Table of contents
Abstract
Introduction
Chapter1 Depression
Chapter2 Suicide in pregnancy and postpartum
Chapter3 Suicide in eating disorders
Chapter4 Treatment of depression
Conclusion
References
Appendix
Glossary
Abstract
Objectives: The theme of the paper is depression. Depression appears in many areas of one’s life. However, this paper will concentrate on two areas that greatly affect women- namely pregnancy and eating disorders. The chapters will provide information on the experience of pregnancy, and its possible outcomes (e.g suicide) as well as a detailed account on eating disorders and its outcomes. The final chapter will explain the treatments used for depression. This paper’s main goal is to discuss the experience of depression in pregnancy and eating disorders as well as provide information on medications that can be used to treat depression.
Methods: Research articles and literature from web databases were gathered to compile the information provided in this paper.
The risk of suicide is a significant factor in all types of depression. Pregnant women experience higher rates of depression than non-pregnant women of childbearing age and therefore suspected to have a higher risk of suicide. However, studies have shown that very few pregnant women commit suicide although the thoughts of suicide are frequent. It was found that pregnant women were 1/20th as likely to commit suicide as nonpregnant women of childbearing age. After birth, depressive symptoms increase-80 percent of mothers are said to suffer depression after giving birth. It was shown that within the first month the numbers of suicides were very high (approximately 24 percent) compared to during pregnancy (between 3-5 percent). Another concern is that in general women are likely to have eating problems.
When pregnancy is complicated with an eating disorder many pregnant women express concerns about gaining weight and retaining a youthful figure. A higher frequency of postpartum depression occurs with the symptoms of an eating disorder. Nearly one-half of the women with the symptoms of an eating disorder reported postpartum depression suggesting increased risk of suicidal behaviour. Studies revealed that patients that suffer from anorexia nervosa show higher suicide rates than patients that suffer from bulimia nervosa. However, suicide attempts occur more in patients with bulimia nervosa -specifically the purging type.
Treatment for depression during pregnancy include antidepressants, psychotherapy light therapy and very rarely ECT. However, in pregnant women antidepressants are prescribed is a lesser degree. In eating disorders, the most effective treatment is a combination of antidepressants together with cognitive behaviour or interpersonal therapy. Treatment of depression has been boosted since the 1950’s when the first antidepressants were introduced. The main focus in treating depression is balancing the neurotransmitter levels. However currently many researches show that abnormalities in neurotransmitter levels are not the only causal factor in depression. This area of treating depression is still developing today.
Conclusion: Depression is a pathologically severe level of sadness. It arises from the complex interaction of genes, social factors and environmental factors. Although pregnancy is usually a joyous time- depression can occur. The evidence of high brain chemical serotonin supplied by the fetus implies decreased depressive symptoms by the mother. Since suicide is a significant factor in depression the fetus therefore, ensures its survival during pregnancy explaining the very low suicide rates during pregnancy. Therefore, being a mother may suggest protection against suicide
However, after birth the serotonin levels and other aspects that were influenced by the fetus during birth decline. This is illustrated by the postnatal depression most women experience after childbirth. It should be stated that, in some cases postpartum has protective factors as those during pregnancy and in some cases it does not. When the pregnancy is complicated with an eating disorder, weight gain and body shape changes accompanying pregnancy can provoke extreme distress. This distress can then result in depression and then presumably suicidal thoughts. Nevertheless, during pregnancy the fetus still ensures its own survival. In general, eating disorders are known to be serious psychiatric disorders that can contribute to the risk of suicidality but at postpartum, the eating disorder may increase or decrease.Therefore it is suggested that more research has to be done in this field of study.
Depression during pregnancy , postpartum and in eating disorders is a challenging illness to treat. Careful assessment and consideration of possible effects on the child should be considered. Antidepressant drugs are drugs used to treat depression. Monoamine-based antidepressants remain the most important form of treatment. There are three main subdivisions in the monomergic-based medications: SSRIs, MAO inhibitors;, and TCA’s; Most antidepressants exert their initial effects by increasing the intrasynaptic levels of serotonin and/or norepinephrine and effects occur in the course of a few weeks. None of the three was consistently better that the other, individual patients might respond to one better than the other
Introduction
“I start to feel like I can’t maintain the facade any longer that I may just start to show through. And I wish I knew what was wrong. Maybe something about how stupid my whole life is. I don’t know. Why does the rest of the world put up with the hypocrisy, the need to put a happy face on sorrow, the need to keep on keeping on?... I don’t know the answer; I know only that I can’t. I don't want any more vicissitudes, I don't want any more of this try, try again stuff. I just want out. I’ve had it. I am so tired. I am twenty and I am already exhausted.” (Elizabeth Wurtzel). Indeed, depression is a mood disorder that interferes with the ability to function properly in the society and frequently causes problems with work, social and family adjustments. Moreover, depressed mood have various consequences on health ( McWen, 2004). Studies have shown that women get depressed more often than men (Appleby, 1991). Women with depressive illnesses do not all experience the same symptoms. (Misri, 1995) In addition, the severity, frequency and how long symptoms last vary. Symptoms of depression include a persistent sad, anxious or helpless feeling. (See appendix: table 1). Depression often coexists with other illnesses. Especially among women, depression coexists with eating disorders such as anorexia nervosa, bulimia nervosa and others. ( Micali, 2008). Another risk period of depression for women is postpartum. According to many studies, bodily and environmental changes can be the cause of depression in new mothers after childbirth, which is called postpartum blues (Kinsley & Keyser, et al., 2006). This paper will concentrate on these two areas.
This study consists of four chapters. The first chapter will discuss depression, as well as some benefits in pregnancy in relation to the mother and child relationship. The second chapter focuses on the risks and rates of suicide in pregnant women during their pregnancy and in the postnatal period. It will also address suicide in pregnant women with eating disorders. The third chapter will discuss suicide in women with eating disorders in more detail. Lastly, the fourth chapter will give a detailed account on the use of antidepressants in treating depression both during pregnancy and in women with eating disorders. Furthermore, we will also discuss how antidepressants, electroconvulsive therapy and mood stabilizers function. The etiology of depression will also be mentioned.
Introduction
In the fields of psychology and psychiatry, the terms depression or depressed refer to pathologically chronic or severe levels of sadness, perceived helplessness, disinterest, and other related emotions and behaviors. The Diagnostic and Statistical Manual (DSM) states that a depressed mood is often reported as feeling depressed, sad, helpless, and hopeless (Butcher, 2007). It is indeed harmful for the human body and can affect proper functioning of the brain (McEwen, 2008). Feelings of depression are caused by a chemical change that affects how the brain functions. A normally functioning brain is a giant messaging system that controls everything from your heartbeat, to walking, to your emotions. The brain is made up of billions of nerve cells called neurons. These neurons send and receive messages from the rest of your body, using brain chemicals called neurotransmitters. These brain chemicals—in varying amounts—are responsible for our emotional state. Depression happens when these chemical messages aren’t delivered correctly between brain cells, disrupting communication (Butcher, 2007). Think of a telephone: if your phone has a weak signal, you may not hear the person on the other end. Their communication is muted or unclear.
