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Speaker 1: Welcome to Katie's Crib, a production of Shonda Land Audio

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Speaker 1: in partnership with I Heart Radio. It's a biological phenomenon

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Speaker 1: postpartum depression. It's not about your character, it's not about weakness,

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Speaker 1: it's not about being a bad mother. It just happens,

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Speaker 1: and it happens to a lot of us. Information provided

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Speaker 1: by Dr Kiristein during this podcast is for general education

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Speaker 1: purposes and should not be relied upon as professional medical advice, diagnosis,

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Speaker 1: or treatment for any individual. Welcome back to Katie's Crib.

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Speaker 1: I have someone here today who saved my life past tense,

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Speaker 1: is currently saving my life. I am still working with

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Speaker 1: her and I feel so grateful to have met her

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Speaker 1: in the darkest steps of despair in my own personal

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Speaker 1: life journey, and now I have her as one of

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Speaker 1: my greatest tools in my toolbox for all the ship

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Speaker 1: that will come my way in my life. So basically,

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Speaker 1: Dr Stein, you need to live forever. Thanks so much. Um.

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Speaker 1: This is psychiatrist Dr Kiris Stein. She's an assistant clinical

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Speaker 1: professor at the u c L A Semil Institute of

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Speaker 1: Neuroscience and Human Behavior at the u c L A.

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Speaker 1: Giffing School of medicine. Wow, that sounds really fancy. She

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Speaker 1: has her own private practice in Beverly Hill, specializing in

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Speaker 1: general adult psychiatry and Perry natal psychiatry. Thank you very much.

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Speaker 1: She also volunteers as an attending psychiatrist at the u

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Speaker 1: c L, a women's Life Center and outpatient program devoted

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Speaker 1: to assessing and treating women with psychiatric conditions associated with

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Speaker 1: reproductive life events and hormonal challenges. What a mouthful guy. Okay, welcome,

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Speaker 1: doctor Stein, thank you. The truth is, I'm just another

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Speaker 1: person who just went in one direction and learned a

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Speaker 1: lot about medicine and psychiatry and perinetle medicine. So hopefully

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Speaker 1: when patients see me or hear me, they know that

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Speaker 1: I'm just another human being who's just their partner and

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Speaker 1: trying to get them better. That's what it felt like.

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Speaker 1: And what was weird was when I reached out to

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Speaker 1: you to go back a little bit. I've been working

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Speaker 1: with a therapist for twelve years, and when I reached

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Speaker 1: about the three four week mark postpartum with my daughter,

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Speaker 1: I had in my o B four week check up

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Speaker 1: and she asked how I was doing, and I said,

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Speaker 1: oh ha ha, as a joke, because I brush everything

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Speaker 1: off and I'm still uncontrollably sobbing all the time. And

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Speaker 1: she was like, oh, that's something to look at. I

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Speaker 1: asked my therapist what she thought, and she said, yeah,

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Speaker 1: I think you should go to a psychiatrist. And already

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Speaker 1: I'm up in arms like what, No, I don't know,

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Speaker 1: I don't know. Okay, you know what. I'll go to

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Speaker 1: a psychiatrist and she's gonna give me some awesome panic

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Speaker 1: attack medication that's gonna go under my tongue and anytime

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Speaker 1: I get a panic attack about COVID or that I

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Speaker 1: can't do this or that I hate parenting right now,

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Speaker 1: I'm just gonna slip this thing under my tongue and

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Speaker 1: get a great night's sleep. I get introduced to Dr

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Speaker 1: Stein through my therapist. We have about a two hour

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Speaker 1: saltation to which at the end you say to me,

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Speaker 1: in my playing of it, oh no, honey, this isn't

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Speaker 1: like just to slip under your tongue once in a

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Speaker 1: while situation. You have postpartum depression and anxiety and it's

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Speaker 1: pretty high on the Edinburgh Postnatal Depression scale. And I

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Speaker 1: was like, what, No, not me. I'm a podcast host.

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Speaker 1: I'm a stable person. I've never been on medication, I've

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Speaker 1: never been diagnosed with depression. I'm the rock of my

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Speaker 1: family and all my friends. This isn't possibly happening to me.

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Speaker 1: And Dr Stein was like, you've been uncontrollably sobbing for

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Speaker 1: the last two hours and I have news for you.

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Speaker 1: You can't muscle your way through this, So can you

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Speaker 1: tell me at that time how you diagnosed me and

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Speaker 1: my personal case? And again this this goes to everyone listening, like,

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Speaker 1: this is my own personal story. How did you know

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Speaker 1: that I had postpartum depression versus like blues? Well, um,

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Speaker 1: there's a very big difference between the blues and postpartum depression.

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Speaker 1: Eight almost eight percent of women suffer from the blues,

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Speaker 1: and it's usually mild, and it usually occurs within the

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Speaker 1: first week of delivery, and it involves anxiety, your ability, tearfulness.

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Speaker 1: So you may have been experiencing some of that and thinking, okay,

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Speaker 1: talking everything up to oh, this is postpartum blues in

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Speaker 1: the beginning, and that usually lasts though no more than

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Speaker 1: two weeks. Okay, and it's mild. It doesn't affect functioning. However,

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Speaker 1: yours continued, Yours continued and got worse, and I would argue,

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Speaker 1: I think maybe it even started before the baby was

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Speaker 1: more it's called prenatal depression if it's started that way,

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Speaker 1: but postpartum depression. Actually six of postpartum depressions start before birth.

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Speaker 1: I definitely was not myself my entire pregnant. See, I

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Speaker 1: did not feel I felt overwhelmed, fear, panic attacks, sadness,

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Speaker 1: and I thought when I had the baby, and I

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Speaker 1: blamed it all on COVID, I blamed it all. Well,

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Speaker 1: it's like being pregnant in a pandemic, isolated, and when

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Speaker 1: the baby comes, I'll feel great because I will have

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Speaker 1: done it. I will have brought the baby safely into

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Speaker 1: the world. The baby came, and it took a down shift.

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Speaker 1: It was not the It got worse, Yes, it got

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Speaker 1: way worse, and it got worse with time. Yes, which

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Speaker 1: is what we normally see often see with postpartum depression

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Speaker 1: when it's a clinical depressive episode more than the usual

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Speaker 1: postpartum blues. And this scale, this Edinburgh, which by the way,

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Speaker 1: Edinburgh is like my favorite place I've ever gone in

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Speaker 1: the entire world. So I'm like, why does it have

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Speaker 1: to be Why is it called that? At what is

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Speaker 1: the Edinburgh post Natal to President scale. Well, it's a

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Speaker 1: ten point scale that it is pretty simple to answer.

