The conversation explores the internal biological changes that occur in a woman's body throughout her lifetime and how they can affect her mental health. It discusses the hormonal changes during puberty, menstrual cycles, pregnancy, postpartum period, and menopause. The conversation also delves into the definitions of depression and postpartum depression, highlighting the symptoms and criteria for diagnosis. It emphasizes the importance of creating awareness, support groups, and education about mental health. The role of friends, family, and corporations in supporting women's mental health is also discussed. Postpartum depression is a common issue faced by new mothers, but it is often misunderstood and overlooked. The symptoms of postpartum depression can include disturbed sleep, irritability, lack of interest in the baby, and changes in mood. It is important for new mothers to seek professional help as soon as they notice any changes in their behavior or mood. Maternity leave policies should be more flexible to accommodate the needs of new mothers, and workplaces should provide designated spaces for breastfeeding. There is a need for better awareness and understanding of mental health issues, including postpartum depression, in society.
Guest's Bio: Dr. Aaskash Ponda is an MD in Psychiatry and a consultant psychiatrist at the Ponda's Psychiatric Care, Vadodara. He finished his MBBS from Civil Hospital Valsad, and MD in Psychiatry from MGM Hospital in Mumbai. He received the prestigious Young Scholar Fellowship at an International Conference in Hyderabad.
Takeaways
Full Interview Transcript:
Nazneen Kachwala (00:00.0)
Hi, Dr. Aakash. Thank you for joining in for such an important conversation. I think this topic is very relevant. It was relevant earlier as well, and I think it is more relevant in today's time. And I'm very, very glad to have you for this episode. So Aakash, I'll start by asking you that
Dr. Aakash Ponda (00:18.452)
Definitely, it's my pleasure.
Nazneen Kachwala (00:30.208)
Before we jump on to the main conversation, to the main topic of our postpartum depression, I would want to understand that what are the internal biological changes that happen in a woman's body throughout her lifestyle or throughout her lifetime that actually affect her mental health positively or negatively?
Dr. Aakash Ponda (00:52.81)
Right, so it starts since birth. So when a baby girl is just born, the maternal hormones are at its peak. And just after the birth, they decrease to a very, very low levels. And then till puberty, those levels are maintained. So very low levels of estrogen, progesterone, which are the main hormones in a woman's body.
Dr. Aakash Ponda (01:17.742)
those are at a very very minimum level and at puberty what happens is that they start increasing so at puberty there are a lot of changes which occur in a woman's body and those changes also affect her physically as well as mentally and the mental aspects of it are mainly sometimes they're very mood fluctuations which are observable
Dr. Aakash Ponda (01:44.406)
by the feeling. The other thing that happens very often is they become hypersensitive to emotions. So that is one thing that they start feeling and they start getting affected by a lot of things. So because of these hormonal changes which have happened first time in their lives, it is very new to them. This very, very, because they have not been trained for it, what is happening to their body, what the changes, physical changes also that undergo, they undergo
Dr. Aakash Ponda (02:13.816)
puberty so because of that there are also very many times body image issues which they face so when they look in the mirror they see a person who is completely different they're not seen this version of her ever before so that also affects a lot of times after that there are menstrual cycle starts the stuff of puberty
Dr. Aakash Ponda (02:40.11)
that is a very cyclical change which happens in every woman's body a monthly cycle which is a regular cycle 25 days, 30 days depends on person to person but during that time there is a rise in estrogen then the estrogen drops and there is a rise in progesterone so because of these cyclical changes the rise and fall of estrogen progesterone there are a lot of emotional disturbances which a woman
Dr. Aakash Ponda (03:10.134)
Also, would like to add that missing the periods, missing the menstrual cycle, having irregular cycles or having menorrhagia which is the quantity of and the days of the menstrual cycle are increased or hypomenorrhea or know, decreased days of cycle or decreased menses. These are also affecting a woman mentally as well
Dr. Aakash Ponda (03:40.702)
Always a regular cycle is very important for a woman's body. So whenever there is a break in such, they feel very apprehensive, they feel very scared because they don't understand what is going on. So a lot of times, a gynecologist may help at this time. After that, during pregnancy, there lot of hormonal changes in the body.
Dr. Aakash Ponda (04:09.782)
with that HCG is a hormone which increases in the body with that another hormone known as prolactin also increases and this is the first time in their lives when these two hormones started increasing so everything is controlled by the hypothalamus which is present in our near -earth brain which in turn handles all the hormonal changes in the body of the human so it goes step by
Dr. Aakash Ponda (04:38.698)
the hypothalamus, then the pituitary gland, then the ovaries. So there is a go down the troponins, secreting hormone which gets secreted by the hypothalamus. these cyclical changes happen in a woman's body because of which during pregnancy also there are a lot of mood fluctuations, lot of irritability which can't be explained by formal reasons. A lot
Dr. Aakash Ponda (05:07.894)
changes in the temperature of the body as well, right? Then sleep cycle may be affected because of that. The rhythm of the day also changes because of that. So just after the delivery of the child, there are other changes that take place. There's a rise in prolactin which had started secreting since pregnancy.
