I haven't had PPD (never having been pregnant), but thank you for this post. It is so important to talk about these issues. I grew up in a family of mental health professionals (dad is a psychologist married to a social worker; mom is a librarian at a mental health hospital), so I have been hearing about the importance of psychological health my whole life. Please please please remember: There is nothing shameful about having depression (post-partum or otherwise) and nothing shameful about needing help. Don't be afraid to talk to your partner, your family, and your doctor if you are having trouble coping. And like Blade said, don't be afraid to accept or ask for help.
I have never been diagnosed with PPD, but I have had some baby blues that leave me with a lot of sympathy for women who do suffer with it.
I did not notice anything with my first or second child apart from what I expected with exhaustion, feelings of inadequacy, or frustration. With my third I think really delt with baby blues. I remember about 2 months after he was born I would break down crying for completely ridiculous things. I remember I was really scared to leave the house because I was terrified I was going to forget one of my kids either at home or the place we were going. I really was so scatterbrained that this was a legitimate fear. I obsessively counted my children all of the time and sometimes I would panick because I thought I had 4 children instead of 3. I also would get really panicky at night and couldn't sleep. My husband, who I think suspected what was going on, would stay up listening to everything that I had to say and would rub my back to help me relax. I don't remember how many months I felt like that, but it eventually tapered off to where I felt myself again.
I'm definitely familiar with the topic. I'll share what I can here with only a bit of time to post while the babies are nursing. Since I have a pre-existing condition (bipolar disorder - which was previously diagnosed as depression, general anxiety disorder, and post traumatic stress disorder), it was pretty easy for me to see the signs that I was suffering from PPD-since the feelings were not new to me. However, I can definitely see the danger and stigma in a new mom, who had not had those types of feelings before, not coming forward or asking for help because they believe they are within the normal realm of emotions after birth.
It's definitely more than the "baby blues" (not to discount that by any means) or feeling overwhelmed and tired by being a new mom. It's a feeling of constant worry and dread...like you can't bare to get out of bed or face the world. It's a feeling that you can't do anything right and are not worthy of being a mom. My only strange aspect is that I don't get PPD symptoms right away or even within a month or two of birth. The critical time for me personally seems to be 3-6 months and as I'm starting to get into that period now, I've started to take alot of precautions and keep on top of any symptoms quickly. My earliest symptom or sign that I am going to have an episode or need to make adjustments to a current treatment is "racing thoughts" and lack of concentration. I feel this beginning to happen to me some days and it makes me fast forward and worry about what may be in a few more weeks, but over the years I have developed pretty good (not perfect!) coping skills so I can stop those negative thoughts in their tracks. Because of my long battle with bipolar, my DH and I are pretty intune to my earliest symptoms and we know what works to get me stable. I don't LIKE alot of the things that get me where I need to be (I'm not a medicine fan), but I know what needs to be done if it comes to that.
The only time I've really been diagnosed with PPD was after #2 was born. I was about 3 months pp when I decided I needed to see my therapist and look into medication. He diagnosed me with PPD, but because I had some history with him, he wanted to explore a bipolar dianosis too. Then, a month later, I had a very serious episode and he actually called that "post partum psychosis" (still to this day one of the scariest sets of words I have ever seen)
Some of my symptoms: I tend to swing alot more towards "mixed episodes" or straight mania than full blown depression so they may be different than traditional PPD. Anxiety- worrying about everything, not having an confidence in decisions I've made or being able to make decisions in general (little things like what to wear in the morning could take 40 minutes), feeling alot of pressure to set high goals or be "super mom", not being able to sleep, not being interested in things I normally like alot (even something simple like a tv show- I'd be bored with it or feel like I didn't deserve to watch it because I didn't finish X first), starting a ton of new projects, but never really having any long-term intentions of finishing them, not wanting to socialize at all, etc.
