Category Archives: SSRI

Meeting Enemies Undaunted

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Last night, when I took to my keyboard to write “Finding Life at the End of My Comfort Zone”, I did not need to write it to complete my 500 words for the day. It was just time to admit what had gone on in my life for the past year and how I was coping. After I hit publish, I exhaled. Finally. It was all out. For me, part of healing is being open and transparent.

Not more than a couple of minutes after hitting publish, the post received a comment from someone who has never commented here. It was held in moderation, and I will not be publishing it as a comment. I am, however, going to publish it here, addressing why it is a highly inappropriate response to my post yesterday.

The entire comment is as follows:

Hi! I think that it’s great you’re taking medications to help yourself but I am so sure that you can do so much more awesome things than taking medicine. I am one of those who don’t step outside my comfort zone as well and you know stepping outside the first couple of steps are the hardest but gradually you’ll become stronger to keep pushing yourself forward. You should try meditation it’s not religious at all too. It’s a practice to obtain peace and can really reduce stress. I believe you can do it, you just have to tell yourself that you’re strong enough! I wish you good luck of your journey! :)

You ready to analyze it? I am.

Let’s start with the greeting and the first sentence:

Hi! I think that it’s great you’re taking medications to help yourself but I am so sure that you can do so much more awesome things than taking medicine.

Notice the cheery greeting, complete with exclamation point. She’s HAPPY! She thinks it’s awesome that I’m taking medications to help myself BUT.. wait…. what’s this? She’s sure I can do so much more awesome things than taking medication? Really? Based on what sound evidence? Is she a physician? Has she discovered some amazing new way to deal with situational depression brought on by an insane amount of stress in a short period of time?

*GASPS* Wait – I know! I should have stuck with just my HappyLight, regular rest and relaxation, supplements, and prayed harder, right? Right? *smacks forehead* I totally failed that one, right?

She then goes for the “I relate to you” sentiment with this line:

I am one of those who don’t step outside my comfort zone as well and you know stepping outside the first couple of steps are the hardest but gradually you’ll become stronger to keep pushing yourself forward.

Oh really? Preach on, sister, preach on. That’s how it works, huh? After two episode of PP OCD, an episode of antepartum depression, post-divorce depression, I had NO clue that the first couple of steps were the hardest. I’ve been through the “gradually you’ll become stronger” thing and know that it’s a hard process. I also know that pushing yourself forward is necessary for progress. Of course, these are all things I thought I addressed in my post which, clearly she read because she commented, right?

Perhaps there’s a solution of which she’s aware that I haven’t thought of yet?

There is!

You should try meditation it’s not religious at all too. It’s a practice to obtain peace and can really reduce stress.

Aaaaaaand here’s where it gets fun, people.

Never mind the call I made to a medical professional after fighting on my own for months against the beast inside me, a beast egged on by the stress of living with very negative neighbors who attacked us verbally or intimidated almost every time we stepped outside and wild children who screamed and yelled outside our condo until the wee hours of the morning, interfering with any chance of sleep at night in addition to an insane amount of anxiety through the day.

Never mind the discussion I had with her during which I stuttered, nervously spilling all the details of the hell in which I found myself, fighting back the urge to completely lose it as I did so.

Never mind the years of school and practice my Nurse Practitioner has under her belt which allowed her to have a very compassionate discussion with me about my current state of mind and what my options were to fix it while calming me down at the same time.

We discussed the possibility of therapy but we cannot afford a weekly therapy session right now because we are not insured. But meds which have worked before were an option. So after two weeks of working my way up to making the call, I walked into a pharmacy and picked up a bottle of pills, feeling as if I were less than a toddler’s forgotten cheerio stuck in a couch cushion.

Apparently, what I should have done instead was head over to YouTube and find a meditation video. Boom. All better, right?

An article in Forbes earlier this month touts the benefits of meditation as rivaling that of anti-depressants. The study in the article specifically focuses on “mindfulness meditation” as the preferred form. If it works for you, fabulous. Kudos. I am a huge fan of doing whatever works for you.

Here’s the thing about depression and mental health issues, however: there are a myriad of treatments available because we are not all built alike nor do we all arrive at our diagnosis via the same path. We also do not find our road to wellness along the same path.

Don’t even get me started on the entire religious aspect of this comment. Let’s leave that out of it because we wouldn’t want to offend anyone, would we? (Which is clearly why she specified that meditation is not religious, right?)

Since my brush with Postpartum Mood Disorders, my life is increasingly mindful. In fact, over the past year, I am healthier mentally than at any time in my life. How can I make that claim despite being on anti-depressants now? Mental health does not always mean happy. To me, what it means is a deep understanding of why things happen and accepting what you need to do in order to move beyond them. It means the capability to examine events in your life and hold a healthy response even if it does not lead to joy. The path back to joy, motivation, and yourself is a personal road and no one beside your physician has the right to tell you how to get there. It is YOUR road map, not anyone else’s.

Of course, blogging about my mental health opens me up to criticism and suggestions like this. Some might say that I “deserve” to have comments like this. No one deserves to be told what to do, not even if they’re asking for advice and particularly not if they are opening up about their choices they have already made.

Telling someone that they SHOULD do something other than what they have chosen to do with the help of a medical professional is beyond reprehensible. Making the decision to reach out for help  – to admit you are not okay to a medical professional is an absolutely nerve-wracking experience.

