WEBVTT - Let’s Talk Postpartum Depression w/ Dr. Kira Stein 0:00:01.280 --> 0:00:04.160 Welcome to Katie's Crib, a production of Shonda Land Audio 0:00:04.240 --> 0:00:08.000 in partnership with I Heart Radio. It's a biological phenomenon 0:00:08.520 --> 0:00:12.880 postpartum depression. It's not about your character, it's not about weakness, 0:00:13.800 --> 0:00:18.279 it's not about being a bad mother. It just happens, 0:00:18.320 --> 0:00:28.000 and it happens to a lot of us. Information provided 0:00:28.000 --> 0:00:31.320 by Dr Kiristein during this podcast is for general education 0:00:31.360 --> 0:00:34.920 purposes and should not be relied upon as professional medical advice, diagnosis, 0:00:34.960 --> 0:00:38.920 or treatment for any individual. Welcome back to Katie's Crib. 0:00:39.200 --> 0:00:44.400 I have someone here today who saved my life past tense, 0:00:44.560 --> 0:00:47.040 is currently saving my life. I am still working with 0:00:47.080 --> 0:00:51.239 her and I feel so grateful to have met her 0:00:51.280 --> 0:00:53.880 in the darkest steps of despair in my own personal 0:00:54.040 --> 0:00:56.279 life journey, and now I have her as one of 0:00:56.320 --> 0:01:00.920 my greatest tools in my toolbox for all the ship 0:01:01.080 --> 0:01:04.080 that will come my way in my life. So basically, 0:01:04.160 --> 0:01:07.680 Dr Stein, you need to live forever. Thanks so much. Um. 0:01:07.720 --> 0:01:10.960 This is psychiatrist Dr Kiris Stein. She's an assistant clinical 0:01:11.000 --> 0:01:13.400 professor at the u c L A Semil Institute of 0:01:13.520 --> 0:01:15.760 Neuroscience and Human Behavior at the u c L A. 0:01:15.800 --> 0:01:18.480 Giffing School of medicine. Wow, that sounds really fancy. She 0:01:18.560 --> 0:01:21.039 has her own private practice in Beverly Hill, specializing in 0:01:21.080 --> 0:01:24.720 general adult psychiatry and Perry natal psychiatry. Thank you very much. 0:01:25.080 --> 0:01:27.720 She also volunteers as an attending psychiatrist at the u 0:01:27.720 --> 0:01:30.360 c L, a women's Life Center and outpatient program devoted 0:01:30.400 --> 0:01:33.840 to assessing and treating women with psychiatric conditions associated with 0:01:33.920 --> 0:01:42.240 reproductive life events and hormonal challenges. What a mouthful guy. Okay, welcome, 0:01:42.360 --> 0:01:45.959 doctor Stein, thank you. The truth is, I'm just another 0:01:45.959 --> 0:01:48.480 person who just went in one direction and learned a 0:01:48.480 --> 0:01:53.200 lot about medicine and psychiatry and perinetle medicine. So hopefully 0:01:53.200 --> 0:01:56.200 when patients see me or hear me, they know that 0:01:56.320 --> 0:01:58.400 I'm just another human being who's just their partner and 0:01:58.440 --> 0:02:01.080 trying to get them better. That's what it felt like. 0:02:01.400 --> 0:02:03.680 And what was weird was when I reached out to 0:02:03.760 --> 0:02:06.040 you to go back a little bit. I've been working 0:02:06.040 --> 0:02:10.320 with a therapist for twelve years, and when I reached 0:02:10.360 --> 0:02:13.760 about the three four week mark postpartum with my daughter, 0:02:15.160 --> 0:02:17.200 I had in my o B four week check up 0:02:17.280 --> 0:02:19.679 and she asked how I was doing, and I said, 0:02:19.680 --> 0:02:21.720 oh ha ha, as a joke, because I brush everything 0:02:21.720 --> 0:02:24.720 off and I'm still uncontrollably sobbing all the time. And 0:02:24.800 --> 0:02:27.600 she was like, oh, that's something to look at. I 0:02:27.639 --> 0:02:30.079 asked my therapist what she thought, and she said, yeah, 0:02:30.080 --> 0:02:32.320 I think you should go to a psychiatrist. And already 0:02:32.639 --> 0:02:35.520 I'm up in arms like what, No, I don't know, 0:02:35.639 --> 0:02:37.640 I don't know. Okay, you know what. I'll go to 0:02:37.680 --> 0:02:42.680 a psychiatrist and she's gonna give me some awesome panic 0:02:42.720 --> 0:02:45.960 attack medication that's gonna go under my tongue and anytime 0:02:46.000 --> 0:02:48.360 I get a panic attack about COVID or that I 0:02:48.400 --> 0:02:51.119 can't do this or that I hate parenting right now, 0:02:51.400 --> 0:02:53.440 I'm just gonna slip this thing under my tongue