A growing body of research indicates that postpartum mental disorders that afflict new mothers are more common and include more symptoms than previously thought. As many as one in seven women develop a wide-range of problems including depression, anxiety, and bi-polar disorder in the year after they give birth. In several countries, suicide is one of the leading causes of death of new moms. Scientists say a complex interaction of genes, stress and hormones is to blame. Diane and a panel of guests will discuss the latest findings on risk factors and treatment options for women with postpartum depression and anxiety.

Guests

  • Zachary Kaminsky researcher and assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine
  • Lynne McIntyre clinical social worker at Mary's Center for Maternal and Child Care in Washington, DC. She is also the mid-atlantic regional coordinator for Postpartum Support International, an advocacy group.
  • Dr. Katherine Wisner professor and director, Asher Center for the Study and Treatment of Depressive Disorders, Feinberg School of Medicine, Northwestern University
  • Dr. Peter Schmidt clinical researcher, National Institute of Mental Health

Get Help: A list from Postpartum.net offers resources in every state across the country.

Transcript

  • 11:06:53

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. New research shows that postpartum depression and anxiety in new moms is more common and varied than previously thought. In response to extreme cases of mothers killing themselves or their babies, several states have passed laws to screen women for symptoms.

  • 11:07:18

    MS. DIANE REHMHere to talk about postpartum depression, Dr. Peter Schmidt at the National Institute of Mental Health and Lynne McIntyre with Postpartum Support International. Joining us by phone from WBEZ in Chicago, Dr. Katherine Wisner at Northwestern University. I invite you to be part of the conversation. Give us a call at 800-433-8850. Send us an email to drshow@wamu.org. Follow us on Facebook or send us a tweet. And welcome to all of you.

  • 11:08:03

    MS. LYNNE MCINTYREThank you for having me.

  • 11:08:04

    DR. PETER SCHMIDTThanks for the invitation, Diane.

  • 11:08:05

    DR. KATHERINE WISNERThanks. Yeah, it's a pleasure to be with you this morning.

  • 11:08:08

    REHMGood. Thank you. Dr. Wisner, I'll start with you. I know that there's been some new research on postpartum depression. And it's changed thinking. Tell me what the research is indicating as to how many women do really suffer from postpartum depression.

  • 11:08:35

    WISNERYes. It's a good question. We did a large study at the University of Pittsburgh and screened 10,000 women with a very common screening measure, the Edinburgh Postnatal Depression Scale. And in this large population of women who gave birth, so obstetrical patients, we found that 14 percent or one out of seven women screened positive for postpartum depression.

  • 11:09:03

    WISNERAnd we actually went to their homes, and we did psychiatric assessments to determine, did they actually have a diagnosis? And over 90 percent of the women had either postpartum depression, anxiety, or some other difficulty that was interfering with function. So it is an incredibly common illness. And in that population of women, we asked when the episodes started. And for the vast majority of women, it started immediately after birth.

  • 11:09:36

    REHMHmm.

  • 11:09:36

    WISNERSo there's a clustering of new cases of mental illness in that immediate, about three-month, post-birth period.

  • 11:09:44

    REHMAnd to you, Lynne McIntyre. As a clinical social worker, I gather the understanding of symptoms related to postpartum mental disorders has also changed. Talk about that.

  • 11:10:03

    MCINTYREYes. I think the name postpartum depression has possibly, you know, led us down a road that wasn't where we should have been going. I think for a lot of new mothers, they do have symptoms that mirror a typical major depressive episode, sadness, you know, lack of interest in doing things they liked before. But what we see in the postpartum is that there's a huge anxiety component to it.

  • 11:10:27

    MCINTYREAnd, you know, when I'm talking about anxiety, I mean anxiety that's to the point where it's really interfering with a mother's functioning. She's worrying about her baby's health, her baby's future, her own future. Very frequently the anxiety is focused on the baby. It can be generalized. It can manifest in panic disorders. It can also manifest sometimes in Post-Traumatic Stress Disorder, which is an anxiety disorder.

  • 11:10:54

    REHMInteresting. And to you, Dr. Schmidt, I gather there are studies in Britain and elsewhere indicating that suicide is one of the leading causes of deaths for new mothers.

