Postpartum Progress

Top 10 Stories on Postpartum Depression in 2009

While everyone is off having hot cocoa and unwrapping presents and unstuffing stockings and eating candy canes and lighting candles and blowing horns and drinking champagne, I thought I'd share the top ten posts from Postpartum Progress in 2009.  These were selected based on the number of comments received, trackbacks (links to other blogs), retweets from Twitter and requests for reprinting that I received.  Here you go everybody:

Top Ten Stories on Postpartum Depression, Postpartum Anxiety & Postpartum Psychosis in 2009

1. The Symptoms of Postpartum Depression & Anxiety (In Plain Mama English)

2. From Boob to Bottle: Postpartum Depression & the Unnecessary Shame of Quitting Breastfeeding

3. What Is the Difference Between Grief & Depression After Pregnancy Loss?

4. Six Things That Can Affect How Quickly You'll Recover from Postpartum Depression

5. An Open Letter to Time Magazine About Postpartum Depression

6. How to Decide Whether to Take Meds for Depression or Anxiety During Pregnancy

7. No Judgment Allowed When It Comes to PPD Treatment: What Saves One Woman May Not Save Another

8. All of the posts written by participants of The Mother's Day Rally for Moms' Mental Health

9. Six Things to Avoid if You Have Postpartum Depression or Anxiety

10. ABC Television Should Be Ashamed of "Private Practice" Postpartum Psychosis Treatment

What was your favorite story this year?
 

New Poll: What Were Your Symptoms of Postpartum Depression/Anxiety?

I'm trying something new today.  If you look on the right hand side of your screen and scroll down you  will see a poll on the symptoms of postpartum depression and anxiety.  I've been thinking of adding polls to Postpartum Progress since people seem to like them so much.  But I'm not sure if I want to do these because I think having the poll in my sidebar also makes my site take a lot longer to load. 

What do you think?  Like the idea?  Want to see what other people think about certain topics?  Or would you prefer to have less clutter and a quicker loading time for the home page?  Let me know.

Getting Through the Holidays with Postpartum Depression or Anxiety

For those of you struggling with postpartum depression or anxiety right now, I can only imagine the pressure you are feeling about the holidays. 

I suffered from postpartum OCD all through the holidays in 2001 -- Halloween, Thanksgiving and Christmas -- since my son was born in September.   To tell you the truth, I don't remember much of it.  All I can remember is having to take my son out of his special outfit on Christmas day because he had a diaper blowout within 5 minutes of putting it on.  No memories of what we gave him for gifts.  I don't think we even have pics of that day.

Therese Borchard of Beyond Blue, in partnership with ShareWIK, has put together a 4-minute video about getting through this season while suffering from mental illness.  I think it is wonderful, and gives you permission to be who you are, where you are, during this time, as well as tips on how to get through it. Her husband appears in it as well.  Watch it, with your spouse or partner if you can.

Update: Wendy McDowell also sent in this link with tips on coping during the holidays.

5 Things Dads Can Do to Understand & Help with Postpartum Depression or Anxiety

I'm very excited to share with you that I have been asked to blog a bit on the topic of postpartum depression over on PBS' "This Emotional Life" website. 

My first post is now up.  I'm going to give you a taste of the post here, called "5 Things Dads Can Do to Understand & Help with Postpartum Depression & Anxiety", but then you have to go over to the PBS site to get the rest of it.  Here you go:

You’ve become a dad.  You are thrilled about having this brand new baby in your life, even though you are exhausted and more than a little nervous about figuring out how to properly raise another human being.   You knew this would be a challenge, but you’ve hit a major, unexpected obstacle.  Something is not right with mom.  

Perhaps you can’t exactly put your finger on it, but you know she’s not acting like you thought she would.  Maybe she seems sad all the time and can’t stop crying.  Maybe she keeps saying she’s not a good mom even though you tell her over and over again that she’s doing just fine.  Maybe she’s really angry with you all the time now, or she’s worrying nonstop and can’t relax. 

You are probably unsure whether to make a big deal out of this since it could just be the baby blues.  You don’t want to scare her.  Perhaps this will simply go away with time.  All you know is that she’s not happy, and now you’re not happy either.   Don’t feel bad if you don’t know what to do about it.  Many dads don’t.  Below are five steps you can take to find out what’s wrong and help both her and yourself.  

1. Learn what the symptoms of postpartum depression and anxiety are.  

The baby blues is a normal adjustment period most new mothers go through in the first two weeks after birth. It is not a mental illness and will go away on its own.  If your wife has just had a baby in the last two weeks and is weepy, or having a difficult time adjusting, that’s fairly normal.  It’s not necessary to call out the cavalry yet. 

Postpartum depression and anxiety, on the other hand, are real illnesses that can arise any time in the first 12 months after a baby is born.  If the two-week baby blues period has passed and your partner has any of the following symptoms for more than a week or so, you should consider reaching out to your healthcare provider:

• Fatigue
• Feelings of guilt, hopelessness and/or being overwhelmed
• Irritability or anger
• Deep sadness; frequent crying
• Changes in eating and sleeping patterns
• Difficulty concentrating or making decisions
• Racing thoughts and/or inability to relax
• Constant worrying
• Scary thoughts that she recognizes are wrong and are very disturbing to her
• Thoughts of suicide or of running away

It’s important to point out that she may not experience all of these symptoms.  Some have only one or two.  Postpartum depression and anxiety are not one-size-fits-all illnesses.   

Note:  Postpartum psychosis, a very rare illness that can arise after childbirth, is distinct from postpartum depression and anxiety.  It often shows up in the first few weeks or even days after a baby is born, and its symptoms include delusions, paranoia and hallucinations (seeing or hearing things that aren’t there).  If your partner exhibits any of these signs, she may not be aware of what is happening to her and her illness could lead her to do things she wouldn’t normally do.  In this case, it is important to call a medical professional right away.

2. Gently tell her about your concerns.

If you feel your partner is suffering from the symptoms above, the next thing to do is talk to her.  Sit down with her and let her know you are worried about her wellbeing.  Focus on the behaviors you’ve seen – crying or inability to sleep, for instance -- as the reasons for your concern.  Encourage her to share with you how she is feeling.  Tell her that whatever she is going through is not a weakness on her part and that you know this is not her fault.

Let her know that, if it turns out she has postpartum depression or anxiety, these illnesses are very common.  In fact, they are the most common complication of childbirth, affecting as many as 20% of all new mothers.  They are temporary and fully treatable with professional help.  

Tell her you will stand by her.  Research shows that emotional support from a spouse is an essential factor in the recovery from postpartum depression.  

3. Start working with her right away to get professional help.

Studies show that the sooner women who have postpartum depression or anxiety are treated, the less negative impact their illness will have on the family.  

Women with postpartum depression and anxiety are often extremely fatigued, scared and ashamed.  This can make it very difficult to ask for professional help.  Assist her with this.  You can easily find out what resources are in your area by visiting Postpartum Support International’s (PSI) support page.  PSI has coordinators in every state who will let you know about local peer support groups, specialists and other resources that may be available.  Give her the phone numbers she needs or offer to make the calls yourself. 

If she is resistant to medical treatment, Families for Depression Awareness makes the following recommendations:

“If the depressed person is reluctant to seek help, then don't try to convince the person that depression is causing the problems. Instead, talk about the depressed person's behaviors and the ways in which treatment can help. For example, after you have listened and sympathized with the depressed person's feelings, try to agree on wellness goals (e.g., consistent sleep and feeling less irritable). Then, try to assign some action steps that you can agree on to reach these goals (e.g., after two weeks, if the person does not improve, you will set up a medical evaluation).”

If you want to know what #4 and #5 are, you'll have to click here now!!!!!!  And if you want to watch "This Emotional Life" PBS, be sure to tune in on January 4 to watch the 3-part series.  Oh, and here's my bio on the PBS site.  So cool!

Also, for another piece on dads helping with postpartum depression, here's one my husband wrote about supporting wives during perinatal mood and anxiety disorders.

Self-Help Methods for Postpartum Depression: What to Watch Out For

Speaking of the alternative treatment methods for postpartum depression I wrote about yesterday, I forgot to mention the endless self-help gurus who sell you their wares as the key to getting a fulfilled life, happiness, the perfect weight, the perfect husband and a great car.  I was reminded of these by a new story on CNN.com by Jason Hanna called "Good, Bad and Ugly Self-Help: How Can You Tell?".

"Self-help is a multibillion-dollar-a-year unregulated industry in the United States, according to John C. Norcross, professor of psychology at the University of Scranton.

Norcross says hundreds of quality, research-supported self-help programs on career growth, health and self-esteem exist. But he and other critics say some gurus, promising secrets to greater happiness and wealth, offer advice that at best isn't proven effective and at worst could send someone down a poorly suited or dangerous path."

I was fooled into buying the book "The Secret" by Rhonda Byrne after Oprah promoted it so heavily on her show a couple of years back.  Don't get me wrong -- I definitely believe in the power of positive thinking and ridding oneself of hurtful thought processes.  (In fact, here's a story that just came out about the effectiveness of mindfulness on depression and anxiety, based on research.) But when I started seeing the parts of the book where they talk about envisioning the stuff you want and then getting it, when I started seeing how much of the book was about materialism, I got pretty pissed off and threw it out.  Byrne had a kernel of a good idea, in my own little opinion, but then blew it with all the focus on getting things. 

Plus, I worried about the people who have an illness, like, say, postpartum depression.  What if someone believed that just by thinking it away they could get rid of PPD and thus refused any other type of treatment?  Not that the book says to do precisely that, but you could see how people might fall into that line of thinking.  They might blame themselves if they don't get better and fall into an even worse depression.

As Tim Watkin wrote in the Washington Post:

"Still worse is the insidious flip side of Byrne's philosophy: If bad things happen to you, it's all your fault. As surely as your thoughts bring health, wealth and love, they are also responsible for any illness, poverty or misery that comes your way.

That isn't just implied, it's spelled out: 'The only reason why people do not have what they want is because they are thinking more about what they don't want than what they do want.' By this logic, Holocaust victims brought it on themselves, as did those who lost their homes in Hurricane Katrina. Come on, New Orleans, get over it! Think positive!

'Imperfect thoughts are the cause of humanity's ills,' Byrne asserts, in a stunning sentence that had me pondering how to perfect my thoughts, pronto.

Poverty? 'The only reason any person does not have enough money is because they are blocking money from coming to them with their thoughts.'

Illness? 'You cannot 'catch' anything unless you think you can. . . . You are also inviting illness if you are listening to people talking about their illness.' So . . . got any sick friends who need a shoulder to cry on? Tell 'em to bug off!"

