Tag Archives: PPD

Guest Blog: PPD may have delayed onset…

…and recovery is always possible

My first year with the baby was dreamy, so when I started to decline, I didn’t think it was Postpartum depression (PPD). The docs had said PPD could occur anytime in the first year. They didn’t say what it was when depression occurred after that. Since my self-esteem was plummeting, which is one of the hallmarks of PPD, I concluded that my downward spiral was my own fault, due to poor management of my time and energy. It got ugly as the chemistry in my brain lost more and more balance.

sun-in-fog

What it felt like is that the sun that energizes the earth and had brightened my day was no longer available. I couldn’t feel its warmth. People often use the sun metaphor when talking about depression. When the depression lifts, they say, it is like the sun comes out again. This is very much what it was like for me. When the sun was absent, it was so frustrating because I knew what was missing – a connection to the universe – but I could not get it back. Movement, light, forward momentum – they were gone.

For me, PPD was closely related to the amount of sleep I got. It resolved almost immediately when I got five consecutive good nights of sleep at my mom’s house. She cooked for me and did laundry while my sister looked after the baby. I wrote this poem about it:

Usually, when you walk, you go forward.
In the dark season, your footsteps dissolve in the mighty, silent ink.

Lost, you have no choice but to sink into what you cannot see.

You reach out but your hands slide down the slick walks of despair,

grasping nothing.

This relentless, downward pitch can only be a vein of hell.

And then,

the baby sleeps through the night, you get a day off, you lie down and rest.

Stop

Stop

Stop,

beats your heart. Your mind says nothing.

You feel heat again in your spine. You see orange at the corners of your eyes.

This quiet place at the bottom where the flame always burns,

must be a chamber of heaven

that it took the darkness for you to see.

I wish that I had known sooner that what I was experiencing was a delayed onset of PPD. I would have sleep-trained the baby earlier, and arranged for more visits like the one I just had at my mom’s. A late-onset PPD diagnosis also might have prevented a lot of anger directed at myself for being such a failure at managing my life. So I say, if you have a child under two and you meet the criteria for PPD, it probably is PPD and deserves to be treated as such. At the risk of stating a cliche, you deserve the support you need to feel better.

smileandlean

Sheira Kahn is a recovered bulimic and Marriage and Family Therapist who practices in the East Bay and Marin County. She teaches self-esteem workshops and classes on reducing emotional eating and is co-author of The Erasing ED Treatment Manual, available on Amazon.

At the age of 50, she gave birth to Alexandria in April of 2014. Her blog can be found on www.sheirakahn.com.

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Bitchy is not a feeling (but it could be the baby blues or Postpartum Depression)

bitchy clip artOne of the most surprising aspects of the baby blues and Postpartum Depression for me to learn was how it can show up as irritability, anger, or anxiety. I know I personally never felt like a b*tch (Yes, I know from 16 years of recovery, 14 years of working in mental health settings, and a doctorate in Clinical Psychology that “bitch” is not a feeling) nearly as much as I did after becoming a mom. After becoming a mom, my “b*tch” feeling levels skyrocketed.

How does one know if these feelings (irritability, anger, sadness, loss of self-esteem) are in normal range of mommy/personhood and when they are of concern and needing attention and mental health support?

Shoshana Bennett, Ph.D. (co-author with Pec Indman, Ed.D. of Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression, 2010) offers two simple criteria:

1. The symptoms last longer than two weeks
Postpartum Depression, like non-perinatal depression, includes symptoms for at least two weeks that can affect changes in appetite, sleep, loss of self-esteem, and lack of pleasure. Hormone changes are dramatic postpartum and the baby blues are usually a result of feeling this dramatic change and resolve within two weeks postpartum. 50-80% of women experience the baby blues. The baby blues are much shorter in duration. PPD can be difficult to detect as what new mother isn’t struggling with changes in appetite, sleep, and self-esteem?! However, PPD is more persistent, and:

2. The symptoms are severe enough to get in the way of normal functioning, even if they occur during the first two weeks.
Perinatal mood disorders (including not only depression, but also anxiety, OCD, psychosis, and Bipolar) are more persistent and pervasive and can interfere mildly or dramatically in functioning and care for yourself and your baby.Postpartum Depression (PPD) affects 1 in 5 women (this is the latest evidence- it used to be 1 in 7. I imagine this is due to more women speaking up and receiving help, not more women being affected).  If the symptoms are severe enough to get in the way of normal functioning, even if they occur during the first two weeks postpartum, it is considered to be PPD.

But what ARE the symptoms and how do they show up?
The following are a list of symptoms interspersed with statements made by women suffering from PPD (excerpted from This Isn’t What I Expected by Karen R Kleinman, LCSW and Valerie Davis Raskin, MD, 2013) and comparisons between the baby blues and PPD (excerpted from Kristin B. Hodson, a psychotherapist, and founder of The Healing group.com, a center for Women’s relationship health):

Anger

“Every little thing gets on my nerves lately. Sometimes, I am even furious with my baby. Often, I am angry at my partner.”