Episodes of depressed mood are a core feature of the following psychological disorders (Butcher, 2007).
• Major depressive disorder
• Dysthymia
• Bipolar disorder
• Cyclothymia
• Schizoaffective disorder
• Seasonal affective disorder
• Adjustment disorder with depressed mood
• Postnatal depression
• Depressive Disorder Not Otherwise Specified
Postnatal depression is actually one of the most important disorder between other mood disorders to focus on. Postnatal depression is a form of clinical depression which can affect women after childbirth. It is often caused by sleep deprivation coupled with hormonal changes in the women's body shortly after giving birth, and may be mild or severe. This disorder is more important to focus on compared to other mood disorder due to the fact that women in this state can cause harm to the new born child. Of course other mood disorders have their risks too, but postnatal depressive feelings are caused by the bodily changes after childbirth and is a sudden and unpredicted illness that can affect any mother, and less the fathers. Many researches found out that mothers who suffered postpartum depression were more likely to see their children turn violent as they grow up (Allen, 2003).Moreover, in many researches which have focused on the pregnancy and its consequences on the health of the mother, majority of them found out that the symptoms of depressed mood occurs mainly after the pregnancy, in postpartum, than in prepartum ( Evans, 2001). What can be the reason that women have mostly depression after the childbirth than before, during the pregnancy. To answer this question, first of all I will focus on one of the main biological cause of depression; the level of serotonine in the brain of the pregnant women. Than, I will discuss the changes that occur in the brain structure during the pregnancy. And finally I will explain the hormonal changes and its consequences on the nervous system of the pregnant women.
The Fetus Supply Serotonin
There is evidence that brain chemical serotonin plays a key role in depression. Serotonin is involved in our body’s temperature regulation, sensory perception, and mood control. It plays a major role in emotional behavioural disorders such as severe depression, anxiety, suicide, impulsive behaviour, and aggression ( Mcwen, 2004). Several prescription drugs, including the well known Prozac and Paxil, are used to treat depression because they increase serotonin levels in the brain (Butcher, 2007). Already during pregnancy a fetus starts its own serotonin supply, some of which finds its way to the mother’s brain. The fetus serotonin in the mother’s brain decreases the mother’s depression. It is yet not known whether this regulation, serotonin supply, helps the fetus to ensure its own survival or is it just a coincidence (Kaplan, 1997).
A mother benefits from pregnancy in various ways. The example above is one of many advantages that a mother gets from her pregnancy. A very recent discovery was made by Gavin S. Dawe of National University of Singapore who found neuron cells of the fetus in the mother’s brain. How these stem cells find their way to the brain to migrate is still not known. However, it is known that these cells are able to develop, in the brain, into functional neurons, astrocytes, oligodendrocytes and macrophages. According to Dawe, during their experiments on mice, he saw that after injuring mice mother’s brain, nearly six times more fetal cells made their way to the damaged areas of the pregnant mice than other sites of its brain. This suggests that these fetal cells could respond to distress signals that are released by injured part of the brain. We may conclude that these stem cells protect the mother from injury thus probably insuring its own survival (Tan, 2008). Although this experiment was conducted on mice, there are recent studies that have focused on human as well ( Coghlan, 2005).
Pregnancy Hormones Increase Mothers Attention
Pregnancy hormones, estrogens also play an important role in the physiological and psychological changes of the mother mice. Another research on mice by Lori Keyser ( 1990), a researcher at the University of Richmond, showed that the size of the neurons in some part of brain of pregnant rats increase in volume . Moreover, the length and number of dendrites in the neurons increase as the pregnancy progresses. The same changes were also observed in female rats treated with progesterone and estradiol. These hormones raised the activity and synthesis of protein for the formation of new neurons. After birth, these new made neurons direct the mother's attention and motivation to her offspring, enabling her to care for, protect and nurture her progeny with the panoply of behaviors known collectively as maternal (Kinsley & Keyser, et al., 2006)
Conclusion
In summary, depression is a strong mood disorder involving sadness, discouragements, despair, and hopelessness that last for weeks, months or longer. Depressed mood is a feature of many disorders. Episodes of depressed mood can be seen in many disorders, such as postpartum blues, which has significant negative impact on the children’s as well as on the mother. Many studies backup the fact that the risk of suffering depression after the pregnancy, postpartum, is higher than during the pregnancy, prepartum. Owing to studies that indicate, that babies yet not born advance the maternal brain by supplying neurotransmitters to the mother’s brain, such as serotonin, which is beneficial for the mother with regard to depression. Some other studies found stem cells of the fetus in the mother’s brain, although the purpose is yet not known but the investigators predict it to have a protective function. These alterations promote changes in the mammalian brain that include skills and behavior. From an evolutionary perspective, for the female, these great challenges are to ensure that her genetic investment flourishes. Maternal behaviors progressed to enlarge the female’s chances of success. Still, many benefits seem to emerge from motherhood. In other words, when the going gets tough, the brain gets going.
Introduction
A mother’s joy begins when new life is stirring inside, when a tiny heartbeat is heard for the very first time, and a playful kick reminds her that she is never alone. (Harrison, 1999).
Tears of motherhood submerge during pregnancy and are expressed as tears of excitement, tears of joy, tears of fear and in some cases tears of sadness. Even though the birth of a child is usually a happy event, postpartum depression sometimes occurs in new mothers following the birth of a child. (Butcher, Mineka, & Hooley, 2007). The symptoms of postpartum blues typically include emotional lability, crying easily, irritability, often liberally intermixed with happy feelings. (Butcher et al., 2007).
Postpartum blues or depression may be especially likely to occur if the new mother has a lack of social support and has difficulty adjusting to her new identity and responsibilities or if the woman has a personal or family history of depression that leads to heightened sensitivity to the stress of childbirth. (Butcher et al., 2007).
Suicide risk and rates during pregnancy and in the postpartum period
The risk of suicide is a significant factor in all types of depression. (Butcher et al., 2007). Depression is a common illness, which will affect 20 percent of all women at some point in their lifetime. (Marzuk, 1997). The point prevalence of depression among women of childbearing age is 10 percent and the prevalence among pregnant women is between 4 to 10 percent. (Misri, 1995). Although the puerperium has been associated with higher risks of depression, pregnancy has been considered a relatively quiescent emotional period. However, pregnant women experience higher rates of depression and lower levels of adjustment than non-pregnant women of childbearing age and therefore suspected to have a higher risk of suicide. Surprisingly, studies have shown that very few pregnant women commit suicide. (Marzuk, 1997) but that the thoughts of suicide are frequent (Misri, 1995). Women may keep these obsessive thoughts secret out of shame unless they are specifically asked about them. Marzuk (1997) also confirmed that there is a lower risk of suicide in pregnancy but he also added that this risk is applicable across racial-ethnical groups. Consequently, could pregnancy be a shield from suicide?
