News & Interviews

AUSTIN (KXAN) — “Postpartum is like a slap in the face,” Georgetown mom Juliette Ferguson said.

Ferguson, a mom of three boys, said she was stunned after she had her first son. The anxiety was so bad she could not eat or sleep. It would manifest in anger or rage, and she remembers feeling aching loneliness.

“This should have been a massive red flag to myself, to my husband. I was standing in the living room. The baby was screaming, and I was having a time trying to console him. I called my husband, and I was screaming and crying ‘I can’t do this. I don’t know how to do this,'” she said.

One in seven women experiences some form of perinatal mood disorder and one in five experiences anxiety. Reproductive health expert Dr. Kristin Lasseter said it is crucial to tell someone what you are experiencing because untreated mental health issues during pregnancy and afterward can negatively impact the mom and the baby as well.

Ferguson shared her struggles with perinatal mood disorder to help other moms. She said she remembers that time being completely isolating.

Research shows untreated mental unrest can impact the baby’s growth and development inside the womb and later on. Babies have a greater risk of developmental disorders and medical disorders. They can also have a higher risk for autism and struggle with motor development.

Lasseter said moms-to-be can safely take certain medications and they should seek out treatment or tell a doctor should they experience depression or anxiety.

Lasseter said she tends to see women experience perinatal mood disorder during the third trimester. She said depression can look like irritability, being sad, and affecting one’s ability to concentrate.

“Anxiety can be a lot of worrying and sometimes people don’t even realize they are anxious because they don’t feel depressed and they think perinatal mood disorders are just about depression,” Lasseter said. She goes on to explain how anxiety is very real and not screened as often as depression.

For Ferguson, just talking about this could change lives.

“I think it’s important to talk about it so it becomes destigmatized. It doesn’t mean you don’t love your baby. There’s so many women and mothers who have experienced these things and feel that they are alone,” Ferguson said.

According to a new report, nearly every state in the U.S. Is failing mothers who need access to mental health care. And experts warn it could get worse as more states restrict or ban abortions. The report shows all but ten states got a D or F on maternal mental health. The highest grade was a B minus, only one state got that great, California. The report card by the policy center for the maternal health looked at three points. Providers and programs, screenings and screening reimbursement, and insurance coverage and payment. Doctor Kristin Lassiter is a reproductive psychiatrist and specializes it maternal mental health. She's joining me now. Dr. Lassiter, really appreciate your time, this is such an important conversation, one that is probably not being had enough. I'm sure you're not surprised, because I'm not. Knowing very well the state of maternal death rates in our country

Other Places to listen: iTunes, Spotify

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In this episode, Dr. David Puder, Dr. Kristin Lasseter, and medical student Cara Jacobson discuss treatment of psychiatric illness in the peripartum period.

Dr. Kristin Yeung Lasseter is a renowned reproductive psychiatrist who has dedicated her career to the intersection of mental health and reproductive medicine. 

As the founder of Reproductive Psychiatry and Counseling, Dr. Lasseter has been instrumental in expanding access to reproductive psychiatry services in Texas but also worldwide through her teaching and online presence. Through her steadfast devotion to comprehending the singular hurdles faced by individuals as they navigate the reproductive journey, she has garnered immense respect within the field.

Dr. Kristin Yeung Lasseter's profound contributions to advancing women's mental health in Central Texas have been recognized through the prestigious Association of Women Psychiatrists Symonds Fellowship in 2018. Through her expertise, compassion, and advocacy, she is transforming lives and dismantling the stigma associated with perinatal mental health.

Of note, this episode, and the article below is for information purposes only and we recommend talking with a specialist doctor when considering what is the risk and benefits of particular medications in an individual's specific situation. 

Stephanie speaks with Dr. Kristin Lasseter on Perinatal Mental Health including taking medications while pregnant and breastfeeding. Kristin Lasseter, MD graduated cum laude from Southwestern University with a Bachelors of Science in Biology prior to attending medical school at the Long School of Medicine at the University of Texas Health Science Center in San Antonio. Dr. Lasseter excelled in medical school and was awarded membership into the prestigious Alpha Omega Alpha Medical Honor Society. After receiving her Medical Degree, she completed Psychiatry residency at Dell Medical School at The University of Texas at Austin where she served as Chief Resident. She additionally spent time training in Reproductive Psychiatry at Baylor College of Medicine in Houston prior to starting Austin's first Women's Psychiatry clinic in her fourth year of residency. After graduating residency training, Dr. Lasseter started the Reproductive Psychiatry Clinic of Austin. She also serves as the Medical Director of Pregnancy and Postpartum Health Alliance of Texas, and is the director of perinatal psychiatric consultation services at St. David’s North Austin Women’s Center. In 2018, Dr. Lasseter was awarded the Association of Women Psychiatrists Symonds Fellowship for her efforts and dedication to advancing Women's Mental Health in Central Texas.

On this episode, we speak with Dr. Kristin Yeung Lasseter, a reproductive psychiatrist based in Texas.  Listen today to learn about preparing for pregnancy with anxiety and depression.  You'll learn how to know if you may have anxiety or depression, which treatment options are available, and which medications you can use during pregnancy.  You can find Dr. Lasseter on her website, on Twitter @therepropsych, and on Instagram @the.reproductive.psychiatrist.

Save $50 off when you order your preconception tests today at www.preconceptiontest.com with promo code PODCAST.

Connect with us!  Instagram: @preconceptiontest | Website: preconceptiontest.com |  Email: podcast@preconceptiontest.com

The information provided in this podcast is for educational purposes only and should not be interpreted as medical advice. Please speak with your healthcare provider to learn more about your health before pregnancy.

1 in 3 new parents report their birth as traumatic. This leaves a tremendous amount of new parents adjusting to new parenthood while also overcoming an emotionally traumatizing event. Sometimes the healing is never resolved and subsequent pregnancies and births can bring up past traumatic feelings. T

his week’s episode of Yoga|Birth|Babies was inspired by conversations within our community. Students spoke up about the wounds they carried and their concerns of repeating a challenging birth.  Kristin Lasseter, Board-Certified Psychiatrist who specializes in Reproductive Psychiatry and Women’s Mental Health helps address how healing can begin. She also shares primary symptoms that may arise that can indicate birth trauma as well as ways to mourn the vision of the birth that didn’t happen.

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. To find a therapist near you, check out psychologytoday.com.

Written By Kristin Lasseter MD

There’s a pesky little myth floating around in our culture that if a woman starts a medication for treatment of postpartum depression or postpartum anxiety, then she must take it for the rest of her life.

That’s so false.

In reality, many women who suffer from postpartum mental illness, end up continuing their medication for many years later because it has helped them to feel so much better. I’ve heard from countless patients that they didn’t even realize how anxious or irritable they were until they got on medication. Many come to realize they’ve always had some underlying anxiety that they were not aware of until the medication resolved those symptoms.

Let’s get back to the point though - when can you stop a medication?

Most psychiatric medications work at a biochemical level to help heal the cells in your brain. What I mean by that, is they help neurons form new connections with each other (called synapses), and help them to improve the way they are communicating with each other (using neurotransmitters and receptors). As you can imagine, this complex healing doesn’t happen overnight. Think of your brain cells like plants. They need nourishment to thrive and grow. Psychiatric medications for our neurons are similar to nutrients for plants. They need to watered and given nutrients on a regular and frequent basis to thrive until their roots are fully established.

Once a brain is healthy again, and someone is feeling back to normal, then the clock starts. From that point, until around 9 months, it is important to continue the medication. This helps solidify the healing that has happened with the neurons so that they don’t easily fall back into the old pattern. After someone has been on the medication for about 9 months, then they can discuss with their psychiatrist if it is the right time to taper off of the medication slowly - usually over a period of a month or so.

Ideally, it is best to taper the medication during a time of relatively little stress or major changes. This is because stress hormones have major impacts on our neurons, and have a propensity to disrupt the biochemical reactions that are going on in our brain and the signaling that is happening between our neurons. A brain that has had more time to heal though, can handle these fluctuations easier than a brain that is still trying to regrow those roots.

