Your emotional health is just as important as your physical health. As the number one medical complication of pregnancy and childbirth, one in five women suffers from a mood disorder during their pregnancy and postpartum period. Know that you are not alone. Seeking help is the best thing you can do for yourself and your family.
With a staff that includes board-certified psychiatrists, psychologists, social workers and clinical nurse specialists, we have the expertise needed to diagnose, treat and manage a wide range of psychiatric conditions before, during and after a woman’s pregnancy.
Center for Women's Behavioral Health
2 Dudley Street
Providence, RI 02905
P: (401) 453-7955
Day Hospital/Outpatient Clinic
2 Dudley Street
Providence, RI 02905
P: (401) 453-7955
Moms Matter Clinic
100 Dudley Street
Providence, RI 02905
Spanish speaking staff members are available in the department, and the hospital has interpreters in other languages available upon request.
Every woman faces adjustments when she becomes a mother, but for 10 to 20 percent of women, the emotional and psychological changes brought on by pregnancy and childbirth may be more than they can handle alone. Women & Infants offers a full continuum of care for women dealing with depression or mood and anxiety disorders while pregnant and for those experiencing postpartum depression, anxiety, or other mood issues.
When a patient at Women & Infants – either on one of the inpatient units or in the Emergency Department – is experiencing mental health issues, health care providers will generally ask for a consult through our Women’s Behavioral Health Consultation Liaison Service. Our team of mental health specialists collaborates with Women & Infants’ Department of Social Work, nursing staff and primary medical team to offer psychiatric consultation and suggest necessary services. Consultations are available 24 hours a day.
Our nationally recognized Day Hospital offers more intensive mental health care for pregnant and postpartum mothers. The Day Hospital is a mother-baby unit meaning infants accompany their mother to each treatment day for the duration of their stay. The Day Hospital is a supportive environment led by a multidisciplinary team of clinicians who are experts in perinatal mental health. Our goal is to help patients understand that these negative feelings are not their fault, and to give them ways to overcome them.
The Division of Women’s Behavioral Health also offers outpatient individual, family, and group therapy along with medication management. In addition to a perinatal focus, our outpatient services focus on a broader range of reproductive and life transition issues that impact a woman’s mental health and functioning.
When you are experiencing a change in your life with pregnancy or have added stress due to illness, there is nothing more beneficial than meeting other women who are dealing with similar issues. Women & Infants offers a variety of support groups for new or expectant parents, women who have experienced a loss, cancer patients, and caregivers to meet the many needs of our community and our patients.
For pregnant and postpartum women dealing with substance abuse, services are available through Project Link at The Providence Center. Services focus the impact of substance use in pregnancy and the postpartum period. Child care services are available to make it easier for women to attend therapy sessions.
Pregnancy and the postpartum period are especially vulnerable times for women with an opioid use disorder. That’s why Women & Infants has created Moms MATTER (Medication Assisted Treatment to Enhance Recovery). This unique model of care provides a safe place for pregnant and breastfeeding women with an opioid use disorder to seek compassionate and non-judgmental care in an office-based setting.
Clinical depression is much more intense than simply feeling sad. It can cause a person to lose interest in regular hobbies and life in general. There is a medical cause for depression and it is very treatable.
- Loss of interest in activities you usually enjoy
- Sleep disturbance
- Appetite changes – either eating too much or not enough
- Difficulty concentrating or making decisions
- Lack of energy or motivation
- Feelings of worthlessness or guilt
- Excessive worry and fears (in new mothers, these fears generally revolve around the baby)
- Thoughts of death or suicide
How do you know if you need professional help for your mood before, during and after pregnancy? Answer the following questions honestly.
Studies show that up to 20 percent of women will experience mood or anxiety disorders during pregnancy and the postpartum period. Depression is more than just feeling sad, it's a serious illness where the feelings don't go away and interfere with daily life and activities. The good news is that most people with depression get better with treatment.
Depression results from a combination of factors, including:
Hormones directly affect the brain chemistry that control emotions and mood, which means that women are at greater risk of depression at such times of hormonal shift like pregnancy and the postpartum period.
During pregnancy, levels of female hormones estrogen and progesterone increase. In the first 24 hours after childbirth, they quickly return to normal. Researchers think the drop in hormone levels may lead to depression. In addition, there are other factors such as lack of sleep due to caring for your newborn, anxiety over parenting, relationship stress, and the unrealistic feeling that you need to be a perfect mother may add to feelings of depression.
