[George] The Mind Deconstructed: Mental Health and Wellness with Dr. Kaz and George.
[Dr. Kaz] The statements of Dr. Kaz and
George are not a substitute for medical care, and our opinions are our own. If you are experiencing a mental health emergency,
please seek assistance from a professional in your area.
[George] You can contact us via twitter @MindDeconstruct. I'm your host, George, with me is Dr. Kaz.
Dr. Kaz Nelson is an American Board of Psychiatry and Neurology certified psychiatrist
licensed to practice medicine in the state of Minnesota and an assistant professor in the Department of Psychiatry at the
University of Minnesota Medical School. On
today's episode:
Mental Illness and Pregnancy.
Now, Dr. Kaz, our topic today came from our Facebook page,
where you put out a poll asking what should be the next topic.
[Dr. Kaz] Yeah, our Mind Deconstructed podcast group, which is open to anybody.
Feel free to join and you'll get notifications on Facebook for when we post things to the group site, including new
episodes, but there was a lot of interest in this topic,
"Mental Illness and Pregnancy."
This was an idea of one of the Facebook group members and other people liked it, so I'm very grateful to have this
suggested so we can talk
about it today. This tied with the topic "Alcohol Use and Misuse,"
so
we'll aim to cover that next time. [George] So for our hot topic in mental health, our researchers from Stanford University recently conducted a study
published in the American
Economic Review to determine the effect that a family member's death  may have on children/the child that they're currently carrying.
Is that what that's telling me? [Dr. Kaz] They looked at Swedish infants who were born between 1973 and 2011
whose mother had lost a close relative
during pregnancy and then followed those children through to adulthood. [George] And
what did they determine? [Dr. Kaz] Well, they found that exposure
prenatally (meaning in the uterus of the mother) exposure to a death of a maternal relative increased the rates that children would be on
medications for attention deficit hyperactivity disorder, otherwise known as ADHD or
anti-anxiety or antidepressant medications in adulthood
after following the children over years. [George] That's interesting but it doesn't really seem like something that a pregnant person can really control. [Dr. Kaz] Of course not.
The researchers made clear in their statement
that they said, "Of course you cannot prevent family members from dying and we certainly
don't want our findings to constitute yet another source of stress for expecting mothers," but
they wanted to highlight the idea that stress can
impact health of children and future adults and even in the prenatal period and
that perhaps there should be more resources and social support for pregnant women, especially those who
may
be experiencing poverty or other economic factors. [George] This was a Swedish study? The
Scandinavians try to do a pretty good job with their pregnant folk. [Dr. Kaz] They
do and they have this national database that
allows this type of long-term research over
decades, in addition to databases of conditions that are diagnosed and medications that are prescribed and so a lot of the
epidemiological data
actually comes from those Scandinavian countries. [George] So for today, talking about
pregnancy and mental health, what's different about pregnancy that it gets its own category of mental health topic? Why are we talking about it?
[Dr. Kaz] When it comes to families and reproductive health questions, they tend to
impact one's life significantly.
Family planning issues, working on conceiving issues, those really just cannot be underestimated.
Challenges to conception or even challenges related to pregnancy
can really impact people in ways that they don't necessarily even predict.
[George] So, is it just about the unknown?
You know, it's hard to get pregnant, it's stressful being pregnant. [Dr. Kaz] Or you may be pregnant unexpectedly.  Yeah, it goes both ways. [George] Unplanned
pregnancy which is still possibly another source of stress or strain, is that it? [Dr. Kaz] There's those types of
psychological or social factors. There can be financial stress as you're looking to plan for providing for a
child and caring for a
child, and then there's
also
some pretty significant biological or body-based
changes, including hormones. [George] That's what I was wondering, I mean because there's large amounts of hormones that your
body's not used to. [Dr. Kaz] That's right, and some women have minimal impact related to those hormones and others are
more vulnerable to mood or other well-being issues related to those rapid hormone changes and so it's something to be
aware of and to get some education in advance in case additional helper services are needed. [George] So what are we talking
about? What sort of mental health concerns pop up for the pregnant population? [Dr. Kaz] One of the most common issues men and women face
actually, after the birth of a child is something that we would commonly call the "baby blues" and that's almost
universal change in mood or increase in anxiety that has to do with this impact of having a new
baby. They're not the easiest to care for. The lack of sleep that comes with feeding an infant every few
hours.
