Mental Health After Postpartum

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Photo by Jonas Eriksson via Unsplash

Mental health, after postpartum “ends,” becomes a rough path. The only thing rougher is trying to leave the path and walk alone. I don’t recommend trying to walk alone. I’ve been seeing doctors and therapists since I was twenty-years-old, and the darkest times in my life have been before therapy and between therapists. I’m also a bit of an expert, now, in what to expect when seeing a new psychiatrist. I have been lucky, in that I’ve only ever had to see three, regularly, in ten years. The first appointment is always the same: I describe what I feel, how strongly I feel it, and I answer the very same questions, every time, about when it all began. Each doctor has had to determine for him/herself whether my previously recorded diagnoses were correct, so I don’t blame them, even if it’s no fun for me. (I did get pretty short-tempered with the 100,000 people who questioned me during my stay in the psych ward, at age 21, but I was suicidal, and answering the same questions 100,000 times. After my stay was over, I went happily back to my regular doctor!) Their first questions always have to do with what, exactly, I’m feeling, and how strongly I’m feeling it. Am I in danger? No? Let’s move on…

The next series of questions has to do with when I began feeling this way. Does this sound familiar to those of you who have seen a psychiatrist or other doctor, about your mental health? Have you wondered why they get so focused on when it all began? If you’ve experienced a perinatal mood or anxiety disorder, it’s obvious that the “when” is important! It’s in the name, after all. [Side note: the book doctors are supposed to use to diagnose PMAD gives us four weeks, postpartum, to experience symptoms. Four. I barely even remember my first four weeks postpartum. Doctors can and do fudge this, if they think it’s PMAD, because there’s a big lobby to get four weeks extended to six months.] The name of the diagnosis matters, because it can determine the medicines available to you, or even the number of sessions your insurance company is willing to “give” you with a therapist, or how many weeks you have to use up those sessions. 

What happens, though, if it’s been six months, or six years, and you don’t feel that you’ve “recovered” from what feels really similar to whatever got you that PMAD diagnosis in the first place? Well, a whole new world of possibilities and recommendations opens up. It can be a very scary world, because we may not have the words to communicate exactly what we’re feeling, and doctors use our symptoms to decide our treatments. This is a very subjective, delicate process. The process can take a long time. It can be discouraging. If you’ve heard the standard diagnostic questions as many times as I’ve heard them, you start to see a pattern. I can hear it, these days–the psychosis questions (Do I see things that aren’t there? Talk to people who have died? No? We can move on…) and the bipolar questions (Do I stay awake all night, without feeling tired? No? We can move on…) and the depression questions and the anxiety questions. There are also panic questions. Yes, indeed, panic is different from anxiety. Again, all of this matters, because our symptoms determine our doctors’ options for what they can write on forms and prescription pads, whether we’re eligible to participate in studies or drug trials, and, again, how our insurance companies treat our claim forms.

At this point, I’m usually given the most general of anxiety diagnoses, and I don’t often ask what my diagnosis actually is, because when it comes to anxiety, the names of the diagnoses simply match the descriptions of what I feel. Generalized Anxiety? Anxiety in general. Social Anxiety? Anxiety centered primarily around social situations, but not present in general. Panic Disorder? Panic attacks that occur at random, which is a special kind of fun that doesn’t have any discernible source, different from anxiety attacks caused by a known trigger that anyone would reasonable feel some anxiety about. You get the idea. The “disorder” part only comes in because it’s stronger and more difficult/impossible to deal with than what your average person experience–everyone experiences anxiety. In a bizarre way, I’m lucky. My symptoms are fairly clear-cut, if exhausting and painful, and I respond well to medication, with few side effects. If that doesn’t happen, you may find yourself on a long, hard road. At that point, doctors and patients need to work together closely, and trust each other, if it becomes unclear why symptoms last a long time, or why they aren’t easing up more with therapy and/or medication; symptoms are all we’ve got to go on, after all.

