Back Pain in Pregnancy

What are the reasons for back pain during pregnancy?

• Pregnancy can cause you to gain as much as a quarter of your body weight, adding stress to the back and other weight-bearing structures.

• Center of gravity changes during pregnancy. This change in your center of gravity creates muscular imbalances and muscle fatigue that strains weight-bearing structures in the body and causes poor posture and/makes poor posture even worse.
• Abdominal muscles become increasingly lax in order to accommodate a growing uterus, back muscles compensate by working much harder.
• As your breasts become fuller, added weight in the chest area can pull at your upper spine, creating painful, pinching pressure.
• As your belly gets bigger throughout your pregnancy, your lower back curves more than usual to accommodate the load, resulting in strained muscles and, you guessed it, pain.
• Malfunction in the hip joint is the most common cause of back pain in pregnancy.
• Activities that create unbalanced, uneven weight-bearing of the spine, pelvis, and hips causes back pain during pregnancy, which includes walking and running, rolling over in bed, bending forward, twisting, lifting and navigating stairs.
• Increased level of the hormone relaxin  that is released during pregnancy allow ligaments in the pelvic area to soften and the joints to become looser in preparation for the birthing process of your baby; this shift in joints and loosening of ligaments may affect the support your back normally experiences.
• Poor posture, excessive standing, lifting, twisting, navigating the stairs and bending over can trigger or escalate the pain you experience in your back
• Stress usually finds the weak spot in the body, and because of the changes in your pelvic area, you may experience an increase in back pain during stressful periods of your pregnancy

What helps?

• Good posture. Standing up straight allows muscles to naturally lengthen and stretch, making good posture one of the easiest “exercises” for easing lower back pain. Good posture also means sitting with care.
• Lower back stretching. Lower back extensions safely strengthen back muscles during pregnancy, making their tough work a little easier (and less painful for you).
• Prenatal yoga. Prenatal yoga is a relaxing way to tone parts of the body most affected by pregnancy, including the back.
• Pelvic tilts. Pelvic tilts (also called “pelvic rocking”) strengthen abdominal muscles, relieve backache, and help improve posture.
• Swimming/water exercise. Water supports your weight, swimming and prenatal water aerobics classes relieve pressure from your back and joints while still giving you a great whole-body workout.
• Acupuncture. Acupuncture places thin, sterile needles at specific “energy points” in order to activate the body’s own natural pain relief system.
• Chiropractic care. Chiropractors adjust misaligned joints, especially in the spine, to relieve nerve stress and promote healing throughout the body. This is effective in treating pregnancy-related back pain
• Lumbar support pillows. Keep your head and shoulders in line and use a lumbar support pillow (a small pillow specially designed to fit the lower back) to keep your back properly positioned and pain-free.
• Supportive sleep environment. Sleeping on your side and using strategically placed pillows for support can provide relief from aches and pains, and help you get some much-needed rest. Make sure your mattress is firm.  A body pillow (at least 5 feet long) can also help you find stress-minimizing sleeping positions.
• Crisscross support sling is designed specifically for a pregnant figure, which will help take the burden of your belly’s weight off your lower back.
• Maternity support belt. These are thick elastic bands worn around the hips and under the belly cradle and support lax abdominal muscles.
• Footrest. Use a footrest to elevate your feet slightly, and don’t cross your legs; that can cause your pelvis to tilt forward, exacerbating those strained back muscles.
• Regular physical activity. Take breaks by walking or standing and stretching at least once an hour. Sitting too long can make your back hurt even more.
• Lift properly. Avoid lifting heavy loads, but if you must, do it slowly.
• Keep your weight gain where it should be (extra weight is extra hard on any back).
• Wear the right shoes. Experts recommend a 2-inch heel to keep your body in proper alignment. You might also consider orthotics, orthopedic shoe inserts designed for muscle support.
• No reaching for the stars — or the cookies on the top shelf. Use a low, stable, step stool to get items from high places and you’ll avoid additional strain. (Better still, leave the cookies where they are.)
• Think good thoughts. A calm mind leads to a looser back.
• Warm and cold compresses. Soothe sore muscles by applying cold compresses, then warm compresses in 15-minute intervals. Rubbing your back might also help.
• Warm bath. Take a warm bath (ask your partner to draw it for you). Or turn the shower head to pulsating and enjoy the back massage.
• Body massage. Talking about massages, go get one (after the first trimester and with a masseuse who knows you’re pregnant and is trained in the art of prenatal massage).
• Medications. Over the counter pain medication such as Tylenol is generally safe during pregnancy. Talk to your healthcare provider before taking any medication.
• Sacral belt.
• Learn relaxation techniques to cope with the discomfort and back pain during bed time.

