Given that many doctors incur undergraduate and medical education debts well into the six-figure range, protecting the financial bottom line is sensible, in some cases imperative.  Thus far, I haven’t been swayed to follow the money, because being a therapist is the most stimulating, meaningful and rewarding part of my work. Is it also draining and anguishing at times? Without question. Listening, talking and focusing intensively all day long with patients requires a great deal of stamina, both emotional and otherwise.

A recent article in the New York Times highlights the story of a traditionally-trained (that is, trained in both therapy and prescribing) male psychiatrist who dumped therapy from his practice entirely. It’s a good read, and offers a powerful view of the economic and personal tensions affecting medicine today. Ambitious readers with a particular interest in the field of psychiatry might also want to look at Dr. Daniel Carlat’s Unhinged:  The Trouble with Psychiatry – A Doctor’s Revelations About a Profession in Crisis (2010, Free Press), and especially Of Two Minds: The Growing Disorder in American Psychiatry (2000, Knopf) by female consumer and cultural anthropologist T.H. Luhrmann.

Aside from being fulfilling and even fun to practice, therapy also works — it offers people relief from suffering and helps expand their freedom to choose how to live, think and feel — and in my experience it can work faster than medication and with fewer side effects. Medication will always have a role in our mental health toolbox and that’s a very good thing. Psychotherapy – at least therapy by physicians – may well be on the verge of extinction.

In a nutshell, untreated anxiety and depression in the mother are far from benign events for a fetus. “Toughing it out” and avoiding medication treatment during pregnancy — the default option for many women because it seems the safest strategy — carries substantial risk and can be a misguided choice for both mother and baby.

Maternal depression is receiving more attention nowadays as researchers and clinicians begin to realize the wide-ranging impact this condition has on our health as a nation. If we bear in mind that roughly 1 in 8 women will battle depression in her life, and that most female depression occurs during the childbearing years, we can estimate that the current population of mothers is about 20% disabled by depression.

Last month, an article in one of the major psychiatric journals looked at one question that hovers in our mouths when we consider such statistics:  what is happening to the kids? What is the effect of maternal depression on children, and more importantly, can treating depressed moms make a difference in how their children feel, behave and function? According to this recent study (Am J Psychiatry Wickramaratne et al.; AiA:1–10), the news is good. In mother-child pairs in which the mother is depressed but responds to treatment within 3 months, children are significantly more likely to improve in terms of their baseline psychiatric symptoms, behavior problems and overall functioning. If the depressed mother’s recovery takes longer but she still gets well within a year, her child’s symptoms and behavior improve.  These gains in the children’s mental health were maintained for a full year of observation. In those mothers whose depression did not go away at all within the year, no improvement at all was observed in their children, and in fact, disruptive behavior problems got much worse.

The implications are obvious.  If you’re a mother and you’re depressed, get treatment. Get it sooner rather than later.  If healing yourself isn’t enough motivation, do it for your children.

• Feelings of restlessness and agitation
• Intense worry about the baby, sometimes manifested as refusal to be away from the baby at any time
• Inability to sleep when the infant care schedule allows
• Loss of appetite; diminished self-care
• Extreme self-doubt and belief that one is a “bad” or undesirable mother
• Repetitive, unwelcome thoughts about harm coming to the baby; these may be accompanied by highly vivid and disturbing mental images.
• Crying spells
• Feelings of overwhelm

In more severe cases of postpartum illness a woman may feel uninterested in and detached from her infant and may have paranoid thoughts about those around her. She may feel hopeless and suicidal.

If you or a woman you care about is showing signs of a similar illness within a year after giving birth, seek help immediately. Postpartum depression/anxiety/mood disorder is highly treatable. Many of the medications used in treatment are compatible with safe breastfeeding, and women can often experience relief quickly and begin to have the mothering experience they deserve.

I choose to limit my practice to women because their brains, minds, and life-shaping experiences are as different from a man’s as the human kidney is from bones.  Nephrologists limit their practice to kidney patients, and orthopedists stick to bones. Specialization in medicine came about because of the realization that focusing medical practice on a single organ system or a single demographic (children, for example, or older people) promotes deep understanding and a degree of mastery that leads to better outcomes for patients.

Women deserve dedicated psychiatric care in the same way.

Did you know that the amount of medication in a woman’s bloodstream varies — sometimes significantly — in relation to her female cycle? This is one reason that symptoms of depression or anxiety can worsen in the week or so before a woman’s period. Another reality of being female is that a woman is up to five times more likely to be hospitalized for a psychiatric illness during the years of raising young children than at any other time in her life.

Look for more information on women’s unique biological and psychological issues in future blog posts.  Thanks for visiting.