signs of postpartum depression

7th Blogiversary Fun Facts

By Katherine Stone July 13, 2011

A few fun facts and thank yous on this, our 7th year anniversary:

We love our amazing regular contributors: the lovely and talented Kate Kripke, Kimberly, and formerly, Alexis Lesa

Top countries visiting Postpartum Progress (because women can suffer PPD no matter where they live):

US
Canada
UK
Australia
Phillipines
India
New Zealand
Ireland
Germany
South Africa

Hello friends from around the world! We're so glad to meet you!

Most Popular Post Of all Time: The Symptoms of Postpartum Depression & Anxiety in Plain Mama English

Outside of the usual media (Facebook, Twitter, subscribers, etc.), we've gotten the most traffic from the following friends:

Thank you so much for your support, ladies!!!!

So many of you have written guest posts that I couldn't even name you all, sadly. But we are definitely grateful to you, and all of the participants in the Mother's Day for Moms' Mental Health (they're all listed, with links to their posts, at the link)!

July 13, 2011 11:00 am Filed Under: Postpartum Depression

Postpartum Progress Needs Your Input (WARRIOR MOM ALERT!!!) (BLOGGER ALERT!!)

By Katherine Stone June 30, 2011

***WARRIOR MOM ALERT*** ***WARRIOR MOM ALERT*** ***WARRIOR MOM ALERT*** ***SERIOUSLY***

Alright, Warrior Moms and friends of Postpartum Progress. We need to do some serious work together. Since this is EVERYONE's blog — mine AND YOURS — I need your participation. ASAP. I don't care if you always comment or you are a lurker, I want to hear your voice.

We are about to embark on a massive project. Postpartum Progress has been on the blog host Typepad since the day we started in 2004. Sadly,Typepad was sold and now seems to be going the way of the dodo bird. I'm going to have to spend a couple thousand dollars (oh my God somebody save me!!!!!!!!!) and have it redesigned and migrated over to WordPress. I hope this will result in a better functioning and spiffier Postpartum Progress. I do not want to spend thousands of dollars and do this wrong. That would be a monumental disaster. So I need your input.

This is very important. If you don't speak up or participate, I can't make sure that Postpartum Progress is what you want it to be and that your voices and ideas are properly represented here.

Your assignment? Answer the following:

In terms of the design, what would you change?
Which sidebars (on the left and right-hand side) or content tabs (at the top, directly under our logo) would you get rid of?
Which sidebars or content tabs would you rename so they make more sense to the new visitor?
What things would you like to see added? It could be a new function, a new section, a new idea? Lay it on me!
How can we make this site more functional?
What drives you crazy/frustrates you about Postpartum Progress, if anything?

Do not censor yourself. Throw whatever thoughts and ideas you have my way, big or small. If you're uncomfortable putting them in the comments section, email me at postpartumprogress@gmail.com or stonecallis@gmail.com. I can't wait to hear from you!!

I can't promise that I'm going to be able to take every suggestion, but I'm going to do my best to incorporate everyone's input. Let's make sure we have a highly usable site for the moms who need help, and the people who care for them (dads, docs, therapists, etc.). Let's make sure we continue to kick stigma's ass.

Note, this will mean that Postpartum Progress, for the first time ever, will be shut down for about a week or so. Probably in August or September. I'm going to need your help to not have a complete heart attack while that is happening.

Also …

Our job is to make sure moms everywhere can see that ANY mom can get a perinatal mood or anxiety disorder. Have you recovered? Do you want to inspire others? If so, have you sent in your picture for the Surviving & Thriving Mother's Photo Album? If not, please do so. We NEED you. I WANT your face represented here. We're going to redesign the album so that it fits in with the look and feel of Postpartum Progress (something Typepad does not allow us to do).

And, have you checked to make sure your support group is listed on the support group page? Or that we have the right information? If not, please do. What do I need to add, change or delete?

Thank you in advance for taking action, friends. You are what makes Postpartum Progress tick.

