A comment from the fabulous Katherine Stone of Postpartum Progress!

Katherine Stone, a fellow PPD blogger who writes the awesome Postpartum Progress blog, has commented on my last post...

"This is a good discussion. There are so many different people women can see, and each has a widely varying amount of experience treating these disorders. It is so important to ask whoever you're seeing how much experience they've had treating women with postpartum mood disorders. I actually prefer people who specialize in these disorders, even though they are few and far between. I also had a bad experience with a psychiatrist who just kept prescribing me more and more medications. It definitely prevented me from getting better, and I suffered longer than I should have."

On her blog, Postpartum Progress, Katherine has a list of links to some of the top hospitals and clinics in the United States that have specialties in and conduct research on women's perinatal mood disorders. She researched this list herself and did a great job, offering a great starting point for those who are searching for a medical professional (or a referral to one) who specializes in PPD and other postpartum mood disorders.

Yay, Katherine! Thanks for sharing your thoughts on my blog and doing such great work to increase awareness of PPD!!!

Are there any psychiatrists out there who actually talk to you?

Passing As Myself left a good comment on my last post when I was getting to the point of ranting about how hard it is to find a psychiatrist (this was following a previous post where I ranted about how we all need to get our anti-depressants from psychiatrists and not from other doctors who don't specialize in the brain). Here's what Passing As Myself said:

"I also wanted to point out that some psychiatrists can be even worse than getting meds from a PCP (primary care physician). Many are content to over-medicate and focus on the meds and not include any talk therapy. The best mental health care I ever got was from a psychologist. When I told her I thought I needed drugs, she talked over all the options with me and then called my PCP to ask her to write the scrip. Then she and I could focus our energy on cognitive-behavioral therapy. More than one psychiatrist has prescribed drugs to me without bothering to give me options or explain why they thought their pick was best."

I thought this was such a great point that I just had to post on it.... So I started out this thread of thought trying to express my frustration that there are so many women suffering from PPD who get anti-depressants from their gynecologists or internists, etc., when those doctors clearly do not specialize in the area of mental health and have no business trying to determine brain meds. or dosage levels. I've personally gotten myself in big trouble doing this when I took a new SSRI (that seriously screwed me up) that my gynecologist prescribed, then later found out she'd been receiving "gifts" from the pharma rep. that carried this SSRI.

Here, Passing As Myself has brought up the fact that if you're lucky enough to even find a practicing psychiatrist in your area who takes new patients (hopefully without a 3-6 month waiting list) and is actually covered by your insurance, you still may not receive the care that you need. I once went to a psychiatrist who was already writing out my prescription when we were less than 10 minutes into the consultation. He barely even made eye contact with me the entire time I was there, which lasted about 11 minutes. Crazy. I've since had a couple of good experiences with psychiatrists, so I haven't lost faith in them in general. The very best experience I've had has been with a psychiatric nurse practitioner who didn't simply write up a script; she listened and talked with me for an hour each time I went to see her. Isn't this how psychiatrists used to operate? Why is it that now they're just into prescribing meds?

Anyway, what Passing As Myself has found is a fantastic option when you aren't able to find a psychiatrist who will spend the time with you that you need and deserve. I'm so glad she shared her experience!!

So what's up with our access to anti-depressants?

A woman e-mailed me this morning after reading my last post and said that she's really suffering and needs to see a psychiatrist. She gave birth to her baby after a very traumatic delivery about 6 weeks ago and she's been experiencing some troubling OCD symptoms, like obsessive hand-washing. The problem is that she has no insurance and limited funds, so when she called a psychiatrist that she found in her phone book and was told that it would cost her $225 an hour to see him, she gave up. So I started researching free and low-cost psychiatric resources in her state when this comment appeared on my blog from Moxie Mom:

"I wonder if the inconsistency stems from the availability of seeing a shrink that is affordable since many, many, people have terrible health care. It's much easier for a women to see her PCP (primary care physician) than it might be to see a shrink in that case. Of course, I agree with all of your comments: a shrink would be the best choice. Believe it or not, I have pretty good health care but I see a psychologist and get my drugs from my PCP. All the real psychiatrists wouldn't call me back, even after I left several messages. I called 5 of them. Talk about an eye-opener. Seems to me, all levels of health care providers need to start stepping up their game and thinking outside their box."

Moxie Mom's comment really made me think. I know that in my city, Phoenix, there are very, very few psychiatrists and when you actually find one who happens to be taking new patients, the wait could be as long as 3-6 months. It's ridiculous. There's no way a woman suffering from PPD, not to mention her baby, can wait that long. I could rant about this for hours....