and 0:02:53.480 --> 0:02:56.560 get a great night's sleep. I get introduced to Dr 0:02:56.600 --> 0:02:59.360 Stein through my therapist. We have about a two hour 0:03:00.000 --> 0:03:02.840 saltation to which at the end you say to me, 0:03:04.400 --> 0:03:08.080 in my playing of it, oh no, honey, this isn't 0:03:08.120 --> 0:03:10.120 like just to slip under your tongue once in a 0:03:10.120 --> 0:03:16.000 while situation. You have postpartum depression and anxiety and it's 0:03:16.040 --> 0:03:21.400 pretty high on the Edinburgh Postnatal Depression scale. And I 0:03:21.440 --> 0:03:28.440 was like, what, No, not me. I'm a podcast host. 0:03:28.720 --> 0:03:32.120 I'm a stable person. I've never been on medication, I've 0:03:32.160 --> 0:03:35.080 never been diagnosed with depression. I'm the rock of my 0:03:35.200 --> 0:03:39.320 family and all my friends. This isn't possibly happening to me. 0:03:39.840 --> 0:03:43.960 And Dr Stein was like, you've been uncontrollably sobbing for 0:03:44.000 --> 0:03:48.800 the last two hours and I have news for you. 0:03:48.800 --> 0:03:52.800 You can't muscle your way through this, So can you 0:03:52.920 --> 0:03:56.080 tell me at that time how you diagnosed me and 0:03:56.160 --> 0:03:59.120 my personal case? And again this this goes to everyone listening, like, 0:03:59.200 --> 0:04:01.880 this is my own personal story. How did you know 0:04:02.920 --> 0:04:07.320 that I had postpartum depression versus like blues? Well, um, 0:04:07.400 --> 0:04:10.240 there's a very big difference between the blues and postpartum depression. 0:04:11.200 --> 0:04:13.880 Eight almost eight percent of women suffer from the blues, 0:04:14.120 --> 0:04:17.760 and it's usually mild, and it usually occurs within the 0:04:17.800 --> 0:04:23.760 first week of delivery, and it involves anxiety, your ability, tearfulness. 0:04:24.200 --> 0:04:26.840 So you may have been experiencing some of that and thinking, okay, 0:04:26.839 --> 0:04:29.359 talking everything up to oh, this is postpartum blues in 0:04:29.360 --> 0:04:32.200 the beginning, and that usually lasts though no more than 0:04:32.240 --> 0:04:37.200 two weeks. Okay, and it's mild. It doesn't affect functioning. However, 0:04:38.240 --> 0:04:42.200 yours continued, Yours continued and got worse, and I would argue, 0:04:42.320 --> 0:04:45.720 I think maybe it even started before the baby was 0:04:46.160 --> 0:04:49.840 more it's called prenatal depression if it's started that way, 0:04:49.880 --> 0:04:55.440 but postpartum depression. Actually six of postpartum depressions start before birth. 0:04:56.240 --> 0:05:00.280 I definitely was not myself my entire pregnant. See, I 0:05:00.320 --> 0:05:06.080 did not feel I felt overwhelmed, fear, panic attacks, sadness, 0:05:06.320 --> 0:05:09.080 and I thought when I had the baby, and I 0:05:09.120 --> 0:05:11.400 blamed it all on COVID, I blamed it all. Well, 0:05:11.440 --> 0:05:14.240 it's like being pregnant in a pandemic, isolated, and when 0:05:14.279 --> 0:05:17.080 the baby comes, I'll feel great because I will have 0:05:17.160 --> 0:05:19.159 done it. I will have brought the baby safely into 0:05:19.160 --> 0:05:23.640 the world. The baby came, and it took a down shift. 0:05:23.800 --> 0:05:25.960 It was not the It got worse, Yes, it got 0:05:26.000 --> 0:05:29.320 way worse, and it got worse with time. Yes, which 0:05:29.360 --> 0:05:33.520 is what we normally see often see with postpartum depression 0:05:33.520 --> 0:05:37.640 when it's a clinical depressive episode more than the usual 0:05:37.640 --> 0:05:43.240 postpartum blues. And this scale, this Edinburgh, which by the way, 0:05:43.320 --> 0:05:45.680 Edinburgh is like my favorite place I've ever gone in 0:05:45.720 --> 0:05:47.560 the entire world. So I'm like, why does it have 0:05:47.720 --> 0:05:51.360 to be Why is it called that? At what is 0:05:51.400 --> 0:05:54.279 the Edinburgh post Natal to President scale. Well, it's a 0:05:54.320 --> 0:05:57.520 ten point scale that it is pretty simple to answer. 