Canada

Psychiatrist breaks the taboo about perinatal depression and anxiety

Dr. Vi Nguyen is researching mental health during pregnancy and postpartum. After she gave birth to a son, she experienced the issue first-hand.

Lionel Ducharme, 2 1/2. with his mother, Dr. Vi Nguyen. Nguyen is a reproductive psychiatrist concerned with the mental health of women around issues of pregnancy and childbirth.

Dr. Vi Nguyen understands more than most about perinatal depression and anxiety.

As a reproductive psychiatrist at the McGill University Health Centre, she specializes in diagnosing and supporting women with depression and anxiety related to pregnancy, childbirth and the postpartum period; as a clinician-researcher, her research includes developing screening tools for it.

None of this shielded her from the depression that affected her during pregnancy and that took hold more strongly several months after the birth of her son, now 2½.

The pregnancy had not come easily. Nguyen had a miscarriage. There were infertility treatments, with all the mood fluctuations that accompany them.

“I have always been a Type A personality, working a lot and liking to have control over my life. But that mentality played against me during the whole fertility and procreation issue, when you have to let go, to be flexible.”

When she became pregnant, “I experienced a lot of anxiety and feelings of claustrophobia,” Nguyen recalled. There were the physical restrictions — giving up running, watching her diet — but there was more. “It’s the psychological burden of having to be careful. Yes, it is a meaningful burden, but it is still a burden.”

Having anticipated that early pregnancy would be difficult, she was followed closely by a psychotherapist and had a lot of help from family. “I feel like I got the help I needed,” she said.

“The pregnancy and immediate postpartum period was as hard as I expected it to be, but I was prepared. The return to work phase I was not prepared for.”

Vi Nguyen and Simon Ducharme with their 2 1/2-year-old son, Lionel Ducharme. at home on Thursday June 17, 2021.
Vi Nguyen and Simon Ducharme with their 2 1/2-year-old son, Lionel Ducharme. at home on Thursday June 17, 2021. Photo by Pierre Obendrauf /Montreal Gazette

About nine months after giving birth, Nguyen “really hit a wall.”

“We were co-sleeping and there was my son’s crying as we did the sleep training, arranging daycare, trying to go back to the life of a clinician-researcher, which is really two jobs, and trying to be a mother.”

Before giving birth, she had anticipated returning to work quickly. “But every mother is different: I realized I wanted to spend time with my child — and that is not compatible with the demands of the 21st century, being an MD and having a husband who is also a clinician-researcher.”

Ultimately Nguyen delayed returning to work by several months; she and her husband, a psychiatrist and clinician-researcher like her, had couples psychotherapy. She started anti-depressant medication. She continued her research while on maternity leave but started seeing patients again only in January. She is returning to work progressively but says she doesn’t want to go back full-time.

An estimated one Canadian woman in five experiences perinatal depression and anxiety — more during the COVID-19 pandemic. Yet it remains a taboo topic, said Nguyen, 38: it’s to help break that taboo that she chose to share her story.

“What I went through is a common, rather than unusual, experience, and I think a lot of women talk about it if you give them the space to talk about it,” she said. “I know not everybody is as open as I am. But how is that helpful, to deny what we have?

“Becoming a mother, I think you have to find your own way. Use labels if they help you: Depression is just another word for pain.”

It’s normal for new parents to have fears, Nguyen said, but “if your worries are keeping you from functioning, it’s time to get help. This is true for new moms and it is also true for their spouses.”

Vi Nguyen is returning to work progressively, more than two years after the birth of son Lionel, but says she doesn’t want to go back full-time.
Vi Nguyen is returning to work progressively, more than two years after the birth of son Lionel, but says she doesn’t want to go back full-time. Photo by Pierre Obendrauf /Montreal Gazette

She is involved in two large-scale studies to measure mental health and other parameters during pregnancy and postpartum, and in two studies on partners and their mental health. Her research is supported by the Montreal General Hospital Foundation, in part with funds raised each summer during the Pharmaprix Run for Women.

A protocol Nguyen developed for mental-health screening and referral has been implemented for patients in the MUHC high-risk obstetrics clinic. (Patients are considered high-risk for reasons including age, fertility issues or a history of miscarriage.)

Women determined to be at low risk for anxiety and depression are referred to online resources; those at moderate risk are referred to their family doctor or to group therapy; those deemed high risk are referred to psychiatry.

“The resources are there, but they are disorganized,” Nguyen said. “What we need is more organization and more harmonization of services.

“There are women out there not getting help: The whole purpose of the run and all these initiatives is to get these women help. The reality is that the healthcare system is not nimble enough to respond to the needs of pregnancy and postpartum.”

Findings of a survey of 435 health and social service practitioners unveiled at a recent symposium of the Canadian Perinatal Mental Health Collaborative Nguyen helped to plan showed nearly all believe a national perinatal mental health strategy is needed to address gaps in screening and treatment.

“For me, part of being a psychiatrist includes this advocacy component,” she said.

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