The Run for Women, brought to you by the LOVE YOU by Shoppers Drug Mart<\/a> program is a 5K Run\/Walk, and 10K Run taking place in 18 cities across Canada on September 27th<\/sup>. This year, the program, which supports 18 local charities providing critical mental health support and care across Canada, is going virtual.\u00a0 This is all about supporting women and the healing power of a loving community.\u00a0 In Toronto, the funds will go towards Women\u2019s College Hospital\u2019s Women\u2019s Mental Health Program.\u00a0 We recently spoke with Dr. Simone Vigod, Psychiatrist-in-Chief at Women\u2019s College Hospital and an internationally renowned researcher at Women\u2019s College Research Institute about maternal mental illness, what the options are and why The Run for Women is so important.<\/p>\n Part of what has happened is postpartum depression has become a euphemism for any postpartum mental health issue.\u00a0 That is natural, because people are more familiar with it.\u00a0 Various celebrities, like Brooke Shields, have admitted to postpartum depression.\u00a0 That leant a lot of demystification and normalization around this concept. That it was OK not to be OK around the time of pregnancy and more particularly, after birth. Mental health issues come with a whole set of beliefs and attitudes.\u00a0 A lot of people feel stigmatized by having a mental health issue \u2013 there is a lot of shame associated with it.\u00a0 I think that in the early days, that\u2019s what the term postpartum depression did.\u00a0 It doesn\u2019t mean that there is something wrong with you if you have this and also, we know how to treat it.<\/p>\n Over time, the problem is that there are many different kinds of mental health issues that happen during pregnancy and postpartum.\u00a0 Any mental health issue or addiction<\/a> can happen during pregnancy or after delivery.\u00a0 Unfortunately, what has happened over time, is that postpartum depression got really popular as a way to conceptualize the whole set of factors. If women had depressive symptoms during pregnancy, they may have starting thinking that wasn\u2019t a \u201cthing\u201d.<\/p>\n We are almost certain that postpartum anxiety is more common than postpartum depression.\u00a0 There are a lot of women who have had traumatic experiences early in their lives that get reactivated during delivery and then have Post Traumatic Stress Syndrome (PTSD) diagnosed postpartum. It also looks like it\u2019s more common to get OCD-type symptoms postpartum like needing to clean and doing repetitive activities to calm down.\u00a0 I think part of what is happening now is that women are saying \u201cWait \u2013 I can\u2019t see myself in postpartum depression.\u00a0 That\u2019s not reasonable.\u201d In fact, if you add up all of these other things combined, they might be even more common then having a depressive illness which is by definition sad, not motivated and feeling really guilty.\u00a0 That happens too, it\u2019s just not the only thing.<\/p>\n I think it\u2019s a little of the translation from the clinical to the public.\u00a0 Mental health professionals have always known that you can have any mental health issue but there is a little lost in translation and women advocates are starting to say, wait, I want to see myself in my symptoms and rightly so.<\/p>\n Absolutely.\u00a0 It hasn\u2019t been shown that pregnancy itself necessarily increases the risk \u00a0for a perinatal mood disorder.\u00a0 But pregnancy is a time when a lot of people who had pre-existing mood disorders stop medication.\u00a0 If they have had a severe illness and stop medication abruptly or they were using it to stay well, they can be at high risk.\u00a0 For some women, stopping medication is going to be a risk factor.<\/p>\n In the postpartum, that\u2019s where there really is a spike of unusual levels of depression and anxiety and we think that some of that is genetic, heritable-biological.\u00a0 Clearly, some women have a sensitivity to the rapid hormonal shifts that happen during the time of delivery.\u00a0 If a woman has a previous history of a mental health issue, if she has a family history of a mental health issue, particularly mood disorders like bi-polar disorder and depression, that may be an increased risk for her.<\/p>\n In addition, some of the social and psychological issues that happen in the transition are risk factors.\u00a0 That can include lack of sleep, the stress of having a sick baby, having severe marital discord or domestic violence and having major financial pressures.\u00a0 You can imagine what the pandemic is doing to stress levels.\u00a0 The third major risk factor is social support.