When Postpartum Depression isn’t Depression

Our youngest daughter was conceived via IVF. When we went in for the transfer, the on-call doctor matter-of-factly informed us that our embryos were all doing very poorly and were not going to survive. In fact, he all but assured us that the transfer wouldn’t take and suggested that we start planning our next attempt. But 11 days later, the lines on the pregnancy test told us she was here.

Her hCG numbers crept up slowly. Increasing, but never quite doubling. Our nurse mentioned the possibility of a chemical pregnancy. Blood was drawn again and again and again. But then  the hCG levels finally skyrocketed. She was still here.

At 20 weeks, I found myself in Labor & Delivery due to severe dehydration from a stomach virus. During the ultrasound, we learned that I had only 1 artery in my umbilical cord, instead of the usual 2. She was getting only 1/2 of the nutrients that she should be getting. But she grew. At appointment after appointment, we learned that she was barely hanging on to the very bottom of the growth curve.

At 39 weeks, my water broke. It was 16 hours of not-much-happening, followed by the terror of hearing your OB call for an emergency c section. The urgency of the race down the hall, seeing nurses literally drop their files to run along side me, and the doctors and nurses shouting over each other, all sent me into a panic. Probably unfounded, but when the anesthesist finally put the mask over my face, I knew in my heart we had lost her.  But just 11 minutes after my OB’s eyes told me something was very, very wrong, my baby was delivered and unwrapped from the cord that she had been trussed up in. She was breathing and pink. She was here.

Our baby had proven herself a fighter every step of the way. But I couldn’t see it like that. In my mind, I imagined a figurative Grim Reaper hiding in the shadows, determined to finally take the baby who wasn’t supposed to be here. I started imagining every sort of horrible death that you could imagine – for both of my girls. Drownings, fatal car wrecks, falls down stairs. There was suddenly danger everywhere. And the images weren’t just fleeting thoughts, they were nauseatingly graphic and they lingered, haunting me for the better part of the day or night. I avoided going downstairs while holding the baby out of fear I would trip and crush her. While wearing her at the grocery store, I had to kiss the top of her head at every aisle to convince myself that she was there and not forgotten in the car in the 90 degree heat. At one point, I was so worried about SIDS that I decided to stay awake while my baby was sleeping so I could make sure she was breathing. I settled into my rocking chair, leaned towards her bassinet & just sat, determined to watch until morning — that night and every night after until the danger of SIDS was gone. That is the moment when it finally occurred to me that something was very wrong, but I didn’t know how to gain control of the horror film that was constantly running through my head.

I wasn’t depressed.  Once the initial hormone dump was over, I wasn’t crying. I wasn’t lethargic and down and unwilling to get out of bed. If anything, this intense need to protect my children had me at near-manic alertness. As I called around to find a therapist to talk to, one said,

“It sounds like you have some postpartum depression and I think you need to be seen as soon as possible.”

“Ok, but I’m not depressed, so this isn’t PPD,” I insisted.

 

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And that started my journey to understanding that Postpartum Depression is very often not actually depression. Of course, in many cases it is, but it is also anxiety, OCD, and more. Recently, it has been recategorized to Perinatal Mood and Anxiety Disorders to attempt to better reflect the reality of the range of experiences that women (and men!) can have. And this is one case where wording matters, because if you’re only looking for depression, it’s easy to miss some of the other symptoms, and early detection and treatment is important in getting “you” back. Even many OBGYNs who are (thankfully!) now screening at the 6 week check up are using a standard depression screening. You know…the one that asks the mother of a 6 week old if she has experienced any changes in her sleep schedule.

Thankfully these days, women are more alert to signs like lingering baby blues, crying spells that last beyond the first few weeks, difficulty bonding, disinterest in things that used to bring joy, and more, during the first few weeks or months after birth. But it’s important to know that PPD/Perinatal Mood and Anxiety Disorders may also start at any point in the first year…or even during pregnancy. It may present as anxiety, anger/rage, intrusive thoughts, or even physical symptoms.

