Sunday, April 16, 2017

I had postpartum anxiety (and you can, too).

Ugh. UGH.

I don't want to write this post. Our life is SO GOOD and so beautiful and busy and I love Bennett to the ends of my teeth and...I so want to take advantage of the beautiful function of our memories that savors the soft bits and softens the hard bits.

However, so many of you are having babies, and I find myself wanting to much to share the signs to watch for. Even with a decade of working in mental health, I wasn't primed to catch the symptoms in myself, and if postpartum depression is only just beginning to be recognized, postpartum anxiety is somehow leaps and bounds even behind that.


I had postpartum anxiety. Lots of women get postpartum anxiety. Twenty percent? Probably more. That means you know someone who experienced it.

And spoiler alert--I'm on a psychotropic medication for the first time in my life for it. And very, very happy about that.

I knew I was higher risk to develop postpartum depression. Some thyroid stuff that has meant a couple bouts of hormone-linked depression for me and just generally falling a bit on the less sunshiny side of the optimistic spectrum meant we all knew to keep an eye on my mental health after Bennett was born.

And yep, I did get postpartum depression, though because I felt like absolute hell at 2 weeks postpartum and significantly better at 6 weeks, the relativity meant I thought I was all the way better, which I wasn't (news flash: being a little or even a lot better is not the same as being all the way better).

Free tip: postpartum depression and the baby blues ARE NOT THE SAME THING. In baby blues, the prevalent emotion is joy with bouts of intense sadness or overwhelm. Baby blues is also over by 2 weeks, no wiggle room. If you're still depressed after that, it's not baby blues. Baby blues sounds much less scary than postpartum depression, so I think we gravitate toward it because postpartum depression is Andrea Yates (but it's not. Andrea Yates had postpartum psychosis, which is also very important but different.) and baby blues sounds kind of cute and definitely less scary, but we're not doing any of us any favors by pretending PPD is something it's not. Calling it baby blues doesn't make it so.'s the ugh part. Ugh. Ugh ugh ugh.

After Bennett was born, after he woke me up for night feeds, I often wasn't able to get back to sleep. Usually, my thoughts would race for at least 45 minutes, sometimes a couple of hours. I don't even know about what. They would just be doing their own Indy 500 and none of my mindfulness skills or tried and true get-back-to-sleep-skills or even the occasional and desperately needed Ambien would stop them. So B would wake me up and then I would be up, just having fun on my own, knowing it was only a tiny bit of time I had before he'd be up again, which of course makes it even harder to fall asleep.

Many times, my heart would race faster than it has raced any time I wasn't riding my bicycle up some godforsaken mountain, only I would be lying in bed in the dark, desperately using diaphragmatic breathing and thought reframing to get it to slow down. It didn't work.

At least once, it raced so fast the thought crossed my mind that I was going to have a heart attack. Thankfully, I am familiar enough with the symptoms of panic that I didn't haul myself to the ER at 3 am, but I sure as hell wanted to.

SO. Major symptom I totally missed: I often wasn't able to sleep when given the opportunity. Yep, new moms don't get a lot of sleep. That is true. But when people asked about my sleep and I told them I was sleeping for shit, they nodded knowingly and fed me some bullshit about how that's the way it goes with a new baby. WHICH IS TRUE BUT NOT IF YOU THINK YOU MIGHT HAVE A HEART ATTACK IN THE MIDDLE OF THE NIGHT BECAUSE YOUR BODY IS GOING BANANAS. Major major screening question that needs to be asked instead of the "are you sleeping more or less than usual?" is, "can you sleep when given the opportunity to sleep?" If not, why?

There were also the days when B was crying and I would feel like I was going to die (I might have some death anxiety? You think?), like literally (and I mean that literally) explode and die, and I'd go into the kitchen and put my head on the counter and sob, sob, sob while Harry tried to calm B. I felt completely and beyond helpless. My whole body hurt during those minutes.

And the fights! I was so snappy and bitchy to Harry all.the.time. And we have done our work talking about this and working through it, but guys? Many times, didn't think our marriage was going to make it. Our 11+ year super solid felt impossible. I was constantly irritable which Harry handled kindly much of the time but I couldn't expect him to carry that load all the time (hey, I wasn't the only one with some new stuff going on, right?), and when he responded in kind, things blew up quickly. And again, my response would usually be to feel like I was going to literally explode out of my skin. The overwhelm can't be put into words.

