Understanding Postpartum Depression with Cathy Dore, LMFT.

Montare Media presents Season 2, episode 18 of the Discover U Podcast with JD Kalmenson: Understanding Postpartum Depression with Cathy Dore, LMFT.

Learn More about Montare Behavioral Health: https://montarebehavioralhealth.com/about/digital-library/

JD Kalmenson interviews Cathy Dore, LMFT, to shed light on the unique challenges to women’s mental health during the pregnancy and postpartum period. Understanding the difference between “baby blues” and a more serious depressive event, is just one of the distinctions you will learn about in this episode.

Cathy Dore is a licensed marriage and family therapist based in Toluca Lake California, where she specializes in women's health, with a focus on pregnancy and childbirth. Cathy is a member of Maternal Mental Health Now, Los Angeles County's perinatal mental health task force. She has served on the board of Postpartum Support International, and is the co-founder of the Motherhood Consortium, an inclusive community of professionals who provide care and nurturing for mothers, families, and their babies. Cathy's clinical experience spans 20 years both as a private
 practitioner, and with several well-regarded mental health agencies throughout Southern California, where she serves diverse urban populations, providing psychotherapy for a broad range of clinical issues, including depression, anxiety, stress management, abuse, and trauma. Additionally, Cathy has been a contributing writer for several parenting publications. 

 Host Kalmenson is the CEO/Founder of Renewal Health Group, a family of addiction treatment centers, and Montare Behavioral Health, a comprehensive brand of mental health treatment facilities in Southern California. Kalmenson is a Yale Chabad Scholar, a skilled facilitator, teacher, counselor, and speaker, who has provided chaplain services to prisons, local groups and remote villages throughout the world. His diverse experience as a rabbi, chaplain, and CEO has inspired his passion and deep understanding of the necessity for effective mental health treatment and long-term sobriety.

Follow JD at JDKalmenson.com

Transcript

JD Kalmenson: 

Welcome to another episode of Discover U, our podcast exploring innovative and effective solutions to issues in mental and behavioral health. I'm JD Kalmenson, CEO of Montare Behavioral Health, a family of dynamic and comprehensive treatment centers in Southern California. I'm so honored and excited to introduce you to our wonderful guest today. Cathy Dore. Cathy is a licensed marriage and family therapist based in Toluca Lake California, where she specializes in women's health with a focus on pregnancy and childbirth. Cathy is a member of Maternal Mental Health Now, Los Angeles County's perinatal mental health task force. She has served on the board of Postpartum Support International, and is the co-founder of the Motherhood Consortium, an inclusive community of professionals who provide care and nurturing for mothers, families, and their babies. Cathy's clinical experience spans 20 years both as a private practitioner, and with several well-regarded mental health agencies throughout Southern California, where she serves diverse urban populations, providing psychotherapy for a broad range of clinical issues, including depression, anxiety, stress management, abuse, and trauma. Additionally, Cathy has been a contributing writer for several parenting publications. Welcome Cathy. So happy to have you with us today. Thank you for taking the time. 

Cathy Dore:

Glad to be here.

JD Kalmenson:

Thank you. Thank you so much for taking the time to talk with us about your important work in perinatal health. It's an area that needs to be talked about more, and I'm so glad to have the opportunity to benefit from your expertise in this area. How did you get involved with this type of you know, this type of behavioral health and providing therapy for this niche demographic?

Cathy Dore:

Well, it was personal. I had become a licensed therapist, and was working as a therapist, and I had had a baby, and two years later I had two babies at the same time. And in having those pregnancies and those children so close together in time it got me very interested in maternal mental health and I started reading and looking and researching, and here we are.

JD Kalmenson:

Wow. So that's, that's amazing when you see how your life experiences impact your professional career and you utilize them to, you know, really make an impact. Briefly, can you describe for our audience, what is the criteria for perinatal mood disorder? Meaning how long does it last, what makes it recognizable or separate from regular depression and anxiety? 

Cathy Dore:

Well, about 10%, well, not even about 10% really of women experience depression during pregnancy. And that translates into the postpartum time. So you know, what, can you ask the question again?

