Psychiatry and Pregnancy: Real Words from a Real Psychiatrist

For this month's entry, I interviewed a wonderful woman, mother, and reproductive psychiatrist, Emily Dossett, MD, MST. Dr. Dossett is the Assistant Clinic Professor of Psychiatry at the University of Southern California, the Director of the Maternal Wellness Clinic (an outpatient clinic dedicated to perinatal mood disorders, at Los Angeles County/USC), and a reproductive psychiatrist in private practice. But she is also a mom of two young boys. Hopefully her insights will help us all consider the importance of mental health in pregnancy.

Walker: How do you define "perinatal mental health?"

Dr. Dossett: Perinatal mental health refers to emotional and psychological wellness from the beginning of pregnancy (or even immediately before) until roughly one year after delivery. Of course, many women who present with psychiatric issues during this time frame have previous histories as well.

Walker: How did you get interested in the field of perinatal and postpartum mood and anxiety disorders?

Dr. Dossett: I was originally interested in child and adolescent psychiatry when I was in medical school. However, I realized as I entered psychiatric residency that many of my young patients were in fact there because of difficulties with their own mothers' mental illness and turbulent lives. I truly believe that perinatal psychiatry is the closest thing we have to "preventive psychiatry." I have always liked OBGYN as well -- so it was a nice way to stay connected to that field.

Walker: What is the main reason women come to your practice?

Dr. Dossett: Women often come to my practice -- a psychiatric practice -- because they have profound symptoms that are affecting their jobs, their families, and their ability to function. Usually, they have tried other, less "invasive" treatments than psychiatric medication, such as therapy, exercise, or herbal medications, but can't seem to find the relief they need in order to keep going.

Walker: Do you see any over-arching themes in symptoms?

Dr. Dossett: The main themes are depression -- usually tearfulness, inability to get out of bed, and most disturbingly, lack of joy or excitement about pregnancy or the new baby. I also see a good deal of anxiety, whether it's panic attacks, obsessions and compulsions, or general anxiety. Much of this anxiety is focused on the baby and how it is doing. Women often feel a good deal of guilt and self-criticism about their ability to carry a pregnancy or mother a child, which plays into both sets of symptoms. Physically, sleep and appetite problems are very common. Suicidal thinking is unfortunately common as well.

Walker: How much does stigma play a role in women feeling confident to get help?

Dr. Dossett: Stigma is enormous! I refer a good deal to the "Myth of Motherhood" -- this idea that a good mother is always happy, always selfless, always in love with her baby. No mother feels that way all the time, but no one wants to admit it. For women with PMADs, they feel much worse about themselves in comparison to this idealized mother, and are that much more reluctant to speak up and get help.

Walker: Why do you think PPMADs are so prevalent today?

Dr. Dossett: I think they've always been there -- I just think we're detecting them at higher rates. Women have suffered in silence for many, many years about some very real emotional and psychological issues connected with motherhood.

Walker: How do you see partners/spouses affected?

Dr. Dossett: They are often devastated. Fathers and partners feel pushed aside, unable to connect, and hurt personally. They often get frustrated or even angry, mostly because they feel helpless in the face of the disorder. I've seen marriages really suffer as a result. Fortunately, when help is available, the marriage can pull through, though it is difficult.

Walker: Generally, What is the most difficult part of this illness for pregnant and breastfeeding women?

Dr. Dossett: For many women, aside from the symptoms themselves, there is a real sense of both guilt and grief that they are not experiencing this special time in their lives with joy. Women often start crying in the interview when I ask how they feel about the pregnancy. For many, these pregnancies and babies are longed for and planned, but all the excitement and pleasure disappears in the face of the Perinatal Mood/Anxiety Disorders.

Walker: What should women today do to advocate for their mental health in pregnancy?

Dr. Dossett: That's tricky. For women who are depressed and anxious, it's all they can do in the morning to get up and out of bed, let alone advocate for their mental health. That's part of the problem. For women who are healthy or who are survivors, we need to continue to speak out to each other, to families and friends, and to our policy makers. We also need to talk to our doctors to make sure they are treating us properly by paying attention to our mental health.

Walker: Where do we need to do a better job as a society?

Dr. Dossett: We need to stop putting pressure on women to live up to the "Myth of Motherhood." We need to understand that pregnant and new mothers get sad and anxious, too, and that's okay -- and that when it develops into an illness, it's okay to get help. We need to allow women time to heal and recover through extended maternity leaves, more supportive policies at work, and practical support through childcare and health care.

Walker: Can you share a story of recovery?

Dr. Dossett: For purposes of confidentiality, nothing too specific, of course! But I can tell you that I have many women in my practice who came to me devastated by depression or anxiety in pregnancy or in the months afterward, and they have now gone on to have healthy babies and families. Many are now going for the second or even third child, which lets you know that there is recovery and hope!

Thank you to Dr. Dossett for giving time to Giving Birth With Confidence. If you need more information regarding depression and anxiety during pregnancy or postpartum, and resources in your area, you can visit Postpartum Support International (PSI) at www.postpartum.net; or call the warm-line volunteers at 1-800-944-4PPD.

Emily Dossett, MD, MTS currently practices reproductive psychiatry in Pasadena, California, where she works primarily with pregnant and postpartum women facing psychiatric issues. In addition, she serves as Director of the Maternal Wellness Clinic, an outpatient clinic dedicated to perinatal mood disorders, at LAC+USC. At Assistant Clinic Professor of Psychiatry at USC, Dr. Dossett also teaches medical students and residents about clinical care for maternal depression. She conducts maternal depression screening and treatment seminars for the Los Angeles Best Baby Network, LA Care, the Welcome, Baby! Home Visitation Program, and the Los Angeles County Department of Mental Health. She is an active lecturer and writer on perinatal mood topics. Dr. Dossett is also on the Executive Committee of the Los Angeles County Perinatal Mental Health Task Force, a consortium of over thirty individuals and agencies dedicated to policy change and service improvement for perinatal mood and anxiety disorders. Most importantly, she is married to Giancarlo DiMassa, MD, and is the proud mother of Giuseppe, age 4 years, and Luca, 2 years.