June 30, 2011 1:11 pm Filed Under: Postpartum Progress News

Dads Must Deal With Indecisiveness During Postpartum Depression

By Katherine Stone June 27, 2011

One evening, I waited impatiently for my husband to come home from work. It was another one of “those” postpartum depression days and I needed to be rescued. Not that my son was being a pain, it was because I was sinking in my own shoes.

When he walked in he kissed me lightly on the forehead and asked me how my day was. I rolled my eyes at him as if he should have automatically known how crappy it was.

The following conversation took place:

Husband: Sounds like you need a drink. Do you want me to make you one?

Me: I don’t care.

Husband: Well do you want me to make you one or not?

Me: I guess.

Husband: I’ll just make you one. What do you want?

Me: I don’t know.

Husband: I can make you a martini. A beer?

Me: I don’t know. Whatever is easiest for you.

Husband: Well what do you feel like? I’ll make you whatever you want.

Me: Ugh. I don’t know babe…

Then he just went and made me a drink. (Please note: I do realize that drinking alcohol can act as a depressant.)

What I’m trying to get at here is that postpartum depression and anxiety can make a person extremely indecisive. It’s not that we’re trying to be difficult. It’s just that we really don’t know what we want.

We. Don’t. Know. Period.

Making decisions as simple as what to drink can be extremely daunting for us. Sometimes these decisions can spur anxiety and frustration and, when interacting with our loved ones, can ignite arguments.This is why I think it’s important for our caregivers/spouses/significant others to understand this aspect of our illness. Here are some tips on how you can help (from my husband’s and my perspective):

Know that we are nottrying to be difficult
Know that making simple decisionscan be hard for us. Our minds are firing at 100 thoughts per second (or, for others, our minds aren’t firing at all). It is hard to filter through all of those thoughts to come up with a decision.
If you find that we are getting flustered by making a choice,be patient with us.
Don’t demand an answer.
Ifwe cannot come up with a solution, it is more than ok togive us one. Don’t be afraid to just say “Ok, we’re going toXYZ for dinner”.The majority of the time (for me, anyway) we are worried about the kind of impact our decision will have on you and others. By choosing for us, we feel less pressured … and in my case totally relieved.
Give us simple choices. Don’t ask things like “What colour should we paint this room?” because you will end up with a room painted orange.

I know that these may seem silly to you, but to those with PPD, the littlest things can create gigantic turmoil within us and between us. The small steps you take for us, the larger steps we can take towards our recovery. You, the Dad/caregiver/spouse/significant other are an integral part of our success in this. Remember that.

Even though we may not say it, we thank you so much and love you even more.

So what helps you when you’re indecisive?

Kimberly

June 27, 2011 11:25 am Filed Under: Help for Fathers, Postpartum Depression

Looking Back At Andrea Yates, 10 Years After the Tragedy

By Katherine Stone June 20, 2011

Ten years. How can it be ten years already?

It was on June 20, 2001, that the tragedy happened. Andrea Yates drowned her five children in the midst of postpartum psychosis. That was just a few months before my sweet boy, my first child, was born in September.

In the fall of 2001, I was suffering. Scared and sick and feeling as though I was the worst mother in the world. And I kept seeing Andrea’s face, the image of her repeated so many times on the TV screen looking so slack and empty, standing there in her orange jumpsuit. I believed it was possible that I was her. I could be standing there, too.

I didn’t know about the spectrum of perinatal mood and anxiety disorders. I didn’t realize the difference between the intrusive thoughts of postpartum OCD and the delusions of postpartum psychosis. I didn’t know there were hundreds of thousands of women suffering at the very same time alongside of me. As if the symptoms of these illnesses aren’t enough, we are further traumatized by the stigma and lack of support and services available to us when we suffer them.

I know that the tragedy of the Yates family created more awareness. I know I should be looking at all that has been accomplished over the last ten years, butI just don’t feel like saying “It’s been 10 years and look how much has changed!”

