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Sharing the Journey with Dr. Shoshana Bennett

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Having started out much like myself as a survivor of PPD, Shoshana Bennett has done more than just dig herself out of a deep dark place – she’s risen far above it and has been reaching back to help others find their way back out and into the bright Clear Sky. In fact, Dr. Shoshana appeared just this past Tuesday on The Doctors to speak about Postpartum Mood Disorders and offered to help currently struggling moms. She serves as a true inspiration and source of caring support for those of us who advocate and are struggling through our own dark path. Thank you, Dr. Shosh, thank you.

Would you share a little bit about yourself with us?

A survivor of two life-threatening, undiagnosed postpartum depressions, now considered a pioneer in the field, I founded Postpartum Assistance for Mothers in 1987, and am a former president of Postpartum Support International. I’ve  helped over 17,000 women worldwide through individual consultations, support groups and tele-classes. As a noted guest lecturer and keynote speaker, I travel throughout the US and abroad, training medical and mental health professionals to assess and treat postpartum depression and related mood disorders. I have earned three teaching credentials, two masters degrees, a Ph.D. and am a licensed as a clinical psychologist. Currently, I am working to pass legislation that helps reduce the incidence and impact of postpartum mood disorders. You can contact me through http://ClearSky-Inc.com.

I’ve written Postpartum Depression For Dummies and co-authored Beyond the Blues: Understanding and Treating Prenatal and Postpartum Depression. My latest book Pregnant on Prozac will be available in January of ’09. I’ve also created guided imagery audios that are specifically focused on helping moms take care of themselves.

How did you become focused on Postpartum Mood Disorders? What drew you in to the subject?

Out of personal experience with severe postpartum depressions (along with OCD, panic, and PTSD), it became my mission to educate. There was no help for me back in the ‘80s. When I realized there was a name for what I had gone through, I understood that my family and I didn’t have to suffer like we had. Since then, it’s been my passion to help prevent that pain and isolation in others.

As I look back at my two episodes of Postpartum Depression with OCD tendencies, I see very clearly now how they helped to mold me into the woman I am today and allowed me to develop my tenacity and increase my self-esteem. What are some of the biggest things your experience with PPD allowed you to realize? Through sharing my experience and expertise with clients and colleagues, I experience the deepest, most satisfying feelings. I know my suffering was not in vain – my purpose is to get the word out that there’s hope and that moms will recover with proper help. I get to witness my clients’ lives transforming before my eyes. They often tell me they’re happier than they were even before their postpartum depressions! I am so thankful that out of personal devastation came this glorious path.

As a mom, what have you found to be the most energizing about motherhood? The most challenging?

As many of your readers will agree, our children are our best teachers. My kids always hold up that proverbial mirror so I will be the best person I can be. This is both what’s most energizing and most challenging. It’s not always easy to take an honest look (right?), but I truly love the personal growth involved. I find this challenge stimulating and exciting.

What are some of the biggest challenges you have faced in juggling motherhood and work?

I earned a doctorate degree when my children were quite young. Most of my studying and papers were completed between 3 and 6 in the morning, before my kids woke up, which took some discipline. Also, working from home can be easier in some obvious respects, but more challenging in others. For instance, I needed to learn to keep my work contained in my office , instead of letting it spill into my kitchen and living room. Psychologically and physically it took some practice setting and keeping those boundaries.

We often encourage mothers to remember to take time for themselves. What is it that YOU do to recharge your batteries?

In between writing chapters for my next book Pregnant on Prozac, I take walks, do yoga, and visit with friends. I travel and speak quite a bit, but these are things I can do anywhere. Almost every day I put on some great, upbeat music and I focus on my next steps personally and professionally. I’m also a huge believer in nutrition – I eat really well to support healthy brain chemistry and body functioning. Every month I also receive a wonderful massage. I encourage my clients to take good care of themselves physically, emotionally, psychologically and spiritually, and I do the same for myself.

