Category Archives: Depression

Q&A: pregnancy blues–when to see a therapist

Fran writes:

"I’m almost eight weeks into my second pregnancy (first ended in miscarriage) and have been feeling horrible both physically and emotionally. I know that anxiety and mood swings are par for the course, especially in the first trimester, but am wondering at what point you draw the line and say, "This is not just pregnancy," and seek outside help. I don’t mean this to sound scary–I’m not suicidal, by any means. But I do get very black sometimes, and (on top of feeling horrible) spend a lot of time wondering if this is okay, or if crying all afternoon and feeling hopeless warrants a discussion with the doctor."

I think if you’re wondering if you should see a therapist, you should see a therapist.

And I mean that for pretty much all of life, not just pregnancy. Because if you’re feeling like you think you might need professional help, or even just an objective paid listener, you should find one. I think it’s easy to feel like going to a therapist means admitting that there’s something really wrong, but it doesn’t mean that at all. It just means that you need someone to give you some feedback or help you formulate a plan to deal with whatever it is that’s stressing you.

It’s not even that big a commitment. You can go see a therapist just once even, and for some situations that’s all it takes. When I was very depressed during my first pregnancy, I saw a therapist who specialized in women’s issues around pregnancy and mothering. I don’t remember if I had two sessions with her or three, but that was all it took to get me to a better place so I could get through the rest of the pregnancy. (The September 11th attacks happened when I was almost four months along, and I really credit those sessions with the therapist and the things she had said to me about pregnancy with helping me deal with the event and my grief and that whole ball of wax.) And deciding to see the therapist was a big step in deciding to take myself and my own feelings seriously for a change. That was a big thing for me.

So to me it sounds like you definitely need to see a therapist. Whether or not it’s "just pregnancy," it doesn’t matter. You should go see someone who can help you through this time and all the conflicting emotions and the bad physical sensations and the fear and guilt and all of that. You should decide that your feelings are important, and you can take yourself seriously. You can ask your OB for a recommendation, or call a midwifery practice or birth center and ask for one. If you know any childbirth educators, they’ll have good recommendations, too. You definitely want someone who’s worked with pregnant women before and who understands those special issues.

Did anyone else see a therapist during pregnancy? Or did you tough it out and now wish you’d seen someone? It was only when my therapist sent me a newspaper clipping about prenatal depression that I realized it wasn’t just me, that there are tons of us who get depressed during pregnancy.

More on PPD and Q&A on breastfeeding in front of a 3-year-old

Jillian wrote me to add to Friday’s post on PPD after weaning:

"I wanted to add to your "trifecta" of massage, omega-3 and exercise.Add: High potency B vitamin pill, like a B100 or Stress B. Consider
adding 500-1000 mg of magnesium citrate pills per day as well.

Many
women who have been pregnant and nursing, and on birth control as well
(!), have become borderline deficient or downright deficienct in B12
and B6, among the Bs, as well as in magnesium. B vitamins are
absolutely required for the body to make serotonin. Low
serotonin=depression. Many women who suffer from PMS are B vitamin
deficient as well. You can google or pubmed this stuff, but I looked
into it extensively. I also found my PMS, cycles and moods to improve
considerably with a B100 (on top of my high potency multivitamin)
daily, plus 500 mg mag citrate.

You can safely take a B100 on
top of a multivitamin that provides tons of B, because B isn’t absorbed
that well. It’s what makes your pee green when you take vitamins,
actually."

Very good to know. Thanks, Jillian.

And now a question from Anon:

"I can’t seem to find any info on the subject of breastfeeding in front of a 3 year old. Do you think it is it healthy to my 3 year old’s psyche to let him see me breastfeed his baby brother?

We are expecting in November and I never thought this would be an issue but my husband thinks it is weird that I still bath with my toddler and now he thinks it is "unhealthy" to let him see me nursing the baby. My son is now noticing that my anatomy is different to his and is starting to be curious about it and it kinda freaks my husband out a little. I weaned my son from the breast at around 13 months so I doubt that he remembers anything about nursing. I just wondered what you thought about it."

I can appreciate that your husband might have some qualms, because our society is so geared to thinking of the breasts as sexual and not functional. But he just hasn’t thought it through logically: If it caused psychological damage to watch a baby being nursed, then every older child of a nursing mother across the world would be psychologically damaged either from having watched it or from being sent into another room every time the baby nursed (talk about a recipe for sibling rivalry!). Moreover, there are tons and tons of kids who were still nursing at the age of 3 and have no psychological problems. So your husband can turn his worries from nursing to all the other stuff that’s going to happen when the new baby comes in November.

