Advertisement

Series: Is Motherhood Depressing?

Treating Depression: What Works?

Types of Depression

The National Institute of Mental Health defines three major forms of depressive illness:

1. Major depression - Also referred to as unipolar or clinical depression, major depressive episodes last at least two weeks. They may last for several months or longer and may occur several times over the lifetime.

2. Dysthymia - While milder and longer-lasting (at least two years), the symptoms of dysthymia are the same as those for major depression. People with dysthymia frequently lack zest and enthusiasm for life, living a joyless and fatigued existence that seems almost a natural outgrowth of their personalities. They can also experience major depressive episodes.

3. Manic-depression (or bipolar disorder) - This is a less common form of depression that involves cycles of depressive symptoms alternating with mani

Numerous studies find that a combination of medication and psychotherapy works best for treating severe depression, while psychotherapy alone may work just as well as medication for mild or moderate depression. Here's a look at your options in both cases:

Medication

Today, doctors have dozens of medications from which to choose. None is better than the other; everyone reacts to medications differently, and you may even find that a medication that's worked for you in the past suddenly stops working.


  • Selective serotonin reuptake inhibitors (SSRIs) - These include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). They work by blocking the brain's reuptake of serotonin, a neurotransmitter that helps regulate mood, sleep, eating and more. SSRIs allow serotonin to remain available to the brain. Side effects include loss of libido, nervousness, nausea, diarrhea and insomnia, most of which tend to disappear over time.
     
  • Tricyclics (TCAs) - Includes drugs like Elavil and Ludiomil. These drugs inhibit norepinephrine reuptake or both norepinephrine and serotonin reuptake. Side effects include fainting, weight gain and headaches.

  • Monoamine oxidase inhibitors (MAOI) - These drugs include phenelzine (Nardil), isocarboxazid (Marplan) and tranylcypromine (Parnate). These drugs inhibit the action of monoamine oxidase, an enzyme that breaks down brain chemicals like serotonin implicated in depression. Can produce life-threatening interactions with common foods like aged cheese.
     
  • Mixed reuptake inhibitors - Bupropion (Wellbutrin) and venlafaxine (Effexor), which regulate transmission of norepinephrine, dopamine and/or serotonin. Buproprion tends to have very few side effects, while venlafaxine's side effects include nausea, headaches and loss of libido.

  • 5-HT modulators - Nefazodone (Serzone) and trazodone (Desyrel). These drugs block receptors in the brain for the 5-HT enzyme, a precursor of serotonin. They have a low risk of side effects, but they may cause sudden drops in blood pressure upon standing, headaches and daytime drowsiness. In rare cases, nefazodone may cause liver damage.
     
  • Norepinephrine and 5-HT modulators: Mirtazapine (Remeron) - Blocks serotonin receptors and tends to relieve symptoms sooner than the SSRIs. Side effects include weight gain and daytime drowsiness.

Therapy

The two most common and best-researched types of therapy for depression are interpersonal therapy (IPT) and cognitive behavioral therapy (CBT).

  • Interpersonal therapy defines depression as a treatable mental illness that is not the patient's fault. It focuses on connections between current life events and the beginning of depression to help patients understand and overcome their depression, while also helping patients develop positive life events to counteract the negative cycle of depression.

  • Cognitive behavioral therapy helps people change the negative perceptions of the world that contribute to their depression.

 




Is Motherhood Depressing?

By Debra Gordon

It started with something as simple as the vacuum cleaner. It was Saturday, the day I enlisted my three sons, ages 4 to 13, to help clean the house. While I don't recall the exact details of that morning seven years ago, I do remember screaming at my oldest son because he didn't vacuum properly. I can still see the fear on the other boys' faces, and the disgust on the teenager's.

"You're out of control," he yelled back, as I continued my tirade. "You're nuts."

Actually, I was depressed. It was February during my first-ever northern winter, my husband had been traveling off and on for the past six months, and the combination of working full-time, parenting practically solo, and the day-after-day grayness, snow and icy cold proved too much. Despite the antidepressant medication I'd been taking for nine years, something tripped the tenuous balance of chemicals in my brain and the depression came crashing down.

I was first diagnosed with depression when my oldest child was 4. And while I would never blame my children for my depression, after living with this disease for 15 years I can now clearly see that - despite how wonderful they are - my children contribute to the stressors that tend to trigger my depressive episodes.

I'm hardly alone. A groundbreaking study published in late 2005 found that being a parent - whether mother or father - significantly increases your risk of depression, regardless of race or economic status. The findings add some fuel to previous studies that found that women in their childbearing years are especially vulnerable.

"In terms of depressive symptoms, parenthood is not good," says Robin Simon, Ph.D., of Florida State University, who, along with Ranae Evenson, Ph.D., of Vanderbilt University in Nashville, conducted the study. Yet, Simon notes, "We still have these cultural beliefs that parenthood is the key to lifelong happiness, and that having children will improve your well-being."

