Tag Archives: Therapy

Medication or Therapy?

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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.

Can you put a price on Postpartum Depression?

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Earlier today, someone I follow on Twitter tweeted about the cost of Postpartum Depression.

She stated: “Researcher asked me how much PPD “costs” & I can’t find figure anywhere. Surely, there is a $ amount. #ppd #postpartum.”

My response: What does she mean by how much does it “cost” In terms of what? Treatment? Time lost to illness? Memories lost?

There are some things #Postpartum steals from you on which you cannot put a price.

Her: @unxpctdblessing that is so true. She’s a researcher and is studying that which is measurable. So much can not be measured.

Me: I suppose she could create a hypothetical woman and start by pricing various antidepressants, typical co-pays or out of pocket.

Her: @unxpctdblessing well, all of those are real costs but she’s talking about financial cost in terms of health care, lost work, etc.

Me: I have no idea where you would get those numbers. It would depend on so many things from woman to woman.

Her: very interesting research study! We’ve been using a spectrum approach to talk about the #postpartum period. Thanks for the thoughts! I’ll pass them on!

This conversation took place nearly 5 hours ago. I’ve been consumed with it ever since.

How on earth do you put a price on Postpartum Mood Disorders?

Sure, you can talk about financial cost in terms of health care, lost work, etc. But what about the emotional cost? The lost and missed memories? The heartache and damage it does to marriage, to bonding with your infant, to the anxiety which comes storming into your life as a result? What about the cost of a divorce or family estrangement as a result? Do you measure that with legal costs? How do you put a price on someone’s mental health? Someone’s heart? Someone’s love and life?

My Postpartum Mood Disorders?

Nearly destroyed my marriage.

Severely affected my bond with my two daughters.

Cost me enjoying the infancy of my two daughters which fed into anger during my son’s infancy because I was able to enjoy his.

Missed several family events, etc, because of anxiety/paranoia, breakdown.

Therapy for over a year.

Medication for over two years.

Fed into antepartum depression.

Stole nearly three full years of my life.

How on earth do you put a price on all of that? I know I can’t. I don’t even know where to start. Frankly, there is no number big enough to cover everything I lost during the three years of the first years of my motherhood. No number.


Enriching postpartum therapy through at-home activities

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In addition to the different types of therapy we discussed yesterday, there are some at home activities you can do (provided your therapist has approved them) to enrich your professional care and journey toward wellness.

First, start a gratitude journal. But I don’t journal. I hate writing! Don’t worry – this isn’t having to write an entire page every day. It’s a simple two entries a day. In the morning, when you first wake up, grab your pen and journal. Write down three things for which you are grateful, no matter how small that thing may be. As your day progresses, focus on what has made you laugh or smile. Once you have retired to bed each night (even if it’s for two hours), write down at least three things which made you smile or laugh during the day. At the beginning, even just barely cracking a smile counts. This activity is two-fold. First, it forces your brain to refocus on the positive things in your life. Second, it provides physical evidence of the positive influences in your life you can look through on the particularly tough days.

Second, write down all five senses on a sheet of paper. Taste, touch, smell, sounds, and sight. Write down five of your favorite things for each sense. Chocolate, silk, a favorite perfume, a cd or song that makes you smile, favorite color or flower or art. Post the list on the fridge. Treat yourself to at least one thing from EACH SENSE every week. Rotate them out. Putting the list on the fridge helps family members and friends to know what to help keep around the house as well. (Sneaky, I know)

Third, take time for yourself. Schedule it if you have to. One thing I love to do is to dress up my lunch. It’s my quiet time of day and I have been known to make a frozen pizza and a coke look like it belongs on a table prepped by Gordon Ramsey. Lean Cuisine never looked so haute. I’ll also treat myself to the routine of making tea. The key is finding one thing you love and making sure you do it at least once a day. Without interruption.

Some other moms will put positive post-its throughout the house and even in the car to help give them a boost when they need it most.

A successful recovery relies heavily on your active participation. If you’re not participating, you’re not getting better. YOU are the most important quotient in the equation when it comes to journeying toward mental health wellness!

How did you actively participate in your recovery? Have any tips for currently struggling moms? We’d love to hear them!


Be sure to stop back tomorrow for the triumphant return of the Friday Soother, my weekly gift to you!

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!