Hey everybody! A really happy Friday to you in St. Louis. If you are watching us this is the first really nice we’ve been the long time and we’re in an office. I’m here with Dr. Cynthia Rogers who is joining us from Belly to Baby this week. My name is Abby I have been doing this we were just talking about it since week 13 or 14, and I think in my pregnancy and now at 37. So I’m not going to do the math adds up just 20 something maybe? I don’t know it’s not as easy to calculate as a sale price of a Kate Spade purse but um… We are now at the point that we’re now talking postpartum issues which is so crazy! But one of the most common topics that comes up about postpartum is postpartum depression, the baby blues, those kinds of things. So throughout the next several minutes we’re going to be talking to Dr. Rogers about postpartum depression and the baby blues. We welcome your questions as well so feel free to type those in in the comments and we’ll get to as many as we can live. And if we don’t get to them live we’ll do our best to circle back and review those later and get back to you with answers. So thank you so much for joining us! Tell us a little bit about who you are, what you do, and why you became a psychiatrist who is interested in helping moms who struggle with these issues? So I am both a child psychiatrist and perinatal psychiatry working with pregnant and postpartum moms. And really the interest in helping them stemmed from my work with children. So it’s really difficult to help children if you have a mom or caregiver that’s struggling. So it became apparent that if I really wanted to make an impact in how children develop that I needed to work with parents and the mom’s specifically. So I initially started working with moms and dads with kids in the intensive care unit at Children’s because it’s a really high risk population because of the stress that they’re going through. And then over time I joined with another pediatrician who was interested in helping moms, the full-term babies, and we formed a service dedicated to treating pregnant and postpartum moms, here at the medical center. Well and now you see parents on all ends of the spectrum because the NICU. So just to give you some indication of where we are, the NICU is the newborn intensive care unit at St. Louis Children’s Hospital. This is all part of the Women and Infant’s Program that is a collaboration among Barnes-Jewish Hospital, St. Louis Children’s Hospital, and Washington University School of Medicine. And we’re all here on the campus right off Kings Highway. So you see these patients, some mom delivers a baby at Barnes-Jewish or in many cases outside in the community and the baby whines up here. Then at what point is your interaction take place with.. with the parent? So our service includes social workers, coordinators, therapists, psychologists, and psychiatrists. So initially in the Neonatal Intensive Care Unit our coordinators need the parent’s to check in with everybody because an important component of what we do is provide education. Even to mom’s that are not suffering and then when we screen mom’s with a measure we use to assess their level of depression. Those moms that are having significant symptoms either get refers to seeing a therapist, or if their symptoms are very severe gets referred to seeing a psychiatrist. And how do you know and we can talk about it in use in the clinical setting that you see in the NICU, but more generally I think the biggest question is how do you know what what is the very basis of it what is postpartum depression versus what are the baby blues? So the basic blues are commonly experienced by women a few days after having a baby. They might have some periods of sadness that seemed to come out of the blue or you know crying spells. But it resolves on its own and it’s a very brief. Postpartum depression is a brain disorder and it involves significant impairment in the mom. So periods of sadness and even more than that, is not enjoying things that you would normally enjoy including being with your baby, having difficulty sleeping, having no appetite, trouble concentrating, and being very fatigued. At it’s worst there are feelings of worthlessness, hopelessness, and even at times thoughts of wanting to die, or wanting to kill yourself. Some mom’s experience intrusive thoughts of wanting to hurt their babies. They don’t want to hurt their babies but they have these scenes or images that pop into their mind that they might hurt their babies that are very scary for them. Is it something that you would recognize in yourself? Or is it something I mean, I- I think back and it’s not comparable but it’s the closest example I can come up with. It was my first trimester and I was talking to someone the other day. And it is like the worst problem I have is in the first trimester. It was a hot mess you know, I cried for no reason and all of these things. But I didn’t know that until it was over and until I felt normal again. I didn’t realize that it was strange. Yeah! So can you recognize that in yourself or is it something that you really