Welcome back to part two of my interview with Dr. Thorne. Today Dr. Thorne goes into great detail about the beast that is postpartum depression including the risk factors and how to find the right therapist. The Risk Factors
The number one risk factor is having postpartum depression with a previous child. A big non-biological factor is husband or partner issues. Yet, most of my patients have great husbands and great babies which makes them feel even more guilty. I’ve had doctors say to me,” I never thought that one would get PPD.” Those are the ones that get it. Those type A, high functioning women. They are shocked because they’ve done everything right and achieved everything in life. I always say, if you are that personality type (and other personality types get PPD too), and this is to be understood and not judged, but those mechanisms and coping skills that you put in place got you this far in life--to be in control, to be organized, to do, to accomplish--they aren’t bad, they got you this far. But when that baby comes, those coping mechanisms don’t work anymore and you are emotionally naked. The baby is running the whole show. You can’t make a list and feel better. There can be a genetic component if you have mental illness in your family. Risk factors will be different for everyone. You can have one, three, or seven risk factors. It’s not one size fits all.
Talking to New Patients
I give each new patient a check list of various risk factors and the Edinburgh Postnatal Depression Scale to fill out. I look at the scores and responses and where they are on the spectrum and we go over it together. This takes the ownership off the patient and places it more on the risk factors. I let the mom know I’m not surprised at what’s going on because look at your risk factors. I always want to know if my patients have family and social support because so many couples move away from their support network when pregnant. It’s a huge risk factor even though it’s not the number one. This power couple is together, living their lives and doing great. So they think, we can move away because everything is wonderful. Then they do, have a baby and it’s like why did we move away. One baby is too much for two people. We need more. If we need to hire a tribe, make a family, then let’s do that. Some people have the funds and some don’t. 15 years ago I would have told you day care isn’t the best option. Today, I would tell you that’s your tribe if you need it to be--whatever you have to do.
Deciding Between the Baby Blues and Something More Serious
The textbook answer for when to call it a postpartum mood disorder is usually 10 – 14 days, but if the symptoms are excessive or severe even in those two weeks, you need to get them checked out. If you take the Edinburgh Postnatal Depression Scale and you score anything over a 10, you get checked out. What we want to do, and some doctors have started doing it at the six week check up, is follow up with the mother. Your answers on the Edinburgh while at the hospital can look very different from your answers once you’ve gone home or even at the three month mark. The environments are completely different and the support network has changed.
Postpartum Depression Manifesting Later On
PPD doesn’t have to hit right away. It can come months later and could also be triggered by something such as difficulty breastfeeding or even weaning, I treated a mom who lost her job and her baby was about a year old. She was stopping breastfeeding and lost her job at the same time. That was a huge trigger for her and it didn’t happen within the typical time period. Generally speaking, it can be diagnosed all the way up through the first year, but then after that it would be considered maternal depression or anxiety. I’ve had women come to me with their second one, both children are very close in age, and they feel like they’ve had PPD since their first one and never really got better or felt right.
How Long Postpartum Depression Lasts
I had this woman in yesterday who is brilliant. As a therapist, I like to ask, “What do you think?” So many of the brilliant, accomplished women I see want you to tell them what to do. A lot of these type A women coming in want to get better and just get it done They want to do A, B, and C, and then they will be better. It’s not just these women who suffer from PPD, but I say this because one of the most difficult things for these and all women with PPD is that they have done everything by the rules so they want you to say do this, this, and this, and then you will be better. It doesn’t always work that way and that’s the hardest part to understand.
I even remember 20 years ago coming home from the mall at 2pm so exhausted and I was so mad that I was that exhausted at 2 o’clock--that this is my new normal and feeling like this is horrible—that I’m going to be like this all the time. And It doesn’t make sense if you thought about it logically because you’re not going to be like that forever. Babies grow and change, but the feeling is so bad then that it’s too hard to think otherwise. I’ve had patients leave saying, "Dr. Thorne doesn’t know what she’s talking about. I’m never going to get better." I wish I could promise a certain length for recovery rather than a simple promise that you will better, but there are just so many variables and each woman is different.
Why Postpartum Depression Goes Untreated
If PPD goes untreated, you can get better, but it’s going to take much longer and there are things you might still have difficulty with. And who knows what will happen in that span to yourself, your family, and your baby. The biggest problem is that people don’t know what the symptomatology is. PPD is different. It's usually an agitated, anxious, irritable depression. People will tell others with typical depression to exercise, go out, get your nails or hair done, and you will feel better. No. It’s not that way with this. PPD is like any other sickness. Take pneumonia for example. We need to get you well first, then you can do those things. We need to first nurture mom. Get her healthy again and her head above water. The other difficulty is that you can have good days and bad days. It’s a very up and down disorder until you get better. The good thing is women are coming in earlier. 15 years ago women white knuckled it for eight months or longer--living with intrusive thoughts, etc.
Finding the Right Therapist
It’s so important to see the right person. PPD must be treated by a therapist who specializes in it because it is its own animal. Sometimes, women will go to three people before they get to me. You might often start with someone in your insurance network, but that doesn’t mean they are the best fit or a specialist. At our practice, The Prenatal and Postpartum Center of the Carolinas, there are four of us and we really try hard not to turn anyone away and do some pro-bono and sliding scale work. We can’t do it with everyone, but we have all made that commitment. Another thing I want to point out is that most of the psychiatrists and psychologists writing the books about PPD all had some form of it. Patients will also identify more with those who have experienced it too.
Join me Friday for the final part on our Interview. Dr. Thorne will be sharing all about the importance of therapy for treating postpartum depression and anxiety, what husbands and other family members can do to support mom, and how we can lessen the stigma surrounding this illness. Subscribe below so you don’t miss it!
BIO: Dr. Judith M. Thorne practices as a Licensed Clinical Psychologist in Charlotte, NC. She possesses an MA in Applied Psychology (1989), an MS in Applied Psychology (1993) and a Doctorate in Clinical Psychology (1997). She has served on the board of “NC depression after delivery”, has been a resource for “NC moms supporting moms” and has received certification from Postpartum Support International. Dr. Thorne has been in private practice for over 18 years, treating children, adolescents, adults and couples. Over the last 17 years, she has become an expert in perinatal anxiety, mood and psychotic disorders. She also treats those who have experienced infertility and loss. Dr. Thorne has taught at the University level, has conducted continuing education, appeared on local news to provide information and has acted as a supervisor to both psychologists and social workers. She personally experienced a postpartum adjustment after the birth of her first child and is passionate about helping others to navigate through this difficult experience.