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Body Changes and Discomfort in Pregnancy

Body aches

As your uterus expands, you may feel aches and pains in the back, abdomen, groin area, and thighs. Many women also have backaches and aching near the pelvic bone due the pressure of the baby's head, increased weight, and loosening joints. Some pregnant women complain of pain that runs from the lower back, down the back of one leg, to the knee or foot. This is called sciatica (SYE-AT-ick-uh). It is thought to occur when the uterus puts pressure on the sciatic nerve.

What Helps?

•                Lie down.

•                Rest.

•                Apply heat.

Breast changes

A woman's breasts increase in size and fullness during pregnancy. As the due date approaches, hormone changes will cause your breasts to get even bigger to prepare for breastfeeding. Your breasts may feel full, heavy, or tender.

In the third trimester, some pregnant women begin to leak colostrum (coh-LOSS-truhm) from their breasts. Colostrum is the first milk that your breasts produce for the baby. It is a thick, yellowish fluid containing antibodies that protect newborns from infection.

What Helps?

•                Wear a maternity bra with good support.

•                Put pads in bra to absorb leakage.

Constipation

Many pregnant women complain of constipation. Signs of constipation include having hard, dry stools; fewer than three bowel movements per week; and painful bowel movements.

Higher levels of hormones due to pregnancy slow down digestion and relax muscles in the bowels leaving many women constipated. Plus, the pressure of the expanding uterus on the bowels can contribute to constipation.

What Helps?

•                Drink eight to 10 glasses of water daily.

•                Don't drink caffeine.

•                Eat fiber-rich foods, such as fresh or dried fruit, raw vegetables, and whole-grain cereals and breads.

•                Try mild physical activity.

Dizziness

Many pregnant women complain of dizziness and lightheadedness throughout their pregnancies. Fainting is rare but does happen even in some healthy pregnant women. There are many reasons for these symptoms. The growth of more blood vessels in early pregnancy, the pressure of the expanding uterus on blood vessels, and the body's increased need for food all can make a pregnant woman feel lightheaded and dizzy.

What Helps?

•                Stand up slowly.

•                Avoid standing for too long.

•                Don't skip meals.

•                Lie on your left side.

•                Wear loose clothing.

Fatigue, sleep problems

During your pregnancy, you might feel tired even after you've had a lot of sleep. Many women find they're exhausted in the first trimester. Don't worry, this is normal! This is your body's way of telling you that you need more rest. In the second trimester, tiredness is usually replaced with a feeling of wellbeing and energy. But in the third trimester, exhaustion often sets in again. As you get larger, sleeping may become more difficult. The baby's movements, bathroom runs, and an increase in the body's metabolism might interrupt or disturb your sleep. Leg cramping can also interfere with a good night's sleep.

What Helps?

•                Lie on your left side.

•                Use pillows for support, such as behind your back, tucked between your knees, and under your tummy.

•                Practice good sleep habits, such as going to bed and getting up at the same time each day and using your bed only for sleep and sex.

•                Go to bed a little earlier.

•                Nap if you are not able to get enough sleep at night.

