We're Here To Help You Answer: Do I Have Postpartum Depression or Anxiety?

Welcome to the season 1 finale of So Glad You Asked! In this powerful episode, we’re unpacking some of the most essential questions about maternal mental health — including one that many moms quietly struggle with: Do I have postpartum depression or anxiety?

To help us understand this important topic, we’re joined by Dr. Lee Cohen and Dr. Marlene Freeman, Director and Associate Director of the Ammon-Pinizzotto Center for Women’s Mental Health at Mass General Hospital. Alongside Dr. Ruta, they’ll break down how to recognize the signs of postpartum depression and anxiety, when to seek help, and where to find support. Whether you’re navigating postpartum challenges yourself or want to better understand these conditions to support someone you care about, this episode offers practical insights and actionable tools to help you manage postpartum mental health with confidence.

As we head into our summer hiatus, follow us on Instagram @mghcwmh to hear Dr. Ruta answer more listener questions and explore our resource hub at womensmentalhealth.org for more support and information. Take care, and we’ll see you next season!

Recommended Resources:

• Learn more about Postpartum Psychiatric Disorders at womensmentalhealth.org
• Learn more about Perinatal OCD and Psychosis
• Find a therapist or join a support group at postpartum.net 
• Watch the trailer for More Than Blue, a documentary on postpartum depression across America

Disclaimer: This podcast is not intended to be a substitute for professional medical care. The views, thoughts, and opinions shared today are the speakers’ own. **Trigger Warning** postpartum depression, anxiety, OCD, and psychosis

Like What You Heard?

• Hit follow so you never miss an episode
• Leave us a review to share your feedback
• Have a question for Dr. Ruta? Leave us a voicemail at (617) 643-9232 or email us at podcast@womensmentalhealth.org for a chance to join us on air.

So Glad You Asked with Dr. Ruta Nonacs is brought to you by the MGH Center for Women's Mental Health and the J. Willard and Alice S. Marriott Foundation.

Transcript

Allie

[ 00:00:00 ]What you just explained was exactly what I had experienced with multiple kids. And I was so ashamed of those thoughts. I imagined I would carry my baby down the stairs, that exact scenario. And I would imagine dropping my baby every time. And I've never dropped anything going down the stairs. It's not like that's something that happens to me. I mean, those thoughts never would have occurred to me. But I felt so ashamed that I was thinking of that or imagining that happening. So I never brought it up to anyone.

Dr. Ruta

[ 00:00:30 ]Welcome to So Glad You Asked, the show where real moms bring us their toughest questions. I'm Dr. Ruta Nonacs, a perinatal psychiatrist at Mass General Hospital with over 30 years of experience supporting the mental health of moms.

Allie

[ 00:00:44 ]And I'm Allie Hales, a mom of four. I know what it's like to scour the internet wide awake at 2:00 a.m. with a million questions, wondering if what I was experiencing was normal. That's why we created this show. It isn't just for real moms, it's by real moms.

Allie

[ 00:01:00 ]Welcome to the season finale of So Glad You Asked. Today we're talking about something deeply personal, widely experienced, and often misunderstood, postpartum depression and anxiety. Whether you've gone through it yourself, are currently navigating it, or know someone who is, this conversation is for you. These questions, 'Is this normal? Is there something wrong with me? 'Do I have postpartum depression or postpartum anxiety? 'Can be incredibly hard to ask and sometimes even harder to find answers to. To help us understand this complex topic, we're joined by two of the leading experts in the field, Dr. Lee Cohen and Dr. Marlene Freeman, Director and Associate Director of the Ammon Pinizzotto Center for Women's Mental Health at Mass General Hospital. Alongside Dr. Ruta, they'll walk us through how to recognize the signs, when and how to seek support, and what approaches actually work, whether you're a parent, a partner, a provider, a friend, or simply someone who wants to better understand maternal mental health. We hope this episode leaves you with compassion, clarity, and concrete tools for healing.