I just can't go there.  I don't think I attracted my postpartum OCD, or asked for it, or that it was my fault that it took a while to get over it.  And thank God my friends didn't avoid me in order not to be contaminated with my mental-illness-germ-filled words.

How we think is crucial to our recovery from mental illness.  Having a positive attitude and believing that we WILL get better is key.  We have to eliminate our unhelpful thought processes.  Getting help from professionals is important, but so is taking responsibility for ourselves, and this is where self-care can contribute mightily to getting better.  But it's also important to be aware of those who are more concerned about lining their own pockets than about you as an individual and how best to help you heal. 

Self-help is not wrong or bad.  It's good.  You just need to be wary of the people out there who are selling you a bunch of hooey.  Unfortunately, they're mixed in with the good guys.  The CNN.com article suggests 5 things you should watch out for when considering different self-help therapies.  Check them out.

Related story:  Beyond Blue: Mindfulness Doesn't Mean Anti-Medication

The Faces of Postpartum Depression & Recovery

Thanks to Sara R. and Jennifer L. for sending me their photos for the Surviving & Thriving Mothers Photo Album!  It's an awesome thing to see pictures of smiling faces when I know that not so long ago those same faces were filled with despair.  You both are an inspiration to mothers suffering from postpartum depression, anxiety and psychosis. 

If you are someone who suffered from depression during pregnancy and survived, or from post-adoption depression, please know we want your photos as well!  Send them to me at stonecallis@msn.com!

The Symptoms of Postpartum Depression & Anxiety (In Plain Mama English)

What does it feel like to have postpartum depression or postpartum anxiety?  What are the symptoms?  How do you know when you have it? 

I thought we'd have a talk today about the signs of postpartum depression and anxiety, and we'd do it in "plain mama English".  We won't use words like hypomania or dysthymia or suicidality or psychomotor agitation.  We will use the words we hear in our heads when we think about what the hell is happening to us ...

When you read the lists below, keep in mind a few very important things: 

1. You may not be experiencing all of the symptoms below or even most of them.  Postpartum depression and anxiety are not "one-size-fits-all" illnesses.  Your experience may be focused on just a few of the following symptoms and you may not have others at all.  For instance, some women with postpartum depression are sad and crying all the time, whereas others don't experience the sadness but are instead very angry and irritable.
2. Many people have a feeling like the ones listed below every now and then.  For a day, or maybe two.  We all have bad days.  Postpartum depression and anxiety are not bad days.  Women with postpartum depression or anxiety have symptoms like these most or all of the time, for a period of at least 2 weeks, and these symptoms interfere with their ability to function on a daily basis.
3. Postpartum depression and anxiety are sometimes "comorbid".  This means you can have a bit of both, or all of both.  If you have symptoms on both lists, that's not out of the ordinary. 

Okay.  Here we go. 

You may have postpartum depression if you have had a baby within the last 12 months and are experiencing some of these symptoms:

• You feel overwhelmed.  Not like "hey, this new mom thing is hard."  More like "I can't do this and I'm never going to be able to do this."  You feel like you just can't handle being a mother.  In fact, you may be wondering whether you should have become a mother in the first place.
• You feel guilty because you believe you should be handling new motherhood better than this.  You feel like your baby deserves better.  You worry whether your baby can tell that you feel so bad, or that you are crying so much, or that you don't feel the happiness or connection that you thought you would.  You may wonder whether your baby would be better off without you.
• You don't feel bonded to your baby.  You're not having that mythical mommy bliss that you see on TV or read about in magazines. 
• You can't understand why this is happening.  You are very confused and scared.
• You feel irritated or angry.  You have no patience.  Everything annoys you.  You feel resentment toward your baby, or your partner, or your friends who don't have babies.  You feel out-of-control rage. 
• You feel nothing.  Emptiness.  You are just going through the motions. 
• You feel sadness to the depths of your soul.  You can't stop crying, even when there's no real reason to be crying.
• You feel hopeless, like this situation will never ever get better.  You feel weak and defective.  You feel like a failure. 
• You can't bring yourself to eat, or perhaps the only thing that makes you feel better is eating.
• You can't sleep when the baby sleeps, nor can you sleep at any other time.  Or maybe you can fall asleep, but you wake up in the middle of the night and can't go back to sleep no matter how tired you are.  Or maybe all you can do is sleep and you can't seem to stay awake to get the most basic things done.  Whichever it is, your sleeping is completely screwed up, and it's not just because you have a newborn.
• You can't concentrate.  You can't focus.  You can't think of the words you want to say.  You can't remember what you were supposed to do.  You can't make a decision.  You feel like you're in a fog.
• You feel disconnected.  You feel strangely apart from everyone for some reason, like there's an invisible wall between you and the rest of the world.
• Maybe you're doing everything right.  You are exercising.  You are taking your vitamins.  You have a healthy spirituality.  You do yoga.  You're thinking "Why can't I just get over this?"   You feel like you should be able to snap out of it, but you can't.
• You might be having thoughts of running away and leaving your family behind.  Or you've thought of driving off the road, or taking too many pills, or finding some other way to end this misery.  Or you may have thoughts of harming others.
• You know something is wrong.  You may not know you have a perinatal mood or anxiety disorder, but you know the way you are feeling is NOT right.  You think you've "gone crazy".
• You are afraid that this is your new reality and that you've lost the "old you" forever.
• You are afraid that if you reach out for help people will judge you.  Or that your baby will be taken away. 

You may have postpartum anxiety or OCD if you have had a baby within the last 12 months and are experiencing some of these symptoms:

• Your thoughts are racing.  You can't quiet your mind.  You can't settle down.  You can't relax.
• You feel like you have to be doing something at all times.  Cleaning bottles.  Cleaning baby clothes.  Cleaning the house.  Doing work.  Entertaining the baby.  Checking on the baby. 
• You are worried.  Really worried.  All. The. Time.  Am I doing this right?  Will my husband come home from his trip?  Will the baby wake up?  Is the baby eating enough?  Is there something wrong with the baby that I'm missing?  No matter what anyone says to reassure you it doesn't help. 
• You may be having disturbing thoughts.  Thoughts that you've never had before.  Thoughts that make you wonder whether you aren't the person you thought you were.  They fly into your head unwanted and you know they aren't right, that this isn't the real you, but they terrify you and they won't go away.  These thoughts may start with the words "What if ..."
• You are afraid to be alone with your baby because of the thoughts.  You are also afraid of things in your house that could potentially cause harm, like kitchen knives or stairs, and you avoid them like the plague. 
• You have to check things constantly.  Did I lock the door?  Did I lock the car?  Did I turn off the oven?  Is the baby breathing?
• You may be having physical symptoms like stomach cramps or headaches, shakiness or nausea.  You might even have panic attacks.
• You feel like a captive animal, pacing back and forth in a cage.  Restless.  On edge.
• You can't eat.  You have no appetite.
• You can't sleep.  You are so, so tired, but you can't sleep.
• You feel a sense of dread all the time, like something terrible is going to happen.
• You know something is wrong.  You may not know you have a perinatal mood or anxiety disorder, but you know the way you are feeling is NOT right.  You think you've "gone crazy".
• You are afraid that this is your new reality and that you've lost the "old you" forever.
• You are afraid that if you reach out for help people will judge you.  Or that your baby will be taken away. 

Now that you've gone through these lists are you thinking "How the heck does this lady know me? Is there a hidden camera in here?"  Nope.  What this should tell you is that you are NOT alone and you are NOT a freak and you are NOT highly unusual.  If you are having these feelings and symptoms then it is possible you are experiencing a common disorder that 15 to 20% of new mothers have, and it is completely treatable.  Just reach out for help.  There are people who've seen all of this before and know exactly what is happening and how to help you.  They won't be shocked by what you have to say or what you are thinking.  There are also women going through this who you can meet with and talk to.

If you are pregnant and are having symptoms similar to those listed above, you should know that you aren't unusual either.  You may have antepartum depression or anxiety, which are just as common but occur during the nine months of pregnancy. 

Oh, and it's a good idea to speak with your physician to get a physical so that you can rule out other illnesses that may be causing your depression or anxiety symptoms, such as an underlying thyroid problem.

One last thing:  If you are having moments where it seems like you can see or hear things no one else does, if you are feeling paranoid as if others are out to get you, if you are feeling that you or your baby are somehow related to the devil or God in some way, or if you are having thoughts of harming yourself or others, it's important to reach out for help right now.  These symptoms require immediate attention as they could be signs of postpartum psychosis or severe postpartum depression.  If you have these symptoms, your illness has the potential to take over and lead you to do things that you wouldn't normally do.  In order to avoid that it is important to reach out for help right away so that trained professionals can help you get stabilized and healthy.

Postpartum Nurse: "Don't Worry Unless You Have Thoughts of Harming Your Baby"

Over at the Confessions of a First Time Mom blog, the writer shares her very compelling experience with postpartum anxiety.  You should read the whole thing, but I wanted to highlight one particular part:

"I honestly didn't realize I was suffering from PPD. I thought I was just nuts. When I was discharged from the hospital after having Josiah, the nurse told me that being emotional was normal. She said most women get the "Baby Blues" and not to worry unless I had thoughts of harming my baby. I never had thoughts of harming Josiah so I figured I was just a terrible mother. Not wanting to admit how I was feeling I kept my mouth shut."

AAAAARRRRRGGGGHHHHHHHH!  Can you hear me screaming all the way from Georgia?

Don't worry unless you want to harm your child!  If you don't feel the need to pick up some sort of weapon, you're good to go!  I'd say you've got 100% mental health!  Yay for you!  Go get 'em girl!

Newsflash:  Not every woman with a postpartum mood or anxiety disorder has thoughts of harming her children.

That's one uninformed nurse.  Yikes.

Note: For information on intrusive thoughts, which are scary or disturbing thoughts you may have in the postpartum period, click here.  You might also be interest in my story called "The Endless What-Ifs of Postpartum Anxiety".

The Endless What-Ifs of Postpartum Anxiety

Dr. John Grohol at Psych Central offers up an explanation of anxiety in his discussion of a recent article in the New York Times Magazine.  What is it, he asks, then quoting from the Times piece:

"Anxiety is not fear, exactly, because fear is focused on something right in front of you, a real and objective danger.  It is instead a kind of fear gone wild, a generalized sense of dread about something out there that seems menacing -- but that in truth is not menacing, and may not even be out there.  If you're anxious, you will find it difficult to talk yourself out of this foreboding; you become trapped in an endless loop of what-ifs."

Oh, have I been there.

What if my son never loves me?  What if I don't know how to be a mom?  What if I never stop crying?  What if I harm him by ---------? (fill in the blank with the many terrifying ways I wondered about hurting my son which I won't list here so that I don't make you start thinking the same damn things) What if he doesn't wake up?  What if my husband doesn't come home from his trip?  What if I can't get my baby to eat?  What if I'm not who I thought I was?  What if I stay this way forever?

