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