Maggie McKay (Host): Welcome to UAMS Health Talk, a podcast from University of Arkansas for Medical Sciences. I'm your host, Maggie McKay. Joining us today is Dr. Jessica Coker, psychiatrist, to discuss the Women's Mental Health Clinic at UAMS. Thank you so much for being here today to tell us more about this very important topic.

Jessica Coker, MD: Thank you. Thank you for having me.

Host: Of course. Let's talk about the importance of maternal mental health. Why does that matter?

Jessica Coker, MD: Yeah, I think it's a great topic, and one that is getting more and more attention. The reason why we think it matters so much is that we know that fifteen percent of women who deliver in the United States can suffer from postpartum depression or anxiety. Here in Arkansas at UAMS, those numbers are higher and probably closer to 20%.

So, we think around one in five women who are pregnant or postpartum will struggle with a mental health disorder during that timeframe. So, it's a significant number of people. And I think it is really important because we know that mental health impacts your ability to parent and that we want to make sure that the family is healthy.

Host: And could you talk about the service provider, ambulatory and inpatient?

Jessica Coker, MD: Yeah. So here at UAMS, we have a Women's Mental Health program that includes both ambulatory services and inpatient services. The ambulatory clinics are located here at our main campus and also within the OB clinic at the Women's Center. And we provide psychiatric care for women who are currently pregnant up to one year postpartum or are trying to conceive and want to discuss their medication options.

Here in our Women's Mental Health Program, it mostly consists of medication management and talking about medication versus therapy options. We also have the inpatient unit, which is a dedicated women's unit. It's actually only one out of four in the entire country that primarily takes care of women during pregnancy and postpartum period. And so, it's really special for women who need that extra level of care, and may be in a crisis that they need, you know, more attention, quicker changes, more thorough diagnostics. So, we have both of those services within our Women's Mental Health Program. We also provide consult service to the obstetrics department here. So, women who are actively in the hospital because of their pregnancy can also see us while they're in the hospital.

Host: And you touched on this a little bit, but could you go more in depth on the differences between psychiatry and therapy?

Jessica Coker, MD: Yeah. It's a great question. Yeah, I often get confused by it sometimes, and it takes a while for people to understand what the differences are. So, therapy is what a lot of people think about when they hear psychiatry or therapy, but that is basically talk therapy. You go in, you sit down with an individual, you talk through maybe some of your anxiety or your mood or issues that you may be having at home. And therapists can diagnose mental health disorders and use talk therapy in order to treat those. Some people will say like cognitive behavioral therapy is a technique used in therapy.

Psychiatrists are medical doctors, so we have gone to medical school. And then, we do a four-year residency to get specialized psychiatry training. And we are primarily used for diagnosing mental illness, so we are experts in that, as well as using medications for treating mental illness. So, psychiatrists can also do therapy, but it's not our main specialty. So if you are interested in medications or maybe getting a clear diagnostic picture, then a psychiatrist is a perfect choice. If you're more interested in talking with somebody and working through maybe some issues that way, a therapist or a psychologist is a better fit.

Host: And are medications "safe" during pregnancy? How do you determine that?

Jessica Coker, MD: Yeah. It's something that we talk to a lot about our patients because, of course, people are very concerned about taking medications and exposing their unborn child to medications and can be very fearful. And many years ago, women were told to not take medications because they were not safe.

We try to avoid the terminology safe versus unsafe, because it's a little misleading. We talk about medications as far as risk versus benefits. I always like to explain that all medications can carry some risk to your infant, but also having untreated illness can carry risk to your baby. And so, we have to balance, like, what is more risky—to be sick or to take the medications? And that's a conversation that you have to have on an individual basis with your provider in order to determine what the best option is for you.

We know that women who are sick or have depression or anxiety are not able to parent as much as they would like to or as well as they would like to. And we know that being well and healthy can lead to better outcomes.

Host: I don't know if they still do this, Dr. Coker, but I remember, when I was in the hospital with my son and I was going to be released, you had to fill out this questionnaire on your mental health. Like, are you depressed? Are you sleepy? Do you want to harm your child? And I'm like, "Wow." Do they still do that? And what are some ways to improve mental health both during pregnancy and postpartum?