Nazneen Kachwala (05:12.77)
Okay.
Dr. Aakash Ponda (05:37.304)
to support breastfeeding and the other hormones start decreasing. So there's a major difference in the levels of hormones pre -pregnancy and post -pregnancy, postpartum because of which a lot of times as we will discuss in this session, a lot of times there are proper mood changes, the postpartum blues as well, postpartum depression.
Dr. Aakash Ponda (06:05.952)
At times there is postpartum psychosis which may be caused in the uterus. So these are the major changes which happen till postpartum period. After that there is a perimenopausal period which is also a very tough time for a woman in her life. It is just the beginning of menopause. So the regular cycles start changing. The periods come late. They come two monthly, three monthly.
Dr. Aakash Ponda (06:35.668)
which as I said it affects a woman they start feeling that change inside their body a lot of hot flushes which happen a lot of loss of control of emotions which happens during this period also in the menopausal period which happens just after the premenopausal period there are physical changes in the body which start taking place
Dr. Aakash Ponda (07:05.502)
so a lot of cases of osteoporosis start and because of which the bones start becoming brittle and they start feeling very tired which sometimes they feel it is very unexplainable they start having multiple pains in their body knee pain start back pain start and all these are directly related to the hormonal changes which take place in that body
Nazneen Kachwala (07:33.154)
Okay.
Dr. Aakash Ponda (07:34.998)
and then as aging increases all these hormones which we discussed they come to a very very low level just like a pre pubertal level so this is the whole cycle that takes place in a woman's body I know there is a very scientific explanation of this but you know as a woman you would definitely relate with whatever I have said and yeah
Nazneen Kachwala (07:44.108)
Alright.
Nazneen Kachwala (08:00.393)
yeah, the cycle, what is the length of the cycle? So it starts from pre puberty as soon as a woman is born or girl child is born. And then what is the average age until which the fluctuations of these hormones continue?
Dr. Aakash Ponda (08:15.374)
Right, so menopause average age is 51. So till that time these major changes monthly changes as well as know, cycle changes happen in the women
Nazneen Kachwala (08:29.44)
Okay, okay. So like you know, you have probably experienced and have spoken to a lot of women who are struggling with these biological problems, but I'm sure you must also be knowing about the various impacts of different social, cultural, and maybe financial troubles that a woman undergo or face through in her life. So what do you think is the impact of these factors on the mental health?
Dr. Aakash Ponda (09:00.33)
Right, so a woman has to play a lot of roles in her lifetime. So it starts like being a sister to someone, a daughter to someone. It proceeds to become a wife of someone, a mother of someone, grandmother. A lot of roles have to be accomplished by a woman. So definitely there a lot of responsibilities which as a man I fail to understand a lot of times because
Dr. Aakash Ponda (09:30.926)
I don't know how they handle so many responsibilities. So a lot of times when women come to my OPD and I ask them what do you do? Just a regular question, just to take their stand. They look some rapper. They say, I don't do anything. I'm like, you must be doing something. So they answer with saying that I'm just a housewife.
Dr. Aakash Ponda (09:58.848)
Being a homemaker is a very big responsibility. You have to have so many roles that you have to fulfill in that day. You have to take care of the whole house, children if any, the husband taking care of very small things like paying the bills, going to the office, cooking the meals, various responsibilities. So women themselves try
Dr. Aakash Ponda (10:28.746)
negate all these rules and they say that I'm just a housewife which is very surprising for me because I've seen my mother do so much for the family and which I can't even you know put it on paper those very rules she has undertaken so sometimes they don't even understand what they're doing for the family and they're not appreciated that much by the family members so that is one thing that I've observed this is a very daily occurrence in my opinion every day this happens once or twice and then I scold them
Dr. Aakash Ponda (10:58.745)
that you know you're doing so much for your family and you just tell that I'm just a housewife doesn't make sense to me right. Financial responsibilities as well in these days you know everyone is working and everyone has to work it's interesting and with that the other responsibilities of you know these all these horrible changes which I just told you every month the
Dr. Aakash Ponda (11:28.856)
some change occurs in their body physically and mentally and even beyond that you know going to work in spite of the pain going to work you know working regularly and know fulfilling their duties I mean I can't say more about it I can't praise them
Nazneen Kachwala (11:50.174)
Yeah, so I think we'll come to the main subject of our discussion since we have built probably the foundation of this topic. I would want you to explain what is, how do you explain the word depression and how do you explain postpartum depression? Is there a difference between the two?
