THE CLOAKED DEPRESSION OF FATHERHOOD:

HELPING FATHERS OVERCOME PARTNER POSTPARTUM DEPRESSION (PPND)

Fatherhood is an incredible gift!  But sometimes, complications can accompany it. Some fathers or birth partners can experience something called Paternal Postpartum Depression (PPND). 

Chances are you haven’t heard of it, but you may have heard of something called postpartum depression or Perinatal Mood and Anxiety Disorders (PMAD) in new mothers. (Simply stated, PMAD describes the distressing feelings that some mothers experience during pregnancy [also known as perinatal] and throughout the first year after pregnancy [also referred to as postpartum]). Well, it stands to reason that if your partner is experiencing these symptoms, you might also be suffering from some type of mental or emotional fallout.

The symptoms of Paternal Postpartum Depression (PPND) aren’t quite as obvious as the well-known symptoms women experience with PMAD. Men who seek treatment for PPND often report feelings of hopelessness, ambivalence, having trouble focusing, feeling indifferent about spending time with their partner or child(ren), feeling critical of themselves, and/or feeling sad or angry as their precursors for seeking help.

If your partner is experiencing PMAD, you (DAD) might also be suffering from some type of mental or emotional fallout.

Because men often suppress their emotions, PPND can also reveal itself through somatic or physical forms such as alcohol or drug abuse, increased/decreased appetite, weight gain, headaches, indigestion, nausea, diarrhea or constipation, and even insomnia.

Currently, it is estimated that one in every four new fathers is suffering from PPND - and research indicates an increased risk of up to 50% for mates with a partner suffering from a perinatal or postpartum mood and anxiety disorder (PMAD).  Furthermore, the symptoms of PPND can be difficult to identify because they gradually build over time – often not occurring until 3-6 months after the birth of the child.  

One in every four new fathers is suffering from PPND.

Guys, you need to reach out. Parenthood can be phenomenal, but it’s bloody hard work!  If you’re experiencing negative feelings, please seek professional help while the issue is minor - so it doesn’t have a significant and long-lasting impact on your family.  

Left untreated, PPND can affect the mental health of your spouse and your ability to effectively support and bond with your partner and child(ren). It can also have a direct impact on your child’s psychosocial development and behavior and negatively impact your marriage. Both PMAD and PPND can rob a couple of their joy and cause shame and guilt during what is supposed to be a special time in your life.

You are not the only one feeling this way. PPND is a relativity misunderstood and marginalized mental health issue. There has been a significant lack of professional attention and acceptance which has stigmatized father’s experiences, resulting in many men never seeking treatment or experiencing a vacancy of treatment options.

PPND is a relativity misunderstood and marginalized mental health issue.

The impact of PPND can be significant, but professional clinical treatment for Paternal Postpartum Depression (PPND) is available. Do not suffer in silence. Speak up and let your voice be heard!

Want to know more? Concerned that your partner might be experiencing Paternal Postpartum Depression (PPND)? Reach out and book a complimentary, 20-minute phone consultation. Book through my website or call 512-470-6976. There’s help in your corner! 

Written by: Simon Niblock, MA, LMFT

Simon is a Licensed Marriage and Family Therapist who specializes in relationship therapy for men and fathers. He is the founder of Simon Niblock, Relationship Therapy for Men, a tailored psychotherapy service that caters for men and fathers who seek to establish and evolve meaningful and fulfilling relationships with themselves and those that matter to them the most

One of my friends texted me the other day and said, “I can’t believe it’s only Monday!” 
She was wrong.
It was actually Tuesday.

The time during this pandemic can feel like a perpetual Monday though. It’s as if we’re starting at the beginning of a long week every single day, with so much time before we get relief. For many of us, this pandemic has completely changed our lives, and we’re left wondering what it will be like in a few weeks, or even in a few months. 

While many have called this pandemic “unprecedented,” I beg to differ. Our world has been through pandemics many times. In fact, our species has been through more horrible pandemics than this, but, fortunately, the majority of us weren’t alive to experience those. So far, humans have always figured out a way to adapt to illness though and go on with living. I doubt it will be much different in this situation.

How do we endure it though? How do we make sure we’re not just burying our heads in the sand and waiting for time to go by? Life is just made up of moments, so even though this moment may not be our favorite, it’s still worth trying to be present for. It’s part of life. Not to mention, there are probably people in your life who depend on you in some capacity, and you cannot take care of others without taking care of yourself first.

A pandemic is stressful. Stress is inevitable, and the effects of stress on us are normal. If we can get through pandemic stress, we can probably get through most stressors in life. The best way to cope with stress is to focus on mental and physical wellness. In the end, it’s our body and mind that take us through this world, from one moment to the next. If we can optimize our wellbeing, we have a better chance at getting through this major stressor without major consequences on our bodies.

