Postpartum and Perinatal Depression-Part 1

By on February 16, 2023

In this episode of Healthful Woman Podcast, Dr. Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City, speaks with Dr. Emily Miller an assistant professor of OB-GYN, maternal fetal medicine, and psychiatry at Northwestern University regarding postpartum and perinatal depression.

Depression is a common and serious medical illness that can negatively affect how a person feels, thinks, and acts. While most people may connect depression with someone who has experienced great loss or misfortune in their lives, new mothers can also experience depression.

Most new mothers will experience postpartum “baby blues” after childbirth, which involves mood swings, anxiety, crying spells, and trouble sleeping, which usually lasts for up to two weeks. However, postpartum depression is a more severe, long-lasting form of depression that new mothers experience.

Bringing Mental Illness to the Forefront

Unfortunately, mental illness is often not regarded in our society as being as important as other illnesses. “Depression is a major medical illness,” Dr. Miller explained. “There’s neurobiology behind it. And we would never conceptualize it like, ‘Hey, you know what, just snap out of that preeclampsia. Stop doing that. Or don’t have diabetes. Just don’t.’ But we do that with depression. And I think we as humans stigmatize mental illness and say, pregnancy or not, just try to muscle through it or be stronger than that instead of recognizing it as the disease that it is.”

This misunderstanding of the seriousness of mental illness has lead society, and therefore the medical community, to sometimes put depression on the backburner.

“I think we do hard stuff in MFM.” said Dr. Miller. “We manage complex cases. Screening for depression is really not that hard. And I’m not suggesting that we all become psychotherapists, that would be great but that’s not within our sphere. But the pharmacotherapy of depression/anxiety is also not that complex. And when we can talk about giving anti-rejection medications for someone with a transplant in the nuanced fashion that we can, it’s hard for me to imagine why we feel like we don’t need to do that for pharmacologic therapy for mental health conditions.”

To help better improve the system and increase awareness for mental illness and mental health, Dr. Miller believes that screening with initiation of treatment is key. “These are our patients, and we need to be screening with a validated screen and we need to, when we see that screen, interpret it, dialogue around it, and recommend a treatment plan,” she says.

Postpartum Depression

“When we talk about postpartum care and anticipatory guidance, you know, we talk a lot about this concept of ‘baby blues’,” said Dr. Miller. “The data would suggest that 50% to 80% of women will experience this ‘baby blues,’ which is feeling overwhelmed, tearful, crying but still being happy. And that usually resolves within two weeks postpartum.”

Postpartum depression may be mistaken for “baby blues” at first. However, symptoms will become more intense and last longer, and may interfere with a mother’s ability to handle daily tasks or care for her new baby. So, the big question is, where does the “baby blues” cross the line into postpartum depression?

“Differentiating that from postpartum depression, I think the two paths that we monitor, the two very characteristic features of depression are either having a depressed mood, feeling down, blue most days of the week, or what we call anhedonia, not enjoying day-to-day things,” explained Dr. Miller. “And so, one of the two of those needs to be present to meet diagnostic criteria for depression. The data will suggest one out of every seven postpartum people will experience this. That’s not rare. You know?”

Many new mothers may also find themselves confused as to what they are feeling, as postpartum depression may be the first time that they have ever experienced mental illness.

“The postpartum period is the time where, for many people… they don’t have a history of mental health illness, or mental health diagnoses, or mental health treatments, and it may be their first experience with depression or anxiety, and to talk about that,” said Dr. Fox.

Patients who are experiencing symptoms of depression or anxiety are encouraged to speak with their provider regarding their symptoms, as treatment is available.

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Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!

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