(This is the point at which I plug the book Siblings Without Rivalry by Faber and Mazlish. If you’re having another child, if you do absolutely no other prep, read this book. If you already have more than one child, read this book. If you have siblings, reading this book might help you understand your relationship with them better and could help you improve things between you. If you’re an aunt or uncle or interested adult in the life of siblings, read this book.)

On a related topic, it’s very healthy for your son to learn, in a factual way, about the differences between boys and girls. His noticing that you and he have different parts is great, and any factual, age=-appropriate explanations you give him are going to help him. It’s also going to be healthy for him to learn all the normal things about babies–how they’re fed, that they pee and poop, that they cry and need to be soothed, etc. It’s all giving him more information about the way humans work.

It sounds like your husband may be very concerned about the inappropriate sexualization of your son. That’s a really valid concern, especially in our society (Bratz, anyone?). But withholding factual information about basic differences will actually backfire by making him more vulnerable to information coming from other sources. A kid who knows the facts and has all his questions answered honestly to his age level is going to be much better equipped to live in a world that sends some really confusing messages about our bodies.

Comments?

Q&A: PPD after weaning toddler?

And back to something more serious leading into the weekend…

Jeanne writes:

"I really want to know if anyone has dealt with symptoms of postpartum depression after weaning. I’ve tried to do some research and have come up with very little. I definitely didn’t see it coming, and actually assumed things would really get back to "normal" after we weaned, so it’s all a bit confusing.

My daughter turned 2 in May, and she nursed for the last time right around the 4th of July. For the months leading up to and after her birthday, she was only nursing after waking up in the morning and after waking up from her nap in the afternoon. Toward the end, we very slowly went from those two sessions (which were already brief) to only nursing in the morning, to nothing. So we were both ready for this chapter to end, and if anything, she and I are even closer now than we were before we weaned.

But ever since then, I’ve felt so down. The kind of down that I can’t control, where I know I can’t just give myself a pep talk or go out and be active and it’ll be okay. Looking back, it’s gotten worse as time has gone by. This has all been accompanied by poor sleep, bad headaches at least once a day, bone-tired feeling, lack of appetite…and now it just feels like an accomplishment if I get showered and get us out for a little bit during the day. What I’m grateful for is that I still want to be a mom (definitely didn’t feel that way on my relatively few mild postpartum days) and am having so much fun with my little girl. It’s just everything else – (patient) husband, housework, friends, spirituality – that I’m just not into right now.

In consultation with my midwives, I went back on a regular birth control pill about a year ago, even though I was still nursing when I went back on. The thought at the time was that I’d had really bad breakthrough bleeding on the progesterone-only pill and with depo provera shots, and since my daughter was eating solids very regularly at 15 months, she wasn’t getting a majority of her nutrients from nursing. And I didn’t think at the time that we’d nurse much longer, but we went for almost a whole year beyond that!

I’m sure that with the decrease in hormones from lactation, plus the pill hormones, plus whatever else, is all contributing. I just had never heard anyone talk about such an ordeal and would love to know if others struggled and what they did to help themselves."

I’ve
definitely heard of women suffering from some PPD after weaning, and
whenever I get questions about weaning I make sure to warn the woman
that she may suffer a dip in hormones that could throw her into some
PPD. That combined with the hormonal stuff of being on the pill is undoubtedly what threw you into PPD.

Some of my readers may disagree with me, but it seems
to me that most of the other things in your life are pretty stable
right now, you’re not having any hidden emotional issues, and you’re
dealing well enough to be able to experiment with some ways to get out
of the PPD without having to go on meds. I don’t have anything against
meds for women who really need them to manage, but it does take
anywhere from a few days to a few weeks for them to kick in, and
depending on which one you’re taking you can have truly a nightmarish
time getting off them (Effexor is the worst one I know about). So if
you’re not in crisis mode, I’d see if you can kick your hormones back
into place without the meds first. I’d make sure you’re doing three things:

* In her The Big Book of Birth (my review here),
Erica Lyon cites a study that showed that a 15-minute massage every
day prevented PPD as well as meds did in newly postpartum women. I’d
say it’s worth a try. If your partner doesn’t know how you’re feeling,
definitely ‘fess up, and when he asks what he can do to help, ask him
for a 15-20 minute massage every day. He’ll probably be thrilled to do
it, because it’s something physical and concrete that he can do (many
men love that). It sounds like you’re feeling some distance from him right now, and a short period of nonsexual touch every day from him could help bring you closer together without any real pressure on either of you to "do something about it."

