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Melanie Cole (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed, so you can make informed healthcare choices for yourself and your whole family. Back to Health features, conversations about trending health topics and medical breakthroughs from our team of world renowned physicians at Weill Cornell Medicine. Today's special episode is part of our Women's Health Wednesday series, which features in-depth conversations with Weill Cornell Medicine's top physicians on issues surrounding women's health throughout the life course. Listen here for the information and insight that will help you make the most informed and best healthcare choices for you. I'm Melanie Cole and joining me today to talk about depression in women is Dr. Lauren Osborne. She's the vice chair for clinical research in the department of obstetrics and gynecology at Weill Cornell Medicine.

Dr. Osborne, it's such a pleasure to have you with us and you and I were talking a little bit off the air. This is such a crisis, an epidemic that we are in right now, this mental health crisis, really an epidemic. And since COVID even worse, can you tell us a little bit about depression, the prevalence that you've been seeing? What are you seeing every single day? And give us a little working definition so we know what we're talking about here.

Dr Lauren Osbourne: Absolutely. I think you're completely right, Melanie. It is a crisis and the pandemic has exposed a crisis that was already there and has also exacerbated that crisis. We're seeing a lot of depression in adolescents, particularly, and in the population I work. With which is exclusively women, primarily in pregnancy and postpartum. We're seeing a big increase for both. But I think it's also important to understand what depression really is. Depression doesn't just mean that you're stressed over these world events that are going on. It doesn't mean that you're sad. Everybody gets sad. Everybody has times where they have a low mood.

But depression is really a combination of symptoms that can include low mood, but also a lot of other symptoms. In some people, particularly in women, it can also include irritability instead of low mood. It can include social withdrawal. So not taking an interest in things that you ordinarily would take an interest in, feelings of low energy, a lower ability to concentrate. Often a lot of feelings of guilt, self blame, and low self worth. And when you have a combination of those things and they're present for at least two weeks, that's when we call it depression.

Depression really has to affect your functioning. And for the population I work with, which is women, depression, and women we know is about twice as common as it is in men. And that has not changed through the pandemic. That's been the case ever since we've been measuring depression across the lifetime in people worldwide. We think there's about a 10 to 15% incidence of depression. In any one given year for women. That's about 10% from men, about 5%.

Melanie Cole (Host): Wow. You know, this is such a problem. So tell us a little bit about how depression differs, because we're all anxious right now, right? There's sadness. There's grief. There's anxiety. There's all of these different sort of under the umbrella spectrum of these kinds of disorders. So tell us a little bit about how worry and grief and sadness and anxiety all differ from clinical depression?

Dr Lauren Osbourne: Absolutely. So each of those things that you mentioned, worry, grief, sadness, those are feelings that people have, right. And everybody has feelings. You might have a low moment when you find you didn't. Get into the college of your choice or an anxious moment when you're waiting to hear news about something. But if it's a moment and it passes and you can go on with your life, then that hasn't reached the level of a disorder. So really the distinction is what is the degree of functional impairment for the person.

So if you are feeling those feelings overwhelmingly they're lasting for several weeks and you find that you can't go about your regular life. You're not able to engage in work the way you should or get your tasks done for school or take care of your family, whatever it is that you do with your day, if your functioning is impaired, that's when we really have to worry that it's reached the level of a disorder.

Melanie Cole (Host): Well, then along those lines, as we women are trying to do everything, but we're learning more and more that we have to put our own masks on, a little irony there, before we put the masks of our loved ones on. If we don't take care of ourselves and certainly our mental health, we cannot care for everybody else. Do you think that women, we're trying to do too much? We're trying to be superwomen. We're trying to work and raise our kids and maybe we have older parents and we've got siblings. We've got all these things going on that make it so that we have just unbelievable pressures that we're putting sometimes on ourselves and on our own shoulders. Are we doing this to ourselves?

Dr Lauren Osbourne: That's a great question. and I think that there's a combination of answers. I don't think it's fair to say that all people who are stressed or have unusual burdens will develop a clinical disorder like depression, but in people who are vulnerable to that anyway, there's no question that the increase of stress or increase of added burdens can expose something or can trigger an episode in somebody who was vulnerable. And I think we've really seen that with the pandemic where women's roles have been dramatically affected by the pandemic.

