[SPEAKER_00]: You did not want to miss this episode about perinatal mood and anxiety disorders, with the psychiatrist who is certified in perinatal mental health.

[SPEAKER_00]: Welcome to the all about pregnancy and birth podcast.

[SPEAKER_00]: If you're having a baby in the hospital, you are giving birth in a system that too often takes away power from women over what happens in their own bodies.

[SPEAKER_00]: I'm Dr.

Nicole Calloy Rankin, subpracticing for certified OBGYN, who's had the privilege of helping go well over at Thousand Babies into this world.

[SPEAKER_00]: I've been a doctor for over 20 years, and I'm here to help you take back your power, advocate for yourself.

[SPEAKER_00]: and have the beautiful pregnancy and birth that you deserve.

[SPEAKER_00]: This podcast is for educational purposes only and it's not enough to do for multiple advice.

[SPEAKER_00]: Check out the full disclaimer at Dr.

McCall Rankin's.com full with slash to disclaimer.

[SPEAKER_00]: Now let's get to it.

[SPEAKER_00]: Hello there, welcome to another episode of the podcast.

[SPEAKER_00]: This is episode number 241, whether this is your first time listening, or you've been listening before.

[SPEAKER_00]: I'm so glad you're spending some time with me today.

[SPEAKER_00]: So Dr.

Stephanie Wagle is a mother, physician, author, motivational speaker, teacher, cancer survivor, marathon runner, and founder of Improve Medical Culture.

[SPEAKER_00]: She has a degree in psychology, biology, medicine, and she has over 17 years of experience working in the mental health field as a psychiatrist.

[SPEAKER_00]: In 2023, she decided to become certified in periodatal mental health, specifically advanced studies in periodatal psychopharmacology, which is the use of medication for pregnant people.

[SPEAKER_00]: She feels this is an area that is understudied, which is so true, and that pregnant women deserve an educated professional to provide correct diagnosis and treatment.

[SPEAKER_00]: Yes, amen to that.

[SPEAKER_00]: She really heavily advocates for expansion and integration of p-mets, care, and p-mets are [SPEAKER_00]: We have a really informative conversation.

[SPEAKER_00]: You're going to learn a lot.

[SPEAKER_00]: We talk about what are perennial mood and anxiety disorders.

[SPEAKER_00]: It's more than just postpartum depression, how common they are risk factors, the most common conditions that she sees.

[SPEAKER_00]: This may surprise you, spoiler alert.

[SPEAKER_00]: It's actually not postpartum depression.

[SPEAKER_00]: We also talk about when someone should seek help because some level of sadness anxiety is normal when you have a baby, but when do you know to seek help?

[SPEAKER_00]: Where should you get help from?

[SPEAKER_00]: When should you consider medication?

[SPEAKER_00]: We also chat about her approach to taking care of someone who was already on depression or anxiety medication prior to pregnancy and then they become pregnant.

[SPEAKER_00]: What should you do about continuing or not continuing to take that medication?

[SPEAKER_00]: What do you do if you decide to stop your medication during pregnancy?

[SPEAKER_00]: What are your options for managing your mental health while off medication?

[SPEAKER_00]: Also, when should you restart medication postpartum if you are breastfeeding?

[SPEAKER_00]: Tons and tons of useful information.

[SPEAKER_00]: Oh, and we end with talking about the recently approved medication for postpartum depression.

[SPEAKER_00]: I'm gonna, I'm gonna mess this up.

[SPEAKER_00]: Zoran alone, I don't know where we come up with these medications, but this is the first FDA approved medication for postpartum depression, so we chat about how it works, how it's different than other medications.

[SPEAKER_00]: really, really good information in this episode.

[SPEAKER_00]: Now, you know where else you can get some really great information.

[SPEAKER_00]: My birth plan class, make a birth plan the right way.

[SPEAKER_00]: If you're having a baby, you need a birth plan, but that piece of paper, that ain't enough of a birth plan, I teach you the way to make a birth plan, [SPEAKER_00]: that is going to actually help you have the birth experience that you want.

[SPEAKER_00]: You can check out my free birth plan class.

[SPEAKER_00]: It's at DrNacleRankin.com forward slash birth plan.

[SPEAKER_00]: It is highly highly informative.

[SPEAKER_00]: Useful people love it and there's a little goody at the end of the class too.

[SPEAKER_00]: So do check that out.

[SPEAKER_00]: All right, let's get into the conversation with DrWabble.

[SPEAKER_00]: Thank you so much, Dr., is it Dr.

Wackle?

[SPEAKER_00]: I should have asked you before we started.

[SPEAKER_01]: Oh, that's it.

[SPEAKER_00]: I got it right.

[SPEAKER_00]: Dr.

Wackle.

[SPEAKER_01]: Yes, you know, it's tailwackling.

[SPEAKER_01]: And there we go.

[SPEAKER_00]: Well, thank you so much for agreeing to come once in the podcast.

[SPEAKER_00]: I'm really excited to have you talk about this really important topic.

[SPEAKER_01]: Thank you so much for having me.

[SPEAKER_01]: I'm so excited.

[SPEAKER_00]: Yes, I want to just stop by telling us a bit about yourself and your work.

[SPEAKER_00]: And even if you're family, if you like, [SPEAKER_01]: sure so I live in Northern Virginia and I've been in the D.C.

area for oh my goodness 14 years um but I keep moving for them further out into the suburbs [SPEAKER_01]: And I have two kids.

[SPEAKER_01]: I have a daughter.

[SPEAKER_01]: She's four and a son who's 19 months old, so it does get louder.

[SPEAKER_01]: Yeah, yes.

[SPEAKER_01]: And I like distance running.

[SPEAKER_01]: I just did the Marine Corps marathon.

[SPEAKER_00]: That is impressive.

[SPEAKER_00]: Yes.

[SPEAKER_01]: Yeah.

[SPEAKER_01]: I'm not going to sprinting, but to continue to run for hours and hours somehow I can do that.

[SPEAKER_01]: Okay.

[SPEAKER_00]: Yeah, and let's see, and then your practice tells about your pure practice and you're sure.

[SPEAKER_01]: Yeah, so it's called improved life, PLLC, which they may be with the PLLC at the end for professional limited liability corporation.

[SPEAKER_01]: and prove life.

[SPEAKER_01]: And so we've been around for about seven years in the northern Virginia area, and I specifically tried to focus on the treatment for young women adolescents, but we also see everybody because we have other providers here, Dr.

Dr.

Driscoll, [SPEAKER_01]: And the males, and I specialize in ADHD.

[SPEAKER_01]: She doesn't specialize in ADHD.

[SPEAKER_01]: And then we have therapists too.

[SPEAKER_01]: And then we have Maryam Zim, who we couldn't function without she's our office manager.

[SPEAKER_01]: And yeah, so we do ADHD testing, anxiety, depression, OCD, PTSD, mental health in general.

[SPEAKER_01]: But I knew specifically try to focus on adolescence [SPEAKER_01]: people of reproductive potential because I have this certification in prenatal psychopharmacology.

[SPEAKER_00]: Why don't you tell us what that's about?

[SPEAKER_00]: What does that mean?

[SPEAKER_01]: Yes, so as we were kind of discussing earlier is there's not really too much that [SPEAKER_01]: goes on in medical school or residency in regard to medications to be prescribed specifically psychiatric ones for people when they're pregnant because I think it's a bit of a sticky situation.

[SPEAKER_01]: I have on my YouTube channel it's called [SPEAKER_01]: The therapeutic orphans, it's a video about how women when they become pregnant kind of just are told by either the pharmacist or their providers.

[SPEAKER_01]: You know, it's not taking everything because healthcare workers in general have a greater sense of [SPEAKER_01]: responsibility if something negative happens for something that they have done or prescribed as opposed to something negative happening that they didn't prescribe so let's say there's they prescribe something there's a negative outcome it's there's a lot of guilt and responsibility but if they don't prescribe something there's a negative outcome like that connection really isn't there so I think a lot of prescribers air on just not prescribing anything [SPEAKER_01]: which actually does have detrimental effects.

[SPEAKER_01]: Right.

[SPEAKER_01]: I wanted to fill that gap because somebody needs to be able to go to a doctor that's going to be willing to prescribe them something while they're pregnant.

[SPEAKER_01]: And my understanding is that there's only two or three other physicians in the entire state.

[SPEAKER_01]: with this certification.

[SPEAKER_01]: And the fact that a lot of prescribers aren't really super educated in this creates a lot of confusion because then people get conflicting information.

[SPEAKER_01]: So I thought let's get some real information out there and allow for pregnant people to be able to get some medications.

[SPEAKER_01]: So absolutely.

[SPEAKER_01]: I got that certification [SPEAKER_00]: pretty exciting for me.

[SPEAKER_00]: And really, and really important, and I don't think we even said you're a psychiatrist.

[SPEAKER_00]: Yes.

[SPEAKER_00]: Yes.

[SPEAKER_00]: Yes.

[SPEAKER_00]: Yes.

[SPEAKER_00]: Yes.

[SPEAKER_00]: You're a psychiatrist.

[SPEAKER_00]: And tell us actually what training you go through to become a psychiatrist.

[SPEAKER_00]: I'm big on how to make sure that people get information from reliable trustworthy sources because there's so much out there online, you know, in social media, [SPEAKER_00]: anybody can sort of put it in whatever it says.

[SPEAKER_00]: So please tell us about what training you went through to become a psychiatrist.

[SPEAKER_01]: Right so um I all it all started not long ago.

[SPEAKER_01]: So I got my undergraduate degree in psychology and I graduated a year early because I was also premed and I had a writing minor so I had like 24 credits well it was a lot and they were like oh you [SPEAKER_01]: What do I do before I go to medical school since I'm graduating early?

[SPEAKER_01]: So that I got master's degree in biology and during this time, I worked as a psychometrist at Allegheny General Hospital.

[SPEAKER_01]: We did like west cons and card sort like testing on [SPEAKER_01]: people that had traumatic brain injuries and that sort of thing.

[SPEAKER_01]: And then I also worked at EPMC in the geriatric department for a while.

[SPEAKER_01]: and it was a lot of psychiatry because you know there's a lot of dementia and that sort of thing in the geriatric population.

[SPEAKER_01]: And then I went to medical school and I did some mental health things on top of going to medical school because a lot of medical school like doesn't really get into too much psychiatry, but [SPEAKER_01]: I worked for United Planet and I worked at the United States Coast Guard and I did a lot of mental health related things in addition to going to medical school and then I did my internship and then I did two years of psych residency and then I opened up my own private practice because I didn't want to work for the man anymore.

[SPEAKER_01]: There you go.

[SPEAKER_01]: work for myself and that actually worked out pretty well.

[SPEAKER_01]: I won't digress too much, but I was actually diagnosed with cancer when I was in residency.

[SPEAKER_01]: It was very challenging and so opening up a private practice allowed me the flexibility to go to doctor's appointments and [SPEAKER_01]: I take care of myself, which is really important for physicians in general, but especially incite chyatri needs to have your own mental health, so you take care of other people's.

[SPEAKER_00]: Well, I hope you're in remission now in everything as well, yeah, we'll get it.

[SPEAKER_01]: Yes, hi, I'm scanning another MRI in two months, so hopefully that looks good.

[SPEAKER_00]: Yes, there you go.

[SPEAKER_00]: And then I get how did you get interested in psychiatry?

[SPEAKER_00]: I'm just curious.

[SPEAKER_01]: Well, I really like talking to people in high school.

[SPEAKER_01]: I was voted most outgoing and then in medical school.

[SPEAKER_01]: I was social chair every year and I just really like to listen.

[SPEAKER_01]: I like to talk to people and some of the specialties didn't allow me enough time to really talk to my patients.

[SPEAKER_01]: I thought [SPEAKER_01]: My ED, like, rotation was fine, but they were like four minutes for patient.

[SPEAKER_01]: I'm like, but I have so many things I want to add right.

[SPEAKER_01]: And so it's like, I get like an entire hour to talk to people.

[SPEAKER_01]: Right.

[SPEAKER_01]: And, you know, really, really get into the psyche and to analyze people.

[SPEAKER_01]: And I just think it's so super interesting.

[SPEAKER_01]: Yeah, I love it.

[SPEAKER_01]: I love it.

[SPEAKER_01]: I love it.

[SPEAKER_00]: So let's get into perinatal mood disorders.

[SPEAKER_01]: Is it P, P, M, A, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, D, [SPEAKER_01]: So if I'm just speaking for the general population, which is what my audience is, yeah.

[SPEAKER_01]: That's where I'll go.

[SPEAKER_01]: Yes.

[SPEAKER_01]: I usually say postpartum depression because most people and the general audience in the general population know what postpartum depression is.

[SPEAKER_01]: Right.

[SPEAKER_01]: But I actually prefer to use the term p-mads.

[SPEAKER_01]: And there's two reasons I [SPEAKER_01]: Think P-Mads is more appropriate.

[SPEAKER_01]: Again, P-Mads is perinatal mood and anxiety disorder.

[SPEAKER_01]: P-Mads encompasses a greater period of time.

[SPEAKER_01]: So post-partum depression, post-partum is just after birth for another year.

[SPEAKER_01]: But perinatal in the P-Mads is from conception to one year after.

[SPEAKER_01]: So it encompasses a greater period of time.

[SPEAKER_01]: Additionally, number two is that postpartum depression is just depression where as pmeds would be OCD, anxiety, PTSD, all sorts of other psychiatric issues.

