My first almost wordless blog post, ever. The words in this image say it all. It is an important message that we, as family members, friends, neighbors or even colleagues of new mothers, should take very seriously. Permission to use this image granted by Karen Kleiman, MSW, LCSW, founder of The Postpartum Stress Center and author of numerous books on perinatal mood disorders.
This is the third of my series of blog posts about postpartum insomnia.
I met Bryn recently via the closed Facebook group for Postpartum Support International. Thank you, Bryn, for sharing your experience on my blog. I am very glad that the process of reflecting back to the time you suffered from postpartum depression (PPD)/postpartum anxiety (PPA) and putting your thoughts down was cathartic. I’ve always found blogging to be a therapeutic process, and I encourage all my readers to consider writing/blogging about your experiences. It will truly make a difference and help you process/validate what you went through.
Now, without further ado, here are Bryn’s 10 Q&A…..
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When/what was the first indication that something wasn’t right, and how long after childbirth did the first sign occur?
My first sign was probably before I even left the hospital. I had a regular check-up at 38w6d and had low amniotic fluid, so I was induced that evening, Friday. Delivered Saturday morning and went home Monday late afternoon. During that whole time, I maybe slept a handful of hours total. Early Monday morning I was a wreck, sobbing about putting baby girl in the nursery so we could sleep and sobbing because I couldn’t sleep. But that just registered to me as Very Emotional First Time Mom. My first official indication that something wasn’t right was trying to sleep at home Monday night and free falling into my first-ever panic attack. I felt very, very dangerous. I remember looking at some scissors and making some very disorienting, strong connections to my panic and danger and those scissors. I actually picked them up and will never forget my husband saying, “Bryn, put down the scissors.” I made DH drive us (me and the three-day-old, poor girl) right back to the ER, where I had another panic attack. My folks had visited earlier that morning, had already driven home (80 miles away) and then drove back to be with me at the hospital. DH’s mom drove to our house to set up helping out with baby girl (So, so grateful to have one grandma who’s a Labor & Delivery Nurse and one grandma who’s a Licensed Professional Counselor Mental Health Professional). I finally got some Ativan and went home to try sleeping with Unisom. This was around 2am. DH’s mom woke me up around 6am to nurse. So, I maybe got four hours of sleep. I remember feeling so incredulous that, even after everything that had happened the previous night, she would actually wake me up. But, um, duh, I do have a baby now. Four hours was generous! I was very much in denial. So, short answer, my first sign that something wasn’t right happened 2-3 days postpartum.
Did you suffer from insomnia? What other symptoms did you experience, if any?
Yes. Monday night I got a few hours of sleep after Ativan and Unisom. Tuesday night, I tried melatonin and didn’t sleep. Wednesday late afternoon, I tried to go to bed early and took Unisom since that worked okay Monday night. I didn’t sleep and was also so whacked out with constant anxiety and mini-panic attacks that I pleaded to go back to the hospital. I begged and begged the ER to sedate me. I was out of my ever-loving mind, clinging to DH and just losing it. At 8pm, after a lot of doc consults and one psych consult (and the number to the local crisis stabilization unit), I finally got a cocktail of Benadryl, Ativan and Haldol. I slept for 10 hours, waking up at 6am and went right back to high-strung anxiety and all-day panic. Thursday night, I tried Ambien and woke up after an hour. Made a deal with DH that I would go to baby girl’s first doc appointment Friday morning and then we would check me in somewhere. We’d spent a week trying to figure out what the hell to do with me and how to get me better, and now it was the professionals’ turn.
Now, just out of curiosity, do you have a personal history of depression and/or anxiety or other mood disorder?
I had a brief period of depression in high school after moving cross country my junior year, but that experience didn’t lead to anything that truly interfered with my life the way my PPD/PPA did after I had my baby. The sadness during my junior year definitely felt different than other times in my life. I remember functioning like a zombie, numb for a few months until I got into the swing of things. My mom says I barely ate for a few weeks, but I don’t really remember that. I didn’t have any treatment beyond the school counselor getting me involved in the basketball team as a scorekeeper. It wasn’t until after I gave birth that I experienced a mood disorder that prevented me from sleeping, functioning and enjoying the baby that I gave birth to after a very stressful IVF cycle so much so that I truly needed medication to help with recovery.
Did you see a doctor right away, and was he/she able to help you? What course of treatment did he/she prescribe? Did he/she diagnose you with a postpartum mood disorder?
Tuesday, after my first panic attacks, we went back to my midwife to check in with her about all this. They prescribed Xanax, which turned out to not really agree with me. I don’t remember them diagnosing me with a mood disorder of any kind. And I don’t remember PPD/PPA being mentioned. Just that I was having difficulty getting back on track. But I did take the Edinburgh and remembering scoring off the charts, so maybe we had that discussion? I really don’t remember.
If you had to take meds, what was it/what were they and how long did you have to take it/them? Did you have enough resources to help you with your recovery? What kind of resources did you have (e.g., support group, postpartum doula, psychiatrist, partner reduced work hours/worked from home)? Did you have enough practical help (e.g., late night feedings) with the baby?
I started with Xanax (anti-anxiety) from my midwife, which just gave me jitters and put me out of sorts. I first checked in to a local, free, crisis stabilization unit Friday morning (one week postpartum) in Cookeville, TN where we were living at the time, but once I got fully checked in and started assessing the place (with my vast knowledge of psychiatric help facilities [sarcasm]), I started freaking out that they weren’t going to be able to help me because the doctor had already gone home for the day and I had zero confidence they could get me to sleep that night. I went into panic mode again. The nurse got authorization to give me some Ativan (anti-anxiety). I called my family to come get me, and we headed to Vanderbilt Psychiatric Hospital instead. The Ativan really helped keep me calm for about an hour or two. I kind of wish I had had that all that first week, but of course, that wouldn’t have addressed any underlying issues.
