Dr. Pari Ghodsi did a Facebook Live interview with us about postpartum depression (PPD). Board certified and an active fellow of the American College of Obstetrics and Gynecology, Dr. Pari currently practices in Los Angeles. It was such an informative interview (thanks to great questions from Sydney Giannell and our BraveMoms) that we just had to share it here (lightly edited for readability). For more information on postpartum depression, check out The Many Faces of PPD.
Sydney Giannell: This topic is definitely important for all moms and their loved ones, and it’s especially important and personal for me since I was diagnosed with postpartum depression after my daughter, my second, was born. Before we get started, though, I want to remind our BraveMoms that our talk today is just for informational and educational purposes and should not be considered official medical advice. Please consult with your health care team if you have concerns about your physical or mental well-being. Here we go. One of the most frequent questions we see is how to recognize postpartum depression. Dr. Pari, can you give us a quick definition of PPD?
Dr. Pari Ghodsi: Postpartum depression is where you're going to feel intense feelings of sadness or what we call apathy, where you don't feel like doing anything, and a lot of times this is going to interfere with your daily activities. That's when you know it's postpartum depression. But it's also defined as the amount of time that you're experiencing it. It's normal for moms to start feeling a little bit sad, anxious, and tearful a few days after they have a baby. That's normal, and we categorize that more as postpartum blues, and that can last for a few weeks. But postpartum depression is really if you start having those kind of intense feelings after about two weeks of delivering. If you start experiencing that in the first year, it’s really postpartum depression.
Sydney: I think I was about four months postpartum when I was diagnosed with postpartum depression.
Dr. Pari: A lot of people don't realize that. They think, “Oh, well, I had my baby six months ago; it can't be that.” But actually, if it's in that first year, and you're feeling those feelings, and it's lasting several weeks, and you feel like you can't manage, it's still categorized as postpartum depression.
Sydney: So you have already touched on it, but for postpartum depression and baby blues, are they related? How are they different?
Dr. Pari: So they're not necessarily related. Postpartum blues is something that's much more common. And again that's something that's going to go away on its own. It just takes some time. It's more like an adjustment phase, whereas the postpartum depression isn't going to necessarily go away just within a few weeks. It's something that's going to last longer, and it's also the intensity; it's going to really interfere with your life.
Sydney: Is anyone at higher risk for postpartum depression, and who might that be?
Dr. Pari: People who are at higher risk for postpartum depression are people who have experienced depression at other times in their life. That already predisposes you, so it's important to let your OBGYN know very early on. Even if you were depressed as a teenager, and it's 20 years later, you still are going to be at higher risk for postpartum depression than a person who has never experienced depression. So that's one thing. Also, any sort of mental illness that runs in the family is going to predispose you for postpartum depression just as it predisposes you for regular depression. So that's something to know. And then also if you have had some other kind of trauma – if you have a death in the family, a divorce, you lost your job around the same time that you're in that first stage of being a mom – that can predispose you. And also that goes along with social support. Unfortunately, women who don't have the same social support as some others and feel more isolated, they're at a higher risk as well.
Sydney: Are there any steps that we can take before delivery, while we're in pregnancy, to help avoid postpartum depression or lessen the effects of it?
Dr. Pari: A lot of it, unfortunately, is going to be chemical, and some people are just going to get it. And nothing they can do can really help that. With that said, again if you've had a history of depression, it's important to tell your doctor as soon as the pregnancy starts. Sometimes your doctor will even suggest you going on an antidepressant right when you deliver to prevent against that if it's something that's been prevalent in your history. So always talking about your history, being upfront with your doctor about that. Also if you start experiencing feelings of sadness or depression within your pregnancy or towards the end, always speak up. That can help prepare you. If you're feeling isolated, try to reach out, try to build yourself some sort of support system for when the baby comes.
Sydney: I'm all about finding your tribe and village to help support you. If someone thinks that she might be experiencing postpartum depression, what should she do?
Dr. Pari: The first thing to do is reach out to your OBGYN. I think sometimes since it's four months or six months or even eight months after you've had your baby, you're like, “Oh that's not my doctor anymore. I already had my baby. I had my postpartum visit. She cleared me. I feel maybe awkward or unsure if I should pick up the phone.” And I just encourage everybody to do so. A lot of times, if you've had a baby, your OBGYN might be the first doctor that you can get into. And that's really the important thing here; if you're feeling those feelings and symptoms, don't delay. Try to get in to see a doctor as soon as you can, whether that is your OB or your family practitioner. If you're ever in a situation in which you feel that you want to hurt yourself, you want to hurt others, you want to hurt your baby, you're hallucinating either visually or auditorily, then you need to go to an emergency room.
