Treatment of Depression in Pregnant Women - Research Paper Example

Treatment of Depression in Pregnant Women Research Methodology Ekhlas Aljohani EDUC 630 Dr. Absael Antelo The objective of this research is highlighting the appropriate treatment measures that pregnant mothers should use to reduce the challenges they face due to pregnancy depression. Cases of pregnant mothers suffering from depression and stress are likely to reduce in the events of increased awareness of the contributing factors of stress and the necessary measures to curb them. Women with moderate depressions can manage these symptoms with psychotherapy, support groups, and light therapy. Although these measures help in managing pregnancy depression, pregnant mothers have the responsibility of choosing the best treatment. While most pregnant mothers use antidepressants to manage prenatal and postnatal depression, this study proposes other significant measures that can do better that antidepressants. The method for this research is a mixed method approach. The qualitative part of the study is observation and interviews while the quantitative part is considering the number of patients presenting symptoms in different health centers for a period of one year. Statistical analysis of the data obtained would help in determining the prevalence of depression in pregnancy. Contents Table of Contents Chapter I: Introduction……...………..…………………………………..……………pg 5 Context of the Study………………………………………..…………………………..pg 5 Statement of the Problem…………………………………..…………………………..pg 5 Purpose of the Study………………………………….…………………………………pg 5 Research Questions (Qualitative question,Qualitative question,Mixed-method question) ..pg 6 Delimitations………………..………………………………………………………..pg 6 Significance of the Study………………………..………………………………………pg 6 Assumptions……………………………………………………………………………pg 6 Summary……………………………...………………………………………………..pg 7 Chapter II: Literature Review…………………………………….………...……….pg 7 Background………...……………………………………………………………………..pg 7 Contributing Barriers and Motivators………. ………………………………………….pg 8 Application of Critical Thinking Theory………………………………………………pg 9 Organization of Awareness…………………………………………………………......pg 10 Challenges of diminishing depression in pregnant women ……………………………pg 11 Proactive in helping pregnant women treat depression ……………………………….pg 15 Chapter III: Methodology…………..………………………………………………..pg 16 Theoretical Framework………………………………………………………………pg 16 Research Design………………………………………………………………………pg 17 Role of Researcher………………………………………………………………… …..pg 17 Setting and Participants……………………………………………………….……… pg 17 Data Collection and Analysis Strategies………………………………………….….pg 18 Methods of Achieving Validity………………………………………………………,.pg 19 Chapter IV: Conclusion……………………………………………………………..pg 20 References…………………………………………………………………………….pg 21 Chapter I: Introduction Context of the study There is evidence suggesting that women have a higher prevalence of suffering from depression during pregnancy. The fact that this presents adverse effects to the mothers place emphasis on the need for addressing the issue. Cases of pregnant mothers suffering from depression and stress are likely to reduce in the events of increased awareness on the contributing factors of stress and the necessary measures to curb them. In order to solve this, the health sector should find appropriate treatment for pregnancy depression. Pregnancy depression refers to a mental situation of pregnant mothers, whereby they are sad and feel they do not want to do anything. The present research paper will aid in highlighting the common symptoms of pregnancy depression and the appropriate treatment measures that pregnant mothers should take into account to address this problem. Problem statement According to the World Health Organization, pregnancy depression is currently an epidemic affecting many mothers across the world. Most pregnant mothers are highly affected by prenatal and postnatal depression. Since pregnancy depression is not “protective”, adequate treatment is necessary for pregnant mothers. Most pregnant mothers do not understand the necessary appropriate measure to address this issue and therefore, this field needs further research to educate mothers on how to cope with such condition. Women with moderate depressions can manage these symptoms with psychotherapy, support groups, and light therapy. Subsequently, the research identifies various symptoms that are witnessed such as stress factors (Katherine & Wisner, 2009). Considering that depression during pregnancy may pose serious problems to the mother, the issue needs urgent addressing. Therefore, this is the only way to ensure that expectant mothers are not exposed to intense dangers that may emanate from depression and stress. Treatment of pregnancy depression is a substantial public concern. During pregnancy, most researches reveal that a great number of mothers may be living in depression and failing to realize. . The intensive researches