May 27, 2021 • 39 mins
Katie Lowes opens up about her own experience with postpartum depression and invites to the show a key person who helped her through, psychiatrist Dr. Kira Stein.
Through Katie’s survivor story, Dr. Stein addresses some of the most common stigmas associated with this treatable disorder. Katie and Dr. Stein talk through the signs and symptoms of PPD and how it differs from baby blues and postpartum psychosis. Together they share how medical care saved Katie and can help fellow parents suffering from PPD feel like themselves again.
Katie’s Crib Notes:
- Edinburgh Postnatal Depression Scale
- Understanding Maternal Depression - UCLA Maternal Mental Health Program
- The American Psychiatric Association’s postpartum depression information page
- Harvard’s Massachusetts General psychiatry program’s Women’s Mental Health webpage
- Georgetown University’s Postpartum Depression: Signs and Resources for Help
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Katie's Crib, a production of Shonda Land Audio
in partnership with I Heart Radio. It's a biological phenomenon
postpartum depression. It's not about your character, it's not about weakness,
it's not about being a bad mother. It just happens,
and it happens to a lot of us. Information provided
(00:28):
by Dr Kiristein during this podcast is for general education
purposes and should not be relied upon as professional medical advice, diagnosis,
or treatment for any individual. Welcome back to Katie's Crib.
I have someone here today who saved my life past tense,
is currently saving my life. I am still working with
her and I feel so grateful to have met her
(00:51):
in the darkest steps of despair in my own personal
life journey, and now I have her as one of
my greatest tools in my toolbox for all the ship
that will come my way in my life. So basically,
Dr Stein, you need to live forever. Thanks so much. Um.
This is psychiatrist Dr Kiris Stein. She's an assistant clinical
professor at the u c L A Semil Institute of
(01:13):
Neuroscience and Human Behavior at the u c L A.
Giffing School of medicine. Wow, that sounds really fancy. She
has her own private practice in Beverly Hill, specializing in
general adult psychiatry and Perry natal psychiatry. Thank you very much.
She also volunteers as an attending psychiatrist at the u
c L, a women's Life Center and outpatient program devoted
to assessing and treating women with psychiatric conditions associated with
(01:33):
reproductive life events and hormonal challenges. What a mouthful guy. Okay, welcome,
doctor Stein, thank you. The truth is, I'm just another
person who just went in one direction and learned a
lot about medicine and psychiatry and perinetle medicine. So hopefully
when patients see me or hear me, they know that
(01:56):
I'm just another human being who's just their partner and
trying to get them better. That's what it felt like.
And what was weird was when I reached out to
you to go back a little bit. I've been working
with a therapist for twelve years, and when I reached
about the three four week mark postpartum with my daughter,
I had in my o B four week check up
(02:17):
and she asked how I was doing, and I said,
oh ha ha, as a joke, because I brush everything
off and I'm still uncontrollably sobbing all the time. And
she was like, oh, that's something to look at. I
asked my therapist what she thought, and she said, yeah,
I think you should go to a psychiatrist. And already
I'm up in arms like what, No, I don't know,
I don't know. Okay, you know what. I'll go to
(02:37):
a psychiatrist and she's gonna give me some awesome panic
attack medication that's gonna go under my tongue and anytime
I get a panic attack about COVID or that I
can't do this or that I hate parenting right now,
I'm just gonna slip this thing under my tongue and
get a great night's sleep. I get introduced to Dr
Stein through my therapist. We have about a two hour
(03:00):
saltation to which at the end you say to me,
in my playing of it, oh no, honey, this isn't
like just to slip under your tongue once in a
while situation. You have postpartum depression and anxiety and it's
pretty high on the Edinburgh Postnatal Depression scale. And I
(03:21):
was like, what, No, not me. I'm a podcast host.
I'm a stable person. I've never been on medication, I've
never been diagnosed with depression. I'm the rock of my
family and all my friends. This isn't possibly happening to me.
And Dr Stein was like, you've been uncontrollably sobbing for
(03:44):
the last two hours and I have news for you.
You can't muscle your way through this, So can you
tell me at that time how you diagnosed me and
my personal case? And again this this goes to everyone listening, like,
this is my own personal story. How did you know
that I had postpartum depression versus like blues? Well, um,
(04:07):
there's a very big difference between the blues and postpartum depression.
Eight almost eight percent of women suffer from the blues,
and it's usually mild, and it usually occurs within the
first week of delivery, and it involves anxiety, your ability, tearfulness.
So you may have been experiencing some of that and thinking, okay,
talking everything up to oh, this is postpartum blues in
(04:29):
the beginning, and that usually lasts though no more than
two weeks. Okay, and it's mild. It doesn't affect functioning. However,
yours continued, Yours continued and got worse, and I would argue,
I think maybe it even started before the baby was
more it's called prenatal depression if it's started that way,
(04:49):
but postpartum depression. Actually six of postpartum depressions start before birth.
I definitely was not myself my entire pregnant. See, I
did not feel I felt overwhelmed, fear, panic attacks, sadness,
and I thought when I had the baby, and I
blamed it all on COVID, I blamed it all. Well,
(05:11):
it's like being pregnant in a pandemic, isolated, and when
the baby comes, I'll feel great because I will have
done it. I will have brought the baby safely into
the world. The baby came, and it took a down shift.
It was not the It got worse, Yes, it got
way worse, and it got worse with time. Yes, which
is what we normally see often see with postpartum depression
(05:33):
when it's a clinical depressive episode more than the usual
postpartum blues. And this scale, this Edinburgh, which by the way,
Edinburgh is like my favorite place I've ever gone in
the entire world. So I'm like, why does it have
to be Why is it called that? At what is
the Edinburgh post Natal to President scale. Well, it's a
(05:54):
ten point scale that it is pretty simple to answer.
It's online. Actually, I gave you a link to put
on your website associated with this podcast so that women
can access it. And it's some pretty simple screening questions
that can help women O b g n s and
pedetriten's and psychiatrists just get a sense of how severe
(06:16):
their depressions are and if they should get more help
if it's severe enough, if you even wonder if you're
experiencing a clinical depression and a clinical depression. The difference
with the clinical depression and the postpartum blues. Want to
make sure is that everyone understands is that a clinical
depression is a depression that impedes functioning, makes it hard,
(06:37):
at least in the postpartum context, to take care of yourself,
your baby, to nurture the baby. If left ongoing, it
has implications on the development of the baby. Yes, with
our listeners, I think I had postpartum blues with my son.
And the reason I say that now is because I
could function. I didn't hit the lows in the depths
of the rock bottom I did this time around, but
(06:58):
the first time. I you have to say, at eight
months postpartum, I opened on Broadway. I made my Broadway debut.
I mean that was my life's dream since I was
a little girl. And I put on a face, but
I was miserable. And it wasn't until I weaned. When
he was after a year, he was about fourteen fifteen
(07:19):
months old, and I remember looking in the mirror being like, oh, there,
I high should I think I was really sad that
that last year, and I feel like myself now. The
difference after Vera was that it felt like the weight
of the world to return a text. It felt like
I had done a champion feet by taking a shower.
(07:41):
When my daughter would cry and need me to breastfeed,
I felt immediate spikes and anxiety that I even had
to go into her room and care for her. And
all of those things were met with massive dread. Like
my worst times would be in the morning at five am.
I'd wake up early knowing that the day was neig
start and the kids were going to start needing me
(08:02):
at six am, and I was fucking terrified, horrified dread.
