Susan Hamilton

Mindfulness yoga during pregnancy for psychiatrically at-risk women: Preliminary results from a pilot feasibility study

Prenatal psychopathology may have an adverse impact on mother and baby, but few women receive treatment. We offered a 10-week mindfulness yoga (M-Yoga) intervention to psychiatrically high-risk pregnant women as an alternative to pharmacological treatment. Participants (N = 18) were primiparous, 12-26 weeks pregnant, and had elevated scores (>9) on the Edinburgh Postnatal Depression Screen at baseline. In addition to a baseline diagnostic assessment, women completed self-ratings on depression, mindfulness, and maternal-fetal attachment before and after M-Yoga. Findings suggest that M-Yoga was feasible, accepted and effective. Symptoms of depression were significantly reduced (p = 0.025), while mindfulness (p = 0.007) and maternal-fetal attachment (p = 0.000) significantly increased. Overall, this pilot study is the first to demonstrate that M-Yoga may be an effective treatment alternative or augmentation to pharmacotherapy for pregnant women at high risk for psychopathology.

Vitamin D levels and perinatal depressive symptoms in women at risk: a secondary analysis of the mothers, omega-3, and mental health study

BackgroundVitamin D insufficiency may be associated with depressive symptoms in non-pregnant adults. We performed this study to evaluate whether low maternal vitamin D levels are associated with depressive symptoms in pregnancy.MethodsThis study was a secondary analysis of a randomized trial designed to assess whether prenatal omega-3 fatty acid supplementation would prevent depressive symptoms. Pregnant women from Michigan who were at risk for depression based on Edinburgh Postnatal Depression Scale Score or history of depression were enrolled. Participants completed the Beck Depression Inventory (BDI) and Mini International Neuropsychiatric Interview at 12–20 weeks, 26–28 weeks, 34–36 weeks, and 6–8 weeks postpartum. Vitamin D levels were measured at 12–20 weeks (N = 117) and 34–36 weeks (N = 112). Complete datasets were available on 105 subjects. Using regression analyses, we evaluated the relationship between vitamin D levels with BDI scores as well as with MINI diagnoses of major depressive disorder and generalized anxiety disorder. Our primary outcome measure was the association of maternal vitamin D levels with BDI scores during early and late pregnancy and postpartum.ResultsWe found that vitamin D levels at 12–20 weeks were inversely associated with BDI scores both at 12—20 and at 34–36 weeks’ gestation (P < 0.05, both). For every one unit increase in vitamin D in early pregnancy, the average decrease in the mean BDI score was .14 units. Vitamin D levels were not associated with diagnoses of major depressive disorder or generalized anxiety disorder.ConclusionsIn women at risk for depression, early pregnancy low vitamin D levels are associated with higher depressive symptom scores in early and late pregnancy. Future investigations should study whether vitamin D supplementation in early pregnancy may prevent perinatal depressive symptoms.Trial registrationhttps://clinicaltrials.gov/ Registration Number: NCT00711971

Use of Antidepressants During Pregnancy?: What to Consider when Weighing Treatment with Antidepressants Against Untreated Depression

Introduction Mood disorders impact many pregnant women, particularly those who have experienced symptoms prior to conception, and there are significant barriers, including stigma and access, to seeking and receiving appropriate treatments. Antidepressants are a helpful option in treating perinatal depression, but research on risks and benefits of antidepressant use in pregnancy is difficult given lack of “gold standard” comparative trials. Methods This paper summarizes current state of knowledge on the safety of antidepressants during pregnancy by providing a summary of the literature published in the past 3 years (January 2013–October 2015). We identified 21 reviews and meta-analyses that were included in this summary report. This report is meant to provide a user-friendly, yet comprehensive guide summarizing the abundant, and in part contradicting, literature on risks and benefits of antidepressants during pregnancy, in order to assist busy primary care prescribers in educating their patients. Our goal is also to contrast the risks/benefits of untreated depression in pregnancy versus treatment with antidepressant medication in pregnancy, and in such support prescribers in their decision-making. Results The past 3 years have yielded an abundance of publications on the topic, in part, with conflicting findings adding to confusion and concern among providers, patients, and their families. Many reported studies have methodological problems limiting their impact. Data on adverse effects of medications on pregnancy and fetal outcomes have to be weighed against the impact of untreated illness and poor health habits associated with untreated illness on the same outcomes. Discussion Medical-decision making is often complex and seldom free of risks. Obviously, as providers we cannot guarantee that fetal exposure to antidepressants is totally free of risk, yet this is true for any medicine taken in pregnancy. However, to date, perinatal psychiatry has collected enough evidence to suggest that, if the clinical picture warrants it, the use of many antidepressants, especially the SSRIs, is favorable compared to exposing mother and child to untreated depressive illness.

Mindfulness yoga in pregnancy: A promising positive treatment augmentation for women experiencing depression or anxiety

: Intense encounters with mortality - such as a diagnosis of a terminal illness or a sudden brush with mortality due to an accident or injury - can have positive transformational effects, leading to what positive psychology refers to as ‘flourishing.’ In particular, intense encounters with mortality may generate a heightened sense of appreciation for life, more authentic relationships and lifestyles, and an increased ability to be “mindful”, in the sense of becoming more focused upon the present, and more vividly aware of one’s surroundings. (This is termed ‘externally-oriented mindfulness’.).This can be seen as a form of ‘spontaneous mindfulness’ caused by a re-orienting of attention, away from the future and the past, and into the present. Examples of this shift are given, and other reasons for its emergence are suggested. The positive effects of encountering mortality are contrasted with the findings of Terror Management Theory. The intensity and directness of the individual’s encounter with mortality may be a significant factor in whether it has negative or positive effects. It is suggested that increasing our awareness of mortality - such as by making a conscious effort to contemplate death - can help us to gain some of the positive transformational effects of an intense encounter with mortality (or IEM): Intense encounters with mortality - such as a diagnosis of a terminal illness or a sudden brush with mortality due to an accident or injury - can have positive transformational effects, leading to what positive psychology refers to as ‘flourishing.’ In particular, intense encounters with mortality may generate a heightened sense of appreciation for life, more authentic relationships and lifestyles, and an increased ability to be “mindful”, in the sense of becoming more focused upon the present, and more vividly aware of one’s surroundings. (This is termed ‘externally-oriented mindfulness’.).This can be seen as a form of ‘spontaneous mindfulness’ caused by a re-orienting of attention, away from the future and the past, and into the present. Examples of this shift are given, and other reasons for its emergence are suggested. The positive effects of encountering mortality are contrasted with the findings of Terror Management Theory. The intensity and directness of the individual’s encounter with mortality may be a significant factor in whether it has negative or positive effects. It is suggested that increasing our awareness of mortality - such as by making a conscious effort to contemplate death - can help us to gain some of the positive transformational effects of an intense encounter with mortality (or IEM)