned about myself. It was almost a gift in that, I don't know how to describe this..... I learned about myself... I've learned to take time for myself. (#19).

Some were surprised to realize that they had not been able to communicate how they had felt when they were at their lowest. As well, many identified a previous lack of awareness about the possibility of experiencing depression during pregnancy:

I never thought that I would have worries. I didn't know that I should look out for, you know, these types of things. (#16).

As the research participants recounted their experiences, many told of why they had participated in this study. Women felt it was important that other women be aware that depression can occur during pregnancy, and if it does, women should talk about their problems. Indeed, all of the women in this study identified a need to talk as part of the therapeutic process.

One of the reasons I wanted to do this study was because I really think it's important for women that are pregnant, either the first time, the second time, that if they really think that they can't handle it any more, they really need to talk to somebody. It's important. (#3).

Part 8 will be published soon.

The researchers were Heather Bennett, Heather Boon, Sarah Romans and Paul Grootendorst. The above is a partially modified reproduction of their research. Also their references have been omitted for ease of reading.

Reference:
Bennett HA, Boon HS, Romans SE, Grootendorst P. Becoming the best mom that I can: women's experiences of managing depression during pregnancy – a qualitative study. BMC Women's Health 2007, 7:13 (11 September 2007). © 2007 Bennett et al., licensee BioMed Central Ltd.
This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0

Related articles:
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Depression During Pregnancy – Part 2
Women With Depression During Pregnancy – Part 3
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Pregnancy and Depression Seeking Support – Part 5
Dealing With Depression During Pregnancy – Part 6

The Atkins Low Carbohydrate Diet: Does It Work?

The Atkins low carbohydrate diet is the diet that promotes weight loss through the consumption of foods low in carbohydrates and quite high in fat and protein contents, but not necessarily low in calories.

It was the brain-child of Dr. R. C. Atkins who claimed that it would initiate a greater weight loss than a conventional, low calorie diet composed of a "balance" of carbohydrates, fats, and proteins.

In addition, it was supposed to be friendly to those prone to diabetes because of the low intake of carbohydrate; it might reduce the body's need for insulin.


The Atkins diet concept is diametrically opposed to that used for years by traditional nutritionists and medical specialists.

Our initial response to the Atkins diet was that it might not be safe because years of scientific evidence suggested that high fat intake would surely raise blood cholesterol, thus increasing the risk of cardiovascular disease.

What ensued were numerous heated debates in print and on television about the worthiness of this diet.

Unfortunately, most of the battle lines were drawn on shaky grounds because they were based on age-old dogma, and lacked serious scientific inquiry.

Fortunately, this was about to change. Some results of very important research are now beginning to appear in the scientific literature. Hopefully, this new information will eventually determine unequivocally which side is right.

One of these studies was reported in the New England Journal of Medicine in 2003. The investigators' aim was to conduct a controlled experiment to determine the differences in weight loss of both obese men and women who consumed either the basic low carbohydrate Atkins diet or a conventional diet of reduced total calories. The study lasted for one year.

Besides weight loss, a number of other tests also were conducted, including blood sugar, blood cholesterol, HDL cholesterol (the good cholesterol), insulin levels, and blood pressure.

The results were interesting and different than most traditional nutritionists would have expected.

As Dr. Atkins had claimed all along, after 3 months, the volunteers who ate the Atkins diet lost 7-10% of their original body weight while those who ate the conventional low-calorie diet only lost 3-5% of their original weight.

After 6 months, the results were similar to those at 3 months; however, after one year, those on the Atkins diet had regained enough weight so that differences in weight loss between the two diets were not significant.

Another interesting result supported the view of the traditional nutritionists in that total serum cholesterol was increased about 3% while those fed the conventional diet had reduced their cholesterol about 5%.

However, the "good" cholesterol was increased about 20% in those consuming the Atkins diet but only about 3% in those consuming the conventional diet.

Neither diet affected blood sugar, blood pressure, or insulin levels, although the insulin levels of those consuming the Atkins diet tended to be lower than of those consuming the low calorie conventional diet.

The final results of the study suggested that volunteers who consume the Atkins diet may initially lose weight faster than those consuming the conventional diet, but after a long period of consuming the diets, the differences may be lost.

The investigators suggested that a longer and larger study be carried out before conclusive assessments are made about the benefits or dangers of consuming low-carbohydrate, high-fat, and high-protein diets.

Another interesting study appeared recently in the journal Perception and Motor Skills.

This group studied the effects of the Atkins diet on the response of volunteers to acute physical exercise.

