Category Archives: Depression

Q&A: TIme change and its evil spawn

So now that those of us in North America and Europe are done with this fall time change, it's all starting to hit the fan. Some of the problems are kid-related: kids waking up too early, going to sleep too late, or just being all screwed up.

The solutions to those problems are, as with all things parenting, a choose-your-own-adventure. Some people just go cold turkey to the new ("new"?) time. So if your child has been going to bed at 8 pm (or 6:30 pm if you live in Seattle), even though 8 is 9 to the kid, keep them up until 8. After a week or so they'll adjust. Others bump the kid up to the new bedtime 10 minutes a night. So you'd start with 7:10 tonight, then 7:20 tomorrow night, etc. until the kid is going to bed at 8 by the weekend. Others will seize the opportunity and start putting the child to bed at 7.

If it's the morning that's particularly screwed up, you could try blackout shades, or "blackout shades": cardboard and/or aluminum foil over the windows.

The older I get, and the older my kids get, the more I find that the time change messes with me more than it does them. And it's not the time part, but the light part. For some reason, it doesn't much bother me how light or not it is when I wake up in the morning. But it makes me truly and seriously sad when it's so dark so early at night.

I've been trying to figure out how to deal with this, as it's an actual problem. And what I'm coming up with is trying to work things so that I can just coast through the hours that feel too dark to me (for me, now that daylight savings time is over, here at the eastern end of the time zone in NYC, that's about 5:30-7:30 pm). I'm going to do as much dinner prep ahead of time as possible, and make sure I have things all set up for the kids to go to bed, so I'm not doing any scrambling when it's time to get them down for the night.

Does anyone else have this issue? It almost feels like SAD (which I sometimes get a touch of, and which my aunt has seriously and has described to me). If so, how do you manage it? Does anyone else have the opposite problem, of being depressed by getting up in the dark? How do you cope?

Q&A: More effects of this !@#$%^ war

Michelle writes:

"I'm freaking out a bit and I'm hoping you and the Internets might be able to help calm me down.  In the way of background, our 10 month old son is at an in-home daycare 4 days a week, and has been there since he was 3 months old.  The daycare was recommended to us by some friends who have a 5 year old and a 2 year old.  We have been thrilled with our provider, "Jenny," and she absolutely adores our son.

Jenny's husband returned from a year-long overseas deployment 2 months ago and Jenny has mentioned to me that they've been having trouble adjusting to having him home again.  Then, a couple of days ago, he just left, and Jenny hasn't heard from him since, short of a text message saying he was meeting with a counselor.  I found this out yesterday when I went to pick up my son.  He was in a swing-set baby swing, by himself, and Jenny was on the complete other side of the yard.  He was just hanging out, staring down at the ground.  He wasn't upset, but he was definitely all alone. When I saw him, I was really surprised and upset…  Jenny is usually right there with him.  I ran and grabbed him, and when I turned around to see why Jenny wasn't there, she was sitting in a chair staring off into space.  I asked her if she was okay and that's when she told me what happened with her husband.

I understand why she's distracted, but I worry that with her mind elsewhere she'll be unable to properly care for the kids.  I spoke with the friend of mine I mentioned above, and neither of her kids have said anything about things being "weird" at Jenny's, which makes me feel a bit better.  I also worry, though this is probably my new-mom paranoia coming out, that her husband is going to become violent and come to the house while the kids are there.  It sounds like the person who held his post prior to him arriving committed suicide, and that many of his superiors needed to be replaced because of the stress.

So, what I need, I guess, is some reassurance….  How have other people dealt with it when their daycare provider is having bad personal problems?  And I suspect I'm overreacting when I worry about her husband hurting the kids or hurting her in front of the kids, but I would love for someone to tell me to chill out about it…"

I am so, so, so sorry for Jenny and her husband that this is happening. They are not alone. I've been reading all kinds of articles about how returning military people are having major problems reintegrating into their families and lives when they come back from being deployed. The system is starting to get overwhelmed, and returning military people are slipping through the cracks and families are being destabilized.