JD Kalmenson:

Sure, sure. I'm gonna absolutely. Cuz I, I did, I did add a bunch of details in this I'll take it from the top. yeah. Can you, could you briefly describe the criteria for perinatal mood disorder?

Cathy Dore:

Perinatal is considered the timeframe from conception through childbirth. Postpartum time is the time from childbirth through the first year after pregnancy. So the first year of having a baby. And the criteria is all of the symptoms of depression, a major depressive disorder, as we would find in the DSM, but it's considered to be during that time. So all of the symptoms you've had you'd have for a major depressive episode, you would find a woman experiencing either during pregnancy or during that postpartum time. 

JD Kalmenson:

Very interesting. And does it have any sort of unique features and properties that would make it separate or distinct from regular depression and anxiety?

Cathy Dore:

It does in that it's that monumental transition time of her life. There's no other time in a woman's life, particularly, and for men too, it where she has so many changes going on. So all of the issues that may have been in her life prior to getting pregnant and having a baby become even more heightened. Issues with family, issues with health, issues with finances, issues with her partner, her marital situation, issues with her professional situation, right? Everything gets affected when a woman has a baby and depending on how she adjusts to all of those shifts in her life it may create some feelings of depression, or anxiety. 

JD Kalmenson:

So it exasperates everything that's going on. Every stress inducer gets exasperated with somebody who has postpartum depression.

Cathy Dore:

Correct. And for some it's just a monumental adjustment period, but for others, it can be a period of major depression. It can come with obsessive compulsive disorder being exacerbated. If that was a preexisting condition that she had, if bipolar was a preexisting condition that can be exacerbated as well. So there's a lot of things that can happen in a woman's brain during pregnancy and during her postpartum adjustment time that affect her emotionally and psychosocially too. All the interpersonal relationships in her life.

JD Kalmenson:

What percentage of the population experienced this?

Cathy Dore:

10% of women experience depression or anxiety during pregnancy. And I wanna emphasize depression. It usually we lean one way or the other. So some people, when they experience depression, lean more into the depression, and some are more, become more anxious. It kind of depends on the individual. About 15% of women experience postpartum depression. So after the birth of the baby, so it's about one in eight.

JD Kalmenson:

So there are in, in other words, if I'm my math is correct, it would seem that everyone, or almost everyone who experiences perinatal mood disorder would have that type of depression or symptoms extend postpartum, but not necessarily everybody who has postpartum, did that begin at the perinatal stage?

Cathy Dore:

Correct. That's right on. Not everybody is feeling symptoms of depression during pregnancy. But those who do, tend to continue to have that experience postpartum. 

JD Kalmenson:

Right. And is there a typical length of how long it lasts after postpartum? 

Cathy Dore:

Postpartum depression can have an onset anywhere from the first few weeks after having a baby and can last until, you know, a year or two after having a baby. The DSM categorizes postpartum depression as having an onset in the first six weeks following childbirth. We kind of know that that's not really true. We know that women can be doing just great for the first six weeks and then all of a sudden… 

JD Kalmenson:

Comes outta nowhere

Cathy Dore:

Set in. Yeah. Yeah.

JD Kalmenson:

Interesting. So when, I mean, just before we move on from this, do you ever see outliers and, and cases where the postpartum depression can last years later, three, four years later,

Cathy Dore:

You do. It's kind of rare, but every once in a while, somebody's still in a very depressive state and they're two to almost three years in to having their child. And they really haven't bonded well with their child. And there's a lot of detachment, lot of lethargy, lack of motivation. You do our goal is hopefully to treat it

JD Kalmenson:

That's right.

Cathy Dore:

That's get people up and going and feeling better about their situation and bonding and with their babies. But yeah, you do see it later.

JD Kalmenson:

So you mentioned bonding with the babies. What are some of the symptoms, the classic symptoms of perinatal mood disorder as well as postpartum depression?

