End in sight for PPD?

September 8, 2012 3:49 PM

New mom to an 11 week old (who was 6 weeks premature). Postpartum depression still spiraling downward. I spent the last 5 weeks convinced the PPD was caused by a lack of support and put a lot of energy into setting up that support network, but it hasn't helped. How long did it take, and what did it take, before you started recovering from your postpartum depression?

It feels like I've got the whole works in terms of support: a supportive lactation consultant; weekly counselling; fish oil/iron supplements/probiotics; health care providers aware of my situation. I'm taking part in a study of online CBT for PPD and should probably be able to continue online CBT after the study is done. My mom has been traveling 4 hours to my house to help almost every weekend. She takes the baby overnight when she's here so I only have to get up to nurse once in the night. During the week, my mother-in-law comes in the morning for 2 or 3 hours so I can sleep a little (the kid only sleeps in 2-3 hour stretches at night or often not even that much). There isn't really any additional support (like babysitters) in my small community and I'm maxing out the mom support as it is.
We're in the middle of harvest on our farm, so my husband is working all the time, and as we get into later September and October, it will only get busier. After harvest, he'll be able to be a lot more supportive and involved, but who knows when harvest will be over.
Zoloft is an option, although the psychiatrist I saw last week thinks I should manage without if I want to continue breastfeeding. The bigger problem is that it too will take several weeks to kick in.
I am so, so done, and there's still another month and a half minimum before harvest is over. I'm weepy and low and regret having this kid so much. Other than meds, I am doing everything everyone recommends doing for PPD and it just doesn't get better. It is so discouraging to put so much energy into all of this -- going to appointments, going for walks, doing relaxation exercises, doing online therapy -- and I just keep feeling worse.
Looking for advice on anything else to try, and your experience on how long it took before you started feeling better.

posted by bluebelle to health & fitness (38 answers total)

See another psychiatrist. There are meds choices and dosages that are compatible with breastfeeding. You're doing everything else already, so not trying that makes no sense.

Best to you. I can only imagine that this must be so hard. You can do it.
posted by Sidhedevil at 4:07 PM on September 8, 2012 [11 favorites]

Do you know any other moms, especially with babies? I didn't have severe PPD, but I definitely had something going on, and having a weekly get together with other moms and knowing other people were going through what I was made a huge difference in my outlook. There may be a mommy and me group locally you can join, drop in on. I felt like I was in a fog for the first 2 or 3 months. It sounds like you are being really proactive trying to get the support you need, which is huge. Good luck - hang in there, it does get better.
posted by snowymorninblues at 4:13 PM on September 8, 2012

Vitamins. LOTS of them.

Frankly, I can't believe how simple and overlooked the whole vitamins thing is. I went to a great doctor at a great hospital, and was staggered at the lack of after-care.

You just grew another person. You're depleted, and that makes you feel shitty.

Yes all of the other stuff people will suggest.

And go ahead and take a good multi-vitamin, extra vit C, and def extra iron.

It won't hurt you, and likely within a few weeks you will have improvement as the vitamins kick in.

Take every day, not just when you think of it. Do vitamin C twice per day.

Best to you.
posted by jbenben at 4:16 PM on September 8, 2012 [3 favorites]

I am going to assume that if you are in a rural community that doc might be the only one you have access to. You need to make him understand that you know that there are other options out there for you to take medwise and still breastfeed. (Only you know whether or not he is just not all that supportive of breastfeeding or if he just needs a little prodding to do a little research.)

That having been said, it sounds to me your main problem is not getting enough sleep, and having your husband unavailable to spell you during the week. Have you been able to work with your pediatrician to see if there are ways to get your baby to sleep better at night? In fact, if I were you (and I speak as a former breastfeeding mom here) I would investigate giving the baby one bottle of formula for the last evening feeding and see if that would buy you a little more sleep time. If you prefer not to do that, how about taking the baby to bed with you to nurse?


Worst case scenario, if you are really struggling that badly, it really is okay if you decide to stop nursing. But that is YOUR choice, and should only be made if that is what YOU want to do.
posted by St. Alia of the Bunnies at 4:22 PM on September 8, 2012 [2 favorites]

(Oh, and b-complex vitamins rock if you struggle with depression, if you aren't taking them already.)
posted by St. Alia of the Bunnies at 4:23 PM on September 8, 2012 [3 favorites]

Cosleep. You'll get more sleep. Baby will get more sleep.

