Following PPD

A Mother's Journey Through PPD/A

2012-02-17T10:18:00.000-08:00

Fourteen years ago I gave birth to a beautiful, healthy baby boy, at 7 lbs. 9 ounces, and named him Owen (not his real name). I’d been waiting for Owen for a few years. I’d had two miscarriages before him: one in my 10th week of pregnancy and one in my 14th week of pregnancy. Right after the second miscarriage, I needed a D&C and lost 1.5 liters of blood during the procedure, which was quite scary. The medical staff in Europe, where I was living at the time, told me, however, that the blood loss was a fluke. As I found out after delivering Owen, it really had not been a fluke because after he was born, I lost 3 liters of blood due to the uterus not contracting, and it took medical staff 6 hours, from 1PM until 7PM, to get the blood loss under control. It was a life-threatening situation; thank goodness for blood transfusions! I don’t really remember much of this because I was mostly out of it, but my husband will never forget… to this day he says those 6 hours were the longest hours of his life. A doctor had talked to him twice during this time to tell him they were trying to do everything they could, but were not sure if I was going to make it. Obviously I did.

I was in the ICU for 2 nights and then was wheeled into a room with 2 other mothers who had just delivered their baby. Between the 3 of us, we always had one baby that was up and needed to be fed. So, needless to say, I got very little sleep; so little that I broke down crying on my 5^th day at the hospital and begged my husband to take me home. He supported my decision, and I checked myself out of the hospital. That first night at home, I experienced my first panic attack ever. I asked my husband to call 911 because I thought I was dying. I could feel extreme tingling in my whole entire body from head to toe, so much so that I felt I was leaving my body, which I thought meant that I was about to die. My husband called the doula that had helped us deliver Owen and, over the phone she explained that I was experiencing anxiety. She recommended my husband normalize the experience, turn on some calming music and make me a warm drink. He did all of that while I experienced one panic attack after another and had yet another night of no sleep. And so our journey to hell (as we refer back to it) had begun.

I became an insomniac (even though I used to fall asleep at the drop of a hat) and had absolutely no appetite, even had an aversion to food (even though I had been a total foodie my whole life). I lost about 30 lbs. in a little over 2 weeks (pregnancy weight included) and became thinner than I’d ever been. I experienced many more panic attacks and started having intrusive thoughts, which were very graphic and therefore very disturbing. I saw danger everywhere, literally everywhere! I would look at things and worry about how those things could potentially hurt my baby. For example a window: he could fall out, a bath: he could drown, a knife: he could get cut, a belt: he could get strangled, a washer/dryer/ oven: he could end up in there and would never make it out alive. I had stopped nursing Owen about 2 weeks after he was born – very heart-breaking decision, but I’d come to realize that as long as I kept breastfeeding, my body would be unable to catch a break - and had started bottle-feeding. Every time I mixed up the bottles I thought for sure I was using the wrong water or not the right amount of formula, and that would eventually kill him. Owen’s level of dependency on me seemed to be a responsibility I could not handle; he just seemed too vulnerable to be put in my incapable hands. I had thoughts of disappearing, of no longer having to be a part of Owen’s life or my husband’s life, not just for their own good, but also for my own survival. Owen felt like a leech, sucking the life right out of me. Because of his existence, I felt myself just withering away… slowly, but surely. My thinking scared me tremendously because I thought I had gone completely crazy. I did not know what the thoughts meant: did they mean I wanted to hurt my baby? Or maybe they meant I became “bad” overnight and was turning into a criminal? As I was trying to make sense of it all, I knew one thing with certainty: I no longer trusted myself. So, I told my husband (who I thought, without a doubt, was going to leave me and take the baby with him, but at that point, I had already come to terms with that). When I told my husband that I no longer wanted to be left alone with Owen and why, he immediately went down the stairs to talk to our neighbor, a psychiatrist. The psychiatrist came to see me that same day and listened to my story as well as he could because I was sobbing the whole time. He wrote me a prescription for an anti-depressant - one that also helped with sleep and appetite -, which I started taking that day. I slept well that same night for the first time in almost 2 months! I also started seeing someone for therapy, just a handful of times, but it helped. I also stopped spending time alone with the baby. We were expats, so we flew family and friends out to help us. Once my thoughts were back to normal and I trusted myself again, which was about 2 months later when Owen was around 4 months old, I started taking care of him by myself again. And so our journey back from hell had begun.

