Ep 141: Peripartum and Reproductive Depressions with Dr. Ida A. Eden

We need to be talking more about perinatal, postpartum, and peripartum depression to reduce the stigma around these disorders. Here today, to do just that, is Dr. Ida A. Eden. Dr. Eden is a board-certified psychiatrist with formalized training and expertise in women's reproductive mental health. She has particular interests in perinatal mood and anxiety disorders and the psychological burdens of infertility and perinatal loss. She graduated with honors in Neuroscience and Medical Anthropology from the University of Michigan, earned her M.D. with honors from the University of Maryland, and completed her residency at New York-Presbyterian Hospital/Weill Cornell Medical Center. She also completed fellowship training in Women's Mental Health at NYU/Bellevue Hospital. Dr. Eden is passionate about teaching and remains on the faculty at Weill Cornell where she supervises and mentors trainees interested in reproductive psychiatry. Join Rena and Dara as they delve into a discussion with Dr. Eden about reproductive depression, how preexisting conditions can influence their likelihood, and why we should be optimizing our mental health as best we can before, during, and after pregnancy. We talk about why optimizing mental health is essential, and she unpacks different stressors and psychological strains common in the peripartum period. Furthermore, we discuss the difference between Baby Blues and Post Partum Depression (PPD), how a diagnosis of PPD is treated, and dive into the hot-button topic of medication use in this period. Don’t miss out on these valuable insights offered by Dr. Eden, start listening now!

Transcript

Speaker 1: 0:13

Hi everyone. We are Rena and Dara , and welcome to Fertility Ford . We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Ford Podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate. We are so excited to Welcome to Fertility four Today, Dr. Ida Eden. She is a board certified psychiatrist with formalized training and expertise in women's reproductive mental health. She has particular interests in perinatal mood and anxiety disorders and the psychological burdens of infertility and perinatal loss. Dr. Eden completed her undergraduate education at the University of Michigan where she graduated with honors in neuroscience and medical anthropology. She received her MD with honors from the University of Maryland where she was inducted into the A OA Medical Honors Society and served as president of the Gold Humanism Honors Society. She completed adult psychiatry residency training at New York Presbyterian Hospital, Weill Cornell Medical Center, where she participated in research and education projects within reproductive psychiatry. She then received her fellowship training in women's mental health at NYU Bellevue Hospital. In addition to her work as a private practice physician, Dr. Eden is passionate about teaching and remains on faculty at Weill Cornell where she supervises and mentors trainees interested in reproductive psychiatry. Thank you so much for coming on today. What an amazing introduction and I only had to do it twice. So that is always my most nerve wracking part of the podcast reading the bio and yours is a very impressive one.

Speaker 2: 1:56

Thank you. I'm so excited to be here. My first foray into podcasting, you'll have to tell me if I have a good podcasting voice.

Speaker 1: 2:03

Oh , it's great. It is absolutely wonderful. So , so excited to have you on and your bio is super impressive and I was so happy that we connected because it just sounds like we're so, like-minded and to do an episode about peripartum, perinatal, PPD , all those subjects. We haven't touched upon those for a while in our podcast, so I'm really excited to have you on to share your expertise because those are obviously such important topics to discuss and share. And I think unfortunately they're not really talked about until you have to talk about them and then it's very hard.

Speaker 2: 2:42

Absolutely. And I'm so excited to work together and I always love meeting folks who are passionate about this field and and immersed in the field like you are. And I totally agree. I think that unfortunately, listen, it's perina depression. These reproductive depressions are so prevalent and they often go under recognized undertreated and they're so treatable, theoretically. So we need to be talking about it more. We need to be reducing the stigma and the shame around these disorders and these diagnoses. So very excited to be here to talk more about it today.

Speaker 1: 3:16

So, okay, let's dive in first by sort of defining what you would classify or diagnose as a perinatal disorder or peripartum, which that is actually a new term for me, peripartum. I had to sort of look into that. That has not come up so much for me . So let's sort of start by defining those and how they might present.

