Depression setback or just a bad day?

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raindrops on a window with traffic in the backgroundMany people who have experienced depression (of any sort) know what it feels like when you start slipping. That’s how I’ve always described it – it generally isn’t really one giant, fell-swoop sort of crash, but more like that feeling you get when you’re sitting in your car and you realize the parking brake isn’t on and you’ve taken your foot off the brake and you’re rolling. For one split second you think, “ACK!” Except of course in the car scenario you can just put your foot back on the brake or yank the parking brake up and hopefully prevent any serious damage.

That’s not always the case when depression starts to take over.

To be fair, sometimes it is. Sometimes catching it early enough makes it possible to reverse the backwards slide enough that depression doesn’t take hold. And sometimes, you’re actually not slipping at all. Sometimes it’s just a bad day.

How to know if it’s just a bad day

Learning to recognize when it’s a bad day versus an ongoing issue was one of the hardest lessons for me to learn. At any sign of my usual symptoms I used to panic. I’d think ahead to the next few weeks or months and what I had on the go and assume that none of them were going to happen and wonder why me and let in that little bit of self-loathing that seems to always come along with a new bout of depression. It took wise and experienced friends and supporters asking the same question over and over for me to start asking it of myself: “Is this really a sign of a problem or is it just a bad day?”

When I was really caught in the up-and-down of recovery from PPD, it was actually “just” a bad day relatively often. Not always, of course, and that’s not to say that a bad day doesn’t really and truly suck. But recognizing a bad day is such a huge part of managing depression and not letting it throw you into the deep, dark spiral.

I was talking to a friend about this the other day. “I feel like I’m sliding backwards,” she said. I knew the feeling well, but also knew enough to poke a bit. “Do you think it’s just a bad day,” I asked, “or something more?”

Let me be clear: Answering that question isn’t always easy. Sometimes it’s really hard to be objective enough about our own mental health to be able to realize that it’s a bad day and tomorrow might very well be better. But sometimes it really is as simple as asking that one basic question. And if the question makes you think about specific things — a disastrous morning getting the kids out the door to school, a medication change, being overtired thanks to a child who decided Wednesday night was a good one to test mom’s fortitude — chances are you’re in the Bad Day Zone and needn’t worry about the backwards slide.

That was the case for my friend in our recent conversation. She thought one particular thing might have triggered it, “but it’s definitely a bad day,” she said. “I’m going to try to start over tomorrow.” Sometimes it’s the simple strategies that are the best ones of all.


photo credit: Unsplash

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Warrior Moms Are Key to Fighting Stigma

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Susan and Tiny BeanI had the thrill and honor recently to attend the recent Special Legislative Commission on PPD meeting with Representative Ellen Story this month.  My new friend (and fierce advocate and mental health professional) Mara Acel-Green extended an invitation to the open meeting – and upon walking in, I was floored by the feeling that Postpartum Progress belonged in the room.

The Commission invited Deborah Wachenheim to speak about her sister Cindy, whose story was featured in The New York Times earlier this year. Listening to Deb speak about the events leading up to her sister’s postpartum psychosis and death, I was struck by the genuine interest and concern of the room.  This was a meeting full of top tier mental health and birth professionals, legislators, and non-profit leaders.  Their heartfelt appreciation for Deb’s willingness to share something so personal (and freshly raw) and thoughtful questions gave me hope that the meeting was not just government lip service.

As the meeting progressed, organizations checked in with progress reports, included MCPAP for Moms, the Department of Public Health and the Community Health Center pilot programs.  Throughout each of their discussions, time and time again, the question that kept resurfacing was “How do we make sure screened mothers are being supported after their diagnosis?”

What these doctors are really concerned about is How do we get moms to follow through with their diagnosis and treatment?  The Commission has been focused up until this point primarily on training primary care physicians, pediatricians, and birth care workers on screening for postpartum mood and anxiety disorders.  But as any survivor can tell you, screening and diagnosis (though absolutely essential) are only the first of many hurdles on the path to wellness.  As suggestions were shared, I noticed that their solutions all focused on actionable items for healthcare workers.  And it seemed to me they were missing a piece of the puzzle.

Postpartum Progress doesn’t just “drop kick despair.”  It kicks stigma in the teeth.

