Research Finds Postpartum Depression Symptoms May Begin Before Giving Birth

ALISON ST. JOHN: You're listening to KPBS Midday Edition, I am Alison St. John, sitting in for Maureen Cavanaugh. Having a baby is supposed to be a joyous event, but for a surprisingly large number of women, childbirth comes along with disturbing mood changes. They range from disquieting thoughts about harming the baby, to a full postpartum depression, or even psychosis. A couple of articles in the New York Times recently took a long hard look at postpartum depression, which can be crippling, and sometimes life-threatening. We have two experts in studio to talk about what we know about this, and what can be done to help women suffering from these unexpected thoughts and feelings about their babies. My guests are Doctor Sean Daneshmand, a Gynecologist and Doctor of Obstetrics at Sharp Mary Birch Hospital for Women and Newborns. Thank you for joining us. SEAN DANESHMAND: Thank you for having us. ALISON ST. JOHN: And also Doctor Christopher Morache, of Sharp Mesa Vista Hospital. CHRISTOPHER MORACHE: Hi there. ALISON ST. JOHN: Let's start with Sean, what exactly is postpartum depression for people who may not have experienced it? Give us an idea of how many people, and what percentage of women who have babies experience it. SEAN DANESHMAND: Clinical postpartum depression is depression that occurs within twelve months after delivery. Unfortunately, 8 to 15% of women can succumb to having these symptoms. ALISON ST. JOHN: The New York Times article was saying perhaps one in five, it is probably hard to define, do you think it is a growing phenomenon where people are becoming more aware of it? SEAN DANESHMAND: With all of the stressors that we have out there, certainly now the New York Times articles shed some light on the fact that it is important to start paying attention to these women. Before and during pregnancy. It seems that a third of these women already have these symptoms. If you have a genetic predisposition, and you have all of these hormones that increase suddenly 100 fold and now plummet, and you have the stressors behind it, certainly you can end up with the disease. It is important to have open to medication with your patience. ALISON ST. JOHN: It is interesting that you called it a disease, that is an important distinction where people may feel guilty for having these feelings, but you call it a disease. SEAN DANESHMAND: Yes, because it has very significant implications for your child, the bond that you have with your child. It has very significant implications for your marriage, and your relationship with your partner as well. ALISON ST. JOHN: I sort of interrupted you copy you are telling us the basics of postpartum depression. Is there anything else that you wanted to tell us? SEAN DANESHMAND: It is very common for women to have postpartum blues, which is not really a disease. That is where women are very excited after delivery, their emotional, they suddenly have a child that they will be responsible for the rest of their lives. They are lacking sleep, they are breast-feeding, they may have some mild signs of depression or blues, but if it persists after two weeks then we have to start thinking about depression. These are symptoms that come up within a four-week. Depending on who is defining it, and the American Psychiatric Association defines a within four weeks. The World Health Organization defines a within six weeks after delivery. Again, insomnia, lack of appetite, anxiety, you have to remember about two thirds of these women may have other psychiatric symptoms, such as anxiety. ALISON ST. JOHN: According to the article in New York Times, a lot of disturbing thoughts about harming the baby. SEAN DANESHMAND: Postpartum psychosis is a a lot more rare than depression. ALISON ST. JOHN: Is that part of the definition? SEAN DANESHMAND: Yes. ALISON ST. JOHN: Well let me switch to Chris, you're the psychiatrist. When does it become psychosis, how often do you see that? CHRISTOPHER MORACHE: As Doctor Daneshmand mentioned, the mood symptoms are just one component that happened to be the most common, as many as one in five as you mentioned. The psychosis part is much less common, and a lot more volatile and disturbing. It becomes a lot more dangerous, these are intrusive psychotic thoughts, voices, rational thinking. It really does affect the bonding with mom and child at that point, it becomes very dangerously imperiled. ALISON ST. JOHN: Can you give us an example of some of those dangerous thoughts? CHRISTOPHER MORACHE: We have both seen patients over the years where they feel the the baby is somehow a threat to them, or they feel as they are about to harm the baby be do not want to be anywhere near the baby. They feel that someone is going to come in and steal the baby, or they feel that they have visions of harming the baby. ALISON ST. JOHN: Sean? SEAN DANESHMAND: I think when you talk about the development between mom and child, psychosis is rare. These thoughts are delusions, hallucinations, but it is very important that immediately, when you see that, you listen to that patient. It is important family members that are listening right now, it is very important, because many times the pediatrician will see that mom two days after