How to recognize postpartum depression?

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Transcript

Chrissy Billau:

Welcome to Prescribed Listening from the University of Toledo Medical Center. On this podcast, we interview experts to get the answers you need and can trust. I'm your host, Chrissy Billau. This is part two of our discussion with psychiatrist Dr. Victoria Kelly, all about women's mental health. During part one, we talked about the weight women carry with stress, the expectations society puts on them, and the growing number of women with ADHD, among other things. This week, we continue our conversation getting into the mental health struggles of motherhood. Let's ask our expert.

For many women, the first year of motherhood is dark and complex. I'd like to talk about postpartum depression. Postpartum depression cases have also been up shocking. Everything's up. What have we been seeing here locally in UTMC lately?

Dr. Victoria Kelly:

We have been seeing quite a lot of crises and stressors for sure. And I think with the pandemic, it has again, accentuated everything of that women and mothers have had to go through and bear the brunt of. Specific to postpartum depression, we've definitely been seeing higher rates of it. And I think the biggest things that you can really do, number one, is to recognize it. And I think we probably have more than we get treatment for, because there's a lot of stigma attached to that. So a lot of times, what it'll present with is they not feeling connected with her child. Brook Shields wrote a fantastic memoir, Down Came The Rain is the name of it, of her struggles with postpartum depression. And I think that's probably one of the most common thing. A numbness, a disconnect that, "Oh my God, society says I should be jumping for joy and pinching these little cheeks and snuggles and all this, and all I want to do is nothing. I'm empty."

So that's not typically what people think of when they think of depression. They think boohoo, sad, crying, that kind of stuff. So number one is recognizing it. And then number two is getting that intervention as quick as possible. There's so many things that go into it. Sleep deprivation, hormonal changes, those are a huge factor. And especially also if you're breastfeeding and stuff, that also still impacts your hormones. And if your menstrual cycles have recalibrated and let alone the psychological transformation that women have to go through with the stages of pregnancy and then becoming a mom, and literally every aspect of your life changes. Interestingly too, after you have a baby, your brain changes and they've demonstrated neuronal changes in a mom's brain for up to two years, because essentially it's rewiring to be able to be a good mom for your baby.

Chrissy Billau:

Well, at the same time, thinking I'm not a good mom.

Dr. Victoria Kelly:

Exactly. Yeah. See, evolutionary, that's good because it'll keep making you do better. But we don't live in those times anymore. So it's like, "Thanks, brain, could you just stop it? That would be good." But mommy guilt, another way to look at is parental burnout, and it stems from love. But you get this inferiority guilt, perfectionism. And no matter what, it's like a damned if you do, damned if you don't. And you're going to have these mommy guilty thoughts anyway. And whether it's about something you're doing, like going to work, eating junk food or just whatever or things you're not doing. So let's say you're not breastfeeding or not taking that time for yourself. You're not going to win no matter what. So the biggest thing is well, don't play that game then.

Don't play that game. And if you are triggered by social media, don't look at that. It's as simple as that. But there's so much data out there about Pinterest or not ... Sorry, Facebook is the most data because it's been around the longest, about if you literally just open Facebook, there's data that show that your mood decreases just from that. So anything that contributes and feeds this beast, don't. So social media is a lot of it. And coming to terms with this myth of having it all. Having it all does not mean doing it all. And society wants women who are strong and independent, but also perfect mothers and sex goddesses and all this stuff. It's like, "Yeah, it can only be one of those things at any one time." And there is no perfect mom. And 75 to 80% is good enough. Good enough mom is perfect. Yes, everybody. Nobody is in the hospital tonight. Nobody was bleeding. Everybody's semi-okay.

Yeah. So it's in a way, it's seeking perfection. So your mom guilt is going to stop when you stop trying to be perfect, and you accept and acknowledge that you're not perfect. So you got to be open and honest with yourself, which is really hard for a lot of people, to be okay with being imperfect and decide ... Obviously, if you've actually done something really wrong, well that needs addressed, but that's not what we're talking about. And then fill your own cup. That's an analogy that a lot of kids use at school. Are you a cup filler or whatever? So fill your own cup. Oh, you haven't? Dude, I hear so many things from my kids from elementary school and daycares and stuff, but they want to embody and start those habits of you want to fill other people's cups too.