[SPEAKER_01]: So pmeds has a greater time period and then it encompasses more symptoms.

[SPEAKER_01]: So I use postpartum depression because most people know [SPEAKER_00]: more people would be included into that category, which is really important because it's not just post-partum, as you mentioned, and it's not just depression.

[SPEAKER_00]: Like anxiety comes up, birth trauma, things like that come up.

[SPEAKER_00]: So I really appreciate that you're talking about we need to expand it in a more encompassing way.

[SPEAKER_00]: It's great that we talk about post-partum depression, but we need to add the things to that to talk about as well.

[SPEAKER_01]: That's right.

[SPEAKER_01]: You don't want to leave people out.

[SPEAKER_00]: Exactly.

[SPEAKER_00]: Exactly.

[SPEAKER_00]: So how common are perinatal mood and anxiety disorders?

[SPEAKER_01]: Well, the for a postpartum depression.

[SPEAKER_01]: So there's no statistic, I think, specifically on PMAs, but on postpartum depression, they estimate every one out of six.

[SPEAKER_01]: It's actually one out of five to seven, but I think one out of six makes more sense.

[SPEAKER_01]: women and then actually, um, dance can get postpartum depression and the statistics are one out of 10 dance.

[SPEAKER_01]: Really?

[SPEAKER_01]: 10% of dance.

[SPEAKER_01]: Yeah.

[SPEAKER_00]: Oh, see, I did not know that.

[SPEAKER_00]: I didn't know what was that common in dance.

[SPEAKER_00]: Yep.

[SPEAKER_00]: Okay.

[SPEAKER_00]: Okay.

[SPEAKER_00]: All right.

[SPEAKER_00]: And then what are some risk factors for developing any of these conditions?

[SPEAKER_01]: right.

[SPEAKER_01]: So they're pretty what you would imagine.

[SPEAKER_01]: So risk factors would include if you have some sort of environmental stressors like lack of support from your family or financial concerns [SPEAKER_01]: it's like an unexpected pregnancy that you were not preparing for or there's abuse going on or job insecurity.

[SPEAKER_01]: So we have the environmental factors, you know, any of those stressors those are going to be like negative points, right?

[SPEAKER_01]: And then of course we have our genetic predisposition.

[SPEAKER_01]: So if you have [SPEAKER_01]: family history of postpartum depression, or if you yourself, has had some mental health challenges in the past, but sometimes it can come with no signs, no predictors, nothing, it could just be seemingly, you know, no cause, but so definitely risk factors [SPEAKER_00]: Now, when you see folks that have these disorders or issues or concerns, do you mostly see depression, do you see some anxiety, do you see some PTSD, like what do you see in your practice?

[SPEAKER_01]: Oh, I see it all, but I- Okay.

[SPEAKER_01]: You know, I think it's a, if I had to guess, it's probably comparable with anxiety and depression.

[SPEAKER_01]: Okay.

[SPEAKER_01]: Um, so we have this hormone pregnant alone, which sort of functions in a way to be protective helps anxiety and after birth, it decreases and if you have something that's helping with anxiety and then that decreases your anxiety is going to go up.

[SPEAKER_01]: Right.

[SPEAKER_01]: And I really see a lot of anxiety [SPEAKER_01]: It could also be that they're not sleeping and that they have this new life form.

[SPEAKER_01]: They have to adjust their entire life.

[SPEAKER_01]: But there's more mental factors and environmental factors.

[SPEAKER_01]: So I would say anxiety is a lot more prevalent postpartum than maybe people might think.

[SPEAKER_00]: Yeah, I agree to.

[SPEAKER_00]: I actually think I had my first daughter was born a premature eight weeks premature and looking back.

[SPEAKER_00]: I most definitely had anxiety because I was scared.

[SPEAKER_00]: She was like something was going to happen to her.

[SPEAKER_00]: I came home to a level that wasn't, you know, it was excessive.

[SPEAKER_00]: So I can see that we don't talk about anxiety enough and like the social media pressure of having everything perfect and all those things.

[SPEAKER_00]: I'm not entirely [SPEAKER_00]: Yeah.

[SPEAKER_00]: Now, some level of sadness, well, I shouldn't say sadness, but maybe some level of your, especially if it's your first baby, some anxiety, some, some level of that, maybe normal during pregnancy and postpartum, when should someone suspect that this is a problem and that they, they need to seek help for it?

[SPEAKER_01]: Okay, good question because it could be confused with the baby blues, which is in an estimated 70% of postpartum moms and that's two weeks.

[SPEAKER_01]: So if it's longer than two weeks, it's not baby blues.

[SPEAKER_01]: Also, if it's [SPEAKER_01]: Just being a little emotional, emotional, irritable, tearful baby blues, if it's longer than two weeks, then you start thinking about depression.

[SPEAKER_01]: But if it becomes to the point where it is in peating your activities of daily living, like your blues is so severe that you cannot even shower or get out of bed.

[SPEAKER_01]: That's going to be something that you want to probably get some help for and so you want to make sure that [SPEAKER_01]: I think a big component is the other people in your life saying, you know, you're not acting like yourself.

[SPEAKER_01]: You seem different because if you're going through this, you're probably not able to really recognize it as well as people on the outside.

[SPEAKER_01]: So people are commenting to you that you just see my unusual or like, you've been isolating and people are like, well, I mean, if you just had a baby, it's not like you're gonna go.

[SPEAKER_01]: And now you're ready for it.

[SPEAKER_01]: But you know, when people start commenting, that's like a big clue that it's gonna be more than just your typical baby blue.

[SPEAKER_00]: Sure, sure.

[SPEAKER_00]: And then to follow up to that, where should people seek help?

[SPEAKER_00]: Like should they go to a psychiatrist right away?

[SPEAKER_00]: Should they start with a therapist?

[SPEAKER_00]: Like what are things that, where should they go to look for?

[SPEAKER_01]: excellent question.

[SPEAKER_01]: So the screening as recommended.

[SPEAKER_01]: So the American Academy of Pediatrics recommends when the baby comes in, you actually hand the parents, the screening form.

[SPEAKER_01]: At the first visit in the two months and then I think six months, I could say that doesn't happen a lot.

[UNKNOWN]: So [SPEAKER_01]: But, and then O-B's are supposed to provide like the scale.

[SPEAKER_01]: It's either Edinburgh or if you're from Scotland, Edinburgh scale to Mons at some point throughout the pregnancy.

[SPEAKER_01]: So, the O-B's and the pediatricians are supposed to be doing the initial screening and then if it [SPEAKER_01]: comes back positive or even if it's negative, but the OB or pediatrician just gets the sense that there really is something that needs to be looked into.

[SPEAKER_01]: They should refer to a psychiatrist, but then like I was saying earlier, is that not all psychiatrists are well versed and a lot or just like I'm actually just not going to prescribe anything on a little too afraid of what could potentially happen.