That's quintessential postpartum depression. And and you're pointing out some
important aspects of it. So with postpartum depression, we see
the usual depressions is in low mood, which is what
we see with a regular non postpartum, non pregnancy related depression,
(08:25):
But often we also see a prominence of anxiety and
even obsessions. And there's a difference, and I could explain
that shortly. There's a sense of being overwhelmed with fatigue,
with the challenge of facing the daily needs of the
baby and the family and um. There's just a real
(08:45):
sense of helplessness and worthlessness and for many women a
sense of incompetence about their parenting abilities, particularly with negative
thoughts about themselves and and and sometimes the rest of
the family. It just it can be really something that
is beyond their control. It just happens. Many women get
this about one in five. That is what the study show.
(09:12):
It kills me, one in five. It's huge. It's it's
extremely common, and just because it's common doesn't mean that
it's not serious. It's also the most common ebseentric complication
postpartum depression. So there is something where you think, when
(09:32):
you've been diagnosaed for postpart impression, you think, what's wrong
with me? And how could this have possibly happened? If
I'm a woman, I'm meant to rear children, I'm meant
to be a mother. This is supposed to be my
greatest calling. How how could this chemical imbalance even be
a thing? All women when they have a baby, they
go through the same, relatively the same thing with hormonal changes.
(09:55):
We know that estrogen and progesterone just crash plu mint
between having the baby and postpartum period within two weeks easily.
Do we know if that's the cause? Probably not. I
don't think it's the cause, because again, there's a majority
of women who don't get postpartum depression from the same
(10:17):
kind of crash. So we think that possibly there's an
increased sensitivity maybe to that hormonal fluctuation, And that goes
along with the knowledge that we have that certain women
who have either had postpartumpressions in the past, or mood
changes associated with menstruation or pre menstrual PMS, or have
(10:38):
had mood changes associated with taking oral contraceptives, that those
women are more likely to have postpartum depression. So there
might be a certain subset of women and maybe they're
medically predisposed. Not sure yet, You know, we need more data,
more research on it, but that's what it looks like
at this point that certain women are more likely under
(11:02):
certain situations, okay, to experience postpartum depression. And keep in
mind also we're in a natural disaster. It's called the pandemic,
so that increases stress hormone levels as well. So maybe
there was a threshold that, for example, you that you
just your body couldn't take. It was the pandemic, it
was the hormonal changes that maybe you're more sensitive to.
(11:24):
There's a lot of maybes here because we don't know
for sure. I don't know if you know this, but
you called into prescription to Walgreens and I let it
sit there. Dr Stein four days. I was like, ah,
not me. I'm going to get a second opinion. I'm
going to leave it there. I'm going to have a
long conversation with my husband and say, but I'm only
six seven, eight weeks out, give me a shot. Let's
(11:46):
look at this again at three months postpart of four
months postpartum. And then on the Saturday morning, I woke
up and I had horrible thoughts about my son. Suicidal
images kept come into my head, suicidal thoughts of it
would be easier if I wasn't here. I can't wake
up one more day like this. I don't want to
(12:07):
see my children. And then I got scared. I scared
myself into I've never had thoughts like this. I'm going
to go into a psychiatric word and I'm going to
have my children taken away from me because I'm unfit
to parent. I don't trust my brain anymore. I don't
recognize it. And I'm terrified. And I called you at
(12:28):
a nine am on a Saturday, hysterical crying. I didn't
know what was wrong with me. I didn't think I
could get through a Saturday with my two kids without help.
And it was so awful, and I drove to Walgreen's
like a five mileur It was like, I am starting
medication today because I don't see a way out of this.
(12:50):
I have to try something I've never tried before, because
I'm also at a place I've never been before. How
did you reach the diagnosis that met occasion was a
choice for me? Obviously, this is my own personal tail.
Why medication? Yeah, not everybody who comes in to see
me with postponed depression gets medication. So just letting you know,
(13:12):
it depends on the severity, and it depends on what's
been tried and what's worked. You tried everything. You had
been in therapy, right. I mean, can I say how
long you were in there? I don't even know how long? Okay,
So so you were in therapy for a while. There
was no doubt in my mind that you had tried everything,
talking to behavioral tasks and homework and and she you
(13:35):
want to walk crystals. I was pressing oils and crystals
to my heart, praying faith. I was begging ancestors. My
amazing acupuncturist was like, what about your placenta pills. I
was like, honey, I've been taking the placenta pills. I
dehydrated my placenta. I've been eating it for two months.
(13:56):
You're right, thank you. I did try. I tried everything. Right,
So you tried everything for a while, and it was
extremely clear to me, I do not try any of
those things. And you showed up to me with a
mild to moderate case. I might say, okay, maybe we
should just try psychotherapy and make sure that you have
all a bunch of supports and you're not isolated. But
you'd have done all that you were actually reaching out
(14:18):
to friends. I mean, I think you were a little
bit hesitant to maybe can reach out as much as
you did later on. Yes, Yes, I had reached out
to my two friends Mary and Talia, who I'm going
to have on this podcast, Mary and Talia. I reached
out to them because I knew they had postpartum depression,
and I knew that they had experiences with medications. So
(14:39):
I was already doing the research and seeing how other
mothers responded. Casey Wilson, who I had on this podcast,
I called her. She took me through her exact story.
So I was dipping my toe in, but I was
feeling I fell for every trap of feeling emba arrist
(15:00):
and ashamed to admit that I was feeling like a
failure in my mental health was not going great. Was
really hard. It's a biological phenomenon postpartum depression. It's not
about your character, it's not about weakness, it's not about
(15:20):
being a bad mother. It just happens, and it happens
to a lot of us. And often it's not just
postpartum depression. It mixes with anxiety, a lot of anxiety,
and so that's why a lot of people get confused
sometimes when there's so much anxiety involved in postpartum, depression
is at the forefront of people's minds and they don't
realize they're also depressed. If someone has tried lots of
(15:53):
things and you do feel that medication is an option
that they should try, my understanding was that zoloft is
great at work with both depression and anxiety, because I
was struggling with both. A lot of the antidepressants deal
with both. It depends on other other symptoms, other side effects.
I just personalized the specific choice of medications to what
(16:13):
the patient is experiencing. I would say that most of
the antidepressants that I work with in women who are
breastfeeding or not postpartum, it depends on their personal situation.
It may not be just about anxiety or depression. But
that was a big thing too. I felt such guilt
about wanting to breastfeed and also wanting to take medication
(16:35):
and knowing that I needed it. And now that I've
been on the medication, I do feel the light of Oh,
it sucks that I'm on zoloft and breastfeeding, and yes,
I wish I wasn't in a situation, but I can't
tell you how much more fun and a better time
I'm having mothering her. The fact that I am obsessed
with her now and like love being her parents, and
(16:57):
love parenting my son even though he's a three nature,
that trade off is fucking worth it for me. What
would you say to women who are still afraid that
medication would get into their babyes systems? There are several
antidepressants that we can use in breastfeeding that are relatively safe,
and so the risks benefit analysis for each patient has
(17:20):
to be taken to consideration. But generally speaking, we can
treat most postpartum depressions very easily with medication. UM, I
think the best course of action is to prioritize mother's
mental health and ultimately the baby's health. If the only
(17:41):
reason why you're not going to take a medicine that's
going to help you with your depression is because you're
afraid a small amount will enter your baby system. As
a psychiatrist, you want to honor everyone's desires and there
and then what they want, and of course the psychiatrist
will support you in whatever decision you make. But I
worry that risk benefit analysis is skewed. There if somebody's
(18:03):
severely depressed. I completely agree. And I have to say
I was so freaked out about breastfeeding Vera, and I
had to really weigh out, Okay, the options do I
quit breastfeeding. In my personal case, I felt like that
was going to cause me to be further to wake
my depression worse because I felt like I had breastfed
(18:23):
Alby for a year and it felt unfair and I
was felt terrible. And you said you were doing really
well with breastfeeding. You felt connected and bonded with the baby.