Postpartum Mood Disorder recognition and acceptance has come a LONG way but we still have miles to go. What do you see as some of the hurdles we still have to cross?

For one, the DSM should recognize the postpartum mood disorders as their very own diagnoses. Right now, there is no actual diagnosis of postpartum depression, so it’s viewed by many well-meaning professionals as no different from any other depression. For any woman who has been depressed before having a baby, and then has ppd, she absolutely knows that ppd feels different. Also, the right questions for moms and dads need to be asked in OB and pediatricians’ offices as a standard practice. It is definitely going in the right direction, and doctors are increasingly “tuning in” to these questions and listening better to the answers given. In addition, medical doctors are also understanding that prescription medicine doesn’t always need to be the first line of treatment. Many of my clients have not needed medication once they receive a solid plan of action with natural healing.

What is your philosophy regarding your approach to Postpartum Depression? How did you develop this philosophy?

I am solution-focused, not problem-focused. I focus on wellness and healing and helping depressed women get “un-stuck” as fast as possible. I learned many years ago that women can recover remarkably quickly when they have very simple and practical steps to help them move forward.

What advice would you give to medical professionals who may come in contact with a mother who is depressed? What are some of the best things they could do for this mom? What should they not do?

Funny – I was just asked to present at a women’s conference on just this topic. It’s important to speak to this mom with care, sensitivity and respect – reassure her that she’s not inadequate, there’s nothing to be ashamed about and handle the topic very matter-of-factly, as gestational diabetes (or any other common perinatal illness) would be approached. A practitioner should not dismiss depression as “normal” or give pat advice such as, “go out on more dates and get your nails done and it should pass.” Depression needs to be taken seriously and a referral to a therapist who specializes in the field should be provided.

And last but not least, if you had a chance to give just one piece of advice to an expectant mother (new or experienced), what would you say?

Pregnant women call me all the time, since they want to prevent depression and anxiety later on in the pregnancy and also postpartum. I help them with a simple plan of setting realistic expectations, sleeping at night, eating/nutrition, and getting emotional and physical support. So much joy and happiness can be experienced (and mood disorders greatly minimized, if not completely avoided), when there’s a solid plan of action in place!

Mondays with Pec Part II

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Today we finish up last week’s post with Pec by looking at signs and symptoms of various mental health conditions that can occur during the postpartum period. As always, discuss any concerns you may have with your caregiver.

How do I know if I have postpartum depression or anxiety?

Symptoms can vary from woman to woman. Here are some of the most common symptoms:

  • Sadness (sometimes comes in waves-women feel “up and down”)
  • Guilt (often women feel like they aren’t good moms, “maybe I just wasn’t cut out to be a mom”)
  • Irritable, less patient than normal (women often say they are snapping at their partners, or not enjoying their older child/children the way they did before)
  • Sleep problems (often hard to fall and/or stay asleep at night)
  • Appetite changes (may eat more or less than usual), often rapid weight loss
  • Lack of feelings toward baby (“I can bathe her and feed her, but I don’t really feel what I thought I’d feel towards her)
  • Worrying about every little thing (“it feels like my mind won’t shut off”)
  • Lack of fun or pleasure (I often hear things like, “I used to sing in the shower or with the car radio…. I’m not singing anymore”).
  • Overwhelm (“I just can’t cope”)
  • Lack of focus and concentration and difficulty making decisions

Postpartum Obsessive-Compulsive Disorder (OCD)

About 3-5% of new moms get postpartum Obsessive Compulsive Disorder. Women who have a history of OCD or a family history of OCD are at a higher risk. I find that in my practice women who describe themselves as “worriers” or “anal” (have a high need for order and things being “just right”) are at a higher risk.

The word obsessive refers to repetitive thoughts. Compulsions refer to the behaviors people do to avoid or minimize the anxiety produced by the obsessive thought. In the movie As Good As It Gets, Jack Nicholson portrayed a character with severe OCD.

