Who is the best person to diagnose post partum depression/anxiety

June 29, 2009 7:26 AM

Who is the best person to diagnose Post Partum Depression/Anxiety?

Your OB, psychologist, psychiatrist, marriage counselor? I gave birth to my son the end of Dec 08 and the first week he was home, my whole world changed to where all I see in my husband are his bad points and we fight every week since then. I realized something was up with me so I'm back in therapy to figure it out (she's a LCSW who I've seen before). Yet I just feel like it's going nowhere. But I also don't know if my feelings towards my husband are PPD, PPA, or just wanting a better life for me and my son. Plus I have a constant feeling that something bad will happen to our son. He was born with meconium aspiration syndrome and I realize now how serious it was. For an hour I didn't get to see my son, hear what's going on, etc. The docs just distracted me and wouldn't tell me what's going on but I KNEW that something was wrong. At 6 weeks, he acquired RSV and was struggling to breathe and was in the hospital for a week. Then more bumps in the road from double hernia surgery, another 2 week bronchiolitis infection and trouble breathing, acid reflux, milk allergy, etc. All I "see" is something bad happening to him. I love him more than words can say to the point of tears (literally) and I just feel like no one cares about him like I do, including my husband. He talks about vacations without him, going out and about disturbing quality naps in his crib (which throws him off), taking him swimming (he's in class now), etc. I just have this intense feeling that he will die. I don't know why. And I also feel that my husband's influence on him is nothing but trouble--the way he grew up with a rough crowd, never went to college, etc. It scares me to death and now all I do is worry, worry, worry that our son will follow the same road. So we fight to the point where my husband is lashing out--screaming at me in front of our son (I demand for him to stop and he blames me for provoking him), telling me somethign is wrong and I need "fixing", etc. I want him to go to therapy for his attitude/behaviors and he doesn't do anything with the phone number. So I thing about divorce a few times a month and worry the effect staying or leaving has on our son. He's only 6 months old.

Sorry to ramble. I'm so confused and lost at to where to go, what to do, is this PPD/PPA, do I need meds, or is it really that my son opened to my eyes that in the end, my husband isn't the right person for us and we should be apart? Do I stick with this therapist, go to my OB and have her recommend someone, or get us both into marriage counseling and have him sort it out?

posted by dasheekeejones to health & fitness (20 comments total)

I'm so sorry you feel this awful. 6 months seems to be an awfully long time to feel this way and it doesn't sound like you'll have much perspective on your marriage if you're preoccupied with thoughts of your son dying. Talk to your therapist about referring you to a psychopharmacologist, if you're willing to try meds, and if she or he resists, talk to your OB or GP about the same thing. Additionally, it might be worth trying a different therapist. Good luck.
posted by chesty_a_arthur at 7:32 AM on June 29, 2009

Your concerns are based in reality. Your husband's behavior, as you describe it, is abusive.

You should probably focus on finding a safe place for you and your baby, not on trying to "fix" yourself.

I'm surprised that your therapist is not encouraging you to seek safety, you may want to establish a connection with a social worker at the nearest domestic violence shelter, quickly!
posted by HuronBob at 7:33 AM on June 29, 2009 [1 favorite]

Huron, I have thought about it and talked with the therapist about it. She said divorce and a baby is VERY difficult. Plus my husband threatened to take our son away from me saying I'm unfit because of my "mental issues". Two lawyers and a friend's father who was a domestic court judge for 25 years said there is no way that would happen---yet I'm scared. And I'm also scared about staying or going--what would be best for my son and to have him down the right path? I can't bare sharing weekends where I can't see him for one of them.

(and Huron your puppy is beautiful!)
posted by dasheekeejones at 7:38 AM on June 29, 2009

I don't get the sense that there is physical abuse going on here. I read the "lashing out" as verbal. Can you clarify, dasheekeejones?

But to answer your questions, the only people who can accurately diagnose a psychological issue are psychologists and psychiatrists. If necessary, a psychologist can refer you to a psychiatrist, who can prescribe medication. Other medical doctors (such as an OB) may be experienced in recognizing the symptoms, but won't be able to give you the ongoing talk therapy that you need.

It would be a good idea to call your OB and ask if they can refer you to a psychologist who is familiar with PPD or PPA. IANAP(sychologist), but your description sounds EXACTLY like me at the same point post-partum, even to down to the part about wondering if my husband would hurt our daughter through negligence or through misguided parenting attempts. I was diagnosed with PPD and, eventually, clinical depression as well.

