Dads and Perinatal Mood and Anxiety Disorders

“We’re pregnant!” As a Dad of now four kiddos, I remember the mix of excitement and terror that came with our first positive pregnancy test. I also remember feeling for the first time (and truthfully still live with) a unique brand of anxiety that goes along with being a parent.

It is very normal to experience symptoms of anxiety and depression while expecting and after the arrival of a newborn. Symptoms of anxiety can include restlessness, feeling keyed up or on edge, being easily fatigued, difficulty concentrating, muscle tension, and sleep disturbances such as troubling falling or staying asleep. Symptoms of depression can include depressed mood, loss of interest in previously pleasurable activities, sleep disturbance, fatigue, feelings of worthlessness, indecisiveness, and thoughts of death or suicide. If you are noticing that these symptoms are persisting or increasing in yourself or your partner, you may be experiencing what is known as a perinatal mood and anxiety disorder (PMAD). Did you know that 1 in 7 women and 1 in 10 men experience a PMAD? To put that in context, that’s a minimum of 3 to 5 parents of students in a class size of 30.

What to know and expect about a PMAD? To begin, it is not the fault of the Mom or Dad and no one did anything wrong to bring the symptoms on. In my work as a clinical therapist, I know that people can under-report the intensity, frequency and duration of their depressive and anxious symptoms. There are a variety of reasons for this, including not wanting to feel like a burden in general or to their spouse in specific, not knowing how to talk about feelings that are persistent and even scary at times, feeling guilt or shame, as well as just being overwhelmed and too exhausted to take note of what is being experienced. The reason for sharing this is that if you are noticing that you or your partner are exhibiting symptoms of anxiety and/or depression, those symptoms could be more intense than you are observing and are likely going to be under-reported by your partner.

What can you do? As a Dad, you are going to feel tired and overwhelmed at times too. Have you felt as a Dad that more is being expected of you? That’s probably because it is! In his book, The New Rules of Marriage, Terry Real talks about 21st century expectations for marriage and how they have shifted. He extends this to indicating that expectations for us as Dads have increased and rightfully so. Taking a hard look at ourselves and how we can share in the hard work of managing the household (e.g., cooking, laundry and cleaning) and talking about this with your partner would be helpful.  

You can be empathetic and show understanding by asking open-ended questions. For example, two great questions are: “What can I do to help?” and “What do you need from me?” Additionally, be prepared for your partner have different answers to those questions depending on the day or that your partner may not be able to speak what they need in the moment. That is totally okay.  On this note, another way to be helpful is to take initiative without being asked. A key point here is communicating with your partner to see if they want to be asked, prefer you take initiative, or a combination of both.

You can encourage self-care for your partner and for you. You can encourage rest, exercise, socializing with friends and prepare healthy meals. You can go with your partner to see the doctor and/or to see a therapist. One avenue to consider when seeking therapy is that many companies and plans have what is called an Employee Assistance Program (EAP). EAPs typically authorize a certain number of sessions (often 3 to 4) that are no cost to the employee or spouse.

Finally, you can get informed and seek out support from people who have been there or who are currently going through what you are…you are not alone! You can communicate with your partner and loved ones in a caring yet direct way that you are concerned about them. The links below are two great places for Dads to start…

http://postpartumdads.org/

You got this and will get through it! There is hope!


-Written by Joe Halaiko, LPC-IT, SAC-IT

Joe Halaiko, LPC-IT, SAC-IT specializes in relationship concerns, trauma, grief/loss, managing chronic illness, depression, substance abuse and anxiety. He has prior experience in human resources and can help people strategize on work issues or navigate career transitions. He works with adolescents, adults, couples and families to develop goals tailored to each of their individual needs. He uses an integrated approach, drawing on Person-centered, Existential/Humanistic and Narrative models, as well as using Cognitive Behavioral and Motivational Interviewing strategies. He plays guitar, and believes in the power of creativity, possibility and compassion.

The Light Went Out–My Postpartum Journey

Trigger Warning: suicidal thoughts

The Light went out.

“You’re glowing!” – I heard it so many times during my pregnancy. I felt the glow; I really did. I could feel the abundance of love and happiness that beamed from my face; the happiness that embraced me. That same glow followed me through childbirth, through the long, sleepless nights of nursing a tiny human and the dreaded witching hour that came in the evening. That glow got me through, but that glow dissolved. My light went out and this is the story of my recovery. I promise, if you keep going, you will also recover from your time of darkness. The light will return.

While growing up, I suffered from a mild form of OCD and some anxiety, though those things never inhibited my ability to live.  I loved to live, to smile, to laugh, to joke—but that all changed. After my third baby, I felt the shift. If you have ever gone through a perinatal mood or anxiety disorder (PMAD), you know that feeling and the very words you’re reading are likely filling your soul with the feelings you once felt. The dark, all-encompassing hole of spiraling thoughts, that you were sure had no end. The hole that completely swallowed you and and made you feel as thought there was no way out. I can look at pictures that I forced myself to take with my sweet newborn and remember the thoughts going through my mind—not feelings of harm, but of hopelessness. PPD/PPA stole my shine at one point; it took the light from within me. The light that once was illuminating my every move—it went out and with little warning.