0:05:57.640 --> 0:06:01.040 It's online. Actually, I gave you a link to put 0:06:01.080 --> 0:06:04.719 on your website associated with this podcast so that women 0:06:04.760 --> 0:06:08.880 can access it. And it's some pretty simple screening questions 0:06:09.000 --> 0:06:12.560 that can help women O b g n s and 0:06:12.680 --> 0:06:16.159 pedetriten's and psychiatrists just get a sense of how severe 0:06:16.600 --> 0:06:20.800 their depressions are and if they should get more help 0:06:21.000 --> 0:06:23.760 if it's severe enough, if you even wonder if you're 0:06:23.839 --> 0:06:26.679 experiencing a clinical depression and a clinical depression. The difference 0:06:26.680 --> 0:06:28.960 with the clinical depression and the postpartum blues. Want to 0:06:28.960 --> 0:06:32.719 make sure is that everyone understands is that a clinical 0:06:32.760 --> 0:06:37.159 depression is a depression that impedes functioning, makes it hard, 0:06:37.360 --> 0:06:40.240 at least in the postpartum context, to take care of yourself, 0:06:40.640 --> 0:06:43.800 your baby, to nurture the baby. If left ongoing, it 0:06:43.839 --> 0:06:47.599 has implications on the development of the baby. Yes, with 0:06:47.640 --> 0:06:50.920 our listeners, I think I had postpartum blues with my son. 0:06:51.200 --> 0:06:53.840 And the reason I say that now is because I 0:06:53.839 --> 0:06:56.880 could function. I didn't hit the lows in the depths 0:06:56.920 --> 0:06:58.880 of the rock bottom I did this time around, but 0:06:58.920 --> 0:07:01.599 the first time. I you have to say, at eight 0:07:01.640 --> 0:07:06.919 months postpartum, I opened on Broadway. I made my Broadway debut. 0:07:07.320 --> 0:07:09.400 I mean that was my life's dream since I was 0:07:09.440 --> 0:07:12.000 a little girl. And I put on a face, but 0:07:12.040 --> 0:07:15.680 I was miserable. And it wasn't until I weaned. When 0:07:15.720 --> 0:07:19.000 he was after a year, he was about fourteen fifteen 0:07:19.000 --> 0:07:22.160 months old, and I remember looking in the mirror being like, oh, there, 0:07:22.200 --> 0:07:25.480 I high should I think I was really sad that 0:07:25.480 --> 0:07:28.800 that last year, and I feel like myself now. The 0:07:28.800 --> 0:07:33.200 difference after Vera was that it felt like the weight 0:07:33.280 --> 0:07:37.280 of the world to return a text. It felt like 0:07:37.440 --> 0:07:40.320 I had done a champion feet by taking a shower. 0:07:41.440 --> 0:07:44.200 When my daughter would cry and need me to breastfeed, 0:07:44.280 --> 0:07:47.560 I felt immediate spikes and anxiety that I even had 0:07:47.600 --> 0:07:50.240 to go into her room and care for her. And 0:07:50.360 --> 0:07:54.640 all of those things were met with massive dread. Like 0:07:54.800 --> 0:07:57.920 my worst times would be in the morning at five am. 0:07:57.960 --> 0:08:00.200 I'd wake up early knowing that the day was neig 0:08:00.280 --> 0:08:02.000 start and the kids were going to start needing me 0:08:02.040 --> 0:08:07.160 at six am, and I was fucking terrified, horrified dread. 0:08:08.000 --> 0:08:13.600 That's quintessential postpartum depression. And and you're pointing out some 0:08:13.640 --> 0:08:17.520 important aspects of it. So with postpartum depression, we see 0:08:17.560 --> 0:08:20.520 the usual depressions is in low mood, which is what 0:08:20.880 --> 0:08:25.160 we see with a regular non postpartum, non pregnancy related depression, 0:08:25.240 --> 0:08:30.280 But often we also see a prominence of anxiety and 0:08:30.480 --> 0:08:32.840 even obsessions. And there's a difference, and I could explain 0:08:32.880 --> 0:08:36.720 that shortly. There's a sense of being overwhelmed with fatigue, 0:08:37.520 --> 0:08:42.400 with the challenge of facing the daily needs of the 0:08:42.440 --> 0:08:45.400 baby and the family and um. There's just a real 0:08:45.440 --> 0:08:48.319 sense of helplessness and worthlessness and for many women a 0:08:48.360 --> 0:08:52.559 sense of incompetence about their parenting abilities, particularly with negative 0:08:52.559 --> 0:08:56.120 thoughts about themselves and and and sometimes the rest of 0:08:56.120 --> 0:08:58.640 the family. It just it can be really something that 0:08:58.800 --> 0:09:02.880 is beyond their control. It just happens. Many women get 0:09:02.960 --> 0:09:11.200 this about one in five. That is what the study