Big hugs for you.
posted by k8t at 4:25 PM on September 8, 2012 [4 favorites]

Weaning was a huge help for me. That first 8 hour stretch of sleep...wow. It was like a whole new world the next day.

If you can't see another psychiatrist, consider weaning and trying the zoloft. Otherwise, look for another doctor. There are medications compatible with breastfeeding.
posted by the young rope-rider at 4:27 PM on September 8, 2012 [4 favorites]

I am so sorry to hear how much you are struggling. Have you considered moving in/extended visit with your mum or MIL? It sounds like you need a lot more support, which, as you know was the norm up until very recently. Sometimes by going to your mum/MIL you can also access THEIR support network to spread the work out. Sleep deprivation is a torture unto itself, let alone with PPD on top. Almost all women I know used meds to combat their PPD; I think you need to insist on the meds.
posted by saucysault at 4:31 PM on September 8, 2012 [2 favorites]

I don't know if this is an option for you, but if your husband is this busy and your mom is willing, is there any way you might be able to go stay with her for a while? Would that interfere with your counselling? It seems from what you've said that you would get more day-to-day help that way.
posted by showbiz_liz at 4:32 PM on September 8, 2012 [4 favorites]

You don't need to wean to try zoloft. (You can totally wean if you want to, of course.) Here's what Kelly Mom has to say about breastfeeding and SSRIs.


Here's the American Academy of Pediatrics statement on breastfeeding from February 2012. (it's a PDF.) It notes that sertraline (zoloft) is among the least problematic medications for lactating mothers.

I know this is so, so hard, but do try to focus on the days as they come. Next month your baby will be in a totally different place, so you don't need to dread it now.

Feel free to MeMail me.
posted by purpleclover at 4:47 PM on September 8, 2012 [9 favorites]

I felt better within 3 days of starting to take Zoloft. (Granted, it didn't fully kick for a few weeks, but I *did* feel remarkable better very quickly.) My OB & everyone else I talked to said that it's generally accepted as safe for breastfeeding babies/mothers. My daughter certainly didn't show any adverse reaction.

http://kellymom.com/bf/can-i-breastfeed/meds/antidepressants-hale10-02/ has a very good article by Dr. Thomas Hale talking about breastfeeding & various antidepressants.

From the article:
"Zoloft is the “best drug choice so far”. It has a low, low transfer rate to breastmilk (17-173 ug/liter) in mothers taking up to 150 mg/day. In one excellent study of 11 mother/infant pairs, the zoloft was undetectable in 7 of the 11 breastfeeding infants’ serum and minimal in the other infants. In two other studies of one and three mother/infant pairs respectively, zoloft was undetectable in the plasma of all 4 infants. A theoretical concern with Zoloft is that some babies may not gain weight as rapidly or as well when breastfed by moms on Zoloft; so weight gain should be monitored and dosage tweaked as necessary."
posted by belladonna at 4:49 PM on September 8, 2012 [2 favorites]

From a user who prefers to remain anonymous:

The first thing you should know is that it will and does get better. It's easy to get quite anxious that you will feel like this forever, that the it will effect your relationship with the baby etc - none of that is true, I promise you.

It still sounds - to me - like you're not really getting as much sleep as would be ideal yet. I empathise, it was like that for us too, and it was hell, and it definitely slowed down recovery from PPD for my partner.

Related to this: Are you actually sleeping when you can? My partner found it very difficult to sleep when she "should" have been sleeping (part of the PPD manifestation was anxiety). Our doctor prescribed temezepan, only temporarily, and it was so, so helpful in getting her sleeping when I or another family member was doing nights for the baby.

Additional things that helped on the sleep front: Expressing milk (machine, hand pumps were difficult for us) so that I or someone else was able to do whole nights, and was able to do first feeds or get the baby up in the morning every night.

Do you think it's possible that your isolation is exacerbating things? My partner found it very helpful to get out of the house (the last thing someone with PPD wants to do, that's for sure). It wasn't even seeing friends or family, just getting out was very helpful to us.

