Q&A: post-partum depression starting 5 months post-partum

B writes:

"I have finally accepted the fact that I am depressed and have been for a month or two.  Not really sure when the clinically defined "depression" started.  My baby is five months old, so I am not sure if this still counts as post-partum depression.  I have been put on medication and told that it is still safe to breastfeed my child. All this time I thought it was due to sleep deprivation because my kid still wakes up every four hours for nursing.

I hate being part of that 10% of women who experiences depression because I would have liked to believe that I could handle this on my own and not enlist the aid of mood enhancers.

Would you consider this a post-partum depression?"

Yes, I would. I think depression that comes on you after you've had a baby is post-partum depression.

Even though it seem like you've been mothering your baby forever, 5 months is still pretty tiny. I don't think it's at all odd that you developed post-partum depression once the initial flurry of activity and adrenaline rush of parenting a true newborn is over.

In a lot of ways, I think 3-4 months has the perfect conditions for PPD. You've survived the intial hormone rush of the first 12 weeks, so you stop being so vigilant about monitoring yourself for PPD. The baby might be old enough to sleep through for four hours at a time, but that's still sleep-depriving for you, even though it's normal for her. And you just don't have the support anymore that you did at the beginning. Everyone expects you to be an old hand at this, and doing it with no problems. In the meatime, it's starting to sink in to you that this is the new normal, and you wonder why it's even worth getting out of your pajamas if the whole day is just going to be the same grind.

I hate that so many of us develop PPD*. (I think that 10% figure is extremely low, BTW. Maybe 10% seek treatment, but I think there are tons of us walking around with some low-level depression at any given time.) I hate that we have to take drugs to help us function appropriately. But I think they're an appropriate response to an inappropriate situation.

If we had more cultural support for mothering and parenting in general--and I don't mean people stopping us to tell us how cute our kids are and then giving us some guilt trip about either working or not working and what and how we're feeding our kids--we wouldn't be stretched to the breaking point physically or emotionally. If we lived in less isolation from each other we'd have people to share the burden with on a daily basis. If we hadn't screwed up our food chain so much we'd be eating foods that were naturally higher in the nutrients our bodies need to be able to keep us on a more even keel emotionally. If we were able to trust our parents more, and therefore learned to trust ourselves more, we wouldn't be so twisted up about every minor decision we make about our kids and we wouldn't judge other parents so harshly.

Mothering in this time and place can be a really screwed-up proposition. It's amazing most of us come out of it as whole as we do. 

I'm sorry you have PPD. I'm sorry you have to go on medication, and that that makes you feel bad. But you have to take care of yourself, for your own sake and for your child's sake. PPD is an illness caused by a lot of factors, not a personal weakness. You will get better. You might also want to consider seeing a therapist to talk through a lot of the stuff that seems to happen as a matter of course to most modern mothers--body issues, issues surrounding the pregnancy and birth, relationship issues, self-esteem, etc. It's too much to just stuff down and try to cope with on your own.

Can we start talking about this more? I don't just mean here. I mean IRL. When you see a mom with a baby, can you tell her her baby is cute and then ask her "How are *you* doing?" And then let her talk about it if she needs to? Let her know she's not the only one barely holding it together, and that it will get better, and she can and is doing it.

* Full disclosure: I'm the daughter of a parent with clinical depression who has been on medication for 20+ years. I have had depression myself for years (never medicated), and was severely depressed during part of my first pregnancy. I made a conscious plan to ward of PPD, and aggressively followed that plan after the birth of my first son. I believe that (and the hormones from nursing) kept me from developing PPD despite my many risk factors for it. After having my second son I stopped following the plan (I got cocky), and found myself depressed from the time he was around 4 months until he was around 11 months.

Comments

[Kelly]

Man...this is hard stuff. It's so easy to put a guilt-trip on oneself for somehow being weak if you're depressed. But it's just simply not the case.

