Kate Kripke

Kate Kripke is a Licensed Clinical Social Worker (LCSW) specializing in the prevention and treatment of perinatal mood and anxiety disorders. She is also a Colorado state coordinator for Postpartum Support International. Kate lives in Boulder with her husband and two daughters and writes an eponymous blog.

    Six Things You Should Know About Antidepressants and Pregnancy

    Six Things You Should Know About Antidepressants and Pregnancy -postpartumprogress.com

    In light of the recent uproar over the article on antidepressants and pregnancy that was published this week on the New York Times‘ Well Blog, I thought I would pause today on the unknowns that likely burden every single mom who suffers with a perinatal mood or anxiety disorder like PPD. There is so much mixed-up and contradicting information out there: co-sleep/don’t co-sleep; breast-is-best/healthy mom-is-best; have a birth plan/let go of the birth plan; cloth diaper/disposable diaper; medicine for depression and anxiety is safe/medicine is not safe. As if being a mama wasn’t confusing already, all of this conflicting info is enough to make a mama’s head take a double-spin. And its exhausting!

    Those of us who specialize in perinatal mental health wish more than anything that there were more “knowns” for you—that there was one right answer for everyone so that we could take the burden away from you for having to figure it all out. And we know that when you are tired and anxious and overwhelmed and unsure there is nothing more difficult than having to make a decision when the information is complicated and so much unknown exists in the midst of it all. Truthfully, it’s not okay that we don’t know more, and we need to keep on doing the research necessary to continue to build toward more clarity.

    So, what I want to say to you is this: If you are frustrated, we get it. If you are confused, it makes sense. If you are angry, you get to be angry. And if you have questions, ask them. 

    When you reach out for help from a trained professional, you have a right to know their expertise, their commitment to best practice and professional development, and their loyalty toward helping YOU decide what the best course of action is for your particular situation. Not every mom with postpartum or antenatal depression or anxiety will end up including medicine in her treatment plan, but many will. And those of us out there rooting for you and your babies understand the trust that you put in us to help you decide what is the safest and most appropriate way to help your family thrive.

    So, to summarize what I consider to be some of the most important parts of the beautifully written response to the New York Times story on antidepressants and pregnancy from PSI, here are six important facts:

    1. It is not possible or appropriate to make one blanket statement regarding the use of SSRI medication during pregnancy (or breastfeeding). These decisions need to be made on a case-by-case basis and must take into account each mom’s unique symptoms and family picture.

    2. While there has been some research that suggests that SSRIs may not be safe to take during pregnancy, there is more research to suggest that they are. And, when we look closely at this research, the statements made to suggest that SSRIs are dangerous to a fetus are selective and do not account for the whole picture. Another way of saying this is that many of these studies you sometimes see covered by the media are not “clinically sound.”

    3. Untreated and under-treated perinatal mood and anxiety disorders can have significant negative effects on a developing baby’s social, emotional, and cognitive development. This, by the way, is rarely if ever debated.

    4. Sometimes lifestyle changes like increased sleep and nutrition or non-pharmaceutical treatments like acupuncture and light therapy help a mom recover from her symptoms, but sometimes they do not and a more involved treatment like psychotherapy or the use of an SSRI is required for a mom to be well.

    5. Taking an SSRI medication during pregnancy under the guidance of an appropriately trained clinician is not irresponsible.

    6. There is most definitely some “gray area” when it comes to the use of SSRI medicine during pregnancy and breast-feeding. And many of us are uncomfortable with the “grays” and want instead for there to be more a more black-and-white, clear answer to these things. While this gray area can be confusing, however, it does not need to be as scary as the New York Times suggests.  Instead, we can try and think of the gray as a place for options.

    So, moms: On behalf of all of the appropriately trained perinatal mental health specialists out there, we know that these decisions are hard for you and that the choice of whether or not to take medicine while you are pregnant or lactating is rarely simple. We believe that you want what is best for your baby (and so do we!), and we are confident that the choices that you make that lead you to wellness will undoubtedly benefit your kiddos in the long run.  

    We will continue to research and understand the role of pharmaceutical medicine in the treatment of perinatal mood and anxiety disorders and will advise you on best practice and sound clinical knowledge. We will not mislead you. We will let you know what we don’t know, but we will also let you in on what we do and we will do this with educated knowledge and research-based understanding. 