show. 0:09:12.080 --> 0:09:15.600 It kills me, one in five. It's huge. It's it's 0:09:15.600 --> 0:09:19.800 extremely common, and just because it's common doesn't mean that 0:09:19.880 --> 0:09:25.720 it's not serious. It's also the most common ebseentric complication 0:09:26.960 --> 0:09:32.200 postpartum depression. So there is something where you think, when 0:09:32.200 --> 0:09:34.800 you've been diagnosaed for postpart impression, you think, what's wrong 0:09:34.840 --> 0:09:38.079 with me? And how could this have possibly happened? If 0:09:38.120 --> 0:09:41.679 I'm a woman, I'm meant to rear children, I'm meant 0:09:41.679 --> 0:09:43.480 to be a mother. This is supposed to be my 0:09:43.559 --> 0:09:48.520 greatest calling. How how could this chemical imbalance even be 0:09:48.640 --> 0:09:51.480 a thing? All women when they have a baby, they 0:09:51.480 --> 0:09:55.400 go through the same, relatively the same thing with hormonal changes. 0:09:55.600 --> 0:10:00.280 We know that estrogen and progesterone just crash plu mint 0:10:00.400 --> 0:10:06.800 between having the baby and postpartum period within two weeks easily. 0:10:07.440 --> 0:10:12.040 Do we know if that's the cause? Probably not. I 0:10:12.040 --> 0:10:15.080 don't think it's the cause, because again, there's a majority 0:10:15.080 --> 0:10:17.400 of women who don't get postpartum depression from the same 0:10:17.480 --> 0:10:20.800 kind of crash. So we think that possibly there's an 0:10:20.840 --> 0:10:25.520 increased sensitivity maybe to that hormonal fluctuation, And that goes 0:10:25.559 --> 0:10:29.520 along with the knowledge that we have that certain women 0:10:29.720 --> 0:10:33.520 who have either had postpartumpressions in the past, or mood 0:10:33.640 --> 0:10:38.320 changes associated with menstruation or pre menstrual PMS, or have 0:10:38.400 --> 0:10:43.240 had mood changes associated with taking oral contraceptives, that those 0:10:43.280 --> 0:10:47.880 women are more likely to have postpartum depression. So there 0:10:47.960 --> 0:10:50.680 might be a certain subset of women and maybe they're 0:10:50.720 --> 0:10:54.800 medically predisposed. Not sure yet, You know, we need more data, 0:10:55.160 --> 0:10:57.920 more research on it, but that's what it looks like 0:10:58.040 --> 0:11:02.720 at this point that certain women are more likely under 0:11:02.720 --> 0:11:07.440 certain situations, okay, to experience postpartum depression. And keep in 0:11:07.480 --> 0:11:10.920 mind also we're in a natural disaster. It's called the pandemic, 0:11:11.240 --> 0:11:15.160 so that increases stress hormone levels as well. So maybe 0:11:15.480 --> 0:11:18.480 there was a threshold that, for example, you that you 0:11:18.600 --> 0:11:21.240 just your body couldn't take. It was the pandemic, it 0:11:21.360 --> 0:11:24.560 was the hormonal changes that maybe you're more sensitive to. 0:11:24.840 --> 0:11:26.560 There's a lot of maybes here because we don't know 0:11:26.600 --> 0:11:29.120 for sure. I don't know if you know this, but 0:11:29.640 --> 0:11:33.280 you called into prescription to Walgreens and I let it 0:11:33.320 --> 0:11:36.920 sit there. Dr Stein four days. I was like, ah, 0:11:37.040 --> 0:11:39.160 not me. I'm going to get a second opinion. I'm 0:11:39.160 --> 0:11:40.560 going to leave it there. I'm going to have a 0:11:40.600 --> 0:11:43.319 long conversation with my husband and say, but I'm only 0:11:43.760 --> 0:11:46.600 six seven, eight weeks out, give me a shot. Let's 0:11:46.640 --> 0:11:48.920 look at this again at three months postpart of four 0:11:48.960 --> 0:11:53.200 months postpartum. And then on the Saturday morning, I woke 0:11:53.320 --> 0:11:57.479 up and I had horrible thoughts about my son. Suicidal 0:11:58.360 --> 0:12:02.480 images kept come into my head, suicidal thoughts of it 0:12:02.480 --> 0:12:05.040 would be easier if I wasn't here. I can't wake 0:12:05.120 --> 0:12:07.439 up one more day like this. I don't want to 0:12:07.440 --> 0:12:12.400 see my children. And then I got scared. I scared 0:12:12.520 --> 0:12:16.640 myself into I've never had thoughts like this. I'm going 0:12:16.720 --> 0:12:18.960 to go into a psychiatric word and I'm