Every one of these feelings can be normal in the weeks and months after adding a baby to your family. But it’s the severity and length that will tip you off to the need for help. If you have not felt like yourself for 2 weeks, if you’re having more bad days than good, and/or if your feelings are starting to affect how you live your life then it is time to reach out for help.

It’s now estimated that 1 in 8 women suffer from Perinatal Mood & Anxiety Disorder.  If you’re feeling a little out of control, it’s important to remember that you’re not alone – by any stretch of the imagination – and that you don’t have to live like that. You can get you back, and the earlier you can get help the better it can be.

If any of this sounds familiar, or if you suspect you may have Perinatal Mood and Anxiety Disorder, please reach out and get help. Ideally, try to find someone who specializes in postpartum care. Someone who is familiar with different treatment options, who can paint a realistic picture of what recovery looks like, and who is up to speed on the latest research regarding medication and breastfeeding (if that is a possible hurdle to seeking treatment).

Here are a few resources to help you learn more and find support, if needed:

  • For 6 Surprising Symptoms of Postpartum Depression and Anxiety, check out this article.
  • For a full list of symptoms of depression, anxiety, OCD and psychosis, look here.
  • Both of the above links go to PostpartumProgress.com which is an incredibly helpful site in general.
  • For local support as well as general information, check out Postpartum Support International. The Georgia listing is here and includes contact information for the local Atlanta Coordinators and several nearby support groups. The coordinators will help folks get the resources they need during this period. Depending on your needs, that may be a therapist, support group, lactation consultant, doula, warm-line, fitness group, reference book, blog etc. They also offer training and talks to help educate the community on Perinatal Mood and Anxiety Disorders.
  • Mental Health America of Georgia also has some great information on their Project Healthy Moms site.
  • And a brief word of caution. There is an incredible amount of information and support online, but be careful not to let yourself be drawn in to online support at the expense of real-world help. During vulnerable periods, anxiety and doom and gloom can be contagious. A new mom support group or playgroup can be a great first step in building your support network, since much can be resolved when a mom doesn’t feel isolated.

And it bears repeating one more time: PMAD is treatable and the quicker you get treatment, the quicker the symptoms will decrease.

 

A big thank you to Elizabeth O’Brien, LPC, who helped me with the resources section of this post. She is a volunteer co-coordinator for Postpartum Support International and has been in private practice since 2004. She has had the opportunity to train doulas, public health nurses, early childhood educators and the community on Perinatal Mood and Anxiety disorders, runs women’s groups on Mindful Mothering, and is currently co-developing a lecture series on the psycho-social aspects of the postpartum years. Currently, Elizabeth is facilitating a free New Parent Support group every Friday at Intown Midwifery from 11:00 am-noon, and a Free New Moms Support with NorthSide Hospital every other Thursday 10:30-11:30 at the Baby’s “R” Us in Dunwoody. She is currently accepting clients. You can reach her via her website, facebook page, or call her at 907-378-6972.

Mother With Baby PMAD

 

 

 

 

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Alicia

A New Orleans girl turned Georgia peach and stay at home mom to 2 daughters. Before taking the leap into full time mothering, I worked at at an Atlanta-based advertising agency. I have lived in Smyrna for almost 10 years and am still not sure how I managed to find a job more chaotic and unpredictable than advertising.

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Comments

  1. Fantastic Alicia, I am so glad you were brave enough to write your story. You can’t imagine how many families you are going to help. Thank you.

  2. Excellent article. As a peri-natal massage therapist and yoga therapist, I’ve been researching yoga as treatment for Perinatal Mood and Anxiety Disorders. I recently met with Elizabeth O’Brien’s colleague, Jacqueline Cohen, as a resource for my research. I’d love to talk with you, if you’d like to connect. You can email me via my website, http://www.mother-to-mother.net. All the best, Rebecca Leary Safon NMT RYT 200

    • Thank you! I actually recently started yoga just for some all-around benefits. I’d be very interested in hearing more about using it as a treatment! I’ll be in touch.