A British study found that pregnant women were 1/20th as likely to commit suicide as nonpregnant women of childbearing age. (Marzuk, 1997). Being a mother in itself may therefore suggest protection against suicide. The two exceptions to this are women who experience stillbirth and adolescents in whom the suicide risk is significantly elevated. (Misri, 1995).
Risk factors sited for depression during pregnancy include a previous termination of a pregnancy, bereavement during pregnancy, and a previous personal history of depression. (Misri, 1995). The etiology remains illusive, but interactions among biological, psychological, and social factors are said to have a substantial role, although for any given individual one factor may be more influential. (Misri, 1995).
One biological approach states that low central serotonin activity has been linked to a higher risk of suicide. (Marzuk, 1997). It’s further explained that pregnant women have been reported to have higher levels of urinary serotonin and its metabolite in late gestation than nonpregnant comparison subjects. This shows that blood levels of serotonin rise during pregnancy. It is of interest that the fetus produces much of the serotonin observed in pregnancy, this perhaps suggests an evolutionary advantage to the inhibition of self-destructive behaviours by the mother (Marzuk, 1997).
Serotonin is a neurotransmitter involved in regulating mood states, disturbances in its balance in the brain results in altered mood states such as depression. ( Butcher et al., 2007).
This would mean after birth the serotonin levels would fall and no longer inhibit possible self-destructive behaviours of the mother, increasing the risk of suicide. There may be other reasons to why women are less likely to commit suicide during pregnancy but it is important to mention that during pregnancy and postpartum, depression is commonly misdiagnosed as an adjustment problem implying a transient benign course, (Misri, 1995) therefore finding the reasons for lowered risk of suicide during pregnancy becomes difficult. Now let’s consider the risks and rates of suicide after pregnancy.
As earlier stated the puerperium has been associated with higher risks of depression.
Although the prevalence of suicide in the general population increases with age, within the population of pregnant women teenagers seem to be at considerably greater risk. (Marzuk, 1997). The explanation may be that as pregnancy seems to be often unwanted among teenagers (the abortion rate is higher) the negative impact of becoming pregnant is likely to be greater and the protective effect of motherhood reduced. Therefore teenagers who are depressed about being pregnant represent a high risk of suicide. (Marzuk, 1997).
An important psychosocial finding is that marital conflict is common among pregnant and postpartum depressed women. Given that, 1/3 of pregnancies occur out of wedlock, being married may convey some protection against suicide but also may increase depression from marital discord. (Marzuk, 1997).
It is interesting that one study showed that in some cases postpartum had protective factors as those during pregnancy (Appleby, 1991), but others did not (Misri, 1995).
Furthermore, another study found that suicides had three categories according to their relation to childbirth. An American study found that in a sample of psychiatric inpatients those who had had suicidal thoughts and those who had actually carried out a parasuicidal act were distinguished by child-related concerns. (I.e. suicide would harm the children, it would not be fair to leave the children to the care of others, and a desire to watch them grow up. (Appleby, 1991). Could the same concerns about the children exert a protective effect on women in the first year after childbirth?
There seems to be supportive evidence. Firstly, the absence of a low mortality ratio after stillbirth supports the presence of young children as the crucial protective influence. (See Appendix: table 2). The stillbirths were first pregnancy, so no older children could compensate. Secondly, the continuing low risk of suicide at the end of the first postnatal year (See Appendix: table 3) would be expected if concerns over young children were indeed protective.
During pregnancy it is important to not only eat for two but to eat well, so as to contribute positively to the baby’s growth and development. In general, women fear weight gain of 25 to 35 pounds, it is a terrifying thought for pregnant woman and an obnoxious torment for women with eating disorders such as anorexia nervosa or bulimia nervosa. (Micali, 2008).
What then, would be the reaction of women who are both pregnant and suffering from an eating disorder? Probably, panic-stricken.
Suicide in pregnancy with an eating disorder
It has been seen that suicide during pregnancy is unlikely but that after birth the increase in depression may result in an increased risk of suicide. What then will be the effects on suicidality when a pregnant woman has an eating disorder? This section will attempt to answer this question.
The eating disorders (EDs) are common in women in developed countries. The onset of these disorders typically is in adolescence or young adulthood. (Micali, 2008). Symptoms found in EDs include a morbid fear of fatness and a strong belief that self-worth is tied exclusively to weight, shape, or appearance. It is interesting to see that a higher frequency of postpartum depression occurs with the symptoms of an eating disorder. Thus the prospect of weight gain during pregnancy is terrifying for many of these patients. (Micali, 2008).
Nearly one-half of the women with the symptoms of an eating disorder reported postpartum depression that was confirmed by medical records. (Franko, 2001). It is likely that the high rate of postpartum depression in this group was a function of past affective disorders. (Micali, 2008). It is also possible that the physiological and psychological stresses of having an active eating disorder exacerbated this risk in the symptomatic group. The vulnerability to postpartum depression may have been increased by the medical complications of eating disorders (e.g. dehydration), as well as by environmental factors such as poor social support. (Franko, 2001). It was found that, women with current or past histories of bulimia nervosa reported a significantly greater number of miscarriages and were more likely to be treated for postpartum depression. (Franko, 2001).
Eating disorders have also been linked to neurotransmitters such as serotonin, which modulate appetite and feeding behaviour. Low serotonin levels were reported in women with anorexia nervosa and bulimia nervosa. Since serotonin is also involved in mood disorders, eating disorders and mood disorders often cluster together. (Mineka et al., 2007).
In short, women with a recent or past ED had a higher risk of laxative use and self-induced vomiting during the first four months of pregnancy compared with controls. High exercise levels in pregnancy were more common in women with a recent or past ED. More symptoms of anxiety and depression were noted. Women with a recent ED had high pre-pregnancy weight and shape concerns, with a decrease during pregnancy compared with before pregnancy. Women who have bulimia in pregnancy have lower self-esteem and are more dissatisfied with life and their relationship with their partner, compared to pregnant women without eating disorders. These findings suggest that, although pregnancy may improve ED symptoms in women with a recent-onset disorder, symptoms and cognitions remain increased in this group of women. (Micali, 2008).
Many pregnant women express concerns about gaining weight and retaining a youthful figure. When there has been a history of anorexia nervosa or bulimia nervosa, weight gain and body shape changes accompanying pregnancy can provoke extreme distress, distress resulting into depression and then presumably suicidal thoughts. However the studies are inconclusive and state that although eating disorders may have secondary influences on suicide risk or suicide rates, the difference with normal pregnancy is not that large, however significantly higher.
