Family Health Webinar Series: Help and Hope for Postpartum Depression


I’m a little dark or nice a cat. Do you have your lamp that you love me last time. The lamp that you loaned me last time. Yes, please. Sorry. Oh yeah, thank you. I read when you are Caitlin I said, great. And I will probably open the platform in about One minute, and then all all Your Shannon that will get started. And then whenever it hits 12 I’ll just let you make the initial introduction Okay, perfect. Great. I was muted. Okay, it looks like we already have participants. So we will get started here in about four minutes. So we’ll give time for everyone else to show up. Thanks so much for being with us. All right, everyone. Thank you so much for joining. I will turn it over to Shannon Royce to give our introduction Hello everyone, my name is Shannon Royce and I’m the Director of the Center for faith and opportunity initiatives or what we like to call the partnership center. We are so happy that you’ve joined us today for this third installment of our new webinar series on Family Health Which also happens to be an installment in our ongoing mental health one a one series today’s webinar focuses on postpartum depression. With up to 13% of mothers nationwide experiencing the effects of PPD this webinar seeks to offer help Hope and pathways to healing for women, along with specific information about how leaders and members of faith communities my care from others experiencing postpartum depression in their midst. We’re pleased to be hosting Dr. Dorothy think and Dr. Leslie Walker today for this important discussion, we will introduce our speakers in a moment. But first, let me hand it off to my colleague, Caitlin for a few housekeeping notes. Caitlin Hi, good afternoon, everyone. My name is Caitlin Shelton, and I am the Special Assistant to the partnership Center here at HHS, I have just a few housekeeping notes for you. Before we get started. First, this is an educational webinar off the record and it’s not intended for press purposes. If you are a member of the press, we will be happy to connect you to our press office here at HHS after the program, please email [email protected] if you wish to be connected. Next, I see that a few of you may be having difficulty. With audio. If you can’t hear us clearly you may find it helpful to call into the number on your screen, rather than listening through your computer. We have found that that sometimes works better for sound quality. Also, please use the chat feature to let us know of any challenges your experience and we’ll do our best to address those. Be on the lookout for follow up from us in the next couple of days will send out an email with a link to a recording of today’s webinar, along with several resources that can be helpful to you. Including a copy of the slide decks from our presenters today. If you have any questions you can email us at [email protected] Finally, we have a question and answer session at the end so please make comments and share your thoughts in the question box which is also seen at the right hand side of your screen. Please use the question box now to share the city and state that you’re listening from. We would love to see it. And now I’m excited to welcome our two speakers for today, Dr. Dorothy think and Dr. Leslie Walker. Dr. Dorothy think is the Deputy Assistant Secretary for women’s health and the Director of the Office on women’s health here at HHS, and the Department of Health and Human Services HHS. She received her medical degree from Georgetown University School of Medicine and completed her combined internal medicine and pediatrics residency at the University of Pittsburgh Medical Center. She completed a National Institutes of Health Postdoctoral Fellowship in endocrinology and metabolism at the Columbia University College of Physicians and Surgeons in New York. Dr. Frank brings to HHS extensive experience treating women’s health issues. She is board certified in endocrinology internal medicine and pediatrics. Dr. Think has done extensive research relating to women’s health presented at national meetings and published numerous peer reviewed articles. Most recently, Dr. Think practice at the hospital for surgery special surgery in New York Presbyterian Hospital at Cornell University where she served on the faculty and worked with women to attain optimal health. Thank you so much for joining us today. Dr. Think Our next presenter is Dr. Leslie Walker, Dr. Leslie Walker’s MD and Ms neuroscience degrees are from the University of Michigan. She completed her psych psychiatry residency at Johns Hopkins University in 2000 and began a solo practice currently in Cleveland. She specializes in treating physicians and women’s mental health and formerly served in the Cleveland VA hospital as the women’s trauma program psychiatrist. She teaches at Case Western Reserve School of Medicine and speaks nationally on psychiatric topics work, family balance faith resilience and self care. She is married to a physician and has two children, her upcoming book as a practical guide for patients and families managing bipolar two disorder. Thank you so much for joining us Dr. Walker and Dr Fink, and Dr. Walker Walker. I will now turn it over to you. Thank you very much. Caitlin and let’s see if we can Is this slide working for everybody. Let’s see. We don’t have yet. Okay, let’s go back. Well, you do all the work to get everything all set up and then somehow it’s Not there. I see post PowerPoint slide show. That’s really strange. Do you see that Yes, now From beginning Okay, very good. Sorry about that. Everybody. So, um, thank you so much for the opportunity to talk about postpartum depression. It’s such an important talk it topic and affects so many women and So many families. And one of the really rewarding parts about treating postpartum depression for me is that when I help a woman who has postpartum depression. I know I’m helping so many other people It’s just a ripple effect because when a mom is affected, an entire family is affected, and I want to make sure that we clarify the Difference between baby blues and sort of normal responses to postpartum depression or sorry to be postpartum and contrast that with what’s Different in postpartum depression, which is a brain condition. It’s a mental illness that can affect a large number of women. So in baby blues. Which is really common about 80% of new moms will have the baby blues. It occurs right after delivery and last about two weeks and with baby blues. Women have some symptoms that can feel kind of like depression because they’re really exhausted. Other sleep deprived. They’re often Hungry, but they don’t have any time to eat or, you know, they feel kind of crummy and they have to, you know, My goal long time without being able to shower and take care of themselves, but these are normal experiences of Adjusting to the exhaustion of going through delivery, the adjustment to having a new baby and learning how to feed and take care of a new baby. And so baby blues don’t need clinical attention, but we do need support and encouragement and just practical helps In contrast, postpartum depression affects about 15 to 20% of new moms. It depends a little bit on the type of study that has been done. So there are a lot of different statistics. But the bottom line is that that on the order of 15 to 20% of new moms will actually meet criteria for having an episode of major depression. That starts within four weeks of delivering a baby or sometimes starts within the last four weeks of pregnancy and continues through delivery in the postpartum period often getting worse after delivery. Some definitions will actually include postpartum depression is any depression that starts within the first year after