* Make sure you’re forcing yourself to do 15-20
minutes of exercise a day. If you’ve got a T-Tapp DVD, put it in and
actually press "play" and just do the Basic Workout Plus. T-Tapp is
definitely a mood enhancer. (If you want to start with T-Tapp, read Summer’s great summary of how to start and what video to start with here.) If you’re not a T-Tapper, climb stairs for
15 minutes, or dance around the living room for 15 minutes, or (if it’s
cool enough where you live) go for a brisk walk for 15 minutes.

* And make sure you’re taking Omega 3 supplements, either fish oil or flax seed oil, every day. At least 1200 mg a day if you can.

If
you’re hitting your hormonal mood problem with the trifecta of massage,
exercise, and Omega 3s, you should start to feel better in a week. If
you’re not feeling better after two weeks, ask your midwives for help,
because you might need to have your thyroid tested or look for other
physical explanations for your mood.

In the long run, you might consider non-hormonal birth control. It’s not for everyone, but the fertility awareness method/natural family planning method has a high reliability rate when all the rules are followed by a motivated couple. For the basics on FAM, read Toni Weschler’s Taking Charge of Your Fertility. (Yeah, I know those of you who’ve gone through infertility are rolling your eyes, but for people without fertility problems, TCOYF is a revelation about how your cycle works and how you can use your cycle to prevent or achieve pregnancy.) Giving your body a break from the hormones might help it regulate itself and get you back into a better frame of mind.

Did anyone else suffer from PPD after weaning? How long did it last? Did you treat it or did it just pass?

Q&A: post-partum insomnia and irrational fears

Continuing with the theme of admitting how hard this can be sometimes…

Wendy writes:

"I’ve developed insomnia. 8 month old baby wakes up only 1x per night now (hooray) sometime between 2-5 am. I breastfeed, he goes back to sleep and I lay awake for a couple of hours. I’ve also lost my ability to nap. Overtired? PPD?

Also, since the baby was born, I’ve become afraid to fly (plane crash), afraid to drive (car crash), afraid to walk around the block (car crashing into the stroller), afraid of sitting in my house (tree falling over and crushing us), afraid to go into the bank (bank holdup)….I have not become a shut-in but find myself preoccupied with worst case scenarios."

I think this is post-partum anxiety, which is technically different from PPD, but I think is also caused by a complex interaction of factors, including hormones.

I am going to hazard a guess that a lot of us have suffered from some mild form of insomnia after having babies. Which is an unbelievable pisser*, because if the baby is actually asleep, it’s cruel that we aren’t, too. I’ve definitely gone through periods of this, even when I was not depressed in any other way. And it seemed to ebb and flow with my hormones and exercise and nutritional intake.

I also noticed (and why do I feel still a little scared to admit this, even now?) that I had preoccupations and almost visions of something bad happening for the first few months with both my kids. With my older one, I was constantly worried that a car would jump the sidewalk and hit the stroller and kill him. Sometimes I couldn’t get the thought out of my head, and I’d lie awake at night worried about it. Then when I had the second baby, the fear was that somehow my older one would accidentally snap the baby’s spinal cord and leave him paralyzed. I could not shake that fear for a good 4-5 weeks, starting about 2 weeks after the baby was born. I’d be sitting with them both, playing with the older one and holding the baby, seeing it happen in my mind as if it was a memory instead of some cruel mind trick.

The one good thing was that with the second one I didn’t worry that there was something wrong with me, and I have the blog world to thank for that. By that time I’d read enough "shameful confessions" online to know that there are things we’re afraid to admit, but that a lot of us are dealing with. Just because I hadn’t heard other women joking around about how afraid they were of really unlikely things in the first few months didn’t mean tons of us didn’t deal with it.

But back to Wendy’s problem: Just because lots of us have dealt with the insomnia and ultra-worry doesn’t mean that you should have to suffer through it. I think that taking Omega 3 supplements (2,000-3,000 mg a day of fish oil or flax seed oil**), getting 20-30 minutes a day of exercise, and getting 10-15 minutes a day of sunshine will probably fix you up in about a week or two. At least to the point that you can catch your breath and figure out what else you need that can ease your load and help you start to reach out to get some help.

You may find that you need counseling and/or anti-depressants, but I’d rather see you do the Omega 3s and exercise and sunshine first, because if your body’s a little off-kilter you should fix that first before going on meds so they’ll be even more effective (and just so your body doesn’t get depleted). I’d give them a few weeks to kick in, then call your doctor if things aren’t significantly better. (Mention "crippling insomnia" and "persistent worries" to get them to take you seriously.)

