I Think I Have Postpartum Depression. Now What?

There is so much information available about postpartum depression that it can be hard to know where to begin. Reaching out for help can feel scary when you don't know where the conversation will lead. Finding a doctor or therapist, getting to appointments, and managing treatment can also be time-consuming, especially for new moms.

In this episode, Dr. Ruta and Allie are joined by two renowned reproductive psychiatrists, Dr. Kristin Yeung Lasseter, MD, and Dr. Lee S. Cohen, MD, for a crash course in postpartum depression. What is it? How common is it? How is it diagnosed and treated? When should you ask for help? Together, they provide the context so you can focus on the most important steps toward wellness.

Dr. Lasseter is a board-certified psychiatrist based in Austin, Texas, who specializes in reproductive psychiatry and women's mental health. She is the founder and president of Reproductive Psychiatry and Counseling, a practice that includes psychiatrists and psychotherapists specializing in mental health across the reproductive lifespan and serves patients throughout Texas. Dr. Lasseter is also affiliate faculty in the Department of Psychiatry and Behavioral Sciences at The University of Texas Dell Medical School. She volunteers with Postpartum Support International's Psychiatric Consult Line and raises awareness about reproductive mental health through speaking engagements and social media.

Dr. Cohen is the Director of The Ammon-Pinizzotto Center for Women's Mental Health and Associate Chief of Psychiatry for Philanthropy and Department Communications at Massachusetts General Hospital. He is also the Edmund and Carroll Carpenter Professor of Psychiatry at Harvard Medical School. After completing his residency and fellowship training at Massachusetts General Hospital, he became a national and international leader in women's mental health and was among the founders of the field of perinatal and reproductive psychiatry. His work spans research, teaching, and clinical care, with a focus on the treatment of mood and anxiety disorders and a special interest in psychiatric conditions associated with female reproductive function. These include psychiatric disorders during pregnancy and the postpartum period, depression in midlife women, and the relationship between infertility and mental health. Through his research, Dr. Cohen has helped shape the care of patients living with psychiatric illness.

Resources:

• Follow Dr. Lasseter (@the.reproductive.psychiatrist) for evidence-based, easy-to-understand data on maternal mental health
• Explore the perinatal mood support groups from Postpartum Support International
• Read more about postpartum depression from Dr. Ruta’s blog
• Watch the More Than Blue documentary

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, suicidal ideation

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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

Listener 00:00:00

I am worried about my mental health postpartum. Is there anything I can do or take medicine to prevent or help that?

Dr. Ruta 00:00:06

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 and helping them navigate the emotional highs and lows and the often unexpected challenges that come with planning a family, pregnancy, and motherhood.

Allie Hales 00:00:29

And I'm Allie Hales, a mom of four. I know what it's like to scour the internet wide awake at 2 a.m. with a million questions, wondering if what I was experiencing was normal. That's why we created this show.

Dr. Ruta 00:00:41

And because we know the questions don't stop when an episode ends, we've created even more support beyond our podcast. Our new website, sogladyouasked.org, is now live with trusted resources, personal stories, and a place to submit your questions.

Allie Hales 00:00:58

One thing I have learned through becoming a parent is how much we prepare for the baby, but not always for ourselves. We talk about feeding, sleep schedules, and what to expect during delivery, but we do not always talk about what it might feel like emotionally after the baby arrives. For some people, that might look like mood changes, feeling overwhelmed, or moments of doubt. And for others, it can be something more serious like postpartum depression. One of the hardest parts is that it is not always easy to tell the difference between what is expected and what might need more support.

00:01:31

When you layer in stigma, fear, and the pressure to feel grateful or happy, it can make it even harder to recognize what is going on, let alone ask for help. This is something that clearly resonated with many in our community. Our postpartum depression episode last season was our most listened to, which tells us just how many people are navigating this or wanting to better understand it. The truth is, postpartum depression is common, it is treatable, and there are effective options that can help people feel like themselves again. Today we're going back to the basics: what postpartum depression is, how it is diagnosed, and what treatment can actually look like.

00:02:09

Today we're joined by two leaders in the field of reproductive and perinatal psychiatry, Dr. Lee Cohen and Dr. Kristin Lasseter, who bring both clinical expertise and a shared commitment to helping people better understand and navigate mental health during the reproductive years. Doctor Cohen is also familiar to our listeners. He helped shape and develop this podcast and joined us in season one, and we're grateful to have him back for this conversation.