\u00a0 Social support when it occurs is extremely protective and can prevent postpartum depression and anxiety in some cases. Lack of social support, whether that is practical or emotional is a really strong risk factor for someone developing postnatal depression or anxiety disorder.<\/p>\n Women and their partners ask me this all the time.\u00a0 The very first step is \u201cHow do I know if I\u2019m just feeling overwhelmed or if I have a mental health problem that requires treatment?\u201d\u00a0 What I say to people is that it\u2019s about the severity of how overwhelmed you are feeling. If you are having thoughts of not wanting to be here for example, even if it\u2019s fleeting, that is severe and you should reach out for help.<\/p>\n The other thing that I talk about is stickiness.\u00a0 If you feel overwhelmed, but a few minutes later, after you go for a run or talk with a friend or just have a chance to take a shower and you feel back to your baseline, that\u2019s a good sign that this isn\u2019t spiraling into mental health problem that might require ongoing therapy or medication.\u00a0 If the issue is really sticking, you can\u2019t shake that mood and with postpartum women you can\u2019t sleep even when your baby is sleeping, you can\u2019t shut your mind off and you have really negative thoughts in your head that you can\u2019t just shake, that\u2019s when it\u2019s really important to reach out for help.<\/p>\n There are so many things that can prevent perinatal mental illnesses like interacting with others, having support, taking time for yourself and getting good sleep. If somebody is feeling a little overwhelmed and having mild symptoms, those things are going to be really helpful.\u00a0 When someone is in the position where they have more low days than not, they are so anxious they can\u2019t sleep even when the baby is sleeping or they are having very severe symptoms, that\u2019s when we should be looking at a treatment.\u00a0 By treatment, I mean therapy with a trained therapist.\u00a0 In more severe cases, if therapy doesn\u2019t help a person enough, then that\u2019s when we start to talk about medication.<\/p>\n It\u2019s tough.\u00a0 As much as some women know logically that some posts are sanitized, it hits at a deep emotional level when you are pregnant or you are postpartum especially, the first time. There is so much uncertainty with pregnancy and parenthood.\u00a0 You have to make all of these decisions all of the time.\u00a0 You don\u2019t necessarily know what the best or right answer is or if there even is one. There wouldn\u2019t be 30,000 books written about pregnancy and parenting if there was one right way to do things.\u00a0 Every time you see something like this with somebody \u201clooking like they are doing it better than you\u201d, it can really hit and twist inside. You can go down a spiral where you convince yourself that you aren\u2019t good enough.<\/p>\n There have been some studies on social media where there might be a U-shaped curve.\u00a0 Some is good, because you want people interacting with others, but if you are on it too much, it becomes very hard to separate yourself and give yourself a reality check. We see a lot of women who have had difficulty, whether it\u2019s online or part of Mommy groups and my advice is always if you are feeling like that in a group, maybe you need to find a different group where people are being more realistic.\u00a0 If anyone is saying that things are absolutely perfect all of the time, and they are always making the right decisions, that is few and far between.<\/p>\n It\u2019s hard because everyone wants to do their best and I spend a lot of time with parents talking about Donald Winnicott a pediatrician who in the 1950s coined the term \u201cgood enough mother\u201d [we talk about \u201cgood enough parent\u201d now].\u00a0 The whole idea is that you don\u2019t have to be perfect, in fact, you don\u2019t want to be perfect, because what you want to show your child is that you can be imperfect and flexible and still feel like you are doing a good job.\u00a0 That\u2019s what you want to model for your kids, not that your child has to do everything perfectly or they are worthless.\u00a0 What we want to say is you can try, and persist and correct and everything is going to be OK and you are worthwhile even if this one outcome isn\u2019t good enough.\u00a0 That\u2019s the approach that we try to take with parents.<\/p>\n Social media is all consuming and during the pandemic, people have not had social support, person-to-person interaction, so a lot of life is online.\u00a0 I encourage mothers to look at the other side of social media because people also post pictures about what it feels like to be very pregnant or running around after a two-year-old all day.