Cathy Dore: 

Well, the classic symptoms of perinatal mood disorder, and postpartum depression specifically are all of the same symptoms you would find in depression along with a few extras. So, you know, low depressed mood, low appetite, inability to sleep insomnia, anhedonia, you know, can't really experience any pleasure and joy. I would say a lot of women experience, acute anxiety re when we say excessive worries, very excessive worries. If especially if somebody's been kind of an overachiever or tends to lean toward O C D obsessions, compulsions, wanting to obsessively protect their baby. So that happens along with sometimes intrusive thoughts. So the idea that thoughts float in and out that I could harm myself or my baby could get harmed most of the time, those are depressive symptoms. The obsessions that happen during postpartum depression are really focused on taking care of the baby, protecting the baby, and harm to the baby could happen and I wouldn't be able to control it.

JD Kalmenson:

Wow. So I mean, the fact that a lot of these symptoms are really malnourishment for the body, whether it's insomnia or, you know, not being able to eat properly, that's gonna cripple and paralyze the entire nervous system and make somebody extremely vulnerable to any type of any type of behavioral health or any type of real functionality, because this is somebody who's severely compromised. So go ahead.

Cathy Dore:

I would add to what you've just said. You have to remember the hormonal shifts that are going on in a woman's body with the estrogen and progesterone dropping and also cortisol levels. So if you're not sleeping, we all know in the mental health world, if you're not sleeping and you have disrupted sleep, if you're up every two hours to feed a baby, your cortisol levels are gonna be really high, and your adrenaline as well.

JD Kalmenson:

That's right.

Cathy Dore:

And that's gonna help… that's gonna contribute to impairing your ability to function and take care of this baby, and it's going to, to really affect your mood.

JD Kalmenson:

So would you say that the primary causation to begin with for postpartum is these hormonal changes or is this one of the symptoms?

Cathy Dore:

I'd say it's a combination. It's a recipe. I think the hormonal shifts contribute to postpartum depression. And depending on who women is, like I said, 15% of women experience postpartum depression, that same 15% of women experience other hormonal challenges in their reproductive life usually. So women who experience migraines, ovarian cysts, endometriosis, other things like that, sometimes are more at risk for postpartum depression. So they have, there's a biochemical component.

JD Kalmenson:

Right.

Cathy Dore:

In addition to that, if the woman has a lot of life stressors that are very challenging, especially during the time of childbirth, that's gonna contribute as well.

JD Kalmenson: 

Very, very interesting. So the life stressors are not necessarily, you'll correct me if I'm wrong, the way I'm perceiving this is that postpartum depression or the experience of, of women's health throughout pregnancy, and then postpartum… It has a, it takes a toll on the body and the nervous system. And so therefore with that weakened nervous system, there would be a weakened resiliency and capacity to deal with major life stressors that otherwise, without this weakened nervous system, we might be able to respond to with optimized functionality and it wouldn't necessarily cripple us and paralyze us. So it's almost like…  so it's the strong life stressors are really highlighting the weak and nervous system. And showing that this is what's gonna happen when, when you have this type of stress going on as well. 

Cathy Dore:

 You look at the way we had babies a century, two century years, millions of years ago. It wasn't the way we do it now. We had babies in community. We had babies in strong support systems, right. We, we had babies in a village. And we had the village there to help support the mother through the adjustment and support the baby and the whole family. 

JD Kalmenson: 

Yeah.

Cathy Dore:

We don't do that. Now we have babies in isolation. 

JD Kalmenson:

Yes. 

Cathy Dore:

But if you are a woman in our society now, and let's say, say you have professional responsibilities, you are married. And maybe there are stressors going in your marriage, things aren't going great. You don't feel very supported. You have a baby, and you have responsibilities in this relationship, and to your job, you're gonna not feel so good. 

JD Kalmenson:

That's right.

Cathy Dore:

You're gonna feel very overwhelmed

JD Kalmenson:

For sure.

Cathy Dore:

And unsupported

JD Kalmenson:

And yeah. And that's even without the hormonal changes, let alone, when you add that into the mix.

Cathy Dore:

Yeah. That's right.

JD Kalmenson:

As far as postpartum depression being a separate diagnosis, does the fact that we single it out and refer to it as a different type of depression, is it really just describing the causation, but in actuality, from what I'm hearing, it's a classic standard type of depression and anxiety with the traditional symptoms and debilitating you know, expressions that you would find in regular depression, anxiety, it's more just really ascribing the source and origin of the condition. Is that right? 

Cathy Dore:

That's right. I mean, if, if you were to go to the American psychiatric association, they would say it's a major depressive episode during that time of a woman's life. Yes.