00:02:35

Dr. Lee Cohen is the director of the Ammon-Pinizzotto Center for Women's Mental Health and Associate Chief of Psychiatry for Philanthropy and Department Communications at Massachusetts General Hospital. He is the Edmund and Carroll Carpenter Professor of Psychiatry at Harvard Medical School.

00:02:51

Dr. Cohen is a national and international leader in the field of women's mental health and was among the founders of the field of perinatal and reproductive psychiatry. His work spans the domains of research, teaching, and clinical care in the area of treatment of mood and anxiety disorders with sub-specialty interest in psychiatric disorders during pregnancy and the postpartum period, depression in midlife women, and infertility and mental health.

00:03:16

Dr. Kristin Lasseter is a board-certified psychiatrist based in Austin, Texas specializing in reproductive psychiatry and women's mental health. She is the founder and president of Reproductive Psychiatry and Counseling, a practice dedicated to supporting patients' mental health across the reproductive lifespan.

00:03:34

Doctor Lasseter also serves as affiliate faculty at the University of Texas Dell Medical School. In addition to her clinical work, she volunteers time at Postpartum Support International's psychiatric consult line and raises awareness about reproductive mental health through education, speaking engagements, and social media.

00:03:52

Dr. Cohen and Dr. Lasseter, we are so grateful you're here.

Dr. Lee Cohen 00:03:56

Thanks for inviting us, Allie.

Dr. Kristin Lasseter 00:03:58

Yes, thank you so much for having me.

Allie Hales 00:04:02

Thanks for coming on. To start us off, I think it'd be helpful to ground us in some of the basics. So when we say postpartum depression, what are we actually talking about? How do you help patients understand the difference between expected mood changes and feeling tired, feeling overwhelmed, and then clinical postpartum depression?

Dr. Kristin Lasseter 00:04:22

It can be really hard for some people, especially when you're trying to judge it yourself. So when you're asking the patient to try and decide on their own. But one thing that I think is really helpful for people to understand is that it feels very different from what would be normal and it's more long-lasting. So it's not just, you know, periods throughout the day of maybe feeling more emotionally labile or more kind of up and down.

00:04:51

Instead it's most of the day not feeling yourself, feeling down or not feeling interested in things or maybe not feeling bonded to your baby, whereas just, you know, the normal kind of hormonal changes, you still have those moments and the majority of the day of feeling like yourself. You're definitely going through a huge stressor, so it feels similar to another time you're under stress, but it's not this overwhelming sense of feeling like the world's on your shoulders or or it's hard to feel the same emotional bond as you normally would.

Dr. Ruta 00:05:31

Just to build on that. I also think what sometimes makes it a little bit difficult to diagnose is that postpartum depression often comes with a lot of anxiety. And what's normal worry about a new baby and what's more of a sign of postpartum anxiety or the front edge of postpartum depression. So moms might worry that their baby's not eating enough, not sleeping enough, sleeping too much, not breathing. And if those start to interfere with functioning, then we think more along the lines of depression and anxiety as opposed to just normal worry.

Dr. Lee Cohen 00:06:10

Yeah, Ruta, I think it's a great point, and I also think it's helpful to say sort of what it's not. Patients talk a lot about the is it postpartum blues or is it depression? And we know that out in the community, seventy to eighty percent of women will have transient reactivity or up and down in mood in the first week to ten days postpartum. And that's normal.

00:06:37

I think that when we talk about, to Kristin's point, when we talk about postpartum major depression, we're talking about a level of symptoms that goes beyond the sort of normal ups and downs of the first ten days or so and really starts to have a quality of more enduring depression. And you know, it's such a depleting time, physically, emotionally. It's so new for moms. When I hear moms talk about not experiencing any joy at all from the experience, on the other side of really the depletion factor, then I start thinking more about postpartum major depression.

Allie Hales 00:07:20

Yeah, for me, I remember with my first, he was born early and so it was this very big whirlwind of events, and I don't even really think I could get a pulse check for myself on what was happening because it was just overwhelming in so many ways. And, thinking about when mom is checked in on, for me it was never before six weeks. And I think about all of the emotional ups and downs I had experienced between birth and six weeks.

00:07:53

And I guess I just am curious when you think about all of those changes and all of those emotions, is it something that a partner can be looking out for in those six weeks, like until you talk to your provider? I'm just curious at what point in between that time do you reach out about postpartum depression.

