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Expert Q&A: Perinatal Depression

Psychiatrist Amalia Londoño Tobón, M.D., IMH-E® Mentor answers frequently asked questions about perinatal depression.

When someone we love is suffering, it's natural to want to give advice. And at the same time, we may fear that our unsolicited advice will put them on the defense. However, given that the risks for untreated peripartum depression are so great for the mother and baby (including preterm birth and social, emotional, and cognitive deficits in the baby years later, and the risk of suicide in a small number of a new moms with peripartum mood disorders), it is crucial our loved one receive timely support. Some thoughts on how to help your sister: offer to spend time with her, let her take naps, join her for a walk, allow her to engage in self-care in the way she finds most effective (such as taking a shower, eating a meal in silence or with a friend or partner, or getting out of the house for a manicure or haircut).

Ask her how she is sleeping, and how her mood is. Let her know you are not judging her and you are there to help — empathize, validate and normalize her experience. For example, you can say: “I can only imagine what you’re going through,” or “This must be a really rough time,” or “You are doing such a great job.”

If she doesn't share her feelings with you, suggest for her to share with her medical professional (obstetrician, pediatrician, family doctor, primary care professional). You can also offer to help find a psychiatrist that specializes in peripartum depression. Many moms find it very helpful to join a new moms’ support group, often available through the local hospitals. Sleep, rest, help with the baby, good communication and a supportive partner, are the basics in the recovery period for all new moms. Those who have symptoms of depression should not hesitate one bit to seek professional help. It is by no means a sign of weakness. If your hot water heater broke-and was leaking-would you call a plumber? I imagine most people would. (This just happened to me and it wouldn't occur to me to try to fix this myself, when there are people better equipped to handle this!) Then why do we try to take it upon ourselves to “fix ourselves” emotionally when things are tough?

Absolutely. A new baby is an immense joy as well as a lot of work! It can be a stressor for the entire family. About 4 - 10% of fathers will experience symptoms of postpartum depression. New fathers with a personal or family history of depression, those feeling unprepared and those dealing with unemployment/ financial difficulties may be at greater risk. Struggling with work-life balance, difficulties with communication and division of labor in the family can all exacerbate the transition into fatherhood.

Get as much support as possible, for example look for a new moms’ group or even the second or third-time moms’ groups through your local hospital. Try to line up several reliable family members or friends to help or get hired help. Plan as much in advance as possible, take shifts, make selfcare a priority. Spend 15 minutes a day checking in with your partner about non-baby related issues. The basics are key — eating well, sleep, and exercise within reason. Shoulder rubs from your partner, and if you can afford to splurge, a massage, can help. Touch can be very relaxing and soothing, especially with all the aches and pains of our bodies creating and carrying another human for almost a year! Setting realistic expectations, working on communication, asking for help, learning relaxation techniques (such as progressive muscle relaxation, deep breathing, mindfulness and yoga) can also help. Consider talking with your doctor about medication in moderate to serious cases.

Some warning signs include trying to sleeping when the baby sleeps but unable to sleep, constantly feeling overwhelmed, being unable to find joy and pleasure in anything, crying much of the time and feeling hopeless or helpless. She may think there is no end in sight. A mom may feel regretful about having a baby or feel that she is incapable of taking care of herself or the baby. A mom may often feel anxious and may become preoccupied with the baby getting germs or being harmed. These may also be symptoms of obsessive-compulsive behavior as well, which may occur in the perinatal period alongside symptoms of depression. In severe cases, a woman may even have thoughts of hurting herself or even the baby. If you see concerning signs, encourage her to seek help from a mental health professional.

Don't stop treatment without speaking to both your mental health clinician. There are obstetricians, primary care doctors and psychiatrists that are quite knowledgeable and comfortable about medication options during pregnancy. Ask your clinician about their training in your condition during pregnancy and postpartum, and if they do not have training, give them information on resources where they can have more specialized consultation, or ask for a referral to a different clinician who has specialized knowledge. Many women decide to be in talk therapy during pregnancy for additional support and coping skills. Speak to your partner and close family members about the warning signs you experience. You may even want to have a psychiatrist identified in advance or even seek a consultation in advance so you have help in place, should symptoms return. I'm a big believer in doing what we can to maintain feeling healthy and preventing relapse. For each episode of depression that you have experienced in the past, there is an increased likelihood of relapse. It is great that you are planning ahead. Figure out childcare and parental leave in advance, some companies are offering both partners leave. Getting sleep, support, and having a good therapist to talk to about the life changes are all key. All women should receive a screening for mental health issues and in fact, many states are doing this a part of the routine OB/Gyn exam. Peripartum mood disorders impact an entire family and should be taken seriously.

Content Author

Sudeepta Varma, M.D., PC, DFAPA

Sudeepta Varma, M.D., PC, DFAPA

Sudeepta Varma, M.D., PC, DFAPA, is a board certified psychiatrist with a private practice in Manhattan. She is also a clinical assistant professor of psychiatry at the NYU Langone Medical Center and a frequent media contributor. 

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