After my own diagnosis, 5 months postpartum, I continued to struggle for almost 6 months with treatment compliance.  It wasn’t that I refused treatment, but instead that I was still struggling with so much shame that I just couldn’t comply.  Depression and anxiety rob a person of their sense of truth and rationality.  Psychosis steals reality itself.  How anyone could expect me to take responsibility for my own mental health treatment in 2009 still leaves me in disbelief.

I attended therapy regularly but fought against taking medications.  And though I knew the right answers to my therapist’s questions and believed them on some level, deep down I still carried such stigma about mental illness that I couldn’t separate myself from my disorders.  Not until I found Postpartum Progress.

Reading stories of other mothers just like me, I found my own courage reflected back to me.  Here were women who had battled the same terrible thoughts, who had raged at their babies, and who had felt worthless in their roles as mothers – and I looked up to every. single. one.  Postpartum Progress doesn’t just “drop kick despair.”  It kicks stigma in the teeth.

This is why I credit Postpartum Progress and #PPDCHAT with saving my life.  Not because Katherine Stone or Lauren Hale treated my anxiety and depression, but because they showed me I was worth saving – that I could and would get better.

This is what legislators, healthcare professionals, and non-profit organizations need to know: the key to getting mothers to follow through with treatment?  Is to disintegrate the stigma.  No one does that better than the Warrior Moms.

I’ll be meeting with the Commission staff and other Massachusetts organizations in the coming months to make sure Postpartum Progress is a part of the important conversations they are having about treating and supporting mothers during and after pregnancy – because the patient community?  Is that final piece of the puzzle.


Author’s Note: Postpartum Progress recently collected survey data from its Warrior Mom community and FaceBook fan page.  75% of respondents indicated that Postpartum Progress increased their likelihood to seek professional help for their condition.  You can read the entire report HERE.

photo credit: Susan Petcher

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WTFP?!: Why Access To Women’s Healthcare Matters

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Recently, on a Thursday, I went to have my annual physical exam. I was completely shocked when, during the breast exam, my gynecologist found a lump. Just a few days later, on Tuesday, I had a diagnostic mammogram. I was sure they’d come in the room right after the mammogram and say all was well, but after looking at the mammogram results the radiologist decided to immediately give me an ultrasound. I was sure he’d come in after the ultrasound and say all was well, but instead he told me I needed a biopsy. Two days after that, on Thursday, I underwent a core biopsy on my right breast. And the next day, Friday, I received the results. I have a benign fibroadenoma. In a little more than a week I was able to get several different exams and find out what was going on inside my body and have a plan for moving forward. And THAT, my friends, is how women’s health should go all the time. We should all have access to the information we need. The tests we need. The trained and competent physicians we need. The supplies we need. The support we need. And all in a timely fashion.

It’s not like that in most places of course. Women don’t have access to even the most basic things like contraception. And it’s not just a few million here and there that don’t have access. It’s 220 MILLION women in developing countries who want access and can’t get it. When you take away that access, you take away the power a woman has to make plans, to design her own life and decide what she wants to do and when. If she has no way of getting her hands on any sort of birth control then she can’t decide whether and when to have children.

I got to spend some time recently hearing from EngenderHealth, an organization dedicated to training healthcare providers around the world in order to help ensure family planning and reproductive health services are available to more women in more places. I appreciate their work and I know it’s important. I was able to plan my own family — my husband and I were married eight years before we decided to have children. We were financially and emotionally prepared and ready to welcome what ended up being our amazing son and, four-and-a-half years later, our fabulous daughter into the world. It was access to contraception and good women’s healthcare that allowed us to make those plans and have a family exactly the way we wanted to. I think other women, other parents, should be afforded that same access.

But because of cost, gender inequality, the huge distance it often takes to travel to a place that might or might not have contraceptive supplies, and lack of trained providers, among many other barriers, millions of women don’t have access to contraception. EngenderHealth is working to change that. And we can help them this fall by raising our voices and taking small actions as part of their WTFP?!  (Where’s the Family Planning) campaign that will lead to more women getting the healthcare they need exactly when they need it.

If you think women should be able to decide when and if they have children, join in. If you think being able to survive childbirth and have healthier babies is important, join in. And if you think women should have the ability to stay in school or build some type of business or career that gives them financial stability before they have a family, if they choose, join in. Because family planning and contraception contributes to all of these things. Join in. Let’s all ask: #WheresTheFP

Find out more by clicking here and be sure to follow EngenderHealth on FacebookTwitterLinkedIn and YouTube.

