Tag Archives: Anti-Depressants

Medication or Therapy?

In a very insightful piece at the NY Times in the Well section, “To Treat Depression, Drugs or Therapy“,  Dr. Richard Friedman, M.D., explores recent research which examined the manner in which people respond to either medication, therapy, or both.

It’s a question we hear a lot as we support women fighting their way through a Perinatal Mood & Anxiety Disorder. The concern is valid, for a variety of reasons. Breastfeeding mothers worry about what the medicine will do to their children. All mothers worry about the stigma about being on a medication. Therapy provides its own challenges with childcare and financial being the two primary ones.

So how do you choose? Why is it that what works for one doesn’t work for another?

Turns out, according to the research Dr. Friedman examined, it comes down to our brains. The research, led by Dr. Helen Mayburg of Emory University, holds great potential for successful treatment of those of us who struggle with mental health issues.

“Dr. Helen Mayberg, a professor of psychiatry at Emory University, recently published a study in JAMA Psychiatry that identified a potential biomarker in the brain that could predict whether a depressed patient would respond better to psychotherapy or antidepressant medication.”

Read that again. A biomarker. In the brain. This vein of research, which involves imaging the brain, may one day allow us to side step the arduous task of finding the right medication for our own situations.

Go read the article, which also touches briefly toward the end on Dr. Charles Nemeroff’s research regarding the treatment response of those who endured childhood trauma. (This is also very enlightening).

Mental health will always be a challenge. How our brain works affects everything we do, everything we are, everything we hope to be. It’s a fight to get it all done. But it’s a fight worth every single breath.

Finding Life at the End of the Comfort Zone

On our refrigerator, there is a simple black square magnet with white words in English sprawled across it. This magnet blends in with our refrigerator, making the words even more noticeable as it rests at the top of the freezer door, right in the center. What are these words?

They say this:

“Life begins at the end of your comfort zone.” ~Neale Donald Walsch~

J purchased it for me on a dreary Sunday last winter during a visit to a local art museum. Of all the colorful things in the gift shop, the simplest thing, devoid of any true colour, caught my eye.

Why?

Because the words spoke to me. They challenged me to push myself further than I was comfortable. For the first time in weeks, I felt hope. When we bought the magnet, it was not too long after Sandy roared through our area, leaving me more traumatized than I wanted to admit.

Over the past year, I have pushed myself past my comfort zone. I auditioned in NYC for Listen to Your Mother (and am auditioning again this year, only for Northern New Jersey), I joined an in-person mom’s group, and I am back to pushing myself again after a setback with former neighbors which left me afraid to set foot outside by myself, even after we moved.

Within the past month, I started going back to the gym, I’ve ventured to various places by myself, and I plan to start walking around the neighborhood once it’s not covered under a ton of snow and the temperature won’t turn me into an instant popsicle. Oh, and I am learning how to drive in the snow. Slowly. Don’t laugh, most of my driving years were spent in the deep south where it does not snow often. Yes, I am a Jersey girl and perfectly capable of tolerating the cold but that doesn’t mean I know how to drive in the snow. It’s not that difficult to do, I’m realizing.

I owe this diving out of myself to the courage in asking for help.

I made a phone call back in December to our nurse practitioner to follow up with her about the situation with the neighbors. I saw her back in August due to extreme anxiety because of the situation – anxiety which left me afraid to open the blinds, turn on lights, or do anything beyond sit on the couch and watch TV for nearly 5 days straight. My sleep even suffered and my appetite vanished. I refused to leave the condo, in fact, unless J was with me. I needed help. In August, she prescribed something for anxiety. It worked and got me through the remainder of our time there as well as through our move.

But my prescription ran out.

We were happier at our new place. It was quiet, no screaming children at 11pm, no neighbors calling us names, no trapped in a dark condo. Instead, there was peace, quiet, and a lot of sunshine as all the blinds were opened and the light poured in from every possibly window. I still found myself triggered by certain situations and sounds despite the new tranquil environment. Shell-shocked from the former residence.