Although this study was only 3 weeks long, the results strongly supported the hypothesis that individuals who consume the Atkins-type diet will experience more fatigue, more negative and less positive effects of exercise than those consuming the more conventional low-calorie diet.

However, humans are amazingly adaptable, and it would be interesting to see if they would overcome these negative effects after having consumed the diet for a much longer period. However, it's also possible that the effects could become even more detrimental.

Although these types of studies provide important scientific information to help the consumer make decisions about food consumption, the power of myth is strong.

Most of us believe what we want to believe, and most of us need a crutch or gimmick to get us through life, whether that gimmick is proven or not.

As most non-conventional diets, the Atkins diet started out as a gimmick, and as a result, numerous individuals have tried it, or are currently using it.

One estimate is that over 10 million copies of the book have been sold and that four times more people have read about the Atkins diet than any other.

We can only hope that further scientific experimentation can tell us whether this type of diet is indeed worthwhile or worthless.

Reference:
U.S. Department of Agriculture, Agricultural Research Service.

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Alcohol’s Effect on Heart Disease Risk

Alcohol’s Effect on Heart Disease Risk - Frequency of Light-to-Moderate Drinking Reduces Heart Disease Risk in Men.

A 12-year study of 38,077 male health professionals found that men who drank alcohol three or more days per week had a reduced risk of heart attack compared with men who drank less frequently. Men who drank less than one drink a day had similar risk reduction to those who drank three.

Many epidemiologic (population) studies have reported that moderate drinking — for men two drinks a day — is associated with a reduced risk of heart disease.

This study looked at the relationship between quantity and frequency and found that it was the frequency of drinking — not the amount, the type of alcohol, or whether or not it was consumed with a meal — that was the key factor in lowered heart disease risk.

Compared with men who drank less than once a week, men who consumed alcohol three or four days a week had approximately 2/3 (68 percent) the risk of heart attack, and men who consumed alcohol five to seven days per week had slightly less (63 percent) the risk. Study data suggested no additional cardiac benefit to drinking more than 2 drinks a day.

Also, the study authors point out that the small number of study participants who drank roughly three and a half or more drinks (50 or more grams of alcohol) per day limited their ability to study the harmful effects of heavy drinking. However, heavy drinking has well documented adverse health effects.

The study, published in this week’s New England Journal of Medicine, was based on an analysis of data from the Health Professionals Follow-up Study, which has followed a population of male dentists, veterinarians, optometrists, osteopathic physicians, and podiatrists, ages 40 to 75, for 12 years.

Kenneth J. Mukamal, M.D., M.P.H., at Beth Israel Deaconess Medical Center, was lead author for the project, which included scientists from the University of Sydney, Sydney, Australia; the Harvard School of Public Health, Boston; Brigham and Women’s Hospital, Harvard Medical School, Boston; and the Massachusetts General Hospital, Boston. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Heart, Lung, and Blood Institute (NHLBI), and the National Cancer Institute, all components of the federal government’s National Institutes of Health, supported the study.

NIAAA director Ting-Kai Li, M.D., said, "This rigorously conducted observational study adds to the epidemiologic evidence of a strong association between light-to-moderate alcohol consumption and reduced risk of heart disease. Only by research on the mechanisms of alcohol’s effects on the cardiovascular system, and perhaps the liver, and the genetic background of how individuals respond to alcohol, will we provide a scientifically informed means for assessing the risks and benefits of alcohol use on a person-to-person basis."

NHLBI director Claude Lenfant, M.D., said, "There are well-proven ways to prevent cardiovascular disease and reduce its risks, including lowering cholesterol levels and blood pressure, maintaining a healthy weight, being physically active, and stopping smoking. These preventive measures do not have the risks associated with alcohol consumption. Therefore, we do not advise the public to begin drinking alcohol to prevent heart disease. However, those who already drink alcohol should be aware that current evidence suggests that moderate drinking may reduce the risk of heart disease in some individuals."

At entry into this study, all participants had to be free of heart disease. Participants in the study completed questionnaires on diet every four years. Investigators confirmed the validity of the questionnaire responses by comparing them with seven-day dietary records in 127 participants.

The investigators controlled for numerous health and dietary factors, including smoking, exercise, diet, and family history of premature heart attack. Also, because alcohol use changes over time, and the effects of alcohol may be short-term, the study tracked the effect of recent versus baseline alcohol consumption, and found that the level of risk was more strongly related to recent, rather than past, consumption.

