eNewsletter - May 2015

Behavioral Health Partners

Maternal Mental Health
Linda Huelke-Pfleger, M.S., LCPC

In the past, healthcare professionals have recognized depression in a portion of women after they deliver a baby, which many people called postpartum depression. However, research over the past decade has discovered that along with symptoms of depression, symptoms of anxiety are pervasive in new and expectant mothers both before and after delivery. These disorders are now called Perinatal Mood and Anxiety Disorders.

Approximately 15-20 percent of pregnant women and new mothers in the first year after giving birth experience a perinatal mood and anxiety disorder, making this the most common complication of childbirth. Diagnoses of postpartum depression, post-traumatic stress disorder, postpartum obsessive compulsive disorder (OCD), anxiety and postpartum psychosis are included in this statistic.

Although 60-80 percent of the population experience “baby blues” within the first few days following childbirth, this transient emotional state typically does not significantly interfere with a new mother’s ability to function or care for her baby. These disorders affect nearly one million women each year in the United States alone but, despite their prevalence, perinatal mood disorders often go undetected in medical offices. As a result, many women go without treatment and suffer needlessly, negatively impacting their ability to enjoy this special time in their lives.

Symptoms may differ for each woman but typically include: excessive worry or fear of the unknown; feelings of sadness, irritability, anger or guilt; changes in sleep or eating patterns; intrusive or scary thoughts; difficulty concentrating and with daily decision making; and, in the most serious cases, thoughts of harm to oneself or baby. While new research continues to explore genetic predisposition to these disorders, we are aware that adjusting to a newborn is not easy.

Rapid hormonal changes during and after pregnancy, along with the stress of our fast-paced living plays an important role. There are factors that can significantly influence the course of treatment and recovery. Many women believe that they cannot safely continue their mental health medications once they find they are pregnant and abruptly discontinue them. Rather than achieving a positive result for mother and baby, this action is the leading cause of relapse in maternal mental health disorders.

In the interest of optimal health during pregnancy and the months following delivery, it is important to discuss thoughts regarding medication changes with a physician. In the onset of a perinatal mood disorder, many women are acutely aware that they are not feeling like themselves and that essentially something is wrong. This is a good reason to discuss one’s feelings and behaviors with a partner, loved one or medical/mental health professional.

No one needs to suffer in shame or silence with a disorder that, when identified in the early stages, can be quickly and effectively treated. Obstetricians, pediatricians and nurses at medical offices and hospitals throughout the country, including Edward-Elmhurst Healthcare, have taken an important step by requiring screens for perinatal mood disorders, which leads to early detection and access to assessment and treatment.

Edward Hospital and Linden Oaks Behavioral Health, both in Naperville, provide several options for women with a perinatal mood or anxiety disorder who are seeking care.

• Call the Mom's Line: Edward provides a phone line dedicated to women (or anyone concerned about a woman) who may be experiencing signs or symptoms of post-partum depression. Call 630-527-7294.
• Join Nurturing Mom: A support group for post-partum depression and anxiety, the Nurturing Mom support group meets on the second and fourth Wednesday of each month at 11:45 a.m. at Our Saviour's Lutheran Church across from the Edward Hospital ER. Babies are welcome. No registration necessary.
• Get a free behavioral health assessment: Contact the Linden Oaks Behavioral Health Referral Line at 630-305-5027 for your free assessment.

There are many organizations working to increase awareness for perinatal mood and anxiety disorders. Climb Out of the Darkness is the world’s largest event raising funds for awareness of postpartum depression, postpartum anxiety and all other mental illnesses related to pregnancy and childbirth. The Chicago-Western Suburbs team will walk/run Saturday, June 20 at 9 a.m. at the Danada Forest Preserve-East Trail. For more information on Climb Out of Darkness or this event, contact Lara at laravv@comcast.net. To register visit: www.crowdrise.com/COTD2015.

Linda Huelke-Pfleger, M.S., LCPC
Linda is a licensed clinical professional counselor in the state of Illinois and is certified by Postpartum Support International as a postpartum mood disorders specialist. She attended Indiana University where she received her Masters of Science in Counseling Psychology. Linda has worked in the field of behavioral health in private practice, community mental health and hospital settings for the past thirty years. She currently works at Linden Oaks and Edward Hospitals in Naperville, coordinating maternal mental health services as well as the integration of behavioral health services to medical patients.

Review of a new PMAD Documentary, The Dark Side of the Full Moon
Nadjeh Awadallah, EdD, LCPC

By and large the evaluation of physiological and emotional symptomology has been treated as distinct and separate processes. Even medical professionals may discount or overlook the interrelatedness between physical and emotional experiences. Yet, perinatal mood and anxiety disorders (PMADs), which have seemingly long been overlooked or under-evaluated, have had a profound impact on the overall health and well-being of expectant and new mothers.

The film The Dark Side of the Full Moon addresses the impact of PMADs—specifically postpartum depression and postpartum psychosis—by documenting several women who experienced symptoms during pregnancy and after they gave birth. The film sheds light on the systemic deficit in resources, education and awareness of PMADs.