\u00a0 If you look for the other stuff, that\u2019s there too.<\/p>\n It\u2019s one thing to worry about COVID<\/a> itself, and with a lot of viral illnesses, there is uncertainty about whether pregnant women might be more susceptible to catching it or have more serious complications as a high-risk group.\u00a0 Then, there is the anxiety of having a new baby during the pandemic.\u00a0 The evidence and research from past pandemics suggests that often, it\u2019s not the virus itself or the fear of it that takes the biggest mental health toll on the population. It\u2019s the containment effort.<\/p>\n What we\u2019ve seen since the state of emergency was declared in the middle of March is broad social and financial disruption.\u00a0 Pregnant and postpartum women don\u2019t have help. They may be more worried about finances; their partners may be struggling too and that could lead to domestic discord.\u00a0 In addition, healthcare services have been different so pregnant women don\u2019t get to have their partners come in with them for appointments.\u00a0 There were periods of time where during delivery, support people were only there for short periods of time. All of the community-based supports that we have in place that we know prevent postpartum depression and anxiety weren\u2019t happening.\u00a0 Lactation clinics and even postpartum support groups weren\u2019t available.\u00a0 We added stress and took away support.<\/p>\n There is a group out of Calgary that did a survey in April and May of pregnant women.\u00a0 Close to 50% of women were reporting elevated levels of psychological distress.\u00a0 Whether that\u2019s a mental illness, we can\u2019t tell from a survey, but certainly elevated levels of psychological distress are going to put them at risk. We have had increases in referrals to our clinics.\u00a0 Looking at Ontario data, visit levels for postpartum women to family physicians and to psychiatrists for mental health issues, mainly depression and anxiety, have been increasing.\u00a0 It\u2019s been a rough time for pregnant and postpartum women and for parents of young children.<\/p>\n Pregnancy and postpartum are one thing, but there are so many vulnerabilities in our society that may make people doubly vulnerable.\u00a0 Maybe they were already poor, maybe they were an immigrant or from a racial or ethnic group that already had disadvantages in health or in the system, and these disadvantages can get compounded.\u00a0 Even around things like being able to offer people virtual care. \u00a0Digital care is amazing, but people are talking about it in terms of the digital divide where there are some people that are going to get left behind if we aren\u2019t careful.<\/p>\n The first thing to remember is if you aren\u2019t doing well, that is a valid feeling and there are treatments and help for it.\u00a0 It is important to give them some de-shaming and destigmatizing language about this and give them hope that they can improve.\u00a0 Then I would recommend Postpartum Support International\u2019s Canadian page<\/a>, so women from anywhere in Canada can reach out and get connected to local services.\u00a0 They can also connect you with online postpartum support groups.<\/p>\n People can reach out to their family doctors, their midwives and obstetricians who can provide some healthcare, especially in primary care with the family physicians who have access to support groups and social work therapists and then, if needed, can refer people to mental health professionals for therapy and treatment.<\/p>\n![\"Perinatal](\"https:\/\/divine.ca\/wp-content\/uploads\/2020\/09\/Simone-Vigod-Headshot.jpg\")
Most women are familiar with postpartum depression.\u00a0 Why are other perinatal mood disorders still not widely discussed?<\/h3>\n
Are there any risk factors for perinatal mood disorders?\u00a0 Who is most vulnerable to them?<\/h3>\n
What steps should a woman take if she has had a history of depression and is pregnant or finds that she is feeling overwhelmed during or post pregnancy?<\/h3>\n
We are in an age where people share their lives for better or worse on social media.\u00a0 How does this affect the average woman mentally?<\/h3>\n
What impact has COVID-19 had, generally speaking on women\u2019s mental health, particularly with new and expectant mothers?\u00a0 How has it changed your own practice?<\/h3>\n
What would you say to a woman who doesn\u2019t know how to reach out \u00a0or where to look for help?<\/h3>\n
What resources are available at places like Woman\u2019s College Hospital to help a woman deal with any type of maternal mental illness?<\/h3>\n