Sydney: Good to know. I ended up having some other mental health things bearing down on me, and then I finally made the call to a bunch of counselors my insurance covered, psychologists. And only one ever called me back, which I can't believe. Only one of them did. She diagnosed me with multiple things: postpartum depression, anxiety, OCD, which apparently I was diagnosed with as a child and didn't find out about until I was an adult. And then also PTSD from my labor and delivery, which was really interesting. So I think all of those things, like you were saying earlier, massively predisposed me for postpartum depression.
Dr. Pari: And the other thing that you're again bringing up, which is a good point, is that sometimes it's hard to get in as a new patient somewhere. So that's why I'm saying if you're feeling those feelings, just call your OBGYN, even if it's been six months or seven months; that might get you in faster than trying to get in to see a new psychologist or new psychiatrist. A lot of times, to be a new patient, it can take some time.
Sydney: I had no idea that I could call my OB. I was like, you go to a counselor or a therapist, and so that's all I knew to do. I also put it off because I thought I didn't have it. I was like, they're going to think of me as a bad mom if I say I have these feelings. Or they're going to want to take my kids away because I say I have these feelings. Or we knew we wanted to adopt one day, but we were afraid they wouldn’t let us adopt, which my therapist totally signed off on. We're adopting. The finalization happens in two months.
Dr. Pari: Oh congratulations!
Sydney: I just want to say to moms, don't let that scare you.
Dr. Pari: Well, that's why the awareness is so important – for us to talk about these issues so that people realize what is normal, what is not normal. And when you start recognizing what is not normal, then it takes the blame and the shame off of yourself and this idea of, “Oh it's me. I'm a bad mom. I'm not trying hard enough. I'm not cut out for this.” When you start recognizing that, no, this is a disease, and it's something we need to talk about, and people need to become aware and talk to their doctors, then collectively we can do a better job of educating and recognizing it.
Sydney: Do you have any advice for loved ones who may be worried about a new mom who’s not herself?
Dr. Pari: I've definitely, in practice, had loved ones call me, spouses call me, relatives call me, and I don't think that that's a bad idea at all. If you are concerned, of course talk to somebody. Talk to the person directly. Let's say you're my partner, and I feel like you might have postpartum depression, of course I think it's best to talk to you about what you might be experiencing. I actually had a partner call me once and say, "Oh I think my wife has postpartum depression," and then when I spoke to the wife, she was like, "No, he's just an A-hole who's been cheating on me." So I was like, okay, well that's interesting. So directly talk to the person. But I don't think there's anything wrong with reaching out to a health care provider yourself if you're concerned about another person.
Sydney: We also tend to get a lot of questions about medications and breastfeeding. We talk about breastfeeding a lot at Kindred Bravely. So lots of moms want to know if they can nurse while taking antidepressants or if their milk supply will be affected. What information do you have about that?
Dr. Pari: Unfortunately, no medication is perfect. There are risks with everything, and the antidepressants that are used for postpartum depression can be transmitted through the breast milk. With that said, it's very, very, very low. So it depends on the type of medication. Of course, there's some more than others, so it's all about measuring the risks and benefits. Of course, I promote breastfeeding as well. And a lot of times, it's just talking to your OB, talking to the pediatrician, and then figuring out what's best for you.
Sydney: So I took and I still take Sertraline or Zoloft. And I breastfed my daughter until she was almost two years, and I started taking it when she was four or five months old.
Dr. Pari: Zoloft, Prozac, Wellbutrin, they're all safe. And again this isn't medical advice, everybody's personalized, and it's also dose-dependent, depending on what dose you're on. And so that's why it’s important for you to weigh that with your doctor, your OB, but then also your pediatrician to make sure that they think it's safe for the baby.
Sydney: I did both those things before I went on it. I talked to the pediatrician and my OB at the same time, trying to figure out what was good. So while medicine is the answer for some, a lot of moms also end up asking what can they do aside from medicine. So what else can moms do to help themselves feel better?
Dr. Pari: So we kind of touched on talk therapy or psychotherapy, trying to talk to a counselor of some kind. There are also support groups out there for women who have postpartum depression. Group therapy is always good. Again building that tribe so that you have other people to talk to and support. Exercise, as you know, is a great way of elevating your mood naturally. So trying to stay active, that can help combat depression, and just trying to take care of yourself.
Sydney: That was my biggest thing - and I saw a lot of this on our event page for this - finding your tribe and your village. Now, having gone through it myself, I try to be proactive with friends who I know have just had babies, whether I know they're predisposed or not, just trying to let them know that "Hey, I'm here, and I'm a safe place for you to talk to, whether it's good or bad. Even if you need me to come over and just hold the baby so you can shower or fold your laundry.” I'm not the best cook, so I sent a Grubhub gift card to somebody, Postmates or DoorDash. I sent them an e-gift card so they didn't have to make dinner, supporting them in little ways and letting them know that I'm there if they do need to talk. And then I know some resources that I can help send their way.
