Interview with Ryan Walker, PA | Psychiatrist

Please share your Professional Background. I initially studied law and started practicing but I wasn’t passionate about it. Studied physician assistant PA and specialized in psychiatry in Western Massachusetts. I have been practicing with Elevate psychiatry since. 

How long has Carolina been your patient? For about 3 months. Since May 2021. 

What is Carolina’s diagnosis? Postpartum depression 

What medications is she currently taking? Duloxetine 60 mg and Olanzapina 7.5 mgs which is pretty much the mid range of the dosage. 

What type of clients do you work with? I exclusively see adults (18 to 90 years old). I see a wide range of patients of diverse income levels and different psychiatric illnesses and disorders. From regular disorders to more complex patients. 

What experience do you have with postpartum depression? At any given time I see about 5 patients with postpartum depression whom I see every 2-4 weeks for medication management. 

When do you recommend for people to seek help? As soon as possible. With the earliest onset of signs of feeling depression or symptoms. There is an online assessment – Edinburgh postnatal depression scale – that people can do. 

I highly recommend reaching out to a professional in order to avoid long and short term negative effects on parents and child. Ppd can decrease time of breastfeeding and bond of mother and child for example. 

Long term cognitive mental health of child can include effects such as a decrease in language development, an increase probability in levels of anxiety and depression in children. 

What is the therapy plan recommended for postpartum depression cases? Generally antidepressants we like to use as they tend to be safer with breastfeeding. SSRIs like zoloft. SNRIs (one of meds I’m taking) that is effective and minimally passes to breastmilk. Another one we like to use is wellbutrin. They are effective and safe for child as well. 

  • > I was told at the Mercy hospital psychiatric unit that my medications were not safe for breastfeeding so I was throwing away the pumped milk and weaned off days after being hospitalized. I was sad about this as breastfeeding has always been important for me and I was really proud of reaching 8 months and Emma growing healthily although the last pediatrician visit she hadn’t increased as much weight as the Doctor wanted to see. I feel that that visit and conversation was an offset to my emotional whirlwind and the pediatrician was not too sensitive about it. 

What research / statistics do you have on postpartum depression? 

The prevalence in the US of moms that experience postpartum depression is 9-10 % and it’s about 10-16% worldwide. Interestingly to note is that fathers can also go through postpartum depression. Typically moms start feeling signs of depression within a 12 month period following birth but postpartum depression can technically start during the pregnancy. 

Although the exact cause is unknown there are a few factors that can contribute such as genetic susceptibility , hormonal changes people go through and pre existing psychological disorders. The exact cause is still unknown but it is thought to be a multifactorial thing. Nothing with the brain is white and black. 

What are some online resources that people can use? I usually direct people to two main resources. One is more generic and the other is more specific for postpartum. 

The more generic one is: (National Alliance on Mental Illness) that has easy to understand information that is accurate, non stigmatized and unbiased that also has support groups by state. 

Specific for postpartum disorders is: with information and local support groups that people can access.

What signs and symptoms should people be looking for? Depression has a lot of physical and cognitive symptoms. Physical symptoms are sometimes harder to notice as they include symptoms such as fatigue, which most moms will be feeling or noticing anyways. Mood symptoms include a fancy way of saying feeling down, anhedonia which is another fancy way of the feeling of not finding joy in things you normally like to do, feelings of worthlessness or guilt, decrease concentration and decision making (Carolina and I speak a lot about this one). Suicidal thoughts or ideations. If you feel even one of those you should reach out to your primary Doctor, OBGYN or Psychiatrist to get screened.

Therapy is also very helpful. Ideally treatment would include both therapy and medication but doing one or the other is better than nothing.

  • of context to this post. I saw Ryan about two weeks after being hospitalized. I will write a post about deciding on my psychiatrist as I saw two simultaneously after leaving the Hospital. One was recommended by my family and is highly experienced in postpartum depression and is an ex OBGYN in Argentina. Ryan was recommended by a colleague of Richards and his group is also covered by our insurance. For full disclosure, psychiatrist visits in the US can range from $150 to $400 per session without insurance.

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