engage people to understand the problems that expectant mothers face during their prenatal or postnatal periods. Additionally, pregnancy depression needs a lot of concern since it also affects the life of the infant. There is need of pregnant mothers to engage themselves in the above mention approaches to reduce depression during pregnancy (Altshuler L, & Cohen ML., 2005). The purpose of the study The goals and objectives of this research are to identify various methods through which the society may be capable of defining the presence of stress and depression in pregnant mothers. Secondly, the study enables scholars to assess different methods of treating pregnant women facing such conditions, and determine which of the intervention techniques is effective (Bonari, L., Bennett, H., & Einarson, A., 2004). Research question Qualitative question- how does psychotherapy, support groups, and light therapy aid to address the issue of pregnancy depression? Quantitative question- will psychotherapy, support groups, and light therapy reduce pregnancy depression affecting pregnant mothers? Mixed method question- how does the use of non-drug treatment methods for depression in pregnant women impact on the physicians and pregnant women’s perception on depression treatment methods? Hypothesis Cases of pregnant mothers suffering from depression and stress are likely to reduce in the events of increased awareness on the contributing factors of stress and the necessary measures to curb them (p.54). Significance of the study Therefore, can we effectively change pregnancy depression issues by teaching pregnant mothers on the effective measures to take into account during the prenatal and postnatal periods? This is what my study seeks to show, and I have found many sources that have helped to support my theory. The study comes up with some appropriate approaches that pregnant mothers should engage in. These approaches include psychotherapy, support groups, and light therapy. These approaches can highly help pregnant mothers to cope with the challenges of pregnancy depression (Department of Health, 2014). Limitation of the study The study has both qualitative and quantitative limitations. The quantitative limitations of this study will be related to the size of the research sample and how pregnant mothers will respond to my research. In order to be certain of the varied symptoms, a reliable sample size is a critical consideration. On a small scale, identification of a health center that handles a considerable number of antenatal cares would be the initial step. The qualitative limitations of the study will be whether the pregnant and health officials will provide me with all the necessary information needed for the completion of the research (Department of Health, 2014). Delimitations of the study The following will be the scope of this study. The research will highly focus on pregnant mothers, the depressed, and health workers. The aim of this study will be to establish the appropriate measures that pregnant mothers should take to cope with the challenges of depression. The sample would consist of health workers to support the research venture, as well as seeking consent from the patients (Katherine L. W., 2009). Chapter II: Literature Review Background The issue of depression during pregnancy remains to be a major challenge for pregnant mothers. It has been one of the major problems affecting the society currently (Meltzer-Brody, 2011). Edwards & Mohllajee (2008) state that, 8% and 7% of all pregnant women seem to have prenatal and postnatal symptoms of pregnancy respectively. Moreover, many pregnant mothers seem to be unaware of the essential ways of treating prenatal and postnatal depression yet it highly affects their lives and outcome of the infants. Objectives Symptoms of Depression during Pregnancy and Ways of Treatment remains to be societal issue that needs further research (Edwards &Mohllajee, 2008). This research aims at determining the ways of treating prenatal depression since it affects the outcome of the infant. This paper purports to limit the use of antidepressants, as a treatment for perinatal depression. Search Strategy The methods used to search for the data collected for this research is journal articles by different authors. This is because a large number of writers have tried to discuss this issue of pregnancy depression and such articles provided me with plenty of information for my work. Criteria for selection My research topic is about the symptoms of depression during pregnancy and ways of treatment. Since there are so many articles discussing about pregnancy, I only selected the articles whose contents specifically discussed about symptoms of depression and ways of treatment. Extraction of data Writing this paper only required me to extract information from the articles that covered a discussion about symptoms of depression during pregnancy and ways of treatment. Since all the