Here’s something really interesting I read in Erica Lyon’s The Big Book of Birth (I have a review copy, so I don’t know if my page number would be helpful, but it’s in the last paragraph of the "Massage" section in Chapter 4):

a recent study showed that if a partner massaged a new mother for fifteen minutes a day it is as effective (!) as medication for moderate postpartum depression.

I think it’s probably a combination of feeling taken care of by someone else and the way massage helps your body regulate itself (the same way getting regular massages helps you fight off colds better in the winter). But if you have a partner or friend who would be willing to massage you for 15 minutes every day, it might help regulate your system, too.

So. Yeah. It’s a problem, but you’re not a freak because it’s not that unusual (unfortunately), and it’s treatable.

Anyone want to share? Bizarre fears you had when your babies were little? The most sobbingly cruel episode of "I finally got this child to sleep and now I can’t fall asleep myself" you can remember? What you’re wearing today? (It’s supposed to be gorgeous and sunny here in NYC on Monday, so I’ll probably be wearing a red-and-white patterned wrap dress and red slingbacks to work.)

 

* By the North American phrase "pissed off," meaning angry, not "pissed" meaning drunk, which would undoubtedly be more pleasant.

** Hey, I still have no idea what the deal is with flax seed oil, whether it’s completely safe for all of us, or not so great for fetuses but fine for post-partum moms, or whatever. I’m still tempting fate by taking it, but know that I’m not a doctor or nutritionist and am not recommending it specifically so take it at your own risk.

Reader call: depression during pregnancy and cleaning bath toys

Here are two things readers need help with today:

Amy writes:

"I just wanted to know if you got depressed with your second pregnancy?
I am in my first pregnancy, 2nd trimester and very depressed. It has
made me rethink getting pregnant again because it is so painful!!! I
feel like I am too scared to go through this again."

I did get depressed with my second pregnancy, but nowhere near as badly as with my first. (With my first I saw a therapist to help me deal and stop having panic attacks.) The depression wasn’t as severe and it didn’t last through as much of the pregnancy. I think the really important thing about it, though, was that I knew it was hormonal, and was therefore just another one of those physical symptoms I had to deal with, like constant nausea and restless leg syndrome. That way it didn’t really touch me the same way it had the first time through. I coudl tell myself it was an annoyance instead of a prediction or personal judgment.

Anyone else who was depressed during a first pregnancy want to share what happened during subsequent pregnancies? So many of us get depressed during pregnancy, and we really need to talk about it with each other, so your comments are very important.

And now for something completely different:

Molly writes:

"My daughter has a huge inventory of rubber and plastic bath toys. Some of them have ‘blow holes’ where you can squeeze water in and out of the toy. Over the course of the past few months these toys have gotten slimy, no matter how hard I try to rinse and dry them. Also, the water inside some of the toys never gets completely flushed out and I cringe to think of what microbes are flourishing in there.  I want to dunk them all in a bleach solution for the afternoon, and get the bleach inside the ‘blow hole’ toys, too.

What do you think?

My only worry is the possibility of residual bleach from the ‘blow hole’ toy coming into contact with my daughter at some point. (Of course she loves these toys the best.)

Should I just chuck them all and buy a bunch of new ones?"

I can’t be the only one laughing here, because I’m betting 80% of the readers have gone through this exact same process and line of reasoning. Sucking the bleach water in to get out the black mold, but then worrying about the bleach water, and thinking the whole thing is impossible.

I have no idea. My gut feeling is that the bleach water is probably less harmful than that mysterious black slime mold, but who knows? Ultimately, I just sidestepped the problem by switching us to hard plastic boats and a bunch of "guys" (action figures) that do lots of rescue work in the tub.

Anyone else?

Q&A: post-partum depression starting 5 months post-partum

B writes:

"I have finally accepted the fact that I am depressed and have been for a month or two.  Not really sure when the clinically defined "depression" started.  My baby is five months old, so I am not sure if this still counts as post-partum depression.  I have been put on medication and told that it is still safe to breastfeed my child. All this time I thought it was due to sleep deprivation because my kid still wakes up every four hours for nursing.

I hate being part of that 10% of women who experiences depression because I would have liked to believe that I could handle this on my own and not enlist the aid of mood enhancers.

Would you consider this a post-partum depression?"

Yes, I would. I think depression that comes on you after you’ve had a baby is post-partum depression.

Even though it seem like you’ve been mothering your baby forever, 5 months is still pretty tiny. I don’t think it’s at all odd that you developed post-partum depression once the initial flurry of activity and adrenaline rush of parenting a true newborn is over.