•                Drink needed fluids earlier in the day, so you can drink less in the hours before bed.

Heartburn and indigestion

Hormones and the pressure of the growing uterus cause indigestion and heartburn. Pregnancy hormones slow down the muscles of the digestive tract. So food tends to move more slowly and digestion is sluggish. This causes many pregnant women to feel bloated.

Hormones also relax the valve that separates the esophagus from the stomach. This allows food and acids to come back up from the stomach to the esophagus. The food and acid causes the burning feeling of heartburn. As your baby gets bigger, the uterus pushes on the stomach making heartburn more common in later pregnancy.

What Helps?

•                Eat several small meals instead of three large meals — eat slowly.

•                Drink fluids between meals — not with meals.

•                Don't eat greasy and fried foods.

•                Avoid citrus fruits or juices and spicy foods.

•                Do not eat or drink within a few hours of bedtime.

•                Do not lie down right after meals.

Hemorrhoids

Hemorrhoids (HEM-roidz) are swollen and bulging veins in the rectum. They can cause itching, pain, and bleeding. Up to 50 percent of pregnant women get hemorrhoids. Hemorrhoids are common during pregnancy for many reasons. During pregnancy blood volume increases greatly, which can cause veins to enlarge. The expanding uterus also puts pressure on the veins in the rectum. Plus, constipation can worsen hemorrhoids. Hemorrhoids usually improve after delivery.

What Helps?

•                Drink lots of fluids.

•                Eat fiber-rich foods, like whole grains, raw or cooked leafy green vegetables, and fruits.

•                Try not to strain with bowel movements.

•                Talk to your doctor about using products such as witch hazel to soothe hemorrhoids.

Itching

About 20 percent of pregnant women feel itchy during pregnancy. Usually women feel itchy in the abdomen. But red, itchy palms and soles of the feet are also common complaints. Pregnancy hormones and stretching skin are probably to blame for most of your discomfort. Usually the itchy feeling goes away after delivery.

What Helps?

•                Use gentle soaps and moisturizing creams.

•                Avoid hot showers and baths.

•                Avoid itchy fabrics.

Leg cramps

At different times during your pregnancy, you might have sudden muscle spasms in your legs or feet. They usually occur at night. This is due to a change in the way your body processes calcium.

What Helps?

•                Gently stretch muscles.

•                Get mild exercise.

•                For sudden cramps, flex your foot forward.

•                Eat calcium-rich foods.

•                Ask your doctor about calcium supplements.

Morning sickness

In the first trimester hormone changes can cause nausea and vomiting. This is called "morning sickness," although it can occur at any time of day. Morning sickness usually tapers off by the second trimester.

What Helps?

•                Eat several small meals instead of three large meals to keep your stomach from being empty.

•                Don't lie down after meals.

•                Eat dry toast, saltines, or dry cereals before getting out of bed in the morning.

•                Eat bland foods that are low in fat and easy to digest, such as cereal, rice, and bananas.

•                Sip on water, weak tea, or clear soft drinks. Or eat ice chips.

•                Avoid smells that upset your stomach.

Nasal problems

Nosebleeds and nasal stuffiness are common during pregnancy. They are caused by the increased amount of blood in your body and hormones acting on the tissues of your nose.

What Helps?

•                Blow your nose gently.

•                Drink fluids and use a cool mist humidifier.

•                To stop a nosebleed, squeeze your nose between your thumb and forefinger for a few minutes.

Numb or tingling hands

Feelings of swelling, tingling, and numbness in fingers and hands, called carpal tunnel syndrome, can occur during pregnancy. These symptoms are due to swelling of tissues in the narrow passages in your wrists, and they should disappear after delivery.

What Helps?

•                Take frequent breaks to rest hands.

•                Ask your doctor about fitting you for a splint to keep wrists straight.

