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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Searching for Theodicy

When I was in college, I took a brief interest in Christian apologetics - defending the faith through objective and rational arguments.  I thought at the time that it was important for winning people over to Christ.  I then realized that no one (no one!) is ever converted through rational debate.  You could debate an atheist until you are blue in the face, and s/he wouldn't budge an inch.  Faith is not something that can be won through an argument but is the work of God.

Image: Stuart Miles

So for awhile, I thought apologetics was just for people who wanted to argue and that it really wasn't worth my time.  I'm now realizing that apologetics is not just for defending the faith but also for encouraging believers.  Apologetics is, in essence, theology in different clothing, and good theology is vital to our faith.

I don't label myself as having postpartum depression/anxiety/intrusive thoughts anymore, but I still bear the scars.  I recently became lax about staying away from the news, and I read some news articles that shook me to the core.  I was awake almost the rest of the night doubting God's goodness, wrestling with my faith, wondering if I could even call myself a Christian anymore.

That night, I came across the term "theodicy" for the first time, which is basically an attempt to answer the problem of evil.  I think I know deep down that a true theodicy doesn't exist -- as in, there may be logical arguments for the existence of evil, but those arguments will never resolve the pain caused by evil or make it obvious that God had no choice but to allow this world to become as broken as it is.  I'm okay with that - I don't presume to think that I as a human being could ever have the same perspective as God does.  But I also think it's important to strengthen my faith with good theology.  My friend recommended Ravi Zacharias, so I'm looking to get one of his books soon.

And how did I end up getting to sleep that night?  I prayed.  Even when I doubt Him, God is my comforter.

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Guest post at Postpartum Progress

I don't usually blog twice in one week, but I'm incredibly privileged to share my story on Postpartum Progress today.  Postpartum Progress is an incredibly informational PPD website and blog that provides tons of educational material as well as support for postpartum mood disorders.  The website is where I first learned about intrusive thoughts.  I'm not usually a huge advocate for Asian-American issues, but my personal experience with PPD/PPA made me realize how little awareness and acceptance there is among Asians.  Please check out my story:  A Culture of Emotional Restraint: Asian-American Mom Shares Her Perspective on PPD.

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Two under two

Some of you may wonder how I ever had a second child, considering how depressed and anxious I was with my first child.  I knew I wanted my daughter to have a sibling, so the decision to have a second child was cerebral rather than emotional.  I prepared myself for double the stress and read tips on "baby bunching" (having two children under the age of two).

Image: digitalart

Having two children is definitely harder than one on some levels.  There's more laundry to do.  There are two nap schedules to coordinate, which makes it difficult - some days impossible - to get out of the house.  I'm outnumbered when we do go out, so just getting everyone in and out of the car can be a workout.  Don't even get me started on mealtimes - I can't wait until the day all four of us can eat the same thing for dinner, unassisted.  

But ironically, there was a huge emotional burden that was lifted from me when I got outnumbered.  A lot of my depression and anxiety stemmed from my obsession with my daughter.  I wanted to "make the most" of every moment with her, so I forced myself to sing, play, and hold her during every waking moment, no matter how tired or bored I was.  There was nothing else to do but spend time with each other, so that's what we did.  I also never let her cry if I could help it

When I had my second child, I was forced to stop obsessing.  I can no longer immediately respond to every child's first cry.  Oftentimes, one of my children will just have to cry while I finish a certain task.  I've learned that that's okay.  I've noticed that when there's more people around, my kids are less likely to seek my individual attention.  Even though they aren't old enough to play together, just having another child in the room helps to keep them more occupied.  I don't quite understand the psychology behind it, but I'm grateful for it.  I've learned to tell my daughter to play by herself if I'm busy or tired and to not feel guilty about it.  It's been good for her, too, because she has learned to be more independent and creative.

So if you are a young mother with just one child, take heart that having another child may be twice the work physically and logistically but will provide a level of emotional freedom when you are no longer revolving your life around just one child.  I still obsess over certain things and feel anxious daily, but I'm somehow able to enjoy motherhood more now.

Having said that, I can't even imagine having a third child.  If any moms with 3+ children would like to share how much more difficult or easier that is, I would love to hear from you!

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How it all (sort of) ends

When I was in the midst of my postpartum anxiety, I feared that the daily panic attacks would affect my physical health.  The anxiety and stress were so intense and frequent that I could not imagine overcoming them.  I felt that my only hope would be a divine intervention - a miraculous healing or perhaps a certain Bible verse that would provide instant peace.

Image: Sura Nualpradid

And...nothing of the sort happened.  I got better over time, but there was no trigger or moment that I can point to as the start of the healing.  I no longer have daily panic attacks or intrusive thoughts, but I'm still susceptible to both.  Depression does not characterize my state of being, but it is still a familiar friend.

We give praise when God blesses with discrete changes in circumstance or emotional state (I was sick, and He healed me.  I was laid off, and He provided a job for me.  Bonus to anyone who gets engaged in the process.).  And rightly we should give praise to God for those blessings.  But sometimes our struggles in life do not have an identifiable turning point and resolution.