Being diagnosed with Post Partum Depression & Anxiety was such a relief to me! It showed me that psychiatrists had heard of this illness before and that I was not the only one suffering from it. I was so happy about the diagnosis that I told everyone about it: family, friends, and neighbors. My guilt about being the most ungrateful and undeserving mother on this entire planet started to subside little by little. I would say, all in all, it took about a year for me to feel completely like myself again, but I did get consistently better once I reached out for help. In hindsight, I guess I had a few things going against me: giving birth in a foreign country with no - to a very low - support system, changing from having a full-time job to becoming a stay-at-home mom and the isolation that comes with this, a traumatic birth, prior miscarriages, an extremely colicky baby who could cry for 7 hours straight, and finally, a genetic pre-disposition to depression and anxiety. This temporary “soul loss,” as I call it, and permanent loss of a large part of my innocence and naiveté luckily did end up serving a much greater purpose.

I became a Marriage and Family Therapist treating new mothers who suffer from depression and anxiety. Also, eight years ago, my husband and I adopted an adorable baby girl at birth, so Owen has a younger sister. Both kids are doing great and I’m confident I am a “good enough mother.” And last but not least, my husband and I are celebrating our 20^th wedding anniversary next year, and I can honestly say that most of our two decades together consist of fun times with memories that put a smile on my face J

The Basics

2011-11-08T09:03:00.001-08:00

Two of our board members recently drafted an article highlighting the basics of Perinatal Mood and Anxiety Disorders. This is great information or review for everyone.

Perinatal Mental Health: Differentiating Mood and Anxiety Disorders From the Expected Emotions of New Motherhood

Perinatal mood and anxiety disorders (PMADs) are frequently underdiagnosed among health and mental health professionals alike. Too often the symptoms that coincide with these disorders are confused with “expected” emotions during this time. It is important that clinicians know the risk factors and presenting symptoms for PMADs, in order to ensure proper assessment and treatment. Without such treatment, PMADs can impair the developmental trajectory of the baby and family.

Risk Factors

There are numerous risk factors that can increase a woman’s vulnerability to PMADs. Biological risk factors can include a genetic predisposition to anxiety or depression, a family history of PMADs, a history of hormonal sensitivities (i.e. severe PMS), thyroid problems, or infertility issues. Social risk factors include family stressors, unplanned pregnancy, a history of pregnancy loss, or a lack of social support. Psychological risk factors can include perfectionist behavior, worrying, high need for control, or a history of physical or sexual abuse or neglect.

Differentiating Between PMADs and Expected Emotions

Differentiating PMADs from a “normal” reaction to childbirth primarily depends upon the factors of timing and the degree to which functioning is impaired. The DSM IV states a postpartum onset specifier of within 4 weeks postpartum for mood disorders; however, most experts in the field believe the onset to be anytime within the first year postpartum. Below, the four disorders associated with PMADs are described in brief detail.

Postpartum Depression (PPD): 80% of women experience the baby blues within the first 2 weeks after childbirth. Baby blues consists of crying, mild sleep disturbances, moodiness and sadness, but the woman can still function well enough to adequately care for her baby. In contrast, women experiencing PPD may not be able to function well enough to take care of the baby and/or herself, and she will meet the criteria outlined in the DSM IV for major depression.

Postpartum Anxiety (PPA): All new moms worry, but in moms with PPA the worry affects their functioning (e.g., a mom cannot sleep when her baby sleeps because she is watching her baby breathe, or a mom doesn’t want to leave the house for fear of the baby crying.) Generalized anxiety and /or panic disorder may be present.

Postpartum OCD (PPOCD): These women often suffer from intrusive thoughts of harm coming to their baby or of them harming their baby. These thoughts are ego dystonic. Women may change their behavior to avoid the feared image (e.g., avoiding crossing bridges for fear of throwing her baby over the edge).

