BEYOND THE BABY BLUES
A proposed program could give researchers a chance to provide more comprehensive care to new mothers and perhaps answer the question still lingering about postpartum depression.
Written by Cory Chandler
In the period following childbirth, a time most commonly associated with relief and elation, many new mothers instead find themselves coping with depression and an unexplained loss of purpose commonly known as the baby blues.
This low period, lasting an average of three to five days, occurs in nearly 80 percent of new mothers, making it the most common affliction of women following childbirth.
For most women, these feelings gradually fade as the hormonal shifts following delivery subside, and women grow accustomed to their new role and responsibilities. In some cases though, these feelings persist and escalate into a more serious condition known as postpartum depression.
Little is known about the causes of postpartum depression. The illness affects one in 10 women, and symptoms include anxiety, frequent crying, mood swings, sleeplessness, loss of pleasure, and appetite loss, but little headway has been made into the biological and psychological factors causing the disorder.
Magnifying this problem is a failure by many doctors to correctly diagnose and treat postpartum depression before it reaches a critical level. Most women do not see their obstetrics/gynecology doctor until six weeks after childbirth, which is too late to diagnose the onset of the disorder in most cases, and many medical students are never trained to look for the symptoms, even though many women are faced with the disorder.
A proposed program could give researchers at the Texas Tech University Health Sciences Center a chance to provide more comprehensive care to new mothers and perhaps answer the questions still lingering about postpartum depression.
Several obvious factors are currently believed to cause postpartum depression. Hormonal shifts occurring as the body adjusts to its post-pregnancy state are thought to be the largest contributor, but stress caused by the responsibility of caring for a new child, the trauma of childbirth and sleep deprivation also often are blamed.
If implemented, the West Texas Center of Excellence for the Mental Health of Mothers would give researchers a way to study how issues such as social support, education, health awareness, biological factors and interpersonal relationships also can play a role in the onset of postpartum depression.
Gary Sutkin, Ph.D., an instructor of clinical obstetrics/gynecology and one of the founders of the proposed center, said understanding how these factors affect women suffering from postpartum depression could help with diagnosis and treatment of the disorder.
"So many women suffer from postpartum depression," he said. "And although we have effective treatments, we don't understand how these treatments will work according
to ethnicity. Often, a Hispanic woman will respond differently than a Caucasian woman to drugs or counseling. I also think that the more this is studied, the more the word will get out that this is a serious clinical condition that is currently under recognized and under diagnosed."
Sybil Hart, Ph.D., an assistant professor in the Department of Human Development and Family Studies for Texas Tech University and one of the developers of the program, said the center also would provide an improvement in the quality and continuity of treatment that women receive following childbirth.
"Most women stop seeing their obstetrician once they have their baby," she said. "They begin to see a pediatrician for their child, but all the care they received during pregnancy drops off sharply after delivery. We want to try to improve on the comprehensive care they receive to ensure that they do not fall between the cracks."
Hart said the center could accomplish this by drawing upon all the resources available at the Health Sciences Center, including experts in obstetrics/gynecology, child development, nutrition and psychiatry to study how nutrition and drug regimens modify biochemical changes and alleviate postpartum depression.
At the moment, new mothers and researchers alike will have to wait for the answers they are seeking though. The proposed center has been put off indefinitely until funding can be found to implement it.
Richard Dickerson, M.D., Ph.D., an associate professor of pharmacology and toxicology who has been involved with the search for funding, said requests for grant money have not been successful so far.
Sutkin said those involved with the Center for the Mental Health of Mothers are now searching for new potential funding sources. He said he and his colleagues are excited about the opportunities the center presents because it would allow several departments and schools of the Texas Tech campuses to conduct research into the disorder.
Allahyar Jazayeri, M.D., Ph.D., an associate professor of obstetrics/gynecology and director of Obstetrics and Maternal Fetal Medicine, was the individual who initially came up with the original idea for starting the program. He said the center would include members of the departments of Biochemistry, Psychology, Psychiatry and Human Development and Family Studies and the School of Obstetrics and Gynecology and Pediatrics in the Health Sciences Center. It would also entail a coordinated effort between the Health Sciences campuses in Lubbock, El Paso, and Odessa.
Jazayeri said the campuses in El Paso and Odessa would help recruit patients, conduct surveys, and collect data, but the processing and lab work would be done in Lubbock to keep the results consistent.
Jazayeri said the equipment necessary for processing this information already is available, and the majority of the $120,000 sought by the grant proposals would be spent in acquiring a research nurse who would oversee the work conducted by the center over a two-year period.
"What is most important is that we have someone who keeps track of the patients once they are enrolled. We need someone who will follow up on them and make sure they make appointments. We cannot rely on residents to do this because they have other priorities."
Jazayeri said most of the rest of the funding would go to purchasing Enzyme-Linked Immunosorbant Assays, or Radio Immunoassays, which measure specific substances and hormones in the blood.
ELISA is a two-stage process in which a target antigen binds with specific antibodies. Any materials not bound to these antigens are washed away and color is added to indicate the presence of the antibody.
Radio Immunoassays bind radioactive isotopes to antigens, which are measured by a gamma ray counter. The antibody is detected by adding radio labeled ligands.
Jazayeri said these assays cost up to $700 per kit and run approximately 40 per sample, but because most of the equipment already is available, work could begin even without the kits once a research nurse was in place.
"We already have the lab space we need, so we would not require much to buy the supplies," he said. "We could start collecting and storing blood samples now and six months later, once we have purchased the kits, we could take the samples out of the freezer and begin working on them."
Jazayeri, who will be leaving the Health Sciences Center in May to pursue a private practice, is no longer involved with the effort to establish the center. He said Hart would be primarily responsible for overseeing further efforts.
Hart said she plans to continue trying to establish this center because it would help provide doctors at the Health Sciences Center with the ability to deal with issues involved with postpartum depression before they become a major problem.
"Relying on mothers to come to us with these problems is clearly not enough," she said. "Even those who are not in the most critical of situations could need our help, and this way we can make referrals before the situation reaches a crisis level. People have
a tendency to believe that if a problem is psychological instead of physical they shouldn't worry about it as much."
In the wake of the Andrea Yates case, in which a woman believed to be suffering from postpartum psychosis drowned her five children, the disorder has been placed in the national spotlight. Postpartum depression has been under new scrutiny by the public, and Hart said she hopes this awareness will heighten interest in the center.
She said she believes a broad source of organizations would be interested in the information gleaned from the research conducted by the center. These organizations range from philanthropies to baby formula manufacturers. Hart said minority groups also could be interested because the Health Sciences Center has a large number of Latin American women patients available for study.
Dickerson said he believes the research would be noteworthy, even without the publicity, because it would provide an opportunity to help women around the world.
"I see a lot of patients go through this condition," he said. "It is not a subject that is routinely taught to us as medical students, but every patient still needs to talk about it. I don't want to help just my patients, but every woman in the world with it. This is a great opportunity for us to intervene on the part of women everywhere."
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