In a lot of ways, I think 3-4 months has the perfect conditions for PPD. You’ve survived the intial hormone rush of the first 12 weeks, so you stop being so vigilant about monitoring yourself for PPD. The baby might be old enough to sleep through for four hours at a time, but that’s still sleep-depriving for you, even though it’s normal for her. And you just don’t have the support anymore that you did at the beginning. Everyone expects you to be an old hand at this, and doing it with no problems. In the meatime, it’s starting to sink in to you that this is the new normal, and you wonder why it’s even worth getting out of your pajamas if the whole day is just going to be the same grind.

I hate that so many of us develop PPD*. (I think that 10% figure is extremely low, BTW. Maybe 10% seek treatment, but I think there are tons of us walking around with some low-level depression at any given time.) I hate that we have to take drugs to help us function appropriately. But I think they’re an appropriate response to an inappropriate situation.

If we had more cultural support for mothering and parenting in general–and I don’t mean people stopping us to tell us how cute our kids are and then giving us some guilt trip about either working or not working and what and how we’re feeding our kids–we wouldn’t be stretched to the breaking point physically or emotionally. If we lived in less isolation from each other we’d have people to share the burden with on a daily basis. If we hadn’t screwed up our food chain so much we’d be eating foods that were naturally higher in the nutrients our bodies need to be able to keep us on a more even keel emotionally. If we were able to trust our parents more, and therefore learned to trust ourselves more, we wouldn’t be so twisted up about every minor decision we make about our kids and we wouldn’t judge other parents so harshly.

Mothering in this time and place can be a really screwed-up proposition. It’s amazing most of us come out of it as whole as we do. 

I’m sorry you have PPD. I’m sorry you have to go on medication, and that that makes you feel bad. But you have to take care of yourself, for your own sake and for your child’s sake. PPD is an illness caused by a lot of factors, not a personal weakness. You will get better. You might also want to consider seeing a therapist to talk through a lot of the stuff that seems to happen as a matter of course to most modern mothers–body issues, issues surrounding the pregnancy and birth, relationship issues, self-esteem, etc. It’s too much to just stuff down and try to cope with on your own.

Can we start talking about this more? I don’t just mean here. I mean IRL. When you see a mom with a baby, can you tell her her baby is cute and then ask her "How are *you* doing?" And then let her talk about it if she needs to? Let her know she’s not the only one barely holding it together, and that it will get better, and she can and is doing it.

* Full disclosure: I’m the daughter of a parent with clinical depression who has been on medication for 20+ years. I have had depression myself for years (never medicated), and was severely depressed during part of my first pregnancy. I made a conscious plan to ward of PPD, and aggressively followed that plan after the birth of my first son. I believe that (and the hormones from nursing) kept me from developing PPD despite my many risk factors for it. After having my second son I stopped following the plan (I got cocky), and found myself depressed from the time he was around 4 months until he was around 11 months.

High Stakes

At brunch the other day one of my friends was holding my 1-year-old. He was chomping on a sour pickle (and flicking the juice all over my friend, who thought it was funny), and reached for the piece of cake on my friend’s plate. "Can he have that?" my friend asked. "Sure. He’s the second child. He can have pretty much anything," I replied.

I’ve been thinking about that conversation, and why it is that the experience of parenting the second child (or subsequent children) is so different from being a first-time parent. The recent exchange I had with Jody and Elizabeth on the posts about the woman who didn’t want to spend a weekend with her friends got me thinking about even more, specifically about how sometimes as mothers we can’t let anyone else take too much care of our children. But then I read Kateri’s latest post, and thought, "Aha!"

"Aha," because Kateri wrote in the most direct way possible about why being a first-time parent feels so high stakes and raising subsequent children does not. Go read her post. It’s short (something that can’t be said about any of my posts) and pithy and hit me right between the eyes because it’s the essence of why parenting’s so hard emotionally. I’ll wait. No, seriously–click and read it, leave a friendly comment, then come back here.

Now that you’re back, can we talk about two things? The first is how it feels to let go and let other people take some of the emotional burden of parenting, and the second is how to give yourself a break and avoid putting yourself in a perfectionistic parenting box.

Letting other people take over some of the care and emotional energy of thinking about your child is rough. That’s been one of the hardest things for me as a mother–the letting go of needing to be the one in charge all the time, or the repository of knowledge (and let’s face it, I’m Cliff Clavin), or the one the baby really wants. And I think that I had an easier time than lots of mothers do, all things considered. I had to make a serious effort to force myself to allow my husband to do things the way he wanted to with our son when he was tiny. It was hard to listen to my son crying, knowing that I knew how he wanted to be held and that my husband wasn’t doing it "the right way." I started leaving the apartment so I wouldn’t have to swallow my words of "advice" to my husband.

