What are the risk factors for Postpartum Depression and anxiety? Can your personality contribute to your risk? Check out this article of mine, published on www.GoodTherapy.org.
Take a test to see if you have Prenatal or Postpartum Depression
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 depression and anxiety 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 sudden loss of my mother only a few years before, a previous birth trauma, an unsupportive marriage, and breastfeeding difficulties. But even though I had suffered from depression before, after the death of my mother, my postpartum symptoms were not recognizable to me.
I did OK after my first child was born, although it was a difficult time for me. But after my second child, my stress level was off the charts. My older son was kicked out of two day care programs because he wouldn’t use the potty (he regressed after his brother was born). I never made enough milk for the new baby because of my stress level and because he was so big (born almost 10lbs) , and he refused to nurse completely 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 daycare that would take my challenging and potty-resistant older son.
In the meantime, I had difficulties in my marriage. My husband worked long hours, and when he was there he criticized my parenting style, my cooking, and my housekeeping. Even our challenging preschooler was my fault! 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 Multiple Sclerosis, and I was sent for neurological testing. The tests came back normal, although MS couldn’t be ruled out (a bonus for my anxiety, of course!).
My symptoms came and went, and then began to include nausea and vomiting along with the dizziness, a complete lack of appetite, and an inability to sleep. I had a low-grade fever on and off for a couple of months and my white blood-cell count was high. I lost 16 pounds beyond the baby weight, 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, my chest burned 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 issues, 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 was dying, and at that point I wanted to die if they couldn’t stop the misery I was living in. I was admitted to a psychiatric inpatient unit, 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 an anti-anxiety medication 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, which gave me time for the antidepressant to start working and allowed me to take care of myself for a change. 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 later couples counseling, I recovered. I still had anxiety at times, but I also had joy and passion for life. I became a lactation educator, started a small business helping other new moms, and led new parent support groups for several years. 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 maintaining good 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 like some people seem to do, or living life in a way that generally makes me unhappy. I am obligated to do work that I love, to have a healthy relationship with my husband, and 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 mental health issues began when my second child was seven months old, and yet no one ever considered a postpartum condition. My symptoms were fully consistent with panic disorder and depression, and yet my doctor and my therapist (yes, a trained 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 and mothers can return to enjoying their lives again.
Call PSI Warmline (English & Spanish) 1-800-944-4PPD (4773)
Email support@postpartum.net
Take a test to see if you have Prenatal or Postpartum Depression
As parents, our job is never-ending. For the next 18-21 years, you are either “on duty” or “on call” 24/7. Strangely, while this never-ending job doesn’t necessarily get easier with time, it often seems less like “work” as our children (and we) mature, and more like “life.”
But it is easy, as we grow into our role as caretakers of our children, to forget another important person who relies upon our care – ourself. We all make this mistake sometimes. If you don’t make sure that your own nutritional, health, emotional, and spiritual needs are met, who do you think will? It has been my experience that the answer is “no one.” As much as our partners may want to attend to our needs, they cannot do it for us. No one but you really knows what it is you need, and many of the things that fulfill us as human beings cannot be done for us.
No one but you can make sure that you eat a balanced diet, get regular exercise, indulge in treasured hobbies or activities, get needed downtime, or connect with beloved friends and family.
How important is it to make sure that your own needs are met? Only you can say. One mom might be able to tandem-nurse twins and a toddler while home-schooling her older two children and never see a movie or have dinner out for five years. And be perfectly content. Another might feel burdened and overwhelmed if she doesn’t have lunch with a friend or enjoy a leisurely uninterrupted bath weekly. Or maybe you need an hour every day to drink a cup of tea and read the paper or a good book. You are the only person who can say when your engine’s running low on gas, and what it takes to fill it up.
And it doesn’t help to feel guilty about what you need to do to take care of yourself. If your child needed a nap long after his peers had given it up, would you tell him to “tough it out” and be grumpy for half the day? No, you would do whatever you could to arrange things so that he could get his nap. You deserve the same recognition for your unique temperament and needs.
And you don’t do anyone any favors if you let yourself run on empty for too long. No one wins if you allow yourself to run out of gas on the side of the road. And everyone is affected when you are running low, not just you. You don’t make it to the finish line any faster if you never slow down and take it easy.
This is your life. And raising children is a path, not a destination. You cannot travel the path with joy and stamina without giving yourself the same care you give your children. So take some time this week and plan a couple of activities you can do that will help “fill up your tank.”
This is a topic that I cover regularly in my new parent support groups, because it is so important to remember as a new mom or dad. It is easy to feel that the needs of your new baby, and even your partner, outweigh your responsibility to take good care of yourself. But this is a dangerous trap, because you are only as good a parent as you are nurtured as a human being.
This is not meant to be a guilt trip about getting your nails done or taking time to work out. The whole idea of nurturing yourself is about minimizing the avoidable “shoulds.” You don’t want anything about your own self-care to feel like an obligation. Pick ways to take care of yourself that you look forward to, and that fill your cup. It could be as simple as a long, hot shower with the music turned up high (while someone you trust minds the baby). Or taking an hour at Starbucks to read the paper over coffee while your partner has some baby bonding time.
Each of us as parents needs to listen to the voice inside of ourself that tells us when we’ve reached our limit. Parenting with heart requires living with heart, which is only possible if you feed your own spirit and body, and set appropriate boundaries to prevent building up resentment.