    And, we know that this does not feel easy, although we wish that it were. But you have our promise to continue to learn and push and stand by your side as you do what is required to be your best self. For you and for your baby.

    ~ Kate Kripke, LCSW

    Understanding Vulnerability in Postpartum Depression

    vulnerableWhat comes to mind when you hear the word “vulnerability?”  Really, what are the images, words, and reactions that invite themselves along with that word?  My guess is that it is something like this: weakness, fear, shame, powerlessness, and insecurity.  I imagine that, for most of you, the word vulnerability sends with it a warning sign and a very deafening message of “Be Tough!”  I imagine that all of you reading this know what it feels like to be vulnerable and that most of you are working very, very hard to run in the opposite direction.  To prove to others that you are anything but.

    My post today comes after being reminded, again, of Brene Brown’s phenomenal research on vulnerability.  Her message is that in order to feel strong, empowered, and connected we must face vulnerability head on.  Not run from it or resist it. Her decade of research tells us that the people who run from vulnerability are the ones who continue to feel shame, a lack of worthiness, and fear; that the people who embrace vulnerability are the ones who feel worthy, connected, and strong.  It is somewhat counter-intuitive, isn’t it?  This conclusion may confuse many of us who have been taught, from an early age, that admitting to vulnerability is failure.  But this conclusion may, when all is said and done, provide postpartum moms some freedom.

    For the majority of women who walk into my office, vulnerability is assumed to be a dirty word. For the first-time therapy client, the brand new mom, or the woman who exists in a place of shame and unworthiness, the idea of vulnerability is one to be avoided at all costs.  This idea is terrifying.  For many people, it equates failure.  It suggests lack of competence.  This resistance takes charge of the mom who is suffering in silence and is terrified to ask for help because she assumes this means that she is weak.  This gets expressed in my office as, “I feel so much shame for having to be here.  I feel like I should be able to do this without any help.”

    But yet that mom is there, in my office.  That mom is vulnerable.  Not because she is weak, but because she is a mom.  And she is human.

    Lets, just for a moment, name all of the times in early motherhood that we are vulnerable:

    When we try to get pregnant; when we learn that we are pregnant; during the first trimester; when we experience miscarriage; when we become pregnant again; when our bodies change before our eyes; when we give birth; when we adopt a child; when we attempt to breast feed our babies; when we choose to bottle feed our babies; when we wean; when we bring our babies home from the hospital, when our midwives leave, or when we bring our adopted babies home for the first time; when our babies cry; when we don’t have the answers; when we make mistakes; when we experience our partners’ struggle; when we are tired; when we are hungry; when we forget to change a diaper and our babies get a rash; when we lose our temper; when our feelings are hurt; when we realize we have hurt someone else’s feelings; when we are trying to cook dinner, tend to a newborn, and manage our toddler’s tantrums or endless chatter all at once; when we burn the toast; when we don’t recognize our bodies; when we have sex with our partners; when we are cold; when we are hot; when we are lonely; when we are sad; when our hormones are shifting; when we are surprised by something; when we are disappointed by something; when our expectations aren’t met…. Get it?


    What many of us do is this: Panic.  We assume that if we are vulnerable there must be something wrong with us.  And so we pretend to feel invincible when we aren’t.  We say that we are fine when we’re not.  We refuse help when we need it.  And we attempt to be who we aren’t in that moment- we pretend to be moms who are super-human and impenetrable.

    What would it mean if being “strong” meant knowing our limits and asking for help when we need it?  What if being worthy meant understanding our own individual challenges and working with them rather than against them?  What if being competent meant being super duper authentic with where we are emotionally, physically, and spiritually in each and every moment?  What if being okay meant being willing to not be okay?  What if the ability to acknowledge vulnerability was strength and not a weakness?

    Well, what Brene Brown’s research says is this:  We would be happier.  It says that we would feel more connected to others.  It says that we would report more feelings of worthiness and less shame.  It says that we would feel more competent, more capable, and more in control.  It says that by simply “leaning in” to discomfort we will be freed of the burden or it.  Imagine that!

    Postpartum mood and anxiety Disorders like PPD have many layers to them.  Moms who struggle with depression and anxiety often are dealing with a double whammy of vulnerability- they are both vulnerable because they are moms and because the symptoms associated with depression and anxiety are making it hard for them to think with clarity and confidence.  These moms may want nothing more than to wish their vulnerabilities away because they feel awful.  But the more they try to NOT be vulnerable, they more they feel that they are.  And they feel shame, and guilt, and worthlessness.    And they resist these feelings of vulnerability.  And around, and around, and around.