But it got easier and my husband started to know what our son needed more and more. The feedback loop worked like a charm. And then, when my husband was laid off and home all the time, he and my son really learned each other. He had 15 months of being at least as hands-on as I was, and I think that’s still a major influence on our relationship and my identity as a mother. At one point I started being afraid that my husband might be a better parent than I am. When I realized how scared I was of that, I forced myself to really consider that it might be the case. And you know what happened? Nothing. If my husband was a better parent than I was, it was still OK. I was still a great mother, my son still loved me, and the world kept turning.

So, Question #1 for you: Do you feel like you’ve come to terms with other people being good at caring for your child? If yes, how did you do it, and if no, what work do you think you could do to get there?

On to the second thing, which is giving yourself a break and making parenting decisions less high-stakes. I’m not sure there’s really any good way to do it. First-time parents are, by nature, concerned about everything they do in taking care of their children, and that’s the way it’s supposed to be. I just wish we could put less pressure on ourselves to do things perfectly all the time. That pressure leads to stress, depression, and the one-upsmanship that makes interactions with other parents so much less helpful than they could be.

I don’t tend to feel guilt very often or to let others’ opinions of me guide my thoughts or actions. (I think that’s a result of the way I approach decisionmaking about parenting and in general, but that’s a whole different post.) But even if I did, I think I’ve devised a pretty decent strategy for putting parenting decisions into perspective. When I was pregnant with my first son, I made a parenting mission statement for myself. I figured out what were my main goals as a parent, and then some smaller goals, too. When I started to get stressed out about what I should do, I referred back to my mission statement. If it didn’t have anything to do with one of those goals, I just took the path of least resistance or more fun. It’s been remarkably freeing.

So, Question #2: How do you keep yourself from sweating every small decision you have to make as a parent? Is it getting easier as your child(ren) grows older?

I’m hoping we can start to find some way out of the mental and emotional mazes we keep ourselves running around in. So please share your experience, whether you’ve gotten to where you want to be or not. As usual, you can post anonymously if you want to by putting "www.google.com" or "www.fake.com" into the "URL" box and only I’ll be able to see whatever real or fake email address you put in the "Email Address" box.

Q&A: mom eating nothing but junk food

A reader I’ll nickname "Sunshine," who wrote me a few months ago about easing her encroaching PPD, writes:

I have another question for you but it’s more
general, sort of to see what your opinion is since the opinions I’ve found on
the internet (Mothering.com, babycenter.com, kellymom.com and elsewhere) vary
widely.  I searched your archives and couldn’t find a similar question, but
I apologize if I missed it.

The question is, do you believe it’s detrimental to
eat junk food while BF?  I started out eating a great diet and really tried
to hold the line on trans fats since I know they pass into the milk, but for the
past few months (depression?) I have been eating increased amounts of processed
and fast foods.  I mean, I eat fast food pretty much every day
now.  I still take supplements – a multivite with iron, probiotics, and
Omega-3’s (right now: cod liver oil) but I basically eat like crap.  Almost
no fresh fruits and veggies and I never cook at home; the best I can do is
Annie’s Organics meals.  🙁  I feel so guilty about it but can’t seem
to pull myself out of the cycle.  On Mothering.com I have basically been
made to feel that I am poisoning my baby and that she would be better off with
formula.   Anyway, I have a
feeling I’m being defensive at MDC about the issue because I suspect they are
right.  However Kellymom disagrees.  I so want to believe Kellymom,
but…

I feel like a bad mother in so many ways right now…but this has been weighing on me…

So, I just wanted to get your opinion.  Also,
I think I am finally going to see someone about the depression.  I have
been avoiding it because I hate dealing with mental health professionals. 
Hate it, hate it.  And I’m not sure (from prior experience) that there is
much they can offer me.  But I have to do something; I’m becoming more and
more apathetic and my daughter deserves better.

In the past when I suffered depression it was
all-consuming.  I find that this is not the case with what I am
experiencing now.  My daughter brings me much joy, and I am not living
under a black cloud.  But still, I do not feel right – I have little energy
and am very critical and crotchety and feel hopeless and overwhelmed almost
every day, and like I’m not a good-enough mother.  So that is depression,
right?"

Honestly, I think it’s malnutrition, with a sweet lacy overlay of depression.

I don’t know how detrimental it is to your milk to eat nothing but junk food while breastfeeding. I do know that breastmilk has benefits formula will never have even when it has high concentrations of PCBs or other chemicals and even when the mother smokes. Breastfeeding is a robust process. We’re designed to feed our babies even under horrible conditions. Women kept and keep their children alive breastfeeding in concentration camps, in droughts and famines, in refugee camps. Unless you’re taking drugs that will hurt your baby or are in danger of passing HIV to your baby, your milk is always the best choice from a health standpoint.

