PSI Response to Tragedy in News Reports
May 21, 2014
The members of Postpartum Support International (PSI) are deeply saddened by the story of Carol Coronado, who was arrested on Tuesday on suspicion of murdering her three daughters in a Torrance, CA home. The children's ages range from 2 months to three years.
As an organization, PSI is dedicated to prevention of these incidents through education, early diagnosis and treatment of maternal mental health distress.
It is essential that families know where to find information and resources, and know that there are many different kinds of pregnancy and postpartum mental health disorders, with a range of severity and symptoms. We are here to help families and providers understand more about perinatal mental health.
Postpartum Support International has more than 200 Coordinators around the world, who provide support, encouragement, information, and local resources for perinatal mood and anxiety disorders. Visit www.postpartum.net for insights and local resources or call 1-800-944-4PPD (1-800-944-4773) for warmline available in English and Spanish.
Today we learned of the CA mom arrested and three children found dead, the youngest just 2 months old. We are deeply saddened for everyone in the family, and want to remind all PSI is here. Our caring volunteers are here for info, support, and resources. Every day. We are the safety net for families. Call us at 800-944-4773 (Eng or Span) or visit www.postpartum.net
PSI has a position paper on Postpartum psychosis related crimes here
For Media Inquiries, please contact Sharon Gerdes at firstname.lastname@example.org
Maternal Mental Health Symbol Contest
May 5, 2015
PSI Position Statemen on Perinatal Psychosis related Crimes
Postpartum Support International (PSI) is an organization dedicated to the mental health of mothers and fathers and the well-being of families around the world. PSI advocates for screening, treatment and prevention of mental illness in pregnant and postpartum women, and for access to informed healthcare providers.
In rare cases crimes - including neonaticide and infanticide - are committed by women with postpartum psychosis, which is too often unrecognized, ignored or inadequately treated. While most countries provide compassionate legislation, in the United States women often face lengthy and sometimes lifelong incarceration. It is the intent of PSI to promote positive change and advocate for improved knowledge among attorneys, judges, law enforcement, health care providers and the public about perinatal mood disorders including psychosis, and to help change outdated legislation where possible.
Postpartum psychosis occurs after childbirth in 1-2 mothers out of 1000 births. The symptoms typically begin within the first 2 weeks postpartum and can include delusions, hallucinations and paranoia. At times the mother loses complete touch with reality. Although the symptoms of postpartum psychosis are severe and present great risk, they are treatable and women are capable of full recovery. Postpartum psychosis is a temporary illness that needs to be looked at differently than chronic psychiatric disorders. This difference must be understood as women are assessed, defended and evaluated for crimes committed during a temporary delusional state. Legal insanity definitions can be misleading because the woman may at times be able to differentiate right from wrong, yet in that delusional state be influenced by extreme compelling thoughts, hallucinations or commands which instruct her to harm her baby. PSI works to increase public and professional understanding that postpartum psychosis, while it presents a serious potential for harm, is treatable and temporary.
While PSI cannot provide psychiatric or legal evaluation in individual cases, we can provide compassionate understanding to confused or grieving families, and support to incarcerated mothers through our Pen Pal Network for Incarcerated Women. Further, we can help legal and health care providers better understand perinatal mental illness and provide adequate care. We can assist those who are supporting individual cases by sharing information, data, and rationale for just and fair treatment. And we can provide resources to psychiatric and legal professionals who are knowledgeable in the field of Perinatal Mood Disorders.
Through education, advocacy and providing resources for prompt and proper treatment, PSI endeavors to prevent postpartum psychiatric illness and the risk of tragic results that may occur as a result.
PSI Response to Cynthia Wachenheim tragedy in New York
March 15, 2013
March 15, 2013. "Our hearts and prayers are with the memory of Cynthia Wachenheim, her family, and their community in New York as they begin to cope with this heartbreaking tragedy,” said Leslie Lowell Stoutenburg RNC, MS, president of Postpartum Support International. “We are always deeply saddened by the anguish and suffering a family endures when a woman is afflicted with a Perinatal Mood Disorder. Postpartum Support International is dedicated to raising awareness for the assessment and treatment of these mental illnesses by providing social support, education and access to qualified professionals in the field. Today, our work to raise awareness of resources and the promise of recovery is ever so important."