My advice is to go see someone yourself first, and ask your therapist when it might be appropriate to being your husband along to one of your sessions, or to go to couples therapy with another therapist.

You can get through this. Recognizing that something out of the ordinary is going on is the first step, now you just need to follow through.
posted by SuperSquirrel at 7:50 AM on June 29, 2009

My husband yells when our fights get bad. He insists on me answering him, admitting I'm wrong, or it feel like I should beg for forgiveness. The only physical time he touched me was last week when I refused to look at him, he grabbed my arm to make me pay attention and left a thumb print bruise. He denied he did it. That alone bugged me. He saw it as there would be no way him touching me left a bruise, it would have 4-5 finger prints. The underside of your arm is sensitive--bla bla bla. I told him it is a perfect match to a thumbprint. He didn't feel bad or sorry because in his mind, he didn't do anything. He has a huge problem with accountability. God forbid you point out that he can be a real jerk. I grew up in a very abusive household where my father didn't close fist my mom--he was a grabber, choker, etc. I told him he has no idea how this thumb print made me feel---he took it over the edge and said "I can't believe you are calling me an ogre like your father."

So there you go. One of the many reasons he needs therapy but won't go. "There's nothing wrong with him. He likes himself," he's told me before.

I brought him to therapy long ago. He argued EVERYTHING and was very angry and screamed at me during the session (he didn't like I caught him in a lie in an email I found; it was allll about the invasion of privacy not the fact that he lied in the email).

So here I am. Confused about my feelings. Scared to leave and get divorced. Heartbroken that if I do, I have to share time away from my son. When my sole purpose is to be the best mother this boy can have so he can have a wonderful, productive, and happy life and not to make the same mistakes me or his father made in life. I don't want him to have either of our negative characteristics. I would do anything for him.
posted by dasheekeejones at 7:58 AM on June 29, 2009

Dasheekeejones... Yes, being divorced with a baby is difficult, but not as difficult as raising a child in fear and pain.

I'm not advocating divorce at this time, only that you establish a connection with a shelter, and a therapist that is focused on your safety (and the baby's)...
posted by HuronBob at 8:02 AM on June 29, 2009 [3 favorites]

As someone who had severe medical trauma in myself with childbirth, pre and post-partum depression, and then a VERY sick child, I want to throw in my two cents. Please do NOT read this as minimizing or marginalizing anything you are going through - that is not my intention at ALL.

First, please keep in mind that sickness of a child is a terrible thing that tears many families apart. Many men and women deal with the problem differently. It's almost (but not) like PTSD - your husband CAN'T deal with it. His lashing out and so forth (*) are signs of his OWN mental instability right now. You are both in very bad places.

Personally, though my initial DX and medication were handled by my OB, I quickly turned to a psych counselor that specializes in women's issues, family grief and illness counseling, and she has been a godsend. Personally, I do not like ultimatums in relationships "Attend counseling or I will divorce you," but at the same time, my sense here is that you are dealing with some natural emotional responses to a sick child and attempting to manage them humanely and responsibly. Your husband, dealing with those same stimuli and responses, is NOT attempting to manage them humanely and/or responsibly.

Is there someone he trusts or is very close to that can help you reach out to him and understand? Someone who can help him gain some insight and see how his behavior is affecting his family - particularly the screaming and lashing out? I think you should continue on with therapy, perhaps find a counselor who focuses on the types of issues you are going through, and do not feel guilty for considering medication if you need it.

(*) I am sort of assuming your husband was NOT like this before you had the baby. Please understand that I am NOT trying to excuse or justify his behavior - but assigning blame is useless and it seems to me he needs professional help of some kind dealing with the adjustment to a new baby and the child's illness.

Good luck to you.
posted by bunnycup at 8:04 AM on June 29, 2009

Bunnycup,

Unfortunately (on all counts listed), he was like this before just not 6 months straight (he blames it on me), he thinks he's fine/great, was diagnosed with generalized anxiety and was on meds--he stopped after the free samples ran out, and his mother/sister have commented about his behavior. They now don't speak to each other (his sister on and off) because they're tired of his ways.

