5 Things podcast SPECIAL: Breaking the stigma of postpartum depression and postpartum psychosis

The Food and Drug Administration recently approved the first pill to treat postpartum depression, a condition that affects around 1 in 7 women in the U.S. The disorder can become life-threatening. What are some of the best strategies for recognizing, understanding and dealing with postpartum depression and postpartum psychosis? Julie Lamppa, a certified Nurse-Midwife at Mayo Clinic, joins us for a conversation about maternal mental health

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Dana Taylor:

Hello and welcome to Five Things. I'm Dana Taylor. Today is Thursday, September 21st, 2023. This is a special episode of Five Things.

The Food and Drug Administration recently approved the first pill to treat postpartum depression, a condition that affects around one in seven women in the United States. Health experts say Zuranolone could be a game changer. The disorder threatens not only the wellbeing of the mother, but the entire family and can become life-threatening.

What are some of the best strategies for recognizing, understanding and dealing with postpartum depression? We're joined now by Julie Lamppa, a certified nurse midwife at Mayo Clinic and mother of two. Thank you for joining us, Julie.

Julie Lamppa:

Hi, Dana. Thank you so much for having me. I appreciate it.

Dana Taylor:

Postpartum depression has, at times, been dismissed as baby blues, or simply attributed to the hormonal changes that come with childbirth. What is postpartum depression and how does it differ from normal emotional adjustments after childbirth?

Julie Lamppa:

Yeah, that's a great question. It is very true that postpartum baby blues are labeled to include the up and down emotions, mild symptoms of depression within the first couple weeks after having a baby, usually within the first two to three weeks. That actually is experienced by about 80% of women. It is a really high volume.

How we distinguish the difference between the baby blues and postpartum depression is depression that is occurring within the first one year after having a baby. The first four months is the highest risk time, but people need to be aware that anything within the first one year of having a baby would be labeled back to that postpartum timeframe. That can be really surprising for a lot of women in that they don't relate the two things together. There's a lot of other postpartum mood disorders that are more so even related to anxiety, to OCD behaviors, to PTSD.

Dana Taylor:

Pregnancy is a situation that's ripe for anxious thoughts. Postpartum depression was described by one mom as something that can make all of your choices feel high stakes. Who's an ideal patient for medication?

Julie Lamppa:

The highest risk patients for perinatal mood and anxiety disorders, or postpartum depression, are those who have history of depression. Other ones would be you're in a situation where you're pregnant or postpartum and you don't have a lot of support from your partner or from family or from friends, social isolation. The extreme ages of childbearing can be a risk factor. Greater than 40, but also teens and early twenties. We might want to consider counseling during the pregnancy. We want to maximize mental health as much as possible during the pregnancy to set us up for a really good postpartum experience.

Dana Taylor:

What are some of the potential underlying causes or triggers of postpartum depression, something that's easily dismissed, like sleep deprivation, just a change to your daily schedule? How do those play a role?

Julie Lamppa:

There's the feeling of aloneness. We're still needing to really talk about postpartum depression a lot in order to get it more mainstream and so people don't keep it to themselves. A lot of times people just feel really isolated. With depression in and of itself, you sometimes want to isolate. That is going to cycle things backwards where you're blocking people to come in to recognize and to help.

Dana Taylor:

Certain strategies are only effective if they come in time. When postpartum depression has gotten to the worst place, it can be as serious as suicidal ideation. What do you want mothers to know?

Julie Lamppa:

Yeah. The most important thing is just really giving women the encouragement and the permission to please share what they're feeling. Sharing what they're thinking with their partner, with family, with friends, with their provider, because they are not alone in this battle. We want people to be aware of suicide hotline numbers, 988 to call. Postpartum Support International also is a really, really, really nice organization. You will get lifted out of this, but it's hard to do it alone. People are going to want to help you.

Dana Taylor:

Well, in postpartum psychosis it's less common, but obviously more severe. Earlier this year, a New York oncologist fatally shot her baby and then herself, tragically. What are some of the distinguishing characteristics and emergency signs of this condition? How do they differ from signs of postpartum depression?