Discussion
The relationship of suicide and pregnancy is very complex however the articles managed to give reasonable support to their claims. In most cases, the results could be generalised to women across cultures but in some cases it was restricted to a small group. For example
Appleby (1991) attempted to calculate age adjusted mortality ratios for suicide by women in the first year after childbirth and during pregnancy. His population data was of women from England and Wales aged 15-44 who committed suicide in the year after childbirth or during pregnancy from 1973 to 1984. His results showed that women in the first year after childbirth and during pregnancy have a low risk of suicide however Marzuk studied women from New-York City aged 10-44 from 1990-1993 but also put them in racial-ethnic groups. His results showed that there is a low risk of suicide during pregnancy but did not comment on postnatal suicide risk.
Appleby’s (1991) study found the standardised mortality ratio during pregnancy to be 0.05, whereas a study six years later Marzuk (1997) showed the standardised mortality ratio during pregnancy to be 0.33. Although they are both low and have the same conclusion, it is clear that there is a significant increase. The difference may have risen from the time period chosen, the length of the study, social factors, cultural factors, form of data collection i.e. Appleby (1991) used information from the office of population censuses and surveys-suicides in general female population (annual records of death) whereas Marzuk (1997) manually reviewed medical examiner case files. Another difference may be the definition of suicide. To be considered a case in Marzuk’s (1997) study an individual had to have been certified as a suicide by the Chief medical examiner. Also a lot of assumptions were made for example to calculate the expected number of suicides of pregnant women, both live births and abortions were included under the assumption that women who had live births during study period were pregnant for 38 of the 52 weeks.
From these differences it can be noted that there is plenty of room for improvement and suggestions for further study. Relying on death certificates may result in detecting fewer pregnancies but the use of medical examiner data lowers the observed-to-expected ratio.
Both live births and stillbirths were included in the postnatal calculation. Stillbirth should not have been considered because the grieving process may exaggerate the depressive mood in the postnatal period compared to live birth postnatal depression.
It is difficult to find the true reason or cause for suicide. Those who were pregnant and died were assumed to have committed suicide as a result of depression, other factors such as social factors, may have been involved, and these factors need to be further investigated.
The first postnatal year is a time of close contact with health professionals and family or friends. It may be that the risk of suicide is reduced by early detection and close support. However, table 3 (See appendix) shows the highest risk of suicide to occur in the first postnatal month, which is surprising and another factor to be studied.
The hormonal balances in women during pregnancy can be mimicked to see if the same protective outcomes will occur. This finding would be intriguing because it may suggest that pregnancy could be a model for exploring protective factors against suicide in women in general.
There are a number of limitations to the study of eating disorders in pregnancy as shown by Franko (2001). He had only two subjects with anorexia, the results could not be generalized and the ability to determine predictor variables was limited due to the small group size. Most notably, the absence of a comparison group did not allow comparisons to women without eating disorders. The use of a comparison group is strongly recommended for any future studies. The use of medical records for data collection and the lack of data from some subjects were further limitations. Micali (2008) also states that most of the studies that have focused on this topic have either been small or have relied only on clinical samples; therefore, generalizability of results is a problem. Many rely on retrospective assessments of ED and/or pregnancy outcomes of varying degrees of validity and reliability, with few prospective studies. Peery (1999) emphasises that the method of using case studies means that most of the work reviewed above is based on a highly selected sample of patients, possibly exaggerating the negative effects of the eating disorders on pregnancy.
In Franko’s (2001) study to be included, the participants had to be female and speak English, be at least 12 years of age, and reside within 200 miles of the study site. Exclusion criteria were evidence of organic brain syndrome or terminal illness. This also illustrates what Peery (1999) mentioned about highly selected sample of patients possibly falsifying results.
Therefore, the data limits the ability to comment on the relative contribution of biological and environmental factors, but it can be suggested that the relationship between postpartum depression and eating disorders deserves further study.
Conclusion
Pregnancy has been considered a relatively quiescent emotional period. However, pregnant women experience higher rates of depression and therefore suspected to have a higher risk of suicide. Surprisingly, studies have shown that very few pregnant women commit suicide even though suicidal thoughts may be frequent. Due to this lower risk of suicide during pregnancy it is possible that pregnancy shields women from suicide. The interaction of biological, psychological, and social factors are complex and still remain illusive. Nevertheless, the influence of neurotransmitters such as serotonin and gonadal hormones such as cortisol, prolactin and thyroid hormones has been mentioned .The presence or lack of social support (marital status and doctor care) is also thought to contribute.
Another concern is that in general women are likely to have eating problems. Many pregnant women express concerns about gaining weight and retaining a youthful figure. If these pregnant women have an eating disorder the effects on the suicide risk and suicide rates also changes. The interaction of biological, psychological, and social factor are once again complex. When there has been a history of anorexia nervosa or bulimia nervosa, weight gain and body shape changes accompanying pregnancy can provoke extreme distress, distress resulting into depression and then presumably suicidal thoughts. Unfortunately, the studies are inconclusive and state that although eating disorders may have secondary influences on suicide risk or suicide rates, the difference with normal pregnancy is not that large, albeit significantly higher.
The studied data limits the ability to comment on the relative contributions of biopsychosocial factors on the suicidal risks and rates in pregnancy alone and in pregnancy associated with an eating disorder therefore it is suggested that the relationship of these variables deserves further study. This in the future can then be used as model for reducing completed suicides in women.
Introduction
Amanda is a girl of 22 years old, has a height of 170 cm and a weight of 40 kg. This is not a normal weight. When Amanda was 18 years old she was diagnosed with an eating disorder. Amanda suffers from this eating disorder for almost 6 years now. Eating disorders are characterized by a severe disturbance in eating behavior (Butcher, Mineka and Hooley, 2007). Amanda developed this disorder because she was looking through magazines with skinny models and she has the idea that if you are not skinny you are not attractive so she decided to lose weight. The weight loss did not go fast enough so she stopped eating. She suffers from Anorexia Nervosa. Amanda is still not happy with her body and as an addition to her eating disorder she also developed a depression. For the last few months she does not seem to get back on her feet and has been thinking of committing suicide.
Nowadays, eating disorders are getting more common in society. Most people that suffer from an eating disorder are teenage girls. However, teenage girls are not the only ones that suffer from eating disorders. Also older women and even men can suffer from an eating disorder. There are different types of eating disorders but the most common ones are: Anorexia Nervosa and Bulimia Nervosa. People that suffer from an eating disorder have striking features; disordered eating is one of them. However, the intense fear of becoming overweight and fat is at heart of Anorexia and Bulimia Nervosa (Butcher, Mineka and Hooley, 2007). Suffering from an eating disorder is something very serious and should not be undermined. Therefore this chapter is going to answer if there is a relation between attempted suicide and eating disorders.
