Women's Mental Health Q&A with Psychiatrist Pooja Lakshmin

Nyssa speaks to women's mental health specialist and perinatal psychologist, Pooja Lakshmin, about the biggest 'unmentionables' surrounding women's mental health, how to help yourself and those you love who are suffering from postpartum depression, and the biggest changes she wishes to see in the field of psychiatry. 

Dr. Lakshmin treats women struggling with a wide variety of issues including but not limited to: depression & anxiety during pregnancy and the postpartum period, grief after miscarriage or infertility, and trauma due to childbirth. She takes a humanistic and integrative approach to treatment and believes that no one modality can fix everything. Her practice is located in the Tenleytown neighborhood of Washington, DC.

What are the biggest ‘unmentionables’ you hear when it comes to women’s mental health? What are the most effective steps to overcoming those taboos, in your opinion? 

Over the past decade or so, as a culture, we've become more open about the hardships of motherhood. We all know about the sleep deprivation, the fatigue, the feeling of perpetual guilt . But, there is still a tremendous amount of stigma that comes with seeking professional help - whether through therapy or with medications. We underestimate just how much women are conditioned to take care of others, and how that conditioning impacts our capacity to receive help. This modeling begins in childhood, and interestingly, I think through early adulthood, many women are able to get by being the care-taker and emotional fixer in their relationships. Then, motherhood hits. The postpartum period is when women are particularly vulnerable to developing a mood or anxiety disorder. And so, in a culture that says women should be strong, independent, and resilient at all costs, admitting you need help feels like you're a failure. Spending time and money on your own well-being is at best, indulgent or frivolous and at worst, selfish. When the truth is that facing depression or anxiety takes tremendous strength and courage. One of the most effective ways to overcome this is to surround yourself with other women who value their own emotional well-being, and distance yourself from those who shame you for prioritizing your mental health (e.g. the "friends" who say "But, you're not REALLY depressed!?"). 

If someone is concerned about their risk for developing postpartum depression, or concerned for a parent-to-be in their life, what steps would you recommend taking before the birth to help mitigate that risk or to establish a strong emotional game plan with one’s family and friends? 

There's a couple evidence-based steps women and families can take. First, if you have a prior history of depression, anxiety, or bipolar disorder (whether during the perinatal time period or not), that puts you at a higher risk for developing postpartum depression. Research shows that approximately 40% of women with a history of depression will go on to develop depression during pregnancy or postpartum. That number goes up if you go off of antidepressant medication. So - if you have a  history, make sure to talk to your doctor. See if it makes sense to stay on your antidepressant medication. Get back into therapy for extra support. It's also important to recognize that about 30% of mom's who will develop a perinatal mood or anxiety disorder see symptoms in pregnancy. Having depression or anxiety during pregnancy puts you at higher risk for developing postpartum depression. Finally, we know that both sleep deprivation and lack of social support are implicated in postpartum depression. Starting in pregnancy, make a plan for how you can get 4-6 consecutive hours of sleep postpartum. It needs to be consecutive for your brain to get the benefit. I know it sounds daunting to aim for 6 consecutive hours of sleep with a newborn. Even if you can't get this anchor sleep every night,  2-3 times a week is better than nothing. Social support is also protective - so if you have family or friends available, reach out. Make a list of the meals your family lists, send out errands that can be done. Never say no to help. Ask your OB's office for recommendations for support groups. Postpartum Support International also has chapters in every state, and offers help with referrals and support groups. 

What are some ways that friends and family can provide meaningful emotional support for those who have lost a baby (due to stillbirth or miscarriage, for example)?

The loss of a baby is devastating. Perhaps the most important thing you can do is to be present and not look away. It’s okay if you don’t know exactly the right thing to do or to say. By making contact and listening, you’re showing that you care. It’s also important to recognize that future children don’t replace the child that was lost. Avoid statements like “you’ll have another baby soon” - as that can come off as dismissive of grief and also signals that you aren’t open to receiving the difficult feelings that come after the loss of a baby. 

What is the biggest change you wish to see— and be a part of— within the world of women’s mental health and perinatal psychiatry? 

My goal is to empower women. I see my work as a perinatal psychiatrist as an extension of this mission. In my clinical role, I support women in times of suffering and walk beside them in their healing. In my role as an advocate and fellow human on this journey, I educate women about the emotional complexities of navigating this world as a woman, and I offer permission - to take up space, to ask for what you want, and to put your own well-being up front. We live in a world where we are constantly told we can “have it all”, yet, many of us are buckling under the pressure of that expectation. Do we even want it all? We’re told that self-care is the antidote to this burden, but in the end it ends up feeling like just another thing on the to-do-list. I want to live in a world where women feeling empowered to make choices and set limits based on their own values. Where women don’t need to stay small in service of a job, relationship, or family role. For me, mental health is more than treatment of suffering. Mental health is about being energized, fulfilled, and living life with purpose. And, there's a connection here to perinatal psychiatry. For many women, the isolation, identity loss, and even martyrdom that can come with motherhood has them finally understand that their own emotional well-being matters  And, that it’s up to them to take control of it. I want to be part of that movement  - where we put women in the driver's seat of their own lives.