Questions to Ask Yourself When Considering Medication for a Perinatal Mood Disorder

One of the things I’ve always struggled with when I hear a story about overcoming a PMAD without medication is the lingering question, could it have resolved sooner if medication had been used? And one of the things I’ve always struggled with when I hear a story about overcoming a PMAD with medication (since my experience in life has taught me that there is no such thing as a silver bullet) is the question, how? I’m all for using every tool available to you, but I can’t help but wonder…how did you know you needed it? How did it help you? What else did you do? So in order to answer those how’s, here are some questions to ask yourself when considering taking this tool out of your toolbox.

Symptoms

Yes

No

Have you had thoughts of harming yourself or your baby?
Have you experienced a lack of appetite leading to rapid weight loss?
Does your anxiety or depression interfere with your ability to care for yourself or your baby?
Have you had trouble following your OBGYN or pediatrician’s recommendations, either pre- or postnatal?
Do you use alcohol, marijauna or other substances to manage your anxiety or depression?
Do you have symptoms that worry you or those who know you? If they don’t currently know, would they be worried if they knew?

adapted from Nonacs et al. 2005

If you marked yes for any of the symptoms above, please make an appointment with your physician to discuss medication as an option to treat your depression or anxiety. An open and honest discussion together with your doctor can help you determine the best treatment plan for you and your baby. Please advocate for yourself to be well, even if that means asking for a second opinion with a psychiatrist who specializes in maternal mental health. Remember, even though exposure to medication might not be ideal in your mind, infant exposure to the symptoms of anxiety and depression can have a real impact as well.

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Your Postpartum Daily Vitamin

Find your mantra: Mine ways, “I’m doing the best that I can.” I’m a fan of,  “I will be kind and gentle with myself today,” too.

Find your tribe. You cannot do this alone. You need people who get what you’re going through right now. And you might have to let go of some friends who are not understanding and helpful right now. It’s hard to make new friends, but more likely than not, that other new parent you see at the park is lonely, too.

Be curious. Step back and look at what you’re feeling from different angles. Don’t be afraid of your feelings and shove them away. You don’t have to deal with it right now. Just having the willingness to lean into the difficult emotion at some point gives you a sense of competency and courage that might give you the strength you need to get through the day.

Be truthful. Be truthful about your new reality. You have a new reality: a good one, but a hard one. Be truthful when others ask you how you are. Being truthful could free up someone else to talk about her struggles, help someone else feel not alone, help you find meaning in your struggle. Or it could help you find some much needed emotional and practical support. Acknowledge that your thoughts, feelings, and behaviors are all connected. Your mental state is affected by getting showered and dressed. Your feelings of shame are affected by binge eating. Don’t be afraid to speak the truth. Usually, speaking the truth out loud takes the power out of it.

Be kind: If you choose to be kind to yourself, you will feel that you deserve kindness and grace during this hard season. You would give it to another mom or dad in this situation in an instant. Give it readily to yourself. That means checking your mean thoughts at the door. You wouldn’t accept that from a friend or your mother-in-law. Don’t accept it in your own mind. Being kind means giving yourself grace when you feel you have messed up by looking at it as a learning opportunity, acknowledging that you need help sometimes and that is ok, learning from but not allowing yourself to ruminate on your mistakes.

Find meaning: Find a way to give back to the next mama you meet, whether it’s something as simple as opening the door for her while she’s struggling with the carseat, giving a meal to a new family after the birth of their baby, creating art out of your pain, or joining a postpartum organization to help others.

Practical things that helped me, and could help you, too. Everyone is different, but you never know until you try:

–Tell yourself, this won’t last forever. You will make it through this season.

–Ask yourself: What one thing can I do for my self-care today? (Not laundry or dishes, but something that nourishes your soul.) 

–Reframe worry as evolutionarily adaptive and look for it to be so, stop ruminating when it’s not. Print out a STOP sign on your fridge if need be.

–Breathe. Take big deep breaths, lion breaths, sighs, etc. like you practiced for during labor.

–Sing out emotions as a silly song or dance. Silliness can diffuse the tension, makes the baby smile, makes you feel like a good mom, and makes you breathe! Singing is cathartic.

–Even though it sucks, exercise. Endorphins are Mother Nature’s antidepressant! 

–Even if you don’t want to at first, sometimes it’s ok to go ahead and have sex to feel connected to your partner (It counts as exercise, right?) You might have more fun than you expected! Reframe sex as play. 

–Get your feelings OUT. Journal for 5 minutes. Belt a sad song. Scream gutturally. Dance to your favorite feel good song. Cry for 10 minutes. Make a list of all the things that are not right right now. Make a list of the moments that you felt like a good mom, the “I’ve got this” moments, fleeting as they may be. Just get them out.

–Celebrate the strength of women and mamas around the world. Look up a story about a woman you respect.

–Thinking about helping others with your stories, too!

–Talking to other parents who are ahead of you on the journey, .ie. done with breastfeeding or through the little kid phase, and seeing how their lives are more their own again can give you hope.

–Make a date with another parent. Seeing someone else going through the same thing can lighten your load.

–Download the app, Stop, Breath & Think. Listen to a meditation once a day for a few minutes and watch your patience grow as you practice mindfulness.

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Sweet Pea Muffins a.k.a. Breakfast, Solved!

These are my breakfast saviors. Give me something I can warm up in 30 seconds and has fruits/veggies/whole grains in it to keep me energized and satisfied until lunchtime, and I’ll be a happy mama. Most importantly, I can eat it with my left hand while I juggle five other things with my right.  Enjoy!

Sweet Pea Muffins, so named after the nickname we gave to EV 🙂

Purée 1 c. defrosted frozen peas &  1/2 banana  with a tbs of water

Mix together with:

1/3 c. Agave 

1/3 c. Coconut oil 

2 egg whites 

1 tsp. vanilla

1 tsp. lemon juice 

1/4 tsp. salt

1 1/2 tsp. baking powder

1 tsp. baking soda

1 c. whole wheat flour

(Gluten intolerant option: 1/2 c. Spelt flour plus 1/2 c. Bisquick gluten free flour,  aka Rice flour with 1/2 teaspoon of xantham gum and 1/2 of baking powder) 

1/2 c. Oats (oat bran makes it heartier)

Spoon into silicon muffin cups to the top and bake at 425 for 10 minutes and at 375 for 8 minutes. Breakfast, for mama or baby, solved!

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Learning to Flex Your “Uncertainty Muscle,” or Specific Coping Tools for Dealing with Postpartum Depression and Anxiety

woman-plank-exercise-yoga-outdoors-01232015-500x279

The visual I want to give you today is flexing your “uncertainty muscle.” Imagine your pre-baby life for a moment: you wake up to an alarm that you set, maybe hit snooze once our twice, shower, dress in something that expresses your personality or your desired professional persona, sip steaming hot coffee, have the mental space to plan out your day and most of the time, it goes (somewhat) according to plan. Post-baby, you’re lucky if you get a shower and one thing on your list accomplished.

Living with so much uncertainty, not even knowing if you will be able to attend to any of your own needs today, is extremely difficult for us as humans, let alone women in one of the most vulnerable seasons of life—recovering from the effects of pregnancy and birth on our bodies, sleep-deprived like we’re being tortured in a POW camp, breastfeeding (which is a whole bundle of challenges in and of itself), attempting to scale the Everest-sized learning curve of conflicting parenting information on the internet and from unwanted advice, and most likely stressing about finances and our marriages.

While we have very little we can actually DO about all these stressors, we can, little by little, like an underdeveloped muscle that we are working on at the gym, start to flex our “uncertainty muscle” and watch it grow with practice and post-workout pain. We don’t have to like it, but we can learn to accept some of the uncertainty and cope with it, using some of the tools below. As we slowly realize that uncertainty is universal to all mothers in this season of life, we are reminded we are not alone. Like childbirth, other mothers have survived this helpless baby phase, and we will too. So what do we do to keep our sanity?

Just to throw some levity (and more uncertainty) into your day…

First, a fun question for you: “As a parent, you have a conundrum. You are always tired, hungry, and dirty. You can only solve two of these issues, max. What do you do?”

Sample answers: eat a sandwich in the shower; eat a scoop of peanut butter and fall asleep dirty; shower and nap nut digest your own stomach lining. Now post yours in the comments…Go!

Six coping tools for dealing with postpartum depression and anxiety, or the stress of just plain old uncertainty:

1. Laughter: Laugh with your partner about the silly faces your baby makes, at funny videos online, with other mothers at the ads for baby items where everything looks white and pristine (sans spit up). We know that laughter is our best medicine, but it can feel like such an effort sometimes, like dragging a boulder up hill because guess what, everything is a huge effort in life right now and your reserves are depleted and you’re not sure you’ll ever sleep again, let alone sleep in, so things don’t seem so funny right now. But we know from science that laughter releases feel good neurotransmitters like serotonin and dopamine and helps to reduce the amount of cortisol, the stress hormone in your system. If you need a little inspiration, laugh (in a non-bitter way, ) at Buzzfeed  or HuffPost articles about the challenges you never thought you’d face as parents. There is humor in the mess and the mystery of motherhood.

