Today’s post is a book review with a mission: to promote awareness about anxiety and depression before, during and after pregnancy. I sent a copy of this book to my mother. I will send one to your local library if it doesn’t have a copy. This book is so important. Thankfully, its title is better than “Pregnancy and Anxiety/Depression Bible.” It is my bible, though, and it is actually called:
This is the only comprehensive source about what to do if you already have anxiety, depression, OCD, bipolar disorder, etc. and want to have a baby/are pregnant. I am not exaggerating. Want to read a book about postpartum depression? Everyone and her sister has published a book on it. Take your pick. Lived with this your whole life and want to prepare for pregnancy with that plus an increased risk for postpartum you-name-it disorder? ONE BOOK. One. Many thanks to everyone who has worked to erase the stigma on PPD. Seriously, you have done amazing work. Can we also turn some attention to pre-existing, prenatal & postpartum anxiety? Even the Surgeon General knows that anxiety disorders are more common in women. I can’t help but feel that we don’t have more books about this because people just don’t want to talk about it in general. In my experience, we refuse to talk about something when we are ashamed. In fact, this blog is part of my effort to stamp out my own shame and feelings of failure and inadequacy. Stomp! Stamp! Stomp!
And now, about the book:
Dr. Bennett writes as though her readers were sitting in her office. She has obviously spent a lot of time talking with patients and their families about treatment options and pregnancy. Her extensive experience shows as she relays scientific/medical information in a conversational tone but avoids throwing everything at you at once. Her information is backed by research, but her tone is never cold. Patients’ stories (names changed, of course) sprinkle the text, proving that these decisions are different for everyone. She also calms fears obviously related more to the stigma surrounding mental illness than to reality. This woman is clearly used to talking to real people. The fact that my mother really liked this book says a lot, too, because when she’s worried, she can’t just ask about it at the next therapy session. Relying on me for information can be hard; I used to practice denial like some people practice yoga. This book helped us so much, because it gave us a more neutral place to start talking to each other about the decisions that would come up when I did get pregnant. The more my family knows in advance, the less I have to explain all at once.
You see, there are two distinct parts to any decision I make about my treatment and pregnancy. There’s the medical/psychological part, obviously, where I look at the risks and benefits with my team of professionals, a process I talked about in an earlier post and will talk about again later in this post. Then there’s the part where I explain that decision to close friends and family. My mom, my mother-in-law, my sister, by very closest friends. Don’t get me wrong–not everyone has the right to ask for more information. I don’t mean to imply that women who take antidepressants during pregnancy have to explain themselves. My advice for dealing with self-righteous people who tell you what to do and/or demand that you justify a decision they don’t understand is simple: walk away. My dad likes to say “Don’t argue with an idiot. He’ll drag you down to his level and beat you at his own game.” Most of what my dad says about people in general is unkind and untrue, but I am inclined to agree with his assessment of idiocy. This process I’m talking about, the one that comes after the decision, involves educating the people who love me. They worry. Their hearts are in great places. I want to them to feel included and informed.
There’s a special person in that group: my husband. Dr. Bennett is so eloquent about partners. She has talked to many, because they are necessarily part of her patients’ decisions. Nathan is my everything. I get antsy when he’s away from home. He’ll obviously be the father of any kid I bring into this world. So I gave him a privilege no one else has. I even signed papers to make it legal; he can talk to my therapist and psychiatrist directly. [Time out to say thank GOD these papers exist separately from the marriage contract, so there are no secret phone calls ala Don in Mad Men calling his wife's psychoanalyst to get a full report on every session. Nathan would never do something like that, but I'm just glad it's not legal anymore in general.] Nathan has the advantage of being able to come in to the office and ask my therapist or psychiatrist direct questions. He still talks about the time he got to spend alone with Dr. C, my psychiatrist, when they just asked each other questions about how best they can help me. And that conversation is still helpful for me, too, if only because the fact that they know and like one another gives me a great shorthand when talking to them. Nathan’s trust in my “team” has a lot to do with feeling included. But it’s not so easy for all partners. Some of them come into this process for the very first time after one partner is already pregnant and the decision must be made as quickly as possible. Some people don’t even know they have any feelings about medication and pregnancy until they’re staring at an ultrasound. Nathan might experience that. And we have a place to go, an expert to ask, when these heartbreakingly delicate decisions come up. As Dr. Bennett points out, this saves everyone so much heartache. It gives the conversation a safe space and a time limit. No unending circular discussion necessary. I’m not about to invite everyone I’m close to. And I don’t have to, which is great because it sounds exhausting. I can just give them a copy of this book and talk to them after they read it.
