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Introduction: This is The Healthier You Podcast from UPMC Pinnacle.

Prakash Chandran: When we think about having a baby, many people think of all the love and joy they bring into our lives, but if we're being honest, the babies can also bring a lot of emotional stress too. Today we will be talking about perinatal mood disorders and the range of emotions in new and expectant mothers might feel before and after. Their pregnancy. Here with us to discuss is Dr. Nazanin Silver, Gynecologic Psychiatrist of Women's Behavioral Health at UPMC Pinnacle. Dr. Silver, it's a pleasure to have you here today. So many of us have heard of postpartum depression before, but this is actually the first time I'm hearing the term perinatal mood disorder. So can you start by telling us what that is?

Dr. Silver: Sure, just a quick little background about myself and what a gynecologic psychiatrist is, I am double boarded in Obstetrics and Gynecology and Uro Gynecology. I've retrained in psychiatry. This covered essentially the reproductive health cycle of a woman and mood disorders. Specifically perinatal mood disorders are disorders that start from the point of conception, so from the moment you conceive to up to one year after birth. And they include things like depression and bipolar disorder. And that can vary in range from major depressive disorder, baby postpartum blues, to bipolar disorders, also include elevations of moods.

Host: I see. So you mentioned two of the most common things that we see. What are kind of the most common signs that you see when this disorder is manifesting itself? It sounds like that postpartum depression is just are part of the perinatal mood disorders, but can you talk about maybe specifically some of the more common things that you're seeing?

Dr. Silver: Sure, absolutely. That's correct. Post partum Depression is a segment, is a part of the perinatal mood disorder. Some of the symptoms when you are depressed are as follows, lack of interest in activities you used to find fun. Just feeling down. Feeling irritable, agitated. Crying a lot. Something called, anhedonia, lack of energy. In addition it can effect your sleep. So you either sleep too much, or sleep too little. It can affect your appetite, you either eat too much, or not eat enough. And just an overall lack of interest in life, lack of motivation. Those are some of the more common signs. Some of the more serious signs can lead into things like sycosis, so imagining things, having thoughts that are not true. Thinking they are true and suicidal ideations, so self harm [inaudible 03:05]. And these can be really scary thoughts for women and their families, but they're actually a real problems that exist. As you've mentioned, having a baby is something wonderful, but the reality of it is it is a huge adjustment. So, Physically, hormonally, and emotionally is on everyone involved. Especially the mother.

Host: Yeah. Just related to that you know, I imagine for a lot of women it's pretty tough to admit that they're having a hard time with these emotions because it is supposed to be such a happy time and a joyous occasion. Do you find this to be the case?

Dr. Silver: Absolutely. And I think that that's the unfortunate stigma about mental health out there, you know, after you have a baby you're supposed to be so happy and elated. Well, having a baby is a big deal. It's a big deal on the physical body of a woman, on the emotional health of a woman. You know, you're going from all these physical changes to suddenly caring for another human being, not sleeping, being worried, being tired not being able to care for yourself because you've got to care for this other human being and all these emotional things going on within your body that you may think, why am I not happy? This is a blessing. It is a blessing. But there's also a lot of other things going on. Being a mom is not an easy job.

Host: It certainly is not. And like you said, it's something that manifests itself right at conception. And it can last after the pregnancy. Is that correct?

Dr. Silver: Yeah, correct. You know, we hear a lot about post partum depression, truthfully it can start from conception all the way one year out. Post partum, most people think is just a few months after delivery. That's actually incorrect. It can last all the way to one year ago.

Host: Wow. So it can actually affect you for some time and it's, it's really good to know. And hearing it, you speak about it today that this is very normal. Do you happen to have any percentages or statistics about how many women this affects?

Dr. Silver: Yes, absolutely. So in general from the post partum perspective it can affect anywhere from five to 20% of woman. That's the partum depression part, Post partum blues, which usually lasts from about, from postpartum day two to day four, and resolve within two weeks. That can affect up to 85% of new moms, so it's not a small number. Furthermore, you know, up to 70% of women, report cases of depression during being pregnant. So, you know, these are real numbers, real stats. And something that we deal with on a regular basis. I'd had mentioned psychosis before. You know, which means essentially, hallucinations, disturbed sleep, thought disorganization, confusion, agitation, that can affect only about 0.1 to 2% of all women, however, it is a psychiatric emergency and need it is associated with an increased risk of suicide, infant neglect, and harming the baby. So those are important things in mind. In addition, one of the strongest risk factors for depression during pregnancy is the history of depression, so if you or someone you know, had a history of depression and is pregnant and, or has delivered, there risk of being depressed again is much higher than somebody who's not had that risk. You know, talking about if they're on medication, if they decide because they're pregnant discontinuing medication, it increases the risk of relapse by 68%. So we're talking about big numbers.