It sounds like Jenny has no idea what to do about this. We have no idea if the husband is going to become violent. I wouldn't rule it out, but I also wouldn't say it'll definitely happen. The sooner they can get help, the better off everyone will be, and the more stable the situation will become.

I think the best resolution to the problem would be for you and the other parents to start poking at the system in your area to see what support services there are for returning soldiers and their families. I'd start looking around for EMDR therapists.(EMDR is the process that's showing the best results in treating PTSD effectively and rapidly.) And I'd call the VA and see if there are support groups for families. It's good that he's seeing a counselor. Very good, and seriously lessens the likelihood that he'll be violent. But we have to hope that the counselor knows what to do with PTSD cases.

Does anyone out there have experience with getting help from the system for a returning soldier and family? Jenny and her husband aren't the only ones that are dealing with this. And not everyone has a Michelle who's worried about it.

Bring our troops home NOW.

D-MER, or feeling crappy when your milk lets down

This just in from the “Who Would Ever have Suspected This” Files*:

“Dysphoric Milk Ejection Reflex

Defining D-MER:
What It Is

DysphoricMilk Ejection Reflex is a newly recognized condition affecting
lactating women that is characterized by a brief surge of dysphoria, or
negative emotions that peak before the milk ejection reflex, or
letdown, and then dissipate quickly after the milk release.

How D-MER Presents:
What Mothers Feel

The negative
emotions, or dysphoria, that a mother with D-MER experiences often
manifest “in the mother’s stomach” – a hollow feeling, a feeling like
there is something in the pit of the stomach, or an emotional churning
in the stomach. Mothers report varying types of emotions ranging from
dread to anxiety to anger, these emotions fall on three different D-MER
spectrums which are described in more detail below. The common thread
between the D-MER spectrums however, is the wave of negative emotions
or dysphoria, prior to letdown, that then lifts within another 30-90
seconds, and then usually repeats with each letdown.

A key piece of D-MER is that a mother with D-MER feels absolutely fine except just before her milk starts to flow….”

Ho-ly crap, people. I had no idea. I’m guessing right about now those of you who nursed for more than a day or two are either shaking your heads in surprise like I am, or reading this with your mouths open because this happened to you. Apparently all kinds of women have D-MER, no matter how easy it is for them to nurse, how soon their milk comes in, etc.

If this looks like you or someone you know, read the whole story at the D-MER website. Since this is such new information (and how did they even put it together?–I can’t imagine that most women with it would talk about it, because we’re not usually allowed to say anything even remotely negative about how we feel during breastfeeding), please go take their survey about it.

The tagline of the D-MER website is “Because Breastfeeding Shouldn’t Make You Feel This Way.” Seriously.

* Actually, it was an IBCLC (lactation consultant) who sent this to me. She herself had it with each of her kids, but had no idea it happened to other women!

Check yourself

Last night I met a mom of a 7-week-old. We were talking about how things were going for her, and she said that she was wondering when she was going to start enjoying it, and that she woke up every morning with a sense of dread and a feeling of "How am I going to make it through today?" We were talking about her baby, and she seemed not to know what to say about him.

We talked some more, and it became pretty apparent that she either had mild PPD or was on the border of it. We talked about some things she could do that start feeling better immediately (exercise that works your core–so T-Tapp, pilates, or yoga, Omega 3s at 3,000mg a day, and B complex vitamins) and asked her to talk to her doctor in a few days whether or not she was feeling better, just to get a professional helping her.

As we were leaving, she told me she was glad she’d talked to me, because she’d thought she was just being a cry-baby about it.

That’s the thing about PPD. When you’re sinking into it, you don’t say "Aha! I have this illness called PPD. Let me get some help." You just think things suck and you don’t feel very good. And, yeah, most people aren’t really loving the gig at 7 weeks, so you feel like maybe it’s all normal. But why is it so hard for you? And if you tell your partner and s/he doesn’t know what to do so s/he just tells you "it’ll get better" then you think maybe it really is just weakness or being a whiner.

It’s not. In the first two weeks post-partum, your hormones will be whacked out and you’ll laugh and cry for no reason. Past that point, though, if you feel dread all the time, and don’t feel joy several times during each day, you’re sinking into PPD.

YOU ARE NOT WEAK. Your hormones are out of whack, and you have a treatable illness. You can probably get some relief by making some small changes, you may need meds but you won’t have to stop nursing unless you want to, and there is nothing wrong with you as a person. You are suffering from a physical illness.

Over on the left is a PDF you can download with some suggestions of things you can do to help lift the greyness (to me depression always felt like being rolled in that pink fiberglass insulation–I was still there on the inside but I just couldn’t seem to interface with the rest of the world) and give yourself a little bit of breathing room. Download it, show it to your partner, and tell him or her that you need help. Start with one or two of the things on the list, and get your partner to call your provider. They will help you.

Comments? Support? Requests for support?

Mix-a-lot

1. Do not buy The Wonder Weeks for more than US/Ca$20. It is absolutely not worth more than that.

2. I just wanted to call some attention to the new website PPD Connect, a place for moms with PPD (or who think they might have PPD, or are even just feeling a little crappy) to go and tell their stories and get some support from other women who are going through it, or who have been through it. If you’re a PPD survivor, you might want to stop by to leave some support and light at the end of the tunnel. http://ppdconnect.typepad.com/

Don’t forget you can download my "14 Tips To Prevent Postpartum Depression" PDF over there in the left-hand column for free.

3. And now a question from Tegan:

"Since I’ve become a breast-feeding mother experiencing the occasional painful clogged duct, I’ve had no problem finding problem solving tips, i.e.:  warm compresses, massaging the breast, and nurse nurse nurse on that side to clear the clog.  But I’ve always wondered, does that mean that the baby gets a mouth-full of cloggy coagulated milk at some point?  Just curious."

It does, but they don’t seem to care at all. I think it’s probably more
like yogurt or the skin of vanilla pudding than anything else.

FWIW, you can help prevent plugged ducts by taking flax seed oil or lecithin capsules daily.

Now I’m craving pudding.

4. If anyone’s interested in a T-Tapp challenge for the new year, I just signed up for the "6 weeks to a new you" thread on the T-Tapp.com forums.

Really important study–we need your help

Hi all. This was supposed to post Monday, so I’m attaching Tuesday’s post to the end of it. Please please read through the first part and pass it on.

Leslie Davis, a researcher at Illinois State University (in the U.S.) is doing a study on pre-natal and post-partum depression, and she’s trying to tease out the differences in mood disorders (depression vs. anxiety, etc.) so that they can work on more effective plans for treatment.

She needs women to fill out their online survey. You are eligible if you are pregnant and 26 weeks along or more, or if you are between 6 week and 6 months post-partum.

Please, please please, if you are in this category or know people who are, fill out the survey. Forward on the URL to everyone in your childbirth ed class, new moms’ group, breastfeeding support group, online support group. Ask the moderator of any online boards you post on if you can post the link there.

The more responses the researcher gets, the better info she’ll have and the better prevention/diagnosis/treatment we’ll be able to offer to pregnant women and new mothers. (The results of the study should be available in the summer of 2008, so I’m going to ask Leslie to update us then on what she found.)

Now, for Tuesday’s post, I’m cleaning up holiday gift requests.

A grandmother is looking for good toy suggestions for 2 1/2 year-old twins (boy/girl, if that affects your response any).

Following up on the post last week about asking friends and relatives for nicer quality toys, Kristen wants to make things as easy as possible for her relatives:

"So I need some help…I have a 6 month old son and I’m trying to buy
him toys that are made in the US or Europe.  Any good websites or
stores that you can suggest?  I’m trying to encourage my family and
friends to buy him the more expensive toys that are of better quality
than the cheap plastic ones and I know that options are important."