For sure, I wouldn't want to take that away from you.
And then you I think you were getting enough sleep,
So yes, for sure, continue and start medicine. Yep, yep.
(18:43):
And then I've talked to some mothers who breastfeeding, like
you said, caused them such depression and pain because they
it was stressful to them that it wasn't going well,
breastfeeding was going so poorly that it wasn't until they
just quit and started bottle feeding that they started enjoying motherhood.
And it really I'm one of those mothers. I'm one
(19:04):
of those mothers. I tried for I think it was
six months with my daughter and I couldn't produce. When
you rescue, do the best, your child gets dehydrated because
they're struggling to get the milk out, and then you're
pumping on afterwards, hoping to get eke out every ounce
on one ounce after forty you give them the formula.
They'll be happier because they're fatiated. You'll be happier because
(19:29):
you sleep, and you won't be faced with failure after failure.
So that's that situation. But I do also have to
add that when I was so freaked out, I texted
the best lactation consultant in Los Angeles, the lactation consultant
to the stars, Linda Hannah, who has been on this
podcast and is fucking amazing. And I texted my pediatrician,
who is also incredible. I have never received text back
(19:51):
fast enough that said, go on the zoloft. Great, great,
your baby is fine. My what they we're concern The
pediatrician who's number what concerned is my baby, was very
concerned about my mental health and said, please, you're fine.
(20:11):
To have a healthy baby, need a healthy mom. Yeah,
that's simple. Whatever choice that is for you to go
on medication. That's been absolutely for breastfeeding or whether to
quit breastfeeding entirely, or you know, any of the things
we've discussed. Because you know, Dr Stein, I want to say,
not only medication, but you sent me meditations to be
doing when my anxiety flared up. We talked about some
(20:34):
faith centering practices that I can do to really lift
my spirit up to a higher power. And it was
very helpful. You You really encouraged me to FaceTime friends
that even in COVID, like going out for a social
distance walk with a friend and being honest was so
groundbreaking lee helpful. Um, So there were so many things
(20:55):
working in tandem, is what I'm trying to say, you know,
and it's really just medica patient. I would never say
that it's other things. When somebody suffering from a moderate
or severe episode of depression, somebody shows up mild to moderate,
I generally recommend that they try other things if it's
(21:15):
moderate to severe, and your case it was severe. Yeah,
it was severe, you know, based on the Edinburgh That's
what you said at the end of overse conversation. It
was like the mic drop of all mic drops in
my life. Now, postpartum depression, it can happen anytime. Cases
start after delivery, mostly during the first month postpartum. Okay,
(21:39):
but almost nine percent of cases occur by four months postpartum.
Total of the postpartum depression cases so there are a
few are between fifth and the twelve month postpartum. There
are different definitions from different associations and organizations of what
postpartum depression is. I kind of like the concept that
(22:02):
postpartum depression can start during pregnancy or within twelve months postpartum,
and that's the American College of Centric's and Ganecologies definition.
Got it because I think it covers everything. But as
I mentioned before, almost six of postpartum depressions start before
the baby is born, so that would be before conception,
(22:28):
women who are just conceiving well depressed, and thirty during pregnancy. Yep,
that was me. And now I've just heard my first
story of a man who got diagnosed with postpartum depression
after his wife delivered their baby. Is that a thing?
It is a thing. And about ten percent of fathers
(22:51):
get a postpartum depression they get postpartupression is just clinical
medical major depressive disorder, whether a male or a female.
If it's after your child has had has been born
and it's been diagnosed within the year, it's postpartum depression.
And about ten percent of men experience clinical depression either
(23:14):
during their spouses or their partners pregnancy or during the
postparton year. Wow. Wow, that's fascinating. I mean there's a
lot of suffering. Oh my gosh. How long does postpartum
depression last? Typically it depends on if it's treated or not.
(23:34):
So in general, the estimation is that postpartum depressions can
last at least a year. What is the risk I
worry now endlessly about women who go untreated or delay
seeking treatment. What is what's the risk there? Well, there's
a risk to themselves depression, clinical depression, untreated and prolonged suicide.
(23:59):
Women taking care of themselves increases the risk of marital
and partner discord. Not being able to take care of
their families, their babies the way they would normally want to,
missed edutrian visits, not taking your penatal vitamins, or some
women forget to get to work, more accidents, for example,
or they forget to put their babies in their booster seats.
And in terms of the baby mother infant attachment to
(24:22):
the bonding is usually diminished when it's a significant postpartum
depression and just a lack of responsivity, emotional responsivilty, and
even physical responsivility to their babies. And it's not intentional,
it's just that's the way you're functioning if you have
postpartum depression, and babies are just more at risk. Therefore,
(24:43):
when their mothers are less connected with them, less nurturing,
less likely to as time goes by, like peekaboo or
read to them or saying to them, the babies tend
to develop into older children and even adults who are
more likely to experience depressive episodes themselves and anxiety and
other behavioral difficulties themselves. So it is a concern. Wow, God,
(25:08):
that is so there's a risk to not treating as
well people forget that. How do you recommend mothers prepare?
I don't know if I could have done anything differently.
But let's say a woman listening is pregnant, she hasn't
(25:31):
dealt with depression in the past, or or whatever. Maybe
she has, but like, what, what do you what? We
want for sure for sure if someone has had a
history or a family history of mental illness, even just
general amountal illness puts you at risk in your family,
So if there's a family history, if there's a personal
history of just not only postparts depression, but depression in general,
clinical depression, or a history of an anxiety disorder. Anxiety
(25:55):
disorders are the most common psychiatric disorders that people can
have in the United Say, it's so, it's not that uncommon.
But also if you're at risk if you're struggling economically,
which is ironic, I understand if if you're in terms
of you're struggling economically, but yet you need to seek
extra care um financially, that can be very difficult. So
if you're striking economically, if you're having difficulties with obstetric complications,
(26:21):
prenatal complications, that puts you at risk. Thyroid disorder, diabetes,
medical illnesses will put you at risk, particularly if you're
experiencing crisis and your family, like difficulties with with your marriage,
or if you have a history of trauma, sexual trauma
or being a victim of domestic violence, if you're single,
or you have very few supports in your life, Definitely
(26:44):
you're more at risk the more children you have, more
having many children or more than one is a risk
factor because your hands are full, there's sleep deprivation during breastfeeding,
or even just the baby crying all the time. You know,
that also is a trigger for postpondon depression understandably. So
if you're more at risk for all those reasons, and
there are probably others I can go into, then I
(27:06):
would say have a conversation with your o B. Have
a conversation. Hopefully your OBI is already screening for those
risk factors before like that the first visit, prenatal visit
and then intermittently throughout pregnancy and then postpartum, you know,
before even leaving the hospital. It would be great if
(27:27):
a nurse or an OBI just went through the Edinburgh
Post at All Depression Scale. I know that a lot
of pedetricians are now because they are seeing the moms
more than the obs postpartum, are administering the Edinburgh scale
as well, and that's really helpful. And also it's not
just getting the number of severity from the Edinburgh Scale,
(27:48):
it's opening up the door for a conversation about depression
normalizing it. It is so common and as you said, culture,
the culture that we live in wants us to be
superwomen and we're not. And that's okay, we're not super women.