Dr. Lee Cohen 00:08:15

You know, when I think about postpartum depression, I think about a continuum of symptoms. For example, as I mentioned, patients who may have postpartum blues, and then patients who have postpartum major depression, and then when we think about the most severe form of postpartum psychiatric illness, that is postpartum psychosis, which in a way is a standalone separate discussion. What I'm so pleased about is that whether you're talking about blues— which really doesn't require much in the way of treatment, it's time limited by definition—but when it comes to postpartum depression and even the most severe form of postpartum psychiatric illness, postpartum psychosis, in 2026, we have very effective and studied treatments for those illnesses.

Dr. Kristin Lasseter 00:09:05

I personally don't think there's ever a bad time to reach out. If you're ever even questioning it, I think it's fine. It's really hard for some people to tell because it is a really anxious time, kind of like Ruta is saying, there's so many changes going on, especially if you're a first-time parent. Now you're keeping this little creature alive and you've never had to do this before, you don't know what's right, what's wrong, what you're supposed to be doing or not. And so it can be confusing whether or not what you're experiencing is normal, and so I don't think it's ever a wrong time to reach out if you're even questioning it.

00:09:41

But for a lot of women, they're kind of focused on the baby and not even recognizing when things are changing with themselves. And so I do think it's helpful to have your partner kind of check in with you and make sure that you're doing okay, that you're taking care of yourself and feeling okay. And then also checking in about how are you feeling towards the baby or or how are you feeling toward yourself? Are you having thoughts that you're not a good enough mom or especially if you're having thoughts of “I should escape in some way or I wish I wouldn't be around here or my baby would be better off with a different mom,” those are definitely red flags that something's not right. Or sleep, sleep can be a big one. You should be exhausted and able to fall asleep pretty easily, especially after that first week of adjusting to this weird schedule. And if you're having a really hard time sleeping because you're up worrying about things or you just can't settle down your mind, that can be another red flag.

Dr. Lee Cohen 00:10:44

You know, Allie, what I love about Kristin's comments is that, when you sit with a new mom and you ask, “How are you sleeping?” and you know, just the schedule is so brutal depending obviously on the sleep schedule of the newborn, but some moms will look at you and say , “Are you kidding me? When I put the baby down, I'm out.” And then for others, over the years I've seen tears come to their eyes and they say, “You know, when I put my head down, I'm ruminating, I'm worried.” To Ruta's earlier comment, “I'm anxious.” Those are the patients that I start worrying about.

00:11:23

I love the idea of folding in the partner who has the luxury of looking over even in those first six weeks Allie over this period of time to get a pulse on how things are going and the sense that something really may not be right here. Our documentary More Than Blue hit the streamers, and we took such effort to fold in the partners into the documentary. The partners were so hip to what was going on. They had an opportunity to say something is really not right here even given some of the normal chaos that goes along with that new postpartum period.

Dr. Ruta 00:12:06

One of the real tragedies in our field is sometimes you see a mom three months, six months, nine months out and they've been feeling miserable since the baby was born. And I think to your point, Kristin, if you have any concerns, call your provider. I also just want to suggest as another place you can go, Postpartum Support International has a warm line. And it has lots of informational materials because I think a lot of people don't want to bother their doctors or it's too hard to reach their doctors or they don't know, well, maybe “I'm not doing as bad as other moms I know.” So I think PSI is really a good resource for getting information and really know that nothing is too small to make a call to your provider because we don't want to see women at nine months who've been suffering since the birth of their child. That's not time we can get back.

Allie Hales 00:13:06

Yeah, and Kristin, I'm wondering if you could speak a little bit to the stigma that you see your patients dealing with and at what point are they calling you and asking you for help? And how did they get to that point to then call your office?

Dr. Kristin Lasseter 00:13:21

I think usually by the time they get to that point, they've been suffering for a while and usually it's more severe. But a lot of them kind of have that thought that Ruta was talking about, like, “Well, other people have it worse or maybe this isn't as bad as I think it is.” And so unfortunately, I feel like by the time they actually get to see a psychiatrist, they could have easily gotten help way earlier than by the time they're coming to see me.

Allie Hales 00:13:52

And I just wanted to follow up with that because I feel like just in the conversations we've had about this, it seems to be recurring that women wait until much later to seek help when they could have received help much earlier due to accessibility, due to stigma, due to, I mean, for me, I know I downplayed a lot of my own symptoms with things just feeling like I'm fine. Like women all over the place do this, I can do this, like I'll just figure it out.

00:14:20

And I know that there are some things in place, like the EPDS. But for me, I mean, I've talked to Lee and Ruta about this before, but I lied on all of my EPDS scores. Like, I went into my office at six weeks and I took the questions and I answered them how I knew I was supposed to answer them, but I did it because I didn't know what would happen if I scored highly on the test. I was scared. I felt like I was a good mom and good enough at least to be taking care of my own child, and I just had all of these worries about what would happen if I answered honestly.