delivery. And so then they’ll have higher numbers, but kind of a more strict definition would be The depression symptoms start within four weeks of giving birth. And what’s different about postpartum depression is that even though a new mom is exhausted. She may not be able to fall asleep when she tries to rest. She may just have all these scary thoughts or anxieties running through her mind. A lot of new moms who have postpartum depression actually lose their appetite and they may not even sort of have the energy or the interest in Showering or taking care of their hygiene, because they’re just so depleted and exhausted. And in baby blues, we sometimes see cheerfulness or kind of being sentimental, like, you know, there’s a hallmark commercial on on On TV and people kind of tear up or I remember when I was postpartum and I was talking to my mother in law on the phone and I just started crying and I wasn’t even sad. I just kind of started crying. So that type of cheerfulness is normal in just adjusting to the postpartum time and those hormone changes in contrast in postpartum depression. Women might be tearful but they’re also filled with a lot of fears and anxieties, especially about there’s their sense that they may be a bad mother. Some moms with postpartum depression. Are really afraid that they’re such a bad mother that they might even damage the baby. And so they don’t want to take care of the baby. They think other people should take care of the baby. Because they’re afraid they’re doing it wrong. And they’re so afraid that they might hurt the baby in some way other moms with postpartum depression. Can can be stuck obsessing about danger to the baby and feel very, very anxious and just kind of Keep the baby all to themselves and be afraid that if anybody else were to hold the baby or take care of the baby that something would go wrong. So either extreme might be a sign of postpartum depression. And baby blues moms feel at the beginning. pretty overwhelmed and they might have thoughts like, I’m not, I’m not sure if I’m going to be able to manage this. What was I getting into, you know, am I going to figure out how to feed the baby and change the baby and what to do when the baby cries. And and just wonder if they’re doing it all correctly, but then baby blues over the first two to four weeks. As the new mom and the new family get used to caring for that baby. They usually start to feel more and more competent And so at that two week mark. Most women with the baby blues are starting to feel better and starting to feel more confident But in postpartum depression. It gets worse with time after delivery and so at two to four weeks. A lot of women with postpartum depression are feeling worse and worse. Sometimes, day by day and this may make some of the moms feel like they’re never going to get better and they can that fear of of damaging the baby that they love so much. Really, can an extreme in extreme cases can actually Cause the mom to feel she should end her life to protect her baby because she’s afraid that she is not going to do a good job as a mom and she might damage the baby and that is an emergency where Mom, who is having thoughts of ending her life needs to be seen by a mental health clinician right away. So the risk of postpartum depression as we said is about 15 to 20% of pregnant women. And I’m saying pregnant, not just postpartum because unfortunately it’s also possible to have a postpartum depression after there is a field death. So if a woman has a miscarriage or if she has a stillbirth That woman is particularly vulnerable to depression, along with the grief and natural grief that she would feel some losing her baby. But sometimes we forget that that can be again her hormone changes are going on. And so she is also a risk of postpartum depression symptoms. If moms have already in their life had major depression or bipolar disorder. Then about 33% of those moms will have an episode of postpartum depression. And if there’s a mom who has already had an episode of postpartum depression with an earlier pregnancy. Then her risk of having a postpartum depression in subsequent pregnancy is about 50% that’s really high. So those are moms in my practice that I work with very closely during pregnancy and in the immediate postpartum time To do things to reduce the likelihood that they will develop depression and to make sure we’re giving them a lot of help and support and many of those moms will elect to stay on medication during their pregnancy to try to reduce the risk of having depression afterwards. I want to talk about two other postpartum mental illnesses that kind of still occur to help make sure you know what they are and that these are also treatable conditions that we want to help women get to mental medical attention right away. The first one is called postpartum and that affects about three to 5% of moms giving birth and postpartum OCD, the mom has no intent to harm her baby she is not homicidal But her brain can give her thoughts intrusive thoughts and fears that she might harm the baby. Or sometimes in OCD, the woman will get mental images of harming the baby. So I had one mom who had these mental images of throwing her baby over the balcony of her apartment. And another mom who had images of putting her baby into a microwave and neither of these moms had any actual intent to harm their baby. Neither of them would would act on any act any of those images, but they were so disturbed by those images that of course they felt that something was wrong and that That you know that they they thought they were going crazy. But many of those moms are afraid to tell anybody. They’re having those kinds of symptoms because they’re afraid that someone will take the baby away from them. Or they’ll be hospitalized. So they don’t report these symptoms as soon as we find out about them. This is a very highly treatable condition that we can With a combination of medication and therapy, we can help these women get better and often they’re just so relieved once They tell us what’s going on and we can say, oh, we know what this is. This is postpartum OCD. It does not mean you don’t love your baby. It does not mean you’re going to hurt your baby. And we can help. In contrast, postpartum psychosis is very rare. So this is only about point one to point 2% of Of births and postpartum psychosis occurs quickly after delivery, usually within the first two weeks after birth. Most often postpartum psychosis is actually a mania that occurs in bipolar type one disorder right at that immediate postpartum time and so women they have paranoid delusions like thinking that the government or the FBI is out to get them or is after their baby. Women in the state usually don’t need very much sleep they might be highly agitated and talking really fast, very irritable and, you know, and they have really lost touch with reality. And that puts them and the baby at risk because if they think that someone that there’s a threat to them or to their baby. They may take action and self defense to harm someone else or worse think that they are protecting their baby if they would do anything you Think that they’re protecting their baby by ending their baby’s life as a protective measure. So this is a true psychiatric emergency moms who have symptoms of postpartum psychosis need to Again, be seen as an emergency in an emergency room by a psychiatrist and usually they would be admitted to hospital for safety. But this remains a very treatable condition and these moms get better and can return to full function and taking care of their babies. Well, so this is also a very treatable condition. So back to postpartum depression which is still by far the most common condition in terms of mental illness after delivery. What