Stretch marks, skin changes

Stretch marks are red, pink, or brown streaks on the skin. Most often they appear on the thighs, buttocks, abdomen, and breasts. These scars are caused by the stretching of the skin, and usually appear in the second half of pregnancy.

Some women notice other skin changes during pregnancy. For many women, the nipples become darker and browner during pregnancy. Many pregnant women also develop a dark line (called the linea nigra) on the skin that runs from the belly button down to the pubic hairline. Patches of darker skin usually over the cheeks, forehead, nose, or upper lip also are common. Patches often match on both sides of the face. These spots are called melasma or chloasma and are more common in darker-skinned women.

What Helps?

•                Be patient — stretch marks and other changes usually fade after delivery.

Swelling

Many women develop mild swelling in the face, hands, or ankles at some point in their pregnancies. As the due date approaches, swelling often becomes more noticeable.

What Helps?

•       Drink eight to 10 glasses of fluids daily.

•       Don't drink caffeine or eat salty foods.

•       Rest and elevate your feet.

•       Ask your doctor about support hose.

Urinary frequency and leaking

Temporary bladder control problems are common in pregnancy. Your unborn baby pushes down on the bladder, urethra, and pelvic floor muscles. This pressure can lead to more frequent need to urinate, as well as leaking of urine when sneezing, coughing, or laughing.

What Helps?

•                Take frequent bathroom breaks.

•                Drink plenty of fluids to avoid dehydration.

•                Do Kegel exercises to tone pelvic muscles.

Varicose veins

During pregnancy blood volume increases greatly. This can cause veins to enlarge. Plus, pressure on the large veins behind the uterus causes the blood to slow in its return to the heart. For these reasons, varicose veins in the legs and anus (hemorrhoids) are more common in pregnancy.

Varicose veins look like swollen veins raised above the surface of the skin. They can be twisted or bulging and are dark purple or blue in color. They are found most often on the backs of the calves or on the inside of the leg.

What Helps?

•                Avoid tight knee-highs.

•                Sit with your legs and feet raised.

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Posted in: Valley OBGYN

How to Treat Heavy Periods?

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What is menstruation? Menstruation (men-STRAY-shuhn) is a woman's monthly bleeding. When you menstruate, your body sheds the lining of the uterus (womb). Menstrual blood flows from the uterus through the small opening in the cervix and passes out of the body through the vagina. Most menstrual periods last from 3 to 5 days.

What is the menstrual cycle?

When periods (menstruations) come regularly, this is called the menstrual cycle. Having regular menstrual cycles is a sign that important parts of your body are working normally. The menstrual cycle provides important body chemicals, called hormones, to keep you healthy. It also prepares your body for pregnancy each month. A cycle is counted from the first day of 1 period to the first day of the next period. The average menstrual cycle is 28 days long. Cycles can range anywhere from 21 to 35 days in adults and from 21 to 45 days in young teens. The rise and fall of levels of hormones during the month control the menstrual cycle.

What happens during the menstrual cycle?

In the first half of the cycle, levels of estrogen (the “female hormone”) start to rise. Estrogen plays an important role in keeping you healthy, especially by helping you to build strong bones and to help keep them strong as you get older. Estrogen also makes the lining of the uterus (womb) grow and thicken. This lining of the womb is a place that will nourish the embryo if a pregnancy occurs. At the same time the lining of the womb is growing, an egg, or ovum, in one of the ovaries starts to mature. At about day 14 of an average 28-day cycle, the egg leaves the ovary. This is called ovulation.

After the egg has left the ovary, it travels through the fallopian tube to the uterus. Hormone levels rise and help prepare the uterine lining for pregnancy. A woman is most likely to get pregnant during the 3 days before or on the day of ovulation. Keep in mind, women with cycles that are shorter or longer than average may ovulate before or after day 14.

A woman becomes pregnant if the egg is fertilized by a man’s sperm cell and attaches to the uterine wall. If the egg is not fertilized, it will break apart. Then, hormone levels drop, and the thickened lining of the uterus is shed during the menstrual period.