Speaker 2: 3:36

Sure. So we think of the peripartum, it's sort of an umbrella term, right? Or it's kind of loosely defined as the period around, you know, trying to conceive pregnancy in the postpartum. So we hear a lot about postpartum depression and that falls within the umbrella of perinatal depression, right? And so perinatal depression is an umbrella. It includes what we call antenatal depression. So that's depression that occurs during pregnancy and postpartum depression, right? Which is a depressive episode happening in the postpartum. Our statistics are, are really, really staggering. What we know is about of women who end up having a perinatal depression, a quarter of those women will actually enter pregnancy already having met criteria for depression already depressed. Another third around 33% will become depressed during the pregnancy. And then about 40% of those depressions happen in the postpartum. So postpartum depression is prevalent. And then anytime I'm meeting a woman who, who in the postpartum who was depressed, I'm always thinking and wondering, when did this depression occur? Right? Is this really actually an antenatal depression or depression that happened even before pregnancy that I'm just now capturing and seeing in the postpartum? But the terminology, you know , when I get caught up in the semantics, although it's important, it's important and that it falls under this kind of umbrella category where we can kind of think of women even sort of outside of as falling within this umbrella.

Speaker 1: 5:00

Okay. So would you say is someone that has a prior history of anxiety or depression, are they more at risk to develop postpartum or perinatal depression?

Speaker 2: 5:12

Absolutely. Right. If you're someone who struggled with mood or anxiety disorders, predating pregnancy and the postpartum, and we do think about, you know, the pregnancy and the postpartum as uniquely vulnerable times, then you will have an elevated risk. Of course, there are things you can do to minimize and reduce your risk and sort of optimize your mental health, but you're at an elevated risk compared to someone who's really never struggled with , with depression or anxiety.

Speaker 1: 5:37

Okay. So even if your depression or anxiety has been quote unquote dormant for years and you're not even taking any medication anymore, maybe you had an episode when you were in college or high school, but that still puts you more at risk during pregnancy or, or pre-pregnancy or

Speaker 2: 5:53

Post. Yeah. And there's of course different sort of stratifications of risk, right? We think of depressive episodes, we can categorize them even differently. Someone who had a depressive episode, let's say, that was discreet in college that was really well treated , yes, they will be at somewhat elevated risk compared to someone who's never struggled with mood or anxiety. But then there's someone who, let's say, had a depressive episode or tends to get sort of mood destabilizations around their period. That's another risk category, right? Or someone who, when they started an oral contraceptive or may have had a depressive episode. So we kind of stratify risk, although as a whole, like if you're struggled with, with mental health concerns, we're going into the, into pregnancy and postpartum, ideally wanting to sort of have our antennas up.

Speaker 1: 6:38

Okay. And you, you had sort of said before, there are things to do to optimize mental health. So what are some of those things that you can control on your end or, or look out for?

Speaker 2: 6:49

Absolutely. And I'm, I'm glad you sort of mentioned that risk , we think about risks that sort of modifiable or non-modifiable, right? So genetics and sort of history of a mood disorder or anxiety disorder aren't necessarily modifiable, but there's so much you can do. And the biggest I would say is to really come into pregnancy and ideally sort of as you're trying to conceive prior to that, having optimized your mental health, right? And that looks different for every single person. For some people that may include a medication like an SRI that has kept them, well for many, many years, for most people, that includes optimizing nutrition, right? Really kind of bolstering your support. Pregnancy in the postpartum is a time where I'm telling all of my patients who, who may not always be so easily able to sort of reach out for help and support from other people, that this is a time that whatever you can comfortably outsource, you should right? Bolstering your supports, making sure that, that you have spoken to your mental health provider, to your reproductive psychiatrist about you're all on the same page. What are some red flags that we look out for ? How do we know that Jane is perhaps kind of revealing or what are some red flags we look out for that , that you are going through a depression or that that's emerging or anxiety is emerging Nutrition. We actually have a lot of good data to support that diet, essentially, like the Mediterranean diet are really protective against a perinatal depression. And so I'm always talking to my patients about optimizing nutrition, including , uh, fatty fishes to , to sort of bolster those omega threes of vitamin D. We know folate, for example, in pregnancy and fetal development. It also really may be protective against a perinatal depression. And then exercise. These are the kind of behavioral lifestyle modifications that are low hanging fruit that we really wanna modify going into a time when you're trying to conceive pregnancy in the postpartum. We wanna limit, you know, as much as possible trial and error. We wanna just, whatever's keeping a woman, well, of course, you know, that's a , that's a nuanced discussion, but we want to keep, we wanna keep you well going into pregnancy in the postpartum .