  • 11:11:13

    SCHMIDTThat's right. I guess, as Katherine alluded to, that in this country, say, out of the three to 4 million live births each year, even taking kind of conservative measures of the number of women at risk, it would be over a half a million women per year who are at risk for developing a depression. And there's clearly different levels of severity. I think in Katherine's study, she identified 15 to 20 percent of women in her cohort did experience some feelings of self-harm. The study that you're referring to is what was called the Confidential Enquiry into Maternal Deaths.

  • 11:11:51

    SCHMIDTAnd it actually -- we don't have a similar study in this country. But in England, they monitored kind of causes of maternal death. And slowly, over the years, as postpartum hemorrhage or bleeding or postpartum infections were really, you know, prevented and well treated that what emerged was that deaths from kind of, you know, suicide, death in the context of depression was becoming one of the leading causes of maternal death. And these suicides are different from the typical pattern of a woman's effort to, at other times in her life to harm herself and...

  • 11:12:35

    REHMHow so?

  • 11:12:36

    SCHMIDTGenerally, there's a male and a female pattern of lethality to suicides. And men tend to use methods that are far more lethal, such as hanging or throwing themselves off of bridges, whereas women would frequently resort to self-poisoning, taking overdoses of medications. In the postpartum, they found, in the study, that postpartum women tended to use a much more lethal method of suicide, so...

  • 11:13:03

    REHMHuh. Interesting.

  • 11:13:05

    SCHMIDTAnd it's -- fits in with people's views and women that I've spoken to. In the severe forms of depression, there really is this dissociation between her role as a mother, her role as a, you know, in a family, in a social network, where that dissociation and that numbness around social affiliation kind of takes about a 180-degree turn. And they become more isolative and brooding. And that may lead to a very scary situation, and it may happen very quickly.

  • 11:13:35

    REHMInteresting.

  • 11:13:37

    SCHMIDTI've seen many women in my clinical practice where this may happen over a couple of days. And you see them, and then suddenly, the next thing you hear is that, you know, things have gone south very quickly.

  • 11:13:48

    REHMWow.

  • 11:13:48

    SCHMIDTShe's in a very frightened state.

  • 11:13:50

    REHMDr. Wisner, I can certainly remember having my own children and many years ago and having a certain amount of anxiety and a certain amount of feelings of isolation being at home by myself with a child. Is there this range though? I mean, isn't there a certain amount of normal depression, anxiety, isolation, feelings of isolation with childbirth? Isn't that normal?

  • 11:14:33

    WISNERYeah. So it's a wonderful question. And I share your experience. And it probably was the experience of having my own children that made me look carefully at what an incredibly wonderful but also stressful event having a child is, particularly your first child. So you have the labor, delivery, pain, the 24/7 responsibility for a new little child that they don't come with manuals.

  • 11:15:04

    WISNERAnd you certainly have anxiety about this new experience and how successful you're going to be as a mother. There are many of these parent adaptation feelings that are very common in new parents and would fall under what you labeled normal. There's also the baby blues, which are very common. And these are transient, you know, gone by about 10 days, feelings of sadness, irritability. But they're transient, and they're low level.

  • 11:15:36

    WISNERAnd there's not the kind of deep dark thinking that Peter described. And, again, that's very common and thought to be related to the physiologic and emotional adjustments to the early postpartum period where we begin to worry about depression is what Lynne emphasized, that there's a sustained sad down mood. Or I agree completely with her that many women are far more aware of feeling uncomfortable, anxious, overwhelmed, stressed, and deny that they're depressed, even though we call the disorder depression.

  • 11:16:11

    REHMAh.

  • 11:16:13

    WISNERThat is a very prominent feeling mood state in the postpartum period. But in depression, what happens is there's a difficulty feeling positive emotions. So one of the patients I saw last week said, you know, I know I love my husband, and I know I love my baby. But the feeling -- I just can't feel it.

  • 11:16:36

    REHMHmm. Hmm.

  • 11:16:36

    WISNERSo the ability to feel these positive emotions becomes compromised. And it's then a set of physiologic symptoms, too, appetite changes, weight changes, feeling restlessness all the time, agitated, inability to sleep, even when the baby sleeps because the brain won't turn off. And it's...

  • 11:16:57

    REHMI want to pick up on that sleep aspect, Lynne, because, seems to me that that's one of the most difficult parts of bringing a new baby in, is the sleep deprivation. And doesn't that lead to certain symptoms?

