antidepressant

Antidepressants Aren’t Taken By The Depressed; Majority Of Users Have No Disorder

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Flaws in access to reliable psychotherapy may lead people with mental burdens to pop pills instead.

A new study published in The Journal of Clinical Psychiatry reports some 69 percent of people taking selective serotonin reuptake inhibitors (SSRIs), the primary type of antidepressants, have never suffered from major depressive disorder (MDD). Perhaps worse, 38 percent have never in their lifetime met the criteria for MDD, obsessive compulsive disorder, panic disorder, social phobia, or generalized anxiety disorder, yet still take the pills that accompany them.

In a society that is increasingly self-medicating itself, capsules, tablets, and pills are turning from last resorts to easily obtained quick fixes. Between 1988 and 2008, antidepressant use increased nearly 400 percent. Today, 11 percent of the American population takes a regular antidepressant, which, by the latest study’s measure, may be a severe inflation of what’s actually necessary.

“I think while psychotherapy is another option to helping people obtain better mental health, there are roadblocks,” said Dr. Howard Forman, medical director of the Addiction Consultation Service at Montefiore Medical Center. Forman, who wasn’t involved with the study, points toward cost, availability of experts, and time demands as the main reasons people may decide to pursue alternatives.

Dr. Ramin Mojtabai, of Johns Hopkins Bloomberg School of Public Health, and his colleagues relied on data from four samples, the Baltimore Epidemiologic Catchment Area Study Wave 1, which began in 1981, all the way through Wave 4, which ended in 2005. In total, they used data on 1,071 participants, including four interviews and an assessment on current antidepressant use. Similar to the national average, 13 percent of people reported using antidepressants.

Medications to offset perceived, yet undiagnosed, chemical imbalances don’t just include those targeted to mood. Amphetamines like Adderall help people find focus, and benzodiazepines like Xanax quell anxiety — or so their users claim. But when the bottom falls out on casual use, quick fixes may turn into heavy dependence. “I have no concerns about the prescription of SSRIs leading to dependence,” Forman said. Prescriptions are generally accompanied by a doctor’s oversight. “I think that any medications that are taken without the oversight of a physician, especially drugs with abuse potential, such as Xanax, are very concerning for the development of dependence.”

Solving this problem of antidepressant overuse may be partly systemic as well as personal. Mental health care is improving in the U.S., particularly as the stigma fades and people no longer feel embarrassed to seek treatment. But more can be done to give patients peace of mind, Forman says. This may help reduce their urge to unnecessarily self-medicate, as the people who don’t need medication take solace in the reassurance of their health, while those in need find the same comfort in the confirmation of an illness. The main priority is removing the element of uncertainty.

“We all experience periods of stress, periods of sadness, and periods of self-doubt,” he said. “These don’t make us mentally ill, they define us as human.”

Source: Takayanagi Y, Spira A, Bienvenu O, et al. Antidepressant Use and Lifetime History of Mental Disorders in a Community Sample: Results From the Baltimore Epidemiologic Catchment Area Study. The Journal of Clinical Psychiatry. 2015.

Single Dose Of Antidepressant Lexapro Can Change Brain’s Wiring In Just 3 Hours

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A single dose of Lexapro, a commonly prescribed SSRI antidepressant, quickly produces dramatic changes in the architecture of the human brain.Photo courtesy of Shutterstock

One out of every 10 Americans takes an antidepressant, according to the National Health and Nutrition Examination Survey, while one in every four women in their 40s and 50s do so. Now, a new study finds a single dose of a commonly prescribed SSRI (serotonin reuptake inhibitor) quickly produces dramatic changes in the architecture of the human brain. Specifically, brain scans taken of volunteers before and after one dose show a reduction of connectivity throughout the brain, with an increase of connectivity in two separate regions — all in just three hours.

What are SSRIs?

