When the Risk of Not Getting Help for PPD Just Isn’t Worth It

Babies are resilient. There’s no doubt about it. But babies and children may be negatively affected by a mom’s untreated depression, anxiety, or other mood disorder during pregnancy or postpartum. And it seems to me that this might not be a risk worth taking.

Please note carefully the specifics of what I said above: “Babies and children may be affected by a mother’s UNTREATED depression, anxiety, or other mood disorder during pregnancy or postpartum.” Many, many of you can attest to the fact that children whose mothers suffered from prenatal or postpartum depression or anxiety and received treatment are just fine- even thriving as so beautifully highlighted in a blog post by Katherine Stone.

Moms who make it a priority to get support, follow treatment recommendations from a trained professional, get well, and take care of themselves do so to benefit not just themselves but also their children. And most of these kiddos go on to be happy and healthy preschoolers, teens and adults.

What we worry about is when a mom’s depression or anxiety goes untreated. It is these instances when there is high potential for emotional, social and developmental delays in babies and children. I say this fully knowing that this fact may bring additional layers of anxiety to women who already suffer, and I am hopeful that those women understand that this post is not a condemnation or a finger shake. It is, instead, a compassionate offering through a realistic look at the risks that may come to those who do not reach out for the support that they deserve.

I am motivated to write this after reading an article in the New York Times Magazine that talks about Depression in Preschoolers. While we know that there are many factors contributing to the development of depressive symptoms in children this young, and that often these children do not have parents who are depressed themselves (and, conversely, having a depressed parent does not necessarily mean that a young child will also be depressed), we do know that many of these little people may not have received the empathetic attunement and emotional mirroring from their mothers that they need to thrive. Babies need to be attended to and heard, they need to be held and comforted, they desire eye contact and voice recognition, and if a mother is unable to provide these things because she is depressed or anxious, a baby may suffer the consequences.

So, here are some of the risks for babies and children whose mothers suffer from UNTREATED antenatal or postpartumdepression and anxiety:

  • Pregnant women who are depressed are less likely to take adequately care of themselves and their unborn babies.
  • Preterm labor has been linked to depression and anxiety in pregnant mothers.
  • Preeclampsia has been linked to depression and anxiety in pregnant mothers.
  • Depression and anxiety during pregnancy has been linked to low birth weight in babies.
  • Babies whose mothers were depressed or anxious during pregnancy are more likely to have eating and sleeping challenges and are more likely to be difficult to soothe.
  • Attachment and bonding may be negatively affected and this can have an impact on a child’s ability to form healthy relationships during school-aged years and on through adulthood.
  • Fathers, whose partners are depressed, are also more likely to develop depressive symptoms in the postpartum period. If this happens, neither parent may be able to attend to the emotional needs of their newborn.
  • Mothers who have postpartum depression tend to spend less time engaging in eye contact, mirroring facial and voice expressions, and casual play with their babies. All of these activities are important for bonding and attachment.

With this said, we know that other caregivers, such as a father, grandparent, other family member, friends, and nannies can provide the emotional reciprocity that is needed if and when a mom is temporarily unable. While a baby needs its mother first and foremost, that child will absolutely be okay if, temporarily, it is getting all of its physical and emotional needs met by someone else. What matters most, truly, is that mom gets the support that she needs to feel well so that she can care for her babe in the ways that are important to both of them.

So, moms, if you are suffering, please get help. For you and for your little one.

Kate Kripke, LCSW

Tips On Parenting Well While Suffering A Mental Illness

Some of you are experiencing postpartum depression or anxiety with your very first child. Still others are having it with later children, and are having to parent several kids while dealing with PPD. So how do you care for your children while going through depression or other mental illnesses?

Psych Central has taken on this question, offering tips on parenting well while coping with a mental illness. My favorite?

“The best predictor of kid functioning is parent functioning,” said Sherman, also co-author of Finding My Way: A Teen’s Guide to Living with a Parent Who Has Experienced Trauma and I’m Not Alone: A Teen’s Guide to Living with a Parent Who Has a Mental Illness. Even if you don’t want to seek help or get better for yourself, do it for your kids. Model healthy choices. Remember that acknowledging that you need help and seeking help are signs of strength."

Getting help is a gift to both you and your children.

Go check out the article. It includes tips for single parents, too, as well as a list of other resources on this topic.

Suffering PPD & Worrying Whether Your Child Will Love You? Read This.

You will get better, and your child will love you.