are the risk factors that might make us more worried about postpartum depression in a woman again if if she has had previous depression or anxiety episodes. If she had trauma. For example, if she had a traumatic childhood or if she’s been a past has experienced something like rape in the past. If she has poor social support, not a lot of friends or family if she has financial stressors. If she’s poor woman or girl who is young is more at risk for postpartum depression issues an immigrant. And again, that probably means less social support and other difficulties accessing healthcare. If there’s a traumatic delivery like an emergency cesarean section or if there are metal comp medical complications during delivery or afterwards for the mom or for the baby. Those are risk factors for postpartum depression. There’s some baby factors that are also risk factors on a baby who has feeding or nursing difficulties baby who’s really colicky or baby with special needs. Those also might put a mom more risk for postpartum depression and I’m finally if a mom doesn’t have a supportive partner or if she’s married but there’s a lot of marital conflict that can be a risk for postpartum depression. So what do I look for if I’m evaluating a woman in my office or if I’m hearing about a woman from somebody who’s concerned I look for moms who can’t sleep, even though they’re exhausted. Who aren’t eating, even if they have time to eat and there’s food placed in front of them, but they just aren’t hungry and sometimes you can see that on the outside as unusually fast weight loss because for most women. It’s kind of hard to lose those pounds after they have a baby. Again moms who are kind of extremes, either they won’t let anybody else hold the baby. Or they won’t care for the baby themselves and they’re afraid that they’re a bad mom and they shouldn’t be allowed to take care of the baby so they want somebody else to do the baby care all the time. If a mom has a really significant personality change from her usual self, then that makes me concerned about the possibility of a postpartum mental illness. And again, look, especially at that two week mark if moms are getting worse at two weeks instead of starting to feel better and more confident, then that would be someone we’d want to think about the possibility of postpartum depression. Who can help. Well, if there is an emergency situation if the mom might be suicidal if she’s having bizarre behavior or seems to have lost touch with reality. Then that is an emergency and the mom should be taken to an emergency room for psychiatric evaluation. In some cities. There are mobile crisis teams who can actually come to you come to the mom in her home and help assess patient and then can facilitate hospitalization or urgent mental health care if that’s needed For most moms if they seem to be depressed or very anxious, then the their, their current healthcare professionals are a very good starting point. So either an obstetrician or their primary care physician would be a good start. Even a pediatrician who might be seeing the baby could actually identify a mom who might be having symptoms of postpartum depression and could help act help her access resources. When they are seen by the obstetrician or the primary care physician, they might be able to be started on medication treatment but if If not, we want to make sure that they are very rapidly connected to a psychiatrist who can help take care of them and offer more specialized care and referrals. If the resources are available in your area to directly get connected with a psychiatrist quickly then that’s terrific. Because We are the ones who are the, you know, really, the experts in mental health diagnosis and treatment and this is what we do and we typically have more time to spend with patients and to do an initial evaluation. Than a primary care doctor does. So if you are in an area where there are University hospitals and medical schools there will often be a women’s mental health specialty clinic. And that would be a great place to call and say, I’ve got a postpartum mom, she really needs to get seen quickly, you know, can you get her in fast. Most of us in psychiatry recognize that postpartum depression is not something we can sort of say, you know, come back in three months, we really need to see those moms quickly. Other good local organizations with like high interest would be Community Mental sorry community mental health clinics. And and then just people who like me are in private practice in the community. There are larger groups. There are individual providers. And ideally you’d like to have someone who has a lot of experience in treating postpartum depression, but any psychiatrists will have had some experience during their four years of residency in this kind of referral. Sorry, this guy died. This kind of diagnosis and treatment. So in case you’re not sure what a psychiatric evaluation involved. I just thought I’d spell it out a little bit. What I do is I attain a history from the mom and from a trusted person who knows her and who might be able to say how how she is now compared to how she normally is. And that’s because we don’t have any diagnostic tests for postpartum depression or depression in general. There’s no blood test or brain scan that can tell us what the psychiatric diagnosis is we have to talk to the person and listen well ask good questions. And then we have to observe their behavior. So I’m going to ask about the mom’s past psychiatric Symptoms on any past treatment she’s had and what worked in the past, if she ever has had trauma in the past what her family history is like if there’s any history of psychiatric conditions or substance abuse or suicide in the family Alaska about her medical history and whether she now or in the past. Is using alcohol or cigarettes or marijuana or any other drugs. I’m going to ask about her psychiatric symptoms during her pregnancy. I’ll ask about her labor. I’ll ask it. I have how things went after delivery. So all of these things we’ve been talking about like sleep and mood and cheerfulness anxiety hopefulness whether she feels competent whether she feels like she’s a good mom. And she’s having any thoughts about death or suicide. I will be asking all those types of questions. So you can see, it takes a little while. Can’t do that in five or six or seven minutes. And then I’m going to ask about her available supports you know what are her resources that she has. And that can include friends and family financial resources. Where she lives and what what’s available near her, but it can also include faith communities, she’s part of a church that is bringing her casseroles, or I’m has people looking in on her. If possible, I observed the interaction between the mom and the baby and see if mom seems to be responding to the baby but if If that’s not possible, and the baby’s not there, then I know when I asked mom about how she feels and if she feels like she is connected or bonded on to the baby. And that information all together is what allows me to say, I think you have this diagnosis. I think you have postpartum depression and then we talk about the different treatment options and together we decide on a treatment plan going forward. One question that sometimes people ask is, well, what happens is we don’t treat postpartum depression. You know, and the main risk is that the depression will linger and untreated depression, whether it’s a postpartum depression or depression and other times of life. If it’s untreated depression episodes typically last about nine months and Kindle even longer. And the longer that someone is depressed, the more risk that there are bad consequences for not just that person, but for their family, their career their