Archive for the ‘Women’s Issues’ Category

I have had chronic sleeping problems for 10 years. I am a 58 yo woman going through menopause. My mother is 90 and still on sleeping pills. Could my condition be hereditary? Which pill will give me 7 hours of sleep leaving me refreshed the next day?

See the Do’s and Don’ts of sleeping habits on my site:   

 http://askdrjones.com/wp-content/uploads/2006/06/sleep_dos_and_donts1.pdf

Make sure you are doing all the cognitive and behavioral things you can do to optimize sleep. 

You are in a high risk group for insomnia.  Sleep problems are more common in women than men, increase with age, and are aggravated by menopause.  The onset of your insomnia coincides with perimenopause.

Estrogen has many more potential benefits than risks for most women – especially brain benefits.  Unfortunately, if you still have your uterus you have to take some progesterone.  There are options like long acting intrauterine forms of progesterone that can minimize side-effects.  I am totally opposed to oral estradiol such as Estrace.  http://test.askdrjones.com/2007/04/28/say-goodbye-to-the-pill-ladies/

  Premarin or synthetic Cenestin by mouth and or estradiol cream/gel or patch is the best form.  The WHE study 5 years ago scared a lot of women about estrogen replacement therapy but the women in the study were on average 10 years post menopause and never used estrogen – that puts women at greater risk and may apply to you especially if you smoke.

One milder option is prescription DHEA which in women mainly turns to testosterone (good for bone and muscle) but then in the brain is converted to estrogen – avoiding the increased risk of estrogen related breast cancer.  

There are occasional women who benefit from natural progesterone (Prometrium) at bedtime since it has a natural benzodiazepine like sedative effect.  I recommend that you don’t take synthetic progesterone like Provera.  

Any form of alcohol can contribute to sleep problems because it causes arousal as it wears off.  If you do drink alcohol make sure it is not within 3-4 hours of going to bed.

We are fortunate to have very effective sleep medications that provide normal sleep.  The mildest, shortest acting is Sonata, usually 10mg-20mg lasts 4-5 hours.  Benzodiazepines such as Xanax, Klonodine, Ativan, etc., shouldn’t be used at bedtime because they decrease stage 4 sleep (the most important type of sleep), but they can be used for early awakening with inability to get back to sleep – since we get all our deep sleep in the first three hours.

Lunesta (2-4mg is needed) for sleep but may cause a bad taste in 15-20% of people (less likely if taken with orange juice).

In general, Ambien CR is better than Ambien tablets because they frequently don’t last long enough.  The generic form is probably weaker.  The CR form is not as strong as the tablets for inducing sleep but lasts longer.  Some people have to combine CR with the short acting tablets to get to sleep.

All of these sleep medications work better on an empty stomach – combined with good sleep habits as I stated earlier.

Circadian rhythm problems can also contribute to the problem.  Morning bright light and or evening melatonin or prescription Rozerum may also help. 

Adding Tenex or Clonidine, or occasionally Prozosin can be helpful.  Trazodone, Seroquel, or low dose Doxepin may help.  Neurontin (up to 800mg) or Lyrica also induce normal sleep.

Chronic insomnia can be very resistant because of all the anxiety and conditioned negative expectations.  It is harder to treat initially and gets easier as fear of insomnia subsides.  When problems persist a sleep study can help identify problems such as restless legs, myoclonus, or sleep apnea.

When all else fails there is a medication that usually works, Xyrem.  It is highly regulated because of previous misuse of it as GHB.

Because good sleep is so essential you have to persist until you find what works for you.  Don’t give up until you find the right medication at the right dose.    

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How can I prevent recurrence of depression and what do I do if the depression does come back?

Depression runs in my family and I’ve been on the same medicine for a while with no episodes of depression.  About two weeks ago I woke up feeling not myself and contributed it to getting my period on top of coming down with a respiratory infection.  Still not feeling well after two weeks I think it might be depression because I feel tired, confused thinking, can’t focus, etc.  I’ve called my doctor and he told me to up my medicine 100mgs.  My question:  

Since I have not had an episode of depression in quite some time could it have been brought on by me not feeling well?

 


 

Dr. Jones’ reply:

I’m not sure what antidepressant you are on – but it was possibly Zoloft or Luvox since they can be increased by 100mg increments, but not SNRI’s (Effexor, Cymbalta) or other SSRI’s (Prozac, Celexa, Lexapro, Paxil).