He sees our son as fine, it's over, it's no big deal. Just watch out for the next lung issue (colds go to his lungs and it's 2 weeks of nebulitizers with steroids and for me worry about him not waking up). For me it's a neverending fear of everything yet I don't want to raise a wimp. I was a very active tomboy (who looking back did many, many, many stupid things and am glad to be alive/not hurt). :)
Everything I see in our house, outside, etc. all I can think of is the worse happening to him (for example we have an aquarium at home where you can get in from the top. I constantly am terrified of him finding access and drowning). I check on him 3 times a night, etc. I can't sleep anymore, I cry when I think about him because I love him so much, I want this marriage junk fixed, I don't know what to do, I'm scared of meds, and in the end I'm really tired of being the only one willing to fix things.

Ok sorry this is turning into an Ivillage discussion board post. :) I do appreciate everyone's opinions. I'm at wits ends on where to turn to next for help.
posted by dasheekeejones at 8:11 AM on June 29, 2009

My PPD was confirmed by my OB/GYN at my six-week checkup with my first baby, and treated by my family doctor with my second. Zoloft did wonders.

If you have PPD (and it certainly sounds like it), it can be treated -- and once it's under control, you'll be able to look at the situation with your husband more clearly. Look here for phone numbers for people who can help you.
posted by The corpse in the library at 8:12 AM on June 29, 2009 [1 favorite]

On non-preview: you say you're scared of meds. I was, too, but I'm so glad I took them. Without them, I was a sad lump on the sofa, barely functioning. With them, I was able to fall in love with my baby. You can breastfeed while taking Zoloft (and others, I presume, but that's what I took), and you wouldn't have to take it for the rest of your life -- just a few months, while you get yourself back together.
posted by The corpse in the library at 8:15 AM on June 29, 2009 [1 favorite]

Dasheekeejones,

Sounds to me you are in distress because you are not living in a loving and supportive environment.

Are you waiting for your therapist to confirm the source of your discomfort or encourage you to seek a divorce? Because I am pretty sure most therapists don't/won't do that. I believe it is considered unethical for them to insert their opinions into your process, or otherwise advise you on what to do (lawyers, shelters, etc.) unless you specifically ask for that sort of thing. (And I'm pretty sure they won't recommend a lawyer. But you get the idea.)

I realize you are very riled up and perhaps you think you are over-emotional about things - yes? If you are judging yourself to be over-emotional right now, does this negate that you and your son may be in an unsafe situation? Is it possible you are not in any immediate "danger" right now, but perhaps you've suddenly become clear that the long-term consequences of remaining in the situation you've described is unacceptable, and this is causing you to panic? Like, maybe if you don't leave now, you may never have the courage to do so? Or do you feel you are in immediate danger??

Please take a deep breath. Thanks. Now - are you and your son in immediate danger in some way?

Whatever your answer is to the above questions, I suggest that is where you start.

(If you are in immediate danger, please call abuse hotlines, shelters, etc - do it now. If you are in immediate danger please get help ASAP. Or, if you judge your situation stable, then maybe what follows will be of some value, I hope;)

I do suggest you keep your own counsel until you can find a new therapist. I think either you need fresh eyes, distance from friends and family with their own agenda, or maybe just a new therapist to help you gain perspective during this new chapter of your life. It seems your old therapist isn't "clicking" with where you are right now in your life/situation. I mean, you seem to be in crisis, and I'm not sensing any support.

If you hunt for a new therapist (internet! therapists/clinics have web pages stating their credentials and specialties!) I'm thinking maybe interview a few until you find someone who feels like the right "fit."

State your goals for therapy upfront with a new therapist. Like, "I'm here to discuss in session my options and choose the BEST way forward myself and my son, because I'm not sure our current family environment is appropriate or improvable." Then figure it all out in the privacy of your therapists office.

If you decide that it would be best to get divorced and have custody of your son (accepting appropriate involvement from his father) then use your private therapy sessions to formulate a plan to make that happen. Or, maybe when you feel some safety/comfort/perspective on things - you might find your feelings about your marriage have changed. Perhaps you'll find strategies that help you communicate better with your husband, and that might help you find a way to steer your family in a direction that gives you a true sense of safety. Whatever you discover and implement as a result of therapy, it most certainly will be an improvement over where you feel you are right now in your life.

I don't agree with medicating, BTW. I've had some bad side effects with meds. Also, I've found solving a particular problem and taking direct action whenever I felt distressed or in crisis has been far more beneficial for me overall. AND, some great and unexpected things have happened whenever I've put an effort into changing situations that have made me feel "freaked out." YMMV.

Best.

