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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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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What do you do all day?

One of the big things I struggled with after I became a stay-at-home-mom was what to do with my baby all day.  Of course, I spent a lot of time nursing/feeding her, changing her, and trying to get her to sleep, all of which took a lot more time than it sounds.  But there was also this troubling thing that a lot of baby books call "awake time" where the baby isn't eating, sleeping, or pooping, but just...awake.

Image: Idea go / FreeDigitalPhotos.net

I'm not a baby person.  I think babies are cute, but I don't really have the need or desire to hold other people's babies or play with them.  When I get together with other moms, I'd rather have an adult conversation than to play and babytalk with our kids.  Yet I decided to stay home to "enjoy this time," so I felt like I needed to spend every waking hour playing or interacting with my daughter.  I asked other moms what they did all day with their kids and tried to implement the suggestions:

• Read - 2 minutes if you read a whole bunch of board books
• Go for a walk - not possible 6 months out of the year where I live
• Peek-a-boo - 3 minutes (baby could go longer, but I get sick of it)
• Sing - 5 minutes if I sing every song I know multiple times
• Dangle random toys in front of them (I came up with this one) - 1 minute

After many long minutes of sheer boredom, I would think, "We must have passed at least 30 minutes!  It's probably almost naptime!" only to glance at the clock and see that I barely made it past the 10 minute mark.  (Now I always divide my guess by 2 before looking at the clock, but my estimate is usually still too high.)

So here's every (sane) SAHM's dirty little secret: You can do other stuff.  Do chores, work on a hobby, "like" a few things on Facebook.  My friend of a friend at efootprints advised playing with kids in 15 minute chunks.  Having "permission" from someone I consider a supermom to not spend every waking minute interacting with my child was liberating!

Just don't get your expectations too high about what you can accomplish.  If your wife is a SAHM, or if you're tired of your SAHM friend being a "bad friend," please read the next part very carefully --> The time is not consolidated.  Some days it takes me an entire day to do one load of laundry.  I worked on a few home improvement projects that would take a normal person two weekends to complete but took me two months.  I've also found being active (eg: chores or crafts) was more acceptable to my toddler than reading a book, surfing the internet, or talking on the phone (my sister is starting to develop the skill of talking over crying babies, but I don't assume my other friends have that skill).  Also, the time that is spent interacting with my kids is very draining, so sometimes I just want to do nothing when I have free time, and that doesn't mean I'm lazy.

Of course, I still think it's important to spend a lot of quality time with my kids.  I have them "help" with my chores or activities, but I also make time each morning and afternoon to do what they want to do, to hug, kiss, and sing to them, and to make sure I am paying attention to them.

Even though I no longer suffer from postpartum depression (I'll continue to blog about that process in other posts), I still struggle with "regular" depression sometimes.  The sheer boredom and tediousness of taking care of little children contributes a lot to the depression, and having permission to do other stuff has helped me tremendously.  It seems like common sense now, but for the longest time I felt guilty if I wasn't spending quality time with my daughter every waking moment.  I hope sharing my experience frees up other struggling moms to take time away from their baby if that's what they need.

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