Methods
The sources that are used in this research paper are articles that are all conducted out of several different journals and one book. All sources have different inputs on suicide and eating disorders. The articles that are used have all done research at the same topic (suicide and eating disorders) but have all done this in a different way. The book gives us a more general overview about the different eating disorders, so this is more used to explain and derive information from.
Butcher, J.N., Mineka, S., & Hooley, J.M “Abnormal Psychology” (2007) mainly provides general information about eating disorders. It gives a clear description about the different types of eating disorders. However, it does not provide information about suicide and eating disorders.
Milos, G., Spindler, A., Hepp, U., & Schnyder, U “Suicide attempts and suicidal ideation: links with psychiatric co morbidity in eating disorder subjects” (2004) aims to examine the association between suicidality and women that are currently suffering from an eating disorder. It also compared subjects that suffered from a purging type eating disorder with subjects from the non-purging type eating disorder and what differences there would be in the suicide rates.
Pompili, M., Girardi, P., Tatarelli, G., Ruberto, A., & Tatarelli, R. “Suicide and attempted suicide in eating disorders, obesity and weight-image concern” (2006) mainly focuses on suicide rates between bulimia nervosa and anorexia nervosa. The results are conducted with the help of meta-analysis. The article also includes other research that specifies on the difference between subjects that suffer from a purging type eating disorder and non-purging type eating disorder.
Youssef, G., Plancherel, B., Laget, J., Corcos, M., Flament, M.F., & Halfon, O. “ Personality trait risk factors for attempted suicide among young women with eating disorders” (2004) also mainly aims to examine the difference between subjects that suffer from an eating disorder and suicide. This is done by the forming of 5 different groups. The five different groups were based on the following; Anorexia nervosa/purging type, anorexia nervosa/ restrictive type, bulimia nervosa/purging type, bulimia nervosa/non-purging type and a control group. The assessment measures were done by the Minnesota Multiphasic Personality Inventory, the Beck Depression Inventory and a specific questionnaire concerning suicide attempts. (Youssef et al., 2004).
Results
Franco, D.L., & Keel, P.K (2005) concluded that the results revealed by the studies confirm that patients that suffer from anorexia nervosa show higher suicide rates than patients that suffer from bulimia nervosa. However, suicide attempts occur more in patient that suffer from bulimia nervosa and than specifically the purging type. Furthermore, the article also concludes that patients with eating disorders, particularly those with co morbid disorders, should be assessed routinely for suicidal ideation, regardless of the severity of eating disorder or depressive symptoms (Franco and Keel, 2005).
Milos, G., Spindler, A., Hepp, U., & Schnyder, U (2004) concluded that additional psychiatric disorders could contribute to the risk of suicide and suicide attempts in patients that suffer from and eating disorder. It also concluded that subjects that have a purging type eating disorder more frequently have a history of attempted suicide than subjects with the non-purging type eating disorders. At last the article also concluded that eating disorders are serious psychiatric disorders associated with high levels of co morbidity and suicidality (Milos, Spindler, Hepp and Schnyder, 2004)
Pompili, M., Girardi, P., Tatarelli, G., Ruberto, A., & Tatarelli, R (2006) concluded that more suicide is committed by people that suffer from an eating disorder like anorexia or bulimia nervosa than by people that do not suffer from those disorders. The other research that was done in the article made a difference between the subjects that suffered from an eating disorder. There was a group that suffered from the purging type eating disorder and a group that from the non-purging type. The conclusion that can be drawn from this research is that suicide is a major cause of death among patients that suffer from the anorexia nervosa/ purging type. The article also concludes that patients that suffer from an eating disorder more often commit suicide by slowly destroying there body instead of committing suicide in a faster way. The article also concludes that more research has to be done in this field of study.
Youssef, G., Plancherel, B., Laget, J., Corcos, M., Flament, M.F., & Halfon, O (2004) concluded that students with the purging type eating disorder are most at risk of suicidal behaviour. It also concludes that young women that have anorexia nervosa both restrictive or purging type and bulimia nervosa purging type should be given more attention with regard to the risk of suicide attempts (Youssef et al., 2004).
One of the main issues that could cause a problem for the outcome of this research paper could be that the various articles that are used do not all totally agree on the outcome. The main reason for this is that (Pompili et al., 2006) state that data for bulimia nervosa is still scare so they do not give exact numbers about suicide rates and bulimia nervosa. However, Franko and Keel (2005), Milos et al (2004) and Youssef et al (2004) do give numbers for bulimia nervosa. By looking at the other three articles it can be said that the numbers given for bulimia nervosa provide enough reliable information to draw a conclusion.
Another point which is positive is that all articles have conducted or reviewed different studies, which gives a more reliable outcome for the research question. The amount of conclusions that are made with the use of conducted results show a high relevance with the research question
All the articles have used a large amount of studies that have been conducted by various researchers over an extensive period of time. The results that the studies have shown have a great relevance for the conclusion that answers the research question.
All the articles made a difference between the purging type eating disorder and non-purging type eating disorder which made it possible to even specify the conclusion more. All the articles showed somewhat the same outcome, which makes it possible to conclude the outcome without any doubt.
However a lot of results are similar there still can not be made for sure that the overall conclusion is a hundred percent true, because this field of study still has to expand. The articles that study this field are limited so still a lot of research has to be done. This makes it almost impossible to draw conclusions without questions left.
Another point that is important to look at is that the various articles did not all talk about suicide. Franko and Keel (2005) talked about suicide and suicide attempts whereas Youssef et al (2004) only really discussed suicidal behavior. This means that sometimes there can be a difference in outcome because the look different at the term suicide. Overall, all the articles do describe which term they used which makes it easier so compare them.
The last point that draws the attention is that all articles concluded that patients that suffer from the anorexia nervosa purging type have the highest suicide rates.
Conclusion
Eating disorders are serious psychiatric disorders that can contribute to the risk of suicidality. Various researches have shown that there is a relation between suicide and eating disorders. The articles that have been discussed in this research paper all add something to the answer on the research question. The research question consists of two serious psychiatric behaviors. First of all there is suicidal behavior which can be a result of depression. The second part that is included in the research question is eating disorders. Eating disorders are psychiatric disorders related to eating. The question that has to be answered is this paper is: “Is there a relation between suicide and eating disorders?”.
The articles that are used to answer this question all show a high relevance. Franko and Keel (2005) concluded that patients that suffer from the purging type anorexia nervosa are more likely to commit suicide than patients that suffer from bulimia nervosa. They also state that patients with an eating disorder should be regularly informed about suicidal ideation. Milos et al (2004) concluded that patients with the purging type eating disorders are more likely to have a history of attempted suicide. This also strengthens the conclusion that Franko and Keel (2005) made.
The article written by Youssef et al (2004) conducted mostly results with the use of young women that suffered from an eating disorder at that time. They concluded that those women should be given more attention about the risk of suicide attempts.