Here is what is normal during times of stress:
Physical symptoms, such as fatigue, headaches, stomach aches, and diarrhea (maybe that’s where all the toilet paper has gone).
Changes in sleep.
Changes in appetite. 
Feeling more emotional - discouragement, anger, anxiety, sadness, grief, restlessness or overwhelmed.
Decreased motivation.
Increased mood swings.
Isolating and withdrawing from others
Trouble with memory.
Difficulty making decisions or problem solving.
Changes in communication patterns.

We start to be concerned about mental illness when these symptoms become more impairing. For example, someone has so much fatigue they cannot get out of bed. Or their appetite changes so much that they gain or lose a significant amount of weight. Or their emotions become so extreme that they cannot function in relationships well. Another main clue that there is more concern for mental illness is if a person can no longer keep up with their normal work or daily activities. 

It is not uncommon for mental illness to come up during times of stress. In fact, there’s an entire biochemical reaction that goes on in our bodies to prime our brains for mental illness when we are stressed. It’s why most people develop mental illness during times of stress. It has nothing to do with them being weak or not being resilient enough to get through a tough time. Instead, it has to do with biological changes going on in the cells of our brain (our neurons) that then prevent them from functioning well. In other words, our the neurons in our brain fail to function in their normal capacity, which has an effect on our emotions, thoughts, and behaviors. Just like any other organ in our body, our brain can become ill. Similar to other organs, sometimes our brain can be repaired with lifestyle changes alone, but sometimes it needs medication to get it back to good health. And that’s okay.Iin fact, it’s more of the norm. For example, some people can live healthy lifestyles with a great diet and consistent exercise, but still have high cholesterol that requires medication. It doesn’t mean they are a failure at being healthy. It’s just the way their body is - most likely there is a biological and genetic reason that they have no control over. The same applies for the brain and mental illnesses. Try to follow the lifestyle changes that are helpful during this stressful time, but know that if that’s not enough, it’s better to get extra help. Not only for yourself, but for those close to you too.

So here’s a guide to get through a pandemic:

• Learn what’s necessary, then tune out.
  The media is all about hyping up the pandemic or other events going on in the world. Their entire purpose is to capture your attention and keep it. What better way to do that than to dramatize everything? This drama inherently makes us more stressed though. Literally, it increases cortisol levels and primes our body to be in a state of stress. So do your body and mind some good by staying away from the media. Maybe limit yourself to catching up on the news 5-10 minutes a day if you feel it is necessary, but then turn your attention to other, more helpful tasks.

• Exercise your mind.
  Our brain needs exercise just like our body, and it gets this push from challenges in thinking. Therapy is a great way to exercise our brain, but we can use other techniques too, such as mindfulness meditation. Consider downloading a meditation app and practicing (key word: practicing) meditation for 5-10 minutes a day. There are also online courses or workbooks you can get on Cognitive Behavioral Therapy in order to find different tools for challenging thoughts and beliefs. Whatever form of “therapy” you decide to do for your brain can be helpful. Repetition, just like with physical exercise, is key to making changes though.

• Work out.
  Speaking of physical exercise, working out is important for your brain. If we continue to think of the brain as an organ in our body, this shouldn’t be a surprise. Exercise has many physiological impacts on the cells in our brain that improve and optimize the way that they function. It also keeps them healthy longer - anti-aging outside and inside. While any form of exercise is better than none, it appears that sustained aerobic exercise, several times a week, is particularly helpful for preventing and improving mental illnesses.

• Eat well.
  Did you know that there are certain foods that are great for the cells in your brain? In fact, there’s an entire division of psychiatry called nutritional psychiatry that focuses on using food to help mental illness. Eating these foods can also keep our brain functioning well, and help prevent future mental illness episodes. This is particularly important when your body is under stress. A general good rule of thumb for eating well is consuming a good variety of fruits and vegetables every day (aim for 5+ total servings each day), and limiting processed carbohydrates. For our brain in particular, seafood is also a great addition!

• Sleep well. 
  People who get an average of 8 hours of sleep a night live longer than those who don’t. Sleep is important for our entire body - every organ. Poor sleep can impact everything from digestion, to blood pressure to emotions. Mental wellbeing is particularly sensitive to sleep though. Sleep can be a difficult activity to get with a new baby around, or while being pregnant and needing to pee every hour. Aim to practice strict sleep hygiene techniques to improve both quality and quantity of sleep, and get at least 4-5 hours of uninterrupted sleep each night.

