What is a Postpartum Mood Disorder?
On this episode of the Learn With Less podcast, Ayelet sits down with Dr. Katayune Kaeni to address the topics of postpartum depression, anxiety and OCD. Dr. Kat is a psychologist and specialist in maternal mental health and perinatal mood and anxiety disorders.
She works with moms and families to heal from the difficulties of depression, anxiety and other mood changes that can happen during conception, pregnancy, miscarriage, loss of a baby, birth and postpartum. In addition to her professional training, she also draws from her own personal experiences with the challenges of postpartum to discuss this topic.
We’ll hear about her own professional and personal background, and how it is she came to do the work she’s doing now. There are so many misconceptions about the various ways hormones can affect our postpartum experience (and beyond!).
Dr. Kaeni gives us a brief overview of the differences between the “baby blues,” postpartum depression, and postpartum anxiety, dispels some of the common myths about postpartum mood disorders, and tells us what, in her opinion as a professional who works with families struggling with the transition into parenthood, are the best places to start for new parents experiencing postpartum mood disorders.
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Mom and Mind Podcast, hosted by Dr. Kat Kaeni
Dr. Kathleen Kendall Tackett, PhD, IBCLC, FAPA
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Text transcript of this episode
Ayelet: Welcome to episode 64 of the Learn With Less podcast. Today I’m speaking with Dr Katayune Kaeni, a psychologist specializing in perinatal mental health, and the creator and host of the Mom and Mind podcast. Dr. Kat has a private practice where she focuses on supporting new mothers and their families.
She volunteers with postpartum support international, and she works with San Bernardino County’s maternal mental health work group as a subject matter expert to provide training to local mental health and allied healthcare providers. So Kat, thank you so much for being here. Welcome to Learn With Less.
Kat: You’re welcome. I’m really happy to be here and share whatever I can about maternal mental health.
Ayelet: Well, it’s a such an important subject as we all know. And I’ve asked you to come onto the show today to speak about this topic of postpartum depression, anxiety, OCD. But why don’t you tell us just a bit about your own professional and personal background and how it is that you came to do the work that you’re doing now?
Kat: So I’ve been a therapist for quite a while now and I’ve lost count, but so, in terms of my professional background, I’ve always known I wanted to be a therapist. I took a peer counseling class at age 12 and I was like, Yup, this is it. So I’ve been on this trajectory for a while. So in terms of why I started into this particular specialty is because I went through it, so let’s see.
I was already a psychologist working in a major medical system and I got pregnant with my first child, she’ll be eight this next month. Yeah. So I got pregnant with her, pregnancy was fine and great and wonderful. And then after her birth, looking back now I know that my anxiety started day one after her birth and for about a year I went through what again, what I know now to have been postpartum depression, postpartum anxiety and postpartum OCD. But it did take me a long time to figure it out.
And it’s just heartbreaking that, you know, as a therapist, I’m supposedly supposed to be trained in sort of all things mental health and I didn’t know what was going on because really there’s a lack of training for just about everybody, for therapists, for doctors, OB’s really. I mean it’s, it’s getting better these days, but there’s a lack of training so other people weren’t recognizing it. I wasn’t recognizing that I hadn’t had the training to recognize it. I just knew that I didn’t feel well.
They knew that I was ashamed and I felt like, especially as a therapist, it should be able to handle everything and know what was going on and yeah, there’s just all this shame and guilt and confusion around that period of time. And once I figured it out and started reading about it and saw my symptoms listed in a book, I could see that, oh, this isn’t just in my head, it’s a thing that was such relief. So since then I’ve really been “gung-ho,” all-in to making sure that other moms get the information that they need.
Ayelet: Absolutely. And I mean, like you said, early parenthood is so – in general – such a time of that vulnerability, overwhelm, you know, a lack of confidence. All of those things. You’re in charge of a new human being. So of course you’re going to be feeling those feelings already. And then to have that sort of bombarded as well with another layer is, yeah, it’s rough.
Kat: Yeah, it was a lot. Knowing what I know now I can look back and say like, Oh yeah, of course… I had several risk factors that would have put me in a more vulnerable position for that. And, it’s so nice to know that now, but I wish I had known it then.