Dr. Aakash Ponda (12:11.115)
So depression is a mood disorder right in psychiatry we always follow two diagnostic criteria versus DSM -5 which is mainly based in the US the psychiatrists in the US they follow that system in India we do follow ICD which is given by the WHO so for diagnosis we have criteria proper set criteria for diagnosing any case of
Dr. Aakash Ponda (12:39.606)
Depression is mainly a mood disorder in simple language. is a mood disorder where there are changes in the mood of the person which are very pervasive and sustained. the requirement for diagnosing a person with depression is there's a timeline as well. Two weeks of pervasive sustained severe mood disturbances. So mainly the features are sadness of mood. They don't have any pleasure in know the activities that they did before.
Dr. Aakash Ponda (13:09.356)
So for example, if some person likes to go for a swim, for a walk, playing with their kids or going to work, they don't have any pleasure of doing that at all during this period. With that, there are a lot of physical changes which occur. the physical symptoms of depression, mainly there are sleep changes. They sometimes sleep very less or exceed their sleep time.
Dr. Aakash Ponda (13:39.234)
sometimes there are also eating disparities where they don't have any appetite for anything or in some cases they eat excessively especially carbohydrate loaded or rich food there a lot of as I said the sadness is very deep there a lot of negative thoughts all the thoughts that they have are negative thinking becomes very black
Dr. Aakash Ponda (14:05.676)
whatever thought they have, also on the negative side. They have these feelings of hopelessness, helplessness and worthlessness. And also in severe cases, there a lot of suicidal ideations and suicidal tendencies which also take place in such depressed people. In psychiatry, I would like to add that there's always a spectrum of symptoms, right? So a person of depression may also have a lot of features of anxiety as well.
Dr. Aakash Ponda (14:34.592)
anxiety as in restlessness, they may have physical symptoms of anxiety like palpitations, sweating, dryness of mouth. Sometimes they may have panic episodes, but they feel that they may die. They don't understand what is going on and a of physical symptoms of anxiety which are very severe. They feel that something is going to happen to them. They have fear of dying at that time. So all these sometimes there lot
Nazneen Kachwala (14:48.971)
Okay.
Dr. Aakash Ponda (15:04.614)
obsessive complaints where one thought keeps on going on in their brain and most of the time there is a negative thought. In severe depressed cases there are also delusions which happen where there is a thought stuck in their mind that something bad will happen to me, someone will kill me. In severe cases that also happens at times.
Nazneen Kachwala (15:18.434)
Okay.
Dr. Aakash Ponda (15:34.69)
spectrum of symptoms which happen and in depression every person has a unique symptom every thought is unique every person is unique so the way of thinking that develops during this period of depression is very uncharted and unpredictable so we can't can't say for sure what that person will do next sometimes sudden bouts of anger also may happen
Nazneen Kachwala (15:40.267)
All right.
Dr. Aakash Ponda (16:04.334)
So it is a very severe thing. And postpartum depression is going to discuss now. Postpartum depression is a type of depression, but there are specific criteria for it to be diagnosed as postpartum depression. So it may happen a weeks or a months after the delivery of a child.
Dr. Aakash Ponda (16:32.002)
Postpartum depression has features of depression as well as some other features where there are thoughts some thoughts like I can't take care of my child effectively I won't be able to do this there's lots of self confidence as a mother as a person a lot of times hampered sleep just after a baby is born that also may trigger postpartum depression
Dr. Aakash Ponda (16:58.016)
Also the criteria of two weeks has to be followed in Diagnosing Postpartum Depression. But sometimes thoughts of harming themselves as well as the child or as well as the partner may come in their mind which becomes a very very serious issue. So during that time acute management of these thoughts and just are a must. It may have a very heavy consequences.
Nazneen Kachwala (17:30.127)
So how can a woman herself understand that she is probably undergoing these issues and these mental problems and it is basically due to the biological changes that are happening in her body but how can she herself first of all try and understand and try to curb these symptoms or these problems herself?
Dr. Aakash Ponda (17:57.038)
So, when the features of... So, the main features of depression which are sadness of mood, anedonia which is the loss of pleasure, interest in activities of daily life, decreased interest in taking care of the child, playing with the child or taking care of the child, decreased wish to even breastfeed sometimes in acute cases, right? Safe cases. So, these are the features that the woman herself
Nazneen Kachwala (18:14.434)
Yeah.
Dr. Aakash Ponda (18:26.476)
has to be mindful about as well as the family members have to be mindful about that. Even though someone else is taking care of the baby, if the husband is taking care of or a family member is taking care of the baby, still the woman is not able to sleep properly. It is a very happy time as well, know, birth of a child, but if she herself feels that, you know, I won't be able to fulfill my duties as a mother.
