The “I Do” Blues: Postnuptial Depression

THE “I DO” BLUES: Postnuptial Depression

By Sean Kenniff, MD

  A wedding is usually one of the most joyous days in a young couple’s life; a time to celebrate love and hope for a lifetime of happiness. But for some newlyweds the big day is soon followed by a big letdown. 

  “It should be described as the day the prince falls off his horse, and we change from girls into women,” one blogger writes. 

  “What begins the day after marriage? Misery,” replies another. 

  In many cases once the honeymoon is over, humdrum reality sets in, and that can leave unprepared couples coping with postnuptial depression-also called the ‘I Do Blues’. 

  “Building a happy, productive partnership is not easy.  The unrealistic expectations set up by our culture, media images of connubial bliss, romantic novels and song lyrics soon prove to be impossible to create, and reality then sets in,” says Dr. Tina Tessina.

  Dr. Tessina, better known as “Dr. Romance,” is a distinguished California psychotherapist and author of the book, Money Sex and Kids: Stop Fighting About the Three Things That Can Ruin Your Marriage. She says both men and women are at risk of postnuptial depression, because their expectations are often out of step with day-to-day marital life. 

  “Any situation in which the expectations are unrealistic can be considered a ‘set up’ for disappointment, which some people experience as depression,” she says. 

  In the months leading up to the wedding day the bride and groom often become the gravitational center of activity for family and friends. Some couples, especially the brides-to-be, spend so much time planning a wedding that they often fail to plan a survival strategy for the days afterwards; and when the wedding day spotlight disappears, so can a sense of purpose.  

  “People who are emotionally resilient rise to this challenge and work together to solve the problems and improve the relationship.  Those who are not resilient sink into despair and depression, and stop trying,” Dr. Tessina says. 

Signs of postnuptial depression may include

• 1. Lack of energy
• 2. Emotional withdrawal
• 3. Lack of sexual intimacy
• 4. Feelings of hopelessness, or despair
• 5. Frequent crying
• 6. Sleeplessness

  Roughly half of all U.S. marriages end in divorce, so it is normal to have some reservations about the sustainability of a new marriage, or suitability of a new spouse. It’s also difficult for some to move from the ‘me’ mindset of being single, to the ‘we’ mindset of being married. Unfortunately few people want to talk about postnuptial depression for fear it might trigger some trouble-in-paradise rumors, but experts say couples should communicate their difficulties to each other, and a professional. Antidepressant medications can help in severe cases, but most cases of postnuptial depression can be treated effectively with psychological therapy.

  “Counseling will also help you handle situations more effectively,” Dr. Tessina says, “and help you not create more drama and dysfunction in the relationship. “ 

  The best way to avoid postnuptial depression is through careful planning and maintaining perspective. First try not to put overblown significance on the wedding day. Certainly it is an important day, but it is still just another day. Before the big day it may help to delegate wedding responsibilities wherever you can, think about having a less lavish reception, try to avoid obsessions or being a perfectionist, and talk to friends and family about your stress. 

  It’s important to remember loving relationships are like flowers; they blossom quickly, need constant care and change with the seasons. Just watch out for the thorns and expect bees. 

Sean Kenniff, MD is a neurologist, radio host, and television journalist in Miami, Florida. 

Tina B. Tessina, PhD, also known as ‘Dr.Romance’, is a licensed psychotherapist in Southern California with over 30 years of experience counseling couples and individuals. She is the author of thirteen books on relationships including Money, Sex and Kids: Stop Squabbling About the Three Things That Can Ruin Your Marriage. Dr. Tessina also writes the Dr. Romance blog, and is a Relationships Expert for Redbook Love Network, Divorce360.com, and she answers relationship questions at Yahoo! Personals. She can be reached by visiting her website  http://www.tinatessina.com

Pill-Free Prescription for Depression

Dr. Sean’s Pill-Free Prescription for Depression

by Sean Kenniff, MD

    Contrary to popular belief depression comes in many forms. Seasonal Affective Disorder (SAD) is characterized by depressed mood during the winter months. Dysthymia is marked by a generalized and fairly persistent moderate level of depression. Post-partum Depression (PPD), which occurs in roughly ten percent of new moms, is often characterized by severe emotional distress following childbirth. Reactive Depression is a depressive disorder that occurs in response to a particular event. There are several other forms of depression but the most notable of all the depressive disorders is Major Depression, also called Major Depressive Disorder (MDD). MDD It is a severe and often debilitating chronic mental illness.