Postpartum, some women get obsessive worry, often about things happening to the baby. Sometimes women get frightening thoughts or even mental pictures of something bad happening to the baby; often the pictures may be about the mom herself hurting the baby. These pictures can seem vivid and horrifying. Unlike women with psychosis, who are not in touch with reality, these women are painfully in touch with reality. These women know they do not want to hurt their babies, and we call these thoughts “ego alien”. Women with postpartum OCD are horrified, “how could I have these thoughts? I love my baby. I would never hurt her. I feel like a monster”.

These thoughts may just pop into her mind- we call them intrusive, and they are repetitive. Sometimes women have behaviors or compulsions that help them feel safer. These are may include things like hiding the kitchen knives or avoiding being alone with the baby.

Postpartum Panic Disorder

About 10% of new moms experience panic disorder. Some of these women have had panic before, sometimes even in pregnancy.

Symptoms of Postpartum Panic include episodes of extreme anxiety or worry, rapid heartbeat, tight chest or shortness of breath, choking feelings, dizziness, restlessness, and irritability. Panic attacks can happen without any specific triggers, even in the middle of the night. Women often feel a sense of doom or that they are going to die. They worry about when the next attack will happen.

Postpartum Posttraumatic Stress Disorder (PTSD)

Posttraumatic Stress Disorder can occur after birth. PTSD is seen in about 1-6% of women. Symptoms of PTSD include recurrent nightmares, extreme anxiety, reliving past traumas, avoidance of reminders of the trauma (for example, the hospital). Women with Postpartum PTSD often feel that they were abandoned, not well cared for, and stripped of their dignity during the birth. Another common feeling is that their voices were not heard and that there was poor communication during the labor and/or delivery. Some women with Postpartum PTSD state their trust was betrayed; they felt a sense of powerlessness and lack of protection by their caregivers.

Postpartum Bipolar Disorder

Bipolar disorder is often incorrectly diagnosed as depression. It is not uncommon for people with bipolar disorder to suffer over 10 years with an incorrect diagnosis, and therefore, inadequate treatment. Women taking medication for bipolar disorder are often told to stop medication before getting pregnant. Some, but not all, medications used for bipolar treatment can cause birth defects. Unfortunately, up to 80% of women who stop medication become ill during the pregnancy. Postpartum, bipolar disorder puts women at risk for a manic or psychotic episode. Women with bipolar disorder need to be working very closely with a psychiatrist trained in reproductive mental health.

Symptoms of postpartum bipolar episode can include

a decreased need for sleep and severe and rapid mood swings. Often there is a family history of bipolar disorder.

Postpartum Psychosis

Postpartum psychosis is considered a medical or psychiatric emergency. There is an increased risk of a woman hurting her self or her infant or children.

Symptoms of postpartum psychosis can include:

  • Difficulty relaxing
  • Incoherence
  • Decreased appetite
  • Paranoia and confusion
  • Hearing or seeing things others do not (hallucinations)
  • Inability to differentiate reality from hallucinations
  • Difficulty sleeping
  • Delusional thinking (lack of touch with reality)
  • Manic behavior (hyperactivity, impulsive behavior)

These symptoms come and go (she may be fine one minute, and acting strangely the next).

All of these postpartum mood disorders can be treated. If a mom is not well, the family is not well. We now know that untreated maternal illness can cause long term consequences for the infant, as well as other children in the home. Postpartum mood disorders also contribute to marital/relationship stress and discord.

Unfortunately, these postpartum mood disorders do not always go away by themselves without treatment.

You are not alone.

You are not to blame

You will be well again.

Seek treatment from someone trained specifically in postpartum depression and postpartum mood disorders. To learn how to screen a potential therapist, go to http://www.pecindman.com.