Maybe it’s because I hear from so many of you each and every day who still feel confused and stigmatized. There are still so many who don’t know where to go or what to do to get help, or for whom help is not available because of where you live or how much you can afford. Instead, I feel like shouting, “It’s been 10 years, and why is it that doctors are still telling moms they’ve never heard of antenatal depression or postpartum OCD?! Why is it that only 15% of women are receiving treatment for perinatal mood and anxiety disorders?! Why have none of the funds for the Mother’s Act been appropriated?”

I don’t want to stand by and watch as another family falls victim to these illnesses, and another and another. It’s not okay that mothers and babies die, or that mothers sit in jail or psychiatric wards for the rest of their lives. It’s not okay that friends and families grieve. I can’t accept how many mothers never get the help they need, and endlessly fret about how their suffering may have harmed their children.

We shouldn’t need a tragedy to be motivated to take action to support the mental health of our nation’s mothers. Where are you, powerful brands and foundations with the money to help us? Don’t you know that treating PPD is one of the best deals around? It’s a buy-one-get-one-free, because when you ensure the mental health of the mom you are protecting the mental health of the child.

Where are you, mothers of America, including all of those who’ve never had PPD and never will? Do you realize this is an issue that affects us all? Even if you haven’t had postpartum depression, your daughter or your son’s wife might. Someone in your neighborhood or temple or congregation or office may need a lifeline. You may someday be teaching a child whose mother was never treated, or working with a husband who is desperate to find help for his wife. Will the resources you seek then be available to you?

Ten years later, in view of all the Yates family and so many other families have sacrificed, we must collectively demand that more is done to address the most common complication of childbirth. It shouldn’t be just perinatal mood and anxiety disorder advocates and sufferers who care about this. It should be every single entity that has any concern whatsoever for the health of America’s families.

June 20, 2011 11:22 am Filed Under: Postpartum Depression, Postpartum Psychosis

Los Angeles County Wins Award for Innovative Maternal Depression Project

By Katherine Stone June 17, 2011

The National Association of Counties has awarded Los Angeles County a 2011 Achievement Award, given for innovative county government programs that modernize and streamline county governments and increase services to their citizens.

The county received the award for its Maternal Depression Improvement Project, a joint project of the Los Angeles County Public Health's Maternal, Child and Adolescent Program and the Public Defender's Office. Their collaboration has been a great example of public-private partnership, via the Los Angeles County Perinatal Mental Health Task Force, to help support women with perinatal mood and anxiety disorders. They've trained hundreds of local healthcare providers and built awareness via events, bilingual patient education materials, awareness campaigns and more.

I'm so happy that all of their hard work is being recognized in this way!

June 17, 2011 3:23 pm Filed Under: Postpartum Depression

Finding Balance Between Body, Mind & Social Network During Postpartum Depression

By Katherine Stone June 7, 2011

Are you still there? Holding your own hand and looking your suffering in the eye, as we talked about in yesterday’s post on wishing away postpartum depression?

If so, then you are probably ready to add some of the “doing” parts into your recovery process. Yes, the “being” and “doing” is a tricky balance that needs to be considered all along the way. Sometimes you may need to allow yourself to slow down the pace and to acknowledge, once again, where you are and how you are feeling.

We know that perinatal mood and anxiety disorders like postpartum depression are a biopsychosocial challenge for women, meaning that they are most likely caused by disruptions or challenges in a woman’s biology (physiological system), psychology (emotional and psychological system), and social network (including friends, family, and community). Usually, finding wellness requires a look into all of these areas to see where there are strengths and where there are challenges. And these systems are usually somewhat overlapping, like the Olympic Games logo’s circles. There are places where strength in one area might allow for strength in the other, and vice versa. But wellness almost always involves feelings of wholeness in each of these three areas.

So, in my practice I often walk women through each one of these areas in an effort to take inventory, so to speak. We look at where she is grounded and full and also where she is feeling untethered and lacking.

This process looks something like this:

PHYSICAL SELF: What are you doing right now to help your physical body to feel strong? What does your nutrition intake look like? How is your sleep? Are you currently taking medicine for your postpartum depression or anxiety symptoms and, if not, is it important to have a medication evaluation? Are you pushing yourself too hard? Are you engaging in some exercise each day whether it be stretching or walking or other more moderate forms? Are you breathing deeply? Are you drinking plenty of water? Are you getting outside to breathe fresh air and feel the sun on your face?