  3. Thank you for sharing your story. So many moms suffer alone and without knowing this exists.

    • You’re welcome! I agree that there’s comfort in just discovering that you’re not alone in those feelings.

  4. You just described me with my 4th child! I like you, gave birth to the “child that wasn’t supposed to exist.” My only daughter. My husband was on his first tour overseas, and had to leave half way through my pregnancy. I had suffered the classic PPD with my 2nd son, and sought help. This was like nothing I’d ever experienced. I couldn’t sleep because I was so scared she’d stop breathing, I was playing single parent and all I could think was if she dies it’s my fault. Germs?? Oh my. No one was allowed to touch her! I sanatized everything all day every day. It was a crazy time. I think so many mistake that behavior for normal new mom symptoms. It’s defenitly more than that!

    • I know that most new moms have some disturbing thoughts here and there…I don’t recall the exact percentage (if Elizabeth is on here, maybe she can chime in), but I seem to recall that it is the majority of new moms. However, it’s no longer “normal” when it starts affecting your everyday life, when you feel like a stranger in your own body, when every tiny thing provokes anxiety or rage. I think that people are trying to be reassuring when they say “that’s normal,” but it’s really a huge disservice to the mom who is struggling, and it probably causes tons of moms to continue to suffer in silence. I get so frustrated when I hear about friends whose concerns are blown off when they’re trying to get support. Especially since reaching out in the very first place is often a huge step.

  5. Thank you for this. I had PPD after both my babies were born. With my son, I was so afraid I would drop him when he cried uncontrollably and I couldn’t help him and I got upset with myself for not knowing how to be a mother to him and sure I was screwing it all up. With my daughter I was terrified that I would drop something on her when she was on the floor in her bouncy chair (something that did happen eventually, but it was only a loaf of bread and she didn’t even care) or that for some reason, SOMEONE (this nameless shapeless person of my imagination) would put her in the oven and turn it on. Then I had a dream about my son (who was now 2.5) drowning in the bath tub because he snuck in while I showered and somehow I didn’t see him. I couldn’t shower without a panic attack for MONTHS. I can STILL see his face under the water, his hair billowing out.
    I’ve always found it better to share that I had PPD though, to normalize it amongst people.
    I had the anxiety along with the depression, and I still fight to conquer them both every day, even 2 years after having my youngest. Sadly, it was because my Dr. knew I had PPD that she dismissed my concerns about my daughters sleep, finally my child was diagnosed with obstructive sleep apnea and we’re trying to figure out how to help her now. Of course, we switched doctors, because even if a mama is dealing with PPD, her concerns should be taken seriously. I wish PPD could be something that no one needed to hide, that we could all talk openly about it and be there to help other moms in our community who are dealing with it.

    • Oh man, I had the fear of dropping things on the baby too and I gasped at your comment about drowning, because I’ve seen those exact images.

      I’m sorry that your daughter’s sleep issues were overlooked and you were blown off because of the PPD. Glad she’s getting help and that you’ve found a new doctor. I too hope we see a shift to more openness and better understanding of it.

  6. Oh my goodness! This happened to me after my 2nd daughter was born! I thought I was just going nuts! I’m so glad to know this now!

  7. MangoMomma says:

    I had “POST PARTUM MOOD DISORDERS” PPMD’s with my 1st, 22 yrs ago ! like yesterday. Anxiety, OCD, PTSD from a traumatic birth, depression (which was low on my list). The others were a lot stronger. I knew what I had wasn’t PPD. But no info. out there back then. Please folks PPMD not PPD. It’s vital…

  8. Thanks for sharing. I remembered the blow ups that were way out of proportion despite getting some rest every now and then; and feeling imprisoned, helpless, hopeless and despairing for the first 19 months. I thank God for sending me my GP who incidentally was a trained counsellor and she has been such a support and help in ensuring we deal with the root issues of fear. By the transforming grace and healing of Jesus, I am now learning to parent from a position of love, grace, acceptance and self-control instead of rage, guilt, anxiety and fear.