Then J was suddenly let go from his job and we faced losing our brand new place. With some careful maneuvering and help from family and a few wonderful friends, as well as some well-timed freelance work,  we managed to hang on. He found a job, and has been working steadily. I am still trying to  get freelance work going but haven’t lost hope.

While he was unemployed, I was the rock. I did not panic, I held fast and trusted that he would get a job. Once he did, I unraveled – fast. I was wildly unprepared for the roller coaster exit.

J sat me down one night and quietly shared his observances – that he was worried about me, I wasn’t myself. He suggested I call our NP. I struggled with the suggestion. I made it so far without medication. So far. Through a divorce, through the struggle of job-hunting and never hearing anything back, then through Sandy. All of this by myself. I was not sure I wanted to take a pill to get by again. I couldn’t. Could I?

Finally, after realizing every possible option but taking medication had been explored yet I  was still struggling, I made that call in December. We talked about SAD (Seasonal Affective Disorder), situational issues, and what medications had worked for me before. I talked quickly, fighting the urge to just hang up. She was wonderful and very non-threatening, telling me that she would call in the script and I could pick it up if I chose to but did not need to feel beholden to it.

I picked it up the next day.

It has been almost 6 weeks and I have picked up a refill.

The medication is helping quite a bit. I am focusing, I am laughing, and I feel more like me.

Going back on a medication felt like defeat. It felt as if I was calling it in, giving up. But I know that I tried everything I possibly could before making that call. Making that call? WAY outside my comfort zone. It is the most uncomfortable thing possible to call your doctor to tell him/her that you are not emotionally stable. Yet, if it were a broken bone, I would have rushed to the ER. Stigma is a pervasive bastard – I hate it.

Every morning now, I swallow hope, in the form of a small white pill.

One day, perhaps I will get to a point where I will simply hold hope in my heart and mind, not in my stomach or blood stream.

But for now, that is where my hope lies, intermingling with my stomach acid and my blood cells flowing through my veins.

I’m okay with that because I know it is without a doubt, what I need to be the best me I can be right now.

Therapy Choices for the Postpartum Woman

Once diagnosed with a Postpartum Mood Disorder, you are then faced with a literal bevy of choices regarding your path to wellness.

Some doctors may toss pills at you. If that happens, run. Run very fast and very far away from any physician who shoves anti-depressants your way before you’ve even finished describing what’s wrong. A good prescribing doctor will sit down with you and hear you out before grabbing for his pen and pad (or these days, keyboard and internet connection). A good physician should also run a couple of simple blood tests first to rule out thyroid disorders or anemia which need completely different types of medication to show improvement.

Some doctors may suggest psychotherapy. And that is where things start to get a little sticky. What kind of talk therapy? Will there be a couch? Will it be comfy? Will I have to talk about how my Great Aunt Edna used to kiss me on the cheeks and leave funny lipstick stains? Will I have to talk about things not related at all to my current state of mind? Will I be hypnotized? Or any other strange mumbo jumbo I’ve seen happen on TV or in the movies or from my best friend who found this website and…

Hold the phone there.

Cognitive Behavioral Therapy proved to be the best option out there for me. There was a couch but I didn’t lay down on it. I sat cross-legged on it as I drank coffee and chatted with my therapist. She sat in a really cool rocking chair with a foot stool. I got along fabulously with my therapist. That’s not to say we were bestest of buds but she knew what she was doing, just let me talk and work a lot of my issues out. I did occasionally talk about things in my past but it wasn’t at all like “So, you were born… let’s start there.” She met me where I was and let things fall where they fell. Or at least she seemed to. She did ask questions to get me to think about issues and how I was reacting to them. I had not planned on staying in therapy for long but once I became pregnant again, I made the decision to stay in through my pregnancy. Therapy gradually stopped at about 6 months postpartum of that pregnancy as we scaled our sessions back.

While I will not be covering every single last type of therapy out there, my goal is to provide some basic information for the most common therapies  used with Postpartum women.