Speaker 1: 8:59

Hmm . I love all those things and I love it sort of brings to mind control the controllable, right? Those things you can control, exercise, nutrition, sleep , hydration, these sort of low hanging fruit as you call them, you know, I think that is within your power to control those and then outsource things to experts if you need to, such as, you know, a therapist or a psychiatrist. But those low hanging fruit, I mean they're really, they're the most important things that you can do. And I think a lot of times people discount the importance of nutrition, sleep, exercise, and they're so important for mental health.

Speaker 2: 9:33

Absolutely. I mean, I always say sleep is medicine, nutrition is medicine. And we have a lot of good data to support that. As much as you can optimize those things, it's, it's incredibly, incredibly important. So much of my discussions with patients are around those subjects.

Speaker 1: 9:49

Exactly. And I think that it's also important to establish care if you can initially. So you already have people in your support so you don't wait until you feel really bad and you have a hard time getting out of bed or helping yourself that you, you know, have established care with a practitioner who you know that you can call on if you need help.

Speaker 2: 10:11

Absolutely. And I'm so glad you bring that up. You know, I always tell folks, 'cause it's always so clear, you know, what is the role of a reproductive psychiatrist? And really the way that I think about my role is I'm a safety net, right? So my job and my role is to know you and to care for you in more than one way, but ideally to sort of act as a safety net where we're keeping things optimized. And again, if we're seeing sort of red flags emerge, that it's not just all on you to sort of notice and pick up on these red flags. That's my expertise, right? To, to pick up on and to bring those to your attention, to have discussions with you and or your loved one all together, I think about myself as this real sort of protective net.

Speaker 1: 10:54

Hmm . Yeah, I love that. I think it's really important to find someone like that to help bolster you. So let's go and talk also about some of the stressors and psychological strains that might come up in the peripartum period. So change in bodily autonomy, fears around perinatal loss identity and role changes, conflicts between partners, if that's part of your picture. I mean, there's so many things that can come up