Dr. Aakash Ponda (18:57.481)
There is a very acute loss of self confidence. She feels that she won't be able to do anything in the future. I won't be able to feed my child, won't be able to play with my child, I won't be able to take care of her child. These are some symptoms she needs to be mindful about as well as the family members. What they themselves can do during this difficult time, during postpartum depression, asking for help.
Dr. Aakash Ponda (19:26.602)
is very very important. In India, it is a very common accepted thing to go to their family as in their mother and for that period so that the child is taken care of very easily and very naturally. She's in a comfortable space, right? She's in a known space where she has grown up
Dr. Aakash Ponda (19:54.21)
you know, everyone is invited turn by turn to take care of the baby as well. So asking for help freely is one thing that she can do. Communicating her needs very effectively is also one thing because a lot of times a lot of things are unsaid. She'll just keep it to herself so that you know the person in front of her husband or husband's parents are they are they are not
Dr. Aakash Ponda (20:23.04)
affected by her thoughts or emotions. She'll keep a lot of things to herself. So having a clear communication of her needs is also very important. Self care is very important. you know, basic things like going for a bath in the morning, that also is missed by lot of mothers during this period because they feel that if I can't take care of my baby, I can't take care of myself as well.
Dr. Aakash Ponda (20:51.98)
They don't brush their teeth for days. They don't go for baths. So taking care of these small things as well are very important. Taking timely naps and good sleep will also mitigate a lot of symptoms. Whenever the baby sleeping, you can also try to take a nap and you know, handing the responsibility of the baby to someone else and taking a nap. Timely nap is also very important. Also nutrition and hydration are something which are ignored a lot.
Dr. Aakash Ponda (21:21.72)
times in this period. Sometimes because of the features of depression there is a very acute loss of appetite and they don't feel like eating anything. Because of the hormonal changes they do not feel like eating particular things. But whatever they wish to eat, if it is healthy enough, they need to eat it. They need to have a healthy appetite and healthy meat every day. And hydration is one thing which is ignored a lot of times. They just forget to drink water.
Dr. Aakash Ponda (21:51.176)
and to sustain breastfeeding also you need to have good nutrition and diet.
Dr. Aakash Ponda (21:57.868)
These are some things that she can try herself and if everything fails, she can consult a material professional to understand these problems a little better and find a solution to all these
Nazneen Kachwala (22:11.658)
Yeah, yeah. You know, one of the reasons or you know, one of the, if I can say only reasons of recording this podcast on the subject of mental health is to create awareness about these topics. And I think it is very much important that we create a lot of support groups, because sometimes it becomes very difficult for an individual who is undergoing a problem to identify herself or himself. So if the support groups, the families, friends, relatives,
Nazneen Kachwala (22:41.606)
a neighbor or any stranger is there, yeah, if he or she can understand a person and be available for him or her, would be probably, it's just an empathetic, creating an empathetic view towards the person who's undergoing some mental health issues. So with this regards, I think you slightly touched upon the subject of, you know, asking for help, but then it is also very important.
Dr. Aakash Ponda (22:44.27)
definitely.
Nazneen Kachwala (23:10.42)
for the people or the support groups, the friends, families, relatives to understand that this person requires help, especially in the case of postpartum depression or anxiety when a woman is undergoing because unfortunately, still in our culture, know, women have got or mothers especially are seen as people who should be able to do everything. And yeah, and then a lot of tags probably come
Nazneen Kachwala (23:40.342)
along if at all there is some lapse somewhere and this is not a problem of the people but it's culturally the way we've been brought up and lack of education. So what do you think is basically the role of friends, families and how can they be supportive even if the person is not able to communicate or ask for
Dr. Aakash Ponda (24:04.212)
Right. If I could give a newer perspective, you know, my perspective to this issue, lot of patients who come to me when I talk to their family members, they haven't been educated about all this. They have not the slightest idea of what the mother is facing or what changes happen in her body. They feel that it has been going on since ages. So it is a very normal thing.
Dr. Aakash Ponda (24:34.03)
that happens so they don't have a slight understanding of the issue they don't understand it very well so definitely it is a very difficult task to educate them about all these things but change is happening and I'm very positive about the future that know change will happen and they'll understand these things better but mothers who you know they need to educate their child as well
Nazneen Kachwala (24:52.616)
Yeah.
Dr. Aakash Ponda (25:03.308)
these issues, talking about menses and periods, why not? Why can't we have a very clear communication regarding this? Why can't we ask questions regarding that? Still in India, the pads are carried in black bags. It is a taboo to carry them openly. If a man goes to buy pads for his wife or sister,
Dr. Aakash Ponda (25:32.0)
they are judged upon. So all these issues are definitely there in India as well and as well as around the world. And I feel that an open communication and education regarding these issues are very, very necessary. Coming back to the question, the roles of family, friends and relatives, empathy, as you said, empathy is mainly if I can define it very simplistically.