But I still had to figure out how to help this poor woman with no health insurance.... so I'll rant about the general lack of psychiatric care later. I did find a state-funded mental health program in her state that had several psychiatric clinics spread throughout her county. At the clinics, she would be able to have access to either a psychiatrist or a psychiatric nurse practitioner to receive medication if necessary, and also a psychologist for talk therapy. If she qualified all of the services and meds would be free, but even if she didn't qualify financially, she would still receive everything at a 40-60% discount compared to private practices.

That was encouraging and I hope to hear back from her after she finds the support she needs. Moxie Mom, thanks for sharing your thoughts!

I have postpartum depression and need some Zoloft!

So I was chatting last night with a young woman who has a 9-month-old baby and is suffering from postpartum depression. She asked me where to go to get a "good" anti-depressant. She's been going to her OB who has prescribed Lexapro but so far the Lexapro isn't working for her. Before that, she went to her primary care physician who had her taking Paxil for a while, which also didn't work.

What amazes me here is the fact that neither of these doctors should be prescribing an anti-depressant to this woman who is obviously suffering. I mean, when you need medication for your heart, you go to a heart doctor/cardiologist. When you need medication for your brain, you go to (you guessed it) a brain doctor.

Why are so many women getting their anti-depressants from doctors like gynecologists, obstetricians, internists, etc??? Why are we messing around with our brains??? Would you go to a foot doctor if you're suffering from an ulcer? I think there are so many misconceptions about anti-depressants and it has gotten to where they are way too commonly prescribed -- and by any kind of doctor.

So I suggested that this young mother try to go see a psychiatrist so that she'll have the opportunity to get on the right anti-depressant or mood stabilizer or combination of medications, not to mention the correct dosage level for her. She'd never thought about going to see a psychiatrist or even a psychiatric nurse practitioner. None of her doctors had mentioned this option to her. I just don't understand why doctors who are obviously not specialized in the area of the brain feel that they can prescribe brain meds.

Taking a brain medication is a big deal -- not to be handled lightly.

Shoshana Bennett, Ph.D, author of Postpartum Depression for Dummies, joins our conversation!

I am so thrilled to have a comment on my blog from Shoshana Bennett, Former President of Postpartum Support International and Founder/Director of Postpartum Assistance for Mothers. How awesome is this!! Shoshana joins the conversation that developed from my posts on the use of anti-depressants while pregnant and/or breastfeeding. Here's what she says:

"As Anne Dunnewold expressed, the judgment needs to go. There is no one “right” way. Each mother is trying to make the best decision for the wellbeing of her baby, and whatever choice feels right for her needs to be respected and supported.

"In order to make the best choice she can for the welfare of her family, it’s also important for the mom to have solid information on the pros and cons when she make this important decision. Here are some facts which many are not aware of. Most medical professionals who have dedicated their careers to studying the safety of antidepressants in pregnancy agree that they have been focusing too heavily on one side of the issue for years. Now, instead of solely focusing on the possible unknown risk to the baby when the mom takes medicine, they are leaning much more on the KNOWN risks to the baby if the mom is NOT treated. Until a few years ago, most of the focus with respect to taking medications while pregnant was on the possibility of harming the baby. Today, since there is much more data gathered on the dangers of depression and anxiety to the developing baby, the focus has shifted to the possible harm from NOT taking medication if the pregnant woman needs it to feel like herself.

"It’s quite clear from the research in the last few years that depression and anxiety in pregnancy can chemically hurt growing babies. For instance, depression in pregnancy can cause low birth weight and preterm delivery, and anxiety may cause harm by constricting the placental blood vessels and raising cortisol. One thing is for sure that everyone agrees upon. If a woman is experiencing depression or anxiety during pregnancy, she and her whole family (big or little, born or not yet born) needs her to receive treatment. Treatment, of course, does not necessarily involve medication, it’s simply the topic of this discussion. On that note, we are learning quite a bit about effective non-pharmaceutical treatments for depression in pregnancy with no side effects except good ones!"

