What's the Word for. . .

being happy for someone that their life is going well but wishing, just a bit, that they were falling apart because then you'd have some company?

See, I'm still doing well. Really well! And I'm so relieved. I was talking with my psychiatrist and we both agreed that at this point I seem to be out of the woods mental health wise. And while she cautioned me against overdoing it and stressing myself out we both breathed a sigh of relief. Postpartum depression can strike any time during the first year so I'll be seeing my psychiatrist every so often to keep an eye on things, but I'm, well, happy.

It probably helps that the Little Cannoli is a much more even-tempered baby than my other ones. She already sleeps better than her older brother. She smiles and coos when she sees me. She's only two months old and already I feel like she's been part of the family forever. These swelling, happy feelings inside me must be what other new moms feel all the time!

But, to be honest, this happiness makes me a little jealous and a little sad about what I've missed with my other babies. How wonderful it could have been.

That little bit of jealousy and that little bit of sadness are familiar. See, after my second baby when I really started talking about my PPD experiences a few of my other mommy friends would say, "Yeah, it was like that for me too. I was so depressed." Relief would flood through my mind and I would feel like I wasn't alone. Like maybe I wasn't as screwed up as I thought I was. Like all of this struggle had a purpose. Like maybe there was hope for me.

But then none of them ever had more than one PPD episode. I was (am) the only one to have gone through it over and over again. I was (am) the only one whose life is constantly affected by a mood disorder. They all got over it and moved on. I never did.

Hope evaporated. Purpose was lost. And with those two things went perspective. I gave up on thinking I was ever going to be in a place where I could roll with the punches. I accepted that I was a little tweaky and tried to find ways to make the tweaky-ness work for me.

But now I feel like I'm approaching the elusive non-tweaky state of normal. So naturally (hah!) I'm relieved and a little suspicious. There's a part of me that is always looking for warning signs that I'm on another downturn. There's part of me that thinks I must be in some sort of magic state of denial. And there's a huge part of me that feels like I've betrayed my former self. I see women around me all the time who I think might be suffering from this and I want them to know they aren't alone. I want them to know that PPD is hard but it doesn't have to destroy you. I want to be there with them and support them on their journey.

But I know that when you are really down having someone tell you that you'll get over it someday isn't all that helpful. I know that hearing another woman crow about how good it feels to not be hurting doesn't do much good. What does help is having someone sit with you and accept you even when all the protective layers are ripped away. Having someone inhabit that emotionally elemental existence with you--even just for a little while--does more to clear the head and heal the heart than any amount of platitudes and well wishes ever will.

And I'm worried that my current happiness makes it so I can't sit with another woman and share her experience. That was a kind of loss I never expected. Normal is nice--convenient, really--but I never want to forget that don't have to be normal to be a good mom. Just being where you are and take care of yourself and your babies is good enough. Just because some of people are finding normal doesn't mean you've been left behind. Depressed and okay can coexist. Depressed and happy do work together.

Post Partum Depression: 1 Month Out

Baby Number 4, who we lovingly refer to as our Little Cannoli, is now more than 1 month old. I am surprised and a little bit glad that the time has gone by so quickly. Usually my first month with a baby is a descent into chaos and I feel like I spend the next year or eighteen months trying to put my universe back together. To have it go by quickly means that I haven't been lost in the time suck that is depression. (Whee!)I think this is due to several exceptional things.

* I'm still taking my Paxil. It was hard to remember to at first. I've been out of the habit and so I was taking it at weird times and missing days--which is a set up for disaster. But then I got an awesome tip: Put your meds by your toothbrush! You almost always remember to brush your teeth and if your meds are in the same cabinet you'll always see them and be reminded to take them.

* I've got a whole lot more knowledge. During the first few weeks, before the meds had kicked in, I had a few suicidal thoughts (no plans, just lots of negative thinking like I didn't deserve to live and my family would be better off without me because there is no way I would ever be able to be a good mom to this baby) but they were fleeting and usually disappeared if I took a nap. I know about the link between sleep deprivation and PPD so I could take action rather than get stuck in an unproductive mental/emotional thought cycle. I also had a fair amount of intrusive thoughts. Mostly violent ones, like every time I walked up or down the stairs I would see my baby flying down them and splitting her head open or breaking her neck. They were scary but I knew what they were (hormonal misfires in my brain) and could move on instead being consumed by them. I still have some of the intrusive thoughts--I've acquired a whole new repertoire surrounding actual glass glasses--so I'm not sure if I should up my meds or not. I'll ask my psych when I see her.

* I've had a whole lot of support.
I've had offers from both sides of the family to help out with the kids (even though they all live hundreds of miles away!). We got lots of meal from the ladies at Church. And close friends were sensitively checking in on my mental state--friends who had been there--which meant a lot to me. I'm actually still with my mom and dad and it is great. Being with them for the last couple weeks has alleviated so much stress from my mind. I've gotten more sleep and I've been able to conquer caring for all four kids in small bites. I just feel like I've had adequate time to acclimate to the whole situation and actually bond with my baby instead of feeling overwhelmed and destroyed. I keep telling my mom that this time has been such an indescribable gift.

Actually, this whole experience feels like a gift. I'm surprised how sad I am that this is my last little baby. I'll never have another four week old to nuzzle and smell and cuddle. And I always thought that when that time came I'd be glad because it would mean freedom was on the horizon. But I don't feel free. It feels like a loss.

I think some of my feelings of loss are me mourning my previous post partum experiences. Sometimes as I'm nursing or rocking the Little Cannoli part of my mind will go back to when Number 1 or Number 2 were babies and I'll relive those experiences. Part of me will be feeling the frustration of trying to get Number 1 to latch on, or more like the echoes of that frustration, and the other part of me will be so grateful that the Little Cannoli nurses so nicely and then I'll remember (or possibly rewrite) a moment when Number 1 was nursing well. And then the frustration melts a little and the memory loses some of its sting. I'm sure there's some sort of name for that process, but for me letting go of some of that is, well, a gift.

