Depression doesn't always wait till the baby comes

I was featured in an article by Alison Bowen of the Chicago Tribune.  It's very exciting to help raise awareness about antenatal depression on a national level. Links below:

http://www.chicagotribune.com/lifestyles/health/sc-hlth-0819-depression-in-pregnancy-20150805-story.html#page=1 

If you can’t access it, you should be able to here: https://twitter.com/byalisonbowen/status/628985208226873344

How to thrive in motherhood (not just survive)

Motherhood is a mixed-up bag of experiences and changes to every facet of life. I’ve had the great privilege of supporting new moms in my therapy practice for 9 years, and here are some of the observations I’ve made of the ones who thrive, and how they do it.

Make a village. In these modern times, many are far from their villages, and can’t fly them out often enough for real impact. You will not make it without a village. If most of your dearest connections are not near where you live, then you need to make another village where you are. You need the friendly faces and helping hands of folks who can assist and support you. Find a local moms group, and go there. Perhaps the first one that you visit won’t be right for you, but eventually you’ll find your niche. Keep searching, it’s worth it. You will look into the tired eyes of other moms who are in the trenches just like you—sorting out all the confusion of this mysterious new baby, asking questions, voicing doubts, offering encouragement, and laughing through tears, and you will know you are with your journey-women. The women who thrive, find good traveling companions.

Self-care. Taking good care of yourself is critical. Moms often falsely believe that the quality of care of the baby is in direct proportion to their level of self-neglect. No one benefits if mom goes down, least of all the baby. It’s extremely important that you return to doing some of the pleasurable activities you enjoyed before the baby. Whether it’s running, knitting, meeting friends for dinner, or movies with your partner, they need to get dialed back into your life. The challenge of motherhood is that there’s so much less time to nourish yourself in the ways you used to. Difficult though it may be, it’s important to keep making it a goal. The women who thrive make their own care a priority.

Accept ambivalence. There is ambivalence in every single relationship. Read that line again. I say this to my patients all the time, and initially they look surprised, and then there is a moment of profound revelation when it sinks in. There is ambivalence in every relationship - whether it’s with your sister, your partner, your parents - or believe it or not, your baby. It’s completely normal to miss many aspects of your life before children. It’s normal to have mixed-up feelings about it all, because as we know well, the overwhelming joy of the new life comes with many trade-offs, and even losses. The better you can acknowledge the ambivalent feelings, and allow them to exist within you without judgment, the better you will also experience the incredible joys as they come. The women who thrive can accept that mixed feelings are a part of every experience and relationship.

Depressed and anxious symptoms are very common.  They are much more common than you may have imagined, but do not have to just be accepted.  The milestone of childbirth is the most psychologically fragile time in a woman’s life. It’s really a perfect storm of upending events—there are the hormonal shifts during pregnancy and postpartum, the chronic and debilitating sleep deprivation, the round-the-clock demands of this new life, the logistical changes to every. single. aspect of life—and this list could go on and on. Depressive and anxious symptoms are the body’s response to change, so it makes perfect sense that they would emerge in the postpartum period. This time is often bumpy, which can feel surprising, especially if this was a very longed-for baby. The better that you can accept the range of emotions associated with the transition to parenthood, the easier it will be to ask for help, and the better you can thrive in the mix of them. Deciphering whether it’s a postpartum depression or postpartum stress/anxiety—and getting help for it—is very important, because there are real risks for mom and baby associated with not getting treatment. The women who thrive acknowledge what emotions and symptoms they are experiencing, and do something about it.

[clinical notes: a postpartum depression / stress reaction is determined by intensity, frequency, duration and start of symptoms. Generally the symptoms are in clusters, and are characterized by an “agitated depression”. This is not an exhaustive list, but symptoms include; feelings of hopelessness, guilt and shame, anger and irritability, uncontrolled tearfulness and sadness, low interest in the baby, loss of interest, joy or pleasure, intrusive and scary thoughts, constant worry, racing thoughts, insomnia, loss of appetite, restlessness, brain fog, and obsessive thoughts.]

The mother inside. There was a mother inside you, before you became one, and she needs to become known. There are many ways that our own childhoods inform the way we approach motherhood, and this isn’t always good news for everyone. Most of us were mothered in some way, by some brave soul who came ahead of us.  Many of our mothers gave it their all, just like we are trying to do now, but sometimes it wasn't enough. The fact of the matter is, that the mother you had lives on inside you, in some form, for better or for worse - and there’s nothing quite like the crucible of new motherhood to bring her to the surface in very real and new ways. It can be overwhelming to reckon with her, and it can be liberating when you gain the insight to realize that you can make different choices. Here me when I say that no single milestone evokes the past like the transition into parenthood - and nothing else holds the potential for personal growth and expansion quite like it either. What a truly mixed-up bag it is - and likely if you’re reading this, you’re in it already, probably up to your eyebrows. The fantastic thing about insightful friends, therapists, mentors, and wise women is how they can help us to decode the past and inform the future. Reach out to one of these folks, you’ll be so glad you did. The women who thrive get to know the mother that they carry inside, and learn to make choices out of that knowledge.