The decision to come off of psychiatric medications after postpartum mental illness is a very personal one though. It needs to be a well thought out discussion between a woman and her psychiatrist, taking into account how many episodes of depression or anxiety she has had in the past, how severe those episodes have been, what stressors are currently going on in her life, and the other ways to help maintain a healthy brain.

It is important to know that the more episodes of mental illness someone’s brain goes through, the easier it is for their brain to fall back into that illness. For some people, they have had multiple episodes before, so it is almost a guarantee they will suffer from more episodes in the future. The risks of episodes can be very high and detrimental, not only for the person, but for their children and their family. These risks need to be weighed against the actual risks of the medication they are on. The environment that a child is developing in is key to their own future wellness. Research has shown us that children who grow up with a parent with mental illness are more likely to suffer from mental illness and physical illness, independent of genetics. It is hard to take care of the people in our lives who depend on us and give them the best environment to thrive in if we’re not taking care of ourselves first.

I would like to add one more food for thought. I hear a lot of concerns about the emotional and psychological meaning of being on psychiatric medications from people. Sometimes it’s a pressure that people put on themselves - they should be strong enough without medication or learn to manage life without medication. Sometimes it is influenced by family members who are fearful of medications - maybe they’re bad for your health or will shorten your lifespan. Then there is also the stigma of being on psychiatric medications. These fears, concerns and emotions should be discussed openly with a psychiatrist or therapist, but it’s also important to try and challenge thoughts that have no evidence to support them. Mental illness is no different from other illnesses that occur in the other organs in our body. We don’t shame people who have diabetes and require insulin because their pancreas doesn’t function properly. There are always lifestyle changes that can help improve the health of our body, but sometimes that isn’t enough. Being on medication doesn’t mean someone failed or didn’t try hard enough to wish the illness away. It just means their body needs a little help getting back to being healthy.

Written By Kristin Lasseter MD

We used to use barbaric measures to perform surgeries on people. Similar to surgical procedures though, ECT, or shock therapy, has evolved into a safe and effective treatment in modern medicine.

I recall the first time that I saw a patient get electroconvulsive therapy, or ECT. It is so vivid in my memory not because it was anything to remember, but because it was so uneventful.

The patient came in and laid down on the hospital bed. The psychiatrist asked how much his mood was improving. The anesthesiologist started an IV. The respiratory therapist gave him some oxygen, and then the patient went to sleep and his body completely relaxed. The nurse took two electrodes and placed it on the right side of the patient’s head. The psychiatrist pushed a button, and then the patient's foot started twitching for less than a minute while the rest of his body remained still. The nurse took off the electrodes and a few minutes later the patient woke up.

I specifically remember asking, “it’s already done?” It was almost as if nothing happened.

Why does ECT, or “shock therapy,” have such a bad stigma around it? At that point in my medical career, I had been a physician for 2 years. Shouldn’t I have been educated enough by then to know what ECT was really like? How can we expect the general public to have an accurate understanding of ECT if we’re not even teaching medical students and physicians about it? Shock therapy originally got a bad reputation when it first came out because large amounts of electrical current were used in the procedure, and anesthesia and muscle relaxants were not used. That was a long time ago though. Since then, ECT has become way more advanced. It’s similar to surgical procedures - in the old days, surgeries were done with kitchen utensils without any anesthesia or antibiotics. Luckily, medicine has come a long way.

Here are some facts about ECT (no hype or drama):

• It is 10 times safer than childbirth.

• It induces a brief seizure, usually lasting less than 1 minute.

• The entire procedure takes about 5-10 minutes, and recovery is about 15-20 minutes.

• This seizure activity in the brain creates proteins that help neurons form new connections and improve their ability to function normally.

• A muscle relaxant is given in the IV so the patient remains completely relaxed during the treatment.

• Anesthetic is given in the IV, so the patient is briefly asleep during the treatment.

• It is the most effective treatment available for depression.

• It is a safer alternative to medications, and is often used in people who cannot or do not want to take medications, such as pregnant women and elderly.

• It typically consists of 2-3 treatments a week, and most people feel dramatically better within 1-2 weeks of starting treatment.

The side effects of ECT are pretty small when you’re comparing it to the long list of side effects that usually accompanies medication treatment. Side effects often only occur right after the procedure, and can include:

• Muscle aches

• Nausea

• Headaches

• Brief confusion

• Memory loss

• High blood pressure or fast heart rate

Probably the most bothersome risk factor is memory loss, so I’d like to take a moment to discuss what this is usually like during ECT. Most of the time, someone receiving ECT cannot form memories as well as they usually can while they are receiving treatment. Sometimes ECT will also cause someone to forget events that may have happened in the weeks or months before they started treatment. In the vast majority of patients, memory loss improves once they have finished ECT or within the first few months after.

There is no evidence showing that ECT causes any kind of brain damage, in fact there is substantial scientific evidence showing it does the opposite.

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References

1. Mayo Clinic. Electroconvulsive Therapy (ECT). Retrieved from https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894

1. McClean Hospital. (2020, August 21). Why ECT Is Becoming a Preferred Depression Treatment. Retrieved from https://www.mcleanhospital.org/essential/ect-shouldnt-be-last-resort-treatment

1. Riley, A. (2018, May 3). The surprising benefits of electroconvulsive therapy. Retrieved from https://www.bbc.com/future/article/20180502-the-surprising-benefits-of-electroshock-therapy-or-ect

1. Sane Australia. (2018, March 2). Electroconvulsive Therapy (ECT). Retrieved from https://www.sane.org/information-stories/facts-and-guides/electroconvulsive-therapy-ect

1. Seiner, SJ. (2017, December 1). Spreading the Truth about ECT: Facts Help Break Down Stigma Against This Important Depression Treatment. Retrieved from https://www.mcleanhospital.org/essential/spreading-truth-about-ect-facts-help-break-down-stigma-against-important-depression

If you feel like you have no energy, the sound of your little one crying is like nails on a chalkboard, and you switch from sad to angry in a matter of seconds, you may start to wonder if you're experiencing more than just a tough day of motherhood. Parental burnout in toddler moms is a real thing, but it can easily be brushed off as just a rough stretch of parenting. There are dangers of letting burnout linger, but, thankfully, there are also ways to get out of it.

Therapist Nicole Grocki tells Romper that, while "'burnout' isn't a clinical term," it's a way to describe "persistent feelings of stress with little to no breaks." Mothers often go through periods of feeling this way, but this is particularly true for moms of toddlers because "toddlers are constantly on the go" and "emotionally volatile," which can leave a mom feeling "exhausted by [their] mood swings," Licensed Professional Counselor Kirsten Brunner tells Romper.

"There are three main components of parental burnout," says psychiatrist Kristin Lasseter, M.D., "physical and mental exhaustion, emotionally distancing yourself from your child, and feeling incompetent as a parent." As psychotherpaist Kellie Wicklund tells Romper, two of those aspects are present in everyday life when parenting a toddler because tots "are in profoundly dynamic developmental growth, and parenting them requires deep energy reserves that many moms find themselves lacking." Interestingly, burnout can look a lot like postpartum depression, according to Dr. Lasseter, but if the child is over 18 months of age, "the depression is specifically surrounding the mom's role as a parent rather than a more generalized depression."

This type of burnout can happen to any parent at any time, but the toddler years are particularly risky. In order for a mom to take care of herself, and, in turn, provide the best care for her little one, it's important to understand what burnout looks like, what contributes to it, and how to avoid it or manage it when it arises.

1. Common Symptoms

Every mom is tired, but Brunner says those experiencing burnout display physical symptoms of "absolute exhaustion and depletion" such as slumped shoulders or "dark circles under their eyes." A burned-out mom may also look disheveled, like she's not taking care of herself. Grocki notes that this "lack of self-care" could be because she "either has no time or no desire to do so".

In general, burnout symptoms tend to be more behavioral than physical. A burned-out mom may be impatient, and Brunner says she's seen patients "expressing anger or even rage more frequently." She adds that moms experiencing burnout can sometimes be "more tearful, quite emotional" or, on the opposite end, "their emotions are blunted or flat."