  • 11:17:20

    MCINTYREYes. I think it does. Sleep deprivation, and insomnia in particular, it's this funny thing, especially in the postpartum, because it's both a symptom of depression and anxiety.

  • 11:17:31

    REHMRight.

  • 11:17:31

    MCINTYREAnd it also exacerbates what you're already experiencing and makes it worse. I am a survivor myself of postpartum depression and anxiety and, in addition to many of the symptoms that Dr. Wisner just mentioned, completely lost my appetite, restlessness, you know, a fog of indecision and worry. I eventually stopped sleeping.

  • 11:17:54

    MCINTYREAnd there would be nights when my baby would wake up and nurse and go back to sleep. And my husband was laying beside me asleep, and I would be -- I was the most tired I ever was in my life, and I was staring at the ceiling. And, for me, the chronic insomnia is what pushed me to feel eventually suicidal. And it was not a desire to die at all. It was a desire to just have everything stop.

  • 11:18:24

    REHMLynne McIntyre, she's a clinical social worker at St. (sic) Mary's Center for Maternal and Child Care. She's also with the Postpartum Support International. Short break, right back.

  • 11:20:01

    REHMAnd in this hour we're talking about postpartum depression many women feel mild symptoms of postpartum depression after coming home with a brand new baby. But new studies indicate as many as 14 percent or 1 in 7 women had postpartum depression and anxiety related symptoms four to six weeks after birth. Here in the studio, Lynne McIntyre, a clinical social worker.

  • 11:20:42

    REHMYou were just talking about your own depth of postpartum depression. What was going on? Who were you talking to? How did your husband react?

  • 11:20:57

    MCINTYREThat's a terrific question. At first, I didn't talk to anyone. My son was born nine years ago and I went through my entire length of prenatal care without anyone once mentioning to me the possibility that this might happen, even though it's the number one complication of childbirth. I have a personal history of some depression and anxiety and a long family history, which are two, big risk factors that could have been brought to my attention.

  • 11:21:24

    MCINTYREIn retrospect, what I heard from the people who'd know me best and my husband in particular was that my personality completely changed. My husband and I met in the Peace Corps and he said, you're a person who can do anything. And we wanted this baby and we're happy to have him and, you know, what on earth is going on with you? And it took a while and it took that depth of experience for us to say this is not normal.

  • 11:21:53

    MCINTYREThis isn't just adjusting to new motherhood. This is something more than that. And I said to him, I need some help. So, fortunately, I was in a new mother's group. And through that group, I found a social support group ran by Postpartum Support International. And that group saved me, I think. Just being in a room with other women who would say, I wanted my baby, I love my baby and I'm absolutely miserable and I don't know why.

  • 11:22:25

    REHMAnd you actually reached a point where you felt suicidal.

  • 11:22:31

    MCINTYREI did, I did. And, again, it's a strange thing to explain because I didn't want to die, I just was so anxious and so confused in my head and so very tired that that seemed at that point, like, the only option. Fortunately, I didn't take it.

  • 11:22:56

    REHMI'm glad you didn't. Dr. Schmidt, do Lynne's -- does Lynne's experience sound like what you've been hearing?

  • 11:23:07

    SCHMIDTYes. In many women, the pain -- whether it's during the postpartum or whether it's in the context of depressions at other time -- the pain of being so distressed and out of control in any -- have exhausted any options to reduce that pain. Some people talk about psychic pain. The pain often leads to the inevitable conclusion that the only way of stopping the pain and getting some relief is to end it.

  • 11:23:39

    REHMAnd, Dr. Wisner, Lynne talked about having experienced depression even and having a family history of depression. We have an email from Susan who asks, "Are there any pre-partum indicators that would help to target moms who will need help?"

  • 11:24:09

    WISNERYes, there are. And one of the major predictors of who will experience postpartum depression is a woman's own history of either a previous postpartum episode or an episode of depression herself in the past. We also have begun to look at whether having an early onset anxiety disorder. So generalized anxiety or panic disorder or a posttraumatic stress disorder at sometime in childhood or adolescents are generally gatekeepers to adult onset depression.

  • 11:24:46

    WISNERSo we've expanded our criteria, determining who might be at risk to also look at underlying anxiety disorder. In fact, in the study that I told you about, the large-scale screening study, the most common diagnosis in women was recurrent, that is more than the second or greater episode of depression in that post-birth period. But superimposed on an anxiety disorder. So that is a huge risk factor.