PSYCHOLOGICAL SELF: Are you meeting yourself where you are or do you need to set more realistic expectations? Are your priorities clear? Are you consumed by the “shoulds” placed on us by society, books, family, and friends or are you allowing yourself to follow a path that feels right to you? Are you using words of kindness and compassion with yourself or are you using a tone with yourself that is harsh and unsupportive? Are you engaging in thought patterns that are useful and realistic or are you engaging in perfectionist thinking? Do you find yourself thinking in black and white extremes or are you allowing yourself to be open to all that is in between? Are there old family patterns or unresolved family conflict that is interfering with your ability to be present with your baby right now? Do you have a trauma history that is resurfacing and deserves attention? Do you have a number of stress reduction and grounding strategies that are useful in times of chaos or are you feeling ill equipped in this area? Are you currently working with a trained therapist who can help support you and work with you to find new ways of thinking and managing your stress or is it time for you to find one?

SOCIAL SELF: How supported are you? Are you able to ask for help when you need it? Do you have a community of friends, family, neighbors and/or health providers to support you along this journey through postpartum depression? Are you and your partner able to work together during this time of high vulnerability or can you use some support around relationships?

Sometimes it is helpful to see all of this on paper, to create a sort of a table along the way. If this resonates and if you choose to go this route, you might consider a table in which the vertical columns contain the 3 areas of wellness (Physical, psychological, and social) and the horizontal columns contain space for strengths and challenges:

WELLNESS ELEMENT	CURRENT ACTIVITIES SUPPORTING WELLNESS	IS ANYTHING MISSING?
PHYSICAL
EMOTIONAL/PSYCHOLOGICAL
SOCIAL

I want to reiterate that this is a process that is correlated and, often, requires the help of a trained professional who can work with you to sort through the many layers of your being. Sometimes, sometimes, simply going through this process with intention can help you to feel more empowered and in control of your wellness. Often, this is not the case and unbalanced biochemistry or sleep deprivation is just making it too darn difficult to do what you know that you need to feel better. It is likely that once you find some sense of wholeness and wellness in your physical body (including adequate sleep, nutrition, and balanced biochemistry), the other three areas will be easier to work with. And, usually, when you feel a bit more full in all three areas of holistic health, you will feel happy to great yourself right where you are. And you will find joy in simply “being.”

Kate Kripke, LCSW

June 7, 2011 9:56 am Filed Under: Causes

Need Help Finding A Postpartum Depression Specialist?

By Katherine Stone June 2, 2011

Fotolia - © Vladimir Vydrin

On the Postpartum Progress Facebook Fan Page, a reader asked about how to find the best help for postpartum depression or related illnesses. My advice? Ask a mom who knows. I think the best people to talk to are women who have already been through PPD who have been to someone who was really supportive and helped them recover.

There are a lot of survivors hanging out here with us at PP, so I feel fortunate to have gotten to know a lot of the specialists around the country thanks to them and my advocacy work. I am always happy to connect you with them. You can find some listed on the Postpartum Progresspostpartum depression specialists page, or you can ask me a question on Facebook, or you can email me.

Another great thing to do is speak to local advocacy organizations. They often have the best knowledge around about who has a lot of experience in your state treating women with perinatal mood and anxiety disorders. We have a list of postpartum depression support organizations – just find your state alphabetically in the list and contact the organization directly.

Please note, when I say “postpartum depression specialist” that is shorthand for a specialist in perinatal mood and anxiety disorders, also called reproductive psychiatry or perinatal psychiatry. This means this person should be able to help you regardless of whether you have postpartum depression, postpartum anxiety, postpartum OCD, postpartum psychosis, antenatal depression (depression during pregnancy) or whatever. So don’t feel that if you don’t have PPD there is no one who can help you.

I try wherever possible to include special treatment centers from other English speaking countries as well, including the UK, Australia and Canada, so if you are from one of those countries, you may be able to find good contacts from our support organization and specialists lists as well.