• Find a new routine.
  If you’ve been around children, then you know how important a routine is for human brains. When you throw off a toddler’s routine, someone whose brain is still in the early stages of development but very primed for displaying emotions, all hell breaks loose. As adults, our brain hasn’t changed drastically. It still craves routine and its function is optimized when we stick to routines. Fortunately, we’ve developed more of a frontal lobe than we had as toddlers, so we can control our impulse to throw a tantrum when our routine changes, but a change in routine still causes some stress in our body. Even if the change in routine is perceived as positive, like a vacation, we still have an adjustment period to finding a new routine. The same goes for this period of time. Our routine has probably changed, but it is important to find a new one that works for you and stick to it. Also, it’s completely normal to go through some trial and error as you are finding a new routine and adjusting to it. 

• Socialize.
  We are naturally social creatures. It is how we have evolved. We were never lone humans living a life of isolation. All of us need human interaction and socialization to have the optimal environment for our brain. For women in particular, we find that women with strong friendships live longer than those without. For men, studies show that being married increases their lifespan. While we are social distancing, make sure to continue talking and virtually seeing your friends. Keep date nights with your partner and happy hour with your friends. Get creative and have fun with coming up with ideas on how to spend time together during the pandemic.

• Set boundaries.
  While it is important to keep up with relationships and interactions with those we care about, it is equally important to keep boundaries with people. There are certain people in our life who can add to the stress we are going through, so while we’re trying to optimize our mental wellness, make sure you are setting up helpful boundaries around those people. Similarly, set boundaries with your time too - give breaks for yourself from work and caring for family members. 

• Do something nice for yourself each day.
  This is probably one of the easiest, yet most important tools to help mental wellness. Every day, do an activity for yourself that either makes you feel good or makes you feel accomplished. Most importantly though, don’t make it a reward and do it with intention. Meaning, do this nice activity for yourself each day, just because you care (or are learning to care) about yourself. You don’t need to “earn it.” You get to enjoy this activity because it should be a basic human right to care for yourself.

• Allow for support and help.
  When we are stressed, it is important to allow others to support us. In the American culture, this can sometimes be misconstrued as being weak, but in reality, it’s natural. Going back to the fact that we are social creatures, it is normal for us to depend (yes, I said depend) on other people for our wellbeing. You can probably survive without anyone else, just like you can probably survive on a macaroni-and-cheese-only diet; however, that doesn’t mean that is what is most healthy for you. Furthermore, it takes depending on others to form intimate and close relationships. Maybe there is someone in your life who is always independent, never asks you for help, and never opens up to you about their problems. It’s hard to feel very close to someone like that, because you don’t get to support them. The same applies for those around you - letting people support you and help you makes them feel valuable in the relationship and brings you closer together. It also helps decrease your stress and improves your mental wellness.

Please do not walk away from this article feeling the need to make all of these lifestyle changes or to do them 100%. No one is perfect, and no one will be able to fully do all of the things listed above. That’s okay. Having self-compassion during this time is also important. Go easy on yourself. Be kind to yourself. You’re going through a pandemic after all! Normal life will resume soon enough, so find ways to enjoy this moment.

Written By: Kristin Lasseter, MD - Medical Director for PPHA

Helping Her Through: One Husband’s Reflections on PPD

By: Ryan Stockwell

There is no doubt that during postpartum depression, the mother is experiencing things that no man can truly understand or grasp.  It's a dark, scary, anxious place, which is completely contradictory to how everyone thinks new motherhood will be.  There are many places where you can read about PPD from the mother's (or from a woman's) perspective.  However, there doesn't seem to be as much from the father's (or man's) perspective.  I therefore wanted to share my story.

My wife, then of 5 years, was so excited about having a child.  2 kids, actually, was the plan.  She had minor bouts of anxiety and depression in the past but overall, was a happy person and was ecstatic about motherhood.  When our daughter was born, the first couple of days were one of amazement, excitement, love, awe, etc.  But that quickly waned as PPD took over our lives.  Within the first week after our daughter was born, things were very, very wrong.  Constant crying, no/few ways to cheer her up, complete disinterest in anything, fatigue, lots of sleeping, and worst of all, the feeling she had made a mistake. As a father, my head immediately went to the worst place (the things you see on TV and read/hear about in the news) - that my wife wanted to hurt my baby girl.  Looking back now, I realize there is a difference between what my wife was experiencing and Postpartum Psychosis. The later is a medical emergency and a very important one to diagnose immediately.  No one can do this except a licensed professional. So now to the tips that I would give husbands/caregivers:

Tip 1: Take note of the past tendencies. I knew she had previous bouts of depression and anxiety in her life, but I never thought that could impact her as a mother. It’s not always the case that a history of depression or anxiety means your wife will have PPD, but there is a correlation, so as I said, take note.

Tip 2: Get help immediately.  Even if it ends up being a false alarm or preventative, talk to a professional. This can be your wife’s OB/GYN, your general practitioner, your baby’s pediatrician; just reach out. This part was not easy for us, as at the time when my daughter was born, the availability of resources out there to help families suffering from PPD were limited. I remember looking through the yellow pages (yes, I'm dating myself) for psychologists/psychiatrists, making tons of calls, only to find out that few of these knew much about PPD, let alone specialized in it. Thankfully, things are better today, and I can only hope that trend will continue. You might think that just talking to your family or friends will help, but they don't really understand what's going on and at times may make you feel things are “not that bad” and "it will pass."  If I had a dollar for every time I heard that (and said it), we'd be retired on a beach somewhere. 