Host: Wow. Those are definitely big numbers. I actually can't believe that the numbers are that high, but I think it's also potentially reassuring to the people listening that they are not alone if this is something that they are experiencing. So you mentioned if there was a previous history of depression and of taking medication that, you know, you're more prone to having some of these disorders. Is there anything else that maybe might predispose a patient to having some of these things besides what you mentioned?

Dr. Silver: Absolutely. Poor social support. If they've had multiple children, if the pregnancies unintended, social life relations, history of trauma. You know, if a woman is younger, when you're younger, you don't have the same maturity level as somebody who's older and more variance. So that can certainly increase your risks, domestic violence, and also birth complications. Those can all be risk factors that are associated with it. Rapid changes in [inaudible] progesterone which is a hormone associated with post partum depression can also affect it and a thyroid dysfunction can also affect [inaudible 08:03]. Women are not alone. That's the one thing I want to really stress. You're not alone. You're not the only one. Women have been suffering in silence for years, for decades, hundreds of years. And so what we're trying to do is really educate the public about this so that they can seek help because it is something that is not uncommon. And something that is treatable and you don't have to suffer in silence.

Host: Yeah. That's why I'm so glad that we're talking about this today. So let's, let's talk about getting help. So if someone listening to this is struggling with some of these symptoms, what do you recommend that they do for themselves?

Dr. Silver: So if they're struggling with these symptoms, I recommend that they seek help. You know, one of the most important things is to see a psychiatrist. A behavioral health specialist and unfortunately stigma that goes behind seeing a psychiatrist in our society, which is really saddening. But you know, seek help, seek help, just pick up the phone, you know, find out if there's a psychiatrist that deals with these kinds of conditions nearby. And I'm sure most psychiatrists do, and there are psychiatrists like myself that specialize purely in mental health related to from mentees all the way to menopause, including pregnancy and infertility that can really help you and diagnosis these conditions, and help you family and your child without a healthy mother, there is no healthy baby.

Host: Yes, absolutely. And so if someone wants to get help, you're saying just pick up the phone and look for a psychiatrist. But one that specifically specializes in women's behavioral health. Right. And that's kind of what you do at UPMC Pinnacle. Can you talk about some of the benefits that you offer if someone called you and were to visit with you?

Dr. Silver: Absolutely. Most psychiatrists are trained to deal with this, although a lot of psychiatrists feel uncomfortable woman is pregnant however in our practice, both my husband and I, David Silver and myself, we are, as I mentioned [inaudible] OB GYNs and have a number of years in practice. We've been trained in psychiatry related to women's behavioral health. And what we specialize in is exactly what we've been discussing. So from mentee. So if you have 14 year old girl who's having mood disorders and it's going through puberty, that's right up our alley. To pregnancy and post partum mood disorders [inaudible 10:44]. The pregnancy law and having new disorders with that to menopause and Post-Menopausal perceived cognitive decline. So thinking that you know, you're cognitive function is going down and during your menopausal years to, you know, cancer and dealing with cancer and mood disorders related to that. And fertility preservation related to cancer. Specifically for what we're talking about right now. Perinatal mood disorders, that's exactly what we deal with. We are trained in that and we have retrained in psychiatry so that we have both the medical and the physical aspects, and we can help you, you can call, make an appointment with Women's Behavioral health Center at UPMC Pinnacle. And we generally make an effort to see patients within two weeks of their phone, come in for an assessment, give us a call and come in for an evaluation and we can discuss things from there. We have Therapists in our practice that will doing purely therapy. We will be doing therapy as well. And medication management just come in for an assessment. Everything is confidential and will stay within our practice. So privacy is very much respected.

Host: You know, I love that. And I think the most important takeaway from this conversation is that you are not alone and it doesn't hurt to pick up the phone just to get assessed because those emotions that you're feeling are real. And the stats that you mentioned of affecting over 70% of women are staggering. And it just tells us that it's normal and help us out there. So thank you so much for educating us today. For more information on women's behavioral health issues, please visit upmcpinnacle.com, that's upmcpinnacle.com. My guest today has been Dr. Nazanin Silver. I'm Prakash Chandran and thank you so much for listening.