Ayelet: Right. Well I look forward to hearing a bit more about some of those kinds of things as we share them over the course of this episode. But first I think, you know, there’s a lot of misconceptions about the various ways that hormones can affect our postpartum experience. So can you give us just a brief overview of the differences essentially between, you know, the baby blues, postpartum depression, and postpartum anxiety.
Kat: Yeah. First of all I’ll say about hormones is that if you are already in your history, have a sensitivity to the hormone changes like PMS, PMDD, those kinds of things, you’re more likely to experience a perinatal anxiety or depression either in pregnancy or in postpartum. And again, it’s different for everybody but so there’s like a biological sensitivity there.
But for even for people who don’t necessarily have that history, they can still develop symptoms certainly. So for the baby blues, which are very common in about 80 percent of women are about the two weeks after birth. So you’ll have, it’ll be like a PMS, there might be weepiness, tearfulness, agitation, but you’ll also be able to have some periods of time where you feel okay and it’s not, it’s doesn’t feel heavy, it doesn’t feel like it’s dragging you down completely. But it’s an emotional rollercoaster with the sleep deprivation.
So, you know, adjustment, getting used to new stuff. So again, that’s about 80 percent of women experience this period of time and it usually resolves and in about two weeks with good enough rest and nutrition and support and that things that can help someone in the healing process anyways.
But for about 20 percent of women (and it’s different and for different ethnic groups, that number), um, but overall about 20 percent of women will experience more intense symptoms or if during that two weeks or if their symptoms are lasting for longer than two weeks, we’re probably looking at more like a perinatal mental health challenge, more than just baby blues.
So those again, if it lasts longer than two weeks, if it feels pretty intense, like it’s like you’re not feeling like yourself or things feel very strange or you, you know, you’re just not quite sure what’s going on. That’s, those are generally signs that something deeper might be happening. Yeah. So that was, I don’t know if I answered all your questions
Ayelet: Well, I think so think that’s a wonderful description of the difference between certainly the baby blues and then postpartum mood disorders in general. Can you give us – because I think there is a big sort of misunderstanding or lack of understanding about the difference between postpartum depression and postpartum anxiety. How are those things different? And I think also, I mean I’ve read so much about how postpartum anxiety for instance, is extremely under-diagnosed, so can you talk a little bit to that?
Kat: Yeah. So there’s a lot of times depression and anxiety coming together. It’s relatively rare that you would be just depressed. You couldn’t be just anxious – you’re more likely to be anxious for a period of time. But eventually that could wear on too…
Ayelet: Right! Not to be minimized in and of itself.
Kat: So in terms of depression, depression feels like you’re not motivated, you feel sad, you feel down, you can identify that feeling. What’s difficult in this period of time is that you may be having an increase in sleep issues, either feeling very, very tired or not tired, just unable to sleep, rather.. not tired is a separate diagnosis.
But feeling – which I can get into. But yeah, I can tell you, I can tell you everything. So right. The depression: appetite changes, sleep changes, feeling down low motivation, feeling bad about yourself again, which is very common in this period of time. And, but more like the, I’m a bad mom. What’s wrong with me? I can’t do this.
Ayelet: To a debilitating state.
Kat: Right. So all of these symptoms in terms of like, clinical diagnosis, part of what we look at is the symptom set. If you’re meeting some of the criteria for the symptoms, but also if you’re having difficulty functioning. So for a lot of women they start to have difficulty functioning, getting through the day, doing kind of, self care, sometimes difficulty doing baby care as well.
So we’re really looking for, again, is this happening for longer than two weeks? Is it affecting your ability to get through the day? So depression feels heavy, it feels low, your mood is low. You might be crying a lot. In the more severe symptoms are having thoughts of suicide or what I call escape fantasies, like I don’t want to be here anymore. Not necessarily that you want to die, but you just can’t do this.
So, once it gets to that point, the more moderate to severe symptoms, that’s when we start to be in, you know, obviously more and more concerned and something to be taken very seriously. Need to seek help. So in terms of anxiety, anxiety will look a little bit different. Anxiety can look like busy, doing a lot of things – from the outside, this is what it might look like. Difficulty sitting down and resting, difficulty sleeping when you can or resting when you can.