By the end of the 12-year follow-up, the investigators had documented 1,418 heart attacks. Men who consumed alcohol three or more times a week had a reduced risk of fatal or nonfatal heart attack, even when the amount consumed was only 10 grams of alcohol a day or less. A standard drink — a 12-ounce bottle of beer, a 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits — has between 11 and 14 grams of alcohol. Dr. Mukamal, the study’s lead author, said, "We found little difference among different alcoholic beverage types in our study. This further emphasizes the role of frequent intake, rather than any specific beverage type, in the link between moderate drinking and heart attack risk."

In an accompanying editorial, Ira J. Goldberg, M.D., of the Columbia University College of Physicians and Surgeons, New York, points out that some studies show a reduction in cardiovascular disease, but not overall mortality, in patients who drink alcoholic beverages (this study did not report on overall mortality). He notes that alcohol has toxic effects that are well established and that additional research is needed to inform physicians on how to advise their patients.

The paper, "Roles of Drinking Pattern and Type of Alcohol Consumed in Coronary Heart Disease in Men," appears in the January 9, 2003 issue of The New England Journal of Medicine 348(2): 109-118. An accompanying editorial appears on pages 163-164.

The Dietary Guidelines for Americans, issued jointly by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services, defines moderate drinking for men as no more than 2 drinks per day. The Guidelines can be viewed on-line at the website http://www.nutrition.gov.

Reference: NHLBI National Heart, Lung, and Blood Institute and NIAAA.

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Diabetes Health News 16 May 2008

Not All Fat Created Equal
It has long been known that type 2 diabetes is linked to obesity, particularly fat inside the belly. Now, researchers at the Joslin Diabetes Center have found that fat from other areas of the body can actually reduce insulin resistance and improve insulin sensitivity.

In a study published in the May issue of Cell Metabolism, a team lead by C. Ronald Kahn, M.D. found that subcutaneous fat -- fat found below the skin, usually in the hips and thighs -- is associated with reduced insulin levels and improved insulin sensitivity.



Understanding Red Wine's Potential Benefit For Diabetes
New research suggests that resveratrol, a chemical commonly found in red wine, has the ability to lower blood sugar levels, but might have certain untoward side effects. This research will be presented at the American Association of Clinical Endocrinologists (AACE) 17th Annual Meeting & Clinical Congress by Kimberly Martin, MD, and mentor, Dr. F. Ismail-Beigi, on Friday, May 16th, at the Walt Disney World Dolphin Resort in Orlando.

Resveratrol is a naturally occurring chemical found in grapes that has been reported to have cardioprotective, anti-inflammatory, anti-viral, and glucose-lowering properties. The effect of resveratrol on lowering blood glucose in diabetic rats has been reported by several investigators in the past.



High Beta-Glucan Barley Helps Manage Diabetes And Heart Health
Governor Brian Schweitzer appeared at Montana State University to celebrate Montana's scientific contribution to the development of barley varieties that serve as a natural way to help manage diabetes, heart disease and obesity.

The Governor congratulated MSU-trained researchers for their development of BGLife™ Barley, a new strain of barley that promotes healthy blood sugar, is proven to reduce cholesterol, promotes healthy blood pressure and helps control weight, all conditions associated with diabetes and heart disease. These patented barley varieties are the result of almost 30 years of agricultural research.



Diabetes And Alzheimer's Disease Linked By Salk Institute Study
Diabetic individuals have a significantly higher risk of developing Alzheimer's disease but the molecular connection between the two remains unexplained. Now, researchers at the Salk Institute for Biological Studies identified the probable molecular basis for the diabetes - Alzheimer's interaction.

In a study published in the current online issue of Neurobiology of Aging, investigators led by David R. Schubert, Ph.D., professor in the Cellular Neurobiology Laboratory, report that the blood vessels in the brain of young diabetic mice are damaged by the interaction of elevated blood glucose levels characteristic of diabetes and low levels of beta amyloid, a peptide that clumps to form the senile plaques that riddle the brains of Alzheimer's patients.



New Study Finds California Neighborhoods "Designed For Disease"
Californians face an added challenge as they battle expanding waistlines and obesity-related diseases - their address. A landmark study released shows the state's first direct correlation between where you live and your risk for obesity or diabetes.

The groundbreaking study, Designed for Disease: the Link Between Local Food Environments and Obesity and Diabetes, examines the correlation between the health of nearly 40,000 Californians and the mix of retail food outlets near their homes. The key finding: people living in neighborhoods crowded with fast-food and convenience stores but relatively few grocery or produce outlets are at significantly higher risk of suffering from obesity and diabetes.