Vandy Psych checked me in via the ER and a Patient Transfer Unit. That place. I will always remember that place as the lowest of my low points. It was a perfectly fine unit with perfectly great, professional people. That was just where it all came to the point of no return for me. My folks were with me while DH and his mom were with baby girl. We just waited and waited, on furniture that was bolted to the ground, I might add. We had intake and consult after intake and consult. And there were a handful of other folks in the other rooms waiting, just like me, for a bed to open up. Knowing what I know now about the process, they had mercy and definitely pushed me ahead of other folks. I was pacing and freaking out and then pumping and trying to lie down and changing my diaper because I was still only a week postpartum, and pacing and freaking out on repeat. I was so beyond exhausted, my dad paced behind me so I wouldn’t fall over. I pleaded with the staff to get me in so I could just go to sleep. I remember telling anyone who would listen I was this close to just banging my head against the wall to knock myself out. I was VERY aware of feeling this “line” just right there in front of me. I very easily could go ahead and bang my head against the wall. But I knew if I crossed that line, there would be no coming back, not for a long time or without a lot of repercussions. That willpower to not beat my head against the wall or go flailing out of control, letting loose all the fucked-up crazy that was pent up inside me, that was the strongest I have ever been. Ever. I am in awe of myself for not letting go. I guess I come by my control issues and anxiety honestly.
At one point I got pretty worked up and they gave me Atarax (anti-anxiety) to calm down. Man, those -axes do not agree with me. I felt like my soul was trying to come out through my skin and my skin was trying to dissolve off me at the same time. So horrible.
When I finally got to the psych unit, I was given a brief tour and another intake and then some sleep meds. I know Zyprexa (anti-psychotic) was one of them, and I think melatonin (supplement) or Benadryl (antihistamine), or both, were in there, too. This was a bit after midnight and I slept until about 7am. The staff had been told not to wake me and seemed pretty surprised to see me lining up for breakfast.
For whatever reason, I did not have my anxiety and insomnia symptoms during my long weekend stay Inpatient. They switched me from Xanax to Zoloft (anti-depressant) because I wanted to keep trying breastfeeding/pumping. I stepped down on the Zyprexa for sleep and the last two nights switched to melatonin. After three days, I felt ready to go home, against doc’s advice. I didn’t even sign up to attend Outpatient the next day. I felt great. (My discharge papers diagnosed me with “major depression with postpartum onset.”) DH picked me up, and we drove to his mom’s where they had moved during this time to be closer to where I was. When we arrived, I immediately held my baby girl and immediately went straight back into panic and despair. My doc team and family had decided I wouldn’t sleep in the same room as the baby just yet, so I battled through panic (that I hadn’t felt in four days) in another room and somehow slept fairly well. I RAN back up to the hospital the next morning and begged them to let me in the Outpatient program. I participated in that program for the rest of that week (two weeks postpartum) and had no new meds, but did step up my Zoloft.
At the end of that week, we were going to drive back to Cookeville for baby girl’s two-week pediatric appointment and I was pretty worked up about going back to that house, that bedroom, that no-sleep zone. Doc gave me some super low dose Klonopin (anti-anxiety) and I managed to make it to Sunday without taking any. Sunday night I slept in the same room with DH and baby girl, and actually did a night feeding shift (formula) around 2am, I think. We went to her appointment, refreshed some clothing and stuff and drove back to Nashville so I could finish the Outpatient program that week.
That weekend back home in Cookeville started a set-back. I made the hard, but relieving decision to stop pumping and switch to formula. Pumping/breastfeeding sent me into panic every time and I just couldn’t take it anymore. I went back to Outpatient Tuesday (sobbing to my mom on the drive up there, sobbing so hard she made me drive to her place so she could drive me the rest of the way) and Tuesday night confessed to DH that I was having thoughts of cutting myself. Just something to distract me from this misery that I could not escape. I just wanted it all to go away and there was no magic pill for that. Mom drove me to Outpatient again Wednesday morning and I confessed the same to her. With her therapist hat on, she asked me if I had considered checking myself back in. I just sobbed more. I actually really wanted to go back Inpatient. In there, I was safe and taken care of and structured and understood. If I could just pause Life, and if they could just fix me, then I could go be a mom and a wife and Life would be doable again.
So, a week after being discharged, I checked myself back in. This time, I stayed just over a week. I had all my anxiety symptoms, but was at least sleeping fine. The doc team added Risperidone (anti-psychotic) to my meds and Pindolol (beta blocker). When I was discharged, I was scared. I didn’t feel confident this time going back to Life. I gladly went to Outpatient and continued to sleep apart from DH and baby girl. I did okay over my first weekend back (no Outpatient and no structure made weekends scary) and finished out the whole next week.
After being away for two years, we had already planned to move from Cookeville back to Nashville over this summer. So, after this second attempt at Inpatient and Outpatient, I was four weeks postpartum and we needed to be out of our apartment two weeks later.
Luckily, yes, we had resources. We had a ton of resources. Both our families lived in the area and were a HUGE help. We got moved back, DH started a new job, and I had two more months maternity leave. I no longer felt in crisis, but I also did not see the light at the end of the tunnel just yet.
When was the first sign of light at the end of the tunnel and you were starting your recovery?