Worldwide, SSRIs are among the most widely prescribed form of antidepressants, often used to treat depression, anxiety disorders, panic attacks, and personality disorders. Classified as third-generation antidepressants, they are known for having fewer side effects than older pills and work by increasing levels of serotonin, a brain chemical naturally produced by your body. While serotonin serves many roles within your brain, chiefly it balances mood.

For the current study, 22 medication-free participants let their minds wander for about 15 minutes while their brains were scanned with an fMRI, a technology capable of measuring oxygenation of blood flow. Meanwhile, the researchers analyzed the three-dimensional images of each participant’s brain and measured the number of connections between small blocks of neurons known as voxels. After giving each volunteer a single dose of Lexapro (escitalopram), the researchers carefully observed the changes in those connections.

Immediately, the researchers felt surprised to discover the speed with which one dose of the SSRI performed. Within a matter of hours, it had reduced the level of intrinsic connectivity in most parts of the brain, while increasing connectivity within two regions: the cerebellum and thalamus. The cerebellum is responsible for, among other tasks, controling motor skills and balance, while the thalamus regulates consciousness, sleep, and alertness.

“We were not expecting the SSRI to have such a prominent effect on such a short timescale or for the resulting signal to encompass the entire brain,” said Dr. Julia Sacher of the Max Planck Institute for Human Cognitive and Brain Sciences and an author of the study. Sacher believes better understanding of the differences in individual response to SSRIs “could help to better predict who will benefit from this kind of antidepressant versus some other form of therapy.

Antidepressant medicines change brain architecture

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A single dose of drugs used to treat depression can alter brain’s structure only within hours, German researchers have uncovered.

The study conducted by the scientists at the Max Planck Institute in Leipzig found that the most popular class of antidepressants, selective serotonin reuptake inhibitors (SSRIs) could impact brain can change connectivity.

Researchers used a magnetic resonance imaging machine to track brain connectivity in medication, according to the study report published the Cell Press journal Current Biology.

First they took data in free individuals whose minds wander for about 15 minutes in a brain scanner that measures the oxygenation of blood flow in the brain.

Next they gave the group a single dose of escitalopram, the SSRI antidepressant under the brand-name Lexapro, and then scanned the connections in the barin.

Comparing the brain connection 3-D maps indicated prominent changes in brain’s  architecture caused by taking the drug.

“A single dose reduced connectivity in most parts of the brain, but increased connectivity within the cerebellum and thalamus — the parts of the brain associated with motor control and signal regulation only within hours.”

“We were not expecting the SSRI to have such a prominent effect on such a short timescale or for the resulting signal to encompass the entire brain,” said the co author of the study Julia Sacher.

“The findings could be a first step toward figuring out whether a relatively simple brain scan might one day help psychiatrists distinguish between those who respond to such drugs and those who don’t, an area of mystery and controversy in depression treatment,” researchers say.

Are Your Medications Causing or Increasing Incontinence?

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If you are struggling with urinary incontinence or your existing incontinence is getting worse, take a look at the medications you are taking. They may contribute to the problem.

There are four groups of medications doctors commonly recommend that can cause or increase incontinence. If you are taking any of these, you should let your doctor know about your incontinence and discuss your medications (both prescription and over-the-counter) to see if there is another approach to control or eliminate the problem.
The most common incontinence problems arise from medications in the following four categories:

1. Diuretics to reduce excess fluid

Diuretics, also known as “water pills,” stimulate the kidneys to expel unneeded water and salt from your tissues and bloodstream into the urine. Getting rid of excess fluid makes it easier for your heart to pump. There are a number of diuretic drugs, but one of the most common is furosemide (Lasix®).

According to urologist Raymond Rackley, MD, approximately 20 percent of the U.S. population suffers from overactive bladder symptoms.

“Many of those patients also have high blood pressure or vascular conditions, such as swelling of the feet or ankles,” he says. “These conditions are often treated with diuretic therapies that make their bladder condition worse in terms of urgency and frequency.”