Simon and Evenson analyzed data from the federal government's National Survey of Families and Households, which involved interviews with 10,000 adults throughout the country in the late 1980s, with follow-ups through 2003. From the first wave of data, they found that it doesn't matter what type of parent you are - custodial, non-custodial, stepparent, adoptive or empty nester - you still have a significantly higher likelihood of being depressed than a similar childless adult. Their study was the first to compare emotional distress, a major determinant of depression, among parents vs. non-parents.

Simon is quick to point out that her study did not examine the positive side of parenting, like feelings of pride and joy. And she's aware of another study, still under review, that did find greater feelings of joy in parents than non-parents. "So," she says, "it's very possible that the costs and benefits of parenthood cancel each other out."

Whether that's the case or not, health experts are quick to point out that depression is a highly treatable illness, and once identified and treated, sufferers - and their children - often experience a huge improvement, and the joy of parenthood can once again be realized.




Women and Moms Harder Hit by Depression

Many of us associate motherhood and depression with the temporary state of postpartum depression that affects some new mothers during their baby's first year of life. But depression can hit mothers at any time, and women are most vulnerable to depression during their childbearing years.

Surprisingly, Simon and Evenson found no gender differences in their study; being a parent is just as likely to increase your risk of depression whether you're a mom or a dad. And because they specifically studied the stress parents were feeling, their findings also negate previous studies that have suggested parenting is more stressful for women.

Nevertheless, mothers continue to be more prone to depression - primarily because of their gender. Numerous studies find that not only are women twice as likely as men to be diagnosed with depression in the first place, they're most at risk during their childbearing years.

No one knows why women are more vulnerable to depression, or why that vulnerability is highest during childbearing years, but it's likely that stress has a lot to do with it - particularly the stress that comes from raising children.

"I have kids and I derive enormous satisfaction from them," Simon relates. "But I think it's a tough, tough job."

And it's gotten tougher. Today's parents are more likely to be socially isolated without extended families or friends to share the burden. They get less support from their kids because they tend to have fewer children and have them closer together.

Meanwhile, our expectations of our kids and of ourselves as parents have changed, and we're more involved in our children's lives these days.

"Today, if your kids aren't doing so well, you wonder what's wrong with you," Simon notes. All of these stressors could be contributing to the incidence of depression she found in her study.




Depression: The Innocent Victims

Depression in moms can lead to problems in their children, including anxiety, depression or disruptive behavior. But research has found that once the mother is treated, the rate of problems in her children drops significantly.

Depression has numerous implications for a woman's own health, including a significantly higher risk of suicide, heart disease and osteoporosis. But, not surprisingly, it can also seriously impact her children.

"If a mother is depressed, we know that half of her children will have some behavior problem," says Myrna Weissman, Ph.D., a psychiatry professor at Columbia University in New York City, who has studied the impact of a parent's depression on children. She has found that children of depressed mothers are two to three times more likely to have behavioral problems, anxiety or depression themselves than kids whose mothers are not depressed.

Certainly some of this is related to genetics, she says; but genes aren't the whole story.

"What's required to trigger these problems in kids is environmental stress," Weissman says. And having a depressed mother can be incredibly stressful to kids. "If you're depressed, you don't have energy, you feel hopeless and it's very hard to take care of children because they're very demanding."

It's also very hard to listen to your kids because you don't have much of an attention span, and you're more likely to be irritable and even lash out at your children.

In fact, the effect of a depressed mom on her children is so significant that it can even cause depression in infants, says Kathleen Kendall-Tackett, Ph.D., a research associate professor of psychology at the University of New Hampshire and author of Hidden Feelings of Motherhood: Coping with Mothering Stress, Depression and Burnout. That's because depressed mothers are not as responsive to their infant's cues, which is incredibly stressful to the baby. "Babies just shut down if they don't get a response," she says.

The depressed mother disengages from her older child just as she does from her infant, Kendall-Tackett adds. And when she does engage with them, that interaction is more likely to be angry and intrusive, which can sidetrack the relationship.

Depression in a parent can also result in children becoming caregivers. "The kids are forced to grow up and take care of the parent," she explains. "They're always trying to engage the parent and assess her mood. It puts kids in this parental role that isn't healthy."




Treat Yourself to Treat Your Kids

Depression in moms can lead to problems in their children, including anxiety, depression or disruptive behavior. But research has found that once the mother is treated, the rate of problems in her children drops significantly.

One of the best things a depressed woman can do to protect her kids is to get treatment for her depression. In a study that Weissman and her colleagues conducted as part of their longer-term research on depression, they found that once a mother's depression improved with treatment, her children's behavior and symptoms also significantly improved - with no treatment.

More than one-third of the children of depressed mothers in this study had a current psychiatric disorder - primarily anxiety, depressive or disruptive behavior disorders - and almost half had a past psychiatric disorder.