I wonder if I was more exhausted from the lack of sleep or the constant mental gymnastics going on between my ears.  My mind never stopped with the worrying and the thinking and the being scared of the thoughts I was thinking.  It wouldn't stop.  Why won't it stop?  MAKE IT STOP. 

That's when you want to quit.  To run away or give up or maybe something worse.  Because the noise in your head is loud and unbearable and hateful and exhausting. 

For some reason I didn't quit.  I think it was that roly-poly-baby-faced boy looking up at me.  I decided I'd try and reach out for help. 

There must be somebody somewhere who can help me fix this.  This can't be all there is. 

There was.  And it isn't.   

Six Things That Can Affect How Quickly You'll Recover from Postpartum Depression

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 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."

Poem from a Mom with Postpartum Depression & Anxiety

Arriving on Christmas day with those beautiful pink chubby cheeks and eyes of curiosity….

So tiny, so beautiful, this life filled baby squirming, watching, anticipating.

A new life… what mother could ask for more.

Ten little fingers, ten little toes, a beautiful healthy baby girl.

Home from the hospital it all feels surreal, this baby to treasure. We celebrate she’s here!

What happened next, I wish I understood.

Oh if I could.

Darkness and fear have settled in.

It’s all too much where do I begin?

Postpartum they call it and promise it won’t last.

It’s been twelve weeks. I just want my mind back.

Overwhelmed, my mind's always racing,

It never ends the organizing, cleaning, pacing.

Bursts of energy, thoughts that race,

If I could slow down just long enough to concentrate.

Tears fall sporadically night and day…

Can someone please take this pain away?

Doctors prescribe meds and friends are there to listen

But at the end of the day fear closes in.

The sessions, the medications, the attempts to heal me

When will I be free of this anxiety?

Loss of interest, loss of appetite

Please dear God no more nightmares tonight.

I’m sick of living in this gray, in this anxious sorrow.

I choose to have hope for today, for tomorrow.

I know the sun is shining, I can feel its rays.

My baby is beautiful, I am thankful in so many ways.

Jesus, I know you're there, I know you're watching over me.

Squeeze my hand tightly so I can feel you through this insanity.

Remind me Lord that trials make us stronger

Then give me the patience to hold on one day longer.

 

This beautiful poem was written by Barb Lynch, who has gone through postpartum depression twice.

Postpartum Anxiety May Lead to Delayed Puberty in Daughters

A new study presented at the annual meeting of the Endocrine Society shows that postpartum anxiety can lead to a delayed onset of puberty in daughters. 

The study, conducted on mice by researchers in New Zealand, found that low levels of prolactin in early pregnancy causes postpartum anxiety.  (Maybe that's what was wrong with me.)  Puberty was delayed in the daughters even if they weren't raised by their birth mothers.

According to Newswise, late puberty in humans is linked to shortened height and psychological problems that can persist into adulthood.

The Link Between Parasailing & Postpartum Depression

Have you ever been parasailing?  I have. 

As described by Wikipedia, Parasailing, also known as parascending, is a recreational activity where a person is towed behind a vehicle (usually a boat) while attached to a specially designed parachute. known as a parasail. The boat then drives off, carrying the parascender into the air.

I went once when I was on vacation in Lake Tahoe.  This was when I was in college and was willing to risk life and limb just because a cute guy ran the parasailing boat. 

After the fright and thrill of going up into the air harnessed to a parachute, something immediately grabs your attention.  Silence.  You can't hear ANYTHING, except perhaps the air blowing past your ears.  You can see all the people down below, driving around in boats, waterskiing, wave running, frolicking.  At ground level, the beach is a noisy place.  Then up you go and the sound disappears completely.   You suddenly feel strangely separated from the world.  You know what's going on down there, you can see them and you understand what they're doing, but you get the clear sense that you could yell and scream and no one would hear you.  You're there, but then again, you're not.

I was thinking about that experience the other day and it reminded me so much of how I felt when I suffered postpartum OCD.   It was like an out-of-body experience; I was floating above my life watching all the people go about their day and I couldn't successfully communicate with them.  I couldn't connect to them.   I was still there, but in a different place, and I didn't know how to come down out of that place by myself.  Like the boat that eventually pulls the parasailer back down to earth, it took professional help to bring me back to myself, my friends and my family.  I got it, of course, and mercifully returned to the shore of my life.

For more on this, read "Profoundly Alone: The Disconnection of Postpartum Depression".

Catherine Connors: A Letter to New Moms

Give peas a chance.

If you're anything like me, you have trouble asking for help.  I have a lot of trouble asking for help.  And accepting help.  Pretty much anything to do with being helped, I cringe away from.  So I basically never ask for help, ever.  Especially when the darkness hits.  Especially when the darkness hits.  Which is why, despite a history of depression -- and a long and difficult struggle with depression after the births of both my children -- I avoided psychiatrists and therapists.  I would go -- my doctor insisted -- sit through a session without saying much, and then I would leave and toss the prescriptions and never go back.

Until Svetlana.  Svetlana changed everything.

Her name really was Svetlana.  She spoke with a thick Slavic accent and wore a pantsuit, which for some reason made me think that she looked like a banker.  A Russian banker.  Which didn't predispose me to telling her my secrets, but still:  I had hit a breaking point.  I had had what my doctor kindly and misleadingly called "intrusive thoughts" and I had terrified myself and I had promised myself that I would do this, that I would seek help, and this place, this tidy office with a worn leatherette sofa and wilting fern and shelves upon shelves of books on psychiatry and therapy and parenting, was where I had arrived.  This woman, the occupant of this office, would help me, and I would accept her help.  Well, I would at least try.

"Um ... no ... that's not ..."

She frowned.  "Say here, you vant harm your child ... you have violent thoughts ..."

"No, no, that's not exactly right ... I just ..."

"Is chicken scratch.  I cannot read.  You look, tell me vat it say."  She handed me the file with my psychiatric referral.

"Um ..." I squinted at the inky scrawl, "'... reports intrusive thoughts of harming baby ... reports wanting to drop baby on bed, escape home, reports experiencing feelings as violent, aggressive ... denies intent to harm ... denies intent to harm self ... denies suicidal ideation ... reports being afraid of intrusive thoughts.'"  I cringed.  I'd rather not be reading this.  "Sleep deprivation.  Previous treatment for anxiety.  Supportive husband."  I hand the file back to her.  "I didn't say that I felt violent, " I say.  "I said that the feeling itself was violent.  Like a shock.  It frightened me."

"Is frightening, yes, these thoughts."  She looked me in the eye.  "I know you do not vant harm baby."

And I thought, well, that's as good a basis for a therapeutic relationship as any, I suppose.  I could, I decided in that instant, overlook the pantsuit.  I could work with this woman.

And so we spoke at length, Svetlana and I.  Or rather, she spoke, and asked the occasional question, which suited me.  I hate psychiatric therapy.  I hate feeling that I'm being analyzed.  I hate listening to the sound of my own voice droning on and on about can't sleep motherhood hard feel anxious yes family history of depression no not suicidal just TIRED TIRED OH SO TIRED.  I just want a solution.  I just wanted her to give me a solution.

Svetlana, as it happened, was all about the solutions.  "First, we get you to sleep, no?  I give you Ativan; you sleep when baby sleep.  Zen, we test blood:  thyroid, B12, glucose ... your body, I zink, it is PFFT! ... zen we meet again; we talk ... is good to talk ... zen maybe, maybe I give you somezing for depression.  Not now.  Now, you are tired.  You are post-traumatic stress.  You need sleep and peas."  She leaned forward and grabbed my hand.  "Sleep and peas."

I had to think about that for a second.

"Yes," I said finally.  "Peace would be nice."

"Peas is nice," she said.  "I help you to get peas."  She dropped her voice to a whisper.  "I tell you somezing.  Your are not a bad mother.  You are a good mother."  She patted my hand.  "Not to forget."

"No," I said. "Not to forget.  Thank you

Peas is good.  I left Svetlana that day and immediately filled the prescription for Ativan.  Then I went to bed early with that little bottle of peas while the husband took the baby and left me in the sweet, sweet quiet dark.  With my peas.  With my peace.  So that I could rest, so that the morrow would dawn brighter, so that I could -- so that I would -- move a step or two closer to feeling like the good mother that I know I am.

Whatever it takes for you to bring yourself closer to feeling like the good mother that you are, do it.  Do it now.

I wish you peas.

Catherine Connors is the author of the popular parenting blog Her Bad Mother, and recently expanded her storytelling domain with the launch of Their Bad Mother at Beliefnet.com.  She has to remind herself every day that she is, in fact, a good mother.

Quick Survey on Postpartum Anxiety

The fabulous Karen Kleiman has asked me to ask you to participate in a short, five-question online survey on anxiety.  She says ANYONE can answer it, regardless of the age of their baby(s) and regardless of diagnosis or lack thereof.  ANY mother should answer the questions.  It's super quick -- I know because I took it myself.  Click here: http://www.surveymonkey.com/s.aspx?sm=gjiWqGwgleOxe6ltZFnrUg_3d_3d 

Don't Let the Terms "Baby Blues" or "Mild" Postpartum Depression Fool You

I want you to read this brief but great piece by John McManamy at McMan's Depression & Bipolar Web called "Mental Water Torture".  It's about the importance of not blowing off mild to moderate depression until it turns into major depression.  His words apply to women with antepartum and postpartum depression as well.  If we ignore what we're going through, just hoping it will wear off eventually, we may be sentencing ourselves to something much worse.  An excerpt:

"As I sit here writing this, the term mild to moderate depression mocks me. I won't even begin to estimate how many years I've lost to a disorder predicated by the modifiers mild to moderate. The least they could have done was assign the name of a Shakespeare character - Hamlet's disease, Lear's disease, anything, really. Just so long as it doesn't imply I was cut down in the prime of my youth by some invisible stupid nerf bat pounding against the inside of my brain.

For the rest of you: You can end it right now. You don't have to endure the mental water torture any longer."

Why do we wait to reach out for treatment when we know something is wrong?  Many reasons. There's stigma and the fear of facing the unknown (including medication and therapy for those who've never had it). There are those of us who just don't pay attention to how we're feeling and those of us who always put others ahead of ourselves.  There are those of us who decide this is just the "baby blues", even though the baby blues is a normal adjustment period that resolves itself approximately 3 weeks after delivery, and we are still feeling bad, perhaps getting worse, and have already moved past the first few weeks postpartum.