Tip 3: Medication immediately. People have mixed feelings on this, and I understand the need to make decisions based on each person’s particular situation, and a medical professional can help you determine what’s best. In my wife’s case, this was a necessity. Medications need time to work and you need those meds to start working on the physiological and psychological things that are happening to your spouse while she works through other things in therapy. It’s much easier for her to stop taking medications if her and her doctor determine she doesn’t need them then it is to “catch up” by not taking meds and then desperately needing them later. This is not a healing process that happens one step at a time.  Things must work in parallel. Also, don't expect the first "set" of meds for her to be the right one.  Everyone is different and it may take a few different tries to figure out which meds work best.  Be patient, but also diligent.  Talk to the doctor regularly.  Attend the appointments.  Don't think because your wife has a good day she can get off the regime. Medication should never be stopped without the assistance/directive of a medical professional, so be part of this conversation, your wife needs you there.

As for you personally, father/husband/caregiver, you might want to consider medications as well. I personally never got on meds during this, but I think many dads should and in hindsight, I really should have.

Tip 5: Therapy ASAP. Once my wife had started on her medication path, it was time to find her a therapist.  From my experience, this was a crap shoot.  It's like working with any professional - you don't really know who is going to be right until you try a few.  Don't be afraid for your wife to change therapists, but be thoughtful about it.  Don't just change b/c one session didn't go well, but don't ignore repeated signs that the therapist may not be right for your wife. Do not give up, however! Therapy was a miracle worker for my wife, and although I never actually sat in on any of the therapy sessions with my wife (I did drive her to almost all of them) I saw the effects almost immediately. I don't know if it’s a good thing or a bad thing that I was never party to the sessions, it was never really an option for me, but in your case it might be helpful.  I would follow the guidance of the therapist.

Tip 6: YOU WILL CRY. A lot.  Yes, you, husband/spouse/caregiver. You will have days with no hope that things are going to change.  You will breakdown.  You will feel insecurities that you may have never felt before.  You will be angry, scared, sad, and confused.  You will want to fix it, like you do anything else.  That won't work.  You need experts to help.  And know that it will take time.  I'm an impatient person and this was really hard for me. The first 6 months for us were really tough.  There were more bad days than neutral days.  There are a few ok/good days sprinkled in there, and the occasional great day.  Enjoy the better days, but don't think that's the end of it.  This is a monster that likes to rear its ugly head often.

Tip 7: Be honest. If possible, swallow your pride, and share what’s happening with your employer.  Take medical leave if you can, ask for flexibility to work from home and take time off for doctor's visits, etc.  Most employers are willing to work with you, and in the case your employer just doesn’t get it, help educate them. Most importantly, however, be ready to drop literally everything because a bad day is becoming worse.  This is not a time in your life where you can predict what's going to happen next. It just doesn’t work that way.

Tip 8: Accept help from others.  Again, swallow your pride. My mother in law lived with us for several months and I can't imagine going through this without her there to help.  She not only helped my wife (her daughter) in the healing process, but she was a huge help to me.  She was someone I could talk to, compare feelings with, "escape" with, and it was nice to have another set of adult eyes on the situation. Our relationship strengthened exponentially through this, which I am eternally grateful for.

Tip 9: Be Patient. As I said before, this will take time. You must be patient, which I also said before, was extremely difficult for me. It will do no one, especially your wife, any good to try to rush things along. For us, months 6-12 were a little better for my wife, but we were still not out of the woods.  There were more good days than bad, but again, this illness will rear back up several times. (Imagine a roller coaster if you’d like) In fact, these instances continued well into year 3.  Now, don't freak out, because I am not saying the first 3 years are all bad.  After the first year, things got progressively better for my wife and life was slowly getting back to “normal”.  But then, it seemed like once a month to every other month, there would be a recurrence where we felt like we were smack dab back in the first 6 months after birth. It takes what it takes.

Tip 10: Take care of yourself too. Although your first responsibility is your wife and child, you must take time for yourself as well. Take care of yourself or you won't be able to take care of her.  Exercise, mediate, see a doctor, play golf.  Do something that helps ease some of the pressure. In writing this and reflecting, keeping a journal or diary would probably have been therapeutic for me.  It would have allowed me to get my feelings out and also have been able to reflect on the progress that was happening. I could have looked at these progress notes when things got “bad” from time to time.