We can't do it all. It's not possible. In fact,
(28:10):
you know a few thousand years, we can even go
actually two hundred years back. Okay, it took a village
to raise a child. And this is we live in
a very isolated world, so that increases the risk for
I would say everyone when it comes to postpartum depression,
were more isolated. There's less help. There's there's less people available,
(28:31):
easily available, that's in your home to help with the
baby with feedings. Right. Not only is there less help
and less community around raising your baby, there's more pressure
to make it seem like you've got it going on,
between announcements and mailing postcards what the baby looks like,
and social media and posting the first Instagram shot and
(28:54):
tweeting the first you know, my post baby body, I
got it back blah bloody, bloody blah. It's like a
two for to just really mess with the mom only
do you have to do this alone, but you have
to look amazing while you do it. The responsibilities are
very heavy postpartum in particular and going forward, I think
(29:15):
motherhood is the hardest job it's the hardest job. It's
harder than being a doctor. It's harder than being an actress.
By it's harder than being a duchess. Okay, it's harder
than being a duchess. At the time of this recording,
the Megan Markle Harry Oprah interview has happened this week,
and I have to say, I don't know Dr Stein,
(29:38):
but now that I have seen postpartum depression up close
and personal, I look at her and I'm like, she
had postpartum depression dealing with that right now currently during
her second pregnancy. Oh and I also just watched the
Britney Spears documentary and she's sobbing pregnant with her two
year old on her lap, and I'm like, I don't
know if she's being treated, but I feel like she
has post fucking part of depression. That's what I looked like,
(30:03):
sobbing with my son on my lap. I don't know.
I don't know if we'll ever know, and that's their
own personal thing, but I really feel like Megan Markel
needs to come on this podcast. You should invite her.
I knew her, we used to audition against each other
for years, but I hope, Megan Markle in all seriousness,
(30:24):
I just it just my heart goes out again to
anyone struggling. And what's crazy about mental health is that
affects actresses, duchesses, women with four jobs, single women, women
with money, women without money. It's this exactly. It's indiscriminate,
(30:47):
except I would say, the more stress you're under, yes,
that's right, that can also increase the risk of postpartum depression,
of any kind of depression, anyven It isolates. What are
some of the biggest misconceptions around postpartum depression, Like, what
do you wish people understood more about it? Postpartum depression
is more than just the blues. That's extremely important for
(31:11):
people to understand. It's a clinical depression that affects functioning um.
Postpartum depression is not a sign of weakness, it's not
a sign of bad parenting. It's completely treatable. And postpartum
depression is not postpartum psychosis, and I want to explain
the difference. Please. Postpartum psychosis is very rare, one to
(31:35):
two out of a thousand pregnancies. It's usually associated with
bipolar disorder, where people have a history of feeling really
high without drugs, and also depressive episodes. Okay, it's usually
associated with bipolar disorder, but sometimes by the time they
people become pregnant and have a baby, they haven't had
(31:55):
a manic episode yet, so it's kind of about postpartum
depressions are actually bipolar depressions. So then that's important to
factor in psychosis. Let me just describe what that is,
because I'm not sure people really understand what that is.
Psychosis is a break from reality with disorganized delusional thinking.
So that means paranoid thoughts, really paranoid thoughts like people
(32:17):
are after you or trying to get you, or strange
beliefs that don't reflect reality. So it also involves sometimes
hearing voices or seeing visions. So it's a complete break
from reality. So obviously there's very little functioning going on
there and some have even um. You know, the big
risk with postpartum psychosis, which is a psychiatric emergency and
(32:39):
there's a dramatic onset. It's usually the first two weeks
after delivery, but could be later, but it's high risk
for the baby, high risk for the mother and other children.
It's a psychiatric emergency and it should be identified promptly
and hospitalized, but be ut very treatable, extremely treatable, and
it doesn't mean you're gonna your baby's gonna taken away
(33:00):
from you. People always think, oh, I'm gonna go to
the hospital. I think you instead it just in the
beginning you were afraid of going to the hospital and
your baby is being taken away from you. That not
how it works. A psychiatric hospital is extremely nurturing. There's
group therapy, there's intensive you know, psychotherapy, and there's psychiatric help,
and some actually integrate having the baby there in a
(33:20):
safe way. The psychosis is rare, the postpartum depression is common,
and it and yet all of us are here on
the other side and it's treatable and there's no reason,
there's no reason to be embarrassed. I wish people would
talk about it more. I'm sure you have that snapshot
(33:41):
in your mind when you've had a great experience with
it with your baby and you've rest fed them and
everyone's peaceful. But there's a lot going on in between,
and life is messy even in the best of circumstances.
It's hard. Yeah, how do you think loved ones can
best support those with postpartum depression. Listen, don't assume postpartum
(34:06):
motherhood is easy or glorious. It's a huge adjustment and
the support of the validating. Validating means hearing how people
how someone's experience, experiencing their life and acknowledging that it's
a struggle and not saying something like oh, it'll go away,
(34:29):
which so many of us wanted to tend to do
because we wanted to go away. It's understandable, but it's
not helpful. Acknowledging that there's a problem and being there
for someone even just to talk and then maybe do
research for them, help them, you get the care that
they need. There are experts now being trained in perinetal
psychiatry and that's pretty amazing. Beyond just uh psychiatric residency.
(34:52):
They actually have specialties in women's mental health and that's
amazing across their life cycle. So yeah, what's not help
bowl was my mother, who I love so much as
she is the most incredible mother to me and I
love her so much. But like week four, she had
a nice come to Jesus buck up ah conversation with me,
(35:16):
God help me. I hope she hasn't listened to this
episode but she just had a real like you're being nasty,
You're crying a lot, and you need to buck up.
This is all on you. You're the mom. You need
to be the rock for your family. You need to
buck up. Get this, get your son dressed before seven am,
get them in the car. We've all done it. Buck
(35:39):
up and she left January four and January six, I
saw you and I had to say I needed help.
And then we had to have conversations where she had
her own stigmas attached to medication and said things like, well,
(36:00):
if you start, you're never going to be able to
get off. You'll be on it for the rest of
your life and that's not good. And her opinions on
my choices, and Dr sty knows this. I come from
a long line of anxious, worrying mother's, my mother's mother
me and I for me and my personal choice to
(36:21):
separate from how she treats her worries and anxieties for
me to go on medication right now at this point
in my life. Who knows how long or how short
or I don't know. Stay tuned on that listeners. But
I just kept being like, the buck stops here. I
am going to go in a different direction, and I'm
(36:42):
going to try a different way. But that was not
helpful for her to tell me to buck up constantly
and some tough love was not at that time. That
was not, let's sake it a different way. Maybe she
just pointed out that, yeah, you need to take care
of your family and it's not how happening and it's
a struggle, and that forced you to realize you needed
(37:06):
help sooner. Yeah, okay, that's another way of looking at guys.
We're having psychiatry happen right here, right now. Mom, I
love you so much. You're the greatest mother in the
entire world. We're all trying to do our best. What's
also great about Dr Stein is a mother of two herself. Yes,
and I've made many mistakes and feel like that's really
(37:28):
prepared them for the world, give them a lot of experience.
So I really believe in the concept called the good
enough mother, and I'm counting on it because I ain't perfect,
that's for sure. Dr Stein. I cannot thank you enough
for coming on Katie's Crib and for sharing your knowledge
(37:49):
and your experiences and your advice with our listeners on
this incredibly important topic. And also thank you so much
personally for being on the ride with me as one
of my guides through this. We're a team. We are
a team. We're a team. That's it me, you, your therapist,
my husband, team, You're a team, My pediatrician, everybody was
(38:12):
a huge key player and continues to be so Thank
you so much, Dr Stein for coming on Katie's Crib
My pleasure. Thank you guys for listening to Katie's Crib.
I want to hear from you. You guys were in
season four. What do you want to talk about? What
(38:33):
guests do you want to have on? Do you have questions?