Susan Stone at Perinatal Pro adds to that list the misrepresentation in the media of postpartum mental illness.   Compared to the consistently bedraggled, crazy-looking, blank-eyed moms portrayed on TV, many of us can function and present ourselves in a way that hides our underlying misery.  Because of this, we think we don't have an illness requiring professional help.

"There are mothers who may have a pregnancy-related mood disorder but think that because their symptoms do not equal the extreme drama portrayed in such [entertainment] stories, they do not have postpartum depression or another affective pregnancy-related disorder.  They may conclude that their suffering is insufficient to warrant intervention and compassion.  These are the mothers who know that something is wrong, but compare themselves to these extremely rare depictions and think they are just "blue" and attempt to tough it out -- week after hellish week.  So months of silent anguish continue and the potential joy of motherhood is lost to the woman, her infant and her family."

None of these reasons for waiting to reach out for help is acceptable.  It's not worth the future pain we may cause ourselves.

Karen Kleiman, author of "This Isn't What I Expected" and many other great books on our illnesses, wrote about this issue recently in a comment on my post on deciding whether to take meds during pregnancy:

"Sometimes people feel that a risk is greater if they 'do' something or take action, as opposed to just letting things be. Like, 'If I get on that airplane during the storm, the risk will be greater than if I don't go.' That seems pretty clear.

Conversely, there are times when the risk is in fact higher when no action is taken, such as the decision not to do anything in response to having chest pains.

This is the case with women who are pregnant or postpartum. Women who are deciding whether or not to take medication are understandably unsettled by having to made this decision. Often they feel if they "take" the medication, they are taking an action, or engaging in behavior, or making a choice that increases the risk, or so they believe. Thus, they feel it would be better to do nothing.

But we know that in many of these cases, it is NOT better to do nothing and NOT TAKING ACTION can be detrimental; it can significantly increase the risk potential, particularly for women who are severely ill.

So it's a perception thing. We perceive the risk to be greater if we take action. 'If I put this pill in my mouth I will be hurting myself or my baby.' But it's a faulty perception. Sometimes, the risk is much greater when we do not act."

Exactly.  There are a variety of effective treatments.  Go talk to a professional to see if you need one.  Act.

For another piece on this topic, visit "The Myth of Wishing PPD Away".

If I Made It Through Postpartum Depression, I Can Make It Through This ...

So I got a Trojan virus on my computer last week.  Ended up having to scrub my hard drive and reinstall my software.  In the process my audio drivers have disappeared, so I have no sound on my laptop which is very weird.  I think I've gotten most of my files back now, but we'll see.  This has been such an awful situation since my whole "work life" (so to speak) revolves around this little metal box.  This little rectangle with circuit boards and wires and who knows what else inside.  In the meantime, here are some Warrior Moms writing about postpartum depression and anxiety on the web:

Shape of A Mother writes about PPD -- I highly suggest reading the comments because these are women who've been through it and all recommend reaching out for professional help as soon as possible

Natalie writes about how excruciating a day can be when you're home alone with your baby and suffering from terrible postpartum anxiety.  Oh how I now exactly what she means.  I remember that clearly, feeling like every minute took an hour.

Shannon shares her Christian testimony about experiencing PPD at Tara's Out of the Valley blog

Postpartum Progress' "Six Things" Series

If you hadn't noticed it yet, I've created a new series called Six Things.  You can find it on the left of your screen, directly underneath my picture. (Found it?  Good.) 

I decided to develop these documents as a "quick and dirty" way to let people know what I believe are some important things to understand about perinatal mood and anxiety disorders, which include depression and anxiety during pregnancy and in the 12 months postpartum.  These are brief Word documents that you can quickly download. 

If you or someone you know has time to read nothing else, hopefully these Six Things lists will help give you and those who care for you some clarity as you grapple with these illnesses.  These, of course, aren't the only six things you need to know.  You may have another six you'd like to share.  (If so, email me at stonecallis@msn.com). 

So far I've created a Six Things for Moms and Moms-To-Be, and a Six Things for Healthcare Professionals.  There will be more to come ...

UNC & Florida State Conducting Perinatal Anxiety Study

Perinatal anxiety — unhealthy distress experienced during or soon after pregnancy — is the subject of a major new study being conducted by psychologists at the University of North Carolina at Chapel Hill and Florida State University.

“We call perinatal anxiety the hidden disorder,” said Jonathan Abramowitz, Ph.D., co-principal investigator for the study, associate professor of psychology and director of the Anxiety Disorders Clinic in UNC’s College of Arts and Sciences. 

“About 60 to 70 percent of new mothers and fathers have these kinds of thoughts,” he said. “It’s normal to think these things, dismiss them and move on. But when you can’t control your thoughts, or they interfere with your sleep, your health or your ability to care for your baby, then you may need help.”

In some cases, such anxiety results in panic attacks (perinatal panic disorder). In the most serious cases, parents may become obsessed with senseless, intrusive negative thoughts which they can’t seem to control no matter how hard they try, Abramowitz said (pregnancy and postpartum OCD). “They may begin to worry about all kinds of things: What if the baby dies during sleep? What if I lose control and harm the baby? What if I do something terrible to the baby? Worse, they may feel scared and confused about what these thoughts mean — fearful that they will act on these obsessional thoughts.”

The researchers in this study will be looking at how effective cognitive behavioral therapy (CBT) is in treating perinatal anxiety.  All participants in the six-week study will receive helpful childbirth counseling as part of free weekly prenatal classes. Half of the participants will receive elements of CBT as well. Those who complete the study will also receive a modest fee at the end.  First-time pregnant women over the age of 18, and their partners, can learn more and complete a screening questionnaire online at www.babyprepstudy.com.

PPD News as the New Year Begins ...

Lots of news.  So much in fact that I'm not sure where to start ...

Rep. Bobby Rush (D-IL) has reintroduced the Melanie Blocker Stokes MOTHERS Act (HR 20).  Let's hope the 111th Congress can get this through both houses once and for all!

The Postpartum Dads Project is looking for guest bloggers.  Topics can range from new parenting advice to divorce survival.  They prefer a postpartum mood or anxiety disorder angle in all articles.  Guest bloggers can be male or female.  Please send ideas or completed articles to submissions@postpartumdadsproject.org. 

Shoshanna Bennett has just released her new book, Pregnant on Prozac.  The book covers mental health concerns facing women who are pregnant or thinking about pregnancy.  Safety information regarding medication and alternative treatments in pregnancy for depression, bipolar disorder and other illnesses are discussed.  You can order it through the PSI bookstore by clicking here.

Mary Jo Codey recently appeared on the ABC affiliate in New York to share her story about postpartum depression and promote passage of the MOTHERS Act.  Watch it here!

 

Sleep Deprivation Worsens Postpartum Depression

I don't know.  I think I'd put this in the category of "Did they really need to spend money on research to figure this out??"  I suppose I shouldn't be a pain in the butt about it, but it feels obvious.  Anyway, ignore me and read on:

"A study published in the current issue of the Journal of Obstetric, Gynecologic, & Neonatal Nursing shows that depression symptoms worsen in PPD patients when their quality of sleep declines.

Sleep deprivation can hamper a mother's ability to care for her infant, as judgment and concentration decline. Sleep-deprived mothers also may inadvertently compromise their infants' sleep quality because infants often adopt their mothers' circadian sleep rhythms.

All new mothers experience some sleep loss following childbirth, as their estrogen and progesterone hormone levels plunge. They typically spend 20 percent more of the day awake than average during the first six weeks postpartum. Postpartum women wake more frequently and have less dream sleep than non-postpartum women, with women in their first month postpartum spending only 81 percent of their time in bed actually sleeping. Neurotransmitters that influence sleep quality also affect mood, raising sleep-deprived mothers' risk for depression ...

Study author Bobbie Posmontier of Drexel University compared sleep patterns of 46 postpartum women, half with symptoms of PPD and half without. Sleep patterns were monitored for seven consecutive days. Results showed that mothers suffering from PPD took longer to fall asleep and slept for shorter periods. The worse their sleep quality, the worse their depression.

Posmontier recommends clinicians treating women for PPD to address the importance of adequate sleep. 'Mothers can develop a plan to have other family members help care for the baby at night,' she said. 'They also should practice good sleep hygiene. That includes going to bed at the same time every night, avoiding naps and steering clear of caffeine, exercise, nicotine and alcohol within four hours of bedtime.'"

I completely agree with the issue of sleep management for any new mom, but especially those moms who have a perinatal mood or anxiety disorder.  My husband and I had a plan:  I stayed up with the baby two nights in a row, and he stayed up with the baby the next two nights while I slept in a room without the monitor.  And yes, he had a job to go to in the morning.  But he sacrificed so that our whole family could be healthy as soon as possible.  Let me tell you, a full night's sleep does a lot for your ability to cope.  Husbands out there:  You can balk now if you want to, and not stay up to help with the baby.  But if you do, you may pay for it later with a completely incapacitated wife.  Remember, the vow reads "in sickness and in health."

Postpartum Depression & Anxiety: The Waiting Is the Hardest Part

I can't tell you how many women I've spoken to lately who are worried and upset by the setbacks they experience while recovering from perinatal mood and anxiety disorders.  They have a string of good days and think they're finally getting better, and then they have a terrible day and feel that all is lost.  It's heartbreaking.

I know exactly how they feel.  I can remember starting to feel better after beginning my treatment.  I'd have a few good days and begin to glimpse peace.  I'd feel like I was turning the corner.  I'd have a sliver of hope, for goodness sake.  And then -- SLAM! -- the sadness, anxiety, misery and guilt would flood back over me.  I'd think to myself, "Of course.  How could I have been so foolish?  I knew I'd never get better.  I'll never be me again."  I'd be crushed with disappointment, and angry for even thinking I could ever get back to my old self.

I did get better, though.  In fact, I'd venture to say that the me who came out of my experience with postpartum OCD is even better than the me who went in.   It took a while, but that's the deal unfortunately.  Recovery from these illnesses is a process.  I wish it was like bronchitis or strep throat:  Call doctor.  Go to appointment.  Get prescription.  Take 1 pill twice a day with food.  10 days later, all better.  It isn't.  It can be scary to hear that, but it's better to know what to expect so that you can be patient with yourself.   

We all start out with more bad days than good, or perhaps even all bad days.  Then you have a few good ones here and there.  Then you start having more good days than bad.  Then one day you realize you've had only good days, for a long time, and you have this slow and cautious realization that maybe the sun has come out for good.

In the meantime, don't let bad days define you or defeat you.  It's okay to have them, and to feel the bad feelings.  Just don't let them convince you that the progress you've made up 'til now is gone.  You're still moving forward, even on bad days.  Just continue to do the things you need to do to take care of yourself.   