Don't be afraid to ask your husband for more help. I know harvest etc. but it's his baby too, and I bet he wants to support you any way he can. As a partner of someone with PPD, it was very hard for me at times in that I felt helpless and hopeless - standing on the shore while she was drifting out in the water. I wanted to do anything I could.

Finally, again, it does and will get better. For us, citalopram certainly helped but really once the baby was sleeping for more than 2 1/2-3 hours at a time, it was like a new lease on life. Energy levels and ability to cope went so much higher. This process started around the 5 month mark, and steadily improved from there. Best of luck, and please don't be afraid to reach out to this community if you want to.

posted by restless_nomad at 5:06 PM on September 8, 2012 [2 favorites]

It sounds like you're under a lot of pressure to do things the "right" "natural" way (exercise! vitamins! breastfeeding!) whether or not that's the best thing for you. I can't tell from your question whether or not this pressure is coming from within or from outside, but I wonder if you're really getting the right kind of support if no one's given you the "permission" to do whatever is necessary to fight this depression, which may mean SSRIs. I mean, St. Alia said upthread, "Worst case scenario, if you are really struggling that badly, it really is okay if you decide to stop nursing." I would say that it sounds like this is the worst case scenario that you're going through.
posted by Ralston McTodd at 5:29 PM on September 8, 2012 [3 favorites]

I also think if you could move in with your mom temporarily, it could help a lot. I have a 9-month-old who is a terrible sleeper, and a few times over his young life I have hit a Wall of Tired so bad that I thought I was going insane. I go to my parents house, hand my mom a bottle and some formula or expressed milk and essentially say see you in the morning. Even one night of 6-8 hours of unbroken sleep will keep me going for a long time afterwards.

Co-sleeping also helped/helps a lot. Can you nurse while lying down? Once I mastered that it was like a whole new world of nursing for me.

You said you live in a rural area, so I'm not sure how helpful this suggestion will be, but a new moms group can really be invaluable. I have a couple of friends who helped me get through the worst of tiredness, ppd etc by taking my 3-year-old for the day or bringing me dinner. But even more than the logistical stuff they listened to me cry about how tired I was, how I was convinced I'd made a huge mistake or that I was a bad mom. And that helped me too. Do you have friends you could talk to on the phone, at least, who could lend a sympathetic ear?

I promise it gets better and it will get exponentially better the more sleep you get. Maybe your mom or mil could read a sleep book and then summarize it for you since you sound like you'd probably fall asleep reading it. I really like Healthy Sleep Habits, Healthy Child and I'm totally blanking on the name of another one but it's by Karp and it's way famous.

It gets better, really. Three months is a turnaround time and then it happens again at six months. My son and I were both so unhappy until about five months and then he started sitting up and now he is like a different baby. Hang in there, you are doing great. You're a good mom. Parenthood will not be like this forever.
posted by sutel at 5:36 PM on September 8, 2012

The Happiest Baby on the Block! Sheesh, my brain. That's the Karp one.
posted by sutel at 5:37 PM on September 8, 2012 [2 favorites]

I'm so sorry. Up front let me say that I feel like I really understand where you are. And it did get better for me.

I too had a premature kid, and I am convinced it's a huge factor in post-baby despair, if for no other reason (such as trauma, health issues, etc.) than that it takes the kid so much longer to go from newborn blob to "baby who makes eye contact and sleeps".

"Support" made kind of a minimal amount of difference to me. Sleep and getting outside made bigger differences. So support and/or talking to people about my feelings only made a difference insofar as that allowed me to sleep longer stretches or be outside in the light.

Anyway. I imagine you are super tired and don't want to wade through huge blocks of text, so here are my lessons learned in list form:

*Amount of prematurity+extra three months of the "fourth trimester"=kid turns into a person who looks at you and smiles and sleeps. YOU CAN DO IT. Mark it on your calendar. Things will not always be this lousy and unrewarding.

*Co-sleeping was super crucial for us. Not for philosophical reasons, but because it allowed me to get the maximum amount of sleep. Eventually we learned to nurse lying down (on our sides) and it was like magic, because then I barely had to wake up to nurse. But even before that, just not having to wake up enough to get out of bed and go somewhere else to nurse let me fall back asleep more easily. It also let my kid stay asleep for much longer stretches, as did:

*Swaddling for nighttime sleep. Much longer stretches of sleep. May or may not be especially true for preemies. (Dr. Karp has those "Happiest Baby on the Block" books, or DVDs, and they are helpful. But basically the info is mostly "Swaddle the hell out of that kid!")