Postpartum Psychosis (PPP): Research suggests that most women with PPP are those who have not been previously diagnosed with bipolar disorder or who are off their medication postpartum. The onset is usually within the first two weeks postpartum. PPP is a psychiatric emergency. It is important that women with a history of bipolar disorder be followed by a psychiatrist throughout pregnancy and postpartum.

For more detailed information on PMADs or for resources, please visit the following web sites.

www.mededppd.org

www.postpartum.net

www.postpartumhealthalliance.org

Submitted by Gretchen Mallios, LCSW and Yvonne Rothermel, LCSW on behalf of the San Diego Postpartum Health Alliance (PHA). To become a member of PHA and be listed in our provider directory, please visit www.postpartumhealthalliance.org or call 619-254-0023.

PHA's Statement Regarding Recent Events

2011-08-31T12:08:00.000-07:00

Recent news stories about tragedies involving potentially depressed mothers and their babies have shocked and saddened our communities, especially those among us who have suffered perinatal depression or anxiety ourselves. At PHA, we want to take the opportunity to reassure parents that these reported circumstances are extremely rare. Depression and anxiety are devastating for families, but the vast majority of those who suffer pose no risk of harm to others. However, these stories remind us that perinatal depression and anxiety remain stigmatized, underdiagnosed, and all too often untreated. It is our hope that what arises out of these recent events is increased conversation and understanding about these disorders. They are not uncommon – one in eight mothers will experience one – but they are treatable. For information about perinatal mood and anxiety disorders, please visit our website at www.postpartumhealthalliance.org or any of the following helpful sites:

www.postpartum.net

www.mededppd.org

www.postpartumprogress.org

If you or someone you know needs support in dealing with depression or anxiety during or following pregnancy, please call PHA’s warmline at 619-254-0023.

My Journey Through Postpartum Depression and Anxiety

2011-05-31T10:38:00.000-07:00

“Tell them I died.”

I spoke calmly. I had clarity. After weeks of panic attacks, hopelessness, and pain, I had a plan.

Ten months earlier, I found out I was pregnant. What should have been cause for celebration was cause for worry. I bled in the early days of my pregnancy and was advised that I might not remain pregnant for long. I was devastated and desperately wanted to gain control over what was happening in my body. My husband and I soon discovered that all was well, but that we were expecting twins. This was exciting and welcomed news, but started us down a stressful road that included countless doctor visits, a cross-country move to be close to family, early winding down at my job, and significant discomfort for many months. I never did manage to feel settled into pregnancy as we had many surprises along the way including fetal heart concerns, my own heart and lung concerns, fetal monitoring every 48 hours, a diagnosis of preeclampsia, and ultimately an emergency c-section. When my boys arrived five weeks early, but healthy, we were extremely grateful and relieved, but I couldn’t shake the uneasiness that had persisted throughout the pregnancy.

As was the case during pregnancy, our early days with the boys looked nothing like what I had anticipated. I was advised not to breastfeed because they were too small. All of the cute newborn clothes and tiny diapers we had excitedly collected were too big for them and I had to search for anything small enough for them to wear. Everyone who visited commented on how tiny they were, and I felt offended and hurt. No one meant any harm, but after months of obsessing over having healthy babies, I was shook up by each reminder that we didn’t quite make it to the end. I am someone who rarely fails to achieve what I set my mind to, but for many months now, I had been fighting circumstances that were out of my control.

Despite these initial difficulties, we enjoyed our first few weeks with the babies. They were quiet and soft and very sweet. We cuddled and sang and swaddled. I was increasingly exhausted, however, as I could never manage more than a couple of hours of sleep between feedings. Attempts to breastfeed were unsuccessful, but I was determined to provide them with breastmilk. So when I wasn’t feeding or sleeping, I was pumping. I began to feel stuck. I was hooked up to this machine during the only times I might have been able to do something that even remotely reminded me of who I was. The need for breastmilk became obsessive and I misguidedly felt that I could successfully manage at least one part of this process if I could just make enough milk. Ironically, this stress was likely the cause of my inability to make enough milk, and I was deflated each time I had to supplement with formula.