Dr. Lee Cohen

[ 00:02:11 ]Allie, thanks so much for inviting me to participate in this incredibly new podcast. I'm the director of the Center for Women's Mental Health at Massachusetts General Hospital and have been involved in the care of women who are either planning to get pregnant or who are having difficulties during pregnancy in the postpartum period now for several decades. And I'm lucky to be surrounded by colleagues who share the mission of our center, which is that we can mitigate suffering associated with perinatal psychiatric illness.

Dr. Marlene Freeman

[ 00:02:45 ]I'm Marlene Freeman. I'm a perinatal psychiatrist, and I'm the associate director of our Center for Women's Mental Health at Mass General. I have been at different academic medical centers doing work in women's mental health. I've been at Mass General for the past 17 years.

Allie

[ 00:03:02 ] Thank you so much for joining. Dr. Cohen and Dr. Freeman have also been so instrumental and involved since the beginning of this whole podcast. And so, we're really excited to have them join us today. Postpartum depression and postpartum anxiety, I'm really excited to talk about in layperson terms. It's something I never even thought about before becoming pregnant. I really hadn't heard that much about it, thankfully. But then as I became pregnant and as I had friends that were pregnant, I learned more and more. How many people struggle with postpartum depression and anxiety, and just never talk about it. I was wondering if you can just speak in basic terms on what happens in the brain when postpartum depression or postpartum anxiety occur. What happens?

Dr. Ruta

[ 00:03:47 ]The big question, the concept of postpartum depression has been around for a long time. I don't know that we entirely understand what's going on. It's some combination of the hormonal changes that take place after childbirth, as well as sleep deprivation. I think outside stressors play a big role in terms of determining vulnerability, but it's kind of like the perfect storm where all of these things come together and they can create anxiety or depression. Certainly women who have no histories of psychiatric illness are vulnerable to postpartum depression and anxiety, but particularly women with a history, adding those extra stressors can bring out depression or anxiety.

Dr. Lee Cohen

[ 00:04:36 ]Some tests that you could do in a way to sort of make the diagnosis of postpartum depression. Sort of, you know, what Ruta said in terms of it's sort of intuitive that maybe there's some hormonal imbalance. But actually the literature, studies, researchers have sort of looked to see if they could identify that. And we've come up short. Postpartum depression becomes a clinical diagnosis. It's one place where we don't get sort of hung up in neurobiology per se, and we actually listen to the patient and sort of hear about how the patient's struggling and with what array of symptoms.

Dr. Marlene Freeman

[ 00:05:14 ]I would just add that part of the reason why we don't have one picture, one signature for what it is, is that it's often different in different people. So for some individuals, it may be triggered by a hormonal change, but there may be other triggers for other individuals. And also, the presentation can vary so much from individual to individual, and we don't know why. That's another topic. I think for all those reasons, there's a lot of variation in how it presents, causes, and that also makes it really difficult to predict who's going to get it.

Dr. Lee Cohen

[ 00:05:50 ]Right, but I agree with Ruta so much that nothing predicts risk for postpartum depression more than two things. One, a past history of depression. Also, depression during pregnancy. It's probably the strongest finding across studies that women who have had problems with their mood during pregnancy are at increased risk for postpartum depression, sort of a worsening of what was going on during pregnancy that heightens in the postpartum, and that's actually quite common.

Allie

[ 00:06:25 ]So I have a question. There's all these terms: 'baby blues', you're exhausted. There's a lot of different changes happening when you're pregnant and when you're postpartum. How do you know that you're not just exhausted or you're not just overwhelmed in the general kind of normal quote unquote sense? At what point do you talk to your OB or talk to a psychiatrist or talk to someone saying what I'm experiencing isn't feeling normal? Because for me, when I was pregnant with my first, nothing felt normal. So how do you know that what you're experiencing is not normal on a general scale?