The light at the end of the tunnel probably came around six months postpartum. I posted on Facebook that “it suddenly dawned on me that I hadn’t cried or felt miserable and had, in fact, been feeling rather “up” for almost one whole glorious week.” Going back to work was ROUGH. Finally feeling love for baby girl and then leaving her at home with Grandma was ROUGH. I weaned off Risperidone and Pindolol, but stayed on Zoloft. I continued my Psych follow-ups. I tried different counselors, but didn’t find a good fit until almost a year later. Unfortunately, what helped me most, I think, was giving myself permission to be bad at everything except surviving; I was subpar at my job, a crappy wife, I let go of chores and cleaning, and gave up and went to bed around 8pm most nights.
Did you have any more children after this PPD experience, and if so, did you do anything to prepare yourself and were you able to ward off PPD the subsequent time(s)?
I am 16 months postpartum and just starting to think about more kids. This time last year, even thinking about more kids was a big Hell No. But, here we are. Baby girl was such an easy baby and is seriously a delightful toddler. Surely, we’re setting ourselves up for a colicky next kid! I will say, we battled through infertility for a few years before conceiving via IVF, and if we didn’t have frozen embryos already, we’d be one and done. We just don’t have the funds or energy for a fresh cycle, and, clearly, the old-fashioned way just doesn’t work for us.
To those ends, I have been reading What Am I Thinking? by Karen Kleiman. Her book This Isn’t What I Expected was a bible for me during Inpatient and those first several weeks. DH and I want to find some counseling so that we’ve strengthened “us” the best we can before a second potential crazystorm. I will likely stay on my Zoloft, maybe step down a bit, but stay on.
If you could go back in time what advice would you give yourself before you got pregnant?
Advice for pre-crazy Bryn? I don’t know. Unfortunately, I tend to be a “go through the mess myself” kind of person instead of believing the person who says, “Don’t go that way, it’s a mess.” I got pregnant via a never unstressful cycle. I was commuting 80 miles one way for work a few times a week and staying with my folks (away from DH) a few nights a week (thus not having to commute every day). I had Factor V Leiden which meant I gave myself shots of Lovenox in my belly twice a day during the entire pregnancy until six weeks AFTER delivering. I had an ER scare with severe abdominal pain mid-pregnancy (inconclusive, but definitely not pre-labor/BH). And I was eventually induced a week early because of repeated low amniotic fluid. Whew. I think my advice would be Pay Attention and Take It The F Easy. It’s so easy to look back and see the massive amount of stress I was managing and living with. When the swirling hormone stew that is postpartum became a reality, the control I thought I had of everything that I had been dealing with just fell apart.
Did anything positive come out of your PPD experience?
I remember feeling incredibly raw and vulnerable during those first several crisis weeks. And that actually felt good. To just be so real and open and honest and bare with those around me. Everyone knew what was what and I just didn’t care what folks thought of me. I was in crisis. I was a mess. I was fighting for my life. And I REACHED OUT. I RAN to help. Maybe it’s because of growing up with a therapist for a mother, but I had zero shame in seeking help. I had shame about failing my daughter, my husband, burdening my in-laws, scaring the hell out of my parents. But I didn’t have shame about sharing the hell I was going through and hoping someone could reach down and help pull me out. I see that as a positive.
What would you want to say to women currently suffering with PPD?
I have no idea what to say to others going through this. I don’t know that anyone could have said anything to me. I babbled and raged and folks listened and I started meds and I kind of feel like I just waited it out. I just kept putting one foot in front of the other. I made sure I felt safe with the folks around me in case I fell, and then just gritted my teeth and kept going. It REALLY sucked. But it doesn’t now. That’s probably not very inspiring or life-affirming, but maybe that will resonate with someone.
This is the second of the series of posts about postpartum insomnia. I met Kim recently via the closed Facebook group for Postpartum Support International. Insomnia was one of the symptoms that she suffered as a consequence of postpartum anxiety and postpartum obsessive compulsive disorder (OCD).
Thank you, Kim, for sharing your story on my blog!
I’ve always been anxious. It’s been my temperament since day one; just ask my parents. I wouldn’t know that I’ve also had OCD must of my life until after I had my first child. Looking back, all I can say is – DUH! – but in the 90s and even beyond, there just wasn’t a lot of information available about these mental “disorders.” My parents even took me to a child psychiatrist, but to no avail. Admittedly, it’s hard to diagnose someone at such a young age (I was 10), but the more we talk about it the easier it might become, right?
Anyway, before I became pregnant with my first child, I had a miscarriage, specifically a “missed” miscarriage, during the 12-week check, after which the recovery went on far longer than I expected. It was painful, emotionally and physically speaking, but we got through it and got pregnant again.
Surprisingly, I wasn’t as anxious as I thought I would be this time around. Despite moving 2.5 hours away from my family while 6 months pregnant, I was confident everything would be fine. My sister had had 2 kids prior and, to all outward appearances, she had made it look so easy!
Fast forward 3ish months and this baby wasn’t budging. 10 days past my due date, they decided to induce. Again, little to no progress. After 16 hours of contractions, they finally made the decision to do a C-section and, low and behold, there was my baby! Yikes!
From night one, he cried. And cried. And cried. I attempted nursing with very little success, but kept trying. (Eventually, I’d move to only formula, but not before going through several different types before settling on one that didn’t cause the babe major discomfort that led to hours upon hours of late night screaming).
All of this took a huge toll on me physically, emotionally, mentally. I felt like, because my husband was working, I needed to be the one to take care of my child during the night time hours. Sleep was not something that came easily…initially, because of the stress of middle of the night feedings/endless screaming, later because of extreme anxiety/OCD and the consequent insomnia.
If there is one thing I’ve learned from this harrowing postpartum experience is that sleep is ESSENTIAL. We need that time to reflect, to recharge, to RELAX.
