Whenever I talk about the symptoms of perinatal mood and anxiety disorders, I always include “unusual physical symptoms.” What does that mean? It means that any new physical symptoms that begin during pregnancy and postpartum can be related to mental health. My own experience with postpartum mental illness was quite atypical, and that was partly why I suffered for months before receiving the proper diagnosis and treatment.

I had lots of risk factors for postpartum depression: a previous bout of depression, the death of a loved one, a high-risk pregnancy, a traumatic childbirth, an unsupportive marriage, and breastfeeding difficulties. Even though I had suffered from depression before, after the death of my mother, my postpartum symptoms were not recognizable to me.

After my second child was born, my stress level was off the charts. My older son got kicked out of preschool and I was scrambling to find a preschool that would take him. I never made enough milk for the new baby because he was so big, and he refused to nurse as soon as he started solid foods. I felt guilty about “failing” at breastfeeding and I was also afraid that I would not be able to go back to work after maternity leave because I couldn’t find full-time daycare that would take my challenging and potty-resistant older son.

In the meantime, I had difficulties in my marriage. My husband worked a lot, and when he was there he criticized my parenting style, my cooking, and my housekeeping. I was trying my best to make everyone happy, but I was clearly failing.

During this time, I started to have odd physical symptoms. I started feeling that the room was tilting and that I was off-balance. I had to lie down and felt the room was spinning around me. My doctor thought it was either an inner-ear infection or possibly MS, and I was sent for neurological testing. The tests came back normal, although MS wasn’t ruled out.

My symptoms came and went, and then began to include nausea and vomiting, lack of appetite, and an inability to sleep. I had a fever on and off for a couple of months and my white blood-cell count was high. I lost 16 pounds, slept about three to four hours a night, and threw up regularly — out the door of the car, in the sink at the pediatrician’s office, etc. I felt that my body was swaying even when I was perfectly still, and my bed felt like it was shaking as I lay in it trying to sleep. My skin felt prickly and my hands tingled. The dizziness made watching TV or reading impossible, and walking or driving became difficult. I felt sure that I was dying.

My doctor considered an inner ear problem, hormones, diabetes, thyroid, and even encephalitis, but every test came back normal. I was living on Ensure and Gatorade, because I couldn’t keep any solid food down. The stress of caring for my children became unbearable, so we hired a babysitter and I spent most of every day lying in bed, praying to fall asleep for a couple of hours to get some rest. I was prescribed Ativan, but it just knocked me out for an hour or two and I would wake up feeling even worse than before.

After about four months, I fell apart completely and told my doctor that he had to hospitalize me because I wanted to die if they couldn’t stop the agony I was living in. I was admitted to a psychiatric hospital, but my doctor was still sending me around to specialists, trying to figure out what was physically wrong with me.

I stopped vomiting as soon as I was admitted to the hospital. That was when I realized that whatever was going on with me had to do with stress. I spent 12 days in the hospital, during which time I started taking antidepressants and was prescribed anti-anxiety medications that allowed me to sleep. For a few days, all I did was sleep. When I was awake I was no longer nauseous, but I was filled with unbearable emotional pain. I was terrified that I would never be able to care for my children without getting sick. I felt like the worst mother in the world.

After I was released from the hospital I did a full-day partial hospitalization program for a month. I learned in group therapy about the ways in which I had prioritized my responsibility for others way above self-care, in unhealthy and unhelpful ways, and I began to heal. With the help of medication, therapy, and couples counseling, I recovered. I still had plenty of anxiety at times, but I also had joy and passion for life. I became a lactation educator and led new parent groups for several years, and eight years later I went back to school to become a Marriage and Family Therapist.

I still have to be vigilant about managing stress and self-care. I tell myself that this is the “gift” of being prone to depression and anxiety: I don’t have the “luxury” of tolerating a great deal of stress, or living life in a way that generally makes me unhappy. I am obligated to prioritize joy, peace and comfort as well as caring for my family. I know that I always have to be mindful to avoid a recurrence of depression, but I also know that I am strong and resilient and will do whatever I have to do to be healthy and take good care of myself and my children.

My illness began when my second child was seven months old, and yet no one ever considered a postpartum disorder. My symptoms were consistent with panic disorder and depression, and yet my doctor and my therapist never considered these diagnoses. My hope is that in the future, mothers and their caregivers become better educated to recognize perinatal mood and anxiety disorders so that they can be treated early.

• If you need immediate help, please call the National Suicide Hotline at 1-800-273-TALK (8255)
• If you are looking for pregnancy or postpartum support and local resources, please call or email us:

Call PSI Warmline (English & Spanish) 1-800-944-4PPD (4773)
Email support@postpartum.net

• Connect and share support with others moms experiencing postpartum emotional difficulties to reduce feelings of isolation and hopelessness;
• Learn about what causes postpartum disorders, treatment options, and self-care strategies; and
• Practice coping skills (including mindfulness exercises), as well as improving their bond with their baby as they recover.

