Preparing for postpartum depression means having a plan

By Kate Rope, The New York Times, Oct. 23, 2014

depressed-momI knew from the beginning that I had a good shot at postpartum depression if I gave birth again. My first bout with crippling postpartum anxiety propelled me into a career of writing about maternal mental health, so I knew my history increased my odds. Still I was stunned when the panic slammed into me moments after my second child made her exit from my bloated, pregnant body.

The first time around, the anxiety crept up on me. Like a Trojan horse, it made sly use of regular new mom fears about safety and health to sneak full-blown irrational panic deep into my psyche.

By the time I got help nine months in, I wasn’t sleeping, threw up before work, and was haunted by repetitive fears that my baby was very sick. I screamed for an escape from my distorted mind.

I found one through a fantastic therapist, a reproductive psychiatrist and the antidepressant sertraline. The combination was so successful that I weaned off the antidepressant to try for child No. 2.

But before benching my IUD, I made a plan.

I asked my obstetrician about treatment options if I developed anxiety during or following pregnancy. If therapy wasn’t enough, he said, sertraline was a low-risk choice. My reproductive psychiatrist said it would also be safe for breastfeeding. I told her I would check in after delivery, and my husband and I agreed that I could tell him any feelings I had, no matter how scary. He promised not to judge me, but to help me.

And then on a freezing February morning, after a short labor, I pushed my second daughter into this world and descended into another one. This was no creep. This was Defcon 1, “terror alert red” panic.

As the nurse pronounced my daughter’s prodigious weight — 9 pounds, 14 ounces — I was instantly consumed with the fear that I had gained too much pregnancy weight and doomed her to diabetes. I stared at the not-so-little being on the scale, as my obstetrician beamed from between my shaking legs. “What are you feeling?” he asked. “Overwhelmed,” I said, fighting back tears.

I was so scared of the “what ifs,” I could find no joy in what was.

But this time I knew something was wrong right away and told the obstetrician and the pediatrician on call. They said I could take a small dose of the anti-anxiety drug lorazepam while nursing and go back on sertraline if need be. I got my reproductive psychiatrist and therapist on the horn.

We had multiple phone sessions in the following weeks. I used lorazepam sparingly and told myself repeatedly that my mounting fears were not facts. But when my pediatrician diagnosed a small health problem in my new baby, I descended back into the world in which things were very wrong with my children and they were my fault.

Instead of losing myself in sleepless, nauseated despair this time, however, I returned to a small dose of sertraline, swam back to the surface, and resumed life as a mother of normal fears, capable of smiling and laughter.

My goal now, as a writer, editor and friend, is to acknowledge, in a practical, proactive way, the tectonic hormonal and emotional shift that comes with bringing a person into this world, and the importance of preparing for it.

Here is my suggested game plan for anyone planning for parenthood:

•Get to know the symptoms of postpartum mood disorders, especially less talked-about ones like anxiety, extreme irritability and rage.
•Create a sleep plan so you and your partner alternate getting uninterrupted stretches.
•Commit to moving your body as soon as your physical recovery allows.
•Find new-mom get-togethers so you have support and a reason to get out of the house.
•Pick someone with whom you feel safe and ask if you can tell him or her any scary feelings you have during and after pregnancy.
•Bookmark organizations that offer confidential help: Postpartum Support International, the Postpartum Stress Center and in New York, the Seleni Institute (I am editorial director of this nonprofit maternal mental health center). Check out this comprehensive nationwide list from Postpartum Progress.

Women with a history of a mood disorder should add these steps:

•Program your phone with professionals — your obstetrician, primary care doctor, psychotherapist, etc. — you will go to if you need help, and talk with them before delivery.
•Research the breastfeeding safety of any medications you have used in the past. Two great resources: LactMed and the Infant Risk Center. Both have apps for your phone that you can take to doctors’ appointments.

Putting a plan in place does not guarantee that you will have a postpartum mood disorder or that you won’t. It does guarantee you will know how to get help if you need it. And as someone who has taken both the slow train to emotional recovery and the express, I recommend the express.