Uh, what’s happening internally is a lot of worry and that worry, it can be on a spectrum from relatively mild worries to very intense and severe worries. So the worry can be, you know, let me just say there’s a normal hyper-vigilance right after birth and in the first several months of just kind of checking on baby and making sure they’re okay, but this kind of worry is unrelenting. You’re not relieved by checking. It’s, you know, needing to check all the time and it can get to a point where it can develop into an obsessive compulsive type pattern where you’re constantly checking.
I mean, there’s several moms that I met with who talk about laying down with their baby, but just watching them the whole time, not being able to sleep at all, waiting for something because they’re afraid of SIDS or they’re afraid of some other kind of thing that they’ve heard about. So their vigilance is just like on full volume and unfortunately the sleep deprivation makes all of this worse and with anxiety, it can become a sort of a cycle.
Like for instance, another example is a mom whose… you know, her primary job is to feed, whether it’s nursing or bottle feeding. They might anticipate the baby waking up so they’ll just tell themselves, well, I’m just not going to go to sleep because the baby’s just going to wake up anyways and so I’ll just hang out until.
So in the meantime they’re losing sleep and they’re having difficulty functioning. Oftentimes, looking on the Internet for “how do I make sure to get my baby to sleep or eat,” and then the worry starts piling up. That’s an example of what anxiety can look like and feel like. In terms of the obsessive compulsive part…
So, a lot of moms, and dads, frankly, experience what we call intrusive thoughts. These are really like thoughts that come in very quickly, sometimes not anticipated, sometimes related to the situation you’re in and they’re often very scary thoughts or worrisome thoughts. A very common one is like, “what if I drop my baby?” and that it’s not just a passing thought.
It’s like, some people will experience a really physical response and their whole body will sense this tenseness of like, what if my child gets hurt, what if I hurt my child? And because they’re so worried about it, a thought, and that thing happening, they might start to develop behaviors to help cope with that, so that those things don’t happen.
So, for instance, if the concern is that “what if I drop my baby,” they might start avoiding stairs or avoiding narrow doorways or places where they are unsure of their footing, that kind of stuff. Again, to the point where they’re not able to do their daily stuff because of those worries. Again, all of this is on the spectrum so people might be experiencing some of that.
What I do really want to say about those intrusive thoughts is they can be very scary and worrisome. Some people get visual images with the thought when I think it’s very important to know is that even though you’re a scared by the thoughts and maybe doing whatever you can in your power to not do those things, intrusive thoughts don’t make those things happen. You’re not going to do them. It’s purely fear based, purely anxiety based. It is not at all out of a desire or want to do those things. It is absolutely just anxiety kind of edits. Again, with the volume turned up to 11.
Ayelet: I think it took having a baby for me to recognize in my own self how absolutely tied up our identities are completely interlaced with our hormones, our hormonal balance and so when when those things go, you know, quote unquote “out of whack,” it affects every part of us. So, thank you for that description.
I think it’s especially important because as you said, postpartum mood disorders can occur with people who have had mood disorders in the past, but it can affect anyone and so it’s something that you know, especially if for instance you never experienced anything like this, it’s, it can be a hard thing to recognize within yourself.
Kat: Oh, absolutely. And especially with, well, there are different ways that this manifests, but like with new parenthood, because we’re all told that, you know, like motherhood is magical and all of this great stuff, is going to happen and you’re going to get this, you’re going to know what to do when you don’t know what to do and when it doesn’t feel magical, it feels like a personal issue and it’s absolutely not! I mean, this, I frankly, I think all that stuff is a setup and we’re all worse off because of this idealized image of motherhood and it, it puts us into a position to feel extra vulnerable.
Ayelet: Right. And you know, needing to raise ourselves to some level that is, say “Instagram-worthy,” for instance. Yeah, it’s, it’s tough. It’s so tough.