The Postpartum Emotional Recovery Circle will meet at Oak Creek Counseling Center in Pleasant Hill.

Day/Time: Saturdays from 12:00 to 1:30pm (six week commitment for new members)

Cost: Sliding scale from $15-$25 per session, based on income

To register: Call 1-888-637-7404 ext. 30 or email meri@oakcreekcenter.org.

You can download a brochure about postpartum disorders as well as a flyer for the group.

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Postpartum depression (PPD) is different from the “baby blues.” A majority of new mothers experience the “baby blues,” a period of sadness that isn’t debilitating and passes quickly. Symptoms of the “baby blues” include tearfulness, irritability, restlessness, and anxiety. But when symptoms of sadness, irritability or anxiety continue for more than two weeks or make it difficult to care for your baby, there is more going on and it’s time to reach out for help.

Symptoms of PPD include:

Symptoms can vary in severity, but persistent depression often causes new moms feel isolated, guilty, or ashamed.

You should tell your doctor if you have several of these symptoms for more than two weeks; if you have thoughts of suicide or thoughts of harming your child; depressed feelings are getting worse; or you are having trouble caring for your baby or yourself.

Depression is an illness. It is not a sign of weakness or of being a bad mother. It can be treated successfully, and getting help is the best thing you can do for your baby.

Risk Factors for PPD

Any new mom can develop PPD. Its causes may include hormonal and other physical changes, sleep disturbance, emotional adjustments and chronic stress. However, women are at increased risk of depression if they have a personal or family history of depression, if they are have experienced particularly stressful life events such as significant losses, a high-risk pregnancy or traumatic birth, or if they don’t have adequate support from family and friends.

Other Postpartum Conditions:

Postpartum Anxiety and Obsessive Compulsive Disorder
Many new moms experience anxiety rather than sadness after giving birth. Anxiety, panic attacks, irrational fears or intrusive thoughts, or images can be associated with Postpartum Anxiety or Obsessive Compulsive Disorder. Symptoms of a panic attack can include a racing heartbeat, unusual physical symptoms, a sense of impending doom, the feeling that you are dying, dizziness or nausea.

Posttraumatic Stress Disorder after Childbirth
New mothers can also develop post-traumatic stress disorder (PTSD) following a traumatic childbirth experience. PTSD involves reexperiencing the trauma through flashbacks or nightmares, having difficulty sleeping, and feeling detached or estranged from friends and loved ones.

Postpartum Psychosis
Postpartum psychosis is extremely rare but also very serious. It affects only two out of every 1,000 new moms. The symptoms are severe and may include insomnia, agitation, hallucinations, and extreme paranoia or suspiciousness. Postpartum psychosis is a serious medical emergency and requires immediate attention.

Treatment for Postpartum Disorders is Effective

If you believe you are suffering from a postpartum disorder, the first step is to talk to your doctor or mental health provider.

You should be evaluated by your doctor to rule out a medical cause that can contribute to depression.

Psychotherapy, medication or a combination of the two may be needed to get you back to feeling like yourself. But you must continue treatment even after you begin to feel better, because discontinuing treatment too soon can cause symptoms to recur.

The support of family and friends is also instrumental to your recovery. In addition, joining a support group for postpartum disorders can help overcome feelings of isolation, increase coping skills and provide social support.

Getting help is the most important step you can take for yourself and your baby. Untreated maternal depression is associated with developmental delays in babies, as well as potentially serious emotional consequences for your growing child.

How Partners Can Help

New moms suffering from Pospartum Depression and Anxiety need the support of their partner, as well as friends and family. Help with baby care and household responsibilities, provide an ear to listen or a shoulder to cry on, and be patient and understanding with her struggles. And make sure she gets help.

Partners also need to take care of themselves. Having a new baby is hard for partners too. And if the mother is depressed, you are dealing with two major stressors. Partners can also suffer from Postpartum Depression, a often undiagnosed problem.

How to help a partner suffering from a postpartum disorder:

If you’re not sure if you have PPD, complete the Edinburgh Postnatal Depression Scale. It is a fairly accurate way of determine if your symptoms are normal or may require treatment.

But in reality, we can tolerate anxiety. By tolerating it and observing its physical manifestations, we rob it of its power over us. And over time, anxiety will diminish if we refuse to escalate it by letting it take over our thoughts.

Mindfulness is one of the most powerful tools for coping with and transforming anxiety. While it may feel like WE ARE anxious, bringing awareness to our body and choosing to focus on the specific physical sensations we are experiencing allows us to see that we are the observer of anxiety, not its victim. We can choose to halt self-defeating thoughts by returning awareness to our body and reminding ourselves “Anxiety cannot hurt me. It is only a feeling, and it is temporary. I am in control of myself. I can choose to be aware of the anxiety without letting it take over my thoughts.”

Practice doing mindfulness exercises such as this one when you are not feeling particularly anxious, as a way of being ready for anxiety when it comes. Learning to focus your full attention on your body rather than your thoughts takes some practice, but only five minutes a day can make a huge difference in reducing anxiety and helping you cope with it when it comes.

