There is probably no question I am asked more often by moms suffering from perinatal mood or anxiety disorders than "How long will it take for me to get better?" Suffering moms are seeking the exact date when the box will be delivered to their door with their old self inside of it.
"Is it 4 months? 6 months? I heard so-and-so got better by 5 months postpartum, and I'm 10 months postpartum and I'm still miserable, so does this mean I'm a lost cause?"
I actually looked this up in my library of PPD books, and searched online, and couldn't find a single citation of the exact amount of time it takes to recover from postpartum depression and related illnesses. That's because there isn't one! There are many different variables affecting how long it takes each person to get better.
This installment of the Postpartum Progress Six Things series will address six things that can affect your length of recovery from postpartum depression and other mental illnesses related to childbirth. I am hopeful that, armed with this information, you will be able to have a smoother road to recovery.
1. How long did you suffer from PPD before you reached out for treatment?
Most moms with postpartum depression will fully recover, especially if the illness is diagnosed and treated early. It stands to reason that the longer you wait to get help, the longer it may take for you to get better. Recent research found that the rapid remission of depressive symptoms is the most important predictor for the favorable long-term outcome of a depressive episode. (Scadoczky et al, Journal of Affective Disorders, 2004) In simpler words, the quicker you are treated, and the more effective the treatment is, the better result. Why wait to reach out for help when it may only prolong your misery?
2. How severe is your illness?
The more severe your postpartum depression symptoms, the longer it may take for you to get better. A 2002 study found that more severe depression was associated with a decreased likelihood of early recovery. (Meyers et al, Archives of General Psychiatry, 2002) NOTICE, that doesn't say decreased likelihood of recovery, just decreased likelihood of early recovery.
3. How effective is the treatment you have been using?
Some women receive treatment that isn't particularly effective, so their illness doesn't resolve. There are a variety of reasons why this might be the case. There are different kinds of therapies (cognitive behavioral therapy, dialectical behavioral therapy, interpersonal therapy, group therapy, etc.), and different kinds of medications (serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclics, antipsychotics, etc.), different kinds of alternative methods (light therapy, exercise, etc.) and even different kinds of support groups (new mom groups, PPD groups that allow moms to bring their babies, PPD groups that don't allow babies, freewheeling groups and groups with specific agendas at each meeting). It has been proved time and time again that, in the arena of mental health, what works for one person does not always work for another.
In the book "This Isn't What I Expected", Karen Kleiman writes "If you haven't met your goals or if you are actually getting worse instead of better, it is time to consider a change in treatment or a consultation ..." If what you've been doing isn't working, work with your healthcare professional to try something different. Don't give up.
By the way, some people actually have treatment-resistant depression. According to the Mayo Clinic, you may have treatment-depression if standard treatments don't help much or don't help at all. It can be caused by significant emotional stress, not taking medications exactly as prescribed, or other underlying health problems you may have like thyroid disorder, heart problems or substance abuse. Another possibility, if you happen to be on meds, is that your body metabolizes medication more quickly or more slowly than most people. The Mayo Clinic states that you should make sure you're being treated by a mental health professional (not just your regular doctor), be patient and be willing to try different methods of treatment. This may include different types of therapy, different medications, trying a sleep and exercise program, or newer treatments like vagus nerve stimulation or trans-cranial magnetic stimulation.
4. How effective is the doctor or therapist you are working with?
We sometimes make the mistake of assuming the people in the "white coats" know more than we do, so we go along and don't speak up for ourselves when we know we aren't getting better despite following the treatment recommendations. It could be that the doctor you're working with has limited knowledge and experience in the area of perinatal mental health, and has already tried whatever method they know how to use. If you're in therapy, perhaps the method they are using just doesn't work for you or fit your personality. If you're on medication, perhaps they've given you a sub-therapeutic dose, or something that has side effects that are hindering you, or something that flat out doesn't work for you. This may be because they aren't psychiatric specialists, or because they don't know enough about the medications. Or, perhaps you are in a support group that just doesn't make you feel comfortable or supported.
You MUSTspeak up about how you're feeling and how the treatment plan you are on is, or is not, affecting your symptoms. You must talk about how you feel in the doctor's or therapist's office and whether you feel you are being heard and understood. If the healthcare professional you're working with isn't willing to try something else or isn't willing to listen to you, there is another out there who will. Again, Kleiman writes "Treatment failure is not necessarily the fault of the therapist [or doctor]. 'Good' therapists often need to change treatment modalities or consider new options when [the treatment] doesn't have the desired outcome."
Sometimes, though, you may have just gone to the wrong person. That's okay. You have every right to make a change. If you are looking for specialists in the treatment of perinatal mood and anxiety disorders, you can click here, here and here.
5. What is your current life situation and how may it be affecting your recovery?
Getting professional help is crucial, but your doctor or therapist can't come home with you and ensure that your environment is the right one for recovery. If you are in a situation where the people around you are not supportive this may well slow down your process. If your partner, for instance, doesn't believe postpartum depression or anxiety or psychosis are real, or isn't willing to help you get the right amount of sleep or give you help around the house, the resulting stress of that can make it harder for you to get better. A study on the role of support from family and friends in recovery from major depression found that emotional support is significantly associated with depression outcome. (Nasser, Acta Scandinavia Psyciatrica, 2004)
As much as you can, reach out to those who are supportive when you need to talk. Ask your most reliable and encouraging family members or friends to pitch in, or maybe reach out to a local moms group or PPD support group for help. If you can't find local help, you can at least find virtual emotional support from people who know what you're going through here at Postpartum Progress or at places like the Online PPD Support Group or Postpartum Support International.
6. What have you been doing to follow your treatment plan and take care of yourself?
In the end, no doctor can make you show up for appointments. Therapy will fail if you don't open up to your therapist and aren't willing to try some of the coping techniques your counselor suggests you try. No medication will work if you don't take it. No support group will help if you don't attend. Poor sleep and lack of nutrition can prevent anybody from being healthy. Remember that you need to take a key role in your recovery process. I know it's hard. I know you feel like crap. I also know that you can dig deep down and do this. Taking care of yourself and making your health a priority is the best gift you can give to both you and your baby.
One final note: Once you start to feel better, and you will, the Mayo Clinic suggests that "It's important to continue treatment after you begin to feel better ... Stopping treatment too early may only lead to a relapse."
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