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 mask I wear

It starts as soon as they begin to speak.  The first time my daughter said, "No Grandma!" I immediately shushed her.  We must be polite to others!  And she learned to be polite, but she also learned to put on her first, little mask.

Image: Adell Rucke

Later, we learn that the mask not only protects others but also protects us - from the rejection that might happen if others knew our deepest fears, our inner sufferings, our greatest dreams.  So we put the mask on a little more frequently.  And it starts to feel more comfortable, so that this mask, which was meant to hide who I really am, becomes a part of me.  I don't even have to put it on anymore because it's always there.

Sometimes when I talk to other people, I wonder, what's behind that mask?  Does she ever feel unsure of herself?  Does she wonder what the purpose of her life is?  Does she sometimes just want to run away?  Sometimes, there's a small, very small crack - just a faint look in the eye or a falter in the smile.  But most of the time, the mask is seamless, airtight.

When I started this blog, I wanted to take off my mask so that other women would have the courage to take their's off, too.  Because I have all this sadness, guilt, frustration, and anger that just wants to get out of me, but there's also love, sacrifice, joy, and beauty inside of me, too.  The mask keeps it all in and only lets out a sterile version of me.

But when I sit down to write what I really want to say, I start censoring myself immediately.  I don't want to make so-and-so feel bad.  I don't want my kids to read this someday and misinterpret what I mean.  I don't want to discourage my brothers and sisters in Christ.  I don't want to dishonor God.  Raw is good but raw can also be hurtful.  And by the time I'm done writing, I've written something with a lot of inspiration but very little of my heart left.

Don't get me wrong, I love inspiration.  But how do we also be real with each other?  How do we take our masks off without killing each other?  Maybe as long as we live in this broken world with our broken hearts, we can't.  So for now, I'll keep this mask on.  Because it holds together my brokenness.  And it keeps me from trampling on you and breaking you more than you already are.

So...all this is a very long and dramatic way of saying that I might be changing the content and format of my blog soon.  I'm just so tired of struggling.  What about you?  Are you comfortable with your mask?  Or do you wish you could take it off every once in awhile, let your heart breathe a little?

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Getting help for postpartum depression requires telling someone

I tried to get help from my OB, but it just didn't work out.  Before you have a baby, the nurse gives you all these pamphlets and brochures about postpartum depression, and they even make you sign a form that says you have been educated about it.  I used to work on the financial side of the healthcare industry, and I'm a big believer in preventive health.  So I compliantly went to my six week follow-up visit fully intending to get help for what I was sure was postpartum depression.

Image: renjith krishnan / FreeDigitalPhotos.net

However, when the triage nurse asked me if I was experiencing any signs of postpartum depression, instead of saying, "Yes, I wake up crying every day.  I don't want to get out of bed when my baby cries.  I have panic attacks that start when I wake up and don't end until I go to bed.  I can't breathe."  I said, "Um, I think I might have a little bit of anxiety."  I watched her write "anxiety" on my chart.

My OB then walked in looking at my chart, and cheerily asked me how I was doing.  I beamed at her and said, "Great!  I'm doing just fine!"  She never asked about the "anxiety" written on my chart.  I don't blame my doctor.  She asked how I was doing, and I didn't answer honestly.  She was trained to take care of me physically, and she is extremely competent at what she does.  It's just not easy to come out and say, "I think I have postpartum depression" the way it's easy to say, "I have really bad nausea," or "I think I have hemorrhoids."  I was insecure about a lot of things, and I guess I would feel like a drama queen saying I had PPD.  I was a little afraid that she would say it was nothing, and then I would be really embarrassed.

The way doctors educate and screen for postpartum depression should really be designed by psychologists instead of legislators or whoever came up with the current method.  Instead of making you sign something saying that you received PPD education before you have the baby, they should also give you a short, one-minute quiz a few weeks or months after you have the baby.  I don't know if some doctors already do this, but I'm assuming it's not required by law, since I didn't get any such quiz.  It would be much easier to circle a bunch of yes/no questions than to come out and say "I think I have PPD."

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Finding other moms like you

People often say that raising kids is “the hardest thing you’ll ever do.” I’ve found it to be true but also a gross understatement. When I had my first child, comments like, “It will get better” didn’t offer much encouragement to me. Instead, I took solace from a woman who candidly proclaimed to me (in church), “It was hell the first few months. I hated it.” I wasn’t alone.

Image: Ambro / FreeDigitalPhotos.net

I didn't hate my baby or hate being a mother.  Quite the opposite.  I was in love with my daughter, possibly a little obsessed.  Ok, definitely obsessed (will get to that later).  I hated always feeling inadequate. I hated not being in control.  I hated that instead of becoming a more warm, patient, joyful person, motherhood  had made me anxious, jumpy, and cynical.

Most of my mom friends are the "I <heart> being a mom" type, but there are a handful who are the "I hated it" type.  I leaned on the "I hated it" type more in the beginning, but more recently, I have also found real encouragement and great tips from the "I <heart> being a mom" type.  It's good to have both.

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