Anxiety is often associated with depression, even if the depression is not severe. Taking steps to address negative patterns of thinking, grieving losses, and learning to take better care of ourselves physically and emotionally is another important step in dealing with anxiety. If you need help to learn to identify and challenge negative thoughts, work through with past trauma or loss, or learn to improve your self-care and relationships, finding a therapist you trust is a great place to start.

To Take Antidepressants or Not to Take Antidepressants

There are no easy answers to this question (as is true for most important ones!). Studies show that individuals suffering from moderate to severe depression have better odds of recovery with a combination of therapy and antidepressants. However, for some people, changes in diet, additional exercise, and better strategies for coping with stress can work just as well. For debilitating depression, medication can often help to lift a person up enough to be able to meaningfully participate in therapy. But depression generally happens for a reason, and often changes in thinking patterns, relationships or career are necessary for a person to have more happiness and fulfillment in their life. Medication alone may not make these changes happen. Does relying on antidepressants to make life more bearable reduce the motivation to make needed life changes that will improve the quality of one’s life? The answer to that question may be different for every individual, and is something that can be explored in therapy.

Side Effects

Some individuals find great relief on antidepressants, and don’t have any bothersome side effects. But others experience weight gain, sexual side effects or other unwanted secondary effects from these drugs. Sometimes, switching medication can resolve these issues, but in some cases the antidepressants that work for the individual are the same ones that cause other problems. That is a common reason why some people consider going off medication and try to manage their depression in other ways.

Never Go Off Antidepressants Without Consulting Your Doctor

A reminder here is important; never go off antidepressant medication suddenly, or without the supervision of the prescribing doctor. Some of these drugs require an extended period of weaning to avoid serious withdrawal symptoms. And an important factor to consider is the possibility that if you wean off your antidepressant medication, the same medication may not work for you as well in the future. That is one factor that you need to weigh with your health provider when making this decision.

Issues Raised by Weaning Off Antidepressants

Individuals that decide in consultation with their doctor to wean off antidepressants face a whole other set of challenges. The fear of a relapse of depression can be the most difficult part. Coping with the symptoms of withdrawal can be challenging, and often brings up these fears. Also, people who go off antidepressant medication may find themselves more vulnerable to feelings of sadness, irritation, anger and stress than they are used to. Learning coping strategies for these emotions is very important. A really bad day can create a lot of anxiety that the depression may be returning, even if the emotions involved are normal and healthy. Therapy can be an helpful place for reality-testing in terms of what is healthy and what is a signal that depression may be returning.

The thoughts and feelings around the decision to go on or off of antidepressant medication can be confusing. Therapy and consultation with your medical provider to sort through the questions and concerns raised by antidepressants is a good place to start.

Throughout life there are always reasons to feel guilty: the call we forgot to return or the birthday card we forgot to send, or the time we snapped at our partner for no good reason. But when we feel we have failed with our child, this guilt weighs even heavier on our minds.

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Throughout life there are always reasons to feel guilty: the call we forgot to return or the birthday card we forgot to send, or the time we snapped at our partner for no good reason. But when we feel we have failed with our child, this guilt weighs even heavier on our minds.

Guilt is an emotion with a conscience — it helps us try to do our best, and it reminds us of what is important to us. But too much guilt can rob us of enjoyment. And as a parent, there is so much to feel guilty about! If we dote on our child, there’s the house, friends, partner or even job to feel guilty about, and if we try to meet our other obligations, it is easy to feel that you have failed as a parent. It’s a Catch-22!

I wonder sometimes if our parents felt as guilty as we do, or if it is unique to our generation to expect so much from ourselves. And guilt in itself is purposeless. It doesn’t help anyone, but only makes it more difficult to do our best.

When you are feeling guilty, it is important to look at this feeling from some emotional distance, seeing it objectively instead of being its victim. Decide whether your sense of guilt is justified. Sometimes sharing your feelings with a fellow parent can help you sort out what is legitimate and what is perfectionism.

When you feel that you have truly let someone down, it is important to do what you can to make it right. Apologize to the friend you neglected, or the partner or child you yelled at. Try to learn from your guilt to change your priorities and do things differently. Then let the guilt go.

When the guilt is baseless, or unavoidable, like when you feel guilty for a feeling you have, or because you cannot do more than you are capable of, then you need to practice using your “interior parent” to counter those feelings.

If you had a beloved friend who told you she felt terrible because the baby cried while she was on a much-needed outing with her partner, what would you tell her? Probably you would reassure her that she is a wonderful mother, and that she must nurture herself and her relationship in order to be the best mother she can be. You would tell her she has nothing to feel guilty about, and you would also empathize with her pain. This is the role you must also play with yourself.

Listen to your own thoughts, and when they are self-defeating or judgmental, respond to yourself the way you would to a loved one — being a good parent to yourself is part of being a good, loving and joyful parent to your children.