When it was reached the point where a lot of, schools closed or workplaces closed, it was women who quit their jobs to stay home with their kids. It was not men. And that added increased stress, removing women from their careers, the increased stress of taking care of their families in a very uncertain time. So there's no question that women have a different and higher burdens, but I also think it's important to remember that it's not just stress and higher burdens that cause things like this, there's a biological component and people have to be vulnerable to developing a mood disorder. For women during the reproductive years, that vulnerability is higher than it is for men.

Melanie Cole (Host): Well, there's also hormones involved, right? This is also a chemical thing. And as we learn more and more about these mood disorders, we're learning about that. So let's talk about some. The warning signs. How do we know whether we're talking about in ourselves or whether we are talking about somebody we love our daughters, our sisters, our mothers, tell us a little bit about what we're looking for? Also, you can add in there, Dr. Osborne are you noticing what of the red flags that maybe alcohol and drugs may be used to self-medicate some of those symptoms, tamper them down a little bit, but then become problematic in themselves?

Dr Lauren Osbourne: Great question. and it's fairly common to use alcohol and drugs to mask the symptoms of depression or anxiety, or to cope with those symptoms. Somewhere between a fifth and a quarter of people who have a mood or anxiety disorder, will use alcohol or drugs to self medicate. It's more common actually in men than women to do that, but it's prevalent, throughout. And I think in terms of the warning signs and what to look for, again, we're thinking about that degree of functional impairment and we're looking for a noticeable change in mood, but not necessarily a change that indicates sadness all the time.

If we notice that somebody around us is starting to isolate more, isn't wanting to participate in activities, is seeming sad or down, not just for a morning or a couple of mornings, but for a couple of weeks at a time. That's when I would start to worry that there's something going on. But for some people, what we see is irritability and we see that a lot in women, irritability or rage rather than sadness or low mood. So any kind of shift like that, that's sustained over time that isn't just an isolated incidence. That's where I would wonder and worry and want to make sure somebody's evaluated for depression.

Melanie Cole (Host): So then what if we've noticed all of those things in ourselves or in somebody we love, what is the next step? Because it's really hard to find mental health professionals right now. But with the advent of televisits, it's made it so that if someone is licensed in another state, you can see them on your computer and have your sessions that way. But tell us a little bit about the different therapies that are out there. The different modalities that can help someone that is suffering from depression?

Dr Lauren Osbourne: Absolutely. And you're completely right. That it's very hard to find mental healthcare. I think one of the issues is that we have a shortage of mental health providers, but another issue is the way that insurance is structured in this country. People medical professionals who treat mental health disorders are reimbursed by insurance companies at much lower rates than other kinds of medical professionals. So finding a mental health professional, who actually uses insurance is really challenging. Telemedicine has made it somewhat easier, but there are laws across states that make it that you can't treat somebody in another state.

So it's still very challenging. I think that there are a lot of effective therapies though. If somebody can get into treatment, there are a number of very effective psychotherapies. I'm a particular fan of, both cognitive behavioral therapy and interpersonal therapy, which are used a lot with the population that I treat most often, which is pregnant and postpartum women. And interpersonal therapy is a kind of therapy that posits that low mood is often intertwined with interpersonal conflicts or interpersonal relationship problems, and really tries to tackle those things together.

Whereas cognitive behavioral therapy posits that people have automatic thought. About themselves. And if we can change and block the nature of those thoughts, we can improve mood. So those are two really good resources, but I also think it's really important to remember that we have medication treatments for depression and while psychotherapy can be helpful, it doesn't help everybody. And it's also not accessible to everybody. So medications are another option.

Melanie Cole (Host): Okay. So can you just give us a little brief overview? I mean, obviously we're not gonna get deep into the medications here because it's a podcast. We don't have that much time. But there's a lot of 'em on the market. We see so much in the media, there's the SSRIs. And then there's antidepressants. There's all these different things that we see on the market. Can you just tell us a little bit about maybe their role in helping with depression? What are they even supposed to do?

Dr Lauren Osbourne: SSRIs are the most commonly used class of antidepressants, so they are a subset of the antidepressants. There are lots of other antidepressants, but the reason we most commonly use the SSRIs is that they're easy to use and they have the lowest burden of side effects. They're not more or less effective than some of the older antidepressants on the market, but they just have that lowest burden of side effect.S and the theory behind them, although there's constant, reinventing of this theory, we don't really know why they help.

