Sarah DeBrunner, MD, a psychiatrist with UPMC Magee-Womens Behavioral Health Services discusses some of the causes of anxiety and depression in new moms and when and how it’s time to seek treatment.
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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. Along with joy and excitement, the birth of a baby can also bring with it anxiety and depression. So what causes it, and what can new moms do to cope? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast, and joining us right now as Dr. Sarah DeBrunner. She is a psychiatrist who is part of the Behavioral Health Services for women at UPMC Magee-Womens Hospital. Doctor, thanks so much for joining us.
– Thank you.
– Let’s begin with really how common can anxiety and postpartum depression be in new moms?
– Sure. Well, it’s fairly common. So, postpartum depression happens in about one out of seven moms, and postpartum anxiety can occur in about one out of five women. So we know pregnancy is not protective, which we might have thought several years ago. And so this happens a lot more frequently than one would expect.
– So, as we said, you would think this is the most joyous time of their lives, but there are really some physical things that go on to the body that can help to contribute to this.
– Well, correct. Depression and anxiety can happen not just in the postpartum period but also during pregnancy, when mom’s body’s expanding and she’s supporting another being, and it might bring on body image disturbances. Postpartum, then we see hormonal fluctuations that happen. And that might be a precipitator to developing depression and anxiety.
– When we talk about anxiety, how do you define anxiety?
– Well, anxiety is a fairly general term. There is many different types of anxiety disorders. Generally, anxiety is worry, uneasiness, or fear of event coming up or uncertainties. And so, of course, in pregnancies, there is a lot of uncertainties. There is different types of anxiety disorders, such as generalized anxiety disorder, where the hallmark symptom is excessive worry about things. There is social anxiety, where one might fear social situations and even avoid those situations for fear of scrutiny. Post-traumatic stress disorder is another type of anxiety disorder. When a trauma has happened in the past, it can then lead to a constellation of symptoms of anxiety. Panic disorder is another one, which we’ve all heard of. You know, anxiety with a flood of physical symptoms that come on. I’d also like to like obsessive compulsive disorder, which is a related disorder. And this happens at a higher rate in women postpartum. Obsessions are intrusive thoughts or images, typically of something bad happening, and compulsions are the behaviors in response to an obsession or to quell the anxiety. So a common example would be most mothers fear SIDS, but some women, it becomes so distressing that they may not sleep at night. They may be up obsessing over whether their baby is breathing and not sleep at all because they repetitively check on their infants for their well-being.
– When it comes to depression, how do you know when it’s the difference between just, we hear people say baby blues and depression, is there really a thing as baby blues? And let’s talk about what depression means.
– It’s a good question. So yes, baby blues is a thing, and up to 80% of women will experience this. So, it’s fairly normal. What it is is women will feel more emotional. They may have some labile emotions moving from sadness, to anxiety, to irritability, or just general feelings of overwhelm, but it doesn’t typically impact their functioning, and it lasts less than two weeks. So the difference is postpartum depression is then often referred to as a major depressive episode, and this is a more severe form of depression. The two symptoms that have to be met for major depression are a depressed mood that’s sustained, most days, for the majority of the day, for at least two weeks or more. Or, loss of enjoyment in life or typical activities that one does. And then there is a constellation of other symptoms that have to be met, such as feelings of hopelessness, feelings of worthlessness, or guilt. And this is a common one in mothers who are suffering from depression. They may feel like they’re a really horrible mother or they’re not good enough. And then they feel guilty for not being well or feeling depressed. In more severe cases, suicidal ideation can be a part of it, and then other symptoms, such as sleep changes, appetite changes, and low energy are also a part of major depression. Those are also common in women who are postpartum.
– I was just going to say, if you’ve just had a child, clearly you’re not sleeping. And how does that contribute to it as well?
– Well, correct. So, you know, when we make the diagnosis major depression, we’re really relying on more of the mood symptoms, the depression. Because all women are going to be struggling with sleep at this point, but many women might have sleepless nights and it doesn’t impact their mood. It doesn’t lead to depression. Certainly, for some, we know that insomnia can be a risk factor for depression. So if insomnia is occurring, then that’s something to key in on and ask the mom more about and to ask more about and how is her mood as well.
– If you have dealt with depression or anxiety before pregnancy, does that increase the chances that you will suffer with it during and after?
– Absolutely. So, depression in pregnancy is the biggest risk factor for postpartum depression. And so we often use the term perinatal depression to encompass pregnancy and postpartum. So it highlights how important it is to treat depression prior to pregnancy and during pregnancy to prevent postpartum depression.
– When we were talking about the baby blues earlier, are there techniques that patients can do at home when dealing with baby blues? Or are there any sort of things that you say to people, if it’s not an official diagnosis, of things to do at home to feel better? What do you say to moms?
– Right. I always encourage a little bit of self-care. Moms often don’t feel as though they can take time out for themselves, right? They’re focused on taking care of their baby 24/7, and they forget about themselves. So I encourage them to find out who in their supports can physically help them, who in their supports can be that emotional go-to person, and to ask for the help and accept help? That’s really hard for new moms to do. Optimizing sleep can be helpful. There is all sorts of things that can be done. Setting up shift work for sleeping with a partner or family member, whoever can help mom get the rest she needs, or just having someone there to allow mom to take a shower without a baby, you know, right there. Just getting a little bit of a break.
– Right. So you just went through lots of symptoms. How many of those do you have before you should go and get help? And what do you want to say to somebody about when they should consider seeking out help?