Some other behaviors a burned-out mom may display, according to Grocki, are socially withdrawing, an inability to concentrate or make decisions, appetite change (increase or decrease), inability to cope with life's challenges, and just generally not acting/feeling like themselves. Additionally, Wicklund warns that "anxiety and depression can begin to emerge when the output of energy goes on for too long in a state of imbalance."

2. Contributing Factors

The most obvious answer to what contributes to parental burnout would be "the kids," but it's actually a bit more complex than that. Dr. Lasseter says this type of burnout occurs when a "parent [has] too many demands placed on them without enough resources to handle those demands."

"It is often linked to moms who have given too much of themselves to parenting for too long," she continues. "They've become in charge of everything related to their children. This usually stems from a desire to do everything perfectly and be the perfect parent for their children."

Brunner says it's easy to understand why a mom may feel like she needs to do everything perfectly, because she is constantly hearing the "societal message that [she] can, and should, do it all." That narrative only adds to the external factors Wicklund mentions, like a lack of "job flexibility, affordable and high-quality daycare, and family support." Finally, Grocki adds that a "history of mental health issues" like anxiety or depression can also contribute to the development of burnout.

3. Warning Signs

Self-awareness is key to seeing the warning signs of burnout in yourself. You may be inching closer to burnout if you notice you have been "feeling physically exhausted, overwhelmed, less patient with [your] kids, or enjoying parenting less," according to Brunner. Dr. Lasseter reiterates these signs, but also adds that in addition to simply not enjoying parenting as much, you may also notice yourself becoming "more emotionally distant with your children."

4. Risks For Moms Of Toddlers

Parental burnout can happen to any mom (or dad) no matter how old their kids are. However, the toddler years stand out because, as Wicklund explains, "Toddlers are irrepressible and caring for them is relentless. They have plenty of physical abilities, and no good judgement about danger or risk." Dr. Lasseter adds, "They demand a lot from us physically, and demand a lot of emotional attention. They need help doing nearly everything."

Most of the demands toddlers put on their parents have everything to do with their development. "They really want to be more independent but they are still incredibly dependent on their parents," Brunner says. "This creates a constant push and pull — they want to do it themselves, but they really need your help" (any mom who has tried to put a toddler in a car seat can certainly relate to this).

There is also a lot of emotional development happening during the toddler years. "They can't quite express their own needs or desires well yet, so they get easily frustrated and throw tantrums, which can be emotionally and physically difficult on parents," Dr. Lasseter notes. Tantrums are hard enough for parents to deal with, but on top of that, Brunner points out that raising toddlers also means dealing with "night wakings, potty training, and separation anxiety." She explains that all of these factors leave mom in a constant state of "on the go," so it's difficult to simply "sit and enjoy a meal or watch a TV show."

5. How Burnout Is Different For Toddler Moms

The core symptoms and behaviors of parental burnout are similar no matter the age of the child. But, there are additional symptoms/behaviors moms might display in the toddler years. Brunner says a toddler mom could "look for ways to avoid time with her child" or rely on "TV or other devices" more frequently to keep her kid busy. She might even "dread spending long stretches of time" with their toddler.

Grocki adds that toddler moms "may have difficulty setting and maintaining limits," and Dr. Lasseter says they "can become less affectionate, less understand, and less loving" of their child. In more extreme cases, Dr. Lasseter warns that "moms suffering from burnout can also be more neglectful and violent."

6. What To Do If You're Burned Out

Whether you're noticing yourself slipping into a state of parental burnout or you're already there and have been for a while, there are some things you can do to help yourself cope and, ultimately, get out of it. Each expert agrees that one of the best things a burned-out mom can do is seek help, whether it's from their partner, friends, family, or a professional. Some additional things Brunner suggests include finding a way to be around adults (particularly for extroverts) and getting some quiet alone time (especially for introverts). Grocki recommends making time for self care and doing whatever it takes to get a break. Finally, Dr. Lasseter says "it is important to set more realistic and lower goals as a parent, and to be more gentle and kind to yourself." She also encourages moms to seek treatment which "should include therapy and may even include medication."

The hardest part about parental burnout for a mom is that if there were time for things like self-care and alone time, she probably wouldn't be burned-out in the first place. It's perfectly understandable, given all of the challenges toddlers give their moms, but all of the experts agree that reaching the point of total burn-out puts a mom at risk of developing (or worsening) depression. It's important to seek help from the people who love you and/or a medical professional if things just aren't getting better.

Experts:

Kirsten Brunner, MA, LPC, Perinatal Mental Health Specialist based in Austin, TX and Author of the blog Baby Proofed Parents
Nicole Grocki, MS, LMFT, Clinical Therapist & Perinatal Specialist at Maternal Wellness Services
Kristin Lasseter, M.D., Psychiatrist at the Reproductive Psychiatry Clinic of Austin
Kellie Wicklund, MA, NCP, LPC, Licensed Psychotherapist, Owner, & Clinical Director of Maternal Wellness Center‍

This article was originally published on Jan. 13, 2020

Written By Kristin Lasseter MD

This is a common question I get from my patients, and it’s a great opportunity to talk about postpartum depression.

Our culture has been trending more towards being compassionate and accepting of those struggling with postpartum depression. I think this shift can be attributed to all of the people, including celebrities, who have been forthcoming and open to others about their illness. Afterall, roughly 1 in 5 women suffer from some form of perinatal mental illness, and it is an issue that spans across countries, cultures, religions, socioeconomic statuses and even genders.

How does someone know when it is postpartum depression versus depression that occurs at other times though?

The clinical term for actively experiencing depression is called a major depressive episode, or MDE. Once someone has met clinical criteria for one MDE, they are classified as having either Major Depressive Disorder or Bipolar Affective Disorder. In other words, MDE’s occur in different types of mental illnesses. Postpartum depression is a form of a MDE that is specific to the postpartum period. A MDE can be classified as postpartum depression if it starts anywhere between the time of delivery to 12 months postpartum, generally, depending on the reference (some sources say only up to 4 weeks postpartum, whereas others say up to 2 years postpartum). Most commonly, postpartum depression starts around 3-4 months after delivery though. In other words, postpartum depression only earns its name because of the timing of the episode’s onset. The symptoms are not necessarily different or unique to what depression is like in other times of a person’s life, and the best, most effective treatments are also the same. A 2020 research study by Putnick et al. in the journal, Pediatrics, found that a postpartum depression can last up to 3 years after delivery if it goes untreated. This is about the same for a MDE that occurs in other times of life. The negative impact that postpartum depression has on a developing baby, on one’s own body and on society is why it is so important to treat.

Besides timing of onset, the cause of postpartum depression is another factor that can make it unique. Female reproductive hormones change dramatically following delivery of a baby and placenta, which causes a chain reaction to other hormones and systems in the body that is not seen in any other time of life. These hormones have direct effects on the brain and neurotransmitters, especially those neurotransmitters and parts of the brain involved in emotional regulation. Research has provided evidence that there is a subset of women whose brains and neurological systems are particularly vulnerable to female reproductive hormonal changes. These women may never experience another episode of depression outside of the postpartum period, but may be more vulnerable to times of other reproductive hormonal changes, such as around menopause.

The postpartum time is a “perfect storm” for mental illness, not only because of the impact of reproductive hormonal changes, but also because of other extreme stressors. Physically, a person’s body has higher inflammation postpartum because of childbirth. People are also sleep deprived, which increases risk of mental illness, and they are going through the major stress of adapting to life with a new baby. Major stresses, in general, also increase the risk of mental illness due to the way that cortisol levels change. Having a new baby makes arguably one of the highest levels of stress during a lifetime.

Hormonal changes, and other changes in our body after childbirth, or even during times of stress are normal. This is how we adapt to change and how the body helps us get through stress. Depending on genetics and the environment, some people are more vulnerable to mental illness than others, or are more vulnerable at particular times of their life than at other times.

This is why optimizing physical and mental wellness around pregnancy and postpartum is so important in preventing mental illness. Check out our article on The Top 5 Natural Ways to Prevent Postpartum Depression.

Having trouble sleeping? While a melatonin supplement might be tempting, there are other options to consider.