need to rely on other people to identify? It’s a little bit of both and then certainly some mom’s report that they didn’t know how bad it was for a long time. Or until a partner or family pointed it out to them. And I think it’s sometimes easier for our caregivers, our family members, and our support systems to notice it enough before we notice ourselves because it’s a big behavioral change. They notice suddenly you’re not smiling, you’re not happy, you’re not laughing, you’re not sleeping, you’re irritable, and you’re crying all the time. But I do have some mom’s report they noticed it and they noticed it pretty quickly but they were too scared or ashamed to admit it to anybody because they thought that they were a bad mother. Because here’s this new baby that they’re supposed to be joyful about but instead their sad and down and you know just not enjoying anything. So I think it’s a little bit of both but I think one of the important reasons we want family members to be able to notice it is not only because the mom doesn’t notice but because there’s so much shame that they may not report it to anybody. So I think that that’s the thing – and it goes back to that conversation we were having, I think in the very first episode of the series, where we talked about how you never want to seem ungrateful because there are so many people who struggle, or so many people who would give anything to be in the position you’re in when you’ve got the perfect new baby. But you say this isn’t an uncommon issue at the same time. How often does it occur, like do you know the statistical thing or if you just can say anecdotally, it happens a lot? It’s very common, so women that have the full-blown disorder it occurred about 10 to 15 percent. So we’re talking one in eight women and I’ve had many family members, personal friends, who reported to me that they suffered from postpartum depression. It’s more common than other complications of pregnancy. So we’ve spent a lot of time, you know, telling them about preeclampsia, gestational diabetes, or these other potential risk factors. At the end of the day a lot of these mental health issues like depression, anxiety, that are related to pregnancy are more common and unfortunately suicide has a higher morbidity. More women die from suicide related to pregnancy than from these other complications. Really? Oh my God! That is a statistic I had never heard! It’s something we talked about when we’ve talked about birth plans and how I think society sort of has ingrained in us that we can plan so much of this. But it seems like and this is what one of my colleagues said the other day but, it always amazed me that planning stopped at the delivery room. That’s the point at which someone sends you home with a new person, who is going to live under your roof for a good long while and it doesn’t come with an instruction manual or anything of that nature. And you have a massive life adjustment, so is there anything people can do? Anything women and families can do in preparation for those, I think today they call it the fourth trimester, in the fourth trimester? I don’t know what they say but they’re basically just talking about that postpartum period. Is there anything you can do to prepare yourself for it? I think education so that’s one of the reasons our service starts with pregnant women. So we’re now in our pregnancy clinics here at the Medical Center providing education about depression during pregnancy and afterward to a lot of women so that you know that it’s common for the signs and know what the symptoms are. So when they start you can be aware and get help sooner rather than having to wait after suffering for a month before you realize what’s going on, someone in your family realizes what’s going on, and you seek help. When you talk about seeking help, how further do you have to look for a specialist? Or do you talk to your pediatrician, to your OB? Who do you reach out to for that kind of support? All of those are perfect, so our obstetrician partners are very good now at assessing this and screening for it and treating it and so I would say for most women, you know, we all see when we’re not trying in our OB tends to be our main physicians. So we ten to have good relationships with them, so I think that that’s a good first step for a lot of women. The pediatricians are also now screening for postpartum depression, the American Academy of Pediatrics has really recommended that it’s a part of all well baby visits so pediatricians are becoming more aware of it too. They’re sort of your first step – I think at a point where they feel they are not comfortable in treating symptoms of a woman they will refer out to a psychiatrist or psychologist or another clinician. If you already have an established relationship with a clinician that’s also a good place to start. And then we’re here, we take a lot of referrals from the community as well so you know if there’s no one that you know to talk to you, or we don’t know where to find help, we get a lot of calls from women who realize that they’re suffering. And they don’t know