“But I don’t have PPD anymore! I am not supposed to feel depressed or anxious! I should know better than to wake up and feel like I don’t want to face the day! What is wrong with me? Does this mean I am back to where I started?”
In the wake of Katherine’s lovely honesty around her period of stress-related depression last week, we decided that a post on this exact phenomenon is important. Because we are all likely to go through stress at some time or another, and for moms who have struggled through a postpartum mood or anxiety disorder like PPD, these periods of distress can feel downright terrifying (and often way too familiar). Yet they are unavoidable if a mom is in any way human (I know, what a bummer), so understanding what stress related depression is all about and how to take care of you in the midst of it is important.
What do we mean by stress-related depression? Really, all that this describes is an episode of depression (or anxiety) that is triggered by a stressful event or periods of prolonged stress. In clinical terms we call this psychosocial stress, caused by disruptions in someone’s environment. A mom who is typically healthy can go through something that feels stressful — anything from a new job, an exciting move, a vacation, or building and renovating a house, to illness, financial loss, relationship conflict, or loss of a loved one — and suddenly feel as though she has lost all semblance of mental health and clarity. She can feel as though she is suddenly incapable. Behind. Incompetent. Unable.
Here’s the thing though: stress itself is neither bad nor abnormal and is, in fact, an entirely acceptable and normal psychological and physiological response to both positive and negative situations in one’s life. What matters in mental health is not that you avoid stress, but that you know how to deal with it so that it doesn’t linger. Prolonged stress can lead to increased cortisol and decreased serotonin and dopamine (neurotransmitters responsible for emotional wellness) if it isn’t managed well. Without these neurotransmitters and adequate brain functioning we simply become less resilient to the stress that we are facing, and we become symptomatic (tearful, anxious, overwhelmed, fatigued, hopeless, apathetic). This is often what occurs when we aren’t mindful about taking care of ourselves while we are feeling stressed.
While stress-related depression is not necessarily a relapse of postpartum depression, we do know that moms who struggle with PPD are usually those whose brains are genetically more vulnerable to imbalances in brain chemistry. Moms who struggle and recover from PPD may need to be mindful of self care and emotional wellness throughout their lifetimes. This does not mean that they are certain to relapse and develop severe symptoms or depression and anxiety again, but that they need to be mindful of what is required to prevent these symptoms from reoccurring, whether that be with medicine, sleep, exercise, nutrition, or all of the above. Stress in life is inevitable, and a brain that is predisposed to any form of mental illness (depression, anxiety, OCD) needs to be well nurtured so that it can weather the storms.
Imagine a tree or plant in your yard somewhere. If it is not watered, fed with sunlight, and well cared for it will easily be blown over in a storm. Our brains work the same way.
And the good news? Stress-related depression and anxiety are usually much shorter-lived than a postpartum mood and anxiety disorder like PPD. Especially if you have some awareness about what your brain and body need to be well and you can ask for help early.
With that in mind, here are 10 tips on how to both manage stress when it comes in uninvited and how to take care of yourself so that the stress doesn’t take over:
- Notice when your life speeds up. Most of us, when life gets busy, speed right up along with it. We tend to push out our needs when we are in periods of busy-ness and we end up making very little, if any, time for self-care. We forget to eat. We skip the exercise. We stay up later. We give up our rest, our breaks, our downtime, because we feel like we have to in order to get things done. But this never works because more times than not we end up running out of fuel. Crashing. We forget to put on our own oxygen mask first and then we have nothing left to give to anyone. So, instead, notice when your life gets fuller and, instead of rushing to meet it, make a conscious effort to slow yourself down. Schedule in meals, exercise, sleep, and breaks. In the long run these moments will save you.
- Have a mantra. “I am okay even when I don’t feel that way”, “This too shall pass”, “I matter”– this can be anything that helps you remember that you are doing your best, that you are not super human, and that times when you don’t feel great do not equate to you not being great.
- Take care of the cold. When you notice early signs of emotional distress (tension, headache, belly upset, tearfulness), nourish yourself like you would at the earliest hints of a cold. When you wake up with a sore throat or runny nose, do you rush out for an hour-long work out or stay up as late as you can? Let’s hope not. So, let’s prevent the flu. Eat your veggies and plenty of protein. Get some rest. Be kind to yourself as you would if you were noticing early signs of physical distress.
- Give yourself permission to feel bad. With changes in weather, hormonal shifts, increased workloads, childcare demands, and household chores piling up it would be impossible not to feel overwhelmed. Again, remember it is not the feelings of overwhelm that are problematic, but whether or not you take care of yourself when you notice them.
- Talk to someone. Blog. Go see your therapist. Talk to your husband or best friend or random grocery store clerk who asks you how your day is going. When we hold our tension inside it will inevitably build up until there is no more room to store it. Give yourself some space in there.
- Breathe. Seriously. When we are stressed we all tend to become physically tense and take short, shallow, chest breaths. We use only a limited amount of our lung capacity. When we respond physically to an event or situation this way, we tell our brains that it is important to panic. Even if this isn’t really true. Our brains need adequate oxygen to function effectively, and believe it or not, we have a huge amount of control over this. Practicing that deep belly (or diaphragmatic) breath can literally change our physiological response to stress.
- Know that it will pass. Because it will. Perspective is really important during periods of stress, and it is also the first to go when we become depressed or anxious. And you can remind yourself if this is your mantra – “This Too Shall Pass.”
- Avoid alcohol, drugs, and caffeine. It is so easy to drink one too many glasses or wine or coffee when you are feeling badly because, in the moment, it feels like it will help. But the truth is that drugs and alcohol will not help you to feel less depressed (they are depressants) and caffeine will not help you to feel less anxious (it is a stimulant).
- Acknowledge cognitive distortions. This is the basis for Cognitive Behavioral Therapy (CBT) and we know a huge amount about how and why thoughts really do impact the way that we feel. Catastrophic thinking, should statements, all-or-nothing thinking, discounting the positives, discounting your coping skills, “what if” thinking, fortune telling, and overestimating the threat will, inevitably, make you feel awful.
- Be mindful of your emotional limit. Often, managing your stress alone just isn’t going to cut it. Don’t be afraid to call and make an appointment with your therapist again as you may need additional support during this time. Sometimes, just one or two sessions back will be all that you need to resurface again.
~ Kate Kripke, LCSW
Photo credit: © Stuart Miles – Fotolia.com