[SPEAKER_01]: So in a perfect and ideal world, you'd want to refer them to a reproductive psychiatrist, but like there just aren't very many of those at all.

[SPEAKER_01]: So you could get them in presumably with a therapist much.

[SPEAKER_01]: quicker.

[SPEAKER_01]: However, if it's an emergency, you would definitely want to refer to, I hate to say the ER, but if they checked that they're having suicidal thoughts on the scale, you know, an emergency is an emergency.

[SPEAKER_01]: Right.

[SPEAKER_01]: And you got it.

[SPEAKER_01]: Actually, so I will digress briefly to describe four levels of mental health care.

[SPEAKER_01]: So the first is your basic standard outpatient.

[SPEAKER_01]: They'll be there if it's psychiatrists in an office.

[SPEAKER_01]: And then up from there, if things are more severe, there's intensive outpatient and that's where.

[SPEAKER_01]: Patients get like three to five days for a couple hours of therapy group therapy they're in a program.

[SPEAKER_01]: If it's something going on like with draw or drug abuse or something where you need to be medically monitored and you want to have a nurse and vital signs, that would be a partial hospitalization program where you're pretty much in their all day every day but you do go home at night to sleep.

[SPEAKER_01]: And then [SPEAKER_01]: You, so you, let's say you're doing the screening and they say that they're having suicidal thoughts or having thoughts about harming others that they think that they might act on or if they are so disorganized that they cannot take care of themselves like they don't remember where they live, right?

[SPEAKER_01]: That would be an inpatient hospitalization and that's all day all night.

[SPEAKER_01]: Okay.

[SPEAKER_01]: And so I just wanted to be clear that there's different [SPEAKER_01]: So if you're screening and somebody seems to have some mild depression, I would try to get them in.

[SPEAKER_01]: This is a postpartum support international.

[SPEAKER_01]: And then there's subcategories, there's different states like postpartum sport, Virginia, you can type in where you live.

[SPEAKER_01]: And there's actually a whole bunch of therapists that have the certification.

[SPEAKER_01]: And so if you're screening and it seems like there's depression, you could refer to one of them.

[SPEAKER_01]: I would just not I would make sure that you're referring to somebody that has some training because you don't want them to get conflicting information because then they'll be distrustful of health care providers, but if it's something serious, then you know.

[SPEAKER_01]: you got to get to one of those other levels of care that I just got to got you got you.

[SPEAKER_00]: Okay.

[SPEAKER_00]: So I want to back up for a minute and talk about people or not back up switch topics baby for a minute and talk about people who are on medication before they get pregnant either for depression or anxiety and then become pregnant.

[SPEAKER_00]: What is your discussion or conversation about staying on medication versus coming off medication?

[SPEAKER_00]: What are your thoughts on that?

[SPEAKER_01]: Yeah, this is kind of funny because I'll get calls from my colleagues like my other friends who are psychiatrist and they'll be like, hey, Stephanie, I have a patient on dada dada.

[SPEAKER_01]: And then she just told me she's pregnant.

[SPEAKER_01]: Oh my goodness.

[SPEAKER_01]: And I'm like, well, calm down.

[SPEAKER_01]: So my general philosophy and and again, this is not medical advice because everybody's different and so [SPEAKER_01]: Like, just because this is what would be applicable to most people doesn't mean that the average listener it's going to apply exactly.

[SPEAKER_01]: But the general philosophy that I have is that if they're on a psychiatric medication that is working, [SPEAKER_01]: I continue it.

[SPEAKER_01]: Accept that book out.

[SPEAKER_01]: All the other ones, which is Bell Pro Academy, and has, I don't prescribe that to people of reproductive potential anyway.

[SPEAKER_01]: So if they're on that, it was some other genre.

[SPEAKER_01]: But all the other medications, if they're working.

[SPEAKER_01]: Don't mess with it.

[SPEAKER_01]: Okay.

[SPEAKER_01]: One question I get a lot from other prescribers is should I decrease XYZ medication and the answer is no and the reason is is because if you decrease their medication, they're still going to be exposed to the medication, but now initially they're going to potentially be exposed to uncontrolled mental illness.

[SPEAKER_01]: And I'm trying very hard not to go off on tangents, but again briefly, I would like to point out that [SPEAKER_01]: uncontrolled mental illness in the pregnant person.

[SPEAKER_01]: And I'm not going to get too science-y I swear has epigenetic effects on the unborn child meaning you can turn on and off DNA.

[SPEAKER_01]: So let me just put it in terms that if you are not controlling your mental health that actually negatively affects the baby.

[SPEAKER_01]: So if you think like, oh, you know what, [SPEAKER_01]: through this depressive episode because I don't want my baby to be exposed to the medication.

[SPEAKER_01]: Your baby is actually going to potentially have some negative outcomes from your suffering as well.

[SPEAKER_01]: But I'm going to get back.

[SPEAKER_00]: And I thank you for saying that that is so, so important because I think people actually [SPEAKER_00]: And they mean, well, they think they're doing the right thing by coming off of medication because they're protecting their baby, but not realizing that so much about the baby's health is dependent on the mom's health.

[SPEAKER_00]: So it's just really important.

[SPEAKER_00]: So I'm really glad you brought that up.

[SPEAKER_01]: Yep, and I, I could go out on the epigenetics, but I won't, but suffice it to say, when I get these calls from other prescribers, my patient is on this medication.

[SPEAKER_01]: I found out their pregnant.

[SPEAKER_01]: Do I decrease it?

[SPEAKER_01]: Do I stop?

[SPEAKER_01]: And if it's still with hope, that's different.

[SPEAKER_01]: But any other psych med typically, I would say, no, because you decrease it, their potentially exposed to untreated mental illness, and they're still being exposed to the medication.

[SPEAKER_00]: Gotcha.

[SPEAKER_00]: Gotcha.

[SPEAKER_00]: Yeah.

[SPEAKER_00]: And then, so then, what do you do if someone does that?

[SPEAKER_00]: And I should back up and say, obviously, you'll have a discussion with your doctor about any potential risk for the baby.

[SPEAKER_00]: Like, we're not just going to, and they're actually very few risk of for psychiatric medicines that impact the baby.

[SPEAKER_00]: I don't know if you want to talk about that as well.

[SPEAKER_00]: Anything's to be on the lookout for, or, you know, people can just talk to their [SPEAKER_00]: Maybe switch to a different one or do you just say stay the course for what you're on good question I get this all the time.

[SPEAKER_01]: So in general Separate avocado the psychiatric magazine that's working just keep it the center now [SPEAKER_01]: There's talk that Paxle, there are studies that Paxle can have negative, okay, you know, if this is really getting into like specific case by case things, if that's Paxle's the first thing they ever tried, then maybe you could switch to like Zoloft, you know, but it depends on how many other medications they tried.