– I think in general, moms know when they’re not feeling well. When they just aren’t functioning like they used to. They will know when their mood is just not the same as it used to be. And if there is any doubt about how well she’s doing, if there’s something wrong, I would seek them to talk to someone right away. And then we can figure out if there is a diagnosis of major depression. Certainly, if a mom is having any suicidal thoughts, that’s an emergency and we want her to talk to someone right away. When a mom’s functioning is starting to be impaired, let’s say she is having trouble taking care of herself or her infant, that’s of course a sign that we want her to talk to someone and seek help.
– So what does treatment look like? Give folks a sense. And I guess, first, talk about the Behavioral Health Services for women at UPMC Magee and sort of what the thinking was behind putting that program together.
– Well, sure. This is a very specialized and vulnerable population and often forgotten about. And so, there is specialized care that goes into women who are pregnant and postpartum, especially medication management. It’s helpful to have a risk discussion with moms to help them make the best treatment plan during pregnancy and postpartum. So there is risks of mental health in pregnancy, there can be risks of medications in pregnancy, and it’s our job to help the mom come up with a plan she feels comfortable with after understanding both sides. So that’s what we do at Magee Behavioral Health. We have a set of therapists and psychiatrists that all specialize in in women’s mental health. We have our general outpatient services, and then we have a more intensive outpatient programming, which is called the NEST IOP. And that’s where moms who are struggling with more moderate to severe illness, and they might need a little bit more treatment, and that includes individual therapy, group therapy, and medication management if it’s warranted.
– Can you talk a little bit about how you really work to balance medication therapies? It’s not a one-size-fits-all approach.
– That’s correct. And all women will make a different decision on their treatment and what they feel comfortable with. With mild depression or mild anxiety, we always start with psychotherapy, and that can be quite effective in managing someone’s symptoms. When symptoms become moderate to severe, we also introduce medication management as an option. Both therapy and medications tend to be the most helpful.
– And what do you want to say about stigma? For a long time, there was lots of stigma attached to therapy, et cetera. Do you feel, I guess, first, that that stigma is going away and that people are recognizing, taking care of your mental health is important?
– Right. I think we’ve improved with stigma. You know, celebrities have come forward and shared their stories about their struggles with postpartum depression and anxiety, and I think that’s helped women not feel alone. It’s still an issue, though. And the dilemma with stigma is it certainly prevents moms from coming in and seeking help. They might feel as though if they’re struggling, they’re going to be viewed as an unfit mother, and they worry about how others will view them. We know that problems just proliferate in the dark, and unfortunately mom’s depression and anxiety can impact the health of their baby. So this does become a driving force for women to come in. It’s a good motivating factor for them to seek help. But if someone is struggling, I always encourage women, reach out to a family or a friend who you think might be understanding, or reach out to us because we don’t want any mother to be suffering alone and in isolation.
– Right. One thing we should point out is a mother saying, “I’m busy enough, I can barely take care of my baby. I’m dealing with this depression. I don’t have time to drive and go sit in an office and have a therapy session.” But that’s not necessarily the case.
– Not anymore. Yeah. So with the pandemic has brought on telehealth services. And the majority of work I do is through telehealth now. So the mom can be sitting at home, you know, going about her day and then take a break to talk to her therapist or her psychiatrist, and it’s really convenient. We’ve been able to reach out to so many more moms this way. It cuts down on the barriers of transportation or finding child care for your child to come into our office to be seen.
– And have you seen, especially since the onset of COVID, an increase in cases and an increase of women who are struggling?
– Absolutely. There is more stress in the world, and especially for our young parents. So, you know, the saying, “It takes a village to raise a child,” is there for a reason. And then with the pandemic, that village is cut off, right? Because no one wants to contract COVID. And so what we see in our young moms is that parents or family members who might typically come in to help aren’t able to. And then, of course, moms who have older children who are in and out of school, they might be being sent home from school because of exposures, that’s an added burden and added stress on them. And so the stress of parenting has really risen during the pandemic, and we are seeing a lot more referrals.
– And so how do you define the success? What’s a success story for you?
– Well, a success story is a mom that gets to the point where she’s feeling back to herself, right? She is doing well, she feels happy, she is enjoying life. She may still be on medications a year postpartum, or she might be at the point where if she feels well enough, she can taper off of medications. And I’ve had many patients who have sent me messages after they’ve had their second child and they got through their pregnancy well, they didn’t postpartum symptoms. They’re so excited to have gone through the process and in a better way, right? Without feeling down and out and being able to enjoy their pregnancy. And often, they’ve picked up a lot of tools in the first pregnancy to have helped them do that in the second pregnancy. And that’s such a success, to see that they’ve gone through this struggle, and, you know, they’ve been able to move on and have another child and really do well.
– Dr. Sarah DeBrunner, thank you so much for coming in and spending some time with us today. Some great information.
– Thank you.
– You’re welcome. I’m Tonia Caruso, thank you for joining us. This is UPMC HealthBeat.
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UPMC Western Psychiatric Hospital is the hub of UPMC Behavioral Health, a network of community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors. Our mission is to provide comprehensive, compassionate care to people of all ages with mental health conditions. UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. We are here to help at every stage of your care and recovery.
For more than a century, UPMC Magee-Womens Hospital has provided high-quality medical care to women at all stages of life. UPMC Magee is long-renowned for its services to women and babies but also offers a wide range of care to men as well. Our patient-first approach ensures you and your loved ones get the care you need. Nearly 10,000 babies are born each year at Magee, and our NICU is one of the largest in the country. Our network of care – from imaging centers to hospital services – provides care throughout Pennsylvania and Maryland, giving you a chance to get the expert care you need close to home. The U.S. Department of Health and Human Services recognizes UPMC Magee as a National Center of Excellence in Women’s Health, and the Magee-Womens Research Institute is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology.