Meditating on Some Actual Facts

As the discussion continues to swirl around recent remarks by popular author and "spiritual guru" Marianne Williamson decrying depression screening and medication during and after pregnancy and claiming that PPMD is normal (news flash: it's not normal), I've realized that there appear to be some misconceptions contributing to Ms. Williamson and her supporters' commentary. I thought I'd take a moment to address some of the comments I keep hearing that are inaccurate.

1. Across-the-board screening doesn't mean across-the-board medication. Screening is intended to help identify women who are struggling and/or at risk for prenatal or postpartum mood and anxiety disorders, such as Postpartum Depression. That's it. If you go to an appointment, are screened, and your doctor says "I'm worried, let's talk", that isn't synonymous with "Here's a prescription for medication."

2. No, the screening is not a blood test. That's because there is no blood test for prenatal and postpartum mood and anxiety disorders. Blood tests can't read your mind and tell that you're having Intrusive Thoughts. Blood tests can't detect suicidal ideations. Blood tests can't tell that you're hearing voices in your head. Blood tests can't pick up on the fact that you're spending half the day crying for no reason, not sleeping, sleeping too much, have no interest in sex, or most of the other symptoms. Is screening perfect? No. But neither are blood tests. Is increased screening a vast improvement? YES!

3. Prenatal and Postpartum Mood and Anxiety Disorders are not the same thing as the normal hormonal changes that occur during and after pregnancy. PPMD go far beyond that. The normal hormonal changes that occur should clear up within the first few weeks postpartum, and should not leave you unable to function. These normal changes should not include Intrusive Thoughts, thoughts of hurting yourself or someone else, hearing voices, etc. For more on the symptoms of PPMD, check out Postpartum Progress' lists of Symptoms of Postpartum Depression and Anxiety (in Plain Mama English) and Postpartum Psychosis Symptoms (in Plain Mama English) .

4. There is no one guaranteed or right way to prevent or treat PPMD. Not all women will respond the same way to the same treatment, not all women need the same treatment, and even the same woman may need or respond differently to different treatments at different times. I myself have experience in the fact that different pregnancies meant different situations needing different responses. After one pregnancy, I needed medication. After a different pregnancy, I needed to switch the birth control I was using. A different pregnancy lead to me needing therapy but no medication starting or stopping. The point is not to try to get all women to use medication. The point is to make all methods of treatment available for everyone, with no shame or stigma.

5. There is no conflict of interest for the task force that has recommended increased screening for pregnant and postpartum women. The U.S. Preventative Services Task Force has a page specifically for the disclosure of Conflicts of Interest and it can be viewed here. Here's the screenshot.

The idea that the recommendations for increased depression screenings of pregnant and postpartum women is designed to pad the pockets of "Big Pharma" is a manufactured conspiracy theory that is inaccurate and dangerous.

Increased screening is a good thing. Increased screening means more women getting the help they need at a very vulnerable time. Increased screening means fewer lives lost. Increased screening means healthier and happier moms, babies, and families. If increased screening means more women taking medication, cool. Medication SAVES LIVES. Too many women currently suffer in silence. PPMD go underreported, too often going undiagnosed and misdiagnosed. The way to fix this is through more conversations (ones that are NOT ignorant and based in fallacies), through more education and awareness, through a decrease in stigma and shame. That is what I and my fellow Warrior Moms have been working towards, and we will not sit quietly and see it undone by people who are uneducated and ignorant about the truth, as we have already shown through our success with #MeditateOnThis.

When it comes to PPMD, facts trump conspiracy theories. Meditate on that, Marianne & Co.

Postpartum Depression Is Not Normal

Content/Trigger Warning: This post contains discussion of suicide and symptoms of Postpartum Mood and Anxiety Disorders, including intrusive thoughts. If you are feeling vulnerable, you may want to exit this post and read it some other time. You are loved.

"CODE ALERT: U.S. Preventative Services Task Force says women should be 'screened for depression' during and after pregnancy. Their answer, of course, is to 'find the right medication.' And how many on the task force are on big pharma's payroll? Follow the money on this one. Hormonal changes during and after pregnancy are NORMAL. Mood changes are NORMAL. Meditation helps. Prayer helps. Nutritional support helps. Love helps." 

-Marianne Williamson

Dear Marianne,
Last night (Wednesday 1/27/2016), I read your post opposing screening for Postpartum Depression. And you know what? It hurt my heart. As I read your words, I thought back to my own experiences after giving birth, and thought of the many stories I've heard from other women who struggled, and there are many of us out there. We have struggled with Postpartum Depression, Postpartum Anxiety, Postpartum OCD, Postpartum Psychosis, Postpartum PTSD, Antepartum Depression, and the list goes on. Our stories are many and varied, but one thing remains consistent: what we have been through and continue to go through is not normal. It may be common, but it is not normal.

There is nothing normal about Intrusive Thoughts that make you change your routine out of fear of the terrible thoughts and pictures that spring unbidden into your brain.

There is nothing normal about depression that leaves you unable to function, that leaves you sitting listless in a rocking chair, staring off into space with tears rolling down your cheeks as you rock your baby, wishing the pain inside you would ease for just a few moments.

There is nothing normal about anxiety attacks that cause you to have to pull over on the side of the road while you struggle to breathe, or have you sitting on the stairs at home hugging yourself and rocking back and forth while you hyperventilate.

There is nothing normal about hearing voices tell you that your baby is being possessed by the devil.

There is nothing normal about being traumatized by a birth experience that feels like something out of a nightmare and has you terrified at the idea of giving birth again.

There is nothing normal about finding yourself at the top of the stairs in the middle of the night, considering throwing yourselves down them to try to make the pain stop. There is nothing normal about walking away from those stairs and then thinking "I could just take a bunch of painkillers left over from a loved one's surgery, so I could go to sleep. Everyone would be better off without me and I'd find some relief from this crap."

There is nothing normal about having to go to the Emergency Department in the middle of the night and ending up admitted to the hospital for a week for in-patient psychiatric care while you stabilize from crisis mode. There's nothing normal about not being able to stop crying long enough to answer the nurse's questions.

There's nothing normal about feeling like you're a total and complete failure as a mother, a monster, because of the lies your brain is telling you.

There is nothing normal about Postpartum Mood and Anxiety Disorders. There is nothing normal about the number of women we lose to Postpartum Mood and Anxiety Disorders each year. There's nothing normal about the fact that suicide is one of the highest causes of maternal mortality in developed countries. There's nothing normal about the fact that new cases of Postpartum Depression occur in at least 600,000 women in the United States each year, and that's just the ones we know about. Once you start factoring in unreported/undiagnosed cases, the numbers jump significantly. It is common, but it is not normal.

There is nothing normal about Postpartum Mood and Anxiety Disorders. Postpartum Depression is not the same thing as the "baby blues", it's not the result of the "normal hormonal changes" that occur after pregnancy. It's not those normal hormonal fluctuations that are seeing calls for increased depression screenings during and after pregnancy. It's not those normal fluctuations that require medication and hospitalization and therapy.

I've experienced the normal baby blues, and I've experienced Postpartum Depression, Postpartum OCD, and Postpartum Anxiety that left me with two hospitalizations. There's a world of difference. Prayer, meditation, reading books, and good nutrition helped with the typical postpartum hormonal adjustments. They did NOT help with my PPMD. You know what did help when I ended up in the hospital after wanting to kill myself?

Medication.

And for that life-saving medication that helped return my life to some semblance of normal, that helped me be able to function, I thank heaven and "Big Pharma".

Please, Marianne, educate yourself before you cause any more harm, before you do any more damage to fragile women who are hurting. And you have already done harm and damage. I know this because I have been told this by women who were hurt and ashamed and scared after reading your words on Facebook and twitter.

And a quick note to all the mamas out there who are experiencing PPMD, you are not alone. What you are going through is not normal, but it is common. You have people who love you. We see you, we know your pain and desperation, and we love you. We are here for you. You have only to reach out to us and we will stand by your side and help you find your way through this. Don't let the stigma and ignorance that exists in the world get you down or keep you from reaching out for help.



For anyone who wants to educate themselves about the realities and truths of Postpartum Mood and Anxiety Disorders, these links are a good start.

Postpartum Progress
Postpartum Support International
My Postpartum Voice
#PPDChat on twitter

Postpartum OCD Powerpoint

This past semester (Fall 2014), one of the (college) classes I took was Women's Health Issues. One of the assignments was to do a research presentation on a women's health issue. This included putting together a slideshow addressing the basics (symptoms, definition, treatment, etc.) which we then had to present to the class. I chose Postpartum OCD. We had a 4-minute time limit, which was REALLY difficult for me to meet, so it ended up being a VERY basic overview. I could have easily talked for the whole class period and just scratched the surface of PPOCD. It's such a complex and under-discussed issue...

Anyways, I thought I'd share my Powerpoint presentation in case it can be of help to anyone. I've got it uploaded to Google Drive so that anyone with the link can view it. Enjoy. :)

Happy 10th Anniversary to Postpartum Progress and Katherine Stone!!!

"If you have knowledge, let others light their candle in it." -Margaret Fuller

5 years ago, I was a brand new mother. I had a whopping almost 3 months of experience as a parent under my belt. I had given birth to a beautiful daughter on April 23, 2009. Life as a new mom was pretty terrible for a little while, courtesy Postpartum Depression, Postpartum OCD, Postpartum Anxiety, and what I suspect was some Postpartum PTSD after a very difficult birth. I ended up being hospitalized twice, taking medication, and seeing a therapist. It was one of the darkest periods of my life.

One day (I can't remember when, exactly), as I dragged myself through the dark tunnel of PPMD, I came across a candle. It burned brightly. It called out to my soul and to my heart. At the time, my own candle was pretty much out, but that candle gave me hope. It helped me find my way out of darkness and isolation, to safety, support, and love. From that flame, I was able to re-light my own candle. That flame was Postpartum Progress.

10 years ago, Katherine Stone started Postpartum Progress. Countless women and families have been helped in many ways. I and my family stand among them. Postpartum Progress made a huge difference to me. It was helpful beyond words to find a site with so much good information written in a way that I could understand, a community of women to help support me, a safe haven to let me know that I wasn't alone and I really was a good mom, a warrior. Postpartum Progress has been a God-send to so many.

Today, I dedicate my blog to celebrating Katherine and Postpartum Progress. 10 years of dedication to awareness, education, and outreach is kind of a Big Freaking Deal. Postpartum Progress has been a game-changer for women with PPMD and today, I'm throwing virtual confetti in honor of an amazing person who had an idea and then put that idea into action.

Katherine, my dear friend, you beautiful wonderful soul, you rock my socks off! And I put socks on specifically to type that, which should tell you exactly how much you mean to me, since I pretty much never wear socks. Thank you for everything you have done and continue to do. I am forever grateful to God for leading me to you and to Postpartum Progress. Because of Postpartum Progress, I got the courage to share my story and to reach out to a fantastic community of some of the strongest women I know, who have become friends and sisters of my heart and my spirit. I hope you never go a day without the knowledge that you are loved. As we celebrate the birthday of Postpartum Progress, know that your candle has been a much-needed beacon to help light the way for many who couldn't see on our own. Some day, I will get to meet you in person (and I will squeal and make a fool of myself and probably end up a blubbering mess as I tell you what an honor it is to meet one of my honest-to-goodness heroes who helped save my life, my sanity, my marriage, and my family, who has become a friend). For now, I'll have to stick with sniffling my way through the beautiful stories I've been reading about the other women you've helped. We are many.

Happy Anniversary!!!!!

*eats more ice cream*

To everyone reading this, I'd like to share the words I borrowed from Good Girl Gone Redneck:

If you'd like to help support Katherine's efforts with a donation to Postpartum Progress you can do so very easily online. Postpartum Progress is a non-profit organization and your donation will be tax deductible. Your donation will go towards supporting an organization that supports ALL mamas EVERYWHERE.

If you or anyone you know is experiencing symptoms of postpartum mood disorders, please consider reaching out for help. Postpartum Support International has a toll-free support line you can call 1.800.944.4PPD and a map of local support resources for you.

Looking to talk to mamas like you? #PPDChat is a weekly Twitter chat where you can find discussions related to living your life postpartum.

Looking for hope? A reminder that you WILL get through this? Check out the Warrior Mom Photo Album and see these smiling faces. That will be you - soon.

Breastfeeding and medication

Recently, I was talking to someone on Twitter about breastfeeding on (and after) antidepressants, and it hit me once again how big a role breastfeeding can play in a woman's decision whether or not to seek treatment for PPMD. For me, among other fears (such as my child being taken away from me), I was so far into the whole "Breast is best" mindset that, when the filter of PPMD was added to the mix, the idea of having to stop breastfeeding my baby was horrifying and extremely upsetting. Concern over having to stop nursing is one that I frequently hear/see brought up and it is totally understandable.

I have written a couple of blog posts in the past about why Breast is not always best (part 1 and part 2). That is not going to be my focus for this blog post. In this post, I'm just going to share what my personal experiences have been with breastfeeding and medication.

When I was admitted to the hospital with a diagnosis of Postpartum Depression, my baby was 3 months old and exclusively breastfed. I had held off on getting help but finally realized I was at a crisis point and went to the ER, where I was transferred and admitted to a psychiatric facility. Because I specifically didn't want to have to stop nursing my baby, we tried talk therapy for the first day or two, but I could hardly even open up about how I was feeling and we quickly realized that medication was necessary. They started me on Lexapro (I was soon switched to Celexa, a generic version, for Insurance reasons), Ativan, and Ambien, which are not considered "safe for breastfeeding", so I had to stop nursing. I was extremely upset, but accepted that if I wanted to get better, this was what needed to happen. My baby did fine switching over to formula and the only discomfort was on my end because I stopped nursing/pumping cold turkey (ow, ow, ow). 5 years down the road, my daughter is extremely smart and well-adjusted, and we continued to bond very nicely. Actually, I think we bonded better because I was on medication and was able to connect better (I definitely remember the connection better after starting medication).

That first admission, diagnosis, and start of medication were in July 2009. At the beginning of December 2009, I was diagnosed with hypothyroidism (my doctors had previously missed it, but that is a whole different story for another time). Pregnancy can cause hypothyroidism, and hypothyroidism can cause mental and emotional health problems. I was promptly started on a low dose of Levothyroxine, a thyroid hormone replacement medication, and started to see my symptoms lessening pretty immediately. My dosage only had to be adjusted once to get my TSH and T4 levels back to within normal limits, and that also kicked the rest of the PPMD symptoms. After 3 months of Levothyroxine, I was able to stop taking the Celexa, Ativan, and Ambien that I had been on since July, and all was well.

I have been on this same dosage of Levothyroxine for 5 1/2 years now and it has never needed adjusting. During my pregnancies, the OB monitors my thyroid levels with bloodwork once a trimester (more often if I start experiencing anything unexplained  that could be symptoms of my thyroid medication needing an adjustment), but so far everything has been fine.

In April 2011, I gave birth to our second baby. Even though we were sure the PPMD had been related to the hypothyroidism, at my midwife's recommendation, I started taking Zoloft at 38 weeks pregnant (read what the Mayo Clinic has to say about antidepressants during pregnancy) as a prophylactic measure, and weaned off of it at about 6 or 7 months postpartum. This was shortly before finding out that, much to my shock and attempts to prevent pregnancy, I had another bun in the oven.

That second baby nursed through Zoloft, Levothyroxine, and the first two trimesters of my third pregnancy. She finally weaned herself at about 13 months. I was about to force her to wean since she had started biting (yay for teething). Let me tell you, I thought getting a tooth to the boob was painful enough under normal circumstances but with pregnancy making the girls extra tender? Yeeeeeeeeah.... "ow" doesn't quite do it justice. But, at that point she was down to usually only nursing in the middle of the night and she weaned herself, so it all worked out happily for both of us.

I started on Zoloft again at about 35 weeks with my third pregnancy. The original plan was to wait until 38 weeks again but I had some symptoms of depression and anxiety that were due to situations that were going on totally unrelated to pregnancy and we thought it best to start the Zoloft a little early. Baby #3 was born in September 2012. I was able to come off the Zoloft at about 3 or 4 months postpartum that time, again with no issues. The only issues I had were when I started using the Nuva Ring and got super tired (plus some intrusive thoughts) but that all went away when I discontinued the Ring. Baby #3 was EBF until I started school fulltime when he was ~4.5 months old. At that point, I got a good double electric breast pump and started pumping so that he got exclusively breastmilk at daycare and EBF when he was with me. With my school schedule and everything else going on in life, the pumping got to be a bit too much and eventually I stopped pumping; he got formula at daycare and breastfed when I was around. He self-weaned at 9 months.

I've done a wide range of options for feeding my children. Exclusively breastfed, Formula fed, breastfed through pregnancy and a little past the first year mark, breastfed plus breastmilk in a bottle, and breastfed plus formula. I've nursed on different medications and off of them. There is no shame or failure in any of these methods that I chose to feed my children. At the end of the day, what matters the most isn't *how* I fed my babies but *that* I fed them.

My experiences and feelings may not be yours. I can not say what is right or wrong for you and your family, aside from telling you that taking care of yourself is absolutely right, and that anyone who looks down on or tries to shame you for how you feed your children is 100% wrong. What I can tell you is that you are a good mother no matter what method (or combination of methods) you choose to feed your baby[ies]. In order to take care of others, we have to take care of ourselves first and practice radical self respect. Self-care is vital to not only our own well-being but the well-being of our babies and our families.

Whatever your choice, make it and don't let anyone get you down. If they want to say that they don't approve or agree or whatever, you feel free to send them on over to me and I'll gladly have a friendly chat with them.