Speaker 2: 11:21

So much, right? And I think ultimately emerging motherhood in parenthood has this really unique ability to sort of draw out and force us to contend with ourself the kind of death that we may not have really until this, this kind of unique window in our lives and that, you know, what we're talking about now, this sort of psychological , um, themes and subjects that can emerge. Oftentimes my patients don't anticipate. These are things that will come up for them , right? And it can be a difficult one. And I will say also a very rewarding one. You know, we talk a lot in this field about how pregnancy and the postpartum fertility treatments, that entire period of what we'll call that perinatal period is a negatively vulnerable time. True. And it can be a really positively vulnerable time, right? It's often the first time women present to mental health treatment and want to sort of look in the mirror, metaphorically speaking. And so it's this really rich psychological time that can be this kind of unique window into understanding yourself. So how I talk about my patients , right? Starting a romantic relationship, I'll think about that as you're , you know , part of what's difficult about that is you're having to look in the mirror, so to speak, right? Understand things about yourself or maybe beyond your awareness. And then starting in , in emerging motherhood and parenthood, all of a sudden you're surrounded by mirrors , sort of how I think about it. And that can be really stimulating for a lot of folks, right? Where you're having to things about yourself or becoming revealed and understood in ways and they were maybe dormant to kind of use your word earlier up until now, right? So you're contending with so much and really what's this time period is unique in that there's so much unfamiliarity that you're having to contend with so much unknown right? Now. Let's start with the period where you're maybe trying to conceive, right? There's questions like, am I enough? Will my body fail me? If it does, where does that anger go? Right? Suddenly you're contending with the fragility of life, fragility of really all things that can be so challenging. And then there's a lot of shame, as you know, right? With this population about the inability or the struggle to conceive pregnancy like you talked about. There's this immediate gene in bodily autonomy, right? And so a woman, maybe someone who, for a while relationship with her body was dormant, was fairly sort of quiescent. And then body and body image. These struggles can kind of come up again in a really unanticipated way for so many women. And it can be a real point of shame so much about, as you know, about this entire kind of perinatal period is romanticized, right? And it's often just not that way. Pregnancy is , is a time often of a lot of gain, but it's also a time of for a lot of loss, right? You're, you're losing a relationship with your body as you knew it. Maybe your identity as you knew it as a professional person shifts and works . Other thing I , another, a psychological theme is there's a lot of surveillance that happens in pregnancy from an obstetric standpoint, right? Are you someone where, you know , advocating for yourself is that that difficult? How does that kind of present itself in this period ? And then of course there's this kind of undercurrent of fear for a lot of people, especially for folks who are pregnant following loss, right? Pregnancy is this kind of delicate orchid that we have to keep alive somehow. And um, a lot of it beyond our control. I'd say the biggest theme that I hear come up all the time that is incredibly difficult for folks to content with , right ? Is as pregnancy progresses , as parenthood kind of starts conflict come up about how you were mother and parented. What were the things that you didn't get? What were the ways in which you were misattuned to here? All of a sudden you are a mother, right? And you're also sort of forcing to contend with ways that you were mothered growing up. I tell my patients, 'cause this is often something that don't anticipate. There's never really another time other than childhood that a mother needs to be mothered more than in the postpartum. And so just such a richly vulnerable time, like I said, both sort of, you know, negatively there are risks, but also really positively.

Speaker 1: 15:22

Well , I think those are all fantastic points. It really was such a well-rounded and comprehensive sort of overview of, and that's even just a snapshot, right? Of some of the things that people might experience. And you know, something I talk a lot about with my patients is so many times people just barrel through, right? Like they just keep going and they don't stop to pause and think, okay, who am I now? Right? Because the person you are, even when you're trying to conceive, right , that's a different person than you were before. And then when you're pregnant and then when you become a mother. And so as you said, like this is such an amazing time to do work on yourself, to really check into yourself, who am I now at such a time of evolution and change. But so many people, they don't stop to do it and then they start to beat themselves up, right? Like, well, why can't I work 80 hours a week, you know, when I'm heavily pregnant? Or why is my body changing? Why do I not have the same energy that I did? And they expect to be the same person they were before. And so there is a lot of loss too. And so a lot of times it comes up, you know, in my own work with people that you can have juxtaposing emotions, right? You can be happy about one thing, but also sad about the same thing. And that can be really psychologically confusing for people.

Speaker 2: 16:36

Totally. And that's such an important concept that both can exist and not really threaten one another, right? Like they can live right alongside one another. Fears about your body changing and a changing relationship with your partner and real joy about being a mother and a real kind of connection with, with a being that maybe you haven't experienced this kind of death . And both those things can exist, just like you said.

Speaker 1: 17:00

Yeah. And I think it , it's complicated for people a lot of times, you know? And especially for someone that had a very difficult pregnancy journey and maybe they went through a lot of fertility treatment to get there. I think a lot of times, you know, I see that for those patients, they feel that they're not entitled to have emotions that can be perceived as difficult or complaining. So they feel like they don't have a right to complain that pregnancy might be tough or that being a new mom might be tough because they feel like, well this is, you know, the only thing I wanted for all these years and I should be happy. But it doesn't mean that you don't have the right to go through all the same emotions everyone else goes when becoming a parent. Right. It's really hard. And so I see that crop up a lot too.

Speaker 2: 17:42

Absolutely. And I, I always will sort of say we don't talk in shoulds because shoulds read shame, right? So there's no such thing as a should. There's no one way that that a woman is that a human should feel going into a period that is so incredibly individualized and unique for every single woman, right? We bring our path and our histories to pregnancy to becoming a mother. That's different for every single person. Mm .