JBB
posted by jbenben at 9:32 AM on June 29, 2009

Oh god no, my son is in no immediate danger at all. What I was saying is I worry about him unnecessarily. I think it stems from his birth and then his 6 week illness (along with every month something new cropped up). I love him so much that I can't believe he's here (I was told getting pregnant was going to be very difficult).

For my goal to figure out what's wrong, I don't know why I constantly worry about something bad happening to him and why as soon as he got home, I basically didn't like my husband anymore. I just focus on his negative points--present and past. My goal is for us to be the best parents and be 100% different than how we were raised (and outcomes). That's all. I want my husband to go to therapy but he won't make a move (despite telling me he will). He feels it's all me and I need "fixing" (which I don't see it that way. I just need 'something'.)

I have racing thoughts that just send me up and down. I don't know if it's PPD, PPA, or me realizing that "wow, maybe my husband and I really don't belong together as a couple."

But I can say that both of us love our son beyond words. He is the best thing that has happened to us as individuals.

I'm hesitant to the meds because if this really is a case of 'you and your husband don't belong together' then why medicate? If it's really a medical diagnosis of racing thoughts, ups and downs, can't sleep, etc, then I"m open minded but afraid of the side effects (I was on a few before and I didn't like it).

Sorry to confuse JBB
posted by dasheekeejones at 9:46 AM on June 29, 2009

...was diagnosed with generalized anxiety and was on meds--he stopped after the free samples ran out...

This is a very important fact.

People who have mental/emotional/etc. problems that are diagnosed and seen as needing medication don't need to just stop medication, whenever they feel like it. All sorts of problems follow. And, if they do stop taking their medication, it is a sign that they don't want to be responsible enough for themselves (and their children) to care for their own medical issues. If he didn't like the way those meds affected him, he needed to see about others or go to therapy. His disinterest in doing either is a very real concern, and I don't think you should believe it will get any better, accordingly.

I think you sound very unhappy, (in my opinion) not because of any postpartum issues, but because of the reality of the situation. Trying to be with someone who doesn't want to take care of themselves is difficult enough. Trying to be with someone like that, and care for a sick child, is a million times harder. I don't think medication is the solution, in your case. A new therapist sounds good, definitely, as well as some hard thinking on whether this is what you want to do in the long run.

Some questions to ask yourself:

- Do you see your husband getting help (medical or therapy) any time soon?

- Do you see your husband "growing" (or "growing up" perhaps)? Having a child is a growing experience for both of you, and if he's not willing to grow into the role, it's going to make things a lot harder.

- Where do you see yourself, your husband and your son in the next five years--ten? I hate these questions, too, because the future is so largely unknowable, but it is still an important concept to have a think about.

- Are you staying in the situation you're in (with your husband) now, simply because you have a small child, or because you're in love? Think hard about this one. The question of whether you actually should stay with your partner is a completely different one, but the question of why you're personally staying is an important one.

- Would you be able to support yourself and your son, either by yourself or with the help of friends, family or various aid programs, if you did divorce now/soon? (The answer to this doesn't matter if you feel you need to get out now. If that is your gut reaction, you should do that through a women's shelter ASAP.)

- Can you eliminate any of your stress now? There are clearly a lot of stressors you're dealing with, but if you can eliminate one or two now, that'd really help, I'm sure. Think about what little things could be done or changed to make your life easier. Again, a new therapist does sound like a good idea.

Good luck with this.
posted by metalheart at 10:04 AM on June 29, 2009 [4 favorites]

It used to be that the usual way of handling this was to pack a bag and go home to Mama, baby in tow, and sit there and (1) be mothered yourself (2) sulk (3) sort things out with the benefit of a little distance between you and Dad.

Do you have that option available to you?

What are you fighting about? You say 'I worry... We fight' without much elaboration as to what the arguing is about.
posted by kmennie at 10:04 AM on June 29, 2009

My goal is for us to be the best parents and be 100% different than how we were raised (and outcomes).

This is probably another important fact. Is it possible that you loved your husband as-is, before the baby was born, but now that your son is here, you're realizing you want things to be different and "perfect" now that someone depends on you? It's a bit of a different thing when it's just the two of you, just needing to get along, from having someone who's learning from your every move. This is something that definitely can be discussed in therapy, and it would be good to venture into in marriage counseling, I think. If you can't get your husband to go, though, it will be a problem, maybe.
posted by metalheart at 10:08 AM on June 29, 2009 [1 favorite]

The implication that if your concerns are based in reality, you don't need to worry about depression or meds or therapy concern me. Situational depression is still depression, and if there's a tool out there that can help you feel better, and help give you the strength and power to take care of yourself and your family, please don't hesitate to inform yourself and consider it.
posted by Salamandrous at 10:21 AM on June 29, 2009

You should both see a counselor together.