Kat: Yeah, it is. I have some thoughts about social media, but… There’s so much pressure during this period of time. I feel like this is the most scrutinized period of time in a woman’s life. Everybody’s giving you their advice and opinion and telling you what to do and you’re just, you know, trying to figure out how to get some sleep half the time. And it’s, it’s a lot. It’s really intrusive, I feel, from the outside world.
Ayelet: Right, whether or not you are dealing with a mood disorder – so intense. Yeah. Well, thank you. That’s great. Let’s take just a brief break to hear a word from our sponsors and then we’re going to hear a few tips and resources from Dr Kat about some of the common myths and best places to start for struggling families as well as her own favorite resources that she recommends to families that are interested in seeking out more about this topic.
Ayelet: Okay, Dr. Kat, I am hoping that you can dispel a few of those sort of most common myths about postpartum mood disorders and just tell us what in your opinion, as a professional who works with families that are struggling with that transition into parenthood, what are the best places to start for new parents who may be experiencing postpartum mood disorders?
Kat: I strongly believe that information is powerful. There’s really a lack of information that we’re given this new mothers about all of this, frankly. So I think getting the information first is key and with that, there are plenty of really great resources out there. I rely a lot on postpartum support international in terms of just getting symptoms and understanding kind of what things are.
Again, kind of looking into your symptoms from a reputable place, from a place that does this, it’s going into the Internet is fascinating. I find a lot of information, but if you can start with a place that does this work and get your information there, it’s the best place to start. Like I said in my own experience, just seeing my symptoms, listed out, you know, on paper that – I didn’t write it. Somebody else wrote this. They know what’s going on and that was such relief right there.
Ayelet: Absolutely. What about some of these common myths? What are some of the sort of common myths that you see doing the work that you’re doing?
Kat: I think we touched on one of them a little bit earlier, that motherhood is magical. It’s this sort of portal into amazingness and it’s along with that comes the pressure of feeling like, well, the myth then is that you’re supposed to know what to do. That is a really big one that I see a lot of people and they’re feeling like failures because they don’t know what they’re doing. I feel like we should be teaching moms that nobody knows what they’re doing and where you’re learning this – this is on the job training.
Ayelet: Yeah. We are all winging it. Yeah.
Kat: I mean there’s absolutely some prep that you can do, but you don’t know until you’re in there what’s happening. I think some other… along with that, that things will come easy is that breastfeeding will come easily, and for some people it does and for other people it takes quite a few interventions to try and pump and nurse and produce and for other people, they’re unable to for any number of reasons, produce.
And it’s just another way that people feel like failures. Along with that, there just happens in our society right now. There happens to be, um, a strong push for breastfeeding, which is fine. But I, I like to also put in balance there that it doesn’t mean you’re a failure if you can’t or if you don’t want to. If you don’t want to, that’s fine. Your baby is going to be fine.
Ayelet: Right. And I think the most important thing, again, is the fact that you are healthy and you are able to be there, be present and…
Kat: Yeah, I’ve found that for a lot of women who have a lot of difficulty nursing and breastfeeding, then it, it makes it sometimes hard to connect with their babies because of it. They’re just so focused and sometimes it becomes obsessive in and of itself to figure out how to do this and fine, like if that’s your drive to figure out what’s going on, fine. But I, I do like to balance that out with your, your mental wellness is just as important.
Ayelet: Yeah. And it’s again, it’s, it’s what is the most important piece for you. And I think it is – it’s so easy to get our brains funneled into some specific thing. I certainly remember feeling like I wanted to keep track of things, right. I wanted to keep track of when I was feeding my baby, when he was sleeping to get a sense of control and when I sort of looked up, you know, three, four months later and I was still doing it really intensely. I was like, what am I doing? This isn’t helping anybody. So yeah, it’s rough.
Kat: Yeah, it is hard. That worry right there. I did that too, actually.
Ayelet: Yeah, I think it’s really common because it’s such an out of control time and I think holding onto those things that, for instance, we came into motherhood sort of touting or believing or, or wanting out of the experience can, it can be really difficult to separate from those things. Um, and sometimes we don’t have to, but I, I don’t know, I like to say that, you know, you can’t have the perfect easy time getting pregnant. The most beautiful glowing pregnancy, the straightforward, wonderful birth and then the most happy postpartum bonding experience plus easy time with your partner. Like something is going to give, right? Some things! So.