So for me getting past this - I need my DH and extended support system (other family members), I take time for myself to do yoga each day (it's my love) and to read and meditate. I also have a "quiet time" every afternoon here. Everyone has to do something quiet and that gives me alone time to gather my thoughts, journal, call a friend, write a letter, or maybe just text DH or something like that...or it gives me uninterrupted time to finish a task I had started earlier. I really value "quiet time" My faith is a really big part of my recovery. I have several bible verses that I meditate on and repeat to myself when needed. I pray for strength and help.
The last thing I wanted to add was if you do need medication -it's a great thing at times- please speak to your doctor about Dr. Thomas Hale's book on meciations while breastfeeding. Pediatricians, OBs, and Psychiatrists are all great people and they have great intentions for you and your little one, but Dr. Hale has studied and tested this specific topic. He is the expert and he will consult with your doctor or they can pick up his book for information. I continued nursing while taking medications (I've never started taking meds before 4 months after birth though so my nursling(s) was larger and not nursing round the clock then, which Hale often uses as a good guideline for safety). There have only been a few times (I've tried soooo may different drugs and combos over the years) that I've "pumped and dumped" and that was only to be conservative.
Crunchymama, thank you!! Lots of great advice, and it's good (for me at least) to hear from someone else with bp. Boyfriend read your response and has already put "quiet time" and yoga time down as essential parts of the day. It sounds like your husband and you are able to deal with it very well, which is wonderful.
What I'm scared of is the shame. I know that I am at this moment aware of the possibility, and I know it's a normal condition and nothing to really be ashamed of, but when you get PPD I would assume the shame and horror takes control, and I'm terrified I'll be able to hide it from people. I'm already sad about not being able to breastfeed, it feels like one of the biggest most important mother-baby bonding things is taken away from me, and the lack of sleep and extreme uncomfortableness of the late stages of my pregnancy, and I am scared I'll go into motherhood sad and depressed from the start.
I have struggled with depression before so I tried to prepare for ppd in a few different ways. I talked a lot with my husband to open his eyes to some warning signs because I know it is the kind of thing that a person might not recognize as happening to herself in the moment but maybe a loved one could see it (as a result, he was so patient and lovely -he always is but he treated me with extra sensitivity and sweetness <3 and regularly checked in with me to see how I was feeling).
Labor did not go how I had envisioned and I took that pretty hard. Eventually, though, I decided to promise to be gentle with myself -that no matter how labor/delivery/the early days went, I was a human worthy of kindness from myself and I was determined to take care of myself as well as my baby.
When I am overwhelmed or sad, I tend to withdraw from others and I was afraid of that happening, especially made easy by a big move to a new state just after our baby was born so I had heart to hearts with my dear friends (the best people in the world, I'm convinced) and they never let me slip away. They kept calling and sending letters/packages/cards, they visited me, and no matter how terrible I was at returning phone calls, they held me close and supported me, they told me I was a great mom. I didn't end up with ppd but I was exhausted and had a hard recovery from delivery (fractured tailbone :( among other things) and I am incredibly grateful to have felt so cared about and it was so comforting to be affirmed like that in my new role as a mom but also remembered and valued for the things that make me "me".
Anyways, it was a very stressful time for a lot of reasons but it gets easier, it really does. I wish someone had told me that then. As much as I tried to prepare, I still cried a lot and worried that I should be happier. How could I love this baby so much but still be so stressed?? I wasn't prepared to be "on" all the time, you know? I didn't know that some babies hate, hate, hate to be out of their mama's arms for 2 minutes or that I would spend hours and hours nursing every day. -or that breastfeeding might be challenging! Ultimately though, I fell wildly in love with my little baby right away and more and more each day and I decided he deserved a mom who was happy and that gave me peace to take care of myself (a crying baby in a crib would stress me out so much but really, he was okay, and the shower that I put him down for 10 minutes to take was so, so good for my outlook).