A first step is to make sure you are following your doctor’s prescription instructions exactly. As an alternative to water pills, Dr. Rackley recommends restricting salt in your diet and exercising for weight loss. Both of these can reduce salt retention and hypertension naturally.

2. Alpha blockers for hypertension

Another class of drugs used to reduce high blood pressure or hypertension by dilating your blood vessels can also cause problems. These medicines are known as alpha blockers. Some of the most common are Cardura®, Minipress® and Hytrin®.

These are usually more of an issue for women. Again, discuss this with your physician, because there are alternative drugs you may be able to take.

Men typically take these to treat an enlarged prostate (benign prostatic hyperplasia or BPH) which can restrict urination by putting pressure on the urethra. By relaxing the muscles in the bladder neck, they allow smoother urine flow for those patients.

3. Antidepressants and narcotic pain relievers

Some antidepressants and pain medications can prevent the bladder from contracting completely so that it does not empty. That gives rise to urgency or frequency or voiding dysfunction. They can also decrease your awareness of the need to void.

“Some of these drugs can also cause constipation,” Dr. Rackley says. “Constipation, in turn, can cause indirect bladder incontinence because being constipated takes up more room in the pelvis that the bladder needs to expand.”

4. Sedatives and sleeping pills

Using sedatives and sleeping pills can present a problem, especially if you already have incontinence. They can decrease your awareness of the need to void while you are sleeping.

The best way to address this situation, Dr. Rackley says, is to take other steps to relax and improve your sleep. Getting more exercise to make you tired, for example, can help. It’s also important to maintain a regular bedtime and wake-up schedule. Dr. Rackley says finding other ways to relax before bed — meditation, reading a book or listening to soothing music or sound effects (e.g., rain or waves) — can also help you sleep better.

 

5 Ways To Boost Happiness Naturally Without Antidepressants.

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A few years back, Harvard conducted a study to reiterate what many in the psych professionals already know – Americans are addicted to anti-depression meds. We (though not myself) pop Prozac, Celexa, Effexor, Paxil, and Zoloft pills like they are candy in an attempt to boost mood and feel better. The increase in sales of anti-depressants is up a startling 400%. This pill-popping became the norm, even though clinical studies suggest there are numerous natural remedies that can help us feel better, without the pricey and life altering side-effects that many of these drugs can cause.

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Indeed, many individuals can find relief from depression with simple lifestyle changes, even just dietary changes. Even the spice turmeric has been shown to treat depression better than Prozac, one of the best selling, yet least effective anti-depressants of all time. Phytotherapy Research said that not only is turmeric effective at treating depression, but it is likely more effective than some of the most common anti-depressant drugs currently on the market.

Additionally, there are several things people can do to boost their happiness levels without ever popping a pharmaceutical pill. Here are 5 potential solutions:

5 Ways to Boost Happiness Naturally

1. The Easiest Way to Feel Better, by Far, is to Exercise. In study after study, scientists have proven that just moving your body makes you feel better. Exercise boosts dopamine levels and oxytocin levels – two hormones responsible for happiness and love; one dampens pain, the other makes you feel ‘bliss.’ Why take a pharmaceutical drug that might cause you to have migraines or become suicidal when you can just spend 10 minutes throwing a Frisbee with your dog, or walking along a path in nature? (Spending time with your dog and being in nature also happen to boost your happiness hormones, so you can get two for the price of one!)

2. Spend Time with Friends and Family – Spending time with friends and family or even interacting with social media friends across cyber space can boost levels of seratonin and oxytocin, and even help you to live longer. We are social creatures. If you’ve been hiding in your house and not interacting with other people, consider volunteering, attending a social gathering, or even going on a date. Your better mood is waiting on this action.

3. Get Outside – New York-based naturopathic doctor Alan Logan, co-author (with Dr. Eva Selhub, an internal medicine physician) of Your Brain on Nature: The Science of Nature’s Influence on Your Health, Happiness and Vitality, believes that the energy from mountains, trees, plants and water can improve your sleep and mental outlook. You don’t have to abandon city life, but try to find trees, natural reservoirs of water, birds, flowers – anything that is natural. Your health and happiness depends on it.

