"One in four first time mothers had depressive symptoms caused by postpartum depression or postpartum stress syndrome. PPD strikes women without any history of depression, without complications in pregnancy, mothers who are in difficult marriages, mothers who are in satisfying marriages, or single."
Postpartum Depression:
Naming the Pink Elephant
(Rat) in the Room
by Dr. Linda Shanti
Common sense disclaimer: this blog is not
intended to diagnose or treat Postpartum Depression (PPD). For a list of
resource referrals for PPD screening and treatment, see end of blog.
Recently,
I attended a talk at a well-known research university and teaching hospital in
San Francisco on the maternal brain. I was so excited to learn more about how
the brain is affected during pregnancy and postpartum for mothers, especially
as it affects women in recovery, women who struggle with Postpartum Depression
(PPD), and their bonds with their children, I excitedly prepared to meet other
clinicians and mommies working with mommies and their postpartum brains. This
is a brief summary of what I heard:
Mothers that
exhibit consistently increased pup LG (i.e.
high LG mothers) by comparison with low LG mothers show increased oxytocin
expression in the mPOA and the paraventricular nucleus of the hypothalamus and
increased projections of oxytocin-positive cells from both mPOA and
paraventricular nucleus of the hypothalamus to the VTA...(Shahrokh D, et al., Endocrinology,
151 (5): 2276-2286, May 2010. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869254/)
WHAT? If
your brain has just glazed over, and you heard the teacher in the Peanuts
cartoon saying “WaWaWa WAAA,” you are not alone. Ok, it is a given, going to an
empirical, research-based talk, that there would be a focus on brain chemicals
and how this affects behavior. It is also an ethically understandable given
that much of this research would be done on rats rather than human brains,
especially the brains of pregnant or newly postpartum mothers. However, when I
asked the doctor giving the talk giving the talk how this “licking and grooming
behavior” of rats might be different for mothers suffering from Postpartum Depression
(PPD), she said “We don’t do these studies or have any research in this area on
people with major mental illness, so I can’t comment on that.” And yet, in her
conclusions for this talk, she discussed how rats with increased oxytocin and
dopamine had increased licking and grooming behaviors, which might show that
stronger attachment occurs in human mothers with increased oxytocin and
dopamine. So, in my mind, it is not that big of a leap to then ask what about the mothers with decreased
oxytocin and dopamine?
Who suffers from PPD?
Despite
the myth/stigmatization that PPD is a major mental illness that only affects a
few, severely mentally disturbed women, PPD does not discriminate in whom it
affects. In their book This isn’t what I
expected, Karen Kelinman, MSW, and Valerie D Raskin, MD write:
It is
estimated that 400,000 women in the United States suffer from Postpartum
Depression (PPD) each year. One in four first time mothers had depressive
symptoms caused by postpartum depression or postpartum stress syndrome. PPD
strikes women without any history of depression, without complications in
pregnancy, mothers who are in difficult marriages, mothers who are in
satisfying marriages, or single. It strikes women who had easy pregnancies and
deliveries and women who suffered long, complicated labors and/or cesarean
sections.
In the
March 2013 issue of Parenting magazine, it is stressed how susceptible new
parents are to depression. “From pregnant women to fathers to mothers of
multiples to stay-at-home moms, [new parents] experience depression at rates
twice that of the general population.” http://www.parenting.com/article/xanax?cid=searchresult
According
to National Research Council Depression in Parents, Parenting, and Children
(2009), “fifteen million children
are living in households with a depressed parent, so there are enormous numbers
of young lives at stake.”
So. Lots
of women have PPD. Lots. Think of it
this way: if everyone has a mother (which we all do) and one in four of those
mothers had PPD, one out of every four adults has a mother who had Postpartum
Depression. And most likely, it is more
than one in four.
What is Postpartum Depression
(PPD)?
According to June A. Horowitz, PhD, APRN, BC, FAAN, the signs and
symptoms of PPD include:
Loss of interest or pleasure in life, Loss of
appetite, Less energy and motivation to do things, Difficulty
falling asleep or staying asleep, Sleeping more than usual, Increased
crying or tearfulness, Feeling worthless, hopeless, or overly guilty, Feeling
restless, irritable, or anxious, Unexplained weight loss or gain, Feeling
like life isn't worth living, Having thoughts about hurting yourself or your baby
(This link also includes signs and symptoms of
postpartum psychosis and anxiety:
http://www.mededppd.org/mothers/hear_it_from.asp)
And yet, as noted by Dr Teri
Pearlstein et al American Journal of Obstetrics & Gynecology, (357, April,
2009):
The diagnosis
of PPD is challenging because of changes in sleep patterns, changes in
appetite, and excessive fatigue being routine for women after delivery.
To this I need to say, Right
On! Who as a new mother, doesn’t suffer
from difficulty falling or staying asleep, loss (or gain) in appetite with
breast feeding and/or hormonal changes, and having less energy and motivation
to do things in the first year postpartum? Anyone with a child under the age of
one year old will have drastic changes in their weight, sleep, energy, and
motivation levels during the first year of parenthood!
