Life After Birth: What to Do About Postpartum Depression and How to Find Help

0:00:13 William Moyers
Here we are again for Let's Talk, the award-winning podcast series produced by Hazelden Betty Ford. I'm your host, William C. Moyers. I'm also an alum of the organization. In 1989, I began my journey from addiction to recovery and beyond to this moment. Welcome to this conversation about post-partum depression and substance use. Our guest, Dr. Alta DeRoo, the Chief Medical Officer of Hazelden Betty Ford. Welcome, Alta!

0:00:41 Dr. Alta DeRoo
Thank you, William!

0:00:43 William Moyers
Thanks for being with us today. I've got to ask you before we dive into this very serious subject. How did you get interested in addiction medicine considering that you came from the 24 years of service in our military and also you're an OB/GYN? How do you match those up?

0:01:00 Dr. Alta DeRoo
Right. So, I was—you know I was an OB/GYN in the military and I had a personal history with addiction. So, my father was alcoholic and I'm also in recovery. And when I started seeing more of these patients in recovery, I started getting interested in the actual treatment, in the medications, and the medicine of addiction. And so, there was an opportunity for me to work in a clinic while I was still in the military. And I was able to treat patients with substance use disorders and become Board Certified in Addiction Medicine. And so when I retired from the military, I combined the two of treating pregnant patients with substance use disorders. As well as their partners. And then it grew from there. And it's become a passion. [smiles, nods]

0:01:55 William Moyers
Well we're so glad that you've brought that passion and that remarkable expertise to this important leadership role at Hazelden Betty Ford, Chief Medical Officer. Did you ever think you'd become the CMO of an organization like this?

0:02:08 Dr. Alta DeRoo
Ah no, William, I didn't. [Both chuckle] I was incredibly humbled for the opportunity. And at first, I didn't think I was worthy. Of being, you know, leading medically such a great organization. Whose mission I shared and I was aligned with all these principles. And then when I saw what we were all about and working here as Medical Director for a while, learned more about it. And then there was no doubt in my mind.

0:02:38 William Moyers
And there's no doubt in our mind either. We're so glad you're here. Let's talk about this very serious subject of post-partum depression. What is that?

0:02:48 Dr. Alta DeRoo
So post-partum depression is a true medical diagnosis. That can happen anywhere from two weeks to six months to a year from a mom who just delivered. And post-partum depression is marked or heralded by changes of function of the mom. Where she can't get out of bed. Or she doesn't wanna shower. She cries a lot at the simplest things. And not to minimize it all, but the things that she wouldn't have normally got upset about before. But it goes a little deeper. It affects eating. Eating too much, not having an appetite. Not enjoying time with friends that you used to enjoy things with. Not doing the activities that you used to enjoy. So, it's where this diagnosis truly starts to hit the functioning of the mom.

0:03:46 William Moyers
But what's the difference between post-partum depression, a very serious condition, and baby blues?

0:03:53 Dr. Alta DeRoo
Yeah. So baby blues is something very normal that most moms experience. Within about two weeks of baby delivering. And that's gonna be a hormonal change that happens after you deliver a baby that causes us, meaning me I'm a mom too, you know? Where we may cry, we may be more emotional, but we can recover from it. And it passes after the two weeks. The baby blues can be helped by exercise or hanging out with the people that we used to. Or baby blues can be exacerbated by not sleeping enough. So you see the trend here is that the baby blues is treatable. You do a little self-care, you ask for a little extra help, and eventually these baby blues pass. But when the baby blues start turning into a dysfunctional way of being and now you can't take care of yourself or your baby, that's when you need to seek medical help. For the concern.

0:04:54 William Moyers
And post-partum depression there's gotta be a connection between it and substances, yes?

0:04:59 Dr. Alta DeRoo
Yeah. So there is a literature out there to show that when a mom who may be dependent or may have an underlying substance use disorder, perhaps they are abstinent from that coping mechanism that they had during pregnancy. Well now they're at increased risk for depression if they haven't gotten those coping skills—if they haven't achieved those coping skills and not using that drug or that medicine anymore. Also another high-risk population would be those patients who have had a history of depression. Not even a history of post-partum depression, but just any history of depression increases your risk for post-partum depression. But we do see a correlation with a substance use disorder and pregnancy, and then post-partum depression.

0:05:49 William Moyers
How does a woman begin to determine if perhaps her use of substances is crossing that line and pulling her downward?

0:06:04 Dr. Alta DeRoo
So probably the biggest thing to do is share it with your OB/GYN. Either while you're pregnant or post-partum. So there are—we do surveys when you're pregnant called an Edinburgh Depression Scale. And we can ask you certain questions that will give us insight as to maybe there—there are some symptoms there of depression. And we do that early in pregnancy, also in your third trimester, and it's done in your post-partum visit. This is a way for us to screen people who might have signs and symptoms of post-partum depression or even a substance use disorder that may be contributing to the post-partum depression.

0:06:46 William Moyers
Can post-partum be treated with medications?

0:06:49 Dr. Alta DeRoo
Absolutely. [nods] Yeah so the medications that we can treat the post-partum depression with are the same thing that we would use to treat any population. Even a mom who wasn't pregnant. There are some kinder, gentler medications that we can use to treat a mom with post-partum depression. Zoloft is a good one. A minimal amount of it gets into breast milk. So that's one that we tend to favor.

0:07:13 William Moyers
But drinking a glass of red wine or using marijuana or taking an extra pain pill, those aren't good ways to address post-partum?