Having insomnia is challenging enough on its own, but having insomnia while pregnant is a whole new ballgame. Between tossing and turning to find a comfortable sleeping position with your ever-growing belly and constantly getting woken up by heartburn or kicks to your abdomen by an active fetus, we don’t blame you for trying to find a solution to get those ultra-important ZZZs.

Melatonin supplements are a common remedy for sleeplessness, but don’t run to the drugstore just yet. Read on to learn more about the safety of supplemental melatonin during pregnancy as well as other options that can help you get the sleep you (desperately) need.

Are Melatonin Supplements Safe During Pregnancy?

The short answer: we don’t know. The safety of any medication taken during pregnancy is determined by thorough research, and the research of melatonin supplements is still ongoing, so scientists and doctors don’t have enough information yet about the effects it can have on a developing fetus.

You probably know that your brain produces melatonin naturally to regulate your body’s ability to sleep and be awake, but if it doesn’t produce enough, a melatonin supplement is sometimes appropriate to get your brain back to the levels it needs.

So how exactly does a melatonin supplement affect your natural melatonin levels? “When taken as a supplement,” says Dr. Kristin Lasseter, reproductive psychiatrist at Clinic of Austin and co-host of the WomenWell online community, “this changes the normal amount naturally found in the body to levels up to twenty times higher. We don’t know what unnaturally high amounts of this hormone do to a baby or to a pregnancy though.”

Researchers do know that developing fetuses’ brains actually take in some of your natural melatonin as it crosses the placenta, Dr. Lasseter explains, and “there are certain times during the pregnancy when melatonin levels are naturally higher, such as the third trimester, indicating that it likely plays a very important role in the pregnancy and baby’s development.”

Melatonin and Breastfeeding

Just like how your naturally produced melatonin crosses the placenta to your baby, it also passes through breast milk, which is good news if you’re nursing or planning to nurse, since “[it] is believed to help develop and regulate the infant’s sleep-wake cycle,” Dr. Lasseter says. However, just like with pregnancy, there isn’t enough information on whether taking a melatonin supplement while breastfeeding is safe for baby.

Insomnia Treatments That Are Safe for Pregnancy

“It should be noted that treating insomnia, or sleep disruptions, in pregnancy is really important since insomnia during the pregnancy comes with its own set of risks, including postpartum depression and anxiety,” Dr. Lasseter says. And since melatonin supplements and other sleep aids aren’t proven safe for pregnancy, it’s a good idea to be familiar with the other available treatment options:

• Safest and most effective: Cognitive Behavioral Therapy for Insomnia, or CBT-I (either with a therapist or with a self-guided online program)
• Most widely-studied medication: Doxylamine (found over-the-counter and is also used to treat nausea)
• Alternative wellness options: Yoga, mindfulness meditation, acupuncture

Note: As with any treatment during pregnancy, talk to your provider/ob-gyn about which options are best for you in your unique pregnancy.

If you experience depression, anxiety or other mental health concerns, taking care of yourself is key, and sometimes that can mean getting treatment with antidepressants. But what if you’re pregnant or planning to become pregnant?

It’s totally understandable if you’re being extra aware (and maybe a little cautious) of what you’re consuming while pregnant, and medication is no exception. But taking care of your mental health is important whether it’s before, during or after pregnancy.

If you’re not sure about how antidepressants might affect you or your baby, read on to find out what medical doctors have to say about starting or continuing mental health medication during pregnancy.

Are Antidepressants Safe During Pregnancy?

When it comes to taking any kind of medication during pregnancy, explains Dr. Kristin Lasseter, reproductive psychiatrist at Clinic of Austin and co-host of the WomenWell online community, the important thing to understand is that, in some cases, the amount of medication that baby is exposed to in the womb actually has fewer risks for baby than exposure to the pregnant parent’s untreated illness.

Another thing to keep in mind is that, as medications are tested for use during pregnancy, rather than medications being deemed “safe,” what you’ll see instead is the potential risk level—for example, the lowest-risk medications (known as Category A drugs) will be labeled something like “failed to demonstrate a risk to the fetus” or “no evidence of risk.”

Risk Level of Antidepressants During Pregnancy

As far as severe birth defects, “evidence shows no increased risk of miscarriage, congenital malformations or neurodevelopmental effects later in life with use of antidepressants in pregnancy,” Dr. Lasseter says.

Studies on the most common antidepressants taken during pregnancy—SSRIs (selective serotonin reuptake inhibitors) like Prozac (fluoxetine), Zoloft (sertraline) and Paxil (paroxetine)—seem to show low risk overall. “Some data suggests that these medications may be associated with an increased risk of certain birth defects. However, the absolute risk seems to be low (approximately 1%),” says Dr. Nathan Fox, ob-gyn, creator of the Healthful Woman podcast and Babylist Health Advisory Board member. “Furthermore, it is difficult to know if the small increase seen in birth defects is related to the medication itself or due to other underlying risk factors in the women or increased surveillance in their babies for minor birth defects. For this reason, it is very important to balance the possible risk of these medications with the risk to maternal mental health of stopping them.”

What birth defects, exactly? “The most commonly seen issue is neonatal adaptation syndrome,” says Dr. Lasseter, “which is when a baby has a more difficult time adapting to life outside of the womb than normal.” While doctors and researchers don’t know whether the baby’s difficulty adapting has to do with withdrawal from the medication or from exposure to the SSRI in general, here’s what they do know about neonatal adaptation syndrome: one study found that it affects about one-third of babies exposed to SSRIs in the third trimester, and while it does show up within the first few hours after birth and can include symptoms like irritability, restlessness, respiratory distress and difficulty eating, cases are typically mild and disappear within two to three weeks (skin-to-skin contact has been shown to be effective at reducing symptoms).

Risk Level of Untreated Mental Health Concerns

But if you’ve been taking antidepressants for any period of time before getting pregnant, and going off that medication puts your mental health at risk, your doctor will usually recommend that you stay on your medication while pregnant, says Dr. Fox. It’s important to understand that stopping antidepressants can increase your risk of relapse of major depression or anxiety, which can carry their own risk to the pregnancy.

Untreated maternal mental health issues have been related to premature birth and low birth rate as well as child developmental issues like emotional and behavioral self-regulation, Dr. Lasseter says. The most important point: Taking care of baby starts with taking care of you, and that includes your mental health.

Stopping Antidepressants While Pregnant

If you decide you’d rather go medication-free during your pregnancy, you need to talk to your health care team before making any changes to your medication schedule. In fact, any changes in your medication should be made under the supervision of your psychiatrist, says Dr. Fox.

Why the supervision? “Pregnancy is a high-risk time for mental illness symptoms to appear or recur,” Dr. Lasseter says, citing a 2006 study that found that, “among the 201 women in the sample, 86 (43%) experienced a relapse of major depression during pregnancy. Among the 82 women who maintained their medication throughout their pregnancy, 21 (26%) relapsed compared with 44 (68%) of the 65 women who discontinued medication.”

The risk of relapse increases further during the postpartum period, Dr. Lasseter continues, with postpartum depression and postpartum anxiety often appearing if mental health concerns were present during pregnancy.

If you’re concerned about dosage, rest assured that your doctor will likely recommend that you stay on your current dosage as long as it’s working for you. “Research shows [the risks of antidepressants during pregnancy] are independent of the dose of the medication,” Dr. Lasseter says, and it’s safer to continue whatever dosage eliminates your symptoms than to reduce your dosage and experience symptoms as a result.

Other Options for Prenatal Mental Health Treatment

Whether you’re not on antidepressants at all or you’re taking antidepressants prior to getting pregnant and your healthcare team gives the okay for your pharmaceutical treatment to stop, there are other non-medicated options to care for your mental health during pregnancy (but keep in mind that you should still consult your healthcare provider before trying any of these treatments):

• Psychotherapy: Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) are the two types of therapy with the most evidence for treating mental illness during pregnancy
• Increasing social support
• Mindfulness meditation
• Yoga
• Massage therapy
• Acupuncture
• Getting plenty of high-quality sleep
• Eating healthy foods

What about supplements, especially those that claim to be mood boosters? “While many people believe that ‘natural’ treatments like herbs and supplements are ‘safe’,” Dr. Lasseter says, “the reality is these substances are mostly experimental with very little research about their safety to the baby in pregnancy.”