Dr. Pari: Well, I think that's really a big thing too. It’s not just having a support group that's maybe gone through postpartum depression; that's a separate issue, going to group therapy. But then also what you're talking about is just having friends and people who love you around you. I think a lot of new moms tend to get isolated because they're obviously figuring things out, they're sleeping on the fly, they're trying to breastfeed, and they are stuck in the house trying to figure this all out, and then they don't really know, “Should I take my baby here? Should I take my baby there?” And a lot of people will think to themselves, “Oh my friends don't want to come over. I have a baby, it's crying, and I can't entertain.” But I think it's so important for you to realize people who love you still love you, they want to be there for you, and even if it is just to drop by and say hi, you want to keep seeing people because social isolation can definitely predispose you for depression.
Sydney: Is it a common side effect to feel sick from antidepressants?
Dr. Pari: So it depends on the type of antidepressants, it depends on the person, but yes, that is one of the common side effects. There are GI symptoms, nausea, vomiting, or diarrhea. With that said, most people adjust to that within the first month.
Sydney: Good to know. So I've heard about a lot of moms with doctors telling them they have to stop breastfeeding if they have postpartum depression, not because of medication. Is there proof that you know of that you should stop breastfeeding just because of postpartum depression?
Dr. Pari: No, not at all. Do you know what the reasoning behind that is?
Sydney: No, I just know that some friends have been told to stop breastfeeding, that it will make it easier. My youngest, who we're adopting, I actually got to nurse a little bit the first four months of his life. I was still producing colostrum. It was stressful, so I could see how that could maybe add…
Dr. Pari: It might be just case dependent, like if the mom's main source of frustration, anxiety, and sadness is coming from a difficulty of breastfeeding. Then obviously that might be something that you might want to eliminate. With that said, if you're a woman who’s experiencing postpartum depression, but you're not having any trouble breastfeeding, well then it wouldn't make any sense to stop. I don't think it's breastfeeding. I think it might be for those particular women breastfeeding was a source of frustration, anxiety, and sadness. Does that make sense?
Sydney: A trigger or something. And I would say if you want to breastfeed, mamas, find a La Leche League, a lactation support group, or a lactation consultant who can help you. I know with two of my children, they had really, really bad tongue-ties. They were not able to latch, and so it was really frustrating, and that did not help. Things got better with my postpartum depression with my daughter when we got that tongue-tie fixed.
Dr. Pari: That's the thing. I think if the breastfeeding is the source of the sadness, well then that's something to work on and/or stop if it's necessary. But I don't want people to get confused into thinking that breastfeeding is associated with postpartum depression. That’s not a generalized issue.
Sydney: I wanted to make sure that was clear because I've heard that before. Thank you. Would you be able to address questions about postpartum PTSD?
Dr. Pari: Sure. So post-traumatic stress disorder is a disorder where people have feelings of stress, depression, a lot of times there are recurrent dreams, and anxiety surrounding a certain situation. And there are issues where people have traumatic births, whether that be an emergency C-section, a very painful labor, or something that happened to their baby. At any rate, it becomes a traumatic event for them. And any time you have a traumatic event, you are at risk for a post-traumatic stress disorder where certain things might trigger those feelings of sadness, anxiety, and stress for you again.
Sydney: That's partially why I chose to have a repeat C-section with my daughter. I didn't sleep at all the night before I made that decision because I was really having a lot of anxiety thinking about going through labor again because my first was an emergency C-section. And then my second, I chose to have the C-section, and I had the best sleep I’ve ever had before going in the next day. Even since then, when I've had to help with C-section related blogs or events in our company, which I'm very passionate about, I'm very open and very real, I talk about all the messy stuff that I've gone through in hopes it will help somebody out there, but I really have had to work with different coping mechanisms, healthy coping mechanisms, to get through that anxiety and the feelings of depression. So I know that it's possible; I know what it feels like.
Dr. Pari: It's definitely something that exists. Again, not everybody's going to come across something like that. It's going to be something that's rarer, but it's also something to be aware of and something to not be ashamed of.
Sydney: That's what I had to get through, not being ashamed of what was happening. That was the biggest thing for me, which is why we do this! To take that shame away. Another question. Is it possible to have postpartum depression and actual depression at the same time? Having anxiety and PTSD all going on at the same time as the depressions have hit? So having all of it at the same time, I think, is what they're asking.