Good doctors and your more knowledgeable and patient loved ones can help a lot, if you find yourself trying a series of medications that seem to be all side-effects and no relief, or if you keep hearing that no one knows what’s “wrong.” This seems especially common with depression and bipolar, which just don’t appear with specific, consistent symptoms, the way anxiety and psychosis, do. A good health care provider will focus more on what helps you than on telling you what to call this experience. If the medication that helps you is usually prescribed to bipolar patients, then your doctor may write a number on a piece of paper that says “bipolar,” but you might not feel like you fit the standard description. That’s ok!

An insight that really helped me change my perspective on all of this has to do with this symptom-based, “do you respond to lithium/Zoloft/Ativan?” method: asking a patient and doctor to figure out exactly what symptoms are relevant, and how strong they are, is similar to what doctors used to do, when they were treating patients whose bodies were ill, before we knew about bacteria, viruses, and other things that we can measure and see. I certainly hope that a doctor has never described the “nature” of your fever, but that’s how it used to work, before we knew how to take someone’s temperature and what caused our bodies to get fevers. Because the brain is so darn hard to get a good look at, we have to look at all these other things that seem related to what’s going on in there. But we don’t know much of anything. Those brain scans the media loves to show us really only show where the blood is going. We can guess at what that means, and our guesses seem pretty good, but we don’t know in the same way that we know that somewhere around 98.6 degrees fahrenheit is a healthy body temperature. In other words: some sort of “meter,” like a thermometer, for brain chemistry would come in really handy, but we are nowhere near that place.

I don’t mean to sound discouraging; I mean to send out patience and a forgiving attitude, especially towards yourselves. You may encounter doctors who cling to the current system, in the same way that doctors once felt certain that figuring out what kind of fever you had was the absolute best way to figure out what kind of illness you had. They are doing their very best with the tools given to them, but you may want to look for someone who understands that the tools available have limitations. If you hear some scary names used to describe you, please don’t feel like those words have determined your fate. The scary names may change, and after all, they are really just medicine’s best attempt to describe the kinds of symptoms they, and you, can describe. Make sure that they, and you, keep your eyes on the prize: do you feel better than you did, before the most recent change?

I sometimes envy Warrior Moms who are given a clear-cut PMAD diagnosis, because they have an end in sight. Of course, it’s not that simple. I’m sure the women who have changed medications, a long and grueling process, envy my tolerance and responsiveness to meds. My very first therapist (coincidentally, she wasn’t a prescribing doc) told me something that I repeat, often: I walk a path. The path isn’t coming from anywhere, and it’s not going anywhere. Sometimes, I don’t walk on that path. My care providers and I work to get me back on to the path simply because it is easier to walk, there, than it is to walk across the ground that isn’t so smooth. I may never reach a point where I don’t have to think about that path. It may always take some work, from me, to stay on it. I might always need medication to smooth my way.

None of us will reach a destination called Finished. Whether or not someone writes a number on a form to send to an insurance company to get us medical treatment for how we feel, we are always going to have ups and downs. When will we get “better”? If we are asking about feeling better than we used to feel, then maybe the answer is: soon! But if we are asking about being completely healed, perfect, and never afraid or sad, ever again, well: never. The path is just not going to any destination, let alone destinations like Perfect and Finished and All Done.

Photo by Jonas Eriksson via Unsplash

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Warrior Mom Conference Countdown

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Warrior Mom ConferenceThere’s nothing like connecting with another mom who has been through postpartum depression, anxiety, OCD, psychosis, or has experienced any of these illnesses during pregnancy.  An instant understanding and sisterhood binds you together, as you share your story and recognize yourself in a kindred spirit.  The truth is that, though there are many brilliant medical professionals tackling the challenges facing women with maternal mental illness, only another survivor can truly know what you’ve gone through.  And so we come together, digitally, and find solace in our camaraderie.  The Postpartum Progress blog, Facebook page, and private patient forum have connected women just like me to support and evidence-based information for 10 years now.