Jessica Coker, MD: Yeah. So, it might not be the same questionnaire, but we do do similar questionnaires. Most people are using either the Patient Health Questionnaire or the Edinburgh Postnatal Depression Scale. Both of these just ask you depressive symptoms. And we do try to screen women at least once during their pregnancy at postpartum, at delivery, and then their six-week postpartum visit for depression or suicidal thoughts. So, that is still done, because we know that it's a high-risk time and that women can experience these symptoms, and we want to make sure we can get them any resources that they need. I hope women never look at it as punitive if they report those symptoms. And I think that's important to stress because we are here to help, make people feel better.

To answer your second question, the things that people can do is, of course, if you are struggling, you feel like you need help, please reach out, and get help. We have our clinic here. There's also other providers in the state. But I also always think about healthy things that we can all be doing to live a better and healthier life, like exercise, eat well, drink plenty of water, get sunshine. And I know you have to make sure that's okay with the pregnancy if you are pregnant and listening to this, for exercise. But majority of people can exercise during pregnancy, and that has shown to be really beneficial.

I also emphasize really good sleep. One thing that I think we don't do a good job of is helping women understand that sleep is very good for your mental health. And even after you have a baby, you are still supposed to be able to sleep. And often, we give women mixed messages that, like, they will never sleep again because they've had a baby, and that's just not true. You should be able to sleep. Your sleep will be broken, and it won't feel as restful because it is broken sleep. But once you have baby asleep, you should be able to go to sleep. Not being able to sleep is one of the biggest warning signs for mental health disorders. And so, I always encourage women that if you're not sleeping or you're worrying about baby all night or your thoughts are racing, those are definite signs to get help.

Host: What are some other warning signs to seek psychiatric care when you're pregnant or postpartum?

Jessica Coker, MD: Yeah. Of course, having suicidal thoughts is a big warning sign and a red flag. So if anybody is experiencing those, they should seek immediate help at a local emergency room or call 911 or call your provider.

But other warning signs is feeling very tearful, feeling really sad, and you're not sure why you feel so sad, or feeling very irritable and not feeling like you're able to interact with people in the way that you would like to. Like I said, poor sleep is one of the biggest warning signs. And you can even experience physical effects from anxiety or depression in pregnancy or postpartum, like feeling like you're really anxious and even your body feels anxious, having headaches. Those are all also warning signs. Not being able to get out of bed or not being able to do the tasks that you want to do are all big warning signs for not doing well.

We do know that, you know, for pregnancy and postpartum, the biggest high-risk time is around delivery. And so if you ever experience even more severe symptoms like hearing voices or having paranoia or maybe thoughts that you don't feel like you can control, those are really serious warning signs that also need immediate attention.

Host: I'm so glad that this conversation is out in the open these days because even like 10 years ago, there wasn't much ever said about it. You weren't warned about it. And then, people came out with books like Brooke Shields' and made it normal. So in closing, is there anything else you'd like to add that we didn't cover?

Jessica Coker, MD: Oh, that's always a great question. I think I would add that, you know, here in our program, we really focus on mothers being the bedrock of our communities and of our families, and we know that moms kind of run the households. They run communities. They do a lot of work for our state and our communities. And so, we really do want to focus on this. And I am glad it is part of the conversation, because there's a lot of help out there. You do not have to suffer in silence, and you can feel well so that you can be the type of person, mom, woman that you want to be. So, I encourage people to get help for that.

For our clinic, you do not need a referral. You can just self-call to make an appointment. The number for that is 501-526-8201, and you can ask to be scheduled. And if you are interested in inpatient care, then you can always come to our local emergency department to get those services.

Host: Well, thank you so much for sharing your expertise on this very important, as we said, topic, because it affects everybody who's having a baby. So, we really appreciate your time.

Jessica Coker, MD: Yeah. Thank you so much.

Host: Of course. Again, that's Dr. Jessica Coker. For general information and appointments, please call 501-526-8201. That's 501-526-8201. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to UAMS Health Talk.