Women with a family history and or prior history of depression who respond to an SSRI or SNRI can have return of symptoms if their serotonin level is reduced (as it is premenstrually, post partum, or during perimenopause).  Being ill can also contribute to relapse by disrupting sleep or normal thyroid function.

Previous studies have shown that:  "the dose that gets you well keeps you well", but even then the relapse rates are:  20% of patients have recurrence within 3 years,  50% relapse if the dose is lowered, or 80% relapse if medication is stopped.

Recurrent depression not only causes distress and possible short term impairment, it can also increase your vulnerability to future episodes and decrease your responsiveness to treatment.

There are several things that can help prevent recurrence:

  1. Good sleep – 7-8 hours every night (Lunesta, Ambien provide normal sleep)
  2. Physical activity – daily vigorous activity for at least 30 minutes (a 2 mile walk or equivalent)
  3. Omega 3 fatty acids – take twice daily.  (I trust Cooper brand the most)
  4. Bright light daily 
  5. Thyroid – make sure thyroid levels are good  test.askdrjones.com/ 
  6. Cognitive behavioral therapy – if needed
  7. Other medications – other medications may help such as alprazolam, atypicals, stimulants
  8.  L Methylfolate – (Deplin,  Cerefolin, or Cerefolin NAC)  – these contain a form of folic acid that gets into the brain cells.  Deplin was recently approved by the FDA as an add-on treatment for depression.  Cerefolin also contains B12 and Cerefolin NAC has a third ingredient that increases glutathione (a powerful brain cell antioxidant).  These medications not only can improve mood, but improve cognition and energy.  Caution:  taking Deplin if your B12 level is low can be harmful.  It is safer to either check your B12 levels or take Cerefolin. 
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Brooke Shields, John Nash, and the national APA meeting

Two thunderous standing ovations highlighted this year’s APA meeting. They were as different as you could imagine. An intimate conversation with Brooke Shields about her battle against nature’s cruelest mood disorder – postpartum depression – and Dr. John Nash (A Beautiful Mind) reading a paper he wrote in which he describes his battle against schizophrenia through metaphors of economic theory and the complex mathematics of game theory (for which he received a Nobel prize). Each presentation was in front of hundred’s of physicians and other professionals. One was alternately funny and gut wrenching.  The other was a mind twisting exercise in obfuscation.

What they had in common was each individual had the courage and strength to open their heart and soul to the professional world so that their stories could help us help others.

Dr. Nash’s presentation was interesting at times and touching at times but mostly unemotional.  I wish he had been interviewed in front of the audience instead.

He likened becoming psychotic to part of his mind going on strike. The most provocative thing he said was that to him his new insight into mathematics and his paranoia were both novel ideas not shared by anyone.  The only difference was that one was true, was labeled genius, and was rewarded with the Nobel prize.  The other was not true, was labeled insanity, and got him committed to a locked psychiatric ward.

The schizophrenic mind can’t tell the difference. Of course sometimes ideas are true but sound crazy.  And for various reasons society is not ready for them and may even persecute those who dare to challenge the current version of truth (like the earth is the center of the universe).

I was the most moved by Brooke Shields. Maybe because I have helped women who struggle with postpartum depression for over 40 years. 

What can possibly be a more joyous time than having a new baby – looking into your eyes, cooing, and responding to your love?  What can be more painful than when you as a mother feel nothing, or rejection, or thoughts of harming this poor helpless creature?  What could be more shameful and guilt producing? 

Everyone is saying how cute and precious your baby is, and you’re thinking "I wish you would shut up," or maybe even, "Please take this baby with you."  And if you do share that you’re not feeling right they say, "Oh, it’s just ‘baby blues.’  It will pass. it’s normal." 

And you’re thinking, "You don’t understand. I want to die. I feel empty, hopeless, inadequate, overwhelmed."  Or if they suggest medication, what you hear is you’re weak or crazy or both!  When you’re a celebrity with fame and fortune, a loving husband, and all the trappings of a perfect life, but you feel like a total failure, you see no hope for even being o.k. again and thoughts of suicide come to mind.

As Brooke Shields discussed this torturous beginning to motherhood, the pain of her experience was palpable throughout the ballroom.  The first turning point occurred for her when she had sent her husband to get a changing table, but he returned empty handed.  He sat on the bed and broke down.  She had never seen him cry.  He said "I went to the store and there were all these mothers and babies and families, and they were so happy.  Why aren’t we happy?" 