Dr. Aakash Ponda (26:02.07)
It is trying to wear the other person's shoes, being in their shoes, right? Being in their position, which as I said, that is very difficult for them to understand. But what if I was there in their place and what if I have never been trained for raising a child? is my first experience. I've never been, my body has never been going through anything of this sort ever.
Dr. Aakash Ponda (26:31.532)
So just being mindful about her emotions, her mother's emotions. Even if, you know, reading the body language and facial expressions, this is one thing that a lot of people miss. Sadness is always, you know, very evident in most of their faces and happiness is also very evident. So if you have a newborn in your
Dr. Aakash Ponda (27:01.536)
So normally expression is you're smiling and know playing and playful cheerful If the mother's expression is none of that if it is It has a very tired look. She has no smile on her face She's not cheerful at all. She's not playful at all You see that sadness deep sadness in her face. Then you need to ask what is happening then create a safe space So that she can open up freely right sometimes
Dr. Aakash Ponda (27:31.49)
Confidentiality is one issue that a lot of mothers face because of which going to a mental health profession is very easier because you get a safe space. There's an unknown person but definitely a lot of people do not feel comfortable to share a lot of things on the first meet. But husbands can definitely try to be more confidential about whatever the wife is sharing about her emotions.
Nazneen Kachwala (27:40.482)
Hmm. Hmm.
Dr. Aakash Ponda (27:59.682)
not share those with his parents, with her parents, right? That she was saying that day that she won't be able to take care of her baby in the future. That is something, you know, even vocalizing that may be very difficult for the mother. So just being mindful and creating a safe space is very, very important. And when you suspect something like that, also giving options, but not forcing her to take a
Dr. Aakash Ponda (28:29.792)
at that moment. happens is sometimes give the child to your sister for a few days, you will relax. Separating the child from the mother is also very difficult for her during this time. Just give the child to your sister for a few days. There is something which definitely happens in the rural areas of India. A lot of times the babies only grow with
Nazneen Kachwala (28:52.68)
Yeah
Dr. Aakash Ponda (28:58.89)
Massey or the mother
Dr. Aakash Ponda (29:00.604)
sister, they grow old and they have no special connect with their own mothers. That is one thing that I've observed in a lot of my patients as well. yeah, so friends also can definitely babysit at times, give opportunity for the mother to take naps. Husbands have to share the responsibility.
Nazneen Kachwala (29:03.902)
Yeah, the mother herself, yeah.
Dr. Aakash Ponda (29:28.96)
but this is a very easier said done done. So I feel
Dr. Aakash Ponda (29:38.102)
Educating them since since you know the time they start understanding all these things Would be a long way to go like the Age of puberty for men as well. It's a very difficult time for them, but They also start being mindful about their emotions as well So that that age I think education is very important, which is lacking There's no chapter in our biology regarding maternal health mental health of mothers
Dr. Aakash Ponda (30:08.044)
maybe I had it, why not? It is an important stage of everyone's lives. that is something that can be done by the government and various agencies.
Nazneen Kachwala (30:18.624)
Yeah.
Nazneen Kachwala (30:19.874)
And also many, many people, unfortunately, even today, they don't go to schools. And people who go to schools, as you said, don't have a special chapter on the subject. So, you know, let alone people who are not into the schools. And so they are actually brought up very conventionally, very traditionally that this is just a process and you've got to be a part of it. It could it's it's a one way to look at
Nazneen Kachwala (30:45.81)
that you know you are, it's a process and you need to be accepted, but it's also very important to see the other sides of it and be mindful of them. And I think that the other institutions besides the educational institutions, as you know, there are very various different places, religious, for example, institutions where most of the people in India tend to go. I think it's
Dr. Aakash Ponda (31:00.769)
Definitely.
Nazneen Kachwala (31:13.084)
There's something, it's a responsibility of these institutions as well to educate the people who are coming for spiritual discourses to openly have a dialogue and conversation about these subjects because it could be one of the best sources of educating the masses, especially those who are not going to the schools and formal educational institutions. Yeah, yeah. And the food.
Nazneen Kachwala (31:41.858)
We spoke about the help that the relatives and friends who could extend. But most of the women today are working. And they have a nine to five jobs and some of them are even stretching for 12, 13 hours a day. And then they have some added responsibilities of the household as well. What do you think can the corporates do? Now here we are talking about the educated masses, right?
Nazneen Kachwala (32:12.026)
But still I see that there is a lack in the empathetic view or approach towards the women who are working in the corporate. It's just seen by these people also as a process and they are given some time off, a few months off work and after which they are not paid and they are expected to be on the job or they are going to lose their job. Or do you think that there could be some changes in the
Nazneen Kachwala (32:40.618)
approaches of the corporates, how they function and how they take up this issue of postpartum depression or mental health of women during this time.
