Educating Mental Health Professionals About Perinatal Mood Disorders

•November 3, 2014 • Leave a Comment

It’s always an exciting opportunity when we can help to educate other health care and mental health professionals about perinatal mood and anxiety disorders. It’s the way to increase awareness of these disorders, so as to recognize the symptoms, allowing us to intervene early. Providing treatment as soon as possible is key to a woman’s prompt recovery.

Therefore I’m pleased to announce that I will be presenting a session entitled, Perinatal Mood and Anxiety Disorders: Diagnosis, Treatment and Positive Outcomes, this Friday November 7th from 2:30 to 5:30 at the Annual Convention of the Illinois Psychological Association. The conference is being held at the Hilton Doubletree Northshore Hotel in Skokie, Illinois.

In addition to my presentation and a short film from Postpartum Support International, there will be a panel of women who volunteered to tell their own stories of postpartum depression and answer audience questions, as a way to help educate mental health providers so that other women can get the help they need.

If you haven’t already done so, please register at the link below.

Preparation is Key: Concerns About Another Round Of Postpartum Depression?

•October 27, 2014 • Leave a Comment

The Post-Postpartum Depression Blog

Many women who experience postpartum depression are understandably reluctant to take a chance with another pregnancy. They’re aware of the challenges of the illness for themselves, their family, and the newborn. So, believing they are fated to go on the same roller coaster journey, they stop at one.

While I respect every woman’s decision on family planning, I do let my patients know that a first bout of PPD doesn’t necessarily mean it will be repeated with subsequent pregnancies. But, at they same time, I do alert them they are at higher risk and although we can put a prevention plan in place, it could still happen again.

A recent article by Kate Rope, an award-winning journalist and contributor to and the Huffington Post, proposed a worthwhile route if there is fear of another round of PPD. Her suggestion is: Be Prepared, and Rope managed this by arranging beforehand…

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Preparation is Key: Concerns About Another Round Of Postpartum Depression?

•October 27, 2014 • 1 Comment

Many women who experience postpartum depression are understandably reluctant to take a chance with another pregnancy. They’re aware of the challenges of the illness for themselves, their family, and the newborn. So, believing they are fated to go on the same roller coaster journey, they stop at one.

While I respect every woman’s decision on family planning, I do let my patients know that a first bout of PPD doesn’t necessarily mean it will be repeated with subsequent pregnancies. But, at they same time, I do alert them they are at higher risk and although we can put a prevention plan in place, it could still happen again.

A recent article by Kate Rope, an award-winning journalist and contributor to and the Huffington Post, proposed a worthwhile route if there is fear of another round of PPD. Her suggestion is: Be Prepared, and Rope managed this by arranging beforehand a team of specialists, a treatment plan, continuously monitoring her emotional well bring, and intervening early if symptoms commence.

In my book, “Happy Endings, New Beginnings: Navigating Postpartum Disorders,” I recommend several coping strategies that will also prove useful. And as a theme in my book — that the postpartum journey can lead to a positive, life-changing event — Rope’s experience led her to “a career of writing about maternal mental health.” In her case, she survived the first pregnancy and postpartum period with the help of a therapist, a reproductive psychiatrist and antidepressants. And because that combination was successful, she made a plan for her second child.

Despite awareness and organizing, PPD hit Rope again, but this time, she confessed her feelings to others and acted on her plan. She writes that instead of losing herself in sleeplessness, and despair, she returned to a small dose of an antidepressant, “swam back to the surface, and resumed life as a mother with normal fears, capable of smiling and laughter.”

Here are some points in her suggested game plan:
•Get to know the symptoms of postpartum mood disorders, especially less talked-about ones like anxiety, extreme irritability and rage.
•Create a sleep plan so you and your partner alternate getting uninterrupted stretches.
•Commit to moving your body as soon as your physical recovery allows.
•Find new-mom get-togethers so you have support and a reason to get out of the house.

As Rope discovered, putting a plan in place does not guarantee you will have a postpartum mood disorder or that you won’t. But, it does guarantee you will know how to get help if you need it.