It’s inspiring to witness the support community the Warrior Moms have created and exciting to think that in only 165 days, we get to bring over 100 of them face-to-face at the inaugural Warrior Mom Conference.  As wonderful as digital hugs are, I have to tell you that nothing, nothing beats meeting another survivor in person.

We’re hard at work behind the scenes here at Postpartum Progress, creating an amazing conference experience that will educate, inspire, and empower our Warrior Moms.  We can’t wait to announce our conference schedule, which will feature some of the leading experts in maternal mental health along with self-care workshops, and advocacy training.  We’ll be connecting with the folks at home with our new Homestead Warrior Mom program, and have thrilling ways for our conference attendees to connect with peers from across the country.  But most importantly, we just can’t wait to see our Warrior Moms in person and give them real, honest-to-goodness hugs.

Want to be in the know?  You can keep up to date with the latest Warrior Mom Conference news over on our Facebook page.  Visit the official conference webpage.  And be sure to follow us on twitter @WarriorMomCon!

Want to sponsor our conference?  Email us at wmc@postpartumprogress.org.

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Mental Illness Didn’t Crush My Dream of a Family

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3347120739_0d840078faPhoto Credit: carf via Compfight cc

I was diagnosed with Bipolar Disorder after experiencing two manic episodes in the same month, each requiring hospitalization. At the time I was devastated and felt as though my dream of having a family had been shattered.

I knew I wanted to be a mom from a young age. I adored babysitting and loved being in charge. In my mind I’d meet the man of my dreams in college, we’d get married soon after, and when the time was right, we’d start a family.

In reality, that all did happen, with one exception.

I met the love of my life while in college. We dated for four years before he proposed. At 24, we said our vows in front of family and friends, promising to love each other in sickness and in health. Little did we know sickness wasn’t far off. We’d have just over two years of health before mental illness knocked the wind out of our nearly perfect love story.

Madness struck me before I’d even had the chance to decide that I was ready to try for a baby. My diagnosis of bipolar disorder left me wondering if I’d ever be healthy enough to be a mother. A year went by as I struggled to keep my chin above water, my depression pulling me deeper and deeper into the ocean of despair. I felt like I had nothing to live for.

My husband and parents fought hard for me. I saw countless psychiatrists, and even a noted doctor from NIMH (National Institute for Mental Health) who told me, as I sobbed in his office with my husband by my side, that I could still have children if I wanted. It was possible, he said. And staying on medication under doctor’s supervision would be a good idea.

After a year of intense suffering, I couldn’t take it any longer and finally agreed to try a medication my doctor had been recommending. It took several months for me to feel the full effects, and for my old, up-beat personality to begin to reemerge. My husband and I took things one day at a time, and when the weeks added up to a full year of stability, the year of hell began to fade into the shadows of our minds. Thoughts of pregnancy began to fill my head, and all of a sudden I was pleasantly distracted from my illness.

I’d accomplish my dream of having a family; it was so close I could taste it.

Looking back now, with two healthy kids and six years of parenting behind me, sure, I’d do things a little differently.

I was medication-free for my first pregnancy and although I did fine and had no symptoms of my bipolar disorder during the 40-weeks, the same can’t be said for the four weeks after my son was born. Postpartum psychosis ripped me from my newborn but I was fortunate it only took a week in the psych ward to return me to my family. In hindsight, part of the problem was the pressure I put on myself to be a “perfect” mom to my new baby. Maybe if I wouldn’t have been so insistent on breastfeeding, I wouldn’t have gotten sick. Maybe if I would have let family help more with the night feedings, my mind wouldn’t have lost control of itself.

Lessons learned, I agreed to do things differently the second time around. I thought I had all the proper precautions in place. I did my research and decided that since the medication I took had the greatest risk to the fetus during the first trimester, I’d work with my doctor to taper off the med once I got a positive pregnancy test. The plan was to go back on the med in the second trimester and remain on it for the duration of the pregnancy.