Also, though, I was endlessly patient with my baby but I found I had a shorter fuse with my husband. He gently brought it to my attention when I wasn't fair to him and worked with me to figure out what was going on. -I mean, I was pretty ridiculous sometimes. I remember my husband taking the baby into the living room in the morning to let me sleep in a little and baby started crying and husband waited 30 seconds to soothe him and I was so upset! :s I am so thankful to him for not taking these things personally since they weren't like me and instead, being concerned for me and wanting to help. I did get dressed and out of the house most days, even for just a short walk, it really does help.
Ooh, and, this may sound frivolous, but I have always enjoyed playing with clothes and dressing up and it was hard to not feel like myself and to not have a practical wardrobe I felt good in right away. Right after giving birth, few of my clothes fit but the maternity ones were not nursing friendly so it was a recipe for yoga pants and tank tops, which is fine but did not make me feel good. Once I bought a few things that were a little more polished and easy to throw on, it was a lot easier to leave the house -which was huge for me. Eventually my clothes fit again but it took me a long time to be able to really exercise because of my labor injury and that was another hard thing. I just assumed that I would have my baby and resume my fitness activities and that would help with my mood and body image.
Oops, sorry for the novel. But to those of you in the thick of this business of becoming a mother or maybe you already are one, please know, motherhood is challenging (sometimes incredibly so and definitely in ways that you didn't imagine) but you are likely a wonderful mom and no one will love your baby as you do. I am cheering for you. Please be gentle with yourself and let others help you. You are precious, you matter.
Thanks to everyone thus far for sharing their stories. I really have noticed one common theme (which I felt too, exhausted and cradling my newborn): there is an incredibly perverse belief, sometimes unfortunately propagated by 'experts,' that once the baby is born the mother must subjugate absolutely everything to the child. After all, motherhood is about sacrifice, right? Firstly, I reject the belief. I think new mothers need to sleep, shower, socialize, engage their brains, relax, etc, just like other human beings. But secondly, if you're grinding yourself down to a little nub in caring for this child, you aren't providing good care.
I personally found it impossible to appreciate the degree of sleeplessness. As crunchymama can attest, there is nothing quite so sleepless as surgery residency, and I was thriving in surgery residency. What I failed to appreciate is the unrelenting nature, the lack of a 'post-call' day. Sleeplessness is usually a symptom of, rather than a cause of, mania and depression, but it can absolutely tip people over into mania. This is why again I think the incidence is so high in women with preexisting BPD (50% in women with bipolar I, 40% in BPD II). And the thinking on psychotropic medications thoroughly rejects their complete and total withdrawal throughout pregnancy and breastfeeding. Lithium in particular is safe after the first trimester, as are most anti-depressants. Again I think this reinforces the point that new mothers absolutely should prioritize their health and sanity equally with their baby's, because in doing so they are providing better care.
@labmama what happened to you was horrific. I'm not sure that could even be called PPD since it had such a specific and readily identifiable cause. The position of wetnurse has existed since the beginning of time in all human cultures precisely because the ability, and desire, to breastfeed is nowehere near universal. A minority, but still a very substantial fraction, of women cannot produce enough milk to adequately nourish a baby. It has always been thus. It is not a matter of willpower or technique. The kind of shaming and bullying you experienced really upsets me.
I will also echo ottilie's recommendation of a cleaning service. It might seem like a luxury to some, but if you find a spare $100/wk in your budget it makes a great deal of difference. And while a night nurse will frankly be out of most people's budgets (and in the US at least unavailable outside of major cities) coming up with shifts of care duties helps a great deal. I personally found breastfeeding to be enjoyable-- in moderation. I was more than happy to hand off feeding to duties to someone else. As you baby is older it is more realistic to pump extra milk throughout the day again to allow someone else to feed the baby, if you are truly deeply philosophically afraid of formula.
Thank you so much everyone for your bravery and honesty in your posting. Ladies, you need to know that I have so much respect for you all. Depression isn't easy.*
And thank you Blade for bringing this topic up.*
I'm not a mum, nor will I be one soon, but this thread caught my eye.