00:14:59

And also too, I mean, it varied by the day. There would be some days where I felt great and I really was scoring low on the chart. But then there were other days where I wasn't feeling that way, and I just didn't really know what to do with that screening. So, I guess I'm just interested if you could talk a little bit about the EPDS and what we can do to help catch moms before they reach this point of suffering for months before they seek treatment?

Dr. Lee Cohen 00:15:33

Allie, you raised multiple issues. The EPDS, which is the Edinburgh Postnatal Depression Scale, is a very well-validated scale. It's been translated into dozens and dozens of languages. It's been used for decades now. And it's reliable, and we have had universal screening here in America over at least the last decade or so. And that was a big improvement because it had been used in the UK for years and years and then was adopted here in a more standard of care fashion. But I loved your comment, Allie, about what do you do with it? And I think that we don't do a great job at explaining to new moms what we're going to do with the screen after it's scored because I think moms are concerned. Are they going to be reported? Is a child going to be taken away from them?

00:16:26

We hear about this when patients talk to us about the EPDS. I think we fail by sort of not sharing with them that it's a screen and that we'll use it as sort of a springboard for further discussion about how they're doing. And that simple, very short, context providing an explanation is not typically given to patients, I don't think.

Dr. Kristin Lasseter 00:16:52

Yeah, that's an excellent point because I feel like on social media, for example, I will have so many people reach out in my DMs or even just leaving comments on stories, telling me how much they're suffering, and I think for a lot of people they don't feel comfortable talking to their provider about it because sometimes they don't have that kind of relationship with their provider.

00:17:17

Or to Lee's point, it's being given maybe by the administration or the nurse or someone at the hospital who isn't necessarily going to run through like, “Hey, this is what's going to happen if this score is positive or if you do admit to some of these things.” I think people have a lot of fear around admitting to those thoughts, too.

Dr. Lee Cohen 00:17:39

And Ruta on the science side, I'm not familiar with a whole bunch of data that looked about, to Allie's point, the stability of the EPDS over time because moms talk about it all the time. Like, are you talking about yesterday? Or are you talking about this morning or two weeks ago? Because we know what the interval is for observation in the question, but I don't know how that plays out in terms of both how moms answer and really the stability of the measure over time.

Dr. Ruta 00:18:09

I think people who score low on the EPDS tend to score low and people who tend to score high tend to score high over time, but there is a lot of day-to-day variability. And I think that also, outside of the questionnaire, there's depression but there's also just reactive mood. So if your baby does well that day and you're really enjoying it and it's sunny outside and you were able to go for a walk, you feel good. And then if something goes wrong the next day, you forget that you felt good the previous day. So, I think even though it says during the past week, how did you feel, I think there's tremendous volatility of mood. But we also know that if you take an EPDS at three days postpartum, so sometimes these women are still actually in the hospital, and if they score very high, those women are more likely to go on to have postpartum depression. So high tends to score high and continue to be high, but there are a lot of day-to-day fluctuations.

Allie Hales 00:19:18

No, I mean it's good to hear 'cause I just really didn't know that much about it when I was having babies. It just goes kind of like, “Okay, this is just a way for us to check in and see how you're doing.” And that was kind of all that was said about it. And I remember each of my six-week appointments were pretty short and I really loved my OB, but it was very quick, like, okay, everything looks great, see you next time you're pregnant kind of thing. It just ended up being like okay, we're done, and that was it.

00:19:48

I think even for screening, too, we know that even though it exists, many women still don't get the care that they need, whether they score high but then they don't come into the doctor's office or they miss their six-week appointment or whatever it might be. But why do you see that gap still existing?

Dr. Kristin Lasseter 00:20:10

I think for a lot of people, they just don't have the time and the resources to go get the recommendation that their doctor makes. Or I hear all the time of in terms of therapy, like, “Oh, I just haven't had time to call the therapist, or I called them, they never called me back, and I just don't have time to follow up or taking care of a baby, a newborn is just exhausting and it's it's so time intensive,” and I don't think people realize that, but when you're in the moment, you just don't have the time and the resources to do that and it's not easily accessible.

Dr. Lee Cohen 00:20:46

Kristin, it's so helpful to hear. I'm familiar with the data that showed, and now it's five to seven years out from the study, I think at least, where for women who scored positively on the EPDS with enough symptoms to meet criteria for major depressive disorder, if you look down the road, the number of those patients that got treated, that actually got treated until they were well, you were in single digits.