Dr. Ruta

[ 00:07:04 ]I think that's why so many women take a long time to realize something not normal is going on, because it's not always so easy to tell. And baby blues is typically thought to be really the first two weeks of the postpartum period. And it's not really sadness. It's more like the same type of crying or increased emotional output that people have during emotional times. They're not sad about anything, whereas postpartum depression really has a sense of sadness or really feeling negative about things. Things won't get better. The baby would be better without me. I think where it can be really challenging is sort of pulling anxiety out of that, because there are many things that make women anxious. Their baby is new to them. They don't understand what's going on. Breastfeeding can be difficult. And I think if those anxiety symptoms persist, or if they're very severe, if they interfere with sleep, if they interfere with enjoyment, those would be things that one might think. Hey, maybe I should talk to my obstetrician or somebody else who's gone through the experience of the postpartum period.

Dr. Lee Cohen

[ 00:08:25 ]Ruta, you would probably agree, though, because we see it clinically when we sit with patients all the time, that so many patients come in with a complaint of generalized anxiety, and it's part and parcel of postpartum depression because it's so hard to tease off anxiety and depression in new moms who are coming in. And they're frankly coming in with both. Allie, the reason I liked the way you teed us up so much was that sort of teasing postpartum depression from postpartum anxiety can be very challenging. And it may not be, frankly, all that important because we end up sometimes using the same interventions, the same treatments to help women manage both.

Allie

[ 00:09:09 ]I think one of the other things that I had just heard about and started to understand while we've been working on this podcast are intrusive thoughts. I thought that intrusive thoughts were only very, very extreme thoughts of harm to yourself, to your baby. And then someone was explaining to me that intrusive thoughts can also be these kinds of anxiety-driven thoughts that come up all the time. And so I was wondering if you could speak a little bit about that as well.

Dr. Ruta

[ 00:09:40 ]So intrusive thoughts occur commonly with postpartum depression or postpartum anxiety. And they're really thoughts about something bad happening. And often, that can be to the baby. It can be to a loved one. At its most sort of disturbing, it's when a mother thinks that she might actually harm the baby, although she has you know, no intention, no ill will against the baby. These thoughts are just really horrifying. And I think as a parent, you're carrying the baby down the stairs. You imagine dropping the baby, but you hold on to the baby and the thought goes out of your head. When you have postpartum depression, those thoughts are like Velcro. You can't get it out of your head. They're just stuck and they keep coming back. It can make women so distressed that they are afraid to be alone with their baby. And I think those are thoughts often that women don't want to bring up with their treaters because they're afraid that they might alarm their treaters, they might be hospitalized, the baby might be taken away from them. But I think it's just one of the symptoms of postpartum depression or anxiety.

Allie

[ 00:10:58 ]Dr. Ruta, what you just explained was exactly what I had experienced with multiple kids. And I was so ashamed of those thoughts. I imagined I would carry my baby down the stairs, that exact scenario. And I would imagine dropping my baby every time. And I've never dropped anything going down the stairs. It's not like that's something that happens to me. I mean, those thoughts never would have occurred to me. But I felt so ashamed that I was thinking of that or imagining that happening. So I never brought it up to anyone because I just felt like-wow, I'm crazy. What am I thinking? Like I would never share that information with anyone. So you just saying that as something that lots of women experience, even for me years out, is extremely validating.

Dr. Lee Cohen

[ 00:11:45 ]You know, I think that we may have been the first group to report about postpartum OCD. And one of the things, Allie, that we noticed as we spoke to those patients, was that they were tortured by those thoughts. They were tormenting, and they would come in with a level of distress that was sort of unrivaled. And again, we found that it was exquisitely treatable. Sometimes we go to meetings and there are these debates about whether postpartum OCD is part or not of postpartum depression. And so, I think it's helpful to sort of point out we can see postpartum OCD symptoms in the absence of postpartum depression. And regardless, these symptoms sometimes co-occur; they co-mingle, that we use, sometimes, very similar tools to treat both postpartum depression and postpartum OCD on the medication side. And so, I think the most important thing is that women get into treatment because, as you sort of said from your story, it can stop a patient in her tracks.

