Tuesday, January 17, 2012

The Family Connection- what about the rest of us?

     Often, when a new mother is suffering with PPD, she has a great support system of family, friends, and professionals.  This is ideal.  However, sometimes her partner is left feeling out in the cold.  He suddenly has this new partner that he doesn't recognize or understand.  He can wonder, "will I ever have my wife back?"  We all expect that a new baby will bring certain changes.  Often, though, we are unprepared for the actual changes that come with pregnancy and childbirth.
     It is common for a man to feel that he needs to help, and wants to fix the problem.  While this is a normal reaction, it is important to remember that this is not something he is capable of fixing.  The best thing he can do is to offer support.  Common mistakes that a partner can make in this situation are to expect his wife to just "snap out of it," to tell her she has so much to be thankful for, why is she so upset?  Or to tell her things like, "you know what your problem is...?"- these kinds of statements imply that his partner has control over how she is feeling, which people who are clinically depressed do not, and they also imply that the depression is somehow her fault, which of course, it is not.
     The best thing a partner can do in this situation is to just support his wife and their new baby.  Try not to have any expectations.  Try to understand that she is not feeling like this on purpose, and there is nothing that can be done in the immediate future to bring her out of it.  Hopefully, she has a therapist that she is seeing, and perhaps as her partner, you could also see the same therapist, who could help to provide some understanding of how the new mother is feeling.
     Understand that she may not be getting the rest that she needs, so any time that the mother has opportunity for rest or sleep, she should be taking it.  Work around the house can either wait for later, or be done by the husband or someone else.  Cooking is not something that she may be capable of, so ordering out for a while may be a solution.  Shopping can be done by the partner or family members.
     The biggest thing that a partner needs to remember is to be patient.  This is a temporary situation.  Eventually, with help from friends and family and professionals (and perhaps medication), he will begin to recognize his partner again.  PPD is not a permanent condition.  Patience, support, acceptance, and love will go a long way toward helping a new mother heal from depression.

Checklist- Could this be happening to me?

     Some symptoms of depression, like sadness, are obvious.  Most people think of a depressed person as being sad.  But what about a person who isn't sleeping?  Or who can't seem to stop moving?  Would they typically be looked at as a depressed person?  How about a person who is detached, argumentative, or who has lost a lot of weight suddenly?  In my case, I did not fit what my Obstetrician thought of as "depressed," so she did not think I had a problem.  Awareness is something that is so important, not just for the OB/GYN, but nursing staff, family members, and friends.  I have included a checklist of symptoms taken from several sources in hopes of increasing self-awareness of depression.

1) Do you feel more tired than usual?

2) Are you crying often, seemingly for no apparent reason?

3) Do you notice that you are having trouble concentrating?

4) Have you lost interest in things that used to make you happy?

5) Do you feel guilty?

6)  Do you feel anxious, or panicky?

7) Are you feeling bonded to your baby?

8) Are you having recurring nightmares, or flashbacks?

9) Do you feel anger toward the baby, your partner, or family members?

10)  Are you calling the pediatrician often, yet not being reassured by his or her advice?

11)  Do you feel restless?

12)  Are you unable to sleep, or are you sleeping more than usual?

13)  Do you have recurring, intrusive thoughts about harming your baby, or of some kind of harm coming to your baby?

14)  Do you find that you are having exaggerated high or low moods?

15)  Are you uninterested in sex?

16)  Have you noticed intense anxiety or fear, rapid heart rate, shaking, or dizziness?

17)  Are you avoiding certain places, television programs, news, or situations in order to avoid intrusive thoughts of feelings?

18)  Are you very preoccupied with thoughts of germs or cleanliness?

19)  Do you feel restless, unable to relax?

20)  Do you feel a sense of emptiness or despair?

Any of the above symptoms are cause for further evaluation.  If you or a family member or friend has just had a baby, or had a baby in the last year (people tend to think of PPD as happening immediately after birth, but often, it shows up later, sometimes as late as many months or a year after the birth), and if any of the above sound familiar, please check into it further.  I have included links to local organizations that have referrals to therapists who specialize in PPD.  Another alternative is to ask your healthcare provider, whether you see an OB/GYN or a midwife, this person should have a list of therapists in the area that specialize in PPD, and should be able to refer you to someone who can help.

Saturday, January 14, 2012

What's the Alternative?