[SPEAKER_01]: So if they are already on Zoloft and Prozac and then Paxle is the one that worked.

[SPEAKER_01]: then you can keep Paxle on.

[SPEAKER_01]: But if Paxle is the first thing you, you could potentially try them on Zolloft.

[SPEAKER_01]: And then [SPEAKER_01]: I don't just tell my patients, all right, just keep on.

[SPEAKER_01]: I have this big lengthy conversation.

[SPEAKER_01]: And I feel bad because I go into studies.

[SPEAKER_01]: Sure.

[SPEAKER_01]: They're probably like Dr.

Wagel, like I feel like I'm in school again.

[SPEAKER_01]: But I'll go into studies because I need them to make an informed decision.

[SPEAKER_01]: And I'll say, you know, this, for example, there have been studies that have shown that the SSRIs can cause [SPEAKER_01]: increase length and duration of crying and newborn babies.

[SPEAKER_01]: And then I have to say like it's the potential that your baby is going to cry more than most babies going to be enough for you to stop it and that sort of thing.

[SPEAKER_01]: But I'll go through the studies and I'll say this one found this is this a deal breaker for you.

[SPEAKER_01]: That sort of thing.

[SPEAKER_01]: And then I also introduce them to [SPEAKER_01]: some apps like mommy meds and things like that.

[SPEAKER_01]: And I do like to visit mommy meds.

[SPEAKER_01]: Mommy meds.

[SPEAKER_00]: That's what I've heard of then.

[SPEAKER_01]: Yeah, it's a good one.

[SPEAKER_01]: MGH Women Center for Mental Health has like my favorite sources.

[SPEAKER_01]: And so, okay, when I continue and pregnant woman on a medication, I go over studies.

[SPEAKER_01]: I give them resources like the apps.

[SPEAKER_01]: And these are apps created by professionals.

[SPEAKER_01]: And then I give them the resources like MGH's website and then the fourth thing I do which is not required and I understand that pregnant people are just so busy and overwhelmed.

[SPEAKER_01]: They probably don't have time.

[SPEAKER_01]: But I asked them to enroll in studies because it's not ethical to put pregnant women into studies about different medications.

[SPEAKER_01]: But if you're already pregnant and taking the medication, that's how scientists are going to gather the data.

[SPEAKER_01]: for future discovery.

[SPEAKER_01]: So I say, you know, I know you're busy and obviously you're having mental health issues, so I don't want too much on your shoulder.

[SPEAKER_01]: But if you want to sign up for these studies, so that's the fourth thing that I do, but that one isn't really recording.

[SPEAKER_01]: But it is required that you have to listen to me.

[SPEAKER_00]: Talk about all the information.

[SPEAKER_00]: Yes.

[SPEAKER_00]: And which is important.

[SPEAKER_00]: People should make decisions from being informed, and you want them to be informed, which is great.

[SPEAKER_01]: Exactly.

[SPEAKER_00]: So then if someone decides to stop their medication with them, which I'm sure some people do obviously I don't force people to continue eating, right?

[SPEAKER_00]: Yeah, exactly.

[SPEAKER_00]: Obviously you give them those resources that you talked about, and I presume maybe therapy is also another option.

[SPEAKER_01]: Oh yeah, yeah, yeah, yeah.

[SPEAKER_01]: I'm not just like, here's a pill.

[SPEAKER_01]: Right.

[SPEAKER_01]: in most cases especially because it's even more sensitive, even more serious of a matter when you're pregnant.

[SPEAKER_01]: I don't know.

[SPEAKER_01]: I don't think I've ever said to a pregnant person on meds, you don't need therapy because there's so many life changes coming up and you need support.

[SPEAKER_01]: like 99.99% of the time I also recommend therapy.

[SPEAKER_01]: I just wanted to clarify that.

[SPEAKER_00]: Yep, gotcha.

[SPEAKER_00]: Thank you.

[SPEAKER_00]: Thank you.

[SPEAKER_00]: Thank you.

[SPEAKER_00]: So then if someone decides to stop, when do you recommend that they restart their medicine after they have the baby?

[SPEAKER_00]: Especially particularly at their breastfeeding.

[SPEAKER_01]: This is one of those things that I cannot generalize.

[SPEAKER_01]: This is a super case by case, basically.

[SPEAKER_01]: So especially because the concentrations of different psychiatric medications are excreted to different percentages in Fresno.

[SPEAKER_01]: And just to throw like an example out there, if the mom has ADHD, [SPEAKER_01]: And she's on something like Addera, that has a higher excretion into the breast milk than something like Ritalin, which is a methylphenidate, that has a lower excretion.

[SPEAKER_01]: So I would have to actually see what medication they're on.

[SPEAKER_01]: But if I have to generalize, [SPEAKER_01]: Um, most of the time it is because of the benefits of breastfeeding.

[SPEAKER_01]: And again, I know I get I can have like a whole another topic about like breastfeeding, but it it is thought that the benefits of breastfeeding outway.

[SPEAKER_01]: Um, the the um.

[SPEAKER_01]: excrete like the exposure in the Medicaid.

[SPEAKER_01]: Now, for things like, then Zardine has a penis, which is like, um, Zanex, um, and out of van those, this clonopin, those types of things.

[SPEAKER_01]: You will probably not find a doctor that's like, yeah, you could breastfeed, except for me, if you're checking in with me, if I've analyzed the whole situation, if you're inside so bad, if you're having panic attacks, then I will say, okay, you can take this benzodiazepine and breastfeed as long as you're checking in with me, but I want to make sure that you watch.

[SPEAKER_01]: there's two things.

[SPEAKER_01]: The baby is like somulant and like super sleepy and with thought like then then you know that the amount that is being excreted is having an effect on the baby.

[SPEAKER_01]: So you have to pay attention to the cues from the baby.

[SPEAKER_01]: The other thing is [SPEAKER_01]: that I tell women that take benzodiazepines while breastfeeding to watch out for is following like what if you get knocked out like benza really make you like you know like and you don't want to be breastfeeding and then you take um [SPEAKER_01]: Well, Prasalam and then you're just like fall asleep holding your baby.

[SPEAKER_01]: So if you're going to do that, you're going to need support from your partner to really keep an eye on you to make sure that you're not just like passing out in a chair, but then you also want to observe the babies.

[SPEAKER_01]: The medication when to start taking it in terms of breastfeeding is very medication and patient specific.

[SPEAKER_01]: So unfortunately, I don't have a doctor and surgery.

[SPEAKER_00]: I'm thinking more like Zoloft affects her and those kinds of medicines.

[SPEAKER_00]: We tend to restart those pretty quickly.

[SPEAKER_01]: Yeah, you can breastfeed on those.

[SPEAKER_00]: Okay.