what to do and they don’t have anyone to turn to and we have to solve those with referrals to us and referrals into communitie. We’ll be sure to put what contact information you have for this program in the comments section of this broadcast right after we’re finished so keep an eye out for that. And is there any determination of- can you say, okay, so I wake up in week one and just feel miserable but it’s diagnosed early. First of all how is it diagnosed and how do you treat it? So like most mental health disorders it’s diagnosed from symptom report and some observation of the clinician. So we really it’s the mom’s saying I’m not sleeping, I’m not eating, nothing makes me happy, and has difficulty concentrating and there are other symptoms that we discussed before. And so sometimes we have screening measures, questionnaires that we have the mom’s fill out. Otherwise the symptoms are found just by asking a question. It’s the obstetricians that are pretty good at diagnosing it and then mental health clinicians are all well-versed in diagnosing and this is not necessarily anything different than depression at other points in life either. In terms of the treatment,for mild depression where you’re having the symptoms but it’s not super impairing, psychotherapy really isn’t the best first treatment. When the- symptoms become so severe that you can’t take care of yourself, you can’t take care of your baby, having thoughts about wanting to die, wanting to kill yourself that’s when you know medication really becomes necessary. And so the combination of both therapy and medication are proven to be most effective. I think anybody who is around, I don’t know how long ago it was maybe 10 years ago the whole Tom Cruise & Brooke Shields conversation we’ll call it. And relearning where – the question of how safe — —is the use of the medication safe while you’re caring for and potentially nursing a baby? So the studies that we have to date show that the most common medicines that we use- are fairly safe. There’s no medicine that has no risk. I will say that a lot of women who are pregnant and postpartum are on a lot of other medications too and also potentially carry risks like anti hypertensive medications or — diabetes or insulin. So it’s not that you know these medicines are included or have to be any, you know, less states and other medications. The evidence so far points to the fact that depression itself is dangerous to the mother and to the baby both during pregnancy and in the postpartum period. So we have to weigh the risks and benefits with each individual mom and whether or not medication is the best option. So we can’t say the medicine have no risk but having depression also has risks. Papers we’re gettin well yeah— so you know that’s why you can’t just say well, you know, since the medicine has a risk I’m not going to treat someone because we don’t treat someone then we’re leaving them with the risk of the disorder and it’s not just suicides that happen during pregnancy. It’s been associated with pre-term birth and other eccentric complications, lack of prenatal care, other things that are also detrimental to the mom and the baby. So it’s kind of just that I’m a much- much simpler level. I talked about- there was a someone who I was buying a soda at a gas station months ago but I was clearly showing I was pregnant and the person behind me said are you sure that’s a good idea and I was so tired and I had another hour and half to drive and it’s got to be better than falling asleep on the road right? So I mean I think it’s just a matter of really having a clinician that you can talk to and understand what the risks are and know that, you know, not doing something can be every bit as harmful or more harmful than doing something. And that’s why, you know, the American Congress with obstetrician and gynecologist come out in favor of if you have been in significant depression, using medications during during pregnancy and postpartum period then it’s necessary. And the other thing to keep in mind is it’s not a one-time decision. It’s not like you decided “I’m going to go on medicine” and then if something happens later. — you know you have to continue this. It’s an ongoing conversation that you should be having with your your clinician about risks and benefits and how you feel about it in any given time. I will say though that for women who’ve been treated successfully on medicines, of roughly stopping your medication because you’ve got pregnant is associated with relapses. So that’s something else that’s why it’s really helpful if you have a prior history, which is kind of the number one risk for postpartum depression, to talk with your clinician about what you should or shouldn’t do if you become pregnant. I think that’s my next question about risk factors. Are there any people who are more predisposed or who should be more on the lookout than others? Yes, so those who have had a prior history of depression, or anxiety, or strong family history, are at greater risk than those who have other stressors in their life. Like a lot of marital stressors, or