Postpartum Progress

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 Progress' New Research Page Provides Better Access to Studies on Postpartum Depression

Since it is so hard to keep track of the research coming in almost daily on perinatal mood and anxiety disorders, I've decided to add a research page to Postpartum Progress.  You can find it on the right-hand side of your screen underneath "Help Is Here", #5. 

I won't be able to list every single piece of research that comes down the pike, but I will put links on that page to the most current, most interesting, most often cited research.  I've created categories to try and organize it, such as Genetics & Postpartum Depression, Screening for Postpartum Depression, Risk Factors for Postpartum Depression, etc.

Hope this page is helpful to you should you need to find some specific data.  If you know of a study that should be listed there and it isn't, please send me a link at postpartumprogress@gmail.com.  And to my brainy, scientific-type, evidence-based medicine readers, if you see a study on there that you don't think is valid, tell me that too and I'll remove it.

Beyond Postpartum Blogger in New WebMD Video on PPD

Amber Koter-Puline, author of the Beyond Postpartum blog, is featured in a new video on WebMD about postpartum depression.  Check it out!  Great job Amber!

One Mom On Rising Up Out of the Hell of Postpartum Depression

This is a poignant post from Tamra at Surprisingly Sane, who is recognizing her one-year "anniversary" of suffering from postpartum depression.  She starts out describing what last November was like ...

"I can’t remember last November.  I have no recollection of celebrating the holidays or what I bought everyone for Christmas.  Did I get anyone gifts?  Did I even get my own kids something from St. Nicholas?  Maybe someone pulled out a camera with proof that I was breathing through that time, but it sure wasn’t me."

And then she describes how she feels now ...

"The fact that I am sitting at my kitchen table next to an open window filled with blue skies and sunlight in the gorgeous city of Seattle, Washington a year later is proof to me that there simply MUST be a God, He/She MUST love me, and for whatever reason… my life MUST be worth living.

I believe that now.

A year ago, I couldn’t."

So glad you are well Tamra.

Can Women With Postpartum Depression Even Talk About Happiness?

Let's face it: postpartum depression is a bummer of a subject.  So are postpartum OCD, postpartum psychosis, intrusive thoughts, mental illness ... shall I go on?  These things are real and they can't be ignored, but they're not gleeful things to discuss.  Necessary but not exactly fun.

I don't get a chance to talk a lot about happiness here.  I talk more about finding one's way back to it.  Postpartum Progress is sort of a stop along the way to happinessland.  You just left the twin cities of Darkness and Misery and now you're here in Postpartum Progress and on the way to full recovery with a final destination of Happy Momville.  You can't see where you're going because Happy Momville is a little bit of a ride from Darkness and Misery and nobody gave you a precise map, but I've made the journey and I know for a fact that Happy Momville can be reached and in fact is a pretty cool place to be.  You'll see.

Today I happened upon an interview that Gretchen Rubin of the Happiness Project just conducted with "momblogger" Liz Gumbiner who writes Mom-101.  It's such a basic discussion, yet an important one in that Rubin asks questions that we rarely ask ourselves but should:  What makes you happy?  What detracts from your happiness?  How do you give yourself a happiness boost? 

Is it ridiculous to even bring up the subject of happiness on this blog?  I'm not sure.  Thinking back to when I suffered from postpartum OCD I can't say I felt much happiness whatsoever during that time.  There were a few "decent moments."  I can't think of a word to describe those times, fleeting moments where I glimpsed that maybe I could love my son and maybe he could love me.  (What's a word to describe the wide open space between misery and bliss?)  I probably would have wanted to PUNCH someone who tried to talk to me about happiness during that time.  

Concerned person: Katherine, how could you give yourself a happiness boost right now?

Katherine: Are you kidding?  F*&#k you.  (Pow.)

if someone had wanted to talk to me about recovery, though, or being healthy, or getting back to the old me, I think I would have been open to it.  Aren't those words -- recovery, health, being me, renewal, healing -- synonyms for happiness, or at least things that can lead to it?

Even if the word "happiness" is anathema to you right now, you can admit that it is truly where you want to be.  You want to get back to your own specific brand of happiness, your own version of what being contented in life means.  And even though you have no control over your genetics, your brain chemistry, unsupportive people who may be around you, and some of the other things that might have led you to this crappy place called Darkness and Misery, you are empowered to take steps to fix the situation.  

In fact you've already taken steps to fix the situation, perhaps without knowing it.  You've identified the problem that has stopped you in your tracks.  That's why you are here, reading this blog.   And now that you are finding out what is wrong you are also finding out what you can do to turn things around.  You are finding out that what is happening to you is temporary.  You are finding out who to talk to and where to get the help you need and who is dedicated to supporting you through this.

You're on the road to the h-word.  We just won't call it that. 

Postpartum Progress Blogroll for Moms with Postpartum Depression

I've been busy redoing the Postpartum Progress Blogroll this week.  I've taken off blogs that no longer exist or that haven't been updated in quite a while, and tried to add a few more.  Since I've added some that weren't on the blogroll before, you should definitely check it out.  You'll mainly see blogs written by mommas who are currently going through (or are survivors of) postpartum depression or related illnesses.  They include (but are not limited to):

Unexpected Blessing

Dooce:  this is linked to her posts on depression and postpartum depression

Ivy's PPD Blog

Atlanta PPD Mom

Pretty Swell Mama

Laughing Through The Chaos

Mood-Disordered Mama

Life with PPD

Sophie in the Moonlight

Go Erin Go

Surprisingly Sane

His Boys Can Swim

Ohana

Postpartum Dads Project: for dads whose wives/partners are suffering

Dig Toes In

TheMommyblog.net

The Smiling Mask

The Mommy-Muse Blog

Oh, and since my mind is crammed with too much data, I know there are people I've inadvertently left off the list.  If you think you are one of those people, let me know at postpartumprogress@gmail.com.   Please note that I generally only list writers who've written at least a couple of times about PPD and related topics, as they can serve as a great resource to those who suffer. (Oh, and make sure you check the list first before you fire off an email about how you're not on it!)

Oh, and I hope you'll add Postpartum Progress to your blogroll too!  Pweez?! as my daughter would say ...

Depression Hurts: Overcoming Depression With Dooce, Finslippy, the Mommyblog & DadGoneMad

I finally had a chance to mosey on over to Momversation to see their new video and discussion on overcoming depression.  The 6-minute video features bloggers Heather Armstrong of Dooce, Alice Bradley of Finslippy, Mindy Roberts of TheMommyBlog.net and Danny Evans of DadGoneMad.  They share their feelings on what it's like to suffer from depression. 

The video is fantastic.  I love it.  Wish there was more of it.  I was moved by all of the speakers, particularly by Mindy Roberts, who has been through postpartum depression 4 times. 

FOUR TIMES!!!!!!  Great Caesar's Ghost! as grandma would say.

Regardless of their specific mental illness I know you will definitely connect with their observations.  Those of you currently suffering will benefit most of all.  As I stated in my comment on Momversation:

"Despite the progress we've made on public communication to erase stigma and ensure people feel safe reaching out for help, I still hear from women each and every day with a perinatal mood and anxiety disorder who are:

• given erroneous information about postpartum depression and related illnesses (its causes, its symptoms, what to watch for, its treatments, etc.)
• deeply hurt by the reactions of those around them who don't understand what serious illnesses these are (friends, spouses/partners, clergy, employers, doctors)
• made to feel afraid to take medication or seek counseling
• convinced they are alone and there is nowhere to turn

It's just awful and it makes we want to pull my hair out on a daily basis. As the little people in the town of Whoville shout from the tuft in Horton Hears A Who!: We are here! We are here! We are here!"

Okay fine.  It wasn't a tuft.  It was a small speck of dust.  But still ... We are here!!

Are Children Forever Marked By Their Mothers' Postpartum Depression?

Casey, who writes the blog Moosh in Indy, has written a very beautiful piece on her depression and how it may (or may not) affect her child.  It is a true love letter to her daughter.  The photos she includes of she and Moosh together are just gorgeous, and I found the sentiment of her post really compelling.

"I have always worried about the day you would be old enough to know when I’m not doing well. I’m not the mom you deserve when I’m in the dark. But you are so resilient. You take such good care of me when I’m lost in my own brain. You heal me. But it’s not fair, you’re only four. I sometimes wonder what I would be like if I didn’t have these demons to battle. Would I be very average and boring? I guess it’s not even worth giving any thought to. This is my trial."

Casey has received more than 80 comments on her piece, some of which are from women with or who have had postpartum depression.  They are worth reading as well, like this one:

"My own mother went undiagnosed with postpartum depression for about 5 years. It just wasn’t talked about much 'back then.' Those were dark times for her. (and my dad…in med school & residency!) I was about age 2-7 during this time and I can vaguely remember times of hearing her cry in her bedroom and sensing that things weren’t always right but that’s about it. I remember having a happy childhood.

Talking to her after having my last baby, she expressed to me that during her darkest times she would have one goal for her day: That her children could say they had a happy mom. And I can say that."

Some of the women who go through postpartum depression are women who've always suffered depression.  Some knew they suffered all along, some have just realized it for the first time through their bout with PPD.  Whether you are in a temporary dance with depression, or you are someone with whom it remains, you wonder and worry about your babies.  I still worry to this day whether all that crying during his infancy was somehow permanently imprinted on my son somewhere like a tattoo or a scarlet letter.  Is it deep down in him somewhere waiting to explode?  Will he have depression as well?

I know you think the same things.  I know you ask yourself the same questions.  We have to remind ourselves that all life, even lives that have never been touched by any form of mental illness, includes suffering.  All children see darkness at some point.  There are traumas, letdowns, disappointments, deaths, failures ...  Our children will have them.  Other children will have them.  All we can do is give love one day at a time.

For more on this, read What Have I Wrought: Postpartum Depression's Impact on Our Children.

Psych Central: The 7 Myths of Depression

Dr. John Grohol at Psych Central has just published a blog post on the 7 Myths of Depression.  All of these would, of course, apply to women with postpartum depression as well.  A couple of the key points he makes:

"In depression, time alone doesn’t help, nor does willpower (”Pull yourself up and stop feeling so sorry for yourself!”)."

"While the exact amount of time will vary from person to person based upon the severity of the disorder and how well the various treatments may work for each individual, most people who have depression do not need to be on medications for the rest of their lives (or be in treatment for the rest of their lives)."

He also points out that depression is not just a medical disease.  It is actually much more complicated than that, and can include genetic factors, past history, current stressors, coping ability, level of social support and more.

To read the whole piece, click here.

Do Women Use Postpartum Depression As An "All-Access Pass for Bad Behavior"?

Megan, the very popular (and pregnant) blogger at Velveteen Mind, wrote what I found to be a VERY interesting post about postpartum depression and blogging.  (Be sure to read the comments as well.)

Part of her story is about why she didn't blog about her bout with depression with her first child, and how she fears having it with her second.  (Sending out a prayer that she doesn't get it this time.)

She also writes that she finds many women blogging about postpartum depression and using it as sort of a badge that allows them to do anything they like. 

"Such is the irony of our social media existence.  That which is rarely discussed openly in our real lives is hashed out so thoroughly online that it begins to sound trite ... Since when did postpartum depression become a shield?  Since when did it become an all-access pass for bad behavior?"

I'm very interested to hear what you think about this.  Are you seeing people use PPD in their blogs, or in person, beyond simply sharing their experience?  Do you worry that women may use their illness as an excuse in blogging or in real life?  I imagine that there are those who are unwell emotionally regardless of their PPD, who might use any illness or perceived life trauma as an excuse to behave badly.  I have to say that I haven't personally seen that in the stories I've read on the web or the women that I follow, but I also realize I only see a small portion of what's out there.

