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!

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.

What happens when you don't get help

For the last week my mom has been in a locked-down psychiatric ward located in a major hospital. I was stunned when I got the news because long ago I completely gave up on the possibility that she would seek or receive help. At 66, my mom has lived with bipolar disorder, perhaps OCD and other mental issues for her entire life. However, she has never been diagnosed. Somehow, by some miracle, she has managed to compensate, traveling through life while sliding up and down her manic roller coaster.

Now, she is emaciated, down in the darkest depths of a crash, and unable to function. She must weigh about 90 pounds. Tears stream down her face and neck. Her sentences are loose, jagged. She says she's confused. She has officially been diagnosed with bipolar disorder (at last!), paranoia and a "shade" of schizophrenia. She is on 5 different medications.

When I spoke to her psychiatrist for the first time this week, I found my voice. It rumbled up from a terrified little girl who walked on egg shells and hid in her bedroom. Give me the podium please. Finally, I am heard! The psychiatrist very patiently listened as I recounted bits and pieces of my life as my mom's daughter. My stories confirmed her diagnosis.

On the one hand, I'm so relieved that my mom is getting help. On the other, I'm beyond frustrated that it took till she was 66 years old to get there. I'm told it's never too late, but after all the sick programming that her brain has undergone, I just don't know. I guess I can only hope. All I ever wanted as a child was a healthy, stable mom.

Growing up, I thought my mom was "crazy." I couldn't understand why people didn't see the person she really was. In retrospect, I can see how well she hid her mental illness behind a wall of denial, taking great pains to reveal it only to my brother and to me. My dad would come home from work each day and suddenly Mom morphed into the perfect mother and wife. When my brother was killed in a car accident at the age of 15, a part of me was actually envious of him -- he got out. I wanted so badly to follow him. Instead, just months after his death, I went away to the college on my acceptance list that was geographically the farthest away from home. I still have a hard time going back to my home town, even at the age of 41, because images of the abuse from my childhood come rushing back.

My mom may have had PPD as well, although I really don't know. What I do know is that she was a mom with a severe mental illness who never got help. I'm sure there are women who suffer from PPD and other mental disorders who never recover for whatever reason. It's their kids who end up suffering -- they're the ones left to pick up the pieces.