Dr. Pari: It is possible, but it's also kind of how we define things, right? If you're somebody who already suffers from depression, you become pregnant, you're still suffering from depression throughout your pregnancy, now you’ve delivered a baby and you're still having depression – we'd probably just categorize you as someone who suffers from major depressive disorder. It's more of a postpartum depression when it's coming on only in that time period after you've delivered, a few weeks after and up to a year. Does that make sense? It really doesn't matter in the sense that you're going to be experiencing the same feelings. It's just more of a definition. And then also people with postpartum depression, often when that resolves, they're not going to necessarily have depression at other times in their life, whereas people who have major depressive disorder may. So that's kind of a little nuance.
Sydney: Does it end around a year postpartum?
Dr. Pari: No. That's where if it's starting, we can say it’s still categorized as probably postpartum depression. It can last beyond that. Obviously, if you get postpartum depression at 11.5 months, it may not end right in two weeks, right? And again these are all kind of nuances, but it just makes more sense when we can categorize it like, this occurred after a birth, so we know it's probably more postpartum related.
Sydney: Got it. How do I process or handle the guilt? I feel so guilty having postpartum depression and postpartum anxiety, says a mom.
Dr. Pari: I'm sorry. It's important for you to talk to a counselor to help you overcome those feelings. It's a very common thing for women to feel guilt and the things that they're lacking as a mom. Even when it's not something as serious as postpartum depression or postpartum anxiety, even when it's small things like, “Oh I feel like I'm not a good breastfeeder. I feel like I'm falling asleep too often. I feel like I can't manage my baby and work.” We tend to put a lot of guilt on ourselves. And when you add in problems like postpartum depression and anxiety, it can become very overwhelming. I think the most helpful thing is to talk to a health care professional to help you work through those feelings.
Sydney: For me, one thing that helped was knowing that it wasn't just that I was crazy or choosing to be sad. It wasn't that I could just choose to be happy or know that some people had it worse than I did. It was more of a chemical thing. It was not just me choosing to be this way. It's hard when not everyone around you understands that, but I try to help others understand that. Am I right in that?
Dr. Pari: Yeah, and I think that's part of the awareness, that's why we're talking about it today, so that people can realize if this does happen to you, if you do suffer from postpartum depression, you're not alone. And it's also not something to be embarrassed about. It's something that you can manage, but in order to manage it, you have to accept it and not feel ashamed about it, not feel guilty about it.
Sydney: Now, this will probably have to be our last question. It's kind of along the same lines. How can you handle bouts of sadness and crying? How can you handle it and how can you get through it?
Dr. Pari: So if it's within the context of the postpartum depression, hopefully, first of all, you've identified that and you're doing other things to treat it, possibly medication and therapy. And then I think if you go to a therapist, they're going to help you. And again I'm an OBGYN, so when it comes to certain types of techniques of therapy, that's not my expertise, but of course if you go to a therapist they might help you with getting certain tips to try to soothe yourself in those moments.
Sydney: One last question, I think we can answer this in the time. When having postpartum depression, is it possible to also start hallucinating and come close to where you’re afraid you're going to hurt your child?
Dr. Pari: So, this is a possibility, and if this were to happen to you, it is so, so important for you to just go directly to an emergency room. This is where you have postpartum depression with psychosis. If there's one message that we leave with here today, if you have any feelings of hurting yourself, any feelings of hurting someone else, a feeling of hurting your baby or your child, if you are hallucinating visually or you're hearing things, you need to immediately go to an emergency room.
Sydney: Right. We want everyone to be safe.
Dr. Pari: Yes.
Sydney: Dr. Pari, thank you again so much.
Dr. Pari: Thank you for having me.
Sydney: It's been so helpful to be reminded that we're not alone in this. We have a whole team, we've got our doctors, we've got friends and family or can find those friends and family. You mamas at home have us at Kindred Bravely, as well, on your side. And there are ways to feel better. Please don't hesitate to call your doctor if you are concerned about your well-being. We cannot emphasize that enough.
Being open about our emotions takes incredible courage, but that bravery is the best gift you can give your children. Showing them that it's okay to be vulnerable will help teach them to be compassionate towards others and themselves. So while you're trying to heal yourself, you're also teaching your kids a valuable lesson, which my therapist actually shared with me. I got really sad that one of my kids was pretending to be sad one day, and I was like, "Oh no, this is all they know." My therapist said, "No, you're showing them a range of emotions, and you're showing them that you're working through them to get better as well."
But also if you're looking for a supportive community of moms, we'd love to have you join our Facebook Group KindredMamas. It's a wonderful place for moms to connect, share ideas, and encourage each other to keep being brave.
Have a great night, BraveMoms, and thank you again, Dr. Pari.
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