Postpartum Support International response to: Domar, Moragianni, Ryley and Urato, The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond, Hum. Reprod. Advance Access, October 31, 2012
CLICK HERE to read PSI's Nov. 2012 Open Letter to the Maternal Mental Health Community and the Media in response to Domar article
The article on SSRIs in infertile women by Domar, et al (Journal of Hum. Reproduction, October 2012) has been met with quick responses from reproductive mental health experts, and questions from women and their providers about the risks of using antidepressants during pregnancy. Below is a response from PSI, including talking points, quotes from PSI President Leslie Lowell Stoutenburg, RNC, MS and Immediate Past President Lucy Puryear, MD, and more detailed discussion points gathered from experts in perinatal psychiatry. Special Thanks for thoughtful input from PSI Colleagues: Adrienne Einarson, RN; Lucy Puryear, MD; Leslie Lowell Stoutenburg, RNC, MS; Benita Dieperink, MD; Emily Dossett, MD; Laura Miller, MD; and Margaret Spinelli, MD.
The recent article in USA Today (10/31/12, Weintraub) reported that a review published in the Journal of Human Reproduction questioned ‘the assumption that depression is bad for a fetus’, and concludes that ‘antidepressants often confer more risk than benefit…’ Although this article was written based on the author’s clinical opinions, it was not substantiated by a published research study, nor were the authors specialists in the risks and benefits of medication use during the perinatal phase. It’s our experience that articles like this impact women and their families by creating fear and anxiety about treatment options, therefore leaving these women at risk for abruptly discontinuing medication or not seeking the care they need. PSI looks forward to further research being disseminated to educate and inform the public about perinatal mood disorders, hopefully reducing stigma about treatment options.
- Depression during pregnancy is the single biggest risk factor for postpartum depression; effective mental health support and treatment during pregnancy will reduce the risk of postpartum distress.
- Decisions about psychotropic medications in pregnancy clearly need to be made on a case by case basis, just like the treatment of diabetes, hypertension, thyroid disease, seizures, cancer, asthma, or any other medical condition in pregnancy.
- The article is a narrative description of literature, not a quantifiable research study.
- We are concerned that women who take antidepressants before or during pregnancy will be frightened by this article. We want them to know that there are many studies, not referenced in the article, that show little statistical risk of antidepressant use during pregnancy, and many healthy babies born to women who took SSRIs while pregnant.
- The authors assert at the outset that it is a “standard recommendation” that “the benefit of antidepressant use outweighs the risk of depression during the gestational and post-partum period”. This is not the case. The standard recommendation, repeated in the conclusions of numerous studies of antidepressant use during pregnancy, is to carefully weigh the risks of prescribing medication against the risks of withholding medication in each individual case. This is well expressed in the words of a Food and Drug Administration (FDA) advisory regarding antidepressant use during pregnancy: “Women who are pregnant or thinking about becoming pregnant should not stop any antidepressant without first consulting their physician…The decision to continue medication or not should be made only after there has been careful consideration of the potential benefits and risks of the medication for each individual pregnant patient.”
- Providers who have contact with pregnant, postpartum, and post pregnancy-loss women should have competency in reliable assessment and treatment approaches for perinatal mental health. Professional competency includes an understanding of the risks of untreated symptoms as well as the use of medication during pregnancy.
- There are reliable organizations that collect and analyze data on effects of maternal medication use during pregnancy and breastfeeding. Women, their families, and their providers should weigh the data on specific medications gathered by reliable studies. Some of those options are: Motherisk; MGH Women's Mental Health Center; MedEdPPD; Infant Risk Center, and OTIS .
- Medical Education should integrate the study of mental health in general, and specifically Perinatal mental health, especially in the fields of Obstetrics, Gynecology, Pediatrics, Family Practice, Endocrinology, and Psychiatry.
