A special series on African-American, Asian-American and Latin-American women with postpartum depression.

6 Ways You Can Be an Empowered Patient During Pregnancy When You Have Bipolar Disorder

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The best person on my care team? My OB. Hands down. When we found out I was pregnant (far sooner than we had planned), my husband and I decided right away that no matter what course of treatment  we decided upon after speaking with my doctors, our number 1 priority was my mental health. Still absorbing the shock, I remember my husband standing in our bedroom with his fingers lacing their way through mine, saying, “Health and wellness, Addye. That’s our focus, ok? Your health and wellness. No guilt, no shame, no matter what happens. YOU and your health are what’s most important. We’ll do whatever it takes. We’ll get through this together. I promise. Let’s do this.”  I’m pretty sure I was fighting back tears and a whopping dose of fear in that moment as I high fived him and agreed: We could do this. I could do this.

And I did. I have. I’ll be a year postpartum next month, and as I watch my youngest son crawl into the room he shares with his two older brothers, I think back to that moment in my bedroom and feel proud of that promise we made, and the treatment option I chose.

Given my previous history with PPD, the nature of my illness, and the increased risk of relapse I faced because I have bipolar disorder, we decided staying on two out my three medications was what health and wellness would look like for me…as well as for the baby and the rest of my family.

That was my choice, but I know many other mothers with bipolar disorder who opted to go without their medications during their pregnancies and remained healthy throughout. No matter what course of treatment you and your care team decide upon, the important thing to remember is that you DO have options. There’s nothing I hate more (aside from stigma) than coming across an article on the internet that gives women with bipolar disorder incomplete information regarding their treatment options during pregnancy and breastfeeding, doesn’t point to what resources they can utilize to make informed decisions, and doesn’t tell them how they can navigate the unique challenges they’re faced with.

So let’s talk about how to do that, shall we? (This post is going to a bit long, but bear with me, I believe what I’m sharing with you is important)

1. Build Your Care Team, Create a Treatment Plan

I cannot stress the importance of this enough: You MUST have people on your medical team who have experience in treating pregnant women with mood disorders. Think of this as your Dream Team. People you want on this team are your OB, your psychiatrist, therapist (if you have one), and a pediatrician. It’s possible your obsectrician will also want a reproductive psychiatrist and maternal fetal medicine doctor on your team as well, especially if their experience on this front is minimal. Thankfully, my OB had extensive experience with caring for women with bipolar disorder during their pregnancies and knew pretty much everything that’s out there regarding medication use during pregnancy and breastfeeding. He was up to date on the latest research available and proved to be my most invaluable resource on my care team. Seriously, he’s the one who gave me the confidence that all would be well, and that choosing to stay on at least two of my medications was a safe and healthy choice. Both he and my psychiatrist spent a lot of time going back and forth, weighing the risk vs. benefit of staying on meds or going without, and although they disagreed on a few minute points, they ultimately decided staying on medication would be healthiest for me, and ultimately, baby.

Also be sure to find a pediatrician to consult. You’ll need one anyway after the baby is born, so you might as well find one who knows about medications, postpartum mood disorders, AND does depression screenings at well visits. (Our pediatrician does and it has been incredibly helpful to me this past year.)

Finally, ensure that the team you build has your mental health as their top priority. As soon as a woman becomes pregnant, the focus tends to immediately shift toward the health of the baby and stay there. In the past, I’ve dealt with OB’s who only cared about how I was doing physically and what impact any physical conditions I had would have on my baby in utero. Not once did they focus on my mental well-being, let alone have it guide my prenatal care. Listen: I completely agree that baby’s health is a priority. I do. But I’m going to just come right out with it and say that a mother’s mental health is what’s most important and should be the foundation of her prenatal care, and if no one on your team shares in that philosophy? They shouldn’t be on your team or in charge of you and your baby’s care. Period. Same goes for the person treating your mental health condition. My first psychiatrist through the VA was woefully uninformed and unhelpful when I told her I was pregnant. It took a lot of pushing, but I was finally able to have my care transferred to a psychiatrist with a background in pharmacology and reproductive psychiatry, and it made a significant difference in my overall care.

2. Communicate and Advocate

Everyone on your care team should be in constant communication with you and each other through every phase of your pregnancy and delivery. They should also be able to come to an informed consensus (with you) about your treatment. There is nothing worse than having two of your doctors at an impasse over a part of your treatment plan because they just disagree. It’s incredibly frustrating and the last thing you need to be worried about. If this happens, don’t be afraid to speak up and advocate for yourself, reminding them that they are there to help care for you and your baby, and you need them to work together.

Always be open and honest with your care team about what you’re feeling and experiencing throughout your pregnancy, so they know how to help you as soon as possible. Part of my treatment plan involved staying off of my mood stabilizer during my first trimester, but remaining on my anti-depressant. At 11 weeks, I called my OB and told him my mood was starting to take a nosedive and I was worried about a depressive episode. He moved my NT ultrasound scan up to the start of week 12, and as soon as he reviewed the results, gave me the all clear to start back on my mood stabilizer.

3. Do Your Own Research, Knowledge is Power

There are books out there on  medication use during pregnancy and breastfeeding and the variety of treatment options available for women in our situation-get your hands on them and read as much as you can, being sure to talk with your care team about what you learn as you do. When researching my treatment options and discussing them with my team, books I read included Pregnant on Prozac by Dr. Shoshanna Bennet, Medications and Mother’s Milk 2012: A Manual of Lactational Pharmacology by Dr. Thomas Hale, and The Complete Guide To Medications During Pregnancy and Breastfeeding: Everything You Need to Know To Make the Best Choices for You and Your Baby by Carl P. Weiner MD and Kate Rope.  I also read everything I could on the MGH Center for Women’s Mental Health blog, which has a wealth of information on research studies and how to use their findings to make informed treatment decisions with your clinician.

4. Create a Birthplan That Takes Your Mental Health Into Account

Initially, I considered going without pain meds for my delivery. I read all I could about natural child birthing methods, and had it in my mind that I’d hypnobirth my way through labor and delivery, even if  I wound up crying uncle and utilizing some form of pain medication. But at 28 weeks, I landed in L&D with contractions that wouldn’t stop without magnesium. In fact, they didn’t really stop the rest of my pregnancy. I contracted every day of my third trimester without ever dilating more than 2 centimeters. Previous experience reminded me that neither of my labors with my older two progressed without intervention, despite having intense, painful contractions that were off the charts for a week. Looking back, I’m positive this contributed to the panic and anxiety I had during both deliveries and afterward. With this third go around, I was miserable, exhausted, starting to have anxiety attacks, and was starting to cycle between nesting induced hypomania and depression.

At week 38 I told my OB I was done and worried that continuing would put me over the edge and trigger a depressive episode-and I hadn’t done all of this preventative health and wellness work to be in a dark place when my baby boy was placed on my chest. I knew my limits, and wanted a bit more control. I wanted an induction. He agreed, and a week later I was in the delivery room smiling and laughing as I stared lovingly at my newborn-100% anxiety free. It was a calm and beautiful experience and in my opinion, gave me the strong start postpartum I needed.

Whatever your birth plan is, make sure it’s flexible, realistic, and compliments your treatment plan.

5. Have a Support Network

Having the love and support of friends, family, and your partner is so important. Lean on them when you need to, and don’t be afraid to ask them for help. Inform them of ways they can be a support to you. My friends (fellow Warrior Moms) and my husband did an amazing job of supporting me during my pregnancy and this past year. I couldn’t have made it without them to call, text, and share this experience with. A therapist can also be an invaluable resource to you during this time; they can help you process all you’re experiencing and develop coping strategies for managing your postpartum period. Consider finding support online in a private forum for pregnant and new moms with mood disorders (like Postpartum Progress’ Smart Patients Forum or the #PPDChat private group on Facebook), or find what’s available to you locally through organizations like NAMI or DBSA.

6. Self Care

Try to find ways to incorporate rest into your day as much as possible, even if you already have other children. Do not go without sleep. Create manageable to-do lists, and reconstruct your expectations about how much you can get done each day-especially if you’re working. Practice deep breathing exercises, and engage in physical activity that is both safe for you and baby and feels good. Engage in activities that are calming and nourish your soul-even if it’s binge watching your favorite show on Netflix. Keep track of your mood either in a journal, or with a mood tracking app on your phone; this will help you be able to communicate to your care team and support network how you’re doing. (I use iMood Journal) Prenatal massage, mani/pedis…whatever self-care looks like and is for you, be sure you do it and do it as much as possible.

 

I hope this is helpful and gives you a good starting point for creating a plan that works for you. Remember-You have options when it comes to treatment. You can do this. I promise. You got this, mama.

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A Whole Lotta Warrior Moms Say Thank You, Katherine, for 10 AMAZING Years

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Katherine ComputerI dove headfirst into blogging about Perinatal Mood & Anxiety Disorders because of Karen Kleiman.

But I grew into an online advocate because of Katherine Stone. She embraced me as I fumbled through the early days of running a blog, a website for struggling women, and my third pregnancy after two terrifying episodes of Postpartum OCD (which, incidentally, is what Katherine also struggled with during her experience with a PMAD).

If I had a question about something online, I turned to Katherine. She always got back to me and sometimes prodded me to do more and be more involved. More importantly, she always treated me as if I were equal to her, this amazing woman who had no fear about discussing the nitty gritty about PMAD’s online.

Postpartum Support International dragged me onto FB but where I flourished was on Twitter. I noticed, back in the early days of Twitter, that people were having these “parties” for certain products. I thought to myself, why can’t we do that for PPD? I floated the idea by Katherine and a couple other bloggers (Amber and Ivy). They were absolutely on board and Katherine whole-heartedly supported the beginning of #PPDChat.

#PPDChat is now the go-to hashtag for PMAD support on FB. There’s a closed FB group with over 350 members. I may have started it, but it wouldn’t exist if it weren’t for the experience, support, and genuine caring flowing from Katherine in my early online days.

She inspires more than simple advocacy (although few of us would dare call it simple – it is EXHAUSTING but worthy), she saves lives, she kicks stigma in the ass repeatedly, and genuinely cares about the people who reach out to her.

I don’t think she has any idea how many lives she has changed. How many advocates now exist because of her decision to live her life out loud. To stand up, shouting until she is heard, when the world expects us to sit down and be quiet. The passion in her heart far exceeds capacity and overflows abundantly to those around her.

To her family, a sincere and heartfelt thank you as well for sharing the woman of your lives with us. For without your support, all of us would not be the women we are today. I would be remiss to not acknowledge your important role in Katherine’s work.

Be proud – your wife, your mother, your daughter – she saves lives.

Below are several blog posts, written by women who celebrate how Katherine has affected their lives. To read them, you will need a box of Kleenex. These are women from all walks of life, women who found themselves covered in the dark mud of a PMAD but were yanked out of it by Katherine or found Katherine after they found their way out and now reach down behind them along with Katherine to rescue others who find themselves trapped in the mud hole of a Perinatal Mood & Anxiety Disorder. (Because let’s face it, no one wants to go muddin’ in a PMAD!)

Katherine, you’re changing the world with every breath you take, every stroke of the keyboard, every post, every outreach, every encounter, every awkward step outside of your comfort zone. You are loved, your work has wrapped the world over and made it a brighter place. We are always climbing out of the darkness with you and we will never stop.

Keep on keepin’ on, lady.

You’re not alone, and neither are we.

 

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Jenny @ Tranquilamama: My Lifeline Through PPD & PPA

Robin @ Farewell Stranger: Postpartum Progress: 10 Years of Magic

Jennifer @ Bipolar Mom Life: The Relief In Finding Postpartum Progress

Danielle @ Velveteen Mama: My Postpartum Progress

Charity @ Giggles & Grimaces: Hope In A Computer

Jenny @ Jenny Kavensky’s Blog: It Takes a Village

Erin @ Erin Margolin: Happy Tenth Anniversary, Postpartum Progress

Morra Aarons-Mele @ Women & Work: In Celebration of Katherine Stone and 10 years of Postpartum Progress

Tina Duepner @ The Duepners: Cheers to 10 Years

Esther @ Journey Through PPD: Happy 10th Anniversary To Postpartum Progress

Ravion Lee @ Vain Mommy: Postpartum Progress Turns 10: The Woman Behind The Change

Kristina @ Sew Curly: Postpartum Progress Is 10

Rita Arens @ Surrender Dorothy: In Celebration of Katherine Stone

Katie Sluiter @ Sluiter Nation: I Am Not Alone and Neither are You

Cristi Comes @ Motherhood Unadorned: Postpartum Progress: Kicking Ass for 10 Years!

Tabatha @ Tabulous: A Love Letter To The Woman Who Saved My Life

Susan @ Learned Happiness: First and Last: Happy Anniversary, Postpartum Progress!

Deborah Forhan Rimmler via My Postpartum Voice: Guest Post – On Meeting An Angel

Beth @ Beth Bone: Thank You Just Doesn’t Seem Enough

Andrea @ Good Girl Gone Redneck: Happy 10th Anniversary, Postpartum Progress

Julia Roberts (not THAT one, the other one!) via Postpartum Progress: The Man Behind the Woman Behind Postpartum Progress

Jess @ Just Jess In the ATX (note – this was not written for the anniversary specifically but was shared to the FB page for the blogathon to show the impact Katherine had on Jess’ life and recovery, therefore, it’s shared here): Picture Perfect 

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Toward A Better Understanding of Postpartum Depression

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emergency-stop-buttonThe following post is about a potentially triggering topic.

Please be aware of this as you continue and if you are in a particularly fragile or sensitive state, you may want to skip this post altogether.

This post will continue below the graphic to the left.

If you’re choosing to skip this post, here’s a really adorable video of a tiny hamster eating a burrito to watch instead.

Because well, a tiny hamster. Eating a burrito. What’s not to love???

(I’m kind of in awe of how fast the little guy chows down!)

 

 

 

Last night, on Facebook, I noticed a post by The Postpartum Stress Center:

 

Postpartum Stress Center FB Snapshot

 

 

 

 

 

As an advocate, one of the biggest things I fight is stigma and misinformation. Sure, I reach out and help women seek help as they battle against whatever form of Perinatal Mood & Anxiety Disorder they may have looming large over their lives, but the majority of time, I am correcting issues like the one Karen Kleiman (founder of Postpartum Stress Center) refers to above. The post refers to an article appearing at the Miami Herald’s website about a mother who attempted to drown her child. She also tried to poison and smother him when he was just two months old.

Nothing is more infuriating than reading an article about a mother who has harmed her child only to discover the only term used within said article is postpartum depression.

I cannot emphasize the following enough: Women with postpartum depression are highly unlikely to harm (and therefore kill) their infants. Women who struggle with postpartum psychosis, however, are far more likely. That said, at this point, the only person stating she suffered from postpartum depression is the mother. Her family admits she sought treatment shortly after her child was born but we do not have details. Yet one mention of postpartum depression and boom. We’re off to the races without putting the right saddle on the horse.

I reached out to Karen Kleiman for her thoughts about this situation. This is what she had to offer about Armour “blaming” PPD:

“Of course Armour blamed it on PPD. That’s all we talk about. PPD is so frequently used when referring to any postpartum mood or anxiety disorder. in fact, it is used when there is NO mood or anxiety disorder, such as the Baby Blues. So, yes, until we have a clear diagnosis (and even then, the diagnosis can be wrong) we need to be careful. That’s the media as well as the public at large. She is being judged by all of us.”

She is most definitely being judged by all of us, whether we want to admit it or not. All we can offer at the moment is conjecture, which is a dangerous thing if accompanied by misinformation as well.

Here’s a quick lesson:

Postpartum Depression, a commonly used umbrella term for the mood disorders on the Postpartum Mood Disorder spectrum, is also the term for one of the disorders on the spectrum. Postpartum Depression may consist of but is not limited to: sadness, crying for no reason, lethargy, lack of interest in previous activities/hobbies, distance from baby and family or social activities, anger, irritability.

Postpartum Psychosis, the most serious of the Postpartum Mood Disorders, often involves (but again, is not limited to): auditory or visual hallucinations, the inability to care for oneself and make decisions. Considered a medical emergency requiring immediate hospitalization, this particular disorder also carries the deadliest rate of both infanticide and suicide.

As you see, the two are quite different beasts. They are on the same “spectrum” as they are both mental disorders which occur after the birth of a child, but the signs and symptoms for both are of completely different degrees.

Karen continues, with this:

Let’s face it, even the experts disagree. The lines are blurry and they are getting blurrier instead of clearer. More and more cases are unfolding that are confounding experts and have us wondering what variables are related to what, if you know what I mean. So education is indeed the key. But education isn’t enough. Because mental illness isn’t crystal clear and many definitions merge into each other. So we also need compassion and patience. We need to stop jumping to conclusions, stop judging, stop presuming we understand what happened, and we need good assessments, good treatment, good journalism and continued advocacy. But in reality, we live in a culture that wants information NOW and they want it whether it is accurate or not. Sensationalism sells and we scaring the hell out of women who are just trying to understand and trying to heal.

How can we fight back? By continuing to do what we do. Get the right information out there. Spread it around as best we can. Journalists are fighting against deadlines and unfortunately, this doesn’t always leave them time to check their facts.”

What can families and friends do to better educate themselves in order to help loved ones who may end up fighting the nastier beasts on the Perinatal spectrum? They can do the following, according to Karen:

Again, women and their families need to be alert to changes in personality or behavior after a baby is born. If something doesn’t seem right, it probably isn’t. It is far better to overprotect her and be mistaken, than to miss the opportunity to get her the help she needs. Here is a link to our Emergency Room Guidelines, which will give you info about screening for psychosis.”

The number one thing to keep in mind, particularly if you think it can’t happen to you or someone you know, is that it can.

Postpartum depression and psychosis can happen to any one. It happens to loving mothers who have anticipated the birth of their baby with joy and excitement in their hearts. It is cruel, brutal illness that does not discriminate. It is no reflection on the mother, who is suffering. Surely, we can have compassion for mothers who are suffering.” -Karen Kleiman

The article at the Miami Herald pointed out that Armour had created a video, portraying her love story with her partner, and her joy about her upcoming birth. What went wrong? How could a happy mother possibly go from overjoyed to attempting to kill her own child? Therein lies the more important question and story, in my opinion. It’s a difficult story to write, to comprehend. But the more we write about it, with the proper terms and information included, the more we encourage mothers to step forward, courage in their hearts, to seek help before it is far too late.

I reached out to Dr. Kenneth Johnson, the chair and professor of obstetrics and gynecology in the Nova Southeastern University College of Osteopathic Medicine, who was quoted in the Miami Herald article, offering him a chance to clarify the statement used in the piece. This is his response:

“I of course agree with you that even with severe postpartum depression it is very rare for mothers to harm their baby.  Postpartum psychosis is more severe and more likely to be associated with risk to the mothers baby.  Separating the two conditions is very difficult clinically as there is almost always overlap with severe depression when psychosis is evident.”

He is right, and Karen Kleiman makes the same point in her article at Psychology Today. The difficult issue with Psychosis is that until there is a break, it’s very difficult to discern if the person is struggling with severe depression or with psychosis. Psychosis is always a medical emergency and requires immediate attention.

Another thing to keep in mind, particularly given that July is Minority Mental Health month, is the lack of education regarding mental health issues among minority populations. A’Drianne Nieves, who blogs at Butterfly Confessions, is passionate about speaking up about mental health issues and the lack of resources, voices, and education which exists today. She had this to offer about Armour’s situation:

Education, man. Distinction between illnesses & awareness about the range of their symptoms. Doctors need to really start educating women on this. She didn’t have PPD. Whatever treatment she received I’m sure it wasn’t adequate or last long enough or maybe they just misdiagnosed her. Her family-did they know the symptoms of psychosis? What to do? Who to call? Education. Education, especially in minority communities is lacking and is a critical need.

A’Drianne also offered this on her FB page when sharing the Miami Herald article:

This is why we need more awareness on postpartum mood disorders and their symptoms among women of color. FACTS. We need FACTS on the wide range of symptoms and distinction between each illness. Facts and support/access to resources…..This is why #MinorityMentalHealth Month matters. This is why we need to keep advocating and have more people of color SEEN in the mental health advocacy space, especially online and in mental health magazines and other publications/literature.”

The media is not only getting their facts wrong, they are increasing stigma. As Karen so brilliantly states in her piece at Psychology Today, ” Journalists, Doctors, Everyone: Let’s Get it Right”:

“Let’s get it right. Lives depend on it.”

They do depend on it. The wrong description or sensationalized information causes women and their families to fear help instead of embracing it with open arms. I have lost count of how many times a mom told me she can’t take medicine because her partner is afraid it will turn her into Andrea Yates. Or how many of us must avoid the Internet when sensationalized stories are bandied about with horrible comments attached – comments which range from the pitied to the enraged to the downright vicious. Comments which categorize all of us with a Perinatal Mood Disorder as monsters. We are not monsters, you know. We are you. We are your mothers, we are your sisters, we are your daughters, your cousins, your wives, your aunts…we are the cashier at the store, the accountant down the hall, the lawyer defending you in court, the doctor you take your children to when they’re sick, the employee at your favourite restaurant, the postal employee who delivers your mail, we are every woman and we are just like you with hopes, dreams, and lots of love to give. But we live in fear as we struggle because the media paints what we fight with such dark intense strokes.

