Introduction-Peripartum Depression and Postpartum Depression (PPD): Is PPD Time-Specific?

Meet the experts for this debate on the timing of PPD. Nicole Cirino, MD, argues for a narrower definition of PPD, while Melanie Barrett, MD, advocates for an overarching broad definition of PPD. 

Transcript:

Nicole Cirino, MD: Welcome to the Great Debates and Updates in Psychiatry. The topic today is peripartum depression and postpartum depression, also known as PPD. What timeframe should PPD be classified as, and why is this important? The Great Debates is brought to you by the Psych Congress Network. I'm Dr Nicole Cirino, and I have with me my colleague today, Dr Melanie Barrett. Let's start by introducing the discussion that we'll have for this series. As reproductive psychiatrists, this is something that we frequently discuss amongst ourselves. I'm happy to bring in the audience today as well, and I'm interested in your feedback about this important issue. Here are the two sides we're going to be just debating today. The first side, A, I'm going to argue that the timing of onset of PPD is of utmost importance in determining one's clinical approach. The more specific the classification of when PPD occurs, the better the clinical outcome. PPD has a distinct pathophysiology that includes the effect of fluctuating hormones and neuroactive steroids. They uniquely impact mood and behavior. They'll rise significantly in pregnancy with a drop in the postpartum period and further fluctuations during lactation. The American Psychiatric Association defines PPD as a major depressive episode with a specifier. The peripartum onset specifier they define this as the onset of depression occurs during pregnancy or within 4 weeks of delivery. And you'll see as we get into this debate that I think this definition is even too broad.

Melanie Barrett, MD: I'm Dr Barrett, and I'm going to be taking side B. So, I'm going to argue that postpartum depression is best characterized by an expanded timeframe that includes the first year after delivery. As this more accurately captures the variability and postpartum depression presentations, postpartum depression cannot be strictly defined by time. As outlined in the DSM-5, PPD is related to major depressive disorder, which can occur at any time. We also have a wide range of evidence about the onset of PPD and no real consensus.

Nicole Cirino, MD: Great. So, let's start by discussing a bit about who we are and how we practice so we have some context of why this matters and what we treat. Dr Barrett, will you tell us about your role in ISRP and also what your practice is like?

Melanie Barrett, MD: Yes, so I'm currently serving as the President for ISRP, which stands for the International Society of Reproductive Psychiatry. Our mission is to increase awareness, education, and collaboration within the field of reproductive psychiatry. We've had the opportunity over the last several years to partner with Psych Congress to bring educational content in this area. In practice, I'm a clinical psychiatrist. I do outpatient work. I work for a large behavioral health company, and I'm located outside of Oklahoma City. I have a focus on perinatal mood and anxiety disorders and also provide interventional services. I've been able to lead our team for our brexanolone clinical program, so share Dr Cirino's passion for women's mental health, and I'm happy to be here today.

Nicole Cirino, MD: Thank you, Dr Barrett. A little bit about myself. I'm also involved in ISRP, where I was able to get to meet Dr Barrett and work with her, as well as Postpartum Support International. And I am professor and the chief of the division of reproductive psychiatry at Baylor College of Medicine in Houston, Texas. We have a large outpatient perinatal clinic called the Women's Place at Texas Children's Hospital here in Houston. And Dr Barrett, I did some math, kind of looking at both of our practice realized the combined total of our clinic serves about 10,000 perinatal patient visits a year, which is pretty impressive. I know we also do a lot of training of clinicians just on reflecting on the enthusiasm around this field has really grown over the past few years, and it's really incredible. Before we begin, we have a quick poll we'd like you to respond to. We're interested in your feedback. You'll see some questions on your screen next to where this video is playing. Go ahead and respond to those questions now.