Melissa writes:

"My son will be 4 in mid-December.  As one would expect he is full of
questions about the world and everything in it.  We have gone to the
library with some questions and done some research on the internet, but
I thought we might also want to look at having a good children’s
illustrated (we are not quite reading just yet, but trying
hard) dictionary or a set of encyclopedias at home for some old
fashioned look it up exploration.  Do you are your readers have any
recommendations?"

My 5 1/2-year-old is loving the Scholastic Children’s Dictionary I listed over there on the left in the sidebar. I’m not sure about encyclopedias, but I’m sure someone will have suggestions. I just discovered Simple Wikipedia, which is just Wikipedia, but using simple language and without some of the content that makes regular Wikipedia so much fun but also too wild for kids.

Then Liz writes:

"I am looking for a good book that might have some good suggestions for
fun and developmentally-beneficial activities I can do with my 5 month
old.  A kind of "Daring Book for Girls" for babies.  I consider myself
a creative person, but I’m running out of things to do with my baby.
I’m not sure I can play on that playmat and simply pass toys back and
forth with her for too much longer.

Any good ideas?"

I, personally, think you should just do your normal activities with the baby in a sling and narrate what you’re doing and that will help her development more than anything. But that’s also because I’m not a "down on the floor playing kids games" kind of mom. Which may explain why my kids are great at baking and cooking and doing laundry with me, but good at playing Legos with each other and not me. 😉

I know someone out there will have suggestions of books or of activities to do. And toys for the other questioners.

But first please pass on the survey info to any interested parties you know.

Save Women’s Lives and Hearts

"A beautiful young mother of two has been missing in Rhode Island now for more than a month.

Her name is Katie Corcoran and she is suffering from
postpartum psychosis.  She was supposed to be released from the
hospital to her family, but on September 5th, in some kind of mix-up,
she was sent off in a taxi instead.  Her husband, small children,
family and friends haven’t seen or heard from her since."

This is a quote from the blog Postpartum Progress, a blog by Katherine Stone that collects information and support for women suffering from postpartum mood disorders. Katherine, along with BlogHer and Postpartum Support International are asking bloggers to spread the word today about the MOTHERS Act:

What is the MOTHERS Act?  The Moms Opportunity to
Access Help, Education, Research and Support for Postpartum Depression
Act, or MOTHERS Act (S. 3529),
will ensure that new mothers and their families are educated about
postpartum depression, screened for symptoms and provided with
essential services.  In addition, it will increase research into the
causes, diagnoses and treatments for postpartum depression.  The bill
is sponsored by Senators Menendez and Durbin.

This is important. Really important. AS many as 800,000 American women every year get PPD or another postpartum mood disorder, and only 15% of them will be assessed or treated. That’s tragic, and we shouldn’t fall through the cracks.

I’m going to ask you to do three things:

1. If you’re an American or live in the US, call your senators’ office today to ask them to support the MOTHERS Act (S. 3529). Find your senators’ contact info by going to www.senate.gov and using the drop-down box in the top right corner to find your state.

2. Start talking about PPD. If you experienced it, share your experience. When you see other new moms out and about, ask how they are, and really look at them when they answer. You might be a vital part of the safety net we should have in place.

3. I’ve posted a PDF of "14 Tips to Prevent Postpartum Depression" over there on the left-hand side of this page. Please download it and print it out, and give it to the pregnant women and new moms you know. (If you want more than five copies or to reprint it, please email me about rights.) It’s better to prevent PPD than to try to battle it, so let’s make sure women know there are things they can do to lessen their likelihood of getting serious PPD.

55-week sleep regression

And today we tell the tales of the 55-week (13 month) sleep regression. Kamala and Kelly wrote me virtually identical emails detailing how their daughters were waking up and staying awake for more than an hour in the middle of the night, and crying hysterically if they were left alone. (The only difference was that Kamala’s daughter has been sleeping through for several months already, so the waking up was new, while Kelly’s daughter was still waking up twice a night but used to go back down easily, so the staying awake is new.)

