In a study published in March this year in JAMA Psychiatry, 1,396 of 10,000 mothers screened positively for postpartum depression on the Edinburgh Postnatal Depression Scale (EPDS). This study sponsored by the publicly funded National Institute of Mental Health in the US shows that depression after childbirth is a significant problem. Unfortunately, postpartum depression remains underidentified and undertreated. Some of the following are common myths about Postpartum Depression.
Postpartum Depression (PPD) is the same as baby blues.
Unlike baby blues that goes away after a few days, postpartum depression lasts for weeks to months. The symptoms of PPD is the same as for a Major Depressive Episode.
PDD is normal and ok to be sad after having a baby.
Whilst changes in mood may be normal after birth, if they are prolonged or are affecting your ability to care for your child, you should seek medical attention. If left treated, PDD can lead to:
1) Inconsistent and poor childcare
2) Avoidant or venting type of coping strategies with child
3) Insecure attachment between mother and child (may result in anxiety and depression of the child in later life)
4) Risk and danger if mother becomes agitated or suicidal with depression
PDD occurs right after birth.
It can occur right after birth or even up to a year later. Most of the time it occurs within three months.
Treatment for PDD will prevent me from breastfeeding and harm my baby.
Effective treatment is available for PDD. Antidepressants safe for pregnancy can be used to treat PDD after the risks and benefits have been discussed. Psychological therapy with techniques such as CBT is also useful.
It is unfortunate that PDD often goes unrecognised leading to tragedies such as these. Seek help today as PDD can be treated!
Monday, 13 May 2013
Wednesday, 10 April 2013
The Myths About Antidepressants
Antidepressants are the mainstay of treatment for clinical depression and anxiety disorders. These medications are effective and safe for the general population. However, many remain skeptical about antidepressant treatment and many myths remains.
1. I will become reliant on antidepressants and be addicted.
This is one of the main concern that my patients have when they have to be started on an antidepressant medication. It is important to realise that unlike sleeping pills, it is not possible to be addicted to antidepressants. Antidepressants do not cause tolerance or cravings like street drugs do. The fact that there are no street values with antidepressants attest to the fact that they are not addictive. However, if a patient is on high doses of antidepressants for a long time, it is best for him or her to seek the advice of the psychiatrist and not stop medication abruptly as this can cause "discontinuation syndrome". Discontinuation syndrome can lead to physical discomfort and can be completely avoided by weaning off the medication slowly in a few weeks.
2. My condition will become worse that when it started if I stop the medications.
Your condition will not worsen or rebound simply because you stop your medication. Antidepressants treats your depression or anxiety and also protects you from future episodes. If you stop the medication, it is like you taking off your armour. You will be vulnerable to depression or anxiety again.
3. Antidepressants have terrible side effects.
Newer classes of antidepressants like SSRIs are currently the mainstay of treatment. Unlike older antidepressants, these newer medications are well tolerated. At times, side effects can still occur to the minority of people. Known side effects include weight gain, sedation and rarely sexual dysfunction. These side effects are reversible and if any these side effects arises, you must inform your doctor who will switch you to another medication.
4. My brain will be affected by the medications!
Sometimes patients worry that they will be "changed" by the medications and their brain will become different. Antidepressants normalises the neurotransmitters in your brain and this in turn makes your mood normal again. Antidepressants are not "happy"pills. They help by making you cope better so that you can solve the problems you have in life and it is up to you to find new meaning and happiness.
5. I'll have to take medications forever!
Many patients are afraid that once they are on medications, they cannot come off it. Majority of patients will become better once they have been treated and will come off medications. Some patients who have multiple episodes of mood or anxiety problems and may decide to stay on the medications long term. Your doctor will discuss with you the pros and cons of taking medications and how long you will require them. Ultimately, you have the choice of whether to take medications and the choice to stop them.
1. I will become reliant on antidepressants and be addicted.
This is one of the main concern that my patients have when they have to be started on an antidepressant medication. It is important to realise that unlike sleeping pills, it is not possible to be addicted to antidepressants. Antidepressants do not cause tolerance or cravings like street drugs do. The fact that there are no street values with antidepressants attest to the fact that they are not addictive. However, if a patient is on high doses of antidepressants for a long time, it is best for him or her to seek the advice of the psychiatrist and not stop medication abruptly as this can cause "discontinuation syndrome". Discontinuation syndrome can lead to physical discomfort and can be completely avoided by weaning off the medication slowly in a few weeks.
2. My condition will become worse that when it started if I stop the medications.
Your condition will not worsen or rebound simply because you stop your medication. Antidepressants treats your depression or anxiety and also protects you from future episodes. If you stop the medication, it is like you taking off your armour. You will be vulnerable to depression or anxiety again.