Bathtub Scene in “Homeland” Stirs Discussion on Postpartum Disorders

•October 16, 2014 • Leave a Comment

Friends were calling; clients were bringing it up in our therapy session. “What did you think of ‘Homeland,’ they asked, each of them turning to me, expecting praise or derision.

The popular Showtime series is in its fourth season and it stars Clair Danes in the central role of a CIA operative who, in addition to a dangerous job, struggles with bipolar disorder. If that weren’t intrigue enough, the writers throw into the mix a baby from an affair with a character that was killed off in season three.

In the Oct. 5 episode, Carrie Mathison has been part of a bungled operation and is forced out of her post in Islamabad and returns home. While stationed there, her sister has cared for the baby.

But, as Hayley Krischer writes in Salon, “Carrie doesn’t want to be home. She doesn’t miss her baby. She runs when she hears her baby cry. And it’s not because Carrie can’t occupy those two spaces—can’t be both a strategic, ruthless CIA agent and a mother: it’s because Carrie clearly is struggling with post-partum depression, or maternal mental illness.”

Carrie’s struggle is vividly described in a disturbing scene — one that engendered all of the calls for my opinion. She gives her daughter a bath, with the camera lingering on the baby in the bathtub, shifting back and forth from the innocent child to Carrie’s haunted face. The baby slips for a moment and those of us watching hold our breath to learn if she will go so far as to let the baby sink.

Gratefully, Carrie doesn’t go any further, instead lifts and comforts her daughter. But she recognizes the possibility of her being a danger to her child, so she maneuvers to get sent back to Kabul, where no offspring are allowed.

As disturbing as this scene was, I’m glad the writers brought into the open the issue of postpartum mental illness, or what we often refer to as perinatal mood and anxiety disorders. But as often the case when the media or TV present these issues — often for shock value — they leave the public slightly more educated but largely more confused.

So in an effort to set the record straight and inform the public, let’s talk about two different possibilities of what form of postpartum illness Carrie has. There are many women with postpartum depression and anxiety who have obsessive thoughts, which take the form of hurting their baby or someone else hurting their baby. When these symptoms are the predominant problem, we call this postpartum obsessive-compulsive disorder.

Women who have these obsessive thoughts experience intense distress, anxiety, guilt, and shame. This is an ANXIETY disorder and it can also lead to feeling more depressed, with panic, anxiety and self-doubt about their own love for their baby, and uncertainty about their sanity and ability to trust themselves.

Postpartum obsessive-compulsive disorder is the most misunderstood perinatal illness in which women suffer — often in silence. It is the most secretive of the postpartum disorders, as the women themselves realize their thoughts are “crazy thoughts” and fear that someone may take their child away if they only knew.

To set the record clear, these are not the women who hurt their babies or commit infanticide. But they are so afraid of their own thoughts and filled with self-doubt, that they often avoid being alone with their babies. The risk is this can affect attachment and the mother-baby bond. In addition, it’s difficult to get more comfortable and competent as a mother when you avoid taking care of your baby.

There is another type of postpartum illness that is exceedingly rare, called postpartum psychosis (PPP). This affects 1-2 out of 1000 new mothers and has been correlated with bipolar disorder. Women with psychosis are at risk for harm to themselves and/or their babies (although it is rare for them to hurt their babies, they can), as they often have delusions, and/or hallucinations, impaired reality testing, and impaired judgment. These women with PPP need immediate hospitalization for their own, and their baby’s safety, until they are stable and non-psychotic.

It’s unclear which of these disorders Carrie has. Is Carrie having postpartum obsessive thoughts, or by her behavior, is it more likely that she is having psychotic symptoms that wax and wane, in which her judgment is impaired, but then realizes what she’s doing and snaps back to reality?

While we’ll have to wait for more episodes to hopefully learn the answer, I’m grateful “Homeland” has opened this topic up for discussion.

Early Diagnosis of PPD Is Critical For Shortest Recovery

•October 3, 2014 • Leave a Comment

Everyone has heard of the “baby blues,” which are defined as transient mood fluctuations shortly after the birth of a baby. The medical community considers these symptoms common, but when symptoms continue more than two weeks or are accompanied by significant anxiety, panic attacks, obsessive thoughts or just aren’t getting better, it’s a disservice and dangerous to dismiss a new mother’s depressed or anxious feelings as “perfectly normal.”