     Once I started on medication, I felt much better.  Therapy was going well, I was learning tools to keep myself feeling better, and I was taking good care of myself.  I started to wonder if I really needed the medication at all.  As a result of my hospital experience, I was not enthusiastic about doctors or medication.  I have always been interested in natural health, and I started to research alternative methods of dealing with postpartum depression.
     One website that I had discovered over the first year in dealing with PPD was Mothering.com.  Mothering also used to be a magazine, but they have switched completely to an online format.  There is a forum section that has open discussions on everything from finding a pediatrician or food co-op in your area to vaccines, postpartum depression and PTSD, to pets and poetry.  I found the mental health forum to be very helpful.
     It was here that I started researching alternative ways to deal with depression.  Fish oil was something that I discovered very early on, and started taking right away, with the blessing of my doctor even while I was taking the zoloft.  I noticed a big difference in my ability to deal with stress after taking the fish oil.  I started with 1000 mg a day, and slowly went up to 2000.  I stopped there, but many people will take 3000 mg or more.  Fish oil does have blood thinning effects, though, and it should not be taking close to any surgeries.
     Another supplement with which I had success was vitamin B complex.  Vitamin B is very helpful for any type of stress.  It helps with anxiety, depression, and low energy.  One has to be careful not to take it late in the day, though, or insomnia may be a problem.
     Something else that anyone who is suffering from PPD should do is to get their thyroid and progesterone levels checked.  Pregnancy, especially from the second pregnancy on, can deplete the thyroid.  Also, pregnancy and breastfeeding have an effect on progesterone levels.  This is something that should be checked as a matter of routine, even before starting antidepressants for PPD.
     St. John's Wort is also a very popular supplement for depression.  It should never be taken concurrently with antidepressants, though, due to the danger of something called serotonin syndrome.  Too much serotonin in the body can cause problems, even death.  One needs to be careful when taking drugs that increase serotonin.  Only take ONE serotonin enhancing drug at a time.  If taking an ssri, do not start St. John's Wort, and vice versa.
     Exercise, though not really considered an "alternative" therapy, is something that increases overall wellbeing, energy, and mood.  Regular physical activity is an effective weapon against depression.  The problem with it is that someone who is depressed often does not have the motivation to get themselves moving.  This is why the "light in the room" effect of medication is so helpful for many people.
     Acupuncture is another alternative that many women choose, and it has been proven to be helpful in some cases.  The thinking with acupuncture being that it opens up energy pathways in the body and brain, allowing life energy to flow more easily and the person is able to function better.  I did try acupuncture, and I was amazed at the effect on my energy level after treatment.
     Reiki is a form of energy healing that is also very effective, based on my personal experience.  In Reiki, the practitioner uses their hands to bring good energy to the patient, feeling for places that need a change of energy and allowing positive healing energy to flow through them, in to the patient.  I have had several Reiki sessions and found them to be very beneficial.  There have been studies done in hospital settings that show that surgery patients heal better when Reiki is included as part of their recovery.
     There is also a form of Yoga, called Life Force Yoga, that is proven to help with mild to moderate depression, anxiety, and perimenopausal mood changes.  I have included a link on the Helpful Links page to a practitioner of Life Force Yoga in the Chicagoland area.  Yoga appeals to me for so many reasons, and it has been something I have used in my recovery from PPD as well as for overall wellness.

Tuesday, January 10, 2012

Helpful Resources

Bennett, S. Ph.D., & Indman, P., Ed.D., MFT (2006). Beyond the Blues, A Guide to Understanding and Treating Prenatal and Postpartum Depression. San Jose, CA: Moodswings Press.
Briggs, G., Freeman, R., & Yafee, S. (1998). Drugs in Pregnancy and Lactation (5th ed.).
Baltimore: Williams and Wilkins.
Dalton, K. (2001). Depression after Childbirth (4th ed.). New York: Oxford University Press.
Hale, T.W. (2004). Medications and Mothers' Milk (11th ed.). Amarillo, TX: Pharmasoft Publishing, LP.
Misri, S. (2002). Shouldn't I Be Happy: Emotional Problems of Pregnant and Postpartum Women. New York: The Free Press.
O'Hara, M. et al. (1995). Postpartum Depression: Causes and Consequences. New York: Springer-Verlag.
Placksin, S. (2000). Mothering the New Mother: Women's Feelings and Needs After Childbirth, a Support and Resource Guide. New York: Newmarket Press.
Raskin, V., M.D. (1997). When Words Aren't Enough: The Women's Prescription for Depression and Anxiety. New York: Broadway Books.
Reiss, U., M.D., & Reiss, Y. (2004). How to Make a New Mother Happy: A Doctor's Guide to Solving Her Most Common Problems – Quickly and Effectively. San Francisco, CA: Chronicle Books.
Rosenberg, R., M.D., Greening, D., Ph.D., & Windell, J., M.A. (2004). Conquering Postpartum Depression. Cambridge, MA: Da Capo Press.
Sebastian, L. (1998). Overcoming Postpartum Depression and Anxiety. Omaha, NE: Addicus Books.
Venis, Joyce A., & McCloskey Suzanne (2007). Postpartum Depression: An Essential Guide for Understanding and Overcoming the Most Common Complication after Childbirth. New York: Marlowe & Company.

