An Interview With Jake Frankel
Postpartum Depression is NOT the only perinatal mood and anxiety disorder you should be on the lookout for. Mothers can also suffer from anxiety, OCD, bipolar, psychosis. This is why you might now hear the term PMAD which stands for Perinatal Mood and Anxiety Disorders.
Postpartum depression affects millions of women worldwide, yet it remains a topic that is often misunderstood and stigmatized. Through this series, we aim to shed light on the various aspects of postpartum depression, including its symptoms, causes, treatment options, and the impact it has on individuals and families. As part of this series, we had the pleasure of interviewing Dr. Melissa Dennis.
Dr. Melissa Dennis is a board-certified OB/GYN and the Chief Medical Officer for Partum Health, a direct-to-consumer company that supports families during fertility, pregnancy and postpartum to improve the standard of maternal healthcare. As the Chief Medical Officer for Partum Health, Dr. Dennis leads a team of expert specialists that help birthing individuals access the specialized, comprehensive care they need to make their pregnancies and post-partum experiences healthier and more supported.
Thank you so much for joining us in this interview series. Before we begin, our readers would love to “get to know you” a bit better. Can you tell us a little about yourself?
I am Dr. Melissa Dennis, a board-certified OB/GYN and the Chief Medical Officer for Partum Health, a direct-to-consumer company that supports families during fertility, pregnancy and postpartum with multi-disciplinary care. I spent most of my medical career in Chicago taking care of patients and learning the ins and outs of leading a large healthcare system. Now as the Chief Medical Officer for Partum Health, I aim to take that knowledge and help birthing individuals access the care they need to make their pregnancies healthier and more supported. In my off time (what off time?!), I also serve as the Medical Advisor for NBC’s Chicago Med alongside my husband and force my grown children into awkward conversations.
Ok, thank you for that. Let’s now jump to the primary focus of our interview, about postpartum depression. Let’s start with a basic definition so that all of us are on the same page. Can you please tell us what postpartum depression is?
It is important to start by differentiating between “baby blues” and postpartum depression. The “baby blues” are very common, affecting 75% of new mothers. If you are experiencing the baby blues, the onset is typically 1–2 days postpartum, and the symptoms resolve spontaneously by ten days postpartum. Common symptoms of the baby blues include irritability, crying spells, and poor sleep.
Postpartum depression (PPD) is a mood disorder that usually emerges during the first 4 postpartum weeks (although many feel this should be extended to within one year of giving birth). The criteria needed to diagnose postpartum depression are the exact same as those needed to diagnose depression outside of pregnancy, with the addition of onset within four weeks of giving birth. According to the Diagnostic and Statistical Manual (DSM-IV), the manual used to diagnose mood disorders, an episode of major depression is defined as:
At least two weeks or more of persistent
- Depressed mood OR
- Loss of interest in daily activities
PLUS, AT LEAST FOUR OF THE FOLLOWING ASSOCIATED SYMPTOMS
- Appetite disturbance
- Sleep disturbance
- Psychomotor agitation or slowing
- Fatigue
- Feelings of worthlessness or inappropriate guilt
- Poor concentration
- Suicidal ideation
It is also important to recognize that the non-birthing partner can also experience postpartum depression; everyone should be looking out for symptoms.
Can you discuss some common misconceptions about postpartum depression and why they are harmful?
In my practice, these were the most common misperceptions that we need to debunk so that mothers can get the help they need:
- Postpartum depression is self-limited and will always resolve without treatment.
- You did something “wrong” if you are experiencing postpartum depression.
- Your physician or midwife will not be able to diagnose or treat your symptoms.
- If, after shared decision-making, you choose to start a medication to manage postpartum depression, you will have to stop breastfeeding.
These are myths and I encourage mothers to work with their doctors to get all concerns and questions answered so they can develop an individualized treatment plan that meets her needs.
Can you explain the role of hormonal changes in postpartum depression, and how does this influence treatment approaches?
The causes of postpartum depression are multifactorial and are not fully understood. The extreme fluctuations of reproductive hormones (largely estrogen and progesterone) that happen immediately after birth are likely a contributing factor to postpartum depression, with some women being more sensitive to these fluctuations than others. It is known that hormones are building blocks for creating neurotransmitters, the body’s chemical messengers, in the brain. Until a novel medication is created that tackles postpartum depression at a hormonal level, standard treatment options currently are those that target the neurotransmitters in the brain such as serotonin and dopamine. These include antidepressants and anti-anxiety medications that are safe and effective during breastfeeding.
How does postpartum depression impact the bonding between a mother and her baby, and what interventions are available to address this?
Postpartum depression can negatively impact bonding, but it is good to recognize that with or without postpartum depression, bonding is not always immediate. For some, it happens instantaneously. For many, bonding evolves over time as the baby becomes more interactive and can mirror emotions. There are some babies that are in the NICU for many months due to prematurity or medical complications, and those parents and babies often have delayed bonding as well.
To help facilitate bonding, it is important to first address and treat the underlying issue — depression. Additional things that can help are skin to skin contact, feeding the baby, and making noises/cooing in response to the baby’s sounds. It is also important to recognize that a few moments away may be the safest and most effective way to grow a healthy bond long-term.