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Causes of Memory Loss – Low Folate Levels

High homocysteine levels and low folate levels cause memory loss. The B vitamin folate may help reduce memory loss according to data from a recent nationwide health and nutrition survey, NHANES III.

Researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, Mass., were looking for a relationship between blood homocysteine levels and memory loss.

Earlier, their research had established that homocysteine levels were higher in elderly people with low intakes of B vitamins, especially folate.

They had also validated reports that homocysteine - a byproduct of our own amino acid metabolism - increases risk of stroke, which is a major player in the loss of cognitive function.

But they wanted to see if high homocysteine levels or low B vitamin status had a more subtle influence in memory loss among people over age 60.

That’s because B vitamins are involved in the synthesis of chemicals crucial to brain function, according to nutritional epidemiologist Martha Morris, who led the study. Or, homocysteine itself might be toxic to nerve cells.

Morris collaborated with Paul Jacques, Irwin Rosenberg and Jacob Selhub at the Boston center, which is funded by the Agricultural Research Service, USDA’s chief scientific research agency.

Luckily, the NHANES III included a sensitive test of recall after a short delay, one that can identify individuals with a milder loss of recall.

Others had reported that homocysteine was related to Alzheimer’s disease, as well as to poor cognitive function in elderly both with and without dementia.

Perhaps 75 percent of dementia is due to stroke or Alzheimer’s disease, which is now thought to develop from minor strokes. So the researchers excluded data from people who had suffered a stroke.

Their analysis showed elevated homocysteine levels were associated with memory loss. But the survey subjects whose blood folate levels were in the upper half appeared to be protected from memory loss even if their homocysteine levels were high.

Reference:
Judy McBride, USDA, Agricultural Research Service.

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ADHD Stimulant Medications - Heart Attack, Strokes and Mental Problems

ADHD Stimulant medications increase stroke and heart attack risks and risks of adverse mental symptoms. On February 21, 2007, the FDA directed the manufacturers of all ADHD stimulant medications approved for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) to develop Patient Medication Guides to alert patients to possible cardiovascular risks and risks of adverse psychiatric symptoms associated with the medicines, and to advise them of precautions that can be taken.

An FDA review of reports of serious cardiovascular adverse events in patients taking usual doses of ADHD products revealed reports of sudden death in patients with underlying serious heart problems or defects, and reports of stroke and heart attack in adults with certain risk factors.

Another FDA review of ADHD medicines revealed a slight increased risk (about 1 per 1,000) for drug-related psychiatric adverse events, such as hearing voices, becoming suspicious for no reason, or becoming manic, even in patients who did not have previous psychiatric problems.

The FDA recommends that children, adolescents, or adults who are being considered for treatment with ADHD drug products work with their physician or other health care professional to develop a treatment plan that includes a careful health history and evaluation of current status, particularly for cardiovascular and psychiatric problems (including assessment for a family history of such problems).

As part of the Agency’s ongoing regulatory activity, in May 2006 the FDA directed manufacturers of these products to revise product labeling for doctors to reflect concerns about adverse cardiovascular and psychiatric events.

These changes were based on recommendations from the FDA Pediatric Advisory Committee and the Drug Safety and Risk Management Advisory Committee. To help patients understand these risks, an additional part of this revised labeling process is the creation of a Patient Medication Guide for each individual product.

The medicines that are the focus of the revised labeling and new Patient Medication Guides include the following 15 products:

• Adderall (mixed salts of a single entity amphetamine product) Tablets

• Adderall XR (mixed salts of a single entity amphetamine product) Extended-Release Capsules

• Concerta (methylphenidate hydrochloride) Extended-Release Tablets

• Daytrana (methylphenidate) Transdermal System

• Desoxyn (methamphetamine HCl) Tablets

• Dexedrine (dextroamphetamine sulfate) Spansule Capsules and Tablets

• Focalin (dexmethylphenidate hydrochloride) Tablets

• Focalin XR (dexmethylphenidate hydrochloride) Extended-Release Capsules

• Metadate CD (methylphenidate hydrochloride) Extended-Release Capsules

• Methylin (methylphenidate hydrochloride) Oral Solution

• Methylin (methylphenidate hydrochloride) Chewable Tablets

• Ritalin (methylphenidate hydrochloride) Tablets

• Ritalin SR (methylphenidate hydrochloride) Sustained-Release Tablets

• Ritalin LA (methylphenidate hydrochloride) Extended-Release Capsules

• Strattera (atomoxetine HCl) Capsules

Reference:
FDA News - ADHD Medications and Cardiovascular, Psychiatric Adverse Events - Accessed 1 March 2008.

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