Both girls escalate tension when left to cry, so the experiments Kelly and Kamala and partners have done have only left everyone shaky and unhappy and even more tired yet unable to sleep. Kelly is afraid that she’s scarred her daughter by letting her cry for too long for two nights. Both women are afraid that this is never going to end, and don’t know what to do when the kids wake up in the middle of the night.

I’d love to talk about some techniques for this period, and I remember clearly both my boys going through it. (I remember feeling extremely insulted by it both times. It wasn’t enough that we’d made it through the first year–things just had to fall apart for a month after that year? Honestly.) But I can’t remember for the life of me what I did about it.

I think there are two lesson to be learned from that: 1) It eventually ends, and 2) memory is merciful and you won’t remember all of the suffering. And if you don’t remember it, the baby certainly won’t remember it. So I don’t think Kelly should worry about having hurt her daughter with the crying.

Is there anyone who’s just come through this phase who has some good suggestions about how to make it through the hour+ awake sessions in the middle of the night? I think that if the kid is playing alone in the crib and isn’t getting upset, you should just sleep through it. But if the child needs someone there while s/he’s awake, there’s got to be something that will bore the child to sleep. I’d probably choose Food Network over Sesame Street, and keep the lights dimmed and the sound low to see if it would help mesmerize the child into slumber. But I’m betting someone out there has even better suggestions. Complaining about this phase is, as always, allowed.

FWIW, the skill developed during the 55-week leap is the ability to follow programs, meaning dealing with a bunch of little events. The example in the Wonder Weeks book is the program "eating lunch," which involves the ritual of sitting in the high chair, getting a bib put on, eating the foods, getting cleaned off, etc. No wonder kids start to seem so much more independent at around 14 months.

(Has anyone else been watching the BBC show–now on the Discovery channel in the U.S.–"Last Man Standing"? It’s 6 youngish American and British athletes who go to tribal villages and participate in their tests of strength and fighting rituals. I’ve been watching, thinking how lame it all is. Any woman who’d mothered a child through the age of 5 could beat any of these guys in tenacity, endurance, and feats of strength under adverse conditions. Brazilian piranha-tooth cuts on the legs rubbed with chile powder? Try 36 hours of unmedicated labor.  Zulu fighting sticks? Try sleep regression after sleep regression. Running 30 miles uphill in sandals? Try nursing all night for months and still holding down a full-time job. Maybe I should work up a pitch for the show: kick boxer, triathlete, and bodybuilder vs. mom of high-needs baby, mom of twins, and mom of three kids under age five.)

4 month olds

I’m really, really behind in my life today. And I’ve been getting a ton of questions lately from people with 4-month-olds. And there’s just so much going on at that age that makes it a tough, tough time–they don’t really nap yet, their nighttime sleep is falling apart (thank you 4-month sleep regression), you may be back at work or seriously wondering what made you decide not to go back to work and either way it screws with your head, you probably haven’t lost the baby weight yet and don’t feel sexy but then there’s Scary Spice doing the cha-cha looking like a brick house, and your baby is probably not as fat as your doctor wants him or her to be, and it all just sucks.

A very helpful nursing-related post about breastfeeding at 4 months from CJ:


Things to consider if your four-month-old baby coasts down the growth charts

So I’m going to just open up the comments, and those of you who remember your 4-month troubles, (or are in the middle of them) post them, and we’ll all commiserate. I don’t think there’s much of a cure for most of this stuff except for time and being gentle with yourself, and realizing that you do what works at the time and then when it stops working you do something else. Think about getting sleep today, not what might happen a year from now.

Book Review: Understanding Your Moods When You’re Expecting

This is a review of Understanding Your Moods When You’re Expecting, by Lucy J,. Puryear, M.D.

Puryear is a psychiatrist specializing in women’s reproductive mental health at Baylor in Texas, and she’s seen tons and tons of women at all stages in pre-conception, pregnancy, and postpartum problems. She says she initially thought she was going to be an ob-gyn, but found that she’d have no ability to help women with their moods and emotions during the pregnancy because of the limitations of the system, so she switched to psychiatry. Now she works with women before, during, and after pregnancy.