The women interviewed in the film hadn’t been provided sufficient treatment to address the episodic behavioral health symptoms that arise as a result of hormonal changes during pregnancy. Quite often, when these women inquired about how to address symptoms, they were met with minimal actionable recommendations. Obstetric physicians would direct these women to psychiatric care, and a number of them reported that the psychiatrist would then classify the problem as a matter for the OBGYN. This disconnect contributes to the larger problem at the heart of this issue: stigma.

It is estimated that nearly 15 percent of women experience symptoms related to PMADs, yet the symptoms are often underreported to a healthcare professional because of the perceived stigma associated with behavioral health. The perception of stigma is exacerbated by the lack of awareness concerning the commonality and treatability of PMADs. Many of the women in the film painted a picture of isolation and guilt regarding their symptoms.

In many cases, the fact that their doctor did not introduce this topic discouraged the women from inquiring about unwanted intrusive thoughts, anxiety and anhedonic/depressive mood. Worse still is the fear that their children could be taken from them if they are deemed an unfit parent as a result of a behavioral health diagnosis.

The film also references a number of nationally-reported instances of suicide by mothers who had suffered from PMADs. Testimonials from family members demonstrated that a lack of social support was a contributing factor. One interviewee stated that she had no idea that her sister had these symptoms prior to her suicide.

The film acknowledged obstacles in the continuum of care. It included an account of a woman who, upon seeking guidance in a hospital’s emergency department, was unnecessarily place on a 72-hour hold for suspected suicidality. This woman was discharged without recommendations for follow-up care, and was left with the impression that seeking help was the wrong choice. This account was juxtaposed with that of another woman who was not treated at all, despite reporting increasingly emergent symptoms that resulted in a failed suicide attempt and permanent physical disfigurement.

The film is jarring at times, with stark depictions of distress and helplessness experienced by those afflicted with PMADs, with no access to services/information to address symptoms. The film also depicts the pressure to adhere to social expectations, which often minimize the link between emotional and physical wellness. In one instance, a doctor prescribes Xanax over the telephone without making any referrals for counseling services and the patient ultimately attempts suicide via overdose with the prescription.

Accounts like this one are far too common. Approximately 4-5 percent of women are being screened using the Edinburgh Postnatal Depression Scale (EPDS), an insufficient number compared to a 20 percent estimated incidence of PMADs symptomology in women treated by obstetricians.

A mother in the film stated it best when she said: “When it boils down to it, it’s still a mental health issue, and nobody talks about mental health.” This film illuminates basic misconceptions about the seriousness of these symptoms, which are shown to be “the best kept secret of motherhood.” Women largely don’t talk about these symptoms, and are not encouraged to talk about them by many medical professionals.

The Dark Side of the Full Moon is an important documentary, because it draws the conclusion that behavioral health services are an integral factor to consider in one’s overall health. Further, the presentation of behavioral health symptoms should lead to a multi-angled investigation of cause, and involve collaboration between the patient and healthcare professionals at different levels.

As a clinician who has treated patients diagnosed with PMADs, I found this documentary to be quite eye-opening. It presents a relatively unknown or unconsidered component of women’s health. It also raises questions about the congruency of different channels of care and the episodic nature of mental health disorders.

These issues, if unaddressed, can pose a longstanding impact on a patient’s overall quality of life. Additionally, the social and emotional development of a child being cared for by a parent impaired by PMADs can be negatively impacted, creating a psycho-developmental ripple effect which can lead to possible difficulties for the child as well.

Watching this film reinforced my goal to continue to self-educate on the nature of these disorders, and to also educate my patients on PMADs. I whole-heartedly recommend this film to other healthcare professionals and staff working in both behavioral and non-behavioral health capacities.

For information on how to host a screening for your office or to obtain more information about the movie, visit www.darksideofthefullmoon.com.

Nadjeh Awadallah, EdD, LCPC
Nadjeh is a Licensed Clinical Professional Counselor and Community Liaison for Linden Oaks Behavioral Health/Northwest Community Healthcare. Nadjeh holds advanced degrees in clinical psychology as well as education, and has worked in the mental health field since 2008 as both a clinician and an educator. A graduate of the University of Wisconsin Milwaukee and Illinois School of Professional Psychology, Nadjeh earned a Master’s Degree in Clinical Psychology and completed his practicum internship at Catholic Charities-Diocese of Joliet. Nadjeh also earned a Doctorate in Education from Argosy University. He has taught upper-division courses in Psychology and Human Development at Argosy University and Rockford University. Nadjeh previously worked as a therapist and program developer for Swedish American Hospital and the Intake and Assessment Department at Rogers Memorial Hospital.

Free CE Webinar: DSM-5: What's Different?

The next Webinar in the Linden Oaks Wednesday Webinar Series is DSM-5: What’s Different? The online presentation will examine recent DSM-5 changes and how they will affect the behavioral health industry.

Our Webinar speaker Nadjeh Awadallah, EdD, LCPC, is a licensed clinical professional counselor who has worked in a variety of different behavioral health settings including behavioral health program development.

This educational activity, which can be done from your office or home, is scheduled for Wednesday, June 17, 2015 from 12:00-1:00pm. Continuing education credit will be available for CADC/IAODAPCA, LCPC/LPC, LCSW/ MSW, LMFT, and Psychologist (note what you need at registration).

Registration is required as spots are limited. Access to the Webinar will be granted upon registration.

Register online

Questions? Contact us at: lindenoaks@edward.org.