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Speaker 1: It's online. Actually, I gave you a link to put

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Speaker 1: on your website associated with this podcast so that women

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Speaker 1: can access it. And it's some pretty simple screening questions

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Speaker 1: that can help women O b g n s and

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Speaker 1: pedetriten's and psychiatrists just get a sense of how severe

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Speaker 1: their depressions are and if they should get more help

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Speaker 1: if it's severe enough, if you even wonder if you're

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Speaker 1: experiencing a clinical depression and a clinical depression. The difference

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Speaker 1: with the clinical depression and the postpartum blues. Want to

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Speaker 1: make sure is that everyone understands is that a clinical

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Speaker 1: depression is a depression that impedes functioning, makes it hard,

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Speaker 1: at least in the postpartum context, to take care of yourself,

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Speaker 1: your baby, to nurture the baby. If left ongoing, it

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Speaker 1: has implications on the development of the baby. Yes, with

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Speaker 1: our listeners, I think I had postpartum blues with my son.

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Speaker 1: And the reason I say that now is because I

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Speaker 1: could function. I didn't hit the lows in the depths

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Speaker 1: of the rock bottom I did this time around, but

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Speaker 1: the first time. I you have to say, at eight

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Speaker 1: months postpartum, I opened on Broadway. I made my Broadway debut.

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Speaker 1: I mean that was my life's dream since I was

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Speaker 1: a little girl. And I put on a face, but

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Speaker 1: I was miserable. And it wasn't until I weaned. When

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Speaker 1: he was after a year, he was about fourteen fifteen

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Speaker 1: months old, and I remember looking in the mirror being like, oh, there,

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Speaker 1: I high should I think I was really sad that

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Speaker 1: that last year, and I feel like myself now. The

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Speaker 1: difference after Vera was that it felt like the weight

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Speaker 1: of the world to return a text. It felt like

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Speaker 1: I had done a champion feet by taking a shower.

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Speaker 1: When my daughter would cry and need me to breastfeed,

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Speaker 1: I felt immediate spikes and anxiety that I even had

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Speaker 1: to go into her room and care for her. And

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Speaker 1: all of those things were met with massive dread. Like

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Speaker 1: my worst times would be in the morning at five am.

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Speaker 1: I'd wake up early knowing that the day was neig

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Speaker 1: start and the kids were going to start needing me

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Speaker 1: at six am, and I was fucking terrified, horrified dread.

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Speaker 1: That's quintessential postpartum depression. And and you're pointing out some

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Speaker 1: important aspects of it. So with postpartum depression, we see

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Speaker 1: the usual depressions is in low mood, which is what

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Speaker 1: we see with a regular non postpartum, non pregnancy related depression,

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Speaker 1: But often we also see a prominence of anxiety and

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Speaker 1: even obsessions. And there's a difference, and I could explain

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Speaker 1: that shortly. There's a sense of being overwhelmed with fatigue,

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Speaker 1: with the challenge of facing the daily needs of the

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Speaker 1: baby and the family and um. There's just a real

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Speaker 1: sense of helplessness and worthlessness and for many women a

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Speaker 1: sense of incompetence about their parenting abilities, particularly with negative

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Speaker 1: thoughts about themselves and and and sometimes the rest of

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Speaker 1: the family. It just it can be really something that

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Speaker 1: is beyond their control. It just happens. Many women get

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Speaker 1: this about one in five. That is what the study show.

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Speaker 1: It kills me, one in five. It's huge. It's it's

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Speaker 1: extremely common, and just because it's common doesn't mean that

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Speaker 1: it's not serious. It's also the most common ebseentric complication

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Speaker 1: postpartum depression. So there is something where you think, when

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Speaker 1: you've been diagnosaed for postpart impression, you think, what's wrong

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Speaker 1: with me? And how could this have possibly happened? If

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Speaker 1: I'm a woman, I'm meant to rear children, I'm meant

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Speaker 1: to be a mother. This is supposed to be my

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Speaker 1: greatest calling. How how could this chemical imbalance even be

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Speaker 1: a thing? All women when they have a baby, they

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Speaker 1: go through the same, relatively the same thing with hormonal changes.

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Speaker 1: We know that estrogen and progesterone just crash plu mint

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Speaker 1: between having the baby and postpartum period within two weeks easily.

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Speaker 1: Do we know if that's the cause? Probably not. I

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Speaker 1: don't think it's the cause, because again, there's a majority

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Speaker 1: of women who don't get postpartum depression from the same

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Speaker 1: kind of crash. So we think that possibly there's an

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Speaker 1: increased sensitivity maybe to that hormonal fluctuation, And that goes

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Speaker 1: along with the knowledge that we have that certain women

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Speaker 1: who have either had postpartumpressions in the past, or mood

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Speaker 1: changes associated with menstruation or pre menstrual PMS, or have

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Speaker 1: had mood changes associated with taking oral contraceptives, that those

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Speaker 1: women are more likely to have postpartum depression. So there

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Speaker 1: might be a certain subset of women and maybe they're

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Speaker 1: medically predisposed. Not sure yet, You know, we need more data,

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Speaker 1: more research on it, but that's what it looks like

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Speaker 1: at this point that certain women are more likely under

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Speaker 1: certain situations, okay, to experience postpartum depression. And keep in

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Speaker 1: mind also we're in a natural disaster. It's called the pandemic,

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Speaker 1: so that increases stress hormone levels as well. So maybe

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Speaker 1: there was a threshold that, for example, you that you

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Speaker 1: just your body couldn't take. It was the pandemic, it

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Speaker 1: was the hormonal changes that maybe you're more sensitive to.

