Dealing with depression in pregnancy and after

Medical Director, Pregnancy
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Dealing with depression in pregnancy and after

Join me for a discussion of mood disorders in pregnancy. Lots of women have heard of postpartum depression, but did you know that anxiety can be just as common after having a baby? And that these issues can show up during pregnancy as well? Let’s chat so you can know what to be on the look out for, and how to deal with these complications if they arise so you can enjoy your baby to the fullest! I’ll answer all your questions and post some food for thought!

Comments

  1. Great topic. The portrayal of PPD (and postpartum anxiety and psychosis) in the media seems to be the extreme. I know sometimes this is the case but it distances people from acknowledging that sometimes the symptoms are less obvious.

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    1. I did the recent coverage of Hayden Panettiere’s struggle with PPD was really fair and did a great job of highlighting how PPD can show up long after the newborn phase – we definitely need more awareness of that! (more here about her struggle: http://www.today.com/health/hayden-panettieres-postpartum-depression-it-can-happen-any-time-first-t50146)

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    2. In fact, PPD can diagnosed up to a year after a woman gives birth. Some moms wonder if they are too far removed from their delivery to have true PPD, but it can certainly happen: http://www.bundoo.com/qotd/can-i-develop-postpartum-depression-or-anxiety-when-my-baby-is-older/

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      1. That’s helpful… especially because people may think they’re in the clear once those early weeks postpartum have passed.

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  2. For any pregnant moms out there, I am curious if your OBGYN or midwife has brought about depression/anxiety at a prenatal visit and discussed the warning signs for it either in pregnancy or after? Do you feel like it’s something you’re prepared to look out for?

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    1. My OB always asked (or maybe it was the nurse before I actually saw the OB) about “feelings of wanting to harm myself or someone else.” I always thought it was an odd way to put it. I kind of feel like it should have been discussed even after I answered NO though. I mean, maybe I just answered NO because I was ashamed… That wasn’t the case, but they didn’t know that. They always asked the same question, I always answered the same way, and that was that.

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      1. True, that’s a generic screening question that they were probably required to ask as part of your “vital signs” – but I agree, it needs to go deeper than that! Discussing signs to look out for – while reassuring women that feeling this way is a true medical condition and not a sign of bad parenting or weakness – is so important so women feel OK about speaking up!

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    2. My OB/GYNs (two different for each of my two kids) both screened at prenatal visits, but more so at postnatal visits. I thought they approach it well and liked that even when I said I felt good, they proceeded to share warning signs and what to look out for (in case I was uncomfortable discussing).

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      1. That’s such a great way to do it! That way no mom gets left out because it is assumed she is fine. Did you have a 10 question screening quiz if you remember? This popular screening tool (called the Edinburgh Postnatal Depression Scale) is a great, quick way to screen for PPD.

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        1. I remember a quiz with my second child but not with the first.

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  3. PPD fact: Postpartum depression is the most common complication of pregnancy, affecting about 12% of all women who deliver (and this is probably higher if we did a better job of diagnosing it), so this is definitely something all moms-to-be should know about!

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  4. Screening new moms for depression has been a hot topic in the news this week. New recommendations say that all new moms need to be screened, because it is so common and because we know treatment works! You can read more about that here: http://www.nytimes.com/2016/01/27/health/post-partum-depression-test-epds-screening-guidelines.html?emc=edit_na_20160126&nlid=52668989&ref=cta

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  5. Keep in mind their is a difference between the baby blues and PPD, but both can be difficult to deal with alone. Seeking support for either one doesn’t mean you are a bad mom. https://www.bundoo.com/articles/baby-blues-or-postpartum-depression-how-do-i-know/

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    1. Excuse me, I meant “there” 🙂

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    2. I was going to ask about the difference. Thanks for the link!