(As a side note, It's ironic that Megan uses the term "shield", as a shield features so prominently in the Postpartum Progress logo.  I wanted to point, for anyone wondering about the meaning of the logo, that our shield represents fighting back against our illness, fighting back against the stigma, being brave enough to reach our for help and being as strong as possible during our recovery.  Go, Warrior Moms, Go!)

When it comes to Dooce, I think Heather Armstrong became "Dooce" only in small part because of her writing about postpartum depression.  I think she became Dooce for many other reasons, and her power and influence now is because of all of them.  I would imagine that some days she is thrilled because she has a successful business now thanks to her blog, and some days she probably feels she created a monster that she must continue to feed daily.  Those readers who mistakenly use Armstrong's bout with PPD to defend or support every move she makes are simply ignorant about what PPD is.   

Postpartum depression is not a life sentence.  PPD does not define who we are, nor does it let us off scot-free should we live our lives poorly in the future.   It's temporary. 

Thank God.

Your Vote Could Make PPD Part of Mutual of Omaha's Ad Campaign

Want to help get postpartum depression featured in a national TV campaign next year?  You can!

From more than 1,000 real stories from people recorded during Mutual of Omaha's "aha Moment" Tour this summer, 75 people were selected to participate in the first-ever Mutual of Omaha "aha Moment" online survey.  Following public voting, the top 10 vote-getters will appear in Mutual of Omaha's 2010 TV ad campaign.

Among the 75 videos chosen is a woman named Lesley from Grand Rapids, MI, who suffered from postpartum depression and was inspired to help other women facing the same problem.  Here is her short video. (I believe that Lesley is a Moms Bloom volunteer.)

Click on the link above to watch her video and vote for it to be one of the ones featured in Mutual of Omaha's TV commercials.  (Just click the vote button underneath her video.) I already voted!

Your Bad Days Will Become the Exception, Not the Rule, with Postpartum Depression

The mom at the blog Go Erin Go! writes about having a bad day despite having progressed well on her recovery from postpartum depression.  As I've shared with you before, this is normal.  It happens to all of us. 

Some people have setbacks much worse than Erin's, as described in her post.   For all of us, though, bad days tend to cause fears that we really aren't getting better.  A bad day makes you feel like maybe you'll never get better.  Maybe you were just fooled for a moment.  Maybe the good days you started having were a fluke. 

They weren't a fluke.  They were real.  And there will be more of them as long as you continue to take care of yourself and work with your doctor.  Check out Erin's story, and then for more on setbacks with postpartum depression and anxiety, read this:  The Waiting is the Hardest Part

Wishing for an Open Discussion Between Clinicians & Consumers on Perinatal Psychiatry? Now's Your Chance!

I'm really excited to share with you that the current issue of the Journal of Clinical Psychiatry features a set of commentaries all focused on Perinatal Psychiatry.  Read on, because there is a way that you can be a part of an interesting discussion on the treatment of women with perinatal mood and anxiety disorders, and I really want you to participate.

There are 9 commentaries, plus an introduction by Marlene Freeman, MD.  Each is a short read and not too full of medical jargon, so for those of you who aren't clinicians I'm pretty sure you will be able to understand what they're saying. (No multilayer perceptrons here.) If you're wondering what a commentary is:  Rather than being a paper on the results of a specific piece of research that is published in a medical journal, commentaries are more like op-ed pieces.  The writers provide their observations and opinions, citing the research that forms the basis of these ideas.  Here's one of the titles to whet your appetite:  "Influence of the Media on Women Taking Antidepressants During Pregnancy" by Adrienne Einarson.

Here's the even cooler, interactive part:  The Journal of Clinical Psychiatry has created an online, open forum for you to post comments and ask questions about each of them.   Did you agree with what you read?  Disagree?  Do you have other ideas?  Would you like clarification on something? 

You can start posting your responses today in the forums, and later in the month the authors of the commenataries will offer responses to your comments and questions. 

Anyone can participate; you don't have to be a doctor or in the psychiatric field.  I would encourage all the Warrior Moms out there to read these pieces and share your own opinions or ask questions for clarification.  (Just please be sure to be dignified and constructive if you disagree with something.)  This is an important way to keep the lines of communication open between the medical field and the patient community.  We don't always get to interact in this way so I really encourage you to take advantage of this.  And of course the Journal would love to hear from my clinician readers as well!

It is free to participate but you will need to register for a free account in order to do so.  Just click on the link in the above paragraph.  For each article you can click "full text with forum" and it will allow you to read the piece and comment.  The first time you try to do it, you will be asked to join the Net Society Platinum.  Fill out the form and you'll be on your way.  (Note for the consumers who sign up: for medical school graduation year, I clicked N/A.  For profession I clicked other mental health.  Once you fill out the initial form and submit it, you will then be taken to a page asking you if you want to subscribe to the Journal.  You don't have to.  You can scroll down to the bottom to find your name and login.  It may ask you one more time if you want to update your profile.  Once you're done I'd suggest closing the window and using the link above again, logging in and commenting away.)  

Have Spanish Researchers Figured Out How to Predict Who Will Get Postpartum Depression?

So a new study came out last week that was ALL OVER the internet and Twitter about how Spanish researchers found a way to predict who will get postpartum depression.  I saw the articles everywhere, but I waited to write about it because I wanted to understand exactly what the big new idea was before I covered it here. 

In a published study, these Spanish researchers say they've figured out a way to predict 80% of postpartum depression cases, a method they say has higher accuracy than any other.  As reported at US News & World Report:

"Early diagnosis of postnatal [or, postpartum] depression would make it possible to intervene to prevent it from developing among women at risk," Salvador Tortajada, a researcher at the Polytechnic University of Valencia and lead author of a new study on the methodology, said in a news release from the Scientific Information and News Service in Spain.

Per Psych Central, the researchers used artificial neural networks and extracted a series of risk factors highlighted in previous studies (stuff we already knew about):

• the amount of social support for the mother
• prior psychiatric problems in the family
• emotional changes during the birth
• neuroticism (a tendency to be less emotionally stable and more affected by stress than the average person)
• genetic variations in the serotonin transporter gene (genes with high levels of expression lead to an increased risk of developing the illness)

I read as many of the stories online about this as I could find.  They all pretty much parroted the press release from Spain but it was difficult to find much more than that.  None of them had a link to the study.  None of them explained to me how this method can or will be implemented in the real world.  None of them explained how, once these women are identified, we can ensure they receive the proper treatment. 

Anyway, after doing some digging I finally found the journal in which the study was published online:  Methods of Information in Medicine.  And then after doing some more digging I found the study.  It's called "Prediction of Postpartum Depression Using Multilayer Perceptrons and Pruning".

Huh?  What the heck are multilayer perceptrons? 

A multilayer perceptron is a feedfoward artificial neural network model that maps sets of input data onto a set of appropriate output.

Sorry.  I don't speak Russian.  

An artificial neural network is a mathematical model that tries to simulate the structure or functional aspects of biological neural networks.  They can be used to model complex relationships between inputs and outputs or to find patterns in data.  Feedforward refers to giving pre-feedback to a person or an organization from which you are expecting feedback. 

Wha?

Are you lost?  Me too.

Tell me more, you say?  I can't.  The article costs $25 euros and I just don't have $40 right now to spend on it.  Besides which, I doubt I'd be able to understand a darn thing the paper says.

One thing I thought was odd, though:

They say they've discovered two protection factors that reduce the risk of getting postpartum depression - age (the older the woman the lower her chances), and whether or not a woman has worked during pregnancy (which reduces the risk). That seems strange to me, since I've known so many women who had PPD who waited until they were in their 30s or later to have kids, and so many women to who had PPD who had careers before they had them.   

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."

Mom with PPD Needs Your Support; Another Encourages Women To Get Help Sooner Than Later

Here is a mom who needs your support.  Go to her blog and let her know she's not alone.

And here's another mom who waited quite a long time to get help for PPD, but wishes she had reached out earlier.  I love this message at the end of her post:

"I go back to my doctor tomorrow. I can't wait for him to see how much better I feel. I am enjoying myself for the first time since Panda Girl was born. I am able to see humor in everyday life again. Each setback is not the end of the world. The sky is no longer falling. My only regret is that I suffered for so long. Truly it took about a year of misery for me to give up and seek help. If I can reach only one person who is soldiering through in silence and convince her to get help, then I will feel as if my pain has not been in vain."

Dear reader, could she be talking to you?

New Study Tests Whether Educational Intervention Can Prevent Postpartum Depression

The National Institute of Mental Health reports that a new clinical trial is being conducted in New York to test how effective a brief intervention program may be on preventing postpartum depression by preparing mothers to deal with stressful triggers and depressive symptoms.  (Prevention!  Wahoo!)  The study will last 6 months.  Participants will be randomly assigned to receive either treatment as usual or the behavioral education intervention.  The intervention will involve two parts.  First, after giving birth and while still in the hospital, participants will complete an education session with a social worker and receive materials about PPD.  Then, 2 weeks after discharge from the hospital, participants will receive a call from the social worker, who will conduct a needs assessment that addresses participants' physical and emotional health.  If a participant is experiencing distress, the social worker will refer her to appropriate resources and will reinforce self-management skills.  

The study is being conducted at Mount Sinai Hospital on participating patients in the Maternity Unit.

What Bad Clinicians Can Do To Moms: An Ugly True Story of One Mom with Postpartum Depression

Right now I'm supposed to be baking a cake.  And finishing the laundry so that I can pack stuff for all four people in my family for our Labor Day weekend trip to the mountains -- clothes, video camera, digital camera (does it need batteries?), video player for car ride (oh crap, it's not charged up), son's bday presents (oh crap, I don't have any wrapping paper).  And taking a shower so that I can be at my son's school by noon to help with a class project.  I have less than two hours to complete all of this and more.  But I CANNOT do that at the moment because I MUST, MUST, MUST write about this:  

Jane, the mom over at His Boys Can Swim, was just diagnosed with postpartum depression.  So this week she went to her very first appointment with a psychiatrist.  I just know the readers of Postpartum Progress will be as upset about this as I am.  Here is a bit of what happened at her appointment (and my commentary as well in italics):

"I filled out tons of paperwork and wondered why they were asking such vague questions.  There was nothing about pregnancy or postpartum depression and I began to wonder if this psychiatrist was the right one for me."

No questions about pregnancy or postpartum depression?  Hello?!  This is the first hint of trouble.

"The receptionist, and I repeat, receptionist, started asking me questions.  Some personal about any sexual, emotional, or physical abuse (no) to what my husband’s name, age, how much caffeine he drank."

How much caffeine her husband drinks?  And this has to do with PPD how exactly?  And is this receptionist a clinician?  If so, she should have said so.  If not, she shouldn't be interviewing the patient.

"Next page of paper was all about sex.  'When was the last time you had sex?', she asked.  I told her that it was the day before I had my son – July 22nd.  She made a face and was like 'Wow, that’s been a while.  Do you feel like your sex drive has diminished?'

I wanted to say, 'No moron.  Again I’m here for postpartum depression, which means that I just had a baby, which means that I couldn’t have sex until I was cleared by my OB, which again, was last Friday.'  It was completely pointless and she kept on asking questions like this.

I kept on telling her the same damn thing, 'I just had a baby so…'"

Start heading for the door.