A note on building a team: as Dr. Bennett so wisely advises, a team of people who each have expertise in a different area is the best way to go. Therapist and Psychiatrist are, in my case, two members of that team. There’s a whole chapter in Pregnant on Prozac on “The Importance of Therapy” and a subchapter called “Pills Are Not Enough.” I couldn’t agree more. My psychiatrist says he will refuse to write prescriptions if I don’t stay in therapy. He doesn’t think it’s safe to stop checking in with a professional, nor does he believe that true progress is made by only taking pills. There’s no treatment of the underlying problem in that approach. And one unfortunate truth of psychiatry is that pills eventually stop working. [Your body gets used to that chemical, metabolizes more of it, less of it gets to your brain, and you have to find a new one. This is the same reasons why alcoholics need a lot more liquor to get drunk than those of us who almost never drink--the liver takes out more and more of the stuff that makes you drunk before it can get to your brain.] Dr. Bennett feels the same way about therapy: treat the mind, not just the brain chemistry!
But there’s another chapter called “When Professionals Don’t Agree.” This is more and more likely to happen as my team of professionals expands to include experts on each of the things I want help with: therapist, psychiatrist, nutritionist, general practitioner, neurologist. So far, I already have that going. When we visit the Columbia University Women’s Mental Health Center, I’ll add an expert on mental illness, psychopharmacology and pregnancy. When I do actually find myself pregnant, I’ll add either obstetrician, midwife, or both. Then, I’ll add a doula. At the very end, there may be new nurses and doctors in a hospital who become part of the team. I am going to spend a lot of time in a lot of offices! What if they don’t agree? Who should I listen to? I should listen to the person who has the most expertise in that issue.
As Dr. Bennett points out carefully and forcefully, expertise in a field like psychiatry or obstetrics does not guarantee expertise in treating a pregnant woman who has an anxiety or mood disorder. This book confirmed my opinion that my psychiatrist is a great doctor because he says things like “I’m not an expert in pregnancy and antidepressants.” It also had me primed to accept his referral to the experts at Columbia University who are comfortable giving me advice on that topic.
So, what if my nutritionist doesn’t like the idea of me taking antidepressants during pregnancy? She is an expert on many things brain-related, but not on psychiatric disorders. I will kindly ask her to let me make that decision and to focus on my diet. I will look for a midwife or OB/GYN here in New Haven who has experience with pregnant women who have mood disorders, but even if I find such caregiver, s/he might disagree with the Columbia expert about medication during pregnancy. What then? Well, I will give each team member a list of the other professionals’ phone numbers so that they can argue among themselves, if necessary. I will most likely take the advice of the Columbia expert because I will have asked them for advice specifically about medication during pregnancy; I will be asking the midwife or obstetrician to help me with other maternal/child health issues and to be with me during labor/birth. Can you see why this whole Team of Experts idea is a truly great idea? Read the book for more on how to go about building your team, especially for some great advice about how to identify a true expert.
This is a long book review, I know. But as you can see, it’s not just a book review. It’s a compilation of the advice I have so far found most helpful in the pregnancy/medication decision. The first place I encountered most of that advice in one place, in easy-to-read prose, was Pregnant on Prozac. [By the way, she discusses many possible medications, not just Prozac, but it does make for a pithy title, doesn't it?]
The book is for everyone who is at risk for every kind of mood disorder before, during or after pregnancy. I recommend it to anyone who is at all worried about this issue. Did you know that obsessive-compulsive disorder is relatively common during pregnancy and postpartum? Checking to make sure the baby is still breathing every five minutes is not normal. You should feel nervous but not having panic attacks about taking a new baby outside. I mention this one in particular, because many, many, many people tell women who suffer from OCD during or after a pregnancy that her worries are normal. Yes, it is normal to worry. No, it is not normal to fear nap-time because the baby could just stop breathing at any moment. But it is so hard to see and happens so easily because moods change all the time when hormones go crazy. Wouldn’t it just be great if every woman knew the warning signs of an actual disorder? Wouldn’t it be great if more women could feel free to ask an expert “is this normal?” Wouldn’t it be nice to know that it is normal? And wouldn’t it be really nice to get help if it isn’t?
Psychological screenings are slowly becoming part of routine prenatal and postpartum care. But it’s not happening fast enough. I believe that the best way to make this happen faster is for women to demand that their doctors take better care of their mental health. Go ahead! If you’re pregnant or just had a baby, on your next doctor’s visit, say “I want a psychological screening, just to make sure.”
Here, I’ll walk you through a psychological screening to make it less scary: you sit with a doctor and answer questions about your daily life. Your habits. How you feel about ordinary things. They take notes. Some of the questions sound weird, but they are just questions. Trust me, they want honest answers. They’re not hard questions, but the tricky part is to stop looking for the meaning behind them. That’s a little hard, especially with all the note-taking. But it doesn’t necessarily mean anything. Focus on being as honest as possible, and focus on the question at hand. If they ask “How often do you check on the baby while she’s napping?” then just tell them. If you freak out and ask “What does that mean? Are you saying I do it too often? Are you saying I don’t love my baby?” then they will try to calm you down and bring you back to answering the question. They won’t tell you what it means, so don’t bother asking. Remember that if you give honest answers, you’ll get an honest answer. And that these people deal with liars for a living.But seriously, you know what’s a lot scarier than a diagnosis? Trying to deal with an undiagnosed mental illness all by yourself. Trust me. That’s harder than anything.