It's also a gift to see my older three, who I struggled with so intensely, being kind and soft and patient with the newest sibling. It reminds me that even if things were rocky when they were born their lives have been filled with love and that things are going to work out.

I'm not projecting into the future. After we get home from my mom's things could fall apart or they could be fabulous. Odds are life will be a mix of stress and fun and disasters and peace. But I'm not trying to figure those out. I'm just here, loving my baby and enjoying my kids. Because they are all gifts--gifts that I am just now starting to see clearly.

Postpartum Depression: 1 week out (I Want My Mommy !!)

Baby is one week old now and I'm not depressed. I haven't even had the baby blues. What I am is anxious. Well, that and charmed by sweet new little one. And feeling quite blessed to have three other beautiful children. And excited for what the future holds.

But, really, I'm feeling pretty anxious.

See with each baby my mom comes out to visit and takes over the cooking and the laundry and the cleaning. She coos over the funny faces that my baby makes. She plays with the older kids. She chats with me through the somewhat endless hours of nursing.

And then she leaves. As in gets driven to the airport and flies across the five states that separate us and goes home to my dad and little sister.

That's usually when I start to lose it. Turns out I'm a pretty good mom when I not the only mommy in the house. But when it's just me I get easily overwhelmed.

Knowing this, we've planned. I started taking Paxil just after Baby was delivered. My husband is taking some time off work next week. And, since school is almost out, I'm going to my mom's so that she can keep mom-ming me and my brood a little more. We're calling it a family reunion (except my brother can't come, which makes it not much of a reunion at all!), but I think we all know that it's actual just a bunch of people willing to sacrifice so that I don't go crazy.

And that makes me feel overwhelmed in a whole new way. A good way. There are people who love me and when I ask them for help they are willing. Even when it means getting overrun by hordes of preschoolers!

Everybody needs a mommy. Especially when you are a mommy. I wonder how many cases of PPD could be ameliorated if we were all able to mom each other a little more.

When the Monkey Falls Out of the Tree: inside a psychiatrist's office

On the front of her brochure, my psychiatrist (yes, I actually got one. . . it was a complete fluke; I happened to call right after a patient canceled an appointment so the receptionist stuck me in that slot. Really. And no. The psychiatrist is not covered by my insurance. *Sigh*) was tall-ish and blond-ish and smiling. In living color, she was lanky and gray-haired and frighteningly skinny. She also had glasses that she had to frown to see through. And she had a lot of bookshelves with oversized books about pretty much everything.

I think I liked her. When I think about the $400 I dropped for the two hour intake exam, besides feeling nauseous, I thinkI really like her. Finding a new psychiatrist would tantamount to burning money at this point.

For simplicity's sake I think I'll refer to her as my Personal Female Freud, or the PFF, from here on out.

I was a little nervous going in. The kiddos had swim lessons today and that is always stressful. (Three cold, hungry children plus one mommy multiplied by a germy, slippery locker room equals a gazillion bemused/horrified on-lookers and a lifetime of embarrassment. Someone please remind me of that next summer when I'm signing up for swim lessons.) And we had to run to the library. And my visiting teachers also came today. And the sliding door of our Toyota Sienna got a massive scratch--you can see it from far away--in the rec center parking lot. I was pretty tired and stressed--and late!--by the time I reached my PFF's office.

I sat down on her cushy couch, checked the clock, and immediately began talking--rapid fire style. I quickly listed all the dates of my pregnancies and deliveries along with my medicines and dosages. When she asked for a family history I listed in all the people with mental health issues in generational order, complete with relation to me and treatments received. I began giving her examples of my symptoms (what I am like when I'm raging, what I'm like when I'm truly down, what are my panic attacks like, what types of intrusive thoughts I have and what happens when they get too loud) when she interrupted me.

I was startled. My therapist, who is more of a BFF than a PFF, rarely interrupts me, which is a major reason why I like her. I have a real need to be heard and understood and I don't always get that in my life. So when the PFF cut me off, I was little offended. But then I realized that a PFF is not a therapist. She's an MD. A doctor. A diagnoser and prescription writer. I slowed down and began giving condensed, yet honest, answers. My PFF wanted specific details and a few big picture clarifiers, but not my memoirs.

After a few more history questions, she began getting out her big books and a magnifying glass. The big books were full of such small print that she couldn't read them without one. She opened her Physician's Desk Reference, held her magnifying glass about half an arm's length away, and began reading aloud about my medication and pregnancy and lactation. Here are my notes (which, I feel obligated to point out, don't serve as a substitute for a trip to your own PFF. Seriously. Get your own!):

*Cymbalta is new. As in, only two years old. The previous generation drug, Cymbalta's mommy, was called Effexor. There isn't a ton of research on Cymbalta directly, but there are some conclusions you can draw based on research about the older drug.

*In pregnant rats and rabbits who took 7 to 15 times the human dose of Cymbalta, there were issues. Duh! You could give them 7 to 15 times the human dose of water and they'd have issues. You know, when you consider that animals are spiritual beings too, well, that's really sad that some of them are experimented on that way. I'm grateful to them. I also think I'll have to search out quite a few vermin in the next life and thank/apologize to them. (That last part was my conclusion. Not the PFF's. The Physician's Desk Reference doesn't talk about spirituality. Even though it's so big it will hang off the end of your knees when you put it in your lap and looks like it's the actually the Big Book of Everything.)

*In women who took Cymbalta while pregnant there were some correlated complications, especially for those who too them during the third trimester. The symptoms the newborns exhibited (like an increased startle reflex, difficulty regulating body temperature, and shallow/irregular breathing) were similar to those in adults who were having a serotonin overdose. No one knows if that's what is really going on with the babies, but there is something different about some of them. No long term effects were mentioned. Probably because the drug is too new to know.