At the top of the list is Cognitive Behavioral Therapy which is actually a blanket term for several types of therapies with similar traits. Primarily Cognitive Behavior Therapy (CBT) promotes that WE have power over our moods through our thoughts. You can read more about it by clicking here. A great resource now available for women and clinicians alike when it comes to treating Postpartum Depression is Karen Kleiman’s Therapy and the Postpartum Woman. You can read more about it by clicking here. (In the interest of full disclosure now required by the FTC, I have not been compensated at all for including this link. I sincerely believe it’s a good resource.)

EMDR or Eye movement desensitization and reprocessing is gaining popularity as an option. EMDR is most effective with Post Traumatic Stress Syndrome. You can read more about this approach by clicking here.

Peer Support/Group therapy is also an option. The primary benefit of this option is the realization it provides to women of not being alone. They really aren’t the only ones having a panic attack when they get in a car or experiencing frightening thoughts prancing through their mind at the most inopportune moments. Many times this option is a cost-effective option as well because many groups do not charge. A group led by a therapist may only charge a small fee such as $10-15 for attending. While peer support should absolutely not replace professional medical care for Postpartum Mood Disorders, it is an important aspect to add to recovery. If your area does not have a local peer group, you can find help online. The Online PPD Support Page has a very active forum for postpartum women. You can also visit the iVillage Postpartum or the Pregnant & Depressed/Mental Illness Boards. (Shameless plug on the iVillage boards, I am the Community Leader for both.) Another bonus of peer support? It reduces the recovery time.

Pharmaceutical therapy is also an available option. Some women are against taking medication and that’s perfectly okay. No one should ever be forced to take medication. Typically, pharmaceutical therapy is paired with another type of therapy. In fact, combining pharmaceutical therapy with a type of Cognitive Behavioral Therapy has proven to be one of the most successful approaches for the Postpartum Woman. Sinead O’Connor really put it best during an appearance on Oprah in regards to the function of psychiatric medications. They are the scaffolding holding you up as you revamp yourself. There are risks involved with taking medications and you should absolutely educate yourself, talk with your doctor, and if you end up deciding to take medication, be sure to inform your child’s pediatrician if you are nursing so they can be involved in monitoring for any potential issues.You should also familiarize yourself with the symptoms of Serotonin Syndrome, a fast-acting reaction which occurs for some people when they do not metabolize medication quickly enough. The build up results in a severe toxic situation. You should also avoid stopping any pharmaceutical therapy without consulting with a physician. Stopping suddenly can cause very negative symptoms similar to Serotonin Syndrome. If you have any signs or symptoms of Serotonin Syndrome, get medical help immediately.

For more serious cases of Postpartum Depression that do not respond to medication, Electroconvulsive Therapy may be suggested. ECT has come a long way since the 50’s and is a viable choice for many women who do not respond to medication. Now, I am not saying that if you choose not to take medication, you’ll be given ECT. This is for women with severe depression who cannot metabolize or do not respond at all to medication. Choosing not to take medication does not buy you an ECT ticket at all.

For women who want to use a more natural approach, there are a lot of choices. Again though, I have to urge you to make sure you are seeing a professional during your recovery. Don’t take something because it worked well for Aunt Martha. Check with your doctor and make sure it’s applicable to your situation and okay for you to take in combination with any other medication you may already be taking. Be sure your naturalist or herbalist is licensed and trained. You’ll also want to make sure that any herbs/natural supplements you are taking are compatible with breastfeeding if you are doing so. You can visit the blog over at Rebuild from Depression for a food/diet based approach.

Note: I had a reader, Steve, from Noblu.org leave a comment regarding IPT or Interpersonal Therapy. You can click here to read his comment. Thanks, Steve, for stopping by and sharing your knowledge with us!

As you can see, there are a lot of options available if you are diagnosed with a Postpartum Mood Disorder. More and more practitioners are becoming familiar with these disorders. More help is available today than even 6 years ago when I was first diagnosed. Remember to ask questions when choosing a therapist, advocate for yourself and what best fits your personal lifestyle philosophy. Don’t settle just because you want to heal. You have the power to say no. It’s your body, your mind, your say.

Tomorrow we’ll be discussing some things you can do on your own to help your recovery along. Stay tuned!

Just Talkin’ Tuesday 10.06.09: Have you experienced dismissive clergy?