In addition to having mood swings, crying spells and trouble sleeping, which are all signs of the "baby blues," women with postpartum depression may also have feelings of deep sadness, low self-worth, guilt, and anxiety.
No. Women with postpartum depression need to be treated by a mental health professional.
Absolutely. Symptoms like exhaustion or lack of energy are common both in pregnancy and depression. Speaking to a professional can help you decide if you are experiencing more acute symptoms than other pregnant women.
Depression and anxiety are the most common. How your mental health is affected during pregnancy depends on the type of mental illness you experience, whether you receive treatment, any recent stressful events in your life, and how you feel about your pregnancy.
Many women worry during pregnancy about everything from changes in your role in life and in your relationships to whether you will be a good mother. You may also fear childbirth itself, or fear having problems during the pregnancy. Check with a mental health professional if you're concerned.
Not necessarily. We now have over 10 years of evidence that certain medications can be safely taken by pregnant and breastfeeding mothers.
Get adequate sleep, good nutrition, exercise, and seek social support as well as minimize stress and obligations.
This is not always the safest option because being off of your medication may be more harmful to you and your baby in the long run. A pre-pregnancy evaluation is advised if you are currently taking medication.
Women are twice as likely as men to have a major depressive disorder episode after puberty. The reasons for this increased prevalence are not fully understood. Possible reasons include hormonal fluctuations during the reproductive years, and the stress of work, child rearing and caring for aging parents.
It is possible that the current expectation of many women that they be able to successfully have a career, raise a family, and support extended family and friends may contribute to depressive episodes. Recent studies suggest that the prevalence of depression in men may be higher than previously thought, possibly underestimated due to societal expectations that men not discuss their depressive symptoms or seek treatment.
The reproductive years, and particularly times of hormonal fluctuation, represent times of risk for the expression of mood and anxiety disorders in women who have the genetic predisposition to these disorders. Hormonal fluctuations occur each menstrual cycle, leading to problematic premenstrual low mood and irritability in some women. Some women have the onset or exacerbation of mood or anxiety disorders during pregnancy and particularly during the postpartum period when gonadal hormones decrease rapidly.
Another time of risk for the onset of a mood or anxiety disorder is at perimenopause, or the few years preceding the cessation of the menstrual cycle. Perimenopause is characterized by hormonal fluctuations and common symptoms include:
In a minority of perimenopausal women, the mood and anxiety symptoms are severe enough to warrant treatment.
Risk factors for both men and women include:
In addition, natural hormonal fluctuations, such as those experienced postpartum or during perimenopause, may trigger an episode of depression in women. Women also often try to "do it all," such as having a challenging career while also being the primary caretaker of children and extended family members.
Occasional sadness, feeling "blue" or "having a bad day" is part of the human experience. The persistence of sad feelings, particularly in the absence of a particular stressor such as loss of a loved one or loss of a job, suggests that the low mood may be a mood disorder that needs evaluation and treatment. A major depressive episode is defined as the persistence of depressed mood and/or a loss of interest or pleasure for at least two weeks, accompanied by at least five of the following symptoms:
The signs and symptoms of depression during pregnancy or during the postpartum period are the same as men or women can have at any time (see above). Postpartum women may also note the onset of worries and fears about the newborn, and this is normal and transient in most women. It can be difficult to diagnose depression in pregnant and postpartum women because many of the normal symptoms of pregnancy and being newly postpartum overlap with symptoms common to depression such as trouble sleeping, low energy, and changes in appetite. There are screening instruments specific to depression during pregnancy and the postpartum period. The Edinburgh Postnatal Depression Scale (EPDS) is one example that is commonly used by clinicians.
Since there are many known negative effects of untreated depression - both during pregnancy and postpartum - for the infant, it is very important that pregnant and postpartum women who are depressed receive evaluation and treatment. The negative effects of untreated depression include lower birth weight, impaired mother-infant attachment, and cognitive and behavioral impairment during the child's development. Many perinatal women consider non-medication options for depression such as interpersonal psychotherapy or light therapy.
If a woman's depression does not improve with psychotherapy or other non-medication treatments, antidepressant medication should be considered. Since the medications that treat depression have possible risks for the fetus and infant, a pregnant or breastfeeding woman with depression should consult with a clinician who has the latest information about the safety of medication use with pregnancy and breastfeeding. The obstetrician-gynecologist and pediatrician have crucial roles in identifying perinatal women who have depression and referring them for appropriate care.