What does convenient and safe access to contraceptives mean to you? Answer in the comments below for a chance to win a Social Good Goodies bag.


Sweepstakes Rules:

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You may receive (2) total entries by selecting from the following entry methods:

1. Leave a comment in response to the sweepstakes prompt on this post

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4. For those with no Twitter or blog, read the official rules to learn about an alternate form of entry.

5. Sign up for EngenderHealth newsletter at the following link, and leave a comment on the post saying you did so.

This giveaway is open to US Residents age 18 or older. Winners will be selected via random draw, and will be notified by e-mail. The notification email will come directly from BlogHer via the sweeps@blogher email address. You will have 72 hours to respond; otherwise a new winner will be selected.

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Be sure to visit the EngenderHealth brand page on where you can read other bloggers’ posts!


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Let’s Talk About Sex (and PPD)

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postpartum depression helpSex after baby. We all know the cliche about its nonexistance – after all, the sleepless nights, the leaky breasts, and the lack of personal space that accompany a newborn aren’t exactly aphrodisiacs.

But sex after postpartum depression? Is a uniquely difficult experience for many mothers.

With my husband’s permission, I wanted to take the time this week to share my own experiences with sex, depression, anxiety, and medications. I know I’m not alone – and I want you to know you’re not alone either.

At first, relations with my husband were slowed only by the physical limitations that follow a vaginal birth: pain, scar tissue, and sleep deprivation. You see, I started my first weeks as a mother with postpartum anxiety and it wasn’t until months later that the depression took hold. But as it slowly invaded my brain, my interest in sex waned. This is a common symptom of depression and, for me, the numbness I felt toward my child and my life spread into my marriage.

It took months for me to accept that I was suffering from postpartum OCD and postpartum depression and to seek help. When my doctors put into place both talk therapy and medication plans, I finally began to feel just the smallest bit like myself again. But as my happiness returned, my libido only diminished. And though I knew that couples typically experience a temporary drop in marital satisfaction after the birth of a baby, I couldn’t help but feel concerned. It was more than just a decrease in desire.  I found the thought of having sex completely repulsive.

After some research, I learned that the antidepressant I was using (an SSRI) is linked to sexual dysfunction in a high percentage of patients. I nodded my head as I read about the symptoms, including loss of desire and inability to climax. It felt like I was being punished for treating my depression, and I wondered how a marriage is supposed to survive both mental illness and celibacy.

So as hard as it was, I brought up my concerns with my psychiatrist. Over the two years that followed, we worked through a series of medication trials, finally settling on a mood stabilizer that seemed to alleviate the depression without such a severe impact on my sex life. When I became pregnant with my second child, however, I chose to return to my SSRI, knowing there was more research to support its safe use during pregnancy. I made that decision knowing I would be sacrificing my libido, but fully aware of the risks untreated depression carry for both baby and mother during pregnancy.

I wish I could tell you that the sexual side effects were limited to my first postpartum period. But, sure enough, they returned as the medication took hold and I felt the depression and anxiety lift. I also wish I could tell you that this is a story written entirely in the past tense, but almost 3 years postpartum, I still take the SSRI daily, and it continues to impact my desire and performance.

At times, it feels as if I have to choose between sanity and marriage. I hate that the medication that works so well — that allows me to feel like a calmer, more rational version of myself — takes something so important away from both me and my husband. But I am also grateful for the life it allows me to lead. My doctors and I speak about the sexual side effects of my medications at each appointment and are constantly balancing them with the therapeutic benefits – and we have tweaked dosages and timings to help as much as possible. (I won’t get into the details – that is something for you and your doctors to discuss.) For now, we’ve found a plan that, while far from ideal, allows me to continue treatment for my medical condition.

I hope that if nothing else, these last 6 years negotiating the world of antidepressants, mental illness, and sex allow me to help someone who may be suffering in the same way:

I want you to know that if you are experiencing sexual side effects from your anxiety, depression, or medications that you are not alone.

It’s important to be honest and open with your doctors about all side effects and symptoms you are experiencing, including loss of libido and lack of performance.

Finding the right medication and other treatments for postpartum depression (and other mood and anxiety disorders) can be a complicated process, but there are many options out there and probably one that will fit your needs.  Don’t give up.

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