So it’s recommended that they be avoided during pregnancy unless fully backed by quality research on the safety to developing fetuses and pregnant people, specifically.

Taking Antidepressants While Breastfeeding

If you’re planning to continue, start or restart treatment with antidepressants during the postpartum period, whether or not you nurse or pump is something to consider.

Dr. Lasseter tells us that exposure to antidepressants through breastmilk can result in mild side effects like drowsiness or irritability, but the medication “is secreted in very minimal amounts in breastmilk, [so] these side effects are typically rare and the majority of babies have no issues” when nursing or being bottle-fed pumped breastmilk.

The Key Takeaway:

Taking care of your mental health is extremely important no matter what stage of pregnancy or postpartum you’re in. If your mental health is a concern, there’s no need to go without treatment while pregnant.

If you’re considering taking antidepressants during pregnancy, talk to your healthcare provider to see if it’s the right treatment option for you. But if you’d rather not take medication while you’re expecting a baby, there are other non-medication treatments you can also discuss with your provider.

No matter how you care for your mental health during pregnancy, reducing any symptoms of depression and anxiety will help both you and baby.

Kristin Yeung Lasseter, MD, Founder and President, Reproductive Psychiatry Clinic of Austin, Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, Dell Medical School at The University of Texas at Austin, presented a session titled “Mood Disorders Related to the Menstrual Cycle” at this weekend’s Psych Congress in San Antonio, Texas. Her session explored the research supporting neurohormonal influences of cognitive and emotional symptoms that can arise premenstrually and discussed evidence-based treatments for premenstrual dysphoric disorder.

In this Q&A she expands on her session and talks key takeaways for clinicians.

Question: What are the key differences between premenstrual dysphoric disorder (PMDD) and premenstrual exacerbation of underlying mood or anxiety disorders that clinicians should be aware of?

Answer: The key difference between PMDD and premenstrual exacerbation (PME) of underlying mental illness is the persistence of symptoms, even if only mild, after the menstrual cycle. Specifically, in PMDD symptoms improve once the menstrual cycle starts, and are absent in the week after the menstrual cycle. With PME of mental illness though, symptoms can still be present throughout the menstrual cycle and become more severe or distressing in the week or two before the start of the next menstrual cycle. The most common misdiagnosis of PMDD is actually due to premenstrual exacerbation of another underlying mental illness, which is why using a diagnostic tool is required for PMDD assessment.

Q: What diagnostic tools are available for clinicians to utilize when diagnosing PMDD?

A: The most commonly used diagnostic tool for PMDD is the DRSP, or Daily Record of Severity of Problems. Other tools available include, Visual Analogue Scales for Premenstrual Mood Symptoms, Premenstrual Tension Syndrome Rating Scale, Calendar of Premenstrual Experiences, and the Premenstrual Assessment Form.

Q: What is the “gold standard” evidence-based treatment for PMDD?

A: The first-line, evidence-based treatment for PMDD is an SSRI, specifically sertraline, fluoxetine, paroxetine, citalopram, or escitalopram.

Q: Are there any misconceptions on this topic that you would like to clear up?

A: Despite what many believe, PMDD has not been shown to be related to abnormal hormone levels. In fact, patients with PMDD are indistinguishable from healthy controls when looking at peripheral ovarian hormone levels. The pathophysiology is more complex, which is likely why the majority of hormone replacement therapies have no significant effect in treating this disorder.

Kristin Yeung Lasseter, MD, is a Board-Certified Psychiatrist based in Austin, Texas who specializes in Reproductive Psychiatry and Women’s Mental Health. She is the Founder and President of Reproductive Psychiatry Clinic of Austin, which hosts multiple psychiatrists and psychotherapists in Central Texas specializing in mental health across the reproductive life span. Dr Lasseter is also the Secretary of the Austin Psychiatric Society, the Lead Perinatal Psychiatry Consultant at The Women’s Center of Texas at St. David’s North Austin Medical Center, and Affiliate Faculty at The University of Texas Dell Medical School, Department of Psychiatry and Behavioral Sciences. She volunteers her time at Postpartum Support International’s Psychiatric Consult Line and raises awareness about reproductive mental health through speaking engagements and social media (Facebook & Instagram: @the.reproductive.psychiatrist).

by Ashley Ziegler

I vividly remember, when my youngest was about 5 months old, I was screaming at my 4-year-old because she spilled something on the floor. It was then that my husband’s patience with my postpartum rage wore out, he stopped sugar-coating things and told me that going to therapy was no longer a suggestion, it was a condition. I was so infuriated that I stormed off, packed my suitcase, and got a hotel room, where I spent the night crying because I had reached a point where no one wanted to live with me—and I hated myself for it. It didn’t matter how hard I tried to keep my cool, my anger was uncontrollable, and I had no idea why it was happening.

While my circumstances were unique, my situation wasn’t. Postpartum rage is not uncommon, but unlike postpartum mood disorders such as depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, and obsessive-compulsive disorder (OCD), it’s not talked about nearly enough. Because of this, new moms who are experiencing this anger can feel isolated, scared, and carry far more guilt than they should.

What Is Postpartum Rage?

“Postpartum rage is a condition in which a new mother feels periods (or bursts) of extreme anger, irritability, and explosiveness,” maternal mental health counselor Kirsten Brunner, MA, LPC, tells Romper in an email. The frequency of these outbursts can vary, but when they occur they’re often uncharacteristic and leave new moms feeling out of control and wondering, “why am I so angry at my husband or partner after having a baby?”

While postpartum rage is a lesser-known behavior, Brunner says it’s actually very common in new mothers, particularly because it can be caused by a number of factors, some of which every new parent experiences.

What Causes Postpartum Rage?

According to Brunner, postpartum rage is a fairly well-known symptom of postpartum depression, postpartum anxiety, and postpartum bipolar disorder. In an email to Romper, psychiatrist Kristin Yeung Lasseter, MD, says postpartum rage can also be a symptom of postpartum PTSD, but at this point, it’s not considered a standalone disorder.

That being said, a new mom doesn’t have to be suffering from any of these mood disorders in order to experience postpartum rage. “So far, research suggests that postpartum rage can come from multiple factors,” Dr. Lasseter says, “including reproductive hormone changes, sleep deprivation, poor support, and major life changes postpartum.” She further explains that these factors individually can cause changes in the brain that make emotional regulation difficult, so when a new mom is experiencing them all at once, “it makes for a perfect storm.”

Other factors Brunner notes could contribute to postpartum rage include a birth experience that didn’t go according to plan, a baby born needing special care in the hospital, such as a stay in the neonatal intensive care unit (NICU), or born with a condition that requires extra care at home. Finally, she says moms who feel pressured to get everything right or whose family is crowding her or not showing up for her at all can also result in extreme anger and irritability.

Postpartum Depression & Rage

The Anxiety and Depression Association of America estimates that while 80% of new moms experience the short-term “baby blues,” about 13% are diagnosed with postpartum depression (though, that estimate may be low, as many women go without reporting their symptoms and treatment). The symptoms can start within a week of delivery, but sometimes they start as early as the third trimester or even a month or later after delivery. Regardless of when the symptoms start, postpartum depression and rage often go hand-in-hand, so ignoring all of the other triggers of postpartum rage, this statistic alone shows just how common this behavior is.

Postpartum Anxiety & Rage

Brunner notes that the general struggle of losing the normal control, predictability, and consistency of everyday life after the arrival of a baby is often enough to trigger postpartum rage. Since new moms with postpartum anxiety experience these same symptoms, only with more intensity, it’s no wonder why rage is a common symptom of the mood disorder. Looking at data from The Journal of Nurse Practitioners, between 11% and 21% of new moms in the U.S. are diagnosed with postpartum anxiety, which once again highlights how many new moms might also be struggling with the symptom of rage.

How Long Can Postpartum Rage Last?

Given the many factors that can contribute to postpartum rage, it’s hard to say exactly how long a new mom can expect to experience it. New moms may notice a decrease in outbursts once their baby starts sleeping through the night or after they’ve developed a predictable routine and feel more confident in their new role.