Kat: Right. And that’s normal.
Ayelet: Exactly. And anyone who says that they had all of those things is lying to you.
Kat: Right, or they are a magical creature.
Ayelet: Yes, they are a unicorn. I wanted to know also in my mind, number one, there’s a myth about the idea that just that term postpartum mood disorder, it’s not necessarily something that is experienced in those early days, weeks and months. It’s also something that can be experienced within those first few years and actually, in the comments here in the chat with our live workshop, we have one of our listeners here talking about how in the beginning she didn’t realize that the worry was ever present and that it took some time.
Can you speak to that a bit and do you have experience with seeing things later, that happen not within those first 6 to 12 weeks, but potentially when a mother is weaning, if she’s breastfeeding or later on. Is it something that always occurs in that very early time or can you talk a little bit about that?
Kat: It doesn’t only happen in those early times. There are some significant things that can and do happen in those early times. Like if someone is going to have what is a very rare but severe condition called postpartum psychosis. Often it’s showing up in those first three weeks, and that is a very distinct break from reality and it’s very severe symptoms outside of that, symptoms can develop really within anytime during the first year.
You could feel fine, and still develop onset of symptoms within the first year and there are some other research shows that for symptoms that have not been worked through or resolved or attended to that symptoms can peak at four years postpartum, which is a long time to be suffering. However, so in terms of when there are vulnerable periods of time where symptoms can start and that is absolutely at weaning, restarting your period and yeah, I mean those are the most distinct times where are biologically you’ll see it an onset.
Ayelet: Right, because of course, there’s a change in our hormones again, right?
Kat: Yeah, absolutely. So those are more vulnerable periods of time. But also, there’s other stuff that can happen. There can be a slow accumulation where there’s a lot of, a lot of the times around six to nine months for any number of reasons. That’s where we do see a lot of either onset or increase of symptoms.
Um, there, yeah, so basically anytime within the first year you can start experiencing this and it is, it’s hard to tell all the time when things actually really, really start again. There can be like a slow onset – sleep deprivation is always gonna make it worse.
But in terms of even women who are going like in recovery and kind of healing in their process, there will be times in their healing where we’ll see dips and whatnot because especially if there’s like a fast stop breastfeeding or they’re like, right, there period is starting. Or if they have had, uh, several nights of for sleep or if there’s a new stressor in their life, like they’re often is, do I return to work? Partner got laid off. I don’t know, grandparent has a health issue.
Any number of things. I had actually really a patient ask me an interesting question. Like, is what I’m experiencing really depression or is it just because of life issues? And the answer is, it’s like, life issues caused depression. I mean, what this is essentially your body is so complicated. There’s so much going on and biochemically, all over the place, there’s a lot of things happening.
Oh, I’m going to interject here for a second and urge all moms to have their thyroids checked because that’s another thing that can aggravate and make symptoms worse, so sometimes women develop something called Postpartum thyroiditis which can make their thyroid go really high up and it makes them very anxious and jittery or they can have hypo thyroid, which is a low thyroid. It feels like depression, so that’s something to get checked out just as a – just rule that out. Yeah. There’s a lot of stuff!
There’s a lot of stuff happening. It’s a very complicated system we have in our brains and bodies, and what depression and anxiety is… they have their own set of symptoms that we talked about, but also it’s a high level of stress. And when your body is experiencing a very high level of stress and also impacts your body functioning and increases inflammation. It does all this other stuff. And actually, I have a really great resource.
There’s a woman by the name of Kathleen Kendall Tackett who does amazing research and she looks into all of this about how, you know, how does depression affect breastfeeding, how is inflammation and our stress response impacting this period of time in maternal mental health. So I would check her out. She has amazing resources that can really go deep into explaining the kind of biological changes that are happening.
Ayelet: I think it’s also just so important to know that fact that it’s not necessarily right at birth or right after birth that these things can come on, so in some ways, even the term postpartum is almost a misnomer because we associate it so much with those very, very early days and weeks. So, that’s tough.