However, your milk is going to be better quality the better you eat. We know that cows’ milk from cows that eat grass instead of grain is higher in nutrients and CLA (conjugated linoleic acid). We know that eating oatmeal increases the quantity of human breastmilk. Anecdotally speaking, I know of someone who was pumping and when she started taking alfalfa (the leaves, but mashed into tablet form) she noticed her milk had a thicker cream layer than when she wasn’t taking alfalfa. Babies prefer to drink milk that is flavored with garlic that their mothers have eaten than milk without garlic flavors. It just makes sense that the better the food that goes into your mouth, the better the food that comes out of your breasts.

Junk food and fast food are addicting. It doesn’t surprise me one bit that you feel powerless to start eating better–those foods are designed by the manufacturers to make you want to eat more and more of them. It’s like being addicted to a drug. But you’re going to have to struggle as hard as you can to work yourself free. It’s the only way you’re going to feel any better.

Any responsible mental health professional is going to ask you about your lifestyle and diet before prescribing any medications. And s/he isn’t going to prescribe anything without also asking you to get back on track with your diet as soon as possible. Anyone who does prescribe meds for you at this point without looking at your diet is only going to do you a disservice. Yes, in the short term you might feel better (although many anti-depressants take a few weeks to kick in fully), but unless you start eating better and taking care of yourself physically and emotionally, you’re going to get weaker and more drained and lifeless and you’ll have to keep upping your dose.

So call to make an appointment, but start changing your diet today. That way, by the time you get in to see the doctor or therapist you’ll have a truer picture of your mental health. You’ll know how much of what you’re feeling is depression and what is because you’re not giving your body the fuel it needs to keep you mentally healthy and full of energy. If you do decide to go on anti-depressants, they’ll work that much better because your body will be healthy and functioning better.

You can do this. You can change your diet. For yourself and for your daughter.

After you read this, have a little cry. Then pack up your daughter and go to the grocery store. While you’re there I want you to buy:

  • a bag of baby carrots
  • a pint of grape tomatoes
  • a bunch of broccoli
  • 2 cucumbers
  • 2 bell peppers
  • a bunch of bananas
  • 6 apples
  • a tub of garlic hummus
  • some crystallized ginger
  • a package of frozen peas

Cut up the cucumber, broccoli, and bell pepper as soon as you get home from the store and leave them in a Tupperware in the refrigerator. Before you seal the top of the container, eat a few pieces.

In the morning when you wake up, drink a big glass of water and eat a banana. Then get out a handful of baby carrots, a handful of tomatoes, half a cucumber, some spears of broccoli, and half a bell pepper. Put them on a plate in the living room or playroom or wherever you spend time with your daughter. Try to eat a few bites every half hour or so, either nude or dipped in the garlic hummus.

If you do end up going to a fast food place, force yourself to order a salad, or at the very least get lettuce and tomato on your burger. (Pickles, while delicious, don’t count as vegetables.)

When you hit the 3 o’clock slump, eat an apple (with peanut butter or cream cheese, if you want) and a few pieces of crystallized ginger.

While you’re cooking your mac and cheese, grab a big handful of frozen peas and put it in the bottom of the strainer. When you pour the pasta through the strainer the water will thaw the peas and the pasta will heat them up. Toss them together with the cheese sauce so you have mac and cheese and peas.

If you just eat a little bit of any kind of vegetable at a time, before you know it you’ll have eaten 5 servings a day. In a few days you’ll start to feel a little better, and a little more energized. You might find the strength to stay away from the fast food places and eat better meals.

I know so many of us have been stuck in a trap of needing to use food to regulate our moods, even when we know the foods are just making things worse. If you can just take baby steps and keep checking in, we can help you get out from under the junk food depression. I wish I lived near you and could just bring you a big salad and some pasta primavera and a hug.

You’re a good mom. All you can ever do is the best you can at that
moment. You’re having a crappy time right now, but you’re still the
perfect mother for your daughter. Things will get better.

Q&A: depression during pregnancy

Jodi writes:

"This will be short and sweet. This is my
first pregnancy and I am almost three months along. I am very excited
and feel lucky because I got pregnant the first time I ever went
without protection (thank god I was a responsible teen). I am 33 and as
my ob/gyn said "On the senior citizen side of birthing"  (hell of a
bedside manner I know ). Anyway here is my thing I have been feeling
DOWNRIGHT DEPRESSED for a few weeks. I am usually outgoing and love to
have fun but I just feel sad and kind of remorseful that I have not
done more of the things I set out to do. Did you ever experience
this? It is making me feel very guilty."

