Maternal Mental Health: Postpartum Depression, Postpartum Psychosis, and the Work Ahead

Maternal Mental Health Awareness Month is an opportunity to reflect on a career dedicated to women’s mental health and to look ahead — because we still have a ways to go. Dr. Lee Cohen, Director of the Ammon-Pinizzotto Center for Women’s Mental Health at Massachusetts General Hospital and Professor of Psychiatry at Harvard Medical School, describes the strides made in perinatal psychiatry over the last decades.

Postpartum depression remains the most common complication in modern obstetrics. In the United States, screening has become standard practice in almost every state and has been endorsed by the American College of Obstetrics and Gynecology and the American Psychiatric Association — advances that have improved the identification of women suffering from postpartum depression at a critical time in the lives of their families.

Effective pharmacologic and non-pharmacologic treatments exist, including cognitive behavioral therapy, for which there is an evidence base supporting efficacy. Patients have strong preferences about whether they want to be treated with medication or a non-pharmacologic approach. Yet the majority of patients do not get effective treatment. There is a gulf between identifying those patients and seeing that they get well. Obstacles include difficulty navigating the healthcare system and the isolation and stigma of feeling ill at a time when patients feel they should be doing better. Educating patients and collaborating with support groups in the community and with colleagues who are treating those patients are paths to decreasing stigma.

There are many ways to educate patients about postpartum depression. A new documentary, More Than Blue — for which Dr. Cohen served as executive producer — shares the faces and voices of postpartum depression in America and is now available on major streamers.

Among the most serious conditions in women’s mental health is postpartum psychosis. Debates about where postpartum psychosis should land in the DSM are, Dr. Cohen suggests, less important than ensuring that clinicians in emergency departments and in the community are equipped to effectively treat those patients. The message for patients: postpartum psychosis is an exquisitely treatable and preventable illness, and wellbeing is easily recaptured even on the other side of such a serious problem.

May is Maternal Mental Health Awareness Month — a terrific opportunity to take stock of the road traveled in perinatal psychiatry and to look ahead at the opportunities to do even better by patients who may be suffering from maternal psychiatric illness, so that we can maximize the likelihood of moms and families doing well.

Resources

• JCP Focus on Women’s Mental Health
• Postpartum Support International — resources for health care providers, patients, and families; advocacy; federally funded crisis line and warm line; connection to local resources
• MGH Center for Women’s Mental Health
• MGH Postpartum Psychosis Project — resources for patients, families, and health care providers; research
• More Than Blue — documentary on the faces and voices of postpartum depression in America
• So Glad You Asked — podcast, now in Season 2, with patient-facing information about pregnancy, postpartum, motherhood, and related topics