What is a typical menstrual period like?

During your period, you shed the thickened uterine lining and extra blood through the vagina. Your period may not be the same every month. It may also be different than other women's periods. Periods can be light, moderate, or heavy in terms of how much blood comes out of the vagina. This is called menstrual flow. The length of the period also varies. Most periods last from 3 to 5 days. But, anywhere from 2 to 7 days is normal.

For the first few years after menstruation begins, longer cycles are common. A woman's cycle tends to shorten and become more regular with age. Most of the time, periods will be in the range of 21 to 35 days apart.

What kinds of problems do women have with their periods?

Women can have a range of problems with their periods, including pain, heavy bleeding, and skipped periods.

• Amenorrhea (ay-men-uh-REE-uh) — the lack of a menstrual period. This term is used to describe the absence of a period in:
• Young women who haven't started menstruating by age 15
• Women and girls who haven't had a period for 90 days, even if they haven't been menstruating for long

Causes can include:

• Pregnancy
• Breastfeeding
• Extreme weight loss
• Eating disorders
• Excessive exercising
• Stress
• Serious medical conditions in need of treatment

As above, when your menstrual cycles come regularly, this means that important parts of your body are working normally. In some cases, not having menstrual periods can mean that your ovaries have stopped producing normal amounts of estrogen. Missing these hormones can have important effects on your overall health. Hormonal problems, such as those caused by polycystic ovary syndrome (PCOS)or serious problems with the reproductive organs, may be involved. It’s important to talk to a doctor if you have this problem.

• Dysmenorrhea (dis-men-uh-REE-uh) — painful periods, including severe cramps. Menstrual cramps in teens are caused by too much of a chemical called prostaglandin (pros-tuh-GLAN-duhn). Most teens with dysmenorrhea do not have a serious disease, even though the cramps can be severe. In older women, the pain is sometimes caused by a disease or condition such as uterine fibroids or endometriosis.
  
  For some women, using a heating pad or taking a warm bath helps ease their cramps. Some over-the-counter pain medicines can also help with these symptoms. They include:
• Ibuprofen (eye-byu-PROH-fuhn) (for instance, Advil, Motrin, Midol Cramp)
• Ketoprofen (key-toh-PROH-fuhn) (for instance, Orudis KT)
• Naproxen (nuh-PROK-suhn) (for instance, Aleve)

If these medicines don’t relieve your pain or the pain interferes with work or school, you should see a doctor. Treatment depends on what’s causing the problem and how severe it is.

• Abnormal uterine bleeding — vaginal bleeding that’s different from normal menstrual periods. It includes:
• Bleeding between periods
• Bleeding after sex
• Spotting anytime in the menstrual cycle
• Bleeding heavier or for more days than normal
• Bleeding after menopause

Abnormal bleeding can have many causes. Your doctor may start by checking for problems that are most common in your age group. Some of them are not serious and are easy to treat. Others can be more serious. Treatment for abnormal bleeding depends on the cause.

In both teens and women nearing menopause, hormonal changes can cause long periods along with irregular cycles. Even if the cause is hormonal changes, you may be able to get treatment. You should keep in mind that these changes can occur with other serious health problems, such as uterine fibroids, polyps, or even cancer. See your doctor if you have any abnormal bleeding.

When does a girl usually get her first period?

In the United States, the average age for a girl to get her first period is 12. This does not mean that all girls start at the same age. A girl can start her period anytime between the ages of 8 and 15. Most of the time, the first period starts about 2 years after breasts first start to develop. If a girl has not had her first period by age 15, or if it has been more than 2 to 3 years since breast growth started, she should see a doctor.

How long does a woman have periods?

Women usually have periods until menopause. Menopause occurs between the ages of 45 and 55, usually around age 50. Menopause means that a woman is no longer ovulating (producing eggs) or having periods and can no longer get pregnant. Like menstruation, menopause can vary from woman to woman and these changes may occur over several years.