However, if the postpartum rage is a symptom of another postpartum mood disorder it could last for months or possibly, in severe cases, even years. For example, postpartum depression can last throughout a baby’s first year of life, so it wouldn’t be a surprise if a mom who was diagnosed with postpartum depression is still experiencing symptoms of postpartum rage 6 months after her baby was born.

That being said, if the rage is a symptom of another postpartum mood disorder, there are treatment options available. If the behavior is the result of an outside factor, new moms may find it easier to control and manage with the help of a counselor.

When to seek help for postpartum rage

Unfortunately, there is no magic formula for how to overcome postpartum rage, but getting professional help can significantly help. “Parents should most definitely seek help for postpartum rage when it is causing them distress, is impairing their ability to go about daily life as usual or is negatively impacting their relationship with others,” says Dr. Lasseter. Additionally, if the anger isn’t subsiding or it’s being accompanied by disturbing thoughts or feelings, Brunner suggests getting help “without delay.”

Treatment for postpartum rage

According to Brunner, treatment for postpartum rage has a few different looks. First, antidepressants and antianxiety medications are often prescribed to new moms suffering from postpartum depression or postpartum anxiety, and these medications are meant to manage the symptoms of these mood disorders, so they may help with rage. Non-medication treatment usually comes in the form of talk therapy and self-care.

It’s important to remember that, even though it’s not openly discussed nearly enough, postpartum rage is common. It’s also not a reflection on someone’s ability to be a mother. “Postpartum rage is not caused by being a bad mother or parent,” says Dr. Lasseter, “Oftentimes people feel a lot of guilt when they have postpartum rage, but it’s not a symptom someone chooses to get.” Rather, she says, it’s the body’s way of letting you know something is wrong and that it needs to be taken care of. So, if you’re experiencing frequent bouts of rage, regularly lashing out at the people you love, and/or living every day with a short fuse, it’s okay, and there is help.

If you or someone you know is experiencing depression or anxiety during pregnancy, or in the postpartum period, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.

Experts:

Kirsten Brunner, MA, Licensed Professional Counselor specializing in relationships, pre and post-baby support, and perinatal mental health.

Kristin Yeung Lasseter, MD, Founder and President of Reproductive Physichiatry Clinic of Austin, Board Member of the International Society of Reproductive Psychiatry, Secretary of the Austin Psychiatric Society, and Affiliate Faculty and the UT Dell Medical School, Department of Psychiatry

Author: Edgary Rodríguez R.

While it's common for women not to know they are expecting right away, parents who are planning for pregnancy can take steps to ensure a healthy pregnancy and delivery. A knowledgeable specialist can follow up on your family health issues, go over your gynecological history, provide advice on vitamin products to take and offer emotional support.

If you plan to have a baby in the near future, you should seek preconception care. This preconception visit is important to prevent complications during pregnancy and health problems for your newborn. If you previously had a baby, it is important to see your healthcare provider, too, because your medical status may have changed.

What medical professionals recommend

Obstetric complications in past pregnancies, as well as previous premature birth or miscarriage, are warning signs for health professionals. By knowing your situation at an early stage, a doctor can advise you on the best steps to take.

The first weeks of gestation are critical for the development of the fetus. This is a period of vulnerability to certain factors, such as medications and alcohol.

Planning can ensure that lifestyle and medical issues are reviewed as a form of prevention. Ravina Bhanot, M.D., an OB-GYN based in London and the founder of Zonas Fertility, explained some of the reasons you should seek preconception care:

• Review your medication to ensure no drug will affect your baby
• Check which vaccinations you need
• Receive counseling on alcohol, smoking and drugs
• Discuss exercise before and during pregnancy
• Receive advice on folic acid

"During preconception, we typically discuss diet/exercise prior to pregnancy and continuing this while pregnant," said Vonne Jones, M.D., an OB-GYN at Total Women's Care in Houston. "We also review past medical history and review what risk factors a potential pregnancy can pose."

Jones also discusses the risks of preexisting conditions with her patients prior to pregnancy.

"[We] review any risks of genetic diseases within the family to determine [the] patient's risks," Jones said. "Carrier screening—determining if one is at risk for potential genetic traits—is also recommended."

Chronic conditions are also addressed. "Many chronic medical conditions, such as diabetes, hypertension, psychiatric illness and thyroid disease, have implications for pregnancy outcomes and should be optimally managed before pregnancy," according to recommendations from the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine.

The most susceptible populations are especially encouraged to seek preconception care to ensure the health of the mother and baby. Bhanot advised being careful if you suffer from conditions including epilepsy, coeliac disease, diabetes mellitus, thalassemia or obesity (a body mass index greater than 30), or if you or your partner were born with a neural tube defect such as spina bifida.

The importance of a psychiatric consultation

When someone has a history of mental illness or is taking psychiatric medications, it is advisable to have a psychiatric consultation because pregnancy and postpartum are high-risk periods of relapse of mental illness, explained Kristin Yeung Lasseter, M.D., a board-certified psychiatrist and the founder and president of Reproductive Psychiatry and Counseling of Austin, Texas.

Lasseter, a specialist in reproductive psychiatry and women's mental health, advised discussing the benefits and safety of psychiatric medications prior to conception.

"By the time they find out they are pregnant, the fetus has already been exposed to the medication and it is more risky to switch medications at that point," Lasseter said. "Preconception planning can help someone understand which medications they feel comfortable continuing during the pregnancy and the risks of relapse of their illness."

Every patient is different. Therefore, each case must be evaluated on an individual basis.

"A perinatal psychiatrist will typically evaluate the patient's personal psychiatric and medical history, their family medical history, past treatments that have been trialed and their success or failure, current psychiatric medications and current mental health status," Lasseter explained.

Monitoring is important before, during and after pregnancy.

"If the patient is already pregnant, the psychiatrist also considers the health of the pregnancy and fetus, and which medications the fetus has already been exposed to," Lasseter said.

Lifestyle changes

Prenatal health specialists can also clarify which products and foods to avoid.

Bhanot advised women to avoid the following:

• Vitamin A
• Unpasteurized cheese, blue cheese and soft cheese
• Raw and uncooked meats, as well as liver
• Raw eggs, such as poached eggs
• Smoked fish, such as smoked salmon and trout
• Swordfish, marlin, shark and raw shellfish

But not everything is forbidden. Coffee lovers will be happy to hear they can drink moderate amounts while pregnant.

"You can have caffeine, but no more than 200 milligrams per day," Bhanot clarified, and "no more than four cups of herbal tea a day."

Reproductive education is essential for hopeful parents. With the right knowledge and guidance from a specialist, many mothers can have healthy pregnancies with happy outcomes.

Author: Edgary Rodríguez R.

The fear of being labeled a bad mother, selfish or crazy discourages many women from seeking help for mental health in time. Lack of knowledge about perinatal mental health disorders is another barrier in society. In recent years, postpartum depression has received a lot of media coverage, which is great because it raises awareness, but other disorders remain largely unnamed.

"When it comes to perinatal mood disorders, we often hear about postpartum depression but rarely do we talk about postpartum anxiety. However, it's a lot more common than we think. In fact, 10 percent of postpartum women will develop postpartum anxiety," said Sandra Konja, Psy.D., a licensed clinical psychologist and maternal mental health specialist based in San Diego.

Just because it's less known doesn't make it any less important. Postpartum anxiety is as common as postpartum depression, so it should not be ignored, because not getting treatment in time can affect both mother and baby.

"If left untreated, postpartum anxiety can negatively affect the bond between the mother and the baby. In addition, postpartum anxiety has been associated with impaired child social-emotional development," said Annette Attolini-Fertuck, Ph.D., a licensed clinical psychologist and perinatal mental health specialist based in New York City.

How to recognize postpartum anxiety

Postpartum anxiety presents as a constant state of worry, where the fear is often irrational and related to the concern of hurting or not taking proper care of the newborn.

"Postpartum anxiety is when an anxiety disorder occurs during the first 12 months after giving birth. It is different from postpartum depression, which is caused by depressive disorders," said Kristin Yeung Lasseter, M.D., a board-certified psychiatrist and the founder and president of Reproductive Psychiatry & Counseling of Austin, Texas. She specializes in reproductive psychiatry and women's mental health.