going to 0:12:19.240 --> 0:12:21.800 have my children taken away from me because I'm unfit 0:12:21.840 --> 0:12:24.920 to parent. I don't trust my brain anymore. I don't 0:12:24.960 --> 0:12:28.679 recognize it. And I'm terrified. And I called you at 0:12:28.679 --> 0:12:33.160 a nine am on a Saturday, hysterical crying. I didn't 0:12:33.160 --> 0:12:36.240 know what was wrong with me. I didn't think I 0:12:36.240 --> 0:12:39.480 could get through a Saturday with my two kids without help. 0:12:39.559 --> 0:12:42.440 And it was so awful, and I drove to Walgreen's 0:12:42.520 --> 0:12:46.720 like a five mileur It was like, I am starting 0:12:46.720 --> 0:12:49.600 medication today because I don't see a way out of this. 0:12:50.240 --> 0:12:53.000 I have to try something I've never tried before, because 0:12:53.000 --> 0:12:57.079 I'm also at a place I've never been before. How 0:12:57.120 --> 0:13:00.560 did you reach the diagnosis that met occasion was a 0:13:00.640 --> 0:13:03.839 choice for me? Obviously, this is my own personal tail. 0:13:04.320 --> 0:13:08.960 Why medication? Yeah, not everybody who comes in to see 0:13:08.960 --> 0:13:12.640 me with postponed depression gets medication. So just letting you know, 0:13:12.880 --> 0:13:15.360 it depends on the severity, and it depends on what's 0:13:16.000 --> 0:13:20.559 been tried and what's worked. You tried everything. You had 0:13:20.559 --> 0:13:22.640 been in therapy, right. I mean, can I say how 0:13:22.679 --> 0:13:24.920 long you were in there? I don't even know how long? Okay, 0:13:24.960 --> 0:13:27.679 So so you were in therapy for a while. There 0:13:27.800 --> 0:13:31.200 was no doubt in my mind that you had tried everything, 0:13:31.360 --> 0:13:35.520 talking to behavioral tasks and homework and and she you 0:13:35.800 --> 0:13:40.000 want to walk crystals. I was pressing oils and crystals 0:13:40.040 --> 0:13:45.400 to my heart, praying faith. I was begging ancestors. My 0:13:45.679 --> 0:13:51.200 amazing acupuncturist was like, what about your placenta pills. I 0:13:51.240 --> 0:13:53.360 was like, honey, I've been taking the placenta pills. I 0:13:53.440 --> 0:13:56.320 dehydrated my placenta. I've been eating it for two months. 0:13:56.920 --> 0:14:00.320 You're right, thank you. I did try. I tried everything. Right, 0:14:00.480 --> 0:14:03.640 So you tried everything for a while, and it was 0:14:03.840 --> 0:14:06.320 extremely clear to me, I do not try any of 0:14:06.320 --> 0:14:08.240 those things. And you showed up to me with a 0:14:08.280 --> 0:14:10.360 mild to moderate case. I might say, okay, maybe we 0:14:10.360 --> 0:14:13.760 should just try psychotherapy and make sure that you have 0:14:13.880 --> 0:14:16.360 all a bunch of supports and you're not isolated. But 0:14:16.600 --> 0:14:18.680 you'd have done all that you were actually reaching out 0:14:18.720 --> 0:14:20.360 to friends. I mean, I think you were a little 0:14:20.400 --> 0:14:23.840 bit hesitant to maybe can reach out as much as 0:14:23.840 --> 0:14:27.120 you did later on. Yes, Yes, I had reached out 0:14:27.200 --> 0:14:31.200 to my two friends Mary and Talia, who I'm going 0:14:31.240 --> 0:14:33.800 to have on this podcast, Mary and Talia. I reached 0:14:33.800 --> 0:14:36.160 out to them because I knew they had postpartum depression, 0:14:36.200 --> 0:14:39.320 and I knew that they had experiences with medications. So 0:14:39.360 --> 0:14:43.040 I was already doing the research and seeing how other 0:14:43.160 --> 0:14:46.680 mothers responded. Casey Wilson, who I had on this podcast, 0:14:46.720 --> 0:14:51.280 I called her. She took me through her exact story. 