- For a thorough commentary on the way research on antidepressants in pregnancy is portrayed in the media and the negative effects on practice and treatment, please see the commentary in Am J Psychiatry Feb 2012 by perinatal psychiatry expert Margaret Spinelli, MD http://ajp.psychiatryonline.org/article.aspx?articleid=483675
- Differences in severity of symptoms require different treatment interventions. It is extremely important to distinguish between women with mild to moderate depression versus those with severe depression, including comorbidities of OCD, panic, pronounced anxiety, or even suicidality. We recognize that psychotherapy, support groups, exercise, Cognitive Behavioral Therapy, Interpersonal Psychotherapy, and Omega-3 fatty acids are well-established and effective treatments and can be extremely useful. However, they might not be enough for the small percentage of women who are severely ill. These women not only need care - which sometimes includes medication - they need fully informed consent. This includes not just risks of medication, but risks and effects of untreated illness.
- The article is said to be review on treatment for infertility patients, however, one-third of the paper is about the lack of efficacy of antidepressants in general.
- This article was a “meta-analysis” of some of the research literature, not a quantifiable research study, and is subject to author bias and opinion.
- There was no mention at all that depression during pregnancy is the single biggest risk factor for postpartum depression.
- To say there is no evidence for effectiveness in pregnancy is true, but that is simply because there are no randomized control studies, not because this has been proven.
- All of the studies that were picked were ones that found negative effects, with no mention of how marginal the statistical significance really was.
- The citations used seemed to be drawn to support a single perspective. All of the studies picked for inclusion in the article were ones that found negative effects of SSRI use, with no mention of how marginal the statistical significance really was. The references section included studies only on the negative effects of antidepressants in pregnancy; for example, it included only one study by a one well-known researcher, in which an increased risk for miscarriages was found, but did not refer to her many published studies that showed no risk.
- The article states "There is compelling evidence that SSRI use prior to and during pregnancy can pose significant risks to the pregnancy and to the short- and long-term health of the baby…” The only reason that the evidence looks “compelling” is that the authors picked the studies they want to make that point.
- The article made no mention of the ill effects of untreated depression on pregnancy or birth outcomes. However, one citation included is Katherine Wisner's article in the American Journal of Psychiatry from 2009, which showed a control group with a 6% rate of PTD, untreated depression with a risk of 21%, and SSRI exposure with a risk of 23%. So while SSRIs certainly do seem to increase risk, so does untreated illness. There are many other studies that found similar risks of untreated depression or anxiety to the outcomes of SSRI use in pregnancy.
- The idea of "confounding by indication" - or the idea that untreated depression is actually the etiology of many of the poor outcomes linked to SSRI - was not adequately addressed.
- The "absolute risk" was rarely cited. For instance, in the case of PPHN, the risk is "two-fold", but this increased the risk from 1/1000 to 2/1000. In addition, we know that surgical, as opposed to vaginal, delivery far more significantly increases PPHN risk, and that there is concern that women with anxiety or depression either elect more frequently to have C-sections or need them for medical concerns. Thus, mode of delivery, not SSRI use, becomes a more likely predictor of PPHN than SSRI use.
Postpartum Support International Letter to DSM 5 Committee
June 13, 2012
Below is the text of the letter we sent to the American Psychiatric Association committee developing the updated Diagnostic and Statistical Manual 5 (DSM 5), in respose to their invitation to submit comments. Below is the text of our letter. To download the letter as a PDF click HERE.
David Kupfer, MD
Chair, DSM5 Task Force
American Psychiatric Association
1000 Wilson Boulevard, Suite 1825
Arlington, Va. 22209-3901
Dear Dr. Kupfer,
Thank you for inviting Postpartum Support International to send a representative to the briefing meeting for DSM 5 at the American Psychiatric Association meeting in May.
We continue to support the recommended addition of a specifier, as it is stated on the DSM 5 website, “With Postpartum Onset,” that can be applied to a current or most recent Major Depressive Episode, Manic, or Mixed Features in Major Depressive Disorder, Bipolar I Disorder, or Bipolar II Disorder, or to Brief Psychotic Disorder, and that the onset of the episode be extended to within 6 months postpartum.
