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Closing Arguments
During closing arguments, our panelists summarize their points of view from each of the 3 rounds to provide comprehensive support for their respective sides.
Dr Gisele Apter: Hi, everyone. Thanks for joining us for the closing arguments of our Great Debates in Psychiatry Series. Dr Payne, Dr Hoffman, this is your last chance to change our viewers' minds. Please give us your best closing argument. And again, Dr Payne, you may begin.
Dr Jennifer L. Payne: Thank you very much. I think Dr Hoffman and I probably agree more than we disagree and have just slightly different views of the world of postpartum depression. I’ve chosen to study postpartum depression because it is a type of major depression, and we’re able to predict when someone will develop postpartum depression, unlike major depression—outside of the postpartum time period. I think the postpartum time period is a particularly vulnerable period for developing a depressive episode, and this is likely due to the stress of becoming a parent, sleep deprivation, and the hormonal changes that women undergo throughout pregnancy. And then, right after delivery. I’m studying, biologically, what exactly is going on in women who develop postpartum depression. And we think that changes in allopregnanolone and the GABAergic system likely underlie the biological vulnerability to postpartum depression.
Dr Payne: Understanding exactly what happens biologically in the development of postpartum depression, I think, will shed a lot of light on exactly what’s going on in major depression. In general, major depression can be thought of as a heterogeneous disorder with several different, similar, and overlapping biological vulnerabilities leading to what we call clinical depression. And so understanding one type of depression, namely postpartum depression, will help us understand major depression in general. Regardless of the biology, it’s incredibly important to identify and treat postpartum depression, and we’re not doing a great job. We identify about 50% of cases of postpartum depression and treat even fewer. In contrast, gestational diabetes is a far less common complication of pregnancy, and we screen 99% of women for gestational diabetes. We can do better for postpartum depression. So I urge everybody who knows a pregnant woman to be on the lookout for postpartum depression and to encourage treatment. It’s important not just for the woman but also for the developing fetus and child that’s exposed to maternal depression. So, a quick and effective screening is needed, and once identified, women need to be treated. So, thank you for listening to me, and I’ll turn it over to Dr. Hoffman.
Dr Apter: Thank you very much, Dr Payne. Great. Dr Hoffman, your closing strong arguments.
Dr Gisele Apter: Hi, everyone. Thanks for joining us for the closing arguments of our Great Debates in Psychiatry Series. Dr Payne, Dr Hoffman, this is your last chance to change our viewers' minds. Please give us your best closing argument. And again, Dr Payne, you may begin.
Dr Jennifer L. Payne: Thank you very much. I think Dr Hoffman and I probably agree more than we disagree and have just slightly different views of the world of postpartum depression. I’ve chosen to study postpartum depression because it is a type of major depression, and we’re able to predict when someone will develop postpartum depression, unlike major depression—outside of the postpartum time period. I think the postpartum time period is a particularly vulnerable period for developing a depressive episode, and this is likely due to the stress of becoming a parent, sleep deprivation, and the hormonal changes that women undergo throughout pregnancy. And then, right after delivery. I’m studying, biologically, what exactly is going on in women who develop postpartum depression. And we think that changes in allopregnanolone and the GABAergic system likely underlie the biological vulnerability to postpartum depression.
Dr Payne: Understanding exactly what happens biologically in the development of postpartum depression, I think, will shed a lot of light on exactly what’s going on in major depression. In general, major depression can be thought of as a heterogeneous disorder with several different, similar, and overlapping biological vulnerabilities leading to what we call clinical depression. And so understanding one type of depression, namely postpartum depression, will help us understand major depression in general. Regardless of the biology, it’s incredibly important to identify and treat postpartum depression, and we’re not doing a great job. We identify about 50% of cases of postpartum depression and treat even fewer. In contrast, gestational diabetes is a far less common complication of pregnancy, and we screen 99% of women for gestational diabetes. We can do better for postpartum depression. So I urge everybody who knows a pregnant woman to be on the lookout for postpartum depression and to encourage treatment. It’s important not just for the woman but also for the developing fetus and child that’s exposed to maternal depression. So, a quick and effective screening is needed, and once identified, women need to be treated. So, thank you for listening to me, and I’ll turn it over to Dr. Hoffman.
Dr Apter: Thank you very much, Dr Payne. Great. Dr Hoffman, your closing strong arguments.
Dr Camille Hoffman: This has been so fun, and I really don't have anything that I've disagreed with from Dr. Payne, to be honest. She's absolutely right. This is the most common complication of pregnancy, perinatal mood, and anxiety disorders in which postpartum depression fits. So, we also know that this is the leading cause in the US of maternal mortality right now; a combination of accidental drug overdoses and suicide. So this is a topic that is really imperative for everyone to pay attention to work towards improving. It's also true, and it kind of blows my mind that we spend so much of obstetric care trying to identify conditions and disorders that are so much less common than this. And I've often joked with obstetric colleagues who talk about maybe being reluctant to identify, screen, treat perinatal mood disorders that otherwise, you're kind of there.
Dr Hoffman: Otherwise, it's masquerading as all of the other things that we see in OB care. So, it really does streamline our care to go for it—screen it, address it—to provide anticipatory guidance at all of those various visits that I mentioned and do something about it. We know it's the right thing to do. We know for multi-generational reasons, it's the healthier thing to do. It’s just creating a level of comfort within the perinatal community. I think that isn’t the perinatal psychiatry community. That is still one of the remaining barriers that we are more slowly but surely overcoming with our perinatal psychiatry colleagues who devote their research time and their lives to understanding these conditions better. That support the psychiatry access programs that we utilize as obstetric care clinicians to have a better understanding and better guidance for how to manage these conditions when we don't know what to do next.
Dr Hoffman: And getting a patient to see a psychiatrist isn't automatic. So I think teamwork is imperative in this condition, as with many others. And just, I do believe we're kind of hitting a tipping point on the obstetric care side where we realize, wait a minute, we've been trying to do this all along. We've been doing it poorly because we haven't failed or we've failed to acknowledge it. But now we have to if we're going to change overall maternal morbidity and mortality and work with our pediatric colleagues to improve child neurodevelopment and mental health as well. Thank you.
Dr Apter: Absolutely. Great. And thank you very much because this is really a call for action for PPD and perinatal mental health care. As you mentioned, it's the first cause, the first illness, and the most common one. And this is true in the US, and it's true internationally. I can say this from across the ocean. And there's pretty good data in English-speaking countries and internationally. And so, yes, we'll be working for today's patients. As you mentioned, you are working together. Thank you so much for working together for today's and tomorrow's patients because the infants are tomorrow's adults. And so, thank you so much. Thanks. Thanks to my colleagues. Thanks, everyone, for a really lively discussion, A great, great debate. Thank you all for joining us. Be sure to tell us who you think really came out in this debate by answering the poll questions you see on your screen. And stay in tune for the next time, for the next round of debates. Thank you very much. Thanks, Dr Payne. Thanks, Dr Hoffman. Thank you all. Thank you.