Ultimately, the lack of sleep (I was averaging 2 hours a night on the couch with my son so that my husband could sleep) sent me on a terrifying downward spiral. I began experiencing awful intrusive thoughts that, even thought I didn’t understand it at the time, are directly associated with high anxiety and OCD. After some research, I discovered Postpartum Progress, an amazingly informative website that helped me to understand what was happening to me.
Even though I was hesitant to start medication, my OB prescribed me Lexapro. I began taking it and, the first night, woke up experiencing severe anxiety bordering on a panic attack. Now, please understand that this is a side effect listed in the pamphlet accompanying the medication. In a twist of utter injustice, these SSRI (selective serotonin re-update inhibitor) medications can sometimes increase anxiety before decreasing it. It doesn’t happen to everyone, but it did happen to me.
After 3 days of heightened anxiety and very little sleep, I couldn’t take it anymore. I was a stranger to myself, completely lost in the sleeplessness, anxiety, and panic. I could hardly take care of myself, let alone my one month old baby. After a visit to the ER, I made the decision to voluntarily admit myself to a local inpatient mental hospital. During my 3-day stay, I was able to see different counselors (some more helpful than others), let the Lexapro get into my system, as well as start taking trazodone to help with the insomnia.
It’s not a choice everyone would make. And, in hindsight, I’m not even sure I would make the same decision again. However, upon my return home, I was adamant that facing my fears (being alone with my child, especially during the lonely night-time hours) and getting better were my top priorities. My mother-in-law came to stay for a week as added support and my family was extra attentive to my overall well-being. I realize that I’m so very fortunate to have this support system and I fervently pray that all of you are similarly blessed.
***If you aren’t, please, PLEASE reach out to someone, anyone. Join a mom’s group, a Bible study (if that’s your thing), even a Facebook group. There are SO many people out there who have gone through this. We just need to start the conversation and keep it rolling.***
I’m not going to lie. It was a challenging couple of weeks while the medicine took time to really start working. The trazodone helped immensely with my insomnia and the Lexapro helped slow down my mind so I could separate myself from the deceptive thoughts that anxiety allows to creep in. But it got easier every day and, eventually, I began to recognize myself again. It’s not an easy role shift, I’ll tell you that. And it really shouldn’t be, regardless of what’s depicted in movies, television, magazines, etc. There’s a huge learning curve associated with new parenthood. Some take to it right away; others need a little/lot more time to adjust and that’s OKAY.
But please trust that it WILL come. You will learn. You will adjust. And it will be so, so worth it.
I want to thank Mrs. J for sharing her postpartum insomnia story with us. She reached out to me via my blog a little over 2 months ago and we’ve corresponded via email since then. Her twins are now just over 3 months old, and she is relieved and happy to report that she is well on her road to recovery and able to appreciate motherhood. Mrs. J has had 4 other babies before and did not previously experience prenatal depression, postpartum depression (PPD) or postpartum anxiety (PPA). Though, looking back, she thinks she might have had mild PPD before, now that she knows what having PPD is really like. Like me, she was caught blindsided by insomnia, though hers really started before childbirth but was nevertheless what started her on her journey of perinatal illness.
Now, without further ado, here’s Mrs. J’s story.
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When Ivy asked me to share my story on her blog, I jumped at the opportunity. Had I found her blog before things escalated with me, I believe I would not have gotten as bad as I did. Because of my experience, I want to offer hope to other moms who are suffering with PPD, PPA, and dreaded INSOMNIA that is one of the worst things anyone can ever go through, especially after just having had a baby….or in my case babies. That’s why I am sharing my story.
I gave birth to four healthy children before I found out I was pregnant a fifth time. At my 8-week ultrasound, the ultrasound tech looked at me and announced I was expecting twins. TWINS! Wow, that threw me for a really huge loop. After my initial shock wore off, I started to feel rather excited to take on this new experience.
My pregnancy was long but pretty uneventful up until my 7th month. I was diagnosed with gestational diabetes, which in itself is not too big of a deal. You can control it with diet, which I was able to do. But I had been diagnosed with cholestasis during my last pregnancy, and it started rearing its ugly head again in this pregnancy. Cholestasis manifests itself with severe itching, usually on the palms of your hands and the bottoms of your feet. I started to have trouble sleeping when they tested me for cholestasis and during the 10-day wait for the test results. I couldn’t shut off my mind to the worry of having a vaginal twin birth (which was my hope!) and worry that I would have to be induced early for the cholestasis diagnosis and the negative impact it could have on the health of my babies.
I started to really have problems falling asleep. My doctor recommended I take Benadryl to help me sleep, and I was able to fall asleep and stay asleep for at least 6 hours the first two nights. But on the 3rd night, I couldn’t fall asleep. I tried everything from warm baths with Epsom salt to drinking warm milk and avoiding television. I wouldn’t touch caffeine with a ten foot pole. Everything you could read about “sleep hygiene” I tried. Nothing worked. I would pace the floors and move from my bed to the couch and back to my bed, all while my kids and husband were sleeping restfully. I called my OB office countless times and they wanted me to try Ambien. I was terrified to try Ambien, as I had never had to take a sleep aid before and I’d read horror stories of people doing things that they couldn’t remember doing while on Ambien. On the first night, I made my husband stay awake to make sure I didn’t start sleep walking and drive off into the night. I can now look back and laugh at this. I took the Ambien at 9:30 that night and was up by 4:00 in the morning. The second night I took it, I slept for maybe 4 hours. The third night I only got an hour of sleep. I was exhausted. I couldn’t nap during the day. I couldn’t sleep during the night besides a few hours here and there. I was calling and calling my OB office for help, but they couldn’t understand my desperation. My friends and relatives couldn’t understand either, but then again, how can you really understand such desperation until you’ve actually been there. None of them have been through this before.
