There has been a long held belief that diet may influence well-being. The phrase “you are what you eat” suggests that nutrition has an impact on physical as well as mental health. Until recently, however, there have been few studies that provide data to support this idea.
Psychotic disorders such as schizophrenia and schizoaffective disorder are devastating disorders that usually require chronic care and impact individuals and their family members greatly in terms of morbidity and mortality. Research has helped to identify those who may be at greatest risk for developing psychotic disorders. Strategies to prevent psychotic disorders would alleviate suffering and have great public health significance.
Approximately 10-15% of women will experience mood symptoms that meet criteria for a Major Depressive Episode during the postpartum period. However, as many as 50% of women may experience some level of depressive symptoms during the postpartum period. Recent evidence suggests that even depressive symptoms that do not qualify for a diagnosis of postpartum depression may have a negative impact on both mother and child. In spite of the fact that so many postpartum women will experience depressive symptoms, little research has been conducted in order to identify potentially modifiable factors that could reduce the risk of depressive symptoms or the development of a major depressive episode during this time.
Postpartum psychosis occurs in about 1 to 2 per 1000 women after delivery. While there appears to be a strong link between postpartum psychosis and bipolar disorder, it is estimated that about half of women who present with postpartum psychosis have no psychiatric history prior to delivery, making it difficult to identify those women who are at greatest risk for this illness. A recent study, using data from the Swedish Medical Birth Registry, has examined possible risk factors that may be used to identify women at risk for postpartum psychosis.
Our Perinatal and Reproductive Psychiatry team often discusses clinical cases in Rounds, a confidential forum in which we can get advice and consultation from peers who also work in the area of Women's Mental Health. We discussed a patient's situation recently that highlighted the controversial area about how to prevent mood episodes in a woman planning for pregnancy.
Postpartum depression (PPD) is a relatively common problem, affecting between 10% and 15% of women after delivery. Although it is difficult to reliably predict which women in the general population will experience postpartum mood disturbance, it is possible to identify certain subgroups of women who are more vulnerable to postpartum affective illness. Women who have had one episode of postpartum depression have about a 50% chance of experiencing another episode of PPD after a subsequent pregnancy. The extent to which a history of depression (prior to pregnancy) influences risk is less clear, but some studies indicate that between 30% and 50% will suffer from recurrent depression during the postpartum period. Several investigators have recently explored the potential efficacy of prophylactic interventions in these populations of women at risk.
Women who take antidepressants for their depression must make a difficult decision when they plan to become pregnant. Should they continue their medication during pregnancy? Or should they stop? Although there is information to support the reproductive safety of at least some antidepressants, most women, understandably concerned about exposing their babies to medication, choose to discontinue their antidepressant during pregnancy.