A recent story written by Marissa Kristal, suggests that it’s important to recognize that these signs, if left untreated, could result in unnecessary years of suffering.

When I read Ms. Kristal’s account of her journey, it saddened me that her postpartum depression was not identified and treated sooner. Although she eventually received treatment, it’s tragic that she endured it for so long. It’s likely she could have had a much shorter perinatal mood disorder if her doctors, or someone in her close circle, had recognized the signs and, importantly, not minimized her symptoms.

Ms. Kristal’s story speaks to the need for more education for everyone from healthcare providers to the general public. We must emphasize it’s a disservice to minimize symptoms, and we must continue to call for prompt referral to mental health providers with expertise in treating perinatal illness.

Because Ms. Kristal’s words are so poignant, and often repeated by patients in my therapy practice, I’m selecting some quotes here:

“I was particularly proud of my body’s seemingly superhuman capability. I was growing a human. And then she came out. And me? I was no longer superhuman. In fact, in mere seconds I plummeted to what felt like less than human. I was a crying, defeated, exhausted, anxiety-ridden mess.

“I didn’t dare tell a soul about my sentiments. I was petrified they would see me as an unfit mother. Weeks, months, even a year passed, and I did not feel like “me” again. I used to be: a positive, cheerful, friendly gal who came alive when writing, being physically active and spending time in nature.

“My supportive husband suggested couples counseling; I clicked with our therapist and began seeing her for individual therapy. She helped me manage my overwhelming anxiety, the insomnia and panic-attacks, and the isolation and melancholy that had transformed my old, joyful self into a sad, fragile shell of a being.

“With each challenging experience, we develop, learn, and grow. I am not myself. I am a far better self than I was 20 months ago, and I have my difficult postpartum journey, and beautiful daughter who I love with all my heart and soul, to thank for.”

We Would Do Well To Embrace Hispanic Tradition

•September 19, 2014 • Leave a Comment

While I’m oftentimes the first person to trumpet the accomplishments of modern medicine, at times I find that ancient traditions still have a lot to teach us. In particular, I’m thinking of the Hispanic custom of “cuarentena” after childbirth.

In a recent article by author Lourdes Alcañiz, she discusses the many benefits of this practice. It is a wonderful practice, and I believe we could learn a lot from embracing this cultural wisdom and adopting it in the U.S.

Alcañiz correctly points out that for most new moms their first feeling is being overwhelmed. As she says, “such a tiny and fragile being depends on you – paired with the physical exhaustion of delivery, hormonal mood swings, and the lack of sleep – can be pretty tough on women.”

Then she applauds her Hispanic ancestors who created “a wonderful tradition for new moms: la cuarentena, which is still observed in many countries. It is “a period of approximately 40 days, or six weeks, during which the new mom abstains from sex and is solely dedicated to breastfeeding and taking care of her baby and herself.”

This next part of the explanation has me nodding in approval: “During this time, other members of the family pitch in to cook, clean, and take care of other children, if there are any.”

While Alcañiz recognizes that our current lifestyle would make it extremely difficult to follow a traditional cuarentena, she does suggest that new moms may have their own mothers or mother-in-laws, or other relatives or friends who can visit for a few days. “Even if you don’t have the luxury of resting for a full six weeks,” she said, “there are ways you can take advantage of the time available to rest as much as possible.”

Other ideas that Alcañiz suggests that honor the Hispanic tradition are:

• Accept live-in help. If any relatives have volunteered to live with you for a short period of time, don’t reject the offer.

• Ask for help when you need it. Explain to those who’ve offered to help exactly what you need from them. Sometimes we don’t ask for what we truly need for fear of seeming demanding or rude.

• Rest whenever you can, even it’s just a catnap. Your body needs all the rest it can get to recover from the delivery and the nine months of pregnancy.