The time when your body begins its move into menopause is called the menopausal transition. This can last anywhere from 2 to 8 years. Some women have early menopause because of surgery or other treatment, illness, or other reasons. If you don’t have a period for 90 days, you should see your doctor. He or she will check for pregnancy, early menopause, or other health problems that can cause periods to stop or become irregular.

When should I see a doctor about my period?

See your doctor about your period if:

• You have not started menstruating by the age of 15.
• You have not started menstruating within 3 years after breast growth began, or if breasts haven't started to grow by age 13.
• Your period suddenly stops for more than 90 days.
• Your periods become very irregular after having had regular, monthly cycles.
• Your period occurs more often than every 21 days or less often than every 35 days.
• You are bleeding for more than 7 days.
• You are bleeding more heavily than usual or using more than 1 pad or tampon every 1 to 2 hours.
• You bleed between periods.
• You have severe pain during your period.
• You suddenly get a fever and feel sick after using tampons.

How often should I change my pad and/or tampon?

You should change a pad before it becomes soaked with blood. Each woman decides for herself what works best. You should change a tampon at least every 4 to 8 hours. Make sure to use the lowest absorbency tampon needed for your flow. For example, use junior or regular tampons on the lightest day of your period. Using a super absorbency tampon on your lightest days increases your risk for toxic shock syndrome (TSS). TSS is a rare but sometimes deadly disease. TSS is caused by bacteria that can produce toxins. If your body can’t fight the toxins, your immune (body defense) system reacts and causes the symptoms of TSS (see below).

Young women may be more likely to get TSS. Using any kind of tampon puts you at greater risk for TSS than using pads. The Food and Drug Administration (FDA) recommends the following tips to help avoid tampon problems:

• Follow package directions for insertion.
• Choose the lowest absorbency for your flow.
• Change your tampon at least every 4 to 8 hours.
• Consider switching between pads and tampons.
• Know the warning signs of TSS (see below).
• Don't use tampons between periods.

If you have any of these symptoms of TSS while using tampons, take the tampon out, and contact your doctor right away:

• Sudden high fever (over 102 degrees)
• Muscle aches
• Diarrhea
• Vomiting
• Dizziness and/or fainting
• Sunburn-like rash
• Sore throat
• Bloodshot eyes

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Posted in: Valley OBGYN

Depression. What should you know?

What is depression?

Life is full of ups and downs. But when the down times last for weeks or months at a time or keep you from your regular activities, you may be suffering from depression. Depression is a medical illness that involves the body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things. It is different from feeling "blue" or down for a few hours or a couple of days. It is not a condition that can be willed or wished away.

What are the different types of depression?

Different kinds of depression include:

• Major depressive disorder. Also called major depression, this is a combination of symptoms that hurt a person's ability to work, sleep, study, eat, and enjoy hobbies.
• Dysthymic (diss-TIME-ic) disorder. Also called dysthymia, this kind of depression lasts for a long time (two years or longer). The symptoms are less severe than major depression but can prevent you from living normally or feeling well.

Some kinds of depression show slightly different symptoms than those described above. Some may start after a particular event. However, not all scientists agree on how to label and define these forms of depression. They include:

• Psychotic depression, which occurs when a severe depressive illness happens with some form of psychosis, such as a break with reality, hallucinations, and delusions.
• Postpartum depression, which is diagnosed if a new mother has a major depressive episode within one month after delivery.
• Seasonal affective disorder (SAD), which is a depression during the winter months, when there is less natural sunlight.

What causes depression?