"About 30 minutes had gone by and it was now 1:15pm.  The receptionist said that the Dr. should arrive around 2pm and that I was to meet with the male nurse next and then I was free to leave for lunch as long as I was back by 4:30pm.

Um, excuse me? I told her that my appointment was at 12:30pm and that the Dr. was already late since it was 1:15pm.  She asked, 'Didn’t anyone tell you that she arrives at 2pm?'  No they didn’t tell me that because if they did I would certainly have shown up at 2pm instead of 12:30pm."

What kind of outfit is this?  Probably some psychiatrist recommended by a bleeping insurance panel.  Now she gets interviewed by another person:

"Then he asked me what year we were in.  I felt like I was a patient that had just had a stroke or passed out.  I was not seeing a psychiatrist for anything other than postpartum depression, so wouldn’t you have thought that they could have skipped over their 'normal' protocol?

He told me, 'I’m going to tell you three words that I want you to remember and I’ll ask you to repeat them to me later on.  They are: flower, penny, tiger.  Can you repeat them back to me?'

'Flower, penny, tiger' and I added a little eye roll too.

Next he asked who the President of the USA was and I told him Obama.  Then he asked for the Vice President.  Oh shit, I couldn’t remember and I figured this wasn’t going to look good ...

My blood is boiling.  This woman is suffering from postpartum depression.  She gets the courage to reach out for help.  She's been awaiting this day, hoping she can talk to someone about what's going on with her, even though she's scared out of her wits.  She wasn't sent there because she's psychotic.  She wasn't sent there because she has dementia.  I'm seriously practically hyperventilating.

"The Dr. came in [at 3:30 for a 12:30 appointment, I might add] and looked like she belonged somewhere else, definitely not in charge of these patients.  She spent five, maybe ten minutes with me and that was it ..."

Five minutes at the first appointment.  Wow.  Run, Jane, run for your life.

To make a long story short, the doctor then whips out the prescription pad for a couple of medications and tells her to come back in a week for a med check and be prepared to wait again.  Jane decides never to go back.  Who could blame her? 

"Why is it so hard to find good help for postpartum depression?  Why did I just waste 4 hours of my time at that psychiatrist’s office and all she wanted to do was medicate me?  She didn’t even ask me questions about how I was feeling.  The day was such a let-down."

Good question Jane.  It shouldn't be so hard.

Jane's story is a lesson for every new mom reaching out for help.  You must reach out for help, let's get that straight.  But you must also know that if any of the things that happened to Jane happen to you, leave. 

There ARE people who are specialists.  Here is what good therapists and psychiatrists and social workers will do:

• They will operate their offices professionally.
• They will listen very carefully to you and what you are going through.
• They will do what they can to make you feel comfortable and they will welcome questions and concerns.
• They will ask you questions about when you had your baby, how much support you have, how much sleep you are getting, how breastfeeding is going if you are in fact breastfeeding, what kind of symptoms you are having (guilt, sadness, difficulty concentrating, etc.), how you are feeling about being a mom, whether you are having scary thoughts, how well you are eating, whether you have contemplated suicide, etc.
• They will talk to you specifically about postpartum depression and the various methods of treatment (not just medication), and will talk to you about the medication should you choose to take it, including potential side effects.

This psychiatrist, whoever she was, is NOT one of those people. 

There is no excuse for what Jane went through.  It is a wonderful thing that she decided to keep reaching out for treatment and found someone better, rather than just quitting right then and there.  Others, weighted down by the heavy misery of PPD, might have just given up.

Please, my dear readers and clinican friends, speak up on this one.  Now off to that shower ...

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

After the loss of a baby, either due to miscarriage or stillbirth, what exactly is it that a mother goes through as she grapples with this devastating experience?  Is it grief or is it postpartum depression?  Could it be both?

This is an excellent question, and I wanted to follow up on my post this week about postpartum depression and miscarriages and stillbirths to discuss this further.  Sarah Pollard responded to the post with a comment I wanted to highlight:

It can be confusing to sort out grief vs. depression as there are many commonalities. We must remember that grief is a very normal reaction to a very abnormal event (losing a baby) whereas depression/anxiety are disease states that need treatment. Grief in and of itself does not require treatment but instead support, education and understanding from appropriate parties.

Grief can get complicated (depression/anxiety can occur) and it can certainly excacerbate a pre-existing condition like depression, anxiety, Bipolar etc. Women who experience perinatal loss and have a history of any mental health issue should make sure their provider is aware of this history. Women should also be taught how to differentiate between grief and depression and when to seek help.

The typical PPD support group, which usually contains at least a mom or two who is experiencing regret/ambivalence about motherhood, is not the optimal place for bereaved moms to find support. We know these feelings are normal with PPD but imagine the impact of such words on a grieving mother.

Mark, the husband of Paula (whose story was referenced in my last post), echoed these sentiments with he and his wife's personal experience:

"One of the toughest parts of dealing with the PPD after miscarriage was that there are some people who deal with and understand PPD and there are people who deal with and understand miscarriage, but there seem to be few people or resources to deal with the horrible combination of depression and grief that can come when you have both. To make it worse, some of the things that therapists worry about and try to stop in depression patients (like too much sleep) are normal ways of handling grief. There are a number of behaviors that have conflicting meanings or importance depending on if you view it as PPD, grief, or a combination of the two. It takes some real attention to treat them both."

In her book A Deeper Shade of Blue, Dr. Ruta Nonacs discusses grief and depression after perinatal loss and the differences between them. 

"Grief is not just feeling sad.  It is a complicated, sometimes prolonged process by which you learn to cope with a loss and ultimately to move beyond it ... The process of grieving requires time, patience and the support of others. "

She describes several stages of grief.  Feeling numb at first, in total shock.  Sadness.  Then a time where you may be preoccupied with your loss, questioning why, having difficulty focusing on anything else, along with possible changes in sleeping and eating patterns.   Experiencing anger and emptiness.

"With time, you will move toward acceptance of the loss and will be able to settle back into your life.  It is unlikely that you will completely obliterate these painful feelings, but you will eventually be able to give them their allotted space in your emotional life ... The symptoms of grief after a miscarriage typically last about six months to a year and do not usually affect your ability to function for a prolonged period of time; however, some women may have a grief reaction that is more intense or more prolonged.  When the grieving process seems unbearably intense or seems to persist for a longer period of time, this may be a sign of what is called 'pathological' or unresolved grief, or this may be an indication that depression has complicated the picture."

Nonacs states that depression is never normal, even for those who've had a loss, and it can impede recovery if not treated.  I imagine it would be very important in this situation to keep in close contact with someone who can help monitor one's grief and watch out for signs of depression. 

In the meantime, I wanted to offer a few websites of organizations that support grieving mothers and families, and would have more experience in understanding what these families go through:

Share Pregnancy & Infant Loss Support

Missing Grace

Hygeia Foundation for Perinatal Loss

Silent Grief

Chums4mums Connects Moms with Postnatal Depression in the UK

A UK magazine called Take A Break has created a program called Chums4mums that aims to help new mothers overcome postnatal depression (what we call postpartum depression here in the US) by making friends with other moms in their area.  More than 10,000 women have already registered on the Chums4mums website, and according to Nursing Times, Britain's National Health Service has officially adopted the project.  In September, health visitors, midwives and general practitioners will be sharing information on Chums4mums to patients.

Here's the piece that appeared in Take A Break launching the program.

For more on postnatal depression in the UK, click here.

Postpartum Depression After Miscarriage or Stillbirth

I haven't written much here about postpartum depression after miscarriage or other loss, probably because I just don't a lot of knowledge about that particular experience, but it is clearly an important topic to discuss.  Women who suffer miscarriages or stillbirths are certainly at a high risk of experiencing postpartum depression.  I met a mother recently who, when she found out what I do every day, told me that her first child died in his first few months because he suffered from a rare disorder that no one knew he had.  She talked about the horrible, and completely understandable, depression she experienced and how she got through that time.  There are no words ...

Dr. Ruta Nonacs, in her book A Deeper Shade of Blue, devotes an entire chapter to this subject.

"Though emotional distress in pregnancy loss is normal, some women may develop more persistent or disabling psychological symptoms ... Depression may also complicate the picture.  One study found that during the six months following a miscarriage, about 10 percent of women showed signs of depression ... Experiencing a stillbirth or neonatal death probably puts you at even higher risk for depression; one study indicated that a mother's risk for depression after stillbirth is about seven times higher than a woman who has a live birth."

Last month I heard from another mom who wanted to share her story of postpartum depression after miscarriage.  In her email she wrote:

"PPD is so widely misunderstood and rarely talked about.  I've heard even less about living through it after having a miscarriage.  I'd love it if you'd talk about this issue on your blog."

Well, let's start today with a link to her story here so that those of you who have had similar experiences can read it.  I welcome hearing from more of you on this topic.  I hope other moms in this situation will be comforted by your words.

Danish Public Health Experts Recommend PPD Screening for All New Moms

The Copenhagen Post reports that public health experts in Denmark recommend screening all new mothers for postpartum depression.  This, after a research study there found that twice as many depressed mothers would receive treatment if all new mothers were screened.

"The study was carried out by the Centre for Public Health, Århus City Council and mothers’ support group Mødrehjælpen. They are now recommending that all new mothers be screened for depression, instead of the current system where only those suspected of postpartum depression are offered help.

Postpartum depression affects about 6 percent of all new mothers in Denmark and Finn Breinholt of the centre described it as a serious condition.

'It must be detected and treated early, otherwise the child’s first year can be marked by poor linguistic, intelligence and behavioural development,’ said Breinholt."

The study suggested that group counseling could be an important solution in helping new mothers feel less isolated.

Get Help This Week from PPD Professionals Via Toll-Free Call

You're probably wondering why I always remind you of this, but keep in mind new readers are coming to Postpartum Progress every week and aren't always aware of the resources available to them, so here goes:  Every Monday and Wednesday, Postpartum Support International hosts a free open phone session called "Chat With an Expert".  These sessions are facilitated by PSI mental health professionals to provide a free forum for information, support and ideas about resources.  The Monday evening chats are for men trying to figure out how to support their partners, and Wednesdays are for women.  There is no need to pre-register or to even give your name.  Click here for more detailed information, including the call schedule and calling instructions.

About.Com Hosting Poll on Postpartum Depression

About.com's Depression Editor Nancy Schimpelfening has posted a poll:  Did You Have Postpartum Depression?  If you feel like it, mosey on over there and participate in the (unscientific) poll.

Today Show Airs Story on Postpartum Depression

Nice piece on "The Today Show"this morning about postpartum depression done by Darlene Rodriguez from WNBC, who also experienced postpartum depression. 

I only wish Meg Spinelli or Matt Lauer had mentioned other resources for women in addition to their OB/GYN -- like Postpartum Support International, maybe? -- since I hear from many women who say their OB/GYN was less than helpful. 

The piece also doesn't really cover treatments.   Maybe Matt Lauer is afraid of getting in another dustup with Tom Cruise ...

Psych 101: What the Heck is a Mood Disorder And How Do You Know When You Have One?

Today I was a student at Yale University.  You didn't know I was that smart, did you?

Well, I'm not really.  I'd love to be a student of Harvard or Yale, but that's not the case.  (At least not currently ...)  But I was able to watch a lecture on psychology at Yale thanks to a cool new website called Academic Earth, and you can too.  This lecture, which lasts 54 minutes, is given by Professor Susan Nolen-Hoeksema.  It's called "What Happens When Things Go Wrong: Mental Illness, Part 1".