I remember waking up one day and everything within me was off.  It was as though I had left my physical body and I was walking in a dream, but that dream was my reality. Every second felt like a mini-panic attack.  My brain was in a constant battle of fight and flight, circling itself with thoughts that nothing was real, but it was, it was so real. There was a disconnect from my life and family and it consumed me with feelings of hopelessness and defeat. Who were these children? Surely, they were not mine. This house wasn’t home. My husband, well, I was light years away from a connection I had felt with him just the day before. I would sit in the bathroom and have a raging fight within my head over the very real life that was happening outside of those doors—a life I very much did not feel a part of. I couldn’t drive. I couldn’t leave my house; I could barely leave my chair.  I nursed my baby and handed him back over to dad because it was too much.

I didn’t know then that I was suffering from a PMAD. It seems so obvious, I know. I remember exploring options like brain tumors and prayed that doctors would find one and be able to physically remove the mental anguish I was feeling. I didn’t know this wasn’t a job for my primary doctor.  I surely didn’t think I needed a psychiatrist because something was physically wrong with me, not mentally, right? Me—a student that had been studying mental illness for years and who had devoted hours and hours of learning the signs—I didn’t recognize the type of help I needed. I didn’t recognize that I needed medication to reroute the wiring in my brain or that I needed to surround myself with support. I just didn’t know, and it took me almost too long to figure it out. I was almost too late.

Did you know 20% of postpartum deaths are due to suicide and most women suffering from perinatal mood or disorders do not seek treatment (Wisner, 2013)?  Women like me. They don’t know the signs or think they are at risk. Maybe they are ashamed; too ashamed to seek the help they desperately need. What some new moms may not know is there are people out there longing to help them—begging to give them the ladder they need to climb out of the darkness.  People who won’t guilt or shame them but who will encourage and love them. The signs were there. THEY WERE EVERYWHERE, yet I still felt shame and was filled to the brim with denial.

So there I was, longing for help, for someone to pull me out of the water that was filling my lungs, depleting my oxygen, and stealing my life. I needed someone to tell me it would get better; a blog, a friend…anything. Not medicine though—I didn’t need that. I’m not “that” person. I was going to school to help those people, not be one. I just needed a shred of hope. Surely, I could continue hanging from the fraying string of life without the medicine my doctor assured me I needed.

The darker thoughts soon started flooding my mind. I didn’t want to kill myself, but I didn’t want to live. How could I? Nobody could live the rest of their life feeling this way; it wasn’t life, it wasn’t living. For the first time in my life, I understood suicide and the desire to leave the darkness behind. It sounded like a relief. I wasn’t really living anyways. I was simply a beating heart in a lifeless body; a shell that everyone would be better off without. The wall between me and the world was rapidly growing thicker and I didn’t want to be a part of it anymore.

Enter Zoloft.

Now, I know, “prescription medications are the devil.”  I’ve heard it. I’ve seen you write it and share it and rant about big pharma. You’ve listed and rambled on about the long list of side-effects that come with taking SSRI’s and mood enhancers. I’ve scrolled over the posts on social media encouraging people that “nature is medicine, not a pill.” I see you (it’s even possible that at one point I “liked” your post!) but I’m here to tell you that you are the problem. You are an ingredient to a disastrous recipe of misunderstanding mental illness. You are a driving force behind people—moms—feeling shame for taking medicine they desperately need. A huge part of the reason why moms are literally killing themselves and leaving their children and families behind. But a “good” mom wouldn’t need a pill to help her feel love, right? Don’t these moms know the side-effects? Or, that their doctors are at the hands of big pharmaceutical companies and are just pushing prescriptions to fill their pockets? They must not have tried essential oils or used St. John’s Wort, or valerian root, or B12 or D3 or a dose of sunshine. If they had they’d feel better, right? They should try a walk through nature; that would be a cure-all…nevermind that they aren’t showering or picking themselves up off of the couch for days or weeks at a time.

Or, maybe it’s just that you have never felt the overwhelming embrace of a world full of darkness. You’ve been lucky enough to never have to navigate life through a dark tunnel that seems to have no end. We’re taking these medications because we are trying…we are trying so hard! We are desperate to NOT DIE—we do not need your judgement and misguided shame. We need life. We don’t care about side effects of nausea when we don’t even care about living. We don’t care about the profuse sweating we go through, just to feel an ounce of happiness. We don’t care, because we have life—a life we once lost.

The tears literally streamed down my face uncontrollably as I took my first pill of Zoloft. I felt guilt. I felt shame.  I felt like throwing up because I was so confused, but I also felt hope. For the first time in three-long, agonizing months, I felt a tinge of hopefulness, a feeling that things had a chance of getting better. I felt like living was a possible option. I also knew that often medicine can take weeks to kick in, so I scrounged up every last bit of strength in my body and told myself I could hold on for twenty-one more days. I could do this. I looked into the eyes of my children, after explaining my need for medicine and dug as deep as I could to find the energy I needed to live. And I found it. I wove that frayed string of life back together. I built it up, climbed it and threw it out as a lifeline to the others spiraling into a world of darkness.

If you look into your baby’s face and feel nothing, that is not you…that is depression. If you feel like you are nothing, worthless or that life would be better if you were gone—that is not you…that is the depression. If you can’t find the energy to shower or get dressed or move out of your chair, that is not you…that is depression and you are not alone. There is light at the end if you keep going. You are loved. You are more than depression and perinatal mood and anxiety disorders and you will find the spark of life again. One day, you will smile again.  You will half-heartedly laugh again and remember the joy it brings you. You will feel love and you will heal. You will walk outside in the sunshine and take a deep breath of relief—because you’re alive and you beat it. You will look back at your time of darkness and feel like a warrior, because you are. You will look into the mirror and the reflection will be someone you recognize. Do not stop fighting. Do not stop trying to find that light. My light turned back on and if you keep going, yours will too.