But the theory behind them is that they, act on serotonin, which is one of the neurotransmitters in the brain that we think is responsible in cases of depression. And so what they do is they prevent serotonin from being taken back up into the cells in the brain. So they leave it available between the cells where it can act to transmit chemical messages. And that is how it produces its action, but it has a lot of other actions. SSRIs can also combat inflammation. They also work in tangent with some of the other. neurotransmitters in the brain.

So they have a lot of different actions. The thing about them that I think is often hard for people to realize is that they don't work immediately. They take some time to kick in, so you really have to be patient and take them for probably four to six weeks before you're going to see any effect. And that's a really hard thing to do when you're feeling not so great.

Melanie Cole (Host): That's certainly true. Now what about while we're doing that while we're working with the medications and as you say, I mean, sometimes people have to try many different ones and there are so many. If one doesn't work just the same as if you're with a therapist, if the first one isn't really a great fit, you keep looking because some people do have to try a few, right. But as an obstetrician gynecologist, give us your best advice on self care. While we're trying to do these other things, while we're trying to be superwomen, while we're trying to take care of our families and deal with our own depression and anxiety and mood disorders, there are things we can do for ourselves, please tell us about those?

Dr Lauren Osbourne: Absolutely. And I think that's a really important component. And I think people tend to downplay that, but there are lots of things you can do in terms of self care that can really help mood and anxiety symptoms. And I think that's one area where you mentioned before women taking on too much and trying to be superwomen women don't often take on too much in terms of their own self care. They don't tend to prioritize it. And so the things that have an evidence base In tackling mood and anxiety symptoms are exercise. Exercise can be really helpful, especially, yoga has an evidence base for depression and anxiety symptoms. There's quite a bit of data on bright light therapy.

So when I have a patient who is struggling, waiting for that antidepressant to kick in and really wants to do as much self care as she can, I encourage her to get exercise and bright lights. Sometimes that's a walk in the sunshine. Sometimes it's buying a light box and sitting next to the light box during the day. And then I also think giving yourself time, social support. We know that people who have good social connections and have a lot of social support through their family and friends can help themselves in terms of their mood. And whereas people who are more isolated and are more prone to not recovering from mood episodes.

Melanie Cole (Host): Yes. It's such an interesting topic and there's so much Dr. Osborne, that we could discuss, and I'd like you to wrap it up, what you would like women to know. Because also, some women don't seek help because there's been a stigma of mental health issues and barriers that keep us from getting help. I'd like you to take all of this into consideration and speak about really what you want the key message to be about depression, mood disorders, our worry, our anxiety, what we women are trying to accomplish and tie it all up for us with really your best advice?

Dr Lauren Osbourne: I think that you're absolutely right. That women tend not to seek help for themselves. And the message that I would really like to send out there to women is that depression is an illness. Just like diabetes is an illness or anything else, any of the medical illnesses and women wouldn't hesitate to take insulin if they needed it for their diabetes, but women are often reluctant to take medications for depression. They feel like it's a personal failing or something they ought to be able to get out of themselves. And that just simply, isn't true. It's a biological illness. It's affected by things in our, social lives, in our psychological makeup, but it has a biological component and we really need to treat it and address it.

And one thing that often can help women get over that barrier of agreeing to care for themselves is to remember that care for yourself is care for your loved ones and your family as well. We know for example, that when women have postpartum depression, it has a negative and devastating impact on the whole family, on their ability to bond with their child on their relationships with partners and other family members, and has long lasting impact on the emotional and intellectual development of that child. So, taking care of your mental health is taking care of your family.

Melanie Cole (Host): 100%. Thank you so much, Dr. Osborne. This was so informative and important to discuss these things and really bring them out in the open. So women don't feel that stigma. If you're interested in the services discussed here, please visit weillcornell.org or speak to your OB GYN or primary care physician about referring you for mental health services. Thank you so much for joining us today. Weill Cornell Medicine continues to see our patients in person, as well as through video visits.

And you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back to Health. We'd like to invite our audience to download subscribe, rate, and review Back to Health on apple podcast, Spotify and Google podcast. And for more health tips, you can always go to weillcornell.org and search podcasts and parents. Don't forget to check out our Kids' HealthCast. I'm Melanie Cole.

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