JD Kalmenson:

Right.

Cathy Dore:

But then we have to factor in the fact that it's not a typical depression because there are hormonal factors and extenuating circumstances to her adjustment, to this transition of becoming a mother.

JD Kalmenson:

Correct. And that's, and that's really what I wanted to ask you next. I mean, we all know about baby blues, which can come about just lack of sleep, a fussy infant to requiring constant attention. You mentioned getting up every two hours, the overwhelming nature of caring for a baby 24 7. How would you distinguish clinically just a regular situation as somebody who's overwhelmed as a parent, and depression and postpartum depression?

Cathy Dore:

Well duration, intensity frequency is really what I would say. When, when we look at baby blues, it really is. Some people might disagree with this, but that's more of what we would consider an adjustment disorder. if you're, if you're looking at the DSM and you're gonna diagnose, have you ever had a new job? And it was really hard to adjust to and you were challenged and maybe you felt pretty down some days at the beginning of that new job, right? That's kind of how the adjustment to having a baby is for women who really may not be majorly depressed, but might be having some hard days. It's the, the baby blues, right? It's an adjustment to something new and challenging. When you get into major depression, you're talking about another realm. The frequency of the feelings is more, the intensity of the feelings is more, and they last longer duration. So I'm depressed all day, every day, I'm tearful every day, all day, I don't wanna get out bed. I don't want to eat. I don't wanna sleep. I, so it's, it's, it's more, it's just that much more. And a lot of times when people have a baby and there're having what we call the baby blues, they're in that adjustment time. 

JD Kalmenson: 

Right. No, that is so important. They, they say the anecdote about a fellow who he's in The Bahamas and he's really enjoying himself. And he sends a postcard to his therapist. He says, I'm having such a great time. I only wish you were here to tell me why. You know, so not everything is, is is a diagnosis. Based on what you're describing that this is really classic symptoms of depression. So the intervention and the way to treat this depression, would it be accurate to assume that it would be traditional interventions of treating depressive disorder? 

Cathy Dore:

Yes. With the exception of, I, I don't think that it's emphasized as much that people need psychosocial support when they're depressed, as much as we emphasize it with postpartum depression. A woman with a baby home alone is probably going to be depressed. A woman with a baby in a room full of other women with babies who may or may not be depressed, will probably start to feel better.  

JD Kalmenson:

That does.

Cathy Dore:

So

JD Kalmenson:

Why do you think that's the case?

Cathy Dore:

Because when we normalize our experience, we feel less alone. I also think something I wanted to mention is mythology plays a big part of what, how a woman feels after she's had a baby. And the myths around motherhood, childbirth, and parenting contribute to how she feels. So she thinks she's gonna go to The Bahamas to use your analogy or wherever, and have this glorious time. You're gonna have a baby. It's gonna be the best time of your life. You'll be so fulfilled. You'll fall in love instantly. This will be the best thing that's ever happened to you. It will be life changing in such a wonderful way. You'll be glowing, I mean, on and on and on. Right. We have all these myths. And if her experience doesn't match up to that, she's not gonna feel so good.

JD Kalmenson:

Right. Right. That makes so much sense.

Cathy Dore:

If her experience is I'm not sleeping. I'm alone in this. I don't… I'm changing diapers and feeding around the clock, and I get nothing back. And I'm sitting here crying in the corner with no one to help me. She's, it's probably not gonna be glorious.

JD Kalmenson:

That's so true. And then I'm just, as you're saying this, you know, the, the feeling of aloneness is so acutely felt because first of all, even her husband, even if their relationship is wonderful and he tries to be supportive, he did not go through what she went through. He is not the one who's feeding this baby. This baby is not dependent on him. She is the one who can literally not take off for more than 2, 3, 4 hours at a time. And that makes you feel really restricted it you could feel choking. I mean, imagine if it's your first one, it's like, you are a free person. And right now you're, you're on the clock around the clock. There is no vacation from that. And then, you know, the rest of the people around you did not go through that traumatic experience. So there is a, there is a very strong aloneness, which gets countered by being in a room with people who had that same experience with you, mothers, and children, and that feeling of support.

