Yesterday members of the Warrior Moms Book Club discussed the introduction of the PPD book Sleepless Days and talked about preconceived notions.  Today we are going to discuss the onset of the author’s symptoms and what those symptoms felt like for her and her family. 

~ Amber

Amber: On page 25, Susan explains how her anxiety and obsessions began even during her immediate post-birth hospitalization. How she kept straightening and re-straightening her tiny room. It’s no secret that when our minds feel out of control we try to control our environment … both our physical surroundings and the people around us. Thoughts?

KC:  I have at times sought to control my physical environment so as to give the impression of order when I feel out of sorts, but PPD caused me to feel deactivated, useless. I could see so many things before me that could be set straight, yet I was inanimate.

AC: I became immediately obsessed with time … what time, to the minute (and how many ounces, to the drop), did my son eat, have his diaper changed, etc. And, if the feedings were off, I would get wacky, anxious.

APR: In the beginning, I was obsessed with the cleanliness of my surroundings, but did not have the energy to do anything about it. So I was EXTREMELY irritated by my entire house, and resented my husband and myself for not taking care of it. I was obsessed with not letting the baby cry, even one little peep! I would jump out of bed in the middle of the night before she was even done with the first little grunt, like I was a lightning rod.

BR: I had immediate intrusive thoughts about SIDS. The days just after my daughter’s birth my mind was flooded with thoughts of SIDS. I was convinced my daughter would fall victim to it, obsessively talked about it with my family members who visited and combed every book for information on it. If anyone spoke about my daughter’s future I thought to myself how foolish they were, because she’d never survive the threat of SIDS. It took a bit longer for my other symptoms to set it, but I know these thoughts were the first warning signs.

AC: BR, I was also obsessed with SIDS too. I would also re-swaddle my son over and over again because I was convinced he would suffocate.

Amber: In addition to these intrusive thoughts and obsessions you describe, insomnia is a common symptom of PPD. On page 50 Resnick describes a six-week postpartum visit in which she mentions her bouts of insomnia and her doctor’s recommendation to get 5-6 hour stretches of sleep as a warning. While the need for the sleep is clear, she takes her doctor’s advice and becomes defensive. Depressed? She’s not depressed, she maintains, just tired. The internal dialogue on the drive from the visit seems almost argumentative.

What about you? Did you experience insomnia? And did you, like Susan, contend that you were not depressed, just sleep-deprived at first? Why do you think Resnick, who admits to a history of childhood depression, was SO quick to deny that she might be depressed?

KC:  Depression is a place no one wants to revisit. I, too, tried to tell myself that there was another explanation for what I was going through.

AC: I don’t even know if what I had was insomnia. At my six-week appointment, I thought I was totally fine. I remember reading the postpartum checklist and thinking, “Phew, I did it. I didn’t get postpartum depression.” I had no clue. I was soooo aware of my history with anxiety before and during my pregnancy (on Celexa for 5+ years before pregnancy), but the minute I had my son, it was like all awareness disappeared. I feared going back on my meds, afraid some weird side-effect would occur. Clearly, this was a major sign that I NEEDED to be back on my meds.

APR: Insomnia was my most notable symptom, especially in the beginning. I definitely just thought I was tired. I couldn’t sleep when the baby was sleeping, like they always tell you to do. It took me so long to wind down after getting up with my daughter, and then she would just wake up a short time after that. It was torture. I didn’t feel sad. Maybe flat. But I was definitely anxious. It was like the accelerator was stuck. I powered through the exhaustion with a fervor. I didn’t think I was depressed, and maybe I wasn’t, at first. I knew I was definitely sleep deprived. But as the worst winter in 30 years hit us, so did the depression. I was so tired and depressed I could have laid in bed all day and night but was unable to do so because I was so wired/anxious and obsessed with caring for the baby myself. It does seem like Susan was in denial, but hindsight is 20/20.

BR: At first I thought the insomnia was just part of being a new parent, as I had heard so much about new parents not getting any sleep. When I literally was awake for 48 hours straight, and the intrusive thoughts and anxiety took over I knew it was not just new parent sleep deprivation. Resnick’s denial could have come from the fear of experiencing another bout of depression. I too have suffered from depression in the past, and it was terribly scary to think about going through another bout of it, while dealing with the responsibility of caring for a newborn.