0:14:51.880 --> 0:14:54.560 So I was dipping my toe in, but I was 0:14:54.760 --> 0:15:00.360 feeling I fell for every trap of feeling emba arrist 0:15:00.480 --> 0:15:05.560 and ashamed to admit that I was feeling like a 0:15:05.600 --> 0:15:10.320 failure in my mental health was not going great. Was 0:15:10.400 --> 0:15:15.640 really hard. It's a biological phenomenon postpartum depression. It's not 0:15:15.760 --> 0:15:20.240 about your character, it's not about weakness, it's not about 0:15:20.600 --> 0:15:24.480 being a bad mother. It just happens, and it happens 0:15:24.520 --> 0:15:28.120 to a lot of us. And often it's not just 0:15:28.160 --> 0:15:31.760 postpartum depression. It mixes with anxiety, a lot of anxiety, 0:15:32.080 --> 0:15:33.920 and so that's why a lot of people get confused 0:15:34.360 --> 0:15:37.400 sometimes when there's so much anxiety involved in postpartum, depression 0:15:37.760 --> 0:15:39.560 is at the forefront of people's minds and they don't 0:15:39.560 --> 0:15:53.520 realize they're also depressed. If someone has tried lots of 0:15:53.560 --> 0:15:56.280 things and you do feel that medication is an option 0:15:56.280 --> 0:15:59.040 that they should try, my understanding was that zoloft is 0:15:59.120 --> 0:16:01.800 great at work with both depression and anxiety, because I 0:16:01.840 --> 0:16:05.480 was struggling with both. A lot of the antidepressants deal 0:16:05.520 --> 0:16:09.720 with both. It depends on other other symptoms, other side effects. 0:16:09.760 --> 0:16:13.600 I just personalized the specific choice of medications to what 0:16:13.840 --> 0:16:16.160 the patient is experiencing. I would say that most of 0:16:16.200 --> 0:16:18.880 the antidepressants that I work with in women who are 0:16:18.920 --> 0:16:23.320 breastfeeding or not postpartum, it depends on their personal situation. 0:16:23.360 --> 0:16:25.240 It may not be just about anxiety or depression. But 0:16:25.280 --> 0:16:27.840 that was a big thing too. I felt such guilt 0:16:28.160 --> 0:16:35.440 about wanting to breastfeed and also wanting to take medication 0:16:35.840 --> 0:16:38.080 and knowing that I needed it. And now that I've 0:16:38.120 --> 0:16:41.520 been on the medication, I do feel the light of Oh, 0:16:41.600 --> 0:16:45.240 it sucks that I'm on zoloft and breastfeeding, and yes, 0:16:45.280 --> 0:16:47.360 I wish I wasn't in a situation, but I can't 0:16:47.400 --> 0:16:50.000 tell you how much more fun and a better time 0:16:50.040 --> 0:16:53.640 I'm having mothering her. The fact that I am obsessed 0:16:53.640 --> 0:16:57.200 with her now and like love being her parents, and 0:16:57.320 --> 0:17:00.160 love parenting my son even though he's a three nature, 0:17:00.840 --> 0:17:04.879 that trade off is fucking worth it for me. What 0:17:04.920 --> 0:17:06.879 would you say to women who are still afraid that 0:17:06.920 --> 0:17:11.480 medication would get into their babyes systems? There are several 0:17:11.520 --> 0:17:16.280 antidepressants that we can use in breastfeeding that are relatively safe, 0:17:16.720 --> 0:17:20.880 and so the risks benefit analysis for each patient has 0:17:20.920 --> 0:17:24.480 to be taken to consideration. But generally speaking, we can 0:17:24.600 --> 0:17:30.639 treat most postpartum depressions very easily with medication. UM, I 0:17:30.640 --> 0:17:35.639 think the best course of action is to prioritize mother's 0:17:35.760 --> 0:17:41.320 mental health and ultimately the baby's health. If the only 0:17:41.359 --> 0:17:43.600 reason why you're not going to take a medicine that's 0:17:43.600 --> 0:17:46.840 going to help you with your depression is because you're 0:17:46.920 --> 0:17:50.080 afraid a small amount will enter your baby system. As 0:17:50.119 --> 0:17:53.080 a psychiatrist, you want to honor everyone's desires and there 0:17:53.240 --> 0:17:55.120 and then what they want, and of course the psychiatrist 0:17:55.160 --> 0:17:58.760 will support you in whatever decision you make. But I 0:17:58.920 --> 0:18:02.640 worry that risk benefit analysis is skewed. There if somebody's 0:18:03.160 --> 0:18:06.080 severely depressed. I completely agree. And I have to say 0:18:06.119 --> 0:18:10.399 I was so freaked out about breastfeeding Vera, and I 0:18:10.440 --> 0:18:12.719 had to really weigh out, Okay, the options do I 0:18:12.840 --> 0:18:17.919 quit breastfeeding. In my personal case, I felt like that 0:18:18.000 --> 0:18:21.160 was going to cause me to be further to wake 0:18:21.200 --> 0:18:23.640 my depression worse because I felt like I had breastfed 0:18:23.680 --> 0:18:25.760 Alby for a year and it felt unfair and I 0:18:25.800 --> 0:18:29.520 was felt terrible. And you said you were doing really 0:18:29.560 --> 0:18:32.520 well