Important resources:

http://www.MedEdPPD.org (a very informative website)

http://www.postpartum.net Postpartum Support International 1.800.944.4PPD

Beyond the Blues, A Guide to Understanding and Treating Prenatal and Postpartum Depression (2006) by Bennett and Indman

Sharing the Journey with Pec Indman

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Pec is one of the warmest people I have had the pleasure of emailing. Ever. She has been super supportive of all that I do and for me it’s amazing that in just four years, I’ve gone from an unsupportive OB to being able to email an expert like Pec and get a response in mere seconds. What a road! Pec is whole-heartedly dedicated to women and families struggling with Postpartum Mood Disorders and like me, I know she’ll never stop doing what she’s doing. Keep up the amazing work and thank you for sharing a bit of yourself with us!

Would you share a little bit about yourself with us?

I grew up in a very loving family. My parents were active in political movements that supported causes including civil rights and the women’s movement. I became a family practice trained Physician Assistant in the 70’s, and worked in Family Practice and women’s health. After deciding to go back to school, I completed a Master’s in Health Psychology, and then a Doctorate in Counseling. I had Megan, my first daughter just after I completed my doctoral coursework. Emily was born almost six years later, after treatment for fertility problems and a miscarriage.

How did you become focused on Postpartum Mood Disorders? What drew you in to the subject?

About 12 years ago, I was in an OB/GYN waiting room and happened to see a flier by Postpartum Support International (PSI) about Postpartum Depression. I realized that although I had years of training and experience in women’s health and mental health, and had delivered two children, I had been taught nothing about mood disorders related to childbearing. I was horrified and angry. I am still outraged that my Master’s program in Health Psychology never covered anything related to specific issues related to women’s reproductive mental health (for example, PMS, perinatal, or perimenopause/menopause). So, I joined PSI, read everything I could, and went to trainings and conferences. I began teaching for PSI and co-authored a book, Beyond the Blues, A Guide to Understanding and Treating Prenatal and Postpartum Depression. We’ve updated it several times to reflect the latest information and research, and are proud to have it in Spanish, as well. I’ve been honored to be invited to participate and contribute in the creation of several federally funded projects on perinatal mood disorders. I feel very honored to do this work. It’s the most rewarding work I’ve done. It’s also the most fun; I work with nice moms, sometimes they bring their babies, and everyone gets better! What could be more fun?

I know different approaches work for different people. What have you found to be the most successful in your practice with Postpartum Women?

My clients describe me as “warm and fuzzy.” I like to think my office is a comfortable place where women and families can feel safe and free from judgments. One of the things I find that women and families thirst for is information. So often I hear, “why didn’t anyone tell me I was at risk?” I practice a model of therapy called cognitive-behavioral therapy. It is a very practical model that helps people learn how depression and anxiety distort thinking and teaches people how to think differently. My clients really appreciate the practical skills and tools.

As a mom, what have you found to be the most energizing about motherhood? The most challenging?

I feel enormous pride when I watch my girls achieve something they have worked hard to accomplish. The most difficult thing has been standing by while they have experienced life challenges, knowing I can’t take away the disappointment and pain.

What are some of the biggest challenges you have faced in balancing motherhood and work?

I think the idea of “work/life balance” is an impossible goal that sets women up for feeling not good enough. I see it as a juggling act. Sometimes one ball is on the floor-it might be the laundry or the dishes. Or, sometimes a kid gets sick or there is a client emergency. There is no “balance”. I think the key is to be flexible and have clear priorities. Laundry and dishes will always wait for you. I am extremely lucky in that I can arrange my work schedule around my “chauffeur” mom job.

We often encourage mothers to remember to take time for themselves. What is it that YOU do to recharge your batteries?

I am an avid scuba diver and tropical fish lover. My whole family dives, and we just had a delightful family vacation in Cozumel, Mexico. I enjoy taking underwater photos, and my husband takes underwater video. So, when I can’t be with the fish, I can still enjoy their beauty and the magnificent underwater world.