delivery or after being discharged. I was giving an example, the relationship between you and your patient and the caretakers in the pediatricians is all extremely important. The family members play a significant role in this. I had a pediatrician who once called me and said, Sean, and I got very nervous thinking there something wrong with the baby, I realized it was actually the mother that she wanted to talk to me about. The mother was showing signs of depression. So it is very important to be paying attention, because it affects a lot of people in the family. ALISON ST. JOHN: Chris, is it true to say that some woman would hesitate to even admit to some of these feelings, or get help, because there is a stigma surrounding mental illness? CHRISTOPHER MORACHE: I would argue that most women would be hesitant to say anything. They are very unlikely to say to a stranger, so they will say it to someone they trust a repeat baby doctor, pediatrician, obstetrician, a family member, loved one, or the nurse. As you mentioned, recruiting family awareness of this, I am the last person to find out because I am cold and usually with a suspicion that something is developing, or some other mental health professionals called in because of symptoms. But there are signs there, as Doctor Daneshmand noted. ALISON ST. JOHN: Let's talk about some of the signs to be on the lookout for. SEAN DANESHMAND: If a patient has a family history of depression, if the patient herself has a history of depression or postpartum depression, that is a major risk factor. Other stressors going on in life, for example if the relationship of the partner is not good, if the patient was having thoughts of not continuing with the pregnancy, if it is a first-time mom, if the patient had diabetes, if multiple visits are being made to the hospital, or to the office. These are all signs. When there are signs or risk factors we talk about that with the patient. There is a certain number of patients that do not have those recs factors. If patients go on YouTube and just Google postpartum depression, they will see a lot of women who do not have any symptoms or signs of depression prior to pregnancy, and immediately they have these bad thoughts. Those are the patients that are very important. To realize that this is a disease, this is something that affects many wonderful women out there, and it is important to talk about it with your partner, your healthcare professional, to get immediate help. Women that are screened, early, their depressive symptoms are decreased. It is important to talk about it. ALISON ST. JOHN: If you have experienced these mood disorders or depression after your first child, is it likely that you will experience it again after your second and future children? SEAN DANESHMAND: It is more likely, and the patients will tell you Doctor, it was awful. It took me a year to recover from that. Is it possible to be put on medication before I deliver? Those are things that we talk about. ALISON ST. JOHN: On the other hand, if you have had a child and nothing has changed about your mood, you're thrilled having a first child, is it possible to experience this with the later child? SEAN DANESHMAND: Absolutely, and that is why I think it is important. Things have happened since the delivery of that child, until the next time that they get pregnant. Other stressors may have come into their lives and if you have genetic predisposition for this, you may not have the coping mechanisms, obviously you are at risk. ALISON ST. JOHN: Chris, what can you do for women who make it to your office with some of these serious symptoms? CHRISTOPHER MORACHE: Well, recognizing that this is not just you being a bad mom, this is not you being not strong enough, this is an illness. If we can take the blame out of the conversation, moms feel less guilty, less embarrassed, less humiliated by it. They are already getting advice from family members about how to be a better mom than they really are. They are all getting advice. I'm trying to take the blame out of it. I'm trying to have a very candid conversation with them and say that there is no other process in a human's lifetime such as going through postpartum changes. It is about as close as it will come to a cataclysmic change in someone's physiology. Yet it is a normal process. Women's brains, I tell them all of the time, your brain is detoxifying from all of these hormones, estrogen, it is no wonder that you're going to go through all of these physical and emotional changes. The baby blues happen, it is not the baby blues we are worried about. ALISON ST. JOHN: It is not the baby blues you are worried about, what is it? CHRISTOPHER MORACHE: The other bit of advice, advice is cheap for most people, every mom has baby blues. If the mom tells you she did not have baby blues, she is probably not telling you the truth. Baby blues happens right after delivery. You're tired, worn out, your body aches and you have a crying baby. If you have support, a loving family, doctors taking care of you, you can get through it. It is afterward, however, that we worry about the clinical disease of postpartum depression. ALISON ST. JOHN: How much do you know about how that is generated? The causes of it progressing to a clinical disease? CHRISTOPHER