There is one thing you can do to help your recovery process along:  Don't take it over as though you are a healthcare provider.  The first time you feel better, don't decide to quit your meds (if you're taking them) cold turkey, or quit seeing your therapist (if you're seeing one) cold turkey, or quit asking for help or taking care of yourself or following whatever method of treatment you and your doctor have decided to follow.  This could impede your progress.  I know lots of people who decide they know better than their healthcare providers, and so they start making decisions as to what they should and shouldn't be doing without the counsel of trained professionals.  I don't think that's a good idea. 

If you feel like the professional you're working with isn't helping you or hearing you, that's different.  It's okay to go out and find another one.  But if you like the one you're with, don't ignore your physician's advice just because you've started feeling better, or because you've bought into the false belief that you should be over this by now, or because you've bought into the false belief that you should be able to get over this all on your own.  There is no set timetable for recovering from perinatal mood and anxiety disorders. And there is no law of nature that states that you're a better person if you can get over it all by yourself.  No one can get through life on their own without help, regardless of whether they're ill or not.  We all need support at some point.  It just happens to be your turn.

In the meantime, try and accept that you're moving in the right direction, even if you have a bad day.  Try and find inspiration and patience in your faith, or in music and literature, or in nature, or in speaking with women who have long since recovered, who know how you're feeling and who know you can get better. 

We know how hard it is to wait for the clouds to lift.  We know that there are ups and downs, and that it can take a while.  We'll wait with you.  You're worth it. 

PPD Conference in Chicago Oct. 17

Just a reminder that this Friday is the Jennifer Mudd Houghtaling Postpartum Depression Foundation annual conference in Chicago.  It is presented by Mercy Hospital and Medical Center and will be held at the University Club of Chicago.  I will be speaking, along with Birdie Meyer, Sonia Murdock, Dr. Manny Alvarez and many other fabulous people.  Check it out here: http://www.ppdchicago.org/ or here: http://www.ppdchicago.org/site/files/456/16096/76749/353452/Postpartum_Conference_08.pdf.

Will PPD Be on the Rise Due to Economic Downturn?

According to a study just released by the American Psychological Association, the Wall Street downturn has begun to impact the health of Americans.  As reported by USA Today, "Finances now overshadow the more typical daily stressors of work and relationships; 46% report being worried about providing for their family's basic needs."  What's worse, the poll finds that women are more significantly impacted than men.

We already know that financial troubles are a risk factor for antepartum and postpartum depression and anxiety.  So one has to wonder, given the current economic turmoil, whether we will see an uptick in the number of women with these illnesses.  I imagine that we might, and it would be good for healthcare providers to be aware of this.

Portland Family Magazine on Postpartum Anxiety

I'm trying to educate myself about perinatal psychiatric illness.  I've recently learned that I wasn't technically correct when I use the term perinatal mood disorders.  Mood disorders include postpartum depression and postpartum psychosis.  Anxiety disorders, like postpartum anxiety or postpartum OCD, are not mood disorders.  They're different.  Most people probably wouldn't care about such splitting of hairs, but I'm a word person and I always want to be so careful about being correct when I can.  (OCD, anyone?)

Since I went through postpartum OCD myself, I always want to make sure to "represent" for those of us with anxiety.  Stacy Larsen recently wrote a great story in the Portland Family Magazine about postpartum anxiety disorders.  It was well done, and reminded me so much of what I went through when my son was born.  It was like reading about myself.  If you have been through or are going through some form of postpartum anxiety, I think you'll really find this interesting.

How to Use Postpartum Progress

You may be a new Warrior Mom who has just found Postpartum Progress, or someone who has been reading for a while but wants to learn about the various resources available in this blog.  You may have just been diagnosed, or be worried that you may have postpartum depression or a related illness.  Or, you may be a pediatrician, obstetrician, social worker or other clinician who works with moms and moms-to-be.  This blog is for all of you, and this page will help you find your way around.

Postpartum Progress is a blog about postpartum depression and related illnesses intended to provide hope and comfort to the women who suffer, as well as the people who care for them (family, friends, healthcare providers).  It features news, the latest research, a list of support groups around the country, stories from moms and fellow sufferers, and links to major support organizations and treatment programs. 

Below is an outline of some of Postpartum Progress' key features.

For Moms-to-Be & New Moms:

If you have been diagnosed, or think you may be suffering, from postpartum depression, postpartum anxiety, postpartum OCD, postpartum panic disorder, postpartum PTSD, postpartum psychosis or antepartum anxiety or depression, welcome.  I'm really glad to meet you.  I hope you will find a kindred spirit in this blog.

I cover every illness in the perinatal mood and anxiety disorder spectrum, so no matter what you're going through I hope you can find something here that gives you knowledge and comfort.

The "Help Is Here" section (on the right hand side of your screen, underneath the "Welcome" section) includes several important resources: 

• the "What's Wrong With Me?" description of all perinatal mood and anxiety disorders, including risk factors and symptoms
• a list of support groups around the U.S. and Canada
• a list of perinatal mood and anxiety disorder treatment programs in the U.S. and Canada, and
• a list of state and national organizations that offer a wide variety of local resources, services and information.  All of these may be helpful to you on your journey to recovery.  (Please note:  Many of these organizations and groups have "postpartum" or "postpartum depression" in the name, but that doesn't mean they don't serve women with other illnesses.  In fact, they are usually knowledgable of all illnesses across the spectrum and offer support services to everyone.  It's just that postpartum depression is the most widely known of all the illnesses, so that's the name they use.   The proper term for the entire spectrum is "perinatal mood and anxiety disorders" -- that pretty much covers us all.)

Surviving & Thriving Mothers Photo Album -- This fabulous photo album can be found on the right hand side of the home page screen, directly underneath "Help is Here" and above Readers' Favorites.  It features photos of women who have survived perinatal mood and anxiety disorders and their children.  I hope it serves as an inspiration to everyone going through one of these illness by showing that, with treatment, you can be a happy and healthy mom.  I look forward to adding your photo as well.  If you'd like to participate, email me a jpeg to stonecallis@msn.com, along with info on which illness you suffered, what year, and in which state you live.  I use only your first name and last initial.

If you're looking for specific information on a particular topic related to perinatal mood and anxiety disorders, check out the Categories section further down on the left of your screen.  We cover it all here, from Birth Trauma and Breastfeeding to Infertility and Intrusive Thoughts and everything in between.

The Readers' Favorites section (further down on the right hand side of your screen) includes links to the most popular posts I've ever written, based on reader feedback.  These were the ones that struck a nerve or have been most helpful or comforting.  I hope you'll feel the same way about them. 

Read Up (even further down on the right hand side) features a wide variety of books on our illnesses.  If you click on the book, it will take you directly to Amazon.com where you can learn about it, read reviews, and purchase it if you so choose.

As many moms do, you are also welcome to email me if you want to reach out, at stonecallis@msn.com.

For Healthcare Pros:

If you look in the Help Is Here section on the right hand side, you'll see a link to the Tools for Professionals page with a bit of helpful info specifically for you.  Check it out.  Plus, nearly every week I'm posting info on new research and on events that may be of interest to you.  To find them, scroll down the left hand side of Postpartum Progress until you see the Categories section. 
Some categories that may be of particular interest to clinicians:  Research, Obstetricians, Pediatricians, Effects on Children, Screening and Education & Training. 

If you are hospital that has created a special PPD program, someone with a support group or event related to perinatal mood and anxiety disorders, or a researcher looking for participants or announcing research results, please send your news to postpartumprogress@gmail.com so that we can cover it here.

For everyone:

I've created a series called Six Things.  You can find it on the left of your screen, directly underneath my picture.  These brief Microsoft Word documents are a "quick and dirty" way to let people know what I believe are some important things to understand about perinatal mood and anxiety disorders, which include depression and anxiety during pregnancy and in the 12 months postpartum.  If you or someone you know has time to read nothing else, hopefully these Six Things lists will help give you and those who care for you some clarity as you grapple with these illnesses.   

You can Search the entire blog with the search function (powered by Ligit).  It is on the left side of the blog, directly under the subscriber box.  Just type in the topic you're looking for (just like you would if you were searching on Google), and click search and it will take you to a list of posts from Postpartum Progress about that topic.

Home Delivery (on the left hand side, underneath Six Things) allows you to be a regular subscriber to Postpartum Progress.  Just enter your email address and click "Subscribe me!", and you're a subscriber via Feedblitz.  What does this mean?  In the morning, you will receive an email in your inbox with links to each post that I have written the previous day.  This way you always know what's going on without having to remember to visit the Postpartum Progress site every day.  FYI -- I have never, EVER shared the list of subscribers with anyone, so you won't be receiving unwanted email from anyone else.  Also, if you should ever decide you don't want to receive the emails any more, you can easily unsubscribe.

The Listed On section (further down on the left) is simply a list of some of the places on the web that feature Postpartum Progress or have highly ranked it among all internet health sites.  I'm very proud of those associations and happy to display my "blog bling".

I welcome comments on the posts I write.  Just click on the little "comments" link that can be found at the bottom of each post and let me know what you think, or if you disagree, or have a different idea.  And if you have a news tip or story idea, please email me at stonecallis@msn.com.  It is important to note that all commenters on this site are by default considered as non-medical professionals.  If you are a health professional and decide to offer medical information as a commenter, your status as a medical professional must be identified.  If you do make any medical claims, you must offer references or links to material(s) that would support those claims.  It is the policy of Postpartum Progress that all commenters behave at all times with respect and honesty. 

If for some reason you want to learn a little more about me, Katherine Stone, click on the About link and you'll probably get more info than you ever needed to know.  It's underneath my picture.  Just remember, I am not a healthcare professional.  I am simply a mom who has been through this.  Nothing on this site constitutes medical advice.  Postpartum Progress exists to provide peer support.

Again, I hope you find Postpartum Progress helpful and I'm really glad you are here.  God bless you.

P.S.  The Swiper, No Swiping! section (a reference to Dora the Explorer for those of you who don't know) on the left hand side of the blog is a reminder that Postpartum Progress has a creative commons copyright.  You may reprint the original content in this blog with permission, but it must not be altered in any way, and must be attributed to Postpartum Progress/Katherine Stone at http://postpartumprogress.typepad.com.

updated March 10, 2009

News & Observer Covers NC PPD Support

Here's a nice story in the Raleigh News & Observer (NC) about Ann Wimer and her MomsSupportingMoms group for women with perinatal mood and anxiety disorders.  "For more information, visitwww.momssupportingmoms.net or call (919) 454-6946. For information about other services, including how to receive brochures for medical practices and educational outreach opportunities, please contact Postpartum Education and Support at 919-889-3221 or visit www.postpartumeducationandsupport.com.

Moms All Over the Blogosphere Write About Perinatal Mood & Anxiety Disorders

Here's a roundup of what's going on out there in the world of perinatal mood and anxiety disorders this week ...