There is a ton more I could write about my experience and story, but I'll close with these final thoughts for dads/spouses/caregivers out there who are going through this.  Your wife is really sick, give her the time and support to get better.  This is a long healing process, put your desire aside to fix everything.  Be patient and ready for change (our plan of having 2 kids turned to only 1 because of this).  It WILL get better and you WILL come out on the other side stronger, and likely more connected with your wife and baby.

Ryan Stockwell is the husband of Kelly Stockwell, secretary of PPHA.

8 Signs of Postpartum Depression and Anxiety

Before reading this article, I just want to note that postpartum mental illness often looks different in different people. This article should not be used to diagnose yourself or anyone else, rather, it should be used as a tool for signs to look out for. It may be worth reaching out to a mental health professional to discuss the items below in more detail. 

This list is a gathering of the most common symptoms I hear from patients who are suffering emotionally or having a lot of anxiety in the postpartum period. I want to put this list out there, because depression and anxiety after having a baby can look very different from other types of depression and anxiety. Also, I want more people to recognize the signs, because it’s not always easy to know what’s normal and what’s not, especially when you’re in the throes of surviving parenthood. It is so important to get help for symptoms though, since more and more research is showing vast detrimental effects depression and anxiety in a parent can have on the development of a child - both physically and mentally. These symptoms can show up during pregnancy too, and if it’s happening during pregnancy, it often means it will get worse after delivery. So let’s get started on what to look out for:

1. You can’t sleep.

   Let’s be real. No one is sleeping great when there’s a newborn in the house. People who are experiencing postpartum depression or anxiety though, usually have a really hard time sleeping even when the baby is sleeping. They usually feel exhausted and have a desire to sleep, but they can’t relax enough to fall asleep, or their mind won’t turn off with different worries and fears. In some cases, it is thought that sleep deprivation is part of the cause of postpartum mental illness. It is so important for your brain to get good sleep! Make it a priority to get about 5 hours of uninterrupted sleep each day. This can be done by splitting night duties with a partner, parent or night nanny.

2. Scary images or thoughts come into your head.

   It’s normal to be more anxious after a baby comes into your life. Biologically, our brains are designed to be on overdrive with a newborn around, which makes sense from an evolutionary standpoint. New parents can sometimes have intrusive images of scary things happening to their babies, too. These images or thoughts come around daily or multiple times a day, for some parents suffering with anxiety though, and are then considered to be part of postpartum anxiety rather than normal. Sometimes, these intrusive thoughts are hard to let go of, and can cause a parent to avoid doing certain things because of the thoughts. It is not uncommon for parents with postpartum anxiety to have unwanted thoughts or images of harming their own baby too. As you can imagine, this can be very distressing and frightening to a parent, and I often hear parents voice the concern that they are “going crazy.” People who have these thoughts are not at risk for actually harming their babies though, and they’re not going crazy (cue the uneducated providers who call CPS on these poor parents). Instead, they are suffering from symptoms that are likened to OCD and can be successfully treated with therapy and/or medication. 

3. You don’t feel a bond with your baby.

   It is not always love at first sight when a parent first sees their baby, and that’s okay. Some people are slower to warm up to others, including a baby. Also, babies don’t give us much interaction in the beginning, which can make it harder to form that immediate infatuation. I get more worried about postpartum mental illness, though, when the bond isn’t progressing. Some women with postpartum mood disturbance tell me they sometimes feel like the baby isn’t even really theirs.  

4. You feel irritable or sad most of the time.

   There is a thing called the baby blues that occurs in most women after they have a baby. The baby blues doesn’t mean you’re sad all of the time though, and it always resolves after 2 weeks. Those women who are irritable most of the time or feeling sad most of the time, are most likely going through something more than just the baby blues. Anxiety can make people really irritable, and depression can too. While being a parent to an infant is not all rainbows and butterflies, it shouldn’t be complete misery either. 

5. You are unable to feel pleasure or excitement with activities like you used to.

   It’s common that people with anxiety and depression just don’t feel the same excitement as they used to. They don’t look forward to activities very much or don’t find that they get a lot of pleasure out of life anymore. Hobbies often fall to the wayside in parents going through too much stress or emotions, not only because time is more scarce, but also because those hobbies just don’t feel fun anymore. They may also notice they’re less interested in food, going out or spending time with friends.

6. You feel excessively guilty or that you are not doing a good enough job.

   Everyone has moments in parenthood where they doubt themselves or they make mistakes. These moments usually come more often in the beginning as you’re learning about your baby. Not to mention the fact that you finally get down a routine, and then your baby changes it up on you. Very often, though, I hear moms suffering from postpartum depression say that the baby deserves a better mom than them. They talk about how they don’t feel good enough to be the baby’s mother, or how they feel like a burden to their partner. These thoughts are often a product of emotion or stress dysregulation and should raise concern for postpartum depression or anxiety.