    If Brene Brown’s 10 years of research is accurate, we know with a fair amount of certainty that this resistance to vulnerability and this assumption that being vulnerable is a character flaw only causes more distress and creates a deeper sense of isolation and lack of needed connection.   And if we understand this, then we all may want to try something new: we may want to take a deep breath, find our inner courage and strength, and let someone in on our little secret.  Reach out for help. We may want to give ourselves permission to be vulnerable simply because we are.  And my guess is that by doing this, we actually get what we need to feel better.

    ~ Kate Kripke, LCSW

    Photo credit: © intheskies – Fotolia.com

    Normal Postpartum Adjustment vs. Postpartum Mood Disorders

    Normal Postpartum Adjustment vs. Postpartum Mood Disorders -postpartumprogress.com

    I was recently asked to speak about the difference between normal postpartum adjustment and perinatal mental illness at a Maternal Wellness Summit in Denver. My first reaction was, “Sure. That is simple.  I know this like the back of my hand.”

    And then, upon my initial attempt to create a presentation for the audience, who were non mental-health providers working with perinatal women, I was reminded of how undeniably complicated this question really is. It would be so much easier, so much clearer, if we always knew the difference between the two. But even experts in the field of perinatal mental health aren’t always as clear about this as we would like to be. And because of this, too often women get over or under diagnosed with PPD and other similar illnesses.

    What we do know is this:

    • The image of the always happy, gracefully content, instinctively breast-feeding mom of an ever-peaceful baby is a myth.

    • A “normal” or healthy postpartum adjustment includes plenty of anxiety-filled moments, plenty of time feeling isolated, plenty of overwhelm and a healthy dose of uncertainty. Moms in this category will feel better with reassurance and community support.

    • The Baby Blues, defined as a period of 2-3 weeks (and no longer) characterized by emotional vulnerability and mood swings, are a normal and expected part of a healthy postpartum adjustment. The baby blues affect about 85% new moms and go away on their own.

    • Almost all brand new moms will notice changes in appetite, some difficulty sleeping, and a decrease in sex drive. Although these changes are also symptoms of depression, women who experience these are often not clinically depressed and are, instead, simply sharing a common (and transient) experience with other new moms.

    • Approximately 1 in 7 women will struggle with a perinatal mood or anxiety disorder like PPD and, for these women, their symptoms will noticeably interfere with their ability to function as necessary, meaning that their symptoms related to depression or anxiety (or both) will intrude on their ability to sleep, eat, work, care for their children, engage in activities that were once pleasurable to them, or connect with others in social situations.

    Still, there is a vast group of women who get missed in the above “facts.” There are mamas out there who are really, truly struggling more than we might expect them to in a healthy adjustment to motherhood but who don’t necessarily fit the criteria for a major depressive illness or an anxiety disorder. I’ve mentioned these moms before; they are the mamas who hold it all together for those around them but, behind closed doors, fall into a heap on the bathroom floor, or in bed at night, or any place where no one is looking. It’s these moms who I worry most about because they aren’t likely to reach out for the support that they need to thrive.

    (Yes, moms, if this all resonates then know that this post is for you, my friends.)

    In their book This Isn’t What I Expected, Karen Kleiman and Valerie Raskin describe this type of postpartum adjustment beautifully, re-naming what the DSM characterizes as an Adjustment Disorder, Kleiman and Raskin use the term Postpartum Stress Syndrome to describe this too-common experience. They suggest that Postpartum Stress Syndrome is  “marked by feelings of anxiety and self doubt coupled with a deep desire to be a perfect mother.” 

    They go on to say that, “This enormous expectation of being the perfect mother, perfect wife, in control at all times, combined with the very real feelings of inadequacy and helplessness, can create unbearable stress.” There are many, many women out there like the mom described here.

    What we need to do—each one of us who works with perinatal women in a professional capacity or a personal one—is listen carefully to the moms around us. You see, it really doesn’t matter whether WE think that what she is experiencing is “normal” or not. Instead, what matters most is how each and every mom feels she is doing. 