You've comments? Hit me up Katie's Crib at Shanda land
dot com. Bye bye. Katie's Crib is a production of
Shonda Land Audio in partnership with I Heart Radio. For
more podcasts from Shannolan Audio, visit the iHeart Radio app,
Apple Podcasts, or wherever you listen to your favorite shows.
(39:00):
Story story, you never know until you try, until you can,
need to right
Welcome to Katie's Crib, a production of Shonda Land Audio
in partnership with I Heart Radio. It's a biological phenomenon
postpartum depression. It's not about your character, it's not about weakness,
it's not about being a bad mother. It just happens,
and it happens to a lot of us. Information provided
(00:28):
by Dr Kiristein during this podcast is for general education
purposes and should not be relied upon as professional medical advice, diagnosis,
or treatment for any individual. Welcome back to Katie's Crib.
I have someone here today who saved my life past tense,
is currently saving my life. I am still working with
her and I feel so grateful to have met her
(00:51):
in the darkest steps of despair in my own personal
life journey, and now I have her as one of
my greatest tools in my toolbox for all the ship
that will come my way in my life. So basically,
Dr Stein, you need to live forever. Thanks so much. Um.
This is psychiatrist Dr Kiris Stein. She's an assistant clinical
professor at the u c L A Semil Institute of
(01:13):
Neuroscience and Human Behavior at the u c L A.
Giffing School of medicine. Wow, that sounds really fancy. She
has her own private practice in Beverly Hill, specializing in
general adult psychiatry and Perry natal psychiatry. Thank you very much.
She also volunteers as an attending psychiatrist at the u
c L, a women's Life Center and outpatient program devoted
to assessing and treating women with psychiatric conditions associated with
(01:33):
reproductive life events and hormonal challenges. What a mouthful guy. Okay, welcome,
doctor Stein, thank you. The truth is, I'm just another
person who just went in one direction and learned a
lot about medicine and psychiatry and perinetle medicine. So hopefully
when patients see me or hear me, they know that
(01:56):
I'm just another human being who's just their partner and
trying to get them better. That's what it felt like.
And what was weird was when I reached out to
you to go back a little bit. I've been working
with a therapist for twelve years, and when I reached
about the three four week mark postpartum with my daughter,
I had in my o B four week check up
(02:17):
and she asked how I was doing, and I said,
oh ha ha, as a joke, because I brush everything
off and I'm still uncontrollably sobbing all the time. And
she was like, oh, that's something to look at. I
asked my therapist what she thought, and she said, yeah,
I think you should go to a psychiatrist. And already
I'm up in arms like what, No, I don't know,
I don't know. Okay, you know what. I'll go to
(02:37):
a psychiatrist and she's gonna give me some awesome panic
attack medication that's gonna go under my tongue and anytime
I get a panic attack about COVID or that I
can't do this or that I hate parenting right now,
I'm just gonna slip this thing under my tongue and
get a great night's sleep. I get introduced to Dr
Stein through my therapist. We have about a two hour
(03:00):
saltation to which at the end you say to me,
in my playing of it, oh no, honey, this isn't
like just to slip under your tongue once in a
while situation. You have postpartum depression and anxiety and it's
pretty high on the Edinburgh Postnatal Depression scale. And I
(03:21):
was like, what, No, not me. I'm a podcast host.
I'm a stable person. I've never been on medication, I've
never been diagnosed with depression. I'm the rock of my
family and all my friends. This isn't possibly happening to me.
And Dr Stein was like, you've been uncontrollably sobbing for
(03:44):
the last two hours and I have news for you.
You can't muscle your way through this, So can you
tell me at that time how you diagnosed me and
my personal case? And again this this goes to everyone listening, like,
this is my own personal story. How did you know
that I had postpartum depression versus like blues? Well, um,
(04:07):
there's a very big difference between the blues and postpartum depression.
Eight almost eight percent of women suffer from the blues,
and it's usually mild, and it usually occurs within the
first week of delivery, and it involves anxiety, your ability, tearfulness.
So you may have been experiencing some of that and thinking, okay,
talking everything up to oh, this is postpartum blues in
(04:29):
the beginning, and that usually lasts though no more than
two weeks. Okay, and it's mild. It doesn't affect functioning. However,
yours continued, Yours continued and got worse, and I would argue,
I think maybe it even started before the baby was
more it's called prenatal depression if it's started that way,
(04:49):
but postpartum depression. Actually six of postpartum depressions start before birth.
I definitely was not myself my entire pregnant. See, I
did not feel I felt overwhelmed, fear, panic attacks, sadness,
and I thought when I had the baby, and I
blamed it all on COVID, I blamed it all. Well,
(05:11):
it's like being pregnant in a pandemic, isolated, and when
the baby comes, I'll feel great because I will have
done it. I will have brought the baby safely into
the world. The baby came, and it took a down shift.
It was not the It got worse, Yes, it got
way worse, and it got worse with time. Yes, which
is what we normally see often see with postpartum depression
(05:33):
when it's a clinical depressive episode more than the usual
postpartum blues. And this scale, this Edinburgh, which by the way,
Edinburgh is like my favorite place I've ever gone in
the entire world. So I'm like, why does it have
to be Why is it called that? At what is
the Edinburgh post Natal to President scale. Well, it's a
(05:54):
ten point scale that it is pretty simple to answer.
It's online. Actually, I gave you a link to put
on your website associated with this podcast so that women
can access it. And it's some pretty simple screening questions
that can help women O b g n s and
pedetriten's and psychiatrists just get a sense of how severe
(06:16):
their depressions are and if they should get more help
if it's severe enough, if you even wonder if you're
experiencing a clinical depression and a clinical depression. The difference
with the clinical depression and the postpartum blues. Want to
make sure is that everyone understands is that a clinical
depression is a depression that impedes functioning, makes it hard,
(06:37):
at least in the postpartum context, to take care of yourself,
your baby, to nurture the baby. If left ongoing, it
has implications on the development of the baby. Yes, with
our listeners, I think I had postpartum blues with my son.
And the reason I say that now is because I
could function. I didn't hit the lows in the depths
of the rock bottom I did this time around, but
(06:58):
the first time. I you have to say, at eight
months postpartum, I opened on Broadway. I made my Broadway debut.
I mean that was my life's dream since I was
a little girl. And I put on a face, but
I was miserable. And it wasn't until I weaned. When
he was after a year, he was about fourteen fifteen
(07:19):
months old, and I remember looking in the mirror being like, oh, there,
I high should I think I was really sad that
that last year, and I feel like myself now. The
difference after Vera was that it felt like the weight
of the world to return a text. It felt like
I had done a champion feet by taking a shower.
(07:41):
When my daughter would cry and need me to breastfeed,
I felt immediate spikes and anxiety that I even had
to go into her room and care for her. And
all of those things were met with massive dread. Like
my worst times would be in the morning at five am.
I'd wake up early knowing that the day was neig
start and the kids were going to start needing me
(08:02):
at six am, and I was fucking terrified, horrified dread.
That's quintessential postpartum depression. And and you're pointing out some
important aspects of it. So with postpartum depression, we see
the usual depressions is in low mood, which is what
we see with a regular non postpartum, non pregnancy related depression,
(08:25):
But often we also see a prominence of anxiety and
even obsessions. And there's a difference, and I could explain
that shortly. There's a sense of being overwhelmed with fatigue,
with the challenge of facing the daily needs of the
baby and the family and um. There's just a real
(08:45):
sense of helplessness and worthlessness and for many women a
sense of incompetence about their parenting abilities, particularly with negative
thoughts about themselves and and and sometimes the rest of
the family. It just it can be really something that
is beyond their control. It just happens. Many women get
this about one in five. That is what the study show.