In the midst of my feelings of inadequacy and my obsessive need to gain control over situations, the babies developed colic. I’ll never forget April 29^th. They cried for eight hours straight. I attended a wedding that evening and was in a daze, absolutely distraught at the fact that I couldn’t console my babies that day. As I drove home, I experienced what I believe was my first panic attack at the thought of returning home. The next month was torture. Each day the babies seemed to cry more, unresponsive to my attempts to comfort them. They wouldn’t eat without crying and they seemed to be screaming at me all day. I had never encountered a problem that I couldn’t solve just by working harder at it, but no matter how hard I pushed myself, I couldn’t gain control over this situation. Every new formula or medication we tried, every book I read, every person I talked to, every technique I applied resulted in nothing but disappointment. I then went from a manic need to resolve this issue to completely shutting down. I became numb and despondent, unable to motivate myself to do just about anything. My stomach turned at the sight of the breast pump and I couldn’t bring myself to look at the bottles as I filled them and fed my babies. The sound of their cries made me shake and stopped my breathing. Everywhere I looked I saw evidence of my failure as a mother.

I decided, with the help of my family and friends, that I needed help. I saw my primary care physician to talk about medication. Although she was willing to prescribe it and talked to me about how I was feeling, her attempt to reassure me that what I was going through was just normal adjustment made me feel worse. What I was going though was NOT normal. If that didn’t register with her, then I must really be a more terrible mother than even she had ever encountered. I chose not to start the medication, as I was too afraid to give my boys breastmilk while taking it. And Lord help me, I was going to give them breastmilk if it was the last thing I did. I also went to see a therapist who also assured me that everyone goes through a tough time adjusting to motherhood. This was absurd. She didn’t even suggest postpartum depression, and I again felt like no one could ever understand the depths of my pain. What an abnormality I was, truly a never-before-seen case of weakness and incompetence. Even professionals didn’t recognize this. I had never felt more alone and scared in my life.

On Memorial Day, 2006, I found myself unable to look at my babies. They were sleeping in their swings, and I was terrified about them waking up. I knew I couldn’t go to them. I was physically unable to pick them up anymore, as the dread and pain were too overwhelming. I hid myself under the dining room table like a frightened animal and called my husband, my mother, and my father. I was done. It was going to end here.

While waiting for my parents to arrive, I shared with my husband that I was completely unable to function as a mother and that it was time for me to give up. I was going to leave that day and not return. It sounds melodramatic now, but I was clear at the time that I had no other choice. I thankfully was not suicidal, but I was definitely not sticking around. When my parents arrived, I told them that I was leaving and that it was up to all of them to decide what to do with the babies. I wasn’t coming back and I wouldn’t be in touch. I calmly shared that I was finally clear on the fact that I was not only a terrible mother, but I was a terrible person and needed to start over where no one knew of my failures. I was incapable, useless, and selfish, unable to be the wife or mother my family deserved.

The only thing I asked was that they tell my boys that I had died. I never wanted them knowing that they were abandoned and thinking it was their fault. It was mine. I had failed.

My family was clearly rattled by this, and my parents packed up the boys and began to leave with them. It was only at that moment, as my boys were being taken from my home, that I began to feel again. I suddenly cried out for them. I wailed and fought to grab them, and my husband held me back. I reached for them and screamed as they were taken away. As much as it hurt, this deep surge of pain was a sign of hope. I wasn’t totally ready to give up yet.

Over the next week I took my medication, found a new therapist, visited a support group and made sure I was never alone with the babies. I talked and was supported. My husband was a rock, never judging me and never showing how scared he must have been. I had help and I tried to rest. I cried as my breastmilk dried up and as I returned the pump to the hospital. Things still didn’t look as I had expected, and I wasn’t going to gain that control I desperately wanted, but I was going to learn to accept what was. It took a lot of work, a number of professionals, and medication for me to slowly make my way back to myself. Within weeks, the dark cloud lifted. Within months, I began to feel joy.

Five years later, I am a truly happy mother. I love my children deeply and my family is in-tact and thriving. I am sure that I am a good mother and know that my early impressions of myself were clouded by depression, a filter through which your worth is disguised and your hope is destroyed. I have learned to let myself be human, working to accept the things I cannot control and to forgive myself for the mistakes I have made and continue to make. I still grieve the loss of those early months. They are a hazy, dark time for me and my heart hurts to think that I began motherhood under that fog. I worry about what my depression and anxiety might have done to my children while I was pregnant and when they were newborns. I experience pangs of envy when I hear of happy babies who don’t cry and mothers who easily breastfeed their babies. I was robbed of these precious moments. Yet, others have had it worse, and each day that I look at my beautiful boys and feel the joy that we experience together in this life, I am grateful for where my journey has brought me.