I've shared my own stories to prove that. Happy moments that I thought would never come to pass because I had gone through PPOCD and was sure that my life was ruined forever.

It wasn't. And yours isn't either.

Here's a story from another mom — Katie at Sluiter Nation –who has experienced that moment where she realizes that she is a good mom, and she's going to make it, and her baby loves her, despitethe fact that shehad postpartum depression.

I love this story. So happy for you, Katie.

How To Get Information About Specific Meds & Pregnancy Or Breastfeeding

medications and pregnancyI got a question from a reader with PPD today about specific medications and breastfeeding. Wouldn’t you know it, over at Perinatal Pro, Susan Stone just wrote a piece about OTIS, the Organization of Teratology Information Specialists. Here’s the really cool part:

Expectant or lactating mothers, healthcare providers and those who love them can call a toll free number – 866-626-6847 to ask questions about medication exposure during pregnancy and lactation!

Go read Susan’s story to learn more about OTIS and how it works.

You can also visit the MGH Center for Women’s Mental Health and their section on breastfeeding and psychiatric medication.

And you can visit Motherrisk’sresource on breastfeeding and medication, and their page on medication during pregnancy. These sections include information on all drugs, not just psychiatric ones.

Also, click here for more stories on breastfeeding and PPD.

Photo credit: Fotolia – ©Greentree

My Postpartum OCD Baby Grows Up, While I Have An Anxiety Attack

He walks off the bus yesterday with a scowl on his face. His mouth is all scrunched up and his eyes are narrowed. This is not a face I’ve seen before.

Thoughts race through my mind. Did he get in a fight? Did he get in trouble with his teacher?

“What’s wrong buddy?”

He looks spitting mad, this boy who is all sweetness and light.

“Matthew* stole one of my Silly Bandz.” (*name changed)

(If you don’t know what Silly Bandz are, they’re … well, rubber bracelets. All the rage with America’s elementary school children. Kids wear them by the bushel and trade them. They’re considered valuable, and they make me sad I didn’t invent them.)

“What?”

“He took it. The tie-dyed bat.”

“How do you know he took it?”

“Because he grabbed it from my hand. While we were on the bus.”

This is a kid who is as honest as Abe. Really. If my son tells me something I can guarantee you it’s true. He has too much of a guilty complex to lie about anything. (Lucky me.)

“Did you ask for it back?”

“Yeah, but he said he didn’t have it. He said it must’ve fallen on the floor. But I know it didn’t. I know he has it.”

Anxiety is rising in my chest. Someone messed with my boy. He’s only 8. Has the hell of pre-teen and teenaged life begun already? Is today the day? I’m not ready.

We climb in the car, and on the way to pick up little sister from school we discuss his options. I’m not really sure how to handle this. He says he wants me to bring him by Matthew’s house so he can get it back.

Really? Confrontation? Could my son be that brave? I know I’m not.

Mads piles in the car from Montessori and off we go. I discuss various scenarios with Jack.

“What if you ask him for it and he tells you he doesn’t have it? What do you plan to say then? I mean, that’s probably what he’ll say especially if his mom is standing right there. You need to think this through.”

“We’ll deal with that when we come to it, mama.”

Alrighty then.

We pull up in front of Matthew’s house. I decide I’m not getting out of the car because this is Jack’s deal. Not mine. It’s between him and Matthew. I watch him go up to the door. He suddenly looks so big to me.

OMG my heart is pounding like crazy. I’m having a freakin’ anxiety attack. I feel sick to my stomach. I can hardly breathe. My son is the one up there dealing with this like he’s eternally brave and I’m sitting here, slunk in the front seat, completely flipping out.

Mads is craning her neck to try and watch the scene from her carseat.

I see the door open. Lots of back and forth discussion is clearly going on but I can’t see anyone’s face, dammit. I can see the mother is standing there as well.

This is taking so long. What are they saying? Should I get out? Should I have let him go up there by himself?

After a few minutes he walks back to the car.

“Well?!!?! What happened?”

“He said he didn’t take it. I know he did, but he said he didn’t.”

“We figured that might happen, didn’t we? That’s okay buddy.”

“Yep.”

“The outcome doesn’t matter. You were brave and you said what you needed to say. I am so proud of you for standing up for yourself.”

So proud. So amazed to watch this 2nd-grader do something that I’m pretty sure I wouldn’t have been able to do. No … very sure. That’s my boy. I’m filled with all the love in the world.

I tell you this story, as I’ve told you others about this boy, because he is my postpartum OCD baby.