*Wearing my kid constantly when I wasn't in bed with him. I used a stretchy cloth wrap like a Moby, because I could keep the wrap on and pop the kid in and out. I think (and again, I don't think this is a philosophical issue, just a practical one) it let him, as a really grouchy preemie, regulate his systems more. He was calmer when worn. I would do absolutely anything to make your baby calmer. A calmer baby is less despair-inducing to mother.

*Getting outside really, really helped me. Going for a walk when it was light out. Mood-regulating like nothing else.

*I felt totally crazy and isolated. I didn't even need to TALK to other women who understood (although that was ideal). Going to a bookstore that had a coffee place for 40 minutes was enough. Just to be around humans and hear people talking to each other.

*In retrospect I sometimes feel like talking about the despair was counterproductive, because so much of it was caused by the sleep deprivation and the general life upheaval. So talking about it often made me feel worse, because those things were just facts of my life for a while. Whereas in retrospect I realize that what improved my mood was: sleep, outside time, going to a mall to walk around and see other humans, and the moments when I understood that this was situational and temporary and things would improve without me really doing anything in particular.

*In retrospect, I wish I had drastically lowered my standards and goals for EVERYTHING but keeping my kid alive. I wish I had understood that it was okay for us to eat frozen lasagne every night. I wish I had understood that my ONLY JOB was to keep this kid alive and keep myself alive. When I was having the hardest time, just those two things were legit acts of heroism and enough.

*Same point, really: I wish I had understood that if I just thought to myself "Today, I am going to take a walk outside with my kid. And then the rest of the day literally my only goal is to sit in the rocking chair and nurse my baby and hold him while he sleeps and read trashy novels and watch reality TV and eat sandwiches. My spouse is totally on his own." that was more than enough to try to do when you have a grouchy preemie and you are battling despair. More than enough. I wish I had understood that I just needed to slow way, way, waaaaaaaaaay down. (I don't know if this will apply to you - my personality may be weird and especially sensitive.)

*Things do get better. They got better just with time, for me. In retrospect, I wish I had somehow magically been able to grok that because my despair was situational - no sleep! the what have I done monster! - it would also improve really significantly as time passed. I wish I had really understood, and let myself feel, how problematic sleep deprivation is for me. Maybe other people are just more tough or something. But I honestly felt like so much of the despair I felt was purely because of the sleep thing, which was ultimately a self-limiting problem.

I hope you feel better. I felt the way you feel, and I do feel better now. I think things got better when my kid was about two-and-half months old, which is when we worked out nursing lying down, and he began to sleep in longer stretches at night. (I mention this not because I think you should try this method, but because I have heard from others that this was the moment when things started to improve slightly.)
posted by thehmsbeagle at 5:56 PM on September 8, 2012 [17 favorites]

Is there a nearby teenager who could come over for a few hours after school, a young niece or nephew perhaps? It doesn't have to be someone old enough to babysit, just someone old enough to help out with housework, watch the baby for a few minutes while you're elsewhere in the house, friendly company. I remember reading years ago about families in US colonial times who would "borrow" a girl for a few months from neighbors to help new mothers out if they didn't have older children.

Have you tried any online support groups? I know they can be wonderful. I found this link, I know that I've gotten wonderful support in the past from other online support groups.

I hope you feel better soon.
posted by mareli at 6:01 PM on September 8, 2012 [1 favorite]

Not to discount all the good things you are doing for yourself, but I wonder if no amount of therapy or help from mom is going to fix the fact that your husband sounds checked out and you're somewhat isolated. If he's gone all day and then he comes home briefly to eat and sleep without helping, you're basically a single parent with a roommate and that sounds horrible. Even if farming during harvest is a 16-hour day, raising a baby is pretty much a 24/7 job, so he needs to do every little thing possible to get in more time with you and give you the emotional support you need. Coming home for a midday break, hiring extra seasonal help so he can be home longer, doing nighttime feedings so you can sleep. You need to spread the sleep deprivation and parenting around; obviously his job is an important source of income for your family but that doesn't mean it's your job to raise your baby alone until it's convenient for him to parent.
posted by slow graffiti at 6:03 PM on September 8, 2012