Kat: Yeah,I think that that adds to the confusion for people who aren’t feeling well at six, nine, 12, 15 months, two years that they… another common question is, well, I had my baby a year ago, is this postpartum? And “postpartum” has become the term for not feeling well now it’s just postpartum, but whether or not it’s depression or anything.
Ayelet: Right! The one other question that I wanted to ask you about is the fact that of course these things are associated with maternal mental health, but I know there’s been some research, especially in the last few years about postpartum mood disorders affecting fathers and partners. Can you speak a little bit about that?
Kat: Yeah, so in terms of statistics, paternal postpartum depression is about one in 10, about 10 percent of dads may experience that. They may also be experiencing anxiety, like intrusive thoughts, like we were discussing before along with like like PTSD if there was a birth trauma.
Even if the mom feels fine, the father could have had a traumatic experience. They are absolutely experiencing things and I will say it’s not just fathers, it’s same sex partners and primary caregivers or primary support people and also adoptive parents.
Ayelet: Yes, thank you for that distinction. Absolutely.
Kat: Yeah. So, one in 10 dads. However, if their partner is experiencing perinatal mental health challenge, they’re about 50 percent more likely to also experience it. So, the amount of stress that’s on the couple is a lot, anyways during this transition, I think it’s about 67 percent of couples have marital dissatisfaction during the first year without postpartum anything. So throw that in there and then um, it becomes challenging.
So, the partner, the dad in this case, could be very much experiencing postpartum depression. For him, it might look more like agitation, might look more like all of a sudden he wants to be at work longer and stays away from the house longer. Or even for some people they start developing new hobbies all of a sudden they’re really trying to like stay out and stay away, which, you know is challenging for a mom who’s having a hard time because she needs help and this is where a lot of the conflict happens.
So, some of the newer research is showing that for dads it might peek at around three to six months for them, and I haven’t read all of that research yet, but my professional guess is that there could be one of two things things, like an accumulation of stress, but also, oftentimes partners and won’t experience their symptoms at the same time.
You see this a lot in perinatal loss and grief is that oftentimes if there’s going to be like a grief response, the mom is experiencing it first and then once she starts to resolve and get better, the dad or the partner will begin experiencing their stuff. It’s almost like one person’s trying to keep it together and then when they are feeling better than the other person starts to kind of dissolve into their kind of stress.
Ayelet: It makes a lot of sense. Thank you for speaking to that. Do you have any other resources for families who’d like to learn a bit more? You mentioned a couple of really great ones. Are there any others?
Kat: Yeah, there there are quite a few. Well in terms of, you know, I know a lot of organizations who do training, so if you have any listeners who are mental health professionals or really in any way help or support perinatal women, pregnant, postpartum, there’s a lot of really great training out there to kind of dig into this and understand a little bit more. I find like a lot of doulas really find that additional information beneficial.
So I said that postpartum.net, Maternal Mental Health Now and Seleni Institute, and Postpartum Stress Center. Those are all great places. Oh, and Postpartum Action Institute, great places for training. For if you’re interested in kind of the legal advocacy part, 2020 Mom is a great organization for that. They do a lot of work to try and get laws changed and bills on the books to change our systems so that we can support women better.
And, in terms of information resources, postpartum.net is really great. They have the information but also they have online support groups both in English and in Spanish every week, you have the opportunity to call in and chat with an expert once a week, women and moms do, and for dads it’s once a month you can call in and chat with an expert. So that, yeah, their, the way they’re set up for their online support is great.
And they have a warm line. So with volunteers all over the United States and internationally, actually. So if you yourself are experiencing symptoms, you can go to their website, click on your state, and then scroll down the list of providers that could be near you. You call them, not providers, rather volunteers that can be near you and you call them and they that was volunteers to have a list of resources in your area and they can help connect you to the appropriate therapist or some people have other types of supports listed too.
Ayelet: That’s so fantastic. Thanks for that. Well, thanks so much Kat, and thanks to all of the participants of the Learn With Less Curriculum who are here listening live. We are going to continue the discussion and open up for a short Q&A session with you guys in just a minute for everyone listening from home or on the go. Thanks so much for joining us and we will see you next time.