medical health Of course, one of the scariest potential consequences of not treating depression and suicide. And suicide is the cause of about 5% of perinatal deaths which means when a mom dies within the first year after having a baby that’s considered a perinatal death. So it’s a rare cause of perinatal death, but it is there. And in one study, they showed that the highest rate of maternal suicide was in nine to 12 months after delivery. When a mom. It had postpartum depression. And I think that that reflects that issue of untreated depression that has continued to linger and a mom has just been worn down and doesn’t have anything left What about the consequences to the to the baby. Well, we know that if moms depression is not treated those babies are less well attached and bonded to their moms. They have slower language development and there’s a higher risk of child abuse because moms when they have depression, even if they love their children, their frustration tolerance is lower. And so they may be more at risk of harming the child when they’re angry or exhausted, even just for normal child behaviors like crying. That’s especially true if a mom also has trouble with alcohol or other drug abuse. So many people wonder, what are our treatment options. What do we use to help these moms get better. Well, ideally, we want to offer them quality psychotherapy. From a licensed psychologist or social worker therapist who has experience in treating postpartum depression and studies have shown that these types of therapy interpersonal therapy and cognitive behavioral therapy have been more effective than just Like sort of informal support groups at helping women with postpartum depression recover. We also use antidepressant medications and most often we choose an SSRI type of medication which affects your toning And examples of SSRI medicines would be sertraline which is the generic name for Zoloft or esoterica pram, which is the generic name for Lexapro, and there are several others. These medicines we have a long track record, most of them have been around since the 1980s. So we’ve had lots of experience with them in pregnancy and postpartum And sometimes we use other antidepressants. If a mom has benefited from a particular antidepressant. In the past, then I will often use the antidepressant that worked before because my goal is just to get her better as quickly as possible. Most antidepressants have good safety profiles in breastfeeding all psychiatric medications are expressed in breast milk. So we always have to think about the risk and benefit ratio for the babies, but many antidepressants. Are really a very low levels in babies and the babies liver is pretty good at clearing them out. And so the benefit of continuing to breastfeed, even while I’m on takes an anti depressant is often in favor of the mom continuing to breastfeed and take her medication to get better. What about not medication helps well moms need sleep to recover. So we want to try to get at least a four hour block. Of uninterrupted sleep every night. And that means somebody else needs to help with feeding the baby at the beginning, since they often eat more often than that. A healthy diet can be helpful with full eight in green leafy vegetables. Omega three fatty acids like in fish. Making sure she has no Monday, especially if she lives in more northern areas like Cleveland and more north We want mom to avoid alcohol and cannabis and nicotine unfortunately with marijuana Widely available moms are getting bad information. Sometimes that it’s okay to use marijuana during pregnancy or while nursing and that is not recommended for babies. Moms can have light therapy in higher latitudes and that’s a non medication strategy that can be helpful for treating depression. When they’re physically ready exercise like walking is good and social interaction, not just being isolated and stuck at home with a baby, but having visitors or being able to get out. Also can help women to recover. There are a few new treatment options. They’ll just mentioned briefly. There’s transcranial magnetic stimulation for treatment resistant depression. Which is available in some areas, and that is a non medication option there is a new nasal spray called bravado, that is for treatment resistant depression and That is a twice a week. Treatment again for women who have had at least a two antidepressant trials that didn’t work. And really exciting. We have our first ever FDA approved treatments specifically for postpartum depression, which is a steroid a neuro steroids called Roxanne alone. And that’s actually only able to be given in the hospital. It’s a two day IV infusions. It’s very expensive, but for a mom who’s admitted for being suicidal. This would be potentially a really rapid way to help her recover. So I’m going to turn this over to Dr think and talk to you later. Good afternoon, everyone, and thank you, Dr. Walker for a fabulous review and discussion of postpartum depression. I’m really excited to talk with you today about The Office of the Assistant Secretary for Health and Health and Human Services in terms of how we are really looking to support both women and providers when it comes to taking a serious look at how we look at postpartum depression and how we talk about it. First off, I just like to describe a little bit about the Office of the Assistant Secretary for Health, which is called oh ash where I work. We really look to leave America to healthier lives through health opportunity health transformation Health Innovation and health response. And really a postpartum depression falls under all of these, and today I’m really going to be highlighting the health response. From the federal government for postpartum depression. Before I get into that, I want to first address hormone levels during pregnancy. And I will tell you all that I’m an endocrinologist, which means that I really love to talk about any and all hormones. Today, I’m going to focus on estrogen and progesterone and HCG or human chorionic gonadotropin And so in this graph, you can see that, you know, early on in pregnancy in the first few weeks. The green line shows the HCG the human chorionic gonadotropin and that’s the hormone that we check when we think we may be pregnant early on in pregnancy and you can see that it drops down and then Is at a much lower level towards the end of pregnancy. However, the blue and purple lines. While they start off on the lower side, you can see how they slowly increase throughout the pregnancy and then about midway through they continue to increase. And then get up to the highest levels at the end of pregnancy before delivery. And so it’s really amazing when you look at how high these hormone levels get at the end of pregnancy. And you think about my goodness. These levels are so much higher compared to when we are just having our normal menstrual cycle. And what happens during the day today of a month one we’re having hormonal changes. With one not being pregnant, but when we are pregnant. Our hormone levels gets super high And then you can see that after delivery. These hormone levels basically go back to the beginning of the chart here where we say zero, meaning that in the hours after delivery both estrogen and progesterone have dramatic declines in our bodies. And so when hormone levels change a lot of times we can sometimes certain women can feel them more than others. And so just like When we have our menstrual cycle before our period comes on some women tend to feel stronger hormone changes than others. The same can happen to after delivery. When these hormone levels change dramatically. And so I think it’s really important just to take a step back and say wow you know what happens. To the body during pregnancy is dramatic