Perinatal Mood and Anxiety Disorders Trainings

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Earlier this year I was awarded The Polinger Family Foundation Grant through Mary's Center for Maternal and Child Care. As some of you may know, for the past 2 years, I've been working with Mary's Center in their "Train the Trainer" Program, which is designed to build capacity in the DC/MD/ VA community for training specialists in perinatal mental health. I've been invited to do several perinatal mental health trainings with different clinician groups in our community including the Children's National Medical Center Neonatal ICU Fellows in April 20017, and the Council on Patient Safety in Women’s Health Care / American College of
OBGYN Safety Action Series in May 2017. In February 2018, I was awarded the Polinger Foundation grant to further support this mission. I designed project as  a pilot initiative to assess the feasibility of services, and to understand the needs of the community. 

So far this year I've trained nurses at Pathways to Housing, and case managers at McClendon Center. Both Pathways to Housing and McClendon Center are community mental health clinics in DC which  serve a low resource population suffering from severe and persistent mental illness. 

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In April, I held my first patient education session on this topic at our GWU Five Trimesters Clinic. In organizing and planning these sessions, I worked closely with the GWU OBGYN and Mid-Wifery departments. This was a big perk; the way healthcare is structured can have it feel like we are operating in isolation. There is a significant interest in both the patient and the clinician population for more knowledge about PMADS - especially quality, accessible information about medications in pregnancy.

The women in the group felt they could utilize the information and that it changed how they prepared themselves for the post partum period.  Evaluations have been positive - with both groups reporting that they feel more confident in talking with patients/providers about PMADS, and feeling that the training will change some aspect of their behavior going forward. 

 

Me speaking at the American College of Nurse Midwives DC Affiliate Conference on Women's Health and Wellness in April 2018

Me speaking at the American College of Nurse Midwives DC Affiliate Conference on Women's Health and Wellness in April 2018

This pilot project goes through October 2018. I have a couple more trainings in the works over the next few months! Through this work I've gotten a more clear picture of how to tailor the training for clinicians versus patients. I was surprised by how well received the patient education group was - there seems to be a desire for something like this to occur regularly. The women who came to the group were certainly looking for facts and data, and implicitly there was an underlying desire for connection and to process some of the fear and uncertainty around pregnancy and post-partum. I'm hoping to continue doing this type of work going forward. 

 

PL

 

What A Psychiatrist Wants You to Know about Depression and Anxiety in Pregnancy and the Postpartum Period

(This article was originally published on Dr. Emma Basch's  PsychCentral.com blog Maternity Matters.)

1) Post-partum depression and anxiety are common.

Almost 1 in 5 women will experience a mood or an anxiety disorder during pregnancy or in the post-partum period. From a mental health standpoint, it’s the most vulnerable time in a woman’s life. So, if it happens to you, remember that it’s not your fault and there are many other women who have survived and recovered from this illness.

2) Not everyone with post-partum depression feels sad.

Depression and anxiety can take many different forms. In my clinical practice as a psychiatrist specializing in women’s mental health and perinatal psychiatry, I commonly see anger and rage that seemingly comes out of nowhere. Emotional lability, or rapid and exaggerated changes in mood, can be an outward manifestation of depression or anxiety. Everyone experiences depression in a different way. For some women, it can look like not being able to get out of bed and isolating themselves from family or friends. For other women, it can be quite the opposite – going on overdrive to get everything done and becoming irritable and upset with partners and children in the process.

3) It’s common to have scary thoughts.

These most often come up in the form of “what if,” as in “What if I did this terrible thing?” or “What if this terrible thing happened to my baby?” You may picture scary images of an accident happening to your baby, or, you may fear being the one to cause the accident. I see this from women all the time. These thoughts are typically driven by anxiety. Having these intrusive anxious thoughts is very different from wanting to act on them.

4) Taking Medication is OK.

 There is no one-size-fits-all treatment. In the case of perinatal depression and anxiety, we must balance the risks of untreated depression and anxiety during pregnancy and post-partum with the risks that come with exposing the baby to medication in pregnancy or during breastfeeding. This equation is going to be very different for each woman, as we take into consideration the severity of your symptoms, your level of functioning, and the risk profile of the medication in question. As a perinatal psychiatrist, my job is to help guide you in making this very important decision. Social support, moms’ groups, psychotherapy and other healing modalities like acupuncture are also important parts of the recovery process. It’s important to remember that healing from perinatal mood and anxiety disorders often takes a program of several different treatment modalities, and in some cases, medications can be one part of that program.

5) Medications do work, and it takes time.

It can take antidepressants anywhere from two to six weeks to start working, with most people seeing some effects by four weeks. And, it can take up to three months to see the full therapeutic benefits of these medications. That period of waiting is usually the hardest time for my patients. Sometimes you get side effects even before the medication starts working. In some cases, the side effects are severe enough that we need to switch to a different medicine. In other cases, the side effects fade within a few days, and we can keep going. It’s frustrating that we don’t have something that works instantaneously for post-partum depression and anxiety. There is a great deal of research going into just that question, but those treatments are still a ways off.

6) Medications won’t change who you are.

Many of my patients tell me they are worried that taking medication for depression or anxiety will change their personality. It’s true these medicines do re-wire the brain. What I commonly find is that people say medication helps them be more of who they are — or who they want to be — as opposed to changing them into someone different. I know my patients are getting better when they tell me, “I feel like myself again!”

7) Treatment is an ongoing process and it should change over time.

My patients are often worried that if they take antidepressants now, they will be stuck on them for the rest of their life. This is not the case. Treatment should be a collaborative effort between you and your doctor, with guideposts along the way. Some good questions to discuss with your psychiatrist include: How do you measure your anxiety? What is your limit to when you might consider medication? Are there people in your life who know you well, and can serve as mirrors to help you see where you are on your own map? How will you know when you are better? If you are someone with a history of anxiety or depression, and you were previously taking antidepressants, stopping your medication cold turkey puts you at higher risk for developing a perinatal mood or anxiety disorder. These decisions should be made under the care of your doctor. If, together, you make the decision to taper your medication, consider adding in additional sources of support like psychotherapy or a moms’ group.

8) We’re on the same team.

There’s a lot of stigma out there about depression and anxiety during pregnancy and post-partum — and about taking medications as treatment. It seems everyone has an opinion. Plus, if you’re a mom who is on the fence, the internet can be a dangerous place. Find a psychiatrist who you trust and who works collaboratively with you. Ask questions and take notes. If you’d like more information about psychiatric treatment during pregnancy and post-partum, please visit www.womensmentalhealth.org.

The contents of this article are for informational and educational purposes only. Nothing found here is intended to be a substitute for professional medical, psychiatric or psychological advice, diagnosis or treatment. Always seek the advice of your physician or other qualified mental health professional with any questions you may have regarding a medical condition or mental disorder.

This article was originally published on Dr. Emma Basch's  PsychCentral.com blog Maternity Matters. Emma is a friend, colleague and talented psychologist specializing in perinatal mental health here in DC. You can check it out over at Psych Central here: What A Psychiatrist Wants You to Know about Depression and Anxiety in Pregnancy and the Postpartum Period: A Guest Post by Dr. Pooja Lakshmin