[George] Is baby blues different than
postpartum
depression? [Dr. Kaz] Yeah, I think there's an important distinction to make there and I hope that that's one of the things that people can
understand after this, is that "baby blues" is almost universal and it represents a challenge, but
people can also have a greater degree of
depression or anxiety
where it actually leads to a lot of dysfunction or problems, and that might be more in the realm of major depression or a
major anxiety
disorder that can come along in this vulnerable period of time. [George] So what do you recommend for "baby blues?" I mean, you said it's almost
universal, so almost everyone's going through that, which is interesting to me because there's a lot of stress involved with having a baby, but
also it's, you know,
supposed to be this joyous time. You've got your new
bundle of joy and all those great things. [Dr. Kaz] Yeah I think there's this perception that it's a
joyful time and
those who have been through it
also know that it's not that easy and can be a real challenge.
Of course, in many instances it's wonderful to bring a
new
family member into the into the household, but I think sometimes people will actually feel shame if they're feeling tired or,
'Gosh should we have really done this? I'm not sure if I can do it,' and if you have
this conception that it's supposed to be blissful or joyful all the time and then you end up feeling crappy, that can lead to even more shame
which can worsen well-being kinds of issues. [George] You don't have to hide the hard parts. You can live your life with your new
baby and it can be hard and you can be okay that it's not all great and that you know
there are times where that's going to affect you negatively. [Dr. Kaz] Yeah, knowledge that people universally find this challenging, taking care of yourself,
relying on your support network if you have one,
relying on
medical services or mental health services or community-based services to support the period of time following pregnancy. Those are all
possible things people can
do to ensure that they're getting support through what's a challenging time. [George] Are hormone still a part of the "baby
blues?" [Dr. Kaz] Yeah, I think you can't really separate the hormones because at the time of birth there's yet another
influx of all sorts of different hormones that go along with lactation
and the post-birth period and so you can't really separate the hormones out of the picture,
but people have varying degree of challenges related to those hormonal changes. [George] Okay, looking at the bigger issues,
what would you say are some of the... some of the more serious
mental health concerns that women could be facing?
[Dr. Kaz] So like I mentioned, very common is the "baby blues" and then still very common, major depression or serious anxiety,
and that's similar to topics we've discussed in other
podcasts, but in that after the birth of the baby period and
associated with really significant non well-being: lack of interest, lack of self-care,
tearfulness,
sadness, even sometimes suicide thoughts, and so those are really important to identify if they're there, it can
be high risk. [George] Is postpartum depression a separate
diagnosis than major depression? [Dr. Kaz] The criteria are very similar but
we like to identify it separately if it is that postpartum period because
we want to take that into the understanding of what's going on. [George] Is it in some way more treatable or anything like
that? [Dr. Kaz] I would say that there are some different treatment challenges, but I wouldn't say that it's more or less treatable. [George] Okay,
so what what else besides depression, because I know that that's probably
not the only thing facing women out there. [Dr. Kaz] This is much less common, but every now and then
women will develop new onset of very serious
psychiatric or mental
illness. Things like new onset bipolar
disorder, where they have states of mania which can be higher risk or
actually even develop postpartum psychosis
which we just talked about on episode 14 of the podcast,
where people actually lose touch with reality, maybe have
some hallucinations or some delusions, and that is very scary when that happens. [George] If anyone's heard that episode, there's a
whole range of ways that psychosis can manifest. [Dr. Kaz] Yeah, there's pretty substantial loss of touch with reality,
and it can really influence people's behavior and thinking and in the
handful of really terrible outcomes related to
post-birth psychosis, there could even be a risk of death, you know in the infant if those psychotic thoughts are really
influencing that person's behavior in a way that's completely distorted, and so there'll be some
screening typically for new mothers to ensure that there's not postpartum psychosis.