Here's why this lecture is so interesting to me:  Many of those of us who suffer perinatal mood or anxiety disorders arrive at this brave new world of "mental health" for the very first time.  In the past, we may have been ill without knowing it, or maybe this is the first episode EVER for us of depression or anxiety or panic or OCD or psychosis.  Sitting in a psychiatrist's office being diagnosed can feel pretty scary, considering we have such little information or understanding of what's happening to us.  This lecture walks you through what makes a mood disorder like depression or bipolar disorder.  She talks about the criteria used to decide whether someone is really suffering from depression or not, and how these illnesses truly impact people.  She also covers causes, including genetic predisposition, neurotransmitter functioning and stress, and treatments.   You can watch this and realize that what you're going through is a REAL ILLNESS.

One interesting tidbit:  Even though the criteria for diagnosis of depression is that someone experiences symptoms for 2 weeks or longer, the average depression episode lasts six months if it goes untreated.  Another reason to reach out for help. 

Oh, and the website is free and doesn't require registration.  You can just open up the lecture, sit back and learn.  To watch, click here.

Note:  Because of copyright laws you won't be able to see some of the short videos/slides as part of her lecture, but she'll discuss them.

How To Handle Going Back to Work With Postpartum Depression

The Wall Street Journal blog "the Juggle" recently posted a piece on going back to work after suffering from postpartum depression.  It was written, bravely, by a Journal editor named Michelle Gerdes.

"I also struggled with what and how much to tell my co-workers and managers about my PPD. I worried that if I said too much I’d seem unprofessional, like I was blubbering about my personal problems, and it might open the door to questions about how I would be able to handle my job. PPD is widely misunderstood and I didn’t want my cube neighbors to be worried that I was going to break down on the job, throwing myself out of the window shouting “Pacifier! Where‘s the pacifier! Aaaaaaaaack!” Also, I didn’t want my managers to go light on me because they were worried that I’d crack.

So far, well up until this is published anyway, I’ve only told a few people at work about my PPD. Most of my co-workers were very sympathetic and supportive, although some seemed uncomfortable and quickly changed the subject. I’ve been back at work for a couple of months now and am really enjoying the business of journalism again and engaging in professional life. After this life-changing event I feel like I’m even better than I was before I had the PPD, both at work and at home."

What would you do?  Tell your colleagues, or not?  How about your boss?  How will you get things done while still recovering? 

These are great questions, ones that I struggled with myself when going back to work 4 months postpartum while I was still in the throes of PPOCD.  I only told a few colleagues -- people I also considered to be true friends.  I didn't tell my bosses because I didn't feel it was any of their business and because I worried about the stima, of course.  I must admit I had a pretty hard time being at work while I hadn't truly recovered yet.  In some ways it helped that I had something else to focus on, rather than what I believed were my inadequacies at motherhood.  In other ways it was tough because I had such a hard time focusing and really being present in my work.  It's hard to write a marketing plan when you are so tired and confused and miserable.

For those of you that have been in this situation, what did you do?

ACOG & APA Issue Guidelines For Treatment of Depression During Pregnancy

The American College of Obstetricians and Gynecologists, in partnership with the American Psychiatric Association, has just issued specific direction and guidelines on the use of antidepressants during pregnancy.  They must be congratulated for their clear understanding of the nuances of treatment for depression during pregnancy, and for acknowledging that there is no one right answer to this situation as some would have you believe. 

"This is a report intended to reach out to psychiatrists as well as obstetrician-gynecologists," said Dr. Kimberly Yonkers [the report's author, who is from both the Department of Psychiatry and the Department of OB/GYN at Yale University]. "We developed algorithms which I think reflect the fact that there are multiple issues to consider and [that] there should be no knee-jerk response in managing a woman who is depressed and pregnant or contemplating pregnancy. Psychiatric history and a woman's preference are among the important features that should be taken into consideration."

In a nutshell, ACOG and the APA recommend that those with mild depression who are pregnant may be better served trying psychotherapy and seeing if that will relieve their symptoms.  Women with severe depression or those who have a history of depression or psychosis, however, should remain on their medication during pregnancy.  And of course, all pregnant women or those who are thinking about becoming pregnant should discuss their specific situation with their doctors.  Here are just a couple of the common scenarios the report offers along with recommendations to doctors and patients as to how to proceed:

Pregnant Women Currently on Medication for Depression

• After a consultation between their psychiatrist and obstetrician/gynecologist (to discuss risks), psychiatrically stable women who prefer to stay on medication may be able to do so.
• For those who want to discontinue medication and are not experiencing symptoms, tapering and discontinuation may be attempted. However, women with a history of recurrent depression are at a high risk for relapse.
• Those with recurrent depression or symptoms despite their medication may benefit from psychotherapy to replace or augment medication.
• Women with severe depression should remain on medication. If a patient refuses, alternative treatment and monitoring should be in place, preferably before discontinuation.

Pregnant Women Not Currently on Medication for Depression

• For those who want to avoid antidepressant medication, psychotherapy may be beneficial.
• For those who prefer taking medication, risks and benefits of treatment choices should be evaluated and discussed.

If you have access to the September issue of the journal Obstetrics & Gynecology, you can read the entire report here.  It will also appear in the September/October issue of General Hospital Psychiatry. 

Surprisingly, this report has been covered fairly well thus far by the mainstream media.  ABCNews.com did a good piece that included quotes from Dr. Lucy Puryear and Dr. Ruta Nonacs.   Nice job by ABC with a story on Good Morning America as well.  And here is coverage from Medscape and Medical News Today.  The Wall Street Journal Health Blog chose to go with a story angle about ECT for some odd reason.  Will keep you posted if I see more on this ...

For more from Postpartum Progress on depression during pregnancy, also called antepartum depression, click here.

One Day You Will Take Off the PPD Glasses

I was just reading a blog post from a new mom going through PPD who I've recently "met" via the wonders of the Internet.  She was writing about what she is going through and how she knows that logically she should understand that she'll get better one day, but she's "just not that sure anymore".

Here is a message I'd like to give to her and to all of you who suffer: 

Be sure.  Even if you don't believe it, be sure anyway.  Those of us who have been through this are sure.  We know you'll come through this and you will actually go back to being you again.  You just can't see your way because you have PPD glasses on right now.  That's okay.  We can see the light at the end of the tunnel for you.  It's there.  Be sure.

This Is What The Baby Blues Looks Like

Baby blues is not postpartum depression. 

Baby blues is not postpartum depression.

Baby blues is not postpartum depression.

You've heard me say this a million times before.  But now I've said it again.  ;-)

People who don't believe in postpartum depression love to talk about the "overmedicalization of motherhood".  They'll tell you that being a mom is tough.  It's not an illness.  You don't need a doctor.  If you're sad and blue, that's because you are now a parent with a lot of responsiblity, and besides which our society doesn't value or support parents enough, so no wonder you are miserable.  What a red herring. 

When we talk about postpartum depression, we're NOT talking about how hard motherhood is or the fact that new mothers are sleep deprived.  We are talking about an illness that arises sometime in the first 12 months after a baby is born that is so serious it impacts a mother's ability to function on a daily basis.  She may have trouble eating.  She has trouble sleeping, and I don't mean because her baby doesn't sleep.  When her baby is sleeping she often can't sleep, even though she's exhausted.  She can lose her ability to enjoy most if not all parts of her life.  She may experience deep sadness and may often cry.  She has difficulty caring for either her baby or herself because she is so troubled by how she feels.  She may have bouts of uncontrollable anger or irritability.  She may be thinking her family would be better off without her.  This mom needs a doctor.

When we talk about postpartum depression we are not talking about the baby blues either.  No one is suggesting that a woman go out and get treatment if, in the first couple of weeks after the baby is born, she is exhausted and cries for no reason and feels a little bewildered.  That would make her normal.  The majority of new moms have this experience, which, according to Dr. Ruta Nonacs, usually peaks on day 4 or 5 postpartum goes away all on its own at about 2 weeks postpartum.  These moms don't need professional help.  They need time.

Below is the account of a new mom who writes about her baby blues.  Notice the timing of her experience:  the first couple weeks after birth.  Notice what happens:  It goes away.  Notice what she says: I feel better.  I'm getting the hang of this.

This story is an example of the baby blues.  This is what the baby blues looks like.  This is not a story of postpartum depression. 

Expecting Words: My Baby Blues

"Thankfully, my mood changed back to normal a couple weeks after the baby arrived. I realized that I had been through a rough patch that was now over. I was back to my normal self. Don’t get me wrong, I was still tired, but I appreciated my family and took great pleasure in holding my little one. I liked watching him rest, eat and sleep."

Is Depression Real Or Just a Western Phenomenon?

At the PSI conference, UCLA's Dr. Vivien Burt spoke in a really interesting session about depression and why women are more likely to experience this "illness of the brain," as she called it, than men.

First, she discussed the World Health Organization's (WHO) Global Burden of Disease Project, which looks at the most disabling conditions across the world and the impact they have on global health.  She stated that in 2000, the top 5 most disabling conditions were:

1. Lower respiratory infections (pneumonia)
2. Perinatal conditions
3. HIV/AIDS
4. Major depression
5. Diarrheal diseases

I checked the WHO website, and found that their report has been updated with data from 2004.  Depression has actually moved up to the third most disabling condition worldwide.  What I found quite interesting is this paragraph in their report:

"Unipolar depression makes a large contribution to the burden of disease, being at third place worldwide and eighth place in low-income countries but at first place in middle- and high-income countries.  Effective treatments for depression are available, suggesting that this burden could be reduced."

I often hear those who don't believe that depression is a real illness state that it is purely a Western phenomenon and doesn't exist in other places.  Clearly that is not the case, if even in low-income countries it is the eighth most disabling condition among the 135 illnesses that were studied.  For your clarification, here's a sampling of which countries are listed in each category:

High-Income: US, Canada, Australia, France, Germany, Greece, Japan, Kuwait, Saudi Arabia, Singapore, Spain, Israel, Finland, Iceland, UK, Aruba, Puerto Rico

Middle-Income: Argentina, Chile, Czech Republic, Hungary, Mexico, Poland, South Africa, Turkey, Brazil, Egypt, Ecuador, Indonesia, Iraq, Thailand, Ukraine

Low-Income: Afghanistan, Bangladesh, Cambodia, Congo, Ethiopia, India, Kenya, Mongolia, Nicaragua, Pakistan, Sudan, Vietnam

In the year 2030, the WHO estimates that depression will move into #1 as THE most disabling condition across the globe.  Ischemic heart disease will be second, traffic accidents third and cerebrovascular disease [stroke] fourth.

Depression is not just disabling.  The awesome Dr. Ruta Nonacs of the MGH Center for Women's Mental Health sent me a study appearing in the August issue of the British Journal of Psychiatry stating that depression and smoking create the same increased risks for mortality!  From Medscape:

"'We were a bit surprised to find that depression — and not necessarily at a severe level — is associated with mortality at the same strength as smoking,' lead author Arnstein Mykletun, PhD, from the University of Bergen, Norway, told Medscape Psychiatry. 'Perhaps one of the more important new findings is that depression is that strong, even taking into account a lot of potential confounding factors including health status,' he added."

In the same article, Dr. Peter Kramer from Brown University commented that this study, which was large and very thorough, is worth paying attention to.  "Depression, he said, is a multisystem disease that involves changes not only in the brain but also in blood vessels, heart, and bones. 'Of the major common mental illnesses, depression really stands out as looking like ordinary disease across a number of body systems.'"