2. Progressive muscle relaxation: Did any of you hear the phrase growing up, “if you don’t have anything nice to say, don’t say anything at all?” Well, sometimes when you have nothing good to think, there’s no need to think anything at all. Ground yourself in your physicality, in your body. We are more than our thoughts; we are body, soul, and psyche. If you feel like you can’t turn off the negative or anxious thoughts in your head, or if it’s more subtle than that and you just can’t shake those down, blah, moving in slow motion feelings, try this exercise called progressive muscle relaxation. It’s like a guided meditation you can do for yourself, in which you simply tell each of your body parts to clench and let go, and you physically do it. The beauty of it is you can do it sitting down or standing up, whether you’re changing a diaper, washing bottles, driving, showering, or laying in bed. Starting at your feet, say either  in your mind or out loud, “Feet, tense up and release. Calves, tense up and release. Thighs, tense up and release. Hips, tense up and release. Stomach, tense up and release. Chest, tense up and release. Hands, tense up and release. Arms, tense up and release. Shoulders, tense up and release. Neck, tense up and release. Jaw, tense up and release. Head, tense up and release. Eyes, close and open up.” And while you’re at it, your OB would appreciate it if you would throw in a few Kegel exercises. 😉

3. Get your feelings OUT: Journal for 5 minutes. Belt a sad song that makes you feel like the songwriter gets your pain. Scream gutturally. Run or dance to your favorite feel good song. Punch a pillow. Cry on the couch for 10 minutes and then get up and wash your face. Make a list of all the things that are not right right now. Just get them out so they stop rolling around like marbles in your head.

4. The Fours Breathing Exercise: when you feel your heart and mind racing, focus on your breath. Count to four as your breathe in, hold for four, breathe out for four, and hold the emptiness for four. Repeat, repeat, repeat. This is what military snipers and emergency medical personnel trying to keep a trauma victim alive are trained to do. This is not too simple to be effective. This is for badasses. And you as a parent, doing a thousand things a day that no one notices, are actually keeping another human being alive. You are a badass. So breathe…in for four, hold for four, out for four, hold for four. (Practice it now.)

5. Reframe Worry as Evolutionarily Adaptive: Intrusive thoughts of harm coming to your baby are not pleasant, but they are very, very common to parents. Think about it, we as parents care for the most helpless, least developed mammals on the planet, and so it makes sense that a switch would be flipped in our brains to turn on those annoying and sometimes horrifying thoughts to warn us to avoid sharp objects, take a wide birth around corners and edges, watch your step on slippery surfaces, dodge the snarling dog in case it lunges at you and your baby. So reframe those intrusive, worrisome thoughts as evolutionarily adaptive and look for it to be so. Think of it like a good thing gone overboard, and tell someone who will understand in order to take away the power the thought is holding over you. Shame causes us to be secretive sometimes. I will say it again: these thoughts are not pleasant, but they are common to parents. Brush away the worry that you are going crazy like an annoying fly buzzing about your head. Thoughts come and go. Only when we focus our attention on them do we give them an unnecessary amount of power. Then, stop ruminating. Tell your brain, “I got the memo, I will avoid the sharp corner. No need to remind me again.” Print out STOP sign on your fridge if you need a visual reminder. Or put a coin in your pocket to remind yourself that sometimes our weaknesses are the flip side of the coin of our strengths.

6. Find your mantra: Mine ways, “I’m doing the best that I can.” I’m a fan of,  “I will be kind and gentle with myself today,” too. In the moments when I wanted to scream but I was literally looking at my baby—an example would be when I couldn’t soothe her for the longest time and I felt so inept, so helpless and frustrated, and I. just. Wanted. It. To. Stop.—I would say “I’m doing the best I can.” Part prayer, part plea, oh, how I wanted her to hear that and understand me. Of course she couldn’t yet, she was only four months old, but it helped me center myself so I (more importantly) did not scare her and could keep my attachment bond with her healthy.  Besides, on a deeper level, how will I teach her to have grace for herself someday when she feels like she is failing if I don’t start with myself in the here and now? Try saying it aloud to yourself, “I’m doing the best that I can.”

***

My Stop, Breathe & Think Meditation for today: Change. Will you join me?  #sbt 

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