00:21:14

And in fact, that was one of the things that prompted us to say, we need to be doing more in America. We're going to do a documentary and see if we can help with this falling off a cliff postpartum for patients with respect to something like postpartum major depressive disorder. But it's a huge issue, Allie, in terms of what are the obstacles to care for women we're worried about, who screen in, whether it's early or even after six weeks, what are the obstacles? And I think Kristin sort of laid that out in the real world what that's like. What are the obstacles to women actually getting access to care, getting appropriate treatment, and then getting well?

Dr. Kristin Lasseter 00:21:57

Well, and I'm so glad that you did do the documentary and that it’s widely available because I think part of part of the access to care, part of the piece that's making it hard for people to continue treatment or continue treatment to the point that they get well, is the stigma of it.

00:22:16

A lot of people, maybe they get to my clinic and we talk about medication choices, but then just to start medication feels really scary or maybe their family's not supportive of it or their partner or they just have a lot of shame around the fact that now, “I have to take a medication to to get better. I see all these other moms who can do it without that and are doing fine.” And so I think having a documentary that shows real-life experiences and what it's really like is very validating and helps take away some of the stigma.

Dr. Ruta 00:22:52

So when we talk about stigma, I think it's just so complex because I think younger people are much more comfortable talking about mental health issues. They're much more comfortable asking for help, but there's something about being a new parent that nobody wants to see a psychiatrist when they're a new mom. And I think there's internalized stigma where moms feel like they should be able to take care of these things on their own. So even though we've made mental health something that's less stigmatized overall, there's something about being a mom that doesn't make it easy to ask for help.

Allie Hales 00:23:33

I'm glad that you all brought up the point about treatment because treatment for postpartum depression wasn't something I really knew about until very recently. I had my own symptoms and then I really just kind of white-knuckled my way through different pregnancy and postpartum mood disorders just because I felt exactly what you were all describing. But one of the things that surprised me the most learning more about it is that there are so many different treatment options available and that it is something that is treatable, which I just didn't understand and I think gives so much hope.

00:24:07

So, I guess I'm curious to hear about what are those different treatment options and what does treatment for postpartum depression look like?

Dr. Kristin Lasseter 00:24:16

There are so many different treatment options and they can vary depending on what somebody is more passionate about or feels more comfortable with. I like that we have our traditional SSRIs and SNRIs that are really effective at treating postpartum depression and now we have even newer medications like zuranolone or previously brexanolone that could work within days. But for the people who don't want to take medication, therapy can be really helpful.

00:24:50

There's alternative treatments like doing exercise or, for some people, they can feel better with certain supplements. When somebody is having more severe depression, we really encourage them to incorporate all the different treatments because it's really hard to get better if you're just doing therapy or if you're trying to use other forms of treatment that can't necessarily get at more of the biochemical changes that are going on.

00:25:27

I think that some of the newer ones like zuranolone are nice because they work really quickly and so it can be helpful for somebody who's going through severe postpartum depression who maybe doesn't want to go into the hospital to receive treatment or can't wait the weeks it's going to take for an SSRI or an SNRI. And it seems to me because it's labeled a treatment for postpartum depression, people seem to be more apt to taking it than like our traditional medications, especially when they're being prescribed by their OB or someone who's maybe not specifically in the mental health field.

Dr. Lee Cohen 00:26:06

So what I think is so interesting about this discussion is we don't really have data between the older treatments or non-pharmacologic treatments or newest treatments that one is better than the other, because we don't have head-to-head studies showing that using sertraline, which is Zoloft, versus cognitive behavioral therapy versus one of the newest treatments like zuranolone, that one is better than the other. But those medicines have gotten approval because they did demonstrate that, relative to not getting treatment, that they beat out let's say placebo in those in those studies, or patients not getting psychotherapy in the studies of cognitive behavioral therapy. What I'm always impressed with is that patients have very clear ideas about what they want and what they don't want during such a precious time as the postpartum period. And so it may be fine that Zoloft works, but a lot of moms don't want to be on uh antidepressants because they want to breastfeed even though we have very ample data on the safety of medication use during breastfeeding. So I like the fact that we have lots of choices.

Dr. Ruta 00:27:23

I think also just to add to all these great comments that some treatments take time to kick in and to be patient, but on the other hand, if something's not working, to try other options or to connect with your provider. I think it's great to hear that OBs are in the mix, but they typically see patients during pregnancy, postpartum six weeks, and then don't necessarily see the patients unless there's problems.