Sending love and light.

–Written by Jarrika Falls Stephens

References: Wisner KL, Sit DKY, McShea MC, et al. Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings. JAMA Psychiatry. 2013;70(5):490–498. doi:10.1001/jamapsychiatry.2013.87

Dear Postpartum-OCD

Dear postpartum-OCD,

I hate you. I hate you for SO many reasons. I hate you for creeping up on me at a time in my life that was supposed to be filled with joy. I hate the what-ifs and the images you played, re-played and then played again in my mind. I hate how you tried to convince me that I was capable of horrific, gut-wrenching things. I hate that you made me feel that it was best to avoid my children. I hate the way you berated me with intrusive thoughts each one more graphic and terrifying than the last. I hate that you made me want to avoid certain activities and places therefore depriving my kids of experiences they deserved to have. I hate that, because of you, I missed out on so much with my babies. But most of all, I hate that you told me that the only way they would be safe was without me.

I hate that no one even told me you existed. This fact made it so easy for you to convince me that there was something wrong with me…that I was some sort of monster that didn’t even deserve to be a mother. I hate the way you made me view myself. How you stripped me of what little self-compassion I had and made me feel worthless and unlovable.

I hate that you made me feel trapped…that you made me feel like a prisoner in my own mind. I hate that some days you made me wonder if I would ever be well. If there was any end to the agony I was in…if there was any other way out…

But that was before. Through treatment, medication and time, I’ve learned to see you less as an enemy and think of your more as a friend. Because, the reality is that, you’ve made it your mission to protect me, and those I love most. Despite the fact that your warning signals may misfire, I have learned to appreciate the motivation behind them. For your own good (and mine), I’ve learned to challenge you and your screams. I have practiced letting your alarm blare incessantly in my head, in an effort to show you that there’s no real need to be afraid. And in some odd way, I need to thank you. I need to thank you for showing me that I had strength I didn’t know I possessed. For allowing me to find courage to speak out and advocate for other moms who might have a friend like you. But please know that you can rest now. I’ve got this.

–Written by Alexis Bruce

A Post of Hope: Heather’s Story

I didn’t see it coming – literally.

Our first baby came on Christmas Eve. His labor was “spontaneous,” though I had obsessively done all I could to induce labor on my own. The last 6 weeks of my pregnancy were emotionally exhausting. I was over it. I had support from my prenatal swim class instructor and my OB was very aware of my emotional state, but I was still struggling. Drowning my emotional turmoil in Mexican food and Cokes, my water partially ruptured; hours later, we had our baby boy.

By day 5 postpartum, my reality looked like this: Don’t touch me; I’m fine. No, I’m not tired. No, I don’t know why I’m crying. Stop talking so much! And then, perhaps the scariest manifestation of my anxiety, I lost my vision. It started as an inability to look up, followed by the loss of my peripheral and finally culminated with temporary blindness. I never would have imagined that anxiety could make such a significant impact on the body’s physical ability to function. This was not the normal “baby blues.”

I was unable to express what I was experiencing to my husband. When I tried, I would struggle to catch my breath and would cry uncontrollably. He was so concerned, yet I didn’t know how to have him help me. He called the doctor and talked to her for me. Medication was prescribed. A few days later, I felt more in control of my breathing. The crying came less frequently and I had no vision issues. We stayed the course with medication, safely prescribed for a breastfeeding mother. I continued to fall deeply in love with my newborn and worked hard on leveling my emotions.

Looking back, I was anxious the whole pregnancy. I just knew I was pregnant the day he was conceived. Not being able to sleep seemed a natural side effect of pregnancy. Not being able to breathe seemed normal; the baby was squishing my insides. In hindsight, I was hyper. I was a deer in headlights. My eyes and forehead hurt constantly from not relaxing my face.

A few months later, I discovered I was pregnant again. I was almost to my 2nd trimester and hadn’t known it. Enter anxiety. My boys would be just 13 months apart. I just got myself ironed out; not again! I was grief stricken, but why would someone ever be upset they were pregnant? My OB monitored my mental health at each appointment. She suggested I see a therapist but when was I going to have time to do that? Not to mention, I wasn’t ready to unpack all my baggage. I had enough to worry about right now.

I began prenatal yoga which, miraculously, was a therapy session for me. This class really showcased how my anxiety impacted me the most: my breathing. Despite all my efforts, my shoulders would not relax, my chest would not open and I would be panting like a dog rather than using diaphragmatic breathing. When I could finally soften and breathe, I would weep. My instructor would lay hands on me and I’d emotionally break.

With baby number 2, my OB suggested an early induction. We had a plan in place for the delivery and a plan in place to care for my mental wellness after. WIth our first son, my husband, my support system, knew to look for depression or “baby blues”; but what I experienced caught us by surprise. Now we know we should have been ready for it due to my previous struggles with anxiety. Women with previous mental health issues are at a higher risk of developing perinatal mood or anxiety disorders during pregnancy or postpartum.

I’m still working on coping with my anxiety. I’m often asked “What are you anxious about?” I wish it were something or a scenario that made me anxious. My anxiety is chemical. Hormonal. Triggered by situational stress or not getting enough sleep. In my tool box, I have a daily prescription and a situational prescription as needed. I use diaphragmatic breathing exercises, oils, singing and exercise to regulate my breath. I value my sleep and stay as rested as possible for a mother of two toddler boys.