[George] And by death, you mean the possibility that the mother will in some way harm the child based on the
psychosis that she's going through. [Dr. Kaz] It's very rare, but that has happened and of course
we would never ever want that to happen, and of course
the mother themselves doesn't want this to happen when they're in their right mind, but there can
be these very serious postpartum psychosis conditions that you sometimes hear about on the news or the
media that are always heartbreaking when you see them, and that's the last possible thing we would want happen.
[George] So depression, "baby blues,"
psychosis, bipolar-which maybe we'll talk more about it in a coming episode. I think we're gonna do more bipolar stuff. Anything else?
[Dr. Kaz] Yes, I think the main take-home point that I would love to share that might be new
information for people is to talk a little bit about a condition called postpartum
obsessive-compulsive disorder or postpartum
OCD.
[George] Okay, so we haven't talked about OCD
much. We did a little bit actually in Habits, Compulsions so
there's that episode, but how does postpartum OCD manifest? [Dr. Kaz] With OCD, somebody has
intrusive thoughts,
or even pictures in their mind that cause them to do a behavior
to reduce distress associated with that. So in classic OCD, somebody might
worry that their hands are contaminated
by
germs (whether they are or aren't) and then might wash their hands over and over again to sort of manage that fear and
this type of
syndrome
arising, after the birth of a baby, is very, very common.
Maybe even as common as in 50% of moms and then, interestingly,
dads can develop this in the postpartum period too. [George] Hmm, so what does it look like then like
what are they doing that this happens like, when there's a new baby around? [Dr. Kaz] Right [George] Are they doing things with the baby like
changing the baby's diaper a hundred times a day? [Dr. Kaz] Um, typically not. More often they will have a
fear of the baby's health, or a fear about the baby's safety. Sometimes (and this
is kind of cruel when this happens) but they'll sometimes be a mental image of doing something with the baby
that is horrifying. [George] Oh. [Dr. Kaz] Right, like
they might walk past a stairway or something and have an intrusive image of throwing the baby
down the stairs,
for example. [George] Wow. [Dr. Kaz] And I know that's an upsetting thought just to talk about in the podcast, so I'm sorry if anybody
was upset with that, but imagine being a mother and having that image jump into your head. You feel like a monster. [George] Yeah. [Dr. Kaz] And
some women even think maybe I'm going
psychotic or maybe I'm gonna hurt my
baby even though I don't want to (or something like that) and
it's very hard, of course, for people to talk to their doctor about that, or talk to their loved ones
about that because of the shame associated with verbalizing that. [George] Yeah, I don't know
what sort of screening would kind of get that out of someone. [Dr. Kaz] Right. [George] The doctors not really gonna ask
you if you're having thoughts about harming your baby
or that would be tricky. [Dr. Kaz] Right, so this is one of those not often talked about things that needs to be talked
about and normalized more often because of how common it is and because of how
upsetting it is. What's going on is you have someone
who maybe tends to be anxious or tends to be conscientious or wants to be the best parent ever and
their brain actually puts that image in their brain to say, "Well that would be a terrible thing if you
did that, so don't do it."
So it's not reflective of an urge to do that, it's reflective of your body saying, "Oh,
don't do that, you wouldn't want that. [George] This isn't really like the hand the repeated hand washing OCD, this is something else.
[Dr. Kaz] Well, people can then sometimes go and can
do more elaborate things to reduce the likelihood of that happening again. So they might
not go past that stairway anymore, or they might lock away the knives in the kitchen or something like that,
thinking that there's some kind of safety issue. Or, even worse they might hold the baby less or cuddle the baby
less or feel like they should have someone else watching the
child/caring for the child, because they're not suited to do that.