Then the fun started. The PFF started running a battery of tests that I believe she called a mental status exam. She asked me common sense questions (What's today's date? Who's the President of the United States?) common knowledge questions (Who was the previous President? And the one before that? And the one before that? And the one before that--at which point I told her I hadn't been born yet, but I was willing to guess. So then she asked me, "What's the capital of Spain?") and some non-sensical questions (What does it mean when someone says, "Even monkeys can fall out of trees?"). Then she had me draw some pictures, copy some shapes and repeat back lists to her. Then came the toughest question I have ever answered: Count backwards from 100 by sevens. I started to sweat. "It won't take as long as you think," the PFF intoned. I began to calculate and fumbled and tittered and lost my place. I shook my head. I closed my eyes, took a deep breath, furrowed my brow, counted on my fingers, and managed to get the answer right. Turns out the test, my PFF told me when I was done, was to test my concentration. Apparently a lot of people who have been treated for angry/anxious depression are actually ADD. My counting backwards skills proved I'm not that, but as the PFF pointed out, it sure "Looked like your performance anxiety got to you, huh?" Awesome.

As two hours wound down I was tired--it was draining to focus on my issues for that long--but good conclusions were drawn: in my case, particularly because of my perinatal depression, it's probably best to stay on an antidepressant with my next pregnancy. Cymbalta is not the best choice and it's worth trying to wean off it--slowly--and start a different drug near the end of the pregnancy (probably Prozac. Oy! I've never felt so cliche). Apparently there's some estrogen variant that is produced by the placenta that makes pregnant women feel good and we're hoping that will keep my mood adjusted for the bulk of the pregnancy. I'm supposed to call after a month on the reduced dose and we'll decide how fast to take it from there. If I get preggers before the Cymbalta is out of my system, that's okay. No need to cold turkey. It's only the third tri that appears to be a problem.

Walking out of the office, I felt good. we have a plan I can stick with. And the PFF is another supporting fixture in my life, which feels really good. After all, like I answered about the monkey falling out the tree, "Even when you're doing something that should be natural to you, that you should know how to do, you can still end up on your butt."

Oh, and the icing on the cake: one of my visiting teachers cleaned my house while I was at my appointment. The place was trashed when I left and gleaming when I came home. I cried a little. For real. The Visiting Teaching program is just one reason why I love my church.

*Some* Pictures Are Worth a Thousand Words

J is having a bad night and I have no words for a post, but I did find some pictures.

Usually the media uses this kind of pics to define depression:



But here are some more interesting ones I came across:







Like I said, some pictures are worth a thousand words. Too bad the ones that have the words don't get the air time.

What If? (Thoughts on the Melanie Blocker Stokes Mothers Act)

All right folks, I just came home from a very fun Enrichment and I was not pleased to find this (gardening excitement) buzz kill. Over at Postpartum Progress Kathryn Stone reported that some yahoos had this to say about the Melanie Blocker Stokes MOTHERS Act:

"This MOTHER'S Act, with its innocuous sounding name will mandate 'mental screening' for pregnant women. This will lead to many more young mothers being labeled with fraudulent psychiatric conditions and many of them will be put on dangerous psychiatric drugs even while they are still pregnant. . .With help, we were able to stop this Federal bill dead in its tracks last year, but the drug lobby apparently never sleeps and they got it through the House of Representatives."

I gotta say, my family and I are personally hurt by this attitude. The OB who delivered my first baby completely dropped the ball when I needed help for PPD. At no point during my pregnancy, even when I came to a late third trimester appointment crying and shaking with frustration, did anyone in his office mention PPD. I went in for my six week check-up and told him that I felt sad and was having trouble loving my baby but I'd heard that those things were normal so maybe it wasn't such a big deal. I just had the baby blues, right? He had been writing something down and when I looked to him for guidance he only said, "Yeah. Probably." Because he didn't listen and didn't take the time to screen me (or any other patients) I thought my inability to love my child was normal. I thought that laying on the floor next to my baby and crying every time she cried was normal. I thought screaming myself hoarse in anger was normal. It wasn't until I became so paranoid that I was afraid to leave my house (I was too afraid someone would steal my baby or that I'd accidentally kill her) or wash my face (I knew it was irrational, but part of my brain was convinced that someone was waiting in my shower so they could stab me to death) or go to sleep (I had a recurring nightmare of someone sneaking into my baby's room and spiriting her away) that my sister finally convinced me to get help.

My baby was four months old at that point. I lost four months of her life. I struggled and cried and suffered fruitlessly for four months--and my baby struggled and cried and suffered for four months.

What if that doctor had stopped to listen? What if my prenatal educator had given more than the five minute blurb about PPD? What if there was a screening or education program in place to catch people like me?

I went to a different OB when I was expecting my second baby. The woman was a little brusque for my taste but when I told her about my previous PPD experiences (leaving out the paranoia and fears of accidentally harming my baby; I didn't want her to think I was actually nuts) she listened. She explained their screening program to me. She explained my risk factors. She gave me a website. When my second baby was three weeks old and I went back in and filled out a depression questionnaire my OB came in and hugged me. I cried a lot. She told me it wasn't my fault. She gave me a prescription and some business cards and scheduled a follow-up appointment to make sure I got a therapist. She caught me when I fell.

Thanks to a lot of therapy I've let go of the guilt surrounding my postpartum experience with my first. I'm not angry at my first OB any more. But I am still sad. Something died inside me through that experience--some sort of idealism. Motherhood will always be a double-edged sword for me. The wonderful moments will always be tempered by the scary ones. Some things you just can't forget.

I am lucky enough that most of the people around me love me and support me in my search for help and healing, but people making statements like the one above only contribute to ridiculous stereotypes. I cannot believe that there are people out there who think that perinatal and postpartum mood disorders are just a money-making ploy for drug companies. This bill actually gives no money to drug companies or any sort of funding for psychiatric medication!