Thank you for your ideas, everyone.
Yes, being in a rural isolated area is a complicating factor here. There are no other new moms around (nearest moms' group is an hour's drive away; I've been once) and psychiatrists are scarce. It's not like I can just get a cleaning service in or go grab some take-out, either.
I am going to stay with my mom for several days next week to try that out but have to be back on the farm in October to help with harvest (our hired help dries up end of September).
I am co-sleeping with the baby and nursing lying down, but then I sit up to burp him, which wakes me up and makes it hard for me to fall back asleep. I've tried just letting him fall asleep at the breast but he will wake half an hour later, screaming because he's got burps stuck inside that hurt him.
Thank you, belladonna and anon for telling me about your experiences with various meds. It's good to hear that sometimes you can feel an effect right away. Did any of you have to pump and dump during the time when the meds were strongest in your system? The psychiatrist was telling me I'd have to do that even with low dosages of Zoloft, which seems kind of nuts to me but what do I know.
On update:
yes, thehmsbeagle, I think part of the problem here is that by having a preemie, I'm getting an extra long dose of the newborn phase. Everyone keeps saying that by 8 weeks, things improve, but we're at 11 weeks and it still sucks. But by gestational age he's only 5 weeks, so ...
posted by bluebelle at 6:06 PM on September 8, 2012

No, I absolutely did not pump & dump when I took Zoloft. I think your psychiatrist needs to do some research; I've never read anything suggesting that women do that when taking zoloft. Seriously - the study in that Kellymom article talks about the miniscule amounts transferred to nursing babies. Can you talk to your OB/midwife? They are probably more up-to-date on this issue, due to seeing it so frequently.

Good luck. Things WILL get better. Feel free to memail me if you want.
posted by belladonna at 6:14 PM on September 8, 2012 [4 favorites]

I was expressly told by my OB that Zoloft was lactation-safe. Dr. Hale, probably the US's foremost expert on lactational pharmacology, agrees.
posted by KathrynT at 6:20 PM on September 8, 2012 [4 favorites]

I think this psychiatrist doesn't know what he's talking about. Zoloft worked really fast for me.
posted by lakeroon at 6:31 PM on September 8, 2012 [1 favorite]

I don't know what the circumstances of your baby's birth were, but since he was born six weeks early I'm going to assume there was some stress and possibly some trauma involved. You may want to consider whether you have PTSD. It's much more common in new mothers than many think, and is often diagnosed as PPD. I mention it because I was treated for depression after I had my daughter, but it took almost ten years to get a PTSD diagnosis, and it wasn't until I dealt with the trauma that the depression started to lift.
posted by looli at 6:35 PM on September 8, 2012

Here is another article from WebMD called "Antidepressants are Safe For Nursing Infants" which I'll quote for you extensively:
"Zoloft and Paxil. Based on all the studies' results, these are the "drugs of choice" for breastfeeding women, Wisner tells WebMD. Infants exposed to Paxil and Zoloft had undetectable levels of the antidepressant in their blood, she reports...

..the bulk of evidence shows that side effects are short-term and not harmful to the infant, says Wisner. "By and large, babies are pretty good at eliminating the drugs from their system," she tells WebMD. "They're tougher than you might think. Even with Prozac, the majority of kids do just fine."

That doesn't mean some babies won't be affected, Wisner notes. Studies have focused only on full-term babies, not preemies. Also, some babies may have more difficulty processing antidepressants than other babies. However, the handful of studies looking at long-term effects shows no problems...

"exceedingly small amounts of antidepressants are found in breast milk," Cohen says. "We think it's important that women know this, that even if it's a trace amount, the infant is exposed. However, the vast majority of research has been encouraging ... very reassuring about breastfeeding."

Much more is known more about antidepressants than any other drug that women take while they're breastfeeding, he notes. "I don't want to call this a tempest in a teapot, but women take antibiotics, they take drugs for reflux, heart disease, diabetes, high blood pressure, or another chronic medical condition -- but there is not the same concern about those medications that there is about antidepressants."