I am not minimizing PPD
here. Just like other forms of depression, there is a spectrum of severity. The
California Pacific Medical Center’s Perinatal Mood Disorder program advises if
any of the following symptoms exist, to call their nurse triage line to be
further assessed (you can also see a 24 hour hotline as a resource at the end
of this blog):
Can’t
function normally or take care of self, can’t eat or sleep, can’t bond with
baby, has suicidal thoughts, says “I just don’t feel like myself” can’t quit
worrying, can’t stop crying, get out of bed, or leave the house. (Tung Crystal,
Lily, Side by Side Sutter Health CPMC, Spring, 2013)
What I am doing is attempting to normalize that
early parenting is difficult and it is most likely that many more women suffer
from PPD than are reported or studied in the research literature, and that it
is nothing to be ashamed of. And
yet…many women still struggle with it (never report it, get assessed and
treated for it, recover from it) alone. WHY?
SHAME
(Why every blog I write keeps coming back to
this)
There has been an explosion
of popularity recently for Brenee Brown’s TED talk on vulnerability and shame.
In her talk, Dr. Brown discloses
When I
became a vulnerability researcher, I thought, I’m going to leave that shame
stuff behind…I became a researcher to avoid vulnerability and that when being
vulnerable emerged from my data as absolutely essential to wholehearted living,
I had a breakdown. (Brenee Brown on the topic of shame and vulnerability:
Brown shares
that Jungian analysts call shame the swampland of the soul and advises, “We
have to put on our galoshes and find our way and walk around [because]
adaptability to change is all about vulnerability.” And new motherhood is all
about vulnerability in adapting to change and the discomfort of that. Why don’t
any of the virgin mother images show that? Or the glowing pictures of pregnant
and new mothers in parenting magazines?
So what heals shame? Brown
notes to grow shame, put it in a petri dish with secrecy, silence, and judgment.
Add empathy and it cannot survive. This leads to what I believe the missing
factor is in naming the “pink rat in the room.” Leaning directly into support
and releasing the stigma of shame associated with PPD.
What Helps:
Here are some other things I
have found helpful in the first few years of parenting, regardless of whether you meet diagnostic criteria for PPD or not:
1.The Right Kind of Support:
Obviously
psychotherapy and medication interventions as provided by a therapist, and/or
Psychiatrist can be invaluable and necessary components to recovery from PPD.
(For a list of resources in the San Francisco bay area, see end of blog).
Seeing your ObGyn, Medical Doctor and/or a Nutritionist can also be helpful for
looking at how to best balance your hormones and food plan for healing. Moms
groups for postpartum women, Moms groups for women with PPD, childcare and
housework help, friends, and family can all be helpful in alleviating some of
the weight of new parenthood and/or depression.
I had a
nanny start when my baby was 6 months old. She was an older Grandmother and
truly a gift sent to me. She would often do laundry or the dishwasher or mop
the kitchen floor when the baby was sleeping, even though I told her not to.
She was a very humble woman who pitched in to help in many ways without being
asked. The incredible help this was to me was unbelievable. I’ve often wondered
if it was because she saw how much I was crumbling under the weight of new
Mommy boot camp or if she simply was an angel. Regardless, it was helpful. Find
that person or those people for yourself. Ask for that help. Ask for the help
that you need. Ask your spouse, ask your friends, ask your family. Also, it’s
ok to set boundaries with people who are trying to help by offering unsolicited
opinions, advice or unhelpful “help.” If you have a partner who repeatedly
tries to “fix” you instead of listening to you, it is ok to clarify that’s not
what you need. (Partners can also benefit from counseling and book
recommendations on PPD as well).
2. Sleep:
I know,
I know, you’re saying but that’s the PROBLEM! I can’t get any sleep! I have a
BABY! Enlist the support of your partner, support person, or hire a night doula
to you replenish your sleep debt. The link between PPD and lack of sleep/poor
sleep quality is huge.
Also try creating good sleep
hygiene by having a consistent bedtime ritual, not using your computer/iphone
in bed, and staying off caffeine.
3. Get out of the house:
Note that I wrote getting out of the house here and not “Go
for a walk and get some exercise.” Obviously going for a walk and getting some
exercise and sunshine are helpful. But for a new Mom and a new Mom struggling
with depression, getting out of the house is a more realistic and difficult
enough goal. It can be extremely difficult if you are facing depression and
caring for a young child, to get out of the house. It takes turning toward the
opposite action (away from what you feel like and toward what feels
insurmountably difficult) to get yourself dressed (showered and fed if you
can), the baby changed and fed, all the baby gear packed, and the baby into the
stroller/car seat/Gemini/Bjorn/Moby wrap and step out of the house! If you walk
half a block down the sidewalk, celebrate it! If you get to the playground or
the coffee shop, it is a momentous accomplishment. If you meet up with another
Mom, great! If you get to the beach or park and do a mildly vigorous walk, WOO
HOO! Fresh air can work wonders to shift the claustrophobia of being inside a
small house, both literally and in your brain. As a friend of mine in 12-step
program says, “better out than in,” in which she meant better to talk about t
than keep ruminating about it inside your own mind. There is much more room on
the outside for a fresh perspective. This can be true of getting out of the
house as well.