So now we turn to women.  When it comes to women, the WHO states:

"Mental disorders are an important source of lost years of healthy life for women aged 15-44 years.  They make up 3 of the 10 leading causes of disease burden in low- and middle-income countries, and 4 of the leading 10 in high-income countries; self-inflicted injuries are also in the leading 10 causes for low- and middle-income countries.  [Those disorders include depression, bipolar disorder, schizophrenia and panic disorder.]"

What does this have to do with postpartum depression?  Women are more likey to have their first psychiatric admission in the first year postpartum than at any other time in their lives.

Dr. Burt explained that there are two major buckets contributing to why women are more likely to suffer from depression than men.  The first is biological.  We are sensitive to hormonal changes that are happening all of the time in our bodies and can affect mood.  We have quite a few major reproductive-related transitions in our bodies, including the timing of puberty, our prementrual days each month, miscarriage, pregnancy and perimenopause.  (Constant hormonal turmoil!)  The second is psychosocial.  A traumatic history such as parental loss, divorce, marital discord, illness, assault and other such traumas can impact the likelihood of depression, as can childhood developmental issues like poor parental attachment.  Childbearing responsibilities and a young maternal age, as well as negative self image, also raise the risk of depression in women.

Depression is real, no matter where you are on the planet, and women are at the greatest risk.  Don't ignore it.  Get help.

NYU's Reproductive Psychiatry Program Receives $500k Anonymous Gift

Holy moolah, batman!!!!  The Reproductive Psychiatry Program at New York University's Langone Medical Center has received a $500,0000 anonymous donation to support the expansion of its clinical program serving women with postpartum depression and other reproductive-related psychiatric disorders.  Whoever you are, anonymous donor person, you are a blessing to all those who have suffered and will suffer and we thank you!!  I can't wait to see what Dr. Shari Lusskin, director of the program, decides to do with these funds.  The news release mentions research to encourage the development of a more complete body of knowledge on these illnesses and increased services for women.  The gift provides for matching funds beyond the initial amount. 

Psych Central Responds to False Claims About Postpartum Depression

In the midst of moving, I totally bonked and missed out on sharing a post with you from John Grohol at Psych Central responding to false claims about postpartum depression.  It covers the MOTHERS Act and those who think PPD isn't a real illness.  The comments (there are 160 of them) are quite something. 

A Nurse/Mother's Letter to Time Magazine: Alison Palmer

Because I had to take a break from blogging while moving (which, may I say, is such a HUGE, FREAKING NIGHTMARE!!), I missed out on sharing with you a few more letters written to Timemagazine by some amazing advocates for women with PPD.  So I must share them with you now, because their voices are so important.  Still waiting to see if Time prints any of our letters to the editor, or if they ignore the issue completely ...

Dear Editors at Time Magazine:

As a maternal-newborn clinical nurse specialist, coordinator of a Postpartum Emotional Support Program, and most importantly as a mother, the article "Postpartum Depression: Do All New Mothers Need Screening?" hit several nerves.  As a nurse and educator in my role I am compelled to shed some light on the facts that were overlooked by this recent article.  As a mother and advocate for women suffering from postpartum depression, I feel the need to jump up and down to get people to start paying attention to the fact that perinatal mood disorders have a strong biologic component, place an enormous strain on the family unit and have the potential to be lethal.

The Maternity Center at Elliot Hospital in Manchester, New Hampshire, does about 2200 births per year.  We help women achieve their dream of becoming mothers and transform couples into families.  We have a level 3 NICU, can manage the most noninvasive natural labors to the more high-tech delivery of multiples and obstetric complications.  We have formed multidisciplinary workgroups to implement simulation training and communication processes to make certain that as a team we are functioning like a well-oiled machine.  The guidelines, algorithms and policies under which we function serve as a "safety net" or contingency plan for when labor and birth do not follow the expectations of a normal, uncomplicated delivery.  Yes, we operate with our life preservers on, not that we always need them, but they sure come in handy if we start to enter choppy seas.

But this is only the first step in making a mother.  We forget that as we launch these new mothers into the world, they are often quite unprepared for what comes next.  There isn't always a safety net in place for the reality of how challenging the transition to motherhood can be.  While our society gets caught up in the perfect stroller, diaper bag, crib and baby room decor, no one talks about the chaos that comes after we send this new family home.  Trust me, it is less than perfect.  Parenting is not a perfect science, and here's a secret:  there are no "perfect mothers".

After birth there is a dramatic drop in the hormones of pregnancy.  This, along with the cumulative effects of countless sleepless nights can cause a shift in the brain chemistry and may contribute to mood swings, anxiety and/or depressed mood.  There are a number of psychological factors that go along with becoming a mother.  Mom is learning, the baby is learning and it takes time to adjust to this new role and bond with the baby.  This is all met with the normal life stressors of finances, job concerns, family issues and/or a lack of family and friends who live nearby to help.  When one is trying to juggle it all, along with learning how to care for a newborn (or balance a newborn in the context of meeting the needs of OLDER children), this can feel very overwhelming.

Over 80% of women will experience the "baby blues", which are a normal period of high and low emotions during the first several weeks following birth.  Postpartum depression or other mood and anxiety disorders occur at least 20% of the time, and can occur anytime in the first year after birth.  Constant, intense feelings of sadness, worry, nervousness and emptiness that lasts 2 weeks or more, and affects areas of the mother's life like sleep and changes in eating habits, is an illness that requires medical help.  Some women with PPD also have recurrent, disturbing thoughts that can lead to a high level of anxiety and is called postpartum obsessive compulsive disorder.  Postpartum psychosis is rare, affecting only ~1 in 1000 women and occurs most often during the first four weeks after delivery.  These women are severely impaired and may have paranoia, mood shifts, or hallucinations that command her to hurt herself or others, and usually requires immediate hospitalization.  Women suffering from PPD often need medication to treat the biology in the brain, talk therapy to discuss some of the changes in feelings they are having, and support from new moms groups or PPD support groups to have a safe place to share what they are going through with other mothers in similar situations.

I find it outrageous that the interpretation of the MOTHERS Act by Catherin Elton is to assume that this bill would simply support prescriptive proactive or psychotropic drugs and "lead to an increase in mothers being prescribed medication unnecessarily" and "simply contribute to the potentially dangerous medicalization of motherhood."  The goals of the MOTHERS Act are similar to many other preventative initiatives such as those developed by Healthy People 2010 from the U.S. Department of Health and Human Services.

Are the disease prevention and health promotion objectives for obesity, diabetes, asthma, cancer and heart disease and stroke ALL based in pharmacologic management?  Absolutely not!  Physical activity, nutrition, risk-taking behaviors, and smoking cessation are components of the care plan and preventive strategies for these diseases.  A healthcare provider who would simply prescribe a lipid-lowering agent and a beta blocker for a patient with high cholesterol and a previous myocardial infarction without providing counseling on a diet, exercise, and referral to a nutritionist and cardiac rehab would be amiss in providing a comprehensive treatment plan.

Any of the experts in the field of perinatal mental health will tell you that you can't rely on just one type of intervention to treat postpartum depression.  Pharmacology is just one piece of the puzzle.  A healthy dose of endorphins from daily exercise, relaxation/meditation, light therapy, fish oils, a balanced diet, counseling, support groups and avoidance of caffeine and alcohol are just a few of the various interventions that can be beneficial in treating PPD.  Popping a pill every day is not going to help the new mother if she does not have a good sleep hygiene schedule or can't ingest adequate nutrients secondary to her diminished appetite.  Nor will aerobics classes or yoga and meditation around the clock "will away" the guilt of scary, intrusive thoughts the mother might be experiencing.  Each individual is going to respond to a healthy mix of more than one type of interventionaddressing the areas of biological, psychological and social support for PPD.  The MOTHERS Act supports the research and education of clinicians and families in ALL of these areas.

The national governing organizations for perinatal nurses and OB-GYNs also support the objectives promoted by the MOTHERS Act.  The Association of Women's Health Obstetric and Neonatal Nurses' (AWHONN) position statement on "The Role of the Nurse in Postpartum Mood and Anxiety Disorders" states that "Health care facilities that serve pregnant women, new mothers and newborns should have routine screening protocols and educational mechanisms for staff training and client education related to postpartum mood and anxiety disorders." 

On May 6, 2009, Gerald F. Joseph Jr. MD of Louisiana became the 60th president of the American College of Obstetricians and Gynecologists (ACOG).  Dr. Joseph announced that postpartum depression is the theme of his presidential initiative.  He emphasizes the need to develop evidence-based guidelines for ACOG members in the areas of screening, identification, counseling, treatment, referral to specialists and development of community-based resources for women suffering from PPD.  He, too, is taking a multifaceted approach to addressing the multidimensional needs of perinatal mood disorders.  Nowhere do I see it suggested that we develop a recipe book of SSRIs and anxiolytics to be distributed to healthcare providers as a quick fix to treat this problem.

Our organization recently implemented an Inpatient Postpartum Depression Risk Assessment.  An 11-item questionnaire is distributed to EVERY new mother who delivers, and screens them into a risk category for developing PPD.  This screening tool identifies risk factorsand does not indicate that a woman will definitely experience PPD.  Just like someone who smokes, is obese, has high blood pressure and a family history of cardiac disease is at higher risk for a heart attack, these PPD risk factors simply indicate that one might be at a higher risk for the illness.  The "at-risk" moms view a PPD video, receive more in-depth PPD education, get follow up phone calls at home, are offered Visiting Nurse visits and are invited to attend weekly New Moms Groups and the Postpartum Depression Support Group.  In our first month of screening, we had patients screen out as 46% low risk, 21% moderate risk, 30.5% high risk and 2.5% immediate risk.  More than HALF of all of the new mothers who delivered had some increased risk for PPD.  I don't believe that is something that can be ignored. 

When screening for depression in the healthcare setting is based on clinical observation alone, 50% of women suffering from depression are missed (Wilen and Mounts, 2006).  We cannot rely solely on clinical judgment.  Obstetric providers are encouraged to screen for current symptoms of depression with a validated tool such as the Edinburgh Postnatal Depression Screening Scale during follow-up visits.  Our intention is to help moms become aware of the factors that can potentially make them vulnerable to PPD so they can mobilize their support network and make use of available resources.  By screening universally, we hope to reduce the stigma of perinatal depression by encouraging healthcare providers to take about it as a common complication of childbirth.

PPD is very treatable.  Many women do not want to admit that they are having a hard time after having a baby.  It is supposed to be a happy time of their lives!  In reality it is also a major time of change and role adjustment to essentially the most difficult and important job that anyone can do.  If you had diabetes you would see an endocrinologist, take insulin and no one would tell you to "snap out of it".  Your brain is an organ.  We shouldn't treat the mind any differently.  The process we have initiated at our organization is our way of providing the family with their own life preserver, and letting them know that they are not alone as they embark on those unchartered seas called "parenting".  Time, I'm sorry to say you missed the boat on this very important issue.

  

Alison Palmer, RN, MS, WHNP-BC

Maternal-Newborn Clinical Nurse Specialist

Postpartum Emotional Support Program Coordinator

Manchester, NH

A Mother's Response to Time Magazine: Lauren Hale

Lauren Hale's letter to Time magazine:

I am typing this as my dear daughters are asleep on the floor in our living room after a great evening together including S'mores, Orange floats, a movie, and a chocolate bath.

