podcasts

Beyond Baby Blues: Recognizing and Addressing Perinatal Mental Health- Podcast

By Jason Clayden on March 21, 2024

Renowned for their work in women’s mental health and perinatal psychiatry, Dr. Dalthorp and Dr. Barrett deep dive into the monumental role expert care plays in adequately treating perinatal mental conditions. 

This episode uncovers the myriad conditions and their unique presentations during pregnancy and postpartum, emphasizing that the field extends beyond postpartum depression alone.

The discussion concludes with experts underlining the necessity of early detection, empathetic interactions, and preemptive actions towards tackling these conditions.

Learn more about Perinatal Depression

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Nicholette Leanza:

Welcome to Convos from the Couch by LifeStance Health, where leading mental health professionals help guide you on your journey to a healthier, more fulfilling life.

Hello and welcome to Convos from the Couch by LifeStance Health. I’m Nicholette Leanza and on today’s episode, I’m joined by Dr. Rachel Dalthorp and Dr. Melanie Barrett. We’ll be talking about the important topic of perinatal mental health. So welcome Dr. Dalthorp and Dr. Barrett, great to have you on.

According to the World Health Organization, almost one in five pregnant individuals will experience a mental health condition during pregnancy or in the year after the birth, so I’m really glad we’re covering this topic as you both help us understand some of the most common mental health challenges during this time, as well as some innovative approaches to help treat it. Let’s dive in. Can you both introduce yourselves and share a bit about your background in perinatal mental health? Dr. Dalthorp, would you like to go first?

Dr. Rachel Dalthorp:

Sure, and thank you Dr. Leanza for bringing attention to this important topic. We’re really happy to be here. I am a psychiatrist. I’m with LifeStance in Oklahoma, and I’ve had a special interest in women’s mental health and perinatal psychiatry for quite a long time going back to my medical school days. In 2014, I founded a reproductive psychiatry practice called Balance Women’s Health, and there was this idea that we need to focus on treating women in a holistic way and think about not only their psychosocial impact, but also biology. So what’s happening in their brain and their body that is making them at higher risk of mood disorders that are common in those reproductive lifespan transitions.

And so there’s such a need for those services, and that practice of course grew, and Dr. Barrett and I have worked together in that practice, but we’re both really passionate about women’s mental health. And because we’ve seen the impact that expert care can provide for women, we’re very motivated to try to expand that, and to our colleagues at LifeStance, to really improve access to effective care that really addresses these unmet needs in our community.

Nicholette Leanza:

Thank you, Dr. Dalthorp. Dr. Barrett?

Dr. Melanie Barrett:

Yeah. Hi everyone, I’m Dr. Melanie Barrett, and like Dr. Dalthorp, I’m a psychiatrist with LifeStance in Oklahoma. I’ve always had an interest in women’s mental health and did my psychiatry residency training out at the University of North Carolina in Chapel Hill to really develop an expertise in the area. I had the opportunity to have really wonderful mentors while I was there. I was able to join Dr. Dalthorp in her women’s mental health practice back in 2017 and have been working alongside her to really help our community and still have a focus on women’s mental health and my practice today. I just really want to emphasize, it’s an exciting time in the field. We’ve had breakthrough treatment options in the years past, and I think it’s great that we’re talking about this topic, continuing to do, and we’ve got to be there for our patients, so thanks for having us today.

Nicholette Leanza:

You’re welcome and thank you. Could you explain what perinatal mental health encompasses and why it’s such an important topic in the field of mental health? Rachel, can you get us started?

Dr. Rachel Dalthorp:

Yeah. When we think about perinatal mental health, we’re really referring to that entire period leading up to becoming pregnant through pregnancy and up to the first year postpartum. So when we think about mental health, we think about disorders that do occur outside of the postpartum or perinatal period, but they’re a little bit different in that they have an onset that’s related to reproductive hormones. So they have similar overlap in terms of symptoms, but they are in particular to that particular period of time.