Dr. Marlene Freeman

[ 00:12:54 ]So, I would just add that. Depression and anxiety often co-occur, but I think it's especially true for postpartum depression. So a great number of women who have postpartum depression have obsessions or OCD as part of that picture. But there also is a risk of new onset OCD in the postpartum as well as recurrence for women who've had it before. And I think that the time of life that is most vulnerable across a woman's entire life to having OCD, or obsessive thoughts, is the postpartum. There's something about that time that makes it exquisitely risky. And it is true that I think some of the patients who suffer the most are the ones with OCD. And they're often the ones who are most hesitant to share that information with a healthcare provider because these thoughts or images that keep coming back, and that are so terrifying, sometimes something terrible happening to the baby or harming the baby are often misinterpreted by ill-informed healthcare providers. So it's not common, but it does happen that someone shares the those kinds of thoughts, and healthcare provider might be alarmed and confused the situation with postpartum psychosis. So in the case of intrusive thoughts, a woman is not at risk of harming her baby. So she's distressed. She's having these thoughts, and they're treatable. As Dr. Cohen said, in the case of postpartum psychosis, a woman is often not distressed by those thoughts, but the context is so important because in postpartum psychosis, there's a thought disorder. So delusions or hallucinations that go along with any type of thoughts of harming the baby, which is completely different than obsessions, which someone may have as part of postpartum depression or postpartum OCD. And so it's really important that patients are educated about that. So if it occurs, they're not so terrified and that healthcare providers in any setting know about the difference.

Allie

[ 00:14:49 ]I'm so grateful you said that because when I was having those thoughts, I didn't want to share them because I felt like if I told someone this, they'll think I'm crazy and then I won't be able to take care of my kids. And I just kind of spiraled thinking about what would happen if I shared that information with someone. So if someone's listening to this right now and is identifying, you know, I have those thoughts or I have been feeling that way, what's the process to getting help?

Dr. Ruta

[ 00:15:17 ]I think it's really a good question. And I think identifying the people around you who you trust-so if it's your partner, you can start there, or a mother, or a sister, sort of saying, 'I'm having a hard time.' 'I'm having anxiety.' 'I'm having these weird thoughts. 'I don't want to act on these thoughts. Can you help me to navigate help? Perchance, you had a history of psychiatric treatment, you could contact your mental health provider. I think starting out with your skeptic provider if you feel like you have a good relationship with them can be one place. They have access through various state programs to perinatal psychiatry providers. And also Postpartum Support International is, again, a great place to start looking for mental health providers in your area. Because what we really want is somebody with expertise. But I think really lining up an ally who can speak for you and who can say, 'Look, this mom does doesn't want to hurt her kids. 'If anything, she goes 10 miles out of her way to make sure that this child is safe because you're very vulnerable when you're trying to negotiate the health care system on your own.

Dr. Marlene Freeman

[ 00:16:36 ]I think it's important to acknowledge, though, that for postpartum depression, we've really had years of healthcare provider education and education of the public and patients. So people, I think, are more aware of that condition. But there's been almost nothing about postpartum anxiety and postpartum OCD. So people don't identify it when it happens. And often, family, friends, healthcare providers have no idea, even if the person does ask for help. There is often not the knowledge about mental health conditions that occur in the postpartum that are necessary, even among frontline healthcare providers. So for example, an OB, some therapists, some psychiatrists even, primary care doctors, ER doctors; we need to make sure really the entire healthcare workforce is educated about this, and also the public in general.

Dr. Lee Cohen

[ 00:17:29 ]Allie, it actually goes to where you started today. So, you, in describing symptoms, sort of lumped, as would be totally understandable because they so commingle, your symptoms of postpartum depression and postpartum anxiety. But to Marlene's point, we have not had public awareness campaigns that really speak to both. Postpartum depression and postpartum anxiety, and sort of laying out the spectrum of symptoms that women experience from depression to anxiety. And anxiety would include both generalized anxiety as well as those symptoms that you were describing, like intrusive obsessional thoughts. And it's just not out there publicly the way it has been. Which I think is actually a good thing vis-a-vis postpartum depression. I'm so pleased that we have more awareness today than we had 10 years ago, but we have a ways to go in the postpartum anxiety space.

