Maternal Mental Health: Q&A with Dr. Katherine Wisner
Dr. Wisner is the Norman and Helen Asher Professor of Psychiatry and Obstetrics and Gynecology at Northwestern University and the Director of the Asher Center for the Study and Treatment of Depressive Disorders. She joins us here for a discussion on maternal mental health
Q: What are some of the most common mental health issues that pregnant women face?
Major depressive and anxiety disorders are common in women of childbearing age. In a study of 10,000 women screened at 4-6 weeks after birth, 14% (1 of 7 women) screened positive for depression. The most common diagnosis was depression, and the majority of these women also had an anxiety disorder that began earlier in life, often in childhood. The time of onset for women who were screened varied from before pregnancy, that is, chronic depression (27%), during the 9 months of pregnancy (33%) and within 3 months after birth (40%). This is consistent with epidemiologic studies that show a peak in new onset mood episodes in the first 3 months postpartum. This increase in cases is associated with the massive withdrawal of reproductive hormones that occurs at birth, which is a stressor that destabilizes physiological systems.
Q: Most women are familiar with the term the ‘baby blues,’ which can occur in the postpartum period. When should a woman be concerned that what she is feeling might be a sign of something more serious?
The baby blues are transient, mild episodes of tearfulness and anxiety that peak on day 4 postpartum and resolve by 10 days after birth. If the symptoms interfere with maternal function or are worsening across time, or the woman has any self-harm thoughts, the episode is not the baby blues.
Q: Your research focuses on the use of anti-depressants such as selective serotonin re-uptake inhibitors (SSRIs) both during and after pregnancy. How would you council a patient who is concerned with the effects it may have on her unborn child?
The important point is that the underlying illnesses, major depressive and/or anxiety disorders, if untreated in pregnancy also increase the risk for poor pregnancy outcomes, so treatment is an important aspect of pregnancy care. There are several treatments for depression, including psychotherapy and bright morning light therapy in addition to SSRI or other antidepressants. The choice to use antidepressants is justified by the uncontrolled depression or anxiety having a greater impact on pregnancy outcomes than the medication for the individual woman, who is supported to make this risk-benefit decision.
Here is some additional information free to the public:
Each antidepressant has a fact sheet, [information for] the most commonly used one, sertraline, can be found here:
Mother to Baby - Sertraline
Q: Is it safe to take antidepressants while breastfeeding?
I don’t use the word “safe” since it has no consistent meaning for health professionals or patients. I think of it as the level of risk that occurs above that of the baseline risk in any population. However, the majority of antidepressants are found in very low amounts in breastmilk, and the general consensus is that the benefits of breastfeeding, both short- and long-term health, for mother and infant, dramatically outweigh the risk for health newborns. The fact sheets for each antidepressant noted above have information on breastfeeding.
Q: Throughout your career, you have been a champion and advocate for maternal mental health. What is something you would like people to know or keep in mind during maternal mental health awareness month?
Perinatal depression and/or anxiety occur in one of every seven women! These conditions are not rare. You are not alone! Please talk to your doctor! In Illinois, support is available through the
Postpartum Depression Alliance of Illinois