changes and hormones and appreciating those can also help women and those who care for them understand the changes that are happening and support women as they go through these hormonal changes. And the next slides I’m going to be going through some of the incredible work done by health and human services to really look at postpartum depression and so As you all know, we know mental health is really a lot of times, really hard for people to talk about And there’s a lot of stigma surrounding it. And so our goal is to get at that stigma. Look at the barriers and say, what are the barriers for women to talk to their families and their health care providers. And also, how can we help healthcare providers, talk to patients and talk to women and their families about these symptoms. And so I’m going to start off with the National Institutes of Health and what they’re doing for postpartum depression. And so you can see here in through the NIH. There’s the National Institute of Child Health and Human Development. And they have this incredible campaign focusing on moms mental health matters. And you know, I encourage you all to check out these links I have them all on the slides to get more information. And so in the next slides, I will show you some of the support that you can find through the National Institute for Child Health and Human Development. On this first slide, you can see an action plan for depression and anxiety around pregnancy and, you know, as Dr. Walker stated, there are many ways in which women can present with Depression after pregnancy and there are many different mood changes that can occur and not all women present in the same way. And so we really have to be thinking What are the symptoms. How are we talking about them and then how can we make sure that the resources are provided and that we connect women to the right resources at the right time. And so you can see with the green box they talked about some of the symptoms that are more consistent with moods links that can happen too many pregnant women and new moms. And so that goes through and it talks about how yes you know some of those feelings may typically go away after a couple weeks but That doesn’t mean that you shouldn’t cannot continue to watch for signs of depression and other anxiety related symptoms that are in the yellow and red sections below. And so in the yellow box. You can see that those symptoms listed there may be concerning for postpartum depression, anxiety and under there. There’s definitely some wonderful Suggestions in terms of contacting your health provider this in the clinic, some different numbers also encouraging women to talk to other partners family and friends about these feelings so that they can be supportive and help Then you can see in the red box where we really want to say get help. Now, and how we can look to provide women immediate help if these feelings of hopelessness and total despair. And really feeling out of touch with reality and feeling, you may hurt yourself or your baby so that we can provide women this support and you can see that Yes, there’s call 911 for immediate help. There’s also Suicide Prevention Lifeline and then the Substance Abuse and Mental Health Services Administration’s national helpline. That I’ll get to a little bit later in some slides as well. But I think this slide really has a beautiful summary and a good go to to in terms of thinking about the actionable steps. On the next slide. This is also from the NIH, you can see that they have a lot of really incredible ways Of describing some of the things you know yes a lot of time our mothers are prepared for the diapers. The laundry, the middle of the night feedings. But what about these feelings and these mood changes that can happen that must be addressed. You can also see that there’s also a wonderful summary on the next picture there that looks at talking about depression and anxiety and showing ways that you can help. And so when you look at that. I think a lot of the quotations listed there under listen offer support and offered to help Are good ways. If you think that someone in your life may be experiencing mood changes after pregnancy or postpartum depression. There are ways that you can help bring up some of those concerns to them and help them get the help that they need. The next government agency that I’m going to talk about is the Health Resources and Services Administration, also known as herself. And so they have also incredible resources, both online and also in communities for mothers and so you can see here, mental and behavioral health mothers, children and families and also on the side, I have a link that will take you to And awards that were given last year over $12 million for maternal and child and mental health programs that continue now to really go into communities and support the mental health of women and children across the United States. And so this is something that is on our minds and we’re really looking to get into communities and help spread the word and really provide mothers, the support that they need. One more slide with herself. And so this is a really wonderful booklet. It’s a resources for women, their families and friends. And here is one of the quotations from that book that I thought was really wonderful saying that, you know, From a woman treated. She said, I recognize the symptoms and took charge. It was not easy, but with support from my family, friends and doctors and drawing on my own personal strength. I overcame perinatal depression and today I am moving forward. My family as well. My baby as well. And most importantly, I am well And so throughout this booklet and many of the others. There’s a lot of wonderful personal stories to which are also inspiring to women as they’re going through these challenging times when they’re trying to Talk about symptoms that may be hard to talk about and reaching out for the support The Centers for Disease Control and Prevention also have incredible information and the latest research looking at postpartum depression on their website. They go through depression during and after pregnancy and I think something to highlight that is on their website too is that depression doesn’t feel the same for everyone. And so It’s something that you know a lot of medicine is tricky. This way in that Medical conditions can present in so many different ways. But I think that, you know, from the information that Dr. Walker provided and then some of the resources that I’ve gone through so far. There are symptoms that we can look at and say if if women are feeling these ways we need to take a serious look at them and follow them closely. The next slide goes into the Indian Health Service and all of their information about postpartum depression. And so this also gives a wonderful Description of some of the symptoms that you should be looking out for. And again, these lists are not necessarily a list that is an all inclusive list that you must have every single symptom. But it definitely helps described some of the things that women may feel and things that both women, their families. Friends, all those who care for them should be looking out for and there are things that health care provider should also be asking about and looking out for when they screen for postpartum depression. On the next slide, it goes into the Food and Drug Administration and information about medicines and pregnancy. And so, as Dr. Walker talked about, you know, there are a number of different ways to treat postpartum depression. And of course, for every given case, you know, it’s a it’s a personal discussion between the, the woman and her health care provider about what are the best treatment options for her. When we think about that, though, you