[SPEAKER_00]: Well, speaking of medications, postpartum, let's talk about the new postpartum medicine for depression.

[SPEAKER_00]: I don't even know how you say it.

[SPEAKER_00]: Zero.

[SPEAKER_01]: Zero analog.

[SPEAKER_00]: Okay.

[SPEAKER_01]: Yeah.

[SPEAKER_01]: Whenever I talk to people in the general population, I just call it zoo.

[SPEAKER_01]: Because I feel like [SPEAKER_00]: I don't know how they come up with the names for these medicines.

[SPEAKER_01]: I think they just have a random letter here.

[SPEAKER_00]: And just yes.

[SPEAKER_00]: So tell us about this medicine.

[SPEAKER_00]: How is it different than other medicines for depression or like why specific for postpartum?

[SPEAKER_01]: So, you know, it's year 2023, and this is the first year where there's an FDA approved medication for postpartum.

[SPEAKER_01]: All the medications that we've talked about so far, like the SSR, I was like, prosak.

[SPEAKER_01]: Those aren't, those are used for postpartum depression.

[SPEAKER_01]: They're used for depression in general, but they're not specifically FDA-approved for postpartum depression.

[SPEAKER_01]: Now, there was another medication that was approved for postpartum depression earlier called Brook San Juan.

[SPEAKER_01]: However, it's IV infusion over 60 hours.

[SPEAKER_01]: You have to be in the hospital on a cost 30 grand.

[SPEAKER_01]: So, [SPEAKER_00]: you know.

[SPEAKER_01]: I guess celebrities.

[SPEAKER_00]: Right.

[SPEAKER_00]: Right.

[SPEAKER_00]: Right.

[SPEAKER_01]: So that only was it's super practical.

[SPEAKER_01]: So they were able to take that concept and put it in a pill.

[SPEAKER_00]: Okay.

[SPEAKER_01]: Thanksfully.

[SPEAKER_01]: And now that is what is approved.

[SPEAKER_01]: So, um, [SPEAKER_01]: It works.

[SPEAKER_01]: It's not an SSRI.

[SPEAKER_01]: It works similarly to a benzodiazepine and as such, it's going to be a controlled substance.

[SPEAKER_01]: It does technically have some potential for addiction, just like the benzodiazepines like Xanax do.

[SPEAKER_01]: Well, I'll let you ask specific questions.

[SPEAKER_00]: Yeah, no, yeah.

[SPEAKER_00]: I didn't realize that it was so long to that class of medications.

[SPEAKER_00]: So who's a good candidate for it?

[SPEAKER_00]: Like, is this should this be like a first line trial or who is it appropriate for?

[SPEAKER_01]: So most, I would surmise the most of the people that are going to be taking it.

[SPEAKER_01]: And I actually not prescribed it yet because I'm not sure.

[SPEAKER_01]: It last I checked it was not out on the market.

[SPEAKER_01]: there I will prescribe it to people who are not having success on your standard regular antidepressants.

[SPEAKER_01]: And you certainly can take it on top of your regular antidepressants because one of the studies was looking at the medication along versus the medication and other antidepressants.

[SPEAKER_01]: They've already studied people on antidepressants taking it.

[SPEAKER_01]: Well, yeah, I've got a lot to say about it, but I'll go ahead, please go ahead, tell us what I'm super excited about it, but I also don't, so okay, I don't know if I did legal disclaimers, no one is paying me, this is just my opinion about it.

[SPEAKER_01]: I'm not like, you know, I've got stockings, rental, or anything.

[SPEAKER_01]: It's just super promising, and [SPEAKER_01]: But it is, the studies were conducted by the manufacturers.

[SPEAKER_01]: So I just say, you know, keep that in mind whenever you're looking at a study, you want to see what the motivation.

[SPEAKER_01]: So as excited as I am about this medication, I'm not willing to commit 100% that it's going to be fantastic.

[SPEAKER_01]: Because you know, like, people can be biased when reporting things.

[SPEAKER_01]: How, how, now with that said, there's so many great things about this medication, [SPEAKER_01]: allegedly.

[SPEAKER_01]: Okay.

[SPEAKER_01]: We'll find out soon.

[SPEAKER_01]: Right.

[SPEAKER_01]: Um, you only have to take it for two weeks.

[SPEAKER_01]: So wait, you know, really?

[SPEAKER_01]: Is it that wild?

[SPEAKER_01]: Yes.

[SPEAKER_01]: Yes.

[SPEAKER_01]: And so people get really frustrated about Anna to press it.

[SPEAKER_01]: Right.

[SPEAKER_01]: It'll start working in six days a week.

[SPEAKER_01]: Right.

[SPEAKER_01]: Take it for you.

[SPEAKER_01]: Right.

[SPEAKER_01]: But Zeranolum starts working in three days.

[SPEAKER_01]: And you only have to take it for two weeks.

[SPEAKER_01]: Which is in a psychiatric medication.

[SPEAKER_01]: This is mind blowing.

[SPEAKER_01]: Right.

[SPEAKER_01]: That's why I was so excited to say this.

[SPEAKER_01]: But I was like, on disclaimer.

[SPEAKER_00]: Yeah.

[SPEAKER_01]: Right.

[SPEAKER_01]: Right.

[SPEAKER_01]: But if it works not way.

[SPEAKER_01]: Yeah.

[SPEAKER_01]: It's really great.

[SPEAKER_01]: Um, and so it kind of, it's, um, it kind of, [SPEAKER_01]: Let's see.

[SPEAKER_01]: I don't want to get too sciencey, but it, like I said, it works on the same kind of ways that the benzos do on the GABA aerosampters.

[SPEAKER_01]: But it has an additional mechanism of action that your typical benzo, like Xanx, and it just has an extra way of working that those benzo [SPEAKER_00]: Okay, well, I'm excited to see that as it comes out and I did not know that people only had to take it for two weeks, so that could be a game changer seriously.

[SPEAKER_00]: Yeah.

[SPEAKER_00]: Yeah.

[SPEAKER_00]: Um, okay.

[SPEAKER_00]: So as we kind of get towards it, and are there any myths or like, you know, things you wish people really knew about treating psychiatric illnesses and pregnancy or postparta?

[SPEAKER_01]: Yeah.

[SPEAKER_01]: There's lots of myths out there.

[SPEAKER_01]: So I think the first thing we never, I talk about mental health treatment for pregnant persons, the first things that I start talking about is how common it is to [SPEAKER_01]: decrease this stigma and make people feel more comfortable because well in my life I'm obviously constantly talking about mental health and then I'm like you know I just see people talking about getting mental health treatment but that's not the case for all communities and all family some families it's like taboo and talk about it and people think that they're the only person who's [SPEAKER_01]: One in every five to seven women, and even one in every ten men, and then people are like, oh, well, I feel better that I'm not the only person going through this.