There is no single cause of depression. There are many reasons why a woman may become depressed:

• Genetics (family history) – If a woman has a family history of depression, she may be more at risk of developing it herself. However, depression may also occur in women who don't have a family history of depression.
• Chemical imbalance – The brains of people with depression look different than those who don't have depression. Also, the parts of the brain that manage your mood, thoughts, sleep, appetite, and behavior don't have the right balance of chemicals.
• Hormonal factors – Menstrual cycle changes, pregnancy, miscarriage, postpartum period, perimenopause, and menopause may all cause a woman to develop depression.
• Stress – Stressful life events such as trauma, loss of a loved one, a bad relationship, work responsibilities, caring for children and aging parents, abuse, and poverty may trigger depression in some people.
• Medical illness – Dealing with serious medical illnesses like stroke, heart attack, or cancer can lead to depression.

What are the signs of depression?

Not all people with depression have the same symptoms. Some people might only have a few, and others a lot. How often symptoms occur, and how long they last, is different for each person. Symptoms of depression include:

• Feeling sad, anxious, or "empty"
• Feeling hopeless
• Loss of interest in hobbies and activities that you once enjoyed
• Decreased energy
• Difficulty staying focused, remembering, making decisions
• Sleeplessness, early morning awakening, or oversleeping and not wanting to get up
• No desire to eat and weight loss or eating to "feel better" and weight gain
• Thoughts of hurting yourself
• Thoughts of death or suicide
• Easily annoyed, bothered, or angered
• Constant physical symptoms that do not get better with treatment, such as headaches, upset stomach, and pain that doesn't go away

I think I may have depression. How can I get help?

Below are some people and places that can help you get treatment.

• Family doctor
• Counselors or social workers
• Family service, social service agencies, or clergy person
• Employee assistance programs (EAP)
• Psychologists and psychiatrists

If you are unsure where to go for help, check the Yellow Pages under mental health, health, social services, suicide prevention, crisis intervention services, hotlines, hospitals, or physicians for phone numbers and addresses.

What if I have thoughts of hurting myself?

Depression can make you think about hurting yourself or suicide. You may hurt yourself to:

• Take away emotional pain and distress
• Avoid, distract from, or hold back strong feelings
• Try to feel better
• Stop a painful memory or thought
• Punish yourself
• Release or express anger that you're afraid to express to others

Yet, hurting yourself does just that — it hurts you. If you are thinking about hurting or even killing yourself, please ask for help! Call 911, 800-273-TALK (8255) or 800-SUICIDE, or check in your phone book for the number of a suicide crisis center. The centers offer experts who can help callers talk through their problems and develop a plan of action. These hotlines can also tell you where to go for more help in person. You also can talk with a family member you trust, a clergy person, or a doctor. There is nothing wrong with asking for help — everyone needs help sometimes.

You might feel like your pain is too overwhelming to cope with, but those times don't last forever. People do make it through suicidal thoughts. If you can't find someone to talk with, write down your thoughts. Try to remember and write down the things you are grateful for. List the people who are your friends and family, and care for you. Write about your hopes for the future. Read what you have written when you need to remind yourself that your life is IMPORTANT!

How is depression found and treated?

Most people with depression get better when they get treatment.

The first step to getting the right treatment is to see a doctor. Certain medicines, and some medical conditions (such as viruses or a thyroid disorder), can cause the same symptoms as depression. Also, it is important to rule out depression that is associated with another mental illness called bipolar disorder. A doctor can rule out these possibilities with a physical exam, asking questions, and/or lab tests, depending on the medical condition. If a medical condition and bipolar disorder can be ruled out, the doctor should conduct a psychological exam or send the person to a mental health professional.

Once identified, depression almost always can be treated with:

• Therapy
• Medicine called antidepressants
• Both therapy and medicine

Some people with milder forms of depression do well with therapy alone. Others with moderate to severe depression might benefit from antidepressants. It may take a few weeks or months before you begin to feel a change in your mood. Some people do best with both treatments — therapy and antidepressants.

Should I stop taking my antidepressant while I am pregnant?