Dr. Aakash Ponda (32:52.65)
Right, so one thing that comes to my mind is that you know, COVID has been traumatic for a lot of us, but it has also opened up various avenues. This platform as such has been very accepting all across the world. So different modes of work like working from home, giving that flexibility that you know, you can work from home when you need. So definitely they give a
Dr. Aakash Ponda (33:22.766)
period maternity leave for a few months But that may not be enough after that also the child will have those needs the child is still small so a lot of times having the flexibility of work times as well as workplace may help So I think that the period of maternity leave may be enough six months is a good enough period because The woman also
Nazneen Kachwala (33:31.84)
Mm -hmm.
Dr. Aakash Ponda (33:51.848)
many times wants to go back to her routine. She also wishes to start working again. So flexibility of these workplaces may be a good idea. If it is not possible, if she has to turn up to work, then definitely one concern that a lot of mothers have is about breastfeeding. So they can have zones specially designated for breastfeeding which are safe zones.
Nazneen Kachwala (33:54.442)
Yeah. Yeah.
Dr. Aakash Ponda (34:20.606)
they have to keep it separate and very comfortable for the mother that is one thing that all comrades can definitely do because lot of railway stations, airports everywhere it is becoming a norm to have special places for breastfeeding because lot of mothers are not very comfortable to breastfeed in the open so that is one thing that they can definitely do also
Dr. Aakash Ponda (34:48.134)
the managers need to have a very open communication with the new mothers regarding their needs. What do they want? What do they expect from as a change from their workplace or managers? Because every mother is unique as well. Every person is unique. So they'll have different needs. So whatever can be fulfilled, maybe that are easier to fulfill, they can try
Dr. Aakash Ponda (35:18.31)
One thing that they can also try is having a confidential space regarding some issues which they face in their daily lives. Sometimes the productivity or efficiency of the mother may not match the pre -partum levels. So because of various issues that she's facing and because of that a lot of colleagues or the team they may
Dr. Aakash Ponda (35:47.21)
you know, directly go to blame game like you're not working very efficiently, not working very effectively. You used to do this very effectively, you used to match your targets very well, can't, you are not matching those targets now. So having a very confidential safe space is one thing that can be tried and a lot of corporates also, you know, lot of corporate patients also come to me for consultation.
Dr. Aakash Ponda (36:15.962)
But what happens is that there's one thing that I've observed is the prescription that I write or even the notes that I write for the patient, they have to show it to their boss for approval. So, you know, that is one thing that I find very silly because the confidentiality that I had with the patient, you know, I have to write my notes and the prescription that I've given, they have to mix the boxes up and submit it to their boss.
Dr. Aakash Ponda (36:44.67)
level of confidentiality should be maintained is one thing that I personally feel that could be tried. you know sessions, I have been doing a lot of work day stress, mental health awareness sessions in various companies which I have been finding that those are not very common and these are something new that a lot of companies want to try.
Nazneen Kachwala (36:52.245)
Yeah.
Dr. Aakash Ponda (37:13.51)
and want to a lot of HRs they want their employees to attend these seminars, work -life stress management seminars or various mental health seminars. So a rise in that also may help because a lot of people don't have the basic understanding of what mental disorders are or what postpartum depression, what postpartum blues, what everything is. They don't have the slightest idea about it.
Nazneen Kachwala (37:17.387)
Okay.
Dr. Aakash Ponda (37:42.318)
So because I'll just give you an example. Yesterday I went to a company nearby for a workplace and mental health awareness seminar. When I asked them that, what do you think, who goes to a psychiatrist? So 80 % of them had the same answer that if someone is going mad, they'll go to a psychiatrist. So that basic understanding needs to be instilled in that mindset.
Nazneen Kachwala (38:02.582)
Yeah.
Dr. Aakash Ponda (38:10.836)
So, assemblers like this may help as well.
Nazneen Kachwala (38:13.602)
Yeah. So then when do a person or when does a woman who's probably who has identified that she is facing the postpartum or undergoing postpartum depression and the family members also have identified this. But when is that particular time when she can approach for a professional help.
Dr. Aakash Ponda (38:37.486)
See, being very optimistic about this answer as soon as she finds any change in her normal behaviour. When she finds that I am not behaving myself, which is persisting for a few extra days. Sometimes being not in the mood or being sad is perfectly natural. Everyone faces that, even me, even you. But if it persists, persistence. And if the roles that...
Dr. Aakash Ponda (39:07.532)
that person needs to fulfill, not getting fulfilled very effectively. I think that is the right time to consult a psychiatrist, but a lot of times that doesn't happen. lot of times during a very severe stage, they turn up to the OPT and it also becomes very difficult for me to, you know, give effective treatment and then what happens is that sometimes we need to give a bit higher doses than normal.