IANAparent, but it's been my observation that suddenly being a parent is often extremely stressful for both sides (for all kinds of reasons), who then take it out on each other, creating more and more stress.

Marriage counseling will hopefully help you both see your shared situation a little more clearly, with some level of mutual empathy and respect, without getting at each other's throats at every available moment.
posted by Sys Rq at 10:34 AM on June 29, 2009

I'm not a doctor. That said...

Generally, a very common PPD symptom involves *not* loving the baby, or feeling too "lazy" to deal with common necessary baby tasks such as feeding or diaper changes.

What it sounds like here is that you're in a tough pickle, and the emotions are taking their toll on you. While seeing a therapist is a Very Good Idea here (for both you and husband, defiant as he is), I don't think that you're specifically suffering from PPD. That doesn't mean that you're not in danger of the same sort of Major Depression that anyone else can suffer from.

Please make sure that you're always talking to someone about how you feel, and keep up with any therapy. If there are red flags going up, a therapist will see what's up and get you help.

Good luck with all this, to both you and your baby.
posted by Citrus at 11:16 AM on June 29, 2009 [1 favorite]

Thank you everyone. I really appreciate the insight and genuine comments.

In short it's hard and I'm highly confused. My feelings for my husband have changed to a near 360 the week our son came home. I'm not saying I haven't been unreasonable or not stressed. I'm concerned about that. But I think a lot of people are right--situational unhappiness on top of a stressful situation of a baby (as in lack of sleep, financial stress), is pushing me at the edge. Plus I do more than my husband (everyone sees that too).


And for the quick and the dirty:
Do you see your husband getting help (medical or therapy) any time soon? No unless I book the appt and make him go. Then it will be him with the non stop "it's her. Sure I have issues and are not perfect BUT". Ugh Give me a break.

- Do you see your husband "growing" (or "growing up" perhaps)? Having a child is a growing experience for both of you, and if he's not willing to grow into the role, it's going to make things a lot harder. He always complains about not taking a vacation away from him. This bugs me to no end. Parenthood is about sacrifice and wanting to do things with your child

- Where do you see yourself, your husband and your son in the next five years--ten? I hate these questions, too, because the future is so largely unknowable, but it is still an important concept to have a think about. I can't even think about it. All I want is the best, healthiest and happinest environment for our son. I am lately thinking it doesn't involve us as parents together. But I am so afraid of what being apart will do to him. I can't deflect anything my husband says/teaches him.

- Are you staying in the situation you're in (with your husband) now, simply because you have a small child, or because you're in love? Think hard about this one. The question of whether you actually should stay with your partner is a completely different one, but the question of why you're personally staying is an important one. Honestly the way I feel right now is because of finances, our son, and not wanting to give up weekends and holidays. On top of the divorce process hassle. My husband already said he would make my process hell---trial and all. I dont' want to sit there and hear his b.s. He is a very argumentative person and gets a rise out of "passionately" telling his side. I however, cry at the drop of a hat out of frustration with trying to communiate or tell my side when it comes to him (his mother has the same reaction because he's beyond difficult/gets to be a bully)

- Would you be able to support yourself and your son, either by yourself or with the help of friends, family or various aid programs, if you did divorce now/soon? (The answer to this doesn't matter if you feel you need to get out now. If that is your gut reaction, you should do that through a women's shelter ASAP.) Well right now, we/I have zero savings so moving out is tough. I doubt I can afford our current house alone. Apartments are expensive to the point of it's near a mortgage. However, as horrible as it sounds, I would have to wait until my parents are deceased before I could buy a house and be 100% financially ok.

- Can you eliminate any of your stress now? There are clearly a lot of stressors you're dealing with, but if you can eliminate one or two now, that'd really help, I'm sure. Think about what little things could be done or changed to make your life easier. Again, a new therapist does sound like a good idea. This is why I'm back in therapy to find a way to get it out or get a break. I don't have any hobbies or fun because I get little help at home so it's non stop dishes, laundry, etc. All I know is I LOVE our son to death and he makes me happier than words.
posted by dasheekeejones at 12:09 PM on June 29, 2009

Well. It seems we've all identified that a new therapist is a great idea. One step in the right direction;))
posted by jbenben at 1:34 PM on June 29, 2009