7. You have trouble motivating yourself.

   Having a newborn in the house will throw off anyone’s motivation. You’re not sleeping well. You don’t have much time to eat. You barely even have time to go to the bathroom without having this new human protest for you to pick it back up. So when you finally get a moment to rest, you take it. Amotivation, or lack of motivation, comes up when even small activities seem impossible though. For example, not leaving the house for days because it is too overwhelming. Or not bathing, not changing your clothes, not brushing your teeth. Or in some extreme cases, women even have trouble taking care of their baby. 

8. You have thoughts that your family would be better off without you, or wishes that something bad would happen to you.

   If your mind goes to a place where dying seems like a good option, then it is definitely time to talk to someone. Often times, though, it doesn’t start out that way. “Suicidal ideation,” as we call it, is on a spectrum. For some people, it can just be thoughts of escaping, running away, disappearing or pushing pause on life. Others may have wishes that something bad would happen to them, like a car wreck or cancer. And some may actually have thoughts of ending their life, because that seems like the only way out from the suffering. It isn’t though. It’s possible to feel normal again, but it takes telling someone in order to get there.

This blog post was written by Kristin Yeung Lasseter, MD who is the current Medical Director of PPHA and Psychiatrist at Reproductive Psychiatry Clinic of Austin

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Top 5 Natural Ways to Prevent Postpartum Depression

How to prevent postpartum depression is a frequent topic that comes up when I am talking to patients and other providers. To help squash some of the myths out there on the internet, and to provide some evidence-based education, I have put together a list of the top 5 natural ways to prevent postpartum depression. Keep in mind though, if someone has a history of two or more periods of depression in their past or has a history of bipolar disorder, the risk of those symptoms coming up again during pregnancy or postpartum is greater than 60% (higher for bipolar disorder) if they are no longer on medication. Because mental illness symptoms in pregnancy and postpartum have significant risks for baby, it is important to take the necessary steps to prevent mental illness from coming up during this important time. For some people, the safest option might be to continue their medication. For everyone, though, using these 5 natural tools to prevent mental illness will help keep both mom and baby healthier!

1. Support Network

   Postpartum depression rates have increased over the decades, and one likely culprit is the change in our society structure. Women are more present in the workforce, and are working until they are older. This likely means a woman doesn’t live near other family, and that other family and friends also have jobs that take them away from helping when baby comes. 

   As humans, we have evolved as very social creatures though. We depend on social and emotional connections to thrive. This dependency on connection is even more imperative around the time of pregnancy and postpartum, as a woman’s brain is changing in many ways to prepare her for motherhood. Multiple studies have shown the importance of a woman’s support network during the postpartum period, and this makes sense logistically. If a woman has help with cooking, cleaning, working, and taking care of her other children, she is bound to have less stress, and, therefore, is less at risk for postpartum mental illness. Similarly, if she has someone to confide in about her struggles or fears, or someone to give her some time away from her newborn to rest, she is also going to fair better mentally and physically than a woman who does not have those opportunities. There was also a recent study that showed a baby’s IQ was directly correlated with the number of people in the mom’s support network. This isn’t surprising though. Many studies confirm that if mom does better mentally, then baby also thrives more in developing mentally and physically. 

   Take time to plan your postpartum period. Utilize the people who offer to help. Decide who will bring which meals, who can help out with other children, who can clean, and who can give mom and dad a needed break. Consider hiring a postpartum doula or a night nanny if friends or family are scarce. There are so many resources out there to help you plan for this time, including this Postpartum Workbook. PPHA is a local Austin organization that offers a doula voucher program so that families who would not otherwise be able to afford a doula, can. Visit pphatx.org to learn how to apply.

2. Food

   Food and exercise are two lifestyle modifications that frequently show up as prevention tools for illnesses. It is no different with mental illness. Let’s not forget that the brain is an organ in our body, just like our heart, liver, kidneys, etc. And just as other organs benefit from a healthy lifestyle, so does our brain. 

   Eating a diet high in sugar and other processed ingredients increases the amount of oxidative stress on neurons, or the cells that make up our brain. Oxidative stress is a term that refers to chemicals our body makes in response to certain environments that harm the cells in our body. This makes it much more difficult for our neurons to function optimally, which increases our risk of developing mental illness. Eating a diet with a lot of vegetables, fruits, legumes, beans, and fish has shown to decrease this oxidative stress. Given this information, it is no surprise that The Mediterranean Diet has specifically been studied for its health benefits, and has shown to improve mood in some people. Overall, it serves as a great guideline for healthier eating habits. There are also psychiatrists who specialize in Nutritional Psychiatry, which studies how foods impact mental health. Dr. Drew Ramsey is one of the well-known psychiatrist in this field, and has published several books to help people eat foods that better brain health.