  • 11:25:15

    WISNERAnd we have developed prevention treatments for women who have this history. The other factors are ones that you would anticipate -- substantial marital discord, life stressors are important additions to tipping that scale over for postpartum depression. So the woman develops the illness after birth.

  • 11:25:39

    REHMAnd joining us now by phone from Baltimore, MD is Zachary Kaminsky, a researcher in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine. Dr. Kaminsky, I know you're working on a genetic screening test that can indicate if a pregnant woman will likely develop postpartum depression?

  • 11:26:16

    DR. ZACHARY KAMINSKYThat's right, Diane. And thanks for having me on the show.

  • 11:26:19

    REHMSure.

  • 11:26:21

    KAMINSKYYeah. So we believe our research is very promising even though it's in early days. We have some exciting findings. In my lab, we study DNA and specifically something called DNA methylation. Basically, we're talking about molecular marks connected to genes that act like light switches or perhaps it might be more appropriate to think of them like dimmer switches because they can function to turn up or down various genes.

  • 11:26:49

    KAMINSKYSo, unlike what everyone else has been talking about, we're really looking at a molecular study of postpartum depression here. So in our study, we hypothesize that women who are at risk for postpartum depression would be more sensitive to estrogen. But more specifically that this sensitivity would manifest in more extreme changes to these molecular dimmer switches on the DNA.

  • 11:27:16

    KAMINSKYSo the first thing we did was to look in experimental animals to find out where estrogen causes changes to these switches. So a lot of previous work in postpartum depression, some in fact that I know Dr. Schmidt has been involved in, has shown that women at risk for postpartum depression seem to be more sensitive to hormonal changes, like the extreme changes of estrogen that occur right after giving birth.

  • 11:27:43

    KAMINSKYSo the first thing we wanted to do was to find out where estrogen was causing these changes in the brain, and specifically we looked in an area of the brain called the hippocampus, which previous animal research and some brain imaging has shown to be one of the key areas where estrogen acts to change mood. So we used a method that allowed us to measure all the switches in the genome at once and found where estrogen was causing a change.

  • 11:28:12

    KAMINSKYSo now armed with these brain-related targets of estrogen, we were ready to make the jump into humans and start looking for relationships to postpartum depression.

  • 11:28:21

    REHMSo, now, how many women are in your study?

  • 11:28:26

    KAMINSKYWell, thanks to a collaboration with Dr. Jennifer Payne who runs the Women's Mood Disorder Center at Hopkins, she had collected blood samples during pregnancy from about 52 women who were followed into the postpartum period. Now some of these women had gotten postpartum depression and others hadn't, and we had all this information. But importantly, we could go back to the blood and look to see what these molecular switches that respond to estrogen were doing in the at-risk women.

  • 11:28:55

    KAMINSKYAnd in essence, we're going back in time to ask what was happening in the blood before the person became depressed. And the first thing we found was that those women who were going to develop postpartum depression showed a more extreme change to these dimmer switches at the estrogen responsive gene. So estrogen was dialing up the dimmer switches in the women who were going to get postpartum depression.

  • 11:29:18

    KAMINSKYAnd this is really exciting because it really supported previous research that showed that postpartum depression might be caused by a sensitivity to hormones. And importantly that this sensitivity manifested on a molecular level, at genes important for mood responsive areas of the brain.

  • 11:29:36

    REHMSo you're now testing your theory, I gather, using blood samples from a larger group of pregnant women.

  • 11:29:48

    KAMINSKYThat's right. So once we found these changes, we found that we are able to predict with about 82 to 85 percent accuracy who was going to get postpartum depression.

  • 11:29:57

    REHMWow.

  • 11:29:57

    KAMINSKYAnd this was really exciting. So, now, moving forward, we're really trying to expand on these studies. And we've started a collaboration with Elisabeth Binder who is a researcher both at Emory University and the Max-Planck Institute of Psychiatry in Germany. And we're looking at about 400 women from the general population. Now, these are women who do not have a previous history of mood disorders.

  • 11:30:24

    KAMINSKYAnd we're basically trying to replicate the predictive accuracy of our findings. Now I can't say too much about the results, because the analyses are ongoing. But basically what I will say is that our model is performing very promisingly.