Cathy Dore:

And to go to go back to your question about what's the difference between postpartum depression and a regular depression, the other things that play a part of this are your experience of childbirth and the experience you're having in the process of having a baby. If you go through a traumatic birth, something doesn't go quite right, that plays a major role in how you feel about yourself, your baby. If you can have PTSD after having a baby, if there was a threat to your life or your body, and it was really terrifying, you don't necessarily wanna hold your baby, this, this being that came out of you and, and harmed you. And also it's just the, the fear of all of it. If you're not getting along with your partner the partner relationship is, and how it functions is essential to how a woman feels postpartum. It's a major risk factor for postpartum depression. If she doesn't have a supportive partner and system of people to rely on

JD Kalmenson:

Very interesting. Would you say that amongst couples who aren't together postpartum or who are not in a healthy relationship, the susceptibility and likelihood of postpartum depression being a fact, you know, taking place, would you say the susceptibility is a lot higher?

Cathy Dore:

Yes. 

JD Kalmenson:

 Um hmm.

Cathy Dore:

Yes. it's funny, cuz I've done a lot of research on, you know, the role that marital relationships and attachment between the adult partners, the marriage unit, plays in postpartum depression and how it affects it. And if that relationship is not a good, healthy, strong one, it, things can go south really fast when a baby shows up.

JD Kalmenson:

Wow. And I'm, I mean, is there any aspect of it that the mother looks at the baby and is just reminded of the partner who she's not happy with.  Is that a variable?

Cathy Dore:

Yeah. The other thing that can happen in cuz you mentioned the father's experience, the father has his own experience of childbirth and often we marginalize him. Right. And our society, we focus just on the mother and the baby dyad. But if you think about it, poor guy, he's like out here on the sidelines, he's witness to this birth. It might be very scary for him. He's these may be people he cares so deeply about. I mean he loves this woman and he's having a child and he doesn't get acknowledged much. And then also once a baby comes into the relationship, it’s no longer a dyad, it's triad and there can be lots of feelings that the father may have. He may feel marginalized. He may feel envious of his baby, that his wife is giving all this attention to the new baby. There's a lot that can go on in their relationship when the baby comes.

JD Kalmenson:

Very, very interesting. And I guess talking about the, the myths, I wanna ask you something that I, I I've only heard about, and I would love to get your take on whether there's truth to that. So is there any aspect of postpartum depression where the mom, at least hormonally feels like she's lost a part of herself because she's been carrying this baby feeding this baby, nurturing this baby within her and now yes, the baby's alive. And that was the point and the goal, and this is so beautiful, but she did lose a part of herself in that process. Is that a factor or is that just a pure myth?

Cathy Dore:

Oh, absolutely. It's a factor. It's an identity crisis really? That happens. So, you know, along with everything else, we're talking about all these changes to her body, to her psychosocial self, she's having an identity crisis often, you know, who am I? I used to be this person and now I'm this person. And a lot of loss… loss of freedom, loss of spontaneity, loss of the ability to do what you want when you want, how you wanted it. And that may have been your lifestyle for a long time. 

JD Kalmenson:

Right.

Cathy Dore:

Lifestyle's gone. So yeah, women have a, a major identity crisis can happen around it. And it also another factor is how their mothers, or their parents see the role of motherhood. So if a mother, a new mom has an adult mother whose life was completely focused on her children, that may be the expectation now of her adult daughter, who's become a mother. And there's a lot of you know, discord in that when the new mother says, well, and I wanna, I'm gonna take maternity leave and go back to work and I'm gonna take my baby to daycare. Well, her adult mother may not approve of that. And that gets conveyed whether directly or indirectly. 

JD Kalmenson:

Right. Or even indirectly, we instinctively fall back to that as our model, even if it wasn't the best one.

Cathy Dore:

Right. And a lot of that contributes to the identity crisis. Am I doing the wrong thing if I leave my baby? Should I quit my job and stay home with my baby? Am I a bad mother? Right. The question of, am I a bad mother? And what makes me a good, good mother is pretty central to everything we're talking about. 

Cathy Dore:

And it can also be fathers because fathers come into this transition having an identity crisis of their own. And part of that is what makes a good father. But part of that is what is their expectation of their partner? Is their expectation of their partner to be the way their mother was?