Just Talkin Tuesday The church and depressionOn October 2nd, 2009, Psych Central posted about an ongoing Baylor University Study. This study examines the response of clergy and pastors to mental illnesses. As I read the post, tears came to my eyes. Turns out that even though clergy and pastors are the most frequently sought during times of crisis (even moreso than psychiatrists or other mental health professionals according to Baylor’s press release), they are also most likely to be dismissive of mental health issues.

“The Baylor study found that despite recognizing a biological basis to all mental illness, the views of the BGCT (Baptist General Convention of Texas) pastors surveyed vary across disorders in how much they believe environmental or spiritual factors, such as personal sin, lack of faith or demonic involvement, play a role. Major depressive disorders and anxiety disorders were viewed by pastors as having greater environmental and spiritual involvement and were more often dismissed than the more “severe” mental illnesses like schizophrenia or bipolar disorder.”

Another interesting view point of this study was that these same pastors were more likely to recommend medication for a biological illness than for a mental illness. Referrals were more likely to be given to professionals known to be Christan than to those not known to be Christian. Just an opinion on that – perhaps because the clergy/pastors felt these professionals would back up their dismissiveness regarding the congregant’s condition and also not prescribe medication.

Christians struggle with mental illness just like members of any other faith. Dismissing their symptoms or struggles can do so much more harm than good. “The Gospel According to Prozac” is great article focusing on faith, mental illness and medication. It appeared back in 1995 in Christianity Today. The author really narrows the issue down in just one paragraph:

“Ultimately, the primary concern for Christians is not what Prozac will do to them but the whole idea of relying on a miracle drug for emotional and psychological well-being rather than on the God of miracles.”

When I read the Psych Central blog post and subsequent Baylor University press release regarding this study I was absolutely dumbfounded. I cannot tell you how many times I have referred women to their local churches a source of solace. After all, you should be able to rely on your faith in time of need, right? Forgive me if I am mistaken but that is the purpose of the church, correct? Even Jesus loved those who were mentally ill and healed them. And aren’t we all raised to “Love thy neighbor as you love thyself?” To do unto others as you would have done to you? to LOVE those around you regardless of their state? To not judge?

As the magnitude of this study hit me, I suddenly had to wonder how many women I had sent straight to the offices of clergy who only shot them down and left them blaming themselves for their illness.

I believe choosing to take anti-depressants does not make one weak. I believe in the support of the church for those who are hurting. It saddens me to think that there are those on the front lines with their heads in the sand regarding this issue. This month is Mental Health Awareness Month. I want to urge you to visit NAMI Faithnet to read about how you can approach your own church and help grow their sensitivity and awareness towards those with mental illness. I’ve helped other members at my own church and hope you will do the same.

Ok, off my soap box now – let’s get to the Just Talkin’ section of this post. Did you seek help from your local church? What was the response? How did you feel when you approached your clergy? Have you made a difference in the local faith community when it comes to Postpartum Mood Disorders or Mental Health Illness? Talk to me!

Just Talkin’ Tuesday: The MOTHER’S Act

LegislationOn February 23, 2001, Melanie Stokes gave birth to a baby girl. Just three months later, she committed suicide. Melanie’s death gave birth to a very dedicated activist – her mother, Carol Blocker. Frustrated with the failure of physicians to appropriately care for her daughter, Carol worked endlessly to keep Melanie’s tragic death from becoming meaningless. Through Carol’s tireless advocacy and work with Representative Bobby Rush (IL), the Melanie Blocker Stokes Act has now become The MOTHER’S Act.

The MOTHER’S Act as it reads in the current version would provide funds for a public awareness campaign, education campaign for caregivers, increase availability of treatment options and entities as well as require the current Secretary of Health & Human Services to conduct a study regarding the validity of screening for Postpartum Mood & Anxiety Disorders.

More and more research is slowly uncovering potential underlying causes and risks related to Postpartum Mood & Anxiety Disorders. More and more women and caregivers are becoming educated as more of those who have survived a PMAD speak up to share our story.

