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The ABC's of PPD

~ Charlotte Cowie is a freelance editor, writer, and blogger. She has dealt with PPD and postpartum PTSD and is now working to raise awareness of postpartum mood disorders. She would also like to offer her support to mothers dealing with PPD. A former resident of Edmonton, she now lives in Texas with her family.~



July 2011 Edition

It’s Not the Baby Blues: A PPD Overview

Pregnancy books contain a lot of good information about pregnancy, childbirth, and the postpartum period. But none of them include much about postpartum mood disorders. Yes, they all talk about the baby blues. But those paragraphs (about a paragraph or two per book), usually only include a single sentence, possibly two, about postpartum depression.

Most likely, that sentence is a variation of “Contact your doctor if the baby blues lasts longer than two weeks, as you may have postpartum depression.”

To me, this almost blasé treatment of PPD is disappointing. Despite what people may think or want to believe, PPD is common. (According to the CDC’s 2008 report, 11-20% of new moms suffer from postpartum depression. These results are based on self-reported numbers, so I would guess that the true number is quite a bit higher.) For a disorder that affects so many people, a single sentence or two at the end of a paragraph just isn’t good enough.

I’ve discovered that most people do not or cannot address the enormity and severity of postpartum mood disorders. Many people want to sweep PPD under the rug and pretend it, and other disorders like it, don’t exist.

This is wrong. It’s wrong because it leaves many mothers adrift and without support. It’s wrong because it misinforms and leaves plenty of room for assumptions and wrong conclusions. And it’s wrong because it feeds the stigma we’re all trying so hard to shatter. PPD, or any other postpartum mood disorder, is not something only “crazy people” get.

Let’s do the math. I’ll take a middle of the road estimate and say that 15% of new moms will be afflicted with postpartum depression. In a group of ten women, one or two of them will be suffering from PPD. In every group of ten women. How many babies are born each year? How many women become new mothers every day? Are all of those women “crazy?”

No. They are not. I’m not crazy. You’re not crazy. And it’s demeaning and discouraging to have people say that we are.

A low percentage of women reach out to get help. This is unfortunate but not surprising, given how much negativity surrounds PPD and mental illnesses in general. Some women will hide it, making it hard to detect.

The community health nurses gave me the PPD screening test shortly after my oldest daughter was born. But if you’ve ever taken this test, you’ll know that it’s pretty easy to figure out what the “right answer” is. So I gave those answers. Not because I wanted to misdirect the nurses, but because I refused to believe I could get PPD. I couldn’t have PPD, because only “those” people got it.

Silly me. I didn’t learn until much later that PPD can and will affect anyone. When a mood disorder strikes, it’s indiscriminate. It doesn’t care if you’re rich or poor, young or old, what your job is, where you live, or what you look like. It just strikes.

And when it strikes, it’s like getting trapped in a deep, dark pit with no way out.
Symptoms of PPD

PPD is generally diagnosed in the first three months postpartum, but for some women, diagnosis can take a year or more. Moms who are diagnosed later will likely have shown symptoms of PPD for a while.

The symptoms of PPD are very similar to the symptoms of the baby blues. Because of this, I kept insisting (to myself) that I just had a really bad case of baby blues. This turned out to be true, since a “really bad case” of baby blues can be called “postpartum depression.” (Not always, of course, but baby blues can lead to PPD.)

Symptoms of PPD can include:
-Severe sadness, emotional numbness, crying spells
-Withdrawal from family, friends, and once-enjoyable activities
-Constant fatigue/sleepiness or insomnia/trouble sleeping
-Overeating or loss of appetite
-Strong sense of failure/inadequacy
-Intense concern about the baby or a lack of interest in the baby
-Thoughts of suicide or fears of harming the baby

I’ll take a moment here to say that, contrary to popular belief, PPD is not postpartum psychosis. Postpartum psychosis is a severe postpartum mood disorder, but it’s rare.
Causes of PPD

In my case, I ignored my symptoms for a long time. I thought that maybe I just couldn’t cope. Or maybe I was selfish. These were things people told me to get me to “snap out of it;” maybe they were true.