I avoided the serious PPD, but have, like most moms, gone through some of the low-grade stuff. A lot of it was due to sleep deprivation, and some of it was just due to feeling overwhelmed, like I was simply existing to care for everyone else, and ya know, most of the time, the kids, they just don't seem that grateful at 3 1/2 years and 11 months! :)

Like Moxie, I had a depressed parent. In my case, my mom. And in my early 20s, I was hospitalized twice for depression. Somehow though, perhaps it was the oxytocin from nursing, I wasn't slammed by PPD. But I still sought counseling after both kids were born, and had a few stints on Wellbutrin and Zoloft.

You're doing the best thing, which is getting help. Have you thought about joining a mom's group? I know, I know, the thought was daunting enough to me even in my best moods. But if you get through those first few meetings, chances are you'll find someone with whom you'll connect. And that's priceless.

[hedra]

May I put in a plug for the book 'The Ghost in the House: Motherhood, Raising Children, and Struggling with Depression' by Tracy Thompson? I'm only part-way into it, but it has already completely shifted my thinking on PPD, and depression in mothers as a general issue (what she calls 'maternal depression' - which isn't necessarily the same thing as 'technical PPD' but is a fairly common and not at all unexpected reaction to the demands of motherhood in our era!).

Heck, the first two pages of the introduction changed my life! I stopped feeling dragged down and despairing about the ongoing cycles of struggling with PPD (it resurges at 2 years postpartum with twins, commonly - I'm working my way through that surge now). I started seeing the larger picture, and seeing myself as someone who has a lifelong illness with sometimes long periods of remission. Just like so many other mothers.

Keeping myself in remission is a daily task. It takes medical support, and family support, and planning. For me, most of my untreated motherhood was spent at the level of 'dysthymia' - a general 'not energetic' and 'not quite *there*' version of depression. I have to be on top of my dietary needs to keep that at bay (while nursing, I absolutely cannot let the Omega-3 level drop. Period.). I can also pretty easily slip into something deeper if I'm not really careful. And I've had times where I have not been really careful, and I went out of remission entirely.

The book is still in hard-back, but it is worth the expense. I'm reading it in the bathroom, which is my only real reading time (I read 1-2 pages at a time, most days!). But that's still useful.

As for whether it is PPD 'officially' or not - the official definition I think includes any depression starting in the first year postpartum, so yes, that counts. But that's just the name, not how to function, respond, cope. With multiples, it is 'still PPD' in cycles to as many years as there are children in the birth set, at least according to some experts. But for anyone, it is depression because it is depression, and I'm not sure that separating it out as 'PPD' vs some-kind-of-REAL-disorder is as useful as we think.

Oh, and B, give yourself great credit for figuring it out and getting treated as quickly as you did. I had 'mild PPD' after each pregnancy (starting around 6-8 weeks, lasting about 8 weeks) until the twins, when I didn't even realize I was depressed until they were 6 months old, and I was a lot MORE depressed than the other two times! I knew it was likely, and I didn't even see it. Even then, I didn't get started managing it properly for far too long. Congratulations on seeing it, and on taking action - I know how hard it is to do.

[hedra]

Oh, forgot to mention - the book deals with patterns of behavior and thinking that stem from having depressed parents, and how to manage that for yourself and for your own kids. That's a huge big deal right there, for me!

[Kelly]

I had mild pregnancy depression and definite PPD with my first (who was born very early and in the hospital at the time it started). I think the 10% number is WAY LOW. Like Moxie says, maybe that's the number of women who seek help, but some just try to work through it, some don't recognize it til it's getting better, and some don't have it as badly. YOU ARE NOT WEAK. You're strong for recognizing this change in yourself and seeking help! It's the best thing to do for your child and yourself. Thank you for being strong enough to know what your limits are and when to seek help.

[-erica]

My kids are 4 and 7 years old, and I've just gotten around to being depressed - is that still PPD? Hahaha. I wanted to address B's term "mood enhancers". Depression can be a chemical imbalance in the brain, and that's what the medication tries to fix. You can't just "snap out of it". Or at least alot of people can't, without the help of medication to fix the chemical imbalance. It was hard for me to admit I needed help. I don't think of it as a "happy pill". It is medication for a health problem.

[Linda]

Medically speaking, post-partum depression is any depression that begins in the first 12 months after birth. (Not sure if it applies the same for 12 months post adoption.) Anything after 12 months is regular depression.

[Ally]

My PPD started at around 6 months and by 9 months I was at rock bottom. Looking back, I think, like Moxie mentioned, the nursing hormones created by exclusively breastfeeding those first 6 months helped protect me a bit. I was on a hormonal and emotional high, and the crash down was pretty ugly.

For me, since I've done serious time in therapy already, Z0loft once a day was all it took. Suddenly, I was myself again and I wish I hadn't lost those three months!

I view taking medication for depression as essential as taking my asthma medication. Both keep me breathing, day after day.

[holly]

Our society really takes for granted what a woman goes through to build another body, deliver it on schedule, and then support that new life 24/7. (Much less two bodies at once- Hedra!) It is amazing and hard and you are doing it!

From my experiences with the strange new experience of motherhood, here are some things you might want to consider:
1. Finding a psychiatrist or counselor who specializes in women’s reproductive issues. I saw a counselor who had once been an R.N. in an O.B.’s office and saw a real need for care in this area. So, she went back to school, got another degree, and now she sees mommies. So yes, this is a need, for many, many women! I found the support, advice, and medical care from a “women specialist” invaluable. I second Moxie's notion of finding a therapist to work with.
2. Joining a mom’s group or even just a weekly music and baby class. Getting out to something with other moms on a regular schedule without over-extending myself was really helpful.
3. Giving yourself a break somehow. For me, the house freaked me out. I really had unrealistic expectations! So we hired a cleaning service for a while. It made a huge difference and allowed me to get “back on my feet.” Not physically, but you know what I mean.
4. Speaking of “getting back on your feet,” I agree with Moxie and others that 5 months postpartum is still pretty much in the thick of things. My baby just turned a year old and I FINALLY feel like I am emerging from the “fog of hormones” and have a little of my old spunk back. (Or is the PPD clearing? Hmmm…)

If you are concerned about breastfeeding and taking antidepressants, as I was, you can get more info from:
http://neonatal.ttuhsc.edu/lact/
This is a site about breastfeeding pharmacology from Texas Tech University run by a professor of pediatrics and a clinical pharmacologist who studies the actual amount of medications passed into breastmilk and how much medication the baby might receive. You can enter the "breastfeeding and medication forums" as a “guest” and read questions from LC and nurses to an expert in the field about a variety of medications. He has also written the book, Medications and Mother's Milk, which has a new 2006 edition out. It might make you feel better.

I hear you Moxie, on talking about it all IRL. Very good point! Will do.

B, hang in there! You are doing it right; listening to your body and seeking help is the best thing for you and your family. Best wishes.

[Hillary]

Wow. Some very smart mothers are out there.

I was on antidepressants through my whole pregnancy and still am. My son is 9 months old. My depression started years before, after my daughter was born.

Who cares if it's PPD or regular depression. It's just a label. The important thing is that you realize things are not "right."

Please consider what others have offered.
Therapy (a must in my opinion) and joining a Mom group.

After my daughter was born, I (a natural introvert) hermitted inside my house and cut myself off from the world. I had just moved and knew no one. All the things I was going through I spoke to Mom's about years later. I would have been very relieved to hear their words of support when I was in the thick of it. It's amazing how the commrodery of woman can help you heal—maybe not all the way—but pretty well.

hang in there ((hugs))

[Linda]

Hillary,

It actually does make a difference if it's PPD or "regular" depression. I just heard a speaker discuss this topic. Diagnosis and treatment can be different between the two types, just like seasonal depression is different than adjustment disorder is different than major depression, bipolar depression, etc. They are different and the meds and counseling are varied. Having an accurate diagnosis can be important and finding a couselor who specifically treats PPD can make a huge difference.

[shayneegray]

As usual, Moxie has nailed it with the thoughts on the support structure available to parents. I've recently come to the realization that I've basically been sad for my daughter's entire life (she's 21 months). I doubt it qualifies as depression, as I'm not overwhelmed at any time and I certainly have times when I enjoy things. But at baseline: sad. There are some precipitating factors in addition to the stress of being a new parent. During the same span as my girl's 21 months, I've lost all three of my grandmothers and my two beloved pets (about every four months or so there's been another death). And our family and most of our friends live in other states. Those friends we have here all have babies around the same age as ours, making extra help nonexistent. So this sadness is completely understandable and "normal," I suppose. Yet it bites.

[B]

Hi, I am the one who wrote to Moxie. Yes, I just asked my doctor and I have been diagnosed with PPD. Oddly enough,just putting a label on it has made me feel better about it within the last week. Thank you for all your help, everyone.

[Cheek]

I met a new mom last week with a gorgeous 4-week-old boy, and she would absolutely not hear of anything being difficult or frustrating. Everything, every single thing, was sunshine and roses - she loved getting up in the middle of the night to have her "special time" with him, for example.

I wanted to be generous in spirit and celebrate the good time she was having, but the dark side of my soul wanted to punch her out. I wish more women would talk about how difficult it is, and not try to paint this picture of motherhood as the most fulfilling, wonderful experience. If that is truly your experience, then great, but at least acknowledge that quite a few women are going to find it challenging. I just got this "la-la-la, I'm not listening" sense from her that made me both concerned and infuriated.

[Midwestern Deadbeat]

Gee, every time I drop in I seem to find something that speaks directly to my current situation. (I actually just wrote a post about PPD.) So far I've been unsuccessful at finding a therapist, but I scheduled a regular physical with my doctor and I'm going to ask her for a referral.

There are some great comments here! Thanks, Moxie and everyone, for the resources and the insight. I really needed it.

[Katie]

Cheek, are you sure her reality was really "sunshine and roses" or is it possible that she was so sure that it's *supposed* to be sunshine and roses that she was going full tilt with trying to sell the version of life she thought people think she should be having. I don't think I went overboard, but I think there were definite moments when I was selling the parts of my reality that were closer to what people expected to hear. Then there were moments at Mom get togethers where I couldn't shut up about "when do they ever sleep." With all the expectations, I could see trying to convince oneself and everyone else that everything is peachy keen, when its not.

[Cheek]

That was exactly what set off alarm bells for me, Katie. Every time I tried to engage her in a real, honest conversation about motherhood ("Boy, those diapers sure can get messy, huh?"), she responded with the sunshine and roses ("Oh, no, his poop is actually perfectly self-contained and smells of budding lilacs."). There was also a certain air of competition in her tone. But then again, I have an evil soul, so maybe I'm just jellus.

I just know that when I was a brand-new mom, I craved those commiserating conversations when I didn't have to put on the sunshine & roses act. I tried to give this new mom some of what helped me, and she would have absolutely none of it. Like I said, I'm probably just jellus, or maybe she just didn't feel comfortable opening up to me, but I felt like there was a lot going on under the surface that wasn't getting a voice.

[Linda]

Cheek,

The OB unit at the hospital I work for has a list of therapists in our area who specialize in PPD and what insurance they take. They retrain the therapists a couple times per year so everyone is on the same page. When a mom calls, the nurses can just find out her insurance and give her a choice of 4 or 5 different therapists. You may want to try the OB unit of a hospital or two nearby.

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I am a finishing my dissertaion for my doctorat in clinical psychology. It's been on hold because I had a baby. It's been 6 months and two weeks since she was born. I had tinges of PPD previously, but as of yesterday I feel so lonely and as if I'm going to cry. And I'm already on 80mgs Prozac. It doesn't help that we moved across the country to CA right after she was born and I know nobody here. Since it's Saturday my husband took care of our daughter and let me sleep in. But when I got up, strangely, my daughter avoided looking at me. I wonder if she senses something even though this morning was not as emotionally rough as right now.

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