Screening question number 2: are you feeling more irritable or snappy than usual?

And then there was the health anxiety, feeling that every pain or illness meant I was really and truly going to die. I had visions of having to go to the hospital and not being able to raise my child. I was worried he was going to get sick and die. I was worried Harry was going to get sick and die. I already have some general health anxiety (which this experience has illuminated, thank goodness), but it was off the charts.

And the intrusive thoughts. Ugh ugh ugh times a million, but I had intrusive thoughts of bashing B's head on our marble coffee table. These came and went in less than a second and absolutely scared the SHIT out of me, but they came. And they made me feel like a horrible, no good mother.

Important tidbit number 3: intrusive thoughts can be a big red waving flag for postpartum anxiety. These intrusive thoughts are related to OCD, which is in turn related to anxiety disorders. The most common triggers are sharp objects, heights and water, but obviously there are others. And we as mothers MUST have safe providers to talk to about this without being afraid of being reported to CPS. If a mother is horrified by these thoughts and takes action to avoid them (like me not holding B near the coffee table on tough days), we don't need to worry about her hurting her baby. We need to worry about HER and her well-being. Like, write that lady a prescription already because having those thoughts sucks.

Oh, and I had a little tiny shopping addiction, which was kind of fun but kind of problematic in light of thousands of dollars of medical bills and our primary breadwinner (me) taking 3 unpaid months off of work for maternity leave (USA! USA!). That kid got a ridiculous number of footed pajamas in the 3-6 month range. I don't know what it was about footed pajamas--maybe feeling like if I kept him warm I was a good mother?--but the compulsiveness behind that little habit was another marker that something was up.

And on lower-levels, I had trouble wanting to be around people and just generally felt kinda blah. I wasn't walking around my house with greasy hair weeping and feeling sad, which for some reason (even though I absolutely know better), is kind of what I expected. I thought that since I was spinning out and able to talk and function and shower and all of those things (basically because I didn't meet the criteria down the line for depression). I was fine.

But I wasn't.

And can I be real real for a minute here? Since day 1, I have been absolutely invested in Bennett's safety and well-being from the beginning, even when I had just had my belly cut open and couldn't even stand up. And I am super, super lucky that that was my situation because feeling that way doesn't mean anything special about me. It was just luck. On some level, from day one, I cared deeply about my baby. But honestly? I didn't fall in love with him until he was several months old, and I didn't fall in head-over-heels batshit crazy love until...8 months? 9 months?

And this is probably one of the things that made it hardest for me to recognize what was going on, because saying I was struggling with mental health issues in those early months was, in effect, calling the game. The minute I said, "I'm not okay," I was admitting that I was never going to be able to be in love with my baby in the first few months of his life, which is such a tremendously sad thing to accept, and it is something I will never get back. For so many months, I subconsciously held out hope that things weren't really so bad, that we were doing just fine. I think this has so much less to do with outward appearances than with what I so wanted for myself and my family when we became three. It wasn't about guilt and shame as much as it was about loss, and accepting that my early months carried a lot of loss of feeling and experience, although we had been handed a perfect, beautiful baby. That juxtaposition is hard, guys.

In November, when Bennett was 7 months old, I left for 2 nights to go to a Postpartum Support International conference as a provider. And I got so much more out of that conference personally than I could have predicted. I went in with a mentality of "oh yep, I totally know what's going on and I'm fine! Just fine! And ready to help other women who are struggling!" And within 24 hours of leaving the conference, I had an appointment with my NP to start an anti-depressant/anti-anxiety medication.

I know. It's obvious. I don't know if it was the flashing images of crushing my baby's skull, the panic attacks in the middle of the night, the sobbing in my office or thinking I was going to have to get divorced that tipped me off, but genius that I am, the conference helped me put the pieces together and realize that I deserved to feel better than I was feeling that that time, and more importantly, that I could.

Because ladies, you do not have to tough this out.