So we think that mental health is one of the most important parts of maternal health because of the negative impact that we see in women and families when mental health disorders go untreated. So in general, women who are in their reproductive years, they do have a high risk of mood disorders and mental illness. I think I read a statistic that 27% of women who are in that reproductive period have experienced depression or anxiety in the last year, which is a huge number. So there’s an enormous, and we know that there are these risk factors for developing mental illness or having their mental illness worsen. We know that depression, it’s the most common complication of pregnancy. So 16 to 25% of women who are pregnant are going to meet criteria for depression.

And it’s more complicated than gestational diabetes. And if you had a baby or you are close with someone who’s had a baby, you know that we do a really good job of screening for gestational diabetes. We do that glucose tolerance test, we screen for it, and then we get mom’s treatment, but we don’t do that for mental health in the same way, so a real need. And really importantly, suicide combined with overdose is the most common [inaudible 00:04:50] postpartum period. So that’s a statistic that we need to really engage and do something about. We think these deaths are preventable, and to do that, we have to get women into treatment. Dr. Barrett, what do you think about mental health conditions that are common during pregnancy? Can you talk a little bit about how they present differently than maybe outside that time period?

Dr. Melanie Barrett:

Yeah, absolutely. So like Dr. Dalthorp was mentioning, so when we’re thinking about mental health conditions that could occur during pregnancy or the postpartum period, we need to be thinking about, okay, what are mental health conditions in general? Because those are going to be occurring, they do occur in that perinatal period. And now they may look similar clinically, but they may also have a more nuanced presentation, and I think that’s really important to be educating our patients on and then also ourselves on so that we’re able to identify when our patients are presenting in these different ways to be able to get them the help that they need.

So when we’re thinking about depression, this is very common during pregnancy and the postpartum period. I really recommend, especially in the postpartum period, being able to set up an appointment time with your patient within two weeks, really, after delivery. We know that delivery date is not set in stone, so really communicating with your patients ahead of time to reach out to you if this delivery date changes. I think that the advent of telemedicine has been remarkable, really, to reduce barriers to being able to access our patients and for them to be accessing care during this time.

So that postpartum depression, it can really present as a more anxious depression. There can be ruminations, there can be difficulties with breastfeeding, there can be excessive guilt. There’s thoughts of what should, in one’s mind, that postpartum period look like, those external, societal pressures. So it’s really important to be talking to our patients, all patients about this during pregnancy, identifying the risk factors and be thinking about things that we can do ahead of time to identify early and to be there for our patients.

We need to be thinking about generalized anxiety disorder, obsessive compulsive disorder. This is a big one. So this can be very difficult for our patients, for women to talk about out of either fear of what it might mean, out of not knowing what exactly is going on. Our patients can be dealing with really intrusive, scary, unwanted thoughts. They can take on contamination obsessions, it can be fear of accidental harm that might come to the baby. Now, these are patients who are not wanting any harm to come to their baby. They may be so distressed by these thoughts that it’s very difficult to talk about. There can be significant avoidance. This can be very detrimental. So I think it’s very important to know about, to talk about and then also be able to differentiate from postpartum psychosis, right?. And these are emergencies. Patients do not have insight into their delusions or their line of thinking, and really it represents an emergency and should be treated as such.

We think about bipolar illness. We really need to be emphasizing the importance of mood stability throughout pregnancy. And as we’re getting into that third trimester and in the postpartum period, emphasizing the importance of sleep, involving partners if possible. We need to be screening for substance use disorders. I think another thing that some might not think about is the potential impact of medical complications that can arise during pregnancy or with delivery. Miscarriage, pregnancy loss. We need to be evaluating for grief. We would be considering postpartum depression, potentially, be screening for PTSD for how these traumas impact women. So we really think that this time period of pregnancy, postpartum, women are particularly vulnerable to rapid shifts in hormones during this time so it’s great that we’re talking about this, just increasing awareness of the importance of this time.

