Like most mothers-to-be, Mary Bicos thought having a baby was going to be the happiest time in her life. That’s why she couldn’t understand why she cried as she left the hospital after giving birth; why she didn’t enjoy the time she spent with her baby, Michael; or why she was completely disinterested in the activities she loved before she became a mom.
After seeing her physician and a social worker, Mary was referred to Dr. Ariel Dalfen, a psychiatrist at Mount Sinai Hospital’s Perinatal Mental Health Program. Within a week of the referral, Mary sat down with Dr. Dalfen for a consultation and was promptly diagnosed with postpartum depression (PPD). “At first it was upsetting but it also felt good that someone was finally taking my concerns seriously,” says Mary. “I felt like somebody finally cared about how I was feeling.”
Mount Sinai’s Perinatal Mental Health Program is one of the largest programs in Canada to offer assessment, short and long-term treatment to outpatients, inpatients and women in crisis who are having concerns around pregnancy, fetal loss, infertility and postpartum mental health issues. Depending on the patient, the program offers one-on-one consultations, in dyads (together with their partner or child), and in groups.
“A large number of the women we see suffer from postpartum depression or are at high risk of developing the illness,” says Dr. Dalfen. “Our program offers comprehensive care for these women before, during and after the birth of their child.”
Mary began by seeing Dr. Dalfen twice a week for one-on-one counselling. During these consultations, she learned her history of depression combined with a difficult birth (she had to stay in the hospital for six days after delivering her son) put her at a high risk for developing PPD.
“I had depression previously when I was divorcing my ex-husband, but I thought it was situational – a one-time thing,” explains Mary. “I figured since now I was happily married I wouldn’t get depressed again so I didn’t mention anything to my doctors.”
Dr. Beverly Young, another full-time psychiatrist in the Perinatal Mental Health Program who works with Dr. Dalfen, explains that, like Mary, many women don’t realize they’re at risk for PPD, highlighting the need for more education around the illness.
She recommends women who have had previous experiences with depression, like Mary, should inform their physician or midwife if planning to get pregnant or upon learning of their pregnancy.
“We prefer to see at-risk women before giving birth so we can warn them about the signs of the illness and ways they might prevent it,” says Dr. Young. She says women who suffer low-level anxiety or have a strong “Type A” personality (someone who’s highly organized and makes lots of lists and plans) are also more likely to develop the illness due to the sudden upheaval a baby causes.
Women who are at especially high risk for PPD, such as those who suffer from bipolar disorder, may be eligible for Mount Sinai’s Five-Day Five-Night Program. This program allows high-risk women to stay in the hospital for an extra five nights after they’ve given birth for monitoring and, most importantly, so they can catch up on their sleep.
“Studies have shown that sleep deprivation worsens postpartum depression and the more sleep a woman gets greatly reduces her risk of developing PPD after birth,” explains Dr. Dalfen. “This program allows them to rest while knowing their baby is being taken care of by trained nurses.”
Psychiatrists at Mount Sinai are also in the midst of planning a pilot project that would reserve two beds on the psychiatric inpatient unit for women suffering from severe postpartum depression so they and their baby can be admitted and cared for on a longer-term basis. “The program would be one of the first of its kind in Canada,” says Dr. Beverly Young. “It’s an important part of our commitment to comprehensive care.”
Mary says her treatment at Mount Sinai has improved her life significantly, including her relationship with her now 16-month-old son Michael. She is committed now to helping raise awareness of PPD among other women. “In many ways I was lucky,” says Mary. “I had my family around to help me and watch the baby while I got help, but so many women don’t have that level of support. I want all women to be able to receive the wonderful care I did, regardless of their circumstances.”