know, sometimes women can say one I’m scared of taking medicines. What if this medicine goes into the breast milk and then you know providers can have concerns to about The safety of medicines. And so, the FDA has a wonderful links that can really help you make good choices about medicines, as well as other things that can impact both you and your baby. So I encourage you all to check that out if you do have questions about medicines. Next is our SAMHSA. Agency. And so this is the Substance Abuse and Mental Health Services Administration or SAMHSA and this Is another booklet that is accessible online. That is incredible toolkit for family service providers. And I think that, you know, this was just an example of what’s in that booklet, but basically it is a wonderful resources that really helps give ideas for Helpful thoughts for women and suggestions for things that could potentially help with mood changes and how they can best manage it. And then finally, I would like to also show you and share with you the wonderful website that my own office has our own office on women’s health And so this also has an a wonderful sheet that goes through postpartum depression and you can print out a fact sheet that you could take with your provider to help the discussion when you’re going through any symptoms that you want to address when you go in for an appointment. And so I thank you for your time today and I’ll hand it back over hand it back over to Dr. Walk. Dr. Walker. Alright, let’s see if I can get back on to the control panel. Get me back on to the control panel. Let me see if I can fix it for you. Give me one second. Oh, there we go. Okay. Okay, so, whoops, that didn’t work. It really does not like that that choice. Okay. I’m to I want to take a little bit of time to talk specifically about what happens when postpartum depression happens in people of faith because historically there have sometimes been Kind of barriers erected between faith communities and mental health communities. And one of my real callings is to help bridge that that gap. So I am somebody who comes from a Christian tradition and speaks within that tradition to try to help Pastors and other parts of the faith community I’m learn more about psychiatry and mental illnesses, but I also work within the psychiatry community to try to help people understand people of faith and some of the fears that they might have Men, they are considering whether or not to get mental health treatment. So one problem is that sometimes people within faith communities see things like depression and anxiety. That are common to everyone see those as primary primarily spiritual problems without realizing that that major depression or clinical depression. And anxiety disorders like panic disorder obsessive compulsive disorder are actually mental illnesses and they are not common to everyone. And one of the reasons why it’s sometimes hard. I think for people to understand that is because major depression is a brain condition, but it can cause symptoms that look spiritual in nature. So things like a sense of distance from God or people who normally pray and read the scriptures And feel God’s presence. When they do that during an episode of depression, they often don’t feel that connection to God. In fact, it can get so bad that the brain can make someone feel that they are actually being punished by God, or that they are guilty for things that they haven’t even done Or have a sense that they are beyond forgiveness that they won’t go to heaven that they’re no longer worthy to be loved by God. And you can understand why that would sound like a spiritual problem, but it is accompanied by changes and sleep and appetite and how the brain works to control memory and concentration and focus and levels of energy are low, and people are feeling pessimistic and even having thoughts of ending their own life, then it’s not just a spiritual problem. It really is a brain condition that we need to address directly So what sometimes keeps patients from getting medical help. Well, I can tell you in my experience of patients who had a delay sometimes weeks or months, and sometimes years before they actually were able to come in and see me. Some of the things that kept them from getting help were members of faith communities or their families who offered spiritual solutions like prayer and scripture reading or anointing or pastoral counseling. But never suffered rough recommendation or support for getting medical help. And sometimes, one of my patients was actually told that God would punish her if she sought psychiatric help because that would mean she didn’t have enough faith. And I’ve heard that from several people that they were told that if they took an antidepressant. That meant that they didn’t have enough faith or that they weren’t working hard enough to read scripture, or to confess Sometimes people use success stories of other people with depression, who got better by using prayer and scripture alone. And while I’m so thankful that those people were covered That doesn’t mean that’s true for everyone. And so we don’t want to shame, people who do need medications or psychotherapy, or both. In order to recover from their brain conditions. And there are sometimes, unfortunately, members of the family or a husband or partner or a pastor, people who are, are, I have a position of authority for this mom’s life. Who forbid her to get treatment. And in that case, um, you know, again, the risk is that the depression will just continue on for longer. So when I talked to patients from the faith community side. I tried to explain that major depression is a brain condition and our brains do all sorts of amazing things that we don’t fully appreciate until they don’t work. So your brain control sleep appetite mood, anxiety, whether or not you get angry and how well you can tolerate frustration your motivation, your energy levels how hopeful, you are Whether you can feel pleasure, your ability to feel pain how interested you are in social things and social interactions and relationships. And fundamental your will to live. So when us patient has major depression. These things are affected and and it’s not just a spiritual problem. But uh when major depression occurs and somebody’s whole body is functioning differently. They can look on the outside like they’re being lazy. Or they just seem pessimistic or maybe they seem like they lack faith and they might even say, You know, I’m not sure I’m a Christian anymore. I’m not sure. I still loved by God and And that’s one of the real challenges for the faith community is to come alongside them and support them and say, We think this might be a medical condition. Let’s get you some help, instead of blaming them or shaming them. We know that major depression interferes with someone’s ability to function. And it actually makes people take much much much more effort to do basic tasks at home or at work. And if we provide medical treatment for the postpartum depression, so that could include things like medications or psychotherapy, or both. Then that can help them recover more quickly, so they can return to their calling at home and at work and in the ministry. How can feed communities help well pastors or pastoral counselors or other people within the church can visit postpartum families and if they have any concerns or if they get a phone call or email or a text from someone who is a concerned about the mom. Or them for evaluation have a shortlist of the people in the resources in your community that might be able to help Um, you can educate families about postpartum depression as a medical condition, not just a spiritual problem. And support medical treatment for postpartum depression, just like you would support treatment for cancer