Allie

[ 00:18:24 ]I was wondering if you'd be able to speak to the treatment. So postpartum anxiety is something that I really didn't hear that term until very recently, but I do think I had postpartum anxiety after my second child and I just didn’t realize it. I was totally overwhelmed. I had a 21-month-old who was born early. I had a traumatic birth situation with him. And then my second was born, you know, with some complications as well. And then she was in a hip harness and was crying all the time. And I had no family around. And I look at the symptoms of postpartum anxiety and I feel like that was completely me, but I didn't know that that was me. I just felt like, you know, of course it's hard being a mom and I just need to figure it out. Understanding now that postpartum anxiety is a thing and there are resources, I'd love for you to just talk a little bit about how postpartum depression and postpartum anxiety are treated and what is available to help.

Dr. Marlene Freeman

[ 00:19:23 ]So we have a menu of treatment options that really can be tailored for the individual. In almost all situations, we would recommend some form of psychotherapy and support. So it could be individualized psychotherapy. It could be a group therapy. It could be one of the specialized evidence-based therapies that have been studied a lot. But it's really important that we make sure that individuals can access treatment with therapists. Also, we have resources like Postpartum Support International for when individuals can't find local resources that they can contact Postpartum Support International, which also offers online no-cost groups, which can be incredibly beneficial for women in terms of feeling less alone. And then we also have medication options .So our standard treatments are selective serotonin reuptake inhibitors, or SSRIs, which are the most commonly known antidepressants that have been long studied, long used. And we have more information about SSRIs than perhaps any other type of medication in the context of breastfeeding. So we're very comfortable around SSRIs in women who are breastfeeding. So one of the downsides of SSRIs, which work for both postpartum depression and anxiety, is that they take a while to start working. So, if someone is really severely anxious, for example, or can't sleep, we often prescribe something for sleep or anxiety that's going to work more rapidly as a bridge to more comprehensive, fuller treatment responses with antidepressants. There also has been a relatively newly approved treatment, zuranolone. And then that treatment course is stopped. So it's two weeks. Studies showed generally rapid improvement, but we don't know the long-term course after that. And it's often the case that individuals who do try that new medication are on a standard antidepressant as well. So we're still learning more about how it's being used in the community, but that is a new exciting class of antidepressant medications.

Dr. Lee Cohen

[ 00:21:32 ]I couldn't agree with Marlene more. We just finished a documentary film, More Than Blue, which we're now on a distribution plan across the country for screening. And one of the most powerful experiences that I had being involved in that film was hearing about the isolation of postpartum women who had depression commingling with anxiety and the feeling that they somehow couldn't get access. To the various treatments, whether it was a support group getting an appointment with their PCP or back to their OB to get medicine, whether it be short-term or longer-term, and so that navigation is such a challenge for the new mom who is exhausted and not sleeping, and doing demand feeding or breastfeeding, that's a big lift you know right there, let alone trying to navigate our current healthcare system and get those sorts of services. But it's not like we don't have treatment because we do. Allie, you're a mom of four, and I just wonder, as a mom, and when you talk to moms, where's the greatest obstacle? Is it stigma? Is it that people feel embarrassed to sort of raise the issue? Or is it care navigation, that you're feeling something but you really sort of don't know where to go? Because I think if we knew that, we'd be more equipped to sort of tackle the problem. So I was wondering, as a mom, where's the greatest obstacle?