(09:12):
It kills me, one in five. It's huge. It's it's
extremely common, and just because it's common doesn't mean that
it's not serious. It's also the most common ebseentric complication
postpartum depression. So there is something where you think, when
(09:32):
you've been diagnosaed for postpart impression, you think, what's wrong
with me? And how could this have possibly happened? If
I'm a woman, I'm meant to rear children, I'm meant
to be a mother. This is supposed to be my
greatest calling. How how could this chemical imbalance even be
a thing? All women when they have a baby, they
go through the same, relatively the same thing with hormonal changes.
(09:55):
We know that estrogen and progesterone just crash plu mint
between having the baby and postpartum period within two weeks easily.
Do we know if that's the cause? Probably not. I
don't think it's the cause, because again, there's a majority
of women who don't get postpartum depression from the same
(10:17):
kind of crash. So we think that possibly there's an
increased sensitivity maybe to that hormonal fluctuation, And that goes
along with the knowledge that we have that certain women
who have either had postpartumpressions in the past, or mood
changes associated with menstruation or pre menstrual PMS, or have
(10:38):
had mood changes associated with taking oral contraceptives, that those
women are more likely to have postpartum depression. So there
might be a certain subset of women and maybe they're
medically predisposed. Not sure yet, You know, we need more data,
more research on it, but that's what it looks like
at this point that certain women are more likely under
(11:02):
certain situations, okay, to experience postpartum depression. And keep in
mind also we're in a natural disaster. It's called the pandemic,
so that increases stress hormone levels as well. So maybe
there was a threshold that, for example, you that you
just your body couldn't take. It was the pandemic, it
was the hormonal changes that maybe you're more sensitive to.
(11:24):
There's a lot of maybes here because we don't know
for sure. I don't know if you know this, but
you called into prescription to Walgreens and I let it
sit there. Dr Stein four days. I was like, ah,
not me. I'm going to get a second opinion. I'm
going to leave it there. I'm going to have a
long conversation with my husband and say, but I'm only
six seven, eight weeks out, give me a shot. Let's
(11:46):
look at this again at three months postpart of four
months postpartum. And then on the Saturday morning, I woke
up and I had horrible thoughts about my son. Suicidal
images kept come into my head, suicidal thoughts of it
would be easier if I wasn't here. I can't wake
up one more day like this. I don't want to
(12:07):
see my children. And then I got scared. I scared
myself into I've never had thoughts like this. I'm going
to go into a psychiatric word and I'm going to
have my children taken away from me because I'm unfit
to parent. I don't trust my brain anymore. I don't
recognize it. And I'm terrified. And I called you at
(12:28):
a nine am on a Saturday, hysterical crying. I didn't
know what was wrong with me. I didn't think I
could get through a Saturday with my two kids without help.
And it was so awful, and I drove to Walgreen's
like a five mileur It was like, I am starting
medication today because I don't see a way out of this.
(12:50):
I have to try something I've never tried before, because
I'm also at a place I've never been before. How
did you reach the diagnosis that met occasion was a
choice for me? Obviously, this is my own personal tail.
Why medication? Yeah, not everybody who comes in to see
me with postponed depression gets medication. So just letting you know,
(13:12):
it depends on the severity, and it depends on what's
been tried and what's worked. You tried everything. You had
been in therapy, right. I mean, can I say how
long you were in there? I don't even know how long? Okay,
So so you were in therapy for a while. There
was no doubt in my mind that you had tried everything,
talking to behavioral tasks and homework and and she you
(13:35):
want to walk crystals. I was pressing oils and crystals
to my heart, praying faith. I was begging ancestors. My
amazing acupuncturist was like, what about your placenta pills. I
was like, honey, I've been taking the placenta pills. I
dehydrated my placenta. I've been eating it for two months.
(13:56):
You're right, thank you. I did try. I tried everything. Right,
So you tried everything for a while, and it was
extremely clear to me, I do not try any of
those things. And you showed up to me with a
mild to moderate case. I might say, okay, maybe we
should just try psychotherapy and make sure that you have
all a bunch of supports and you're not isolated. But
you'd have done all that you were actually reaching out
(14:18):
to friends. I mean, I think you were a little
bit hesitant to maybe can reach out as much as
you did later on. Yes, Yes, I had reached out
to my two friends Mary and Talia, who I'm going
to have on this podcast, Mary and Talia. I reached
out to them because I knew they had postpartum depression,
and I knew that they had experiences with medications. So
(14:39):
I was already doing the research and seeing how other
mothers responded. Casey Wilson, who I had on this podcast,
I called her. She took me through her exact story.
So I was dipping my toe in, but I was
feeling I fell for every trap of feeling emba arrist
(15:00):
and ashamed to admit that I was feeling like a
failure in my mental health was not going great. Was
really hard. It's a biological phenomenon postpartum depression. It's not
about your character, it's not about weakness, it's not about
(15:20):
being a bad mother. It just happens, and it happens
to a lot of us. And often it's not just
postpartum depression. It mixes with anxiety, a lot of anxiety,
and so that's why a lot of people get confused
sometimes when there's so much anxiety involved in postpartum, depression
is at the forefront of people's minds and they don't
realize they're also depressed. If someone has tried lots of
(15:53):
things and you do feel that medication is an option
that they should try, my understanding was that zoloft is
great at work with both depression and anxiety, because I
was struggling with both. A lot of the antidepressants deal
with both. It depends on other other symptoms, other side effects.
I just personalized the specific choice of medications to what
(16:13):
the patient is experiencing. I would say that most of
the antidepressants that I work with in women who are
breastfeeding or not postpartum, it depends on their personal situation.
It may not be just about anxiety or depression. But
that was a big thing too. I felt such guilt
about wanting to breastfeed and also wanting to take medication
(16:35):
and knowing that I needed it. And now that I've
been on the medication, I do feel the light of Oh,
it sucks that I'm on zoloft and breastfeeding, and yes,
I wish I wasn't in a situation, but I can't
tell you how much more fun and a better time
I'm having mothering her. The fact that I am obsessed
with her now and like love being her parents, and
(16:57):
love parenting my son even though he's a three nature,
that trade off is fucking worth it for me. What
would you say to women who are still afraid that
medication would get into their babyes systems? There are several
antidepressants that we can use in breastfeeding that are relatively safe,
and so the risks benefit analysis for each patient has
(17:20):
to be taken to consideration. But generally speaking, we can
treat most postpartum depressions very easily with medication. UM, I
think the best course of action is to prioritize mother's
mental health and ultimately the baby's health. If the only
(17:41):
reason why you're not going to take a medicine that's
going to help you with your depression is because you're
afraid a small amount will enter your baby system. As
a psychiatrist, you want to honor everyone's desires and there
and then what they want, and of course the psychiatrist
will support you in whatever decision you make. But I
worry that risk benefit analysis is skewed. There if somebody's
(18:03):
severely depressed. I completely agree. And I have to say
I was so freaked out about breastfeeding Vera, and I
had to really weigh out, Okay, the options do I
quit breastfeeding. In my personal case, I felt like that
was going to cause me to be further to wake
my depression worse because I felt like I had breastfed
(18:23):
Alby for a year and it felt unfair and I
was felt terrible. And you said you were doing really
well with breastfeeding. You felt connected and bonded with the baby.
For sure, I wouldn't want to take that away from you.
And then you I think you were getting enough sleep,
So yes, for sure, continue and start medicine. Yep, yep.