We would also recommend, very highly, the addition of the 6 month onset specifier to the Mixed Depression and Anxiety Disorder and Obsessive Compulsive Disorder as well, for the following reasons:
In general many postpartum women present with a mixed depression and anxiety picture so the Mixed Depression and Anxiety Disorder seems to be a recognizable diagnosis for primary care doctors and obstetricians who will see many of these women in their practices. In addition, it is important for doctors and other mental health professionals to be trained to diagnose postpartum depression, anxiety, OCD and psychosis to insure the proper treatment and education of their patients and their families. Many families do not understand the nuances of these conditions in the Perinatal time period and depend on solid information and diagnosis to help them know how to support their loved ones. In addition, many women who develop OCD in the postpartum period often have intrusive thoughts about hurting themselves and/or their infants. General practitioners and obstetricians will utilize the DSM 5 to help them recognize this OCD in the context of postpartum depression and anxiety.
As you know Postpartum Support International is a worldwide organization made up of over 600 professional and non-professional members, both individual and institutional. Our membership vocalized their concerns about the DSM 5 and the importance of recognizing the 6 month onset of this condition in affective disorders at the International Marce/PSI conference in Pittsburgh. We are grateful that our voices were heard in this matter. We hope you will consider our additional recommendations in this letter.
Lucy Puryear, MD
President, Postpartum Support International
PSI Response to Postpartum Tragedy
August 25, 2011
Our work through Postpartum Support International is important every day, and every day we are moved to action by the calls and emails we receive from families and providers. Today our passion to help families and providers has sadly been kindled by the news of tragedy. Our dedication to help families, train professionals, and strengthen support networks and treatment pathways has been inspired by the passion to prevent a crisis. On other days, we might be inspired by stories of hope, healing, and courage, and those are good days. In fact, our PSI membership and volunteer ranks are filled with many of us who know very well how much courage and commitment it takes to recover from such crisis. Thank you, PSI Volunteers and supporters, for helping to sustain this valuable work, every day of every month of every year.
Today we heard of the tragedy in the news involving the mother in Orange County California who was arrested and charged with killing her 7 month old son. The 31-year old mother was arrested after the baby had been dropped off roof of a 4th floor parking garage at Children's Hospital OC on Tuesday, August 23. The baby passed away on Wednesday, August 24. We are so saddened and grieving for all involved -- the baby, and also for the mother, her husband, their two older children, and their family. The LA Times quoted the father: "She didn't do it on purpose. She didn't know what she was doing," Noe Medina said, with tears in his eyes. He spoke through an interpreter during a news conference on the grounds of UC Irvine Medical Center in Orange, where his 7-month-old son died.”
In Anchorage Alaska, a mom was charged with murder for the death of her 3 week old baby on August 5th. Our PSI members are working hard there to dispel myths and share facts with their community. There have been too many cases in the news, and too few facts for families. I believe that one of our most important tasks is to share the risks of perinatal mood disorders while at the same time, reassuring women and families that the huge majority of women with PMADs pose no risk of harm to others. We need to help them not be unduly frightened. We need to help them find good providers and resources so that they know when and whether they are at risk.
Quote from Lucy Puryear, MD, PSI President:
“We are always deeply saddened by the anguish and suffering a family endures when a woman is afflicted with a Perinatal Mood Disorder. Postpartum Support International is dedicated to raising awareness for the assessment and treatment of these mental illnesses by providing social support, education and access to qualified professionals in the field.” said Dr. Lucy Puryear, M.D., president of Postpartum Support International. “Our hearts and prayers are with Noe Medina, Sonia Hermosillo and their two other children as well as their community as they begin to cope with this heartbreaking tragedy.”
For all media inquiries, please contact our PR Chair Cathy Dore.