Shoshana S. Bennett, Ph.D. Author, Postpartum Depression For Dummies, http://drshosh.com/

PPD's elusive symptoms

When I suffered from postpartum depression, I kept insisting that I wasn't depressed. My vision of a depressed woman consisted of lots of weeping, general moping around, hand-wringing, etc. Not a woman who was overcome by nausea 100 times worse than any morning sickness and vomiting violently when not on the toilet with diarrhea. I was a gastrointestinal specialist's fantasy. And after I was sent to a G.I. specialist, I went through the ringer: had an endoscopy, a colonoscopy, tests involving dozens of stool samples (so here I felt like total crap and got to mess with it too!), and many, many other pokes and prods. All the while, I couldn't care for my babies, couldn't even function, much less get out of bed to brush my teeth, and was hospitalized twice for several days at a time for dehydration. Three months after all this G.I. fun, my specialist threw his hands up at me, said there was no intestinal cancer, and that I should go home, get over it, enjoy my babies and have a nice life.

So here's the deal. According to the US Department of Health and Human Services, the symptoms of postpartum depression include:

- feeling restless and irritable
- feeling sad, hopeless and overwhelmed
- crying a lot
- having no energy or motivation
- eating too little or too much
- sleeping too little or too much
- trouble focusing, remembering or making decision
- feeling worthless or guilty
- withdrawal from family and friends
- loss of interest or pleasure in activities
- headaches, chest pains, heart palpitations or hyperventilation

This is a helpful list for a start, but I don't see "violent vomiting" or "intense nausea" or "fainting" or "endless diarrhea" or "dehydration" anywhere on this list. I'm sure there are plenty of other PPD symptoms that are not included as well. I've heard from new mothers who developed obsessive compulsive disorder during postpartum when they'd never experienced it before in their lives. All this leads to major confusion.....how do you even know if you have PPD? How do doctors know what to look for?? SO MANY WOMEN ARE NOT BEING DIAGNOSED!!!

Bottom line is that caregivers and family members need to be in tune to any and all disconcerting changes in a new mother and to be aware that PPD can manifest itself in myriad ways, from gastrointestinal issues to obsessive compulsive disorder, to intrusive thoughts. The key to PPD prevention and successful treatment is awareness and education. But especially awareness.....please help me spread the word.

Pregnant and on meds

I just love this conversation that's evolved from my post (a couple of posts back) on taking anti-depressants when breastfeeding! I set out simply to give my personal opinion on the risks involved and now feel way more enlightened on this "hot button" topic. In the midst of the mixed messages we get from drug test results and the medical community, we're left to wade our way through the murkiness of this issue while feeling guilty about whichever decision we choose.

I especially love psychologist and nationally-renowned PPD expert Ann Dunnewold's comment that "we need more honesty among women that this decision is hard" and that "women need to stop judging each other. Society as a whole is hard enough on us, setting up perfectionist, unreachable standards for mothers. We need to keep in mind the absolute truth, for the majority of women: that we are all doing the best we can do."

Several women have commented on my previous posts on this topic, openly sharing their experiences. One is now in the sixth month of her pregnancy with her second child. Not only did she suffer from PPD with her first baby, she has also dealt with severe depression since she was 13 years old. She is currently taking Zoloft and plans to stay on the anti-depressant during her postpartum while breastfeeding. She brought up an extremely valid concern that I hadn't touched on .... although we've been talking about the risks that anti-depressants pose to an infant, what about the risks involved when a mom's depression is left untreated? Studies show that the occurrence of untreated postpartum depressive episodes in a mother is linked to poorer cognitive test scores in their children. And way more tragic -- aside from the potential cognitive and development delays and possible psychological damage -- there is also the risk of a child losing a mother to suicide.

I want to thank this very strong and empowered woman for sharing her story -- openly letting us in on her decision that she's made to be on Zoloft while pregnant -- and bringing up this very important point that weighs heavily in this excruciating decision that so many of us have to face head on. I wish her all the best with the rest of her pregnancy and hope she keeps in touch so we can all celebrate with her when she experiences a joyful, calm PPD-free postpartum!

Ann Dunnewold, Ph.D, author of Postpartum Survival Guide, joins our conversation!

I've had quite the response from my last two posts that hit on the emotionally-charged issue of taking anti-depressants while pregnant and/or breastfeeding. Every comment has been great and I really appreciate the personal stories and thoughts that have been shared.

I was especially thrilled to see a comment today from Ann Dunnewold! Ann is a psychologist and nationally-renowned expert on postpartum depression. Of her several books on the topic, my favorite is "Postpartum Survival Guide." Her latest book, "Even June Cleaver Would Forget the Juice Box," provides solutions to the "mommy madness" that tends to pervade our lives as we feel pressured to aspire to perfect mommyhood.

On that note, her comment is awesome:

"I am so glad you brave women are talking about these issues. We need more honesty among women that this decision is hard--and that pregnancy or postpartum is not always a glowing Hallmark card experience.