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Speaker 1: There's a lot of maybes here because we don't know

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Speaker 1: for sure. I don't know if you know this, but

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Speaker 1: you called into prescription to Walgreens and I let it

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Speaker 1: sit there. Dr Stein four days. I was like, ah,

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Speaker 1: not me. I'm going to get a second opinion. I'm

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Speaker 1: going to leave it there. I'm going to have a

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Speaker 1: long conversation with my husband and say, but I'm only

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Speaker 1: six seven, eight weeks out, give me a shot. Let's

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Speaker 1: look at this again at three months postpart of four

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Speaker 1: months postpartum. And then on the Saturday morning, I woke

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Speaker 1: up and I had horrible thoughts about my son. Suicidal

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Speaker 1: images kept come into my head, suicidal thoughts of it

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Speaker 1: would be easier if I wasn't here. I can't wake

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Speaker 1: up one more day like this. I don't want to

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Speaker 1: see my children. And then I got scared. I scared

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Speaker 1: myself into I've never had thoughts like this. I'm going

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Speaker 1: to go into a psychiatric word and I'm going to

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Speaker 1: have my children taken away from me because I'm unfit

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Speaker 1: to parent. I don't trust my brain anymore. I don't

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Speaker 1: recognize it. And I'm terrified. And I called you at

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Speaker 1: a nine am on a Saturday, hysterical crying. I didn't

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Speaker 1: know what was wrong with me. I didn't think I

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Speaker 1: could get through a Saturday with my two kids without help.

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Speaker 1: And it was so awful, and I drove to Walgreen's

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Speaker 1: like a five mileur It was like, I am starting

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Speaker 1: medication today because I don't see a way out of this.

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Speaker 1: I have to try something I've never tried before, because

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Speaker 1: I'm also at a place I've never been before. How

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Speaker 1: did you reach the diagnosis that met occasion was a

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Speaker 1: choice for me? Obviously, this is my own personal tail.

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Speaker 1: Why medication? Yeah, not everybody who comes in to see

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Speaker 1: me with postponed depression gets medication. So just letting you know,

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Speaker 1: it depends on the severity, and it depends on what's

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Speaker 1: been tried and what's worked. You tried everything. You had

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Speaker 1: been in therapy, right. I mean, can I say how

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Speaker 1: long you were in there? I don't even know how long? Okay,

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Speaker 1: So so you were in therapy for a while. There

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Speaker 1: was no doubt in my mind that you had tried everything,

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Speaker 1: talking to behavioral tasks and homework and and she you

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Speaker 1: want to walk crystals. I was pressing oils and crystals

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Speaker 1: to my heart, praying faith. I was begging ancestors. My

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Speaker 1: amazing acupuncturist was like, what about your placenta pills. I

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Speaker 1: was like, honey, I've been taking the placenta pills. I

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Speaker 1: dehydrated my placenta. I've been eating it for two months.

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Speaker 1: You're right, thank you. I did try. I tried everything. Right,

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Speaker 1: So you tried everything for a while, and it was

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Speaker 1: extremely clear to me, I do not try any of

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Speaker 1: those things. And you showed up to me with a

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Speaker 1: mild to moderate case. I might say, okay, maybe we

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Speaker 1: should just try psychotherapy and make sure that you have

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Speaker 1: all a bunch of supports and you're not isolated. But

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Speaker 1: you'd have done all that you were actually reaching out

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Speaker 1: to friends. I mean, I think you were a little

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Speaker 1: bit hesitant to maybe can reach out as much as

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Speaker 1: you did later on. Yes, Yes, I had reached out

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Speaker 1: to my two friends Mary and Talia, who I'm going

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Speaker 1: to have on this podcast, Mary and Talia. I reached

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Speaker 1: out to them because I knew they had postpartum depression,

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Speaker 1: and I knew that they had experiences with medications. So

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Speaker 1: I was already doing the research and seeing how other

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Speaker 1: mothers responded. Casey Wilson, who I had on this podcast,

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Speaker 1: I called her. She took me through her exact story.

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Speaker 1: So I was dipping my toe in, but I was

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Speaker 1: feeling I fell for every trap of feeling emba arrist

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Speaker 1: and ashamed to admit that I was feeling like a

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Speaker 1: failure in my mental health was not going great. Was

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Speaker 1: really hard. It's a biological phenomenon postpartum depression. It's not

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Speaker 1: about your character, it's not about weakness, it's not about

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Speaker 1: being a bad mother. It just happens, and it happens

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Speaker 1: to a lot of us. And often it's not just

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Speaker 1: postpartum depression. It mixes with anxiety, a lot of anxiety,

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Speaker 1: and so that's why a lot of people get confused

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Speaker 1: sometimes when there's so much anxiety involved in postpartum, depression

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Speaker 1: is at the forefront of people's minds and they don't

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Speaker 1: realize they're also depressed. If someone has tried lots of

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Speaker 1: things and you do feel that medication is an option

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Speaker 1: that they should try, my understanding was that zoloft is

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Speaker 1: great at work with both depression and anxiety, because I

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Speaker 1: was struggling with both. A lot of the antidepressants deal

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Speaker 1: with both. It depends on other other symptoms, other side effects.

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Speaker 1: I just personalized the specific choice of medications to what

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Speaker 1: the patient is experiencing. I would say that most of

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Speaker 1: the antidepressants that I work with in women who are

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Speaker 1: breastfeeding or not postpartum, it depends on their personal situation.

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Speaker 1: It may not be just about anxiety or depression. But

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Speaker 1: that was a big thing too. I felt such guilt

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Speaker 1: about wanting to breastfeed and also wanting to take medication

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Speaker 1: and knowing that I needed it. And now that I've

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Speaker 1: been on the medication, I do feel the light of Oh,

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Speaker 1: it sucks that I'm on zoloft and breastfeeding, and yes,

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Speaker 1: I wish I wasn't in a situation, but I can't

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Speaker 1: tell you how much more fun and a better time

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Speaker 1: I'm having mothering her. The fact that I am obsessed

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Speaker 1: with her now and like love being her parents, and

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Speaker 1: love parenting my son even though he's a three nature,

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Speaker 1: that trade off is fucking worth it for me. What

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Speaker 1: would you say to women who are still afraid that

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Speaker 1: medication would get into their babyes systems? There are several

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Speaker 1: antidepressants that we can use in breastfeeding that are relatively safe,

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Speaker 1: and so the risks benefit analysis for each patient has

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Speaker 1: to be taken to consideration. But generally speaking, we can

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Speaker 1: treat most postpartum depressions very easily with medication. UM, I

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Speaker 1: think the best course of action is to prioritize mother's

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Speaker 1: mental health and ultimately the baby's health. If the only

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Speaker 1: reason why you're not going to take a medicine that's

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Speaker 1: going to help you with your depression is because you're

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Speaker 1: afraid a small amount will enter your baby system. As

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Speaker 1: a psychiatrist, you want to honor everyone's desires and there

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Speaker 1: and then what they want, and of course the psychiatrist

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Speaker 1: will support you in whatever decision you make. But I

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Speaker 1: worry that risk benefit analysis is skewed. There if somebody's

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Speaker 1: severely depressed. I completely agree. And I have to say

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Speaker 1: I was so freaked out about breastfeeding Vera, and I

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Speaker 1: had to really weigh out, Okay, the options do I

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Speaker 1: quit breastfeeding. In my personal case, I felt like that

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Speaker 1: was going to cause me to be further to wake

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Speaker 1: my depression worse because I felt like I had breastfed

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Speaker 1: Alby for a year and it felt unfair and I

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Speaker 1: was felt terrible. And you said you were doing really

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Speaker 1: well with breastfeeding. You felt connected and bonded with the baby.