Hendrick agrees. "At this point, the general consensus is that antidepressants can safely be used during breastfeeding," she WebMD. "There's been so much research and so many published studies that more and more clinicians are feeling comfortable with it."

From the drugs.com summary on sertraline:
"Sertraline is excreted into human milk. Adverse effects in the nursing infant are unlikely...

A study of fourteen mother- infant pairs reported that while mothers receiving clinical doses of sertraline experienced substantial blockade of the platelet 5-HT transporter, platelet 5-HT uptake in nursing infants of treated mothers was unaltered [this is jargon but it means the mothers got measurable effects and the infants did not].

Another study of twelve breast-feeding mothers reported that both sertraline and desmethylsertraline were present in all breast milk samples. Detectable levels of sertraline were reported in three nursing infants and detectable levels of desmethylsertraline were reported in six infants. The data from one study on three breast- fed infants suggested that sertraline and/or its almost inactive metabolite norsertraline may be present at very low concentrations in the plasma of breast- fed infants. No adverse effects were noted in the infants. A case study of a mother breast-feeding while receiving sertraline therapy has also been reported. The drug was found to be present in the mother's milk. However, no sertraline was detected in the infant's serum and no abnormal occurrences were noted in the development of this infant either."
posted by treehorn+bunny at 6:40 PM on September 8, 2012 [3 favorites]

You might also consider talking to your OB/midwife, your general practitioner, or your child's pediatrician about your PPD and desire for meds (if you do want meds) and/or a psychiatrist who's more up to date on treatment for serious PPD.

Often an ob/gyn is more comfortable prescribing psychiatric meds than a psychiatrist is prescribing to a pregnant or nursing woman. And pediatricians deal with PPD and make referrals for it seriously all the time, and it is not weird at all to ask.

Since you're in a rural area with few psychiatrist choices, seeking help from a non-psych doctor may be a good route for you.

(Also, are there teenagers nearby? Can you hire a teenager to come clean your house and/or watch your baby and/or drive to get you take-out one afternoon a week? Just for a little more help. If you know any teenagers/early 20-somethings NOT in school right now, a friend of mine just had a teenager for like nine weeks who came after supper and sat up all night burping and soothing the baby while dorking around on the internet, since teenagers are natural night owls and that's what she was going to be doing anyway! Maybe you could even just hire one for overnights on Saturdays or something.)
posted by Eyebrows McGee at 7:01 PM on September 8, 2012

My daughter is almost 12 and I still struggle. It does get better though.

One thing: Maybe when you nurse at night, instead of sitting up to burp the little guy you can just roll onto your back and set him up by cradling his chin in your hand and patting his back with your other hand. You might even be able to get away with laying him on your chest on his tummy and patting him that way. Sometimes when my kids had gas that position actually helped.
posted by TooFewShoes at 7:05 PM on September 8, 2012

2nding those who say to get another doctor. I took Prozac while breastfeeding (although that probably wouldn't be a first choice now). If you need another anecdote/testimonial to the effectiveness of SSRI meds, here's mine:

After my first was born (23 yrs ago), I assumed the constant sadness—I cried every damn day—and overall inability to enjoy anything was part of the no-sleep/wish-dad-would-pick-up-some-slack package. Fortunately, the family doctor referred me to a psychiatrist who prescribed Prozac. At the time, I was only vaguely aware that PPD existed, had never heard of Prozac (it was brand new), and I didn't believe that this pill was going to make one whit of difference - and for the first few weeks that was the case. Then, around the 4th week, I surprised myself when I laughed at some silly remark from my neighbor about yard work. Although that may not sound like a big deal, I knew immediately that something had changed.

I was still exhausted and still had a ton of work and personal issues to deal with, but removing the constant, nearly overwhelming sadness made it possible to focus on what I need to do. Plus, it was so nice to be able to laugh and have fun again.
posted by she's not there at 7:10 PM on September 8, 2012

We coslept and went from 'proper' burping to having her propped over our bellies face down to rolling her on her belly and patting/rubbing. We were right there so it wasn't a SIDS risk and she got pretty good at it and stopped needing it reasonably early.

