Life after delivery: Q&A with Drs. Peter Alvarez and Diana Wilson on postpartum depression

Life after delivery: Q&A with Drs. Peter Alvarez and Diana Wilson on postpartum depression

WHEN A MOTHER brings home a new baby, regardless of whether or not it’s her first child, it is a very special time. Life after delivery is an important phase when mom and baby strengthen the foundation for a bond that lasts a lifetime. But like all phases of life, there are natural stress factors, which can lead to “baby blues,” or a more severe mental illness known as postpartum depression.

We asked two board-certified local obstetric and gynecologic physicians, Polk County Medical Association member Dr. Peter Alvarez of Women’s Care Florida Lakeland OB-GYN, as well as Dr. Diana Wilson of Watson Clinic’s Bella Vista Building, to share their experience in helping patients get through life after delivery with postpartum depression.

Central Florida Health News (CFHN): In your experience, what are some of the early signs of postpartum depression, and how do you address it with your patients?

DR. PETER ALVAREZ: Insomnia, lack of energy, loss of appetite, weight changes, irritability and anger, anxiety or panic attacks, feeling inadequate or unable to care for the new baby, feelings of shame or guilt, excessive crying spells, regression/avoidance from normal activities or family interactions, expressing desires to hurt self or baby. These signs or symptoms can occur any time before delivery, also.

DR. DIANA WILSON: Early signs of postpartum depression include feelings of sadness and possible anxiety to the point where they don’t want to engage in normal activities, such as going to the movies or out to dinner. There may also be crying. These symptoms can be characterized as postpartum blues during the first two weeks. If it continues beyond those two weeks, it’s considered postpartum depression.

I screen all postpartum patients and give them a handout at their follow-up visit; they usually come back in between four to six weeks post-delivery. A lot of patients may have a history of depression, and they are more prone to have postpartum depression.

CFHN: How can a family member and/or patient recognize the difference between the natural stress of bringing home a new baby and postpartum depression?

DR. ALVAREZ: Although many of these symptoms are common in all patients, if they last for more than two weeks or are exaggerated, then it may be cause for concern and the physician should be notified. For example, it is common to have insomnia postpartum, but an inability to sleep even while the baby sleeps would be abnormal. Any mention of wanting to harm baby or self should be addressed immediately.

DR. WILSON: Usually because the symptoms would last more than two weeks. After two weeks, she may get into a routine and feel like everything’s going to be okay. She could still be crying, lying around and not maintaining her normal hygiene. Family members would notice sadness, lethargy, and lack of interest in normal activities. They may have little or no interaction with the baby.

CFHN: Who is usually first to bring up postpartum depression in the patient/doctor relationship, and would you say it’s still considered somewhat taboo for a person to talk about?

DR. ALVAREZ: Yes, many patients still do not want to talk about it and fail to bring it up. Some fail to realize they have postpartum depression. On many occasions, it is the family who brings it to our attention. Therefore, in order to avoid missing a patient with postpartum depression, I recommend conducting a simple depression screening test for all patients. These are simple screening tools, which consist of only a few questions. They should be done at the postpartum visit, and I also recommend screening during the prenatal care.

DR. WILSON: I do have some patients that will call and say, ‘I need to see Dr. Wilson. I think I’m depressed.’ I don’t think it’s as taboo as it used to be. The media and newspapers have done a better job of educating people. I do see more people reaching out to get help.

CFHN: What are some of the most common treatments, and how greatly does the severity vary from patient to patient?

DR. ALVAREZ: Treatment depends on severity. Patients with mild depression may just need supportive care and counseling. More moderate forms may require antidepressant medication. They should be used cautiously because they do cross the breast milk and may affect the baby. More severe forms of depression/psychosis or suicide ideation will require hospitalization with intense therapy.

DR. WILSON: Sometimes there are antidepressant medications we can place the patient on. It is also important to see a psychiatrist or a psychologist as well. For nursing mothers, there are some types of medication we can try, but sometimes we have to wait. Or, a decision may be made to stop breastfeeding. It is very treatable. Antidepressants work very well. A lot of times short-term therapy is needed. Maybe the patient only needs two to three months, or sometimes longer. It varies.

CFHN: How can a spouse and/or family member be supportive of a mother going through postpartum depression?

DR. ALVAREZ: First, recognize the signs and symptoms of postpartum depression and notify us. If medical treatment is initiated, make sure the patient takes her medication. Assist in caring for the child and other siblings, thus giving the mother a break. They should not completely remove the mother from caring for the child, as bonding is important. Notify us if the patient mentions any desire to hurt self or others.

DR. WILSON: A loved one can help by listening and being aware of the signs and symptoms, validating the patient, and offering to go with them to seek help.

CFHN: In your medical experience, would you say that postpartum depression is more common than people would like to admit, or that awareness and transparency is making it easier to talk about?

DR. ALVAREZ: It is very common. Approximately 40 to 80 percent of postpartum patients will have some short form of mild depressive symptoms (the blues). Eight to 15 percent will have some form of full postpartum depression. That’s a big number. Definitely, over the past few years this topic has had much more exposure. Patients are more willing to talk about it and family members are looking out for it. However, many still go undiagnosed. That is why universal screening tools are recommended.

DR. WILSON: I think it’s a little bit of both. As we have more mothers that are working, and feeling the stress of working combined with the stress of coming home and taking care of the baby and family, there is more awareness. Some patients feel guilty about going to work, but they might talk to a coworker who could say, ‘Yes, I had postpartum depression as well.’

CFHN: What would be your advice to a mother who thinks she might be suffering from postpartum depression, but is anxious or afraid to reach out for help?

DR. ALVAREZ: She should talk to someone she trusts, such as a family member or close friend. Family members should be on the lookout for all the tell-tale symptoms mentioned above and alert us of any concern. For those mothers who are afraid to tell anyone and feel they have suicidal thoughts or desire to hurt the baby or others, they can anonymously call the national suicide hotline 1-800-273-8255 (www.suicidepreventionlifeline.org).

DR. WILSON: I would ask her to please reach out to her OB/GYN physician, because this is what we are here for. Or, they can go to any family member they feel comfortable with, or other new moms who may be sharing what they’re feeling. I let them know that it is very courageous for them to come in and ask for help. For more information, you may visit www.acog.com, the website for the American Congress of Obstetricians and Gynecologists.

CREDIT

CENTRAL FLORIDA HEALTH NEWS staff report

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