articles used contain the necessary information about the topic, there is no need of using a tabular form for data extraction (Department of Health, 2014). Synthesis Many writers have shown their efforts on trying to educate people on the issues of prenatal depression and ways of treating it. This is evident in all the sources used to references this paper. Prenatal depression remains as a challenge to most pregnant mothers and needs many attentions. Most people are unaware about the side effects of prenatal depressions during pregnancy and there is need of ensuring that everyone, especially mothers get enough knowledge about this issue (Cohen &Nonacs, 2004). Contributing Barriers and Motivators Depression during pregnancy is a very common among despite the fact that most of the symptoms are not readily visible. According to the report on statistics of cases of pregnant women with depression, the American Congress of Obstetricians and Gynecologists reveal that prevalent of depression in pregnant women is 18% to 23%. The symptoms are depression are concealed such that not even the pregnant woman in aware that she is suffering from depression. Thus this paper seeks to analyze the emotional and physical symptoms of depression in pregnant women (Bonari, L., Bennett, H., & Einarson, A., 2004). Physical symptoms of depression during pregnancy may be overlooked as a normal thing due to the changes taking place within the body. However, extreme cases of some physical activities or expression may signify underlying depression. A depressed woman will show signs of panic attacks over trivial issues. The panic attacks may be severe and caused by no tangible threats around the woman. Most times, panic attacks lead to shivering, racing heartbeat, breathlessness, increased sweating especially at the palms, and shortage of breath, dizziness and nervousness. Panic attacks are associated with anxiety and fear where the mother keeps worrying about the baby and whether the bay is fine or would be born without complications. Regular pain attacks can have adverse effects on both the mother and the baby and thus, pregnant women should be on the lookout for such symptoms (Turner, E.H et al, 2008). Emotional symptoms of depression are sensitive and not easy to categorize as cause of depression since even the healthy pregnant women have emotional changes and mood swings. However, the emotional symptoms of a woman with depression are more intense. A depressed woman tends to feel more hopeless and worthless every day and this can be indicated by how she talks, crying every day, complaining and feeling agitated over trivial things. She does not enjoy anything even the things she used to enjoy before, she feels empty and sad all the time, she has little concentration span and seems to be in deep thoughts, lack of sleep leading o excessive fatigue, loss of appetite or gain of extreme appetite and above all, inappropriate feelings of guilt (Katherine L. W., 2009). Application of Critical Thinking Theory Depression in pregnant women is very difficult to quality due to the emotional changes most women go through during pregnancy. While such symptoms may not be very visible to both the pregnant woman and the people round her, their effects are very adverse on the health of both the mother and the baby. Depression conceals its manifestation since women associate their feeling of fatigue, loss of appetite, loss of concentration with typical symptoms of pregnancy. The persistent of the typical symptoms of pregnancy are the indications that a woman is falling into depression. While those who understand they are in depression take prescribed antidepressants, others start taking antidepressant before they become pregnant. As such, most case result into inefficient treatment (Edmund, P.et al., 2010). Critical thinking and sensitization of the public and pregnant women in different fora in order to educate them of the normal symptoms of pregnancy and extreme symptoms which signify depression, is imperative to helping pregnant women take precaution and proper care to avoid depression and to seek effective remedy in case of such symptoms. Application of the critical theory will help medical institutions gain more insights into the modes of helping pregnant women and promote healthy pregnancy (Lee S. C., & Lori L. A., 2006). Organization of Awareness Successful assessment and verification of depression in a woman should be followed by proper remedy so as to instill the joy of expecting a baby which is easily loss during depression. Of the commonly used methods of coping with depression in pregnant women, antidepressants top the list. This is because of their easy accessibility as some are taken upon self-prescription. Although prescribed antidepressants are considers effective, most women have developed symptoms of depression which are curable through antidepressants especially the mild to moderate depression. According to FDA