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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What misconceptions do you have about counseling?

For anyone seeking counseling, finding the right counselor might seem overwhelming.  There are so many different counseling designations, approaches to therapy, and on top of that, you need to have chemistry with whoever you see.  My friend who is a counselor recently addressed many of my misconceptions about counseling.  Below is a condensed version of an email she wrote in response to my asking what differentiates the types of therapists (counselor vs. psychologist vs. psychiatrist) and in response to my frustration that I never got a clear diagnosis of PPD.  I wish I had known the information below before seeking counseling so that I would have had a better idea of what to expect (it’s very possible that my counselor was using the goal-oriented method, but I just didn’t see it because I was focused on getting a diagnosis).

Image: Ambro / FreeDigitalPhotos.net

The term "therapist" or "counselor" is just a loose word for any professional who has a license to engage in therapy. This is usually an LPC (Licensed Professional Counselor), an LCSW (Licensed Clinical Social Worker), or a Psychologist.  LPCs, LCSWs, and Psychologists can all do the same thing, but they just have different designations from going to different graduate schools.  It is really someone's training and expertise (not the letters behind their name) that qualifies them to address clinical disorders. A psychiatrist is a medical doctor who gives meds--but they usually do not provide any therapy.

Unfortunately, there are a lot of therapists out there who just do “talk therapy”--they listen, support, and "explore" with you.   It sounds like you were frustrated with this approach and would have benefited more from therapy that was goal-oriented and had specific therapy approaches designed to decrease symptoms, get to the root of irrational thoughts/lies/myths, and develop healthier coping skills.

Also, the therapists that I am on a team with don't really spend a lot of time focusing on the diagnosis.  Even if your therapist told you that you had PPD, a skilled therapist would be focused on:

1. Identifying the specific symptoms that are interfering with your quality of life,
2. Coaching you in coping skills to decrease and eventually eliminate the symptoms,
3. Explore what made you vulnerable to the symptoms and then addressing this vulnerability area (ie: the root issue causing the symptoms), and
4. Walking with you through the cognitive and behavioral changes so that you can see progress and feel better.

The only reason therapists will "diagnose" is to help clients make sense of things and to help them normalize what they are going through, but the real focus of the therapy should be on addressing the symptoms, getting to the root of how to cope, and being sure you understand what made you vulnerable in the first place so that you have LONG term healing.  A good therapist will help you connect the dots by understanding the deeper issues underneath the symptoms and how to change that, not just put a band-aid fix over your symptoms.

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For better or for worse

Men can be pretty clueless most of the time.  I asked my husband to pick up some winter squash for one of our meals this week, and he came home with decorative gourds.  I know a guy whose wife had the baby blues after having each of their kids, and he said, "I don't know why she was depressed.  I mean, she just had a baby, so shouldn't she be happy?"

Image: nuchylee / FreeDigitalPhotos.net

On the other hand, men can be exceedingly patient and compassionate, despite not knowing what's going on.  When I asked my husband whether or not he thought I had postpartum depression, he said, "No."  He later claimed that he was afraid saying yes would cause me to feel sorry for myself and get even more depressed.  Whether he really knew I had postpartum depression or not, what matters is how he treated me.  We had the same conversation almost every day.  "What should I do?  Will I ever feel normal again?  What if I'm like this for the rest of my life?  Do you wish I would stop being this way?"  And every day he engaged in this conversation with me with patience and a listening ear.  It wasn't just my depression and anxiety he had to put up with either.  I was irritable and angry, and my husband bore the brunt of it.  He later told me that he literally had to recite Bible verses to himself on the way home from work to be able to face whatever he was coming home to.

One time near the end of one of my counseling sessions, I was talking about my husband and how he had an unwavering faith in God.  He read the Bible, prayed, and did memory verses every day.  He reminded me that God was good.  He told me that God loved me.  He trusted God to heal me.

And then I cried.

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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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Counseling: some frustrations

Even if I never changed out of my pajamas all the other days of the week, I would always do my makeup and wear something cute for my counseling sessions.  I didn't want her to think I was a total loser, even though I was already revealing to her what a dysfunctional mother, basket-case wife, and terrible daughter-in-law I was.  One time we showed up to a session wearing the same shirt from Ann Taylor Loft (different color).  That was a little weird.

Image: nixxphotography / FreeDigitalPhotos.net

Getting the most out of counseling is difficult for me.  I'm constantly worried about what the counselor will think of me, which makes it hard to be completely honest.  When I would talk about the anxiety I had regarding my in-laws and how I was pretty much blockading them from seeing their one and only grandchild, I couldn't help but think, "She's probably hoping she never gets a daughter-in-law like me."  I tempered myself and never revealed to her the true depths of how anxious I was, how I was afraid to lose my daughter's love to my in-laws, how I wanted to be the only one in her life.  Instead, it became more a conversation about getting comfortable with other people taking care of my kids.  It was helpful but didn't really address the core issue I was dealing with.

Counseling is also very frustrating and sometimes awkward.  I never really know if I'm supposed to just start talking about myself, or if I should let her lead with the questions.  Sometimes I felt like she would ask a lot of questions about a particular issue that was irrelevant to my issues.  Other times I would bait her with something that I thought was perhaps part of my dysfunction (my need for control, for example), but she would gloss over it.  The most frustrating part is that she never really gave me any advice or a diagnosis of any sort and instead would always just ask me how I felt about things.

Me: My husband said that I should be open to the idea of medication if that's what I need.
Counselor:  And how does that make you feel?

Me: Someone suggested that maybe I should just face my fears and start dropping off my daughter with my in-laws on a regular basis.  Then I would see that it wasn't so bad.  (Please tell me that's a bad idea!)
Counselor:  How do you feel about that?

Stop asking me how I feel!  Just tell me what to do!  Yes, I was annoyed that my counselor was trying to get me to explore my feelings.  You definitely don't ever want me as a counseling client.

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