Photo: Stuart Miles, FreeDigitalPhotos.net
Talking about depression brings up fear in many of us. That’s a little odd, given the statistics: In the United States, 11 percent of all people 12 years old and up take antidepressant medication.
The U.S. Centers for Disease Control’s National Center for Health Statistics has continually tracked health conditions using the National Health and Nutrition Examination Surveys (NHANES). The 2011 NHANES report says that antidepressant use in the U.S. increased 400% among all age groups from the late 1980′s through the mid 2000′s.
Common but confusing
Taking antidepressant medication is no longer unusual or reserved for only the most severely clinically depressed. As pointed out by Peter Wehrwein, Editor of the Harvard Health Letter, “23 percent of women in their 40s and 50s take antidepressants, a higher percentage than any other group (by age or sex).”
But if you bring up the topic of depression treatment among a group of people who are on their fertility journey — whether that’s trying to conceive, already pregnant, or in their post-partum period — you’ll hear a lot of confusion in response.
Overheard in a recent thread online about the topic of using antidepressants while trying to conceive: “I’d never take that toxic garbage if I were pregnant!”
It’s obviously an emotional topic.
But complex issues are rarely handled well in black-or-white terms. One young mother, Ellen Cooper-Davis, remembers a whirlpool of emotions during her planned pregnancies. She’d been diagnosed years before with severe depression and had successfully achieved emotional well-being with the help of antidepressants. But she knew about the lack of comprehensive studies on effects during pregnancy. So besides the usual maternal concerns, she recalls feeling “adrift, unsure, and angry” at the inadequate science behind antidepressant use during pregnancy. Cooper-Davis, whose personal story will be in a following blog post here on PureNaturalMom.com, also says she felt shame about her confusion: “Here I am, a new mother, and I’m supposed to be happy and doting!”
The confusion, fueled by fear of the unknown, is understandable.
Women especially at risk
Dr. Jennifer Boisture is a specialist in women’s wellness. She’s one of a few practitioners in the specific arena called reproductive psychiatry, focusing on the special needs of women throughout their fertility journey, from preconception planning and beyond. She says, fortunately, times have changed in terms of approach. “These days, most practitioners recognize depression as a complex, multifactorial disease process.”
In an analysis of data from the CDC’s 2006 Behavioral RIsk Factor Surveillance System, the lifetime prevalence (the number of people meeting criteria for depression at some point in their life) of depression in adult women in the United States was found to be 20 percent.
Dr. Boisture says the same study by the CDC showed the prevalence of depression in American women is almost twice that of men. Some of this is biological — there’s something about female physiology making women more prone to depression.
But she adds:
In my opinion, part of this difference likely is attributable to stress resulting from the multiple roles modern women have to juggle — motherhood, money earner, romantic partner, caregiver to aging parents, friend. The list goes on and on. The darker side of the concept of work-life balance is the idea that it’s even possible to simultaneously be all of these at once.
Barriers to getting help
In spite of its common occurrence, there are barriers to accurate diagnosis and effective treatment of depression. Dr. Boisture describes a recent study’s findings: “Many people do not report depressive symptoms to their doctor at all, for reasons varying from fear of a referral to a psychiatrist or a recommendation to take medication to the idea that their symptoms are normal.”
She says another big problem is that most of us seek treatment from primary care physicians, most of whom don’t have the time necessary to conduct adequate patient histories or to follow up on treatment plans to gauge how a patient’s depression is responding.
Dr. Boisture concurs that stigma is still a tremendous barrier for many:
Almost every day in my practice, I hear a patient say some version of, ‘I don’t know why I can’t just get over this.’ I often liken depression to other chronic medical problems, like hypertension or diabetes; and I advise patients who tell themselves they should ‘just be able to get over’ their depression is like telling themselves they should just stop having high blood pressure or being diabetic. It’s not that simple.
When it comes to depression and its treatment, that lack of simplicity is possibly the only thing everyone agrees on.
About Tracy Morris
I wear a lot of hats while spinning plates and true stories. In between taking care of myself and my family, I write about fertility and other health care topics. Most of my online time lately is spent at two very different places: FertilityTies.com and TrailerParkKarma.com. Perspective is everything -- my pre-teen reminds me daily.
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