JD Kalmenson:

Right.

Cathy Dore:

Right. Well, my mother, you know, she quit her job and she stayed home and baked cookies and did this for me. You're not gonna do that now? 

JD Kalmenson:

That's right. Right. I wanna go back to something you mentioned earlier, just for a moment, in your opinion, should we not hype up how glorious and magical the experience of birth is given the fact that it could lead to a let down and it could lead to feelings of this didn't match up with what I envisioned. So in a proactive, preventative measure to really protect, is that something that we would you recommend based on that? 

Cathy Dore:

Yes, we don't do a service to parents by only emphasizing the light. There is a lot of joy in having a baby. Absolutely. And I say that to my clients all the time, look at your baby, look at your baby. Your baby is smiling. Your baby is looking at you. Your baby is cooing and growing and thriving and, and all of these wonderful things have come into your life. And all these opportunities are, your life has completely changed, but are you not sleeping? Yes. Are you not able to concentrate, focus, do the things you used to do? Yes. So we really should do a better job at preparing people 

JD Kalmenson:

Yeah.

Cathy Dore:

Through the transition.

JD Kalmenson:

And that would actually make them less, less alone if they knew that they were normal and that this wasn't unique or different.

Cathy Dore:

Absolutely. But you know, I, you asked my opinion. I think this applies to most things in our society now. We really have gotten away from preparing people for the reality of the way things life is. It's not always easy. It, we need to emphasize the light in the dark.

JD Kalmenson:

That's right. That's right. With our, our obsession to paint things as, and the upbeat, optimistic, and positive. We're actually sometimes doing ourselves a disservice by creating ill prepared generation to deal and cope and to experience some of the curve balls that are inevitable.

Cathy Dore:

Well, it's funny that you would say that because I find that as I see more and more millennials in my practice, there is a real expectation to have things go well quickly. 

JD Kalmenson:

Yeah. Yeah.

Cathy Dore:

And, and I think that's kind of across the board. It's not just with having a baby it's

JD Kalmenson:

In general with

Cathy Dore:

A lot of things in life. Yeah.

JD Kalmenson:

Instant gratification. Yes. A lack of organic progress. And that's probably just going to make the numbers of people struggling with postpartum depression go up because the more entitled or the more they expect it to be a smooth, seamless process, the bigger the letdown will be when it's not like that.

Cathy Dore:

Yeah. And that is actually a lot of what I do in my practice is a lot of parenting reparenting and a lot of parent education, you know, it's okay to let your child, you know, cry. It's okay for your baby to cry. It's okay to make, you know, parents don't wanna let their children experience pain or displeasure, you know? And they take it personally. Right. So they're internalizing, I must be a bad mother because my baby's crying and I can't soothe my baby. The two things that make a mother feel adequate and have mother self-esteem right off the bat are being able to feed and soothe her baby.

JD Kalmenson:

Yes.

Cathy Dore:

And the other thing we haven't really talked about is the feeding aspect. So breastfeeding particularly is also something that women expect they should be able to do right away. And our society puts a lot of emphasis on you should breastfeed. There's a lot of shoulds around it nowadays. And if she can't do that, which many women can't, it's not something that's natural, it's a learned skill. For her and the baby, then she feels inadequate. And then she feels like she's failed. 

JD Kalmenson: 

Right. You know, it's amazing because there are not a lot of areas in behavioral health where simply informing and transmitting the objective information prior to the event has the actual capability to reduce the acuity and the severity of the event. And this is one of them. I mean, preventative sort of education can really alleviate the loneliness and just, you know, this is a part of the process. 

Cathy Dore: 

We should be teaching high school and college students, what it may be like when they wanna partner with someone and raise a family. 

JD Kalmenson:

That's right. Could you elaborate on the attachment issues piece a little bit more? I mean, we didn't, you, you know, as far as the relationship between the mother and the baby and what postpartum depression can do and how that plays into attachment issues, what's, what's, what's a little color on that. 