But most helpful has been learning my threshold; honoring my limits and asking myself if taking on more will compromise my mental wellbeing. So even though this is something I still work at, I am here to say that it does get better. You will get better. With the right support and tools, you can take the power back from your postpartum anxiety.

-Written by Heather Karazsia

PPD is a Disease

Moms Need to Know PPD is a Disease.

With recent news of the FDA’s approval of Zulessro (brexanolone), a new drug to treat postpartum depression (PPD), there has been a plethora of responses both positive and negative. Zulresso currently comes in the form of an injection through intravenous use and requires 60 hours of inpatient stay at a certified medical center. Although not an ideal form of treatment, it has promising results. As a two time survivor of postpartum depression and anxiety and a maternal mental health advocate in the greater Milwaukee area, I think this is a big win in the world of maternal mental health and here’s why:  Zulresso is the FIRST MEDICATION SPECIFICALLY DEVELOPED AND DESIGNED FOR POSTPARTUM DEPRESSION. In all of the years that Moms have been suffering, there has never been any researched treatment that addresses the complexity of this form of depression. So many of us have been fighting an uphill battle to give PPD and its treatment options legitimacy because frankly, much of our culture, community and medical community, do not think it is a legitimate disease.

We know that PPD and other Perinatal Mood and Anxiety Disorders (PMADs) are the number one complication of childbirth (as common as 1 in 7). We also know that suicide accounts for approximately 20 percent of postpartum deaths and is the second most common cause of mortality in postpartum women (Archives of Women’s Mental Health). Unfortunately, many people consciously and unconsciously believe PPD is a defect of character or is simply brought on by mental weakness. Some think it’s purely an emotional response to the stresses of motherhood, particularly in America where our culture fails to truly support mothers or families. I was told by a maternal educator that I should have “gotten a massage” to get over my PPD. Others deal with OB doctors who think PPD symptoms are normal for sleep deprived new mamas (PPD is not normal. It is common, but not normal). Of course, sleep deprivation plays a role in PPD and usually worsens the symptoms, but moderate to severe PPD often isn’t solved by just getting more sleep. One psychiatrist told me she doesn’t really believe in medication as treatment for PPD and that it’s caused by what we eat – the misconceptions around this condition only intensify and exacerbate the problem.

PPD is a real disease that can be complicated or bettered by our emotional state, our environment, our prior traumas, the way we experienced our child’s birth, our life stressors and our community of support. But at its core, it is a disease. A disease that is not a mother’s fault. PPD looks different on each Mom and symptoms range from mild to severe. Stigma around mental illness, particularly in relation to motherhood, prevents Moms from getting the help they need. Hopefully now, Moms with PPD will have more credibility as they advocate for themselves to their employer, to their family and to their medical providers.

When it comes to helping a Mom recover from a PMAD, it will take more than a drug to fully heal her (sometimes she may not need medication) and I believe most perinatal professional providers know this. A Mom is going to need as many options and tools as she can get to feel better and navigate the physical, mental and emotional toll of this disease.

Better prevention strategies and a cultural shift in attitudes and practices around parenthood are needed to combat PPD but we also need more tools to heal. To think that this medication is pathologizing a life threatening disease isn’t accurate because a Mom could have the ideal situation for bringing home a baby and still get PPD – it is not always preventable. My friend said to me once, “What a Mom needs is medication when she needs it.” I couldn’t agree more.

Moms with PPD need us to call PPD what it is, a disease, like diabetes, like cancer, like many other illnesses that are not equated with shame and stigma. A disease that has a promising chance of being treated quickly with this new medication. A disease that needs more research in prevention and treatment.

This drug isn’t right for everyone, not everyone will have easy access to it, not everyone will need it but for those of us who talk everyday with Moms fighting for their health and well-being, this new drug provides more hope and hope is what keeps our fellow mamas alive.

-Written by Sarah Bloomquist

References
“FDA approves SAGE Therapeutics’ (SAGE) treatment for post-partum depression”
“It Will Take More Than a $34,000 Drug to Stop Postpartum Depression”
“Brexanolone, life saver or bust?”
-Photo Credit: Rosaliartbook

The Silent Struggle after Miscarriage

You are not alone. We hear this phrase in the maternal mental health community so often. But to a mom who who has experienced a miscarriage, it probably doesn’t feel that way. We are missing the mark by not talking about miscarriage and the anxiety, depression or even PTSD that can accompany one. While this post will focus on miscarriage, it’s important to acknowledge moms who have experienced stillbirth or infant loss as well. In my opinion, they each deserve a later post of their own.

According to the March of Dimes, “Miscarriage (also called early pregnancy loss) is when a baby dies in the womb (uterus) before 20 weeks of pregnancy. For women who know they’re pregnant, about 10 to 15 in 100 pregnancies (10 to 15 percent) end in miscarriage. Most miscarriages happen in the first trimester before the 12th week of pregnancy. Miscarriage in the second trimester (between 13 and 19 weeks) happens in 1 to 5 in 100 (1 to 5 percent) pregnancies.”*

These stats give a sterile view of an incredibly real and devastating experience. Because miscarriages often occur early in pregnancy, it’s possible that very few people were aware that a mom was expecting and this can, understandably, lead her to feel misunderstood, isolated and hopeless. Furthermore, watching life continue effortlessly for those around her can make those feelings even more intense.

