How to help someone with post-partum depression

A friend of mine recently gave birth to her first child, and I suspect may be grappling with PPD (and she has taken anti-dpressants in the past, before the pregnancy.) IF that's what's going on, I'm wondering about best advice on if/how I can help her? Her birth prep class didn't really address this, and it sounds like her docs haven't either, and her baby came early. I don't want to stick my nose where it doesn't belong, etc. -- and I want to be sensitive to the vulnerable place she's in right now, just dealing with all the new mom stuff - but also to let her know it's ok to get help, if needed, in case she does cross that line of overwhelmed into actually depressed... Anyone who went through this (or had someone close to them) have any suggestions on how to help, or recognize when that line has been crossed? Or resources she can turn to if needed? She knows she can call me anytime (but I'm no specialist), but then sometimes goes off the map for several days at a time. I'm not sure her partner knows much about it, and I really don't want to offend either of them. Thoughts? Anon

It is difficult to find someone who has experience in this area (including therapists and psychiatrists). I recommend this blog as a good place to start: www.postpartumprogress.com. You can find a list of local therapists to call that can offer specific advice on how to help your friend. Lee Safran in Kensington runs a ''postpartum stress'' support group. That is a good place to start if your friend doesn't believe she has PPD, but is struggling. She can explore issues she's having without automatically labeling her as having PPD and meet other moms who are struggling also.

If your friend has PPD, she may be in denial so she may not be receptive to the suggestion. However she will reach a point where she is overwhelmed and knows she needs/wants help. She will then be ready to accept that she needs help. You don't want her to go past this point, though, and harm herself or her baby.

More you can do: Check in with her regularly. Ask her how she is feeling, how she is sleeping, what she thinks of new motherhood, the new baby etc. If she has trouble sleeping (even if it seems normal), if she loves her baby more or less than she thought she would, is feeling sad, depressed, overwhelmed, angry, etc. she may have PPD. Gently point her to the resources you've found, such as the support group or therapist. You could offer to go with her to the therapist and watch her baby in the waiting room. Listen, even if she is irrational. E.g. perhaps she is worried about a weird smell. Listen to her, and gently tell her that you don' experience the fear the same way (i.e. you wouldn't be worried about the smell). Do not negate her feelings or suggest ways to get rid of them (e.g. tell her to clean the oven to make the smell go away).

Point her to PPD resources now, such as that blog. Have her read about it or read it aloud to her and see if she can relate. Just say, ''I noticed you seemed overwhelmed and I came across this interesting article about new motherhood'' or something like that. You can also ask the moderator for my email if you have more questions. PPD Survivor

Young mother of 4-month-old w/complete mental breakdown

A member of my extended family has recently had a complete mental breakdown. She is the young mother of two adorable kids and needs free or low cost psych services in the Sacramento area as she has no health insurance. She has been diagnosed as Bi-polar and Schizophrenic after a brief (emergency) stay in the county hospital. But many members of our family wonder if this might be a case of Postpartum Psychosis instead since she does have a 4 month old baby. Any referrals or contacts that might be able to help her and her family would be appreciated. Worried Cousin

Postpartum anxiety/depression unsupportive spouse

This is really difficult. Two weeks ago I had baby no.2. The first few days were fine, but I gradually slipped into a state of constant anxiety - excessive worry about the newborn, and a sense of very ''real'' fear - of the ''impending danger'' variety. I spend a lot of time worrying about the baby and (serious) illness. I cannot stop wondering if my 3 year-old toddler will bring something home and infect the baby. I am starting to distance myself from him when I have the baby in my arms - I know this is horrible, and I am devastated by it, but the fear always wins. The only way I can get through the day is to think that another 24 hours have gone by without anything bad happening - it is like a countdown to the 6 week mark at which point the baby's immune system will be better developed. I have also become afraid to cook, or prepare certain foods, i.e., meat, due to the possibility of contamination and threat to the baby. As a result of these (irrational) concerns I am having an incredibly hard time taking care of my other child. The whole thing is awful, and it is making me very depressed.