  • 11:30:37

    REHMSo what you're hoping for eventually is a blood screening test for postpartum depression that, I gather, would be available to pregnant women.

  • 11:30:52

    KAMINSKYYeah, that's right. I mean, we know it's early days. I mean, we're moving forward in trying to develop our findings into a clinical test that we can bring to the public. Of course, there's a lot of regulatory steps that need to be satisfied and we need to make sure that it continues to work in a reliable way in larger groups of women. But we started taking steps to work with a diagnostic company, Physicians Choice Laboratory Services or PCLS, based down in South Carolina to start developing a postpartum depression test.

  • 11:31:23

    REHMExcellent. Zachary Kaminsky, he's a researcher at Johns Hopkins University School of Medicine. Thanks so much for joining us.

  • 11:31:35

    KAMINSKYThank you, Diane.

  • 11:31:37

    REHMAnd turning to you, Dr. Schmidt, how does postpartum depression in women and the general anxiety and perhaps even mental disorder, however temporary, how does that compare to what happens in the general population?

  • 11:32:03

    SCHMIDTWell, it's interesting in a number of comparisons. I think there is a, as Katherine mentioned in her study and this has been shown in several other studies, that there's a clustering of these episodes, whether they're depression or they're just negative mood states, many of which can be more persistent, some get better on their own, others become more chronic around the three months after delivery.

  • 11:32:30

    SCHMIDTAnd although there -- if you compare that, the incidence or the frequency of depressions that occur during that time, it may not be that much greater than depression at other times in a woman's life. I mean, we know that women have about a two-fold increased risk over their lifetime for depression. And the postpartum period may be one period where they're more vulnerable. Certainly, relative to other stages of pregnancy, there's a slight increase.

  • 11:33:03

    REHMAnd you're listening to "The Diane Rehm Show." Lynne McIntyre, how long after a woman delivers a child might the symptoms develop?

  • 11:33:20

    MCINTYREYou know, I think the answer to that question varies per woman. But I can tell you that I've been working with women now for many years and I hear over and over again women say, well, it wasn't until two months or four months or eight months after the birth that I finally figured out what was going on. But when I look back, it started right away. Almost to a woman, they have told me, it started in the delivery room because I didn't feel that special feeling that everyone told me I was going to feel as soon as my baby was born.

  • 11:33:59

    MCINTYREAnd the disconnect, the disorientation, the confusion, some of the worry starts very quickly. But it's not identified as being anything other than just normal adjustment to new motherhood.

  • 11:34:14

    REHMAnd how long would you say it took you to understand and then begin to feel that normalcy you were looking for?

  • 11:34:28

    MCINTYREWell for me, personally, finding out that I had postpartum depression and anxiety was a relief. That's not the case for every woman because some women, of course, you know, and this is in the general population too, there's a stigma attached to depression and anxiety and other mental illness and they don't want the label. I have mothers who come to my group who are really suffering who say, I don't have postpartum depression, but can I come to your group and get some help?

  • 11:34:58

    MCINTYREAnd I say, sure. But, you know, it took a few months to understand what was going on and it took quite a few more months of, first, the social support group and then psychotherapy and then ultimately for me medication to get fully back to myself.

  • 11:35:17

    REHMThere is a or was a story -- a series of articles in 2013 in the New York Times about the suicide of a woman, a successful New York lawyer, who worked for the state Supreme Court. After she had her son, she became obsessed that she had given him brain damage. So when she was 10 months old, she jumped from a building to her death with him strapped to her chest. Apparently, she died, he survived. What can you tell us about that story?

  • 11:36:09

    MCINTYREWell, of course, I didn't know that woman nor, you know, any of her friends or family. What I can say from my own experience and that of the many women I've worked with is you reach a point where you feel, as Dr. Schmidt said, that the only option to solve the problems that you believe you're having in your life and that your baby is having, the only option is death. I think also we see a lot with new mothers that their anxiety, their worries, their fixations are really focused on the baby.

  • 11:36:47

    MCINTYREAnd there's also, in addition to that, a strand of perfectionism, I think, that we see a lot in women who are going to do everything right. The women who from the time they became young adults decided where they were going to college and what they were going to study and when they were getting married, and probably when they were going to have a baby. And then in the postpartum, they're having this experience that's largely out of their control because there's another human being involved.