Knowing that these moms are at a higher risk for developing anxiety and/or depression, both after a miscarriage and after subsequent births, we need to be doing more. We need better screening; both immediately after a miscarriage and at regular intervals thereafter. We need to give moms space to feel safe sharing what they need to feel supported. We need to recognize that grief is a process and that it might include a wide rage of shifting and unexpected emotions. We need to let moms know that there is no “right way” to deal with pregnancy loss and she is the only one who can determine what that process looks like for her. We also need to let moms know that while the emergence of grief, anxiety, depression or PTSD after such a harrowing experience is valid and completely understandable, it is also treatable. Depending on the severity of symptoms, support groups (in-person or through social media), therapy or even medication are valid options to help a mom who is struggling.

I almost feel like I don’t have a right to talk about this issue because I have never experienced a miscarriage myself. However, in this mom-tribe, we have to support one another. We need to be reminded to be sensitive and compassionate towards those around us because we might not know the internal battles they might be facing. Maybe I’m able to speak up when someone who is more closely affected cannot. Or, maybe my “you are not alone” is speaking to someone in a different way…a way that she’s been longing to hear. Your pregnancy matters. Your baby matters. Your experience matters. You are allowed to grieve, to be vulnerable, to be cared for by both yourself and others. You deserve to seek and receive help should you need it. You don’t ever have to go through this alone.

Written by Alexis Bruce

I Take Medication for my PPOCD

Let’s talk meds. You’re not alone if the idea of having this conversation makes you uncomfortable. Because for some reason, we are still vehemently fighting the stigma around the need to take psychiatric medications especially while pregnant and/or nursing. It’s a controversial topic and one that many moms feel passionately about no matter which side they fall on.

I have ZERO shame in sharing that medication is a crucial part of my overall treatment plan and an integral component of what keeps me in recovery. Medication, as well as therapy, exercise and good self-care are what keep me feeling like me. My dad is diabetic and no one would ever expect him to stop taking his insulin nor would they expect my mom to stop taking her high-blood pressure medication so why is my need for a prescription any different? I don’t know if I will always need medication but if it proves to be essential to helping me live my best life…then I’m more than okay with that.

When it comes to maternal mental illness, not every mom shares my views on taking medication (and that is OKAY!!!). However, for those of you on the fence, I thought it might be helpful to talk through some of the common objections to adding medication to your treatment arsenal.

I can’t take medication while pregnant.

We all wish for healthy, full-term pregnancies without the need for prescription drugs. But the reality is that it often comes down to assessing the potential risks the psychiatric medication may pose for baby versus the potential risks if mom is left untreated. In some cases, the risk to the unborn child may actually be higher if a mother is taken of off, or declines to start, medication. Consider a mom who is suffering from severe depression. Without her medication, she may be unable to function in her daily life which means she’s unable to care for any existing children, eat sensibly, get an adequate amount of sleep and ensure she receives proper prenatal care. She may also be at a higher risk of engaging in dangerous behaviors including smoking and/or substance abuse.

Data is still limited but there are several psychiatric medications that are now considered to be safe during pregnancy. An informed and trustworthy provider will be able to discuss these options as well as help to perform your individual risk assessment.

I can’t take medication while nursing.

Similar to a mom’s concern of her prescription drug(s) being passed to her fetus, many moms also worry about potential side effects to baby should their medication be transmitted through breast milk. If together, mom and provider decide that it is best for mom to continue to include medication as a part of her treatment plan, there are several options that doctors now feel comfortable prescribing to breastfeeding moms. Having the discussion with your doctor will likely help ease some of these fears.

Another helpful tool is LactMed which can be accessed online (https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm ) or by using the Lactmed app. LactMed is the U.S. National Library of Medicine’s database containing information on drugs (or other chemicals) to which breastfeeding mothers may be exposed, levels of these substances in breast milk and infant blood as well as the possible adverse effects to the nursing infant. Having some background knowledge can help ensure that you are asking your provider all of the questions that are pertinent to your situation.

I want to try natural or alternative remedies.   

GOOD! Therapy, exercise, fresh air, good nutrition, yoga, mediation, acupuncture, light therapy are just a few of the alternative treatments to take into consideration. There are many options that are available to try prior to seeking medication and there are just as many options available to enhance the benefits of medication should these alternative therapies prove to be ineffective on their own. Personally, I needed to complete Exposure and Response Prevention (ERP) therapy, maintain good exercise habits and work extensively on my self-compassion and mindfulness practice in addition to taking my medication daily. Unfortunately, mental illness does not come with an “easy” button but leading a happy and fulfilling life is absolutely possible!

I should be able to do this on my own.

Ever heard the saying, “it takes a village?” I think this phrase was coined specifically with motherhood in mind. Even more so when motherhood is overshadowed by a perinatal mood or anxiety disorder. WHY should you be able to do this on your own? What is the reward for never asking for or accepting help? WHAT should you be able to do on your own? Change your brain chemistry? When posed this way, the concept seems almost ridiculous! You aren’t alone in any of this. Help is available and you deserve to receive it, whatever that looks like for you.

I don’t want to suffer through the trial and error of finding the right medication and/or dose.

