Thursday, January 13, 2011

The Insomnia Cure for Postpartum Depression -- AKA Stupid Science Reporting

My niece just gave birth to twins, and friends are bringing home their newborn.  So this report on sleep deprivation is personal.

Last year's Best of Stupid Science Reporting comes from (drumroll, please...) the New York Times: In Sleepless Nights, a Hope for Treating Depression by Terry Sejnowski.

Don't Believe Everything You Read In The New York Times

Evidently, 75 published papers with over 1700 subjects in the last forty years have documented that the depressive symptoms of new mothers are relieved after a sleepless night.  Now let's remember the number one rule of research publishing -- for all we know, the same study may have been published 75 times.

On the other hand, if the author didn't double count studies, that would be an average of 23 participants per study.  Whatever the results, with those numbers, they would not be robust results.  A review of literature cited below examined some of these studies.  One had nine participants.  One had three.  These are not studies.  They are anecdotes.

Sleep Deprivation And Euphoria

Moving on.  Anybody with bipolar disorder or for that matter, any student who has pulled an all-nighter can tell you that sleep deprivation lifts mood.  After we talked until 5 AM my freshman year, the most natural thing to do in the world was to go invade a nearby garden and pick somebody's blackberries. 

Sleep deprivation used as a treatment for depression is efficacious and robust: it works quickly, is relatively easy to administer, inexpensive, relatively safe and it also alleviates other types of clinical depression, Sejnowski reported.

Unfortunately, There Is This Little Problem

But before you throw away your pills, read the but.

Continuing from the article -- First, sleep deprivation is not as convenient as taking a pill.  Actually that's debatable.  No doctor's appointment, no worries about in or out of network, no copay, no trip to the pharmacy, no need to check the formulary...  If that were the only downside, it would have much to commend it.

Second, prolonged sleep deprivation is not exactly a desirable state; it leads to cognitive defects, such as reduced working memory and impaired decision making.  Translation: NOT relatively safe.  I remember when my son was three months old and I had just gone back to work.  I stopped at the stop sign, looked both ways, and then pulled out in front of oncoming traffic.

Finally, depression recurs after the mother, inevitably, succumbs to sleep, even for a short nap.

Oops.

Wait a minute -- this is the New York Times here.  Read that again.

Sleep deprivation is wonderful cure for depression.  It's quick, cheap and safe.  That's the good news.

The bad news?  A relapse rate of 100% after 15 minutes.

Yes, that would be a difficulty.

There are a few other difficulties with this stupid science report, as well.

Actually, Sleep Deprivation Is Linked To Postpartum Depression

Lori Ross, et al did a review of the literature on this subject.  Against Sejnowski's 75 studies are piles and piles of studies that assert quite the opposite, that sleep deprivation is a significant risk factor for postpartum depression, almost every woman who has postpartum depression is sleep-deprived, and improving mothers' sleep improves their mood.

Sleep Deprivation And Psychosis

The most serious risk of postpartum sleep deprivation would be psychosis.  Studies back over a hundred years, noting that the almost universal early symptom of puerperal [first six weeks after childbirth] cases is loss of sleep (R. Jones, Puerperal Insanity from the British Medical Journal, 1902).

One or two women out of a thousand experience psychosis after giving birth, putting them at risk for suicide and infanticide.  Depending on the study, 42-100% of women with postpartum psychosis also experience insomnia.  Now that is a robust finding.  Furthermore, there is evidence that sleep loss is the last straw that tips women into development of continued bipolar disorder.

Mood is a continuum item.  Depression would be on one end.  Lifting of depression moves in the other direction.  Then comes euphoria, then mania, then psychosis.

Sleep Deprivation And Mania

And speaking of mania, the experience of people with bipolar and college students is well supported in the literature, that sleeplessness can trigger mania.

Sleep For Prevention Of Postpartum Depression

All this stuff is so well known, the Women's Health Concerns Clinic at St. Joseph's Healthcare has developed a preventive intervention that is routinely offered to patients who present with high risk for postpartum depression. Can you imagine a five-day stay in a private room after childbirth?  These and other strategies aimed at improving the sleep of new moms decreased mood disorders and even psychiatric hospitalizations months after childbirth.

Sleep.  That is the REAL cure for postpartum depression.  Forget baby showers.  The kindest gift you can give a new mom is to take care of the kid while mom takes a nap.

Speaking of which,

Aimee -- get off the computer and go to bed!

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