Finally the question can be answered with the use of all the studies that are conducted or reviewed by the articles in the paper. The answer to the research question is that there is a relation between suicide and eating disorders. However, there still has to be done more research to under built this outcome because still a lot remains unknown about this field of study.
Introduction
Treatment of depression consists of the use of antidepressants, electroconvulsive therapy and mood-stabilizing drugs, possibly in combination with cognitive behaviour therapy. Antidepressants are not used solely to treat depression but also other disorders such as anxiety disorders and obsessive compulsive disorders (Eynde, 2008 & Butcher, 2008). Treatment for depression is relatively effective. Difference sources stating different numbers of treatment effectiveness, Kiss states that 60% of treatments with antidepressants is effective (2008), Gazzaniga (2006) refers to the Treatment of Adolescents with Depression Study (2004) which states that 71 % of people treated with Prozac in combination with cognitive behaviour therapy showed improvement. However there is still at least one in four people with depression not responding to therapy.
Symptoms of depression
Symptoms of depression can be divided into emotional symptoms and biological symptoms. Emotional symptoms are: misery, apathy, pessimism, low self-esteem, feelings of guilt, inadequacy and ugliness, indecisiveness, loss of motivation. Biological symptoms are: retardation of thought and action, loss of libido, sleep disturbance and loss of appetite.
There are two major forms depression; unipolar depression where mood swings are always in the same direction and bipolar depression in which depression alternates with mania (Rang, 2003)
Heredity of depression
It is clear that depression has a strong genetic component however exact genes have not been identified. Genetic predispositions are thought to interact with environmental risk factors, such as stressful life events, which can initiate depressive episodes. However the tendency to live in high-stress environments might also be hereditable. These kinds of relations are difficult to research (Vaishnav, 2008). Also there seems to be a difference in the hereditary component of unipolar and bipolar depression. Unipolar depressions have a less strong hereditary tendency than bipolar depressions. Unipolar depression is thought to be the result of a stressful life event in 75% of the cases (Rang).
Discussion on the etiology of depression
The pathogenesis of depression is not been fully understood. Depressions arise from the complex interaction of multiple-susceptibility genes and environmental factors (Manji, 2001). The most generally accepted theory is the monoaminergic model of depression. However recent associations have been made between impairment in signalling pathways that regulate neuroplasticity and cell survival (Manji) as well as anatomical abnormalities in brain tissue (Lingjiang, 2007)
Decreased monoaminergic activity can be caused by a reduced synthesis, increased degradation, or altered synaptic function (Hollandsworth, 1990). Barton et al. have researched serotonin turnover in depressed patients, which surprisingly was higher than in healthy people, which shows that decreased activity does not necessarily mean decreased synthesis.
The monoaminergic model of depression came to existence when drugs, which were initially not linked to the treatment of depression seemed to release symptoms of depression. These drugs regulated intra-synaptic concentrations of serotonin and norepinephrine (Manji). Over the past forty years people have used clinical studies to uncover specific defects in these neurotransmitters systems. Although abnormalities in the monoaminergic neurotransmission are found, there are also inconsistencies which contradict its causal relation in depression. Rang lists three of them. Firstly, neither amphetamine nor cocaine have antidepressant actions even though they enhance monoamine transmission. Secondly antidepressants have a delayed antidepressant effect which correlates with an decrease of certain brain areas rather than facilitating monoaminergic transmission. Lastly some clinically effective drugs seem to lack any actions that could enhance monoamine transmission. These inconsistencies in the monoaminergic model of depression suggest a more complicated model.
Recent developments have associated mood disorders with anatomical impairments, such as volume reductions, of the brain. Associations have also been made between mood disorders and impairment of structural plasticity and cellular resilience, the cellular ability to adapt to new situations. Furthermore PET imaging studies have shown abnormalities of cerebral blood flow and glucose metabolism in limbic and prefrontal cortical structures in mood disorders (Manji). This summary of current findings by Manji was confirmed by the paper of Lingjiang, L. et al. who are the first to use diffusion tenor imaging (DTI) to investigate abnormalities in white matter microstructure in the frontal lobes of young people diagnosed with MDD. Abnormal white matter was already found in older people, as well as in post-mortem studies. The results of their investigations is that compared with healthy controls, patients with MDD show significantly lower fractional anisotropy (FA) values in prefrontal white matter. Together with previous findings, the present results suggest that micro structural abnormalities in prefrontal white matter may occur early in the course of MDD and may be related to the neuropathology of depression. Furthermore magnetic resonance imaging (MRI) and post-mortem studies have demonstrated reduced grey and white matter volumes in areas prefrontal cortex. As well as the in the number of glial cells and neuron size in the prefrontal cortex. Also functional imaging studies demonstrated lower glucose metabolism and cerebral blood flow in prefrontal cortex in depressed patients. Furthermore post-mortem study reported reduction of packing density and glial cells number in prefrontal cortex in depressive patients (Lingjiang, L. et al.). Glial cells play critical roles in regulating synaptic glutamate concentrations and central nervous system energy homeostasis and in releasing trophic factors which promote cell survival via signal transduction. Abnormalities of glial function could thus prove to be an important factor to the impairments of structural plasticity and overall pathophysiology of mood disorders.
Several diseases affecting the endocrine glands (e.g. hyper- and hypothyroidism) are well known for causing altered mood states. Also depression in women has been linked to fluctuations in sex hormones. These are two arguments for that the endocrine system may be a factor in mood disorders. The hypothalamic-pituitary-adrenal cortex (HPAC) system responds to a variety of stressors. In depression, it is common to find elevated plasma concentrations of cortisol, increased urinary excretion of cortisol. Functioning of the pituitary-thyroid system is also frequently disturbed in depression (Hollandsworth).
Treatment of depression
Antidepressant drugs is a term used to refer to drugs that alleviate the symptoms of depressive illness. In 1952 the first antipsychotic drug was discovered, chlorpromazine (Healy, 1999). It was mainly used as an anaesthesia and tranquilizer. The first antidepressant drug discovered was imipramine. The development of imipramine came about because people were looking for antihistamines, medicines to treat allergic reactions. Pioneers in the development of imipramine were Kuhn and Geigy. In the 1950’s they sent each other their findings and gave many biochemical substances including, imipramine to psychiatric patients.
Even though today’s view is that the cause of depression is more than only a deficiency of monoamines, monoamine-based antidepressants remain the most important form of treatment (Vaishnav). Next to monoamine based antidepressants ways of treatment for depression are electroconvulsive therapy, and mood-stabilizing drugs (Rang).
How do antidepressants, electroconvulsive therapy and mood stabilizers function?
There are three main subdivisions in the monomergic-based medications: SSRIs; selective serotonin reuptake inhibitors, MAO inhibitors; monoamine oxidase inhibitors, and TCA’s; tricyclic antidepressants (Gazzaniga). When with researches it was tried to prove which of the three was a better method to release depression the final conclusion was that even though none of the three was consistently better that the other, individual patients might respond to one better than the other (Rang).