So I thought it was my fault, that I’d somehow caused it. But I didn’t.

I had to repeat that many, many times, though, because I had a hard time believing it. But I didn’t cause it. It’s hard to believe and can be difficult to accept, especially when you’re at your lowest point. But…it’s not your fault. (Really.)

So if you or I aren’t the cause, what is? Hormonal changes are a possibility. Pregnancy and childbirth cause major upheaval. There are a lot of hormonal changes during the nine months of pregnancy and in the months after delivery. Those hormonal changes may lead to changes in brain chemistry (which is another possible cause).

Other possible causes of PPD include:
-Family history of depression
-Sleep deprivation, fatigue, tiredness
-Difficult or high-maintenance babies
-Medical changes in the mother or baby
-Self-criticism or doubting the ability to be a good mother
-The need to be a perfect mother
-Previous PPD or clinical depression
-Absence of support
-Isolation
-Stressful life events or general stress
-Feeling overwhelmed

There are many possible causes, but nothing has been definitively proven. There are also possible factors that can increase the risk of getting PPD.

Those risk factors are:
-Personal history of mental illness
-Lack of support system
-Anxiety or negative feelings about pregnancy and motherhood
-Problems with a previous pregnancy or birth
-Marriage or money problems
-Stressful life events
-Substance abuse
-Antenatal depression (depression during pregnancy)
-Baby blues
-Postpartum stress syndrome (adjustment disorder)

Please note that having any of these risk factors does not mean you’re guaranteed to develop PPD. It does, however, mean you’re at higher risk.

The last three risk factors—antenatal depression, baby blues, and postpartum stress syndrome—are mood disorders of sorts that are already related to pregnancy and motherhood. I’ll be talking about antenatal depression in a later column.

Most new mothers are familiar with the baby blues. It’s that period of time immediately after birth, when a mom can experience periods of irritability, anxiety, mood swings, and crying spells. (You may cry about random things. I cried when my husband shaved, even though I wasn’t attached to his facial hair.) Baby blues generally resolves on its own, though some cases will progress to PPD.

On the surface, mothers with postpartum stress syndrome seem to be okay. They have good coping mechanisms and a good support system. But they’ll fight constant feelings of disappointment about their parenting skills, have low self-confidence, and feel anxiety. This cycle can eventually lead to clinical depression.

As with the other risk factors, it’s not guaranteed that a woman with postpartum stress will develop PPD—some will recover without ever getting clinical depression. However, some women do go on to develop PPD.
The Negative Feedback Loop

I call it a negative feedback loop. Others may call it something else. But for me, and I imagine most women, postpartum depression was like a vicious cycle. It started with my high (and unreasonable) expectations of motherhood, which of course I never met. Then I developed what’s known as distorted self-perceptions, where I thought I was a terrible mother for all sorts of reasons. (I also thought my kids would end up screwed up beyond all hope. Which might still be true, but not because of PPD.) And then I fell into the “cycle of despair,” where each thought feeds back into and intensifies the original negative thought.

According to what I’ve read, this isn’t an unusual range of emotions. The negative feedback loop can be difficult to break. But it’s possible, and many women have done it. (You can, too.) I had to believe in myself before I could do it. I got there, but it took a while.

Eventually, I learned there are situations I can change, and situations I can’t. The trick is to figure out which is which. I wear a bracelet that’s engraved with the Serenity Prayer to help me remember this.
Getting Better

According to the World Health Organization, depression is one of the leading causes of disability worldwide. It’s also the fourth leading contributor to global disease. So PPD—and any other postpartum mood disorder—is an illness, and don’t let anyone tell you otherwise. The good news is, because it’s an illness, it’s treatable.

Your treatment plan is something you should decide with your doctor. There are different treatment options available, but you and your doctor will be the ones to decide what is best for you.

