Climb Out of the Darkness, A New Business, and Other Busyness!

I’ve been a bit absent from the blog, but not because I’ve been hiding! No way. I’ve been BUSY. First, I found this great new self-care idea called Jamberry Nails:

Turquoise and purple ombre nails, with a lace accent on my ring finger! I'm such a grown up!

Turquoise and purple ombre nails, with a lace accent on my ring finger! I’m such a grown up!

I tried a sample my friend sent me, and I loved it so much that I wanted ALL the designs! Well, wearing that sample around, other people loved it, too, and they started asking me about it. It just made sense to go ahead and sell the stuff myself, if it was going to be that easy! It has been SUCH fun adventure. I’m still wrapping my head around the idea that I’m officially responsible for my own “direct sales” business. I’ve done so well, though, and it hasn’t even been three weeks, that my confidence has gotten a huge boost. I love looking at pretty hands whenever I type, play with my toddler, open his snacks, make my endless calorie-filled smoothies (yes, I’m still fighting weight loss and barely winning) – these babies can handle anything, without getting damaged. I just took that picture, and the manicure is five days old!

Well, after signing up with Jamberry boosted my confidence, I decided to register for this year’s Climb Out of the Darkness fundraiser for Postpartum Progress. As I was signing up for it, it became painfully obvious that no one in my area was taking charge of this thing. So, I signed up to be the Team Leader for my area! You should register to climb with a team in your area to support maternal mental health, and you should learn more about what Postpartum Progress does, too. If you’re not going to fundraise for your own area, please donate to my Climb! You can also shop for the cause at my Jamberry site.

I am doing this fundraiser to raise awareness, as well as funds, for the struggle women face with postpartum mood and anxiety disorders. I have struggled with anxiety all my life, but I was shocked and horrified to find that anxiety and depression experienced by pregnant women and new mothers is so often shrugged off and ignored.

According to the Centers for Disease Control, 11 to 20% of women who give birth each year have postpartum depression symptoms. If you settled on an average of 15% of four million live births in the US annually, this would mean approximately 600,000 women get PPD each year in the United States alone.

In fact, more women will suffer from postpartum depression and related illnesses in a year than the combined number of new cases for men and women of tuberculosis, leukemia, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, lupus, and epilepsy.

You might be interested to know, however, what’s missing from the CDC’s estimate.  Women who miscarry or whose babies are stillborn are also susceptible to postpartum depression, but the CDC’s report only looks at live births, so if you consider that 15% of the 6 million women who have clinically recognized pregnancies annually will get PPD, that’s 900,000 women each year.

EXCEPT …

Only 15% of women with postpartum depression ever receive professional treatment.

AT LEAST 1 in every 7 women will suffer–that’s more than will be diagnosed with breast cancer. Postpartum Progress is a national nonprofit that raises awareness of maternal mental health and provides support for pregnant and new moms struggling with it. It is a patient-run and patient-focused organization. I have found the most welcoming, beautiful community, there.

I somehow escaped the terrifying symptoms of a perinatal mood and anxiety disorder, even though my chances of being diagnosed with one are three times greater, because of my history with anxiety and depression. No one in my community has ever asked a harsh question or made a judgment about me; I can get support and help for the challenges I face as a mother coping with anxiety, even if it is anxiety I’ve faced all my life. Support, resources, and e-hugs are always available. I have made lifelong friends. And I have never met a stronger, braver, or kinder group of women in my entire life.

My goal is to raise $1,000 for my climb, and I only have until June 21st! If I reach that goal, I will earn free admission to the Postpartum Progress conference in 2015. I know that you can help. I know that maternal mental health matters to everyone reading this, because you all know mothers. How many of them have struggled in silence? How many of them even know that pregnancy and birth do NOT need to come with terrifying anxiety, or heavy bouts of depression? How many of YOU are struggling, and would like a safe place to get some help? Even if it’s just the message that it’s ok if you don’t feel overjoyed with bliss at the news that you are going to have a baby, or even at the birth of a new baby–moms NEED to know that. Climb, donate, shop for charity. Do something.

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Other news: My husband and child were in a car accident, and while it was very frightening, everything is a-okay with them. Thank goodness for car seats! We’re not thrilled about adding a car payment to our monthly bills, but my new business venture came at just the right time.

I’m continuing to work with a functional medicine practitioner, and will update you as soon as there’s something concrete to say! So far, I just know that I feel great!

Finally, coming up: a post about how you can help check on a friend who has a new baby, while sounding purely supportive and not judgmental!

Not Postpartum Depression… A Postpartum Dip?