Chrissy Billau:

Instead of doing all the things, do you just want to take time to read? Or, "Hey, I just want to take some extra time to do my hair today and not have anyone else bother me"? It can really be something very tiny.

Dr. Victoria Kelly:

Simple. Avoid social media, avoid comparisons, because remember, parenting is not a competitive sport. They don't have medals in the Olympics for it. So you don't need to compare yourself to others. Another thing that I recommend to patients is not to use the word should. I should be doing this. Ding, ding, ding. Really? Let's reframe this. And then yeah, avoid catastrophizing. It's not going to last forever. Those early childhood years are really difficult because the children really do need a lot of guidance, a lot just of every part of us. And about 80% of new moms do have baby blues, but that goes away pretty quickly within the first few weeks. And postpartum depression though, that is a true medical disorder. It could escalate to an emergency if a woman becomes so sick that they develop psychotic symptoms. Or sometimes you can even get postpartum OCD in which you might have really scary, horrifying images of doing stuff to your baby. Yeah. So if any kind of stuff, if there's a new baby around, I don't mess around. We need to get that treatment ASAP, whatever the symptoms that the mom is experiencing.

Chrissy Billau:

So what do you do to get the diagnosis, the concrete answer of, "Yes, this. I have postpartum depression", versus something else going on?

Dr. Victoria Kelly:

So the OBGYN world has their own protocol, and so they'll screen at about six weeks postpartum. So if anybody's had a child, you, get a call from the OBs office or from the hospital or somewhere just to check in, and they'll do a rating scale over the phone with you about postpartum depression. However, if you look at the data about when postpartum depression happens, it's within the first four weeks. So that timing is not great. So the biggest thing really is if you notice you're off, seek help immediately. Or if there's a partner or family member, somebody that's supportive, they can reach out to the doctor if needed.

Chrissy Billau:

So my question is, how can you help someone you love who you see as struggling, who you think maybe, but you don't want to broach the topic to make matters a ton worse? How do you gently successfully help them?

Dr. Victoria Kelly:

Yeah, so one thing for anybody, if you're trying to be supportive of anybody in mental health crisis, is ask, "Are you okay?" That's just opening sentence. And the next thing is listen. Listening, I cannot stress the importance enough. Listening is huge. You cannot fix it. You cannot medicate them. You cannot tell them them what to do. You cannot fix it for them. You can listen. And again, going back to what I was saying earlier, there's such a high level of loneliness in the modern American woman these days, that just having that somebody, that's willing to listen and hear you and accept you with all the warts and all, all the imperfections to be vulnerable, that is amazing. And that is the best thing,

The first step that you can do. Outside of that, if a mom, if you see someone struggling and they say they're okay, you give that opportunity to listen, but they don't take advantage of it. And then you can just offer what you can. So you say, "I'm going to bring a meal over", or, "I would like to do this or that", and be very concrete in terms of what you're offering.

Chrissy Billau:

Yeah. Don't say, "What can I do?"

Dr. Victoria Kelly:

Exactly.

Chrissy Billau:

I'm going to do this.

Dr. Victoria Kelly:

So what I do is I work it on the flip side. If I'm working with women who have mommy guilt or difficulty accepting help from others, again, holidays that comes up too. And they're so stressed from doing it all for the meals. Well. Let somebody else help. And like, "Well, does anybody offer you?" "Oh yeah, they offer." "Do you give them anything to do?" "Oh, no." "Well, let's change that." And so again, receiving permission to receive and ask for help is huge. And also sleep. That's another huge thing that for especially new parents. So offering any help with babysitting, even overnight, taking a shift of overnight feedings or whatever. One of the biggest things for a brand new mom that you can do is help with sleep. Two nights without sleep and your brain just starts to disconnect.