4. Sleep More – Our circadian rhythms are absolutely vital to good mental health. Circadian cycles are our bodies’ way of regulating a host of hormones that are responsible for everything from keeping us alert when we should be to helping us to relax in stressful situations. Lost sleep can even age your brain significantly over time, while more sleep will improve mood just about every single time. Try it. You look tired.

5. Improve Your Diet – Foods for depression can be much more effective than a bottle of junk made by Big Pharma. That saying – you are what you eat – is true. If you eat tons of refined sugar, unhealthy fats, and no ‘living foods’ like organic fruits and vegetables, you will look and feel…not so great! You need high levels of B12, found in fish and eggs, to increase neuronal communication between ‘good’ brain pathways, fiber to avoid spikes in blood sugar and insulin which can lead to depression, folate to keep your brain bathed in cerebrospinal fluid, iron to make sure your blood can transport oxygen, iodine to lower depression and increase memory, calcium to lower anxiety and curb depression, and much more. Try leafy greens, nuts, and foods high in Omega 3s to get an immediate happiness boost.

Antidepressant Eases Menopause-Related Symptoms, Study Finds .

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Estrogen therapy and the non-hormonal drug venlafaxine (Effexor) are nearly equally effective in reducing menopause-related hot flashes and night sweats, according to a new study.

“Our new findings provide critical data for physicians and women making treatment decisions for hot flashes/night sweats. Our data show that first-line hormonal and non-hormonal pharmacological treatments are well-tolerated and effective options for alleviating symptoms,” the study’s lead author Dr. Hadine Joffe, director of the Women’s Hormone and Aging Research Program at Brigham and Women’s Hospital, said in a hospital news release.

“Hot flashes and night sweats … affect up to 80 percent of women in midlife and are the primary menopause-related symptoms leading menopausal women to seek medical attention,” Joffe noted.

Estrogen therapy is considered the “gold standard” treatment for hot flashes and night sweats, but is used at the lowest possible doses due to potential risks associated with the treatment, according to the researchers. These risks include blood clots and an increased risk of certain cancers.

Venlafaxine, also known by the brand name Effexor, is more commonly prescribed to treat depression or anxiety, according to the U.S. National Library of Medicine.

The study included almost 350 women who were either entering menopause or had been through menopause. All of the women had hot flashes and night sweats. They were randomly assigned to receive either low-dose oral estrogen estradiol, low-dose venlafaxine hydrochloride extended release, or an inactive placebo.

After eight weeks, hot flashes and night sweats decreased by nearly 53 percent among women on estrogen therapy. In women taking venlafaxine, those symptoms dropped by nearly 48 percent. Almost 29 percent of those taking a placebo also had improvement in their symptoms.

Compared to the placebo, estradiol reduced the number of hot flashes or night sweats by an average of 2.3 more per day. Venlafaxine reduced the number of these symptoms by 1.8 more per day, according to the study published online May 26 in JAMA Internal Medicine.

The study, funded by the U.S. National Institutes of Health, is the first to compare estrogen therapy and a non-hormonal treatment, and shows that venlafaxine offers an effective alternative to hormone therapy.

10 Surprising Antidepressant Facts.

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Antidepressant facts

Antidepressants are one option for treating depression. They help people with moderate and severe depression.

antidepressant-facts

However, these medications can have side effects.

While your doctor may explain all the pros and cons when prescribing antidepressants, here are some startling revelations about antidepressants you might not have heard about.

http://www.health.com/health/m/gallery/0,,20431831,00.html

You are enough. Always have been and always will be…

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“He who knows that enough is enough will always have enough.” ~ Lao Tzu

For years my life was defined by deep feelings of inadequacy as well as concurrent actions of striving to keep those feelings at bay. Even as a young child, I felt nothing I did was good enough, and I can still recall feelings of intense anxiety, sometimes terror, at simply waking up and knowing I had to go to school. While my parents meant well, I was inculcated with the belief that to be loved meant having to prove your worth each and every day, which meant doing things in a certain way—staying quiet, doing what you were told, getting good grades, taking certain subjects.  In other words, I was given a supposed checklist of success, which would supposedly lead to this elusive state called “happiness.”

