Research uncovers various classes of PPD

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

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

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

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

What varies?

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

Their conclusion?

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

Why does this matter?

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

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

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

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BabyCenter Finds PPD Moms Don’t Seek Help Due To Guilt & Shame

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BABYCENTERBabyCenter®, the number one pregnancy and parenting digital resource, recently asked 1,400 moms about their experience with postpartum depression and found that 40% said they didn’t seek medical help for their illness. Their reasons for avoiding reaching out for help included feeling like they should or did have the strength to get over the feelings without a doctor’s help (30 percent), believing their symptoms weren’t serious enough (25 percent), or feeling too much embarrassment (24 percent) and guilt (23 percent).

 “This study revealed serious findings that need to be addressed,” says Linda Murray, BabyCenter Global Editor in Chief. “Depression is dangerous for women and their babies, and untreated depression can become worse and lead to other complications. Depression affects people from all walks of life, but new moms are particularly susceptible given the stress of becoming a parent, lack of sleep, and hormonal changes. We want moms to understand that seeking help for PPD isn’t something to be embarrassed or ashamed about; in fact, it’s one of the most important things they can do for the well-being of their babies.”

Postpartum Progress is thrilled that BabyCenter put its resources behind taking a deeper look at postpartum depression and how it affects women. It’s so important to understand the barriers that prevent moms from seeking treatment to get the help they need. It stands out to me that the results of the survey found in particular that women felt they should be able to get over PPD themselves or that their symptoms weren’t serious enough to need professional help — those are beliefs we can effectively change by raising awareness about this illness and how it can affect both mom and baby when untreated.

In response to the findings of their study and to lend support to the cause of maternal mental health, BabyCenter is now graciously allowing me to blog regularly on their site to shed additional light on PPD and remind new and expecting moms that there is no shame in feelings of anxiety or depression. If you are experiencing PPD, please know that getting treated as soon as possible is important. Please go check out my very first post on BabyCenter: Asking for Help for PPD: Failure or Fierceness?

“I can’t stress enough that PPD is treatable, but only if moms ask for help,” says psychologist Susan Bartell. “It can be hard, but moms don’t need to be afraid to seek support during this difficult time. And it’s important for moms to remember that help comes in many forms ranging from friends who simply fold your laundry to therapy.”

About BabyCenter

BabyCenter® is the voice of the 21st Century Mom® and modern motherhood. It’s the number one pregnancy and parenting digital destination worldwide, reaching more than 40 million moms monthly in 11 languages across 14 owned and operated properties from Australia to India to China. In the United States, 7 in 10 babies born last year were BabyCenter babies. BabyCenter is the world’s partner in parenting, providing moms everywhere with trusted advice from hundreds of experts around the globe, friendship with other moms like them, and support that’s remarkably right at every stage of their child’s development. BabyCenter is a member of the Johnson & Johnson family of companies.

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Misdiagnosis and Missed Diagnosis: Part 2

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Trigger Warning: This is part 2 of a 2 part story (part 1 can be read here) of my misdiagnosis and missed diagnosis after giving birth in 2009. This post contains some references and details about Postpartum OCD, Intrusive Thoughts, miscarriage, and D&C. If you are feeling particularly vulnerable and prone to triggers, you may want to avoid this post until a later time. 

After I was discharged from my second hospitalization, I still hadn’t been able to get in to see the psychiatrist and ended up at the ER because I was out of Lexapro and had no more refills. Since TriCare doesn’t cover Lexapro on the formulary, I was switched to Celexa (the generic version) and told to keep trying to find a doctor who could see me. I called various doctors and they either weren’t accepting new patients, didn’t have any openings, or in one case, “Refused to take me on” and wouldn’t explain why. Let me tell you, this didn’t make me feel any better.

I went in to see my PCP (Primary Care Physician) to get my Celexa refilled and while I was there, he ordered a lab test to have my thyroid levels checked. I never heard anything back so when I returned to get another refill ordered, I asked the nurse about the results. She looked it up and said “Oh yes, it’s abnormal, he’ll need to talk to you about that”. When the doctor came in, I asked him about it and he said “We’ll take a look at that after we get your meds taken care of”. He never looked at my lab results and left without saying anything.