with breastfeeding. You felt connected and bonded with the baby. 0:18:32.760 --> 0:18:34.520 For sure, I wouldn't want to take that away from you. 0:18:34.720 --> 0:18:36.920 And then you I think you were getting enough sleep, 0:18:37.040 --> 0:18:43.040 So yes, for sure, continue and start medicine. Yep, yep. 0:18:43.720 --> 0:18:46.720 And then I've talked to some mothers who breastfeeding, like 0:18:46.760 --> 0:18:50.640 you said, caused them such depression and pain because they 0:18:51.440 --> 0:18:54.120 it was stressful to them that it wasn't going well, 0:18:54.400 --> 0:18:58.040 breastfeeding was going so poorly that it wasn't until they 0:18:58.160 --> 0:19:02.520 just quit and started bottle feeding that they started enjoying motherhood. 0:19:02.680 --> 0:19:04.760 And it really I'm one of those mothers. I'm one 0:19:04.760 --> 0:19:07.399 of those mothers. I tried for I think it was 0:19:07.480 --> 0:19:11.199 six months with my daughter and I couldn't produce. When 0:19:11.280 --> 0:19:15.159 you rescue, do the best, your child gets dehydrated because 0:19:15.160 --> 0:19:18.400 they're struggling to get the milk out, and then you're 0:19:18.440 --> 0:19:21.280 pumping on afterwards, hoping to get eke out every ounce 0:19:21.359 --> 0:19:24.280 on one ounce after forty you give them the formula. 0:19:24.680 --> 0:19:29.320 They'll be happier because they're fatiated. You'll be happier because 0:19:29.359 --> 0:19:31.880 you sleep, and you won't be faced with failure after failure. 0:19:32.800 --> 0:19:35.520 So that's that situation. But I do also have to 0:19:35.560 --> 0:19:37.880 add that when I was so freaked out, I texted 0:19:37.920 --> 0:19:41.480 the best lactation consultant in Los Angeles, the lactation consultant 0:19:41.480 --> 0:19:43.520 to the stars, Linda Hannah, who has been on this 0:19:43.600 --> 0:19:46.840 podcast and is fucking amazing. And I texted my pediatrician, 0:19:46.920 --> 0:19:51.040 who is also incredible. I have never received text back 0:19:51.400 --> 0:19:56.000 fast enough that said, go on the zoloft. Great, great, 0:19:57.160 --> 0:20:00.840 your baby is fine. My what they we're concern The 0:20:00.880 --> 0:20:05.720 pediatrician who's number what concerned is my baby, was very 0:20:05.760 --> 0:20:11.600 concerned about my mental health and said, please, you're fine. 0:20:11.960 --> 0:20:14.760 To have a healthy baby, need a healthy mom. Yeah, 0:20:15.320 --> 0:20:18.000 that's simple. Whatever choice that is for you to go 0:20:18.040 --> 0:20:21.000 on medication. That's been absolutely for breastfeeding or whether to 0:20:21.080 --> 0:20:23.960 quit breastfeeding entirely, or you know, any of the things 0:20:23.960 --> 0:20:26.680 we've discussed. Because you know, Dr Stein, I want to say, 0:20:26.720 --> 0:20:30.280 not only medication, but you sent me meditations to be 0:20:30.359 --> 0:20:34.640 doing when my anxiety flared up. We talked about some 0:20:34.840 --> 0:20:39.320 faith centering practices that I can do to really lift 0:20:39.359 --> 0:20:41.679 my spirit up to a higher power. And it was 0:20:41.960 --> 0:20:45.760 very helpful. You You really encouraged me to FaceTime friends 0:20:45.800 --> 0:20:48.280 that even in COVID, like going out for a social 0:20:48.320 --> 0:20:50.960 distance walk with a friend and being honest was so 0:20:51.600 --> 0:20:55.160 groundbreaking lee helpful. Um, So there were so many things 0:20:55.200 --> 0:20:57.639 working in tandem, is what I'm trying to say, you know, 0:20:57.800 --> 0:21:01.240 and it's really just medica patient. I would never say 0:21:01.280 --> 0:21:06.240 that it's other things. When somebody suffering from a moderate 0:21:06.359 --> 0:21:10.800 or severe episode of depression, somebody shows up mild to moderate, 0:21:10.840 --> 0:21:15.160 I generally recommend that they try other things if it's 0:21:15.359 --> 0:21:19.960 moderate to severe, and your case it was severe. Yeah, 0:21:20.480 --> 0:21:23.080 it was severe, you know, based on the Edinburgh That's 0:21:23.080 --> 0:21:24.720 what you said at the end of overse conversation. It 0:21:24.800 --> 0:21:27.000 was like the mic drop of all mic drops in 0:21:27.040 --> 0:21:32.480 my life. Now, postpartum depression, it can happen anytime. Cases 0:21:32.520 --> 0:21:39.520 start after delivery, mostly during the first month postpartum. Okay, 0:21:39.880 --> 0:21:43.919 but almost nine percent of cases occur by four months postpartum. 