Postpartum depression and other perinatal mood disorders are a real threat to society. As Kathryn Stone said,

"Have these people not seen the research? Do they not know that women with untreated postpartum depression can go on to have chronic depression for the rest of their lives? Do they not know that women with untreated depression during pregnancy are twice as likely to have pre-eclampsia, twice as likely to have a C-section, twice as likely to have a pre-term delivery and twice as likely to have their baby go to NICU? Do they know the odds of developmental delay for children whose mothers' illness goes on and on and on and on? Do they not know that suicide as a result of postpartum mood disorders is the leading cause of death for women postpartum in the US? The emotional health of approximately 1 million American families EVERY SINGLE YEAR depends on this."

Here's the link to a petition. Please consider signing it and contacting your Senator and Congressperson. Trust me; us depressed mommies (and our babies!) need all the help we can get.

Legislation to for Postpartum Depression (YOU can help make a difference!)

A piece of legislation that has been making the rounds for seven years is up again. The Melanie Blocker Stokes Research and Care act is all about helping women with postpartum depression and psychosis. For details on the bill itself click here. Now, a lot of my readers are probably good Republicans who don't want government managing more of their lives and spending more money. Neither do I. What this legislation does is require that some of the research money that goes to the National Institute for Mental Health and the National Institute of Health be spent on studying postpartum depression and postpartum and psychosis.

So what does all this have to do with you? Well, this bill has never been turned into actual legislation because it hasn't been supported. Your representatives don't know that this matters because their constituents haven't told them so. Here's your chance to make a difference. Click on this link to send an email to your representatives letting them know you care about women with postpartum depression. This is something that could potentially save lives. Please consider it.

Depression Profile: Sue at Um, Thanks for Sharing

One of the best things about blogs is the discovery that you are not alone. My latest find: Sue! Sue is a warrior mommy--she's conquered perinatal and postpartum depression along with some generalized anxiety--with three kids and some truly insightful posts.

Confessions of an Anxiety Ridden Mother could have been my own story. I know what it's like to punch walls and yell at infants even when I know I shouldn't. I loved her honesty about how difficult it is to be a mom, a supportive wife, and a person in your own right. Be sure to look through the comments, too. Her post struck a nerve with several people. Here was one comment that really caught my eye:

Antidpressive meds were designed for the modern LDS woman! First of all, we all attempt to accomplish too much... and if you attend relief society on a regular basis, you try even harder. Calm down and realize that you are a wonderful person who is greatly loved and respected for all the tasks you accomplish.

I know Relief Society isn't meant to work this way, but sometimes it does. My personal solution? Just start admitting your flaws--the real ones, not just the cute quirky ones--when you make a comment. When one person gets real the rest seem to follow. I have to say, though, I'm not the first woman in our ward to do this. There are a couple sisters out there who really open themselves up and put themselves out there and I love it. (Nancy, Verna, De--you are ladies I so admire!) It is only when we are real with each other that I come close to understanding what the concept of Zion is all about.

Another post by Sue, If the Problem Gets Solved, Does it Really Matter How You Solved it?, is the story of how a nice girl with some solid biological issues ends up deciding to she needs medicine. It's a tough decision but Sue makes it deliberately and wisely.

One part I really appreciated was the description of her supportive husband:

I often think about how blessed I am to be married to Dan specifically because of his understanding and support about my treatment for depression. Not only does he have the scientific knowledge of depression, but he has also seen first-hand, from the time he was a little child, the effects of depression. And he knows that the meds work and that they are beneficial. When I started taking anti-depressants, I used them for about a year or so, then went off them during my pregnancy with Lily (not because they're unsafe, but because I was feeling pretty good and didn't think I needed them.) Then when she was about eight months old, I went through a bad time and Dan pointed out that he had watched the same cycle throughout our marriage, that I would fight and try to be positive for six or eight months, then I'd have a drawn out episode of depression that lasted for a couple months. It really caught my attention to hear him say there was a pattern to my behavior.

I was still feeling a little bit like I was weak for needing to take anti-depressants, that now that I was aware of my tendency for getting depressed, I should be able to combat it on my own with behavior modification, attitude adjustment, and lots of prayer. I worked with a counselor for 8 or 9 months and learned so much about my thought processes and emotional tendencies. But even with this knowledge, I still couldn't conquer the beast. I went on and off the meds two more times while Lily was a toddler. After hearing Dan tell me over and over that taking meds wasn't a sign of weakness, it was the same as a diabetic taking their insulin, I started accepting that for me, taking an anti-depressant wasn't a temporary solution to help me kick-start my system. It was something that my brain chemistry required regularly to stay balanced. I was a lifer.

Every depressed person needs someone like this in their life. Someone with knowledge and compassion. Someone who may not be living it but wants to be with you while you do. Someone who can reassure you when your resolve wavers. Sue is extremely lucky that this person is her husband. For me, that support has come through different people at different times. My sister has been there for me (thanks to our cell phones that we use more like walky-talkies!). My husband pulls me out of some sad, icky places when my mind is holding me hostage. Mommy friends,oh!, of course the mommy friends! Having someone to sit in the park/ice cream shop/coffee (except we only ever order steamers and sometimes a pastry) shop with and kvetch about the bad times, well, that's priceless. And, when I'm too afraid to tell anyone else how nuts I really feel, my therapist is there. She isn't fazed by anything.

Thanks, Sue, for your example and your courage. Telling your story is definitely blessing other people's lives. All us other But Not Unhappy Mommies are sending good vibes your way!

"Private Practice" is put to shame!