Is there a possibility that when your mother visits she can bring/cook a huge amount of stuff to go in the freezer? A friend did this just before I had my daughter and it was a lifesaver - it was simple stuff like lasagne, curry, soup and pies, but it made things so much easier on us. There were even frozen pasta/rice containers in case we weren't even up to making those things! I did a mini-version for my sister-in-law and when we visit or babysit for them we try and cook dinner (and try to make something with leftovers). It's just a pretty simple way of making those evening hours simpler.

I hear you on the travelling too - my daughter wasn't a real premmie but a wee bit early and had a few issues at the start and I loathed car drives with her, particularly long ones. Unless someone else drove and I sat in the back with her. I hated them so ended up not driving a whole lot while she was little. And doing it for a mother's group? Nope. Wouldn't have happened.

But yeah, I suggest maybe seeing about the Zoloft/seeing another doctor, and maybe staying with your mother for a little while.
posted by geek anachronism at 7:54 PM on September 8, 2012

I was in a similar situation. Talk to your doctor. They put me on a prescription for Zoloft and in a few weeks I felt like a different person. Made a huge difference. Also, be honest with those around you with what you're doing through.
posted by AbsolutelyHonest at 7:57 PM on September 8, 2012

PPD hit me like a ton of bricks when I had my son. I went on to Zoloft to let me breastfeed and it gave me suicidal thoughts. Once I stopped taking it (and stopped breastfeeding), I began to feel better, but I really didn't get truly better until a few things happened including baby sleeping through the night (6 months), and his personality beginning to show. It also really helped when we were able to begin to put child down for bedtime at 7 and we were able to have the evening to ourselves before we would have a feeding.

During this time, I was also on Prozac and ultimately upped the dose. I felt so much better once the dosage was upped.

My best advice here is that medication is the one last thing you haven't tried and it may be the thing to really help you dig out of the hole. Because it is a hole - this is not permanent. Your baby will not always be a like this. You will sleep again, you will laugh again and you will be amazed at how grateful you are to have your child.

My heart goes out to you - I remember what a dark place that was and I'm so glad I stuck it out. It got SOOOO much better.
posted by Leezie at 8:01 PM on September 8, 2012

How would pumping and dumping even help? Zoloft stays in your system longer than that. This psychiatrist sucks. Tell him what you need to to get the Zoloft prescription, and then when you feel better, find a better psychiatrist.
posted by the young rope-rider at 8:05 PM on September 8, 2012

Re your timeline. I specifically remember, at 12 weeks postpartum, deciding to go see a psychiatrist because the blues were getting worse not better. (My kiddo was full term and I had quite a lot of help; and even so I was not okay.) The psychiatrist's next availability was some 3 weeks out. By the time I went to see him, I was ok and didn't need the meds. (I asked for a Provigil scrip instead, to help with the lack of sleep, but wound up not filling it.)

So... obviously YMMV, but just one data point to say that at 12 weeks I was deep in the darkness and by ~15 it was basically gone.

Good luck to you. People don't talk about PPD enough and that makes it even more isolating. But it does go away, even if it takes more time and help than we expect.
posted by fingersandtoes at 8:08 PM on September 8, 2012

Just wanted to add....

After my son was born, I had booked a few accupuncture appointments, mostly out of good practice. I had been in a serious car accident more than a few years ago, and I had exceptional results with herbs and accupuncture. I ended up an having an unplanned c-section when my son was born, and then complications weeks later. So the accupuncture planning paid off in ways I had not anticipated initially.

Anywho

My surprisingly awesome new female accupuncturist, who was very well versed in herbal medicine, said to me one day, "You know, I'm convinced the prevalence of PPD is down to depletion. There is a reason many traditional cultures have a tradition of 30 days of bedrest after birth."

The first few weeks after giving birth I was a powerhouse, did not rest, and totally overdid everything. Then I almost landed back in the hospital for a transfusion due to anemia. Literally, that was the choice I was given by my doctor, that I could turn up to the emergency room, and the only thing they could and would do was give me a transfusion and supplements.

I was super worried and depressed and freaked the fuck OUT - but I chose herbs, lots of vitamins, my accupuncturists supervision (substitute midwife or doula if you went that route, HERE) and kept the emergency room visit in my back pocket if I needed it.