I read the poem Footprints in the Sand for the first time when I was in elementary school.  In my 8-year-old mind, it was the most inspired and beautiful piece of poetry that had ever been written.  I aspired to have a copy hanging in my house some day.  HGTV has since taught me that my house should be filled with gallery photos and pop art rather than cheesy Christian poetry, but I was reminded of the truth of that poem during my "dark night of the soul."   To be sure, in my darkest times, I felt alone, but even deeper than that feeling of aloneness was the security that no matter how much fear or anxiety filled my heart, no matter how much I doubted God's love and goodness, no matter how much I ignored Him, He would not abandon me.  Sometimes He doesn't "show up" the way we want Him to, but He's still there.

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Postpartum depression and trusting God

The thought that my postpartum anxiety might never go away was a devastating thought to me.  Imagine being anxious about a whole host of things related to your newborn child, and then on top of that, being anxious about the anxiety itself.  Now, you might ask at this point where my good Christian faith was.  And I will be honest.  I did not want to have faith that God would to heal me.

Image: dan / FreeDigitalPhotos.net

Notice I did not lack faith that God could heal me.  I never questioned his ability to do so.*  He is all-powerful.  He can do anything.  And that is what scared me.  He could heal me.  Or He could not.  And if I trusted Him for healing but it was somehow part of His comic plan for me to suffer like this for the rest of my life, I don't think I could have handled that disappointment.  So I protected myself and did not let myself hope that things would get better.

I haven't always been such a spiritual cynic.  In the past, I would pray with great faith for others.  You had a falling out with your friend?  I'll pray for love and healing.  You just survived a natural disaster?  I'll pray for emotional healing and the rebuilding of your home.  But in the end, I was still in my nice, cozy bed in my nice, air-conditioned house living my nice, first-world life.  I also prayed through major life decisions.  God, please provide a job for me.  But if I don't get a job, I'll just move back home.  There was always an out in the past.  When it really came time to trust God with my life, I was too scared to.

*I'm not advocating that anyone pray themselves out of postpartum depression.  I believe that God can heal us of anything but that He may use medicine, counseling, or other resources to aid in that healing.

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Postpartum depression: my biggest fear

I consider a counseling session successful if I cry.  It means that we didn't just sit around making small talk about surface issues but that we hit on a topic that is painful to me - the reason I am seeking counseling in the first place.  I distinctly remember two times that I cried during counseling for my postpartum depression and anxiety.

The first time I cried was during my first counseling session.  My counselor asked me what my biggest fear was.  I answered immediately.  It was that my panic and anxiety attacks would never go away.  My answer and the tears that came with it surprised me.

I suspect that for many women, the worst part about postpartum depression/anxiety is not knowing when and if it will go away.  When you are in the midst of it, the pain is so severe and so constant that you can't imagine the possibility of being normal again.  More terrifying than hearing your baby cry, more terrifying than the thought of hurting your own child, and more terrifying than the thought of someone else hurting your child is the thought that there may not be an end to the anxiety that is eating you up.

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Postpartum Anxiety

Postpartum depression is a bit of a misnomer. Although PPD is characterized by depression, many women also experience anxiety, intrusive thoughts, or OCD (among other things) when they are postpartum. My own postpartum depression soon turned into a raging anxiety.

Image: Salvatore Vuono / FreeDigitalPhotos.net

Depression is like being stuck in mud. It slows you down to the point where it’s easier to just lie there than to do anything. It’s like going into involuntary hibernation. Anxiety is the complete opposite. Anxiety fueled by postpartum hormones is like swallowing a sparkler and having those sparks fly around inside of you constantly. Every waking moment is one long panic attack. My heart was constantly racing, breathing always on the verge of hyperventilation. I’m not sure which one is better.

My anxiety was triggered by my in-laws moving to our neighborhood within a month of my giving birth. It was just too much change at once for me to handle. I worried that my in-laws would be over all the time, even though they have always been nothing but polite and genteel when it comes to manners. I worried that I would be responsible for my in-laws’ happiness. They had sold their dream retirement home in another suburb to be near us after we had their first grandchild. I worried that my daughter would love them more than she loved me, and that was the crux of my anxiety. A friend consoled me by telling me that mom would always be at the center of a young child’s life. Even when the circle expands to include more people who love her and for her to love back, mom would still be at the center. I knew it was true, but I was so scared of losing her love that I wanted to be the only one in the circle.

I know...very dysfunctional, co-dependent, and insecure. I was crazy. Crazy in thinking that way, and crazy in my anxiety. However, I’ve come to realize that we’re all a little crazy and dysfunctional, but we’re just too scared to admit it because we’re afraid of what people will think. My best friend and I will often start conversations with, “This is kind of embarrassing, and you’re going to think I’m crazy, but...” I think if we would all be a little more honest about our dysfunction, we’d realize that crazy is actually pretty normal. So maybe my fears about my in-laws were actually kind of normal crazy, but the level of anxiety I felt was truly crazy crazy. I was sure that my body couldn’t sustain the elevated heartrate and shallow breathing much longer. The physical effects of my anxiety were going to shorten my lifespan. So I went to see a counselor.

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