In many cases, if a woman expresses her concern, her close circle of family and friends may downplay its importance; after all, everyone thinks motherhood has challenges. Likewise, postpartum anxiety is often mistaken for depression because some people have limited information on the subject.

Postpartum anxiety doesn't usually manifest as symptoms of depression, although the two can occur together, Lasseter explained. Depression is associated with sadness and low mood, while postpartum anxiety symptoms include excessive worrying, difficulty relaxing and feeling keyed up or on edge.

Mothers with anxiety disorders often have difficulty sleeping, meaning they are unable to rest when the baby sleeps. Worries don't let the mind rest, either, with racing thoughts, panic attacks and intrusive images of bad things happening to the baby or doing bad things to the baby, Lasseter explained.

What causes postpartum anxiety?

Women with a personal or family history of an anxiety disorder are at high risk for postpartum anxiety.

"Postpartum anxiety can be caused by general anxiety, trauma, perfectionism, social anxiety, panic disorder or OCD [obsessive-compulsive disorder], among others," Lasseter said.

Mothers who have a history of emotions related to worry, especially during previous pregnancies, or a history of miscarriage, stillbirth or a thyroid imbalance are generally susceptible to postpartum anxiety, too.

"Additionally, having inadequate social support, experiencing financial stress, being a teen parent or a mother of multiples can also be risk factors," Konja said.

What are the main symptoms?

All parents can experience worries, with anxiety being a natural response when we feel threatened, in this case, related to protecting the baby. However, when the fear is persistent, the intrusive thoughts don't go away and the concern consumes daily life, we are talking about postpartum anxiety.

Attolini-Fertuck listed some of the symptoms a woman with postpartum anxiety may experience:
Physical symptoms

• Difficulty sleeping (usually falling asleep or staying asleep)
• Nausea
• Dizziness
• Muscle tension
• Increased heart rate
• Chest pain
• Trouble sitting still

Behavioral symptoms

• Checking things repeatedly
• Avoiding certain activities

Emotional symptoms

• Constant worry
• Inability to keep calm
• Fear of going crazy
• Cannot turn your mind off
• Scary thoughts about harm coming to your baby
• Fear of leaving the house with your baby by yourself
• Feeling on edge
• Irrational fears about things that are unlikely to happen

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What can a woman with postpartum anxiety do?

Every woman wants to imagine a lovely motherhood with a healthy baby and the energy to face all the changes, however, not everything has to be perfect during maternity. Many women experience mood swings and concerns, but when the symptoms become acute, they can be overwhelming, disrupting family life and preventing the mother from enjoying this stage with her baby.

"Research shows that parents with anxiety are less likely to engage with their newborns throughout their first year of life, which could result in sleeping and developmental challenges," Konja said. "Children and teenagers of parents with anxiety are more likely to develop anxiety, attention, learning or behavioral difficulties as they grow older."

If you or someone you know is experiencing symptoms of postpartum anxiety, it is essential to seek help. Konja warned that without prompt and appropriate treatment, it is likely to become a long-term condition for the individual. Lasseter added that postpartum anxiety can have significant effects on the developing infant and the family unit as a whole.

"With the right treatment, a mother suffering from postpartum anxiety will get better in time," Attolini-Fertuck said.

If you’re a soon-to-be parent feeling on edge about everything from the results of your next blood test to what color you’re going to paint the baby’s room, you’re not alone. Research from the Journal of Mental Health and Clinical Psychology found that 20% of people reported onset of new anxiety during pregnancy^[1]. In many cases this anxiety is specifically about having a healthy pregnancy, delivery or baby, and is known as pregnancy-related anxiety.

Whether you’re long acquainted with anxiety or are experiencing it for the first time, there is help out there, including professional counseling, medication, acupuncture and more. Keep reading to better understand some of the symptoms and causes of anxiety during pregnancy, and options for coping mechanisms and treatment.

Causes of Anxiety During Pregnancy

Some biological causes of anxiety during pregnancy include hormonal changes that are essential to maintaining a healthy pregnancy. “Women produce more cortisol and estrogen during pregnancy, which can cause anxiety,” explains Kenosha Gleaton, M.D., a board-certified OB-GYN and medical advisor of Natalist.

“In the first trimester specifically, progesterone and estrogen levels rise, which may result in anxiety, irritability, depression, fatigue and feelings of sadness,” she adds.

Those changes in hormone levels can affect areas of the brain that control anxiety and emotional regulation, emphasizes Kristin Yeung Lasseter, M.D., a board-certified reproductive psychiatrist and faculty member at the University of Texas at Austin’s Dell Medical School.

Additionally, a previous personal or family history of anxiety or other mental health conditions, childhood trauma or a history of pregnancy loss or complications with pregnancy, labor or delivery can all be contributing risk factors for anxiety during pregnancy, according to the American College of Obstetricians and Gynecologists (ACOG).

And of course, there’s the understandable anxiety and worry around having a child, which is a huge life event. “It may be related to significant mental stress, such as from stress of an unplanned pregnancy, limited support around such a big life transition or feeling ambivalent about being pregnant,” adds Dr. Lasseter.

Symptoms of Anxiety During Pregnancy

Anxiety during pregnancy can present itself in a variety of ways. Here are some of the main symptoms of anxiety during pregnancy, according to Dr. Lasseter and Georgia Witkin, Ph.D., a clinical psychologist and head of patient services development for Progyny:

• Feeling on-edge, jumpy, nervous or on high alert due to higher levels of the hormone adrenaline
• Excessive worries about the health of the pregnancy, the baby or the preparation for the birth
• Difficulty falling or staying asleep
• Heightened fearfulness in large crowds or other typically anxiety-provoking settings
• Trouble relaxing and tenseness
• Feeling distracted or disoriented
• Having less energy, lower sex drive or lower mood
• Having panic attacks or racing, intrusive thoughts

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What Is a ‘Normal’ Amount of Anxiety During Pregnancy?

Many pregnant people will feel at least a little bit jittery throughout their pregnancy, as there’s a sense of a loss of control over their body and the circumstances around the pregnancy, says Dr. Witkin.

“When you are pregnant there’s a lot of re-living the past: ‘Did I eat right? Did I drink too much? Did I eat enough protein?’” says Dr. Witkin. “There’s also an enormous amount of pre-living the future: worrying about things that haven’t happened yet, such as how long to breastfeed for immunity, what happens if the baby gets sick, etc.”

Dr. Witkin reiterates that anxiety is common during pregnancy but if you’re having difficulty performing your daily home and work tasks or functioning in relationships, it would be helpful to seek further mental health care.

How to Ease Anxiety During Pregnancy

Depending on the level of anxiety you experience, therapy techniques and dietary and lifestyle changes may be able to provide some relief.

Explore Cognitive Behavioral Therapy

Cognitive behavioral therapy, or CBT, is a therapy technique that involves evaluating your anxious or negative thought patterns and applying healthier coping mechanisms. Dr. Lasseter refers to CBT as “the most effective non-medication treatment for anxiety during pregnancy.”

Working with a licensed therapist or counselor on CBT can help you identify certain thoughts or behaviors that trigger your anxiety. From there, you can either avoid some of those triggers if possible, says Dr. Gleaton, or you can learn ways to work through them when they arise.

Employ Relaxation Techniques

Making a point to physically relax your body has been proven to reduce maternal stress, according to a small, 2021 study that analyzed stress levels in pregnant people after relaxation techniques involving music, guided imagery and rest^[2]. Other helpful practices for reducing anxiety symptoms during pregnancy include meditation, acupuncture and prenatal yoga, according to Dr. Lasseter.

Modify Your Diet

Aim for a balanced diet that’s nutrient-rich, which is proven to help with the symptoms of anxiety, says Dr. Gleaton. She recommends adding omega-3-packed foods like salmon (a type of seafood that’s low in mercury) into your meals to help support healthy brain function.

Additionally, a 2020 systematic review found a link between vitamin D deficiency and anxiety in pregnant people^[3]. Dr. Gleaton suggests adding vitamin D sources—such as eggs and sardines—to your plate, as it can help protect against drops in mood-boosting hormones such as dopamine and serotonin.