My OB suggested I go on Zoloft but I was having anxiety about taking an antidepressant while pregnant and I told her I wanted to try Prozac as I was on that before and it had helped with my General Anxiety Disorder. You see, I’m no stranger to anxiety and panic attacks but this was a whole different ball game. I never had trouble falling asleep like this in the past. It’s ironic that I am someone who’s always preached about how important sleep is to mental health….and yet I can’t sleep! I have always needed a full night’s rest to feel good. Why was this happening to me?!
Somehow, I managed to muddle through the last 3 weeks of pregnancy. I was supposed to be induced at 36 weeks because my liver test results for cholestasis showed elevated levels. But 2 nights before I was to be induced, my water broke. Since I wasn’t 36 weeks yet, the hospital policy required me to be transferred to a bigger hospital. The doctor on call there told my OB that he was going to perform a C-section. I was pretty devastated, as I wanted a vaginal birth and both my babies were head down on the ultrasound. Turns out, I progressed way too quickly and couldn’t be transferred. Three hours after my water broke, I delivered two healthy little preemie boys. They didn’t need NICU time, thankfully. But once I got back to my room, I started to hemorrhage. I was terrified. My husband was in the nursery with my twins and not by my side when I started gushing blood. My OB was called in and was able to scrape all the clots out (ouch!). To say I was exhausted at this point is an understatement. I probably looked like death. I certainly felt like I was on the brink of death.
Even after weeks of not sleeping, being up for 30 something hours straight, giving birth and then hemorrhaging, I only managed to sleep 4 hours the first night after giving birth. I thought my body would shut down for hours from sheer exhaustion, but it didn’t. On the second night in the hospital, I asked for Ambien and I was able to sleep for about 6 hours.
After two nights in the hospital everyone was healthy, so they sent us home. The first night home, I didn’t sleep at all. Not ONE minute. I was delirious. I was still taking Prozac at that point. I called the OB and asked if I could be prescribed something besides Prozac and Ambien. She told me I needed to call my family doctor because she can’t prescribe anything other than the general sleep aid and antidepressant. I called my family doctor and got in the next day. He prescribed Xanax to take at night. So, here I thought this would solve my problems. It worked the first and second night, but by the third night (again!) I woke up after an hour of sleep and couldn’t fall back asleep. I didn’t understand how this medication would only help for a couple days but then it wouldn’t work anymore. I’ve never experienced anything like this before. Not knowing why I wasn’t sleeping even though I was exhausted added to my anxiety.
I thank God every day for giving me such a patient husband. He took care of the twins, and we sent our 4 other kids to stay with family. I started feeling desperate again, so I called my family doctor to see what he could do for me. His only suggestion was to double my Prozac dose. The increased dosage didn’t help. Now that I look back, I realize I wasn’t being as honest as I should have been. I should have told him that I didn’t think I could make it through another day. On the ride home from that appointment, at every intersection I wanted a car to plow into us and just end it all. My husband and twins were in the vehicle and that didn’t matter to me. I had lost all will to live. I tried thinking of my kids and how much they needed a mother, but I still did not want to live anymore. I felt so hopeless and desperate. It was on that ride home that I texted a friend to tell her that I think I needed to check myself into a psych ward. She texted back saying that if that’s what I felt I needed, it was the right thing to do. It was what I needed to hear, but it was the hardest decision I’d ever had to make in my life.
At that point, I didn’t know what I needed, I didn’t know who could help me, and I thought no one in the world has been where I was. I just knew that I felt scared, alone and hopeless.
Once in the hospital, the first night was hell. I was still on Xanax. I didn’t sleep at all. I wanted to die that night. And then to be in this strange place, with people yelling out all night long…..I’d never imagined I would ever need to be in a psych ward before. I wanted to disappear. I didn’t want to exist anymore. I feared I would soon be hallucinating and hearing things. I reminded myself I was in a safe place. It was where I needed to be.
In the hospital you are exposed to all different kinds of mental health suffering. It was really frightening, eye opening and even fascinating. I had so much ignorance regarding mental health before that. In that psych ward I saw people with depression and anxiety like me, people having psychotic episodes, people addicted to drugs, old people with dementia, and war veterans with PTSD. It was so interesting to learn from the nurses, doctors, and other patients and see how much help people needed and can get for their mental health problems.
After 6 nights of trial and error I went home. I was on the antidepressant Zoloft, the antipsychotic drug Seroquel as a sleep aid, and Vistaril on an as-needed basis for anxiety. I was terrified to go home and be in the same place where I had such horrible memories the month before. We sent the twins to stay with family. The only ones home with us were our two oldest children, as they had to go to school. I wore ear plugs, turned on the fans for white noise, and slept alone. I managed to sleep 5 hours….still not a full 6 or 7 hours like I would normally sleep, but it was so much better than before. I still felt like my life was never going to be “normal” again.
I remember hearing the train go by not far from our house. I recalled the story of a mom suffering from PPD who threw herself in front of a train and killed herself. I felt I was going to do that. My mind and body were so tired and I was in such a bad place that I could understand why she would carry out such an act of desperation.
After visits with a therapist, a new family doctor, and supportive friends and family, I slowly but surely started feeling better. I started to have good minutes that would turn to good hours and finally turn to good days. Slowly but surely, I was able to sleep longer and longer stretches without waking. If I did wake, I could fall back asleep.
I truly, truly, truly did NOT have any hope at all until I found Ivy’s blog and began reading her experience and the experiences of other moms in the same situation in the comment threads. It was such a blessing to read all of that and realize that there IS hope. THERE IS HOPE. I read about people who said that they felt hopeless and thought they would never return to their old selves again. I FELT THE SAME WAY! When you are in the midst of fighting dark hellish days, it is so hard to believe that life will ever return to a state of normalcy. But IT WILL. If you’re reading this and are experiencing dark days, please know that IT WILL GET BETTER. DO NOT LOSE HOPE and don’t be afraid to reach out for help.