The decision whether or not to stay on medications is a hard one. You should talk with your doctor. Medication taken during pregnancy does reach the fetus. In rare cases, some antidepressants have been associated with breathing and heart problems in newborns, as well as jitteriness, difficulty feeding, and low blood sugar after delivery. However, moms who stop medications can be at high risk of their depression coming back. Talk to your doctor about the risks and benefits of taking antidepressants during pregnancy. Your doctor can help you decide what is best for you and your baby. In some cases, a woman and her doctor may decide to slowly lower her antidepressant dose during the last month of pregnancy. Doing so can help the newborn suffer from fewer withdrawal symptoms. After delivery, a woman can return to a full dose. This can help her feel better during the postpartum period, when risk of depression can be greater.

Should I stop taking my antidepressant while breastfeeding?

If you stopped taking your medication during pregnancy, you may need to begin taking it again after the baby is born. Be aware that because your medication can be passed into your breast milk, breastfeeding may pose some risk for a nursing infant.

What are SSRIs?

Selective serotonin reuptake inhibitors (SSRIs) are a kind of antidepressant for treating depression and anxiety disorders.

However, a number of research studies show that certain antidepressants, such as some of the SSRIs (see box at right) have been used relatively safely during breastfeeding. You should discuss with your doctor whether breastfeeding is an option or whether you should plan to feed your baby formula. Although breastfeeding has some advantages for your baby, most importantly, as a mother, you need to stay healthy so you can take care of your baby.

Before taking medication for an anxiety disorder:

• Ask your doctor to tell you about the effects and side effects of the drug.
• Tell your doctor about any alternative therapies or over-the-counter medications you are using.
• Ask your doctor when and how the medication should be stopped. Some drugs can't be stopped abruptly but must be tapered off slowly under a doctor's supervision.
• Work with your doctor to determine which medication is right for you and what dosage is best.
• Be aware that some medications are effective only if they are taken regularly and that symptoms may come back if the medication is stopped.

Is it safe for young adults to take antidepressants?

It may be safe for young people to be treated with antidepressants. However, drug companies who make antidepressants are required to post a "black box" warning label on the medication. A "black box" warning is the most serious type of warning on prescription drugs.

It may be possible that antidepressants make children, adolescents, and young adults more likely to think about suicide or commit suicide. In 2007, the FDA said that makers of all antidepressant medications should extend the warning to include young adults up through age 24.

The warning says that patients of all ages taking antidepressants should be watched closely, especially during the first weeks of treatment. Possible side effects to look for are worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations. Families and caregivers should pay close attention to the patient, and report any changes in behavior to the patient's doctor. 

Can I take St. John's wort to treat depression?

St. John's wort is a plant with yellow flowers that has been used for centuries for health purposes, including depression and anxiety. However, research studies from the National Institutes of Health found that St. John's wort was not effective in treating major depression.

Other research shows that St. John's wort can make some medicines not work or that it can cause dangerous side effects. The herb appears to interfere with certain drugs used to treat heart disease, HIV, depression, seizures, certain cancers, and organ transplant rejection. The herb may also make birth control pills not work as well. Because of this, people should always consult their doctors before taking any herbal supplement.

St. John's wort is not a proven therapy for depression. If depression is not treated the right way, it can become severe and, in some cases, may be linked with suicide.

How can I help myself if I am depressed?

You may feel exhausted, helpless, and hopeless. It may be very hard to do anything to help yourself. But it is important to realize that these feelings are part of the depression and do not reflect real life. As you understand your depression and begin treatment, negative thinking will fade. In the meantime:

• Engage in mild activity or exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed. Participate in religious, social, or other activities.
• Set realistic goals for yourself.
• Break up large tasks into small ones, set some priorities and do what you can as you can.
• Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself, and let others help you.
• Expect your mood to improve gradually, not immediately. Do not expect to suddenly "snap out of" your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.
• Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
• Be confident that positive thinking will replace negative thoughts as your depression responds to treatment. 

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Posted in: Valley OBGYN