Meanwhile, I am living with an unsupportive spouse. We are not communicating very well, and everything I do is misconstrued as deriving from some (apparently hidden) intent to harm the family, etc. Last week we practically separated, and there are occasional threats of moving out, my moving out, etc. This is very hurtful because I am desperately in need of support, yet I am being treated as if I were some sort of evil monster. The other problem is that I am (obviously) over protective, and therefore uncomfortable watching anyone (including immediate family) handle the baby without a thorough hand washing. So, in addition to all of the above, we have major disagreements about how often is appropriate, etc. I would certainly be better able to try to overcome this problem if I had the right amount of support - but I feel so much anger and resentment constantly directed at me that it has become very difficult. I know that it must be hard to live with somebody who has these problems, and I take responsibility, but at the same time I feel very isolated by the lack of consideration.

I have spoken to a few friends about the situation, but nobody I know has gone through anything even remotely similar. I am really hoping that I hear back from someone who can possibly relate. I know most would advise me to seek professional help, and I am willing (even up for a trial of anti-anxiety meds, although I am not thrilled about the idea since I am nursing). It would be extremely helpful to hear from anyone having gone through postpartum anxiety. - Feeling very alone -

Have you spoken to your OB/GYN about this? What does s/he say? I would start there. The next thing to do is to see a therapist (and couples counselor, if you can do both, or perhaps just a couples counselor, see below) and potentially a psychiatrist. The therapist can help you, long term, to work on whatever issues might have triggered this, while the psychiatrist would be there to manage any medications you might need to take. The OB/GYN can prescribe any drug but my experience has been that they tend not to know as much about the drugs themselves -- which ones work best for which people -- as the psychiatrists do. If you do go this route, I would cross-check whatever your psychiatrist prescribes with your OB, just to make sure that it is not expressed (or minimally expressed, whatever the best case scenario is) in breast milk, etc.

Your husband and the way he is reacting to all of this is another big factor here. In my personal opinion (not being any type of mental health professional, but having gone through something similar), it is important that he is included in some of the work that you are doing so that 1. he is held responsible for his own behavior (it sounds from your description like he has some issues around this whole thing himself and that, conveniently, he is pathologizing you so that he doesn't have to work out what is going on in his own head -- at the very least, this is making him act like a big pain in the you-know-what) and 2. he can gain a feel for what you are going through and perhaps develop some empathy for your situation.

I realize that I included a LOT of professionals above. Listen, this won't get better on its own. You need support; don't be afraid to bring in the big guns. Your life, your health, and your children's health are on the line here. Know that it is important to take care of yourself, first and foremost. anon

2. Your theories about germs are simply incorrect. As a nurse practitioner and nurse midwife, I am happy to tell you that your baby is exposed to all kinds of germs and that this exposure is not nearly the biggest threat to your baby's well being. You have simply chosen the germ issue as a place to focus your anxiety.

3. You are correct that your anxiety is a problem. The fact that you have identified the problem is good evidence that you are ready to and able to heal. Seek the help of your OB/midwife. You need sleep, support (outside of your husband) and possibly medication. What good reason is there for you and everyone else around you to continue to suffer like this? Sleep, support, medication.

I did seek help both starting on drugs and seeing a therapist who specializes in postpartum anxiety and although I still have insomnia moany nights my day to day life has turned around completely.

One thing that people said right away when I started seeking treatment for my condition is how important it is for the mother to get help operationally so she can care for herself. I resisted this mightily but I ultimately needed 2 weeks of essential round the clock help and then a month or so of help at dinner time a few nights a week. Between the times I have needed paid help and the therapy which my insurance does not cover, I have made a real dent in my savings account but it has been worth every cent to be able to get healthy enough to enjoy my sweet baby.

There is surprisingly little support in this area for postpartum anxiety/depression. A therapist named Lee Safran runs the one support group I know of, but the timing didnt work for me so I didnt end up doing it.

If you do ever want someone to talk to who understands, feel free to contact me through the moderator. You are not alone!!