My husband stayed home for 6 weeks to help me with the twins (once they came home) and the other two kids. He also helped with the twins’ night feedings. But after he went back to work, I experienced a major setback. My comfort, my support, my rock was leaving and it felt terrifying. After he went back to work, my doctor upped my Zoloft dose and thankfully my mom stayed over the first week and helped with the twins at night. A few family members helped with nights after my mom went home. It wasn’t until my twins were 13 weeks old that I felt confident enough to not only try taking on the night feedings with the twins but to also starting weaning off my sleep medication. Thankfully, as I write this, I am no longer dependent on my sleep medication! I am only on the Zoloft and I plan to stay on it for as long as necessary to make sure my brain chemical levels stabilize.
Just as Ivy’s husband feared at one point that she would never get better, my husband feared I would never recover. It was very tough for our husbands to watch us suffer and not be able to fix any of it. It was hard for our family members to watch us suffer and not know how to help us feel better. If you are like me and have loved ones who do not understand the extent of our suffering, do not get frustrated with them. They can’t understand because they haven’t been through this kind of hell before. They don’t understand that you are not being dramatic, and that you can’t just calm down, close your eyes and fall asleep.
I know you can’t help how you are feeling and you can’t control your anxiety levels or will yourself to sleep. In fact, the more you try to control it, the worse you feel. Just know that it will get better and you need to give your body time to adjust to your medication. You WILL get better. It just takes time, and I know that when you’re suffering, it feels like time is deliberately tormenting you by crawling so slowly. Hang in there and try to avoid looking too far ahead. Take one day at a time. Once you get the right help, the days will go by quicker and easier.
I look back at these last few months and can now say I am thankful in many ways for going through what I went through. I have gained so much insight and have a whole new outlook on life and on mental health. I’ve learned that PPD and PPA are not due to some character flaw. It’s not my fault I went through it. I’m a survivor and you will be one too!
I am now enjoying motherhood and feeling so incredibly thankful for my two little twin boys. They are such a joy and blessing! I can now relax with my few cups of coffee during the day and not fear that darn caffeine will keep me up at night.
I just watched my 3rd episode of “Chicago Med”….yet another brilliant TV show created by Dick Wolf of “Law & Order” fame. My only regret was not discovering this show sooner! This show has a thoughtfully-written script and characters realistically portrayed by a great cast in a way that–much like “House” in its first season–draws you into each episode. Oliver Platt plays the Chief of Psychiatry at Chicago Med, and I think he’s doing an awesome job! The best part about “Chicago Med,” IMO, is the fact that it’s the only show, as far I’m aware, that affords a weekly story line delving into the realm of mental health. Yes, MENTAL HEALTH. There are multiple story lines happening concurrently with the cast, but from I’ve seen from the 3 episodes I’ve watched, the focus of each week’s episode is primarily about a situation involving mental health. Not just an occasional acknowledgment here and there during a whole television season that yes, there are health issues that aren’t entirely medical in nature (think Dr. House and his addiction to vicodin for his “pain”) but a FULL story line each and every week dedicated to at least one person struggling with a mental health issue.
Finally, prime time television is taking a serious stab at shedding light on mental health! For that, I am grateful. You know why? Because we need to talk more about mental health conditions.
Depression…..PTSD…….Suicide……Obsessive Compulsive Disorder…..Bipolar Disorder….Self Harm….Eating Disorders…..Postpartum Depression…..Sociopathy……Borderline Personality Disorder…..Schizophrenia……etc.
Every single person out there knows someone who has experienced one or more of these mental health issues. You wouldn’t know that, though, because the tendency is for people to hide these things thanks to misconceptions spawned by the very little that we do know about them.
Thank you, “Chicago Med,” for shining a light on mental health. I look forward to future episodes, and hope that more and more people will start watching the show. My hope is that “Chicago Med” will prompt other show producers/directors to create more shows like this, realizing the need to make mental health a part of our daily discourse and encourage discussions and curiosity about these conditions and create a mentality that “Hey, a mental health condition deserves to be diagnosed and treated the same way as, say, diabetes or a heart condition.”
Keeping mental health conditions swept under a rug and a mystery from the public create a taboo mentality that mental health conditions don’t deserve to be treated and you should just “snap out of it” or stop imagining that you even have any kind of condition in the first place. Part of the problem is that mental health conditions are, as quoted in the episode tonight, “invisible.” In tonight’s episode, Dr. Ethan Choi (played by Brian Tee) continues to battle the effects of his PTSD from serving in the military. His girlfriend Vicki makes a reference to mental health conditions as being difficult to diagnose/treat because they don’t necessarily exhibit any physical symptoms and/or there doesn’t appear to be a medical explanation for those symptoms. Modern medicine and technologies are making headway–albeit slowly- in assisting doctors and psychiatrists to confirm and/or make diagnoses via brain scans. The patient under Dr. Choi’s care in tonight’s episode appeared to also be a victim of PTSD from being in combat, but it was through Dr. Choi’s keen observations that they ultimately determined the patient had excessive scar tissues near his heart that caused the sound of his heart beating to echo loudly in the poor guy’s head. So, he wasn’t imagining things and he most certainly wasn’t suffering from PTSD like he was insisting from the beginning! And of course, no one believed him! This is where I applaud the writers for writing a script that shows that, even though someone may appear to be suffering from a mental health condition, you can’t assume that there isn’t a physical or medical explanation for what the person is experiencing until you take the time to determine the root cause for a patient’s experience. Just like depression has a scientific explanation, like a hormonal and/or neurotransmitter imbalance, there is a biological explanation behind every mental health disorder. And it’s the task of research scientists to figure that all out, and I pray they hurry the heck up because we are losing too many people each year to mental illnesses! But I digress…..