Allie

[ 00:22:57 ]All of the above .I mean, honestly, even for me now, I have four kids. I spent a very long time being pregnant or postpartum. My schedule is totally overwhelming and I don't even have a PCP. My OB was my PCP forever. We moved to a new place. I tried to get in with someone. It was like a two, three, four month wait to even see the PCP originally. I think logistics is a huge piece of it. I think stigma is a big part of it. I've always been very much of an achiever type. I want to do the best thing for my kids. I'm going to be the best mom. I'm going to read all the books. I'm going to have the best plan. And then you realize even if you have the best plan, hardly anything in motherhood goes according to plan. But then how do you troubleshoot it when you've never done this before? Yeah, and I think too, understanding that there's treatment. Trying anything new when you're in such a vulnerable position is so hard. Like even making small decisions for me when I was sleep deprived and taking care of little kids, I just felt like my brain wasn't on. And so being able to kind of have this plan laid out, I think also it feels overwhelming to think, oh, I'm going to have to start this whole system that's going to change my whole life forever. When someone goes on medication to help with postpartum anxiety, OCD, depression, what's a typical schedule for this treatment? How long are women on medication? Are they always on medication for treatment? What's a lifestyle change when you are diagnosed with something like this?

Dr. Ruta

[ 00:24:47 ]Postpartum depression or anxiety is that they're concerned about breastfeeding and taking medications. And we often see women at six months, nine months, 12 months instead of when the symptoms start. And we really do want to get women in earlier. We have a lot of data on the use of medications and breastfeeding. The amount that's in breast milk is very, very low. And there's no studies showing impact on the children who are nursing. We also know that some women might not need medication. They might need therapy. So we really want to have women looking for treatment earlier rather than waiting to finish breastfeeding to initiate treatment. If you have somebody who has no history of postpartum depression or anxiety, I think the typical range of treatment is around six months, typically with a serotonin reuptake inhibitor or something along those lines. If somebody's had a history of depression or anxiety, we typically talk about maintenance treatment for those disorders. And I think there's really a wide range here. Some people respond really well to cognitive behavioral therapy for anxiety, so they might not go on medications. I think OCD symptoms, especially sort of intrusive obsessions, can be really hard to manage, and sometimes medications work a little bit better than therapy. I would say in women who have no history, it's really, we're talking about a shorter-term treatment, but it's really important to have the adequate duration of treatment because we have a fair number of studies that look at discontinuing antidepressants early, and often those symptoms will recur during the first six months. So we really want to try to get them out to the six-month or more mark.

Dr. Marlene Freeman

[ 00:26:45 ]I would also want to make sure that women understand that they're not making a commitment to that treatment long term. There's always an ongoing process of collaborative decision-making with her treaters. So if a medication may be warranted, then it can be reexamined. Sometimes patients have side effects or they're just nervous about taking a medication. So they're not making a long-term commitment to the medication. Yet on the other hand, we want to make sure that women know that the goal is remission. Not that they can just struggle through enough, but we want people to know that we're aiming for wellness. And so we don't want to stop short of that.

Dr. Lee Cohen

[ 00:27:22 ]Allie, I always feel badly when a patient says, 'I'm not going to take that medicine; I can just white-knuckle through it. 'And there's just so much data showing that that is not healthy for a new mom. So what I heard from Ruta and Marlene is that We see a spectrum of patients, some for whom it's their first episode, and they make it treated for a short period of time, do well, and to Marlene's point, they are remitted, and we slowly taper them off medicine. But Marlene and I also did a study, and actually Ruta participated in this study years and years ago, where we looked at women with histories of depression, and we followed them across pregnancy and postpartum. And a lot of them go on to have multiple episodes after their postpartum depression because they had that vulnerability from before, and they may have gotten ill during the postpartum period. And again, it was unfortunate when we looked at them 15 years out; they had spent a very significant amount of the time during that 15 years ill because they hadn't really accessed appropriate treatment. And to Marlene's point, they had never gotten well. So, whether it's a short-term course or perhaps even a longer-term course, the goal is to get moms well and to keep them well so that they can do business of being a mom, a partner, whatever the person does in their professional life, whether it's at home or outside the home. But what you're hearing, I think, from us is it's unfortunate when patients don't get well after an episode of postpartum depression and that that sort of defines how they're doing over a long period of time. And that's associated with really decreased quality of life for those moms and for those families.