statistics, only 10% of women who had been treated with antidepressants were able to recover, on the other hand, the 90% shown no signs of improvements (FDA, 2010). This leads to the quest of finding other effective way of solving these problems. Non-drug treatment of depression in pregnant women has proven to be more effective than medical treatment. They include psychotherapy, support groups, and light therapy (Sheila, M., 2004). Psychotherapy is a non-drug treatment of depression in pregnant women. There are two types of psychotherapy; cognitive-behavioral therapy and interpersonal psychotherapy. Cognitive-behavioral therapy helps the pregnant women whose beliefs have been distorted by the pregnancy. Talking to them and restoring their beliefs helps in diminishing the depression. On the other hand, interpersonal psychotherapy is the most specialized form of therapy for pregnant women. These types of psychotherapy focuses on the relationship the pregnant women shares other people around her, the support they give her and how those relationships have changed ever since she became pregnant. This therapy aims to help the pregnant woman to explore her support sources and receive the support offered by the people she is related with in helping her get over the depression (Turner, E.H et al, 2008). Bright light therapy has gained significance over the recent yeas for helping pregnant and breastfeeding women cope with depression. The bright light is illuminated on the women daily for about an hour at an illumination level of 10,000 lux. Others use lower light intensity depending on the patient. The light is monitored so as to be effective is alleviating depression. As such, it is recommended that the light therapy be performed immediately the depressed woman wakes up. This should not be confused with regular lighting since light therapy requires a special light box (The Black dog Institute, 2014). Support groups help pregnant women overcome their depression by being available and trying to calm her down and to cheer her up through different support activities. The support group may be friends, family, religious groups, counselors or professional support groups. The support groups aim to provide both practical and emotional help to the pregnant women to avoid feeling sadness and engaging in negative thinking (Office on Women’s Health, 2014). Challenges of diminishing depression in pregnant women Although many ways of solving the depression problems in pregnant women have been discovered in the psychology field, cases of depression have not been noted to reduce consequently. One of the challenges faced in trying to solve the depression problem in pregnant women is the over-reliance of pregnant women of on anti-depressants. As noted earlier, antidepressants have side effects on the health of both the mother and the baby since they cross through the placenta. Although believers of antidepressants hold that they are effective, research has shown that only 10% of antidepressants treatment ends up being successful. Furthermore, the chemical elements passing through to the baby many have impacts on the immunity of the baby (Edmund, P.et al., 2010). The physical and emotional symptoms of pregnancy have no overt symptoms since their symptoms intertwine with the typical symptoms of pregnancy. This poses a challenge of problem-recognition and thus impedes treatment. When the patient has not been diagnosed with depression, there are very remote chances that they will seek help. Furthermore, unless in the extreme cases where symptoms have more overt manifestation, cases of depression end up without proper diagnosis and eventually treatment. Some pregnant women have complications which cannot be treated during depression. Their conditions may be related to hypertension and the doctors may advice against some forms of therapy that may agitate the patient as they can increase the risk. This means that the patient can only be treated through medical prescriptions as non-drugs treatment may not be effective (Chaudron, 2013). Proactive in helping pregnant women treat depression The treatment a pregnant woman receives when depressed determines her health and that of the expected baby. Treatment of symptoms such as sadness, anxiety and hopelessness is the key to helping them have a successful pregnancy. While it may sometimes be difficult to differentiate the typical symptoms of pregnancy and that of depression, proper care, nutrition and attention will help one to evaluate the health of the pregnant woman. Apart from depending of the extreme manifestation of depression in order to treat the depressed woman, it is wise to prepare and use all the available evidence to identify and confirm early suspicions of depression. This is because early diagnosis will result into early and effective treatment. Various ways are used to guide in this process (Kerr, 2012). Assessment of the past of the pregnant woman to identify