  • 11:37:17

    REHMLynne McIntyre, she is the mid-Atlantic regional coordinator for Postpartum Support International, that is an advocacy group. When we come back, we'll open the phones. Stay with us.

  • 11:39:59

    REHMAnd as we talk about postpartum depression, which can be quite serious, let's open the phones now. We'll go to Josh in Ashville, N.C. Hi. You're on the air.

  • 11:40:17

    JOSHHi. About two weeks after the birth of our second child, my wife described what was almost an acute onset of postpartum depression. She, at the time, was feeling not necessarily that she would harm herself but that she could possibly harm the child. And she was able to kind of objectively evaluate her situation and come to that conclusion and immediately called a friend -- I was on the road -- immediately called a friend. That friend came over. That friend called me. I turned around and came home myself.

  • 11:40:55

    JOSHAnd it just -- it worked out well because she was able to kind of come to this conclusion. It's very hard when someone's feeling depression or anxiety to see things objectively. And I think part of it was that, you know, there was a generalized message amongst all her friends that, you know, we're going to watch out for postpartum. And it just seems like today, with the current campaign, the awareness campaign of PTSD for veterans returning home from the conflicts...

  • 11:41:29

    REHMHmm.

  • 11:41:29

    JOSH...that something like a generalized awareness, like, hey, friends and family, watch, something more than just a clinical evaluation pre- and post and to also kind of follow up on that. In retrospect, looking back on it, it wasn't really acute. It was -- there were many, many things going on that could have helped us maybe anticipate it. So I just think a generalized awareness campaign might be really helpful.

  • 11:41:58

    REHMIndeed. Thank you so much, Josh, for sharing your story. I hope and presume all worked out well. Dr. Wisner, how typical is Josh's story?

  • 11:42:15

    WISNERI think Josh's story is a very heartening one for me to hear because certainly the objective behind the screening study that I did and behind the states that mandate screening for postpartum women is exactly what Josh is suggesting, that there has to be more information, so women who are pregnant are aware that postpartum depression is incredibly common and are prepared to look for the symptoms and that screening postpartum is done, again, because it's so common.

  • 11:42:49

    WISNERI was very pleased to hear that the insight that Josh's wife had was still intact, and she was able to look at it, call a friend, call Josh, and that the outcome was very good. I wish that was the case for many women. But as we've heard on this call, it isn't the case. And there are tragedies that occur that are, I believe, preventable and very sad. So awareness is crucial.

  • 11:43:20

    REHMAll right. Let's go to Jessica in Dumfries, Va. Hi. You're on the air.

  • 11:43:27

    JESSICAHi, Diane. Thank you.

  • 11:43:29

    REHMSure.

  • 11:43:30

    JESSICAOne of your panel members earlier had said that it starts in the delivery room. And I have a question regarding a positive correlation between augmentation of labor and the rise of postpartum depression. I know that we have a 33 percent or somewhere around 30 percent C-section rate, especially in Washington, D.C. And for seeing these higher cases of postpartum, is there any correlation with that?

  • 11:43:53

    JESSICAAnd my second question is regarding placenta encapsulation. I know it's kind of one of those granola things. But I myself, while this is purely anecdotal, I myself had a lot of the precursors for postpartum depression, chose to encapsulate. And while I might have had mild symptoms, I definitely didn't have anything that is in the level of severity that we're talking about.

  • 11:44:16

    REHMAll right. Thanks for calling, Jessica. And to you, Lynne.

  • 11:44:22

    MCINTYRESo to answer the question about labor augmentations, interventions in labor from pain medication up to C-section, I'm not aware of any studies that have established any kind of correlation. What I can say is that the experience of childbirth is most important in the eye of the mother. And if she had what she considers to be a traumatic experience, if she believed that her life or the life of her baby was in danger, then she seems to be at higher risk for a perinatal mood or anxiety disorder, PTSD in particular.

  • 11:45:03

    MCINTYREAnd we also have to keep in mind the dichotomy between the experience that mother had, and possibly her partner, in the delivery room and the experience of the medical professionals who served her because if there's a healthy mother and a healthy baby at the end of the labor, they consider it a success. And there's mom, having had this traumatic experience and thinking she was going to die, and everyone around her is saying, whoopee, great job. So it's -- I think, you know, women do have traumatic experiences in childbirth that can be a risk factor for one of these disorders.