I almost lost it, in fact it took several tries before I could comment to my wife without getting choked up.

She went on to describe how she got on an antidepressant and felt better.  She went back to California and stopped the meds and crashed again.  She describes driving in her car with the baby in the back and thinking, "I could speed up to 80 mph and run into a concrete wall and all this would be over."  Fortunately she called a girlfriend and told her how she was feeling, and her girlfriend made a date with her for lunch the next day. She said her girlfriend was so manipulative because she knew Brooke was compulsive about keeping her commitments and would have to wait until after lunch tomorrow to drive into a wall.  

Brooke called her  doctor who asked if she had stopped her meds.  She said yes and he asked, "Why?"  She thought, "Did I sleep through my 4 years at Princeton?"

So, she went back on meds, had some side effects, changed meds, and eventually, everything was okay. 

3 years ago she went through a 2nd pregnancy without all the stressors of her first pregnancy, which included 7 in vitro fertilizations, miscarriages, death of her father (prostate cancer), an emergency C-section, being away froms support people, and being clueless with expectations of being the perfect mother. 

She described how different this 2nd experience was.  When the OB handed her the baby in the delivery room, her husband was thinking "Please don’t start sobbing," but she felt joyous, relieved, then elated.  She said, "I started telling my girlfriends they could have some of my husband’s sperm (in vitro) if they needed it."  A happy ending.

She tells her story in the recent book Down Came the Rain.  She has done way more than her share in making women aware of what can happen and that treatment is available.  I felt so much respect and appreciation for what she has done.  Then I thought about Tom Cruise (see previous article). I wondered how many women were on the fence about mood disorders, psychiatry, and medication.  How many were influenced by him to not seek help?  How many mothers suffered unnecessarily, and how many babies didn’t bond with their mothers during those early critical developmental weeks and whose lives will be adversely affected forever?

At the same moment I wanted to sing Brooke Shields praises and kick Tom Cruise’s ass.

 

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Say Goodbye To The Pill Ladies

I am now completely against birth control pills. I’m also against hormone replacement with oral estradiol. Estradiol (in every birth control pill) taken by mouth goes through the liver and causes problems with thyroid, testosterone, and the most effective form of estrogen.

In anyone with a history of depression and/or stress reactivity, this can be a major contributing factor to their functioning and quality of life.

For premenopausal women the NuvaRing seems to be the best option. This is because the hormone blood levels are about 1/3 of what they are with the weakest birth control pill.

Controversy continues regarding hormone replacement in postmenopausal women. However, for most women, the benefits outweigh the risks – especially for brain function (mood & memory). Using the right types of hormones and the right dose is essential. The best options are Premarin or Cenestin tablets and/or estradiol by patch or gel.

Remember, estrogen x thyroid x brain transmitters = mood in women.

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Vitamins & Supplements: Are they really worth it?

  We have heard it since we were kids, but do we really need to take our vitamins? 

The answer is yes. 
Most Americans don’t get the nutrition they need simply from the foods they eat, and supplements insure that our body meets its nutrient “quota” enabling our body to function optimally at the cellular level.  However, the vitamin and supplement industry is not regulated by the FDA, so there is no guarantee that products bought from grocery and health food stores are effective or contain the stated ingredients.    
Cooper Complete Vitamins are backed by Science.
That is one reason we decided to make them available to our patients. Reputable physician Kenneth Cooper created the Cooper Institute, a non-profit organization that manufactures, researches and publishes studies on Cooper Complete vitamins. He ensures regular testing to measure efficacy, potency and absorption of Cooper supplements.  Not only does Dr. Jones promote these vitamins, but he takes them himself and he furnishes them to his staff at no charge to promote wellness among staff members.  To encourage patients to take these supplements over other store bought brands, Dr. Jones decided to make these supplements available to his patients at a discounted price, so we offer the Cooper Complete© line of products for less than you can get them at most grocery stores and even less than the price from ordering them directly from his website. 
If you are interested in ordering supplements or would like more information about the supplements, please feel free to contact our office or e-mail us your request to info@askdrjones.com.  


Studies published in the American College of Nutrition and
the American Journal of Medicine found Cooper Complete multi-vitamin lowered: 
· Oxidation rates of LDL Cholesterol by 14%

· Homocysteine levels by 17%

· C-reactive Protein Levels by 32%

High levels of these values are all associated with increased cardiovascular disease risk.