if there is a history of depression either on her life or that of her family will be effective in healing one reach clear conclusions. Assessment of the nature of the existing relationships around the pregnant woman will help in determining the kind of support she is getting. If the woman shows extreme symptoms of pregnancy and she is in a broken relationship, she should be screened for depression. Urgent care is needed for such women as they may turn to using drugs and other harmful substances. Fertility issues are another aspect to assess. Women who have had trouble conceiving are more likely to be depressed as compared to those who conceived with problems. This is because they tend to value the baby so much that they are always worrying about the state of the baby until they fall into depression. Such women are at high risk of suffering and also the baby due to complications. Past history of the woman with regards to emotional and physical abuse or previous loss of pregnancy can be the underlying reason for depression during pregnancy. Evaluation of such issues may help one decide to screen the pregnant woman for depression since extreme symptoms may have a connection with the past history. Early treatment of depression in pregnant women is very effective especially in ensuring the health of the mother and ensuring successful delivery of a healthy baby. Medical treatments have been on the use for a long time and especially antidepressants which are used to treat mood swing and emotional imbalance in pregnant women. However, research has shown that antidepressants are nor effective in most cases and that is why, it is recommended that non-drug treatments be used to treat depression in pregnant women. Psychotherapy, support groups, and light therapy are non-drug treatment methods of depression in pregnant women. Medical care should be recommended in case of unsuccessful application of any of them (Turner, E.H et al, 2008). Limitations According to most of the articles used, pregnancy refers to a period of expressive well-being of a patient. Studies show that a large number of mothers relapses during their first trimester of pregnancy (Cohen &Nonacs, 2004). Relapsing is more prevalent with women who have histories of chronic depression. The only conflicting argument on this topic is that, pregnancy depression is not “protective” and therefore adequate treatment is necessary for women using antidepressants. Conclusion The issue of depression during pregnancy remains to be a major challenge for pregnant mothers. Edwards & Mohllajee (2008) state that, 8% and 7% of all pregnant women seem to have prenatal and postnatal symptoms of pregnancy respectively. Additionally, many pregnant mothers seem to be unaware of the essential ways of treating prenatal and postnatal depression yet it highly affects their lives and outcome of the infants. This is a serious problem, which calls for immediate actions since its effects are more adverse to the health of the developing child. The possible treatments for prenatal depression include using an antidepressant, lowering the levels of placental CRH, psychotherapy, support groups, and light therapy (Cohen &Nonacs, 2004). Advocating women will reduce health issues brought by prenatal and postnatal depression, hence improving the health status of pregnant mothers and that of the infants. Chapter III: Methodology Theoretical Framework In order to establish the emotional and physical causes of depression during pregnancy, and the potential ways of treatment, it would be necessary to design an effective methodology. In order to be certain of the varied symptoms, a reliable sample size is a critical consideration. On a small scale, identification of a health center that handles a considerable number of antenatal care would be the initial step. After seeking consent from the relevant authorities, I would request the health workers to support the research venture, as well as seeking consent from the patients. In one year, it would be possible to have a favorable sample size. The responsibility of the nurses handling antenatal care is critical in the research, because they would be in charge of patient enrollment and diagnostic procedures. Pregnant women that meet the criterion described in the DSM manual of depression would form the eligible group. Moreover, the research would also consider the treatment strategies used to address the cases, and eventually compare the effectiveness of the strategies. On larger scale, the research would involve the collection of data from different health centers (Kothari, 2005).  