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      1. You bet! The way I counsel new moms is that the baby blues is the new mom who cries at the sappy commercials, has moments where she misses her “old life” and at times feels overwhelmed and frustrated – but these moments pass, and there are still more good moments than bad ones. PPD/A (postpartum depression/anxiety) is beyond this – the symptoms are more severe and start to overtake the entire day, making doing routine activities difficult. Sometimes it can be difficult to know so if you aren’t sure, always check in with your doctor or midwife!

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  6. Here’s a question… if you suspect that a friend is struggling, what is the best way to approach her? If she opens up, where should you recommend that she go for help?

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    1. Great question, because definitely having a friend be her champion is a wonderful place to start! I would first ask if she had any thoughts of harming herself or her baby to determine if this is an emergency situation. If not, I’d ask if she’s let her doctor or midwife know and if not, encourage her to call and be seen (and maybe even accompanying her for support or offering childcare so she can get out can show her just how important it is to you that she gets help). Lastly, there are tons of local resources that are wonderful in these instances, such as hotlines, online groups, and local support groups. The Baby Blues Connection is a wonderful organization that primarily serves women in the Pacific Northwest, but they are able to connect moms to resources locally anywhere in the country: http://babybluesconnection.org/bbc/

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    2. The most well-known screening tool for PPD is linked here, and even giving this link to a friend you are worried about can help her realize if she scores in the PPD category. That objective information may help her see that really does need help: http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf

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  7. Thanks so much for the chat everyone! Please feel free to continue posting your thoughts and questions and I will be sure to get back to you. If you know anyone struggling with PPD please send them to this chat so they can get the information they need to get help and realize they aren’t alone!

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  8. We’ve received some emails tonight from Bundooers who didn’t want to comment publicly here, so I want to raise a topic based on a few emails I received tonight. A common thread was regarding screening and how the questions are developed. One Bundooer remarked that the writing and chosen words don’t resonate with women who have PPD and that women experiencing it use different ways to describe it. How are the screening questions developed and how are OB/GYNs trained to screen? Dr. Jen, I thought you’d have some input.

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    1. The good news is that the EPDS – the most common tool used for screening for PPD – has been very thoroughly researched and tested. It’s been validated across many languages as well. However, no test is perfect and there will never be anything that diagnoses any disorder 100% of the time, without missing some people and overdiagnosing others. One problem that may arise with the EPDS is when doctors/midwives use different score cut-offs to diagnose PPD. Another problem is that women may be screened too early (say at 1 week postpartum when PPD may not show up until 6 weeks postpartum) when in fact they later go on to develop PPD. Yet another problem can be when a woman is answering the survey with her partner in the room and she lies about her answers because she doesn’t want to be judged. The bottom line: there are a few ways to screen for PPD, but the EPDS that I mentioned is one of the best, both in ease of use and accuracy. It’s estimated that it will diagnose 90% of women who have PPD. That’s a great number, but it does mean 10% of women who have it are missed. These may be the women who don’t quite understand the questions, or don’t feel the questions really describe how they experience PPD, or those who don’t want to answer honestly for fear of being judged. This is when the art of medicine comes in and a doctor or midwife should still give warning signs to everyone, and even if the test is negative but they are worried about a new mom, should arrange more follow-up. Lastly, every woman should be given info about PPD BEFORE they deliver, and the best information I’ve seen uses real quotes from moms who’ve experienced it, with language such as “I knew something was wrong when I felt I was just babysitting someone else’s baby” or “I felt nothing when she cried.” This kind of information is easy to understand and relatable, and may help a new mom realize she has a problem that needs attention.

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    2. And despite my long answer I realize I forgot to address one of your points: how OBs are trained to screen for PPD varies so widely. There is no standard unfortunately. And when it comes to being trained on how to treat it, the lack of uniform training is even worse. Definitely something all providers caring for women need to feel comfortable diagnosing and treating, and if they don’t they need to know who to refer to who does!

      For further reading regarding the EPDS:

      https://womensmentalhealth.org/posts/screening-for-postpartum-depression-new-data-on-the-epds/

      https://womensmentalhealth.org/posts/identifying-postpartum-depression-a-three-question-screening-tool/

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