financial stress, mark greater risk than those who have high-risk pregnancies medically are at greater risk. And then it’s in terms of the postpartum period if you have an infant— —you’re at higher risk. And if you don’t have a lot of support, or you don’t have a supportive partner, or a lot of family around that gives you a lot of support during pregnancy, or during the postpartum period that also put’s you at greater risk. And once the diagnosis has occurred and you’ve initiated treatment is there anyway can you set a clock? I mean is there any amount of time that someone can think- like right now I’m three weeks at max away from a cure to heartburn-so do you have a point at which you can say it’s going to be three weeks or it’s going to be two weeks? Do you have a countdown or is it? You mean the perils of being risk free? Oh I’m sorry, it’s once you’ve been diagnosed with postpartum depression can you say it’s only temporary and will end by ‘x’ date? Unfortunately no, so as each individual person link of an episode is different, how quickly treatments work for individuals are different. So we can’t say I’m going to treat you today and then it’s not like a course and you’ll be in 14 days and then you’re cured unfortunately. And have you had instances where it’s the depression that maybe initiates during pregnancy? I had a friend who we would describe some of the things you were talking about- like just -in her word she said “I just felt like if something happened to me it wouldn’t hurt.” Like I mean it wouldn’t be a big deal, it wouldn’t matter, and it didn’t occur to me until much later that that wasn’t healthy. You know she just was- but she was pregnant when that started and so is that something that is correlated with postpartum depression or does it usually subside at some point? Yes, depression during pregnancy is one of the major risk factors for postpartum depression and for a long time depression during pregnancy was going under recognized. I think people now are becoming aware that it really is common to have depression during pregnancy as it is during the postpartum period and can be very detrimental to the mom’s health and for baby’s development. So we’re definitely trying to more actively engage clinicians to educate mom’s during pregnancy and screen during pregnancy. Now most obstetricians do screen for depression during pregnancy. And why is that? Why does it occur? So that’s an area of active research, you know, there are some people who believe it’s hormone only related, others believe that, you know, it has a lot to do with an individual’s brain and at a time of acute stress or change. So unfortunately at this point we don’t know exactly what the- – time period and having depression. I should say that it’s not more common to have depression during pregnancy and postpartum period than during other times of life for one minute. So it’s not like this is a heightened time, the risk is pretty much the same throughout but it just seems to be a time when it’s, you know, more harmful to experience. And is there anything before you go down the road of medicine, say perhaps it is just initially it is just the baby blues. It’s just that ‘hormonal swing’ we experienced at pregnancy. Do things like exercise and diet influence- happy, amusing- those lifestyle choices? Do they influence your ability to bounce back mentally or if it’s going to happen that’s going to happen, if it’s going to develop into postpartum depression that it’s going to happen? There’s some research showing that exercise can be helpful in terms of shortening episodes, decreasing something. So I definitely think if exercising is something people can fix with obstetricians approval. Safely engage- and I mean that’s true throughout life that exercise can be very beneficial for mood so that’s something that we definitely recommend. I’m a big fan of yoga because it’s a deep breathing, I just can’t get in a position sometimes but I’ve really seen a deep breathing aspect. Snd especially because one thing we haven’t discussed is that a lot of women who experience not only depression, but also a significant amount of anxiety during the postpartum period. Either with or without depression aside, -yoga can be really helpful for that too. What’s the difference between depression and anxiety? So depression through all those symptoms we talked about the sadness, and not enjoying things, difficulty sleeping, feeling worthless, hopeless, anxieties, really worried, but taken to the integrate. Right? So you can get these near recurrent thoughts that just won’t stop. It’s a postpartum OCD, something that we see quite a bit. Obsessive compulsive disorder, you know, panic attacks like where your heart’s racing, short of breath, you feel like you can’t breathe air, that you might die. That occurs out the blue all of a sudden or just extensive worry that’s a really out of proportion. When you’re worrying about, you know, your safety, your husband’s safety, this could go wrong, that could go wrong, and then you might get some physical symptoms like muscle tension, and headaches, things