Op-Med is a collection of original articles contributed by Doximity members.
Last month was the 31st Annual Conference for Postpartum Support International. PSI was founded in 1987 to increase awareness among public and professional communities about the emotional changes that women experience during pregnancy and postpartum, which can include depression, anxiety and panic, OCD, PTSD, mania, and psychosis. Postpartum care is important to multiple disciplines, and the conference attendance showed it: physicians, psychotherapists, nurse practitioners, midwives, doulas, nurses, lactation specialists, social workers, and more attended.
With such a diverse crowd united for one common issue, it was a good opportunity to introduce attendees to some new programs offered by PSI. Frontline provider training is now available via an onsite course or webinar to provide perinatal mental health training to providers (OB/GYN, Internal Medicine, Family Medicine, NPs, doulas, midwives) that women will encounter during and after birth before coming into contact with mental health providers.
The second new and invaluable resource is the Perinatal Psychiatric Consult Line. This free service allows medical providers to request a consult with a reproductive psychiatrist to discuss preconception counseling and psychiatric medication management during pregnancy and postpartum for their patients. There is a shortage of psychiatrists and other mental health providers, so these resources will provide primary care providers with experience in screening and detection and expert consultation if there is not mental health treatment readily available for their patients.
I attended the conference for the third new program. PSI now offers Perinatal Mental Health Certification with Pearson VUE for psychopharmacology, psychotherapy, and affiliated professions. The Perinatal Mental Health Certification Program creates a structure for professional education and evaluation, and a standardization of training and experience for perinatal mental health specialists. Women, their families, and referring providers will be assured that they are referring to a provider with expertise in perinatal mental health during this important and vulnerable time in their life.
The Perinatal Mental Health Alliance for Women of Color was founded in February 2017 and was well represented at this year’s conference. Recently, awareness about the disparities in pregnancy and postpartum care for women of color has been highlighted in the news. Serena Williams, who has the means for excellent care, had life-threatening complications after birth that were initially not taken seriously. Racial bias is considered to be a cause of why Black women are three to four times more likely than white women to die from pregnancy-related complications.1 There were sessions about the increased rates of infant and maternal death in Black women and children, the impact of present-day and transgenerational trauma on the development of PMADs, perinatal care for immigrants, increased rates of PMADs and less access to treatment in women of color, microaggressions, etc. There were two guests from Indonesia to provide perspective on how mental health issues are viewed in other countries and cultures, lack of access to care, and program development to increase access to care in their country.
Men were not left out. Sessions discussing paternal postpartum depression, the impact of maternal PMADs on fathers and partners, and how fathers and partners can support mothers, were offered. One of the most impactful sessions was a keynote that featured Steven D’Achille. He lost his wife as a result of postpartum depression and has turned his grief into a foundation, the Alexis Joy D’Achille Foundation, to honor his wife by helping women and families impacted by postpartum depression.
The majority of treatments for postpartum depression, and depression in general, for decades have been serotonergic, noradrenergic, and/or dopaminergic medications. Brexanolone is a first-in-class GABA-A receptor positive allosteric modulator. It has been studied as a 60-hour IV infusion for the treatment of moderate and severe postpartum depression with reduction of HAM-D scores of 14 to 20 points at 60 hours and maintained at 30 days. A new drug application was submitted to the FDA in April 2018. Transcranial magnetic stimulation was FDA approved in 2008 for treatment-resistant depression. Although it is not FDA approved specifically for perinatal depression, it is being used successfully as a non-medication treatment option for depression during pregnancy and postpartum.
But there was also space for those who did not get the treatment they needed. The PSI Memorial Quilt was displayed with the names of lives lost as a result of postpartum depression. The conference provided the opportunity to honor them and celebrate those who have recovered. Everyone who attended the conference left more dedicated to serving women and their loved ones impacted by PMADs because this population is underserved and awareness of how to recognize and treat PMADs needs to increase. I look forward to similar content in future conferences as well as discussion of the impact on religion and spirituality on PMADs and even more inclusion of symptom presentation in different races and ethnicities.
1. Health Care Disparity and Pregnancy-Related Mortality in the United States, 2005–2014
Moaddab, Amirhossein, MD; Dildy, Gary, A., MD; Brown, Haywood, L., MD; Bateni, Zhoobin, H., MD; Belfort, Michael, A., MD, PhD; Sangi-Haghpeykar, Haleh, PhD; Clark, Steven, L., MD
Obstetrics & Gynecology: April 2018 — Volume 131 — Issue 4 — p 707–712
2. Focus on fathers: paternal depression in the perinatal period
S Glasser and L Lerner-Geva
Perspectives in Public Health: July 25, 2018
Danielle J. Johnson, MD, FAPA is a board-certified psychiatrist. Her interests include women’s mental health and minority mental health. Dr. Johnson is co-author of the book “The Chronicles of Women in White Coats.” Follow @drdanij on Instagram and Twitter. She is a 2018–2019 Doximity Author.