3. Exercise

   Exercise is another tool to help prevent mental illness. There are several ways this possibly helps our brain to be healthier, but we still have not completely figured out why exercise decreases our risk of mental illness. We know exercise has many benefits on our body that impact mental health such as improving deep sleep quality, regulating stress hormones, increasing endorphins, and improving access to oxygen throughout the body. There is evidence showing that moderate exercise for 30 minutes a day, 5 days a week can improve depression, and that yoga is an effective adjunct treatment for anxiety.

   Women have come up with some pretty creative ways to exercise with a baby, and you can find many of these exercise regimens on YouTube. There are even stroller meet up groups and yoga classes with baby here in Austin.

4. Sleep

   There is a lot of research about sleep and its impact on the body, especially on the brain. As many people know from personal experience, a night of bad sleep can really change your mood or make you feel more anxious the next day. Even small amounts of sleep deprivation can add up over time to impact how the brain functions, making it more prone to mood instability and anxiety. Sleep problems in pregnancy have shown to increase the risk for postpartum mental illness, and those with more severe sleep deprivation postpartum, are also more likely to develop postpartum depression or anxiety. It is so important for the brain to get a minimum of 4 to 5 hours of uninterrupted sleep each night, but this can be impossible when you’re the only one caring for an infant at night.

   Some strategies to help improve sleep after baby comes include, dividing up night duties with your partner (one person takes the first half of the night, and the other person takes the second half), hiring a night nanny for a few nights a week, sleeping in a different room than baby as (s)he gets older, using sound machines or ear plugs, and keeping it as dark as possible at night (this will help baby sleep too). It is very important to practice “sleep hygiene” techniques as well.

   If you find that you are having trouble sleeping at night - whether it’s falling asleep or staying asleep - it is important to talk to a psychiatrist or therapist about this. The most validated way to improve sleep is by using a technique called CBT-I, or cognitive behavioral therapy for insomnia. This is the first-line approach to insomnia, and is much safer and more effective than medication. There are online programs for CBT-I for those who cannot afford therapy or cannot find a therapist who offers it. One such program is Slumber Camp. If you notice you are having trouble sleeping when baby is asleep, this is also a red flag that you may be suffering with postpartum mental illness.

5. Therapy

It can seem unrealistic to some, but going to therapy weekly can actually be as effective as medication at improving mild depression and anxiety symptoms. Weekly therapy has also been shown to help prevent postpartum mental illness in some studies. There are two types of therapy that specifically show evidence in postpartum mental illness treatment: cognitive behavioral therapy and interpersonal therapy.

This blog post was written by Kristin Yeung Lasseter, MD who is the current Medical Director of PPHA and Psychiatrist at Reproductive Psychiatry Clinic of Austin

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What Language Is That?

It’s not uncommon that clinicians throw around acronyms and words that others don’t understand. Just like other professions, the healthcare industry has its own terminology that can be difficult to follow if you’re not trained in it. In fact, there are even courses available to receive a Medical Terminology Certificate.

To further complicate terminology in medicine, different medical specialties use acronyms and phrases that those within other specialties are not familiar with. In the perinatal mental health world, we often throw around a lot of terminology that even other mental health providers are not privy to. This is one of the many reasons we believe it is imperative for all mental health providers involved in treating perinatal patients to receive specific training in this realm.

We thought it might be helpful for others to clear up what some of the phrases, words and acronyms mean around perinatal mental health, as well as the various levels of care. Don’t know what perinatal means? No worries, we’ve got that one covered too.

Levels of Care in Mental Health:

• Outpatient treatment

This refers to the lowest level of care and takes place in an office setting. Typically outpatient therapy appointments last 40 minutes to 60 minutes and occur anywhere from 2-3 times a week to once a month. Outpatient psychiatric treatment appointments last less than an hour, as well, and occur weekly to annually.

• IOP (Intensive Outpatient Program)

  This refers to therapy that is occurring multiple hours a day for multiple days a week. These programs usually take place in an office setting, but can sometimes be located at hospitals. It is more frequent than outpatient therapy, but less frequent than PHP. Patients usually see a psychiatrist who is involved with the IOP once or twice during the program, but will see a therapist in a group setting during the program days.

• PHP (Partial Hospitalization Program)

This refers to treatment that occurs for the majority of the day, 4-5 days a week. The setting is usually at a hospital, but patients do not stay the night in the hospital. While in a PHP, patients are usually seen by a psychiatrist associated with the program a few times, in addition to the therapists they work with during the program days.

• Inpatient treatment

This is the highest level of care. While a patient is inpatient, they are staying in a hospital all day and usually unable to leave the hospital grounds. Inpatient hospitalizations typically last 3-5 days on average; however, it can range from less than 24 hours to months. Long-term hospitalization is a different type of hospitalization that is much more rare, where patients spend months to years in the hospital.

Terminology:

• Perinatal - usually refers to the period of time from conception to one year after delivery, or one year postpartum.

• Prenatal - the period of time from conception until labor, also known as antepartum.