Today I work for the Postpartum Health Alliance, trying to prevent depression and anxiety in mothers and support them if they are suffering. We work hard to share with mothers the message that they are not alone, that how they feel is not their fault, and that they will get better. I have the privilege of talking to women who call seeking help. I have the opportunity to teach doctors how to identify and help women like me. I have a platform on which to affect the conversation about perinatal anxiety and depression. All of the obsessive energy that went into judging myself is now a powerful drive to help others. I hope this story creates understanding and a sense of responsibility among all of us to seek out ways to support one another. Without those who knew, those who cared, I truly would have left. But I am here, and I have so much to teach and share and tell my boys.

Instead of telling them I died, I will tell them I survived.

Mamafest Success!

2011-05-26T09:42:00.001-07:00

A wonderful evening was shared by guests, vendors, and the PHA board and volunteers. Last Friday more than 250 mamas enjoyed a night out with a fabulous view from the La Jolla Country Club, wonderful food, informative speakers, and tons of prizes and exciting auction items. And all for a great cause - supporting PHA!

Thank you to our amazing sponsor, Stroller Strides, and our talented event coordinator Corina Dubois of Celebrate Mama. Please visit their sites at www.strollerstrides.com and www.celebratemama.com. We are grateful for all you did to ensure that the evening was a success.

Mamafest is Here!

2011-05-18T19:33:00.000-07:00

Please join us at MAMAFEST

May 20, 2011

6:30-9:30pm

La Jolla Country Club

Mamafest is an ultimate evening event for moms in the San Diego County area, presented by Stroller Strides. The annual event brings together a variety of different entertainment and shopping options for moms, and gives 100% of the proceeds to the Postpartum Health Alliance. Mamafest is the official San Diego promotional event in support of Pregnancy Awareness Month.

Mamafest features everything a mom could want for her night out! Elements include:

-- a lively shopping marketplace

-- speaker panels

-- silent auction

-- swag bags & FREE giveaways

-- food, socializing, and a cash bar

-- Mamafest magazine

-- local connections

-- and more!

For information and to purchase your tickets, visit

http://celebratemama.com/index .php/locations/mamafest-san-di ego

PPD and PHA in the News

2011-05-02T19:48:00.001-07:00

10 News San Diego aired a story on April 17th about a PHA Advisory Board member, Michael Spangler, the suicide of his wife Annie and the UCSD Maternal Mental Health Clinic. PHA''s Educational Chair, Katie Hirst, MD, was also interviewed in the piece to discuss the issue of PMADs. PHA was pleased to be mentioned as a resource. The video and transcript of the piece can be viewed at http://www.10news.com/news/27696805/detail.html.

Just Announced!

2011-04-19T09:59:00.000-07:00

Join Us for the Next Postpartum Health Alliance Educational Luncheon...

Women's Experience of Childbirth:

What To Do When It's Traumatic

Speaker: Janet Jaffe, PhD

May 13th, 12:00 - 1:30
Elijah's La Jolla

8861 Villa La Jolla Drive,

La Jolla, California 92037

Phone: (858) 455-1461

Cost is free for PHA members and $10 for non-members. Attendees will order and pay for lunch individually off the Elijah's menu. Unfortunately, we are not able to provide CEU's.

Please RSVP to Katie Hirst by email: khirst@ucsd.edu

Janet Jaffe, PhD, clinical psychologist, is the co-founder and co-director of the Center for Reproductive Psychology and co-author of two books, Reproductive Trauma: Psychotherapy with Infertility and Pregnancy Loss Clients (APA, 2011) and Unsung Lullabies: Understanding and Coping with Infertility (St. Martin’s Press, 2005). She is currently in private practice in San Diego.

San Diego Women's Week!

2011-03-29T09:49:00.000-07:00

PHA is proud to take part in this year's San Diego Women's Week!