Once their mothers improved, however, the rate of psychiatric disorders in the children dropped 12 percent in three months, compared to a 6 percent increase in the rates of diagnosed disorders in children whose mothers didn't improve.

"At a time when there are many questions about the appropriate and safe treatment of psychiatric disorders in children, these findings suggest that it is important to provide vigorous treatment to mothers if they are depressed," Weissman and her colleagues noted.

Unfortunately, depressed women with children are less likely to seek treatment than depressed women without children. In her study, Weissman expected to see twice as many participating women with children as she did, given the rates of depression in this age group. Finding childcare, arranging transportation and even failing to recognize depression in themselves are all reasons mothers might not be getting the help they need, she says.

I didn't need Weissman or other researchers to tell me the potential effects of my depression. I could see it in my children's faces when I went into a rage, or was too tired or sad to do anything fun with them. A few weeks after what I still call the "vacuum cleaner" episode, I contacted my doctor and together we worked to readjust my medication. Two years later, after another major depressive episode, I added psychotherapy to the mix, a combination that studies find works better than either medication or therapy alone to treat serious depression.

Today, my kids are 20, 14 and 11. They're healthy - both mentally and physically - and doing great in all aspects of their lives (thanks, I'm sure, to my husband's fantastic parenting). But I still worry, particularly about the middle one and his short temper. Could it be a sign of an inherited rogue gene? Could it be the effects of my own depression?

To try and inoculate them against the effects of my depression, I've talked to them about my illness and their own risks. I also remain vigilant about not overdoing it (too much stress acts like a trigger for my depression) and continuing my own treatment. I still take medicine every day, still talk to a therapist once a week. It's expensive, but it's a small price to pay for both my own and my children's health.





Coping with Depression

DepressionDepression is not something you just "get over." However, there are things that you can do to help yourself, even as you seek professional help and wait for treatment to take affect. The National Institute of Mental Health recommends that you:

checkSet realistic goals in light of the depression and assume a reasonable amount of responsibility.

Break large tasks into small ones, set some priorities, and do what you can as you can.

Try to be with other people and to confide in someone; it's usually better than being alone and secretive.

Participate in activities that may make you feel better.

Mild exercise, going to a movie or a ballgame or participating in religious, social or other activities may help.

Red Check BoxExpect your mood to improve gradually, not immediately. Feeling better takes time.

Red Check BoxPostpone important decisions until the depression has lifted. Before deciding to make a significant transition, change jobs, get married or divorced, discuss it with others who know you well and have a more objective view of your situation.

Red Check BoxRemember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.

Red Check BoxLet your family and friends help you.





Quiz: Are You Depressed?

The National Institute of Mental Health offers the following information to help you identify whether you may be suffering from depression. Put a check mark next to each sign that sounds like you:

I am really sad most of the time.

I don't enjoy doing the things I've always enjoyed doing.

I don't sleep well at night and am very restless.

I am always tired. I find it hard to get out of bed.

I don't feel like eating much.

I feel like eating all the time.

I have lots of aches and pains that don't go away.

I have little to no sexual energy.

I find it hard to focus and am very forgetful.

I am mad at everybody and everything.

I feel upset and fearful, but can't figure out why.

I don't feel like talking to people.

I feel like there isn't much point to living; nothing good is going to happen to me.

I don't like myself very much. I feel bad most of the time.

I think about death a lot. I even think about how I might kill myself.

 

If you checked several items, call your doctor for an appointment and bring this list with you. Ask to be evaluated for depression.




Depression Resources

Depression is neither entirely biochemical nor entirely environmental. Rather, it is most likely a complex mix of the two. Researchers know that depression has a strong genetic component, with the disease often turning up throughout families and over generations. Scientists have even identified some genetic mutations related to depression.

But experts stress that simply having a genetic predisposition doesn't mean you'll become depressed, or that if you don't have the genetic mutation, you'll never become depressed. That's where the environment comes in. The stresses within a person's environment and how the person is able to manage them are a major determinant of depression, experts say.

Online Organizations

  • American Psychiatric Association - 703-907-7300 - Provides a variety of resources for consumers on mental disorders. 

  • Depression and Bipolar Support Alliance - 800-826-3632 - Provides resources for people with mood disorders and their families, including online chat rooms and a newsletter.

  • National Alliance for the Mentally Ill - 703-524-7600 - A support and advocacy organization of consumers, families and friends of people with severe mental illness. Local affiliates provide guidance in finding treatment.
     
  • National Foundation for Depressive Illness - 800-239-1265 - Informs the public about depressive illness and promotes programs of research, education and treatment.
     
  • National Institute of Mental Health - 866-615-6464 - The leading federal institution studying depression and mood disorders. Its Genetics of Recurrent Early-Onset Depression (GenRED) study is recruiting people with depression who also have had a family member with the disease. For more information, email the national coordinating center at Stanford University, genredstudy@stanford.edu, or call 877-407-9529. (All emails and calls are confidential.)

Books

Individual Article Pages:

 

Advertisment