Dr. Marlene Freeman

[ 00:29:12 ]Yeah, and I would just echo, it's not just the mom's health, but there's a very strong relationship between the maternal depression and child development and child outcomes. So it's not just postpartum, it's also maternal depression. So it affects almost every aspect of child development. And so when we had looked at those moms who were well at the beginning of pregnancy, but had histories of depression, when we looked at them, years out after the postpartum, two-thirds of them had experienced major depressive episodes during that child's childhood. And a substantial number of those patients were ill for more than 75% of that child's childhood. So it's not something that we can just write off once the acute postpartum is over. And we want to make sure that people know that once they've had postpartum depression or anxiety, they might be at risk for a mood or anxiety disorder to follow and that it would be important to keep checking it.

Allie

[ 00:30:07 ]So I'm glad that you brought that up about you can be at risk for this for an extended period of time. And it's something that you need to end up being proactive about. And I think I know the answer to this, but I just want to hear it from the experts. Can you prevent this? Is there anything a woman can do to prevent this from happening to her?

Dr. Ruta

[ 00:30:30 ]The most amazing studies I've seen in terms of looking at this is with women who've had a history of postpartum depression. And if you start treatment with an SSRI at the time of delivery, you pretty much totally eliminate the risk of recurrent postpartum depression. It works beautifully. Unfortunately, I think a lot of women aren't aware of that. I think there are also a bunch of studies which have looked at women who've had depression or anxiety during pregnancy, and they've started treatment with therapy during pregnancy. And that's also reduced the risk of postpartum depression and anxiety. So, the message is: it's not going to disappear, but there are things we can do to prevent, and early treatment is better than white-knuckling it.

Dr. Marlene Freeman

[ 00:31:24 ]I would say also, if someone's had postpartum depression or anxiety before, then they should be aware that it can be a highly recurrent condition, that it can happen again and is very likely to happen again after a next baby. So this is another time where we can grasp the opportunity to meet with the patient and a partner or other loved one to talk about how to plan for the postpartum ahead. So, to talk about feeding issues and sleep issues and self-care, and to perhaps if someone's not already in psychotherapy, to arrange for that so that they can already have that in place. Because, as you know, it's impossible to really navigate the system and find a new therapist in the postpartum when you're so overwhelmed. And then to hear that the wait is two months to get a new patient appointment is just excruciating. And then also to have a plan about medication. So some of the patients we've seen who've had postpartum depression might be on medication during the pregnancy. But if they're not, then we really try and tailor a plan about, you know, do they start a medication in late pregnancy or immediately postpartum to prevent a recurrence? Or do we kind of watchfully wait and treat early if it recurs? And so there's a lot of individual preference, but not a lot of data really suggesting what the right answer is.

Dr. Lee Cohen

[ 00:32:41 ]One of the reasons I love your question, Allie, is sometimes if you have the luxury of being able to predict risk. And to Ruta and Marlene's comments, in patients with histories of postpartum depression, we know that that patient's about a 50-50 chance, so about a 50% risk for having another episode of postpartum depression. So that's an opportunity on the front end of the sleepless nights and the anxiety associated with being a new parent, again, of being able to put a plan in place to lower that risk. And so whether it's psychotherapy or support or a medicine, we do have tools to do that. Sometimes I feel that prevention is in a way easier than treating postpartum depression once the horse is out of the barn. Because it feels a little bit like you're trying to do catch-up because you have a mom who's suffering and with this amalgam of symptoms. And we can get that patient well, but it can take up time. And so I'm so glad you raised the issue of prevention in groups of women where we know there's risk and certainly a history of postpartum depression. And also, Our moms who have a history of bipolar disorder are also at a five-fold increased risk for having a postpartum depressive episode. And we can treat that with a number of interventions to limit risk. So prevention is key.