Women's Week is a premier symposium with hundreds of women in leadership roles across all organizations and industries. Designed to inspire, empower and connect women executives, managers, professionals, emerging leaders, young women and social entrepreneurs. San Diego Women's Week is truly an inspiring event.

San Diego Women's Week will provide inspirational keynote speakers, host breakout forums and provide unique opportunities for all who attend. Speakers at San Diego Women's Week will focus on a variety of topics, ranging from health and fashion to business and technology. More than 5,000 visitors from the San Diego region are expected to attend the event hosted at California Center for the Arts in Escondido.

Please check out the event on Wednesday evening, when PHA will be an exhibitor, or on any of the other four days of the event. Learn more at www.sdwomensweek.com.

A New PPD Study - With a Twist

2011-03-17T20:48:00.000-07:00

A new study was published this week that provides information about and raises awareness of a largely unrecognized problem - depression in new dads and the impact it has on their parenting.

The study, “Fathers’ Depression Related to Positive and Negative Parenting Behaviors With 1-Year-Old Children,” appears in the April issue of Pediatrics. Researchers analyzed data from 1,746 fathers of 1-year-old children and found that 7% of the fathers were depressed. Further findings show that about 40 percent of the depressed fathers reported spanking their children, versus just 13 percent of fathers who weren't depressed. The depressed fathers were also less likely to report that they regularly read to their child.

One important aspect of this study is that a whopping 77% of the depressed fathers reported having had contact with their child's pediatrician during their child's first year. As a result of this finding, The American Academy of Pediatrics concluded that "visits to the pediatrician may provide an ideal opportunity to discuss specific parenting behaviors and refer depressed fathers for appropriate treatment."

This conclusion is in line with an important project that PHA is undertaking this spring. PHA has created a new poster that calls attention to postpartum depression and anxiety and will be running a "Poster Drive" aimed at ensuring that a large number of pediatricians throughout San Diego display the poster in their offices. This will raise awareness in both providers and patients - mothers and fathers alike - increasing the chances that parental depression can be identified and treated early.

If you would like to support the PHA Poster Drive, through donations or by volunteering to deliver posters, please contact PHA at info@postpartumhealthalliance.org.

More information about the above study can be found on the American Academy of Pediatrics website at http://www.aap.org/.

10 Facts about Postpartum Depression and Anxiety

2011-01-31T11:41:00.000-08:00

1. You will recover. You are not alone. Anyone can get postpartum depression or anxiety. It is not your fault. It is not your partner’s fault. PPD is a condition of several causes. The causes and cures are biological, emotional, cognitive, social and spiritual. You may have more stress in one or another of these areas, but full recovery should include all aspects.

2. You need regular breaks from child care. Taking breaks from the intensity of caring for your child(ren) is a necessary part of reducing your stress. It is not a luxury.

3. There is no one thing that will suddenly make PPD go away. In your recovery, you will feel better if you take regular, consistent steps of self-nurturing and accepting support. (Practical, emotional, social, psychological and spiritual).

4. You will feel better if you reach out to understanding people and express your feelings. Women who go through PPD without any support end up incorporating their negative feelings into their self-esteem as mothers. Talking to other women who have recovered from PPD is extremely helpful and effective. It is normal to feel embarrassed about your negative feelings, but it will help to have understanding listeners.

5. On the worst days, make it a rule that you will not evaluate your life. Fill your head with senses and even feelings, but leave out comparisons and judgments about your life, your partner, motherhood, your house, etc.

6. Remedies are individual and need to work for you. Remember, different people need different solutions. This applies to questions of medication, alternative therapies, sleeping arrangements, parenting styles, feeding, and what books you read. Learn what works for you.

7. You will feel better if you get outside regularly. Start small and do more as you feel better.

8. PPD/A goes in cycles. There are good days, bad days, and a lot of gray days. If you stick to a plan of self-care, breaks, support and remedies, you will keep feeling better. Don’t despair when a bad day follows a good day. It’s a natural part of the cycle. When you have a hard day after feeling better, do look at your last few days. Did you get any breaks? Did you overdo it? Stuff your feelings? Did the baby have a growth spurt? Are you expecting your period? Make a change in breastfeeding? Are you experiencing extra stress?

