Today is February 19th 2013 a little more than one year after I gave birth to my second child. Looking back on this past year much of it is a blur. Not because I was moving cross country with two children under the age of 2 or finishing renovations on a 100 year old house or living Nomadically with various relatives while my husband drove our animals to California and got our new digs set up...no last year was a blur because for a vast majority of the year I had pretty severe postpartum depression. Not that I knew I was suffering from postpartum depression (PPD). No, if you'd asked me I would have just told you that I was sleep deprived and stressed. I thought I was just having adjustment difficulties. I thought that my behaviors and thoughts (both textbook indicators of depression and anxiety) were the result of being the parent of an infant, not getting enough sleep and having some stressful things going on in my life.
That is the thing about postpartum depression that most people don't know-I didn't know- it is insidious...
Many of the symptoms of depression are the same symptoms experienced by overwhelmed sleep deprived mother's of infants; mood swings, anxiety, sadness, irritability, crying for no real reason etc.. So when do these symptoms cross the line from normal to pathological? It is a hard call. Even as a mental health professional I had a lot of difficulty determining whether my thoughts and behaviors where outside of "normal parameters". In fact, it took me eight months to realize that I was most likely experiencing PPD and another two months to seek and receive treatment.
That is another thing I didn't realize about postpartum depression- if it isn't treated it can go on for months and it can get worse.
That is what happened to me. My PPD DID NOT GO AWAY BY ITSELF and it got worse, so bad in fact that I could not longer ignore it or rationalize my symptoms.
I have always had pretty good mental health. Still in September of last year, I found myself having thoughts about hurting myself constantly. More disturbingly, I had thoughts about hurting my baby. I knew that these thought were completely irrational and I wasn't going to act on them. Still they were unsettling and very difficult for me to talk about.
I mean how do broach that topic with your spouse? "Hi Honey, can you pick up milk on your way home? Oh by the way, I constantly think about driving into a tree and throwing our child out the window."
I am not going to lie it was really hard for me to talk to my husband about this and it was hard for my husband to hear. Since we just moved I was home with our two little ones full time and the hardest thing for us was determining whether or not I should be taking care of our two children full time or whether we needed to get some outside help until I was stabilized. We decided on a mixed approach. My husband stayed home for two weeks while I started therapy and medication and we enrolled my oldest in a two day a week preschool program. This was incredibly helpful and definitely helped me get things under control. I was lucky that the first medication I tried Wellbutrin worked well for me but that is not everyone's experience and it is important to plan for the possibility that you may have to try several medications before you feel positive effects. Some people feel really strongly about not using medication for PPD and I'll admit I didn't want to use medication. I honestly felt like I should be able to get through PPD without medication. I mean medication was for people with mental health problems not for people like me. Still my PPD had progressed to the point that it was seriously interfering with my ability to function and I was desperate so I got on medication but told myself that I would give it only 6 months and then I would reevaluate.
I started my medication on a Monday and by the next Monday something crazy happened- I stopped having intrusive thoughts about hurting myself or my baby. Now Wellbutrin is a little different than SSRIs because it acts on the re-uptake of norepinephrine and dopamine so it typically acts much faster than medication that acts on the re-uptake of serotonin. Still I was shocked and relieved by how quickly the medication worked and those intrusive thoughts disappeared. Since then I have progressively regained my pre-PPD level of functioning. I still have bad days...don't we all? But I feel like myself again and that feels really good!
Here are some tips based on my experience dealing with PPD
1. Trust yourself: If after a couple week post-birth you don't start feeling like yourself again *a sleep deprived slightly overwhelmed version of yourself* you may have PPD.
2. Don't ask other people's opinions: Unless they have experienced PPD the opinion of your mom and sister and best friend may not be to helpful. I talked to several people about how I was feeling postpartum only to have them tell me that "having a baby is hard" and that "how I felt was normal" and that I needed to "tough it out".
3. Find a Psychiatrist or a Doctor with experience treating women's life cycle issues: When you realize there is a problem most women make an appointment with their GP, OBGYN, or talk to their child's Pediatrician. This is not necessarily the best strategy. Many medical doctors are woefully under-trained in the accurate recognition, diagnosis and treatment of PPD and many women who broach the subject with their doctor find themselves taking the depression test from the back of the Paxil box or having their symptoms dismissed as part of normal postpartum. My recommendation is to find a Psychiatrist with experience treating women's life cycle issues. Note: There are antidepressants that are OK to use while breastfeeding. Your GP may not know about them. Go to a Psychiatrist or a Doc with experience treating PPD they can discuss your options with you and help you decide on a course of action. Postpartum Progress (www.postpartumprogress.com) is a great resource for finding a medical professional in your area that can help you navigate the postpartum treatment process.
4. Call in the troops: You are going to need help until you stabilize. If you are staying home with your kids you may need to find temporary childcare for them. For those that have available family or friends call them up and ask for help. For those who don't have that option or would prefer to hire someone sites like Sitter City, Urban Sitter and Care are great places to start. Tip: Military families can access Sitter City for free under a Department of Defense program. For moms who work, PPD is covered by the Family Medical Leave Act (FMLA) up to 12 weeks. 9to5, a national organization dedicated to the issues of working women has a Job Survival Hotline (800) 522-0925 that is a great resource for determining your eligibility under FMLA. In addition, many Companies offer extended leave for PPD or coverage via long-term disability so check with Human Resources. Even companies that are not required by law to offer FMLA often do. Tip: For stay at home moms or moms on maternity leave, fathers/husbands who qualify for FMLA can access up to 12 weeks of protected leave in order to care for their spouse/partner diagnosed with PPD or infant.
Do you qualify for FMLA? (the short of it)
1. Have you worked at your employer for a year
2. Does your employer have 50+ employees
3. Have you worked at least 24 hrs a week during the past year
* some states have more generous FMLA laws, call 9 to 5 hotline for more
information on your state's laws.
What you'll need from your Doc to access FMLA
1. A diagnosis of Perinatal Mood or Anxiety Disorder
2. For Spouse: a medical certification stating that you need to care for your spouse
as a result of PPD. Or you can access FMLA for paternity leave.
4. Prepare to feel like a bad parent: Your not a bad parent but your going to feel like one. It is completely normal so dismiss those feelings as much as you can.
5. Prepare to be embarrassed: PPD is hard. If you are experiencing it your probably feeling really confused and vulnerable. And although PPD is common it is not really talked about and isn't well understood by the public. As a result, people are really stupid about PPD and will say ridiculous things to and about you. If your not prepared for it these comments can really upset you. So my advice..get prepared for them because in all likelihood they are coming.
Things you may hear before and after seeking treatment for PPD:
You just need to take a bubble bath/class/trip etc.. and you'll feel a 100% better
She says she has postpartum depression but she had the baby months ago...
Having a newborn is hard work.
You just need to get more sleep.
Why are you so crazy?
You need to get a grip.
Medication, isn't that bad for the Baby?
Medication, why do you need medication?
Medication, I wouldn't take medication but that is just me.
Why don't you do a detox?
You'd feel better if you exercised more....Etc....
You can expect to hear those comments and many more subtle and not so subtle comments on your "postpartum depression", parenting abilities, general craziness and decision to take medication or not. What can I say people are idiots and there is something about issues surrounding parenting, pregnancy and infants that makes even normally intelligent sensitive people say ludicrous hurtful things. My advice...screw them. Right now you have got to develop tunnel vision. Take care of yourself. Get better. Let everything else fade into the background for awhile. Good luck and remember I am living proof that things can and do get better. There will be an end to your PPD, there is a light at the end of this seemingly endless tunnel.
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