  • 11:45:43

    REHMAll right. Let's go to Jill in Pittsburgh, Penn. Hi there. You're on the air.

  • 11:45:51

    JILLHi, Diane. Thanks for taking my call.

  • 11:45:53

    REHMYou're welcome.

  • 11:45:54

    JILLI'm 31 years old. And I'm -- my husband and I are considering trying to get pregnant within the next year. And listening to you, some of your guests, I am very aware that I'm at risk for postpartum depression. I did have generalized anxiety disorder as a young adult, and I've had a couple episodes of major depressive disorder. And so my question is what I might be able to do to take steps, if I know I'm at risk, before I get pregnant or during my pregnancy that might help me cope with that, should I...

  • 11:46:39

    REHMDr. Wisner.

  • 11:46:42

    WISNERYeah. It's a great question. So what I would suggest is to find a therapist in Pittsburgh, and there are many. You have wonderful psychiatric resources there. And what I typically recommend is tracking your mood on a systematic measure through pregnancy to look for changes in mood. And the higher risk period for you will be in that immediate postpartum period. And, again, tracking is crucially important so that if you develop symptoms that can be -- they can be caught early. And the message that I want everybody to hear is postpartum depression is treatable.

  • 11:47:23

    WISNERAnd it's -- there are many different forms of treatment. The other possibility is that -- we did a study many years ago to look at whether starting an antidepressant immediately after birth would prevent episodes in high-risk women. And in a small randomized trial, we did show that starting a serotonergic antidepressant appeared to prevent episodes in women at high risk.

  • 11:47:48

    REHMHmm.

  • 11:47:49

    WISNERSo that may be an option you would discuss with your physician.

  • 11:47:52

    REHMAll right. And, Dr. Schmidt, to you.

  • 11:47:55

    SCHMIDTYes. I think Katherine's discussion and your caller's question raise two important points that we struggle with when we're trying to help an individual woman. All the risks that we've talked about for postpartum depression are -- they're not absolute risks, and there are risks for depression that occur at other times but that -- so just, regardless of people's past history, it's not -- none of them are 100 percent predictive that a woman's going to develop postpartum depression.

  • 11:48:27

    SCHMIDTAdditionally, as Katherine mentioned, although there's some evidence that we can try to prevent this condition, postpartum depression, with current medication, even in those trials, they weren't 100 percent effective. So I've talked to many women who have phoned me in consultation, and they say the same thing that, you know, I've had these -- this history. I'm at increased risk. Should I take a medication?

  • 11:48:51

    REHMHmm.

  • 11:48:52

    SCHMIDTMy view is it depends very much on an individual basis that, if the woman can identify what symptoms she -- will serve as kind of the trigger or the target, the cue for when she might be getting into trouble, whether it's not sleeping or whether it's some uncontrolled anxiety, and during pregnancy, a network of support has to be developed both with the family -- everybody has to be the big support network, and that's how I think -- if medication's involved, maybe. But it's not going to guarantee to prevent the depression.

  • 11:49:23

    REHMMm. Lynne McIntyre.

  • 11:49:27

    MCINTYREI'm so glad that Dr. Schmidt just mentioned support. And I would like to say to that mom, in addition to all the great suggestions that I've heard -- already been made, put a plan in place for the postpartum period. And when people offer help, say yes. And if they say, can I do anything, say, sure, bring dinner. And when they come over and say, do you need anything? Yes, can you do a load of laundry?

  • 11:49:52

    MCINTYREAnd, honestly, when the doctor says sleep when the baby sleeps, he really means it. And I struggled with that a lot. And I know a lot of us do. But prioritizing your sleep and your rest and really recognizing that this is a different time in your life and we're not supposed to bounce back and be on the cover of People magazine two weeks after we have a baby. So take it easy, and take the help.

  • 11:50:18

    REHMAnd let's go to Sandra in Tampa, Fla. You're on the air.

  • 11:50:29

    SANDRAThank you, Diane. Actually, my question builds off of just these last comments. And, in addition to this physiological aspect of this, I wondered if your panelists could talk also more about the social and cultural aspects of it. For instance, in my mother and grandmother's generation, women had children and had immediately a built-in social network.