Cathy Dore', M.A., LMFT
For other inquiries about PSI, member and volunteer questions:
Wendy Davis, PhD
PSI Executive Director
For Office Info and materials:
PSI Office Administrator
PSI in the Wall Street Journal
This week, the Wall Street Journal published a great piece about postpartum mental health and named PSI as the resource link. Writer Michelle Gerdes includes her own postpartum recovery, research on moms and babies, and a great quote from Kimberly Wong, Founder of the LA County Perinatal Mental Health Task Force and former PSI Board Member. The Wall Street Journal website garners 1,924,000 visitors per day. We are happy to see the increasing awareness of perinatal mental health in the media and applaud Ms. Gerdes for her honest and accurate reporting. The excerpt reads...“One good resource to know about is www.postpartum.net, the website of Postpartum Support International. You can enter your zip code and find help locally. Volunteers will also answer your emails within 24 hours.”
PSI Website visitors can click right on our Support Map to find help in their own communities. We are so proud of our Volunteers for providing the reliable support that connects families with hope and resources every day. The entire Wall Street Journal article can be found by clicking RIGHT HERE.
Thanks to all of you for working together, raising awareness and responding to the emotional needs of new mothers and families in our communities worldwide.
Lucy Puryear, MD
President, Postpartum Support International
HAPPY NATIONAL VOLUNTEER WEEK in U.S.
APRIL 10-17, 2011
A Letter to our PSI Volunteers --
In celebration of National Volunteer Week, I want to say THANK YOU to our wonderful PSI volunteers. PSI would not exist without you. Your volunteer work, your dedication and spirit, is at the heart of PSI’s mission. When PSI was founded by Jane Honikman in 1987, its vision was that every woman and family worldwide should have access to information, social support, and informed professional care to deal with mental health issues related to childbearing. This vision of social support and community networks to address the emotional needs of childbearing women was a radical idea then, as there was much stigma, few providers, and little research. It was difficult for families to find help and no World Wide Web to make the connections we now find at our fingertips. Now in 2011, there is so much more, but in spite of the relative progress and increase in information, research, providers, and public health initiatives, we know in our hearts that none of these advances will work if there is no helpful way to connect families to them. PSI represents that connection, and you volunteers are the way that families make it through the fear and shame that prevent the first steps to wellness. As a PSI volunteer, you are one of more than 215 caring and reliable individuals around the world who make the safety net hold together, creating our own world wide web to help families find the way to help, hope, and recovery. We thank you for all that you do. GRACIAS. We just wouldn’t be PSI without you.
Wendy Davis, PhD
PSI Executive Director
PSI Annual Conference 2011
In Conjunction with PSI of Washington
"Whole Care for the Whole Family"
PSI Pre-Conference Training September 14 & 15, 2011
PSI Conference: September 16 & 17th, 2011
PSI Volunteers Meeting Thursday, September 15th, 2011
Registration Information will be coming soon!
The 2011 Conference will have 7 tracks:
TRACK 1: Before the Baby Comes: Prevention and diagnosis of pregnancy related mood disorders
TRACK 2: Medical Treatment Strategies for Perinatal Mood Disorders: Updated pharmacological approaches
TRACK 3: Non-Traditional Approaches for Treatment of Perinatal Mood Disorders (yoga, naturopathy, massage, nutrition, acupuncture, acupressure, homeopathy, light treatment, etc.)
TRACK 4: Meeting the Needs of Special Populations: Military Families, cultural considerations, refugee families, adolescents, parents of multiples, families with ill or disabled children, women with trauma histories, etc.
TRACK 5: Psychotherapy: Intermediate and Advanced trainings for psychotherapists working with perinatal populations. (Hands on, specifically tailored strategies for Interpersonal Therapy, Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Family Therapy, Psychodrama, etc.).
TRACK 6: The Family: Assessing and treating for mood disorders in the postpartum family (partners with depression; aiding partners in caring for their depressed family member, addressing the impact of PMD on babies and other affected children)
TRACK 7: Support Groups: innovative ideas for forming, maintaining, and increasing the benefits of support groups.
More info coming soon!
May 7, 2010
THIS MOTHER’S DAY, AN EXTRA GIFT FOR NEW MOTHERS
U.S. Senator Robert Menendez, Congressman Bobby L. Rush, and advocates announce celebration of postpartum depression legislation passage.