[SPEAKER_00]: Right.

[SPEAKER_01]: And so that's the first myth is that it's rare.

[SPEAKER_01]: It certainly is not rare.

[SPEAKER_01]: The second thing, and this is one of the most impactful and most important things that I like to emphasize, and I always make sure to bring up when I'm speaking to a group of pregnant persons, [SPEAKER_01]: Well, I explain I don't like to use the word crazy.

[SPEAKER_01]: However, again, when I'm talking to the general population, I do use that term because people know it.

[SPEAKER_01]: I say you're not crazy if you're having unwanted thoughts.

[SPEAKER_01]: a lot of moms because again that hormone that I mentioned earlier that the decreases after pregnancy that is protective for anxiety, it goes out the window and then you have anxiety and along with anxiety you can have unwanted thoughts and they're intrusive a lot of the times and I will do a trigger warning for anybody, sure, right now.

[SPEAKER_01]: Um, the unwanted dots are typically pretty horrific.

[SPEAKER_01]: Like, they wouldn't be unwanted if they were like thoughts about rainbows and butterflies, right?

[SPEAKER_01]: So the unwanted thoughts by definition would be like, what if I drove my car off the road or drop the baby?

[SPEAKER_01]: and that's why I said the trigger of warning.

[SPEAKER_01]: And so when moms start having these thoughts, they worry that they're going to quote crazy.

[SPEAKER_01]: And then they're worried that if they tell anybody, they will be committed to a hospital.

[SPEAKER_01]: And I have to explain that not only are you not crazy, but this is actually very common after giving birth because you're just like worried about everything.

[SPEAKER_01]: And so the differentiating factor between this being something that is anxiety versus this being something that's an emergency that you would need to go to the inpatient hospitalization is are you okay with the thought and [SPEAKER_01]: I'm going to use, and we're going to do it just two different shorts.

[SPEAKER_01]: One is egocent on it, and that is that these thoughts, like I'm just going to drive my car off the road, they don't bother you.

[SPEAKER_00]: Okay.

[SPEAKER_01]: Okay.

[SPEAKER_01]: And if you start to think that it's a good idea, oh, drive my car off the road, that sounds a good idea.

[SPEAKER_01]: I'm not bothered.

[SPEAKER_01]: That is more of a psychotic psychosis type picture.

[SPEAKER_01]: And that is, it, it, it, it, it.

[SPEAKER_01]: in emergency.

[SPEAKER_01]: Sure.

[SPEAKER_00]: Sure.

[SPEAKER_01]: And so if the, they wouldn't really be unwanted thoughts if you're starting to want them, right?

[SPEAKER_01]: And in that case, it's typically other people that are reporting to me my wife is starting to think that this is a good idea more than the baby is a demon and she's actually believing that this is the case of that isn't emergency.

[SPEAKER_01]: That's exceedingly rare.

[SPEAKER_01]: Although if that is something that you're going through, there's medications like for that, [SPEAKER_01]: Now, the other hand is the thing that I see all the time, super common, is ego-disc tonic, meaning the thoughts are bothering mom.

[SPEAKER_01]: Mom would love to get rid of the thoughts.

[SPEAKER_01]: She doesn't think driving off the road is a good idea.

[SPEAKER_01]: In fact, she's terrified of it.

[SPEAKER_01]: Those are ego-disc tonic thoughts.

[SPEAKER_01]: Those are not an immediate emergency.

[SPEAKER_01]: However, we can control those.

[SPEAKER_01]: Those are actually quite common and those could be from anxiety or OCD type picture.

[SPEAKER_01]: And then people were like, oh, I'm so glad I can talk about it.

[SPEAKER_01]: I'm not fear that you're gonna commit me to a hospital.

[SPEAKER_01]: And so, I always, and so many people are like, oh, man, that's such a relief.

[SPEAKER_00]: You, you were gonna save a lot of people.

[SPEAKER_00]: I'm saying that because I'm sure somebody is here.

[SPEAKER_00]: Yes, yes, definitely.

[SPEAKER_00]: Yes, thank you so much for sharing that.

[SPEAKER_00]: That's really important.

[SPEAKER_00]: So then my final questions and I ask all of my expert guests this.

[SPEAKER_00]: What is the most frustrating part of your work?

[SPEAKER_01]: Uh, that's funny.

[SPEAKER_01]: It's a toss-up between, okay.

[SPEAKER_01]: I'm not blaming the pharmacist or anybody that works at the pharmacy.

[SPEAKER_01]: I'm blaming like corporate, because the pharmacies are so overworked.

[SPEAKER_01]: I read an article that there was a pharmacist who fills on average one prescription every minute.

[SPEAKER_01]: And so they're so overworked.

[SPEAKER_01]: But one of the things that really burns my biscuits is when the pharmacy loses my prescription.

[SPEAKER_01]: I really, very agitated.

[SPEAKER_01]: Again, to the point, I have actually started screen-shotting my orders and sending them to the page.

[SPEAKER_01]: To prove, I sent it in, here's the time.

[SPEAKER_01]: Day right, so where are you sending it?

[SPEAKER_01]: Right.

[SPEAKER_01]: But again, [SPEAKER_01]: If you're filling 100 prescriptions in an hour or whatever you're going on at the party, you're going to lose stuff.

[SPEAKER_01]: I don't blame the farmers.

[SPEAKER_01]: Right overwork.

[SPEAKER_00]: Right.

[SPEAKER_01]: This next thing's very difficult for me when my prescription's just disappeared.

[SPEAKER_00]: Yes.

[SPEAKER_00]: And then the patient has to weigh and it's just like a frustrated thing.

[SPEAKER_00]: I totally get it.

[SPEAKER_00]: And then on the flip side, what's the most rewarding part of your work?

[SPEAKER_01]: I love whenever a patient says, I feel that I return to my normal self.

[SPEAKER_01]: I'm back to the way I was.

[SPEAKER_01]: I'm my normal self again.

[SPEAKER_01]: I'm just like, [SPEAKER_00]: Yes, yes, absolutely.

[SPEAKER_00]: And then what is your favorite piece of advice that you would give to an expectant mother or parents?

[SPEAKER_01]: It's to make sure you have a good support system and don't hesitate to take care of yourself.

[SPEAKER_01]: And if anything convinces you to take care of yourself, it would be the epigenetic factors that I talked about earlier, basically, if you, like, let's say you won't take care of yourself for yourself, take care of yourself for your child because [SPEAKER_01]: uncontrolled mental illness or issues going on with you actually does affect the turning on and off of DNA in your baby.

[SPEAKER_01]: So if you're not going to take care of yourself for yourself, take care of yourself, for your your child's genetic.

[SPEAKER_00]: Excellent advice.

[SPEAKER_00]: Excellent advice.

[SPEAKER_00]: So where do people find you?

