Closing Arguments

During closing arguments, our debaters summarize their positions from each of the three rounds to conclusively support their sides of this debate.

Nicole Cirino, MD: Welcome back, everyone. Thank you for joining us for the concluding statements of our Great Debates in Psychiatry series. We'd like to recap some of the discussion that we've covered so far and leave the viewers with some food for thought. So, remember the debate question was: What timeframe should PPD be classified as, and why is this important? In my argument, the timing of onset of PPD is of utmost importance in determining a clinical approach. One-size-fits-all treatment does a disservice for women with perinatal mood and anxiety disorders.

As you can see in some of the examples that I posed, the timing of onset of symptoms does indeed inform the evaluation and the treatment intervention, be it behavioral or a medical intervention. If a medical intervention is needed, these factors also come into play regarding timing. We look at pregnancy safety, lactation safety, maternal side effects, comorbid obstetric conditions, comorbid psychiatric conditions, and the ability to access and comply with treatment plans. Besides the above factors I mentioned, timing can help us predict the course and severity of the illness, when to ramp up treatment, or when to watch and wait. In summary, in order to advance the science of postpartum depression, I'm arguing we should narrow, not broaden, our classification of these conditions.

Melanie Barrett, MD: Yes, I agree that timing matters. Untreated postpartum depression can have devastating consequences. So, by utilizing an expanded timeframe for PPD that includes the first year after delivery, we'll be able to improve access to care. So, as soon as PPD is recognized, one can start with psychosocial interventions and can then make a decision about pharmacologic interventions. Based on the factors that we've been discussing today, comorbid anxiety should always be addressed. Side effect profile is particularly important. Generally, I'm thinking about SSRIs, no matter the timing of onset of PPD and when it comes to adjunctive or second-line treatments, then we do look more closely at the timing of onset of illness and as we gain access to more rapid onset of action treatment options, this may be an additional factor that we can consider based on timing.

Nicole Cirino, MD: Absolutely. I'm excited for the future of our field, and thank you, Dr Barrett, for this amazing discussion. Thank you to the audience for joining us and to Psych Congress for putting this together. Be sure to answer the poll questions you see on your screen. We'll see you next time. Thank you.