Speaker 1: 18:07

Oh, I love that should breeds shame. I like that. I'm gonna file that away. That's a really great, a great point. And I think the pressure that, you know, we particularly women put on ourselves that I should feel this way, I should look this way. Mm-Hmm <affirmative> . No , just be where you are.

Speaker 2: 18:22

Absolutely. And again, I think it sort of goes back to how so much of this gets romanticized, right? Even let's talk about bonding and attachment. I should be bonding and loving my baby from the beginning. Well actually not really. We, we do know that for so many women that bonding and that attachment builds over time, right? It can be difficult to humanize a baby, a newborn in the very, very beginning. Right? Uh , you have just experienced this precipitous hormonal drop, right? You yourself are recuperating maybe after a major abdominal surgery or after delivery like we just talked about. There's so many shifting psychological things that are going on. So like you said, I think it can be really hard for women to give themselves latitude and race around this period and to realize that there's no one way things should happen.

Speaker 1: 19:10

Exactly. Yeah. It's different for everybody and there's no shame in admitting that it's hard. You know, I would say more often than not, people find it difficult.

Speaker 2: 19:18

Absolutely. Absolutely. And with every part of it, right? Pregnancy with body image, for example, I should be accepting of my pregnant body. This was a desired pregnancy. You both can exist. You can both have really wanted this pregnancy and welcome the pregnancy and the baby and have a really hard time with your body changing , feeling unfamiliar body one doesn't have to threaten the other. Right ?

Speaker 1: 19:42

Exactly. Exactly. So let's talk a little bit too about the difference between baby blues and postpartum depression. And so that people may get a good understanding of that, of what sort of quote unquote normal and then what might need clinical intervention .

Speaker 2: 19:59

Such an important distinction, right? Because what we really don't want is for women who have a postpartum depression, right? Or depression that's kind of persisted or developed in the postpartum to sort of , uh, blanket it or to mark that as, as normal. 'cause it's not postpartum depression. So what is baby blues, right? Baby blues is something that we think of, just like you said, as normal, it affects up to 80% of women and it's really confined to the immediate postpartum, right? There's a really specific timeline, which is that it really, you know, it's this sleepiness moodiness, maybe a bit of irritability that happens, you know , in the real immediate postpartum. So in that week or two. And that really should be gone by two weeks postpartum, right ? So it's really discrete episodic and should go away. Now, postpartum depression obviously is incredibly different, right? It's not this kind of common phenomenon that we think about as coming and going. It's both simple, I think and complex diagnose for postpartum depression. We see a lot of the same features in postpartum depression that we see in garden variety depression, right? Things like low mood sadness, low energy and lack of desire. But postpartum depression, perinatal depression can be really unique in that it often includes a high level of anxious distress. These women are really obsessionally concerned. They're ruminating, they have intrusive worries and thoughts. And that anxiety, I think about it as sort of a free floating cloud. It can land on certain things. One commonplace it lands in the postpartum is a real sort of obsessional worry about the baby babies' wellbeing, right ? So these women are monitoring for chest rides or have a really hard time separating from baby they're in distress, right? You know, we know there are different phenotypes or flavors of perinatal depression, of postpartum depression, but that high level of anxious distress is often a real red flag for me that I'm watching out and seeing, does that stick around? Does that get worse? And that makes me think, you know, this is postpartum depression might be something that we wanna make sure is , is is properly screened for and treated. So postpartum depression's more severe, it's more lasting and it does not, you know, we don't in the field think about it at all as self resolving with time like we do with the baby post .

Speaker 1: 22:20

Okay. And so if you do have a diagnosis of postpartum depression, how might that be treated?

Speaker 2: 22:26

Yeah, so again, if there's no kind of one size fits all treatment for women who have postpartum depression, I would say the the one kind of tier , you know , for, for folks who have a mild or or or a milder postpartum depression, oftentimes we can get away with optimizing low hanging fruit that we weren't talking about, right? Bolstering support, getting these folks into evidence-based psychotherapies, optimizing nutrition, right? What are some things that tend to keep you well that maybe you've lost much with yoga, listening to a podcast you love friends , can we bolster that? And then for folks who maybe are on the more moderate or severe end, that's a time to, to really consider medication. And that's such, you know, that's another whole talk in and of itself. But that's when a reproductive psychiatrist can be just so helpful. 'cause you know, part of my expertise is in having a really good sense of what's the reproductive safety profile of these medications and is that a reasonable part of, of the calculus for what's gonna keep you? Well, we know that postpartum depression, if it's caught, it's incredibly treatable, right? And so we wanna be screening in catching these patients as much as possible because it's treatable. It has such lasting impacts for the entire family unit. No one spared the entire family unit's affected . If caught and treated , there's so much harm that we can avoid.

Speaker 1: 23:47

Okay, those are all great points and, and super important. I hope people hear that it's treatable and it's absolutely treatable. And again, it's why it's really important to have care, I think already established with a provider if you think that you are someone that is at higher risk.

Speaker 2: 24:03

Absolutely. Absolutely. And, and you know, I think there's this rhetoric that, you know, the postpartum of course is , is a hard time and, and that will ebb and flow. And yet white knuckling through suffering is not a good idea at all. Right? And so that's never something that we're advocating for our patients, it's just kind of to grin and bear it. And I so think that's what what you're mentioning is helpful is ideally you have treatment in place, you have that safety net in place that you can draw from when

Speaker 1: 24:31

Yeah . And you can't pour from an empty cup, you know, especially when now your cup is even more full of trying to take care of a baby. And so it's really important to ask for help and receive it.

Speaker 2: 24:42

Absolutely. Yeah .

Speaker 1: 24:43

And let's, okay, circle back to another sort of very hot button topic, which is the topic of medications . So we just talked about how they may be used in treating postpartum depression, but let's talk about the use of psychiatric medications for use. You know, any sort of psychiatric disorder DSM diagnosis, either preconceiving, so you're trying to conceive or during pregnancy and the efficacy of using medications. You know, that always, always comes up. People, you know, ask, should I get off my medication? Is it safe? What should I do? So what is your guidance on that?

Speaker 2: 25:18

Yeah, the answer is it totally depends, right? And this is where it's just so helpful to, again, I'll just sort of go back to how I approach these discussions with patients. I always start with initial consultation and in that evaluation we're spending 75 minutes thoroughly understanding what is your psychiatric history, what's your medical history? What does your social life look like? I'm getting a sense of this person's history of suffering where they're at now relative to their baseline, right? And so there's never, you know, we don't ever think in the field of reproductive psychiatry that a medication is either safe or not safe. There isn't that binary, right? It's all framed within what we term a risk, risk discussion. What are the risks, right? In untreated or suboptimally treated anxiety, depression, bipolar illness, OCD, whatever it is that this patient's presenting with. And then what are the theoretical risks in continuing whatever medication or starting whatever me medication we're talking about Now that risk, risk discussion will look different for the EV each and every DSM diagnosis that we're talking about for each patient and based off of how much risk can this person contend with, right? And that's different for every single person. My job is never to convince a patient right, to take or to not take medications. I make recommendations, of course. It's really for you to be an informed patient, an informed consumer. I want you to have a really good understanding of what does our data and our literature tell us about X, Y , Z medication and what does our data and literature tell us about this mental health concern within the context of pregnancy. And so a really individualized discussion, one that we get really granular with. But again, there's no real one size fits all approach. Does that make sense?

Speaker 1: 27:09

Yeah , of course. And I always say, you know, a mother's mental health is the most important. So that's first and foremost. And if you're gonna go off medication and then not be in a good place mentally, that's not gonna serve you. So again, I think it's really important to work with a provider who understands what's safe during pregnancy. We're trying to conceive, there are certainly many options and I think that's what's really important to know that there's options, there's optionality, and getting pregnant or trying to conceive did not mean that you need to backside in your mental health.