or asthma or other medical problems. Other people in the church, whether they’re ordained people like elders or deacons or lay people And this is true. I’m using sort of my church as what’s familiar to me. But this could be true in any faith community. Other people can mobilize resources and supports whether that means praying for this person providing meals or childcare or cleaning These really practical helps make a big difference for a mom who is needing to use all of her available energy just to take care of the baby and take care of herself. We want to really infuse that family with a sense that there is hope that this is a treatable condition that they can get better and that even while they’re suffering. God is still with them and we always appreciate prayers for doctors and therapists to The online resources that I’m going to recommend postpartum support international was cited in one of the slides that Dr. Think mentioned their website is postpartum.net And they have online education about postpartum psychiatric conditions. They have a place you can enter your zip code to find local professionals. Sorry. Local professionals who have self identified as being experienced in treating postpartum mental health conditions. And they have those referrals for local groups and for online support groups so moms who are in a more rural area or moms who just can’t imagine leaving their home can still Join a support group for postpartum depression. A very good source for current information about research in terms of treatment during pregnancy and postpartum is the Harvard and Massachusetts General Hospital women’s mental health group. Their website is women’s mental health.org and that is another good source when a new study comes out, that’s a great place to go. Or you can sign up to receive their Their periodic email newsletter and if you are from a Christian tradition and even from other faith traditions, I think this would be useful. There is a an organization called hope for mental health.org that was started by Rick and Kay Warren after the suicide of their son. Rick Warren wrote a popular book called The Purpose Driven Life and As a pastor of a big church in California and their church now supports an annual conference and a lot of resources for churches. And other faith communities who are trying to more effectively minister to people within their community who have mental health problems. And because these problems are so common. Every family is touched by mental illness in some way, substance abuse, all these problems are very common. And so we really want to engage faith communities in partnership to work together to try to help people who are experiencing mental illness and help them recover. So that’s all that I have. And again, it’s such a privilege to have been talking with you today. So I’m going to turn this back over to I think Caitlyn to take over. Great, thank you so much Dr Fink, and Dr. Walker for your wonderful presentations. I see that people in the comments are saying how helpful all this information is so we’re very grateful to you for providing it Because that’s exactly what we want. We want people to know about postpartum depression and how they can Meet people who might be suffering from it. So thank you so much. We are going to open up for a few questions. I know we’re running close to time we may go over our one o’clock into time And if you cannot remain with us. No worries. At all. We will follow up with the recording of this webinar as well as links to the slide decks in our follow up communication in the next couple of days. So be on the lookout for that. Um, so first let me Start off with a couple of questions. Courtney was someone who emailed us before the event. And she had a few questions. So, um, one of the questions was whether a woman ever stops having postpartum depression or if it’s something that she will deal with with every pregnancy or even for the rest of her life. Dr. Walker or Dr thing would you like to tackle that question. I’m sure I’d be happy to. So, um, one of the Really important things to emphasize is on issues of major depression as a as an illness. Those Times of major depression, our episodes and in between those times. We want people to get into complete remission. So part of Our job as doctors is to try to make sure that whatever treatments, we’re using that women completely recover and get back to their Their previous level of functioning. And in that sense, no postpartum depression. It does not go on forever. And we want to get you out of that episode. However, if you ever have an episode of depression, your risk for having a future episode of depression, whether it’s in the postpartum time or at other times during your life is increased and depression. Like bipolar disorder seems to be a cyclical illness that can come back. So we have to think in terms of people continuing to be vulnerable to new episodes of depression later in life. And for someone who’s had postpartum depression. I told you that the risk that it would come back with a subsequent pregnancy was as high as 50% But it doesn’t happen with all episodes of pregnancy for all women and we’re not smart enough to know why sometimes it comes back and sometimes it doesn’t. But we should be looking for that very carefully. For any woman who has had or any person who’s had three or more episodes of major depression. We absolutely should continue medication and other treatment to try to keep that next episode away as long as possible. So it certainly can be a lifelong condition. But some people are fortunate and have one episode of depression and don’t have another one, but we Don’t necessarily know which group, someone is in. So either way, we need to watch people carefully and if a woman is being treated with an antidepressant. Or with psychotherapy and she recovers. Then she should not stop her medication. Suddenly she should work really closely with her health care professional to determine whether it’s safe for her to stop and if they agree to stop to taper that gradually over time. Let me just follow up with that. Is it possible that a woman could not experience postpartum depression with a first pregnancy and then experience symptoms of post mortem depression during a subsequent pregnancy. Absolutely. So there are women who, you know, might have four pregnancies and they had one episode of postpartum depression. But sometimes when a woman has an episode of postpartum depression that helps us then adjust things for subsequent pregnancies. So we think that we’re actually preventing those future Episodes that could have happened if we hadn’t been very aggressive and providing you know, thinking about sleep thinking about, should she be on medication thinking about arranging help for her from other family members or other supports. Great. Thank you so much, Dr. Think I think this will be a question for you. And I know you might have to go before Question session, but I wanted to ask someone wrote in and asked about women who experience P us more frequently or more acutely than others. And she was wondering if there are, if there’s a correlation between those who suffer from PMS before pregnancy and those who developed postpartum depression after birth. Do you know if there’s a correlation to theirs. It’s a great question. And there are definitely a number of research studies looking at that correlation And so it’s it’s hard in in all of the medical conditions when we’re looking at all the factors that Dr. Walker went through. I mean, there’s so many things that can impact risk. And so there is a lot of studies out there. So in terms of research studies that have looked at that association and there has been a positive association between Women who have mood