00:27:55

So we definitely want to make sure that there's a good connection between patient and provider so that they're getting followed up and we're making sure that these treatments are working because sometimes they don't work or sometimes the dose needs to be adjusted, sometimes we combine them, and I think on one hand it can be frustrating and people don't have a lot of patience, but sometimes I've seen it the other way around like too much patience like keeping up with something even though it's not working.

Allie Hales 00:28:26

I really appreciated all your comments because it is reassuring to hear that there are so many options available and so many different types of options. Like it's not just a one-stop shop and it's not just this is the only path even if you're not comfortable with it. It is reassuring to know that based on a patient's comfort level or what they're interested in doing, there are many different paths to treat it. But what I'm hearing from all of you is that overall it is treatable, and it's something that I wish I had understood.

00:28:57

Another thing that I was curious about in my later pregnancies, and I get questions from friends about it too, but it's more about prevention. So what can women do to prevent or reduce their risk of postpartum depression? And I know a lot of women who have a history of depression or have had postpartum depression in the past, especially, are wondering about this.

Dr. Lee Cohen 00:29:21

So, Allie, I think it's helpful to start with the data on what is the risk for recurrence of postpartum depression. So, for women who have a history of depression, they're at a threefold increased risk for postpartum depression. So it goes from about 10% to let's say 30%. If you have a history of postpartum depression, it goes up fivefold. So you have just a 50/50 chance of not having a return of postpartum depression. And I think it's such a terrific question because I think it's one of the charges to our field and it's one of the challenges that we face.

00:29:59

How do you mitigate risk for postpartum depression in general, and particularly in at-risk populations? What are the data, whether it be non-pharmacologic, like certain psychotherapies, or pharmacologic, so that should you, for example, be starting antidepressant right around the time of delivery, just as an example, if you have a history of postpartum depression where you only have a fifty-fifty chance of of of not having a recurrence?

Dr. Ruta 00:30:29

It's challenging because I think patients aren't so educated about reducing their risk, and I think also sometimes clinicians in the community don't know about reducing risk. But I think if you've had depression or if you had postpartum depression, resuming treatment or continuing treatment with an antidepressant really dramatically reduces the risk. And I think there's also other studies which have shown using certain types of psychotherapy can reduce your risk in the postpartum. I think those are harder to access and they take more time.

00:31:09

So I think the easiest thing is often starting an antidepressant. The other thing is medicine is one part of it, and you really want to talk about a postpartum plan in terms of who's helping you with chores at home, childcare at home, and how you're managing sleep because I think not getting sleep is one of the real modifiable risk factors that we have. And we can really help parents plan and reduce their risk for postpartum depression.

Dr. Lee Cohen 00:31:43

If you ask me as a clinician, if there were one thing that I could do to mitigate risk, it would be to protect the sleep of new moms. There are data that speaks to that at some level, but all you have to do is sit with new moms and their partners and you realize how failure to protect sleep, particularly in at-risk groups, so paves the way to frankly the evolving of postpartum depression. Kristin, I don't know how you do that in a clinical practice and how much you talk with patients and their partners about things like protecting sleep or other things they can do to mitigate risk, but I am curious and also how receptive are they to those sorts of suggestions?

Dr. Kristin Lasseter 00:32:29

I always try to do an appointment in the third trimester where we go through postpartum planning, and I think they love having that because for a lot of people they haven't really thought through, well, “I don't know who's gonna help cook meals or do the dishes or who's gonna take turns with the baby.” So I think that's a fun appointment that we get to do with talking through that information. But I always tell them that support is a huge thing, like making sure, especially if you have the resources, having all the support you can have and that you can never have too much support. You can always later on say, never mind, we don't need your help, but having all the people that you can helping you out in those  first few months is, I think, gold. And then also having mom be able to take time for herself, in addition to her being able to sleep a good amount, I think having mom be able to take time for herself so she's not always the one having to do everything for the baby and she can get time in to exercise or read a book or go for a walk just by herself. I think those moments can be really rejuvenating for women also, and I think for a lot of people, they don't think that's a possibility postpartum.

00:33:49

But I think it's really important for both parents. And then something else that I wanted to comment on is if somebody has discontinued their treatment and they have a history of postpartum depression, I get asked a lot about “Should I just go ahead and restart it postpartum?” And I think the probably safer option is to go ahead and just restart it, but I think for a lot of moms they want a do-over in a way or they want to kind of be able to see, well, can I do it this time now that I know these other pieces of it? And so for my patients, I often kind of give them all of the data that we have of here's how likely it is that you're going to relapse, here are the things that we know can increase that risk, here are the things we know that can decrease that risk. But really there's no right or wrong answer. And so I let them decide what feels most comfortable and what feels best for them because it is such a unique experience that you don't get to have many times in life. And so I think that having people make that decision of what feels best for them in particular is helpful for them.