0:21:44.200 --> 0:21:48.560 Total of the postpartum depression cases so there are a 0:21:48.640 --> 0:21:54.320 few are between fifth and the twelve month postpartum. There 0:21:54.320 --> 0:21:57.760 are different definitions from different associations and organizations of what 0:21:57.800 --> 0:22:01.840 postpartum depression is. I kind of like the concept that 0:22:02.080 --> 0:22:08.400 postpartum depression can start during pregnancy or within twelve months postpartum, 0:22:08.440 --> 0:22:11.919 and that's the American College of Centric's and Ganecologies definition. 0:22:12.320 --> 0:22:15.840 Got it because I think it covers everything. But as 0:22:15.880 --> 0:22:21.920 I mentioned before, almost six of postpartum depressions start before 0:22:22.080 --> 0:22:27.560 the baby is born, so that would be before conception, 0:22:28.000 --> 0:22:34.880 women who are just conceiving well depressed, and thirty during pregnancy. Yep, 0:22:35.680 --> 0:22:38.520 that was me. And now I've just heard my first 0:22:38.560 --> 0:22:42.880 story of a man who got diagnosed with postpartum depression 0:22:42.960 --> 0:22:46.160 after his wife delivered their baby. Is that a thing? 0:22:46.920 --> 0:22:51.640 It is a thing. And about ten percent of fathers 0:22:51.840 --> 0:22:55.560 get a postpartum depression they get postpartupression is just clinical 0:22:55.680 --> 0:22:58.960 medical major depressive disorder, whether a male or a female. 0:22:59.240 --> 0:23:02.120 If it's after your child has had has been born 0:23:02.480 --> 0:23:06.520 and it's been diagnosed within the year, it's postpartum depression. 0:23:06.560 --> 0:23:13.240 And about ten percent of men experience clinical depression either 0:23:14.280 --> 0:23:19.520 during their spouses or their partners pregnancy or during the 0:23:19.560 --> 0:23:23.720 postparton year. Wow. Wow, that's fascinating. I mean there's a 0:23:23.720 --> 0:23:27.679 lot of suffering. Oh my gosh. How long does postpartum 0:23:27.720 --> 0:23:34.400 depression last? Typically it depends on if it's treated or not. 0:23:34.560 --> 0:23:39.719 So in general, the estimation is that postpartum depressions can 0:23:39.800 --> 0:23:42.960 last at least a year. What is the risk I 0:23:43.520 --> 0:23:49.159 worry now endlessly about women who go untreated or delay 0:23:49.200 --> 0:23:52.720 seeking treatment. What is what's the risk there? Well, there's 0:23:52.720 --> 0:23:59.200 a risk to themselves depression, clinical depression, untreated and prolonged suicide. 0:23:59.640 --> 0:24:02.800 Women taking care of themselves increases the risk of marital 0:24:03.080 --> 0:24:06.040 and partner discord. Not being able to take care of 0:24:06.080 --> 0:24:09.439 their families, their babies the way they would normally want to, 0:24:09.680 --> 0:24:13.520 missed edutrian visits, not taking your penatal vitamins, or some 0:24:13.560 --> 0:24:16.159 women forget to get to work, more accidents, for example, 0:24:16.240 --> 0:24:19.520 or they forget to put their babies in their booster seats. 0:24:19.560 --> 0:24:22.600 And in terms of the baby mother infant attachment to 0:24:22.680 --> 0:24:27.160 the bonding is usually diminished when it's a significant postpartum 0:24:27.200 --> 0:24:31.240 depression and just a lack of responsivity, emotional responsivilty, and 0:24:31.280 --> 0:24:35.520 even physical responsivility to their babies. And it's not intentional, 0:24:35.640 --> 0:24:38.439 it's just that's the way you're functioning if you have 0:24:38.440 --> 0:24:43.000 postpartum depression, and babies are just more at risk. Therefore, 0:24:43.320 --> 0:24:46.600 when their mothers are less connected with them, less nurturing, 0:24:46.800 --> 0:24:50.560 less likely to as time goes by, like peekaboo or 0:24:50.640 --> 0:24:53.480 read to them or saying to them, the babies tend 0:24:53.560 --> 0:24:58.840 to develop into older children and even adults who are 0:24:58.880 --> 0:25:02.520