  • 11:50:53

    SANDRAThey had less of a tendency back then where women moving around the country for their countries, so they had a built-in network of aunts around them and their mother, their grandmothers, their girlfriends that were raising -- and that's -- when my mother raised us, there were three or four girlfriends all raising their children at the same time. Whereas, in my generation, we've all moved around the country for our careers. We're far from families. And also, even if our girlfriends are also having children at the same time, the pace of life today with work and juggling just very busy schedules.

  • 11:51:29

    REHMSure.

  • 11:51:29

    SANDRAThere doesn't seem to be this built-in social network for my generation as in generations before. And so I think that exacerbates the feeling of perfectionism. And women are just going to the Internet looking for the best tips on what to do for their new babies, and...

  • 11:51:45

    REHMHmm. I think that's a good point though, that social isolation. Do you think that that entered into your own experience, Lynne?

  • 11:51:58

    MCINTYREI do. I am one of those women that the caller described, somebody who moved from my career and lives far from my family and my family-in-law. But I also think we want to keep in mind the different demographics of the country and the different types of social isolation that we have because, in some cases, it is living physically far from your family.

  • 11:52:17

    MCINTYREIn other cases, we -- for instance, at Mary's Center, where I work as a clinical social worker, we serve a lot of immigrant women who are much further from their families both physically and emotionally. They literally can't return for a visit, and their mothers are far away. And we have other types of isolation, I think, as well with different demographic groups.

  • 11:52:40

    REHMAnd you're listening to "The Diane Rehm Show." Pardon me. Dr. Schmidt, we did not address that issue of placenta encapsulation that Jill also asked about.

  • 11:52:57

    SCHMIDTYes. I was just going to add that -- I mean, she raises a very important point because, increasingly, we're learning that the biology of the placenta is very important in a number of both maternal and baby issues. And so, for example, a basic science study has shown that the placenta's involved for in populating the serotonergic system in the brain of the developing child.

  • 11:53:22

    SCHMIDTSo a lot of new research is focusing on the function of the placenta, the genetic basis present and the genes present in the placenta because that's really where both the mother's and the baby's genes are kind of both present. And so it's a potential wellspring of information that may help us understand both normal conditions related to pregnancy but also specifically postpartum depression.

  • 11:53:50

    REHMDr. Wisner, do you want to add to that?

  • 11:53:53

    WISNERI was excited to hear the caller raise this because we have just done a review of placentophagy and are collecting capsules with careful information about how they're prepared to explore the issue that Dr. Schmidt raised which is that placentas are incredibly interesting and rich material. And what the value of consuming placentas may be has not been researched in a serious way.

  • 11:54:22

    WISNERSo we are collecting the capsules and sending them to environmental analysis lab to determine what the components of the capsules might be after various preparations. And about a year ago, we were relatively unaware of this phenomenon. But many more women have come to us, asking about whether placentophagy will reduce the risk for postpartum depression (unintelligible).

  • 11:54:47

    REHMCould somebody explain placentophagy for me?

  • 11:54:52

    WISNERYeah. Right. Big word that basically means eating the placenta. And in -- as you may know, animals -- mammals often eat their placenta. But that's -- that practice has been generally absent from various human cultures. But it's been a much more popular in the last, say, decade or so as a strategy for improving postpartum wellbeing. And, again, I became interested because of the idea that it might prevent postpartum depression. Placenta are consumed in many ways.

  • 11:55:31

    WISNERThere are actually recipes for things like placenta lasagna, placenta shakes. It can be eaten cooked or raw. And the most frequent example that we see is that the placenta is either dried or freeze-dried and encapsulated for consumption by the mother. We also learned that in our own obstetrical hospital, we have a policy and a consent form for women to take their placenta home with them.

  • 11:56:03

    REHMHow fascinating.

  • 11:56:03

    WISNERSo, yeah, it's very interesting.

  • 11:56:05

    REHMI must say I have always said I learn something new on this program every single day. And that is a new one on me. Well, I'm so sorry we're out of time. It's been a fascinating discussion with Dr. Peter Schmidt at NIMH, Lynne McIntyre, she's the -- with Postpartum Support International, and Dr. Katherine Wisner. She's at the Northwestern University Feinberg School of Medicine. Thank you all so much.

  • 11:56:50

    MCINTYREThanks for having us, Diane.

  • 11:56:51

    SCHMIDTThanks for having us.

  • 11:56:52

    REHMAnd thanks for listening, all. I'm Diane Rehm.

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