(Postpartum) Depression and Health

This is the two-part guest blog post that I wrote for The Other Baby Book Blog.  I wanted to share it here as well, because I feel very strongly that awareness acceptance of depression can aid in helping those who suffer from it.

Part One: Let's Talk

No one wants to talk about depression.  In all of my talking with other moms, in all of the threads on all of the mother- and baby-boards I've visited, I've encountered little discussion of depression of any sort.   Why don't we talk about it?  Perhaps it is because depression has no measurable, tangible or visible symptoms, like high blood pressure, a cough or a rash, so why go to the doctor if you're just in a funk?  Or maybe it's because so many people, including some of those with depression, feel that it's just a bad mood, and it should simply be a matter of "snapping out of it".  But that just isn't the case.  Depression (see also "clinical depression" or "major depressive disorder") is a very real and very serious illness affecting millions of people around the world, and is especially prevalent among women.  For example, an estimated 13% of women will experience postpartum depression (PPD).  Think of all the women who gave birth in your town, on the same day that you (or your partner) did.  More than one out of every ten of those new mothers experienced PPD. 

Postpartum depression is a particularly nasty bit of work.  Unlike "the baby blues", which are comparatively mild and last only a few weeks, postpartum depression (or PPD) is an episode of true depression occurring in the first year after pregnancy and lasting more than two weeks.  In addition to the normal run of symptoms associated with depression, a woman experiencing PPD may also feel a lack of interest in her baby, or even have thoughts of hurting her baby!  Then there's the guilt for feeling that way, or having those thoughts.  And all of this is at a time when the mother is already exhausted, drained, and sleep deprived.  It's a nightmare, and can definitely interfere with the mother's ability to care for her child.

I can tell you from first hand experience that depression is a bitch, and PPD is even worse.  I have struggled with depression intermittently since I was a pre-teen.  I can't tell you how many trips we made from my small hometown to near-by Orlando, visiting different doctors: a child psychiatrist, a counselor, an eating disorder specialist. I'd been on three or four different antidepressants by the time I graduated high school, during which time I acquired a new doctor and a new therapist.  I went off the meds in college, but saw the on-campus counselor for several months.  I went back on the meds after moving to Germany with my husband,   but improved enough during my first pregnancy to leave off of the antidepressants completely. That only lasted until my baby was about a year old, at which point I had my doctor put me back on Zoloft.  A few months after that, I became pregnant with my second child and my doctor switched me to Prozac.  I had a bad spell during the pregnancy, but it was smooth sailing in the months after my second daughter was born.  I stayed on a low dose of Prozac throughout*. 

Now, I'm still fighting it.  It can still creep up on me, slow and subtle and insidious.  Life will start to lose its luster, activities that I enjoy will start to lose their appeal.  I start letting the house work slide, and the meals that I prepare become simpler and simpler.  I play with my children less, and lose my temper more.  I lose the ability to moderate my emotions, so that I fall apart at the slightest bump in the road.  Even the simplest tasks begin seem overwhelming. I find myself ruled by lethargy, sadness, frustration, and guilt that I'm not doing what I know I should.  Then I start to realize that I've been living for weeks in a gray murk.  I begin to recognize that things are not as they should be, and at that point, I seek help.  That is the important thing, especially now that I'm a parent.  I go back on the meds, or I raise my dosage, or I go back to counseling, and the murk begins to clear.

That's where I am now in my fight against depression.  I'm clearing the murk, and wondering, how many other women are walking this path with me?  How many women are not seeking and receiving help, because they don't know that they should, because they are ashamed, or because they don't know who to turn to?  Those are the women who break my heart, and those are the women I want to be talking to right now.  Take a look at some of the links below for information about depression in general, and PPD in particular. Try to evaluate your recent feelings and behaviors.  If you are depressed, there is absolutely nothing to be ashamed of.  (Should a diabetic be ashamed that he needs a doctor to help him manage his blood sugar?)  If you don't know where to start, ask your doctor or try talking to a loved one.  But please, do something.  There is no reason for you to suffer.