Hey friends-
You'll notice in my post on ABC's Private Practice I didn't talk much about the show. Really I talked about myself. (Cause it's my blog and I can if I want to!) Anyway, Katherine Stone had a lot of BAD things to say about the show. I second her in absolutely every way. Read her post. The organization she works for, Postpartum Support International, was livid with how they were duped by ABC. Ms. Stone has asked that we PULL THE PLUG ON ABC's PRIVATE PRACTICE. As in quit watching--which shouldn't be hard to do because the show stinks anyway. I don't care how hot you think Tay Diggs is or that it's a soothing follow up to the drama of Gray's Anatomy. Turn it off. You'll be making a statement that will bless the lives of women every where because you'll be standing up for them--especially for the ones who can't stand up for themselves.

And, um, yeah, Amy Brenneman's character is the WORST therapist EVER. If I met her in real life I'd swat her with a rolled up magazine.

Defining Recovery

I ought to clarify. In my post, That's It! I Quit!, I talked about possibly quitting my meds. Several of you were sweet enough to worry about me and I wanted to thank you. I appreciate all the support I get from my readers. It means a lot to me to know I'm not alone. So I wanted you to know: I didn't quit my medicine. I'm still popping my pill each morning. I figure I should wait until we are in a more settled place or until I have a real medical reason to stop or until I'm better.

Which brings me to my most recent quandary: what does it mean to be better? When talking about a possibly chronic mood disorder, is there a point where the sufferer knows that they are through the worst and will reach a full recovery?

I honestly don't know.

For me, this whole depression "adventure" has been a series of ups and downs. It's not that I'm manic or anything like that, it's just that whenever the good times are rolling there's a part of me that wonders how long it will be before I get a stick in my wheels.

Maybe I feel that way because my depression really took off as postpartum depression (I had anxiously depressed phases in high school but nothing I really perceived as chronic until the third trimester of my first pregnancy). Feeling bad and crazy is hopelessly entangled with mothering because the two happened together. It takes a lot of effort for me to tease apart what is the depression and what are my instincts as a mother and, as an Latter-day Saint, what is inspiration from God. Maybe as long as I'm mommy-ing I'll struggle with this.

Or maybe I feel like my depression is always lurking because I had three babies in four years. That's a lot of stress--a lot of ups and downs--even for normal women. There are a lot of benefits to having kids close together (they are such good buddies!), but there's no doubt that it is also hard.

Or maybe the ups and downs are just the nature of the illness.

The first time I started antidepressants, when my oldest was four months old, I thought that my antidepressant was basically like a supplement. You know, my body didn't produce a certain substance so I would take a pill that would give my body more of that substance. Eventually, I thought, my body would take over and start producing the correct amounts on its own.

Turns out antidepressants aren't that straightforward. Nobody is exactly sure how they work. All the stuff about serotonin (or any other neurotransmitter) being more available in the brain is true, but no one knows exactly what the brain does with the extra stuff. And nobody really knows why some brains don't produce the correct amounts in the first place. We know there's a relationship between hormones and neurotransmitters and we know there's a relationship between general health and mental health, but we don't know the exact nature of those relationships.

It's popular to compare the use of medicine to treat mood disorders to using insulin to treat diabetes. I like the comparison a lot and use it myself when talking with others but a recent conversation with a clinically depressed friend made that comparison even clearer to me. When I told her I wanted to quit my meds she said she'd been there too but she figured it was like diabetes. "A diabetic can't just wake up one morning and decide their to quit taking insulin," she said. "It's not like their diabetes is going to go away just because they learned to manage it. It's an illness and it's chronic. Depression is the same thing."

That was quite a blow for me. I had always looked at this depression thing as something I was going to overcome. I guess it was ridiculous but I really thought that maybe one morning I could wake up and know that I would never have to deal with the crazies again. But it's not like that. You don't get better from clinical depression. All my therapy, all my medicine, all my thinking and writing, is only managing the symptoms. None of it is fighting the illness at it's source because we don't know the source. Or maybe we do. The source is me. It's who I am. It is my life. It is my existence--my body, my soul, my mind, my everything--that feeds my depression.

So what does all that mean for recovery? When you have a cold you wait it out and eventually the symptoms pass. You wake up one morning and know you're not going to be blowing your way through a whole box of Kleenex. Not so with depression. The symptoms will always be cycling around. How do you recover from something like that? What does it mean to "get better"?

Maybe it doesn't mean anything at all.

Support Where You Need it the Most! (part two)

I'll spare you another bizarre bra picture, but yes, we are still talking about building a support system. But, you know, if you really stop and think about it a bra is a good analogy for how to build a support system.

Okay, I'm kidding.

Here's my real point: One of the hardest things about building a support system (besides being honest with others and yourself) is actually calling in that support system. Case in point: me.

When I was preggers with baby #3, J, I was justifiably nervous about the postpartum period. Given the fact that I pretty much fell apart after the first two babies (we were lucky if Mommy quit crying and sleeping and yelling long enough to get everybody dressed and fed--housework, cooking, and laundry were nowhere on my radar), I knew I needed to make some serious preparations for when J would arrive.

So I started cooking. I made several lasagnas, shepherd's pies, and chicken broccoli casseroles and stuffed them in the freezer. Then I made quart after quart of soup and jammed those in too. Next I organized the house. I tore apart all the closets and cleaned them out. I inventoried our food storage. Then I scrubbed everything from top to bottom. Then, while I was weighing the merits of disposable dishes during a session, my therapist asked if I had any help lined up for after J was born.

"Well, my mom's coming out for a while," I stumbled.

"Okay. What about after she's gone?"

"Um. My husband was going to try working from home a bit." I was starting to get uncomfortable.

"What about nights when he's at school?"

"I don't know."

"Okay. What are you going to do on days that you just need a break?" My therapist paused. I squirmed. She continued, "Now, I just want you to consider this. You don't have to decide now. Just consider. What about asking someone to come in and visit once or twice a week and helping with the kids? You could hire someone or you could ask a friend. Just think about it."