I was taught to be competitive, to believe that my self-worth was directly tied to accomplishment.  I could not be of value unless I achieved something. This is a belief system embraced by many, and for me, it only served to deepen the feelings of emptiness and downright devastation that I experienced, especially if I failed at something.  When one lives in a constant state of competition, there is no such thing as ever being good enough.  One lives in a constant fear that you NEVER will be good enough. Even as I continually achieved and collected accolades, I suffered from constant panic attacks, chronic anxiety and depression.  Therapy and anti-depressants would provide short-lived respite.

However, even as I spent most of waking time dedicated to “doing,” part of me was suspicious of what the point exactly was to all this “doing.”  A secret voice was always asking, “Is this all there is?”  Part of me was deeply ashamed that this voice even existed. After all, society was reinforcing that I was doing things the “right way.”  I dutifully checked off the items on my checklist of success, completely believing that once I completed each task, I would be closer and closer to that state called “happiness.”  However, with each accomplishment, I only seemed to be further and further away from where I wanted to be. A part of me resigned myself to believing that perhaps what I really wanted could never be attained, that it was elusive and outside myself.  But even as I tried to give into resignation, that voice and its question “Is this all there is?” continued to plague me.  I had become an adult and done everything that was expected of me.  And I was completely miserable.

“Is this all there is?” became an accusation.  But I busied myself with tasks to which I attached great importance.  I cooked gourmet meals.  I traveled to faraway places.  I did yoga.  I went through the motions of what a good life was supposed to be, never realizing in all those years that what I had longed for resided within myself.  My self-worth still resided in the external— from accomplishments and material possessions, in the need for validation from others.  It never occurred to me that I could give myself validation because I had never been taught that.

I remember back in 2001 discovering a book by Thich Nhat Hanh, in which he spoke about suffering.  It struck a chord with me, but I could not understand it.  For he said to lessen suffering in the world, you had to reduce suffering within yourself.  That concept seemed completely foreign to me. I did not understand how lessening MY suffering could possibly lessen the suffering of others. So even when we are well-meaning in focusing on the suffering of others, it only serves to distract from addressing what needs to change within ourselves.

“We must be willing to let go of the life we planned so as to have the life that is waiting for us.” ~ Joseph Campbell

Fast forward to the present, I now realize that we cannot possibly give or receive love without knowing love within ourselves first.  And how did I finally understand this?  It was when I heard the words, “Who you are is enough.”  I don’t know from whom or exactly when I heard this, but the concept was so revolutionary to me that I shed tears.  And for the first time, I felt free.  I have heard this mantra echoed numerous times from many spiritual teachings and teachers since hearing it the first time, but I finally understood what Thich Nhat Hanh meant.

I have dedicated the past few years to releasing my old belief systems related to worthiness. When the inner voice asked the question “Is there all there is?”, it was really asking, “Are you good enough?”  And the answer has been and always will be, “I am enough.”

You are enough. Always have been and always will be…

Do you think your life would look any different if you knew that you were enough?

Turmeric more Effective than Prozac at Treating Depression.

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Turmeric more Effective than Prozac

It’s common knowledge in the natural health world that pharmaceuticals often (if not always) do more harm than good. It’s also clear that foods, herbs, and other natural sources can offer similar benefits without those nasty side effects. Once again, our beliefs have been affirmed by science: A recent study published in Phytotherapy Research says that not only is turmeric effective at treating depression, it may even be more effective than some of the most common anti-depressant drugs currently on the market.

While previous studies have indicated the effectiveness of turmeric (curcumin) in treating serious depression, this study was the first randomized controlled clinical trial of its kind.