3. Antidepressants have terrible side effects.
Newer classes of antidepressants like SSRIs are currently the mainstay of treatment. Unlike older antidepressants, these newer medications are well tolerated. At times, side effects can still occur to the minority of people. Known side effects include weight gain, sedation and rarely sexual dysfunction. These side effects are reversible and if any these side effects arises, you must inform your doctor who will switch you to another medication.
4. My brain will be affected by the medications!
Sometimes patients worry that they will be "changed" by the medications and their brain will become different. Antidepressants normalises the neurotransmitters in your brain and this in turn makes your mood normal again. Antidepressants are not "happy"pills. They help by making you cope better so that you can solve the problems you have in life and it is up to you to find new meaning and happiness.
5. I'll have to take medications forever!
Many patients are afraid that once they are on medications, they cannot come off it. Majority of patients will become better once they have been treated and will come off medications. Some patients who have multiple episodes of mood or anxiety problems and may decide to stay on the medications long term. Your doctor will discuss with you the pros and cons of taking medications and how long you will require them. Ultimately, you have the choice of whether to take medications and the choice to stop them.
Friday, 22 March 2013
ADHD Increases Risk of Mental Illness in Adulthood
A 20 year long study conducted by Mayo Clinic published recently showed that not only did symptoms of ADHD persist into adulthood, children with ADHD were also much more likely to be diagnosed with other psychiatric illnesses as adults.
In this study, the researchers followed a cohort of 5718 children born between 1976 and 1982. Within the cohort, 367 were diagnosed with ADHD and 75% received treatment for ADHD as children. 29.3% of the children with ADHD were later found to still have the disorder in adulthood and within this group of children, 81% had at least one other psychiatric condition. The concomitant conditions they had included major depression, generalized anxiety, hypomanic episodes, substance abuse and antisocial personality disorder. Also 57% of all children with ADHD had another psychiatric disorder as adults compared to 35% in the control group. The study also showed that suicide rate amongst ADHD children was five times higher than those without the disorder.
These data are no doubt disturbing and brings to the table stronger evidence to what doctors and psychiatrists have long suspected and observed anecdotally about ADHD. The evidences indicate that ADHD is an illness with serious consequences, morbidity and mortality. Starting treatment young will help the children cope with the hyperactive, inattentive and impulsive symptoms, preventing the eventual pathways leading to other serious mental illnesses, personality disorders and suicide. Treatment into adulthood is often necessary and doctors must be vigilant in assessing and picking up co-morbid psychiatric illnesses.
ADHD is by far the most common neuro-developmental condition in children. It should not be trivialised and ignored as it progresses into long term difficulties for the individual. Seek help today!
In this study, the researchers followed a cohort of 5718 children born between 1976 and 1982. Within the cohort, 367 were diagnosed with ADHD and 75% received treatment for ADHD as children. 29.3% of the children with ADHD were later found to still have the disorder in adulthood and within this group of children, 81% had at least one other psychiatric condition. The concomitant conditions they had included major depression, generalized anxiety, hypomanic episodes, substance abuse and antisocial personality disorder. Also 57% of all children with ADHD had another psychiatric disorder as adults compared to 35% in the control group. The study also showed that suicide rate amongst ADHD children was five times higher than those without the disorder.
These data are no doubt disturbing and brings to the table stronger evidence to what doctors and psychiatrists have long suspected and observed anecdotally about ADHD. The evidences indicate that ADHD is an illness with serious consequences, morbidity and mortality. Starting treatment young will help the children cope with the hyperactive, inattentive and impulsive symptoms, preventing the eventual pathways leading to other serious mental illnesses, personality disorders and suicide. Treatment into adulthood is often necessary and doctors must be vigilant in assessing and picking up co-morbid psychiatric illnesses.
ADHD is by far the most common neuro-developmental condition in children. It should not be trivialised and ignored as it progresses into long term difficulties for the individual. Seek help today!
Monday, 11 March 2013
The Top Five Regrets of the Dying
Bronnie Ware is a palliative nurse who has been seeing dying patients. From her experience, she observed five common themes that often resurfaced with regards to the regrets of people who were dying.
1. I wish I'd had the courage to live a life true to myself, not the life others expected of me.
2. I wish I didn't work so hard.
3. I wish I'd had the courage to express my feelings.
4. I wish I had stayed in touch with my friends.
5. I wish that I had let myself be happier.
In essence, the dying often wished that they have lead a more meaningful and fulfilling life. That they have been more true to themselves and in touch of their feelings. They wished they had spent more time with family, friends and with the things they like to do instead of just their work. Such reflections are not new. Kubler Ross in her work about the grief of dying had often alluded to these.
Sadly, our society continues to overemphasize academic and occupational achievements. Family and other social aspects of life are often neglected.
If your time is ending, will you have any regrets?