It is FOR them that I want this. It is FOR women who have experienced and will sadly experience the same level of ignorance and idiocy I myself was exposed to that I want the MOTHER'S Act to pass. No woman deserves to walk into her obstetrician's office and be denied aid or told everything she's feeling isn't real. No woman deserves what has happened to so many of us. Nor does a woman deserve to experience what Amy [Philo] has. I myself have been a victim of Zoloft. It stopped me in my tracks - flashed thoughts of wanting to murder my children through my head. It hospitalized me. Yet here I stand. WITH many other dedicated survivors, reaching out selflessly to those behind us, those who are in the same places we once were. THEY do not deserve uneducated physicians scoffing at them as they dredge every ounce of strength from the depths of their souls in order to avoid harming their children. They deserve compassion, education, understanding, everything the MOTHER'S Act stands for. As survivors - we have a MORAL obligation to tell our stories, to speak up so mothers and families struggling with Postpartum Mood Disorders KNOW they are not alone. When I was hospitalized all I wanted was to talk with another mother who could tell me I wasn't alone. I needed someone to understand what I was going through. Alas, I did not have that. Instead I struggled alone.

I'm sick of the opposition. I'm sick of being slammed because I chose (freely) to take medication. I'm sick of being accused of not being informed when I chose (freely) to take my medication. I'm sick of their lies. I'm sick of their bastardization of this bill. I'm sick of their dedication to limiting the choices and denigrating the hope this bill carries for new mothers everywhere. I'm sick of my hard journey being completely desecrated and ignored because it involves medication as a piece of my recovery.

Mothers need support as they travel through the postpartum period. Regardless of the involvement of medication. They deserve honest, compassionate support at the very least. Not fear-mongering, not harsh words, not screaming, and certainly not judgement. Can't we at least provide that?

An Open Letter to Time Magazine About Postpartum Depression

Monday, July 13, 2009

An Open Letter to the Editors of Time:

Time has done a great disservice to all mothers who are suffering and will suffer from postpartum depression (PPD).  In an article called “The Melancholy of Motherhood” journalist Catherine Elton writes a distorted story that no doubt has already begun to confuse and stigmatize women with PPD.   

We cannot understand why Time would choose to sensationalize what is a very serious medical issue for hundreds of thousands of women in the United States each year, and to create controversy around the MOTHERS Act, the one and only piece of legislation that would help to systematize support and services that are sorely lacking in so many places throughout our country.

There are several points in the article that concern us:

1.The MOTHERS Act is not “dividing psychologists” as Elton opines.  The American Psychological Association, the American Psychiatric Association and the National Association of Social Workers wholeheartedly endorse the MOTHERS Act.    In fact, you neglect to mention that much of the medical community supports the bill.  It has been publicly endorsed by the March of Dimes, the American College of Obstetricians and Gynecologists, the American College of Nurse Midwives, the National Healthy Mothers Healthy Babies Coalition, and the Association of Women’s Health, Obstetric and Neonatal Nurses, among many others.  You didn’t represent any of them in your piece, all of which are highly regarded organizations which have a long record of dedication to the health of both mothers and babies.

2. Elton calls screening controversial and infers it may not even work. Many women will tell you that screening saved their lives, and others who were not screened wish they had been so they could have received treatment sooner.  In fact, Elton interviewed at least two such women but they were not represented in the article.  Screening for PPD is an effective way to identify women who may have it.   Both the sensitivity (misses few sufferers) and specificity (some, but not too many false positives) of the widely-used and validated Edinburgh Postnatal Depression Scale, for instance, is very well-established.  We’d be happy to send you multiple, contemporary, highly-regarded studies that support this.    

3. Elton states that “… increased screening could lead to an increase in mothers being prescribed psychiatric medication unnecessarily.”  First, the MOTHERS Act does not require screening.  Second, none of the screening tools for depression were designed to take the place of evaluation by health care professionals, so it is manipulation to suggest that screening alone will yield treatment of any kind or specifically treatment via medication.  In a study of large scale universal screening efforts of more than 1000 pregnant and postpartum women, screening for depression did not lead to greater rates of treatment (Yonkers et al., Psychiatric Services, 2009).  This is because there are many barriers to treatment, regardless of a positive screen.  Additionally, for those who are able and choose to be treated, many women elect methods that don’t include medication (Pearlstein et al., Archives of Women’s Mental Health, 2006). 

 

4. Time should be more careful when discussing the causes of PPD.  We were surprised to see such a well-regarded publication misrepresent the results of a small research study that provided evidence to support the idea that a subset of women are more susceptible to hormonal changes as a trigger for depression, such as PPD, by prefacing the results with the unsubstantiated statement that “pregnancy hormones … have little to do with PPD in most cases.”  This study showed that for those with a known history of depression, the hormonal changes that occur following delivery may increase one’s risk for developing symptoms during the postpartum period.  Yet Elton attempts to use these results to support Michael O’Hara’s overgeneralization that women without prior history of “lots of anxiety and depressive symptoms” (what does this even mean objectively?!) “are unlikely to have problems in the postpartum period – not even close to likely.”  Reporting results out of context to support the opinions of a source is appalling. 

 

The fact that women who have had depression or anxiety in the past are more likely to experience PPD is nothing new.  This is only one of many risk factors that have been identified.  Your article, however, attempted to make a previous history of depression or anxiety the single key to identifying PPD.  This will lead women who are ill but who have never been clinically diagnosed or treated for a mental illness to believe they must not have PPD.  Many women who suffer will tell you it was the first time they were ever treated for a mental illness and the first time they came to realize they may have suffered from depression or anxiety in the past.  You also leave out women who have no history of depression or anxiety but ended up with PPD for other reasons.  Perhaps you were not aware, for instance, that diabetes is a risk factor for PPD (Kozhimannil et al., JAMA, 2009), as is thyroiditis.  Women who deliver multiples or have babies born with serious health problems also have a higher risk of getting PPD.

 

5.  The language used in the article frustratingly minimizes the devastation that PPD can cause.  Such phrases as “the melancholy of motherhood” and “still, there is no denying that the postpartum period is a difficult one for many women” almost brush PPD off as a blue funk or a trying transition time for new moms.  This signifies a clear lack of understanding about the seriousness of this illness that somewhere between 10 and 20% of women around the world suffer.  PPD impacts a mother’s ability to function on a daily basis.  It is not a difficult period.  Elton asks, “Does PPD screening identify cases of real depression or simply contribute to the potentially dangerous medicalization of motherhood?”  It is no more medicalizing motherhood to identify and treat PPD than it is to identify and treat gestational diabetes, which is universally screened for and occurs in only 3.5% of mothers.

 

As Time reported in June, the National Academies fully endorses screening for parental depression and believes it is crucial, while also emphasizing that screening is not helpful unless there is effective follow up and treatment tied to it.  Supporters of the MOTHERS Act share that belief.  Although effective treatment is available, fewer than half of cases of postpartum depression are recognized (Gjerdingen et al., Journal of the American Board of Family Medicine, 2007).  Even fewer of those women ever receive treatment of any kind.

We are terribly sorry about the experience of the one mother quoted in your article, which happens on rare occasions, but we believe that the MOTHERS Act would actually go a long way to prevent what happened to her.   What this bill actually funds is research, education and awareness.  If these pieces are put in place, women, families and medical professionals will be better educated to prevent false positives from screening.  A well-trained and educated physician will know to refer the patient on to a specialist who can inform her of various treatment options and monitor her to ensure the treatment she chooses is effective.   A woman who has been made fully aware of the kind of services she should receive and the risks and benefits of the treatments available to her will be able to make the best choice for herself and her family.

Time focused on one potential but unlikely consequence of the MOTHERS Act rather than the actual content of the bill and why it is so sorely needed.  We are deeply disappointed.

Sincerely,

Mary Jo Codey, mother of 2, former first Lady of New Jersey, kindergarten teacher, New Jersey  

Carol Blocker, mother of Melanie Blocker Stokes, Illinois

Sonia Murdock, co-founder and executive director of the Postpartum Resource Center of New York, past president of PSI, New York

Cheryl Beck, DNSc, CNM, FAAN, mother of 2, Board of Trustees Distinguished Professor at the University of Connecticut School of Nursing, co-author of the  American Journal of Nursing  2006 Book of the Year award, Postpartum Mood and Anxiety Disorders: A Clinician’s Guide, Connecticut

Amy D. Gagliardi, mother of 4, Director of a Perinatal Health Clinic at a Federally Qualified Health Center, writer, researcher and chair of the Woman's Health Sub-Committee of Connecticut's Medicaid Managed Care Council, Connecticut

Valerie Plame Wilson, mother of 2, author of Fair Game, New Mexico

Adrienne Griffen, mother of 3, founder of Postpartum Support Virginia, and mid-Atlantic regional coordinator for Postpartum Support International, Virginia

Heidi Koss-Nobel, MA, mother, psychotherapist, Chairperson of Postpartum Support International of Washington, Washington

George J. Parnham, Attorney at Law, co-founder of the Yates Children Memorial Fund, Texas

Ann Dunnewold, Ph.D., mother of 2, licensed psychologist, author of Even June Cleaver Would Forget the Juice Box, past president of Postpartum Support International, Texas

Diane G. Sanford, Ph.D., internationally-recognized expert on pregnancy and postpartum emotional health, medical advisory board member on Babycenter.com, adjunct associate professor at the St. Louis University School of Public Health, Missouri

Catherine Connors, mother, author of the Her Bad Motherblog, featured parenting blogger at Beliefnet.com, Maternal Health Editor at BlogHer.com and Partner/Managing Editor at Mamapop.com, Canada

Tonya Fulwider, mother of 2, executive director of Perinatal Outreach & Encouragement, regional coordinator for Postpartum Support International, Ohio

Adrienne Martini, mother of 2, author of Hillbilly Gothic: A Memoir of Madness & Motherhood, New York

Katherine Stone, mother of 2, author of Postpartum Progress, the most widely-read blog in the US on postpartum depression, WebMD 2008 Health Hero, Georgia

Erin Reilly, co-founder of Sound of Silence, Friends of the Postpartum Resource Centerof New York, New York

Jen Stoll, mother of 2, executive director of The Postpartum Resource Center of Kansas, Kansas

Erika Krull, MS, LMHP, mother of 3, mental health counselor, author of the Family Mental Health blog on Psych Central, Nebraska

Wendy N. Davis, Ph.D., mother of 2, psychotherapist & perinatal mood disorders consultant, founding director of Baby Blues Connection, PSI Volunteer Coordinator, Oregon

Therese Borchard, mother of 2, author of the Beyond Blue blog on Beliefnet, author of several books including The Imperfect Mom: Candid Confessions of Mothers Living in the Real World, Maryland

Carol Peindl, RN, MSN, CNS, psychotherapist/nurse for the Prenatal and Postpartum Center of the Carolinas, PSI coordinator for the state of North Carolina, North Carolina

Diana Lynn Barnes, Ph.D., mother of 2, award-winning psychotherapist, past president of Postpartum Support International, California

Lauren Hale, mother of 3, author of Sharing the Journeyblog,  iVillage Community Leader for Postpartum Depression and Pregnancy & Depression/Mental Illness Message Boards, Georgia

Pec Indman, PA, EdD, MFT, mother of 2, psychotherapist, co-author of Beyond the Blues, A Guide to Understanding and Treating Prenatal and Postpartum Depression, Education and Training Chair of Postpartum Support International, expert panelist for the Maternal and Child Health Bureau/HRSA, California

Tara Mock, mother of 2, author of the Out of the Valley blog for Christian postpartum depression support

Ivy Shih Leung, mother of 1, author of Ivy's PPD Blog, New Jersey

Helen Ferguson Crawford, mother of 2, architect, Georgia

Karen Kleiman, MSW, founder and director of The Postpartum Stress Center, author of several books on postpartum depression, Pennsylvania

Joan Mudd, mother, founder of the Jennifer Mudd Houghtaling Postpartum Depression Foundation, Illinois