0:07:26 Dr. Alta DeRoo
No. And especially not the marijuana. Remember that is, you know, there's gonna be some toxins that leak over from marijuana ingestion or perhaps on the clothes or any type of smoking. So we would not want to cope with any of that with marijuana. Marijuana is also a depressant. So if it's a depressant, a CNS depressant, and you're already depressed, that's not something that's gonna help your mood. What also suggests the opioid--if you're getting an upper effect from an opioid, that's a big sign that that opioid is not for you. That's actually one of the indicators where somebody has a risk for developing a substance use disorder to opioids is when you actually feel energized from taking that opioid. So that's actually a really good question.

0:08:16 William Moyers
So, breastfeeding, I mean new moms have got to breastfeed in most instances, how do they manage that responsibility to the baby while taking their legitimately prescribed medications for their depression or their opioid use disorder?

0:08:36 Dr. Alta Doo
Almost all medications are safe—depression medications or anxiety medications and psychotropic meds—are safe in breastfeeding. We have to keep in mind at even little miniscule amount of medication is gonna get through the breast milk. But not enough to affect baby on a large level. And if you are concerned about it, one of the things that you can do is after you take your medication, one to two hours and you are gonna breastfeed, you can dump, you can pump, your breast milk. And then dump that. And then maybe later in the day you can breastfeed baby directly if you're concerned about your levels being high. But rarely, there are any medications that we would say don't breastfeed your baby. It's more of the substances that you know are illicit substances that we would discourage moms from breastfeeding. So if you're using marijuana or methamphetamines and you're breastfeeding, we strongly discourage that.

0:09:37 William Moyers
Dr. DeRoo, let's talk about how a new mom or a second or third or fourth-time mom, not necessarily just a new mom. But a new mom, how does she take care of her mind, body, and spirit particularly if she's in recovery, while also taking care of the needs of the new baby and maybe other children in the house?

0:09:54 Dr. Alta DeRoo
Yeah. [smiles, nods] Right. You know, the first thing that comes to mind is ask for help. Seriously. You don't need to do this by yourself. There's so many other moms, so many other support systems, that you can rely on to get that rest. So that you can indulge in some self-care. And then you can return to the fight stronger, you know? Battling those other three kids that are demanding your attention. So, I would honestly say please don't be a hero. Reach out to another mom. Ask for help. Let us help you. With this really tumultuous period of your body recovering from this, you know, nine/ten-month pregnancy, and then this huge change in hormones in your body. So, you don't have to do it all alone. We're here to help you.

0:10:45 William Moyers
On that note, what role does the partner or the significant other play in support for the new mom or the mom again?

0:10:56 Dr. Alta DeRoo
Yeah. Mom is the vehicle through which that baby thrived. And now baby's maybe depending on Mom for breast milk—that is a lot to put on the mom. If the partner can set some time aside to maybe take the kids or take something off mom's plate, that would be tremendously helpful. For mom to be able to indulge in some self-care.

0:11:34 William Moyers
If there's a woman who's listening or watching this Let's Talk podcast right now, and tuned in because they are worried about their own use of substances within the context of post-partum depression, what's your counsel?

0:11:50 Dr. Alta DeRoo
You know, please come see us. Or please see someone. Some provider that can help you along the way. Whether it's medications or not medications, therapy, counseling, support. There are tons of resources out there. And the weight of this substance use right now seems tremendous. And if you're thinking about your baby and post-partum in recovery, your mind is in the right place. Let us help you get there safely. By helping you stop your substance use disorder, getting it under control, developing a plan of recovery for you. Really come see us. And when I say us, I mean people who wanna treat those with substance use disorders. Come see us, we want to help you, we check shame and stigma at the door. There's none of that here. And we're more concerned about you and baby and getting well rather than any of the judgment.

0:12:53 William Moyers
So Dr. DeRoo, what's your response to the new mom? She's just given birth say eight weeks ago, she's got her hands full at home. And she knows that there's something going on with the substances that she's using. She might not call it dependency but she's got someone going on. She's tuned into this podcast. What's your counsel to them in terms of getting help?

0:13:16 Dr. Alta DeRoo
Yeah. You know, I've been there, William. I do remember those days. And you may be tired, and frustrated, you're relying on this substance and you're afraid to stop, but you don't know who to turn to. I would say the first person would be a counselor, a physician, if you have a primary care provider. Maybe somebody in your community. There are people out there that do wanna help with your substance. And let us also assist you with determining whether this is at-risk use or perhaps you do have a substance use disorder. Allow a medical provider to assess you. And get you some help. Drag those kids with you. Bring 'em to the waiting room. I've seen it. I've, you know, I've been there. In the waiting room with three kids running around. But you need to think about you. Before you're gonna be a good vessel to take care of the kids. So this would be the time to put your care first. And go out there and get some help. So that you can be there for them. Next month and next year.

0:14:28 William Moyers
Because asking for help isn't going to be—the response isn't going to be punishment. They're not gonna take your kids away from you.

0:14:33 Dr. Alta DeRoo
Oh no, absolutely not! No way. Especially when you're going to a medical provider for help. When you're going to a medical provider for help, there is an understanding and there are laws that will protect you too.

0:14:59 William Moyers
Very good. Dr. Alta DeRoo, thank you for your personal passion, your remarkable expertise and bringing it to our listeners today. I think the message that you leave with us is that there is hope and there is help and there is healing no matter where you are along the continuum. [Dr. DeRoo nods] If you're a new mom or an older adult, hope is what gets people to the help and to the healing that they need.

0:15:15 Dr. Alta DeRoo
Absolutely. [smiles, nods]

0:15:16 William Moyers
Thank you Dr. Alta DeRoo, the Chief Medical Officer of Hazelden Betty Ford. [turns to camera] And thanks to all of you for joining us. Remember, addiction to alcohol and other drugs does not discriminate. But treatment works and recovery is possible. So don't wait. If you or a loved one, or your baby, needs help. Ask for help. Do it now. I hope you will join us for another edition of Let's Talk. See ya soon.