I didn't just think about it. I started to argue about it. I listed all the reasons why that just wasn't feasible: money, the need to pay back favors, my kids wouldn't like the person, et cetera, et cetera, et cetera. But, as the pregnancy came to its end I began to wonder if my therapist was right. Maybe I could ask someone for help.

Well, J turned out to be a bit of a high maintenance baby (acid reflux disease and possible lactose intolerance. Wheee!) and I suffered along as best I could. There were times, though, that he would just cry and cry. It set everybody on edge. Soon my oldest, N, was having panic attacks and E--who was not even two years old--was throwing tantrums and breaking things. I needed help. And I started to ask for it.

First I found a good child therapist to help N with her panic attacks. Then I attempted letting a friend do my dishes without "paying her back." One day I called my visiting teacher to see if she would fill in when a babysitter canceled at the last minute. I even called another friend late at night to come over and hold my screaming baby while my husband was at school so I could get the other two kiddos to sleep. The thing that amazed me the most: everybody I asked for help said yes. And they were happy about it.

Things are less stressful these days. J is on an acid reducer. N is starting to manage her panic attacks. E is beginning to understands logic and cause and effect so time outs (and hugs!) are effective. But I still have my really bad days--like the one a week and a half ago--and on those days I can't bring myself to call anyone to come help me. I don't want to intrude on their lives. I keep telling myself that if other people can handle the stress of life with three kids then I should too. I am too embarrassed about how lame I am when I am at my worst. I don't want people to see it. I'm too afraid of what they will think.

But, the other day, a couple days after I'd been down, I told my visiting teachers how rough it had been. The offered to clean my house. I said no. They said, "When do you want us?" I said, "NO." They said, "We'll be here on Friday." And I said, "Okay." And they came last Friday and they cleaned my house. It was nice. I couldn't believe how good my kitchen looked. I couldn't believe how much better I felt. Not just because my kitchen was clean but because I realized I wasn't in this alone. I had support. People would show up. People would help. I breathed a little easier.

I gotta ask, am I the only one with this problem? Do you all find it easy to ask for and receive help? What are some of the most supportive things people have done for you?

Dads feel it too!

I got home tonight from a temple recommend interview and pulled out my brand new U.S. News and World Report. As I flipped through the headlines I came across one that said, Postpartum Depression Strikes New Dads as Well as Moms.

Well, color me surprised!

Here's the lowdown: About 14% of new moms suffer from postpartum depression. Symptoms include, but are not limited to,(doesn't that make me sound professional!) sadness, irritability, changes in weight or sleep patterns and an inability to bond with child. Postpartum depression in women has far reaching effects beyond just the mother's happiness (which is important in and of itself). Children of depressed mothers have more health problems and learning problems, and are at a greater risk for developing a mood disorder.

This is what we knew before, what is new is how men fit the profile: Approximately 10% of new fathers will suffer from PPD (well, not exactly PPD because they weren't pregnant but depression that occurs as a result of a new baby). Their symptoms are almost identical to women except that the increased sadness and irritability lead to destructive behaviors--like drug abuse, reckless driving, and promiscuity--that depressed women don't usually engage in. Depression in fathers also effects children in major ways. Children of depressed fathers get read to less often and have slower language development. Also, the children are more likely to act out destructively.

The causes for men are not as easy to pin down as they are for women. With us chicks it's supposed to be the hormones, but with men it may be that the prospect of caring for a child puts them over the edge or they struggle with the changes in their marriage.

No matter what the cause, the good news is that PPD is highly treatable. As we all have accepted by now (you have, right?) a little therapy never hurt anyone--at least not in the long run :)

For more on this issue read here and be sure to check out this awesome website PostpartumMen.com.

What do you all think? I was dubious at first but the more I thought about it the more sense it made. Have you or anyone you know struggled with this?

Depression Profile: It IS Okay

This is the story of Miss S (the "S" stands for surviving and smiling) an LDS woman living in California and dealing with depression. I am so grateful to her for sharing her story here.

Looking back, I've probably always suffered from some kind of mild depression. I was raised in a home (not LDS)with a lot of yelling and name-calling. I had my son when I was 17 and never married his dad. I went through two divorces before 25. (Sounds really crazy when I say that out loud!)

The first time I thought I had depression was in my second marriage. I was always angry at the man I married (although, later I found out my anger was misdirected. I was actually angry at myself for marrying him). I'd have anger episodes that felt borderline psychotic: breaking down, screaming, shaking, so much fury. I got a quick prescription for Prozac, took it 3 days and threw it out because I figured I wasn't depressed chemically, it was just my situation. So, "we" started marriage counseling together and I kept going by myself after the separation. I started learning about myself and what I needed in my life--how to be happy by myself and those kinds of things.

I met my current husband shortly after that, joined the church at 26, married him at 27, had baby #2 at 28 and baby #3 at 30. My youngest is now 8 months old. I noticed depression kicking in around my seventh month of pregnancy. I didn't realize that's what it was until later. In retrospect, I think I probably suffered from PPD with my previous pregnancy also. My depression was hard to admit to, and to realize that it was depression, b/c for me, I become angry when I'm down. Also, to admit to depression is taboo in my family; "nobody" has it, but looking at my mom, I'm sure she does too. Anyway, I thought it was just PPD and that it would wear off.

My oldest child's father committed suicide 6 years ago. He suffered from bipolar disorder and was suicidal from the time I met him at 13 years of age. Growing up with him, I thought he was faking it, trying to get attention, that he could control it, that it was all "in his head." I tried to get him to focus on other things to distract him from depression. I didn't realize it was a REAL illness until after he died at 24. It was a long road. He turned to street drugs to self-medicate and by the time he got professional help, the meds counteracted and did more damage than good. He died within a year from that time.