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Hormone Replacement Therapy for Depression During Perimenopause

Question: I’m a 48 yr. old female with bipolar II disorder and have been taking 300mg/day of Wellbutrin XL and .25mg of Xanax on an as needed basis for anxiety. My depression and anxiety have increased significantly the past few months due to stress from a job change, death of my mom and an “empty nest.” I’ve also been experiencing some peri-menopausal symptoms such as irregular periods and occasional night sweats.

My psychiatrist would like me to try hormone replacement therapy before making any changes in my meds. My ob-gyn would like me to try Cenestin. I’m very nervous about HRT and would rather try adjusting my present med dosages or changing to another anti-depressant. How do you feel about the effectiveness of HRT for treating depression/anxiety for those of us with bipolar disorder?

— Maureen

Answer: Irregular menses and night sweats in a 48 year old woman is very suggestive of perimenopause. Perimenopause is a period of usually 2-4 years where mood symptoms are common, more so than during menopause. Presumably, the depressive symptoms are related to dropping estrogen levels. Decreasing estrogen results in decreasing serotonin levels in the brain. Lowering serotonin levels doesn’t necessarily cause depression, but in a woman with previous depression or certain genetic vulnerabilities, depression does frequently occur. Another possible mechanism for estrogen benefit is that it stimulates cell growth in the rapid access memory brain (hippocampus).

In bipolar disorder mood changes are more often related to changes in hormones, seasons, steroids or effects of medication than to psychosocial stressors. Estrogen is often the most effective treatment in this situation. For some women this is the only treatment I have found to work. Cenestin, Premarin by mouth, or Estradiol by patch or cream is the best way to take it. Low doses are better to start (.3 Cenestin or Premarin or .025 Estradiol patch or cream). Occasionally, treatment results in hypomania. Wellbutrin can also cause hypomania in bipolar II. Most patients with bipolar disorder need to be on a mood stabilizer (see Best mood stabilizers).

Related article

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Best Medications for Premenstrual Dysphoric Disorder (PMDD)

Premenstrual Dysphoric Disorder responds to medications that enhance serotonin levels. It can be inferred that the cause relates to dropping serotonin levels as estrogen levels fall (since estrogen increases serotonin). Lowering serotonin levels only causes mood symptoms in women who have a genetic predisposition or previous history of depression.
Unlike depression, symptoms of PMDD respond fairly quickly to medication. Typical mood symptoms of PMDD are sad, tearful, feeling overwhelmed, irritability and being overly emotional.
Before deciding whether to use medication every day or just in the last 1-2 weeks of the cycle it is recommended that mood charts be kept for 2-3 cycles. This is primarily to evaluate mood in the first half of the cycle. It is believed that many women have mood symptoms all the time but they are worse during the premenstrual phase. It may be that the lesser degree of depression in the early cycle is normal (by comparison). PME or premenstrual exacerbation of mood symptoms is best treated with daily medication – though sometimes increasing the dose in the last 7-10 days is helpful.

For true PMDD there are several reasons that limiting medication to a few days is helpful. The biggest reason is avoidance of potential long term side effects, especially sexual side effects, possible weight gain and blunting of emotion and motivation. Other reasons include the cost, stigma, and the hassle.
When using medication just during the late luteal phase (last few days of cycle) my first choice is Effexor. Because Effexor is the quickest to cross the blood brain barrier (due to low protein binding) it can be taken for the shortest number of days. It frequently starts working the first day (usually 37.5mg is adequate but sometimes 75mg is needed). Once Effexor is discontinued – usually once menses starts – the Effexor is totally out of the system in 3 days. Most medications take one week to be out of the system. Prozac (fluoxetine) aka Sarafem takes six weeks to clear – i.e., it can’t be taken just during the PMS phase. My 2nd choice and the second fastest to work is Lexapro 5-10mg. Ironically it’s Prozac (Sarafem) and Zoloft (slowest to work) that pursued and received FDA indications.
Although Effexor and Lexapro may work the first day it’s usually better to start them 2-3 days before symptoms usually start – this of course requires using a calendar and keeping track of due dates. If you can tell when you ovulate it’s easy – 14 days later you will start your period.