And when it comes to caffeine and sugar, practice moderation. “These can trigger or worsen feelings of stress and anxiety,” says Dr. Gleaton.

Find a Daily Release

If your OB-GYN gives you the greenlight for exercise, go for it, says Dr. Lasseter, as the hormones you release while sweating are great for stress and anxiety relief. You can also try low-impact activities to help slow down your thoughts and feel grounded in your body, like a daily walk, yoga or meditation session, adds Dr. Gleaton.

Prioritize Rest

You need additional sleep when you’re anxious or stressed to help your body and brain recharge, says Dr. Gleaton, who recommends a solid eight to 10 hours during pregnancy. This can be easier said than done, though—a study in Obstetric Medicine found that 73% of pregnant people experience some form of insomnia by their third trimester^[4].

Sleeping well can be difficult for pregnant people due to increased urine frequency, discomfort, acid reflux and restless leg syndrome, so you might need to allocate some time for a nap during the day. Dr. Gleaton also recommends sleeping with a pregnancy pillow to relieve some of the tension in your back, and a screen-free bedtime wind-down routine including habits like yoga, reading or journaling.

Find Things You Can Control

“Any activity that increases your sense of control will give you a rest from the adrenaline surges,” says Dr. Witkin. Try cleaning your desk or closet, organizing your wallet or paying some bills, she suggests, to balance out what you can’t control with things that you have control over.

Try a Rhythmic Activity

These types of activities can similarly help you ground yourself and calm your mind because you know what to expect next, says Dr. Witkin. She suggests listening to some slow jams, specifically music that is slower than your heartbeat (which is around 72 beats per minute), going for a jog or rewatching a favorite movie or series.

Can You Take Anti-Anxiety Medication During Pregnancy?

One treatment for managing more severe anxiety during pregnancy is medication. Most anxiety disorders are treated with selective serotonin reuptake inhibitors (SSRIs), which are often considered the safest type of anxiety medication to use during pregnancy, according to Dr. Lasseter.

“The most common risk associated with exposure to SSRIs in pregnancy is neonatal adaptation syndrome, which is typically a mild condition that resolves within several days without long-term effects,” says Dr. Lasseter. Neonatal adaptation syndrome may involve symptoms such as jitteriness, restlessness and rapid breathing, mostly in babies whose birthing parents took SSRIs up until delivery. In most cases, these symptoms dissipate within the first five days after birth, according to research in Nature^[5].

Benzodiazepines, on the other hand, which include certain sedative drugs known by the brand names Xanax, Valium and Klonopin, can cause neonatal health issues and should ideally be tapered off during the third trimester or avoided altogether during pregnancy, per research in the Journal of Mental Health and Clinical Psychology.

It’s worth noting, though, the maternal and fetal health risks of severe untreated anxiety when weighing the potential safety risks of anxiety medications during pregnancy, which can include a greater likelihood of complications including preeclampsia, preterm labor, low birth weight and developmental delays in the baby, according to Dr. Lasseter.

When to See a Doctor

If you are pregnant and experiencing feelings of prolonged sadness, fear or anxiety for two weeks or more, reach out to your doctor for guidance. Some keys to look for include anxiety impacting your sleep, appetite, work and relationships, according to Dr. Witkin.

In some cases, these concerns can be addressed in sessions with a mental health professional, whether with a partner or individually. “Most couples who are going through a pregnancy and reach out for help find that between three and eight sessions is enough, but everyone is different,” says Dr. Witkin.

Start by bringing up your anxiety to your OB-GYN, doula or midwife during your next checkup, advises Dr. Witkin. They can then provide a referral to a mental health professional who may specialize in pregnancy or fertility-related mental wellness.

Remember, pregnancy is not just about keeping your baby healthy—it’s about keeping you healthy, both physically and mentally, too

Dr. Shannon M. Clark discusses the following with Dr. Kristin Lasseter, @the.reproductive.psychiatrist :

• Impact of maternal psychiatric illness

• Consequences of lack of treatment or under-treatment on pregnancy outcomes•General treatment concepts

• Specific meds for treatment of depression, bipolar disorder, anxiety, schizophrenia, and ADHD

• Recommendations from MFM and psychiatry

• Resources: MCH Center of Women's Health, Mother To Baby, Postpartum Support Internationa

It Starts With Mom LIVE | Millennials & Motherhood

Millennials have not only taken over the workplace, they are taking over as moms! Our panelists will dig into topics geared specifically to the millennial mom and moms-to-be, including where to find helpful and accurate information on the internet, staying healthy as a busy mom, and starting the parental journey.

Amplify Q&A

Ask Elaine Cavazos, president of PPHA, and Dr. Kristin Lasseter, medical director of PPHA, your perinatal mental health questions live.

Discussing mental illness in our reproductive years and further with Kristen from @the.reproductive.psychiatrist

Kristen Lasseter MD talks about her work with infertility as a reproductive psychiatrist.

Lacey Fisher and Dr. Lasseter talk about reproductive psychiatry and perinatal mental health. Dr. Lasseter is the owner of Reproductive Psychiatry Clinic of Austin.

by: Arezow Doost

AUSTIN (KXAN) — A Central Texas mom is getting ready for a treatment that doctors say will make a big difference in her postpartum depression.

Family Emergency Hospital at Lake Travis is the only facility in Central Texas to provide Zulresso. The FDA-approved treatment is given through an IV over two and a half days.

“Being able to take a woman who is so depressed she can’t even get out of bed, and within a day or two and half with infusion therapy to be able to elevate her mood back to where it’s more balanced,” said CEO of Family Health Systems Dr. Henry Higgins “We think that’s going to have a more dramatic effect on really cutting down on the amount of suicides that occur from postpartum depression.”

Donna Kreuzer says Zulresso would have saved her daughter’s life.

“She never wanted for much. However, she wanted to become a mommy.” said Kreuzer “Have a baby, become a healthy – happy mommy and the ability to raise her healthy – happy baby for the duration of their lives.”

Kristi Couvillon-Wise, 36, lost her battle with postpartum depression in 2010. “Kristi never ever let on to me or to her husband that she was suffering with postpartum depression until 8 weeks later, and she could no longer hide the suffering, the torture, the heartache, the nightmare of severe postpartum depression.”

Her family got her help immediately, but say nothing worked.

“This is a life saver,” said Psychiatrist Dr. Kristin Lasseter “I think women with moderate to severe depression are probably the best candidates.”

Dr. Lasseter says studies show relief within 60 hours. Right now she says moms are being treated with antidepressants which can take up to 8 weeks to work.

“Weeks is a long time to wait to be suffering,” explained Dr. Lasseter ” We lose a lot of women from postpartum depression because we can’t have them get better fast enough.”

Dr. Lasseter says there’s not enough research in terms of if the drug is safe during breastfeeding. Studies found the most serious side effect: loss of consciousness. Zulresso costs $34,000 without insurance.

Dr. Lasseter worries this could delay treatment. She says some insurance companies will cover it, but under certain circumstances.

“What Zulresso could have done for Kristi was to get her well,” said Kreuzer. “She would have been able to resume her health. Her hope would have been restored.”

WHAT IS THE SECULAR SEXUALITY?

Secular Sexuality is a weekly call-in show live from Austin, Texas every Thursday at 7pm CT. We talk about sex from a secular perspective. Sex and sexuality are natural to all living creatures, but religion takes this and twists it into something awful and to be ashamed of.

Acceptance, education, and fun is what we strive for. We lay the intersection of sex and religion (and occasionally ourselves) bare, openly and honestly. We discuss a wide range of topics each week, removing the shame and reclaiming what has been natural to us all along.

Secular Sexuality is produced by the Atheist Community of Austin.

The Atheist Community of Austin is organized as a nonprofit educational corporation to develop and support the atheist community, to provide opportunities for socializing and friendship, to promote secular viewpoints, to encourage positive atheist culture, to defend the first amendment principle of state-church separation, to oppose discrimination against atheists and to work with other organizations in pursuit of common goals.

We define atheism as the lack of belief in gods. This definition also encompasses what most people call agnosticism.