During each of my therapy sessions for the past few weeks, my therapist has said, “So you’re not depressed! …?” (She says it in an enthusiastic tone and somehow then manages to turn it into a question. Therapists can magically turn anything into a question.) Today, we decided that, with Walter approaching six months old, it’s unlikely that the depressed moods I experienced starting in February will develop into full-blown postpartum depression. Women most commonly experience the onset of postpartum depression during the three-to-six month period postpartum. While it can, obviously, happen before or after that time window, approaching six months lets us breath a little easier. This is according to my psychiatrist. Even our pediatrician will probably be keeping a closer eye on me for the entire year, as my favorite go-to, “Plain Mama English” site, Postpartum Progress, suggests. My therapist and I joked as we called it a “Postpartum Dip.” But that’s exactly what it was. It was a postpartum dip, in which low moods threatened depression.

I can’t say whether my brain chemistry reacted well to the increase in my dose of Effexor, which I began really quickly after the low moods hit. I don’t know if it was acting really quickly to get help that did made the difference. I don’t know if it was my amazing support system at home, online (#PPDchat on Twitter, mamas! They promise an “Army of Support,” and they are not kidding about that!) and among distant friends and family over the phone. I’m sure it helps that I would rather admit to any feeling, no matter how “shameful” or unusual or strange, than let any mental health problem escalate. Basically, I’m more afraid of being hospitalized again than I am of telling anyone anything that is going on in my head.

Any, all or none of these things could be the reason why I didn’t develop postpartum depression. I haven’t been kicked out of my support group. I will write more, soon, about what I do still feel; my mental health problems didn’t vanish. I simply don’t fit the criteria for PPD. I can’t tell you what a huge relief that is. Depression is a monster I’m not used to battling every day, whereas my anxiety can be managed with tools I’ve been using for years. It’s not new. It’s not rare, for me. I go to bed tonight full of hope and gratitude.

Oh, and if you’re reading this and I consider you part of my support system: you are not off duty. Ever. Except if you’re sleeping, because sleep is important and creepy to interrupt. But that means that I’m never off duty for you, either! Unless I am sleeping.

Depressed, Postpartum: A Short Update

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Feeling hopeful and enjoying these chubby cheeks.

I have plans to actually go do something for fun with a friend who lives here in Connecticut, and not far away, so I’m going to make this short. (Yes, I am incredibly proud of myself!)

I did not hear my doctor say “Postpartum Depression” yesterday. I have mixed feelings about this. What she did say is accurate and wonderfully helpful. The focus was, as it should have been, on what to do to help. I am to take Bendaryl as a sleep aid, since it works well, on a strict schedule. I am to take my meds on a strict schedule. I have been “compliant” with all of my medication, but my sleep has been so erratic that I don’t take them at the same time every day. That might help. I am also to take a higher dose of my SSRI (one kind of antidepressant), Effexor.

I immediately filled the new prescription and have started the new dose. I am much closer to following the new schedule. I took the Benadryl and slept. Walter, may God bless his tiny heart, put himself to sleep in his co-sleeper after filling up on milk. I hit snooze on my alarm for two hours, but it’s progress.

The mixed feelings I have about knowing that this could be much, much worse? I worry that I got everyone who reads this all worked up over nothing. If it’s just a phase, just a low-mood, might pass on its own but lets give the meds a boost anyway… do I have the right to be posting alongside women with “real” depression?

And then, the emails came. Two. They said “me too.” One, from a dear friend, said that me writing about my feelings so publicly gave her the courage to write and tell me about her PPD diagnosis. No one has said that I don’t feel terrible enough to be asking for help or to be writing about depression. Right in this moment, I feel the truth in that. I am depressed. I could be much more depressed. I could also be two inches shorter or taller. It’s neither here nor there.

Thank you for your support. Thank you for telling me that I have helped you. Thank you for asking me questions. Thank you for talking. Silence is the enemy, here. All monsters are very scary in the dark. Turn on the light, and they might not be so very big after all.

Educate Yourself! Read the Pregnancy and Anxiety/Depression Bible

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:

Pregnant on Prozac: The Essential Guide to Making the Best Decision for You and Your Baby. By Dr. Shoshanna Bennett, Clinical Psychologist.

My Bible for All Things Pregnancy and Medication Related

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.

Placenta Encapsulation: Why not?

(A note of caution: this post is not for the faint of heart or stomach.)

I am glad that I have a long time before I have to make any actual decisions about Baby. If, when, how (birth plan) and what (stuff, stuff and more stuff) can all be decided much later. Including a good year to decide how I feel about little suggestion that shocked the heck out of me:

Eat the placenta. Or, rather, swallow it in pill form. It could prevent postpartum depression.

WHAT? Oh, wait, don’t most mammals actually do this? Where did I learn that? I don’t know. But I don’t remember hearing about human women doing this until yesterday, and it’s already cropped up in about four places since then. So I thought I’d post it here and see what you all think. (The placenta, by the way, is basically what feeds and protects the fetus during gestation. In some cases, it can even protect a fetus from contracting things like HIV from an infected mom. It’s a seriously awe-inspiring organ. And it is “birthed” a few minutes after the baby is born. It’s considered biohazardous waste in the US and hospitals dispose of it as such.) New York Magazine talked about monkeys and other mammals eating the “after birth” and described the process of “placenta encapsulation” in this pretty fantastic article. They also describe burying it and planting a tree over it, which sounds kind of awesome, actually. The “encapsulation” part is the only resin, I’m even considering ingesting a bodily organ that *I* will produce, by the way. I am soooo not brave enough to do what woman in the article says she did–make it into a smoothie and drink it down with some banana mixed in.