I've been dealing with depression and anxiety attacks for years. It really hit me while I was in the midst of high school. I've never liked the way I look, the way my voice sounds, my personality, etc, and being an insecure teenage girl in a cliquey high school didn't help.*
One of my fears is that when I do have a baby, PPD will hit, and I won't know what to do with myself. Even now I have a hard time realizing I'm getting more and more depressed (I like to deny it. A lot.) and how I can prevent it, or help myself. I already find myself nervously wondering if someone like me would be able to be a good mother. I struggled with thoughts and intentions of suicide for a few years, and while I don't have those anymore, I am still afraid of them returning in my future, even more afraid of them returning while I'm a mum.*
I also had a question for anyone who has taken anti depressants; I've been told by doctors that most are not safe to take while pregnant or nursing. One my doctor wanted to put me on wasn't safe if I ever wanted to become pregnant. Is this true?*
Blade, you mentioned that most are safe after the first trimester?*
Thank you again, ladies. You are all super women.
I'm on a rather strong dose of lithium. I went off it when I found out I was pregnant (lithium can lead to heart problems for the baby). I didn't plan on going back on it till after baby was born, but I had a massive manic episode and then crashed into a complete depressive state (which lead to hospitalization) and was put back on. I've had to go into the hospital to have my baby's heart monitored pretty regularly after that, but it's worked out fine. There are other medications that are safer when you're pregnant, but lithium is the only medication that works for me. You can't breastfeed on lithium though, because the baby will absorb it through the milk.
Actually lithium is safe in lactation. The biggest risk is a certain anatomic anomaly in the heart, called Ebsteins Anomaly, but once the heart is formed (very early in pregnancy) thou can take lithium safely. It does prolong the qt interval on the electrocardiogram which predisposes to certain arrhythmias, but very good long-term data (18 years following the same cohort of children) shows children who breastfed to lithium-taking mothers, or those exposed in hero in later pregnancy, have no increased risk of Mila, mental cognitive, or emotnal problems.
The anti-seizure medications sometimes used as mood stabilizers, valproate in particular, are NOT safe, at all, and are strictly contraindicated in pregnancy and breastfeeding.
Atypical Antipsychotics such as quetiapine are often used in bipolar patients. There isn't as much long-term data but a very very low percentage of the drug is excreted in breast milk so they are thought to be safe.
Lamotrigine is also safe.
SSRIs in particular are very well-studied in pregnancy and breastfeeding and are considered safe; sertraline in particular is used as the first-line treatment for PPD in a breastfeeding mother.
@ottilie thank you very much for candidly sharing your story. To be honest I did wonder if something like that had happened to you given some of your comments here, as well as your brief absence from the forums. If you don't mind me using your story as an example I think that's exactly the sort of thing we were discussing above. All of obstetrics, and to a lesser extent pediatrics, is about the maternal-fetal dyad, and privileging one exclusively over the other isn't good for anyone.
@irelandrae, I'm sorry to hear of your struggles. I find it maddening that your doctors would tell you so blithely that antidepressants are off-limits; I think this reflects a very poor understanding of the seriousness of mental health issues during pregnancy and otherwise. As others have said, the implicit (and explicit) pressure upon mothers to sacrifice their mental health is toxic to mothers, babies, and families alike. It's good to be informed about about any medicines you might ingest during pregnancy, but generally speaking I think that what's good for the mother is what's good for the baby. I think, too, that ottilie offers a good example about how any risks to the baby of exposure to medication must be weighed against risks of exposure to maternal illness.
And @ottilie, I know that can shame can be a very formidable aspect of depression and other mental health issues, especially for mothers. It sounds like you've take some important steps to help yourself both now and postpartum, and it sounds like your partner is very supportive, which is awesome. Unfortunately, many messages that are perhaps meant to be empowering (e.g., with regard to natural birth and breastfeeding) can on the flip side be very shaming and blaming. My one piece of advice would be to try to limit your contact with anyone who is not completely supportive, with anyone who doesn't get it or who stirs up any self-blame or shame. This isn't always possible, and I myself wasn't so great about setting limits, but I think it might have helped if I'd managed to keep certain people away for longer.