Selective serotonin reuptake inhibitors (SSRI) are the most widely prescribed antidepressants. They include: fluoxetine (or Prozac), fluvoxamine, paroxetine, citalopram and sertraline. SSRI allow the serotonin to remain in the synapse by blocking reuptake of serotonin in the presynaptic neuron. The difference is that SSRI work specifically for serotonin.
Monoamine oxidase inhibitors do exactly as they say; inhibit monoamine oxidase. Monoamine oxidase is the enzyme that breaks down monoamines. Examples of MAOIs are phenelzine, tranylcypromine, iproniazid. By inhibiting the enzyme that breaks down monoamines MAOs increase the availability. Different MAOs work on different enzymes, leading to the possibility to increase levels of specific monoamines.
Electroconvulsive therapy (ECT) is the stimulation of the brain through electrodes. ECT appears to be especially effective for treatment of severe suicidal depression since is has such a rapid effect (RANG). The mechanism of action for ECT is not very clear. It has been hypothesized that ECT increases post-synaptic responsiveness to norepinephrine, serotonin and dopamine through receptor sensitivity as well as inhibitory effects of GABA function (Hollandsworth).
Lithium, a mood stabilizer is mainly used for its anti-manic effects. Lithium produces many detectable biochemical changes, but it is still unclear how these changes relate to its therapeutic effect. The two processes in which it suspects to interfere are inositol tirphosphate and cAMP formation (RANG).
Treatment of eating disorders
In eating disorders, the most effective treatment is a combination of antidepressants together with cognitive behaviour or interpersonal therapy. Where cognitive behaviour and interpersonal therapy play a more significant role than in the treatment of depression (Eynde, 2008). Bulimia and Anorexia have a high comorbidity with depression. Antidepressants decrease the frequency of binges (Butcher).
Treatment of depression in pregnancy
Treatment for depression during pregnancy include antidepressants, psychotherapy (interpersonal therapy and cognitive behaviour therapy) light therapy and very rarely ECT. SSRIs and SNRIs are most commonly used. When treating a mother with antidepressants there is always the concern of long-term effects on the baby since all antidepressants cross the placenta. When starting therapy risk-benefits analysis should be made for mother and baby. For mild depression non-pharmacologic biological treatments including bright light therapy, are a safe alternative for pharmacologic intervention and therefore preferred. ECT should only be used when the depression is really severe and are acutely suicidal. In depression during pregnancy a distinction should be made between women who have suffered from depression before, and those who experience depression for the first time in their pregnancy. Those who suffer from their first depression during pregnancy should try to avoid using antidepressants. Since for them it is not as effective as those who already know witch antidepressant they respond positively to.
Secondary effects and side-effects of antidepressants
Although most antidepressants exert their initial effects by increasing the intra-synaptic levels of serotonin and/or norepinephrine, their clinical antidepressant effects occur not direct but in the course of a few weeks. This is remarkable since their effect on neurotransmitters increase is direct. Because of this time antidepressants need to start working, hypotheses have been made that they do something else than only increasing neurotransmitter levels. This is called the secondary effect. A number of clinical studies have shown that signalling pathways involved in regulating cell death are long-term targets of antidepressants. During antidepressant drug treatment amygdale, CBF and metabolism decrease to normative levels. Antidepressants and lithium indirectly regulate cell-survival pathways (Manji).
Discussion
In finding the most effective treatment for depression it is necessary to find out more about the etiology of depression. It is clear that in many patients there is something wrong in monoaminergic neurotransmission. However, if it was clear what abnormal white matter in the prefrontal lobes and decreased sizes of certain parts of the brain means this could have significant implications for the treatment of depression. Furthermore antidepressants and Lithium have many positive secondary effects. The causes of these effects should be investigated which could result in the development of drugs that could fight the causes of depression more specifically. And optimize the treatment overall.
Conclusion
Currently the treatment of depression is relatively effective. But as with many things it could be improved by finding out more about the etiology. Especially the exact abnormalities in neurotransmissions, which are very likely not the same for every patient. As well as the significance of abnormalities in the anatomy of the brain.
Overall Conclusion
Depression is a strong mood disorder that affects mostly women. It frequently involves sadness, discouragements and despair. Depressed mood appears in our daily lives as a passing phase but it also appears in many disorders such as bulimia nervosa, anorexia nervosa and has an important role in pregnancy.
Pregnant women experience higher rates of depression but due to the protective functions of the fetus it is shown that very few pregnant women commit suicide. The exact processes are complex, involving modulation of neurotransmitters, hormones and neural cells of the mother’s brain. (Neurotransmitters such as serotonin and gonadal hormones such as cortisol, prolactin and thyroid hormones have been mentioned). Therefore it is suggested that pregnancy may shield women from suicide. After birth, the low suicide risk is generally increased. This period is associated with higher risks of depression and therefore increased risk of suicide. Due to its complex nature, depression is commonly misdiagnosed as an adjustment problem therefore making it difficult to treat.
Another concern is that in general women are likely to have eating problems. When there has been a history of anorexia nervosa or bulimia nervosa prior to pregnancy, this combination can provoke extreme distress. Eating disorders are serious psychiatric disorders that can contribute to the risk of suicidality. Therefore there is possibly a dangerous relationship between suicide and eating disorders that can also aggravate suicide symptoms in pregnancy. However, more research still has to be done in this field of study.
References
Allen, C. (2003). Do Sad Moms Make Angry Kids? Psychology Today, 3104, 21
Appleby, L (1991). Suicide During Pregnancy and in the First Postnatal Year. Department Psychiatry. 302, 137-140.
Barton, D.A. et al. (2008). Elevated Brain Serotonin Turnover in Patients With
Depression Effect of Genotype and Therapy. Arch Gen Psychiatry, 65(1), 38-46.
Butcher, J.N., Mineka, S., & Hooley, J.M. (2007). Abnormal Psychology (13th ed.). Boston:
Peasrson
Evan, J. et al. (2001). Cohort study of depressed mood during pregnancy and after childbirth. British Medical Journal, 323, 257-260.
Eynde, van den F., Schmidt, U. (2008) Treatment of bulimia nervosa and binge eating disorder. Elsevier. 7(4) pp 161-166
Franko, D (2001). Pregnancy Complications and Neonatal Outcomes in Women With Eating Disorders. American Psychiatric Association. 158, 1461-1466.
Franko, D.L., & Keel, P.K. (2005). Suicidality in eating disorders: Occurrence, correlates, and clinical implications. Clinical psychology review, 26(6), 769-782.