Chrissy Billau:

And even when the kids get older, the practices or the games go so late, or there's homework and you're not going to go to sleep before your kid. And it's just like, "Well, we haven't eaten dinner yet. And it's what, 9:30?" So it's all a recipe for just I can't do this. I'm a failure.

Dr. Victoria Kelly:

Yeah. And again, we weren't really made to do this as humans, to function this way with this kind of schedule. So it's okay to take a pause and reevaluate and decide. Kids shouldn't be doing 10 million things every day anyway. There's actually some data that suggests that kids, no more than about two activities a week. And if you think about, it's like, "How is that even possible? How's my kid going to get to Harvard if they're only doing one thing a week or something like that?" So it's our job to be supportive as best we can.

Chrissy Billau:

The expectations, we just got to crush them and make them go away.

Dr. Victoria Kelly:

Yes.

Chrissy Billau:

So let's talk about kids and temper tantrums. For parents, how do you deal with your child's emotions without losing your own mind?

Dr. Victoria Kelly:

Or developing a drinking problem?

Chrissy Billau:

Yes, they're probably why they like ... What is it? The mommy wine time?

Dr. Victoria Kelly:

Yeah. Society has quite normalized that too. But no, I think with that, the first thing is remember kids are not adults. Sometimes we forget that their brains are not little adult brains even. So their brains are constantly in early childhood developing and going through different processes and different times. So in adolescence, with the concept of pruning, their brains and neuronal tracts are growing. And so the brain is deciding what to prune and what to strengthen. So their brains are constant flux, and it's all impacted by the environment. So child brains are not little adult brains. So coming from a perspective of empathy was one. So often we think, "Oh, well, I don't throw a fit if my socks don't match." Maybe you do. Okay, no judgment, but most adults. But that's not the kid.

So number one is recognizing that it is the feeling that they are experiencing is completely normal. Number two, their reaction may seem excessive to an adult, but to a child, it may also be normal. And number three, depending on their age. So a two-year-old throwing a tantrum, rolling on the floor screaming is normal. A seven-year-old doing it, probably not normal. And then also the gender differences, that boys do tend to have a little bit later on the behavioral control. So girls do tend to have a little earlier. So again, a six-year-old boy and a six-year-old girl throwing a tantrum will look different.

Chrissy Billau:

Why are kids so mean sometimes? And how do you as a parent not take it personally besides thinking, "This has all happened because I'm a bad mom"?

Dr. Victoria Kelly:

Exactly. Yeah, if only I could market that in a pill. So most of kids, when they're saying things, there's not really a strong filter, and they don't understand certain things. They've shown that children learn better when they experience it. So you tell a kid, "Oh, it's cold outside. Wear a coat." They'll be like, "Okay, mom. Whatever." And they don't believe it. And they go outside, it's cold. Oh, now they get a coat. Now they believe it. But that's just how a child brain works. So kids, when they're feeling all sorts of ways and thinking all sorts of things, they don't have the ability to necessarily control it or understand it. The prefrontal cortex of our brain, the front part of our brains, is responsible for decision making, executive functioning, one plus two equals three, that the actions have consequences. All complicated moral behaviors. And guess what age that you still have an adolescent brain up until what age, that's not fully developed?

Chrissy Billau:

I'm going into possibly the mid-teens.

Dr. Victoria Kelly:

Oh, later. 25. Around age 20. Yeah.

Chrissy Billau:

Yes.

Dr. Victoria Kelly:

So your child is still technically a child in their brain till about 25. So they can vote, they can join the military, they can buy guns, they can do all sorts and marry and do things.

Chrissy Billau:

But yeah, let's give them cell phones at like 10. That makes sense.

Dr. Victoria Kelly:

No, but so to the point of the meanness, much of it is unintentional. And again, coming from a point of empathy and understanding. So your job as a parent, number one, is don't react. So that's where a lot of the stuff with yelling at your kid, it doesn't work. So don't react. You as a parent need to set a good example if you can, to not lose your own crap and keep it together. Redirect, reframe, because you are teaching them how to deal with all these prickly emotions. You are trying to teach them, trying to model. And also you want to be a safe space for your child. So that when and if they ever truly need you, if they're truly struggling with something like suicidality, eating disorders, sexual violence, whatever it is, that they're going to go to you. So if you can keep yourself together and be a model of calm behaviors as when they're freaking out and having emotions, they're going to be more likely to come to you when it's really more necessary. So little kids can sure be bullies, but it's often very normal.