    • That’s a beautiful shift, Laura. Something I know I work towards every day. It is wonderful that your GP also had the training to allow her to recognize what you were going through and offer help. I am going to repeat your last line to myself throughout the day!

  9. This is exactly my life for the past four years. I had ppd after my daughter was born, 2/6/11. She was a happy surprise but my relationship with her father was FAR from being healthy, mature, or normal (although we loved each other, and still do, very much.) Also, my best friend, who had been a roommate, sister, and even my lamaz partner during parenting classes on nights that my husband had to work late! My best friend, passed away less than one month before our Jo was born. She had sworn to be there forever. “You know I love you and Josephine (she always called her by name) more than anything right?” I can still hear her saying it. So yeah! I had some serious ppd! MDD diagnosed. I received treatment and was doing better. But then the “catastrophizing” began. The horrible images of anything you can think of going wrong to Jo, going wrong! I wouldn’t just have a fleeting thought and move on, I would hang onto that idea and live in it and it became almost like a reality. Graphic images of her being run over in a parking lot because I somehow let her wander off. Being kidnapped and tortured and murdered. And I would go instantly into a panic attack. Wonderful things like that have been my prison for almost 3 years. I am healing but have never seen anyone else share and admit these feelings. I’m going to mention this to my therepist! Thanks again for sharing. We’re definitely not alone, and it’s pretty awesome to see that now. Well, as awesome as this can be 😉

  10. I wish I could have had what you had. Instead I got images and awful thoughts of hurting my own baby :( thank goodness I recovery once she was a year.

    • That’s so frightening. Even as terrible as that is, you’re still not alone in that though! PMAD is a nasty thing, isn’t it? I’m so glad to hear that things got better at the year mark though. :-)

  11. Absolutely-mine was high levels of anxiety rather than depression. Thank you x

  12. Thanks very much for posting your article, and for all the replies. I am putting this on my clinic’s fb page so more families have access to the information. Catherine Lowe, LAc, CNM, Seastar Community Acupuncture, http://www.seastaracupuncture.com

  13. I feel like this when I watch my granddaughter! I’m afraid of everything. I watch her like a hawk. I sleep next to her. I lock and relics doors.

  14. This mother’s birth was highly traumatic, and birth trauma is unfortunately very prevalent in our society. They hyper vigilance she is describing is a common symptom of PTSD.

    Her baby’s nervous system will have also experienced trauma, and there is information now that suggests that children with symptoms of ADHD may be rooted in unresolved traumatic experiences. http://traumahealing.org/beyond-trauma-blog/?s=birth+trauma

    Seeking help from a Somatic or body based practitioner who specializes in working with the nervous system will offer much hope. The Somatic Experiencing website offers valuable information and a list of practitioners. http://traumahealing.org/index.php

    As a mother of 3, trauma specialist and Shamanic practitioner I also know that our spirit also needs to heal from challenging circumstances so we can regain the necessary connection to something greater than us. Without that there can be overwhelming fear that the world is an unsafe place.

    In indigenous cultures birth is experienced as a sacred experience, and my hope is that women can find more support both pre and post birth to allow a way back to this.

    I send deep love and healing to all the women here who are suffering so greatly.

  15. Rivkah Leah says:

    I’ve always wondered when PPD isn’t really PP but really a lack of mental health started years prior that only erupts after birth…? this is an experience close to home and I appreciate your post.