Wednesday, December 28, 2011

Medication- a light in a dark room.

     When I was originally diagnosed with PPD and PTSD, the option of medication was introduced.  I had never considered taking any kind of psychiatric medication, and the thought of it was not attractive to me.  I had found my therapist and trusted her implicitly.  I knew that if I was going to get through this, part of the control was going to have to be handed over to someone else.  I was not going to be able to find my way out of this on my own.
     My biggest concern was not for myself- I was worried about how medication would affect my baby.  I was nursing and planned to continue to do so.  Although my doctors assured me that medication was perfectly safe while breastfeeding, I had begun to question medicine completely after the experience I had when Hayden was born.
     I went to therapy for about 2 or 3 months, without medication.  I did make some progress, but I was having a great deal of trouble following through with a lot of my homework.  The therapy was Cognitive Behavioral Therapy- also known as CBT- a type of therapy that involves doing things that might be uncomfortable in order to change thought patterns.  In my case, this involved things like going out in public with my baby- I was terrified of him getting sick so for the most part, we stayed at home.  I was also supposed to be doing some sort of exercise- exercise has been proven to be just as effective as an antidepressant in mild cases of depression- but I could not find the motivation.  I was supposed to be sticking to some kind of routine during the day, but had trouble following through.  I felt tired all the time, but I wasn't sleeping.  I had physical pain that did not have any medical origin.  I had nightmares and constant anxiety.  It became painfully clear to me that I may have to try the medication in order to function.
     After doing a great deal of research on websites like Mothering.com and Kellymom.com, and reading Dr. Hale's book, Medication and Mother's Milk, I decided to give the medication a try.  In my case, the medication was Zoloft, a selective serotonin re-uptake inhibitor, or ssri.  After two weeks or so, I was convinced that the medication was not working.  I didn't really feel any different.  Then one day, I realized that Hayden had started smiling at me a lot.  I thought, "well, isn't this interesting- he must be going through some new stage in development where he smiles a lot."  And then it hit me- he was smiling BACK at me.  I noticed that things that had caused me so much anxiety all of a sudden did not seem like such a big deal.  I found myself thinking- now what was I so upset about?  I was sleeping, and the mysterious pains were gone.
     The best way I can describe the feeling of taking medication when you truly need it for depression is this.  Imagine you are in a dark room, a room in which you have never been before.  There is furniture, but you aren't familiar with the placement.  You don't even know where the door is in relation to where you stand.  You fumble around, trying to feel your way out of the room.  You trip over furniture, you stub your toe.  You sit down in the middle of the room in frustration, defeated.
     Taking medication is like turning on the light in that room.  All of a sudden, you can see things for what they are.  You have the ability to work your way toward the door.  It might still be difficult to get there due to the obstacles that are present, but you are able to get there because you have the right tool.  Medication is a great tool to have in your arsenal to help you find your way out of depression.

Tuesday, December 27, 2011

Helpful links

http://www.drsarahallen.com/- a therapist in Northern Illinois, specializing in PPD and PTSD following childbirth.

http://www.ppdil.org/symptoms-of-PPMDs.html- Illinois Postpartum Alliance, information on therapists, resources, and symptoms.

www.postpartum.net- a great general resource about PPD.

www.postpartumdads.org- for the dads affected by PPD.

www.birthtraumaassociation.org.uk- birth trauma website, information on PPD and PTSD following childbirth.

Kellymom.com- information on all things mothering, nursing, and medication.  Includes a section on drugs and their safety during pregnancy/breastfeeding.