Ok, grossed out yet? I am! But if you choose the encapsulation, you don’t do it yourself. You find someone, usually through a midwife, doula or an organization called Placenta Benefits, to take away the after-birth in a safe container. That person then gives it back in pill form. You can read the NYMag article if you want more details. According to that same article, scientists aren’t sure why mammals do this, but they have a few theories. Giving birth is hard. Pregnancy is tough on the female body. The placenta, it turns out, has a lot of the same nutrients that get depleted during pregnancy and childbirth.

But here’s the piece from Bamboo Family Magazine that really convinced me to take this seriously:

“Powdered placenta has been used in traditional Chinese medicine for centuries.  In the postpartum period, placenta capsules can be used to

  • Balance hormones
  • Increase energy
  • Increase and enrich breast milk.
  • Decrease the baby blues and postpartum depression.
  • Decrease in lochia, postpartum bleeding.
  • Decrease iron deficiency.
  • Decrease insomnia or sleep disorders.”

And here is what my nutritionist, Jan Katzen-Luchenta, had to say about it when I emailed her:

“Fe, Cu and Zn [Iron, Copper and Zinc] elements appear to have interactive connections in human placenta. The primary essential fatty acid in the placenta is Arachidonic Acid – brain growth. So with Mom being a bit depleted from childbirth – not a bad thing to eat the placenta for extra nutrients. All trace minerals are essential.”

Placenta Benefits.info (PBi) sells this a little too hard, in my opinion, and it’s a bit off-putting. But if this claim is true, I’m listening anyway:

Eighty percent of women experience some sort of postnatal mood disorder, the mildest of which is called the “baby blues”. Symptoms of the baby blues include weepiness, sadness and anxiety, and these negative emotions can last for the first several weeks of the new baby’s life. With proper preparation, the majority of women can avoid the baby blues.”

How do they know this? Why, they have research. Scientific research, of course. Here are just some of the articles their site links to:

  Placenta Increases Milk Production
  Placenta ingestion for pain relief
  Placentophagy alters hormone levels
  Postpartum Depression attributed to low levels of CRH
  Maternal iron deficiency affects postpartum emotions
  Fatigue linked to Postpartum Depression
  Iron supplementation helps fatigue
  The significance of postpartum iron deficiency

Low milk production, pain (yes, it hurts after you give birth, sometimes, a lot, and breast-feeding can hurt, too), the crazy drop in pregnancy hormones and fatigue might all contribute to a low mood. It makes sense that if taking placenta capsules can increase the minerals my nutritionist mentioned and increase milk while decreasing pain, it would help with PPD. And in case it’s not super obvious, I am at REALLY high risk for PPD, PPOCD and quite a few other acronyms.

According to the NYMag article the science out there is pretty small-scale and inconclusive. Ask any woman who has done this, however, and her anecdotal evidence might convince you. And you know what? “It’s just a placebo effect” is not a convincing argument against doing this, because if it’s all in my head, who cares? My mood changes drastically because of what’s in my head all the time! I got stressed out because I put my underwear on inside-out one day last week. The knowledge that no one could possibly know this did not keep me from feeling anxious about what they might think if they did know that I was paying no attention that morning. That is the kind of thing that can throw off my whole day. If taking a happy pill only makes me happy because I think it will, then sign me up anyway. Seriously, though, thinking happy thoughts is an over-simplified way of stating it, but positivity has some serious benefits when it comes to treating mood disorders. I have seen it. Optimistic people overcome serious mental illness a lot better than pessimistic people.

In fact, there is no convincing argument against placenta encapsulation at all. The people who take your money to do it are performing a service I certainly don’t want to do myself, and they tend to be really passionate believers. So I don’t feel like that’s a scam at all. And despite sounding really gross and “akin to cannibalism” it’s something that’s just going to get thrown out if you don’t want to use it. So here’s the analogy I’ve come up with:

If I were in the desert and dying of dehydration, would I drink my own urine to survive? You bet. (Doesn’t the British survival show guy do that in like every other episode?) If I’m dying inside and feeling hopeless and these pills can be taken safely, help me breastfeed AND help with hormone changes, two major factors for new moms at risk for PPD… why wouldn’t I? It’s an odor-less, tasteless pill no bigger than a vitamin supplement. The Pill (the kind that’s meant to prevent pregnancy) used to contain hormones from the urine of pregnant horses. Do you know what’s in your medicine cabinet? I’m just saying.

The question that keeps banging around inside my head is this: do I have a good reason not to do this? If there is any small chance it could help?

Now do you understand why I’m glad I’ve got plenty of time to get used to the idea?