Cathy Dore:

Well, depending on how you are attached is going to affect how you attach to your baby. So, you know, if a mother's very securely attached in her own relationships, she's probably gonna have a, a secure attachment with her child. If she received a very insecure attachment or avoidant attachment from her caregivers, she's probably gonna transfer that onto her child and, and not form a very solid attachment. Right. We see it all the time where women who really didn't have a very good attachment to their own parents are kind of avoiding their babies. Don't really wanna get close, there's intimacy issues. And then the baby kind of gets… 

JD Kalmenson:

Right. Just how do you break the cycle?

Cathy Dore:

You heal the attachment, you work in psychotherapy, you, you just like you do with postpartum depression, you do all the things that you would wanna do, teach them how to be, have a solid attachment with another person. That the one that they have with their baby doesn't have to be the one that they have with their own parent. 

And I'd say with fathers too, there's so many people who go through the world with, you know, fathers who are, they're very detached from, and a lot of those fathers were very avoidantly attached. 

JD Kalmenson: 

Right. That's so interesting. If you can give a, a brief sort of recommendation and guidance to fathers, to husbands how to be the best husband, you can be the best father. You can be with a spouse who's struggling with postpartum depression. What would that advice look like?

Cathy Dore:

You know, it would be the same as I would give to all men. That it, it serves men, their partners, whether they be men or women, and their children, to become vulnerable and to look inward, to become self-reflective and not be afraid of doing that. There's a several therapists who around the country and here in Los Angeles who specialize in working with men during the postpartum time. Men in our country or in our country in our world are socialized to not feel, and to be strong, not weak. Feeling is weak. To go out and slay saber tooth tigers, and then come back to the cave. And what that does is it creates a disconnect with those people they've left behind in the cave, you know, their partner and their children. So I think men really would do well with getting more in touch with their feelings and being able to communicate those with their partners. 

JD Kalmenson: 

That's amazing. I mean, we definitely see the macho masculine sort of image, you know, being when it's blown out of proportion, it could lead to a lot of insensitivity, and it can be perceived as, as being apathetic. Meanwhile, he's only doing that because he can't cope with this. He doesn't know how to respond, then he doesn't know how to be supportive. And that's like a little bit of a vicious cycle as well. And it could also be like, it's, it would, you know, personalizing this whole thing. And the man feeling like somehow she doesn't like him anymore and he's not making her happy. And he's not being that, you know, rock of support that she used to lean on. 

Cathy Dore:

We really do teach them to not communicate, to not feel, to not express. And then their wives show up in my office and say, well, you know, he never talks to me well, (laughs).

JD Kalmenson:

Right.

Cathy Dore:

Yeah. And I feel so alone in this. 

JD Kalmenson:

Yeah. I know. There's the, there's the, the old story about the couple who come to get a divorce after 27 years. And the judge says, what is it? And she says, well, we're married 27 years and he hasn't told me, I love you even once. And the judge looks at the man and he says, is that for real? You haven't told her, I love you even once? He says, well, your honor, you should know, it's not exactly the way she's saying it of course. On the night of her wedding, 27 years ago, I told her that I love you. And if anything changes, I'll let you know. So that, you know, that being yeah. Being super communicative is not exactly the strong in that, in that department of, of emotions and feelings is not exactly the strongest masculine trait. I, I wanna traverse for a second, as far as the interventions go. I know that there's a lot of new cutting-edge treatment for depression. Some of these modalities we utilize in our behavioral health facilities, like TMS, transcranial magnetic stimulation, and ketamine. Would you be open to your clients utilizing that? Meaning what is that something that you see effective for perinatal and postpartum as well?

Cathy Dore:

Absolutely. There’s a psychiatrist I work with all the time who specializes in TMS and I, I have referred people to him. You know, it's hard to get people to go to a psychiatrist anyways, is because stigma still plays such a part in it. But I will do a real sales pitch on why we need medical intervention for our brain, the brain's an organ of the body. And just going and talking to a psychiatrist to get an evaluation and to get information, but to not necessarily take steps to do anything, you don't need to be seeking treatment, you just need to be seeking information. And I do that a lot because there's so much misinformation out there and so much stigma around psychiatric treatment. 