Watch the You-Tube Video of the whole press conference RIGHT HERE
Women’s health advocates joined Congressional champions in the fight against Postpartum Mood Disorders to celebrate the enactment of the Melanie Blocker Stokes MOTHERS Act, the initiative to combat perinatal mood disorders, that was signed into law as part of health insurance reform. The law was authored by U.S. Senator Robert Menendez (D-NJ) and Rep. Bobby Rush (D-IL), who help lead Thursday's event. The brand new law will establish a comprehensive federal commitment to combating postpartum depression through new research, education initiatives and voluntarily support service programs.
Speakers at the conference were:
Carol Blocker, the mother of the bill’s namesake. Her daughter Melanie committed suicide as a result of postpartum depression.
U.S. Senator Robert Menendez (D-NJ), Senator sponsor of MOTHERS Act
Rep. Bobby Rush (D-IL), House sponsor of MOTHERS Act
Susan Dowd Stone, President's Advisory Council Chair, Postpartum Support International
Katherine Stone, Postpartum Progress website author
Sylvia Lasalandra, author, “A Daughter’s Touch”
Albert Strunk, MD, American Congress of Obstetricians and Gynecologists
Dr. Gwendolyn Keit, American Psychological Association
Questions and Answers about the MOTHERS ACT (PDF)
Document prepared by the office of Sen. Robert Menendez
March 21, 2010. PSI Announcement: HealthCare Reform Bill includes the MOTHERS Act.
March 21, 2010
Dear PSI Members, Friends, and Family,
I am so happy to let you know that the Melanie Blocker Stokes MOTHERS Act was included in the passage of last night's Health Care Reform passage.
I can't say it better than Susan Dowd Stone says it in her blog message last night. Please read her message and be thrilled and encouraged at the future possibilities of this wonderful news.
Thank You to Susan Stone for her advocacy and work in this area over the past years! There are countless people to thank for their tenacity and tireless efforts, but I want to thank Susan for being the advocate and front-runner for PSI. Susan has been the face of the MBS MOTHERS Act for PSI and we can't thank you enough.
Thanks to all who have helped with continuing to advocate for women and their families.
Birdie Gunyon Meyer, RN, MA
President, Postpartum Support International
PSI Year-End Letter 2009
December 19, 2009
Dear Friends of PSI,
Seasons Greetings to all members, supporters and new friends of Postpartum Support International. We thought that you would be happy to know that PSI has had a very active year and that we look forward to working together toward more accomplishments in the New Year.
In the past year, PSI:
• Spearheaded national and state legislation for research, education, and public awareness of perinatal mental health and treatment options;
• Expanded best practice efforts for professionals and social support networks, and trained hundreds of practitioners and consumers in the US and around the world;
• Expanded free “Chat with an Expert” phone sessions available each Wednesday to include the Men’s Chat each Monday evening;
• Produced our first PSI Educational DVD, Happy Mom, Healthy Family;
• Developed a new PSI Website to be launched in early 2010;
• Collaborated in a PBS project called “This Emotional Life” as a lead resource for new parents;
• Sustained a PSI Spanish Support Warmline staffed by trained volunteers every day of the week;
• Hired a Program Director to meet the growing needs of our membership and PMD population.
Allow us to thank you for your past support of PSI and its worldwide network. If you have already renewed your membership, we thank you. Membership dues are a large and consistent source of revenue and essential to PSI’s mission. Without them, PSI could not publish the newsletter, keep the phones and website operating, expand our public awareness efforts, advocate for childbearing women and their families, or foster our PSI volunteers and support networks. With your help, PSI can fulfill its mission and insure that pregnant and postpartum women and their families know they are not alone.
As year-end fast approaches, consider sharing the holiday spirit and give a generous donation. Your participation in our 2009 financial campaign furthers our perinatal mental health prevention and educational efforts. Every donation makes a difference in our support of childbearing families. You can give online at www.postpartum.net or mail your contribution to the PSI address below. Your contribution is tax-exempt to the extent permitted by law according the IRS Code Sec. 501(c)(3) .
Birdie Gunyon Meyer, RN, MA
PSI Board President
Lorraine Caputo, LCSW
PSI Membership Chair