Pressure To Breast-Feed? Not Helpful For New Moms, Particularly Those With PPD

•September 12, 2014 • Leave a Comment

While no one debates the health benefits to babies who are breast-fed, at times, the medical community, along with well-meaning family and friends, go overboard. They ignore the mental and physical state of the new mom in favor of rigid, one-size-fits-all recommendations.

A new study presented at the 109th Annual Meeting of the American Sociological Association confirms a finding that often comes up in my therapy practice. New moms seek help for their postpartum depression, and in our sessions, I learn that on top of the expected exhaustion and sleep deprivation, they blame themselves because they assume if they’re not breastfeeding, they’re not living up to societal expectations and the best practices that any mother should willingly take on.

“If my doctor insists I should breast feed,” they say, “and I’m unable to do it successfully, that must make me a failure as a mom, right?” This is a typical case of a woman already battling symptoms of PPD, and now she’s piled on internalized guilt and low self-esteem.

It’s likely that a few of my patients are surprised when I suggest they turn a deaf ear to societal pressure and to those who presume to tell the mom what’s best for her. Breastfeeding can be wonderful for many new moms, but for those that find it too wearying, limiting, and stressful, they must learn how to resist recommendations that are ill suited for their emotional state.

After all, if you are breastfeeding, which means you are totally responsible for nourishing your newborn, this restricts the help you can get from others. This ’round-the-clock role also results in less — or possibly zero — breaks away from the baby. Every new mom needs alone time, to rest and for self-care. And, it limits the help you can get from your partner with nighttime feedings.

Now, take this scenario with a new mom who is already experiencing the symptoms of PPD, add in the sleep deprivation and uninvolved partners that even non-symptomatic women experience. It’s easy to see how a woman suffering from the disorder can feel pushed over the edge.

According to Carrie Wendel-Hummel who conducted the published study, “While the public health push for breast-feeding is certainly good overall…the messaging toward and treatment of new moms who are struggling with-breast-feeding might be counterproductive and harmful, particularly to moms also dealing with perinatal mental health disorders.”

“Counterproductive and harmful” are important results to keep in mind, and must be weighed against perceived benefits to the baby. After all the best benefit for your baby, is a healthy emotionally available mom.

Positive Lessons are often the outcome of Postpartum Depression

•August 25, 2014 • Leave a Comment

One of the major themes of my book, “Happy Endings, New Beginnings: Navigating Postpartum Disorders,” is that positive lessons are often the outcome of perinatal illness. For that reason, I was pleased to read a recent blog post from Anastasia Pollock, MA, LCMHC, KSL, who is the clinical director of Life Stone Counseling Centers.

Through her work with women who experience PPD, she recognized that many of her patients were not only suffering from depression, but also a series of misguided beliefs, expectations, and practices that were hampering their lives. And, it was these negative affects, which likely were in place before pregnancy, that were now exacerbated with the demands of a new baby.

An additional insight from her work — and one that I cannot repeat enough — is that once those harmful behaviors are addressed, and new attitudes move in to take their place, positive outcomes can be a result of PPD. Rather than re-write Pollock’s excellent lessons, I’m quoting edited versions:

“1. I am doing too much.
Sometimes depression is our body’s way of telling us to slow down. This is particularly true when we don’t listen to our bodies regularly and take the cues it is giving us to say “no” to requests of others and take time for ourselves.”

“2. I need to take better care of myself.
A person who is being mindful of their self-care, and following through with it, is far less likely to experience continued depression. The tricky part is that time is now more limited with a new baby in the house. Self-care must be made a priority and supported by those in the support network so the mother can be successful in caring for herself and her child.” (My underlining, for emphasis.)

“3. I am too critical of myself.
Self-criticism is not usually constructive feedback. Treating yourself like a good friend is a great practice, whether you are suffering from depression or not. It is a great preventative tool for future bouts of depression.”

“4. I can readjust my expectations of myself. Postpartum depression is sometimes what forces us to readjust the expectations we have of ourselves as mothers, partners and women.”