Exploring the anxious side of postpartum/peripartum depression

"Here is the world. Beautiful and terrible things will happen. Don't be afraid."  -Frederick Beuchner

It's definitely one of those seasons when it feels like it was a very bad decision to have had children.  If you're like me; overloaded on news about US action in Syria, despairing over the ever-growing incidence of gun violence, and new and grim records on climate change – then read on.  It's been a season when our mama-bear instincts are on high-alert and the good and safe world we hoped to offer our children feels like a mythical fantasy.  Weeks like this can feel tenuous, fragile, and dangerous and many can begin to exhibit some signs and symptoms of anxiety.  It can be all the more worse for those who are new moms and already in a very psychologically fragile time in life.  For a woman in a postpartum stress/depression reaction there can be ongoing suffering - not just in one week that is fraught with bombings and worry - but for weeks at a time.

I'm going to devote this brief essay to 5 of the lesser known symptoms of postpartum stress/depression which don't always make the lists of symptoms to look for.  We as clinicians understand postpartum depression to be an agitated depression, but often the focus is on the depressive symptoms and not always the anxiety responses that can frequently accompany it.  The risk is that the anxious responses can go unrecognized as a part of the postpartum depression, and go untreated for longer than necessary.

Anger:  Anger is one of those very handy emotions - it is a red-flag that lets us know that something is going wrong - that the system is overloaded, and in need of relief.  Beneath anger, is fear.  If a woman is afraid of, or ashamed of her anger - (perhaps because she believes that it's not the way a mother is "supposed to" feel) then it can also lead to intense guilt.  At its essence though, anger is self-protective - a helpful indicator that some critical self-care, and restructuring is needed.  Whether it's throwing shoes, yelling at our partner, or beating the steering wheel - most of us have been there.  The round-the-clock demands of a baby and of all that comes with a thoroughly changed life can indeed bring about anger.  The intensity of the anger, length of episodes, and frequency can begin to paint a picture of postpartum depression / stress, and can be a sign that help, in some form, is needed.

Insomnia:  Everyone tells new moms to "sleep when the baby sleeps!", and it is indeed very good advice - except for the mom who cannot calm her body and mind enough to nap, or even to be able to sleep at night.  For some moms the anticipation of the next cries and the hyper-vigilance that can accompany it is enough to interfere with sleep.  For others the swirling mind of thoughts and worries cannot be quieted, and even in the face of total exhaustion, sleep can be elusive.  Even good-sleepers can end up feeling completely wasted because of the regular waking of the new baby.  Imagine how much worse it is for a new mom suffering with insomnia. The nervous system is on overdrive, and this can be in response to the new and relentless demands of a new baby (not to mention a job, mortgage, and other obligations that still go on even in the postpartum period).  However, sleep is critical to quality of life and sanity, and a new mom who is not able to rest well needs assistance as soon as possible.

Intrusive thoughts:  Intrusive thoughts are often scary and always unwanted.  These thoughts can sound like: "what if I drop the baby?", "what if she drowns while I'm giving her a bath?", "what if I drive off the road while he's in the car?" Let me be clear - an intrusive thought does not mean intent or plan to do harm - it is understood to be an aspect of obsessional thinking patterns.  An intrusive thought is often fleeting, and it causes piercing anxiety because it is at odds with who the mom is fundamentally, and what she wants for her baby (Kleiman, 2009).  The scary, intrusive thought terrifies, and the anxiety and the thoughts can become a vicious cycle.  Many moms experiencing intrusive thoughts experience shame about them - women can become afraid to even admit these thoughts to them-self, let alone share them with another person.  This is a very common stress response to having a baby, and I'm quite certain it's not being talked about very often on playgrounds or over coffee with friends - but rest assured, once the anxiety has settled down, the thoughts will often disappear.

Panicky feelings: Feelings of panic can emerge in the postpartum period with the classic physiological symptoms of chest tightness, shortness of breath, racing heart and sweating.  These panicked moments may accompany intrusive thoughts, or may just break though out of the blue, and often leave a new mom feeling confused about what is going on.  I think it's helpful here to remember how overwhelmed the mind and body is at this time in life-- there are new physical and psychological vulnerabilities as coping skills are maxed out, and the anxious symptoms become a sign of this.

And finally,

Brain fog / confusion:  The word, 'zombie' seems to succinctly describe the state of brain fog and confusion.  It's like the brain is literally full of fog that is blocking the moms ability to concentrate, problem solve and remember things - and this often makes a mom feel more easily overwhelmed and confused.  Women also describe that this can feel like operating from behind a blanket, or like they've had too much alcohol to drink.  It can be a frustrating state--especially when it feels most important to have your wits about you - but this symptom will generally clear up as a woman starts to feel better. 

Any surprises here? Many women suffer with these anxious symptoms and do not get the help they need because they are not the most familiar symptoms of postpartum depression / stress.  However, they are troubling and can be just as debilitating as the depressive symptoms.  Women experiencing these symptoms should know that they are not alone, and that there are many ways - through varied resources of trusted caregivers, to get assistance through this challenging time.*  It's definitely fitting to quote Vimala McClure here, from her book The Tao of Motherhood; "Tell the truth, allow what is - and allow it to be known." 

*Peripartum depression is the most common complication of childbirth, effecting 20% of women.  If you think you may be experiencing symptoms of peripartum depression, you can reach out to your OB or midwife for support and resources.  You can also get in touch with Kellie Wicklund at the contact information below for a free phone assessment, free advice and referral to resources, or to make an appointment with her for specialized therapeutic support. 

Bibliography:

Kleiman, K. (2009).  Therapy and the Postpartum Woman.  New York, NY: Taylor & Francis Group