Cate at 18 Years and Counting is suffering from postpartum depression and anxiety and needs a Warrior Moms Virtual Hug.  Here's a post she just wrote about her obsessions and fears.

Jodi Kluchar has just created the PTSD After Childbirth blog.  I'm am sure that those of you with postpartum post-traumatic stress disorder will want to follow along for information and comfort.  The blog offers info on conferences, birth stories, research and more.

Miranda has just created a blog called Postpartum Help to share her experiences with postpartum depression and try and help others.  Give her a shout out!

Laura at Depressed (but not unhappy) Mormon Mommy has written about the helpful things people said to her when going through postpartum depression, and what she would say to others.

Lisa at the Lis & D blog writes about the recent loss of a friend of hers to postpartum psychosis.  (This breaks my heart.) She also shares her own experience with postpartum depression.

Diane at The Mommy Diaries writes about postpartum depression vs. stress.

Breastfeeding & Postpartum Depression: A Mother Without A Breast

Breastfeeding. 

That word, and the process that accompanies it, can bring about immediate stress for women suffering perinatal mood disorders.  It's a highly charged issue.  For some of us, difficulties in being able to do it at all send us into a tailspin, and can either cause or exacerbate postpartum depression and anxiety.  I thought, if breastfeeding is one of the few things a female body was meant for, why the hell can't I do it?  What a defective mother I was!!  For others, breastfeeding is one of the only ways suffering moms feel connected to their babies, and the idea of taking medication is terribly distressing.   They'd rather continue to be ill than take meds and have to stop breastfeeding, and are nervous about the risks of continuing and passing trace amounts of meds in their milk to their babies.   No matter how we try to look at it, we are filled with dread, guilt and indecision.  I've been meaning to write about this topic for a long time, but then I received an essay in my email this week from Lisa Sniderman.  It is very poignant, and I've decided it will be more powerful to share her confrontation of this issue than mine, with her permission, of course:

"My name is Lisa, and I have a 2-year-old daughter. Unlike some mothers, PPD was far from my first experience with mental illness. I have been diagnosed with bipolar disorder since age 22, although that diagnosis took 4 years of frequent hospitalization and medical guesswork. I have "treatment-resistant" illness; most medications simply increase my symptoms. In 1993, I finally found my miracle in a combination of doxepin and lithium. I got on with my life goals, thanked my lucky stars, and never looked back... until 2005, when I was newly married and hoping to start a family. It turns out that while my medications could be titrated during pregnancy, because of my history I really, really needed them in full dose immediately after delivery.  [Reader's note: titration is the process of gradually adjusting the dose of a medication until the desired effect is achieved.]  Just when my daughter really, really needed to breastfeed. Thus commenced a frantic search for safety information about the drugs.

The outlook couldn't have been worse.  Doxepin has been shown to cause respiratory distress in nursing infants whose mothers take one-third to one-eighth the dose I needed.  Meanwhile, the lactation and neonatal experts are divided on lithium; some recommend 'extreme caution' and frequent neonatal bloodwork, while others say it is completely contraindicated.  Call me nuts, but I couldn't really see myself, in my vulnerable postpartum state, carefully monitoring my newborn for apnea and hepatoxicity 24/7.  I don't think I ever would have slept.

As it was, I panicked right after delivery and tried to go without my meds for my baby's sake.  I lasted three days before uncontrollable suicidal ideations and racing thoughts sent me to the hospital.  At that point, I realized just how real my illness was, though it had been dormant for over a decade.  I went back on doxepin and lithium, and added an antipsychotic for the short term.  At the time, I thought I was a terrible mother for needing these medications.  Worse -- I thought I was a terrible mother for having the illness that these medications treated (hello, stigma!).  Was bottle-feeding really a 'choice' for me?  Only if I could somehow have 'chosen' instead to spend my daughter's first year either in unbearable torment or dead.  The rhetoric of personal responsibility that surrounds breastfeeding, despite the very real barriers so many women still face, disturbs me in general.  When it is applied to severely mentally ill mothers who need uninterrupted sleep, mood stabilizers and antipsychotics, it absolutely stops me cold.

With the passage of time, I stopped cursing God for making me one of the few women who truly cannot breastfeed.  I tend to search for the larger meaning in things, and I don't think it's an accident that the two medications I need are among the only psychotropic medications unsafe for nursing.  I believe this happened so that I could critically re-evaluate my identity as a mother -- and begin educating myself on the cultural disease of maternal self-negation that enrobes new motherhood in impossible expectations.

I gave my daughter a mother without a breast, because I couldn't give her a breast without a mother.   I know that she and I missed out on a precious experience, but we humans are extremely adaptable and many other equally precious experiences came out of my recovery from PPD, and her subsequent development into a secure and happy little girl.  I learned that self-acceptance radiates out, from me to my daughter.  I learned that the real joy of mothering only comes from mothering oneself first.  My husband and I are trying for our second child, a decision I made only when I felt fully reconciled to the idea of not breastfeeding this one, either.  The stakes are just too great.  The risks of bottlefeeding are well-known; the risks of untreated maternal depression, though they can be equally or more grave, are far less imprinted on the public consciousness.  I accept this; the fact that I am knowledgable about my own situation is enough for me.

The ironic thing to me is that someone seeing me mixing formula at the mall might think to herself, 'What a bad mother.  She must not care about breastfeeding.' When, in fact, I am a breastfeeding advocate and would staunchly defend anyone who took flak for nursing a baby -- or a pre-schooler -- in public.  My story is not a threat to everything we know about the wonders of breastmilk, and I'm not presenting it as such.  It is because breastfeeding is so important that my decision was so difficult.  The interaction between PPD and breastfeeding can be a lot more complex than 'take Zoloft -- it's safe!!'  There are other women, caught in the distorted thinking so common in PPD, who refuse any medication out of fear of harming their nursing babies; weaning is sometimes necessary if it is the only way a desperately ill woman will accept treatment.  Many OB/GYNs, lactation consultants and psychiatrists have little appreciation for these complex issues.

I am sharing this in the hope that some other mom out there reads my story and knows that if it comes to the point of treatment vs. breastfeeding, which thankfully isn't often the case, she can find the courage to be a mother without a breast, rather than no mother at all." 

                     

Take Lisa's words to heart.  Your child needs a healthy mother.  Some of you will be able to alleviate perinatal mood disorder symptoms with psychotherapy alone.  Others will continue to breastfeed while on medication, because you and your doctor decide the risks are relatively low.   Still others will stop, because it is easier for them or because certain medications prohibit breastfeeding.  It doesn't matter.  Your child needs you more than anything.

Chat with the Experts Session This Wednesday

Every Wednesday, Postpartum Support International has free open forum phone sessions called "Chat with the Expert".  These sessions are anonymous and offer a place where callers can ask questions and get information for themselves or family members about perinatal mood disorders.  Check here for details on how to join in.  This week's forum will be July 23 at 9pm EST, facilitated by Susan Stone, LCSW, past president of PSI. 

Two Great New Books for Clinicians on Treating Postpartum Depression & Related Disorders

Two great new books are being published for healthcare practitioners (and others!) by two amazing women in the field of postpartum mood disorders, Susan Dowd Stone and Karen Kleiman. 

The first, called "Perinatal and Postpartum Mood Disorders: Perspectives and Treatment Guide for the Health Care Practitioner", was edited by Susan Dowd Stone and Alexis E. Menken and is being published this week.  It provides a wide foundation on these illnesses, and is intended for consumers and students/professionals in the following disciplines: psychiatry, social work, medicine, psychology, nursing, law, advocacy, social support, literacy (reaching consumers), pediatricians, obstetricians, administrators in health care facilities who are considering the issue and adding programs, legislators and health care policy advisors.  Contributors to the book, published by Springer, include Jane Honikman, Dr. Catherine Birndorf, Dr. Margaret Spinelli, Dr. Shaila Misri, Dr. Kathleen Kendall-Tackett, George Parnham, Cheryl Beck and many others. This is a ground-breaking text on the issue in terms of its breadth and depth ... there is none other that provides such a comprehensive overview of the entire issue in a multidisciplinary format.

"The point of the book is that without educating our healthcare teams, we can raise awareness all we want but those who need to identify and help these women will still not be up to par," said Stone.  "Hopefully readers in various disciplines will be moved to more fully explore the issue after reading these 'perspectives' chapters."

The second, called "Therapy and the Postpartum Woman: Notes on Healing Postpartum Depression for Clinicians and the Women Who Seek Their Help", is written by Karen Kleiman.  It is currently available for pre-ordering here and will be published in September.

The book, published by Routledge, provides a comprehensive look at effective therapy for postpartum depression.  Using a blend of professional objectivity, evidence-based research and personal, straightforward suggestions gathered from years of experience, Kleiman's book brings the reader into the private world of therapy with the postpartum woman.   Based on Psychodynamic and Cognitive-Behavioral theories, D.W. Winnicott's "good enough mother" and the holding environment, in particular, it was written by a therapist who has specialized in the treatment of postpartum depression for more than 20 years.

I haven't had a chance to read Susan's book yet (I'm sure it's amazing), but I have seen Karen's and I found it completely fascinating even though I'm not a clinician.  It was so interesting to see that my reactions are not unlike so many other women who go through these illnesses, and to learn how to get around all of my blocks and objections to being diagnosed and treated. 

Part 2 of Becoming Me's PPD Journey

If you read the story last week in Postpartum Progress about the blogger from Becoming Me and her experience with a postpartum mood disorder, you'll want to read part 2.  She writes very beautifully about what it felt like and I know many of you will connect to her journey.

"From The Hips" Pregnancy Guide Offers Deeper Look at PPD

There is a great new pregnancy guidebook out called "From the Hips: A Comprehensive, Open-Minded, Uncensored, Totally Honest Guide to Pregnancy, Birth & Becoming A Parent," written by Rebecca Odes and Ceridwen Morris.  I think this book rocks and will eventually outsell many of the other books that just cause fear and confusion and frustration for women who are about to become mothers.  (Was anybody else freaked out after reading "What to Expect When You're Expecting," or was it just me?)

My favorite feature? The chapter called "The Postbaby Brain" on pages 188-205.  The authors take an unvarnished look at the feelings moms have about parenthood, both good and bad.  And they actually talk about postpartum mood disorders for 5 pages (!), rather than the usual paragraph or two, even offering a list of symptoms for postpartum depression, postpartum OCD, postpartum panic disorder and postpartum psychosis.  It's nice to see a general interest pregnancy book go into more detail about the variety of symptoms one can experience and recognize that PPD is not a one-size-fits-all illness.  I would have liked them to offer a little more information on how to seek help, but they do provide a list of resources on page 194 that includes Postpartum Support International and Postpartum Progress (wahoo!), among other good sites and books.