*According to the Ask Dr. Sears article on PPD, either Zoloft or Paxil would have been safer during breastfeeding, but I'd not heard that until now.  I plan to ask my current doctor about it at my next appointment.

The Mayo Clinic on PPD
Dr. Sears on PPD

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Part Two: 10 Ways to Triumph

There are so many ways to counter depression and its hold on your life, but it will not get better if you do nothing. Professional counselors and therapists are trained to help you work through the illness, and to teach you coping techniques to help you manage it.  Your physician can prescribe antidepressants to help from within the body, or he may refer you to a psychiatrist if he feels that you should be evaluated by someone whose focus is mental health.  A combination of the two (counseling and medication) is often highly effective.  But if you're leery of taking antidepressants, as some natural-minded mamas may be, there are a number of things that you can start doing right now, right at home, to help yourself feel better.  These are my coping techniques, the little things that I've learned to do over the past 18 years that have helped me stay sane.

1)  Ask for help.  Don't be afraid to rely on your support system.  Your family and your friends love you, and they want to help you.  Maybe it's helping with chores, keeping the kids so that you can get a nap, sitting with you while you talk or holding you while you cry.  You know who you have around you, and who will be able to help with what.  Ask.  

2)  Exercise.  In the short term, exercise releases mood-lifting endorphines. In the long term, it'll help you get that pre-baby body back, which will boost your self esteem.

3)  Baby steps.  When things seem overwhelming, break things down into bites you can chew.  For example, if you're having a hard time keeping up with the house work, break it up so that you only tackle one or two tasks per day.  I love making lists, too, so that I get to cross things off of my list as I complete them.  The sense of pride and accomplishment I have when I'm done is a definite pick me up.

4)  Keep an eye on your diet.  It is very common for people with depression to either eat too much or too little, and neither is good.  Not only is it just plain good for you, but when you eat well, you'll feel good about making healthy choices.

5)  Take a step back.  Reflect on your thoughts and emotions from a logical perspective.  If it's hard for you to take that step back, try hashing it out with someone else.  (This is where having a professional counselor or therapist can be very beneficial. An impartial third party will be able to give you a truly unbiased perspective that your mother, partner, or best friend may not be able to.)

6)  Ask for help.  Again.  Ask your doctor, your priest, your pastor, your rabbi.  Seek counseling.  Even for families without insurance or with a restricted income, there are programs in place to help you.  If you're military and far from home, there are about a zillion programs designed to help families.  Take advantage of them.

7)  Educate yourself.  There are about a gazillion things to read.  Choose a few trustworthy sources, and learn about what you're experiencing and why.  Learning about hormones and synopses and neurotransmitters and how they play a role in how I feel emotionally helped me to accept that my depression is not just a figment of my imagination.

8)   Be honest with yourself, about how you feel, what you can do, and what you need.  Act accordingly.   If you know that being alone is just going to give you time to wallow in your negative feelings, then make it a point to get out and around other people.  On the other hand, if you need some quiet time to yourself to unwind and process, then make it a point to do that.

9)  Let go of the guilt.  It's not helping you, and it's not helping anyone else.  Depression is an illness, and to some extent, it is going to affect your ability to function, just as having the flu or a heart attack will affect your ability to function.

10)  Want to feel better.  Want it enough to work for it.  When you're depressed, marshaling the energy to do these things that  I've listed is hard.  It's hard to get out of bed, it's hard to ask for help, it's hard to face our emotions, especially when they're so out of control.

And finally, if you are averse to the antidepressants, try remain open to the possibility that you might need an antidepressant after all.  There may be some unnatural and unnecessary chemicals in there, but balanced against all that you stand to gain, it might be worth it, even if you're pregnant or nursing.  (Again, educate yourself about your options, and discuss them with your physician.)  Whatever you do, please do something! 

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