Dr. Amritha Bhat’s official title is perinatal psychiatrist. But there’s another suitable label for the role Bhat and others in her profession play: pregnancy myth buster.
One lie Bhat readily debunks: that pregnancy is such a joyful time of life that it protects folks against common mental health concerns. Another falsehood she often confronts: that taking psychiatric medication during pregnancy is inherently dangerous to the fetus.
As mental health concerns during and after pregnancy get more visibility through the very public stories of celebrities like Chrissy Teigen and Britney Spears, Bhat sees an opportunity to build awareness about the fact that mental health issues can develop at any point during the “perinatal” period. This period spans the time when someone is trying to conceive, through their pregnancy and until the end of the more commonly understood “postpartum” period, which is the year or so after delivery or after perinatal loss. This stretch of time, Bhat says, is an important window of opportunity for mental health detection and intervention.
“The earliest possible point of prevention [for mental health concerns] is helping someone when they’re pregnant,” said Bhat, assistant professor of psychiatry and behavioral sciences at University of Washington School of Medicine. “Because then you are helping prevent mental health problems in the next generation.”
Bhat spoke with The Seattle Times about common misconceptions about pregnancy and mental health, signs and symptoms to look out for, and the urgency to expand psychiatric care for folks who are pregnant. This conversation has been lightly edited for length and clarity.
Why is the perinatal period important from a mental health perspective?
There used to be this myth of the “pregnancy glow,” where people would think pregnancy is protective [against] mental health conditions like depression and anxiety. It’s actually not.
What’s unique about the perinatal population is that the person experiencing the mental health problems also impacts the fetus or the child. There’s an intergenerational transmission of risk. We know from extensive research that untreated perinatal depression and anxiety can have impacts on the unborn baby during pregnancy or on the baby during the postpartum period.
This is a unique period of time in anyone’s life in terms of interacting with the health care system or social support systems. People tend to get activated to support people who are pregnant. These are great opportunities to identify and treat perinatal mental health conditions.
What risks are associated with perinatal mental health conditions, to both the person who is pregnant and their fetus or baby?
Untreated depression, anxiety, or any other perinatal mental problem, have a lot of negative impacts. Functional impairment, psychological distress, interfering with relationships and functioning in other ways.
When it comes to treatment, it’s always a question of balancing risks. What are the known and unknown risks of the medication we are considering for treatment, and how do those compare with the known risks of untreated depression and anxiety on the baby?
For the infant, the most common ones we talk about are preterm birth and low birth weight. There is also some indication that infant fussiness, difficult infant temperament, anxiety disorders, ADHD and depression [are tied to untreated perinatal mental health conditions].
Perinatal mental health is just one of many factors: Several other psychosocial, systemic and genetic factors play into these outcomes and we definitely need to keep those in mind.
Are there any particular mental health concerns that disproportionately affect trans men who are pregnant, or people of color with particularly high maternal mortality rates, such as Black mothers?
Those are two separate but intersecting questions. The first one, of trans men who want to become pregnant and have a child: [There are] several factors to consider because once they’ve decided to transition, then going back to what is traditionally a female thing — getting pregnant, getting all these vaginal exams — these can all be triggers and cause distress and dysphoria. In addition, some people may stop taking their testosterone for the pregnancy and that could have implications.
Black mothers have been found to be less likely to be screened for depression and anxiety, less likely to receive treatment and more likely to have treatment be interrupted.
What should pregnant people look out for if they’re concerned they might be experiencing a mental health condition?
The symptoms of anxiety and depression are the same as in any other population. Any low mood that is sticking around for several days, negative thoughts, excessive guilt. I think what confounds it in pregnancy and postpartum is that sleep appetite and fatigue are three core symptoms of depression [that also characterize pregnancy and the postpartum period].
This very often [leads to late diagnosis].
If you have any question about whether you need help, you should have a low threshold to get help.
What barriers do pregnant folks face when they try to find or receive mental health care?
It’s the same access problems as mental health care in general: There’s not enough mental health providers to care for all of the patients who need the help. With perinatal mental health there’s the added layer of complexity that the providers, even mental health providers, are not comfortable treating perinatal individuals. Either they have these blinkers on that [pregnant people] can’t be depressed or anxious, or they are not comfortable prescribing medication.
The other added layer is stigma. Not only do they have the stigma of mental health problems, they also have the fear of being judged a bad parent. Or worse, they might be judged as incapable of caring for their baby.
What should be done to raise awareness about perinatal mental health concerns?
I think just shifting our approach toward the fact that emotional well-being and mental health is an integral part of perinatal health.
If a person goes in for their obstetrician visit, or their midwife visit, they get their blood pressure measured almost every time. There should be a similar check-in about emotional well-being because the prevalence of pregnancy-induced hypertension is around 8% but the prevalence of pregnancy depression is 10-12%.
This is not something separate or different or stigmatizing that we’re doing. This is just part of the package of prenatal care.
Resources for pregnant people:
Resource for health care providers: