Katie Sluiter: On Depression in Retrospect

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postpartum depression, mental health, maternal mental healthDear you,

So you found your way to the Postpartum Progress Mother’s Day Rally, huh? Maybe it’s your first time here, maybe (like me) you come back year after year to read the stories. No matter how you got here, you’re probably reading this because either you are struggling, you struggled at one time, or someone you loves is/was struggling.

I fall under all of those categories.

This spring marks four years since my diagnosis of postpartum depression and anxiety. This fall will mark four years of being in therapy for depression and anxiety that was probably with me since my first miscarriage seven years ago (and maybe even before that). After my first son, Eddie, was born in 2009, I developed PPD, PPA, and PTSD. During my pregnancy with my second son, Charlie, I developed antenatal depression and after his birth, another round of PPD. I also developed OCD after Charlie.

I’m in a good place now. One where I can see the pitfalls coming, prepare for them, brace myself when they hit, and heal with a lot more speed. I can write about the darkness and the suffocating loneliness that sweeps in blankets my mind, heart, and soul. I can articulate the rage that bubbles below the surface just before I throw up my hands and seek out my bed to crawl into to try to escape the world.

I can look at depression in retrospect.

This is not a comfort everyone has. In fact, as I work to strengthen myself, I have noticed that my eyes have been opened to others who struggle. As my scars fade, I can see the fresh wounds in others.

And I can listen.

My suffering and the destruction of my mind, heart, and soul have left me with an acute sense of empathy for others who struggle. My experience in finding light after every single fall into darkness has helped me see that there are others in the darkness too.

I am never alone.

They are never alone.

YOU are never alone.

If you are in the darkness, there are others there too. Chance are you can’t see them because the pit of depression is so dark, it’s thick. It’s like a black velvet blanket. The darkness should be comforting, but it’s not; it suffocates, it terrifies.

But you are not alone.

Reach out your hand. There is someone there who desperately wants to hold it.

Reach up. Someone in the light wants to pull you out, or at least offer you a connection to life. To remind you that you have not left. That you are there.

Walk forward.

The darkness is not endless. Those holding your hands will walk with you. They will emerge with you or, if they are already in the light, they will rejoice when you join them.

Know your strength.

When you can’t go anymore, take one more step. And then another. Grab at hands. Reach farther for the light.

The light is always out there somewhere. If it wasn’t, you would be dead. But you’re alive, so keep being alive.

Depression stole moments, days, even years from my life. But those stolen moments that were lived in the dark were replaced by experiences in the light so radiant, sometimes I have just had to close my eyes and feel it, rather than see it.

I want that for you too.

I want you to feel the light on your face.

Keep living.

Someday too, you (or the one you love) will look at depression in retrospect.

You will be the hand that someone else grasps.

~ Katie

Katie Sluiter is just a small town girl…wait no, that is a Journey song. Although she does live in a small town. She is a wife, a mother, a teacher, and a writer. She and her family have joys and they have struggles. Just like you. Follow her on Twitter @ksluiter.

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Postpartum Progress, the world’s most widely-read blog on all things related to emotional health around pregnancy & childbirth, is a service of Postpartum Progress Inc., a 501c3 nonprofit devoted to raising awareness of postpartum depression and similar illnesses. Please consider making a donation today, Mother’s Day, so we can continue and expand our work supporting maternal mental health. Thank you!

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Susan Petcher: On Getting Back to Yourself After Postpartum Anxiety

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postpartum depression, mental health, maternal mental healthDear New Moms,

I’m sitting in my kitchen with the windows open.  The springs here are cool and wet, and the breeze fills the house with a much-needed freshness. From my kitchen table, I can see my 2-year-old as she plays on the back deck with her water table and a paint brush. Her older sister is at school, which means it is quiet enough for me to hear the birds calling to one another and the sound of the toddler’s feet scampering across the wood planks. I am struck by the peace and contentment in this moment and how starkly it contrasts how motherhood began for me.

My anxiety began during my pregnancy with E. I assumed all expectant mothers experienced the same panic, mood swings, and fret that were my daily companions beginning from the moment the pregnancy test turned blue. The anxiety continued during and after a long and frightening labor, and manifested as OCD and eventually depression. Because I wasn’t “sad” like in all those antidepressant commercials, it never crossed my mind that I might be suffering from a mental illness. I had read about PPD, of course, in my pregnancy books, but denial was the most malicious of my symptoms and kept me from seeking help.

My days weren’t filled with crying, like the illustrations in my books. Instead, I spent every waking hour consumed with a kind of nervous energy that buzzed relentlessly under the surface. When the anxiety built up a critical mass, I would explode into a rage. No one was safe from my wrath. I screamed at my husband, my parents, my mother-in-law… and my 3-day-old infant. I found solace in a perfectly-packed diaper bag and symmetrically-folded burp rags. When the bottle tops and bottoms matched color, a bit of the anxiety lifted. But the smallest discrepancy or disruption in my day—a missed nap, a late snack, an unfinished bottle—triggered a time bomb.

It didn’t take long for the unending anxiety to bring about a deep depression. The love I knew I felt for my child and my husband vanished, leaving a cold apathy in its place. I walked through my day a shadow of myself, and I lost sight of any hope.

I tell you all of this because I want you to know that I believed I would never be happy again. I began to internalize the story the depression told me – that I was a horrible mother who just needed to “try a little harder.”  The vision of motherhood I had held onto for so long faded into what I thought was my new life.

What I didn’t know, and what Postpartum Progress showed me, was that maternal mood and anxiety disorders are 100% treatable – that my depression and anxiety did not have to define who I was. My road to recovery was a long one but, with therapy and medication, I found my hope again, and am more resilient than ever.

If your hope has been stolen from you, read on. Let the words of each mother in the Rally sink into your soul… let us lend you some of our hope. Though I know it feels impossible, you will be YOU one day and your days of darkness will be a memory.

With so much love,

Susan

Susan is an elementary teacher-turned stay-at-home-mom who has her hands in a little bit of everything. When she’s not parenting or teaching piano lessons, you can find her blogging about mental health or crocheting her anxiety away. She writes at http://learned-happiness.com, pimps her wares for yarn money at http://etsy.com/shop/learnedhappiness, and tweets @learndhappiness.

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The 6th Annual Mother’s Day Rally for Moms’ Mental Health is presented by Postpartum Progress, a national nonprofit 501c3 that raises awareness & advocates for more and better services for women who have postpartum depression and all other mental illnesses related to pregnancy and childbirth. Please consider making a donation today, on Mother’s Day, to help us continue to spread the word and support the mental health of new mothers.
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It Is Okay To Not Be Okay During Pregnancy

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pregnancy depression, antenatal depression, depression during pregnancyDear mama,

I wanted to word vomit all over our Facebook group when I saw how quickly you backpedaled about not enjoying pregnancy.  I wanted so badly to share my story, but I knew it was not the time or place.  I am writing this open letter to you and all other mamas who do not like pregnancy.  It is okay to not be okay during pregnancy.  I struggled physically and emotionally with my second pregnancy.  In hindsight I clearly had undiagnosed antenatal depression and anxiety, a revelation that my therapist and I discussed.  I had so many warning signs.

I worried about everything constantly.  I was irritable, and it wasn’t just the hormones.  My irritability was a precursor to my postpartum rage.  I lost weight initially, partly due to the restrictive meal plan for my gestational diabetes.  I could not sit still at all which was also a precursor to my severe postpartum anxiety.  I was making lists of all the tasks that had to be done and completed by the time the baby was born.  List-making made me feel like I was in control.

Society does pregnant women a disservice by showing us these photos of airbrushed women who blissfully smile down at their baby bumps.  I rarely smiled or laughed when I was pregnant.  Besides the gestational diabetes, I suffered from sciatica and an umbilical hernia.  I had to wear a postpartum support girdle which alleviated some of the strain on my back.  I have had friends valiantly struggle with sciatica, symphysis pubic dysfunction, pre-eclampsia, irritable uterus and days and weeks of contractions.  Until we change the conversation about how demanding physically, mentally and emotionally pregnancy can be, we will continue to feel like we have to put on the mask.  I very much wanted and planned for my darling baby girl, but I would tell anyone and everyone who would listen that this was my last pregnancy.

People used to laugh like I was a hormonal pregnant woman who should be pitied.  I felt like people thought I was exaggerating my level of stress and discomfort with my last pregnancy.  Those feelings made my rage and irritability even greater.  Do not condescend to pregnant women.  We are adult women who are growing another human(s).  We deserve care that recognizes our entire selves, not just as an incubator for the baby that we are carrying.  My feelings, my emotions, and my health were just as vital and important as that of my unborn child.  I struggled with undiagnosed antenatal depression and anxiety even though I had a supportive medical team that included my ob/gyn, my certified diabetes educator, and my endocrinologist.

Mama, I wish I could learn more about your story.  I have so many questions for you.  Did you struggle too?  Would you like to know more about my story?  Can we get together for coffee and really talk about how difficult pregnancy can be?  Can we stop trying to pretend that it is all sunshine and rainbows?  It is okay to not be okay.  It is okay to admit that you hate pregnancy and that you are miserable.  This does not mean that you do not love your child.  You are brave for reaching out and asking for help.  If you are struggling, please know that you are NOT alone.  Many mamas, including myself, have been in your shoes.  Talk to your therapist, to your partner, and to your doctor.  Check out the resources available here along with testimonies from other Warrior Moms who have struggled with antenatal depression and made it through to the other side.  It does get better, I promise you.

Love,

Jen Gaskell

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Pregnant Moms Deserve Balanced Coverage About Depression & Meds

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I try to follow the New York Times’ Motherlode parenting blog as often as possible, because I always appreciate its intelligent and thorough coverage of parenting topics. That’s why I was a little surprised by yesterday’s story and its potentially misleading headline: Study Links Autism With Antidepressant Use During Pregnancy

The story, written by KJ Dell’Antonia, was about newly published research, a study entitled “Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders,” which appeared last week in the BMJ.

The study’s authors took a look at antidepressants taken during pregnancy, autism spectrum illnesses and maternal depression, trying to figure out what the associations were, if any, between these things. They found a small association between antidepressants taken prenatally and high-functioning autism like asperger’s, but were very careful not to make a direct link between autism and the use of antidepressants during pregnancy. Here’s some of what their published paper concludes:

“If antidepressants increase the risk of autism spectrum disorder, it would be reasonable to warn women about this possibility. However, if the association actually reflects the risk of autism spectrum disorder related to the non-genetic effects of severe depression during pregnancy, treatment may reduce the risk.”

And:

“From a public health perspective, if antidepressant use had a causal relation with autism spectrum disorders, it would explain less than 1% of cases, and therefore would be unlikely to explain the dramatic increase in the observed prevalence of these disorders.”

The headline infers that it may be antidepressants taken by mothers that are causing autism. To be fair, columnist KJ Dell’Antonia proceeds carefully in her story, explaining that there’s no way to know if the mothers’ severe depression caused the increased risk or the SSRIs did. Up until the middle of her piece everything was just fine.

But then the remainder of the piece was dedicated to an interview with Dr. Adam Urato, an OB/GYN who has been a vociferous opponent of antidepressants for years and has made several claims in the past about their use that I believe are misleading.

It comes as no surprise to me that Dr. Urato believes it’s no surprise that antidepressants are harming babies. His feelings about antidepressants are well known. At a site called RxRisk, he wrote, “The complications of SSRI use might be considered tolerable if there was solid evidence of benefit with the use of antidepressants by pregnant women. Sadly, in 25 years of study, not a single study has ever shown improvements in pregnancy outcomes in the antidepressant-treated group.”  HUH? You mean like this lack of evidence?  On the Citizens Commission for Human Rights website, he explains that research he conducted with Alice Domar found that “… there is no evidence of improved pregnancy outcomes with antidepressant use.” WHAT??!

When Domar and Urato’s paper came out last year, I reached out to Dr. Laura Miller for reaction. Dr. Miller is a reproductive psychiatrist, a researcher, and the director of Women’s Mental Health at Brigham and Women’s Hospital in Boston. Dr. Miller was so frustrated by the wide media dissemination of the Domar/Urato study that she wrote an incredibly detailed response. To the assertion that there’s no evidence of improvement of pregnancy outcomes with antidepressant use, for instance, she responded:

‘The authors state that, ‘There is an assumption in the psychiatric community that the risks to a fetus are greater if the mother has untreated symptoms of depression’.  This is not an assumption; it is a finding from numerous studies.  For example, untreated maternal depression during pregnancy is associated with reduced prenatal care (Marcus 2009), preterm birth (Li et al. 2009; Bansil et al. 2010), reduced birth weight (Henrichs et al. 2010), altered behavior at birth (Zuckerman et al. 1990), increased risk of infection (Rahman et al. 2004; Traviss et al. 2012), and more difficult temperaments (Huot et al. 2004).  There is increasing evidence that some of these effects are due to epigenetic influences on fetal development that are mediated by elevated cortisol levels (Glover et al. 2009; Oberlander et al. 2008).”

I highly suggest you read Dr. Miller’s entire response to their paper here.

I have to ask why there was no interview of a reproductive psychiatry expert in the Motherlode piece. Why no response from someone, anyone, who understands the impact of serious mental illness on mothers and children? It’s important to point out the risks of taking antidepressants during pregnancy, but why the focus on Urato, who has made some assertions about treatment of depression during pregnancy that, in my opinion, leave out the whole story (as Miller’s response suggests)? This issue is so charged, so painful to pregnant and prospective new moms who are trying to figure out the best thing to do for themselves and their babies, that it’s imperative to me that all sides of it be covered.

It’s clear to me that Dr. Urato has a bias against antidepressants. Then again, maybe I’m biased. Check that, I know I’m biased. I’m a full-time advocate for pregnant and new moms with perinatal mood and anxiety disorders.  I care immensely about the future health of babies, but equally as immensely about the mental health of mothers. This is why we HAVE to tell the whole story.

I was grateful to see that some of the public comments to the Motherlode piece reflected my feelings about the story. There was New York Times commenter Louise Kinross, who wrote:

“I’d like to hear from psychiatrists on the risk of not treating women with severe depression.”

I would have too, Louise.

And then there was commenter Nan Silver:

“Because it links extremely popular medications with a childhood diagnosis that parents deeply fear, this study is ripe for plenty of hype by irresponsible news outlets. I worry that it will now become gospel that antidepressants are responsible for the dramatic rise in autism rates. The study itself does not at all support that conclusion.”

I have the same worries, Nan.

And then Steve (oh, thank you Steve!):

“You quote only one physician commenting on the results, a Dr. Urato. Apart from his being an ob/gyn there is nothing to indicate that he has any special expertise in the area of treating of depression during pregnancy or about autism.”

He doesn’t.

I’m disappointed that the Times wouldn’t have included or at least hinted at the impact of untreated severe antenatal depression on infants and children in this story. Or the impact of severe untreated depression on pregnant mothers themselves. I’m disappointed that no actual expert on SSRIs in pregnancy, like Adrienne Einarson at Motherisk for one, was interviewed.

This morning I reached out to a few true experts on the topic of maternal mental health. One was Marlene Freeman, MD, Director of Clinical Services in the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital and an Associate Professor of Psychiatry at Harvard Medical School. After reading the Motherlode story she replied, “This is such a confusing and important topic, because there is so much we do not understand about autism, and of course it is such a serious condition.  The authors are very careful in stating that it is not possible to disentangle depression severity and antidepressant exposure, as both potentially being associated with an increased risk.”

“The authors of this BMJ paper do thoughtfully discuss limitations, and they do state that use of an antidepressant may represent women with most severe depression,” Freeman added. “In our clinical experience I would say that is true, that women with mild depression can successfully come off antidepressants, but those with more severe depression would be those for whom antidepressants are indicated.”

I also spoke with Samantha Meltzer-Brody, MD, Associate Professor and Director of the Perinatal Psychiatry Program, UNC Center for Women’s Mood Disorders, and she concurred with Dr. Freeman. “I believe this new paper must be taken with a grain of salt just like all of the other papers on this topic. Thankfully, the Swedish authors do carefully discuss potential limitations although the Motherlode article is more inflammatory,” said Meltzer-Brody. “One point that I don’t think can be emphasized enough— the overwhelming VAST majority of children with autism did not have mothers who took antidepressants during pregnancy! Women with moderate to severe depression during pregnancy need to be treated for their mental illness in the same way we treat all other medical conditions. There are always risks and benefits to consider. I am deeply saddened by the stigma and fear mongering that pregnant women with depression face when weighing treatment options.”

It is true there are risks to taking medication in pregnancy, including antidepressants. But let’s make sure moms know there are risks to suffering from severe depression and anxiety during pregnancy, too. If we’re going to report on this stuff, let’s report on all of it.

I have been and will remain a fan of KJ Dell’Antonia. I just had to write about this, because I believe the Times has a unique ability to reach and inform many, which gives it a particular responsibility in my mind. I need more from the New York Times when it comes to the lives of the hundreds of thousands of women each year who face the dilemma of whether to take antidepressants for their depression and anxiety during pregnancy.

 

Update 4/22 - I just read a blog post from Louise Kinross, one of the commenters I quoted above, who also wrote about the study. It’s worth a read: Making Sense of Autism Risks

Update #2 4/22 - KJ just updated her story this afternoon with links to both my post and Louise Kinross’, which I appreciate greatly.

Update #3 4/23 – I have updated the above story to correct a quote from Dr. Urato in paragraph 8. I also added in some links to data on the impact untreated depression in pregnancy has on children towards the end of the piece.

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