Pregnancy books and online resources will have suggestions. These are usually along the lines of sleeping when the baby sleeps, going out on date nights with your husband, getting out of the house, talking to someone, or trying not to do it all.

Those suggestions make sense on the surface. But when I was at my darkest, lowest point, they were discouraging and unhelpful. I know I’m supposed to sleep when the baby sleeps. But I suffered from insomnia and couldn’t sleep. I knew I should be going out on date nights or getting out of the house, but it was difficult to get the motivation to go—and I knew I wouldn’t be good company. I tried talking to people, which ended disastrously. And someone (not my husband) was guaranteed to say something about me “slacking off” if I didn’t try to get everything done.

And not being able to do any of these things fed into my negative feedback loop.

I wasn’t able to follow those options until after I accepted I had PPD and reached out to get help. I got help when I was ready, when I finally realized something was wrong and wanted to fix it. This could be the case for you, too.

Treatments for PPD can include medication and counseling. The decision to take medication is one you’ll have to make for yourself, with your doctor’s input. Some people decide not to take medication and use herbal remedies instead. Others don’t take anything at all. This works for some people, but not for others. Please discuss it with your doctor first.

And despite what anyone might say, taking medication is a treatment, not a weakness.

Therapy or counseling is another possibility. This can be done in conjunction with medication, though some people only use therapy. If you decide to go this route, it’s important to have a good rapport with your therapist. You’re going to be sharing details of some of your darkest moments, so you should feel comfortable with him/her.

Developing a supportive social network is also recommended. For me, this has been the most difficult. I’ve always been able to talk to my husband, but I’ve had a hard time finding anyone else to talk to. I know it’s important to have supportive friends, people to confide in who won’t laugh at me or tell me it’s all in my head. But I also know that reaching out is hard. Unfortunately, I don’t have any tips to make it easier.

Everyone’s treatment plan will be different. Your plan is what’s best for you. As trite as it may sound, I know you can get better. It might take you a while before you’re ready to get help, and that’s okay. When you’re ready to ask for help, you can. There will be people willing and able to help you.

Just know that you can get help. You don’t have to feel guilty. And remember, there’s nothing to be ashamed of. We can all get through this.


References

Hitti, M. (2008, April 10). Postpartum Depression: How Common? Retrieved from http://www.webmd.com/depression/postpartum-depression/news/20080410/postpartum-depression-how-common.

Kleiman, K. and Raskin, V. (1994). This Isn’t What I Expected: Overcoming Postpartum Depression. New York: Bantam.

National Women’s Health Information Center. (2009, March 6). Depression During and After Pregnancy. Retrieved from http://womenshealth.gov/faq/depression-pregnancy.cfm.

Stevens, L.M. (2010). Postpartum Depression. Journal of the American Medical Association, 304(15). Retrieved from http://jama.ama-assn.org/content/304/15/1736.full.

World Health Organization. (n.d.). Depression. Retrieved from http://www.who.int/mental_health/management/depression/definition/en/index.html


June 2011 Edtion


Introduction

My name is Charlotte Cowie. I will be writing a
new monthly column for PPDA about topics within postpartum mood disorders.

I’m on the road to recovery from PPD and postpartum PTSD. I don’t know if I’m “cured,” but I do know I’m no longer in the pit I was once in. Days are brighter now. I’m happier. My husband’s happier. My kids are happier. My family’s healthier.

Now that I’ve gotten through the worst of the storm, I’m working toward raising awareness of postpartum mood disorders. I feel very strongly about putting PPD front and center in people’s minds—particularly new and expectant moms. Tascheleia was kind enough to allow me to contribute to PPDA.

PPD is an illness, but unfortunately, not everyone believes that. A lot of people in my own social circle waved it off or treated it as something that happens to “other people” or “weak people.” Well, I’m not an “other.” And even though it took me a while to realize it, I’m not “weak.” Neither are you.