I cannot help that someone who would dare to judge someone else’s road has never traveled down a similar road. Because if they had traveled down this road, they would know how detrimental it can be to be judged for their decisions as they fight to get well.

She wraps up her comment with a much better outlook:

I believe you can do it, you just have to tell yourself that you’re strong enough! I wish you good luck of your journey! :)

Yay. Cheerleading! RAH RAH SISK OOM BAH!

Had she skipped the whole rigamarole about “more awesome than medication” and “try meditation instead” this would have been a perfectly awesome comment. THIS is a perfectly acceptable response to someone admitting they’ve settled on a method of treatment for a mental health issue. It empowers, supports, and encourages without judging the decisions of the person.

So, after all of this – how do you perfectly respond to someone who is struggling and has settled on a method of treatment? It’s hidden in this very comment.

Like this:

“Hi! I believe you can do it, you just have to tell yourself that you’re strong enough! I am one of those who don’t step outside my comfort zone as well and you know stepping outside the first couple of steps are the hardest but gradually you’ll become stronger to keep pushing yourself forward. I wish you good luck of your journey! :)”

Now this is how you support someone!

You support by offering encouragement, compassion, and empowering the person who is fighting like hell to be themselves again.

If someone proffers judgment on your treatment choices, do not let it deter you from your healing. You are in the driver’s seat and decide what exit is yours on this interstate of life, not anyone else, and definitely not a stranger who knows absolutely nothing about why you’re in the car to begin with.

A friend of mine said it best on FB, typos and all:

“Hugs. Love. I Get Its. And no judgement here. Take your meds. Meditate if it helps ON your meds. But fuck everyone else and their well-meaning yet severely judgmental opinions. Just do what’s fight for you.”

That’s what I’m doing – fighting for me, always.

Therapy Choices for the Postpartum Woman

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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: The MOTHER’S Act

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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!

TIME Magazine misfires debate on MOTHER’S Act

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Awhile back, I was contacted by Catherine Elton regarding an article which was to examine Postpartum Depression and the Mother’s Act. The email somehow got buried and I did not get a chance to participate in the discussion.

It seems that it would not have mattered if I had been able to discuss my story with her.

Time published the story this week. While the online version has been modified to correct an error with Ms. Amy Philo’s story, you can still see the original version in the hard copy. (Which by the way, I am personally asking you to boycott – even asking if you can take the copy of TIME home from the doctor’s office in order to keep other moms from reading it! And make sure you ASK – because just taking it would be stealing and that’s illegal.)

The original version, entitled “The Melancholy of Motherhood” includes one quote from Carole Blocker, the mother of Melanie Blocker Stokes, a mother who tragically committed suicide after unsuccessful treatment for severe postpartum depression after the birth of her daughter. The quote reflects Ms. Blocker’s confusion as to how someone could oppose the MOTHER’S Act, a bill which is designed to increase public and professional education regarding Postpartum Mood & Anxiety Disorders. Frankly, I’m confused right along with Ms. Blocker.

The only survivor story featured in this article is that of Amy Philo, one of five recipients of an Outstanding Achievement for Mothers’ and Children’s Rights awards from the Citizens Commision on Human Rights or CCHR. CCHR was founded in 1969 by none other than the Church of Scientology, well-known to oppose the entire psychiatric field.

Amy has tirelessly worked against this bill for quite some time now but continues to be tragically misled. Few discussions with her have led to quite the round robin with Amy unable to come up with legitimate research to back up her claims. When asked for said research, Amy refers to her own websites instead of to specific research articles supporting her claims.

I happen to know that Ms. Elton did indeed interview fellow survivors who support the bill. One has to wonder then, why did their stories not make it into the article? Was it length? Was it editing? Or was it intentional? Regardless, the finished piece as published presents a very frightening and deceiptful picture of what new mothers face is this bill is passed. To begin with, the MOTHER’S Act no longer mandates screening. It requires a study to be completed by the Secretary of Health and Human Services (Kathleen Sebelius) as well as funds for an educational campaign for both caregivers and the general public.

I agree that just because a new mother shows emotion she should not immediately be diagnosed as having a PMAD. I also believe that a woman should have free choice when it comes to her treatment decisions and should NOT be judged for those choices. I chose to take Anti-depressants. My first prescription did not work out. But my second one did. Just as with any other medication, sometimes they don’t work so well with your system. So you try another one. You don’t suddenly take your own care into your hands – that’s ridiculous. Would you try to heal a broken leg or diabetes on your own? No? I didn’t think so. So why would you rely solely on self-care when it comes to mental illness? Self-care should be part of the picture but it shouldn’t be the ONLY part of the picture.

I am so tired of being judged and accused of not having informed consent. You know what? When I made my decision to go on Anti-Depressants, I had carried around an informational packet about AD’s & Breastfeeding given to me by the NICU Lactation Consultant with me for a week. I read that thing through and through. I was exclusively pumping for my daughter at the time and did not want to jeopardize her receiving my milk if I ended up having to take something. But I couldn’t function. I couldn’t take care of my family, I couldn’t take care of myself, and a lot of the same thoughts were coming back. Negative, scary thoughts about knives and hurting myself and my family. Yet I wasn’t on anti-depressants. I needed to be able to function. So I made a very informed decision to do so, one I do not regret to this day.

TIME – I am very disappointed in your lack of sharing both sides of this debate. Very very disappointed.

Just Talking Tuesday 07.07.09: Anti-depressants or Not?

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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’!