I get this one! Embarking on the journey to find the right medication(s) and the right dose(s) was extremely overwhelming for me. If I’m being honest, the first medication you try might not be the best one for you. Or, the medication that worked for you pre-baby may not be as effective post-baby (speaking from personal experience). To add to the misery, many psychiatric medications do not reach their full, therapeutic benefit until 6 to 8 weeks from the time the medication was started and that wait can be agonizing (again, personal experience). I got to a point in my own personal journey where this obstacle became irrelevant because I was merely trying to survive. I was so desperate to go back to the person I knew I was and to be able to enjoy one of the greatest times in my life, that I probably would have stood on my head and recited the alphabet backwards if I knew that was the fix. So when my provider (who I trust completely) said she thought a medication would be helpful, I was fully on board no matter what the adjustment period looked like. Maybe you’re not there yet, and that is okay.

I don’t want to feel like a zombie.

I had the same concern. I had no idea what Alexis on an antidepressant would look like. Would I be able to function? To laugh? To feel? In my experience, my medication has actually allowed me to feel and achieve to a greater degree. During the throes of postpartum-OCD, I was not functioning, nor was I laughing, loving or enjoying any aspect of my life or my family. I was completely engulfed by my disease. Medication helped to lift the darkness, clear my mind and allowed me to thrive. It helped enable me to be able to do the hard work in therapy and make the necessary efforts to care for myself. Something that I don’t think would have been possible otherwise.

Taking medication means acknowledging I have a shameful disorder.

It pains me that some of us are still afraid to admit that we may struggle with mental illness. Going back to the previous examples I gave about my parents, why are those diseases accepted and yet my mental illness may not be? I have never been ashamed of my illness and I’ll tell anyone about it who will listen. Because mine just might be the story that someone else needs to hear in order to have the courage to ask for help. We are working hard to make strides to end the stigma around mental illness, especially during the perinatal period. We still have far to go. You are not your illness nor did you choose to have your illness; but you can choose how you’re going to tackle it and what you might be able to do with it.

The goal of this post is not to preach that medication is the right choice for everyone, because it isn’t. However, it is the right choice for some. Sometimes, it’s as simple as having a conversation with your doctor and other times it means truly reflecting and taking ALL risks into account. If anything, I hope this post has made you reflect on your own perspective (whatever that may be) and has helped you be better able to a approach the topic from a place of non-judgement, self-directed or otherwise. Imagine how we could shift the paradigm if we started to empower ourselves, as well as those around us, to do whatever is needed to live our healthiest and happiest lives? That sounds pretty good to me!

–Written by Alexis Bruce

What is a PMAD?

For too long, the media has used postpartum depression as a blanket term used to encompass all perinatal mood and anxiety disorders (PMADs). We are pleased to see the increased use of the term “PMAD” rather than using one maternal mental illness to define a whole category. However, for many, there is still a great lack of understanding regarding the different types of perinatal mood and anxiety disorders as well as their symptoms. Failure to identify, define and share information about these different disorders perpetuates the stigma around maternal mental health and may also make a mom who is suffering feel isolated, alone and afraid to share or ask for help. The fact is that 1 in 7 women get postpartum depression (or another perinatal mood or anxiety disorder); in low socioeconomic communities, that number rises to 1 in 4. For these reasons, we wanted to dedicate a post to explaining the different perinatal mood and anxiety disorders and their symptoms. Please note that symptoms can start anytime during pregnancy or within the first year postpartum.

WHAT IS POSTPARTUM DEPRESSION?

Depression during pregnancy (antepartum or prenatal depression) as well as postpartum depression are more common than many realize. While postpartum depression often becomes the scapegoat for nearly all postpartum mental health issues, there are some hallmark symptoms that are used to identify this illness including the following:

  • Feelings of anger, irritability or rage
  • Regret of becoming a mother or feeling as though you’ve made the wrong decision to have a baby
  • Lack of interest in the baby
  • Loss of interest, joy or pleasure in things you used to enjoy
  • Feeling disconnected or numb
  • Crying and sadness
  • Eating too much or too little
  • Insomnia
  • Feelings of guilt, shame or hopelessness
  • Fear that you will never be yourself again and things will never get better
  • Possible thoughts of harming the baby or yourself.

It is important to recognize that postpartum depression is NOT the “baby blues” which is typically a few days to two weeks of mild ups and downs and weepiness. The key is to ask yourself how often have you been feeling this way, for how long and to what extent are these symptoms affecting your ability to function in your daily life?

WHAT IS POSTPARTUM ANXIETY?

Pregnancy or postpartum anxiety can be present on its own or in addition to postpartum depression. While most moms experience some anxiousness or worry during pregnancy or after giving birth, postpartum anxiety is more severe and impacts a mom’s ability to function and/or bond with her baby. Some symptoms of postpartum anxiety include:

  • Constant worry
  • Feeling as though something bad is going to happen
  • Racing thoughts that are difficult to slow down
  • Feeling like your to-do list is never done or that your work is never good enough
  • Sleep and/or appetite disturbances
  • Feeling as though you can’t sit still, restlessness
  • Physical symptoms such as dizziness, nausea or diarrhea

In addition to generalized anxiety, a mom may also suffer from postpartum panic disorder with which she will likely experience extreme nervousness and recurring panic attacks. These attacks may include dizziness, shortness of breath, chest pain, heart palpitations and numbness or tingling in the extremities. These symptoms are not life threatening and will subside after the attack passes.

WHAT IS POSTPARTUM-OCD?

