Seventeen percent of Americans will experience at least one depressive episode during their lifetime, and women will be diagnosed with depression almost twice as often as men. Robin Kopelman, MD, Assistant Director of the Women's Wellness and Counseling Service at UI Hospitals and Clinics, talks about depression and the Women's Mental Health Service.
What is depression?
Depression is a mental health disorder or an illness that can affect the way you think, feel, and the way you function in your every day life.
What are the symptoms of depression?
There are a lot of symptoms of depression, the primary symptom being the feelings of sadness, hopelessness, or even irritability, sometimes superimposed with some anxiety, as well as difficulty in enjoying usual interests or activities. Some people might not complain about those mood difficulties though. Instead, they might notice some physical symptoms (like stomach upset, headache, muscle aches) and go to their doctors talking about those.
People also may notice feelings of worthlessness or have a lot of negative thoughts about themselves at that time. There are also a number of other changes that accompany depression. Those include changes in sleep, changes in appetite, energy, and also changes in concentration. Certainly the thing that we find most worrisome is when an individual is finding themselves wishing for death or thinking about suicide, which can be very common in individuals with depression.
How is depression diagnosed?
I really look forward to the day when we have a blood test for depression and I think lots of other physicians would agree with me. Right now we make that diagnosis based on the clinical interview. Basically, we determine how many symptoms of depression someone has and how impairing those symptoms are in her life. During that evaluation, it's important that we determine whether or not an individual might have a medical illness either causing or contributing to their symptoms.
Are there certain stages of life where depression is more common?
Yes, there are some stages where depression can be more common. It's certainly more common in younger populations and then again, it seems to be more common in older populations. It may not necessarily be more common at certain stages of life, such as the time during pregnancy and postpartum or menopause. (These are times when people think that there may be an increased risk.) But for certain individuals, that might be a time when they're at greater risk. That may be because of hormone changes—for example, the hormone changes that are associated during those times I just mentioned for women—or because of the transitions that those time periods represent. So, around child-bearing, the transition to becoming a parent, around menopause or later life stages for both men and women—that might be the transition to becoming a retired individual.
Can you describe depression during pregnancy and the postpartum?
Depression during pregnancy and the postpartum is a lot like depression at other times but it can be a little bit harder to distinguish, especially from the normal physical and emotional experiences that a lot of women have when they're pregnant or postpartum.
What we try to do is to distinguish between those changes—sleep being a really good example. When women are pregnant, they may not be sleeping well because they have to get up at night and urinate or they're uncomfortable at night, and we have to try and distinguish that from sleep changes or other changes due to depression. For example, is the woman actually unable to sleep because she's up worrying all night long? So depression is really common in pregnancy and after women have a baby for a few different reasons. We attribute a number of these to the factors like hormone changes that I also mentioned. But we know that there's a huge role for social changes, as well, including that transition to the new role, new responsibilities, or conflicts that might come up with partners over those responsibilities or other issues.
Do people with depression recognize the symptoms in themselves and seek treatment?
Unfortunately, people often don't recognize symptoms in themselves and, unfortunately, even when they do, sometimes those symptoms are not always recognized by their care providers. Sometimes they might be dismissed as due to something else—a good example being pregnancy or being a postpartum woman—but also they might be dismissed as just being due to their medical illness. So even when individuals or the providers recognize their symptoms, people don't always go for treatment either and that can be for a whole number of reasons. We certainly talk about stigma a lot, but there are certainly a number of other barriers to care including finances and time and just the way the mental health system is organized.
How is depression treated?
We do have a number of really good treatments for depression. Medication and either psychotherapy or counseling are really the mainstays, but those can sometimes be supplemented by lifestyle changes like regular exercise and engaging in activities that you like.
What do you need to consider when treating pregnant or postpartum women for depression?
When we're treating pregnant or postpartum women, especially postpartum women who are breastfeeding, we have to consider a number of things. Basically, our main goal is to maximize safety for the baby by minimizing exposure to medication but also minimizing exposure to the depression itself, because that can actually have a number of negative effects in pregnancy and then in infancy. Most of all, we try to take a woman's personal history, her treatment preferences and her partner's treatment preferences, and her ability to access different treatments into account.
How likely is it that once diagnosed with depression you will be treated for depression for the rest of your life?
When a person is diagnosed with major depression, they have about a 50 percent chance that they're going to have another episode in their lifetime. So, with the first episode, we usually treat people and then we try to take them back off of medication or they can leave counseling. And their risk continues to go up the more episodes they have, so we try to reduce the likelihood of that relapse through ongoing treatment with antidepressant medication or psychotherapy.
Do women who are diagnosed with postpartum depression have a better chance of their depression reoccurring with the birth of another child?
Yes actually, women who've had an episode of postpartum depression are at increased risk for other episodes of postpartum depression, specifically. Women might also be at increased risk for postpartum depression just the more children they have. Some people see it, I think at times, that this seems a little bit counter intuitive, this woman's an experienced mom and things should be easier. But especially for women who are sensitive to the hormone changes, they'll remain at increased risk.
With the opening of the new Women's Health Center, is there also a new area specifically for women's mental health?
Yes there is. We have been providing onsite mental health care in obstetrics and gynecology for almost four years now. But with the opening of the Women's Health Center, we're expanding our services—that service is called Women's Wellness and Counseling. And we have several excellent therapists and psychiatrists that can provide specialized mental health care to pregnant and postpartum women.
Are women referred to the Women's Mental Health Service area of OB/GYN or can they schedule an appointment on their own?
Right now we're only accepting referrals from care providers, so women should really talk with their women's health provider and decide together if she might benefit from a referral to our service. |