Dr. Lee Cohen 00:35:10

Kristin, I love the way you laid that out, but I have to sort of sort of share, if a patient was in my office and she had stopped antidepressants because of history of having, let's say, multiple episodes of depression, and she in my mind sort of beat the odds and didn't relapse, even though we know relapse is very common in patients who stop antidepressants proximate to pregnancy. But if she had done sort of well enough and had stayed well, my threshold for putting that patient back on antidepressant would be low because at that point she's sort of racing against the clock.

00:35:48

And I think to your point, I wish we had better data on this, but I worry so much about women losing the race, having recurrence during the postpartum period, and then we're struggling with trying to get her well during such a critical time. And so, I don't think there's a perfect answer here, but I wanted to sort of share the downside of not putting patients back on antidepressants who have responded historically and particularly if they have a history of severe depression.

Dr. Kristin Lasseter 00:36:25

Yes, and that's a great point. I think if somebody has had multiple episodes before, the risk is even much higher and that makes me nervous. For somebody who maybe has only had depression in the postpartum period and it was their first pregnancy and they're coming back and asking what to do again, in those cases, I like giving them all the information, but I also really like giving them the chance to decide what feels best for them.

Dr. Lee Cohen 00:36:52

Ruta, I remember, I'm almost embarrassed,it's over 20 years ago, but I remember in one of our first studies, we gave patients a CD. This is before you could just do it on your smartphone. Everybody got the same information about their options, and women with the same illness history did very different things. And I was pleased with that because it showed me in my mind that we were empowering patients with information and they were free to make the decisions that made the most sense between them and their partners and whoever was taking care of them clinically. But to empower patients with information about these options to Allie’s point that we know work, where there's great data supporting their efficacy. That's my hope for the future that patients will take these treatments and use them if they're suffering.

Dr. Kristin Lasseter 00:37:51

And that they'll have the accurate information to be able to make those decisions too.

Dr. Lee Cohen 00:37:56

Well Kristin, that goes to when you got introduced, and reference was made to how you use social media to get that message across to folks who aren't hopping onto some academic blog. I'm so curious how you do that and what's the language in social media that's used to convey such important information to new moms and their partners?

Dr. Kristin Lasseter 00:38:24

I mean, for me, I often go about it by just saying, here's what the research says or here's, you know, what studies have shown us and or maybe there's limited research on what we're talking about. But I think for a lot of women, they get their information from social media and unfortunately, it's really hard to tell who is actually an expert who actually has training in what they're talking about. And so I think it's for me just kind of laying out like, well, here's the actual data, you can kind of do with what you want. And I greatly appreciate Ruta, your blogs because a lot of times I just send those and I'm like, “This is what it shows. I'm just the messenger. You can believe whoever you want, but this is the information that we have.”

Allie Hales 00:39:15

We did have a couple listener questions. First one is, is breastfeeding protective against postpartum depression or a risk factor for it? I've heard it both ways.

Dr. Ruta 00:39:26

That's one of my favorite topics, which I'm happy to answer. Which is, if it's going well, it can be protective. But if it's not going well, it seems to act as a risk factor for postpartum depression. And I think it's a complicated issue because I think a lot of women who are able to breastfeed have a lot of support and that also reduces their risk of postpartum depression. So I don't think it's exactly a causal relationship, but I think as perinatal psychiatrists, one of our frequent questions is about breastfeeding and antidepressants. I think sometimes when breastfeeding isn't working and is contributing to depression, it's really helpful to give people permission to stop breastfeeding or to modify their schedule because exclusive breastfeeding is a lot of pressure for women.

Dr. Lee Cohen 00:40:27

If we were in our rounds at our center, and I was surrounded by my colleagues, they would say that frankly it goes both ways. We do have some limited data that there's a small group of patients who actually when they start to wean from breastfeeding they may have worsening of depressive symptoms. And I wish we had better data. I wish there was a better literature to really parse out who those folks are. But Ruta, I loved your comment about the mom who is struggling with breastfeeding and where it's really becoming sort of like a day in day out slog. And how do we counsel those patients?

00:41:13

Kristin, I'm curious in the community about what you tell moms, because again, it's not one size fits all, but I've seen moms get demoralized and it seems to be paving the way to them getting worse with respect to their mood. And how do you help them to sort of say perhaps enough's enough and to segue to bottle feeding as an example?