JD Kalmenson:

Right. And it's so misplaced it's so misplaced. The same way nobody thinks twice about getting treatment for medical issues, a hand, a leg, an ear, a nose infection. I mean, what's that the brain is, is another one of those organs, because I guess people don't necessarily consciously see the connection between medical and behavioral health, between the brain and your psychological state and your, your emotional reality.

Cathy Dore:

And to your point, we've advanced so much, and yet we still have so far to go.

JD Kalmenson:

Yes. Yes. And that leads me to my final question. You know, if you can magically make a change in how perinatal mental health is treated or postpartum depression, a societal change, a legislative change, I mean, would you like to see things very different in the future? Or do you think we're on the right course? And that treatment is very effective and that, you know, we we're tackling this issue comprehensively?

Cathy Dore:

I, I think we're doing a good job. I think we've made a lot of progress. I think we, you know, depression is still the number one complication of pregnancy, not diabetes, but we test for gestational diabetes during pregnancy. I think I would like to see every woman assessed for depression during pregnancy. I think that, and, and then provided with treatment options. We get diagnosed with cancer and we immediately get a referral to an oncologist. We don't test and assess and test for depression during pregnancy. And we know that 15% of the population who's pregnant is gonna be depressed postpartum.  So why don't we test them, assess them, and provide them with healthcare providers? Here's a reproductive psychiatrist. Here's a reproductive therapist. And in that first six to eight weeks postpartum, you might wanna give these people a call. Here's a support group that you can go to.

JD Kalmenson:

Yeah. Oh, that makes so much sense. Because then when they go through the symptoms, they know they're not alone. They know this is normal and they have somebody to guide them through this in a professional authoritative way. That is very, very powerful. Wow. 

Cathy Dore:

So that's what I'd like to see changed. I would like to not call an OB GYN with a depressive woman who's just left my office and say, you know what, she's two weeks postpartum. She's suicidal. And have the OB say to me, you know, asking me to treat her postpartum depression is like me asking you to treat an ovarian cyst.

And I've had that happen.

JD Kalmenson:

Wow. That's a, that's a very compartmentalized way of treating, treating women.

Cathy Dore:

Yeah. And that's what we need to get away from. Yeah. And I get that, you know, when you're an OB and somebody gets diagnosed with cancer, you don't treat them, you refer them out. Right. But the same should happen with postpartum depression. You know, I recognize that I'm the medical doctor on this case and I'm gonna give them resources and refer them to where they need to go to get the treatment they need. 

JD Kalmenson:

Amen to that. Thank you so much for sharing your knowledge and experience with us, Cathy. It was really great to talk to you. And thank you for joining us on the Discover U…

Cathy Dore:

Very good to talk with you JD

JD Kalmenson:

Thank you. And how could people find out more about the work that you do and your practice? 

Cathy Dore:

I would suggest that anybody who's interested in post-partum depression and perinatal mood disorders during pregnancy go to postpartum.net. They don't need to come to me. They need to go to postpartum.net, which is Postpartum Support International's website. And then, if you're in Los Angeles, the place to go is Maternal Mental Health Now.  If you just type in Maternal Mental Health, Los Angeles, you'll get to it. And we have resources for therapists, psychiatrists. We have pelvic floor people. We have acupuncture, fertility people OBs, psychologists, everything, and you can find it all there. And you can also find information about symptoms treatment, and you can also find people who've posted about their experiences. So you don't feel so alone.

JD Kalmenson:

Wow.

Cathy Dore:

We have support groups listed on that website. So lots and lots of resources.

JD Kalmenson:

That is amazing. That's amazing. 

Cathy Dore:

Yeah. We started a task force in LA County about 15 years ago, 16 years ago, it was called the maternal mental health task force. And we, it is now called Maternal Mental Health Now. And we are out training and treating and trying people all over the city in the county, trying to do exactly what we've been talking about today.

JD Kalmenson:

Wow. That's extraordinary. God bless you. That's a really beautiful thing for so many. I wanna also thank our audience for joining us too. I hope you enjoyed today's episode of Discover U as much as I did. At Montare, we want you to know that you are not alone on your journey, and to find out more about our innovative treatment programs, you can find us at montarebh.com, and you can listen to our podcast on iTunes, Spotify, wherever you get your podcasts. Wishing you all vibrant health, and a safe and peaceful day. See you next time.