If passed, The MOTHER’S Act would further reduce the stigma surrounding new mothers not ensconced in the Johnson & Johnson glow of infantdom. If passed, the MOTHER’S Act would increase funding for research and possibly open even more doors to understanding the cause and more importantly, the potential for truly preventing Postpartum Mood & Anxiety Disorders. If passed, the MOTHER’S Act has the potential to prevent tragic deaths like that of Melanie Blocker Stokes.

Much of the debate surrounding the MOTHER’S Act has centered on the word “medication.” Medication does not necessarily mean Anti-depressants. It does not mean this is the ONLY way to treat a PMAD. It is merely listed as an option for treatment. And frankly, if one has a doctor with a quicker draw on his/her prescription pad than Billy the Kidd, I’d run away. I’d run away faster than a cheetah.

Another key point of the opposition has been that the MOTHER’S Act mandates screening. In the current version, there is no mandate for screening. The only mention of screening is to require the Secretary of Health & Human Services to conduct a study regarding the validity of screening for Postpartum Mood & Anxiety Disorders. The current standard for screening is the Edinburgh Postnatal Depression Scale, which you can learn more about here.

You can read a copy of the current bill by clicking here.

Go read it. (Don’t worry – it’ll pop up in a new tab/window – I’m cool like that here)

Seriously. Read. The. Bill.

Then read it again.

And then come back here. Be honest.

Unlike this week’s TIME article which failed to present both sides, I promise to allow unedited comments in support of or opposing the bill as long as they are civil. (Any comments including personal attacks will NOT be allowed!)

So let’s get to Just Talkin’ Tuesday already!

Just Talking Tuesday 07.07.09: Anti-depressants or Not?

original photo by thegirlsmoma @ flicker

original photo by thegirlsmoma @ flicker

Today’s topic was inspired by a post over at Postpartum Progress: You don’t NEED Anti-depressants, Do You?

In this post, Katherine discusses the lack of stigmatization regarding pharmeceutical treatment for medical conditions in response to a ScienceBlogs post you can find here.

Anti-depressants are stigmatized. Period. Nitro-glycerin or insulin? Not so much. Why? Just as Anti-depressants may work for me, they may not work for you. And if you have the wrong heart condition and take nitro-glycerin, things may not go your way either. But you don’t hear people judging others for being on nitro-glycerin, now do you? And insulin? Many Diabetics require this life-saving medication. Even pain medication after an injury – do you question that prescription? Most don’t and certainly aren’t stigmatized for taking it because let’s face it – a broken leg hurts – something we all understand.

Mental illness hurts too. It hurts the person suffering. It hurts the people around them. And if the right medication is paired with the right therapy, it can make a world of difference. Why then, are we stigmatized or accused of not understanding informed consent for deciding (of our own free will) to take medication as we heal? What makes the scaffolding of Anti-depressants any different than pain medication as a broken leg heals?

So I’m posing a pretty big question today. And I expect there will be a bit of debate about it – which is good…our different opinions are what keep us interesting! Just keep things polite. No hateful, judgemental or fear-centered comments will be approved.

Do/did you or don’t/didn’t you take Anti-depressants? Why? Why not?

And more importantly – IS it your place to tell someone else they absolutely SHOULD not take them if you don’t believe in them or have had a bad experience? Or should you calmly refer them to research that explains the risks vs. benefits and let them make the decision on their own WITH a professional on board?

Let’s get to Just Talkin’!

Mindfulness Therapy just as effective as Anti-Depressants

According to a new study out of the UK, Mindfulness Cognitive Behavorial Therapy is just as effective as Anti-Depressants in treating Depression.

The study involved groups of eight to fifteen people meeting with one therapist for eight weeks. The participants were taught exercises they would be able to practice on their own. Professor Willem Kuyken of the University of Exeter said: “Anti-depressants are widely used by people who suffer from depression and that’s because they tend to work. But, while they’re very effective in helping reduce the symptoms of depression, when people come off them they are particularly vulnerable to relapse. MBCT takes a different approach – it teaches people skills for life. What we have shown is that when people work at it, these skills for life help keep people well.”

You can read the article by clicking here.