1. I wish I'd had the courage to live a life true to myself, not the life others expected of me.
2. I wish I didn't work so hard.
3. I wish I'd had the courage to express my feelings.
4. I wish I had stayed in touch with my friends.
5. I wish that I had let myself be happier.
In essence, the dying often wished that they have lead a more meaningful and fulfilling life. That they have been more true to themselves and in touch of their feelings. They wished they had spent more time with family, friends and with the things they like to do instead of just their work. Such reflections are not new. Kubler Ross in her work about the grief of dying had often alluded to these.
Sadly, our society continues to overemphasize academic and occupational achievements. Family and other social aspects of life are often neglected.
If your time is ending, will you have any regrets?
Sunday, 3 February 2013
How to Prevent a Relapse of Bipolar Disorder
Read my article on how to prevent a Bipolar Disorder relapse. Click here.
You can read about symptoms of Bipolar Disorder by following this link.
You can read about symptoms of Bipolar Disorder by following this link.
Tuesday, 29 January 2013
Can Changes in Diet Improve ADHD Symptoms?
Parents often ask me if certain food may make the ADHD symptoms of their children worse. One of the purported culprit is sugar and the "sugar rush" phenomenon is well known. Despite a lack of studies to support these claims, anecdotal reports are aplenty.
In this news article a mother reports success with diet changes such as adding vitamins and omega 3's, avoiding addatives- red dyes in particular and skipping the simple processed sugars.
Read about symptoms of ADHD here.
Read about symptoms of ADHD here.
Wednesday, 9 January 2013
Most adolescent suicidal behavior preceded by mental health treatment
A recent research(1) showed that the lifetime prevalence of suicide ideation among adolescents was 12.1%,
suicide plans 4%, and suicide attempts 4.1%. One-third of adolescents
with suicidal ideation went
on to develop a suicide plan and 33.9% made an attempt. Most
adolescents (88.4%) who transitioned from planning suicide to attempting
suicide did so within a year.
Most adolescents who had suicidal ideation (89.3%) and attempted suicide (96.1%) met lifetime criteria for at least one DSM-IV mental disorder, which included major depressive disorder, specific phobia, oppositional defiant disorder, substance abuse, intermittent explosive disorder and conduct disorder. Most disorders significantly predicted suicidal behaviors, and the prevalence of mental disorders generally increased with the increasing severity of suicidal behaviors.
From this study, we can see that it is important to identify and provide early treatment for these troubled youths. Unlike physical illnesses, parents tend to ignore mental health issues and to believe that such problems will go away by themselves. Otherwise, they may feel that seeking help from a mental health professional is too stigmatising and may do more harm to their children.
Such ignorance, often lead to delay in seeking treatment and may result in the youths and parents defaulting follow-ups. Today, suicidal behaviors are among the leading causes of death in Singapore and worldwide, especially among adolescents and young adults. Seek help early and contact a psychiatric clinic in Singapore.
(1) Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents Results From the National Comorbidity Survey Replication Adolescent Supplement
Matthew K. Nock, PhD; Jennifer Greif Green, PhD; Irving Hwang, MA; Katie A. McLaughlin, PhD; Nancy A. Sampson, BA; Alan M. Zaslavsky, PhD; Ronald C. Kessler, PhD
JAMA Psychiatry. 2013;():1-11. doi:10.1001/2013.jamapsychiatry.55
Most adolescents who had suicidal ideation (89.3%) and attempted suicide (96.1%) met lifetime criteria for at least one DSM-IV mental disorder, which included major depressive disorder, specific phobia, oppositional defiant disorder, substance abuse, intermittent explosive disorder and conduct disorder. Most disorders significantly predicted suicidal behaviors, and the prevalence of mental disorders generally increased with the increasing severity of suicidal behaviors.
From this study, we can see that it is important to identify and provide early treatment for these troubled youths. Unlike physical illnesses, parents tend to ignore mental health issues and to believe that such problems will go away by themselves. Otherwise, they may feel that seeking help from a mental health professional is too stigmatising and may do more harm to their children.
Such ignorance, often lead to delay in seeking treatment and may result in the youths and parents defaulting follow-ups. Today, suicidal behaviors are among the leading causes of death in Singapore and worldwide, especially among adolescents and young adults. Seek help early and contact a psychiatric clinic in Singapore.
(1) Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents Results From the National Comorbidity Survey Replication Adolescent Supplement
Matthew K. Nock, PhD; Jennifer Greif Green, PhD; Irving Hwang, MA; Katie A. McLaughlin, PhD; Nancy A. Sampson, BA; Alan M. Zaslavsky, PhD; Ronald C. Kessler, PhD
JAMA Psychiatry. 2013;():1-11. doi:10.1001/2013.jamapsychiatry.55
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