Julie Lamppa:

Postpartum psychosis oftentimes will happen to women who also have had other kind of psychiatric diagnoses before. That's a risk factor. I had mentioned postpartum OCD earlier. I kind of want to distinguish those two because there's some similarities, but certainly many differences. With postpartum OCD, obsessive compulsive disorder, there is a lot of these intrusive, ruminating, disturbing thoughts that enter your mind. For example, a mom holding her baby may feel worried walking into the kitchen and walking by the drawer of knives because she has a ruminating, disturbing, intrusive thought of grabbing the knife and hurting her baby. Some have shared that they're afraid to go and walk by the stairs because they're afraid that they're going to fall down the stairs and hurt themselves and hurt their babies, and then also maybe have the classic OCD behaviors of cleaning and obsessive worrying about their baby. But the difference between postpartum OCD and postpartum psychosis is that with patients with OCD, they understand and completely recognize the fact that the thoughts that they are having are not real. They would not hurt their baby, and they're disturbed by them. The difference with psychosis is there is that disconnect and that not understanding and potentially following through. You're right, thankfully, it is a very, very uncommon finding.

Dana Taylor:

Let's talk about some of the fears that keeps someone from sharing the feeling that something is off, the fear of maybe losing your baby, worrying that there's something going on with you that can't be fixed. How do we move past the stigma of postpartum depression?

Julie Lamppa:

Yeah. Talking about it, exactly what we're doing today, that's the biggest thing. There's just this overall stigma that I'm being a failure as a mom, that I can't handle the normal stressors of being a parent, that people are going to judge me for not loving having my baby and loving being a mom. All of that contributes to it. It's just... Depression, I think is, and mood disorders have just always been stigmatized forever. It's really good that we can talk about it.

Dana Taylor:

Well, should you think about that going into pregnancy? You want to think about all of the good things going in, but is this something to consider before you get very far along in your pregnancy? What would I do if this were to occur?

Julie Lamppa:

Yeah, 100%. Especially if you yourself have risk factors, history of depression. Sometimes even family history can put you at increased risk. But yeah, I definitely think that it's a good thing to just head off from the beginning. That's again, around this time, and setting up your support system, I need my mom to come and live with us for two weeks, and then your mom come and live with us for two weeks after that, and just setting everything up to be as successful as possible.

For people who don't have close families, postpartum doulas are a potential to come over, and not necessarily for that emotional support, but just to help with other things. Sometimes people around you notice mood changes quicker than you do yourself. If your partner or your best friends, your closest people to you, know ahead of time, "Yep. I know that Julie has already told me that she's worried about this because we've talked about it during the pregnancy," then they're going to be at heightened alert for it as well.

Dana Taylor:

Well, Julie, was there a time when women were institutionalized for experiencing these symptoms? Why do you think it took so long for medical professionals and researchers to really study postpartum depression more extensively?

Julie Lamppa:

Yeah, I definitely think people were institutionalized. It's been several years now that I've contributed to articles and such about postpartum depression. When my mother read my first article, the next time that I talked to her, she said, "You know what? I think that I had postpartum depression." She said that I knew that something was wrong when the food wouldn't go down. When we talk about other kinds of symptoms, sleeping too much or not sleeping enough, not being able to sleep, eating too much, not being able to eat, and I'm sure that she had multiple symptoms, but that was when she realized that something was wrong. She went to talk to her OBGYN about it. He told her women are not supposed to have four babies in five years, which she did. This was 60 plus years ago. That awful self-blame.

Dana Taylor:

Most conversations surrounding postpartum depression evolve. What help is available to really help women process or handle those misplaced feelings we talked about, feelings of guilt that they've somehow done something wrong?

Julie Lamppa:

Do all the things when you're having problems with postpartum depression and anxiety. Nutritious eating, getting adequate sleep, so problem solving that to be able to sleep in the mornings or sleep through a feeding at night, spiritual care, getting outside, getting exercise. All of those things are really, really important. Those self-care things should be done regardless.

Supplementing on top, counseling as needed. Cognitive behavioral therapy just helps retrain your thoughts into more positive energy and how to cope with anxiety and depression, and then utilizing medications if needed.

Dana Taylor:

Julie, thank you so much for sharing your insights with us.

Julie Lamppa:

Yeah, thank you so much.

Dana Taylor:

Thanks to Cherise Saunders for her production assistance. Our senior producer is Shannon Ray Green, and our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to [email protected]. Thanks for listening. I'm Dana Taylor. Taylor Wilson will be back tomorrow morning with another episode of Five Things.