I've been on Prozac for about 5 months now and I've tried to wean off twice. I noticed the first time that the depression signs came back right away. The second time, not so much, but a little here and there. I'm nervous that I will need meds the rest of my life. I really don't want to "need" medication, but so far I've noticed that I'm a much better person, wife, mother, etc. with it. I feel better on the medication, but I don't like being dependent on it. I'm only on 10 mg, at one point I thought I'd need more, but I'm taking it every other day now and doing fairly well. Maybe I'm getting better?

But then the other day I was so tired all day, got absolutely NOTHING done at home and had to drag myself to the scout court of honor at church. I've been very tired lately and thought I might be prego again (not to my excitement), but found out that it was PMS (Yay!). I need my energy back.

I like Prozac for the simple fact that there aren't many side effects. I do have night sweats, but not too badly and I get tired off and on. I have some really good, energetic days and other times sleepless nights and dragged out days. My appetite is normal and I've succeeded in losing some weight that I've been working on--but I hear Prozac suppresses your appetite so that might be part of it too.

Spiritually, my depression has affected me a great deal. When I'm not on meds, I'm a monster and want to be left alone; I'm angry and ungrateful. When I'm on meds, I'm indifferent to emotion. I've only cried three times in the last 6 months: once was at church when the Spirit hit me and I couldn't stop crying. I was a mess! Another time I was talking to my good friend and told her I couldn't figure out why I was emotionless. Then the flood gates opened. Either way, I continue to go to church even when I don't feel like it. My husband has helped us stay on track there. I love being active in the church, but many times I feel like I'm going through the motions. I don't set aside the time I should to pray and read scriptures. I think if I did, it would help more. We haven't been to the temple as much as we should b/c of small babies, but my husband just heard a great talk about how we should make the time to go no matter what. He is going with our 13 year old on Saturday to do baptisms with the youth. I might go and do a session on my own if I can find a babysitter.

I wish other people knew (I'm still learning this myself) is that IT IS OKAY. It's okay to be depressed. It's okay to ask for help. It's okay to be on meds. It's not your fault for being depressed; you didn't do anything wrong, it's just a trial in life. I still have trouble going to the clinic b/c I feel weird. I feel uncomfortable, like a freak, like I don't belong and I'm always nervous there. But just because I'm depressed doesn't mean I'm crazy. I'm still learning this. I haven't told my mom or my sister or my son for fear that they will think I'm nuts and should be doing this on my own, without a shrink or meds. I'm so grateful to have a supportive husband. Without him, I probably would go nuts!

We (my readers and I) send you our support and prayers, Miss S! Good for you for building a support system and making an effort to include the Lord in your life and trials. Even if you can't make it to the temple, all the small and simple things you do make a difference. Thanks again for sharing your story.

If anyone else would like to share their story here please email me at lolapalooza AT hotmail DOT com. Put "depression profile" in the subject line so I know you are not a spammer!

Postpartum Depression or I still have a hard time talking about it

My totally awesome blogger sister linked to me today. (Hi, Charlotte!) At the end of her post on the new fad of "pregorexia" she said, "We need less articles about post-partum flab and more about post-partum depression. Less about how to be a hot mommy and more about how to be a good mommy. Less about which star lost the weight the fastest and more about the stars in our eyes when we love our babies."

So here are a few words about PPD that I am glad others said to me and that I think more people need to hear:

*From my doctor, "PPD is an illness. It's not your fault. It is chemical. It's not your fault."

*From a nurse at the hospital when I asked her to hand me my pills, "Oh! I take those too. Sometimes we all need a little help."

*From my husband after I finally got treatment, "It's nice to see the woman I married. You weren't yourself before."

*From God, through the scriptures, "For God has not given us the spirit of fear, but of power, and of love, and of a sound mind." (i.e. Through the atonement of our Savior Jesus Christ there's hope!)

And here are the things I would say:

*This is not you. You are not bad and you do love your child, despite what your brain is telling you.

*You and your child are both in the loving care of our Father in Heaven, even though you can't feel it.

*Get help. Take medicine. Talk to a doctor, a therapist, a friend. Ask for support because you will find it.

*You are not alone in this. So many of us have been there and have survived.

All weaning! All the time!

I'm feeling blue today. I'm hoping I'll pull out of it in a little bit. My kids have only been awake for 45 minutes and I've already turned the TV on. Maybe blogging it out will help.

My baby weaned himself last week, cold turkey--which is also known as the "Ow ow ow ow OW! Method". I was really surprised. Last Wednesday he woke up from his afternoon nap and instead of snuggling up and gazing at me with dreamy eyes, he pushed and writhed and bit me. When he drew blood I gave up. I figured he wasn't hungry and I'd try again later. Well, even at his usual nighttime feedings he still refused. He'd wake up but he wouldn't nurse. After he drew blood three or four times and emphatically told me "All done!" (his only words besides Mama and Dada) I gave up. Actually, I said, "You bet you're done. As in FOREVER!" I was little peeved.

Since last Wednesday I've pretty much been talking and thinking about it nonstop. (All weaning! All the time! Sorry friends!)My OB is pretty convinced that the nursing hormones have something to do with my PPD. Which is one reason I'm supposed to stay on my antidepressant for the whole first year of my baby's life. We are waiting for my milk to dry up and my menses to return so that the antidepressant can smooth out those hormonal transitions since I take them so hard. I wondered what abrupt weaning was going to do to my hormones, so I googled it. There seems to be a consensus. Even Dr. Sears says abrupt weaning can cause depressives episodes.