Don't be afraid to try meds-- it's far worse for kids to grow up with a depresses/anxious mother. Also if you allow this to go untreated it *greatly* increases the risk of a more severe relapse. Been there

If you would like support and want to talk more, please contact me through the moderator. I know for me, PPD was the hardest thing I have ever been through. Please get support-don't try to tough it out alone. BTDT

My advise to you is exactly what you stated in your post: please seek out some professional help. I have, and it has reduced these fears considerably. Also, don't assume that your treatment will require prescription medicine. It may, but it may not. Thinking that treating your anxiety will require you to stop nursing will only prevent you from getting the help you need.

As for your partner, my guess is that he does not understand how ''real'' these feelings are. If he did, he would feel sympathy, not anger towards you. Who would ''choose'' to be this anxious?

Until you get some help, I recommend that you don't make any major changes in your life (e.g. separating). Things will be clearer once you have gotten some help. Good luck. Trying not to worry....

I do think professional help can sometimes be useful, but to be honest, there are so many poorly qualified or unskillful therapists out there, it can be tough to find a good one. I could see a good individual therapist or couples therapist being of help, though. It is very normal for couples to have problems following the birth of a child and a good couples therapist might have some excellent ideas (e.g., spending alone time together, improving communication) that could help you and your partner. Perhaps you can ask people you know whether there is someone they would recommend. Honestly, I haven't had any success in finding a therapist this time around. I am not a proponent of medication, but it worked for me, and it may be worth your trying an SSRI. You could continue to nurse on it or stop, depending on your comfort level. You might also look for a local support group. Sometimes talking with peers is helpful, too.

I am so sorry you are experiencing this. For what it's worth, you are definitely not the only one. You are welcome to e-mail me, if you think it would be helpful. renee

I am a mental health professional and a mama to a toddler who went through something similar during my baby's first year. I struggled with an almost identical situation, except the fears for my baby's health were not quite as pronounced as yours are. You are not alone in suffering this by any means, and you are not alone in facing a spouse who cannot comprehend what you are going through and thinks you have morphed into a crazy, aggressive, irrational alien overnight, while you feel desolate and abandoned in your overwhelming anxieties and isolation.

There is a rational, observing part of you that is still able to assess your condition as out of balance, and this is good. This part of you is reaching out and calling to be helped. And that is so healthy! You are asking to be helped in your all-important role as the person responsible for the life and well-being of a newly-born little individual. There is no greater responsibility! You cannot do this in a polite and civilized manner because you are riding the crest of cosmic birth forces, to put it metaphorically but accurately. I frequently thought at the time of my struggles that a little clan of supportive mothers and female helpers would have made the storm much less forceful. It is a very adaptive emotion when tempered with guidance from caring helpers. Unfortunately, we mamas these days tend to be socially isolated, which makes us vulnerable to overwhelming emotional storms. That is a long way of saying that yes, you are suffering from a pretty serious case of postpartum depression, and yes, it is entirely understandable.

Given your immediate situation now, my urgent advice is for you to seek professional and supportive help now. At the risk of sounding flippant, forget your spouse right now. Politically incorrect or not, I am convinced that men are fundamentally different from women in this. They do not bear children and cannot imagine what this feels like, so their reaction to the postpartum mama bear syndrome is bewilderment at best. At best. And at this critical moment you two are both overwhelmed and not in any condition to to work on your relationship or understanding each other's point of view. That's a luxury you cannot afford right now. Please go take care of yourself by seeking immediate psychiatric support from your health care provider. Ask for support groups for new mothers while you are there. Do it today. No, do it yesterday. This condition tends to get worse if left untreated because the physical exhaustion accumulates and leaves you with less and less coping resources.

Here are a few reassuring words of advice, for what they are worth, while you are dialing your psychiatrist: remember, babies are not nearly as vulnerable to physical disintegration as we imagine. Babies are born in war zones, refugee camps, and slums all over the world. They live and continue to overpopulate our planet. The babies of our distant ancestors were being born in caves and on forest floors. They, too, survived without the benefit of modern sanitation or boiled bottles and pacifiers. Babies are incredibly resilient. What babies need more is an EMOTIONALLY clean environment. That means a mama who is calm, soothing and nurturing, not an angst-ridden one.