9. PPD does not mean you are a bad mother. Negative feelings about motherhood are a result of PPD, not a cause. When we try to make ourselves match our prenatal fantasies, we usually end up depressed. Instead, you can change your picture of motherhood to be more realistic, flexible and satisfying.

10. Your child came to live with you and needs you to be true to yourself. It is okay to have your feelings, to cry and to feel mad and frustrated and even flat nothingness. But do try and make eye contact and touch your baby. It helps if you can smile but don’t get hung up on smiling when you can’t find one inside. Take breaks when you need breaks – if not before you need one.

Courtesy of Wendy N. Davis, Ph.D.

Call for Proposals

2011-01-26T10:26:00.000-08:00

For Professionals: Postpartum Support International is holding its 25th Annual Conference this September in Seattle. PSI is now accepting proposal abstracts. Visit www.postpartum.net for more information.

Did you know...

2011-01-13T11:44:00.000-08:00

Postpartum Support International (PSI) hosts free, live phone sessions every week, including Wednesday chats for moms and Monday chats for dads.

During these sessions callers can talk with a PSI expert about resources, symptoms, options and general information about perinatal mood and anxiety disorders. The sessions are facilitated by licensed mental health professionals, are informational only, and open to anyone with questions and concerns.

Visit www.postpartum.net for more information.

Happy New Year

2011-01-04T08:48:00.001-08:00

From all of us at Postpartum Health Alliance, we wish you the best for 2011!

Advice from a Mother Who Survived PPD

2010-12-28T10:14:00.000-08:00

GET HELP! Talk to someone, anyone, but hopefully reach out to a trained professional.

Get rest when you can. Seek to take care of yourself, even if you feel like you can't lift your head off the pillow. Try to exercise and eat right, take vitamins, and if need be, find a medication that will help through the darkest times. Find the right combination that will work for you.

Try to stay active.

And try to turn any resentment you might have towards your children into a focus for being. See them as a reason to live, a reason to heal.

And let go of the anger. Under the anger is a lot of pain, but you have to peel away those layers before true healing can begin.

Remember you're not alone. Ever.

Finally, accept it. It took me a LONG time to accept that PPD invaded my life. That it changed my being. It changed who I was, who I am and why I'm here. Once you start to see light, once you start to let go and find some strength again, begin to understand that even in your darkest hour, there are things that happened that were good. Pull from those moments. Recreate the happiness PPD tried to take away. Remember the first smiles, the first steps, the first tooth, and know that once the cloud has been lifted, those memories are once again yours and no one or no disease can take those away.

Recovery from PPD long and bittersweet. Those nice memories don't come easy and you have to dig deep to find them. But they do become a defense against PPD when it tries to creep back in.

And it takes time. The scar will be there. While I no longer have PPD, I still have the scar and it will be with me forever. The key is not letting it win, not letting it debilitate you and your family, to not let it take away any more memories or minutes from your life.

Taking Medication While Pregnant - A Psychiatrist's Thoughts

2010-12-07T11:32:00.000-08:00

One of the most common questions I am asked in my psychiatry practice is, “Is it safe to keep taking my antidepressant/antianxiety medicine during pregnancy?” The answer to this involves looking at the risk of medicine use in pregnancy, the risk of depression/anxiety in pregnancy, and the benefit of the medicine. It’s also somewhat unique to each woman, based on her history of depression or anxiety.

My job is not to convince women to stay on medicine. That is a decision that is between the woman and her doctor (ideally with her partner’s input as well). However, the assumption is often made that medicines are always “bad” to continue in pregnancy, when the reality is that depression and anxiety can also be “bad.” If a woman decides to stop a medicine, I always hope that this is an informed decision (ie, she has talked with her doctor and learned about the risks and benefits), not one made out of fear. After she stops the medicine, she should still be seen by a mental health provider, even if only once a month, so that she has someone to check in with in case she starts having symptoms again. Many times this is a therapist or a psychiatrist. Hopefully, if symptoms are caught early, she can improve her depression or anxiety in therapy and avoid needing to restart the medicine (if that is her choice).

But, and this is a big BUT: this should be an informed decision, not a scared decision.