Most doctors/researchers seem to believe that it is the sudden drop in oxytocin levels that brings on sadness when weaning. Oxytocin, which plays a role in bonding and feelings of love (think of that glow after sex), contributes to overall wellbeing and is familiar to most people. Interestingly enough, though, there is another hormone that that has do with nursing and depression. Prolactin is the hormone that regulates milk production. It is the hormone that makes a pregnant woman's breasts grow (it enlarges her mammary glands) and it is the hormone that produces the milk after the baby is born. The thing that is surprising about prolactin is that it inhibits dopamine production--an important "happy hormone" in the brain. It would seem that pregnant and lactating women swap one kind of happy hormone for another. The other thing that struck me as I read about prolactin was that antidepressants slight raise prolactin levels in the body, ostensibly lowering levels of dopamine. Anyway, I don't have any real conclusions to draw from all this. I'm not a doctor or psychiatrist (I know you all are surprised by that admission.), but it has convinced me that what is going on in my body is complicated so it's okay to give myself a break. If the kids watch a little extra TV, well, at least it PBSkids so it's "educational", right? TV is definitely preferable to me yelling at them.

I think the other reason I'm taking this so hard, besides the pain and the mess (yesterday was the first day since Wednesday that I didn't have to change my shirt due to milk leakage), is that I'm feeling pretty rejected. I know Number 3 didn't mean it that way. He is almost a year old so this was to be expected, but I just feel like he was telling me he didn't need me anymore or that I wasn't meeting his needs well enough. I sort of feel like I failed. Now, cognitively I know that those things aren't true but it is how I feel. It's just hard to see him giving those loving looks to a sippy cup instead of me. Oh well, at least he still likes to cuddle when I put him down for sleep.

Things just change so fast these days. A lot of the time I feel like I can't keep up with it. Every time I get a handle on where my kids are and what they need, they change. Sometimes I doubt my ability to adapt. It just takes so much energy! The truth of motherhood, though, is that the work never stops. Regardless of my abilities I have to keep trying because there is no other choice. It doesn't matter how many times I fail (or succeed) new opportunities constantly present themselves. I think it was Yoda who said, "There is no try. Only do." (My hubby is fond of that one.) Or as God said, "Unto whom much is given, much is required" (D&C 82:3). Use the force, Laura!

Depression, Intuition, and The Spirit

For me, one of the hardest things about being LDS and depressed is listening to the voices in my head. I mean, really, I've got a lot of traffic rattling around in there.

The depressed voice in my head is always throwing out things like, "You idiot! I can't believe you did that!" or "Oh, now you've really screwed things up. How on earth do you ever think you can make it right?" or "You are such a *&%$#" Thankfully, that part of my mind is not too creative and I've learned (yay for Cognitive Behavioral Therapy)to tune it out.

My intuition voice is also pretty noisy. Unfortunately, since I am a mother of three children, my intuition is usually attuned to things like "She says she washed her hands but you'd better smell them to make sure she used soap" or "The beloved blankey has been stashed behind the wheat in the food storage cabinet" or, my personal favorite, "You'd better get off the computer because someone is sneaking candy!"

And the last but certainly not least voice, the Spirit, is, reserved for spiritual things, like: "A soft answer turneth away wrath." (Since I have so many anger issues it makes sense the Spirit would address those!) More often than not though, the Spirit feels like an urge to do something and doesn't manifest itself as a concrete thought.

And that's where things start to get complicated.

I've learned to manage my depression on a cognitive level and I've kind of figured out how to listen to my intution and the Spirit, but some days I have a hard time telling which is which.

For example: after Number 1 was born I was quite anxious (and depressed, but I didn't know it yet) about her getting kidnapped. This is a pretty normal new-mommy fear, but my anxiety took it to a new level. Not only did I worry about this in public places but I constantly had visions of someone sneaking in her into room and stealing her from her crib while I was in the bathroom. Now, we lived in a third floor apartment but I was still convinced. Whenever I left her out of my sight, which I only did to use the potty, I tried to mentally calculate how long it would take the baby thief to scale the balconies up to our floor, sneak through our sliding glass door and down the hall to her nursery, grab the baby, run out our door and down three flight of stairs to his getaway vehicle. I actually would argue with myself about how likely the scenario was and what I would do if I ran into the thief.

Eventually my worry got so intense I didn't want to leave the house. Every trip to the grocery store (since that was the only place I was still going) was full of stress. I began to develop little rituals to ease my mind. I always parked in the same spot. I always went through the store in the same order. I never walked more than an arm's length away from the cart. I always kept one hand on the baby (that way if someone tried to take her I could tug back). And I never turned my back to her.

I now know that most of the paranoia and need for ritual was linked to the post partum depression, but at the time I wasn't so sure that it wasn't the Spirit trying to warn me of some tragedy that was waiting for me down the next aisle (or at the cart return, those things were so scary to me!). After all, the Spirit communicates to us in our minds and in our hearts and my brain and my feelings were in constant agreement that something bad was going to happen. There was a part of me that knew my worry was excessive but, then again, maybe this was the "mommy mantle" so many women talked about. Boy, was I surprised when I started treatment for the depression and all those "impressions" disappeared!

I still struggle with it though. Like on days when I wake up feeling like garbage and I don't want to get out of bed but I do because my kids need me and then I yell at them and the thought "No success can compensate for failure in the home" goes ringing through my brain and I feel worse than I did before. Was that a spiritual reprimand? Or, was it my depression mocking me and trying to discourage me? Or maybe it was my intution telling me that I am a failure and no matter what I do nothing will make up for the way I'm screwing up my kids. Or maybe it's some bizarre concoction of all three. . . Either way, there are plenty of times when I can't tease out the depression from the Spirit. Or my intuition from my depression. Or my intuition from the Spirit. All the urges seem to run into each other and trying to distinguish one from the others is like trying to keep track of which hat the magician put the little ball under. They just keep moving faster and faster and my best guess is only a shot in dark.

And really, I guess there's no real way to know--well, maybe in the next life the Lord will explain it all to me. Personal revelation is one of those tricky things about our Church. It's a gift from our loving Father in Heaven, but it certainly takes effort to figure out how to interpret it and use it. If I ever figure it out, I'll let you know!