Qualitative Research After identifying the different treatment strategies used to treat pregnant mothers that suffer from depression, a qualitative research on the efficiency of each would follow (p. 56). This would mean that different patients would receive different therapies, and a close monitoring of each would follow in order to analyze the trends of treatment of depression. In a bid to determine the most effective strategy, the research would consider the time taken by patients to heal, and aspects of their emotional health after the depression. This research would produce evidence-based results on the most effective treatment (Cohen &Nonacs, 2004). Quantitative Research It is important to determine the prevalence of emotional depression during pregnancy. Therefore, the number of patients presenting symptoms in different health centers would be considered for a period of one year. Statistical analysis of the data obtained would help in determining the prevalence of depression in pregnancy (Kothari, 2005).  Research design The interpretation of the data in this research is guided through the application of research methods which are imperative in drawing insightful conclusion for this research. Evidently, the selection of an effective methodology is one of the critical aspects of consideration prior to carrying any research. The selected methodology of qualitative, quantitative and mixed methods determines the data collected, and hence the findings. As highlighted above, there are different facets of this research, necessitating both quantitative and qualitative researchers. This will help in determining the physical and emotional symptoms of depression in pregnant women. Moreover, the above methodology will also determine the most effective treatment therapy (Bonari, L., Bennett, H., & Einarson, A., 2004). Role of the researcher In order to conduct a valid research, the researcher seeks to use both qualitative and quantitative methods of research. Both methods are used in this research in order to identify the credibility of the conclusions drawn. Qualitative research is open and interactive; observation precedes theory as opposed to that of the quantitative research where theory precedes observation, thus the need to adopt qualitative research. On the other hand, the type of data in quantitative research is objective detailed and deeply standardized as opposed to qualitative data which is deep, soft and rich. In this research, in order to accommodate our aim which is ‘to identify the physical and emotional symptoms of depression during pregnancy and the possible treatment without suing antidepressants,’ the data needed ought to be deep and rich. Quantitative research will try to test and investigate the theories that are on the beginning of the study which enhances our understanding of the depression concept (Bryman & Bell, 2007). We can’t say that a particular method is better than the other; the key factor is to consider which suits the best in respect to the research question and objectives. In this case, both methods suited this research well (Bryman & Bell, 2007). Research Setting and Participants This research takes place over a span of one year. In this one year, patients will be assessed and analyzed practically in order to determine if our methods of solving depression made any effects on the patients. The data to be used in this research will be collected from patients and the nurses. They will be used as the form of relationship in their environment; they will also act as patients’ social support groups, psychotherapists and light therapists. Different patients will be observed over one year and the results recorded for analysis (Kerr, 2012). Pregnant women will be recruited to be sampled in this research based in the criterion described in the DSM manual of depression. I believe they will form an eligible group for analysis in this research. Moreover, the research would also consider the treatment strategies used to address the cases, and eventually compare the effectiveness of the strategies. On larger scale, the research would involve the collection of data from different health centers (Kothari, 2005). Data Collection and Analysis Strategies Writing this paper only required me to extract information from the articles that covered a discussion about symptoms of depression during pregnancy and ways of treatment. Since all the articles used contain the necessary information about the topic, there is no need of using a tabular form for data extraction. The information gotten from the review of the literature will shape the analysis of the data in this paper since the results gotten from the qualitative and quantitative data are analyzed against the existing theories and conceptual frameworks (Bryman & Bell, 2007). Methods of Achieving Validity According to Bryman & Bell, (2007, p.165), validity test whether or not an indicator which has been formulated to measure a particular concept does it effectively. The analysis drawn in this paper shows that the research is very valid. The review of the literature and the research done on patients who are pregnant and suffering from depression reveals that reliable support is very essential in healthy pregnancy especially at the immediate environment of the pregnant