In my clinic I often see the following situation: a woman has 1, 2 or more depressive episodes in her life and is doing well on medication (and hopefully with therapy as well). She decides to start trying to get pregnant, and stops her medicine. Or, she waits until she is pregnant, and then stops as soon as the pink line turns up. She feels okay for the first few weeks or months of pregnancy, but the depression or anxiety gradually returns until it is worse than before. Now the woman feels like a failure because “pregnant women are supposed to be happy” and she is not.

Most of these women haven’t told their doctor who gave them the medicine that they stopped, and then they start seeing an OB or midwife, who only asks the woman “What medicines are you taking now?” rather than “What medicines were you taking before getting pregnant?” Because no one else knows that the woman has a history of depression or anxiety, or was on medicine in the recent past, it takes much longer for her to get help and feel better. Some women spend their entire pregnancies feeling terrible, and only after delivery does someone say, “I think you have postpartum depression.” The truth is that the “postpartum depression” started during pregnancy.

The problem with this scenario is that, even though the woman was doing really well before getting pregnant, once she stops the medicine she is at increased risk of becoming depressed or anxious again. A study done at Harvard in 2005 showed this very clearly: they followed 200 women with depression who were feeling good (not depressed) for at least 3 months before getting pregnant. Once the women were pregnant, the researchers watched to see who stopped or continued their medicine, and then who got depressed again. They found:

68% of women who stopped their antidepressant medicine at the beginning of pregnancy became depressed again during pregnancy
21% of women who continued their medicine also became depressed

Women are at much higher risk of becoming depressed again if they stopped their medicine. The bad news, however, is that even those women who continued their medicine were at high risk of depression.

So, what should women do?

Talk to the doctor who prescribed your medicine, and let him or her know you are pregnant or trying to become pregnant. Ask about the risks of taking the medicine in pregnancy, and about what to do if you start feeling depressed or anxious again during pregnancy.
Let your partner know that you are on medicine for depression or anxiety, if you think he will be supportive and helpful in making a decision about what to do.
Get information about the medicine you are on and the risk of depression or anxiety in pregnancy. A great resource is California Teratogen Information Service: ctispregnancy.org/factsheets, or get more detailed information by calling for a free phone consult at 1-800-532-3749.
Tell your prenatal care provider that you are/were taking a medicine for depression or anxiety.
If you don’t feel comfortable asking the doctor who gave you the medicine, or if she or he does not know the answers to your questions, find someone who does. (See our provider directory at postpartumhealthalliance.org)
If you stop the medicine, make sure that you are monitoring your mood, and ideally working with a therapist or doctor to prevent depression or anxiety from coming back.

Most importantly: Do not try to do this alone. Getting help does not mean you are a failure, it just means that someone else is in it with you.

Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, Suri R, Burt VK, Hendrick V, Reminick AM, Loughead A, Vitonis AF, Stowe ZN. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 295(5):499-507, 2006.

Katie Hirst, MD is the Education Coordinator for the Postpartum Health Alliance and the Director of the Maternal Mental Health Clinic at University of California, San Diego.

WELCOME!

2010-11-17T11:13:00.001-08:00

Thank you for joining us at Following PPD. This blog is a product of the Postpartum Health Alliance, a non-profit organization dedicated to raising awareness about postpartum emotional disorders and providing support and treatment referrals to women who are struggling with them.

The name Following PPD has two meanings:

First, PHA intends for this blog to provide current information about Perinatal Mood and Anxiety Disorders (PMADs). These resources are helpful to professionals who want to stay up to date about this issue. Current research, best practices, and upcoming events will be highlighted. In addition, mothers and families who may be struggling personally with such issues will find information to help educate them about their condition. In either case, this blog will help you in following PPD and other PMAD developments.

Second, PHA wants to send a message of hope to those who are suffering with PPD and other PMADs. We encourage you to look forward to a time in your life following PPD. There will be a time when the sadness, anxiety, and worry will subside. There will be a time when you can enjoy being a mother and being a family. All these conditions are treatable. You deserve help and you deserve to get better.

Please continue to check this blog for insights from professionals and survivors, information for assessing and treating patients, suggestions for supporting families that are struggling, and encouragement and information if you are suffering.