And he’s turning out pretty good, REGARDLESS.

Have I Wrecked My Child’s Life? Parenting After Postpartum Depression & Anxiety

Many of you wanted to know how to be a parent after going through postpartum depression & other perinatal mood and anxiety disorders … how to get over the guilt and how to move on as a mom. Today, Ann Dunnewold, PhD,is our guest author. Ann is a Dallas psychologist whose mission is to arm women against the pressures of modern motherhood. A past president of PSI, she is the author of “Even June Cleaver Would Forget the JuiceBox“, and co-author of the new book “Life Will Never Be the Same: The Real Mom’s Postpartum Survival Guide“, a book for real moms that tells the honest truth about what to expect emotionally after the birth of a baby.

Have I wrecked my child’s life?

What mother’s brain has never entertained this question? Proof of our mother-blaming culture lurks in the scowls and murmurs aimed at mothers whose children fall apart in the grocery store checkout line or on any plane. Pre-mama days, the fleeting thought “when I’m a mom, I’ll never let that happen!” is nearly universal.

Growing up in this culture (vs. the moon, for instance), this subliminal standard of “good baby, good mom” — or its darker side: “bad kid, bad mom” — takes root in our brains. Then comes the powerful whammy of postpartum depression and anxiety symptoms, a big, black cloud obscuring the mom you want to be. Overwhelmed with worry, you second guess every decision and freeze near your baby. It’s definitely not the Hallmark card mommy vision you embraced during pregnancy. Concern skyrockets not just about your ability to parent, but about the effects of your mood on your baby. How to be the mom you pictured? Can you ever get past this? Will this warp your child? These fears are entirely natural.

Be reassured.Over 25 years of working with new moms, I’ve seen that moms routinely rally for their babies. Women paste on a smile, push through the daily grind and parent effectively even when bombarded with symptoms. Research says that when moms with postpartum depression cannot care for their children, the baby’s relationship with others — fathers, family members, paid caregivers — protects the baby from ill effects. Babies bond to others, in addition to mom, and learn to trust and love. When mothers get effective treatment, there need be no long-lasting effects on the child’s development.

In the midst of PPD and parenting, it’s helpful to stop and acknowledge what you are doing for your baby. Leave a sheet of paper on the counter. Tally each mothering task: you changed a diaper, you fed, you burped, you rocked, you wiped up spit-up, you patted, you soothed … ad nauseam. Every moment counts, so count them.

Once you’ve recovered, how can you drop the self-doubt about your parenting? Parenting after postpartum depression is just parenting. Feeling good about your parenting, depression and anxiety or not, comes from tuning into some simple truths.

1. We’re human first, mothers second. We all make mistakes, have days good and bad, moods sunny and rotten. On balance, it is the ratio that matters. Even June Cleaver, the pearl-adorned, cookie-baking icon, raised her voice at the Beaver in exasperation. And he was still a perfectly well-adjusted kid.

2. No single parenting event, or period of time, will make or break your child.* Were your symptoms debilitating for two months? Surely you know the importance of the first five years of a child’s life in determining the person he will become. Keep perspective: out of 60 months, two months equals .03%. This is a minuscule influence in the sum total of your child’s life.

* (with a few horrific, unmentionable exceptions. Please don’t go there! Stop, chattering brain — that’s just anxiety! NO reason to assume that because you imagine it, that catastrophe is headed in your direction. Take a deep breath. Consider the odds.)

3. You are not solely responsible for your child’s development. You are ONE influence — along with the combination of genes, temperament, fathers, partners, grandparents, siblings, teachers and peers. Resist the mother-blaming and again focus on the big picture.

4. Acknowledge that total control in parenting, as in life, is an illusion. We think that if we live the right life and follow the rules, results are guaranteed. A perfect life for our perfect child. Wrong, really just wrong. The phrase to tattoo on your forehead is “control what you can, let go of the rest.” Have you made every effort to ensure your child is safely cared for and healthy? Is your baby talked to, fed and changed, loved on, sleeps when tired? You are doing the best you can, controlling what you can. Your child will be just fine.

5. Find a parenting philosophy that fits for you and stick to ONLY that expert advice for two weeks. Read nothing else. Mimic a CD on repeat: “this works for us, this works for us.” Say it to well-meaning advice-givers who flock to new moms like gnats on a watermelon. Listen to your gut. Parenting is not instinctual, but you do know what fits you.