Postpartum Mood Disorder recognition and acceptance has come a LONG way but we still have miles to go. What do you see as some of the hurdles we still have to cross?

We have come a long way, but we have a lot more work to do. Ideally, all women should be informed about risk factors for perinatal mood disorders, before getting pregnant or at a diagnosis of pregnancy. Women should be screened for mood problems during pregnancy and throughout the first year. In order to do this, health care providers need have a better understanding of perinatal disorders and why it so important to take them seriously. And we need to train providers to treat women and families suffering. I am appalled that the most common complication of childbearing is still so misunderstood and poorly treated. I think we need to dispel the myths that still surround perinatal mood disorders. We need to educate women and families about the problem and to be good consumers in seeking treatment. We need to train health care providers to ask the questions and screen, and we need a trained therapist on every street corner.

I believe one of the biggest keys to positive recovery for women is full family involvement -i.e., a supportive and educated husband/partner and family. Of course, education prior to an episode is wonderful but how can we best aid in this process when the family is in the midst of a Postpartum Mood Disorder Crisis?

I agree that family involvement is critical. Whenever possible it is important to include the family in the process of treatment. Often the family is confused and unsure what to say or how to be supportive. Treatment should include family whenever possible.

What makes you smile?

Hanging out with my family, being in a clear turquoise tropical ocean (I did have to learn not to smile at the fish, because it would cause my face mask to leak!), and hearing a mom say “I got my self back”.

And last but not least, if you had a chance to give just one piece of advice to an expectant mother (new or experienced), what would you say?

I have a few words of wisdom:hug and kiss your kids as often as possible, notice the positive, and remember to be emotionally flexible. Know what is developmentally appropriate for your child and have realistic expectations of them. Lastly, if it’s not a health or safety issue, be able to let it go…… somethings aren’t important to make a big issue over.

Mondays with Pec (Part I)

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Pec Indman, EdD, MFT, has been gracious and submitted a wonderful piece from Beyond the Blues, a book she co-authored with Shoshana Bennett. I’ve decided to post in sections. This week, we’ll read about what Postpartum Depression is and who can get Postpartum Depression. Next Week, we’ll be looking at how to identify whether or not you have PPD or PP Anxiety. As always, please discuss any concerns you may have with your physician!

WHAT IS POSTPARTUM DEPRESSION?

What is Postpartum Depression?

Often the term Postpartum Depression (or PPD) is used to describe mood and anxiety disorders that occur within the first year after a baby is born. There are five postpartum mood/anxiety disorders. Postpartum Depression is the most common.

The Baby Blues occurs in up to 80% of new moms. This is a normal response to the hormonal changes, the sleep depravation and adjustments that occur immediately after birth. We don’t consider the blues a mood disorder. The Blues usually begins around day 3 postpartum, and should be gone within 2-3 weeks. With the blues, mood is up and down, and women sometimes find themselves bursting into tears for no reason. But, overall, there is a positive outlook. It differs from postpartum depression in timing (only occurs in the first three weeks) and severity (it’s mild and goes away without treatment).

We believe postpartum depression occurs in between 15% to 20% of all new moms. That’s up to 1 in 5 mothers! Many of us have a stereotype of a depressed person being curled up in a ball with the blanket pulled up over her head, crying. That’s not really how it looks for most women with Postpartum Depression. What new mom has the time to hide in bed? Some call it Postpartum Depression/Anxiety because many women experience both depression and anxiety.

Who gets Postpartum Depression?

Women who have a history (or family history) of depression or anxiety, a previous postpartum depression, depression during pregnancy, a history of abuse, marital/relationship problems, teenage moms, social isolation, or a sick baby are all at an increased risk of postpartum depression. Women who have severe mood changes before their periods or while taking the birth control pill are also at an increased risk of postpartum depression.

Postpartum depression can begin at the birth of the baby, or can occur at any time within the first year. Sometimes sudden weaning or a first menstrual period can trigger the onset.