Chrissy Billau:

Now, we've talked a lot about self-care right now and how you're so focused on your relationships with other people. You need to have a healthy relationship just with me, myself and I right here. With me. And you say you do some of those things, but you come to the conclusion of I need to talk to someone. What's the difference between a therapist and a psychiatrist?

Dr. Victoria Kelly:

So when people need extra treatment from mental health conditions, there are all sorts of possible players for that team. So let me go through a few of them with you. So the biggest thing to understand is that with all these different types of degrees and professionals that people can get help from, like whose the right kind of person that you need help if you need medications, if you need therapy, if you need different types of therapy and that sort of thing, a psychiatrist, most people probably don't know the difference between a psychiatrist and a psychologist. But a psychiatrist is a physician, so they're a medical doctor or a doctor of osteopathy. So an MD or a DO. They're a physician, meaning we did all of our pre-med and then we did four years of medical school. And then after finishing medical school, then that's when physicians choose their specialty.

So you get pediatrics, internal medicine. Those are three-year residencies. But for psychiatry, it's a four-year residency. So we have had 12 years of training essentially by the time that we're done. And then there's other even add-on specialties like child and adolescent psychiatry. So we have a biomedical background, and so we know about all of the ways and medical conditions that can contribute and be impacted. And also the medications, along with the four years of specialty training, includes competencies for various different types of psychotherapies and the practice in different settings. So we might have inpatient, outpatient, nursing homes, hospital floors, emergency rooms, all sorts of places.

And so that's different than a psychologist who is a PhD or a SCID in clinical psychology. And so for them, that educational train is none of it is really biomedical, and it is all on the study of the mind and brain and behaviors. So it is vastly different. So the therapy part, yes, but usually, psychologists tend to do a very formalized therapy like cognitive behavioral therapy, if you're following the therapy to fidelity. And then you get other types of therapists. You can get social work therapists. So if you ever see anybody with A LSW or LISW, that's a type of therapist. Also, a licensed marriage and family therapist, so LMFT. And that means they have a master's degree, and that's a two-year degree.

You can also have a licensed professional counselor, LPC or LPCC, at again a master's degree. So the next question that if I'm referring a patient for dedicated psychotherapy, they'll be like, "Which kind do I go to?" And so if you have relatively straightforward needs, probably any of these backgrounds will be okay. If anything involving children or families, then you might want to go that way and that route. If someone needs dedicated cognitive behavioral therapy for certain conditions like OCD, bad anxiety disorders, things like that, then you might want to do a psychologist. And they can also do other things like desensitization treatments and biofeedback. And then on the prescribing side of things, so none those types of professionals can prescribe. So on the prescribing side, you get a primary care physician. So very often, they do prescribe mental health meds, whether they're antidepressants, stimulants, anti-anxiety, sleeping meds, whatever.

And they are trained to prescribe and deal with mental health conditions. So usually, you don't get referred to a psychiatrist unless you've gone through maybe one or two options of treatments and not achieved the recovery that you want. Or perhaps you have bipolar disorder or a bunch of conditions. It's a little more complicated than the primary care would refer out. So often, we see nurse practitioners, and that is a type of advanced practice nurse. So you see APRN, and then there's four different types of that. And a nurse practitioner is one type. And then a third like clarification is psychiatric mental health nurse practitioner, so PMHNP. So let's add some more letters to the alphabet soup. So if you see a nurse practitioner and their field of specialty is mental health, you will see PMHNP or CNS, certified nurse specialist.