"The official professional position is that a comprehensive "risk-benefit analysis" is necessary, because there is no "Right Answer". This means weighing the possible effects on the mother and baby of either choice —medication or doing without. There are documented serious negative effects of not treating depression and anxiety during pregnancy, including low birth weight. Over the twenty years that I have worked with postpartum moms, information has changed as research and drugs continue to evolve. Responsible, caring healthcare providers are usually glad to look at the issues for any individual’s case. If not, get a second opinion.

"For the facts about meds during breastfeeding, one of the key experts is Dr. Thomas Hale, who has a website at http://neonatal.ttuhsc.edu/lact/ and is the author of a great resource, Medications and Mother's Milk. Dr. Hale is VERY reassuring, feeling most meds are safe--but he is addressing breastfeeding, not pregnancy.

"The most important point in the posts here that I want to re-emphasize is that women need to stop judging each other. Society as a whole is hard enough on us, setting up perfectionist, unreachable standards for mothers. We need to keep in mind the absolute truth, for the majority of women: that we are all doing the best we can do. No woman I have ever seen in my office takes medication for fun. Women take them to function.

"We need to support, not criticize, each other's choices—and know that there as many valid choices as there are women in the world. Trust that you have made the best decision for you, given available info at this point in time. Don’t second guess or torment yourself with “what ifs” once you have decided."

Thank you so much, Ann, for taking the time to visit my blog and to share your valuable insight with us. You're the best!!!

More on meds and breastfeeding

Well, I've been e-mailing with a woman who wasn't at all happy with me after reading my previous blog on anti-depressants and breastfeeding. (She gave me permission to write about our communication on this blog.) She shared with me her experience of suffering from bipolar disorder and being on medication for it since she was a teen. When she and her husband were trying to get pregnant, she went off her meds. But by the end of her first trimester, she was having an absolutely horrible time so her doctor advised her to go back on her medication. She did so and went on to have a symptom-free, wonderful full-term pregnancy. Her baby is now nearly six months old and she's breastfeeding her baby and doing just fine. She feels very good about her decision to remain on medication and knows that she needed to do this in order to function and to be able to take care of her baby. She said she felt like she needed to defend her decision after reading my last post and make it clear that other moms shouldn't feel guilty about the decisions they make.

I absolutely agree with her. I applaud her for handling her illness so incredibly well and being so strong to know her options and then to choose the best one for her and her baby. Taking charge of our own health care is what each of us needs to do. The big stumbling block here, that I was trying to express in my previous post, is knowing our options. Often we're given information by the medical community (via pharmaceutical companies), without realizing we have other options. Or we're given just part of the information, or worse, complete misinformation.

I do feel fortunate that I didn't need to take an anti-depressant while I was pregnant, so I never faced that excruciating choice. I do know plenty of other moms who have and who felt like they wouldn't have made it through their pregnancies without medication. I totally respect and support their decision. I remain skeptical, however, about the safety of taking anti-depressants while pregnant or breastfeeding and think we need to demand more and better testing on these drugs. We shouldn't have to settle for an anti-depressant that is shown to cause birth defects, even if it is only a small percentage. We shouldn't have to settle period, but as women, that's historically what we've had to do when it comes to our health care.

I'm starting to ramble, but I guess what I really want to express here is that I think it's always good to discuss how we all need to respect each other's differences in opinion and different choices. Motherhood is tough enough as it is, but it's certainly way tougher if we don't pull together and support each other.

Just like the mom I've been e-mailing with felt attacked by my statement in my previous post that it's common sense to avoid anti-depressants during pregnancy and breastfeeding, I went through a similar experience when I made my decision not to breastfeed my fourth baby. I had really thought it out and made this decision because I knew it would be in my and my baby's (and my other children's) best interest for me to avoid postpartum depression so that I could be a functioning mother. For me, that meant not breastfeeding so that my hormones would become normalized faster and so that I could immediately go on an anti-depressant and not worry about it being in my breastmilk. It was a good decision for me, but I had a heck of a time expressing that to the nurses on the maternity wing of the hospital where I delivered. Although they didn't come right out and say it, they practically accused me of being a bad mom.

Twice a lactation consultant was sent to my hospital room to try to encourage me to breastfeed. I was given all kinds of "breast is best" cues and whenever I asked for formula for my hungry baby, it took forever for it to be delivered to my room. It was all I could do not to feel guilty for my decision, when I knew deep down, below the crashing hormones, exhaustion and pain from the C-section, that I had made the best decision for me.

These decisions are never easy, are they??