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Listen to Dr. Shoshana Bennett, EmpowHer.com’s host of Mom’s Health Matters talk with Susan Dowd Stone about postpartum depression.
Dr. Shoshana Bennett:
Welcome to "Mom’s Health Matters" with Dr. Shosh. We have with us today Susan Dowd Stone. She is the current President of Postpartum Support International, and she is a lecturer at the Silver School of Social Work at New York University. She received her clinical training from New York University where she was the recipient of a President Service award.
Subsequently, she helped form and facilitate the postpartum psychotherapy program at Hackensack University Medical Center’s Department of Psychiatry. Ms. Stone is a writer and among her recent writings include a co-edited book Perinatal and Postpartum Mood Disorders: Perspectives and Treatment Guide for the Healthcare Practitioner.
She regularly presents at conferences and also in the media. She has appeared in CBS Early Show, ABC News, The Morning Show on Fox, to keep going and going and going. So Susan, welcome.
Dr. Susan Dowd Stone:
Hi, how are you, Shosh?
Dr. Shoshana Bennett:
I am doing great, and we’re so glad to have you here on "Mom’s Health Matters," and we know we’ve talked earlier about the importance of treatment of this devastating disorder of postpartum depression, but I’d love for you to go into a bit more depth about actual treatments. Which is that, what are the treatment options for women when they know that they are suffering?
Dr. Susan Dowd Stone:
Okay. Well there’s a full range, and I am really glad you mentioned it, and please chime in because your book also does it, a fantastic and comprehensive job of covering all this. So if I leave anything out, please jump right in.
Dr. Shoshana Bennett:
Okay.
Dr. Susan Dowd Stone:
I am going to start at the end of beginning social support. Social support is the most basic form of treatment that is available in your community. This can consist of a mom-to-mom peer support group or a support group that may be led by a mental health practitioner with the goal not being therapy, the goal being to connect women to one another so they can see how each other is dealing.
Dr. Shoshana Bennett:
So education and support, you would put really top on the list. Is that what you’re saying?
Dr. Susan Dowd Stone:
Absolutely. When I was in Hackensack, before women would be discharged from the hospital, I would go around and invite the new mom and their babies to come to a new mother’s group. It was just a socialization group. They could come, have a cup of coffee, have some cookies, talk to one another, because Shoshana, I have found that women sometimes just need to tell their birth story.
Dr. Shoshana Bennett:
Yes.
Dr. Susan Dowd Stone:
And all of their stories are so unique. "This is what happened to me. This is how my child came into the world. This was what my experience was." And sometimes in the telling, the relief finds its way to the woman.
Dr. Shoshana Bennett:
You know, Susan, that is such a good point. It’s therapeutic, it’s not necessarily therapy per se, but it’s so therapeutic for the woman. There’s some healing that goes along, isn’t it? Just as you said with the telling of the story.
Dr. Susan Dowd Stone:
Right, it's so validating to share that with other women. We can go, "Oh yes, I didn’t know I was going to have a C-section either. I wish somebody had told me." And all of a sudden, you know, "This was what was happening, and I was reeled off to the operating room." And she wasn’t prepared for that.
So sometimes just reliving it, if it was at all traumatic, that can be extremely helpful. But for women who go beyond the baby blues, which is that period of weepiness and hyper-emotionality after pregnancy, after delivery, if those symptoms persist and worsen, then it may be time to go and get an evaluation.
Hopefully your obstetrician or your primary care physician could offer you a referral to someone who can give you a little evaluation which might include the Engberg postnatal depression screening scale.
All right, and that’s a very simply administered test of a few questions that are very key and extremely reliable in helping us find out what a woman is experiencing. Is it a more serious postpartum mood disorder?
Dr. Shoshana Bennett:
And where would you ideally, what would you suggest or who do you suggest the woman speaks to? Who should that referral be to?
Dr. Susan Dowd Stone:
Ideally, a practitioner who is trained in perinatal mood disorders. And as you know, Shoshana, with all the training and the effort that you have invested and that I have invested, this is a true specialty, and all the time you hear women who went to, who in good faith call their doctor, call their obstetrician, call their pediatrician, and as well meaning as all these healthcare practitioners are, they are not familiar sometimes with the nuances of how these disorders develop.
Dr. Shoshana Bennett:
Yes, and you know, Susan it’s very true what you’re saying. Often therapists, even very good therapists who are good with dealing with depression in general or anxiety in general, even women’s health in general, something falls short when it comes to the perinatal mood disorders. It really is a specialty.
Dr. Susan Dowd Stone:
It truly is. For example, I’ve had women come in whose symptoms ran more to anxiety than depression, and so they might have been told that they had an anxiety disorder, when really sometimes we know that an agitated depression is more common after delivery, and so the nuances of how a woman’s mood disorder may present can be very varied. Have you found that, Shoshana?
Dr. Shoshana Bennett:
Absolutely. With each woman who is experiencing a postpartum depression, she might feel different from the woman right next to her. So that way, everybody needs their own individual plan of action, don’t you think?
Dr. Susan Dowd Stone:
That’s exactly right.
Dr. Shoshana Bennett:
Because the puzzle pieces might be slightly different for each woman.
Dr. Susan Dowd Stone:
That’s right, you cannot make those comparisons, and clinicians need to be very sensitively attuned to those variations on the scene. The good news, however, is as long as we’re talking about treatment, is that these disorders are very easily treated once they are identified. So the sooner that they are identified, the sooner we can proceed with helping mom to feel better again.
Dr. Shoshana Bennett:
Which helps the entire family.