I would also emphasize that your toddler needs the same. So please, for the sake of both your children and yourself, don't worry about some traces of antidepressant in your breast milk. The advantages of a healthy, emotionally balanced and supportive mama far outweigh any negligible residue of medication in your supply. You need this support right now. And your older child needs you. He must be frightened to see the household spinning out into fighting chaos. Ask for anti-anxiety medication along with antidepressants, as the latter take a while to kick in and can initially disrupt sleep, which is the last thing you need. And anxiety is clearly a huge problem right now. Feel free to ask the moderator for my email if you would like to talk more. I do get it. anon

I want you to know that it got a lot better for me, my daughter, and eventually for the marriage. The post-partum hormonal cocktail combined with all of the stress is intense and very difficult, but you may find that it eases over time and even a couple of weeks from now, you'll look back at the most difficult moments and it'll seem like a long time in the past. In our case, I felt better physically/emotionally at about 8 weeks pp but it took a bit longer for husband and I to really sort out our communication issues.

All of the above said, if you are feeling desperate or worried about doing something drastic, please seek medical help. There is nothing to be ashamed of, and in fact it takes wisdom and courage to ask for what we need. Best wishes to you. Erin

I assume you will get a lot of Been There, Done That emails here. Please show your husband, so he can see it is normal. And don't be afraid to laugh about it. You are going through a stressful time. Human emotions are weird. But you love each other and have an amazing new addition to your family.

Remember:
1) It is natural for your hormones to make you overprotective now. Please remind your family about this biological fact.
2) I don't think you are being unreasonable about the handwashing. It's simple and can help prevent a lot of misery.
3) You have to try to get over your fear and show your toddler some serious affection -- make a time to go out together when you will be away from the baby, just the two of you. Even if it's just for an hour. The difference will be amazing.
4) Keep an eye out for PPD and tell your husband to, too. If you ever start feeling destructive, walk away. I know that seems like the opposite of what you are feeling now, but the anxiety can build and take you new places.
5) It gets better each week
Hang tough, mama. Been There

You need to take steps to take care of yourself. Everyone always said this to me, and I was like, whatever. But eventually I found that if I didn't deal with the acute anxiety I had after each of my kids was born, I very quickly went down the path of feeling alone and crazed with worry about my baby and the rest of my family. As that happened, my relationship with my husband became more and more strained. It's pretty easy to not make appointments or not take care of yourself because there are always things to do to fill that time--take care of the baby, laundry, grocery shopping, whatever--but it's so important to press pause on the rest of your life to take steps to deal with the very real feelings you are having. Supporting you from afar

First thing you MUST do, is find a professional who deals with this who can support you. He/she will guide you on how you can deal with your spouse. You can take your kid(s) with you and get support and help.

If you live in the East Bay, Lee Safran is a therapist who deals with PPD and other post partum mood disorders: http://www.leesafran.com/. Call her and if she can't take you/doesn't take your insurance, she will direct you to someone who does or who can do a sliding scale. She also runs a support group.

If you are in SF, the peninsula, or South Bay, or anywhere else and you can do the commute, contact Kris Peterson at El Camino Hospital in Mountain View. They run an intensive outpatient program that you can bring your baby too. You can nurse your baby, rock them, hold them, etc. all during group sessions. http://www.elcaminohospital.org/Womens_Hospital/Pregnancy_Childbirth/Maternal_Outreach_Mood_Services. I attended this for several months and found it life-saving for me, my relationship, and my baby.

You can also call the post partum depression warmline here: 800-944-4773 or maybe (888) 773-7090 Postpartum Depression Hotline. You have to leave a message and they call you back, but it's an excellent way to get support.

Also, there is this blog here: http://www.postpartumprogress.typepad.com/. The woman who runs it had post partum OCD, so know you are NOT alone and this is very common. Also, there are A LOT of good resources on this blog that you might find helpful. There is also a yahoo group for silicon valley (and probably the entire bay area) here for PPD support: http://health.groups.yahoo.com/group/svppmd/. You should be able to find support and suggestions on here that are helpful.