    A new mom may be experiencing the expected levels of vulnerability postpartum (meaning that on paper her experience may be “normal”), but if she is distressed by her experience then this mom needs support. Now. Many full-blown episodes of PPD might be avoided if we listen and observe more carefully rather than assume, though well-intentioned, that she is okay because we interpret her experience to be normal.

    Postpartum distress is an entirely subjective experience, and emotions, experiences,and vulnerabilities that may feel tolerable to one mom may feel excruciatingly difficult to another. One mom may be forgiving of the uncertainty and overwhelm in new motherhood, while her sister next door may judge herself for this very same experience. As I said in my recent talk in Denver, understanding the difference is confusing because it is confusing. There are no rules, no books, and no guidelines that can be used to determine whether or not a mom is struggling postpartum. The only guide for this is the experience of the mom, herself.

    This means that we need you, mamas.  Yes, we need to do a better job of asking you the right questions, knowing what to look for, and following through with our careful and respectful care of you. But we need you to let us in on your experiences and keep us in the loop with regards to how YOU think you are doing. And if you are worried about the way that you feel, please let us know. Your family, friends, and the professionals around you are here to listen and learn.

    ~ Kate Kripke, LCSW

    10 Things A Mom Learned in Therapy That Lead Her to Emotional Health

    emotional healthMan, I love the work that I do.  Truly.  And recently a woman who I work with in my Boulder psychotherapy practice reminded me of this once again.  What this phenomenal woman reminded me of is this: Emotional pain is excruciating, but even depression that keeps someone in a place of deep despair for much of a lifetime can be shifted.  Not easily, of course, but with hard work, commitment, insight, and hope, heaviness can be lifted and emotional health recovered.

    I’d like to share her list with  you of the ten things that she has realized are important for her to feel well.  Ten things she says that she learned in my office, but ten things that, truthfully, she has discovered on her own.

    1.     Pay attention to physical health and symptom reduction. 

    Like so many others, Lisa* spent years in doctors offices seeking help for what she believed to by physical illness.  Emotional pain can be stored in the body and identified initially as physical ailments that seem ongoing.  When insomnia, body pain, and other physical distractions seem unexplainable and chronic, depression and/or anxiety may be the cause.  Lisa spent much of her life seeking help for these issues but now realizes that the cause of many of them was her emotional stress and depression.  What she has found is that when she takes care of herself physically (through sleep, nutrition, exercise, and breath) she feels better emotionally.  And, as she recovers from her depression she feels less physical pain and discomfort.

    2.     Acknowledge, defend, and obtain wants and needs.

    Lisa is not unlike so many others who have been motivated by the shoulds in life.  Lisa has been so accustomed to this that it took some time for her to recognize what her own wants and needs are outside of the shoulds placed on her by others.  When Lisa was able to listen carefully to her own internally driven wants and needs, she found that she not only accessed important instincts but she also was more likely to achieve her goals.   She has found that there is often a need to speak up for herself in this area and she has learned to be her own advocate regardless of the expectations of others.

    3.     Self-monitor and self-soothe.

    Lisa learned the importance of listening for changes in the way she feels.  What she found is that when she is able to notice shifts in body tension, her thought processes, and her reactions to things she is able to catch her rising stress early enough to stop it in its tracks.  Lisa has found deep breathing to be an especially helpful tool, along with other coping strategies for emotional health such as taking a break, exercise, and getting outdoors.

    4.     Accept emotional turbulence and understanding that suffering is temporary.

    As a child, Lisa was not allowed to feel anything other than happiness.  Struggle (especially fear, sadness, and anger) was not welcome in her household.  Because of this, Lisa had learned to dread the negative emotions that are experienced in life. Each time that she experienced even “normal” amounts of distress, she was catapulted into a deep dark hole that she felt she could not get out of.  Through our work together, Lisa learned that emotional turbulence is a normal part of being human, and that if she is able to let go of the need to change or deny it, her suffering is temporary.  This awareness has lifted the additional layer of stress and self-judgment that she often felt whenever she experienced anything other than happiness.  This has made the suffering that she does experience from time to time more tolerable.

    5.     Have self-compassion and non-judgment.

    Along with the above, Lisa has learned to understand the devastating impact that self-judgment has had on her well-being. As she learned to understand why she has felt the way she has with compassion and empathy for herself, her confidence and acceptance of herself has grown immensely. [Read more…]