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Speaker 1: For sure, I wouldn't want to take that away from you.

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Speaker 1: And then you I think you were getting enough sleep,

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Speaker 1: So yes, for sure, continue and start medicine. Yep, yep.

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Speaker 1: And then I've talked to some mothers who breastfeeding, like

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Speaker 1: you said, caused them such depression and pain because they

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Speaker 1: it was stressful to them that it wasn't going well,

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Speaker 1: breastfeeding was going so poorly that it wasn't until they

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Speaker 1: just quit and started bottle feeding that they started enjoying motherhood.

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Speaker 1: And it really I'm one of those mothers. I'm one

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Speaker 1: of those mothers. I tried for I think it was

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Speaker 1: six months with my daughter and I couldn't produce. When

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Speaker 1: you rescue, do the best, your child gets dehydrated because

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Speaker 1: they're struggling to get the milk out, and then you're

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Speaker 1: pumping on afterwards, hoping to get eke out every ounce

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Speaker 1: on one ounce after forty you give them the formula.

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Speaker 1: They'll be happier because they're fatiated. You'll be happier because

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Speaker 1: you sleep, and you won't be faced with failure after failure.

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Speaker 1: So that's that situation. But I do also have to

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Speaker 1: add that when I was so freaked out, I texted

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Speaker 1: the best lactation consultant in Los Angeles, the lactation consultant

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Speaker 1: to the stars, Linda Hannah, who has been on this

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Speaker 1: podcast and is fucking amazing. And I texted my pediatrician,

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Speaker 1: who is also incredible. I have never received text back

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Speaker 1: fast enough that said, go on the zoloft. Great, great,

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Speaker 1: your baby is fine. My what they we're concern The

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Speaker 1: pediatrician who's number what concerned is my baby, was very

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Speaker 1: concerned about my mental health and said, please, you're fine.

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Speaker 1: To have a healthy baby, need a healthy mom. Yeah,

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Speaker 1: that's simple. Whatever choice that is for you to go

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Speaker 1: on medication. That's been absolutely for breastfeeding or whether to

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Speaker 1: quit breastfeeding entirely, or you know, any of the things

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Speaker 1: we've discussed. Because you know, Dr Stein, I want to say,

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Speaker 1: not only medication, but you sent me meditations to be

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Speaker 1: doing when my anxiety flared up. We talked about some

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Speaker 1: faith centering practices that I can do to really lift

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Speaker 1: my spirit up to a higher power. And it was

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Speaker 1: very helpful. You You really encouraged me to FaceTime friends

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Speaker 1: that even in COVID, like going out for a social

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Speaker 1: distance walk with a friend and being honest was so

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Speaker 1: groundbreaking lee helpful. Um, So there were so many things

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Speaker 1: working in tandem, is what I'm trying to say, you know,

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Speaker 1: and it's really just medica patient. I would never say

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Speaker 1: that it's other things. When somebody suffering from a moderate

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Speaker 1: or severe episode of depression, somebody shows up mild to moderate,

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Speaker 1: I generally recommend that they try other things if it's

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Speaker 1: moderate to severe, and your case it was severe. Yeah,

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Speaker 1: it was severe, you know, based on the Edinburgh That's

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Speaker 1: what you said at the end of overse conversation. It

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Speaker 1: was like the mic drop of all mic drops in

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Speaker 1: my life. Now, postpartum depression, it can happen anytime. Cases

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Speaker 1: start after delivery, mostly during the first month postpartum. Okay,

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Speaker 1: but almost nine percent of cases occur by four months postpartum.

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Speaker 1: Total of the postpartum depression cases so there are a

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Speaker 1: few are between fifth and the twelve month postpartum. There

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Speaker 1: are different definitions from different associations and organizations of what

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Speaker 1: postpartum depression is. I kind of like the concept that

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Speaker 1: postpartum depression can start during pregnancy or within twelve months postpartum,

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Speaker 1: and that's the American College of Centric's and Ganecologies definition.

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Speaker 1: Got it because I think it covers everything. But as

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Speaker 1: I mentioned before, almost six of postpartum depressions start before

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Speaker 1: the baby is born, so that would be before conception,

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Speaker 1: women who are just conceiving well depressed, and thirty during pregnancy. Yep,

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Speaker 1: that was me. And now I've just heard my first

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Speaker 1: story of a man who got diagnosed with postpartum depression

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Speaker 1: after his wife delivered their baby. Is that a thing?

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Speaker 1: It is a thing. And about ten percent of fathers

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Speaker 1: get a postpartum depression they get postpartupression is just clinical

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Speaker 1: medical major depressive disorder, whether a male or a female.

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Speaker 1: If it's after your child has had has been born

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Speaker 1: and it's been diagnosed within the year, it's postpartum depression.

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Speaker 1: And about ten percent of men experience clinical depression either

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Speaker 1: during their spouses or their partners pregnancy or during the

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Speaker 1: postparton year. Wow. Wow, that's fascinating. I mean there's a

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Speaker 1: lot of suffering. Oh my gosh. How long does postpartum

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Speaker 1: depression last? Typically it depends on if it's treated or not.

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Speaker 1: So in general, the estimation is that postpartum depressions can

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Speaker 1: last at least a year. What is the risk I

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Speaker 1: worry now endlessly about women who go untreated or delay

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Speaker 1: seeking treatment. What is what's the risk there? Well, there's

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Speaker 1: a risk to themselves depression, clinical depression, untreated and prolonged suicide.

