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It’s not just depression anymore

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I sat in the chair while my friend was putting highlights in my hair, filling me in on how everything was going with her son, who is only nine months older than mine. As the foils crunched and curled, she began to tell me how in the next week she would be going to the doctor to look into medication because her anxiety has gotten out of control since she had her son a year and a half ago. She was apprehensive to do it before then because she had breastfed until he was 9 months old — she didn’t want any medication transferring to him through breast milk.

I swiveled in my chair. “You too? Why doesn’t anybody tell us about this? Everything you read is about postpartum depression. Nobody ever talks about postpartum anxiety.”

We went on to compare notes. Both of us had a history of depression and anxiety pre-baby. Both of us didn’t have immediate anxiety when we were postpartum; it was more like something that crept up on us three months in and escalated from there. Both of us did not feel or recognize symptoms of postpartum depression. Before birth, neither one of us had had depression in the form of self-harm nor wanting to harm others.  Some of you can probably relate to this: our depression came out in the form of a funk, much like Eeyore from Winnie-the-Pooh where everything shows up in the form of pessimism and sleep.

Over the years, I have learned that I have a chemical imbalance that attributes to these funks. I’ve learned to monitor myself and I can usually tell if I’m in the middle of one. I’m also a firm believer in medication (not to be confused with over-medicating) and have learned to seek a health professional if I feel my chemical imbalance – and medical condition – needs monitoring. I would do the same if I had a heart murmur or high blood pressure. The body is a weird thing that has a million little scientific motor systems that need a mechanic at any given time. Nothing to be ashamed of.

What a lot of doctors don’t ask during postpartum appointments is if new mothers are experiencing postpartum anxiety or other postpartum mood disorders. I was asked several times, in several different spaces, if I had any thoughts about hurting myself or others, especially the baby. I was asked in the hospital every day, sometimes more than once, in each of my OB/GYN visits, even at the pediatrician. I thought that was responsible of them to make sure the child was living in a healthy environment. But never once was I asked about the possibility of other mood disorders, which can, in fact, be worse than postpartum depression.

The American Pregnancy Association has outlined new subcategories of postpartum mood disorders: “Baby blues” (the least severe form of postpartum depression); postpartum depression (PPD); postpartum psychosis (PPP); postpartum anxiety (PPA); postpartum obsessive compulsive disorder (PPOCD); and postpartum post-traumatic stress disorder (PPPTSD). Their website does a great job outlining the differences of each and what to look for regarding each mood disorder. Here’s how they break it out:

Baby Blues

  • Crying for no apparent reason
  • Mood swings with irritability and anxiousness
  • Feeling overwhelmed
  • Change in eating and sleeping

Postpartum Depression (PPD)

  • Fatigue
  • Feeling sad, hopeless, and/or overwhelmed
  • Trouble sleeping and eating
  • Feelings of guilt and worthlessness
  • Losing interest in things that you used to enjoy
  • Withdrawing from family and friends
  • No interest in your baby
  • Thoughts of hurting yourself or your baby

Postpartum Anxiety

  • Changes in eating and sleeping
  • Racing thoughts that you have difficulty controlling
  • Constant worry
  • Impending fear that something bad is going to happen
  • Trouble with sitting still and focusing
  • Physical symptoms such as dizziness, hot flashes, and nausea

Postpartum Obsessive-Compulsive Disorder (PPOCD)

  • Overly occupied with keeping your baby safe
  • Compelled to do certain things over and over again to help relieve her anxiety and fears–This can include counting things, ordering things, listing things, checking and rechecking actions already performed, and cleaning repeatedly. This may manifest itself in cleaning, feeding, or taking care of the baby.
  • May recognize these obsessions but feels horror and shame associated with them
  • Obsessions or thoughts that are persistent, are repetitive and can include mental images of the baby that are disturbing
  • Fear of being alone with the baby

Postpartum Post-Traumatic Stress Disorder (P-PTSD)

Traumas that might cause postpartum post-traumatic stress disorder include:

  • Unplanned Cesarean
  • Emergency complication such as prolapsed cord
  • Birth that includes invasive interventions such use of vacuum extractor or forceps
  • Baby having to stay in NICU
  • Lack of support and assurance during the delivery
  • Lack of communication from the birth and support team
  • Feelings of powerlessness

Symptoms of P-PTSD may include:

  • Nightmares and flashbacks to the birth or trauma
  • Anxiety and panic attacks
  • Feeling a detachment from reality and life
  • Irritability, sleeplessness, hyper vigilance, startles more easily
  • Avoidance of anything that brings reminders of the event such as people, places, smells, noises, feelings
  • May begin re-experiencing past traumatic events, including the event that triggered the disorder

Postpartum Psychosis (PPP)*

  • Bizarre behavior
  • Suicidal thoughts
  • Hallucinations and/or delusions
  • Thoughts of hurting the baby
  • Rapid mood swings
  • Hyperactivity

*This is considered an emergency disorder and should be treated immediately in an emergency room or by dialing 911.

Everyone’s heard about postpartum depression and what to look for. I attribute this mainly to a number of celebrities coming out with their stories of postpartum depression in recent years. And good for them. It shouldn’t be hidden. People should know what to look for and the dangers of mood disorders. The more people know about these diseases, the more they can proactively take care of themselves and their families. Awareness allows people to move past the stigma of labels and embarrassment and move into a space of healing — maybe saving a few from physical harm, abuse and even death in the form of neglect, suicide or murder as seen in the media. No mother should ever leave her child filthy and unfed, take her own life, or drown her child in a bathtub because she didn’t recognize or nobody recognized for her the signs of a postpartum mood disorder. As graphic and as hard as that is to read, that is the extreme reality of what can happen. So get over the labels and the stigma and go to a doctor if something feels off.

We’d rather have you around as a parent that may need a little gentle patching up…than not around at all.
Carley Lucas is a working mother of one hysterically giggly 9-month-old. She, her son and her husband live in Central PA and firmly believe a household of laughter is the best form of medicine for any situation.

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