[George] Yeah, they're protecting the baby in some way. [Dr. Kaz] Right, and that's the ultimate harm that comes from this condition. There's zero
safety risk to the infant in these kinds of circumstances, other than the problems that go
along with avoiding the baby if you're worried about it. [George] Well that seems tricky though, because how do you determine that it's not psychosis
where there's a high risk? [Dr. Kaz] Right [George] Or higher risk versus OCD where there's no risk or a
little risk [Dr. Kaz interjects] Of actually harming the baby [George] Right. [Dr. Kaz] Actively. So that's what health care providers need
to be trained in is differentiating those things because obviously you want to identify those high risk situations, but
you don't want to assume that every person who's had an intrusive thought like
that is now psychotic because that's just not the case, and so we, as mental health professionals, are trained in
differentiating an obsessive, intrusive thought versus a psychotic thought or behavior and
it's important for us to do that
well, because the consequences of making a mistake in either direction are high. [George] When should someone out there
actively seek out the help of a doctor? [Dr. Kaz] That's a great question, because knowing that "baby
blues" are so normal and intrusive thoughts are so normal, where is that line? And I would get the same answer
basically that I give when we talk about
mental health issues in general is that when you actually feel like you're functioning on a day to day
basis is being hampered
by these symptoms, then there is no shame in reaching out and asking for help and doing some problem-solving
around this. [George] So, then, when someone does reach out for help, what are the treatments or what are you, what are you
gonna be able to do for them? Especially they're still pregnant, can
they take all the medications that may be out there? [Dr. Kaz] That's a great question,
because I've been talking a lot here about after the baby's birth but there's
also mental health concerns that come up during pregnancy and things that happen to people during pregnancy, so it's an
issue that has to take into account the wishes and the feelings of
the person receiving the care, and so what we do is take things on a case-by-case basis. Understand what are the risks of
taking medications to treat this versus other therapies. What are the risks of not doing that, because there's
also a risk to the child having untreated mental health issues before and after birth in the mother and so
we weigh all of these risks very carefully to the extent that we are able to (based on the information
we have) and make an individual decision in each case that's going to be tailored to the needs of that person. [George] It does seem tricky, because if someone has
major
depression and they go off their meds for their, for the sake of their pregnancy, and the symptoms and everything and then
the birth that that seems like it would be hard to walk back if they have gone down
this hole of major depression or whatever they may be suffering even psychosis if they stop taking their antipsychotic
meds. [Dr. Kaz] Right. There's absolutely risk to that to. So oftentimes,
women or families feel like they are in between a rock and a hard place with these kinds of issues. That's why 
 working closely with
mental health treatment provider to really understand the issues very closely and make some shared decisions together is the most appropriate
way to go about it, because this is a complicated topic. In some cases, we're also missing information on
weighing risks and benefits of any treatment,  because it's very hard to study
pregnant women when it comes to medications or other
treatments for mental health disorders. [George] Yeah, you don't to play around with
someone's pregnancy too much. [Dr. Kaz] That's right. It's high stakes, and so we're going on
limited data, but all medications are evaluated for whether they
cause birth defects or those kinds of things so most of the information we have
is related to those kinds of issues, but short of that, we don't always have the information that
we need to make any guarantees and so that's why we work together on these things to understand the information that
we do have access to. [George] It sounds like the takeaway of this episode and the identification
(even the treatment) is just to make sure you (you know) have good conversations with
your doctor (you know) disclose anything that you're feeling
and be open and discuss and hopefully figure it out as a team. [Dr. Kaz] That's right. There's
rarely right or clear answers when it comes to this and everybody just wants the best possible outcome
and that's possible with good collaboration. [George] Okay, great.
[Dr. Kaz] Many of our podcast listeners are in the state of Minnesota, so I wanted to make a
plug for a local resource here, a group called Pregnancy and Postpartum Support Minnesota or
PSI Minnesota. This is a group of professionals and organization
volunteers who offer mental health support and resources to Minnesota parents and I'm familiar with this
group and know that they are able to tailor services to meet the needs of
individuals and so I wanted to give a shout out for that and those of you who
may be in other parts of the country or the world should take steps to see if they're services in your
area that might be of benefit. [George] That sounds like a great resource. [Dr. Kaz] The bottom line is that if you know
somebody who's struggling with reproductive or pregnancy-related issues, or that's something you're experiencing yourself, or
even for partners or family members
who are facing challenges related to reproductive issues, or childbirth in the family, there is help and
people are
waiting to partner with you in healthy outcomes. [George] It's all about the healthy outcomes. [Dr. Kaz] That's right.
[Music]
[George] Thank you for joining us today. This podcast was produced by Kaz and George. Music by Paul [Dr. Kaz] He's the best!
[George] Contact us and send us your questions on Twitter @MindDeconstruct.
[Music]