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Speaker 1: Women taking care of themselves increases the risk of marital

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Speaker 1: and partner discord. Not being able to take care of

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Speaker 1: their families, their babies the way they would normally want to,

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Speaker 1: missed edutrian visits, not taking your penatal vitamins, or some

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Speaker 1: women forget to get to work, more accidents, for example,

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Speaker 1: or they forget to put their babies in their booster seats.

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Speaker 1: And in terms of the baby mother infant attachment to

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Speaker 1: the bonding is usually diminished when it's a significant postpartum

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Speaker 1: depression and just a lack of responsivity, emotional responsivilty, and

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Speaker 1: even physical responsivility to their babies. And it's not intentional,

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Speaker 1: it's just that's the way you're functioning if you have

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Speaker 1: postpartum depression, and babies are just more at risk. Therefore,

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Speaker 1: when their mothers are less connected with them, less nurturing,

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Speaker 1: less likely to as time goes by, like peekaboo or

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Speaker 1: read to them or saying to them, the babies tend

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Speaker 1: to develop into older children and even adults who are

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Speaker 1: more likely to experience depressive episodes themselves and anxiety and

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Speaker 1: other behavioral difficulties themselves. So it is a concern. Wow, God,

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Speaker 1: that is so there's a risk to not treating as

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Speaker 1: well people forget that. How do you recommend mothers prepare?

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Speaker 1: I don't know if I could have done anything differently.

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Speaker 1: But let's say a woman listening is pregnant, she hasn't

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Speaker 1: dealt with depression in the past, or or whatever. Maybe

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Speaker 1: she has, but like, what, what do you what? We

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Speaker 1: want for sure for sure if someone has had a

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Speaker 1: history or a family history of mental illness, even just

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Speaker 1: general amountal illness puts you at risk in your family,

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Speaker 1: So if there's a family history, if there's a personal

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Speaker 1: history of just not only postparts depression, but depression in general,

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Speaker 1: clinical depression, or a history of an anxiety disorder. Anxiety

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Speaker 1: disorders are the most common psychiatric disorders that people can

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Speaker 1: have in the United Say, it's so, it's not that uncommon.

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Speaker 1: But also if you're at risk if you're struggling economically,

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Speaker 1: which is ironic, I understand if if you're in terms

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Speaker 1: of you're struggling economically, but yet you need to seek

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Speaker 1: extra care um financially, that can be very difficult. So

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Speaker 1: if you're striking economically, if you're having difficulties with obstetric complications,

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Speaker 1: prenatal complications, that puts you at risk. Thyroid disorder, diabetes,

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Speaker 1: medical illnesses will put you at risk, particularly if you're

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Speaker 1: experiencing crisis and your family, like difficulties with with your marriage,

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Speaker 1: or if you have a history of trauma, sexual trauma

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Speaker 1: or being a victim of domestic violence, if you're single,

427
00:26:40,359 --> 00:26:44,720
Speaker 1: or you have very few supports in your life, Definitely

428
00:26:44,840 --> 00:26:47,280
Speaker 1: you're more at risk the more children you have, more

429
00:26:47,600 --> 00:26:50,360
Speaker 1: having many children or more than one is a risk

430
00:26:50,400 --> 00:26:54,800
Speaker 1: factor because your hands are full, there's sleep deprivation during breastfeeding,

431
00:26:54,880 --> 00:26:56,840
Speaker 1: or even just the baby crying all the time. You know,

432
00:26:57,160 --> 00:27:01,480
Speaker 1: that also is a trigger for postpondon depression understandably. So

433
00:27:02,040 --> 00:27:04,119
Speaker 1: if you're more at risk for all those reasons, and

434
00:27:04,160 --> 00:27:06,240
Speaker 1: there are probably others I can go into, then I

435
00:27:06,280 --> 00:27:09,879
Speaker 1: would say have a conversation with your o B. Have

436
00:27:10,000 --> 00:27:13,639
Speaker 1: a conversation. Hopefully your OBI is already screening for those

437
00:27:13,720 --> 00:27:18,840
Speaker 1: risk factors before like that the first visit, prenatal visit

438
00:27:18,920 --> 00:27:23,359
Speaker 1: and then intermittently throughout pregnancy and then postpartum, you know,

439
00:27:23,480 --> 00:27:27,119
Speaker 1: before even leaving the hospital. It would be great if

440
00:27:27,760 --> 00:27:31,000
Speaker 1: a nurse or an OBI just went through the Edinburgh

441
00:27:31,440 --> 00:27:33,920
Speaker 1: Post at All Depression Scale. I know that a lot

442
00:27:33,920 --> 00:27:36,280
Speaker 1: of pedetricians are now because they are seeing the moms

443
00:27:36,280 --> 00:27:40,280
Speaker 1: more than the obs postpartum, are administering the Edinburgh scale

444
00:27:40,359 --> 00:27:43,159
Speaker 1: as well, and that's really helpful. And also it's not

445
00:27:43,280 --> 00:27:48,040
Speaker 1: just getting the number of severity from the Edinburgh Scale,

446
00:27:48,760 --> 00:27:54,520
Speaker 1: it's opening up the door for a conversation about depression

447
00:27:54,720 --> 00:27:59,480
Speaker 1: normalizing it. It is so common and as you said, culture,

448
00:28:00,359 --> 00:28:03,439
Speaker 1: the culture that we live in wants us to be

449
00:28:03,520 --> 00:28:08,120
Speaker 1: superwomen and we're not. And that's okay, we're not super women.