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Thyroid Facts and Myths

I am a bibliophile, or a person who loves books. My friends and family would probably say I am more a hoarder of books, journals, magazines and notes. (More about what causes hoarding later) I love going to book stores and I always see what they have on medicine and neuroscience. I don’t think it’s a coincidence that there are more books on thyroid than any other subject. I believe the reason is low thyroid is an extremely common, fixable problem that may be more frequently mismanaged than any other medical condition. Proper treatment improves fitness and quality of life but most doctors don’t get it. There are two maladies that I have noted in some physicians, PRE EXTRACTION DISORDER and MILK OF MAGNESIA DEFICIENCY. In the first condition they lack important information or don’t understand key principles because their head is somewhere in their sigmoid colon. In milk of magnesia deficiency, they believe things that are sometimes creative or at one time believed, but unfortunately not true – ergo they are full of crap. You may think this point of view is unkind, and you’re right. I believe that as an ADHD person I was put on earth to stir things up and challenge the system, so I won’t apologize for being at times “tacky”.

Why are there so many books about thyroid? I believe when a doctor “gets it” and starts treating low thyroid effectively, they realize how often it is mistreated and how many patients suffer the consequences. I could regale you with case after case of examples, but suffice it to say, I too feel compelled to try and educate the public and my physician peers about the physiology of thyroid hormones.

The thyroid gland in the neck secretes two primary hormones, the more abundant T4 and the more active T3. Most of our T3 is made in other parts of the body by converting T4 to T3. I am working on a thyroid article that will go into detail about all the important nuances, but the key points are:

  • Thyroid regulates the activity of every cell in the body.
  • Many people, for various reasons, are low in T4 and/or T3.
  • Most doctors will order only part of the tests needed for accurate diagnosis (the TSH).
  • Total T4 and T3 uptake and a multiple called T7 or free thyroid index (FTI).

The FTI is preferred by insurance companies because it’s cheap, not because it’s adequate. This test is unreliable according to many reputable texts, so I consider it to be useless. The most important test is the Free T4 and sometimes the Free T3. Even when the Free T4 is within normal range, it may be too low for the individual. It would be analogous to giving you an IQ test in which you scored 90, and I told you this range was normal. The normal average range of IQ is 90-110, but what if you said “my IQ used to be 130”? … Something’s wrong. That may be the case with your thyroid.

One reason that this is missed is that most doctors don’t ask about thyroid symptoms (or a lot of other symptoms for that matter). But if you have fatigue or easy fatigueability you need to review all the possible symptoms:

Dry skin, hair loss, sensitivity to cold, constipation, swelling, decreased memory, depression, or mood sensitivity, weight gain, difficulty losing weight, and infertility.

Even when low thyroid is treated, it usually is undertreated. The main medication used is Synthroid (the generic is especially unreliable). Many patients also need T3, either Cytomel, or in combination Armour or Thyrolar.

In the past 2 years I have attended two lectures by different Endocrinologists who talked about treating low thyroid. They talked about TSH, estimated Free T4 and treatment with Synthroid. No discussion of secondary hypothyroidism (low thyroid) which means due to causes other than an underfunctioning of the thyroid gland. Neither presenter talked about the role of T3 or use of T3 in treatment.
The books on medicine and endocrinology all say that for secondary hypothyroidism the TSH is useless, and yet, that is frequently the only test they get. At the second talk I asked if they believed that the soul was in the pituitary. This is the gland that helps regulate thyroid by monitoring levels and secreting TSH. But the problem is the pituitary (the master gland just outside the brain) is regulated by the hypothalamus in the brain.

Years ago a study found that if post menopausal women not on estrogen were treated with too much thyroid it could worsen osteoporosis. Ever since there is a fear of causing bone loss, and the result has been a lot of undertreatment. The problem is over reliance on the TSH and fear of osteoporosis, “osteophobia.”

In secondary hypothyroidism the thermostat for body temperature and the set point for basal metabolic rate is set too low. I believe a common cause is “hibernation”. Many of us are mostly indoors and some are mostly sedentary. But we adapted over 1000’s of years to being outside all day and physically active. Our energy and sleep were regulated by the bright outside light. Even on a cloudy day it is 10x’s brighter outside than inside. If our brain thinks we are hibernating, and especially if we have cultural heritage from the northern countries, then we compensate by reducing our metabolism until the weather permits productive outside activity. By reducing our temperature and metabolism we conserve energy (stored as fat). This is also why it’s very difficult to lose weight.