Journalists are inching closer to getting it right but there’s still a long way to go. A long, long way.

If you see a story which includes misinformation, reach out. Contact the journalist. The paper. Write a letter to the editor. Speak up.

We owe the women on this road behind us a smoother ride than we have had on our own and in order to do that, we cannot afford to remain silent.

If you are a journalist writing about Perinatal Mood & Anxiety Disorders, reach out to Postpartum Support International for the facts. Or if you’re pressed for time, you can find them online at their Get The Facts Page. If you’re a mom or have a loved one struggling with a Perinatal Mood & Anxiety Disorder, there’s plenty of help out there. You can reach out to Postpartum Progress, to Postpartum Support International, or use the hashtag #PPDChat on Twitter. You are not alone and there is help. Don’t let stigma fool you into believing you’re a monster. You’re not. You are loved, you are not to blame, and there is absolutely a light at the end of your tunnel.

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Recovering From PPD In the Face of Life Challenges

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Today, Warrior Mom Jamelle is bravely sharing her PPD story with us and how realizing she needed help has helped her begin to recover. Please send some love her way in the comments. 
My son was born April 2012. I’d had a slightly difficult pregnancy, including 24/7 morning sickness for the first five months and an outbreak of PUPPP (skin rash) in the last couple of months with a dash of bad acid reflux in between. My labor was fortunately pretty easy and quick and, after a night in the hospital, we were home with our son.

Everything was okay, more or less, at first. I had difficulty breastfeeding. No one at the hospital taught me how and as I worked during my pregnancy, I didn’t have time to seek out assistance. I remember crying those first few days at home because I felt like I was failing my son. Watching videos from youtube helped me understand what I needed to do. I felt more confident about breastfeeding although towards the middle and end of my time doing it (I did it for six months) I began to feel resentful and wanted my body back.

It wasn’t until my parents left and my husband went back to work that I started having suicidal thoughts. I had been warned about postpartum depression from a girlfriend who had given birth the year before, but for some reason I couldn’t equate how I was feeling and what I was thinking to having PPD. Outwardly I’m sure I just looked and acted like a typical new mom: frazzled, sleep deprived and confused. In fact I’m sure that’s how  most people saw me because no one expressed concern for how I was doing. Everyone’s so concerned about the baby and mom just gets pushed to the side. While my husband was gone, I would dwell on thoughts of him coming home to me and our son, dead on the bed. Sometimes I would just think about him finding me dead, with our son crying on the bed next to me.

After three months I went back to work, which helped a little. I was interacting with other adults and doing something with my day other than feeding, changing diapers, and napping. But work added other stressors, causing my depression to manifest in other ways. I became short with people, including my husband. Little things began to irritate me and cause me to become irrationally angry. I had a blow up in Dec 2012 that made me realize something was wrong with me and had been wrong with me since my son was born. It took me another month to tell my husband how I was feeling–my sweet, wonderful, patient husband, who made the call to our insurance for me so I could get help for my PPD.

I can remember feeling such relief after talking to the intake counselor and explaining why I needed help. I had no idea how heavy a burden I was carrying until I had to detail out the thoughts and feelings I was having. They assigned a counselor and a doctor to me; after they assessed me I was put on anti-depressants and something else to help me sleep at night. The meds helped so much. I was feeling more like my normal self and I wasn’t having awful thoughts. I ended up seeing the counselor only twice–she and I didn’t really mesh and I didn’t feel I was getting anywhere with her. Shortly after that I went off my meds (for a very dumb reason that I don’t even want to get in to) and I thought I was going to be fine. Then my husband lost his job and we lost our house not too long after that. The stress of trying to keep my family financially afloat triggered my depression again. Luckily I can recognize the signs now.

I’ve only recently started going back to therapy. I found a counselor I really like and I’ll be going back on meds soon. I wish I hadn’t stopped in the first place but you never know where life takes you. I’m going to be much better about it this time around. This has been really hard to write, but I’m glad I did and thank you so much for listening.

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