Dr. Susan Dowd Stone:
Yes.
Dr. Shoshana Bennett:
You are listening to "Mom’s Health Matters" with Dr. Shosh. For more information you can go to EmpowHer.com, you can certainly go to my website as well, which is drshosh.com and we have on the air with us Susan Stone who is the President of Postpartum Support International, a lecturer, an author, and she is here helping us understand more about the treatment of this very, very devastating disorder of postpartum depression.
So Susan, what else can you, you know, after the woman goes to a healthcare practitioner who she trusts and hopefully that person has some special education when it comes to the perinatal mood disorders, what else? What’s next?
Dr. Susan Dowd Stone:
And that’s so important that they get that education at any practitioner who would like to help women in the perinatal period. Go out of their way to find and take training courses to make them more aware of how these disorders may manifest.
Dr. Shoshana Bennett:
But say we’ve covered social support and peer-led groups that may exist in the community. The next thing may be if these aren’t offering physicians relief would be therapy, would be a referral to a practitioner, social worker, psychologist, psychiatrist in the area who is trained, trained in these disorders so that the woman can go in and get a more full evaluation. "Tell me what’s going on, how are you feeling, are you eating, are you sleeping?" And sometimes when women get the sleep that they need, some of these symptoms go away rather rapidly.
The sleep issue: isn’t that something in our society we take for granted that new moms aren’t going to sleep. I mean, what is with that? Who made that rule?
Dr. Shoshana Bennett:
It’s so ridiculous.
Dr. Susan Dowd Stone:
It is. I mean, sleep is a medical necessity. It is not a luxury, right? It’s a form of torture denying someone sleeping; it’s a form of torture. That unto itself can produce psychosis.
Dr. Shoshana Bennett:
Absolutely, yeah, that’s a great point. Thank you for bringing up the sleep issue.
Dr. Susan Dowd Stone:
All right, and along with that, good nutrition. Good nutrition for all new moms, breast-feeding moms, that’s very, very important. But again, tap someone you can talk to about your level of frustration, anger, sorrow, sadness, what you’re feeling, someone you can confide those feelings in who can help you understand that they are symptoms.
You, the woman, hasn’t changed. You’re not a bad mom, you’re a mom struggling with a disorder, and I believe as I know you do, Shoshana, in the medical model, just because we’re talking about mental health, all the same things apply. There are symptoms and there are treatments and when the treatments match the symptoms, relief can come fairly readily for most women.
So we’ve talked about therapy. If the therapy isn’t helpful, and I use cognitive behavioral therapy and interpersonal psychotherapy and DBT, these are all forms of therapy that help moms learn new skills.
Dr. Shoshana Bennett:
And DBT stands for, I am sorry Susan, could you let our listeners know what DBT stands for again?
Dr. Susan Dowd Stone:
Sure. Dialectical Behavior Therapy. These are all skills-based cognitive behavior therapy that help mom with skills. Say for example, there is an intrusive mother-in-law who is calling every 5 minutes, or you try to encourage your partner to help you more with job responsibilities, but you’re not used to being that assertive, you’re not used to laying down boundaries.
These can exacerbate a depression, if you have other psychosocial stresses in your life. So learning skills of how to manage these interpersonal relationships. How do you want to mother? You’re the one that’s in control here; you make the decisions about how to parent your child and when you want to eat and sleep, and empowering women again who are experiencing not only a major medical illness but are also entrusted with caring for newborn infants.
Dr. Shoshana Bennett:
Absolutely, you got the infant on top of that. It’s not like every, oh the world stops, and you can just focus on your issues. I mean, there is a little person to take care of.
Dr. Susan Dowd Stone:
There’s really no other time in our life when all of these factors collide at the same time. It’s quite a convergence of stressors. We wouldn’t ask someone who has just had their appendix out to care for a two-week old baby, would we?
Dr. Shoshana Bennett:
Exactly.
Dr. Susan Dowd Stone:
We wouldn’t expect them to do that alone, but women who are discharged in 48 hours with a caesarian section, how are they supposed to manage that? That is such a difficult task. So you can understand my point here is that all these psychosocial stressors can pile up and exacerbate what may be an underlying predisposition towards the mood disorder, depending on someone’s history.
You take a tire and you have a few bare areas on the tire, and you run that over a rough road, it’s going to get, you’re going to have a flat tire.
Dr. Shoshana Bennett:
I never heard that analogy. That’s a really good one. Susan, we are coming close to the end of this show. Is there anything else, I know we could do hours on this one topic, but is there anything in particular you would want to add regarding treatments or…
Dr. Susan Dowd Stone:
Yes, I certainly do.
Dr. Shoshana Bennett:
Okay.
Dr. Susan Dowd Stone:
What is established is a full range from depression to anxiety disorders to OCD bipolar disorders, all the way to psychosis, which fortunately is extremely rare, less than one percent, but for some women medication will offer the most and the quickest relief. And this is the decision to be made weighing the pros and cons of all the factors that are involved. And I encourage women to always look at the full spectrum of treatment options available and choose the one that works for them.
Dr. Shoshana Bennett:
Wonderful, Susan, and in other words, there is not a one size fits all. It’s whatever is working for you and whatever is best for working with your family unit. That’s what should be chosen, yes?
Dr. Susan Dowd Stone:
Yes, right, Shosh.
Dr. Shoshana Bennett:
Susan, thank you so much for joining us. Everyone, you’ve been listening to "Mom’s Health Matters" with Dr. Shosh. Thank you so much for tuning in today. You can go to EmpowHer.com for more information. You can certainly go to my website as well, drshosh.com. See you again next time.
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