  16. I couldn’t help but cry when reading this. I used to be on anxiety medication before my husband and i decided to try to get pregnant. My anxiety started about 6 months ago. My daughter is now 1. I thought that my life was to good to be true. I have everything I have ever wanted. I was so afraid of sids that my daughter sleeps with us so I could check on her often. I was always so afraid something so horrible was going to happen, not so much now that she has reached the 12 month mark. But I knew that my anxiety was different than before. My doctor is trying different anxiety medication just having a hard time finding the right one.

  17. This is an excellent article. Thank you, thank you, thank you for sharing!

  18. Thank you for this article. I had horrible anxiety and scary intrusive thoughts after having my son. I also was very depressed to the point of intense suicidal ideations. Thankfully, I was already under the care of an awesome psychiatrist for chronic depression so my post partum issues were dealt with early. I was not aware of the change of the name of diagnosis. The new title is a much more accurate depiction of what is really going on.

  19. Thank you for sharing this. 3 years ago I had this happen to me when my first son was born. I ignored most of my terrible thoughts till it all became too much to handle. I was hospitalized when he was 11 weeks old for about 4 days. They said I had ppd and to this day I wonder how it was diagnosed as that. But you have opened my eyes to another side if the story and for that I’m so thankful! I just delivered number 2 a week ago, and am having mild symptoms again. But feel more prepared to look for more signs after another week has passed beyond the frequent crying spells…. Thank you again for sharing!

  20. Thank you for sharing this information so that moms don’t feel alone. One thought I did have while I read your experience, was that you might also have suffered some post traumatic stress disorder (maybe) after the c-section. A close relative of mine was killed suddenly in a farming accident, my family didn’t realize it, and I found his body… After that, similar to you, my mind would flash images of horrible deaths for what seemed like a long time. i worried that i was going crazy. I also was very tired, and would get light-headed and overwhelmed with a lot of sensory stimulation. It seems to me like your c-section would be extremely traumatic the way it was carried out. Anyway, I am doing better now, and I hope you are, too. You are doing a good job! Keep hanging in there.

  21. Thank you for writing about such an important subject! As a perinatal mental health advocate it’s close to my heart. One of the comments implied how childbirth can serve as a catalyst for perinatal mood and anxiety disorders. It’s very true.

    I advise women and health professionals to educate themselves about ALL the perinatal mood and anxiety disorders/PMADS. Apart from postpartum depression there are seven other PMADS listed on Postpartum Progress’ FAQ page:

    http://www.postpartumprogress.com/frequently-asked-questions-on-postpartum-depression-related-illnesses

    I was diagnosed with the PMAD of bipolar, peripartum onset (postpartum bipolar/PPBD), a.k.a. childbirth-triggered bipolar. This is a separate condition from postpartum psychosis.

    For more information pleasse visit Postpartum Support International’s website:

    http://www.postpartum.net/learn-more/bipolar-mood-disorders/

    My postpartum bipolar disorder/PPBD, or bipolar, peripartum onset is rare but it definitely happens. Postpartum psychosis can be accompanied by bipolar, peripartum onset, but that’s not always the case . At age thirty-seven I had my second baby. I walked into the maternity ward in labor with no previous diagnosis of bipolar disorder. Within 24 hours of my daughter’s birth I was hypomanic and hyper graphic (extreme, compulsive writing); no one recognized I was in trouble until six weeks later when I was acutely manic. The person who noticed my postpartum mania was our pediatrician.

    It was then when I voluntarily admitted myself for hospitalization and received an official diagnosis of bipolar, peripartum onset with no psychotic features. To read more of my story please visit the Postpartum Progress website:

    http://www.postpartumprogress.com/story-postpartum-bipolar-disorder

    Thanks for reading!
    Dyane Leshin-Harwood
    Member, International Society of Bipolar Disorders and
    Postpartum Support International
    @birthofnewbrain #EveryPMADCounts #NotJustPPD
    Founder, Depression and Bipolar Support Alliance (DBSA),
    Santa Cruz County, CA

    • Thank you for your comment! The timing is a surprise since I was just doing more research on this topic. And thank you for linking to your story here so others can read it.