The wonderful thing about this book is that Puryear continues to emphasize that it’s normal and acceptable to feel depressed, scared, angry, and even hopeless during pregnancy. That, to me, is a huge step, that a mass-market publisher has published an entire book talking about women’s negative feelings in a way that validates us. Those of us who have been depressed during pregnancy know that it’s such a turbulent mix of mega-hormones, life changes, and emotional vulnerability that depression is a reasonable response from our bodies. But it’s still so important to hear that it’s normal from the medical establishment (which for years told us we should be happy and glowing, that serious nausea was "only morning sickness," and made us feel like we were going to be bad mothers if we didn’t absolutely love pregnancy). So I’m thrilled that this book is out there.

Puryear writes with an easy, authoritative tone. The book is full of anecdotes about her patients, most of whom she treats with talk therapy, some of whom she treats with anti-depressants. She emphasizes the need for family support, which could be critical for a reader who was trying to hide her depression from family and friends because she was scared of their reaction to it. She also covers some interesting topics, like how to process pregnancy body changes if you have a history of eating disorders and body dysmorphia. The section on telling postpartum psychosis (having persistent thoughts of harming your children) vs. postpartum OCD (having persistent thoughts that something bad is going to happen to your children and trying to prevent it) is extremely important and will probably result in hundreds of women getting treatment for PPOCD who otherwise would have thought they would be seen as monsters.

There are a few things I wish were different about the book, though. The most glaring things for me are that she doesn’t talk enough about alternate treatments for mood disorders and her section on breastfeeding is a big cop-out.

She does have a very brief section on St. John’s Wort and Omega-3s during pregnancy, but not postpartum. She also doesn’t mention any other treatment options for pregnancy or postpartum, even things that we know about–massage, B-complex vitamins, exercise, etc. It doesn’t really surprise me, since she’s an MD so her focus is on talk therapy and medical treatments, but it would have been nice to have this be a big book of what-to-do as well as a big book of you’re-normal-and-you-can-get-through-his.

My real beef is with the section on breastfeeding, which I just think wasn’t completely researched. There is evidence from all over the world that both mothers and babies do better when they are supported in their efforts to breastfeed. It should be treated as a normal part of the process, and we should be giving women all the tools and support we possibly can to help them have successful breastfeeding experiences. But Puryear seems to approach nursing as an expendable option, the first thing to go when a woman feel stressed postpartum. The anecdote she uses tells of a woman who comes in with a 6-week-old who isn’t breastfeeding very well, and she’s afraid she isn’t making enough milk. She’s tired and stressed out and her husband’s at work all the time. (Sound familiar? Growth spurt at 6 weeks, fear of low supply, worst phase of baby crying and fussiness?)

Instead of saying a) we need to get you to see a great, IBCLC lactation consultant right now to figure out why the baby’s not nursing well and whether you’re actually having supply issues, b) we need to get you some help at home, and c) your husband is going to have to take a night shift or two with pumped milk or formula so you can get some sleep, Puryear tells her to stop breastfeeding. Now of course it’s OK not to nurse your baby. But to me this sounds like a patient coming in with a broken toe and the doctor saying "Let’s amputate the foot." Why not deal with the core issue, which is lack of support, to help the mother get some rest and either get the nursing straightened out or know she had all the support she could have before stopping?

So. In general I think this book is great, and is a vitally-important step in having the medical establishment and society at large treat women’s mood disorders during pregnancy seriously. But if you’re entertaining any thoughts at all of nursing, skip that section in this book. Make sure you’ve done some research before you give birth and have the phone number of an IBCLC lactation consultant on your refrigerator and don’t hesitate to call if you’re having any nursing issues at all. It doesn’t guarantee that you’ll be able to nurse successfully, but at least you’ll have a fighting chance. 

Link here to my series on Preventing PPD.