Odes and Morris offer ten "anti-rules" for parents-in-progress, which you can learn more about by picking up their book:

1. Everyone's an expert, but you're the authority on yourself and your baby.
2. Confidence is more important than instinct.
3. Strive for imperfection.
4. Parenting is out of control.
5. There's no such thing as a "natural" mother.
6. Shift happens.
7. Babies are people, not problems.
8. Frustration, resentment, anger, exhaustion, exasperation, aggravation, jealousy, nostalgia, regret, etc., don't make you a bad parent.
9. Look forward, not backward. 
10. There is no right way.

PSI Annual Conference To Be Held in Houston June 4-7

Save the Date!  This year's Postpartum Support International conference will be held in Houston, June 4-7 at the Hilton Americas-Houston.  The event is co-sponsored by the Women's Mental Health Initiative of the Mental Health Association of Greater Houston.  Some of the main speakers include Dr. Margaret Spinelli, Dr. Lucy Puryear, Valerie Plame Wilson and George Parnham.  Registation will begin in March.  I'll be there, and I hope to see you there as well!  For more information, visit www.postpartum.net.

Columbia University To Host "Mood Disorders Across the Female Life Cycle"

On Saturday, March 8, Columbia University will host "Mood Disorders Across the Female Life Cycle" led by Dr. Margaret Spinelli.  The event is being held in conjunction with Postpartum Support International, Postpartum Resource Center of New York, and the National Association for Psychosocial OB/GYNs.  It will be held at the Alumni Auditorium in the William Black Medical Research Building at Columbia University Medical Center.  CMEs are available for MDs, PhDs, CSWs, Nurse Practitioners and Nurses.  To register, click here.

Postpartum Progress Opens Up To Guest Authors

Would you like to be a guest author on Postpartum Progress in 2008?  I have decided to open the blog up to some additional voices this year, as Postpartum Progress continues to grow. 

I've thought about doing this in the past, but haven't done it because I've been nervous about offending people if I edit them or choose not to use their articles.  But I've decided to ty and get over that for the sake of diversity.

You can submit your stories/articles to me at stonecallis@msn.com anytime throughout the year.  Here is how I will make choices about what will and won't appear on the blog:

1) Stories should run no more than 700 words.  I try to keep all my blog posts fairly short and easy to digest.

2) The article must be 100% relevant to Postpartum Progress and its readers, meaning it should be focused on postpartum mood disorders (postpartum depression, postpartum psychosis, postpartum OCD/anxiety, postpartum PTSD) or antepartum mood disorders.  As a reminder, Postpartum Progress is written to SUPPORT the women who have suffered or will suffer, and for their families and friends and those who treat them.

3) I will not run any article in which the writer is attempting to sell their product or service.  No shilling.  I will make an exception, however, for published authors of books focused on PPD and related-disorders if they would like to share an excerpt of their book of which they are particularly proud.

4) I will not run any article where I feel the story has already been done many times on Postpartum Progress, so it would help you to be very familiar with the site.  The subject should be a new and fresh take on the issues surrounding PPD and related disorders.

5) I welcome personal stories of people's experiences with PPD as long as they are fairly concise and well-written.  I also welcome brief summations from people who have been able to attend conferences or roundtables or other events that I have not been able to attend, as long as there is some interesting, newsy nugget of info that came out of the event.  And I welcome stories about newly published research as long as it comes from a highly-regarded source.

I hope this makes sense to everyone.  You will, of course, be credited as a guest author for your story, and should you have a blog or website I will be happy to link to it in your article.  I will try and respond back to each person who submits an article to either let you know that it will appear and when, or to let you know why I don't plan to use it.  If I don't reply back it may be because I get too overwhelmed.

Informative First Thursday Teleconferences Offered By MedEdPPD

I think I've written about this before -- at least I hope I have -- but Dr. Ruta Nonacs was kind enough to remind me of the First Thursday teleconferences held by MedEdPPD.  Here's a link to her post on A Deeper Shade of Blue about these informative sessions.  The next one is Thursday, February 7, and will feature Dr. Margaret Spinelli of Columbia University discussing postpartum psychosis and infanticide.

The Future Is Bright

I had the opportunity this weekend to retell the story of my experience with postpartum depression/OCD.  Even though it has been six years, it astounded me how the feelings rise up and bubble over -- it surprised me that I cried.  I guess it just goes to show what an intense and indelible experience PPD is for everyone who goes through it.  It also served to remind me how different I am today than I was during those dark hours. 

I am so unbelievably happy to be a mom.  It is truly the best job I've ever had or will have.  My children are my oxygen.  Is it easy every day?  Of course not.  When my 20-month old decides to remove her diaper and spread its contents around her crib, I pray for mercy.  When they throw tantrums in public, I want to tell onlookers that they don't belong to me.  But then my funny little six-year-old tells me "Mom, just five more gallons and I'll be as tall as you", and I feel like the luckiest, happiest person in the world.

For those of you reading this who are going through postpartum depression right now I hope you can find some hope in that.  I went from being someone who thought I never should have been a mother, to being someone who delights in motherhood.  You will too. 

5 Things Every New Mother Should Know About PPD

I was recently asked to put together a list of things women should know about postpartum depression.  I thought a lot about what I went through in 2001 with postpartum OCD, and the things I wish I had known that I believe would have lessened the severity of my experience.  While the list below certainly doesn't cover everything, I think it's a good start and I hope it will help many women in their journey as new mothers.

PPD can and often does happen.

Many pregnancy books and childbirth educators gloss over postpartum mood disorders.  They minimally describe the symptoms and emphasize how rare it is.  Actually, 10-15% of new moms experience these illnesses, and some studies report it may be as high as 25%.  My childbirth educator told our class that we really needn't spend too much time worrying about it, so I didn't, and thus I was completely unprepared for what hit me.

Postpartum depression is only one in a spectrum of postpartum illnesses.

Postpartum mood disorders include postpartum depression (PPD), postpartum obsessive compulsive disorder (PPOCD), postpartum psychosis (PPP) and postpartum post-traumatic stress disorder.  PPOCD is often characterized by intrusive thoughts, which are disturbing unwanted thoughts.  When I experienced my first intrusive thoughts -- about smothering my infant son with the burpcloth -- I had never heard of such things.  No one ever told me they were possible.  I was convinced I had just gone permanently crazy, and it never occurred to me that I had PPOCD.  If I had been better informed, I would have felt comfort in knowing what was wrong and that immediate treatment was available.  Instead I kept quiet for weeks because I was afraid I'd be locked up forever and lose my family.  (For more information on each illness and its symptoms, visit the Postpartum Support International website at http://www.postpartum.net/brief.html )

Symptoms can appear anytime during the first year after birth.

Many women think that if they start feeling bad when their child is 3 or 4 months old, or even older, that it can't be related to postpartum depression.  Apparently, even the DSM-IV, the manual that psychiatric professionals use to diagnose psychiatric illnesses, states that your illness can only be diagnosed as postpartum if the symptoms show up within the first four weeks after birth.  This isn't necessarily true.  Postpartum mood disorders can occur any time within the first year after the birth of your baby, though it is true that most are diagnosed within 2 to 4 months postpartum.

Ask your friends and family to be prepared.

It's important to talk about the possibility that you might experience some form of postpartum mood disorder with the people closest to you.  Ask them to educate themselves.  Sometimes we can't see that we're acting differently, or we try to convince ourselves we're fine and purposefully ignore our symptoms.  In that case, it often takes someone close to us to point out that we might need help.  Neither my husband nor my mother knew about what to look for or what to do about it, which made it harder on all of us.

The sooner you get treatment the better.

Many recent studies show that children of mothers with postpartum mood disorders who go untreated for long periods can be negatively impacted over the long term with behavioral problems.  A study published in 2006 in the Journal of the American Medical Association (http://jama.ama-assn.org/cgi/content/short/295/12/1389), for instance, found that children of mothers who have received treatment via medication for major depression or anxiety are less likely to be diagnosed with anxiety, disruptive and depressive disorders themselves, compared to children of women who remain untreated.  You MUST push past the fear and speak up to lessen the impact of these illnesses on yourself and your children.  You must be willing to say how you are feeling and seek treatment so that not only you, but your whole family can heal.

Guest Author: Theresa Borchard of Beliefnet

Therese Borchard, who writes the Beyond Blue blog at Beliefnet, shares her postpartum anxiety story with Postpartum Progress today:

   Although I can’t remember a time in my childhood or adolescence that I lived without depression and anxiety, I guess you could say that I officially joined the elite mentally ill club in 1989, my freshman year at Saint Mary’s College in Notre Dame, Indiana, when I went by the Counseling and Career Development Center to inquire about local support groups (I was just a few months sober). One of the therapists politely invited me back.

   A few months later she rattled off a handful of diagnoses: obsessive-compulsive disorder, eating disorder, anxiety disorder, and depression. She strongly suggested antidepressants, but I resisted. Like fellow twelve-steppers, I thought they would compromise my sobriety. And with my Catholic friends and mentors, I regarded them as a crutch and a short cut from the pain that was necessary for spiritual growth.

    “Life doesn’t have to be this hard,” my counselor told me, giving me a copy of Colette Dowling’s book, You Mean I Don’t Have to Feel This Way. A year and a half later, when I was experiencing suicidal thoughts, I finally cried uncle, clinging to the lifeboat (or prescription) God sent me. After a few trial and error experiments, my doctor and I stumbled on the combination of Prozac and Zoloft, which allowed me to concentrate enough to study, and relax enough to tell a dirty joke (one of my favorite things to do).

   Then I got married, in 1996, and made small people (David and Katherine are now 6 and 4). After the two births, my hormones huddled together to ask each other what the hell they were supposed to be doing now that no baby was in the womb or on the breast. My neurotransmitters (the good guys responsible for feelings of well-being) caught an express train to another brain (the one content with instant oatmeal). Brain cells began to shrink (and I suspect croak) in my prefrontal cortex. A tumor grew in my pituitary gland (also in the brain). And I had a bona fide, genuine mental breakdown. There was nothing mini about it.

   I lost twenty 23 pounds (I could wear an Ann Taylor size 2! That was the only perk.) because I had no appetite (this alone signaled a serious crisis, given my love of all things edible), I contracted one urinary tract infection after another because my immune system was breaking down, I breathed into a paper bag every morning during a panic attack, and I trembled and flailed like Linda Blair in the “Exorcist” because my anxiety was so acute.