Allie

[ 00:34:12 ]I would have loved to have someone really clearly validate what I was going through. That it wasn't just because I was weak or just because I was tired. What I was experiencing was real, and it was something that can be treated. It's not my fault.

Dr. Lee Cohen

[ 00:34:31 ]After 30 years of studying postpartum depression and postpartum anxiety, it's actually in response to your question. That I had this idea of doing a documentary and sort of raising public awareness in a different way, not with an article in a scientific journal, but with a documentary that hopefully would be on a major streaming service so that people would have access to it and take it from behind the curtain and put it right out there. And that's what I hope it does, because you really spoke to how do patients feel less alone and more willing to get help. And I agree with Marlene that support groups can help. But I also just think that raising the conversation to a more audible level will help. And hopefully, we'll do that, frankly, with podcasts like this and with documentary films that in very clear language and actually with the faces and voices of moms tell those stories.

Dr. Marlene Freeman

[ 00:35:29 ]And Allie, I would just add it's a gift for other women for you to share your story.

Dr. Lee Cohen

[ 00:35:34 ]Allie, you are very humble. And I'm so heartened. Thank you for inviting me to talk today because it's frankly your willingness to tell your story that becomes a springboard for us to come together as a village to try to get more women well.

Dr. Ruta

[ 00:35:50 ]Thanks so much for joining us today .And a special thank you to Drs. Lee Cohen and Marlene Freeman for adding their invaluable insights. Over the last 20 years, we've seen a lot of progress in terms of our understanding of postpartum depression. However, the public and health care providers continue to be less familiar with postpartum anxiety. And it turns out that anxiety symptoms are actually very common during the postpartum period. In fact, the literature shows that about one out of every five new moms will experience clinically significant anxiety symptoms. And these symptoms may present as generalized anxiety, panic disorder, or OCD (or obsessive compulsive disorder). But what we see most commonly is that anxiety overlaps or mingles with postpartum depression. And so we see a more complex clinical picture where the mom has depressive symptoms, typically depressed mood or loss of interest in her usual activities, combined with intense anxiety and pervasive worry. What makes postpartum anxiety especially challenging is that postpartum anxiety often comes with intrusive thoughts. And these are distressing and unwanted thoughts that often focus on the baby and something bad happening to the baby. So ashamed or frightened by these thoughts that they often don't share them with other people, and they're often hesitant to ask for help. Another thing we have seen is that it's often difficult to recognize when anxiety crosses the line from a normal experience of new motherhood to something that's more serious or something we would consider to be an anxiety disorder. Many moms are not sure what's normal or whether they should ask for help. What we want to emphasize is this: Whether you're suffering from postpartum depression or anxiety, or if you're just having a hard time juggling the demands of new motherhood, it's important to reach out for help. You can talk to friends or family. You can consult with your obstetrician. Another important resource is Postpartum Support International. This organization offers support. Education, and connections to trained professionals who can help you understand what you're experiencing and help you get the treatment you need. The good news is that there are many different treatments for postpartum depression and anxiety, and these include group therapy, individual psychotherapy, cognitive behavioral therapy, as well as traditional antidepressant and anti-anxiety medications. There are also some newer options like zuranolone, which is specific for postpartum depression. Most importantly, it's important to remember that if you're struggling, it's never too early to ask for help. As a reminder, please note that this podcast is not intended to be a substitute for professional medical care. The views, thoughts, and opinions shared today are the speaker's own. Your feedback and questions drive this show, so feel free to send us an email at podcast@womensmentalhealth.org or leave a voicemail at 617-643-9232.

Allie

[ 00:39:19 ]This is So Glad You Asked with Dr. Ruta Nonacs and Allie Hales, brought to you by the MGH Center for Women's Mental Health and the J. Willard and Alice S. Marriott Foundation. Additional resources are available at Dr. Ruta's resource hub at http://womensmentalhealth.org. Listen and subscribe wherever you get your podcasts.