Unfortunately, the exciting news of the two little pink lines sent me into a manic episode after a week-long battle with elated insomnia. I spent five days in the psych ward at five weeks pregnant battling the most severe mania I’d ever endured. The doctors brought me back from my break in reality with powerful anti-psychotic drugs and I feared I might lose my baby.

Recovery from that most recent hospitalization in April of 2010 was the most difficult. I worked closely with my doctors and my baby girl was thankfully born completely healthy. My postpartum period with her was drastically different than that of my first child, due to the plan I had put in place before she was born. We formula-fed from the start, since breastfeeding wasn’t an option anyway due to my meds. Knowing she’d be a bottle-fed baby from the moment I became pregnant made it easier to get past the sadness over not being able to breastfeed.

Since my husband and I knew that lack of sleep was my number one trigger, he did the middle-of-the-night feedings in her first few months which allowed me to get a solid chunk of quality sleep. We even had my sister-in-law stay with us for the first two weeks since she was home on a break from her job at the time, and she took the night shift. Sleep was still a challenge in those first few months, but luckily she was a great sleeper and we made it through.

One thing is certain: I didn’t let mental illness rob me of my dream of a family. My family is everything to me.

Parenting is no easy task. Throw in mental illness to manage, and it can get intense. Intense, but not impossible. There are resources out there, there is support out there. My kids are worth it all, no doubt about it. I share my story – our story, really – so that other women out there can find hope.

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Research uncovers various classes of PPD

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brainHumans compare themselves to others around them. She has prettier hair. He has a nicer car. Why does she get the corner office when I have worked just as hard? Or the ever popular gym comparisons: I do the SAME exercises as her and yet, nothing. Then we beat ourselves up because we are not achieving the same end results as those around us.

We do the same when we are fighting a Perinatal Mood & Anxiety Disorder. “I’m on Zoloft. It only took so-and-so this many weeks to feel better so I should be feeling better by then too!” Then we hit that milestone and we may not be feeling better. It is so difficult to handle, perhaps even more so than the comparisons in the first paragraph because all we really want is to be better, to be back to ourselves and yet while we are running our own personal marathon toward mental wellness, we compare to those on the same road, forgetting that even on the jogging path, there are those who pass us.

New research out of Chapel Hill, by Dr. Samantha Meltzer-Brody, examined the heterogeneity (that’s a scientific word for diversity) of postpartum depression via a latent class analysis. What she discovered may put some minds at ease when it comes to fighting the battle of postpartum depression.

Turns out, according to Meltzer-Brody, that there are various “classes” of postpartum depression. What does this mean? It means we all are fighting different battles. It’s the same war, but think of it as different levels of skirmishes.

What varies?

“Women in class 1 had the least severe symptoms…., followed by those in class 2…, and those in class 3. The most severe symptoms of postpartum depression were significantly associated with poor mood, increased anxiety, onset of symptoms during pregnancy, obstetric complications, and suicidal ideation. In class 2, most women (62%) reported symptoms onset within 4 weeks postpartum and had more pregnancy complications than in the other two classes (69% vs 67% in class 1 and 29% in class 3).

Their conclusion?

“PPD seems to have several distinct phenotypes. Further assessment of PPD heterogeneity to identify more precise phenotypes will be important for future biological and genetic investigations.”

Why does this matter?

It matters because the more in depth our understanding of how PPD behaves is, the more successful we will be in treating it, and possibly even minimizing any severe episodes. In addition to external influences, there are also internal influences and biochemistry at work here. Thanks to Dr. Meltzer-Brody and other researchers like her, the very real possibility looms of truly individualizing PPD treatment.

For now, we continue to propel ourselves forward, going with what works for us, and in addition to fighting our own battles, remember not to judge those who are doing a bit better than we are. We are all on the same road but we are walking to our own struggles.

(photo source: https://flic.kr/p/d9soWC)

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