It took a long time for my spouse to come around and be supportive and understand me and what I was going through. I also suggest you consider medication, but please see a psychiatrist who is familiar with post partum mood disorders before you see just any doctor. Lee or Kris (at El Camino Hospital) can direct you to good people. I wish I would have taken it sooner. Once I did many of my symptoms have been relieved or non-existent.

Also, you can contact me for support! Please email me and I will send you my phone number right away so you can call me if you need anything. Really. Hannah

I had issues very similar to yours after my baby's birth - but not the insight you have to see how irrational and fearful I was. I became very germ phobic and wouldn't go out with my baby, which made me feel insane. I wouldn't let others hold him which also didn't go over well with my family and friends.

A few things helped a lot. I did end up going on Zoloft which I think helped tremendously. I was very resistant to it but after thinking about it a lot in therapy, I decided to try it and I'm so glad that I did. I saw Lee Safran, MFT and she actually gave me an article about how women's brains look more like OCD brains after childbirth which I thought was facinating. I've always had some anxiety/OCDish tendencies like needing all the dishes done before I can go to sleep at night, but it really skyrocketed after my son was born. I liked her smart and non-pathologizing approach.

My husband and I also went to a workshop she presents called From Partners to Parents and it opened up a lot of opportunity for us to get back on track. I don't think he would go to therapy with me, but he was up for that and it gave us some tools to work together instead of against each other.

I so feel for what you are going through and hope you continue to reach out and get the support you need. Anonymous

Postpartum depression or just sleep deprivation?

My husband is convinced that I am suffering from post-partum depression in addition to the effects of severe sleep deprivation due to the fact that our 6-month old baby refuses to sleep in the crib and wants to cuddle next to Mom and breastfeed all night long. I can't nap very often during the day because we also have a 2 1/2 year old.

I don't feel depressed. Its certainly true that I am exhausted all the time, distracted, irritable, have difficulty concentrating and completing tasks, and am not as cheerful as I used to be. But it seems to me that these are all natural effects of sleep deprivation. We're working step-by-step at getting the baby to sleep on his own in the crib, hopefully in another month or so we can all sleep through the night.

But maybe my husband can see something I can't, after all, he knows me better than anyone else. How would you tell the difference? Does anyone have any resources or suggestions for dealing with (possibly mild) postpartum depression and/or baby-induced sleep deprivation? Exhausted Mama

I met for a while with a therapist, Lee Safran, who was recommended on BPN. She was extremely helpful in terms of gaining some perspective on what was going on for me. She had me fill out an evaluation form which helped me clarify both what was and wasn't ''normal'' for having 2 kids (and a partner who worked long hours.) I would recommend her highly. She can be reached at 496-6096.

Please take good care of yourself. It is really tough work taking care of two little ones. - No longer sleepless...

So before you ask for Prozac: have hubby watch the kids for 1/2 hour every day (and for longer 2 days a week) while you go for a walk and have some time to yourself. Fresh air and exercise are excellent anti-depressants--recommended by my psychiatrist. Once or twice a week, spend an hour or two to get together with a friend or read a book or do something just for you.

My guess is that you'll come back feeling better ... and your husband will be asking for Prozac! Fix the Fundamentals First

Your obstetrician or GP could help with post-partum depression or determining if it's sleep deprivation. You could also check http://medlineplus.gov/ & see if there's different symptoms for those conditions.

A whole month for a sleep solution sounds like a really long time to me - and most babies have another sleep transition at 9 months, so you might hit that at the end of your plan. If it were me, I would check in again with my pediatrician about the sleep plan. Good luck! Alison

