Marie Zahorick, MS, APRN, PMHNP-BC, FNP-C, IBCLC became a La Leche League Leader in 1999 and an IBCLC in 2005. After several years of working as a hospital-based bilingual Spanish-speaking IBCLC, she attended nursing school and eventually became a board-certified Family Nurse Practitioner. In the meantime, she continued working as a hospital-based lactation consultant doing inpatient, outpatient, and NICU lactation. She did not get much sleep.
After graduate school, Marie went to work in psychiatry and also did a post-masters certificate to became board-certified in psychiatry and mental health. She was fellowship-trained to manage patients in the acute inpatient setting, partial hospitalization, outpatient office, and OB patients in the general hospital setting.
She specializes in women's psychiatry, especially medical management of women who are pregnant or lactating. Her expertise also includes general psychopharmacology. She is experienced at diagnosing and treating mental conditions such as bipolar disorder, perinatal/postpartum mood and anxiety disorders, postpartum psychosis, obsessive-compulsive disorder, premenstrual and perimenopausal mood disorders, and personality disorders.
She lives in the Chicago area with her husband and three adult children in their 20s. Her children all breastfed for at least two years but now just make faces when confronted with that embarrassing fact.
If you have worked with mothers for more than a few weeks, you have encountered a mother with mental illness. You may not have recognized the symptoms while talking with your patient. Or, you may wonder if a certain psychiatric medication is “safe” during lactation.
Perinatal mood and anxiety disorders (PMAD) include a spectrum of common mental health disorders: depression, panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, bipolar disorder, and postpartum psychosis.
These disorders often ruin enjoyment of the postpartum experience and bonding with the baby. Perinatal bipolar disorder and postpartum psychosis are particularly dangerous due to severe depression and reckless or bizarre behavior that can endanger mother and baby.
Medicating the lactating mother is a careful balancing act between the health and safety of the mother and the health and safety of the baby. But failing to medicate a mother with PMAD can lead to misery, dysfunction, poor infant outcomes and in the worst situations, injury and death.
This presentation will give an overview of the different classes of antidepressants, antianxiety medications, antipsychotics, and mood stabilizers commonly used in breastfeeding mothers. Electroconvulsive therapy and transcranial magnetic stimulation will also be discussed as non-pharmacologic treatments.
Perinatal mood and anxiety disorders (PMADs) include a spectrum of commonly-occuring mental health disorders. About 17% of postpartum mothers worldwide experience depression, with rates climbing to 60% in some low social-economic status women and adolescent mothers.
However, less well-known PMADs include perinatal panic disorder, perinatal obsessive-compulsive disorder (OCD), and perinatal post-traumatic stress disorder (PTSD). These often include very distressing intrusive or bizarre thoughts, behaviors, or flashbacks.
Perinatal bipolar disorder and postpartum psychosis are particularly dangerous due to severe depression, and reckless or bizarre behavior that can endanger mother and baby. Women with bipolar disorder may have stopped medications during pregnancy and are experiencing mood instability. They may also not realize they have bipolar disorder and require careful diagnosis, since twenty-two percent of depressed women postpartum have bipolar depression. Postpartum psychosis is an emergency and occurs in 1 to 2 of every 1,000 deliveries. This requires immediate hospitalization for safety, due to a 5% suicide rate and 4% infanticide rate. The midwife is part of the safety net for postpartum mothers and is a vital first step for identifying possible PMADs and referring the mother for mental health treatment and support.
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