Mothering.com- a natural living online magazine, and a forum for mothers to discuss natural family living.  Includes a discussion forum on mental health and postpartum depression.

http://www.moodcure.com/- information on natural treatment for depression and anxiety.

http://center4cby.com/birth-parenting-news-anxiety-disorders-in-pregnancy-and-the-postpartum-- period.html- information on anxiety disorders after pregnancy.  I found this one especially helpful.

http://www.prapsych.com/clinicians.htm  - Link to a group of therapists and psychiatrists with locations in Schaumburg, Vernon Hills, and Crystal Lake, IL.  For those more interested in an alternative to medication and traditional therapy, Dr. Janeen Paul at this practice is certified in Life Force Yoga, which is a form of yoga that is useful in treating mild to moderate depression.

http://postpartumprogress.com/fact-checking-the-postpartum-depression-doubters-pills-are-the-easy-way-out - this is a blog article that I found.  I felt it was very useful and helpful in helping new moms facing the choice of whether or not to take medicine for their depression, and it answers back many of the critics of depression medication.

Who, me?

     My first child was born in 2005.  My husband and I had waited for so many years to get pregnant, and had lost two pregnancies already.  We wanted children so badly, and in fact had been researching adoption at the time I became pregnant.
     I was on bedrest for the last third of the pregnancy, due to preeclampsia, which is a condition in which a pregnant woman's blood pressure reaches dangerously high levels. On the day of my 38 week well visit, it was discovered that my blood pressure was 160/100.  My doctor announced that I was being induced that day.  Immediately.
     "I left the coffee machine on.  I am completely unprepared.  I have no bag packed.  I have no birth plan.  I have two more weeks!"  The thoughts were racing through my mind.
     I was admitted and induced.  My labor lasted for approximately 30 hours.  I was attached to a monitor that was broken (which we did not learn until later).  They did not see contractions on the monitor, and even though I was screaming in pain, the nurse insisted that I was not having contractions.  They kept turning up the dose of pitocin.  Even through the epidural, I could feel the pain.  It was excruciating.  I wanted to die.  I hoped for death.  I should have been more careful what I was wishing for.
     After pushing for 3 hours with no progress, I was taken in for a C section.  I was shaking so badly from all of the pitocin that the doctor could not see what she was doing.  She could not get the baby out because he was so stuck from 3 hours of hard pushing.  She was pulling him so hard that my hips were coming up off the table.  That is the last thing I remember.  They put me under general anesthesia in the middle of the surgery.
     I found out later that I nearly died.  I lost so much blood during the surgery that I needed a blood transfusion.  My son, who they brought to me as soon as I was conscious, could not nurse.  He threw up green bile every time I tried to feed him.  He cried and could not be consoled.  They took him away to the NICU and I didn't see him for a couple of days.  No one would tell me what was wrong with him.  They couldn't because they didn't know.  I found out later that on the third day of his life, he passed his meconium.  It was about 6 inches long and solid.  He had basically had an intestinal blockage for the first 3 days and could not nurse because it hurt.  I had a neonatologist from Children's Hospital in Chicago that could not figure out that this baby had not pooped and that is why he wasn't eating.  Any mother in the world could have told her all she needed to do was give him a suppository or take his temperature rectally.  Anyone with common sense could have figured that out.  But Dr. Wonderful had him on two different IV antibiotics, she was taking abdominal x rays, she gave him a feeding tube through which they were feeding him formula- the last thing on earth that I wanted.  She had no regard for my wishes as a mother and used my new baby as a science experiment.  I had no control.  Or so I thought at the time.
     It took me a couple of days to recover from my surgery and the blood loss that accompanied it.  Once my head was clear, I walked in to the NICU at that hospital and fired my son's doctor.  I took him home that day, and that, not the day I gave birth, was the day I became a mother.
     I realize now that mistakes were made.  I know now that a lot of what happened when my son was born was hospital error followed by hospital covering their collective rear ends.  A doctor I spoke to about the experience later called it "defensive medicine."  I know now that I had the power all along to refuse any treatment that they wanted to give him, that as his mother *I* make the decisions.
     A year passed, and what a wonderful year it was.  Except for the worry.  Except for not sleeping.  Except for the flashbacks to the birth and the nightmares about a nurse telling me my son was not going to make it.  It was not until my son was a year old that I found a therapist who could tell me what was wrong.  It was Postpartum Depression- PPD.  And Post Traumatic Stress Disorder- PTSD.  And so begins my journey.  So begins the rebirth from PPD.  I hope that my story and my research can be helpful to new moms and dads.