Speaker 2: 27:40

Absolutely. And I think, you know, I'll often meet with patients even sort of outside of this period apartment window , let's say a woman of just reproductive age. And if that woman's coming to me and is saying, you know, I'm actually thinking or, or, or thinking about family planning within the next so many years, I'm actually already thinking of I'm recommending medication. What's the re reproductive safety profile of this medication? You know, because this is someone who, if I'm starting a medication, I also wanna be aware, is this compatible with the future for them ? And I completely agree, right? Like I always say that to my patients is that your mental health affects the entire family unit, right? Without you being, well actually no one else can do . Well. This whole mentality of all kind of a grin and bear and white knucklehead through pregnancy does not work. It never works. There are some very well-known risks to ongoing depression or anxiety during pregnancy and of course , but yeah , it's having a really kind of granular discussion, ideally well ahead of trying to conceive actually, so that you're going into these kind of more vulnerable windows having already optimized your mental health. If you're starting or continuing a medication, you are going into these periods already having a great sense of, okay, I've had this in-depth discussion with my provider about the reproductive safety profile. I feel good and comfortable accepting the risks, whatever they may be, I want to continue on them . Mm ,

Speaker 1: 29:03

Exactly. Yeah, I think that's a great point. You know, it is about sort of pre-planning if you can. Right? You know, a lot of times I find people are trying to taper off of medications before trying to get pregnant, which is totally fine, you know, and sometimes it's trial and error and you can try and then say, actually I really don't feel good doing this. And then it's about saying, okay, but this medication is safe during pregnancy. I tried. And so I think it's, you know, my best interest to go back on it.

Speaker 2: 29:27

Absolutely. And again, I , I think a lot of my, my role and my job often is also to educate obs and providers who, again, not always, but sometimes will give recommendations about discontinuing medications without taking into account, okay, what are the risks for this person of their depression? Reemerging, right? That's depression is destructive. Anyone who's experienced it tell you, it's not something that that is experienced lightly. And as a whole, the other sort of mantra I'll say is that we wanna reduce all exposures and pregnancy, right? So yes, any medication, whether that be Tylenol, Advil , Unisom , Zoloft, those are exposures and maternal anxiety and depression are major exposures. Those are exposures within and of themselves. So we wanna reduce all exposures, right? So oftentimes that means, you know, if a patient's coming to me and they're , let's say they're taking four different psychiatric medications, some that have just kind of piled on throughout the years, as much as we can streamline their regimen and make sure whatever they're taking, they absolutely need and have a good sense of, okay, what is this doing for you? While absolutely minimizing and producing those other two exposures, that's that we want to have zero exposures in the kind of maternal mental ill illness bucket.

Speaker 1: 30:44

Great point. I love how you say that too. Sort of minimize exposures and present each sort of thing that someone may be taking as, as an exposure. And I think to you also pointed out that sometimes there is a gap in care and a lot of times I think people, you know, may bring mental health up to say an OB or a GP and get an answer that feels really scary or not, right? Because the practitioner that's not there wheelhouse. And so I think it is so important to have a collaborative team and if you get an answer from someone that's not a mental health provider, to not let that dissuade you from seeking help and advice from a mental health provider and someone who really specializes in this. I, I think a lot of times, you know, I see unfortunately people either feel kind of gast or scared from information they got from a different provider and it's not correct. And so to advocate for yourself, right?

Speaker 2: 31:37

Absolutely. And it's hard to blame those patients worse . Like you're being presented with information or a recommendation and you're sort of hearing, oh man, I'm putting my baby at risk. No one wants to do that. At the same time again, we can only have a well baby with a well mom . Right? And, and there's a diad between the two. It's not just baby can be well and mom can struggle. The two are absolutely intertwined and interlinked. We cannot have one who is well without the her . Yeah. And so I completely agree there's a good amount of, there's a good sort of role for being skeptical when it comes to receiving the kind of information from providers. And that's where I can be so, so helpful as a reproductive psychiatrist. Okay. What does the data and the literature tell us?

Speaker 1: 32:21

Hmm , exactly. And I think, I mean, so much of my work with postpartum moms is helping them, you know, sort of that concept of, you know, you have to put your oxygen mask on first, you know, which has become sort of the like big, I think socially talked about theme, but it is so true. You know, again, if you don't help yourself, you can't help someone else. And I think that is very hard for new moms especially to learn how to do. And so then they get themselves in situations where they're totally tapped out, so burnt out because they've now given up all aspects of themselves and any semblance of self-care because they feel like they need to be around baby 24 7 and that is not ever good for anybody. And so just sort of helping women also find a balance of how to take care of yourself while making space and taking care of somebody else.