I end this blog post with a call for “Chicago Med” to include an episode or two on postpartum depression. We desperately need an episode that informs the public of the difference between postpartum depression and other postpartum conditions like postpartum OCD, postpartum psychosis and postpartum bipolar. Please, please, please, Dick Wolf and team of writers: please reach out to Postpartum Support International today and collaborate together on a series of episodes on postpartum mood disorders.
If you look at the statistics, how can people NOT produce more shows on a topic that touches so many lives?
In response to my blog post from February 3, 2016 titled “15%-21% of Moms Suffer from a Perinatal Mood Disorder” in which I mention yet another mother who suffered from a postpartum condition that resulted in tragedy, fellow maternal mental health advocate Dyane Leshin-Harwood left me a comment that prompted me to offer her to explain why it’s so crucial to know the difference between postpartum bipolar and postpartum psychosis. I explained to her that I haven’t seen much out there on a comparison between the two, and of course, the more we speak up about these conditions, the better off we all are! These are illnesses that are extremely misunderstood, which can result in unnecessary stigma, mothers not getting the help they need because they don’t know who to go to for help, doctors not necessarily knowing how to properly diagnose and/or treat these mothers……and sometimes leading to tragic circumstances.
So, without further ado, I’d like to share Dyane’s story and important information about postpartum bipolar disorder. Thank you, Dyane, for all the work that you do as a maternal mental heath advocate!
Postpartum Bipolar Disorder: The Invisible Postpartum Mood Disorder
By Dyane Leshin-Harwood
Bipolar disorder, postpartum depression and postpartum psychosis have recently made media headlines. Katie Holmes stars as a lovestruck poet with bipolar disorder in the film Touched With Fire. The British hit television show EastEnders featured a postpartum psychosis storyline that gained national attention. Last January in a landmark decision, the U.S. Preventative Task Force called for screening for depression during and after pregnancy.
While the greater awareness of postpartum mood disorders is promising, postpartum bipolar disorder, the mood disorder I was diagnosed with, is virtually unheard of. Postpartum bipolar is also known as bipolar, peripartum onset, and it’s arguably the least known of the six postpartum mood and anxiety disorders.
It might seem unimportant to publicize an obscure mood disorder, but every mom’s postpartum experience counts. Many medical professionals are unaware that postpartum bipolar exists. Some postpartum and bipolar organizations are unfamiliar with postpartum bipolar or they’re unclear about its definition.
When I was pregnant, my obstetrician didn’t question me about my mental health or my family’s mental health history. My father had bipolar disorder, but before and during my pregnancy I didn’t show any signs of mental illness.
When I went into labor, my life changed overnight.
We went to the hospital and I stayed up all night in pain. When my daughter Marilla was born the next day, I became hypomanic. I was exuberant and talkative (both signs of hypomania), but I appeared relatively normal. My baby attracted most of the attention, and no one noticed that I was in trouble. Exhausted, I sensed something was off, but I kept my fearful feelings inside.
Within forty-eight hours I had hypergraphia, a rare condition in which one compulsively writes. I wrote at every opportunity, even during breastfeeding, when I should’ve been resting and focusing on my baby. I could barely sleep as my mania escalated, and poor Marilla didn’t gain enough weight because I didn’t breastfeed her sufficiently.
A month postpartum, I knew I was manic; after all, I had witnessed mania in my Dad. I frantically searched the internet about postpartum mania, but my search only yielded postpartum psychosis statistics. During Marilla’s six-week checkup, her observant pediatrician heard my racing voice and pressurized speech (symptoms of bipolar) and blurted out “Dyane, I think you’re manic!”
I burst into tears. While I felt ashamed, I was relieved that he realized what was happening. It was clear I needed hospitalization, but leaving my newborn was agonizing. I admitted myself into a hospital’s psychiatric unit where I was diagnosed with postpartum bipolar disorder.
After years of hospitalizations, medication trials, and electroconvulsive (ECT) therapy, I’m stable and doing well. While bipolar disorder ravages many relationships, my husband and I have stayed together, in part, thanks to the guidance of counselors and psychiatrists. Life will always be a challenge, but my two daughters inspire me to take care of myself.
While chances of postpartum bipolar are low, it can affect any mother. Obstetrician and Perinatal Mental Health Lead Dr. Raja Gangopadhyay of West Hertfordshire Hospitals NHS Trust, UK, explains,
“The risk of developing new-onset severe mental illness is higher in early post-childbirth period than any other time in women’s life. Family history, pre-existing mental health conditions, traumatic birth experience and sleep deprivation could be potential risk factors. Bipolar illness can present for the first time during this period. Accurate diagnosis is the key to the recovery.”
Confusion abounds regarding postpartum bipolar and postpartum psychosis. While the two conditions can present together, postpartum bipolar isn’t always accompanied by postpartum psychosis. Perinatal psychologist Shoshana Bennett Ph.D., co-author of the bestselling classic Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression and Anxiety says,
“Many women I’ve worked with had been previously misdiagnosed with postpartum depression. I always make a point of discussing this during my presentations. In addition, postpartum bipolar disorder deserves its own category separate from postpartum psychosis.”
Mental health screening during pregnancy would be of immense value to every mom. Women with a family history of bipolar disorder could be observed postpartum, and if symptoms manifested they’d be treated immediately. It’s imperative that doctors and other caregivers assess women not only for postpartum depression but also bipolar symptoms.