MORACHE: A lot of it is observational. It has been around as long as we have been having babies, which is now know a lot more about how to pick up on the signs. The 20% you are asking about earlier, is it really just 20% because we recognize it more? Is it a growing phenomenon? ALISON ST. JOHN: That is a good question, isn't it? CHRISTOPHER MORACHE: Sadly, I have to agree with my colleague, it is probably a growing phenomenon. We are both better at recognizing it. I think it is getting tougher and tougher, and we're seeing an increase of that incidence. ALISON ST. JOHN: In the profession, what do you speculate could be causing it? CHRISTOPHER MORACHE: As we mentioned earlier, stressors beyond the pregnancy and delivery. It is having medical complications, having psychosocial stressors, moms without much support or loved ones able to help them. I wish I could tell you exactly what the causes are. SEAN DANESHMAND: I think it is multifactorial. Certainly there is a predisposition to it, but right now in this country, there are a lot of things we can talk about in regards to health for our children and how we are providing mental health for our children, mothers and children. We have to start right now, recognizing that there is a growing problem right now. It is hard to survive right now. Certainly if you have a genetic predisposition, again, you'll end up suffering at one point in your lifetime with these symptoms. It is important to lend a helping hand. We have to start out very early in schools. Make sure we are educating our young ones about the importance of health and mental well-being. We don't talk enough about the brain, the most important organ in our body. We talk more about the gut, we do not talk about the brain. That is what we need to start educating companies be more emphasis on brain and anatomy physiology in schools. This is one way that the patient can recognize the symptoms. ALISON ST. JOHN: Do you think that would help to relieve the stigma, if people understood more about the brain? CHRISTOPHER MORACHE: Absolutely. If you think about it, the American Psychiatry Association, and the other colleges associated with that, we used to have a personality disorder called inadequate. These are shrinks saying this. Thankfully we cured that, because it does not exist anymore. But if you think about it, that is the evolution of psychiatry. Psychiatry used to think of this as a low character, or in immoral problem, these are brain illnesses. A brain illness is no different than a heart disease illness, coronary artery disease, cancer, diabetes. People have lifestyle changes they need to make for those illnesses, but we would not say to someone that has a heart attack who is trying to stay healthy, that it is your fault, just get over it. That is what we tell people who are depressed or are showing signs of stress. ALISON ST. JOHN: Once you have diagnosed it as a disease, a brain illness, are there medications, and are they safe for a woman to take if she is still breast-feeding? CHRISTOPHER MORACHE: This is a difficult topic, there is no generic answer I can give you. Sean and I talk all of the time about the dilemma that we face with medications. Every medicine will have a side effect and a risk to the mom, but, the baby, the fetus. There's a risk of not treating mental illness in pregnancy. It leads to very poor outcomes for mom and very poor outcomes for the baby. ALISON ST. JOHN: What a terrible dilemma for the mother, to worry about harming her baby, and worrying about her own mind and medications. CHRISTOPHER MORACHE: It is, that is why takes a lot of medication and a lot of time. We spent a lot of time with folks talking to them because it is not just a five-minute conversation. ALISON ST. JOHN: I understand that the Affordable Care Act has actually allocated some more money to look into ways of supporting this condition and possibly researching it too. What sort of things are evolving? Are their support groups for women finding themselves in this position? SEAN DANESHMAND: That is what Chris and I were just talking about. Right now we have improved on making the diagnosis and understanding it earlier, because in our office, we give screening tests to every woman who comes in for the postpartum visit. If they score high on it, these are self-reported answers, if they score high on it, we want to see them again or we refer them to a specialist. There still needs to be a lot more help with actually getting these women to get help. Right now with insurance differences, it is hard to get patients to get help. I just had a patient in my office yesterday. This is the third time that I have seen her in my office, crying, and obviously still very depressed. It took her about five weeks to be able to be seen. Yes, I think we're on the right path. ALISON ST. JOHN: The first step is getting women screened. SEAN DANESHMAND: Yes, but still getting the help that we need is not there. Psychiatrists are not getting paid enough. Therapists are not getting paid enough. This is a serious issue, we need to spend a lot more money on mental health. ALISON ST. JOHN: Thank you very much for coming in and shedding light on this underdiscussed topic. SEAN DANESHMAND: Thank you for having me. CHRISTOPHER MORACHE: My pleasure, thank you.