Dr. Kristin Lasseter 00:41:42

Yeah, I think using the analogy that you can't pour from an empty cup is really helpful in those cases of really the most important thing, what's going to be best for your baby, even above the benefits that they might get from breastfeeding is you being mentally healthy, and if breastfeeding is getting in the way of that because it's really a difficult thing for you or it's taking all of your time, that is important to consider because baby really needs you to feel well.

Allie Hales 00:42:14

I appreciate that because on a personal level, I really didn't think I would feel emotional about breastfeeding. I was formula-fed. I went into it being like I don't care. Whatever works, I'm going to do it. Like it's whatever, it's best for me, best for the baby. I felt like, “Oh, I've got this.” Like I can adapt and it's not going to be emotional for me. And then like I mentioned before, my first was born early and everyone in the NICU was saying, “You know, you have to only give him breast milk and he needs that,” and it just felt like so much pressure and it was not what I was expecting.

00:42:53

I really was so set, fixated on he can only have breast milk and I had to pump like every two hours around the clock and all these things and I just look back on it now and I just am so stressed by it even thinking about it, but I mentally knew I'm fine and I had formula, like why do I have this block against it? So I think it is something that, maybe a lot of people don't relate to what I'm saying, but maybe some people do feel like it was more of an emotional decision than they thought it would be.

00:43:28

I think destigmatizing different choices in parenting as long as you're safe and the baby's safe is really helpful in knowing that there are different choices that different people can make. And whatever is best and healthiest for you and your baby is a good and safe choice. And I wish that I had heard more of that before having a baby and before having all of these emotions play into it. I’m wondering what you wish people understood more about postpartum depression and maybe even considering that we talked about this a lot, especially when it comes to the fact that we have treatments that work, they are accessible. So again, just giving you all an opportunity to share maybe a couple last thoughts on what you wish people understood more about postpartum depression.

Dr. Kristin Lasseter 00:44:14

Well, like Lee talked about earlier, when you're going through any other kind of illness or medical condition, you get treatment and there's not stigma around it. And so I think just reminding people that postpartum depression is a medical condition, it's a mental illness, it's something that we don't necessarily have control over, even if we do all the right things, like having all the support or eating the right diet or sleeping enough. Sometimes it can still show up and it's because it's a condition that happens in the brain. And I think helping people understand that part can really take away some of the stigma because they realize that it's not necessarily a failure that they've done but something that's an actual medical condition.

Dr. Lee Cohen 00:45:02

Allie, I think if there was a message that I had frankly after now lots and lots of years of taking care of new moms who are suffering from postpartum depression, it would be one, how terrific it is that we have such effective treatments to manage postpartum depression. And two, how important it is that when patients are suffering, they get over the hump of the obstacles to getting care, do whatever they can and do whatever they need to go and get that care. My vision in America is that we're going to do better because that void between screening and patients getting care and getting well, I think is a manageable void. I think things are going to come together so that the gulf between patients getting screened and actually getting care is going to become much tighter and much shorter. I just don't think we can overestimate the importance of maternal mental health and maternal wellness when we think about the next generation in this country.

Dr. Ruta 00:46:26

It's hard to add to both of those. I agree with them totally. I guess we're all physicians and we provide medical care, but I think this is one of these areas where social support is so incredibly important and really helping new moms to set up networks of support, because the isolation that women experience in this setting is not conducive to good mental health. So really that is an important part of the mix and can be really remarkable in terms of supporting women both as they're healthy but also when they're ill. If you're listening to this episode and questioning whether what you're experiencing is something to worry about, this message is for you. Postpartum depression is common and it is treatable. It can happen to any parent and experiencing it is not a reflection of your ability to be a good parent.

00:47:31

What we talked about today is that we have the tools to identify postpartum depression and we have many different effective treatments. But too often, stigma and fear prevent people from speaking up or getting the care they need. You don't have to wait until things feel unbearable to ask for help. Whether it's sharing how you feel with someone you trust, talking to your provider, or reaching out to a therapist, these are important first steps. Getting support is not a failure. It's a way of taking care of yourself and in turn, taking care of your family.

00:48:10

Thanks for tuning in. 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 Hales 00:48:36

You can find additional resources at our resource hub at sogladyouasked.org. This show is executive produced by Dr. Lee Cohen, produced by Mike Brown and Peri Barest, and edited by Mike Brown. 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. Listen and subscribe wherever you get your podcasts.