Amber: Once her husband takes over the night feedings, Resnick describes nights where she runs downstairs repeatedly because she “hears the baby crying” only to find her husband holding a calm baby drinking his bottle. I found myself the victim of what I call “the phantom cries” and even wrote a blog post about it: http://www.beyondpostpartumblog.com/2011/12/insomnia-and-phantom-cries.html

Is this something you experienced? If so, how did your insomnia or the “phantom cries” impact your PPD/PPA?

APR: Oh man. This was one of the reasons for my insomnia. I would lay awake with my earplugs in and white noise on while my husband was taking care of the baby at night, and I could just FEEL her screaming. Now I wonder, maybe it was really me screaming.  Oh, it was awful.

BR: Yes, I definitely can relate to hearing the phantom cries, and sometimes I still hear them too (when I think my daughter has woken up from her nap). I remember standing in the shower, which during the early days was my only escape, and hearing her cries even over the closed door and running water.

And the insomnia was terrible for me. I didn’t get the night time help from my husband and I would just rock in the nursing chair, with the baby sleeping in my arms until 6 in the morning, when I would call my mom or sister and just sob to them.

Amber: On pages 78 and 79 Resnick describes a middle of the night conversation with her husband after all attempts at sleep (including moving out of their bedroom, herbs, and wine) have failed her. She asks him simply, “Do you think I am having a nervous breakdown?”, expecting fully that he will answer no and reassure her in such a way that she will believe she’s not, either. Instead, he responds that he doesn’t know. She’s devastated, but finally realizes that “nothing and nobody is going to make everything alright.”

This seems to be a turning point for Resnick, in response to which she first cries, finally sleeps for three hours, and then makes a call to her doctor.

What did your turning point look like (if you had one)? When did you realize you needed to reach out for professional help? Was it your choice? A mutual decision? Or, was there a pinnacle moment when there was no choice about reaching out for help, instead help found you?

KC: Four people in my life, unacquainted with each other, had kindly and in love asked me to consider talking to my doctor about PPD.  The final request came from my baby’s pediatrician, who remembered that I had cried easily during two appointments.  I had a very supportive and prepared doctor, yet it was scary to say the words, “I need help.”  After the doctor comes finding a therapist, where I had to repeat the phrase again and again during my search.  Strangely enough, the turning point seemed to be after I finally settled on and met with my therapist.  My anxiety just peaked until I could experience treatment; I did not feel relief just in requesting help.

AC: I don’t remember what prompted me to reach out to my therapist. I do know it was before the moment I KNEW I HAD to go back on my meds. That moment…that moment was horrible. I decided to drive to my mom’s house, which is in the middle of the Adirondacks in New York. No cell service for part of the drive. As I was driving, the idea of breaking down with my newly born son and no cell service began a slow anxiety attack that lasted a good 48 hours. The second night there, I was awake from 2am until probably 10pm the next night. Intrusive thoughts were everywhere and I was a mess. I drove the 4 hours home clenched to my steering wheel with the mantra, “just get home…just get home.” Once there, I knew I could get help and make emergency calls to my therapists and doctors. Torture.

APR:  I had been reaching out for months to my midwives and husband. No one seemed that concerned about me. I must have seemed fine on the outside. I turned away from everyone else except for small talk. But on the inside I was dying. By the time I insisted on seeing a different midwife and getting on medication, it was eight months postpartum. I was trying to nurse my baby and then put her down for a nap. I thought she was asleep, and I put her down in her crib. She instantly popped up and smiled at me. I freaked out. I ran out of the room, to our guest room, and proceeded to cry so hard I was gagging and nearly throwing up. My husband, who had just gotten home from work, saw/heard all of this, and after a moment came into the room and held me while I sobbed. I think this was the moment he knew it was real. Before then, he thought I just needed to ‘get over it.’