And they've gone through the advanced doctorate degree training, often based off of prevention and epidemiology and systems issues, and they have specialty training in that. And sometimes, we'll also see physician assistance in the mental health treatments. And so for physician assistance, those are approximately three years graduate program. And they're usually housed under colleges of medicine at different institutions versus nurse practitioners, which is housed under colleges of nursing. So I don't know if you understood any of that, but-

Chrissy Billau:

Well, normally acronyms scare me anyways. But just listening to all of that and the breadth of people who can help you, it's not ... You don't necessarily have to go to a psychiatrist.

Dr. Victoria Kelly:

Oh, no.

Chrissy Billau:

Okay.

Dr. Victoria Kelly:

Yeah. So a psychiatrist is probably out of all of those the one that can merge it all together the best. So we have the expertise on the medical side and on the psychotherapy side. And again, depending on what else is going on.

Chrissy Billau:

Okay, now I'm going to end on two of the questions that we have asked every doctor on our podcast. And some of the answers are fun too. But Dr. Kelly, you are a psychiatrist. What is the most common question you get from patients, and what is your answer?

Dr. Victoria Kelly:

The most common question I get from my patients is probably something to the effect of, how can I be happy?

Chrissy Billau:

What do you tell them?

Dr. Victoria Kelly:

Good luck. No. Same! I'm laughing. But the reality is that to some extent, society has said that happiness is the goal. But what the heck is that? What does it even mean? And so a part of understanding what the answer to that is, what is it for you? And a different, perhaps healthier way to look at happiness is peace or contentment and acceptance of where you're at and being okay with it. The literal side, I will pick apart. Well, when was the last time you were happy and what was different? What would you like to see changed? Because I have to be able to do that, so I know what symptoms to target, either with medications or with therapy techniques. But a lot of times, people come to us in pain, emotional pain of some kind, and they just want it to go away. So how can I be happy? And you got to be authentic to yourself. And in order to get what you want, you have to know who you are.

Chrissy Billau:

And taking steps to become who you are can be uncomfortable for some of the people around you.

Dr. Victoria Kelly:

It's super uncomfortable for most people. Yes.

Chrissy Billau:

And get rid of those expectations. That's the biggest thing for-

Dr. Victoria Kelly:

Yeah. Recalibrate.

Chrissy Billau:

Yes. Let it go.

Dr. Victoria Kelly:

Yeah. My residents make fun of me because my resident doctors, that I'm the program director, so I'm in charge of them, every July when I get a new batch of interns, I make them do a SWAT analysis, strengths, weaknesses, opportunities, and threats. And so I make them identify what are their strengths, weaknesses, what are opportunities and threats? Because life is a marathon and if you don't know who you are, what tools you have within yourself to use to get there, you're never going to get there. And it's a marathon. We have to be able to survive. And there are certain things that we all do that will bring us down crashing and burning, like not sleeping well, doom scrolling at night to avoid chores, whatever it might be. But really it's about taking charge of your own life, taking charge of your destiny and what you want to do. And the reality is I am also understanding that I'm coming from a perspective of privilege, and I am comfortable with my profession and I can spend the time to do this or that. But the core principles can still be applied no matter what.

And I think the mental health community as a whole has amazing resources that anybody can tap into. You don't have insurance? We still got you covered. You can go to your local mental health board, they will cover you. You can get the services. You need addiction treatment? We got it. We can hook you up. You don't have money for meds? We can help you. You need support groups? National Alliance on Mental Illness, they got you. So help is out there. People just need to really take that first scary step to get it.

Chrissy Billau:

If someone listening to this podcast wants to schedule an appointment with you guys, how can they do that at your clinic?

Dr. Victoria Kelly:

Yeah, so our number is for our outpatient clinic is (419) 383-5695. And they can schedule with any of our therapists. We have several psychiatrists, and we have a wonderful resident clinic that I supervise. And then we have other great providers there too.

Thank you, Dr. Kelly for joining me today for this conversation about women's mental health. I don't know if it's just personally or just with all the talks I've had with a lot of my girlfriends, and it's just ... I think your words will help a lot of people. So thank you.

And that's all for this episode of Prescribed Listening. Tune in next time and subscribe for more on Apple Podcasts and Spotify.