Stick to the Movies, Tom

When film star Brooke Shield's story of her postpartum depression was revealed in her book Down Came the Rain last year, many hoped the world would take note and realize that such a reaction was not a myth, but a very real affliction suffered by women.

Then along came Mr. "I-Know-Everything-About-Everything" — the actor Tom Cruise — displaying his vast knowledge of religion, Ritalin, psychiatry, even what he called the ridiculous use of medications to treat postpartum depression.

Finally, however, Cruise decided to express regret for berating Shields for using medications to help tame her depression. He was wrong, he suggested. (And if he got his comeuppance with the news last week that Paramount Pictures was ending its longtime relationship with him, in part because of his earlier comments, so be it.)

It's about time, say local experts, regarding his apology.

"Postpartum depression is common and treatable, and not a myth at all. And having postpartum depression does not mean that you're not a good mother," says Sandra Wolf, M.D., of the department of OB/GYN at Drexel College of Medicine. "In fact, it is probably one of the most common complications of pregnancy, and occurs in just about 10 percent of women, meaning that close to 500,000 women will be affected by it."

Robert I. Michaelson, M.D., a surgeon in the department of OB/GYN at Abington Memorial Hospital, agrees: "Postpartum depression is a real disorder, not just something in a woman's mind. Unfortunately, expectations are that if a woman has a healthy baby, then she should be happy and fine, but that is, as we know, not always the case. Even with all that she can still exhibit all the symptoms of depression."

Women with postpartum depression may have a disturbance in sleep or eating habits. They may feel restless, anxious and sad. They may have feelings of guilt, decreased energy and a lack of motivation, as well as a sense of worthlessness.

Researchers aren't quite sure what causes postpartum depression, but believe that the dramatic shifts in hormone levels during pregnancy and immediately afterward may result in chemical changes in the brain leading to the condition.

"It's what we call multi-factorial," explains Wolf, "meaning there's not one thing that causes it. Since the hormones drop off so suddenly right after delivery, we've looked at that for years as a causative agent. We haven't been able to link any of those hormone changes specifically with postpartum, but we do know there's a genetic susceptibility to depression, and that along with any major life event — such as childbirth, and probably an association with some of the hormonal changes or at least a sensitivity to them — may explain why some women have postpartum depression and others don't."

But, says Michaelson, the good news is that postpartum depression is an illness that can be successfully treated with medicine and therapy, regardless of the musings of Tom Cruise.

"Women treated with antidepressants and talk therapy usually show marked improvement, and researchers are making strides in developing better medications to treat the illness by targeting the chemical pathways," he notes.

Additionally, says Michaelson, "we have to be on the lookout for it, and when we know certain of our patients are at risk, we have to be especially vigilant. There are also some screening tests that are available."

Indeed, at Drexel, Wolf — who is also medical director of the Ambulatory Unit, where residents see their patients — helps teach the residents what to look for when seeing pregnant women.

The Warning Signs
As she explains: "We teach them to look for certain risk factors, such as a previous bout with postpartum depression, and addressing that all through the pregnancy.

"We also discuss with them options for treatment, so that if they suspect that their patients might be at an increased risk for whatever reason — family stress, history of depression in the family, whatever — to know how to monitor the patient more closely. Or, in severe cases, to start the patient on medication right away."

The bottom line, the doctors agree, is that postpartum depression is common and treatable.

The best way to handle it? All say to have a health-care provider recommend medications, a therapist or support groups that can all help.

Concludes Wolf: "A good support system — from family, friends or a group — is critical in helping the woman become the mother she always hoped to be." 



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