At the end of November, the day after Thanksgiving, my husband, daughter, and myself were in a car wreck. I was driving and we rearended another vehicle. I had a nasty case of whiplash and a concussion, my husband broke his ankle, and our daughter’s car seat did it’s job and she wasn’t even sore. I was given a small amount of painkillers to help with the whiplash, but the whiplash persisted past the medication. I went back to the medical clinic and saw a different doctor. While I was there, I mentioned the thyroid labs that had been done and that I was curious to know what the results were. She took a look and hit the roof, saying that my thyroid results were WAY outside normal limits. She wanted to do a re-test since it had been months since the last test, so she put in a lab to recheck my thyroid levels and put a rush on it, promising to call me back to let me know what the results were.

In less than 24 hours, I got a call back from her nurse telling me that I definitely had hypothyroidism and could I come in that day to see the doctor so she could talk to me about the condition and get me started on medication, and let me know how it would all be handled moving forwards. I was at the hospital with my husband in surgery having his ankle repaired, so I had to wait a couple of days but they got me in ASAP. The numbers on my lab results were extremely bad and I’m surprised my symptoms weren’t worse. I promptly switched doctors so that this “new” doctor was my primary and I refused to ever see the other doctor again. In hindsight, I should have filed ICE Complaints on both him and the Nurse Practitioner who ignored my Edinburgh Scale at my 6 week postpartum check up, but hindsight is 20-20 and all that.

The new doctor informed me that hypothyroidism can be caused by pregnancy. It often clears up, but in some cases it just sticks around. I was started on the lowest dose of Levothyroxine, 25 mcg, and had my thyroid levels checked again in a week or two. The repeat lab showed that my thyroid levels were improving but I needed a slightly higher dose so I was bumped up to taking 50 mcg of the Levothyroxine, and that turned out to be my magic dose. After 3 months of Levothyroxine, my PPMD symptoms were totally cleared up and I was able to wean off of the Celexa, Ativan, and Ambien. I had finally found a therapist to see, and she had me come in a little more often until we were sure that I wasn’t going to have a recurrence of symptoms but soon I was able to stop seeing her as well.

It’s been 4 ½ years since my hypothyroidism was diagnosed and 50 mcg of Levothyroxine has managed my condition ever since. Normal protocol is to have my thyroid levels checked once a year, but when I’m pregnant my levels are checked once each trimester. Even with the pregnancies, the same dose of Levothyroxine has done me right and I haven’t had the same issues, even through 3 pregnancies, one of which was as a Gestational Surrogate and ended at 12 weeks with a D&C for a missed miscarriage.

There are several morals to my story. One is that we desperately need better availability of mental health care, both inpatient and outpatient. I should not have had as much trouble finding a doctor and therapist to see me as I did, nor should I have needed to wait for a month or longer to have an intake appointment after inpatient treatment. The second moral of the story is that medical professionals need to have better training on the difference between suicidal/homicidal ideations and intrusive thoughts and between the various forms of PPMD. Screening on intake (including arrival at the ER) should include noting the differences. There also needs to be better availability of treatment options for postpartum mothers. Being put in a general hospital wing wasn’t that helpful. People who are recovering from substance abuse and addiction aren’t going through the same thing and we just weren’t able to really understand or offer much helpful advice to each other because the situations are so totally different.

The biggest lesson in this story is to be your own advocate. Don’t let medical professionals shirk on their jobs, don’t let them overlook symptoms and cries for help, definitely don’t let them leave an appointment without going over your lab results. Don’t let them rush off without giving you the attention and help that you need. This is not “causing trouble”, this is asking them to do their job. You are your own best advocate.

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Misdiagnosis and Missed Diagnosis: Part 1

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Trigger Warning: This is part 1 of a 2 part story of my misdiagnosis and missed diagnosis after giving birth in 2009. This post contains some references and details about Postpartum OCD and Intrusive Thoughts. If you are feeling particularly vulnerable and prone to triggers, you may want to avoid this post until a later time. 

In July of 2009, 3 months after having my first baby, I finally admitted that all was not well in my world. For 3 months, I had been falling deeper and deeper into a spiral of awful. Sometimes I felt indescribably angry. Sometimes I felt a deep sense of sadness and despair and would just cry and cry and cry, or maybe I’d be about to get out of the car in the parking lot at the store and suddenly burst into tears and not even know why. Sometimes I felt completely numb; I would just sit in my rocking chair holding my beautiful little girl, staring off into space, not really thinking or feeling anything at all other than blankness and emptiness. The worst of all was pictures and thoughts that flashed unbidden into my mind. Thoughts and pictures of dropping or throwing my daughter down the stairs. It terrified me and I would actually cancel appointments if I was upstairs because I didn’t want to carry my child on or near the stairs and those pictures and thoughts become reality. As soon as they entered my mind I would chase them away and hug my baby a little closer and pray “God, what’s happening? Please forgive me and make this go away”. I had no idea what was wrong with me.

At my 6 week Postpartum check up at the Wilford Hall Medical Center OB/GYN clinic, I filled out the  Edinburgh Postnatal Depression Scale questionnaire that I was handed. My answers clearly indicated that I needed further screening but the Nurse Practitioner who saw me just put it to the side without saying anything and never really asked how I was feeling, so I figured that what I was experiencing must be normal (news flash: it wasn’t). Things kept getting worse until eventually, one night in July, I found myself standing at the top of the stairs while everyone else was asleep thinking that everyone else would be so much better off without me if I threw myself down the stairs. I walked away and started to go to bed and then thought that it would be easy to take a massive amount of the painkillers my husband had left over from ankle surgery and just go to sleep and not wake up. I called the chaplain and he met me at the Emergency Room.

I was diagnosed with Postpartum Depression and transferred to a psychiatric facility in San Antonio, since WHMC (the military hospital on Lackland Air Force Base) only admitted service members for inpatient treatment of mental health issues, dependents automatically got referred out. I was breastfeeding my baby and didn’t want to have to stop, so we tried going the medication-free route first with talk therapy, both individual and group. We quickly realized that it wasn’t making enough of a difference, so on to medication it was.

During this time, one of the biggest questions asked of me was “Do you have thoughts of harming or killing yourself or others?”. I answered yes. Partly because I had found myself on the brink of attempting to commit suicide, but also partly because of the thoughts I had been experiencing. I later found out that the thoughts and images that shoved their way uninvited into my mind were Intrusive Thoughts, one of the classic and tell-tale symptoms of Postpartum Obsessive-Compulsive Disorder. I didn’t know, at the time, that there was a difference between suicidal/homicidal ideations and intrusive thoughts, or that there was a whole spectrum of Postpartum Mod and Anxiety Disorders, I thought it was just all part of Postpartum Depression. Unfortunately, it seems that none of the staff caring for me at either of the hospitals knew this either, and I was diagnosed as simply Postpartum Depression. This is one of the things that I eventually hope to see changed: to see better education for medical professionals making them aware of the differences between types of symptoms and the various PPMD.

It only took a few days after starting medication (Lexapro) before I started to feel better. Before starting medication, my mom and my husband had come to visit me at the hospital and when my daughter started to cry, it was a noticeable trigger. My mom and husband had to keep the baby up front and switch off who had her and who was visiting with me. After starting meds, I was able to cope better when she started to fuss, I started to open up a little in therapy instead of sitting huddled up in the corner unable to speak without crying. After a little over a week in the hospital, I was sent home with prescriptions for Lexapro to manage my symptoms on a daily basis, Ativan for sudden anxiety attacks, and Ambien to help me sleep at night. I was also given an appointment to see a psychiatrist outside of the hospital.

When I went to my first appointment it was a total disaster. I ended up having to reschedule after I had been there for a couple of hours and still not been seen, because I had to get home since my babysitter had to leave. They weren’t able to reschedule me for another month or so out. I ended up back in the hospital a month after being discharged due to a recurrence of my symptoms (again, the intrusive thoughts that I didn’t know much about and didn’t know how to manage), and had my medication dosage adjusted. Thankfully, I only had to stay for about a week again and was able to go back home.

To be continued tomorrow…

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