Dr. Aakash Ponda (39:37.576)
And because of that, the stigma regarding psychiatric medications and therapy and various side effects comes into shore. Because the stage at which the patient is coming to me is a very serious stage. And I have to give results because there will be very dire consequences regarding the future decisions that that person takes. lot of suicidal patients also turn up to the OPG
Nazneen Kachwala (40:06.306)
Okay.
Dr. Aakash Ponda (40:07.436)
So optimistically as soon as they see that change you need to consult. Also one thing that I would like to definitely say that the difference between urban and rural population group what happens is that in the rural areas these changes are very very carefully observed by the family members.
Nazneen Kachwala (40:25.302)
Okay.
Dr. Aakash Ponda (40:35.306)
what they do is they don't google their symptoms or know they don't they just go to some person who you know may have an idea about it which most of the times is the head of the village or a serpents and I've seen that a lot of times these head of villages are definitely very helpful and they wish to do good for the entire village so what they'll do is they will directly bring that woman to a psychiatrist or specialist
Nazneen Kachwala (40:45.378)
Okay.
Dr. Aakash Ponda (41:06.232)
directly because they know they may have faced such an issue with some other member of the village so when they see the results they will want everyone to take that help much sooner in the urban population group a lot of times they google their symptoms they think that it is not that severe
Dr. Aakash Ponda (41:33.142)
and they're not very mindful about those symptoms and they try to you know, I'll just go out for a walk or something and I'll be fine. They'll start meditating but that also doesn't work in many severe cases. So that time, that delay of the symptom onset and treatment is also very important.
Nazneen Kachwala (41:57.726)
Okay. So you mentioned about medications, right? Yeah. And so I'll be very honest, I'm very apprehensive to take medications which are particularly related to, you know, psychiatry or which will alter the way probably my brain functions and excretes hormones. I'll be very apprehensive about this. So I would just want you to, you know, elaborate a little onto this that is
Dr. Aakash Ponda (42:19.531)
Right, right.
Nazneen Kachwala (42:25.942)
Is my apprehension alright or is it not? Or I would just want you to say something about this so that I think I know many people like me who would not want to take these medications be it like a simple sleeping pill or you you don't know the composition what it is about and then you don't know for how long you would have to take these medications. So I have a lot of these apprehensions in my mind. So what do you say about this?
Dr. Aakash Ponda (42:53.262)
see most of the people have these apprehensions and I would say that before starting any medication for a pregnant female or breastfeeding female I would also be very apprehensive I would also think 10 times before starting any medication for them but so we'll go back in time so I think 30 -40 years back
Nazneen Kachwala (43:09.491)
Okay.
Dr. Aakash Ponda (43:21.782)
In psychiatry, we only had a handful of medications. The trends have changed. lot of research is going on in this field. A lot of amazing molecules have been coming out. And we get a very proper training of the side effect profile on these medications. And the only goal of the companies that are producing these molecules as of now are to reduce the side effects.
Nazneen Kachwala (43:51.412)
Okay.
Dr. Aakash Ponda (43:53.527)
In the past, I may agree that there were some side effects which may hamper a lot of things. But currently, we have a lot of options. have many of lot of things. thing. Second thing is that sometimes that severity, there are two outcomes. If we
Nazneen Kachwala (44:05.653)
Yeah
Dr. Aakash Ponda (44:22.95)
give results if we don't medicate and we don't medicate the symptoms there can be dire consequences like suicide or harm to the child as well now what is a deadlier having a bit of nausea or GI upset or suicide that is something that people don't understand that well that if you don't treat those symptoms
Dr. Aakash Ponda (44:51.766)
as soon as possible something you know life threatening can happen for the mother and the baby
Dr. Aakash Ponda (45:04.974)
So we had left it no option at that time rather than medicate. So coming back to the question, so as soon as you see any change, as soon as it functioning, it starts getting effective, even social functioning, occupational functioning, personal functioning. That is the right time to go to a psychiatrist or any med like professional because at that time, even without any medications, with therapy as well, we can definitely medicate these
Nazneen Kachwala (45:08.002)
Thank
Dr. Aakash Ponda (45:34.816)
But all this is biological, all this is brain related. Lot of processes in the brain are changed because of which these changes in the mind and body are done. So definitely medications help a lot. We have lot of cases where medications have prevented lot of life threatening things.
Nazneen Kachwala (46:05.475)
Okay. So it goes like what I understood by this is that it goes step by step. First, you try to have a conversation and start with usual therapy. And if you feel that the person is in a more serious.
Dr. Aakash Ponda (46:15.158)
Right, right. It's all about the severity, mild, moderate and severe. So a lot
Dr. Aakash Ponda (46:22.706)
of mild cases may be very, very effective by therapy as well. Moderate and severe cases may need a combination of therapy as well as medications. Also, yeah, yeah. Also, there are other modes of treatment as well, which we can try.
Nazneen Kachwala (46:29.598)
Okay.