450
00:28:08,119 --> 00:28:10,439
Speaker 1: We can't do it all. It's not possible. In fact,

451
00:28:10,880 --> 00:28:12,480
Speaker 1: you know a few thousand years, we can even go

452
00:28:12,480 --> 00:28:16,000
Speaker 1: actually two hundred years back. Okay, it took a village

453
00:28:16,040 --> 00:28:19,160
Speaker 1: to raise a child. And this is we live in

454
00:28:19,440 --> 00:28:23,960
Speaker 1: a very isolated world, so that increases the risk for

455
00:28:24,160 --> 00:28:27,920
Speaker 1: I would say everyone when it comes to postpartum depression,

456
00:28:27,920 --> 00:28:31,280
Speaker 1: were more isolated. There's less help. There's there's less people available,

457
00:28:31,320 --> 00:28:34,680
Speaker 1: easily available, that's in your home to help with the

458
00:28:34,720 --> 00:28:37,600
Speaker 1: baby with feedings. Right. Not only is there less help

459
00:28:37,720 --> 00:28:42,360
Speaker 1: and less community around raising your baby, there's more pressure

460
00:28:42,960 --> 00:28:46,000
Speaker 1: to make it seem like you've got it going on,

461
00:28:46,320 --> 00:28:50,520
Speaker 1: between announcements and mailing postcards what the baby looks like,

462
00:28:50,640 --> 00:28:54,239
Speaker 1: and social media and posting the first Instagram shot and

463
00:28:54,280 --> 00:28:57,280
Speaker 1: tweeting the first you know, my post baby body, I

464
00:28:57,320 --> 00:29:01,520
Speaker 1: got it back blah bloody, bloody blah. It's like a

465
00:29:01,600 --> 00:29:05,680
Speaker 1: two for to just really mess with the mom only

466
00:29:05,760 --> 00:29:07,680
Speaker 1: do you have to do this alone, but you have

467
00:29:07,720 --> 00:29:11,640
Speaker 1: to look amazing while you do it. The responsibilities are

468
00:29:11,760 --> 00:29:15,520
Speaker 1: very heavy postpartum in particular and going forward, I think

469
00:29:15,520 --> 00:29:18,360
Speaker 1: motherhood is the hardest job it's the hardest job. It's

470
00:29:18,400 --> 00:29:21,240
Speaker 1: harder than being a doctor. It's harder than being an actress.

471
00:29:21,400 --> 00:29:27,600
Speaker 1: By it's harder than being a duchess. Okay, it's harder

472
00:29:27,600 --> 00:29:30,000
Speaker 1: than being a duchess. At the time of this recording,

473
00:29:30,320 --> 00:29:34,800
Speaker 1: the Megan Markle Harry Oprah interview has happened this week,

474
00:29:34,960 --> 00:29:37,960
Speaker 1: and I have to say, I don't know Dr Stein,

475
00:29:38,120 --> 00:29:41,480
Speaker 1: but now that I have seen postpartum depression up close

476
00:29:41,480 --> 00:29:44,160
Speaker 1: and personal, I look at her and I'm like, she

477
00:29:44,360 --> 00:29:48,480
Speaker 1: had postpartum depression dealing with that right now currently during

478
00:29:48,480 --> 00:29:50,200
Speaker 1: her second pregnancy. Oh and I also just watched the

479
00:29:50,240 --> 00:29:53,840
Speaker 1: Britney Spears documentary and she's sobbing pregnant with her two

480
00:29:53,920 --> 00:29:56,160
Speaker 1: year old on her lap, and I'm like, I don't

481
00:29:56,160 --> 00:29:58,040
Speaker 1: know if she's being treated, but I feel like she

482
00:29:58,120 --> 00:30:02,560
Speaker 1: has post fucking part of depression. That's what I looked like,

483
00:30:03,080 --> 00:30:05,680
Speaker 1: sobbing with my son on my lap. I don't know.

484
00:30:06,200 --> 00:30:08,160
Speaker 1: I don't know if we'll ever know, and that's their

485
00:30:08,160 --> 00:30:12,240
Speaker 1: own personal thing, but I really feel like Megan Markel

486
00:30:12,360 --> 00:30:16,720
Speaker 1: needs to come on this podcast. You should invite her.

487
00:30:17,480 --> 00:30:19,880
Speaker 1: I knew her, we used to audition against each other

488
00:30:19,920 --> 00:30:24,080
Speaker 1: for years, but I hope, Megan Markle in all seriousness,

489
00:30:24,200 --> 00:30:27,320
Speaker 1: I just it just my heart goes out again to

490
00:30:27,440 --> 00:30:31,840
Speaker 1: anyone struggling. And what's crazy about mental health is that

491
00:30:31,920 --> 00:30:39,719
Speaker 1: affects actresses, duchesses, women with four jobs, single women, women

492
00:30:39,760 --> 00:30:47,360
Speaker 1: with money, women without money. It's this exactly. It's indiscriminate,

493
00:30:47,400 --> 00:30:50,560
Speaker 1: except I would say, the more stress you're under, yes,

494
00:30:50,720 --> 00:30:55,040
Speaker 1: that's right, that can also increase the risk of postpartum depression,

495
00:30:55,240 --> 00:30:58,959
Speaker 1: of any kind of depression, anyven It isolates. What are

496
00:30:59,000 --> 00:31:03,240
Speaker 1: some of the biggest misconceptions around postpartum depression, Like, what

497
00:31:03,280 --> 00:31:07,200
Speaker 1: do you wish people understood more about it? Postpartum depression

498
00:31:07,400 --> 00:31:11,640
Speaker 1: is more than just the blues. That's extremely important for

499
00:31:11,680 --> 00:31:16,960
Speaker 1: people to understand. It's a clinical depression that affects functioning um.

500
00:31:16,960 --> 00:31:19,560
Speaker 1: Postpartum depression is not a sign of weakness, it's not

501
00:31:19,600 --> 00:31:24,560
Speaker 1: a sign of bad parenting. It's completely treatable. And postpartum

502
00:31:24,600 --> 00:31:30,080
Speaker 1: depression is not postpartum psychosis, and I want to explain

503
00:31:30,120 --> 00:31:35,160
Speaker 1: the difference. Please. Postpartum psychosis is very rare, one to

504
00:31:35,240 --> 00:31:40,040
Speaker 1: two out of a thousand pregnancies. It's usually associated with

505
00:31:40,760 --> 00:31:45,440
Speaker 1: bipolar disorder, where people have a history of feeling really

506
00:31:45,520 --> 00:31:50,400
Speaker 1: high without drugs, and also depressive episodes. Okay, it's usually

507
00:31:50,440 --> 00:31:53,000
Speaker 1: associated with bipolar disorder, but sometimes by the time they

508
00:31:53,040 --> 00:31:55,840
Speaker 1: people become pregnant and have a baby, they haven't had

509
00:31:55,880 --> 00:31:59,200
Speaker 1: a manic episode yet, so it's kind of about postpartum

510
00:31:59,200 --> 00:32:02,800
Speaker 1: depressions are actually bipolar depressions. So then that's important to

511
00:32:02,840 --> 00:32:05,960
Speaker 1: factor in psychosis. Let me just describe what that is,

512
00:32:06,000 --> 00:32:08,120
Speaker 1: because I'm not sure people really understand what that is.