Anxiety may also present as pregnancy or postpartum obsessive compulsive disorder or postpartum-OCD. This disorder is known for causing intrusive thoughts that are unwanted and terrifying to the mom who is experiencing them. You might be suffering from postpartum-OCD if you are experiencing some of the following:

  • Worried constantly no matter what others might say to reassure you
  • Disturbed by dark, unwanted thoughts – possibly about harm coming to your baby
  • Afraid to be alone with your baby
  • Spending hours Googling or researching in an attempt to decrease your anxiety
  • Avoiding potentially harmful things such as the stove, stairs, knives or bathtub
  • Obsessed with checking things such as locked doors or your baby’s breathing
  • Sleep and/or appetite disturbances
  • Afraid that if you share what you’re experiencing with loved ones or a doctor, that your baby will be taken from you

A professional who has not been properly trained in perinatal mood and anxiety disorders may confuse postpartum-OCD with postpartum psychosis. Therefore, many moms experiencing intrusive thoughts are afraid to be honest with family, friends or providers. The key differentiating factor is that a mom with postpartum-OCD experiences thoughts that are ego-dystonic or thoughts and/or impulses that are distressing and inconsistent with the person she identifies herself to be.

WHAT IS POSTPARTUM PTSD?

Several events can contribute to a mom experiencing postpartum PTSD. These may include prolapsed cord, an unplanned c-section, alternative means to deliver the baby, feelings of powerlessness or lack of support during delivery or a baby who needs to spend time in the NICU. Symptoms of postpartum PTSD may include, but are not limited to the following:

  • Flashbacks
  • Nightmares
  • Avoidance of stimuli associated with the perceived traumatic event
  • Difficulty sleeping
  • Anxiety and/or panic attacks

We want to stress that trauma is subjective. Your labor, delivery or postpartum period may not be deemed traumatic from a medical perspective. However, if you are experiencing symptoms of postpartum-PTSD, know that your feelings are valid and you deserve to be taken seriously. Please reach out to a provider you can trust.

WHAT IS POSTPARTUM PSYCHOSIS?

Postpartum psychosis is a rare but extremely serious condition that requires immediate medical attention. Approximately 1 or 2 out of 1,000 moms will experience postpartum psychosis. Hyperbolic media depictions have greatly contributed to the inaccurate assumptions about the disorder. While you may have been lead to believe that all moms experiencing postpartum psychosis harm themselves or their children, the reality is that 5% of moms with postpartum psychosis commit suicide and 4% commit infanticide. Those statistics are still far too great for a condition that is treatable.

A mom who is suffering from postpartum psychosis experiences a break from reality. In her psychotic state, her hallucinations, delusions and beliefs make perfect sense to her. As opposed to postpartum-OCD, a mom with postpartum psychosis experiences thoughts that are ego-systonic or thoughts that are acceptable to her sense of self.

It’s important to note that many survivors of postpartum psychosis never harm themselves or anyone else, nor do they experience delusions that give them violent commands. However, because a mom with postpartum psychosis is experiencing irrational thinking and judgement, it is imperative that she be evaluated, treated and carefully monitored by a perinatal mental health professional. Please seek immediate medical attention if you or someone you know is experiencing any of the following:

  • Feeling paranoid or suspecting that others are out to get you
  • Seeing and/or hearing things that no one else does
  • Experiencing thoughts of harming yourself or others that you want to act on
  • You are unable to sleep and have more energy than you’ve ever had before
  • You are irritated by the fact that those around you don’t seem to understand you

In conclusion, the message we’d like to give regarding ALL perinatal mood and anxiety disorders is that they are temporary and treatable with the right, professional help. In no way are you at fault for the symptoms you are experiencing nor do they make you a bad person or a bad mother. Help is available and recovery is possible.

There is no one size fits all when it comes to perinatal mood and anxiety disorders. However if you find that you, or someone you know, is experiencing symptoms of a PMAD, please reach out to a healthcare provider you can trust. If local to the milwaukee area, you can contact Moms Mental Health Initiative by email at mmhimke@gmail.com. You may also contact us via Facebook or learn more by visiting our website, www.momsmentalhealthmke.org. You can also learn more about additional resources near you by visiting Postpartum Support International’s website at http://www.postpartum.net/  or by calling their warm-line at 800-944-4773. Finally, if you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 800-273-8255, or dialing 911. You are not alone.

-Written by Alexis Bruce

Therapy from the Therapist’s Perspective

In this post, Stacy Stefaniak Luther, PsyD, LPC, answers some questions about therapy and what a new mom can expect should she decide to seek help from a trained therapist.

What are some opening thoughts you’d like to share about therapy?

Visiting a therapist can be very intimidating. It takes courage not only to schedule that first appointment but also to attend that appointment. It can be weird, or awkward, to share your personal story with a stranger. Despite these facts, therapy is an effective way to tackle a variety of mental health concerns including those experienced with a perinatal mood or anxiety disorder. Furthermore. therapy can also serve as a means of self-care, which can be difficult to schedule with an infant but is also critically important to mom’s overall well-being.

As a therapist, I recognize the strength it takes to walk into the office each session and bare your soul; sharing intimate details of yourself and your life. But there is something so special about each individual’s story and the details of this story are worked into the therapeutic approach. Therapy is grounded in research, but treatment isn’t one-size-fits-all.

What can I expect at my first session?