• Peripartum - the period of time around birth. This is less well-defined, but usually refers to the few weeks leading up to birth, and the few weeks following birth.

• Antepartum - the period of time from conception until labor, also known as prenatal.

• Intrapartum - the period of time from the onset of labor until delivery of the infant and placenta.

• Postpartum - typically this is the period of time from delivery until 12 months after delivery; however, others may define it as being from the time of delivery to anywhere from 6 weeks after delivery to 2 years after delivery.

• Gestation - refers to the period of time during pregnancy starting from the first day of the last menstrual cycle. Often used to describe the age of the fetus.

• Preterm labor - labor prior to 38 weeks gestation.

• PMAD - perinatal mood and anxiety disorder

• PPD - postpartum depression

• PPA - postpartum anxiety

• PPND - paternal perinatal depression

• PND - perinatal depression

• PMD (vs PMDD) - perinatal mood disorder. PMDD is an acronym for premenstrual dysphoric disorder, which is unrelated to pregnancy.

• EPDS - Edinburgh Postnatal Depression Scale

• CBT - Cognitive Behavioral Therapy

• DBT - Dialectical Behavioral Therapy

• CPT - Cognitive Processing Therapy

• EMDR - Eye Movement Desensitization and Reprocessing

• IPT - Interpersonal Psychotherapy

• IOP - intensive outpatient program

• PHP - partial hospitalization program

• DSM-V - Diagnostic and Statistical Manual of Mental Disorders, fifth edition

• LBW - low birth weight. Refers to the weight of a newborn.

• LGA - large for gestational age. Refers to the size of a fetus

• SGA - small for gestational age. Refers to the size of a fetus. The acronym, SGA, is also used to refer to a class of medications, called second generation antipsychotics.

• MCM - major congenital malformations

• NAS - neonatal adaptation syndrome

• PPHN - persistent pulmonary hypertension of the newborn

• SSRI - selective serotonin reuptake inhibitor

• SNRI - serotonin-norepinephrine reuptake inhibitor

• TCA - tricyclic antidepressant

• ECT - electroconvulsive therapy

This blog post was written by Kristin Yeung Lasseter, MD who is the current Medical Director of PPHA and Psychiatrist at Reproductive Psychiatry Clinic of Austin

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Why You Should Donate to PPHA

No mother in the midst of a perinatal mood disorder should feel alone. No parent experiencing anxiety, depression, or crippling grief from pregnancy or infant loss should feel they have nowhere to turn. The feelings that 1 out of 7 mothers experience in the perinatal period can cause them to feel isolated and filled with shame. These feelings are made worse by a systemic lack of support in a country that does not guarantee paid paternal leave and access to healthcare. Not to mention that the United States is the most dangerous nation to give birth in the developed world. This statistic is more alarming for women of color, who are three times as likely to die from complications of child birth.

As cases of mental illness and complications from birth continue to rise, birthrates among this generation of potential parents is sinking. Though it can be attributed to a variety of factors, the statistic speaks for itself. Mothers, fathers, babies, families, and communities are more in need of advocacy and support than ever. And if we are to be a thriving nation, we must begin with helping families to thrive. This will take legislative progress on the part of family services and benefits. It will take an increased awareness around mental health and perinatal mood disorders. Most of all, it will take supporting new families and being there for them in their time of need.

This is where PPHA comes in. The Pregnancy and Postpartum Health Alliance of Texas was created in 2010 in Austin, Texas, by mothers and mental health professionals who saw a disabling void in the maternal health care system. Families in Austin were in need of resources, so that they could easily find health care providers who could help them through the depths of perinatal mood disorders like postpartum depression. They were in need of a community, that could help erase any negative stigma around mental illness and parenthood. Under-served and low income families were in need of services that were not available to them, because of a lack of health insurance or financial resources. The founders of PPHA saw this need, and they came together to create solutions.

Since then, countless mothers and families have been impacted positively by the work of providers, doulas, and volunteers through PPHA. But although non-profit organizations like this one create great strides in progress for their communities, they often do so without funding. PPHA relies chiefly on donations from benefactors who are passionate about supporting moms and families. Luckily for PPHA and for those experiencing perinatal mood disorders, the call for help has been heard by a vast community of benefactors from Texas and all over the world.

As we continue to expand our reach, aiming to serve more families each year, we ask for donations. This time of year is especially important, as it’s our annual drive for fundraising through Amplify Austin. All day on February 28th, we’ll be asking for donations to reach our $15,000 goal. With your help, we’ll be able to continue to answer the call for help from all affected families. Our impact is lasting and life-changing. Together, we can continue to create a community that supports moms and families in some of their darkest periods of need. To schedule a donation, go to https://www.givegab.com/nonprofits/pregnancy-postpartum-health-alliance-of-texas-ppha

Thank you!