Dr. Aakash Ponda (46:44.204)
lot of other treatments which we can discuss in some other time as well.
Nazneen Kachwala (46:48.96)
Yeah, yeah. So
Nazneen Kachwala (46:50.356)
actually, there are many people, you know, who are, I think it's not a medical certification, but then there are different certifications at present available to become a therapist, to become a, you know, a psychotherapist, hypnosis and all of it. So, but these are not medically certified. So I think first,
Nazneen Kachwala (47:12.852)
I ask this question very often to my guests. So what is the step? if somebody has identified that he or she has a problem, then should the person directly go to a psychiatrist, get a clinical medical help, or it could be like a stepwise, hierarchical approach where she can first go to a usual therapist who just has a certification, a counselor who can just listen to your problems and try to give you
Nazneen Kachwala (47:42.959)
some relaxation techniques, some means and if it doesn't help then he or she can give you a recommendation to approach a psychiatrist. Like what is the usual hierarchy of going through this process?
Dr. Aakash Ponda (47:54.974)
Right, so as we are talking about certification, a lot of courses that are online, can even give you a certificate to become a counselor after a week of training, online training, after only a week, imagine. So, you know, that is one thing that we have been observing a lot in our country, India, that a lot of these certifications may not be very genuine.
Nazneen Kachwala (48:05.812)
Okay. Okay.
Dr. Aakash Ponda (48:23.852)
definitely learn something but practically have an approach to patients and you know because it is a very big responsibility to talk to patients and whatever you are saying may have a huge impact on that person in front of you. A lot of times untrained or less trained or these certificates is very easily available certificates. People have a bias
Dr. Aakash Ponda (48:53.614)
biased approach so whatever they will say may have worked for them or may have worked for someone else which they'll apply to everyone which then is ineffective to that person or may have an opposite reaction may have a worsening in that patient's thought process as well so any medial health professional who has had a proper training
Nazneen Kachwala (49:02.936)
Alright.
Dr. Aakash Ponda (49:22.766)
Here in India, lot of trained psychologists have been given a certificate number which they have to show on the screen on their board and such. We as doctors, psychiatrists also get a registration number which when they put that registration number in a module or a database of the medical registry
Nazneen Kachwala (49:32.45)
Okay.
Dr. Aakash Ponda (49:51.924)
they can get our details, A to Z all details, where we have had training and what is our degree and is our degree true or not. So, I think, so coming back to the question, the experience that I have had, because a lot of people are confused where to go, to a psychologist or to a psychiatrist, going to a psychiatrist would have its own advantages.
Dr. Aakash Ponda (50:21.93)
Right? And definitely the other way around as well. A psychiatrist can then tell, you know, there a lot of therapies, there's, you know, general counseling and talk therapy, a lot of specific therapies, like CPT, DPT, lot of thousands of therapies, which we are definitely trained about. Right? So we can definitely tell the psychologist.
Nazneen Kachwala (50:50.623)
Okay.
Dr. Aakash Ponda (50:50.882)
that you know this person needs this therapy and this may be the diagnosis and for psycho diagnostic approaches, various testings the psychologist can also pitch in and out so joint approach is always better so any center which has a psychiatrist and a psychologist both together in that same campus may be you know a safer way to approach things
Nazneen Kachwala (51:07.307)
Alright.
Nazneen Kachwala (51:17.273)
Got it. Okay. All right. And one question that was also coming to my mind while we were talking is that you said that if a person faces or observes any kind of changes in the mood and especially that's like on the sadder side, right? Is like if a person is becoming very happy more than usual, can that also be considered depression?
Dr. Aakash Ponda (51:44.942)
So, instability, right? If unusual happiness, lot of excessive happiness with irritability also going hand in hand, getting very irritable and very very ecstatic about a lot of things. That may be a sign of mania as well. So that is bipolarity which is also a mood disorder where there
Dr. Aakash Ponda (52:14.218)
different phases of bipolar depression as well as mania. Hypomania also may be a part of bipolarity as well. know, diagnosing that is gets very difficult at times because you know, if person is very happy, no one will take them to a psychiatrist. They'll just think that it is just a phase, but it may get very worse very, very quickly. know, catching those symptoms very early
Nazneen Kachwala (52:40.619)
Okay.
Nazneen Kachwala (52:46.174)
Okay, okay. And in your experience, how common is this problem of postpartum depression in our society?
Dr. Aakash Ponda (52:56.782)
So patients do come to the OPT with postpartum depression but because of the lack of knowledge about postpartum depression why do they turn up to the OPT? The symptoms are mainly I can't sleep properly. They'll just say that I can't sleep properly. They'll just say that even if I wish to sleep I can't sleep and the husband will say that they're not taking care of the baby properly. That's
Nazneen Kachwala (53:14.914)
Okay.
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