(18:43):
And then I've talked to some mothers who breastfeeding, like
you said, caused them such depression and pain because they
it was stressful to them that it wasn't going well,
breastfeeding was going so poorly that it wasn't until they
just quit and started bottle feeding that they started enjoying motherhood.
And it really I'm one of those mothers. I'm one
(19:04):
of those mothers. I tried for I think it was
six months with my daughter and I couldn't produce. When
you rescue, do the best, your child gets dehydrated because
they're struggling to get the milk out, and then you're
pumping on afterwards, hoping to get eke out every ounce
on one ounce after forty you give them the formula.
They'll be happier because they're fatiated. You'll be happier because
(19:29):
you sleep, and you won't be faced with failure after failure.
So that's that situation. But I do also have to
add that when I was so freaked out, I texted
the best lactation consultant in Los Angeles, the lactation consultant
to the stars, Linda Hannah, who has been on this
podcast and is fucking amazing. And I texted my pediatrician,
who is also incredible. I have never received text back
(19:51):
fast enough that said, go on the zoloft. Great, great,
your baby is fine. My what they we're concern The
pediatrician who's number what concerned is my baby, was very
concerned about my mental health and said, please, you're fine.
(20:11):
To have a healthy baby, need a healthy mom. Yeah,
that's simple. Whatever choice that is for you to go
on medication. That's been absolutely for breastfeeding or whether to
quit breastfeeding entirely, or you know, any of the things
we've discussed. Because you know, Dr Stein, I want to say,
not only medication, but you sent me meditations to be
doing when my anxiety flared up. We talked about some
(20:34):
faith centering practices that I can do to really lift
my spirit up to a higher power. And it was
very helpful. You You really encouraged me to FaceTime friends
that even in COVID, like going out for a social
distance walk with a friend and being honest was so
groundbreaking lee helpful. Um, So there were so many things
(20:55):
working in tandem, is what I'm trying to say, you know,
and it's really just medica patient. I would never say
that it's other things. When somebody suffering from a moderate
or severe episode of depression, somebody shows up mild to moderate,
I generally recommend that they try other things if it's
(21:15):
moderate to severe, and your case it was severe. Yeah,
it was severe, you know, based on the Edinburgh That's
what you said at the end of overse conversation. It
was like the mic drop of all mic drops in
my life. Now, postpartum depression, it can happen anytime. Cases
start after delivery, mostly during the first month postpartum. Okay,
(21:39):
but almost nine percent of cases occur by four months postpartum.
Total of the postpartum depression cases so there are a
few are between fifth and the twelve month postpartum. There
are different definitions from different associations and organizations of what
postpartum depression is. I kind of like the concept that
(22:02):
postpartum depression can start during pregnancy or within twelve months postpartum,
and that's the American College of Centric's and Ganecologies definition.
Got it because I think it covers everything. But as
I mentioned before, almost six of postpartum depressions start before
the baby is born, so that would be before conception,
(22:28):
women who are just conceiving well depressed, and thirty during pregnancy. Yep,
that was me. And now I've just heard my first
story of a man who got diagnosed with postpartum depression
after his wife delivered their baby. Is that a thing?
It is a thing. And about ten percent of fathers
(22:51):
get a postpartum depression they get postpartupression is just clinical
medical major depressive disorder, whether a male or a female.
If it's after your child has had has been born
and it's been diagnosed within the year, it's postpartum depression.
And about ten percent of men experience clinical depression either
(23:14):
during their spouses or their partners pregnancy or during the
postparton year. Wow. Wow, that's fascinating. I mean there's a
lot of suffering. Oh my gosh. How long does postpartum
depression last? Typically it depends on if it's treated or not.
(23:34):
So in general, the estimation is that postpartum depressions can
last at least a year. What is the risk I
worry now endlessly about women who go untreated or delay
seeking treatment. What is what's the risk there? Well, there's
a risk to themselves depression, clinical depression, untreated and prolonged suicide.
(23:59):
Women taking care of themselves increases the risk of marital
and partner discord. Not being able to take care of
their families, their babies the way they would normally want to,
missed edutrian visits, not taking your penatal vitamins, or some
women forget to get to work, more accidents, for example,
or they forget to put their babies in their booster seats.
And in terms of the baby mother infant attachment to
(24:22):
the bonding is usually diminished when it's a significant postpartum
depression and just a lack of responsivity, emotional responsivilty, and
even physical responsivility to their babies. And it's not intentional,
it's just that's the way you're functioning if you have
postpartum depression, and babies are just more at risk. Therefore,
(24:43):
when their mothers are less connected with them, less nurturing,
less likely to as time goes by, like peekaboo or
read to them or saying to them, the babies tend
to develop into older children and even adults who are
more likely to experience depressive episodes themselves and anxiety and
other behavioral difficulties themselves. So it is a concern. Wow, God,
(25:08):
that is so there's a risk to not treating as
well people forget that. How do you recommend mothers prepare?
I don't know if I could have done anything differently.
But let's say a woman listening is pregnant, she hasn't
(25:31):
dealt with depression in the past, or or whatever. Maybe
she has, but like, what, what do you what? We
want for sure for sure if someone has had a
history or a family history of mental illness, even just
general amountal illness puts you at risk in your family,
So if there's a family history, if there's a personal
history of just not only postparts depression, but depression in general,
clinical depression, or a history of an anxiety disorder. Anxiety
(25:55):
disorders are the most common psychiatric disorders that people can
have in the United Say, it's so, it's not that uncommon.
But also if you're at risk if you're struggling economically,
which is ironic, I understand if if you're in terms
of you're struggling economically, but yet you need to seek
extra care um financially, that can be very difficult. So
if you're striking economically, if you're having difficulties with obstetric complications,
(26:21):
prenatal complications, that puts you at risk. Thyroid disorder, diabetes,
medical illnesses will put you at risk, particularly if you're
experiencing crisis and your family, like difficulties with with your marriage,
or if you have a history of trauma, sexual trauma
or being a victim of domestic violence, if you're single,
or you have very few supports in your life, Definitely
(26:44):
you're more at risk the more children you have, more
having many children or more than one is a risk
factor because your hands are full, there's sleep deprivation during breastfeeding,
or even just the baby crying all the time. You know,
that also is a trigger for postpondon depression understandably. So
if you're more at risk for all those reasons, and
there are probably others I can go into, then I
(27:06):
would say have a conversation with your o B. Have
a conversation. Hopefully your OBI is already screening for those
risk factors before like that the first visit, prenatal visit
and then intermittently throughout pregnancy and then postpartum, you know,
before even leaving the hospital. It would be great if
(27:27):
a nurse or an OBI just went through the Edinburgh
Post at All Depression Scale. I know that a lot
of pedetricians are now because they are seeing the moms
more than the obs postpartum, are administering the Edinburgh scale
as well, and that's really helpful. And also it's not
just getting the number of severity from the Edinburgh Scale,
(27:48):
it's opening up the door for a conversation about depression
normalizing it. It is so common and as you said, culture,
the culture that we live in wants us to be
superwomen and we're not. And that's okay, we're not super women.
We can't do it all. It's not possible. In fact,
(28:10):
you know a few thousand years, we can even go
actually two hundred years back. Okay, it took a village
to raise a child. And this is we live in
a very isolated world, so that increases the risk for
I would say everyone when it comes to postpartum depression,
were more isolated. There's less help. There's there's less people available,
(28:31):
easily available, that's in your home to help with the
baby with feedings. Right. Not only is there less help
and less community around raising your baby, there's more pressure
to make it seem like you've got it going on,
between announcements and mailing postcards what the baby looks like,
and social media and posting the first Instagram shot and
(28:54):
tweeting the first you know, my post baby body, I
got it back blah bloody, bloody blah. It's like a
two for to just really mess with the mom only
do you have to do this alone, but you have
to look amazing while you do it. The responsibilities are
very heavy postpartum in particular and going forward, I think
(29:15):
motherhood is the hardest job it's the hardest job. It's
harder than being a doctor. It's harder than being an actress.