    A report published by the CDC’s National Center for Health Statistics in 2008 found that in any 2-week period roughly 1-in-20 people are depressed. Serious signs include feelings of overwhelming sadness, suicidal thoughts, bouts of crying for no reason, loss of interest in daily activities, feelings of hopelessness, difficulties with sleep, irritability, and loss of interest in pleasurable activities like sex.

    The cause of depression isn’t entirely understood. There are strong genetic factors that seem to predispose someone to depressive conditions. Negative life experiences can also increase the risk. There is some evidence that serotonin and norepinephrine may be playing a role, and medications that alleviate depression often seem to work by altering levels of these two brain neurotransmitters.

    Treatment with antidepressant medications is essential in many cases, but they can cause some troubling side effects. So here’s how to alleviate some of the signs and symptoms of depression without popping any pills. 

Dr. Sean’s Pill-Free Prescription for Depression

Sunlight

    Lack of sunlight in the winter months can lead to Seasonal Affective Disorder in some people. An ultraviolet sunlamp can help but natural sunlight seems to work best at alleviating the symptoms. So try to get more sunlight or head to a sunnier climate. Just why a lack of sunlight leads to depression is not clear. Some researchers suspect melatonin, a hormone produced by the pineal gland in response to dim light, may have a depressing effect on mood. Other experts have suggested vitamin-D deficiency is playing a role. Vitamin-D is made in our skin during sun exposure and some studies have found a vitamin-D deficiency can lower mood.

Fish

    Countries with the highest rate of fish consumption have the lowest rates of depression, and a diet high in fish, or fish oil supplements containing omega-3 fatty acids, can improve symptoms of depression and stabilize mood swings. A 2002 study that appeared in the Archives of General Psychiatry found taking fish oil supplements resulted in a fifty percent decrease in depressive symptoms. It appears that omega-3 fatty acids in fish help raise the level of serotonin in the brain. One study even suggested that a diet rich in omega-3 fatty acids might help improve depression in people who have not been helped by antidepressant medications.

Walnuts

    Have you ever noticed that walnuts look like the human brain? Well there may be good reason for that because walnuts also contain omega-3 fatty acids. Just ¼ cup of walnuts each day can provide you with an entire day’s worth of omega-3s. Walnuts are also a good source of magnesium and vitamin-B6 which are also important for mood stabilization and brain cell functioning.

B-Vitamins

    The brain uses B-vitamins to manufacture neurotransmitters like serotonin, norepinephrine, epinephrine and dopamine. These neurotransmitters play a critical role in mood elevation and mood stabilization. So fill your plate with healthy sources of B-complex vitamins like whole grains, eggs, bananas, and soy beans. 

Avoid Alcohol

    It’s important to mention that alcohol is well known to depress mood. But alcohol also interferes with the absorption of B-vitamins in the body which can worsen or lead to neurotransmitter imbalances. In fact it is very common for alcoholics to be severely depressed and many of them have significant deficiencies of B-complex vitamins. Alcohol abuse also increases the risk of suicide in people who have depressive symptoms.

Daily Exercise

    Just about every study ever conducted on exercise and mood has shown that regular physical activity improves mood and alleviates depressive symptoms. It’s thought that exercise increases levels of feel good chemicals, called endorphins, in the body. Plus exercise reduces stress, improves self-esteem, improves sleep, and increases energy levels. 

Cognitive-Behavioral Therapy (CBT)

    Cognitive behavioral therapy (CBT) is a specific form of talk therapy that psychologists often use to treat depression. During a CBT session the patient and therapist analyze negative behavioral patterns and dysfunctional emotions through positive insight exercises and systematic goal setting. CBT concentrates on present problems and symptom removal. Several studies have found combining CBT with antidepressant medications improves results and lessens depression relapses. Some studies have suggested CBT alone may be as effective as taking antidepressant medications.

Mindful Meditation

    There is some evidence that mindful meditation may help alleviate some of the symptoms of depression. Unlike traditional forms of meditation where thoughts are cleared, mindful meditation focuses the mind on the present. When done properly the technique allows the person to explore thoughts and actions without judgment. Some practitioners have combined mindful meditation with cognitive behavioral therapy (CBT) into a new technique called mindfulness-based cognitive therapy or MBCT. Studies have shown MBCT may also improve depression in some people. 