Susan Dowd Stone, MSW, LCSW, mother of 1, NJHSS Certified Perinatal Mood Disorders Instructor, Public Reviewer for the National Institutes of Mental Health, author and Adjunct Lecturer at the Silver School of Social Work at New York University, New Jersey

Marcie Ramirez, mother, co-founder of the Maternal Mental Health Task Force of Middle Tennessee, PSI Coordinator of Middle Tennessee, Tennessee

Amber Koter-Puline, mother of 1, author of the Beyond Postpartum blogand Atlanta support group facilitator, Georgia

Amy Tobias, mother, Indiana

Kimmelin Hull, PA-C, LCCE, mother of three, director of Pregnancy to Parenthood  and author of A Dozen Invisible Pieces and Other Confessions of Motherhood, Montana

Sylvia Lasalandra-Frodella, mother of 1, Constituent Relations for the former First Lady of New Jersey Mary Jo Codey, author of A Daughter’s Touch, New Jersey

Lisa Jeli, mother of 1, California

Susan McRoberts, mother of 3, author of The Lifter of My Head: How God Sustained Me Through Postpartum Depression

Sara Pollard, RN, BS, Clarian Women’s Health Services, Indiana

Amy Burt, MA, mother of 3, director of operations, Perinatal Outreach & Encouragement for Moms, Ohio Coordinator for Postpartum Support International, Ohio

Diane Ashton, MSW, mother of 2, founder of PPD Support Hawaii, Hawaii

Laurel R. Spence, MS, PA-C, mother of 3, Assistant Professor, Baylor College of Medicine, clinical physician assistant, Women’s Specialists of Houston, Yates’ Children Memorial Fund/Women’s Mental Health Initiative advisory council member, speaker’s bureau Mental Health America – Houston and Postpartum Support International member, Texas

Sara Binkley-Tow, MA, CIMI, CHBE, PCD (DONA), executive director of Moms Bloom, Michigan

Sarah Pond, mother of 1, founder of Mama2Mama and early childhood development facilitator, Canada

Birdie Meyer, RN, MA, CLC, mother, president of Postpartum Support International, winner of the 2008 Award of Excellence in Advocacy from the Association of Women's Health, Obstetric and Neonatal Nurses, Indiana

Della Palacios, mother of 2, Florida

Kimberly Wong, founder and chair of the Perinatal Mental Health Task Force of Los Angeles, California

Dr. Shoshanna Bennett, Clinical Psychologist, past president of Postpartum Support International, founder and director of Postpartum Assistance for Mothers, author of "Postpartum Depression for Dummies", California

Ilyene Barsky, LCSW, The Center for Postpartum Adjustment, Florida

Time Magazine Skips the Facts About Postpartum Depression

Time magazine has published an article about the MOTHERS Act and postpartum depression.  Written by Catherine Elton and initially entitled "The Melancholy of Motherhood" (now renamed "Should All Mothers Be Screened for Postpartum Depression?"), it is full of inaccuracies and misstatements of fact.  Mothers and experts alike are understandably disappointed that such an esteemed publication wouldn't do the proper research.

Time completely blew it.  The editors should really be ashamed of themselves for allowing an article on a topic that they clearly knew so little about to be published: 

• They state that it is highly unlikely for anyone who hasn't had previous bouts with depression or anxiety to get postpartum depression.  Wrong.

• They state that the MOTHERS Act is diving psychologists.  Wrong. 

• They state that PPD screening (which of course is not mandated in the MOTHERS Act, but hey, why not use a red herring?!) will lead to mothers being prescribed medication unnecessarily.  Huh?  Wha? 

• They misinterpret the findings of the one study they use in the article. Wrong again.

• They only interview a mom who is against screening.  They conducted other interviews with moms who are survivors of perinatal mood and anxiety disorders and support screening, but Time didn't feel it was necessary to include their voices for balance.

More to come ...

P.S.  If you haven't already written to them to express your displeasure, you should.  Letters@time.com  If you'd like to send me your letter I will be happy to share it on Postpartum Progress.

 

Two Short & Sweet Videos About Postpartum Depression

I wanted to share with you some nice videos on the web today about postpartum depression.

The first comes from the BBC in the United Kingdom, and features a doctor discussing the basics of postnatal depression, as the Brits call it, quite nicely.  Check it out here. 

This next one is from a mom named Heidi Howes.  This is part one of three videos she's created to share her experience with postpartum depression.  In this one, I really like how she describes what it feels like as I think many of you will relate.  Check it out here.

And get ready for video from Postpartum Progress as well -- my Mother's Day present was a Flip Mino Ultra videocamera.  I'm getting the hang of it right now but excited to be able to share some video with you very soon!

Esperanza Seeking Feedback on Postpartum Depression Feature

The magazine esperanza, which recently featured a story on postpartum depression, as well as pieces on Mary Jo Codey, Amy Sky and yours truly, is seeking feedback on those articles.  If you would like to send a letter for the Summer 2009 Letters to the Editor, click here.

A Mom Writes About Postpartum Depression & Alcoholism

A mom on the website MomLogic has written a very poignant post called "I Am a Mom and I Am an Alcoholic".  There is no name of the author listed, nor is the article open to comments, which is disappointing because I'd like to thank her for her honesty. 

The woman who writes happens to be a psychotherapist.  In her youth she becomes an addict, but gets sober at the age of 20 and remains that way for more than a decade.  Her mother-in-law dies when she is pregnant with her first child, and she suffers a terrible bout of postpartum depression and anxiety, and begins drinking again.  Her own mother dies 2 weeks before her second child is born, and her anxiety, and thus her addiction, gets worse.  

"At 8 months pregnant, my husband's mom died suddenly, and it took much of his time and energy to process his shock and grief over this loss. After I had my son, my mom's cancer (which had been in remission for several years) returned full force and she was given 2 years to live. I was flattened by postpartum depression and anxiety, which despite my clinical background, totally pulled the rug out from under me ..."

I spent the next few years battling alcoholism and addiction. I stayed sober during my second pregnancy and controlled my drinking while nursing. At 7 months pregnant my mom's cancer took a major turn for the worse. She died exactly two weeks before my daughter was born. After I brought my baby girl home from the hospital, the grief, pain, sadness and anxiety I felt was indescribable."

The author finally went to get treatment and is now 17 months sober.

This is a very important subject to me as I know women who have become alcoholics to blunt the pain of postpartum depression.   Some became that way a long time ago, back when there were no toll-free numbers or support groups and nowhere to turn to get help.  Some become that way in this day and age because they are afraid to or don't want to seek professional help and they don't know any other way to make themselves feel better.  The negative impact of mothers who drink alcohol and take drugs while pregnant or breastfeeding or raising infants is rarely discussed, but this is another reason why identifying women with postpartum depression and anxiety is so important.  

I have great empathy for women like this author.  It is a difficult and destructive road.  As the author writes in the conclusion of her article, "If you are reading this and finding yourself relating to parts of my story, please know that there is a way out of this destructive cycle. You are not alone."

If you have postpartum depression or anxiety, you are NOT alone.  You can get help and get better.

National Research Council & Institute of Medicine Recommend New Strategies for Dealing with Parental Depression

I listened in on the press conference today by the National Academies on a new report from the National Research Council and Institute of Medicine on parents with depression.  Very exciting to hear the level of understanding about how depression impacts families and how important it is to address it. 

From today's news release (to read the entire news release, click here):

"Effective tools and strategies exist to treat and prevent depression, but only one-third of adult sufferers get treatment.  Although many factors affect children's development, parental depression can increase the chances for health, emotional and behavioral problems in children.  The report does not suggest that every parent with depression will inadvertently or deliberately cause harm to their children, but rather than parental depression increases the risks for spillover consequences during critical periods of child and adolescent development.

"'To break the vicious circle of depression, we need to refocus our view of this illness through a broader lens that sees the whole family, not just the individual with depression,' said committee chair and psychiatrist Mary Jane England, president, Regis College.  "Our report describes a new vision for depression care that would provide comprehensive services not just to adults, but to their children as well.  It will take significant policy changes to make this vision a reality, but the benefits warrant the effort.'"

Couldn't agree more.  Highlights:

• 7.5 million parents are affected by depression in the US each year.  16 million children live in those households.
• Only one third of adults who manifest depression are actually treated in any given year.
• Depression interferes with the quality of parenting and puts children at risk for poor health and development. 
• The National Academies endorses screening and believes it's crucial, but also emphasizes screening is not helpful unless there is effective follow up and treatment tied to it. 
• Individuals need an informed choice in the treatments they choose.  
• There are not enough mental health providers in certain areas of the country, and many primary care providers don't have the specific skills or awareness needed to treat parents with depression.
• They recommend parents be able to access screening and services in a variety of locations,including WIC, Headstart, schools and of course doctors' offices (OB/GYNs, pediatricians), community centers.
• They recommend the whole family receive care, with comprehensive services for the children as well as the parents.
• There is powerful evidence of the need for psychoeducation of parents, and they indicated that interpersonal education (such as in the doctor's office) is very effective.  Peer-to-peer support was mentioned as one way to do this.  Education is crucial and there is not a lot of good information out there.
• The group suggests that governors of each state convene a task force to develop and implement the strategies they recommend.

Also, a few facts from the press conference, most of which you probably know if you are a regular Postpartum Progress reader:

• Depression is extremely common and is a universal disorder that affects people regardless of education, race and income.
• The World Health Organization notes that depression is second only to heart disease in the level of disability and lack of productivity it creates in those who have it.
• Females have double the rates of depression of males.
• There are many causes of depression: genetic factors, environmental risks, biochemical factors, personal vulnerabilities and resilience.

I asked the panel to respond to the fears of those who worry that universal screening will just "overmedicalize" depression.  Their response was that screening will be effective if it is attached to treatment, so availability of services and follow through is important.  They also said they emphasize giving parents a choice among treatments by offering a variety of options.  (The same EXACT things I might point out that those in the perinatal mood and anxiety disorder community believe.)

As Dr. William Beardslee, Professor of Child Psychiatry, Children's Hospital in Boston, stated during the conference, "The first two years of life are crucial and we need very intensive interventions at that time for depressed parents."

To order the full report, click here. 

Here's WebMD's take on this.

Clinicians Miss Half of Postpartum Depression Cases

The Agency for Healthcare Research and Quality, which is part of the US Department of Health & Human Services, has posted a few pieces of research on postpartum depression from the last few years, including this one:

"About 13 percent of women suffer from the anxiety, hopelessness, desolation, and fatigue of postpartum depression (PPD) for the first 3 to 12 months of their children's lives. Yet, primary care physicians fail to recognize more than half of PPD cases, despite the availability of depression screening tools that can expedite diagnosis and treatment. Some women and clinicians may confuse PPD with "baby blues," which occur in more than 80 percent of mothers. However, baby blues begin within hours or days of delivery, are characterized by major mood swings rather than consistent depressive symptoms, and typically disappear 2 to 4 weeks postpartum.

While baby blues and minor depressive symptoms often clear spontaneously, PPD is a persistent form of major depression that develops within the first 2 to 6 months postpartum. Untreated PPD can devastate the mother (who loses her energy or joy in parenting), her child (who often has delayed psychological and cognitive development), and her family (with twice the risk of divorce within 2 years postpartum). In extreme cases, PPD can result in suicide and infanticide. Timely diagnosis and treatment of PPD can interrupt these cycles before damage to mother, child, and family become irreparable, explains Barbara P. Yawn, M.D., M.Sc., of the Olmsted Medical Center and University of Minnesota." 