Speaker 2: 33:11

Sure. And, and you know, the other, the other sort of content we'll bring up with my patients is that we were not meant to parent without a village. Really, parenting a baby is meant to happen with support and with people around us. It was never sort of, we think about even sort of like 30, 40 years ago there were supports in place and now more and more it's sort of this like nuclear family it who's intimately taking care of baby and not really outsourcing, outreaching for, for other supports. And that's exceedingly difficult, right? You can't pour from an empty cup. How do we keep your cup full and this and others be kind of contributing to keeping your cup full.

Speaker 1: 33:49

Yes. That is a great, great point. And I could not agree with that more wholeheartedly. Yeah. So I guess before we wrap, anything else that you think would be very important to share with listeners today?

Speaker 2: 34:01

Just that, I think that point that I sort of made earlier, which is that again, there's so much kind of fear-based rhetoric about this time period. The peripartum I'll say is sort of trying to conceive pregnancy and it's certainly, it can be a really kind of negatively vulnerable time, but also a time that can be just so enriching, right? If you kind of lean in or you can understand yourself and the ways that you were parented, what you were given, what you were not , your relationship with yourself with such depth that can be just absolutely so rewarding. And I always, I think it's so helpful to think about it that way actually, in that there's again, there's loss and then there's gain . There's both of these things exist. Hmm ,

Speaker 1: 34:46

I love that. Really, really great point. Thank you so much for coming on today. This has been such a educational and I think really, really important episode and so grateful that you came on to share your wisdom with listeners. I'm sure that this resonated with many

Speaker 2: 35:03

Absolutely. Thank you so much for having me and such important discussions and we were able to have, and thank you so much for the work that you do.

Speaker 1: 35:10

Well you are wonderful and the way we like to end our podcast is by a note of gratitude. So that's something you are grateful for today.

Speaker 2: 35:18

Oh my , I love that. I'm gonna go small. You know what, I had the best chocolate chip muffin this morning and I'm still thinking about it. I'm still grateful for that experience. So that's what came up for me and that's what I'm going with that muffin.

Speaker 1: 35:33

Oh, I love that sounds like a great way to start your day.

Speaker 2: 35:36

It really was. It really was.

Speaker 1: 35:38

Oh , I love that. There's nothing worse than a bad breakfast.

Speaker 2: 35:41

There is nothing worse . You know, you need to start out the day on a good foot and that muffin kickstarted the day for me.

Speaker 1: 35:47

Ooh . Okay. Well shout out to the chocolate chip muffin that you had. Yes ,

Speaker 2: 35:51

Big shout .

Speaker 1: 35:52

And I will go with my village. You know, when you said that, I of course struck a quote with me. I'm so grateful for my village. I could not parent alone. So just super grateful for everyone that helps me raise my daughter and you know, allows me to, to work and do the things that I need to do for myself so that I can show up for her and be present and be sound mind. Sound body. Definitely couldn't do it alone. That's fantastic. So great for my village. So thank you so much for coming on today. This was so important and we would love to have you back for part two.

Speaker 2: 36:26

Would love that. Thank you so much for the opportunity.

Speaker 1: 36:28

Oh, and before we wrap , um, anyone that's interested in working with you or finding out more about you, your information will be in all of our show notes, but just for anyone listening now, tell us how they can find you.

Speaker 2: 36:40

Great. You can find me on my website, ida eden md.com or email me at ida eden md@gmail.com.

Speaker 1: 36:48

Awesome. Thank you so much.

Speaker 2: 36:50

Of course. Thank you.

Speaker 3: 36:53

Thank you so much for listening today. And always remember, practice gratitude, give a little love to someone else and yourself. And remember you are not alone. Find us on Instagram at Fertility Forward . And if you're looking for more support, visit us@www.rmany.com and tune in next week for more fertility .