woman. Furthermore, evidence of failed effectiveness of antidepressants as a treatment for depression during pregnancy is very valid since it is extracted from official statistical reports of credible institutions (Edmund, P.et al., 2010). To ensure that our research meets the validity criterion and relates the validity measurements to our research, we will ensure that the analysis tools which to be used to measure and test for effectiveness of non-drug treatment of depression achieves validity (Edmund, P.et al., 2010). Chapter IV: Conclusion Depression in pregnant women is very common despite the fact that most of the cases are not diagnosed. Treatment of depression in pregnant women depends of successful screening of the patients to identify underlying symptoms which are typical of depressed women. This research serves to discourage depressed pregnant women from using antidepressants to treat depression and instead use non-drug methods such as psychotherapy, support groups, and light therapy. These methods are very effective because, unlike antidepressants, they have no side effects s and are very effective in supporting the patient both practically and emotionally. Future treatment of depression in pregnant women should seek to embrace the non-drug methods of treatment and reduce the use of antidepressants to remote cases only (Kerr, 2012). References “Are Antidepressants Safe in Pregnancy? A Focus on SSRIs,” Therapeutics Letter 76 (January– February 2010), ti.ubc.ca/letter76. Altshuler L, Cohen ML. (2005).The Expert Consensus Guideline Series. Treatment of depression in women. Retrieved on 12th February 2014, from: http://europepmc.org/abstract/MED/11500997/reload=0;jsessionid=q5zUqkQaQzLxE9a XUJVc.2 Bonari, L., Bennett, H., and Einarson, A. (2004). Risks of untreated depression during pregnancy. Motherisk. Retrieved on 12th February 2014, from:http://www.motherisk.org/prof/updatesDetail.jsp?content_id=683 Bryman A., & Bell, E. (2011)Business Research Methods. Oxford University Press, USA; 3 edition. New York. Chaudron, L.H.(2013). Complex challenges in treating depression during pregnancy. Am J Psychiatry; 170(1):12-20. doi: 10.1176/appi.ajp.2012.12040440. Cohen, L. & Nonacs, R. (2004). Relapse of depression during pregnancy following antidepressant discontinuation: a preliminary prospective study. Vol 7 (217-21). Department of Health, (2014). Perinatal Depression. Information for a Healthy New York. Retrieved on 12th February 2014, from: http://www.health.ny.gov/community/pregnancy/health_care/perinatal/perinatal_depressi on.htm Edmund, P.et al., (2010). Efficacy and Effectiveness of Antidepressants: Current Status of Research, Psychotherapy and Psychosomatics 79 (2010): 267–79. Edwards, R. &Mohllajee A. (2008). Elevated mid pregnancy corticotropin-releasing hormone is associated with prenatal, but not postpartum, maternal depression.US National Library of Medicine. Vol 93 (1946-51). FDA, (2010). SSRIs and Treatment Challenges of Depression in Pregnancy. U.S. Department of Health & Human Services. Washington, D.C. Meltzer-Brody, S. (2011).New insights into perinatal depression: pathogenesis and treatment during pregnancy and postpartum. Dialogues in clinical neuroscience.13, 89–100. Katherine L. & Wisner, MD. (2009).Pharmacologic Treatment of Depression DuringPregnancy.American Medical Association. Retrieved on 12th February 2014, from: http://jama.jamanetwork.com/article.aspx?articleid=191970 Katherine L. Wisner, MD. (2009).Pharmacologic Treatment of Depression During Pregnancy. American Medical Association. Retrieved on 12th February 2014, from: http://jama.jamanetwork.com/article.aspx?articleid=191970 Kerr, M. (2012) Perinatal Depression: Treatments & Symptoms. Healthline. Vol 6 (34-80). Kothari, C. R. (2005). Research methodology: Methods & techniques. New Delhi: New Age International (P) Ltd. Lee S. Cohen, MD; Lori L. Altshuler, MD. (2006).Relapse of Major Depression During Pregnancy in Women Who Maintain or Discontinue Antidepressant Treatment. American Medical Association. Retrieved on 12th February 2014, from: http://jama.jamanetwork.com/article.aspx?articleid=202291 Office on Women’s Health. (2014). Depression during and after pregnancy fact sheet.U.S department of health and human services. Retrieved on 12th February 2014, from: http://www.womenshealth.gov/publications/our-publications/fact-sheet/depression- pregnancy.html Sheila M. Marcus (2004).Heather A. Flynn, Frederic C. Blow, and Kristen L. Barry. Journal article of Womens Health. Retrieved on 12th February 2014, from: http://online.liebertpub.com/doi/abs/10.1089/154099903765448880 Turner, E.H et al. (2008). Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy, New England Journal of Medicine 358: 252–260. The Black dog Institute. (2014). Causes and Risk Factors: depression. Retrieved on 12th February 2014, from: http://www.blackdoginstitute.org.au/public/depression/inpregnancypostnatal/causesriskfa ctors.cfm Read More