Free Phone Chat Wednesday for Anyone with Questions on PPD

Don't forget ... if you have questions, Postpartum Support International can help.  This Wednesday PSI is offering its weekly free, open phone session called "Chat with the Expert".  You can join the call to talk or just to listen to others discuss resources, symptoms, options and general information with an experienced member of Postpartum Support International.  You can talk from the privacy of your own home and there is no need to pre-register or give your name.  Sessions are informational only and open to anyone with questions and concerns about themselves, a loved one, friend or family member.  To get information on how to participate in Wednesday's call, or any of the other phone sessions offered, visit http://www.postpartum.net/info-sessions/

 

 

National Academies To Release Report on Depressed Parents & Their Impact on Children

The National Research Council and Institute of Medicine of the National Academies are releasing a report at a public briefing on Wednesday, June 10 called "Depression in Parents, Parenting and Children: Opportunities to Improve Identification, Treatment and Prevention".  The report will be released via a press conference at 1pm EST at the National Press Club in Washington DC.

It explores the interaction of depressed parents, parenting practices and its impact on children as well as strategies to promote effective interventions for widespread implementation in different service settings for diverse populations of families.  The briefing will include the committee's recommendations for improving the quality of care for depressed adults and their children.  The study was funded by the Annie E. Casey Foundation, the California Endowment, the Robert Wood Johnson Foundation, the U.S. Health Resources and Services Administration, and the U.S. Substance Abuse and Mental Health Services Administration. 

Participants in the press conference will include William Beardslee of Children's Hospital in Boston, Frank Putnam of Cincinnati Children's Hospital Medical Center and Mareasa Isaacs of the National Alliance of Multi-Ethnic Behavioral Health Associations.

The briefing will be audiowebcast for those who cannot attend.  Both the webcast link and the form for submitting questions via email will become available at the time of the event at http://national-academies.org.

I wonder whether this report will just reinforce the need for the Melanie Blocker Stokes MOTHERS Act ...

Could Mental Illness Be A Gift? Just Read This Before You Decide ...

I've shared Depressed (But Not Unhappy) Mormon Mommy's posts here before.  This one is just so gorgeous I have to share it with you.  Laura writes about a panic attack she experiences while reading the book "Ecology of a Cracker Childhood" as the author describes her father's mania.

She then shares the text of a letter the book's author Janisse Ray receives from her father later in life -- this is one of the most beautiful things I've EVER READ on the topic of mental illness. It is such a wonderful summation of how I feel about the invaluable gifts I've received since experiencing postpartum OCD.

I know ... if you're currently suffering, you will read the letter and think his sentiments are outrageous.  They couldn't be further from the truth of how you feel.  But you will reach out for professional help, and then one day you will get better, and then one day life will return to your version of normal, and then one day you just might feel the same way.  His letter is a lovely bit of hope.

Thank you, Laura, for sharing this with us.

Six Things You Should Avoid If You Have Postpartum Depression

Today I'm adding to our "Six Things" series with the "Six Things You Should Avoid If You Have Postpartum Depression" or any related illness.  (Note: To see the other Six Things articles, look to the left of your screen underneath my picture.)

SIX THINGS YOU SHOULD AVOID IF YOU HAVE POSTPARTUM DEPRESSION

1.  Scary Stuff

Women with perinatal mood and anxiety disorders can be very suggestible.  What does that mean?  It means you can hear or see something disturbing and then suddenly be convinced it relates directly to you.  You can get a scary idea in your head and then not be able to get rid of it -- it can sometimes get stuck in there and endlessly terrorize you.  It's best to surround yourself as much as possible with positive images so that upsetting thoughts don't get the chance to enter your mind.

Avoid horror movies and scary books.  Don't watch too much news, and don't surf the internet carelessly.  Be very choosy about which websites you go to and which discussion forums you join.  Some "mommy websites" don't have trained moderators running their PPD forums, and you'll run into well-meaning women telling you exactly what you need to do, and not do, to get better.  They don't know you and they don't know exactly what you need.  Each person responds differently to treatment.  Some take meds and some don't.  Some have side effects and some don't.  Some have a great doctor and some don't.  Some get better quickly and some don't.  If you spend all day comparing yourself to what women on the internet have done you can drive yourself crazy.  Try to go to safer sites, where trained peer support and/or research-based information are offered, like Postpartum Support International, the Online PPD Support Group, MedEdPPD, Postpartum Progress or your state's local support organization.

2.  An Overscheduled Life

Does it all need to get done right now?  Really?  Or is your health more important?  A spotless house, empty laundry basket and dishwasher, three-course meal and five different mom and baby classes aren't necessary.  The more you give yourself to do, the more you're likely to beat yourself up when you can't do it all perfectly.  And trust me, you can't do it all.

3.  Thought Monkeys 

The fabulous blogger at Sophie in the Moonlight calls the negative thoughts that most of us with perinatal mood and anxiety disorders experience "thought monkeys".  Many of us unwittingly lend a hand to our illness by accepting these negative thoughts; by telling ourselves we are bad people and defective mothers.  I love how Sophie has brought this to life:

"Thought Monkeys [are] my name for those incredibly destructive, deeply internalized, mischievous thoughts that jump and screech inside my mind, demanding attention, demanding action NOW.  Look at us NOW ... The Thought Monkeys even have names.  In no particular order they introduce themselves as follows:  "I'm Not Enough of, at or for Anything", "I'm A Big Burden"; "I'm Unlovable"; "My name is "The World Would Be Better Off Without Me" and her close cousin "I'm Not Worthy to Breathe In This Air Shared By My Friends and Family"; and my least favorite says "I'm To Blame For Every Abusive Thing That Has Ever Been Done to Me My Entire Life".  Aren't they sweet?  Each one is uglier than the last and they each think they are the most important one.  Hateful little creatures."

Sophie challenges each thought monkey.  She avoids believing they are true.  She fights back with her own mind, argues with herself that these thoughts are wrong.  We have to do the same.  We can't contribute to and even further our suffering by accepting that these thoughts are reality.  They aren't.  They are part of the temporary disease.

4.  Unsupportive People

It may help to temporarily avoid or limit your time with people who blame you for your illness or don't try to understand, as well as people who are judgmental or don't support your treatment and recovery path.  You need positive and supportive people on your side, so spend as much time with those people as possible.  And even if you don't find them among your friends and family, you will find them among the women who have been through these illnesses, so try and find a support group in your area.

5.  Procrastination

Many recent studies show that both the physical and emotional health of untreated women and their children can be negatively impacted over the long term.  Babies whose mothers have untreated depression during pregnancy, for instance, are twice as likely to be born prematurely.  Prematurity can lead to health problems and developmental delays. 

There is just no good reason to wait it out if you are ill, either during pregnancy or postpartum.  Avoid procrastination.  I know you're scared, but it's important to reach out to a doctor and let him or her know what's going on.  As Karen Kleiman, author of "This Isn't What I Expected: Overcoming Postpartum Depression," wrote in a comment on Postpartum Progress:

"Sometimes people feel that a risk is greater if they 'do' something or take action, as opposed to just letting things be.  Life, '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 understandable unsettled by having to make 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." 

This doesn't just apply to the issue of medication, of course, because not every woman needs medication.  It's simply a great illustration of how procrastination can hurt you in the end.  And, by the way, did you know that difficulty making decisions is a symptom of postpartum depression?  You may have to push yourself a little bit harder to take that step of reaching out for help.

6.  Acting Like You Have A Medical Degree

Unless you graduated from medical school and have completed your residency, you shouldn't be diagnosing yourself.  If you think you might have a perinatal mood or anxiety disorder, seek a trained a professional to tell you whether you simply have the baby blues or something more.  And for goodness sake, if you're taking medication, you don't get to decide to stop it cold turkey or reduce the dose without discussing it with your doctor first.  Doing that to yourself could do more harm than good.

An Ode To Our Foremothers: Women With PPD Who Died In Mental Institutions

One of my mothers (I have two) works at the Mississippi State Mental Hospital.  She told me they have some sort of museum or archives there, and in it there is an admitting book that shows, among other patients, the women who were admitted shortly after childbirth and committed to the mental institution for the rest of their lives.  Checked in and never checked out.  This was not unusual in an era where there were no toll-free numbers, support groups and patient brochures about postpartum depression.  Only the belief that these women were "hysterical" and probably weren't coming back from wherever their minds had gone.

I just came upon this poem from a blog called Life At Willow Manor.  I don't know Willow, the author, personally, but her poem is so poignant and beautiful.  It makes me long to hug all the women who were in her great grandmother's exact situation.  I'm so glad we've come a long way from that.  She has given me permission to reprint it here.

Emma

Shadows of my family
hang from this stranger’s pensive smile,
like the locket and chain pinned
to her clean Victorian blouse.

Galena Kansas, branded
on the faded cabinet photo,
tags her face
as cattle marked for market.

She was committed, they told me;
endless days of silence,
absently pulling the chain of her shackle,
fenced in a dark corral.

I tell myself her smile
was tucked away,
resting in the hope chest
with her locket, chain and ruby slippers--

waiting for her tin man
and scarecrow to
link arms and steer her
along that yellow brick road to the sky.

 

From Willow: Emma was my great grandmother. She was committed to Central

State Hospital in Indianapolis shortly after the birth of her first

child, my grandmother, in 1914. It's tragic to think she might have

been institutionalized for life for something as simple as postpartum

depression.

Hear My Interview with Ohio Public Radio on PPD

I haven't quite gotten into the podcast/blog video thing yet.  It's on my list for this year.  But I did do an Ohio public radio interview on WOUB-AM recently and I thought I'd share the audio here.  I talk about perinatal mood and anxiety disorders, my experience with postpartum OCD and Postpartum Support International.  It lasts 30 minutes. 

So ... if you'd rather hear me talk about all of these things than read, click here for the mp3.  It will take a few minutes to download, and will then start playing immediately.

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".

Barnes Wins Welcome Back Award for Postpartum Depression Advocacy

Diana Lynn Barnes, PsyD, is one of this year's five Welcome Back Award honorees who have overcome innumerable obstacles to make a profound difference in the lives of others.  She received the Lifetime Achievement Award.  Congratulations Diana!!!!!

As they describe her so impressively:  Diana Lynn Barnes, Psy.D., is an internationally recognized expert on the assessment and treatment of perinatal mood disorders who has used her own three-year struggle with postpartum depression to help educate others through media interviews, speaking engagements and as an author. In addition to her private practice, she is a nationally known forensic expert in women's reproductive mental health and works with defense counsels in cases of infanticide, pregnancy denial and neonaticide. She is a past president of Postpartum Support International and continues to work with the group to raise awareness of postpartum depression.  In 2007, she wrote her first book "The Journey to Parenthood: Myths, Reality and What Really Matters."  Additionally, Dr. Barnes has been involved with the Henry Mayo Newhall Memorial Hospital in Valencia, Calif. for the past two years to implement a comprehensive pregnancy and postpartum screening program. 

Diana is a great lady and I'm happy that she's being honored in this way!

Eli Lilly and Company will be honoring all of the winners at the Eleventh Annual Welcome Back Awards ceremony in San Francisco, Calif. on Saturday, May 16.  Lilly established the Welcome Back Awards in 1998 to fight the stigma associated with depression and to promote the understanding that depression is treatable.  Each year, an independent panel of national mental health leaders recognizes five individuals for their outstanding achievements, and Lilly awards donations ranging between $10,000 and $15,000 to the not-for-profit organization of each winner's choice. 

And, no ... Eli Lilly did not pay me to write this.  ;-)