4. Find Humor in and normalize
the Shadow side of parenting
When I
was a new Mom, I suddenly I discovered there is a whole world on the Internet
of Mommy blogs! This helped break the isolation that went along with the
difficulty of making plans when having an infant on an unpredictable schedule. I
was often so tired that humor helped much more than advice. This is my most
favorite humorous parenting blogs. It always makes me feel better. www.crappypictures.com She writes about poop, food, sex, body image,
and life before and after kids with short, well, crappy pictures and sentences.
Or check
out this funny “Proof that you are fucking up your offspring no matter what”
chart recently on Huffington Post (Do not I repeat DO NOT use this to fuel your
not-good-enough-Mom critic):
Motherhood
is ripe with myths that need to be challenged. Jill Smokler, author of ScaryMommy has written a new book on how
actually motherhood doesn’t come
naturally that challenges many of the myths of the glowing, natural (nondepressed)
mother. She has a confession board on her blog in which Moms can write what
they are most afraid to admit, and she writes with humor and experience about
challenging the myths of motherhood. Apparently, she also suffered from
undiagnosed PPD: http://www.scarymommy.com/category/PPD/
5. Be discerning about what
you expose yourself to:
I read
on one PPD blog to stay away from depressing movies, books, and literature, http://www.postpartumprogress.com/six-things-you-should-avoid-if-you-have-postpartum-depression This was wise advice. Obviously, you can’t
always avoid being exposed to suffering. Suffering and violence do occur. I am
not saying stick your head in the sand and be in denial. But putting yourself
in the direct line of suffering is not necessary or beneficial. When we had a
new baby, my husband and I watched the film “Life is Beautiful.” This isn’t
necessarily a depressing movie considering the fact that it is about the
holocaust. Before kids, I would have thought, what a lovely movie. However, in
seeing a father trying to protect his young son from the horrors of unnamable
suffering of the Holocaust with sleep deprivation and being the mother of a
baby boy, I found myself wracked with sobbing.
There
will be times in your life, if you like them, to watch movies or read
biographies on addiction, genocide, madness, eating disorders, holocaust
survival, and emergency room dramas. Early postpartum, if you are a sensitive
soul, that’s not the time.
6. Bring in Spirituality and
Radical Acceptance:
A
concept from Dialectical Behavioral Therapy (DBT) that can help with being with
difficulty, depression, and hardship is Radical Acceptance. In an interview
with Tara Brach on Mindfulness, she writes:
In distressing feelings, in
depression, in the immense rite of passage that is motherhood, THERE IS NOTHING
WRONG WITH YOU. You don’t always have to like the experience of motherhood.
Tara states:
Radical
acceptance has two elements: It is an honest acknowledgment of what is going on
inside you, and a courageous willingness to be with life in the present moment,
just as it is. I sometimes simplify it to “recognizing” and “allowing…” You can
accept an experience without liking it.
Thomas Moore, author of care of the Soul, offers the
wise suggestion of simply listening to depression, to what it has to say, to
what teaching it has to offer, to what needs the Soul has in the emptiness:
Because
of its painful emptiness, it is often tempting to look for a way out of
depression...But maybe we have to broaden our vision and see that feelings of
emptiness, the loss of familiar understandings and structures in life, and the
vanishing of enthusiasm, even though they seem negative, are elements that can
be appropriated and used to give fresh life imagination…Care of the soul
doesn’t mean wallowing in the symptom, but it does mean trying to learn from
depression what qualities the soul needs.
If you
have PPD or if you are in exhausted new Mommy boot camp, consider that your
vulnerability is actually your greatest gift. Consider that the emptiness is
the way out, because the way out is through.
Helpful
links/Resources:
National
Postpartum Depression Hotline: 1-800-PPD-MOMS
Suicide
Prevention & Crisis Hotline
(415)
499-1100
It is important for women who might be experiencing suicidal
thoughts/ideas/plans to call this number.
TALK Line
Parental stress, child abuse
prevention, emergency respite care, single parent network, parents' group,
crisis counseling, substance abuse services and ongoing therapy.
(415)
441-KIDS (5437)
TALK
www.talklineforparents.org/
GoldenGate Mother’s Group
therapist referrals and resources:
Postpartum Stress Center:
The author: Linda Shanti McCabe holds a doctorate in
Clinical Psychology and works with women (including pre and postpartum)
recovering from food, weight, and body image issues. She holds SoulCollage®
groups for women (including pregnant and postpartum) using expressive arts to
find and express the many parts of the Self. You can find her at:
Labels: Linda Shanti, Postpartum depression, PPD, Shame