Feeling so depressed with 3 month old

I feel like I am going crazy! I have a 3 1/2 month old son and all of a sudden I am feeling so depressed and having anxiety. I was FINE until a week ago. About 2 weeks ago I finished nursing, I had worked SO hard at it, and now I keep wondering and feeling guilty as to why I stopped after 3 months it wasn't very easy for me and i kept telling myself I would stop after 3 months, so I did. I immediately went on the BC pill, didn't like that one, so changed to another one. My husband and I went away for the night last weekend without the kids and the day after I got home, I started having panic attacks and feeling depressed, I now feel like I don't want to be around my 3 1/2 month old son anymore and I want someone else to take care of him. I also feel like I don't love my 4 1/2 year old son as much as I did before my other son was born(I also went through about 5 miscarriages in between kids, so my 4 1/2 year old was EVERYTHING to me). With my 4 1/2 year old son and I had a bad but very short bout of baby blues with him when he was born for only about 2 weeks. Also, my 3 1/2 month old was in the NICU for a couple of days, but is okay now. but, up until a week ago when I started feeling like I don't care about him anymore, I was so worried about every aspect of his development, not I feel like I don't care. I want my life to be like it was a week ago. I just feel like I don't want to do this anymore, why in one week has this changed after 3 months!!! Will I get back to normal?? my old happy life and feelings?? thank you!

I have been on celexa for about 4 years. When i got pregnant last year, I was very concerned about continuing. I consulted, at length with my psychiatrist and with my OB, about the possibility of damaging my child in ANY way. After looking into medical research, not on google,we all agreed that the research showed that the side effects were very minimal for celexa - And that it was VERY important to have a happy mommy.

There is such stigma about anti-depressants. Consider if you were a diabetic; you would need to take medication to maintain proper chemical balance in your body. It's the same with mental health issues. The off balance of chemicals in your brain is not about you; and it's not about you not trying hard enough or being strong enough to overcome it. It's simple a chemical imbalance.

{I work in mental health as well. thanks for the opportunity to say my two cents about this!}

Postpartum depression the second time around

I had postpartum depression with my first child, which was a horrible experience (in part b/c I had no idea what was wrong with me for months before I got help). I'm 5 weeks away from giving birth to my second child, and feeling upbeat and happy, but am worried about the chances of having postpartum depression again. From doing a little bit of research, the statistical chances of having a recurrence of postpartum depression are surprisingly high (50-80% likelihood). Some research suggests that women begin taking anti-depressants right after the baby is born in anticipation of a recurrence. Prozac worked with me the first time around, but it seems a little crazy to imagine taking anti depressants before depression hits me (but also crazy to even let myself get depressed again). I'd love to hear about the experiences of others who had postpartum depression with their first child, and whether or not they were hit again the second time around, or what they did to stop it from recurring. Thank you for sharing! nervous mama

All I can say that it will get better. It happened with us at around 11 months. Suddenly our boys were chasing each other around the crib and laughing hysterically. They will begin to entertain one another. Now I can take both of them out to dinner on my own. Because twins are so difficult at first (and I can't imagine what triplets would be like), when it gets easier, it seems as if a tremendous weight has been lifted.

A great resource is the San Francisco Mothers of Twins club (http://www.sfmotc.org/), which has a wonderful newsletter (The Diaper Rag) and a great bulletin board on line. Bill

Postpartum anxiety - haunted by fears

I have been dealing with Postpartum Anxiety for the last year. I had a milder case of it with my son and now with my daughter it's worse, including a couple anxiety attacks. Sadly, I didn't realize that that was what I have been going through. I had a really traumatic childhood and figured it was triggered by the birth of my children and preceded to go to a psychotherapist who diagnosed me with childhood trauma and unfortunately didn't know much about Postpartum.

After talking to a friend who told me about her postpartum depression and anxiety experience I did a bunch a research and realized I am suffering from Postpartum Anxiety and have been for almost a year now. I am doing better but still am haunted by some fears especially of dying. I am looking for any kind of support group or a therapist that deals specifically with these issues. I am also really wanting to hear from other women who might have experienced this. I have felt so lonely and isolated, thinking something is really wrong with me. Any support or information would be so appreciated. Thank You

Zyprexa for post-partum anxiety?

Since having a baby 18 mos. ago I've been experiencing increased anxiety, insomnia, temper, etc. And recently it's been exacerbated by some major life changes. I started going to counseling, and recently went to the doctor in search of some additional help. My doctor prescribed Zyprexa as a mood stabilizer. I looked up info on the web and it seems that this drug is primarily used for schizophrenia and bipolar disorder. I was hoping that someone might be able to provide me with some personal experience with this drug...and perhaps the difference between it and Paxil or Celexa (or other more common anti- anxiety meds). Thank you so much. anon