Everyone who lives with a stigmatized illness deserves a chance to find support and empathy from others who understand her experience. Through connecting with those who can relate to our mood disorder, we may not find a magic cure, but virtual support can be profoundly helpful. Postpartum Support International recently created online support groups in English and Spanish led by trained facilitators, while the Postpartum Progress website offers moms a private forum to interact with one another. I’ve never personally met another mom who has postpartum bipolar and I yearn to do so. If you or someone you know is or might be suffering with postpartum bipolar disorder please reach out — I’d love to hear from you!
Dyane Leshin-Harwood holds a B.A. in English and American Literature from the University of California at Santa Cruz. A freelance writer for over two decades, she has interviewed luminaries including Madeleine L’Engle, Dr. Kay Redfield Jamison and SARK. Dyane was diagnosed with postpartum bipolar disorder (bipolar, peripartum onset) in 2007. Dyane was selected as an International Bipolar Foundation Story of Hope and Recovery, and a PsychCentral Mental Health Hero. She’s raising her daughters Avonlea and Marilla with her husband Craig and serves as women’s postpartum mental health advocate. Dyane founded the Santa Cruz, California chapter of the Depression and Bipolar Support Alliance (DBSA) and facilitates free support groups for moms with mood disorders. She’s a member of the International Society for Bipolar Disorders and Postpartum Support International. Dyane’s memoir Birth of a New Brain – Healing from Postpartum Bipolar Disorder will be published by Post Hill Press in 2017. Dyane is a Huffington Post blogger. Visit Dyane’s blog Birth of a New Brain at: www.proudlybipolar.wordpress.com and find her on Twitter: @birthofnewbrain
I’ve been super busy at work these days, sometimes having to work at night, which is why I haven’t blogged much lately. But I couldn’t let today go by without mentioning the announcement today about a major step in the right direction….finally! First thing this morning, I received a text from a friend to check out an article in the NY Times about postpartum depression (PPD), followed immediately by an email from my husband with a link to the same article.
Mental health advocates are excited not just about the news that splashed the headlines of today’s New York Times and NPR about the importance of screening adults for depression. It’s the acknowledgment–finally–that new and pregnant moms need screening because catching and treating PPD early is crucial to the wellbeing of both the mother and the baby, and to the family unit as a whole. I’ve blogged in the past about how screening and seeing someone experienced in treating PPD could have prevented my painful experience. Having the screening recommendation come from the U.S. Preventive Services Task Force is particularly meaningful, as its recommendations have far-reaching impact on things like healthcare (i.e., American College of Obstetricians and Gynecologists, American Academy of Pediatrics, American Academy of Family Physicians) and health insurance in this country. In fact, its recommendations appear in the current issue of JAMA (Journal of the American Medical Association).
This is a major milestone for maternal mental health advocates in this country. And it’s about freaking time! I attribute this milestone to the persistence, hard work, dedication and passion of many, many amazing people either independently acting or as part of organizations formed–too many to list here but foremost on the list is Postpartum Support International (of which I’ve been a member since 2006)–to spread awareness about an all too common condition suffered by mothers that even today people are not aware occurs in 1 out of 7 moms. Seeing my friends’ names in these articles–Heidi Koss, a survivor/advocate/counselor and Wendy Davis, Executive Director of Postpartum Support International–mentioned makes them all the more meaningful to me. They are passionate about what they do because they don’t want mothers and their families suffering unnecessarily.
You would think something like screening, which I’ve blogged about numerously in the past, would be mandated by all healthcare professionals who come in contact with expectant/new moms. In one of my very first blog posts from back in June 2009, I included my suggestions for what screening would entail. Unfortunately, screening has not been embraced because, after all, where there is a positive, there is always a negative. In this case, there are several negatives, with the biggest being none other than STIGMA, one of the 2 biggest barriers to progress for the battle against PPD.
Stigma–and the ignorance associated with it– comes from resistance to change and attitudes about what screening would mean (“Oh, once a mom is screened positively for PPD, then she will automatically be medicated”). That, by the way, is totally false. No one is deliberately trying to medicate every mother and give more business to the pharmaceutical companies. Again, I have blogged plenty about this in the past, but medication is just one way to treat a perinatal mood disorder and in many cases critical to helping restore the neurochemical imbalance that childbirth has brought about. Without medication, I might not have survived my PPD. In most cases, it’s a combination of medication and therapy (like CBT) that is most effective. In some, less serious cases of PPD, therapy or peer-to-peer support (with a PPD support group led by a survivor) and/or an alternative treatment like meditation or acupuncture is sufficient.
Speaking of which, there is another major barrier, which is what happens once an expectant or new mom screens positively for a perinatal mood disorder….can we find them immediate help? Although there are more resources now than there were back when I suffered from PPD, we still have a very long way to go. There is definitely a need for more help among the healthcare, mental healthcare, and peer-to-peer support communities who are experienced in treating perinatal mood disorders. You’ll all too often hear that there is a long wait to see a psychiatrist (an MD who has the ability to prescribe meds), once you’ve found one that is near you that has experience treating perinatal mood disorders. Unfortunately, there just aren’t enough mental healthcare practitioners who are experienced in treating perinatal mood disorders. There aren’t enough mental healthcare practitioners, period. And among general practitioners, not enough are experienced enough or even have adequate bedside manner to know how to treat/behave toward a mother struggling with a perinatal mood disorder. I know, because I had seen one of those doctors, and it was a horrible, horrible experience for me.
These are the problems that we need to overcome if we want to truly be able to prevent any more mothers from falling through the cracks. There are many steps to get where we need to be, but we have attained an important step in the right direction with the recommendation from the U.S. Preventive Services Task Force!