Researchers with the Department of Pharmacology of Government Medical College in Bhavnagar, Gujarat, India compared the effects of turmeric and Prozac (fluoxetine), both used together and individually, in 60 patients diagnosed with major depressive disorder (MDD).

According to GreenMedInfo.com, the researchers used the Hamilton Depression Rating Scale to measure their results:

“We observed that curcumin was well tolerated by all the patients. The proportion of responders as measured by the HAM-D17 scale was higher in the combination group (77.8%) than in the fluoxetine [Prozac] (64.7%) and the curcumin (62.5%) groups; however, these data were not statistically significant (P = 0.58). Interestingly, the mean change in HAM-D17 score at the end of six weeks was comparable in all three groups (P = 0.77). This study provides first clinical evidence that curcumin may be used as an effective and safe modality for treatment in patients with MDD without concurrent suicidal ideation or other psychotic disorders.”

While reading the researchers conclusions indicates one treatment (turmeric) is equally effective as Prozac, it doesn’t account for the negative effects of Prozac, which boost turmeric’s value considerably. Prozac is known to cause “suicidal ideation or other psychotic disorders,” frightening side effects that are clearly absent in turmeric use.

Related Read: 5 Natural Solutions for Preventing Depression

In addition to fighting depression, the bright yellow root commonly used in Indian cooking known as turmeric has been found to have numerous health benefits. In addition to this enlightening research on its efficacy in depression treatment, we know it also has value in the treatment of inflammatory conditions, diabetes, and even cancer. If that isn’t enough, it’s also been shown effective in aiding in weight loss and cutting heart disease risk. Plus, it tastes amazing.

Anti-depressant medications are some of the biggest of Big Pharma’s many big money-makers. Equipped with knowledge like the findings of this most recent study, consumers have the potential to undermine their goal of drugging America and the world.

The Prevention of Postpartum Hemorrhage in the Community.

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Postpartum hemorrhage is associated with one-quarter of all maternal deaths and severe maternal morbidities in the world [1],[2]. Uterine atony is the most common underlying condition leading to postpartum hemorrhage [3] and robust evidence indicates that uterotonics used during the third stage of labor are effective in reducing postpartum bleeding [4]–[6]. Oxytocin has been shown as the most efficacious uterotonic for this indication and the World Health Organization recommends IM/IV oxytocin (10 IU) as the uterotonic drug of choice [7]. Misoprostol and other injectable uterotonics are recommended as alternatives for the prevention of postpartum hemorrhage in settings where oxytocin is unavailable [7].

The availability of oxytocin at the point of care is limited by constraints in the cold supply chain (oxytocin is a thermolabile medication) and the skills and resources necessary for using injectable medications. Ergot derivatives (e.g., ergometrine) are not an alternative in this situation because these medications also require the use of injections and are thermolabile. In addition, ergot derivatives are contra-indicated in women with hypertensive disorders, so their use in unscreened populations should be avoided [7]. Thus, despite the superior efficacy of oxytocin, the use of misoprostol (600 mcg, oral route) for prevention of postpartum hemorrhage in communities and under-resourced settings is quite attractive due to the ease of administration and less complex logistics.

The administration of oxytocin via a Uniject device (i.e., a disposable single-use syringe pre-filled with oxytocin [10 IU]) is an alternative that simplifies the use of oxytocin in under-resourced settings and could be a solution to offer the most efficacious uterotonic to women giving birth in communities and under-resourced settings. In this week’s issue of PLOS Medicine, Cynthia Stanton and colleagues have conducted research that provides crucial evidence to support the use of oxytocin in a Uniject device [8]. This community-based, cluster-randomized trial was conducted in four rural districts in Ghana with 54 community health officers being randomly allocated to either intervention (provision of one IM injection of oxytocin [10 IU] in a Uniject device one minute after birth, 689 parturient women studied) or control (no provision of prophylactic oxytocin, 897 parturient women studied) groups. In this trial, women receiving oxytocin had a substantial reduction in the risk of postpartum hemorrhage (RR: 0.49; 95% CI: 0.27–0.88). Importantly, there were no cases of oxytocin use before delivery of the baby. Based on these findings, Dr. Stanton and colleagues conclude that community health officers using prophylactic oxytocin administered via Uniject can effectively and safely prevent PPH at home births.