Nicholette Leanza:

Dr. Barrett, thank you for sharing just the bigger family of conditions that can happen at postpartum or during the perinatal period, because I think oftentimes people assume it’s just postpartum depression. So what you just explained is that it could be postpartum OCD, it could be postpartum bipolar disorder, it could be postpartum psychosis. So you definitely have extended it out of what else it can look like, so I appreciate that.

Dr. Rachel Dalthorp:

Yeah, I think something that’s really important to think about is that we know that there are effective treatments, and we know if the mom has access to healthcare, she’s going to have a better outcome, she’s going to have access to psychotherapy that’s helpful. Medication a lot of times is helpful. But one of the issues that we see that’s a barrier to accessing care is getting the screening done. So in the ideal time, patients are in the OB office on a regular basis, and we really need to capture them at their visit to screen them so that we can make sure that we get them to appropriate care.

And one of the things that we know through the last 20 years or so of clinical research is that there are risk factors that we can identify if we ask. So we know if a mom has a history of depression before they become pregnant or with a previous pregnancy, or if there’s a family history of maternal depression, if they have stressors in their life, an unsupportive partner or interpersonal violence, if they have a history of trauma, these are all things that we can talk about and screen for, and they make us more aware that we’re going to keep a closer eye in the OB office on these patients and make sure that we have them set up. So like Dr. Barrett said, have them have that visit right after they deliver within two weeks so that we can catch these moms and get them treatment before the impacts of untreated depression are seen in their families and in their children.

Nicholette Leanza:

Let’s look at supportive resources, other supportive resources.

Dr. Melanie Barrett:

Yeah, resources for patients and clinicians. There are so many wonderful resources, so I’ll go through a couple of them. So first, so the MGH Center for Women’s Mental Health, right? This is womensmentalhealth.org. This is a fantastic resource for both clinicians and for patients. Across the lifespan, reproductive psychiatry resources, but specific to the perinatal period, you can go by area of interest. You can look at what is the latest research, what do we know about medications during pregnancy? What do we know about medications and other treatment options during breastfeeding or in the postpartum period. We have moved away from categorizing our medications and our treatments in a way that stratifies exact risk and moved more to an informed individualized discussion with our patients. So I think this is a really important tool for clinicians to use, for patients to use to be able to see, okay, what do we know about our treatment options and how can we make the best decision for our individual patients as possible?

From the clinician side, you can actually sign up for a weekly newsletter that’s going to give you an overview of all the recent publications and information that has come out within the last week. So I think it’s a really efficient way to get information that you need. Postpartum Support International, if you’re not familiar with them, I’d really recommend checking them out. So it’s an international society, but there are local chapters. There’s online support groups that are free, and these can be for a variety of reasons and needs. There are trainings. There’s actually a help line that patients can call. It’s staffed by SI volunteers. Know that this is not a crisis line, but this is for anyone who’s needing more information about postpartum depression.

There’s a good webpage, MotherToBaby that has fact sheets about medications during pregnancy and lactation, LactMed DailyMed, those are also good resources. And then to point out another hotline, so the National Maternal Mental Health Hotline, 24/7, free. It’s a confidential hotline for pregnant and new moms. Again, this is not for crisis help, but it is a good resource for patients.

Nicholette Leanza:

And what about some emerging or innovative approaches you’d like to highlight? Dr. Dalthorp?

Dr. Rachel Dalthorp:

Yeah, I think she mentioned, Dr. Barrett mentioned at the beginning of the podcast how exciting it is. We’re experiencing this time when we’ve had years of clinical research that’s translated into new treatment options. So our toolbox is getting full, and we have treatments that weren’t available just a few years ago. And so I think what we’ve seen in terms of treatment, especially with medications over the past 20 years or so, is that the number of prescriptions that have been given to women in the perineal period is decreasing. And unfortunately, at the same time, those patients aren’t being referred for psychotherapy for other types of treatments so they’re going, for the most part, untreated.