33? Is old?

Bwahahahahahahahahahahahahahahahahahahahaha. Hahahahaha. Ha.

Excuse me while I wipe the tears from my eyes.

I think your OB must have had extremely limited experience if s/he thinks 33 is "on the senior side" of first-time pregnancy. Even the technical definition of  "older" first-time mother doesn’t start until 35. I had my first baby at 29 and I’ve always been The Kid with other moms of children my son’s age. (Now that the kids are around 4, all the other moms at my son’s school seem to be in the 38-45 age range.)  I know a ton of women who didn’t have a first baby until age 38 or 39 (note that I’m not saying that it’s advisable to wait until that age specifically, or that you’ll have an easy time conceiving then, just that I know plenty of people who had first babies then).

All this is to say that 33 sounds positively early to have a first baby to me. Your OB’s comment is uninformed and a wee bit insulting.

But about the depression. Did I ever experience this?

YES.

I spent the first trimester of my first pregnancy in a serious, almost debilitating depression. I had just started building a little teeny career in something I liked better than my old "career." All of a sudden I was pregnant (with a baby we’d been trying to conceive, but somehow didn’t think would come so soon) and felt like I had nothing to show for my life, which would now, of course, be over, because you can’t do anything with a baby.

I dragged through the days, too exhausted from the pregnancy and too heartsick from the depression to do more than two things each day (and sometimes one of them was take a shower). I started having panic attacks. When I went in to a prenatal visit the midwife could tell I was not doing well and she basically twisted my arm to see the therapist that worked with women at the birth center.

What the therapist told me was this: There are extremely powerful hormones surging through your body when you’re pregnant. Different women react to them in different ways. Many women become depressed under the influence of these hormones. The only thing to be done about it is go through the motions of living day by day as best you can. Getting up in the morning is a victory.

What I know is that the depression may change or lessen or disappear by the end of the pregnancy, or it may not. I felt a little better in the second trimester (until the World Trade Center was attacked a few miles from my apartment), and then the depression came back slightly in the third trimester. Since I have had depression in my "normal" (non-pregnant and non-lactating) life, I knew I was at a higher risk for post-partum depression, but I never developed it (I made a hard-core plan to prevent it and it worked).

There’s a website called Pregnancy and Depression that has collected all the available research studies about depression in pregnancy (it also has some info about treating depression while breastfeeding and during mothering, and some info about bipolar disorder). Most of the studies are evaluating the risks to babies of exposure to antidepressants while in utero, but I thought this study was interesting and kind of sad. The conclusion is "Rates of depression, especially during the second and third trimesters of pregnancy, are substantial. Clinical and economic studies to estimate maternal and fetal consequences are needed."

I can tell you what I think the maternal and fetal consequences of prenatal depression are. I think those of us who are depressed during pregnancy doubt ourselves. I think we feel guilty that we’re not glowing, happy little earth mothers, basking in the miracle of human repoduction and our own fecundity. I think we feel cheated out of enjoying something our culture tells us is the pinnacle of human experience, and terrified that we won’t enjoy being mothers. I think we’re afraid that there’s something inherently wrong with us that means we won’t be good, or even adequate, mothers to our children. I think we think that if we’re so depressed during pregnancy we don’t deserve to have children. I think that’s why no one talks about prenatal depression.

But it’s real. It exists. It’s caused by hormones and the enormous changes we’re going through in our views of ourselves and in our relationships. It doesn’t have anything to do with how much we’ll love or enjoy our children, and it certainly doesn’t mean we won’t be damn good mothers. It does not have to mean that we’ll get PPD. It just means that we’re not the happy preggos in the magazines. But that’s OK. We’ll keep on getting up every morning, and we’ll waddle through our days until delivery, and then when the baby is crying at 3 in the morning we can think "At least I’m not still pregnant."

So, Jodi, don’t feel guilty. You’re going through a ton of changes and you have enough hormones to kill an elephant racing through your system. If you end up coccooning yourself your friends will understand. And life’s not over when you become a parent. You can’t do much of anything for the first year or two, but then you’ll get your groove back, only with renewed efficiency and a BTDT kind of fearlessness (that undoubtedly comes from knowing rightly that once a small person has puked into your mouth there’s really nothing left to be afraid of).

If you’re not already supplementing with flax seed oil, consider starting now–it can’t hurt. But try to cut yourself a break, and know that better things are coming for you soon.