Typically, the first session is a “get-to-know-you” session where the provider will ask a lot of questions and you will be encouraged to ask questions as well. Information about follow-up sessions is discussed at this time in addition to diagnosis, treatment, informed consent, confidentiality, and other more technical aspects of therapy. The first impression during this session is critically important. If you are not comfortable, (say so!) and ask about different providers. A client needs to feel comfortable sharing details that may be private and sensitive; therefore, finding a provider who is a good-fit is essential. Professionals will never be offended if the relationship spark just isn’t there. The relationship is the catalyst for healing so don’t be discouraged if finding the right partnership takes time.

How long is a typical session?

Therapy sessions are anywhere from 30-60 minutes, with 45 minutes being average. During these sessions, you are invited to sit back, relax, and share. The therapist will listen and help you reflect. You will also have the opportunity to learn and practice different skills outside of session. Most importantly, there will be validation that the emotions you are experiencing and the thoughts you are having are real and okay.

How often do I need to come to session?

There are many factors that contribute to scheduling future sessions. Typically, although each situation is unique, you will be asked to schedule 1 session a week (or every other week). During these sessions, your willingness and ability to be open and vulnerable is instrumental in determining the effectiveness of therapy.

Can I bring my baby (and/or my older children) to therapy?

If it serves as a barrier to treatment, a good therapist will encourage women to bring infants (and other children) to session if they want to (or have to). Other times, a mom who is able, might choose to find childcare so that she can enjoy her session independently. It is up the mother to determine what she is most comfortable with and what her lifestyle allows.

What is a therapy office like?

Offices are set up in a variety of different ways, yet all are designed to promote comfort and ease. These are not like your primary care provider’s office. Therapy offices are set up with a home-like atmosphere and often reflect the therapist’s personality.

What is a final message you’d like to leave our readers with?

One theme that is extremely common for the women I work with is how alone they feel. The truth is, there are others out there who have had similar experiences or who are currently experiencing the same difficulties. The women I work with have struggled with infertility, experienced the heartbreak of miscarriage, stillbirth, and infant loss. I’ve seen women who did not want to be pregnant or have children who become pregnant, women who struggle to bond with their infant, women who experience intense, frightening intrusive thoughts, women who are sad, women who are scared, women who don’t feel like themselves…the list goes on. It is so important to know that you are not alone. Perinatal mood and anxiety disorders exist but so does treatment. There is no shame in asking for or receiving help!

We would like to thank Stacy Stefaniak Luther, PsyD, LPC, for sharing her perspective with us. If you would like to learn more about Stacy and/or are local to central Wisconsin and would like to schedule an appointment with her, you may find more information on her website: http://www.bhcwausau.com/learn-stacy-luther-ms/ .

You Can’t Tell by Looking

Recently, in our social media feed, we shared a graphic stating “you can’t always tell by looking”. The truth of this statement rings staggeringly true for so many moms fighting their way through the postpartum period.

First, let’s start by considering the expectations we (and society) have placed on ourselves well before baby’s arrival. The nursery needs to be perfect and the house clean and organized. Baby will be dressed in one of the many new, adorable outfits he or she was given and we should be back in our old jeans in no time. Breastfeeding will come easy. This will be the happiest time of our lives. For today’s moms, these impractical expectations are reinforced and perpetuated by idealic Facebook and Instagram posts that set a new bar to which we measure ourselves and our success as a mother.

When this picture was taken, the world saw a mother enjoying an afternoon with her kids at the park. But the reality was that I was at rock bottom and was being completely annihilated by my postpartum anxiety and OCD. While at the park, my mom was on her way to town to help care for my children. Because I was too afraid to be alone with them, this burden had fallen solely on my husband. Intrusive thoughts plagued my mind constantly and I hadn’t eaten or slept much in days. If I was forced to be alone with my kids, I’d keep them outside so that if I went crazy, a neighbor would hear me and save them. I incessantly asked my husband for reassurance, thought daily about checking myself into a hospital and often wondered how much longer I could go on this way. Surely, my kids deserved a better mother.

For some reason, we tell ourselves that the world must never know the pain we are feeling. A mom might tell herself that no one can know how hard it was for her to get out of bed today or that she hasn’t been able to sleep, even when baby is sleeping. No one can know that as she forces herself to rock her baby, she thinks about how she might have made a mistake and how she might wish she never became a mother. No one can know about the terrifying and disturbing thoughts and images that fill her head. So to keep these secrets, she slathers on the concealer, smiles and tells everyone all the things they want to hear.

You also can’t tell by looking, the woman who has suffered a miscarriage. Who is agonizingly grieving the loss of a baby that the world never knew. Or, the mother who carried a child only to lose him or her in some unimaginable way. She might wonder who could understand the physical and emotional torture she has experienced. And then there is, perhaps, the most extreme example of the “you can’t tell by looking” phenomenon which is the mother who hid her struggle and pain so well that the world is shocked when she takes herself from it.

It is true. We can’t always tell by looking but there are a few things we CAN do to help moms come out of hiding. We can ask moms how they are doing…how they are really doing. We can equip them with the information on and the symptoms of perinatal mood and anxiety disorders. We can preemptively point them to resources near them that can help should those symptoms arise. We can take the fear out of treatment – whether that be therapy or the need for medication. We can help moms feel less alone by sharing stories of our personal struggles and providing peer support. Finally, we can work towards ending the stigma around maternal mental health and dispeling the idea that motherhood requires perfection. So maybe you couldn’t tell by looking but I am grateful to have the courage to share that mine is the face of a perinatal mood and anxiety disorder. You are not alone.  

–Written by Alexis Bruce