Peer to Peer Support Proves Effective In Fighting Postpartum Depression

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phoneThose of us active in the PPD community have long hailed the benefit of peer to peer support when it comes to helping mothers combat postpartum depression and anxiety. Now a new study has been published which strengthens the claim that moms helping moms makes a difference.

The anecdotal study, “Quasi-experimental evaluation of a telephone-based peer support intervention for maternal depression” was conducted by nurses in New Brunswick, Canada and results were published this month in the Journal of Advanced Nursing. Participants received an average of 14 calls (364 minutes of phone time in total) from recovered mothers who underwent training to act as peer supporters. The researchers found that depression decreased by nearly half over the course of the study.

This study is interesting to me because the Internet is what I credit for my recovery from postpartum depression and anxiety after Joshua was born in 2009. We all knew I had a greater chance of depression, but for nearly a year I took my meds and did little else to cope. I found Twitter and #PPDChat and Postpartum Progress and suddenly I’d found my “tribe.” My climb out of darkness began and soon I was “back in the world.”

We were led by those who had survived and gradually we became survivors ourselves. Warrior moms.

Many of the women I found who helped me so much were in the trenches with me. Some of my dearest friends were fighting the same battle I was, and our friendships were born of shared experience in combat so to speak. We were fighting for our lives and our families and our children.

In this study, moms were aided by survivors, but, at least so far as we are aware, had no interactions with one another. And still the results were positive.

The researchers found “that some mothers need only one supportive call” to see improvement “likely due to reassurance they have someone to call who understands.”

When I think back to my early postpartum days with Joshua, I remember people bringing food and stopping by to coo over this new baby in my life. I remember people telling me I would “bounce back” and to “enjoy these moments.” But I don’t remember many people asking me how I was but not with that tone that says “no, really, how are you doing?”

That’s not to say that those in my life in the early days weren’t concerned, but many of them weren’t PPD survivors. And that’s really the crux of this study.

Contact with others, particularly with those who’ve “been there, done that” is critical for new moms with a predisposition to depression and anxiety. The simple act of a weekly phone call to check in helped new mothers feel less alone, less judged, and more supported, and as a result, lowered rates of postpartum depression and anxiety to a rate below the rate of the general population.

Just KNOWING someone was out there who understood made a difference. It also helped break down the stigma surrounding mental illness, and those of us working to improve the lives of mothers know the roadblock that stigma creates.

If you’re a survivor, someone who has made it through to the other side, I’d like to challenge you to pick up the phone when someone you know brings home a baby.

Reach out. Give the new moms in your life a call, regularly, and ask how they’re doing. Check in. Then check in again.

While the results of this study are small, not conclusive, and largely anecdotal, they are promising. Even though the study does not reveal what sort of training the peer counselors underwent, there’s enough evidence to suggest that peer to peer support, being an active listener and a non-judgmental presence, makes a difference and improves lives.

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Letourneau N., Secco L., Colpitts J., Aldous S., Stewart M. & Dennis C.-L. (2015) Quasi-experimental evaluation of a telephone-based peer support intervention for maternal depression. Journal of Advanced Nursing 00(0), 000000. doi: 10.1111/jan.12622

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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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