If our hypothalamus is set too low the pituitary will read our level as too high when we take an adequate healthy amount of thyroid medicine. The TSH will then be below the normal range – this is fine. But most doctors overreact and lower the thyroid medicine. Now the patient feels terrible, but their TSH comes up and the doctor is happy – pre-extraction disorder. Most doctors are conscientious. They want to do what’s best for their patients, but in the case of thyroid, they mostly don’t get it.

Low thyroid can cause or worsen depression. In women it is:

Thyroid

x

Estrogen

x

Brain transmitters

(norepinephrine, serotonin, dopamine)

=

MOOD

It’s like for your car you have to have gas, oil, and water. You can’t compensate for no gas with more water. You can’t compensate for low thyroid with an SSRI (antidepressant such as Lexapro). In men testosterone is more important than estrogen. The brain converts testosterone to estrogen in men and women. Older men have more brain estrogen than older women (who are not taking estrogen). Older men have half as much Alzheimers – the only common cause of premature death more common in women.

In bipolar disorder Synthroid or T4 needs to be in the upper part of normal range to help stabilize mood. T3 is more of an antidepressant but obsession by “osteophobic” physicians results in inadequate treatment doses to help with mood. “The operation was a success (we kept the TSH up) but the patient died.”

I will cover osteoporosis n detail later but just a note – adequate estrogen/testosterone/DHEA, weight bearing exercise, and adequate calcium is the prevention/treatment.

Other than that I have no opinions.

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Guilty by reason of …

Please, somebody wake me up and tell me I’ve been having a bad dream. I didn’t just read that the District Attorney in Collin County has charged a Plano woman, Dena Schlosser, with capital murder. She can be put to death for taking a phrase in the Bible literally and cutting off her baby’s arms. It couldn’t also be true that Child Protective Services is not letting her husband have his other two traumatized, confused kids for just the opposite reason. He didn’t take his wife literally when she told him the night before the incident that she was giving the baby to God. He is being punished because he didn’t know his wife was insane before she carried out an obviously psychotic act. But the district attorney hasn’t figured it out, even after the act.

The reason I know that I’m dreaming is that this is 2004. Our government officials couldn’t be that obtuse. How could they expect the husband to take his wife literally? Even in the Bible, when Samuel’s mother said she was giving her son to God, she meant she was dedicating his life to God’s work. I guess if the CPS officials came to a fork in the road – they would eat with it.

Our officials need to make up their minds. They can’t have it both ways. You can’t expect the wife to think metaphorically and the husband to think literally. As a New York newspaper chief editor (and crusty Texan) told his fence riding journalist, "Don’t pee down both legs at the same time." So what’s the problem? The problem is the law is out of touch with reality. I guess you could say the law is not sane. According to the law, there are two options – guilty OR not guilty by reason of insanity. But she IS guilty. She is guilty by reason of insanity.

Scott Peterson is a totally different story. He is obviously guilty by reason of severe narcissism and sociopathy. He has no conscience. Mrs. Schlosser, Andrea Yates, plus another woman in East Texas last year were all suffering from postpartum psychosis. 

The percent of women who become clinically depressed in the few weeks after having a baby is ironically higher than at any time in a woman’s life. Fortunately, psychosis during this period is not common. It only occurs in about 1 in 1000 deliveries. Most of the time, women who develop postpartum psychosis turn out to be bipolar. This is a serious mood disorder that requires continuous treatment, just as does diabetes.

Most women who develop postpartum psychosis don’t murder their babies, but it is a well known possible complication. Most of the time, women who murder their babies lack adequate family network, have husbands who don’t provide enough emotional comforting, and they are usually involved in a fundamentalist church.

One classic symptom of psychosis is concrete thinking (i.e. taking everything literally). Have you ever had a really crazy dream? That’s the way the psychotic mind works when they are awake – and to them it seems real.

Fortunately, we have excellent medications to treat this disorder. Unfortunately, these medications are expensive and our "managed cost" medical system often only provides less expensive, less effective medication. 

Let’s wake up from the dark ages. I believe the United States is the only country that treats infanticide during postpartum psychosis as a crime. Scott Peterson murdered his wife and unborn child because he didn’t want to be bothered by a child or child support. He planned it out carefully and tried to hide the fact from everyone. Dena Schlosser and Andrea Yates murdered their babies to send them to heaven. They immediately called someone to tell them what they had done. Am I crazy or do these two scenarios seem different?

Guilty by reason of insanity!

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Depression and Anxiety Across the Female Reproductive Cycle

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