   Oh yeah, and the endless sobbing: in the deli line at the grocery (“No, it’s not the chicken salad, I just got my period”), in the waiting room at my gynecologist-obstetrician’s office (“I’m sorry, pictures of babies make me cry”), on the hayride at David’s class trip to the pumpkin patch (“I’m allergic to hay”), at Eric’s company dinners (“Please give him a raise”), at Katherine’s physical therapy sessions (“Will she ever walk?”), during sex (“Are you almost done? I have to blow my nose”), in church (twice as hard if we sang “On Eagle’s Wings” or “Be Not Afraid”), and yada yada yada.

   It took two trips to the psych ward, seven different psychiatrists, one endocrinologist, 23 different medication combinations, and several MRIs over two years’  time to get me well again. In other words, I upgraded to the platinum club membership in Club D. Diagnosed with Bipolar II Disorder, I graduated beyond the casual, my-primary-care-physician-can-prescribe-me-my-meds to the critical, regular check-ins with a head doctor.

   Although I have cussed out God too many times to count, asking him what kind of marijuana he was smoking the day he designed my brain, I agree with Kay Redfield Jamison, author of An Unquiet Mind, that “tumultuousness, if coupled with discipline and a cool mind, is not such a bad sort of thing. That unless one wants to live a stunningly boring life, one ought to be on good terms with one's darker side and one's darker energies.”

Searching for Inspirational Items For Suffering Moms

Aside from the Postpartum Depression Links page I've newly started, which you can find on the left of your screen under "Pages", I'm also creating an Inspiration for Moms page that will feature quotes, songs, poems and anything else that might give moms comfort during their suffering.  LADIES, f you have a song, quote, poem, bible passage or any other little item that helped you get through this terrible experience, and would like to share it with other moms across the country and the world, let me know and I'll add it to the page.  Email me at stonecallis@msn.com.  Thanks!

Top Hospitals in U.S. for Psychiatry

U.S. News & World Report has its Best Hospitals feature in this week's issue.  They also rank hospitals based on specialties, including Psychiatry.  I think it is important for women to know which hospitals in the U.S. excel in Psychiatry, given that we need to know where we can go for the best treatment.  I know some of them excel in the treatment of postpartum mood disorders, like Massachusetts General Hospital, New York-Presbyterian University Hospital of Columbia and Cornell, Emory University Hospital, NYU and the University of Pittsburgh Medical Center.  I'm going to look into the others to find out what reproductive psychiatry programs they may have and report back to you.  In the meantime, here is the list of the top 22 hospitals in the United States in the area of psychiatry, as reported in U.S. News & World Report.  Rankings were determined solely by reputation.

1.  Massachusetts General Hospital, Boston, MA

2.  Johns Hopkins Hospital, Baltimore, MD

3.  McLean Hospital, Belmont, MA

4.  New York-Presbyterian Univ. Hosp. of Columbia and Cornell, New York, NY

5.  UCLA's Neuropsychiatric Hospital, Los Angeles, CA

6.  Sheppard and Enoch Pratt Hospital, Baltimore, MD

7.  Menninger Clinic, Houston, TX

8.  Mayo Clinic, Rochester, MN

9.  Yale-New Haven Hospital, New Haven, CT

10.  Stanford Hospital and Clinics, Stanford, CA

11.  University of Pittsburgh Medical Center, Pittsburgh, PA

12.  Emory University Hospital, Atlanta, GA

13.  Duke University Medical Center, Durham, NC

14.  Austen Riggs Center, Stockbridge, MA

15.  Barnes-Jewish Hospital/Washington University, St. Louis, MO

16.  NYU Medical Center, NY

17.  University of California, San Francisco Medical Center, San Francisco, CA

18.  Hospital of the University of Pennsylvania, Philadelphia, PA

19.  Cleveland Clinic, Cleveland, OH

20.  Methodist Hospital, Houston, TX

21.  Hartford Hospital, Hartford, CT

22.  Long Island Jewish Medical Center, New Hyde Park, NY

PPD Workshop in Athens, GA on Aug. 24

On August 24th, there will be a 3-hour Postpartum Depression Workshop entitled: When Joy Finds Sorrow: Clinical Treatment of Perinatal & Postpartum Depression. J. Kip Matthews, Ph.D. will be presenting. He is a licensed psychologist in the state of GA.

To learn more about the seminar and for registration information, click on the following link:

http://www.akcconline.com/ppd_workshop.html

Ladies, Send Me Your Blog & Website Addresses So I Can Link To You

I am going to create a new page in Postpartum Progress that links to women who have blogs or websites that are either specifically about postpartum depression, or have included stories about experiencing postpartum depression.  If you have one of those blogs or sites, please email me at stonecallis@msn.com.  Tell me about your blog or website, and give me your URL web address.  Thanks!  I look forward to linking with you!

University of Michigan Needs Qualified Participants for Two Perinatal Mood Disorder Studies

For those of you living in Michigan, the University of Michigan is conducting two studies related to perinatal depression.  This would be a great opportunity to participate in important research and also to benefit from the care offered by a wonderful medical school.  If you know anyone who might be appropriate, please let them know.

The first is a study looking at the affect of interpersonal therapy on depression and/or anxiety in pregnant women.  It is open to women who are currently pregnant, and have a history of depression or anxiety disorders or are currently experiencing symptoms of depression or anxiety.  You will receive up to 16 sessions of interpersonal therapy free of charge as part of this study.  The locations for the study are Ann Arbor and Ypsilanti.  Click here for detailed info.

The second study is designed to learn more about communication between moms and babies and children's social development during early childhood. They are studying mother’s health issues during pregnancy, baby’s development, and how mother and baby interact with one another during baby’s first year. They will also be looking at hormones in blood and saliva to see how stress impacts mothers and babies both positively and negatively...and how healthy moms cope with stress.  This study is open to women who are less than 26 weeks pregnant and live within 60 miles of the University of Michigan Medical Center in Ann Arbor.  Click here for detailed info.

To Georgia PPMD Survivors & Practitioners

Calling ALL women in Georgia who have survived a postpartum mood disorder, including postpartum psychosis, postpartum depression, postpartum anxiety, postpartum OCD!!!!  (Or if you're a Georgia practitioner who treats a lot of these women.)  Please email me at stonecallis@msn.com.  It's very important.  Will explain later!  Thanks.

-- Katherine

Postpartum OCD & Anxiety Get The Focus

Here's a link to a good story from the Ann Arbor News about postpartum OCD and postpartum anxiety.  Following are highlights from the article by Jo Mathis:

"Postpartum depression has gotten all the press, grant money, and research, and relatively little is known about other mental health conditions in the perinatal period (the weeks before and after pregnancy), according to Michelle Van Etten Lee, training director for cognitive behavioral therapy at the University of Michigan's Psychological Clinic.

Onset of conditions such as OCD is most common during stressful times, said Van Etten Lee. About 30 percent to 40 percent of treatment-seeking women with OCD in their childbearing years date the onset of their disorders to pregnancy or the postpartum, she said.

There is also evidence that hormones play a role in anxiety conditions showing up during pregnancy or postpartum, Van Etten Lee said ...

Van Etten Lee said that just as there's not a lot of research on perinatal disorders, there's not much that looks specifically at treatments for anxiety disorders in perinatal women. ...

Women whose symptoms are significantly distressing or impairing to them, or for whom anxiety is taking significant amounts of time in their lives, should seek treatment, Van Etten Lee said."

NJ Catholic Churches Launch PPD Program

A few weeks ago, the Catholic Church in New Jersey announced a statewide program to educate priests and parishioners about postpartum depression.

The program was unveiled during a news conference in Newark that brought together Archbishop John J. Myers, community health professionals and former victims of postpartum depression.  The program aims to make each of the state's 684 Roman Catholic congregations a source of assistance for women stricken with the illness.  The archdiocese will begin training priests, deacons and lay ministers next month, teaching them about the symptoms, and resources for referring mothers for treatment.  Amen to that!

A Roundup of Major Stories & PPMD News

You should see my inbox these days!  I can't keep up!  There is a LOT going on.  First things first, below is a current list of support groups.  Please check it out if you're looking for one in your area.

Download ppd_support_groups_52207.doc

This is a link to a good article that just came out of the annual meeting of the American Psychiatric Association this week.  No real new news, but it's nice to see the recognition of perinatal mood disorders as a spectrum disorder, and the fact that onset can occur anytime throughout the first year postpartum. 

This is a link to a new book called "Crazy In America: The Hidden Tragedy of Our Criminalized Mentally Ill".  It sounds like it could be good, and similar to Pete Earley's book called "Crazy", which I absolutely loved. 

I've added another beautiful survivor mom to our Surviving & Thriving Mothers' Photo Album.  Thanks Shannon for sending me the picture. 

Here's a link to a great editorial from Newsday by Sandra Wolkoff.   One highlight that reminds us we just don't get over this in a day:

"Frequently, women convince themselves that any slight improvement is a sign that recovery is around the corner. When the black clouds of despair return hours or days later, or another medication seems to prove ineffective, they feel like failures."

Here's a link to a recent story that appeared on the NBC affiliate in San Diego about the Michael Spangler, husband of Annie who committed suicide three years ago after suffering from postpartum depression.  I'm so sorry for his and his little boy's loss, especially when we all know these tragedies are completely unnecessary.

Here's a link to a story from last week in Chicago about Tonya Vasilev, who was found mentally insane for the killing of her two children.  She had suffered depression since childhood, and had been diagnosed with postpartum depression.  The judge said he felt comfortable finding her insane because of the expert medical testimony, thus Tonya will now receive lifelong commitment to a mental health facility rather than prison or the death penalty.  (Trust me, this doesn't mean I'm comfortable with those sweet children being killed.  I can think of nothing more awful and tragic.  But we need to work harder to treat and protect the mentally ill so that things like this don't happen.)

Margaret Trudeau, the ex-wife of the late prime minister of Canada Pierre Trudeau, spoke up about mental health recently and the importance of mental health check-ups to all Canadians.  Trudeau herself suffered from postpartum depression.  Here is a link to the story.

3 New Books About Postpartum Depression

There are lots of new books coming out that are about postpartum mood disorders.  Here are three to look for:

1)  Wiped! by Rebecca Eckler.  Eckler is a parenting columnist for the Globe & Mail daily newspaper in Canada, and shares her experience with postpartum depression, as well as funny accounts of the highs and lows of being a new mom.

2) The Journey to Parenthood:  Myths, Reality and What Really Matters by Diana Lynn Barnes and Leigh Balber.  Barnes, a past president of Postpartum Support International, and Balber help couples run through a "psychological dress rehearsal" of what life will be like once the baby is born and address issues in advance of the baby's arrival.

3)  The Lifter of My Head by Susan McRoberts.  McRoberts writes about how God sustained her during her bout with postpartum depression, and she shares scriptures and prayers that were helpful during that time.