Oh!, and DO NOT feel uncomfortable asking me for help, silly. That’s what I’m here for. YOU. So ask away if you just don’t have the energy to search yourself.

Just wanted to do a quick refresher for those of you who aren’t sure how to find someone to help you.

June 2, 2011 12:54 pm Filed Under: Postpartum Anxiety, Postpartum Depression, Postpartum OCD

Uncontrollable Anger Can Be Part of Postpartum Depression

By Katherine Stone June 1, 2011

Fotolia - © Jason Stitt

I waited very impatiently staring out the picture window. The diaper bag packed hours ago rested on the floor by my feet. I held on tightly to the bundle of screaming baby in my arms and I thought angrily,

“Where is he?”

Minutes passed.

My teeth clenched.

Half an hour passed.

My heart pounded.

An hour passed.

Foot tapping anxiously.

When my husband finally came in the door to greet us my eyes scrunched with so much anger I was sure that he had felt it pierce his soul.

“What is the matter?” he said.

“What’s the matter? What’s the matter? We were supposed to meet my parents an hour ago for fish and chips,” I said, my tone of voice getting louder and more forceful.

“Oh I forgot. Well we can go now,” he said reaching for our baby out of my arms.

“We can’t go now. It’s done. We do this every year on Good Friday and you ruined it,” I hollered.

“Babe, I didn’t ruin it. We can still go and get fish and chips!”

“You don’t get it. We missed my family because you’re a jerk who can’t remember our stupid dinner plans. Plans that we do every year!”

He started to walk away with our screaming infant. I hated that he just walked away and never fought back and without thinking I kicked my foot through a wicker chair.

You see, postpartum depression gave me something fiercer than tears and anxiety.

That betch gave me anger so uncontrollable that not only did it scare me, but scared the people around me.

Yes I, Kimberly, the once meek and shy girl, turned into a raging hostile shat storm of hormonal and chemically imbalanced monster.

And it didn’t take much to ignite that fiery monster within me. It billowed in my stomach every day just waiting for the right moment to combust outwards and it didn’t matter who or what it was directed towards. Dishes, walls, wicker chairs, family and friends, and worse directed towards myself in the form of self-mutilation.

No one or nothing was safe from it.

It was terribly irrational and I couldn’t control it.

Family and friends were afraid of me.

I was afraid of me.

So what things rocked my tension scale?

The way my husband slurps his soup.
The way my brother just trampled in the house with his shoes still on.
The way my dog barked to go outside the second I sat down.
Changing a diaper again after changing it 0.2 nanoseconds ago.
The lady who rammed her cart into the back of my heels.
Anybody who wanted to give me advice on how to parent.
Dog hair on the floor
The house wasn’t clean enough.
So on and so on

Everything.

I felt so ugly inside.

My psychiatrist said that anger and irritability were symptoms of postpartum depression and we worked really hard together at finding the right medication combinations and talking to get me through it.

I also have a little black book that my husband has dubbed the “black bonkers book” where I immediately write down what made me mad. It puts my anger on the paper and I can walk away from it.

Oh, and then there is mommy time out.

Yes, I’m 30 years old and I take a time out either in my room or in the bathroom. It helps to just remove yourself from a situation and just breathe deeply and slowly.

Since blogging, I haven’t read much about the anger and rage portion of this illness which is why I’m writing this today.

So how about you? Do you suffer from rage and irritability among your postpartum depression symptoms? What types of techniques do you use to calm yourself down? How does your family react to your behaviour?

Kimberly

Note: For more stories on anger and postpartum depression/anxiety, read these:

Stark-Raving Mad: Anger & Postpartum Depression

The Rage of Postpartum Depression

June 1, 2011 3:46 pm Filed Under: Postpartum Depression

Hormones & Mood: Is There A Connection Between PPD & Your Period?

By Katherine Stone May 23, 2011

Several of you have mentioned your postpartum depression or anxiety getting worse when you return to having periods after your baby is born. You wonder whether this is an indication that you aren't really getting better at all.