Within a week+ of regular supplementation, I was doing MUCH better. That's when my accupuncturist made that comment. She had seen it before.

Yeah, I was given an script for iron supplements upon leaving the hospital. And I was still taking pre-natals. But no one except my accupuncturist stressed to me how important extra supplementation and bedrest was for me, given the circumstances. It was totally glossed over.

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I guess some people bounce back right away. I did not, despite a very healthy diet (which I maintain.)

I still takes heaps of vitamins, and I feel much better physically and emotionally now in my early 40's than I did in my 30's, when I was just relying on good old organic foods and "proper nutrition."

I see now that at least some of my more emotional times in the last 10 years were down to vitamin deficiencies and resulting poor choices, likely caused by cloudy thinking, because I was deficient and felt like crap a lot.

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I'll never go back. And I doubt I will ever need anti-depressants ever again, since I feel much better.

I said it before - go ahead and take the advice about various drugs that helped others - and please do think about vitamin supplents.

Iron deficiency causes depression, among other things like a feeling of anxiety, and eventually when it is acute enough - shortness of breath - hence more anxiety.

Along with taking Vitamin C 2x's per day, plus the multi once per day, I also take a B-complex 2x's per day, as per St. Alia's suggestion. I forgot that!

I do iron (and avoid anything with calcium) when I can tell I need it. Vitamin C helps with the constipation that can occur w/ iron supplemtation, FWIW.


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I know it the weather is probably still very warm where you are, but as you have just given birth, you might want to do organic beef shanks with some marrow bones + ginger and garlic in the slow cooker. Long cooked stews are easier on your digestive system, the herbs and bones will replace minerals and vitamins you are missing right now.

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Again, congratulations and best to you.

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One of my best friends is a farmer, from a family of farmers. Her life is not easy, and my respect for the tireless work she and her family put in knows no bounds. She has taken over the family farming business now that all of her other siblings have gone on to persue other things.

She's about to get married. They will continue to farm. I'm pretty psyched for when she gets pregnant!

Will I be giving my beloved friend this advice when the time comes? You can bet on it!

posted by jbenben at 8:35 PM on September 8, 2012

I strongly second the suggestion to talk to your OB or midwife about your PPD, as they are more likely to be comfortable prescribing you something.

You can also try talking to your psychiatrist about Zoloft; Dr Hale's work is pretty much the standard reference guide. Do you think your psychiatrist would be open to this discussion? I have a copy of Hale's guide, if you wanted I could scan the pages that have the entry for Zoloft so you could show him/her the nitty gritty details. MeMail me if you would like this. The suggestion to pump and dump reveals that your psych does not know Zoloft very well, because the half-life is 26 hours, so pump and dump does nothing (and is a terrible waste of perfectly good milk).
posted by Joh at 9:17 PM on September 8, 2012

I'd absolutely lie and tell my doctor I was pumping and dumping if that's what it took to get what I needed.
posted by purenitrous at 9:24 PM on September 8, 2012 [1 favorite]

Just another person piling on your psych about Zoloft!

I'm not suggesting that meds are the best option for you; I wouldn't know. However, as someone who has suffered from depression all my life, I switched to Zoloft (sertraline) when I wanted to get pregnant. I took the drug throughout pregnancy and for 18 months of breastfeeding. (My son is now 2.) I'm about to have my second child and will once again be breastfeeding while continuing to take Zoloft.

I live in the Netherlands and attitudes seem to be a bit different here; I have certainly encountered plenty of new mothers from the UK for example who were told that there is no safe SSRI to take during breastfeeding. However my experience has been the opposite.
posted by rubbish bin night at 12:47 AM on September 9, 2012

Strangely enough, neither my GP nor my OBGYN were familiar with drugs compatible with breast feeding and both of them referred me to the psychiatrist. I am armed with some relevant pages from Hale's book (thanks Joh!) and will see him on Tuesday. I really don't know what planet this guy is from either, but at any rate I'll be discussing my best options for meds with him. Hopefully it will help.
posted by bluebelle at 5:35 PM on September 9, 2012

Oh, and now that you mention the bit about the UK, rubbish bin night, I think this psychiatrist went to school in the UK, so maybe that explains his reluctance.
posted by bluebelle at 5:37 PM on September 9, 2012