Harrison, A (1999). Poems for the People - Poems by the People. Retrieved November
3,2008, from Passions in Poetry Web site: http://www.netpoets.com/poems/depress/0078014.htm
Healy, David. (1999). The Anti-depressant Era. Haverd U.P.: Cambridge
Hollandsworth, J.G. (1990). The Physiology of Psychological Disorders Schizophrenia,
Depression, Anxiety, and Substance Abuse. Plenum Press: New York. pp 127 –
233
Kaplan, D. (1997). Is pregnancy a suicide shield? Psychology Today, 917, 21-22
Tan, W. X. (2008). Fetal Microchimerism in the Maternal Mouse Brain: A Novel
Population of Fetal Progenitor or Stem Cells Able to Cross the Blood–Brain Barrier?
Stem Cells, 23; 1443-1452.
Kinsley, C. H., & Lambert, K. G. (2006). The maternal brain. Scientific American, 294 (1)
Kiss, J.P. (2008). Theory of Active Antidepressants: A nonsynaptic approach to Treatment of
Depression. Neurochemistry International, 52(1), 34-39.
depressive disorder a diffusion tensor imaging study. Elsevier brain research 1168.7
pp124-128
McEwen, B., & Lasley, E. N. (2004). The end of stress, as we know it. Washington, D. C: Joseph Henry press.
Manji H.K. et al. (2001) The Cellular Neurobiology of Depression Nature Medicine 7 541-
547
Marano, E. H. (2004). Parenting: Here Comes Trouble. Psychology Today, 30, 15-17
Marzuk, P, Tardiff, K, Leon, A, Hirsch, C, Portera, L, & Hartwell, N (1997). Lower Risk of Suicide During Pregnancy. 154, 122-123.
Micali, N (2008). Eating Disorders and Pregnancy. ScienceDirect. 7, 191-193.
Milos, G., Spindler, A., Hepp, U., & Schnyder, U. (2004). Suicide attempts and suicidal ideation: links with psychiatric comorbidity in eating disorder subjects. General Hospital Psychiatry, 26, 129-135.
Misri, S (1995). Depression During Pregnancy and Postpartum. WellMother.com, 17, Retrieved November 2,2008, from K: Depression During Pregnancy & Postpartum.htm
Pompili, M., Girardi, P., Tatarelli, G., Ruberto, A., & Tatarelli, R. (2006). Suicide and attempted suicide in eating disorders, obesity and weight-image concern. Eating behaviors, 7(4), 384-394.
Rang, H.P. et al. (2003). Pharmacology 5th ed. Churchill Livingstone: Edinburgh. pp460, 535
Ryan, D. Milis, L. Misri, N. (2005). Depression during Pregnancy. Canadian Family
Physician. 51(8) pp 1087-1093
Vaishnav, K., Nestler, E.J. (2008) “The Neurobiology of Depression.” Nature p 893-901
Wells, B.P. et al. (1996). Caring for depression. Cambridge:Harverd U.P. pp15-6
Youssef, G., Plancherel, B., Laget, J., Corcos, M., Flament, M.F., & Halfon, O. (2004). Personality trait risk factors for attempted suicide among young women with eating disorders. European Psychiatry, 19(3), 131-139.
Appendix
Table 1 : Symptoms of depression
1. Persistent sad, anxious or “empty” feelings
3. Irritability, restlessness, anxiety
4. Feelings of guilt, worthlessness and/or helplessness
5. Loss of interest in activities or hobbies once pleasurable, including sex
6. Fatigue and decreased energy
7. Difficulty concentrating, remembering details and making decisions
8. Insomnia, waking up during the night, or excessive sleeping
9. Overeating, or appetite loss
10. Thoughts of suicide, suicide attempts
11. Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
http://www.nimh.nih.gov/health/publications/depression-what-every-woman-should-know/symptoms-of-depression-and-mania.shtml
Table2: Observed to expected ratios for suicide during pregnancy (1973-1984)
AGE (YEARS)
15-19 20-24 25-29 30-34 35-39 40-44
Observed 5 3 4 2 0 0
Observed: Expected 0.280 0.034 0.039 0.039 0 0
Test for heterogeneity: 20.35 df = 5 p = 0.001
Table 3: Numbers of suicides in each four-week period of year after childbirth. (1973-1984)
Four week period after childbirth 1 2 3 4 5 6 7 8 9 10 11 12 13 Total
No of suicides 18 5 8 7 11 7 5 3 3 2 2 1 3 75*
* In one case timing of suicide after childbirth was not recorded.
Glossary
A
Affective disorders: mental disorder characterized by a consistent, pervasive alteration in mood, and affecting thoughts, emotions, and behaviors.
Anorexia Nervosa: an eating disorder characterized by unrealistic fear of weight gain, self-starvation, and conspicuous distortion of body image.
Antihistamines: an agent which serves to inhibit the release or action of histamine.
B
Benign: of no danger to health, mild
Bulimia Nervosa: a serious and sometimes life-threatening eating disorder involves consuming large amounts of food (binge) and then trying to remove the food and calories (purge) by fasting, excessive exercise, vomiting, or using laxatives.
Childbearing age: Any age at which a woman can conceive a child between start of period and menopause.The best age for childbearing is 20-35
Cortisol: hormone that stimulates liver glycogen formation while it decreases the rate of glucose utilization in body cells
D
Depression: The condition of feeling sad or despondent
E
Eating disorder (ED): Any of various psychological disorders, such as anorexia nervosa or bulimia, that involve insufficient or excessive food intake.
F
Fractional anisotropy: is a measure reflecting directional
G
Glial cells: are non-neuronal cells that provide support and nutrition, maintain homeostasis, form myelin, and participate in signal transmission in the nervous system.
I
Imipramine: is an antidepressant medication, a tricyclic antidepressant of the dibenzazepine group.
L
Lability: very rapid fluctuations in intensity and modality of emotions, seen in affective
Reaction.
M
Monoaminergic: Of or pertaining to neurons that secrete monoamine neurotransmitters (e.g. dopamine, serotonin).
N
Neurotic: mentally maladjusted
Neurotic depression: any state of depression that is not psychotic. (dysthymia).
Neuroplasticity: refers to the changes that occur in the organization of the brain as a result of experience.
P
Pathogenesis: step by step development of a disease due to a series of changes in the structure and /or function of a cell/tissue/organ being caused by a microbial, chemical or physical agent
Parasuicidal: person mimics the act of suicide, but does not end up killing themselves.
Pueperium: The approximate six-week period lasting from childbirth to the return of normal uterine size.
Postpartum: period shortly after childbirth.
Postnatal: occurring after birth, especially during the period immediately after birth
S
Serotonin: Neurochemical concentrated in certain areas of the brain affecting mood
Suicide: taking one’s own life
T
Thyroid: A large gland in the neck that functions in the endocrine system. The thyroid secretes hormones that regulate growth and metabolism
Transient benign course: passing not harmful phase
REACTIES
:name
:name
:comment
1 seconde geleden