“5. I can accept myself even though I am not (nor will I ever be) perfect.
There is no such thing as a perfect mom, partner, or human for that matter. Part of treating postpartum depression is helping the woman to accept the depression for what it is: a message from the brain and body, alerting her that changes must be made.”

Can Epidurals Lower the Risk of Postpartum Depression, or Is it Just Another Solution to a Complicated Illness?

•August 17, 2014 • Leave a Comment

Whenever I see a headline suggesting a link to a drug, procedure, or therapy that is reported to lower the risk of Postpartum Depression (PPD), I naturally get excited. For as a healer specializing in the illness, that is my ultimate goal. What remedy — or combination of treatments — will alleviate the suffering of those with the condition?

But typically, soon after I read the latest study, other emotions enter my brain; usually a mix of disappointment and skepticism. As I often find myself wondering is this just one more attempt at trying to find one solution for a complicated illness. The latest example of my roller coaster ride, is a study conducted in China by researchers at the Peking University First Hospital.

The work, positing a theory that women who have an epidural during the birth of their child may have a lower risk of becoming depressed, involved 214 mothers-to-be. Some 107 of that group chose to have an epidural to help with the pain of childbirth.

The results are indeed encouraging: the women who did not have an epidural had a 35% post-partum depression rate, compared with just 14% for those who took the pain relief.

Professor Katherine Wisner, a perinatal psychiatrist from Chicago, who is quoted in the article reporting the research, said, ‘There is a well-known relationship between acute and chronic pain and depression. These findings are quite exciting and further research should be done to confirm them, especially in women at increased risk of postpartum depression and in women from other cultures. Pain control gets the mother off to a good beginning rather than starting off defeated and exhausted.”

As an added bonus, the study found that women who had had the epidural during the study were more likely to breastfeed their children than those women who went without the pain relief.

While all of the above is certainly positive, my question is: have the researchers sufficiently controlled other variables? After all, the first rule in psychology training is that correlation does not mean causation. If the findings hold up with further research, then why not offer every woman who’s at risk — and this is key, “at risk for PPD” with an epidural?

So meanwhile, I’ll sit on the sidelines until I see further investigation to confirm this next tempting theory.

Nurse Shares Her Story Of Typical and Atypical Postpartum Behavior

•August 7, 2014 • 2 Comments

When I was writing my book, Happy Endings, New Beginnings: Navigating Postpartum a Disorders, I believed it was crucial to include personal stories shared by my patients. Naturally, names were changed, but I was certain real-life accounts would resonate more with readers than an academic overview of the condition.

My intuition was correct, as many women have told me that these true stories gave them the courage to disclose to their families the severe difficulties they were facing after the baby’s birth. And, my message of positive growth, transformation and healing showed there could be a brighter future at the end of their struggle.

For that reason, I was impressed with this recent article written by a postpartum nurse that appeared in the Huffington Post. My immediate reaction was to admire her bravery in her willingness to disclose her own experience of suffering for 18 years. She did this, she says, in the hope that others who are afflicted with similar experiences, will rush to get help.

As I’ve often said, and this nurse seconds, the illness should not go untreated for years, as did hers. And, she emphasizes the importance of getting help from a mental health professional that specializes in perinatal emotional illness. With good treatment, women can recover fully and oftentimes positive outcomes and transformations will result.

Here are a few examples of what the nurse says are normal, and not normal behaviors following childbirth:

-Postpartum blues is normal. You can usually shake it off with a shower or a coffee date. With PPD, you may not even care to shower or get out of bed.

-Days, week, and months in which you are physically and mentally exhausted are normal. But if six, eight, ten, or eighteen months later, you are waking up every single morning with a feeling of gloom and dread at the day ahead, it is is not normal.

-Becoming frustrated when your child has been crying for 13 hours in a row is normal. But muttering over and over, “I don’t like this baby I don’t like this baby I don’t like this baby,” is not normal.

-Wishing you had never had a child, and immediately regretting the wish, is normal. But picturing yourself throwing your baby against the wall is not normal.

-Going out for milk by yourself so you can have a “mommy break” is normal. However, contemplating driving past your house after you’ve picked up the milk, in order to speed your minivan into a brick wall is not normal.

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