changes around time of their period and postpartum depression. It’s just that there’s a lot of factors. But I think that there is something to be said for, you know, hormones and hormone changes on our bodies. Can have dramatic effects on how we feel. And so, recognizing that and acknowledging that is important. I would love to have Dr. Walker comment as well from her experiences. But I would definitely say it’s definitely something to think about. But definitely also look at everything else. Dr. Walker described because there are a number of other risks to keep in mind. Sure. The only thing I would add is that many of us in psychiatry. Notice that there are some women who seem to have episodes of depression that aren’t very correlated at all with any type of hormone changes. But many women have what we think of as hormone responsive mood disorders. So they might have started around the time one girl, for her first period. They often have significant mood symptoms like irritability or sadness during the PMs times and and they are people that I would be especially watching for postpartum symptoms and then at the time of perimenopause they might also have a lot of mood symptoms, irritability, anxiety, sleep disruption. So There seems to be some women whose illnesses aren’t very connected to hormones and other women who do have very hormone connected depression and anxiety symptoms. This is along the same lines. Oh, sorry. Did Dr. Frank, did you have something that Was going to say 100% agree with Dr. Walker and that’s some of the The intricacies of medicine, you know, coming to life for all of you and that there isn’t always a cookbook. And so, but there are risk factors and there are things that we would definitely take that into account. So, not to ignore. Hormonal changes in mood that happened before pregnancy, but it’s not a requirement. Great. So this question is along the same lines. Have either of you ever heard of using bio identical hormones for treatment, instead of SSRI for treatment of postpartum depression. Um, and let’s talk to fig wants to take that and she I love to hear what she says to But so far in terms of effectiveness. We have not seen clear effectiveness and there’s a study that looked at applying An estrogen type hormone right after delivery and other studies that have looked at, you know, delivering hormones by a patch. But so far in terms of actual effectiveness and beating placebo. We have not seen that type of response. What’s really exciting about this new treatment that broke sound alone. That’s right now available as an IV infusion. It’s sort of like a progesterone cousin. And so it’s really going to be the closest to sort of a Kind of a hormone idea that we have currently available that has been shown to be effective. So it may be that there are other hormone treatments that are going to come Down the pike. Now that one has been approved, so it’ll be an exciting time for for research, because obviously, anything that happens more quickly. Would be great and sometimes with an antidepressant. It might take two to four to six weeks to start kicking in and we would like women to feel better as quickly as possible. Yes, and I agree with Dr. Walker, you know, we are here today talking about FDA approved medications and other treatment options for postpartum depression. And so there are no research studies that support the use of bioidentical hormones. So we would not condone that. Now, It is fascinating as Dr. Walker said that the medicine that is a metabolite of the hormone Progesterone is available that infusion for the severe cases, but I do think that, as Dr. Walker said this is something where a more work needs to be done, and who knows what could come in the future to help women. Right. Great. Thank you so much. This is a question. That is probably for Dr. Walker, the doctor fame could also pitch in as well. Do you find that for four people have in religious communities. Do you find that them continuing their spiritual practices is helpful in their struggle with postpartum depression. Great question. Yes, absolutely. If they are able to do those types of practices, whether that’s prayer reading Scripture or listening to Spiritual music or participating in in their usual services, then that is wonderful and it is often very comforting to be part of The sort of same rhythms and routines, even if you don’t feel quite the same just staying in those routines is really helpful. What makes a big difference is whether the community comes alongside and supports a woman in that process and that would would help it to be a more supportive environment. So if a woman is able to do those things. Absolutely. It can be an important part of her recovery and some people are able to find Healthcare professionals who share their faith and that can sometimes be even part of a treatment plan and other people sort of do that separately through their, their church or their own resources while they’re working with, you know, a psychiatrist or a psychotherapist Okay, we have another question here about postpartum depression in men and fathers The anonymous attendee says that, according to studies from the NIH postpartum depression in men or paternal part postpartum depression affects anywhere from four to 25% of new fathers and we have not just for The sake of participants listening. We have not checked that fat, but our anonymous attendee says that that is an NIH back. So if you’d like to double check on that you can. What’s the current thinking on this. Have either of you heard of that. I have definitely not heard 25% statistics, but yes, there have been studies that have looked at depression in new fathers and And it’s a higher rate than most of us have appreciated. Obviously, they don’t have exactly the same hormone changes, but some people have wondered about things like see Towson that kind of bonding hormone that also seems to increase in new dads and Certainly the sleep disruption can be a big factor. And just the change in the availability of, you know, especially with the first time pregnancy. Going from a couple to a family. Some dads have strong feelings that they might not be kind of good enough in terms of being able to support the mom or the baby or You know, continue to do all the things that they were doing before and work or and ministry and and be available to this family. So we absolutely see depressions occur in new dads. We don’t, I don’t normally call it a postpartum depression I would call it a major depression in a new dad. But they need treatment, just as much as moms do so, um, you know, we always want to identify and help people get evaluated so that they can get the the treatment and recover and get back to full participation in the family. Great. Thank you so much. Unfortunately, that is all the time that we have for questions. I know there are so many questions that people wrote in about that. We don’t have time to answer. But I guess that just means that we’ll have to have another webinar. And speaking of other webinars. We do have another webinar coming up on addiction and trauma informed care for veterans. That webinar will be held on October 10 as a part of our mental health, one on one series and it will kind of be at the intersection of our mental health and Our series on addiction as well. So please stay tuned for information about that will include a link to register for that whenever we send follow up information with a link to our Recording and then also links to slide decks and other resources for you as well. So thank you so much for taking time out of your busy day to learn with us about postpartum depression and thank you again to our wonderful presenters. Have a wonderful day.

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