By it's harder than being a duchess. Okay, it's harder
than being a duchess. At the time of this recording,
the Megan Markle Harry Oprah interview has happened this week,
and I have to say, I don't know Dr Stein,
(29:38):
but now that I have seen postpartum depression up close
and personal, I look at her and I'm like, she
had postpartum depression dealing with that right now currently during
her second pregnancy. Oh and I also just watched the
Britney Spears documentary and she's sobbing pregnant with her two
year old on her lap, and I'm like, I don't
know if she's being treated, but I feel like she
has post fucking part of depression. That's what I looked like,
(30:03):
sobbing with my son on my lap. I don't know.
I don't know if we'll ever know, and that's their
own personal thing, but I really feel like Megan Markel
needs to come on this podcast. You should invite her.
I knew her, we used to audition against each other
for years, but I hope, Megan Markle in all seriousness,
(30:24):
I just it just my heart goes out again to
anyone struggling. And what's crazy about mental health is that
affects actresses, duchesses, women with four jobs, single women, women
with money, women without money. It's this exactly. It's indiscriminate,
(30:47):
except I would say, the more stress you're under, yes,
that's right, that can also increase the risk of postpartum depression,
of any kind of depression, anyven It isolates. What are
some of the biggest misconceptions around postpartum depression, Like, what
do you wish people understood more about it? Postpartum depression
is more than just the blues. That's extremely important for
(31:11):
people to understand. It's a clinical depression that affects functioning um.
Postpartum depression is not a sign of weakness, it's not
a sign of bad parenting. It's completely treatable. And postpartum
depression is not postpartum psychosis, and I want to explain
the difference. Please. Postpartum psychosis is very rare, one to
(31:35):
two out of a thousand pregnancies. It's usually associated with
bipolar disorder, where people have a history of feeling really
high without drugs, and also depressive episodes. Okay, it's usually
associated with bipolar disorder, but sometimes by the time they
people become pregnant and have a baby, they haven't had
(31:55):
a manic episode yet, so it's kind of about postpartum
depressions are actually bipolar depressions. So then that's important to
factor in psychosis. Let me just describe what that is,
because I'm not sure people really understand what that is.
Psychosis is a break from reality with disorganized delusional thinking.
So that means paranoid thoughts, really paranoid thoughts like people
(32:17):
are after you or trying to get you, or strange
beliefs that don't reflect reality. So it also involves sometimes
hearing voices or seeing visions. So it's a complete break
from reality. So obviously there's very little functioning going on
there and some have even um. You know, the big
risk with postpartum psychosis, which is a psychiatric emergency and
(32:39):
there's a dramatic onset. It's usually the first two weeks
after delivery, but could be later, but it's high risk
for the baby, high risk for the mother and other children.
It's a psychiatric emergency and it should be identified promptly
and hospitalized, but be ut very treatable, extremely treatable, and
it doesn't mean you're gonna your baby's gonna taken away
(33:00):
from you. People always think, oh, I'm gonna go to
the hospital. I think you instead it just in the
beginning you were afraid of going to the hospital and
your baby is being taken away from you. That not
how it works. A psychiatric hospital is extremely nurturing. There's
group therapy, there's intensive you know, psychotherapy, and there's psychiatric help,
and some actually integrate having the baby there in a
(33:20):
safe way. The psychosis is rare, the postpartum depression is common,
and it and yet all of us are here on
the other side and it's treatable and there's no reason,
there's no reason to be embarrassed. I wish people would
talk about it more. I'm sure you have that snapshot
(33:41):
in your mind when you've had a great experience with
it with your baby and you've rest fed them and
everyone's peaceful. But there's a lot going on in between,
and life is messy even in the best of circumstances.
It's hard. Yeah, how do you think loved ones can
best support those with postpartum depression. Listen, don't assume postpartum
(34:06):
motherhood is easy or glorious. It's a huge adjustment and
the support of the validating. Validating means hearing how people
how someone's experience, experiencing their life and acknowledging that it's
a struggle and not saying something like oh, it'll go away,
(34:29):
which so many of us wanted to tend to do
because we wanted to go away. It's understandable, but it's
not helpful. Acknowledging that there's a problem and being there
for someone even just to talk and then maybe do
research for them, help them, you get the care that
they need. There are experts now being trained in perinetal
psychiatry and that's pretty amazing. Beyond just uh psychiatric residency.
(34:52):
They actually have specialties in women's mental health and that's
amazing across their life cycle. So yeah, what's not help
bowl was my mother, who I love so much as
she is the most incredible mother to me and I
love her so much. But like week four, she had
a nice come to Jesus buck up ah conversation with me,
(35:16):
God help me. I hope she hasn't listened to this
episode but she just had a real like you're being nasty,
You're crying a lot, and you need to buck up.
This is all on you. You're the mom. You need
to be the rock for your family. You need to
buck up. Get this, get your son dressed before seven am,
get them in the car. We've all done it. Buck
(35:39):
up and she left January four and January six, I
saw you and I had to say I needed help.
And then we had to have conversations where she had
her own stigmas attached to medication and said things like, well,
(36:00):
if you start, you're never going to be able to
get off. You'll be on it for the rest of
your life and that's not good. And her opinions on
my choices, and Dr sty knows this. I come from
a long line of anxious, worrying mother's, my mother's mother
me and I for me and my personal choice to
(36:21):
separate from how she treats her worries and anxieties for
me to go on medication right now at this point
in my life. Who knows how long or how short
or I don't know. Stay tuned on that listeners. But
I just kept being like, the buck stops here. I
am going to go in a different direction, and I'm
(36:42):
going to try a different way. But that was not
helpful for her to tell me to buck up constantly
and some tough love was not at that time. That
was not, let's sake it a different way. Maybe she
just pointed out that, yeah, you need to take care
of your family and it's not how happening and it's
a struggle, and that forced you to realize you needed
(37:06):
help sooner. Yeah, okay, that's another way of looking at guys.
We're having psychiatry happen right here, right now. Mom, I
love you so much. You're the greatest mother in the
entire world. We're all trying to do our best. What's
also great about Dr Stein is a mother of two herself. Yes,
and I've made many mistakes and feel like that's really
(37:28):
prepared them for the world, give them a lot of experience.
So I really believe in the concept called the good
enough mother, and I'm counting on it because I ain't perfect,
that's for sure. Dr Stein. I cannot thank you enough
for coming on Katie's Crib and for sharing your knowledge
(37:49):
and your experiences and your advice with our listeners on
this incredibly important topic. And also thank you so much
personally for being on the ride with me as one
of my guides through this. We're a team. We are
a team. We're a team. That's it me, you, your therapist,
my husband, team, You're a team, My pediatrician, everybody was
(38:12):
a huge key player and continues to be so Thank
you so much, Dr Stein for coming on Katie's Crib
My pleasure. Thank you guys for listening to Katie's Crib.
I want to hear from you. You guys were in
season four. What do you want to talk about? What
(38:33):
guests do you want to have on? Do you have questions?
You've comments? Hit me up Katie's Crib at Shanda land
dot com. Bye bye. Katie's Crib is a production of
Shonda Land Audio in partnership with I Heart Radio. For
more podcasts from Shannolan Audio, visit the iHeart Radio app,
Apple Podcasts, or wherever you listen to your favorite shows.
(39:00):
Story story, you never know until you try, until you can,
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