There’s no single magical Right Way to parent. All we can hope is to be the best moms we can, given our strengths, personal foibles and world view. This is what I call a perfectly good mom. No one is a perfect mom. But we each can be a perfectly good mom, the perfect mom for our perfectly good kids, by simply embracing our true selves …warts, moods, worries and all.

Do Antidepressants During Pregnancy Lead to Developmental Delays?

Last week came research published on the effect of taking antidepressants on the developmental milestones of infants for those women who have depression during pregnancy.

As reported by Jennifer Thomas of HealthDay:

Using data on more than 81,000 babies born in Denmark, researchers found that children whose mothers took antidepressants during the second or third trimester sat without support later and walked later than children of depressed mothers who did not take medication. This was especially true for boys.

Despite the delays, the children's progress was still well within the bounds of normal development, the researchers noted. Children whose mothers took antidepressants sat about 16 days later and walked nearly a month later than the children of mothers who didn't take the drugs …

Despite some concerns, Dr. Diane Ashton, deputy medical director of the March of Dimes and an ob-gyn, urged women not to make any hasty decisions about discontinuing the drugs and to consult with their doctors first.

"For the most part, we feel it's important for women to be adequately treated for depression during pregnancy," Ashton said. "Depending on the severity of the symptoms, you may not have a choice. If the mother is depressed or suicidal to the point of hurting herself, she needs treatment."

ParentDish interviewed perinatal mood and anxiety disorder expert Dr. Ariel Dalfen to get her feedback on this new study. They wrote:

Dr. Ariel Dalfen, who is a psychiatrist and expert on postpartum depression at Mount Sinai Hospital in Toronto, says that although it's prudent to pay attention to these kinds of studies, it's important to emphasize to patients that the results were inconclusive because "people get very scared." And while she acknowledges that every patient's situation is different, she says that women on antidepressants should never decide to go off their medication on their own.

"When people need to be on these medications, you have to balance the very small potential for side effects that haven't been well-documented with the need to treat their problem," she says. "We never want to take any prescribed treatments lightly, because there is always a small possibility that there could be negative effects on the fetus. But you need to make sure you're balancing all the risks and benefits, including the risks of having an untreated depression during pregnancy."

Also, click here if you are interested in more stories on the topic of pregnancy depression.

Secure Infant Attachment Can Eliminate Negative Effects of Depression & Anxiety During Pregnancy

As we have discussed previously, a mother's depression can affect her child. It can negatively impact bonding and attachment. It canslow cognitive development. The longer the depression goes on, the moreharmful effects may occur. Research shows that children who are abused or emotionally neglected have actual structural changes to their brain that predispose them to depression later in life. Babies are also impacted in the womb when their mothers are depressed or anxious during pregnancy.

On the verypositive side, though,as reported in Science Daily, "research shows that fetuses exposed to high levels of stress hormone — shown to be a harbinger for babies' poor cognitive development — can escape this fate if their mothers provide them sensitive care during infancy and toddler-hood."

The new study represents the first, direct human evidence that fetuses exposed to elevated levels of the stress hormone cortisol may have trouble paying attention or solving problems later on. But what may be more intriguing is the study's second finding — that this negative link disappears almost entirely if the mother forges a secure connection with her baby.

This is great news.The researchers, whose study is published in Biological Psychiatry, found that having a secure relationship with mom eliminated whatever negative effects stress, depression and anxiety during pregnancy would have caused, at least with regard to cognitive development.

If this isn't an argument for reaching out for professional help if you have anxiety or depression during pregnancy or postpartum, I don't know what is. The sooner you can get better, the sooner you are able to provide the kind of care that it would seem may counteract and even eliminate any negative effects thatmight have been created while you were ill.I know for me, at least, that isa huge comfort.

MGH: The Impact of Atypical Antipsychotics on Birth Weight

The MGH Center for Women's Mental Health blog takes a look at new research on the impact of taking atypical antipsychotic medication while pregnant on birth weight.Atypical antipsychoticswould include medications like Seroquel, Risperdal, Abilify, Zyprexa and others. Check out their post on this.