Then, at 13 mos, I asked my husband to watch the baby so I could go to the doctor because I was sick. I had mastitis, an ear infection, and laryngitis (completely unable to talk). My husband was so angry at me because I had not helped with cooking or doing dishes for a couple weeks and our house was gross. He didn’t even ask me what the doctor had said when I got home. I just got the silent treatment. It hurt so bad to have no support from him when I was so sick. I said to him, please tell me what is going on. He said do you really want to know? I said yes, I am afraid for our marriage. He told me how the house was just making him so upset. This low point is what made me call the midwives again because I was so low. We upped my dose of Zoloft again, and this helped a lot. I finally began (most days) to some basic things done and keep my head above water, and things have improved significantly between us.

AC: My husband and I had a huge fight at one point as well. What he was seeing in me was completely different than what I saw in myself. It was shocking, yet eye opening.

APR: Hugs, AC. It is so hard!! I don’t think they can ever really get it.

Amber: Resnick‘s doctor prescribes a vacation, therapy (for “managing stress”), and Benadryl for sleep. Having what she believes is a “magic bullet” for immediate curing of PPD, she “skips into the pharmacy”, as she describes on page 85. This chapter of the book describes in what I believe is pretty accurate form the roller coaster that is PPD, in which you have a good day or good hour, which can either provide hope for your future wellness, or simply be a tease, making you think you’re better only to fall deeper into anxiety or depression when it is over. Did you feel relief when you received your diagnosis? What about your treatment plan? Were you under the impression there was a magic potion that would make the whole thing just go away quickly? Lastly, was your experience a roller coaster? How did you feel about the ups and downs? Were you grateful for a glimpse of wellness, or just more pissed off when you felt badly again?

AC: I do not recall a sense of relief, but I did think this would go away quickly now that I had a name for the thoughts I was having. This false sense of a quick fix did not help. I definitely had days when I thought I was “cured” and I would be racing around the house getting tons of stuff done, only to crash the next day. I was grateful for the glimpse, at first, but then bitter from it. Even now I hold a sense of bitterness towards that false happiness I experienced because it seemed so real.

APR: I hear you, AC. I do the same thing, racing and crashing. My initial strategy was not to slow down at all. I thought it was such a victory when I went to Costco with the baby for the first time on my own without crying. I went to baby yoga, mom/baby hiking groups, etc. I went on a trip by myself with the baby to visit family for ten days at 3.5 months (5.5 hr round trip). When I returned from that trip, I crashed. I still feel like I haven’t really glimpsed wellness. I just feel flat most of the time, definitely not myself. The only time I am really, truly happy is when I see my daughter doing something new or cute. Even when I am doing things I love, like riding my bike or skiing, I try to relish them like my therapist encouraged me. I think oh this is so great, oh it is so beautiful out, etc, but it just feels like words, not feelings…

BR: I felt some relief when my treatment plan finally came together. It took a while to pull together the resources and treatment I knew I needed. And yes, I know the roller coaster well. It started with just short lengths of time where I felt better, then it stretched to longer. A couple weeks ago I had a bad day, and I realized I hadn’t had one to that degree in several months! The roller coaster ride made me feel helpless to start, but the more I read that it was part of the healing process I was able to accept it.

Amber: Speaking of “roller coasters”, on page 121 Resnick describes what she believes PPD to be like, using incredibly detailed analogies as her examples. These include “PPD is like having no censor for thoughts or emotions. Everything that comes up -things that usually get caught in the net of the subconscious and dealt with in dreams-comes to the surface shimmering with energy. The are urgent, insistent, impossible to ignore.” and “A depressed mind also has no quality control.”

Does this accurately describe your personal experience? If so, why? And if not, how would you describe it?

BR: Yes, this is descriptive of my experience as well. I have experienced depression and anxiety in the past, but never have I been so overwhelmed by thoughts and emotions. There was no distraction or relief, nothing I could do to have any control over what was happening in my head.

APR: She was spot-on in this department. I felt like I was just on hyper drive all the time. There were no quiet moments in my experience. It was pure, prolonged fear and dread.

Amber: I, too, found that it took years postpartum for me to feel like I had the tools to fully control my thoughts.  Cognitive Behavioral Therapy is a wonderful resource that when utilized by a therapist trained in perinatal mood disorders can be effective in coping with anxiety and obsessive or intrusive thoughts.

Again, thanks for sharing so openly!  Tomorrow we will talk about Susan’s (and our own) journey to wellness.