About 20 to 40 percent of menstruating women experience moderate emotional and physical symptoms in the days before menstruation starts, and these women are described as having premenstrual syndrome (PMS).
Approximately 5 percent of menstruating women experience severe emotional and physical symptoms that can disrupt relationships and functioning at work or home, and that can last up to two weeks before menstruation starts. This severe end of the spectrum of premenstrual symptoms is called premenstrual dysphoric disorder (PMDD). The symptoms of PMDD can cause a cyclical disruption in women's lives and generally resolve after menstruation begins. Common symptoms include:
Treatment can include:
Sarafem, Zoloft and Paxil CR are each FDA approved for the treatment of PMDD. The oral contraceptive Yaz is FDA approved for the treatment of PMDD in women desiring oral contraception.
Many psychiatric disorders can be associated with depression. These include:
In addition, chronic medical illnesses such as heart disease, hypothyroidism, obesity, and dementia are associated with depression.
When symptoms of anxiety lead to substantial distress for an individual and/or impairment of regular functioning, the individual should seek a diagnostic evaluation. An example would be a person with panic attacks who becomes unwilling to stay alone and avoids public places such as the supermarket because she fears having another panic attack. Another example would be a person with severe worries about contamination that leads to several hours per day of cleaning, checking and worrying about germs.
Depression and anxiety disorders may benefit from different types of psychotherapy, such as cognitive-behavior therapy, which challenges dysfunctional beliefs, or interpersonal psychotherapy, which promotes social support during role transitions. Psychotherapy can provide support, following either a short-term structured program or a long-term plan such as insight-oriented psychotherapy.
Some studies have suggested that the combination of psychotherapy and medication may be more effective than either treatment alone, particularly with severe depression. Although less well studied, there are reports of benefit for mental health problems with exercise, dietary recommendations and supplements such as fish oil, meditation, massage, acupuncture, and light therapy. Some mental health disorders that do not respond to traditional therapies may respond to vagus nerve stimulation, transcranial magnetic stimulation, deep brain stimulation or electroconvulsive therapy.
Milicent Fugate, MD is a fellow at Brown University/Women and Infants Hospital Women’s Mental Health Fellowship.
Margaret Howard, PhD, is the division director of the Center for Women’s Behavioral Health and director of the Day Hospital.
Cynthia Battle, PhD, is a research psychologist in the Center for Women’s Behavioral Health. She is an associate professor of psychiatry and human behavior (research) at The Warren Alpert Medical School of Brown University.
Stacey D’Eletto is the nursery attendant for the Day Hospital, where she has been working since 2007. She holds an associate’s degree in early childhood education and a bachelor’s degree in human services.
Zobeida Diaz, MD, MS, is an attending psychiatrist in the Day Hospital within the Center for Women’s Behavioral Health at Women & Infants Hospital.
Shannon Marie Erisman, PhD, is clinical director of the Day Hospital of the Center for Women's Behavioral Health. She is also a clinical assistant professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University and staff psychologist for the Women’s Partial Program at Butler Hospital.
Anupriya Gogne, MD is an adult psychiatrist with training in addiction psychiatry and women’s mental health. Dr. Gogne has a special interest in working with women presenting with both addiction and psychiatric issues, and also has experience with treatment of trauma and dialectical behavior therapy.
Wilthonie Johnson-Goncalves, LICSW, is a clinical social worker with experience working with at-risk children and families as well as psychiatric patients in an inpatient setting. She received her undergraduate degree in human development and family studies from the University of Rhode Island and a graduate degree in social work from Rhode Island College.
Alpha Lefrancois has been at Women & Infants since 1993. She began as a case manager at Project Link and transitioned in 2015 to her current role as case manager at the Center for Women’s Behavioral Health.
Rosemary McNicholas Ryan, LCSW, is a clinical coordinator for Women’s Behavioral Health. A graduate of Yale University and the Columbia University School of Journalism, Ms. Ryan received her master’s degree in clinical social work, with a concentration in mental health, from Boston College.
Kristin Wedel, LICSW, is a clinical care coordinator in the Day Hospital. A graduate of Bethel College in North Newton, KS, Ms. Wedel earned her master's in social work from Boston University. After working for years with homeless youths with HIV/AIDS, Ms. Wedel trained and worked at Butler Hospital, providing services to patients in the CBT/DBT partial hospital programs, with a particular focus on women’s mental health.