like that. That’s really interesting I know someone else anecdotally was talking about the anxiety issue and you said it’s so hard to recognize because you think so much -that it is just “Well I have a person I’m taking care of now who’s relying on me for everything so of course I’m going to worry about it.” It took me a while to realize that worrying and strategizing how I would deal with people coming into my home and taking my baby and obsessing over it was not normal and it took someone else recognizing it. So if you had advice for support for partners, for family, whoever is helping a mom, in those first couple of weeks what would it be? It would be let her get some rest, you know, and tell her that she’s doing her job and then she, you know, was doing the best that she can. I think a lot of it comes from the perfectionistic “I’m not doing this right”.- Another thing I would say is if you can help her get some sleep. We know that lack of sleep is really a risk factor, and so those early days are tough. Obviously because the babies don’t sleep very much and eating constantly but that level of support where someone who can come do the cooking, and where you can talk to someone, you know, to decrease the stress.- We know that’s not possible for everybody but for those who have people in their lives you can do that for them that can be very helpful. And do not be overly critical, you know. And then we’ve been in situations where we will have to tell you how to parent. So it starts really early. (Laughter) -Just have people in your life, or being supportive of you, taking some of the load off, helping you get some sleep when you can, those are some things that can be really helpful. I’m sure the sleep deprivation can’t help, I mean I’m not just- t I believe we were talking about breastfeeding in the last episode and they were talking about it’s every two to three hours and you’re not supposed to pump until about three weeks in ow is the recommendation. And I (laughter) – is to have that all be on one person because you can’t give up a nighttime feeding if that’s the way you’re going about it. So it is I think pretty important, I will sleep on the baby sleep segment sounds, it sounds ideal, but it’s very different. – I would say I don’t know how anybody can make it happen but any other advice that you would offer? Anything we haven’t covered? I would just say, you know, for women to educate themselves, educate their partners, and the people you know, family, so they know what this is. So they know that if it starts that it doesn’t mean they’re a bad mother, they’re not going crazy, and there’s a common complication of pregnancy and to know as fact that you can have ideas. As you said to plan for the postpartum period to reduce your stress. And figure out who can help you with cooking, who can help you with other things, and it is it’s going to be a stressful period anyway. It’s a big change in your lives it’s being a huge role transition for especially for first-time moms or even if you have their kids at home. And to just be gentle with yourself like you’re learning something new. You’re doing your best to take care of this new baby and to not be -don’t have that harsh critic in your head telling you that you’re doing things wrong. Those are all things that we commonly hear and women can’r do without having significant discussions and I’m sure I talked about this in the past but I think the hardest thing about pregnancy is the lack of control you have over even your image, your body, your life, everything. And that grows exponentially when you have a baby. So I think just adjusting to that reality is the hard thing for many women. I can see how it would affect many in a significant way. I think if your expectations are “I’m going to be a perfect mom, and I’m going to keep everything perfectly like by all the books, and all things online.” They do them to be exactly like that and I’m also going to still, you know, do all the other things that I always did beforehand. In the first you know two or three months of the baby’s life you’re setting yourself for a lot of stress and unnecessary stress. And instead of you saying it’s going to be a challenge, it’s going to be hard, I’m going to do the best I can, and you know as long as I’m seeing this baby. – You’re growing and alive it’s a great challenge and I think is that something that you can help a lot of moms with. I mean darn internet, I mean on Facebook everything looks so perfect, and everyone smiles but people only post the happy picture after and that’s all right. Well thank you so much for joining us! We really appreciate it, so again a really important topic. We’ll put those resources in the comment section of this post after I get back to my office. And next week we’ll be back to talk another postpartum discussion about what happens to your body after the baby is born. And I gotta tell you a little nervous about that one. No one tells you (Laughter) So we’ll look forward to seeing you next Friday one o’clock! Until then have a wonderful weekend enjoy this beautiful, beautiful weather!