Treating Postpartum Depression (and depression in general)

Hello!  Did you think I'd forgotten about this blog?  I haven't!  Now that my experience with PPD/PPA is mostly in hindsight, I've had a few more thoughts I've wanted to share, but it's been difficult to find the time because I've been extremely busy with work lately.  (I'm still a SAHM, but I work from home for my employer on an hourly basis, which means a lot of nights and weekends lately.)

In my experience, I struggled with two different types of depression.  These are not clinical categories, but just what I experienced.

1. The type of depression that hits you for no apparent cause.  You wake up, and before any thought has entered your mind, or before you are even fully conscious, you have a sinking feeling in your stomach.  You physically can't get out of bed.  You don't want to face the day, but there's no (obvious) reason behind it.
2. The type of depression or anxiety that is thought-based.  You think things like, I'm a terrible mom, or I'm a bad person, or No one likes me, or My life is pointless.

Sometimes, of course, I'd feel a mixture of the two.  I'd have panic attacks for "no reason," but I knew that my anxiety about my in-laws moving nearby was the overarching cause, even if I was not actively thinking about it at the moment.

So here's the thing, depression can have both physical (chemical or hormonal imbalance) and thought-based causes.  Medication can help with the first type, and therapy can help with the second.  A lot of times, the most effective treatment is a combination of the two because most people, like myself, don't just experience one or the other.

On medication - talk to your doctor about it.   You don't have to go to a psychiatrist; any family practice doctor can prescribe antidepressants.  However, I'm guessing a psychiatrist might be more helpful if you are struggling with something more than depression, like postpartum OCD or intrusive thoughts.  If you're hesitant to try medication, you could try St. Johns Wort or other natural remedies first.

On thoughts - One thing I've read over and over in the depression literature is that depression is not caused by emotions but by thoughts.  Eg: Sad -> Depressed doesn't tell the whole story.  It takes courage, but if you force yourself to figure out why you feel sad, you will usually find a thought lurking in there that caused the sadness.  Eg: I'm a bad mom -> Sad/frustrated -> Depressed.  Studies have shown that brain chemistry can cause depression, leading to negative thoughts, but that the opposite is also true: changing your thought patterns can actually change your brain chemistry.  (Don't ask me to cite any references...this is a personal blog, not a Wiki article!...just Google it.)  

So what to do about those thoughts?  Cognitive-behavioral therapy (CBT) is a systematic and widely accepted form of therapy to address these negative thoughts and has been proven in clinical studies to be just as effective as medication in some cases.  If you are thinking of going to a counselor, please look for one who uses a systematic approach, such as CBT, rather than just someone who uses "talk therapy."  You can also do CBT on yourself by following the exercises in the book Feeling Good by Dr. David Burns.  (Don't say it won't work until you've actually tried it.  Really - take a pen and paper and do the exercises, even if they seem too simplistic or that they won't work on you.)  It's supposed to work for not only depression and anxiety but also OCD.  You can also try a free, online program that walks you through the steps at https://moodgym.anu.edu.au.  Again, you really need to be committed to providing honest and detailed answers to some of their questions to expect it to work.  If you're too embarrassed to be completely honest with the online format, then stick with the book and pen and paper at home.

Sadly, one of the biggest barriers to treatment of depression is oftentimes the person herself.  If your trigger thought is, "I'm a bad mom," then of course you won't want to do any silly exercises to make yourself feel like a good mom because you don't think it's true.  It's a vicious cycle that the lie that makes you feel bad in the first place (eg: I'm a bad mom) is what keeps you from getting the treatment you need.  Unfortunately, you are the only one who can decide that you're ready to feel better.  But when you're ready, you'll know it!

Well, I hope this post has been helpful.  I'm not sure if I'll have time to blog in the new year, so I tried to pack as much helpful info in this post as possible.  If you're in need of other resources, please check out postpartumprogress.org.  It has a ton of resources and articles, as well as links to other personal blogs on PPD/PPA.

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The postpartum trifecta: depression, anxiety, and intrusive thoughts/OCD

As I mentioned previously, postpartum depression often involves symptoms other than depression, including anxiety and intrusive thoughts (my husband would like to add a fourth category called postpartum aggression).  I actually only recently learned the term "intrusive thoughts," prior to which I referred to them as "scary thoughts."  Postpartum intrusive thoughts might include thoughts of your child getting sick, of you doing something to hurt your child, or of someone else doing something to hurt your child

Back when I was struggling with it more, intrusive thoughts would just pop into my mind.  It's not like I was sitting around thinking, "Hmmm, what are all the possible ways my child could be hurt?"  No, I'd be cuddling with my daughter, and all of the sudden the thought of something really terrible happening to her, sometimes at my own hands, would pop into my mind.  It was very disturbing.

I'm not going to go into detail about what my thoughts centered around in case there are any postpartum moms reading this.  Thinking or reading about scary things can actually make intrusive thoughts worse.  I believe my intrusive thoughts were aggravated by me looking at some pictures of POWs from a war documentary book.  Don't ask me what I was doing looking through a war documentary several weeks postpartum.  I'm a very intellectual and well-read sort of person.

In addition to having scary thoughts about things happening to my daughter, I also had scary thoughts of things happening to me.  I would lie awake at night imagining various scenarios of things that put me in a sweat and made my heart pound.

Emma Pillsbury wiping a grape.

My intrusive thoughts were bad enough to affect my behavior.  On the bad days, I wouldn't leave the house because I was afraid something would happen to me or my daughter.  Severe intrusive thoughts can lead to OCD.  The intrusive thoughts are the Obsession, and the Compulsive behaviors are rituals that help you cope with the thoughts.  The classic depiction is of someone constantly washing their hands or cleaning things.  Think Emma Pillsbury from Glee.  But let me tell you that in real life, coping with intrusive thoughts is not cute and fun like an episode of Glee.

I mentioned the intrusive thoughts to my counselor, and she only told me that "thoughts of mortality" are common for postpartum moms but didn't say much more about it.  My husband knew I was having scary thoughts but didn't understand the extent of how much fear they created in me until two years later.  This whole time, I thought my intrusive thoughts were some macabre part of my psyche that had suddenly come out and that it was primarily a spiritual issue.  I didn't trust God enough.  I didn't know His love and was therefore afraid.  I was relieved when I only very recently learned that there is a biological basis to these thoughts.  I'll be sharing more in future posts about my experience with intrusive thoughts, how they affected me spiritually, and other thoughts I have from the experience.

Have you ever battled any of the postpartum trifecta: depression, anxiety, or intrusive thoughts?  What helped you to cope?  I would love to hear from you, so please leave a comment.  If you have questions, please also feel free to leave in the comments.  I will address any questions/comments in the comments or in future posts.

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