My Story

It took me a long time to realize I had PPD. It took every ounce of strength I had to reach out and get help. Not everyone supported me. In fact, few people did. I found that few people believed PPD exists, while others thought that depression in general is something that can be switched on and off (if only that were true). Others said unsupportive things like “It’ll pass,” “Don’t even bother trying,” “It’s not about you, you know, so quit trying to hog everyone’s attention,” “Snap out of it,” “You just can’t cope,” etc.

Friends and family weren’t particularly helpful, and their words did nothing at all. Except, of course, make me feel worse. I thought I really was just a bad mom, unable to cope. Maybe I was selfish.

But I wasn’t. I was none of those things. I just didn’t know that at the time.

My PPD began as postpartum PTSD. When complications during the birth of my oldest daughter led to an emergency C-section, I was traumatized, in shock—and felt guilty. It was as if, for whatever reason, my body had “failed.”

It seemed to fail even more when I realized I was unable to breastfeed, which was something I’d planned to do. To add insult to injury, the community health nurses kept pushing, trying to get me to continue to breastfeed. They pushed so much, they were telling me—in conversation, not implied—that I was a bad mother for even thinking of switching to formula. I would be a terrible mother if I actually did it.

For a new mom who was still recovering from a C-section, this kind of failure was devastating. I felt guilty, as if I’d failed my daughter somehow simply because she was getting milk from a can. I became very down, very isolated, and very quick to anger, and I still saw myself as a bad mom.

I had a hard time keeping up with the housework. In fact, I couldn’t bring myself to do any housework. Then I felt guilty at the end of every day because I hadn’t done anything fun or educational with my daughter, and because I hadn’t done any housework.

It was a vicious circle.

Somewhere along the way things seemed to get better, but I realize now I’d just convinced myself that they were better. I wasn’t actually coping any better than I had before. But I thought I was. So I thought I would be okay with two children.

I had another run-in with PTSD after the birth of my younger daughter. The birth itself was fine—I’d had a VBAC and now had a beautiful, healthy little girl. The VBAC was good because it was successful. It wasn’t good because I almost died from a postpartum hemorrhage caused by possible retained placenta and a uterine infection caused by…something (no one actually knows).

My PPD grew worse, a result of it going untreated for nearly two years and because of my second bout of PTSD. I grappled with the trauma of my hemorrhage, trying to come to terms with what happened, trying to understand. But I didn’t know how to handle it properly.

To make matters worse, when I got home from the hospital, I found that other than my husband, I had no one to talk to. Whenever I tried, conversation would sputter to a stop and people would get awkward. People said insensitive things and acted in insensitive ways. Some people told me to stop having kids. Some just shrugged it off, like it wasn’t a big deal. Others just stopped talking to me altogether.

After that, I couldn’t bring myself to talk to anyone about what happened. What if their reaction was the same? What if they just laughed at me again? So I kept quiet. And kept spiraling downward.

When I did realize that something was wrong, I sought help right away. Recovery was hard because of my lack of support. I was also ashamed—ashamed people would find out I was being treated for PPD, ashamed about the possibility of being judged, and ashamed of being ashamed.

Needless to say, the path to recovery led everywhere else but recovery. I didn’t think I’d ever get out of that pit.

But I did. Granted, a lot of it had to do with the fact that I moved to Texas, where I was able to get the support and proper treatment that I needed. It was easier for me to stay on the path to recovery when I could start fresh in a place where I didn’t know anyone. Here, I wasn’t ashamed. I didn’t feel like I would be judged, because no one knew who I was. Here, I could concentrate on getting better.

For me, what ultimately worked was moving, starting fresh. This won’t be the case for everyone. What’s truly important is that women suffering from any postpartum mood disorder get the help they need—and the support they require.

As a result of my experiences, one of my goals is to help raise awareness of postpartum mood disorders. Too many mothers suffer in silence because the people around them don’t understand the gravity and severity of these illnesses. Regardless of what anyone might say, PPD is an illness, and it needs to be treated as one. But it also means that it can be cured.

With my column, I hope to write informative articles about topics related to PPD and postpartum mood disorders in general. If there’s a particular topic you’d like to see covered, please let me know.

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