And Dr. Barrett mentioned that labeling system. There’s been some fears about taking medication during pregnancy. And if that is presented to a patient in the wrong way where the patient says, “I have to make a choice between taking medicine and putting my baby at risk, or taking medicine and prioritizing health,” we’re not going to get anywhere. So it’s really important to do that risk assessment and clearly communicate to the patient like Dr. Barrett mentioned, and make these new treatments available.

In 2019, we had the first FDA-approved medicine for postpartum depression. It’s called brexanalone, and it is a neurosteroid. It is a rapid-acting antidepressant. So when we think about the importance of getting mom and baby back connected and minimizing the impact of depression on the entire family, we need to get them treated quickly. So this medicine was really transformative and novel. It’s been out for a few years and Dr. Barrett led our program in Oklahoma to treat mamas with this medicine. One of the issues with it is it’s been hard to access because patients come in to our treatment center and it’s a 60-hour infusion. And so while that’s wonderful, there are a lot of moms that can’t do that. They can’t go leave their family, they can’t come in for treatment.

And so it’s really exciting because we have a new oral version of that same medication that’s going to be coming up available we hope in the next few months. And just looking at the clinical data, it is as rapid-acting and as effective as brexanalone. So this new medicine is called zuranolone, and we just want to raise awareness about that medicine. We want women and their families to know that there’s a treatment that’s effective, that it works quickly, and they don’t have to suffer with untreated depression. It’s a medicine that’s taken once a day with an evening meal, and it’s only 14 days.

So a lot of our patients, they don’t want to take antidepressants because they have these side effects that they don’t want to deal with. Well, this is a short course, and what we’ve seen in women who have this medication is after the treatment, they have the prolonged benefit. So the medicine works to prepare the impact of stress in the brain, and it promotes resilience. And so these moms we see, and Dr. Barrett and I have measured up to a year out of treatment with brexanalone, we see that they handle stress better, that they have this resilience and it’s protective through that first year of the postpartum period, which at that time, we really need to protect non-mental health. Thank you for bringing up the treatment options. It’s an exciting time.

Nicholette Leanza:

This is very exciting.

Dr. Rachel Dalthorp:

Yeah, being able to provide that treatment.

Nicholette Leanza:

Thank you. Any other takeaways you guys would like to share? Dr. Barrett? Dr. Dalthorp?

Dr. Rachel Dalthorp:

I also, I just want to reinforce that perinatal mental illness is common and it’s treatable and stigma and the guilt that is prevalent, that it really keeps women from seeking help. And I think that just as you recognize by having this podcast, Dr. Leanza, we have to talk about it. We have to normalize it and recognize it and encourage women in our lives to seek help. And as healthcare providers, we also have a role in advocating for our patients and trying to work through these barriers that prevent access to mental health care because it’s something that we see and we still experience and patients deserve better.

Nicholette Leanza:

I agree.

Dr. Rachel Dalthorp:

Dr. Barrett, what do you think?

Dr. Melanie Barrett:

Yeah, I agree with all of that. And I just want to emphasize, too, that it’s not a one-size-fits-all presentation, just like it’s not a one-size-fits-all treatment. So I think that there can still be comparison going on. I am not feeling this, so it must not be depression. So I would really encourage all of the patients out there, if there’s any concern, if something just does not feel right, you are questioning it, reach out. You don’t have to have all of the answers. We’re here to help you figure it out and figure out what’s going on and come up with the best solutions for your quality of life. We just try to take off that burden of trying to figure it out on your own. We are here to help.

Nicholette Leanza:

My gosh. Thank you, Dr. Dalthorp and Dr. Barrett for helping us understand more about the perinatal mental health period. I’m sure you helped our listeners learn more about this vulnerable time, as well, so thank you again.

Dr. Melanie Barrett:

Thanks for having us.

Dr. Rachel Dalthorp:

Thank you. Thank you.

Nicholette Leanza:

I would like to thank the team behind the podcast, Jason Clayton, Juliana Whitten, and Chris Kelman, with a special thanks to Jason Clayton who edits our episodes. Thank you for listening to Convos from the Couch. Take care, everyone.