The Baby Blues: One minute you love your husband and the next you want to bite his head off.Postpartum Depression: You are beginning to wonder why you married your husband in the first place, you are continually angry at him, and you consider throwing the vase at him.

The Baby Blues: One minute you are smiling at the baby and the next you feel irritated that you have to get up to feed them the fifth time that night.
Postpartum Depression: You’re dominated by anger daily, not just waking up to feed but towards others and life’s situations that you used to be able to handle.

Sadness/hopelessness

“I cry at least once per day.”

“I feel sad most or all of the time.”

The Baby Blues: You haven’t showered in three days, you have dried milk on your clothes, and you burst into tears at a moment’s notice.

Postpartum Depression: You haven’t showered in a week, you don’t remember the last time you did laundry, and you are crying most of the day, every day.

Poor concentration

“I can’t concentrate.”

Baby Blues: You walk into a room and forgot what you were looking for.
PPD: You cannot remember/memorize facts and figures needed in your professional life, that prior to pregnancy, were easy for you and your baby is 9 months old.

Loss of pleasure/lack of sex drive

“I can’t remember the last time I laughed.”
“I have no interest in making love at all, even though my doctor says I’m now physically able to resume sexual relations.”
“I don’t enjoy the things I used to enjoy.”

Fatigue and difficulty sleeping

“I can’t sleep, even when my baby sleeps.”
“I have no energy, I’m tired all of the time.”
“I have no appetite and no enjoyment of food or I am having sugar and carbohydrate cravings and compulsively eating all of the time.”

Low self-esteem

The Baby Blues: You haven’t had a thought about putting makeup on in a week and you don’t care that you are wearing your pregnancy pants because your focus is on recovery and the baby.

Postpartum Depression: You’re feeling so overwhelmed and out-of-control that you start focusing excessively on your outward appearance so people don’t know how bad and out of control things really are for you.
The Baby Blues: You wonder from time to time if you are really cut out for this mothering thing.
Postpartum Depression: You think you are not cut out for the mothering thing and start having regular fantasies about getting in your car, driving to Canada, and never returning because everyone would be better off.

This list is not intended to diagnose or treat PPD. A full assessment and screening can be done by a therapist (MFT, Psychologist or Psychiatrist) trained in perinatal mood disorders.

If you are having thoughts or a plan of hurting yourself or your baby, you need immediate attention and support. The following is a 24-hour crisis line for new moms.Postpartum Depression Phone Support: 1-800-773- 6667 (1-800-PPD-MOMS). This helpline is available 24 hours a day, 7 days a week for anyone experiencing depression during and after pregnancy, as well as for anyone concerned about a new mother. The telephones are answered by trained crisis counselors who can provide information and referral for treatment.

Postpartum Depression: Naming the Pink Elephant (Rat) in the Room

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Common sense disclaimer: this blog is not intended to diagnose or treat Postpartum Depression (PPD). For a list of resource referrals for PPD screening and treatment, see end of blog.

Recently, I attended a talk at a well-known research university and teaching hospital in San Francisco on the maternal brain. I was so excited to learn more about how the brain is affected during pregnancy and postpartum for mothers, especially as it affects women in recovery, women who struggle with Postpartum Depression (PPD), and their bonds with their children, I excitedly prepared to meet other clinicians and mommies working with mommies and their postpartum brains.

To Read the full article, go here: http://psychedinsanfrancisco.com/?s=postpartum+depression

If you have PPD or if you are in exhausted new Mommy boot camp, consider that your vulnerability is actually your greatest gift. Consider that the emptiness is the way out, because the way out is through.

Helpful links/Resources:

National Postpartum Depression Hotline: 1-800-PPD-MOMS

Suicide Prevention & Crisis Hotline
(415) 499-1100
It is important for women who might be experiencing suicidal thoughts/ideas/plans to call this number.

Postpartum Support International to provide resources in your area:
http://www.postpartum.net/Get-Help/Support-Resources-Map-Area-Coordinators.aspx

TALK Line
Parental stress, child abuse prevention, emergency respite care, single parent network, parents’ group, crisis counseling, substance abuse services and ongoing therapy. 
(415) 441-KIDS (5437)
TALK
www.talklineforparents.org/

GoldenGate Mother’s Group therapist referrals and resources:

http://www.ggmg.org/recommends/Postpartum.html

Postpartum Stress Center:

http://postpartumstress.com/helpful-links/

Linda Shanti McCabe holds a doctorate in Clinical Psychology and works with women (including pre and postpartum) recovering from food, weight, and body image issues. She holds SoulCollage® groups for women (including pregnant and postpartum) using expressive arts to find and express the many parts of the Self. You can find her at: WWW.DrLindaShanti.com

 

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