513
00:32:08,280 --> 00:32:13,280
Speaker 1: Psychosis is a break from reality with disorganized delusional thinking.

514
00:32:13,480 --> 00:32:17,840
Speaker 1: So that means paranoid thoughts, really paranoid thoughts like people

515
00:32:17,840 --> 00:32:19,840
Speaker 1: are after you or trying to get you, or strange

516
00:32:19,880 --> 00:32:25,400
Speaker 1: beliefs that don't reflect reality. So it also involves sometimes

517
00:32:25,840 --> 00:32:29,120
Speaker 1: hearing voices or seeing visions. So it's a complete break

518
00:32:29,120 --> 00:32:32,400
Speaker 1: from reality. So obviously there's very little functioning going on

519
00:32:32,440 --> 00:32:35,840
Speaker 1: there and some have even um. You know, the big

520
00:32:35,960 --> 00:32:39,200
Speaker 1: risk with postpartum psychosis, which is a psychiatric emergency and

521
00:32:39,320 --> 00:32:42,120
Speaker 1: there's a dramatic onset. It's usually the first two weeks

522
00:32:42,160 --> 00:32:45,360
Speaker 1: after delivery, but could be later, but it's high risk

523
00:32:45,400 --> 00:32:48,560
Speaker 1: for the baby, high risk for the mother and other children.

524
00:32:48,640 --> 00:32:51,840
Speaker 1: It's a psychiatric emergency and it should be identified promptly

525
00:32:51,880 --> 00:32:58,080
Speaker 1: and hospitalized, but be ut very treatable, extremely treatable, and

526
00:32:58,200 --> 00:33:00,000
Speaker 1: it doesn't mean you're gonna your baby's gonna taken away

527
00:33:00,080 --> 00:33:01,440
Speaker 1: from you. People always think, oh, I'm gonna go to

528
00:33:01,440 --> 00:33:02,880
Speaker 1: the hospital. I think you instead it just in the

529
00:33:02,920 --> 00:33:05,960
Speaker 1: beginning you were afraid of going to the hospital and

530
00:33:06,080 --> 00:33:08,880
Speaker 1: your baby is being taken away from you. That not

531
00:33:09,080 --> 00:33:13,120
Speaker 1: how it works. A psychiatric hospital is extremely nurturing. There's

532
00:33:13,160 --> 00:33:16,680
Speaker 1: group therapy, there's intensive you know, psychotherapy, and there's psychiatric help,

533
00:33:16,880 --> 00:33:20,440
Speaker 1: and some actually integrate having the baby there in a

534
00:33:20,480 --> 00:33:25,600
Speaker 1: safe way. The psychosis is rare, the postpartum depression is common,

535
00:33:26,560 --> 00:33:28,880
Speaker 1: and it and yet all of us are here on

536
00:33:28,920 --> 00:33:32,880
Speaker 1: the other side and it's treatable and there's no reason,

537
00:33:33,960 --> 00:33:38,440
Speaker 1: there's no reason to be embarrassed. I wish people would

538
00:33:38,440 --> 00:33:41,400
Speaker 1: talk about it more. I'm sure you have that snapshot

539
00:33:41,440 --> 00:33:44,440
Speaker 1: in your mind when you've had a great experience with

540
00:33:44,320 --> 00:33:46,040
Speaker 1: it with your baby and you've rest fed them and

541
00:33:46,080 --> 00:33:49,680
Speaker 1: everyone's peaceful. But there's a lot going on in between,

542
00:33:49,720 --> 00:33:53,000
Speaker 1: and life is messy even in the best of circumstances.

543
00:33:53,040 --> 00:33:59,280
Speaker 1: It's hard. Yeah, how do you think loved ones can

544
00:33:59,360 --> 00:34:05,920
Speaker 1: best support those with postpartum depression. Listen, don't assume postpartum

545
00:34:06,000 --> 00:34:13,800
Speaker 1: motherhood is easy or glorious. It's a huge adjustment and

546
00:34:14,160 --> 00:34:17,959
Speaker 1: the support of the validating. Validating means hearing how people

547
00:34:18,239 --> 00:34:23,440
Speaker 1: how someone's experience, experiencing their life and acknowledging that it's

548
00:34:23,440 --> 00:34:28,560
Speaker 1: a struggle and not saying something like oh, it'll go away,

549
00:34:29,040 --> 00:34:31,839
Speaker 1: which so many of us wanted to tend to do

550
00:34:32,000 --> 00:34:35,000
Speaker 1: because we wanted to go away. It's understandable, but it's

551
00:34:35,000 --> 00:34:38,719
Speaker 1: not helpful. Acknowledging that there's a problem and being there

552
00:34:38,760 --> 00:34:42,160
Speaker 1: for someone even just to talk and then maybe do

553
00:34:42,200 --> 00:34:44,239
Speaker 1: research for them, help them, you get the care that

554
00:34:44,280 --> 00:34:47,719
Speaker 1: they need. There are experts now being trained in perinetal

555
00:34:47,760 --> 00:34:52,240
Speaker 1: psychiatry and that's pretty amazing. Beyond just uh psychiatric residency.

556
00:34:52,280 --> 00:34:55,719
Speaker 1: They actually have specialties in women's mental health and that's

557
00:34:55,719 --> 00:34:59,879
Speaker 1: amazing across their life cycle. So yeah, what's not help

558
00:35:00,000 --> 00:35:03,279
Speaker 1: bowl was my mother, who I love so much as

559
00:35:03,360 --> 00:35:05,920
Speaker 1: she is the most incredible mother to me and I

560
00:35:05,960 --> 00:35:10,799
Speaker 1: love her so much. But like week four, she had

561
00:35:10,840 --> 00:35:16,400
Speaker 1: a nice come to Jesus buck up ah conversation with me,

562
00:35:16,960 --> 00:35:18,759
Speaker 1: God help me. I hope she hasn't listened to this

563
00:35:18,800 --> 00:35:24,880
Speaker 1: episode but she just had a real like you're being nasty,

564
00:35:25,040 --> 00:35:26,879
Speaker 1: You're crying a lot, and you need to buck up.