What are some of the best ways to treat postpartum depression?
If you are at risk for postpartum depression, start by engaging in preventative care with a therapist. Anyone can experience postpartum depression, but we know certain individuals are at higher risk if they have a:
- History of depression/anxiety/OCD/other mental health disorder
- History of eating disorder/SIB (self injurious behavior)
- History of suicide attempt or ideation
- History of postpartum depression or anxiety
- Family history of perinatal mood disorders
- Planned NICU admission
- Fetus with anomalies
- Single parent by choice or no choice
- History of trauma
- History of birth trauma
- History of sexual abuse
- Lack of social support
- Extremes of age of birthing individual
- History of alcohol or other substance abuse or current use
- History or current Domestic Violence
- History of perinatal loss
- History of depression when on birth control pills/ring/patch in the past
Effective treatment options for PPD are therapy and treating any underlying medical concerns or issues that are contributing to depression, such as difficulty with breastfeeding. I also recommend exercise, meditation, sunlight and medication if needed.
Based on your experience and research, can you please share “5 Things Everyone Should Know About Postpartum Depression?”
Here are 5 Things Everyone Should Know About Postpartum Depression:
1 . Perinatal mood and anxiety disorders (PMADS) are the leading cause of overall and preventable maternal mortality and you are not alone.
2 . Postpartum Depression is NOT the only perinatal mood and anxiety disorder you should be on the lookout for. Mothers can also suffer from anxiety, OCD, bipolar, psychosis. This is why you might now hear the term PMAD which stands for Perinatal Mood and Anxiety Disorders.
3 . We want to help you! If you are experiencing signs or symptoms of postpartum depression, reach out to your Obstetrician or Midwife. Don’t wait until a regularly scheduled appointment. Along those lines, please fill out any questionnaires about your mood honestly. If we don’t know, we can’t offer you the care you deserve.
4 . Prevention is possible. If you have one of the risk factors listed above, you are at a higher risk of developing a PMAD. Working with a therapist BEFORE delivery can be effective in preventing postpartum depression. I use the “house on fire” analogy. Let’s try to prevent the fire in the first place by making the safest choices when we can and being prepared. Other postpartum challenges can also contribute to the development of postpartum depression, like pain with breastfeeding or nutritional deficiencies, so set yourself up for a smoother transition by spending some extra time educating and preparing yourself and building a support system before the baby arrives!
5. You might benefit from medication to treat your postpartum depression, and that is OK. If you are breastfeeding, there are plenty of medication options that are safe. Prioritize getting better so you can be more present for yourself, your newborn and your partner (if you are going through this journey with a partner).
What are some practical strategies for supporting a partner or loved one experiencing postpartum depression?
Loved ones can help by:
- Identifying mood changes. Sometimes the person going through it is the last person to realize they are struggling.
- Encouraging them to seek professional help starting with their OB or Midwife and their therapist/Psychiatrist if they already have one.
- Rallying the troops to help (but don’t bring in individuals who add stress to this person!) Offer practical help with daily needs like:
- Laundry
- Food
- Sleep
- Childcare for other children
- Encouraging and supporting sunlight, exercise, nutritious eating, and rest.
- Being non-judgmental in discussions. Everyone’s experience is unique and fear of judgment or shame stops many mothers from seeking help.
What are some cultural or societal factors that may contribute to the prevalence and experience of postpartum depression, and how can we address these effectively?
Culture and religion play an important role in life transitions. Many cultures have different expectations of both the birthing individuals and their support people in the month after childbirth. No one cultural practice has proven to be superior, but those who are part of a culture WITHOUT some type of formal support in place do have higher rates of postpartum depression when compared to those that do have more formal support.
If you are not part of a culture where you anticipate regular support from friends and family, create your own support network leaning on family, friends, and a postpartum doula if possible. Be directive about ways in which these people can help you in the postpartum period.
In general, “bounce back” culture is detrimental to maternal mental well-being. Remember that what you see with celebrities and on social media is not real life. Give yourself grace and time.
Social and structural determinants of health such as socioeconomic status, racism, housing insecurities, and lack of social support can also contribute to postpartum depression.
I recommend mothers:
- Find an OBGYN provider you trust
- Consider working with a birth doula. There are many organizations that offer sliding scale fees or grant-funded doula care, and medicaid and insurance companies are increasingly covering doula services.
- Access care and additional help. Know your resources if you need assistance. For example:
- Pregnancy is a reason why anyone can apply for public aid. Many states are now exploring expansion for 1 year postpartum, but make sure you know your state’s policy.
- WIC Special Supplemental Nutrition Program for Women, Infants, and Children.
- Some states have postpartum home visiting programs.
- Groups that offer free lactation assistance. Google your city!
You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
The movement is underway, but on the issue of improving maternal health outcomes and supporting healthy babies and families, I believe mandatory one year paid maternity leave in the United States will have immeasurable benefits.
How can our readers further follow you online?
Instagram: @partumhealth
TikTok: partumhealth
Facebook: Partum Health
Thank you for the time you spent sharing these fantastic insights. We wish you only continued success in your great work!
Dr Melissa Dennis Of Partum Health: 5 Things Everyone Should Know About Postpartum Depression was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.