If, like me, you are someone who had a perinatal mood or anxiety disorder and also has had premenstrual dysphoric disorder, you can't help but think they are connected in some way. I asked Marlene Freeman, MD, of the Massachusetts General Hospital Center for Women's Mental Health whether there is a known interconnection between postpartum depression and other types of depression that seem to be hormonally related, like premenstrual dysphoric disorder, which is depression and anxiety before your period, and depression during perimenopause. Her answer surprised me:

Postpartum depression. Premenstrual dysphoric disorder (PMDD). Perimenopausal depression. Depression associated with breast milk let down. Mood worsening or improvement with oral contraceptives. Many types of mood disturbances experienced by women over the reproductive cycle are associated with fluctuations of or exposures to gonadal (sex) hormones, primarily estrogen and progesterone.

A woman might experience any of the above. These are real, biologically driven mood disorders or disturbances. It seems intuitive that hormonal changes cause postpartum depression, premenstrual dysphoria (PMDD) and perimenopausal depression, but intuition is not always right, or at least as sophisticated as reality.

There is no simple relationship for women overall between hormones and mood. Variability among women and variability among the lifespan for each woman tells us how complicated the relationship can be. Consider that all postpartum women experience abrupt changes after delivery of estrogen and progesterone levels. A majority of women experience “the baby blues,” but a substantial minority will develop postpartum depression or anxiety.

No single hormonal factor has been found consistently to differentiate those who develop PPD and those who do not. Postpartum depression may certainly be triggered by hormonal changes in some women. However, it is difficult to predict who will be sensitive to hormonal changes. Some women will experience a crashing, immediate-onset depression after delivery, some will experience a sense of being overwhelmed with more gradual mood worsening into a depression, and some women will have depression that started during pregnancy and continued into the postpartum. It is not clear that postpartum depression is a single entity, and it definitely does not appear to have a single cause. We know if a woman has experienced PPD before she is at risk after future deliveries. It is less clear if she is at future risk for PMDD or perimenopausal depression, but it makes good sense to at least monitor her mood and suspect that mood worsening could occur during other reproductive events that are associated with hormonal fluctuations.

Some women will notice the onset of premenstrual dysphoric disorder (PMDD) after they have had children. Some women who already have PPD will notice their mood worsening even more during the premenstrual part of their cycles after their menstrual cycle has resumed. It is reasonable to assume that rather than PPD worsening during the premenstrual (or late luteal) phase, she may be experiencing premenstrual mood worsening or premenstrual mood exacerbation (PME). First line treatments for PMDD and PME are serotonergic antidepressants such as SSRIs, and often higher doses are required during the premenstrual phase of the cycle. [In other words, a mom already on an antidepressant for PPD whose moods worsen during PMS may need a higher dose during that part of the month prior to her period.]

To date, hormonal therapies are used to treat PMDD (in the form of oral contraceptives), hot flashes (estrogen, in numerous forms), and perimenopausal depression (often estrogen and progesterone in combination with an antidepressant). Hormonal treatments have not received adequate study for women with postpartum depression and anxiety. It may certainly be the case that at least a subset of women whose postpartum depression is primarily hormonally driven will be especially responsive to estrogen for example. Studies are underway to assess this as a possible treatment for PPD, as well as to assess which women are most likely to find this as a beneficial treatment.

There is a lot of data backing up the relationship between estrogen and neurotransmitters thought most responsible for mood. However, the actual experience of each woman is different.

I was surprised, because, as Dr. Freeman mentioned, it seems so intuitive that all of these things would be directly related. If your moods are worsening when your period returns, it looks like you may need to look at that as a separate issue from your postpartum depression or anxiety, and talk to your doctor about potential treatment with oral contraceptives and/or a potential temporary increase in your antidepressant. It is comforting, though, to note that a worsening in mood is NOT an indication that you are doomed to having PPD forever or that you've gone back to square one. Like me, you may also have PMDD. As more and more research is done, I hope one day to better understand why I'm so sensitive to hormonal changes, whenever they occur.

May 23, 2011 11:07 am Filed Under: Baby Blues, Postpartum Depression