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.

Read more...

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.

Read more...

Fear and Theology

Although I no longer suffer from intrusive thoughts, I still suffer from one of the after-effects...fear.  The intrusive thoughts awakened in me a fear of the pain and evils in this world that I didn't know before.  I continue to struggle with trusting God with my family and having peace.  This has been a time in my life where I've learned the importance of clinging to what I know to be true, rather than what I feel.  I choose to believe that God is good, even though I still feel fear in my heart, and sometimes that is the best I can do.

Image: Louisa Stokes

 I recently came across a blog where a man powerfully describes his choice to believe in God's goodness in the midst of a terrible circumstance.  He talks about the importance of good theology when dealing with difficult circumstances ("Theology is not for the intellectuals, those in the ministry, and those with too much time on their hands. Theology is for those with guns to their heads.")  He talks about the heartbreaking decision to "disown his children" during this trial (they are God's, not his) and that in disowning his children and all he held dear, he was able to be "invincible."

If I were ever in a situation where I had to make the same decision, I'm afraid my heart would break open and never be fixed.  Actually, I'm sure I don't have the courage to make such a decision now, but I believe God will give me the courage if and when the time comes.  If you are in the same situation where you are confronting fear in your life, I hope this man's courage will also give you courage to keep trusting God.

Read about what happened here (don't worry, no one was physically harmed).
Read about his powerful response here.

And please pray for the Sturms!

Read more...

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.

Read more...

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.

Read more...

How Depression Affected My Prayer Life

Soon after I had my second child, there was a famine in Africa.  There's been a famine in Africa for as long as I can remember, but this one was bad enough to make it to the news.  While struggling with intrusive thoughts, I lost the desensitivity that allowed me to read about suffering and then move on to celebrity gossip without blinking an eye.  I heard that some starving babies didn't even have the strength to cry, and it made me depressed for bringing my babies into such a sad and painful world.  I purposefully avoided the news so that I wouldn't read about it or see any pictures about it. 

I had the same one-sided conversation with God every day, "How could you give life to so many people and then just leave them to suffer, starve, and die?"  I felt foolish for trivial prayers over my kids' sleeping or eating habits.  I stopped praying for myself or for my kids and prayed only for Africa.  If God wasn't going to do something about a cross-continent famine, why would He care about making my domestic life easier?  I thought I would go ahead and do Him the favor of removing those prayers from His Queue so that He wouldn't have to toss them out Himself.

Honestly, I kinda thought that my life would be the same whether or not I prayed, but my prayer strike taught me that prayer is about more than giving God my wish list.  I found myself with a weightier load on my shoulders.  I was less sensitive to sin creeping into my life.  I became more self-centered.  I still don't have a satisfactory answer to the problem of unanswered prayer, but I learned that prayer is about more than just getting what I ask for.  I still pray for Africa, but I also pray for my kids, myself, and other people now, too.  I try to focus less on asking for things and more on giving my burdens over to God.

Read more...

Mental health and faith

People with mental health struggles (depression, panic attacks, OCD, etc.) are often encouraged to pray for God's healing in their struggles.  Pray for joy instead of depression.  Pray for peace instead of anxiety.  Pray for trust instead of fear.  I completely agree that we should pray to God for healing and grace in these areas.

Image: graur razvan ionut / FreeDigitalPhotos.net

However, our focus is often on how our faith can positively impact our mental health struggles, and we don't often discuss how our mental health struggles impact our faith.  PPD and intrusive thoughts, specifically, were destructive to my faith.

The scary thoughts I was having on a daily basis forced me to confront "the problem of evil" in a very personal way.  As soon as I gave birth to my first child, I knew that I would do anything to protect her from fear or harm.  So why did God not protect us from all the fear and harm in this world?  Instead of helping me to understand God's unconditional love, having a child actually made me question it.

Happiest robot on the block.

The problem of evil has been one of God's PR problems for a long time, and I know what the correct Christian responses are to these questions.  But sometimes knowing the correct answers don't keep your heart from asking the questions.  Hint:  The correct answers have something to do with "free will" and "It's not about me, it's about God's glory."  Call me crazy, but I'd rather be a happy, little robot than to live in a world full of broken people with free will.  (Unfortunately, have yet to find proof that this world is actually all about me.)

My faith struggles resulted in something that I hope no other Christian has to experience.  I started to fear that God would punish me for my thoughts.  I would lie there at night having waking nightmares about terrible things happening to me or my baby, and I would think, "God is going to punish me for having these fears by making these things come true."  I wanted to fly away, to hide my thoughts from God, but I knew I could not.  Writing these words, I am filled with a deep sense of sadness for how a relationship that was supposed to bring light to my life actually filled me with a dark and dreadful fear.

Although the intrusive thoughts have lessened, they awakened in me an awareness of evil and resulting fear that I have not been able to shake.  The apostle John wrote, "There is no fear in love.  But perfect love drives out fear, because fear has to do with punishment.  The one who fears is not made perfect in love."  Oh how I long for the day of my perfection!


Droid Image: Ben Jacobson

Read more...

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.

Read more...