Successful completion of this challenging trial is important because it demonstrates the feasibility, safety, and impact of a community-based PPH prevention strategy. It should be noted that this evidence contributes to equity in health as it extends the application of the most efficacious uterotonic for PPH prevention to the community and under-resourced settings. Based on this evidence, prophylactic oxytocin can be offered by community health officers to all women during the third stage of labor.

However, the use of a disposable pre-filled syringe only partially solves the problems related to using oxytocin in under-resourced settings. Cold supply chain issues remain an important obstacle and the skills to administer an IM injection (although simplified) are still required. Thus, investment in the research and development of a thermostable and similarly effective uterotonic is highly desirable. Efforts should be dedicated to optimize the use of cold supply chain for health products at the country level (e.g., harmonizing vaccines’ and oxytocin’s cold supply chains), and the capacity of community health officers to administer IM injections should be strengthened. Another major limiting factor is the fact that oxytocin in Uniject is not commercially available, and the industrial capacity needs to be established or expanded for meeting the demand of large scale implementation programs. It should be noted that despite the efforts to increase the coverage of skilled birth attendance, unassisted births in poor communities will persist as a reality in the foreseeable future in many parts of the world. This is a situation where misoprostol has a potential role, particularly if self-administered [7],[9]. In this context, the efforts to ensure that every woman receives a prophylactic uterotonic during the postpartum period (be it oxytocin or misoprostol) should prevail and competition between methods should be avoided. The best solution is context-specific, and the evidence provided by Stanton and colleagues’ trial expands the boundaries of oxytocin use to the community through trained health officers and Uniject.

It should also be noted that the effort to increase the coverage of uterotonics for postpartum prevention is only one component of the more comprehensive approach that is needed to reduce postpartum hemorrhage–related deaths. Prophylactic uterotonics are the single most effective clinical intervention for reducing blood loss after delivery, but they are certainly not sufficient. Prophylactic uterotonics will reduce blood loss, but some women will bleed after delivery even after receiving a prophylactic uterotonic. If this happens, prompt referral and comprehensive emergency care are crucial elements for survival. Delays in recognizing postpartum hemorrhage, accessing health facilities, and receiving appropriate care in health facilities are major determinants of maternal mortality. The importance of comprehensive emergency care in the management of postpartum hemorrhage (including uterine massage, additional uterotonics, crystalloid products for intravenous fluid resuscitation, blood products, temporizing measures [e.g., balloon tamponade], and access to obstetric surgery) cannot be overemphasized.

If substantial reductions in PPH-related maternal mortality are to be achieved, not only is universal prevention of PPH needed, but also timely and comprehensive emergency care, functioning referral systems, and quality care in health facilities should be available to all women facing complications during pregnancy, childbirth, and the postpartum period.

References

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7.       7.World Health Organization (2012) WHO Recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO. Available:http://www.who.int/reproductivehealth/pu​blications/maternal_perinatal_health/978​9241548502/en/. Accessed 30 June 2013.

8.       8.Stanton CK, Newton S, Mullany LC, Cofie P, Tawiah Agyemang C, et al. (2013) Effect on Postpartum Hemorrhage of Prophylactic Oxytocin (10 IU) by Injection by Community Health Officers in Ghana: A Community-Based, Cluster-Randomized Trial. PLoS Med 10 (10) e1001524 doi:10.1371/journal.pmed.1001524.

9.Smith JM, Gubin R, Holston MM, Fullerton J, Prata N (2013) Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date. BMC Pregnancy Childbirth 13: 44 doi: 10.1186/1471-2393-13-44.

 

Source:PLOS