    It is important to reiterate that for many people with moderate or severe depression medications will be an important, if not critical element of their therapy. So make sure you discuss all of your options with a skilled mental health professional.

What is Worse? This or That?

What’s Worse, This or That?

by Sean Kenniff, MD 

What is worse: being obese or suffering from anorexia nervosa? 

Statistics show anorexia nervosa has the highest fatality rate of any psychological disorder. Up to twenty-percent of those affected will die from the condition if left untreated, and roughly three-percent die even with therapy. Obesity also kills, but much more slowly. The mortality rate for people suffering from anorexia nervosa is higher, and they tend to die at much younger ages when compared to an obese people of the same age. For an obese twenty-five-year old woman the risk of dying is around 0.1%.

What is worse for parents with children: Having a gun in the house, or a swimming pool in the backyard?

In the book Freakonomics by economist Steven Leavitt, statistical analysis reveals that having a swimming pool is roughly 100-times more risky than having a gun in the house. According to Leavitt there are 6-million residential swimming pools in the U.S., and more than 500 children drown in them each year-so roughly one child drowns for every 11,000 swimming pools. Meanwhile there are more than 200-million guns in the U.S., but fewer than 200 deaths in children under the age of ten are due to firearms. Simple math tells you that the risk of having a gun in the home is just 1-child death for every 1-million guns.

What is worse: smoking marijuana cigarettes, or smoking tobacco cigarettes?

This question appeared in an editorial in the British Medical Journal in 2003. From a legal point of view marijuana is certainly worse. But when it comes to your health tobacco cigarettes are a much bigger risk. Two large studies failed to find an increased risk of death associated with cannabis use. While there are plenty of carcinogens in marijuana smoke, people do not tend to chain-smoke the drug-so the overall exposure to those carcinogens is much less. And most marijuana smokers cease smoking the drug in early adulthood. Cigarettes pose a much larger personal and public health risk. However this conclusion comes with a caveat: perhaps the main reason people stop smoking marijuana after a certain age is because of its illegality. As we age we are less likely to commit these kinds of criminal activities. Decriminalization of marijuana may lead to more prolonged smoking and perhaps more deaths. But overall cigarettes are much worse. In the United States tobacco use contributes to roughly 1-in-5 deaths.

What is worse: being married and miserable, or happy and single? 

Research shows happily married couples live longer than singles, and the health benefit of being in a happy marriage is more profound for men than it is for women. People in positive marital relationships have lower blood pressures and reduced levels of stress hormones when compared to unhappily married couples. And a recent study from BYU researchers found unhappily married people have a higher blood pressure, and higher stress hormones than happy singles and happily married folks. So being unhappily married appears to pose the biggest risk to your health. But before you think about heading to divorce court, several studies have shown divorce can increase the risk of death. So try to make your marriage a happy one. 

It’s also important to mention that overall never-married people face the highest risk of death (unhappy and happy singles combined). A study published in 2006 found never-married people faced 5-times the risk of dying from infectious diseases, were 38-percent more likely to die from heart disease, and faced twice the risk of dying from an accident, homicide, or suicide.

What is worse: air pollution or being exposed to second-hand smoke?

Air pollution from industrial pollutants and motor vehicles accounts for 3% of all U.S. deaths according to an article in the European Respiratory Journal. A study from University of Southern California in 2007 found children living near a major highway (within 500 meters) were more likely to have asthma, other respiratory diseases, and were more likely to have reduced lung function and reduced lung growth. Living close to a busy highway has also been associated with an increased risk of heart disease and some cancers. Air pollution alone causes between 22,000 and 55,000 deaths each year in the U.S. according to government statistics, but the National Resources Defenses Council says air pollution is responsible for 64,000 deaths each year. Particulate matter and benzene are thought to be playing the largest role in causing the health problems. 20-million Americans live under air pollution that contains more than 32 toxins at levels 100 times higher than the EPA deems acceptable. The World Health Organization says worldwide there are 2-million deaths due to air pollution each year. So how does second-hand smoke compare? The American Cancer Society estimates exposure to second-hand smoke causes roughly 3400 lung cancer deaths and between 22,000 and 69,000 deaths from cardiovascular disease each year in the U.S. There are approximately 21-million American children (35%) living in homes where they are exposed to second-hand smoke. So the numbers turn out to be roughly the same.