[SPEAKER_01]: I am arrested by, well, they call it the McTaco hot, because there's a Taco Bell McDonald okay, we really rest in Metro stop, that's where my office is, but I do virtual, so as long as you're in Virginia, you could just...

[SPEAKER_01]: find me at www.improvelifepllc.com.

[SPEAKER_01]: Okay.

[SPEAKER_01]: And, oh, I would love it if people found me on YouTube.

[SPEAKER_01]: Yeah, because I put a lot of work into my video.

[SPEAKER_01]: Yeah, let's tap.

[SPEAKER_01]: Where are you on YouTube?

[SPEAKER_01]: Tell us where you are on YouTube.

[SPEAKER_01]: So, it's improved lifepllc on YouTube.

[SPEAKER_01]: And then, [SPEAKER_01]: They're on our website.

[SPEAKER_01]: There is a link to all the social media.

[SPEAKER_01]: My personal, well, my professional Instagram is improved medical culture.

[SPEAKER_01]: That one is focused on my mission to make the culture medicine not so toxic for meds students and residents.

[SPEAKER_01]: They really, they really get abused a lot.

[SPEAKER_01]: There's a [SPEAKER_01]: I have 10,000 followers on there.

[SPEAKER_01]: I'm proud of that.

[SPEAKER_01]: But the clinic has an Instagram too, and that's improved life.

[SPEAKER_01]: PLLC.

[SPEAKER_01]: P is in Paul, L is in Lion, L is in Lion, C is in cousin.

[SPEAKER_00]: Awesome.

[SPEAKER_00]: Thank you so much.

[SPEAKER_00]: And we will link all of that in our show notes.

[SPEAKER_00]: Well, thank you so much for agreeing to come on to the podcast.

[SPEAKER_00]: This was really informative.

[SPEAKER_00]: I know I learned a lot, and I know that people listening learned a lot, and I know you have helped someone [SPEAKER_01]: Oh, I hope so.

[SPEAKER_01]: Thank you Dr.

Nicole.

[SPEAKER_01]: It was super fun.

[SPEAKER_01]: I love talking about this life of stuff.

[SPEAKER_00]: Wasn't it a great conversation?

[SPEAKER_00]: This is so important.

[SPEAKER_00]: There just aren't that many perinatal psychiatrists out there.

[SPEAKER_00]: So I'm really glad that she was able to come on and share her experience.

[SPEAKER_00]: Now, you know, after every episode, when I have a guest on, I do something called Dr.

Nicole's Notes, which are my top takeaways from the conversation.

[SPEAKER_00]: Here are my Dr.

Nicole's Notes from my conversation with Dr.

Wackel.

[SPEAKER_00]: One, I do want to plug postpartum support international.

[SPEAKER_00]: That website has a lot of resources for you.

[SPEAKER_00]: You can put in your zip code and get connected with providers in your area who are actually interested in doing reproductive health, reproductive mental health.

[SPEAKER_00]: So postpartum support international, that website is www.postpartum.net, so do check that out if you need any resources.

[SPEAKER_00]: Second thing I want to talk about is normalizing those unwanted thoughts.

[SPEAKER_00]: I thought that was such a really important thing to mention that we all have unwanted thoughts.

[SPEAKER_00]: It doesn't make us bad people, it doesn't make us abnormal, it just makes us human and it's how we manage those thoughts, how we deal with those thoughts.

[SPEAKER_00]: That is what's going to set us up for success, but it is completely normal to have unwanted thoughts.

[SPEAKER_00]: It's just a part of being human.

[SPEAKER_00]: The next thing I want to talk about is how the most important part of a healthy baby is a healthy mom.

[SPEAKER_00]: She mentioned that she actually prefers to keep patients on their medication if they were taking medication for anxiety or depression as long as they know the risk.

[SPEAKER_00]: Because if you don't take care of yourself, [SPEAKER_00]: then how are you going to be able to take care of a baby?

[SPEAKER_00]: Okay, so really the most important piece and this is something that I believe we miss so much in our society, we focus so much on the baby without realizing the first step for that baby to be healthy is to have a healthy mom.

[SPEAKER_00]: So take care of yourself, take care of the medications, take the things that you need to take in order to be the best healthiest version of you.

[SPEAKER_00]: And the final thing I want to talk about is, since we recorded this episode, there was an article in JAMA, the Journal of American Medical Association, Big Journal, kind of it was like a research letter, maybe, or a opinion letter.

[SPEAKER_00]: Anyway, it expressed some concerns about this new depression medication.

[SPEAKER_00]: And I'll say back up just a little bit, studies and pregnant women or post-pronoun women and breastfeeding are really, really difficult.

[SPEAKER_00]: It can be hard to get people to enroll in studies.

[SPEAKER_00]: I mean, I must be honest, who wants to sign up to be in a study while you're pregnant, that may be concerning for you, or maybe not, maybe not, but for a lot of people, it's a natural concern, right?

[SPEAKER_00]: So I can see how it's challenging, or you can understand how it's challenging to study any medication and pregnancy.

[SPEAKER_00]: But with this particular depression medication, [SPEAKER_00]: You only take the medication for a short period of time, I believe it's two weeks, but you can't breastfeed during that time.

[SPEAKER_00]: They required that people were on contraception during the study.

[SPEAKER_00]: And then the final thing that was really like, hmm, raising red flags about whether or not this medication is as great as it was promised to be, is that they compared the medication to doing nothing for post-partum depression, [SPEAKER_00]: which is not the standard of care.

[SPEAKER_00]: If somebody has postpartum depression, then we're going to treat that with medication.

[SPEAKER_00]: Okay, that will be the standard of care.

[SPEAKER_00]: So what they really should have done is instead of comparing this new medicine to not doing anything, they should have compared it to not doing anything and to a group who were receiving medication for [SPEAKER_00]: depression, like all three groups, or if you're going to have two groups and they should be the medication, the new medication, and then the standard of care for regular postpartum depression, you should not have compared it to not getting anything because that's not a fair comparison.

[SPEAKER_00]: So just keep that in mind if that medication is ever brought up or if you thought about pursuing or interested in that medication, just so you know.

[SPEAKER_00]: Okay, so there you have it.

[SPEAKER_00]: Please share this podcast with a friend.

[SPEAKER_00]: I so appreciate your help in reaching and serving as many pregnant folks as possible.

[SPEAKER_00]: And when you share, it just, it helps me and it helps them.

[SPEAKER_00]: So share this podcast with a friend.

[SPEAKER_00]: Also, subscribe to the podcast and Apple Podcast or wherever you're listening to me right now.

[SPEAKER_00]: Subscribing, make sure that you never, never, ever missed an episode.

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[SPEAKER_00]: So that is it for this episode.

[SPEAKER_00]: Do come on back next week.

[SPEAKER_00]: And remember that you deserve a beautiful pregnancy and birth.