My biggest regret about all of this is not that I experienced any of it. From where I am now, which is a very, very good place, I am grateful for the difficulty of those months because it deepens my experience of being a human in this world. YES, I am glad I got through it. I would not be feeling so goddamn grateful if I were still in that shithole. My biggest regret about all of this is that I was so stinking stubborn about thinking I was just fine, which added many unnecessary months of suffering to the whole debacle. In plain English, I wish I had had the insight to start medication much sooner.

The medication piece. So much stigma! I know. So much stigma. Because if you have to take meds, something must really be wrong with you, right?

Here's the thing. I have taken many medications in my life and I have never felt those medications implied anything negative about me, whether the strength of my body or my morality. People would not think me a more noble person if I spent my life sleeping 16 hours/day and lying on the couch while my hair and eyebrows fell out in clumps instead of taking my thyroid medication, right? You'd think I was an idiot. I don't get any credit for toughing my way through an asthma attack and straight to the ER instead of taking my inhaler. I would much rather my loved on take his statin daily rather than risk a heart attack due to genetically high cholesterol. Most of us take medication when we're not well and it helps us get well. It makes our lives better, it makes us feel better, and it helps us live longer. All objectively good things. So what the fucking hell about medications that help with the illnesses that are anxiety and depression? Or any other mental health issue, for that matter? These are not illnesses of failed morality, so can we please stop pretending they are? It's just bad luck. And we don't have to feel shitty for being unwell. It just is, so let's deal with it and move on.

So I started Zoloft in November and I love it. Love love love it. It is safe for nursing, and I continued to nurse Bennett for nearly 5 months after starting it. Though I know this might be the most taboo thing I've ever said in this space because who would we be as a society if we didn't constantly judge the mothery-ness of mothers? But I truly think it's what allowed me space to fall fully, madly in love with my child, which helps me feel better above and beyond the Zoloft. It helps me feel like I can get stuff done, like exercise and clean my house and spend time with friends, which again, makes me feel better above and beyond the Zoloft. What I'm saying is stop judging this as the easy way out, people. It's a (very necessary) stepping stone, not a crutch. I feel totally like myself on it, with my full range of emotions (when my NP explained that I'd still feel my full range of emotions, I was like, "GREAT. It sounds absolutely awful to just feel happy all the time."). So yes, I feel happy most of the time, but in a normal way, and I still get irritated and angry and sad and blah's just that I don't feel like I'm going to explode from these emotions anymore. They show up in normal, manageable forms and I feel like I can do stuff about them rather than feeling paralyzed by them.

And if this sounds like an advertisement for psychotropic medications, it is. Because I am so over the mentality that psychotropic medications are only okay to try if you've tried all the other "natural" stuff first, like fish oil, therapy (this, coming from a therapist), exercise (this, coming from a Pilates instructor), essential oils, and etc. ad infinitum. Because really, in my mind, what these are is a way to avoid taking medication, which highlights perhaps more than anything the stigma we place on mental illness in this society.

Can I tell you something? We will all most likely struggle with something that will qualify as mental illness in our lifetime. It's just part of being a human in 2017.

So sure, there are a bunch of things I could have tried (and I did encapsulate my placenta and take it religiously for a couple of months hoping to ward of PPD), but Zoloft helped me feel better, and it did the job quickly, and as far as I am aware, it does that job pretty reliably. In contrast to that, do I wish I had spent several months and hundreds of dollars trying to find something else that might have helped a little? No. I would not give up those extra joyful months of motherhood and life to appease an unfounded cultural stigma about mental illness.

And finally, can I say this? I was doing objectively well those months I was struggling. I showered every day and put on makeup every day I went to work. I made home-cooked meals most nights and managed the grocery shopping and other household tasks like normal. I did well at my job. I was able to laugh and seem normal, so much so that I fooled myself for a long time. We cannot wait until things totally fall apart before we decide we deserve to feel better. We do not need to be wanting to die before we decide things are not quite where we'd like them.

In January, after I had been on Zoloft for a couple of months (and had upped my dose once), I started decorating Bennett's nursery. I love design and decorating our home. It's a long-standing passion of mine, and yet I never decorated Bennett's nursery. At the PSI conference, they suggested a screening question for women struggling with perinatal anxiety and depression needs to be "how will you know when you are better?"

I had unknowingly dropped one of my passions, and when I picked it up again--when I felt engaged in my passion again--I knew I was better. And you can, too. Much love to you mamas and the ones who love you.