565
00:35:26,920 --> 00:35:29,440
Speaker 1: This is all on you. You're the mom. You need

566
00:35:29,480 --> 00:35:31,640
Speaker 1: to be the rock for your family. You need to

567
00:35:31,680 --> 00:35:34,839
Speaker 1: buck up. Get this, get your son dressed before seven am,

568
00:35:34,920 --> 00:35:39,200
Speaker 1: get them in the car. We've all done it. Buck

569
00:35:39,320 --> 00:35:46,960
Speaker 1: up and she left January four and January six, I

570
00:35:47,000 --> 00:35:52,800
Speaker 1: saw you and I had to say I needed help.

571
00:35:53,000 --> 00:35:55,919
Speaker 1: And then we had to have conversations where she had

572
00:35:55,920 --> 00:36:00,359
Speaker 1: her own stigmas attached to medication and said things like, well,

573
00:36:00,400 --> 00:36:02,040
Speaker 1: if you start, you're never going to be able to

574
00:36:02,080 --> 00:36:03,680
Speaker 1: get off. You'll be on it for the rest of

575
00:36:03,680 --> 00:36:07,000
Speaker 1: your life and that's not good. And her opinions on

576
00:36:07,239 --> 00:36:12,319
Speaker 1: my choices, and Dr sty knows this. I come from

577
00:36:12,360 --> 00:36:16,080
Speaker 1: a long line of anxious, worrying mother's, my mother's mother

578
00:36:16,719 --> 00:36:21,080
Speaker 1: me and I for me and my personal choice to

579
00:36:21,520 --> 00:36:26,480
Speaker 1: separate from how she treats her worries and anxieties for

580
00:36:26,640 --> 00:36:29,919
Speaker 1: me to go on medication right now at this point

581
00:36:29,920 --> 00:36:32,000
Speaker 1: in my life. Who knows how long or how short

582
00:36:32,120 --> 00:36:35,520
Speaker 1: or I don't know. Stay tuned on that listeners. But

583
00:36:36,719 --> 00:36:40,000
Speaker 1: I just kept being like, the buck stops here. I

584
00:36:40,000 --> 00:36:42,479
Speaker 1: am going to go in a different direction, and I'm

585
00:36:42,520 --> 00:36:47,200
Speaker 1: going to try a different way. But that was not

586
00:36:47,280 --> 00:36:49,920
Speaker 1: helpful for her to tell me to buck up constantly

587
00:36:50,040 --> 00:36:53,200
Speaker 1: and some tough love was not at that time. That

588
00:36:53,400 --> 00:36:56,000
Speaker 1: was not, let's sake it a different way. Maybe she

589
00:36:56,160 --> 00:36:58,279
Speaker 1: just pointed out that, yeah, you need to take care

590
00:36:58,320 --> 00:37:00,799
Speaker 1: of your family and it's not how happening and it's

591
00:37:00,840 --> 00:37:06,239
Speaker 1: a struggle, and that forced you to realize you needed

592
00:37:06,320 --> 00:37:10,480
Speaker 1: help sooner. Yeah, okay, that's another way of looking at guys.

593
00:37:11,960 --> 00:37:15,400
Speaker 1: We're having psychiatry happen right here, right now. Mom, I

594
00:37:15,520 --> 00:37:17,080
Speaker 1: love you so much. You're the greatest mother in the

595
00:37:17,200 --> 00:37:20,000
Speaker 1: entire world. We're all trying to do our best. What's

596
00:37:20,000 --> 00:37:23,640
Speaker 1: also great about Dr Stein is a mother of two herself. Yes,

597
00:37:23,800 --> 00:37:28,600
Speaker 1: and I've made many mistakes and feel like that's really

598
00:37:28,719 --> 00:37:32,920
Speaker 1: prepared them for the world, give them a lot of experience.

599
00:37:32,960 --> 00:37:36,040
Speaker 1: So I really believe in the concept called the good

600
00:37:36,120 --> 00:37:40,120
Speaker 1: enough mother, and I'm counting on it because I ain't perfect,

601
00:37:40,160 --> 00:37:45,080
Speaker 1: that's for sure. Dr Stein. I cannot thank you enough

602
00:37:45,120 --> 00:37:49,040
Speaker 1: for coming on Katie's Crib and for sharing your knowledge

603
00:37:49,040 --> 00:37:52,120
Speaker 1: and your experiences and your advice with our listeners on

604
00:37:52,200 --> 00:37:55,799
Speaker 1: this incredibly important topic. And also thank you so much

605
00:37:55,840 --> 00:38:00,480
Speaker 1: personally for being on the ride with me as one

606
00:38:00,520 --> 00:38:03,799
Speaker 1: of my guides through this. We're a team. We are

607
00:38:03,840 --> 00:38:08,000
Speaker 1: a team. We're a team. That's it me, you, your therapist,

608
00:38:08,280 --> 00:38:12,480
Speaker 1: my husband, team, You're a team, My pediatrician, everybody was

609
00:38:12,560 --> 00:38:16,879
Speaker 1: a huge key player and continues to be so Thank

610
00:38:16,920 --> 00:38:19,439
Speaker 1: you so much, Dr Stein for coming on Katie's Crib

611
00:38:19,719 --> 00:38:29,400
Speaker 1: My pleasure. Thank you guys for listening to Katie's Crib.

612
00:38:30,000 --> 00:38:31,640
Speaker 1: I want to hear from you. You guys were in

613
00:38:31,680 --> 00:38:33,560
Speaker 1: season four. What do you want to talk about? What

614
00:38:33,600 --> 00:38:35,200
Speaker 1: guests do you want to have on? Do you have questions?

615
00:38:35,239 --> 00:38:39,080
Speaker 1: You've comments? Hit me up Katie's Crib at Shanda land

616
00:38:39,320 --> 00:38:45,799
Speaker 1: dot com. Bye bye. Katie's Crib is a production of

617
00:38:45,800 --> 00:38:48,759
Speaker 1: Shonda Land Audio in partnership with I Heart Radio. For

618
00:38:48,840 --> 00:38:51,799
Speaker 1: more podcasts from Shannolan Audio, visit the iHeart Radio app,

619
00:38:51,880 --> 00:38:54,600
Speaker 1: Apple Podcasts, or wherever you listen to your favorite shows.

620
00:39:00,280 --> 00:39:12,839
Speaker 1: Story story, you never know until you try, until you can,

621
00:39:12,880 --> 00:39:14,760
Speaker 1: need to right