Because there is so little (too little) information about the impact of these medications on pregnant women and babies, MGH has a National Pregnancy Registry for women who are taking them while pregnant. If you are pregnant, between the ages of 18 and 45,and on any of the following medications, you should reach out tothis registry:

  • Abilify (aripiprazole)
  • Clozaril (clozapine)
  • Geodon (ziprasidone)
  • Invega (paliperidone)
  • Risperdal (risperidone)
  • Seroquel (quetiapine)
  • Zyprexa (olanzapine)
  • As they explain, "the National Pregnancy Registry for Atypical Antipsychotics is dedicated to evaluating the safety of atypical antipsychotic medications that may be taken by women during pregnancy to treat a wide range of mood, anxiety, or psychiatric disorders. The goal of this Registry is to gather information on the safety of these medications during pregnancy, as current data is inconclusive."

    CALL TOLL-FREE: 1-866-961-2388

    To Have or Have Not: Should You Stop Having Children If You’ve Had Postpartum Depression?

    After my bout with postpartum OCD, I decided I would never have another baby. NEVER. NOT. ONE. MORE. EVER. I’m not the only person who has been through postpartum depression who feels this way.

    I am reminded of the choice I made, a choice that would later be reversed out of necessity, by a story on ParentsConnect called “Postpartum Depression: Why I Won’t Have Another Baby.” This mom writes about how she had always planned to have more than one child, primarily because she so disliked being an only child herself, but has now decided not to after having PPD:

    “I am still plagued by anxiety. I am still on medication and in therapy. And one of the most painful things of all is that I am left with no desire to do this again. I fear starting over. Not just fear of possible PPD, but of having another newborn. Worrying about milestones and growth charts. Almost two years later with my son now, I’m still worrying about growth charts. So I can’t bear to start over with another child. I fear the fear. I truly feel that if I have another child, I will have two kids with only half of a mother. That seems ludicrous to me. I’d rather focus all my love and attention on the one I have than risk his happiness just so I can say I have two children. Would I be doing it for him or trying to fill my own void?

    So this leaves my child an only child. The thing I said I’d never do. The thing that makes other mothers look at me and say, “Oh, you have to have another one! You can’t have just one!” (Is he a potato chip or something? I digress.) I’m treated like just wanting one child gives me two heads, and I find this extremely unfair.

    So tread lightly on women you come across who feel ill-equipped to have more children. You don’t know the pain and guilt that may be underneath.”

    I do. I know it well.

    After taking a year to really get over my postpartum OCD and anxiety, I was not willing to go through that horror for even a second more. I was as done as done could be with having children. No more intrusive thoughts for me. No sobbing. No lack of appetite. No inability to sleep. No overwhelming sadness and guilt. No thank you.

    Then I got pregnant. I wasn’t trying to, I just did. And given the circumstances, which I will be kind enough not to go into, I really shouldn’t have gotten pregnant. At all. It was nearly a miraculous conception. My husband and I were forced to rethink our choice, and in the end we chose to keep our baby (who I would be remiss in not sharing turned out to be our amazing blessing of a daughter Madden). The choice was not without trepidation. You can imagine our fear.

    As an empowered patient, I knew this time I would, at the very minimum, put a team of people around me who were specialists and knew what they were doing. I was watched like a hawk throughout my pregnancy. I received counseling. In the interest of full disclosure, I also took medication, a risk I chose to take based on my personal medical history and after very comprehensive consultations with both my psychiatrist and my OB/GYN.

    Being a mom to a newborn the second time around was pretty awesome, as I wrote in this piece at the time called “On What It Should Be Like To Be A New Mom”. I can’t say whether it was the meds, or the therapy, or a good sleep management plan, or the fact that I had more knowledge about postpartum OCD the second time around that prevented me from getting it again. I have no idea. What I do know now that I didn’t know before I got pregnant with my second child was that we all have choices. We don’t necessarily have to end the growth of our family after having experienced a perinatal mood or anxiety disorder like postpartum depression. Not if we don’t want to.

    Am I saying I think you should have another child after PPD? By heavens, no! I’m not advocating that you should continue to have children, and I’m not advocating that you should cease having children after having had PPD or a related illness. I have no opinion on what the size of anyone’s family should be (except, I must admit, when it comes to those Duggars. Would they just stop it already?) I’m simply saying that those of us who have had postpartum depression or a related illness have more than one option.

    I respect the choice of the mom who wrote the ParentsConnect story. I truly do. I made that same choice. I also respect the choice of moms who choose to press on, despite having a history of perinatal mood or anxiety disorders.

    As Karen Kleiman writes in her book”What Am I Thinking? Having A Baby After Postpartum Depression“, “The good news is that with proper preparation and planning and a healthcare team that is mobilized on your behalf, we can intervene in ways that will minimize the likelihood that you will experience a depression to the same degree that you did previously.”

    You do have a choice.