Speaking of the alternative treatment methods for postpartum depression I wrote about yesterday, I forgot to mention the endless self-help gurus who sell you their wares as the key to getting a fulfilled life, happiness, the perfect weight, the perfect husband and a great car.  I was reminded of these by a new story on CNN.com by Jason Hanna called "Good, Bad and Ugly Self-Help: How Can You Tell?".

"Self-help is a multibillion-dollar-a-year unregulated industry in the United States, according to John C. Norcross, professor of psychology at the University of Scranton.

Norcross says hundreds of quality, research-supported self-help programs on career growth, health and self-esteem exist. But he and other critics say some gurus, promising secrets to greater happiness and wealth, offer advice that at best isn't proven effective and at worst could send someone down a poorly suited or dangerous path."

I was fooled into buying the book "The Secret" by Rhonda Byrne after Oprah promoted it so heavily on her show a couple of years back.  Don't get me wrong -- I definitely believe in the power of positive thinking and ridding oneself of hurtful thought processes.  (In fact, here's a story that just came out about the effectiveness of mindfulness on depression and anxiety, based on research.) But when I started seeing the parts of the book where they talk about envisioning the stuff you want and then getting it, when I started seeing how much of the book was about materialism, I got pretty pissed off and threw it out.  Byrne had a kernel of a good idea, in my own little opinion, but then blew it with all the focus on getting things. 

Plus, I worried about the people who have an illness, like, say, postpartum depression.  What if someone believed that just by thinking it away they could get rid of PPD and thus refused any other type of treatment?  Not that the book says to do precisely that, but you could see how people might fall into that line of thinking.  They might blame themselves if they don't get better and fall into an even worse depression.

As Tim Watkin wrote in the Washington Post:

"Still worse is the insidious flip side of Byrne's philosophy: If bad things happen to you, it's all your fault. As surely as your thoughts bring health, wealth and love, they are also responsible for any illness, poverty or misery that comes your way.

That isn't just implied, it's spelled out: 'The only reason why people do not have what they want is because they are thinking more about what they don't want than what they do want.' By this logic, Holocaust victims brought it on themselves, as did those who lost their homes in Hurricane Katrina. Come on, New Orleans, get over it! Think positive!

'Imperfect thoughts are the cause of humanity's ills,' Byrne asserts, in a stunning sentence that had me pondering how to perfect my thoughts, pronto.

Poverty? 'The only reason any person does not have enough money is because they are blocking money from coming to them with their thoughts.'

Illness? 'You cannot 'catch' anything unless you think you can. . . . You are also inviting illness if you are listening to people talking about their illness.' So . . . got any sick friends who need a shoulder to cry on? Tell 'em to bug off!"

I just can't go there.  I don't think I attracted my postpartum OCD, or asked for it, or that it was my fault that it took a while to get over it.  And thank God my friends didn't avoid me in order not to be contaminated with my mental-illness-germ-filled words.

How we think is crucial to our recovery from mental illness.  Having a positive attitude and believing that we WILL get better is key.  We have to eliminate our unhelpful thought processes.  Getting help from professionals is important, but so is taking responsibility for ourselves, and this is where self-care can contribute mightily to getting better.  But it's also important to be aware of those who are more concerned about lining their own pockets than about you as an individual and how best to help you heal. 

Self-help is not wrong or bad.  It's good.  You just need to be wary of the people out there who are selling you a bunch of hooey.  Unfortunately, they're mixed in with the good guys.  The CNN.com article suggests 5 things you should watch out for when considering different self-help therapies.  Check them out.

While doing my daily required reading of articles, blog posts, tweets and other assorted media across the web about postpartum depression and related illnesses, I came across a question a while back posted on Mamapedia by a mom with postpartum anxiety.  She was looking for advice on natural treatments because she didn't want to take the Prozac prescribed by her doctor.

She received 22 answers by other mothers, many warning vehemently against taking any medication.  These are some of the things she was told by the moms:

For many people, postpartum anxiety is caused by a deficiency of omega-3s and a lack of coping mechanisms.  Read the book Feeling Good and take omega-3s.

Acupuncture works.

If he is suggesting serotonin imbalance, then speak to your herbologist again. Don't go on medication! You have to take too much time to wean off. There are many things that will help the levels naturally

If you don't want to take Prozac, then ask for something less dramatic. (something less dramatic? huh?)

I highly recommend contacting Dr. ____ who is truly an amazing Chiropractor and Nutritionist and would definitely be able to help you naturally.

Please don't settle for drugs that will be only partially successful in masking your issue and give you the side-effects galore. There are so many safe and effective homeopathic remedies.

I don't know the mom who posed the question.  I don't know if her anxiety is mild or severe.  I don't know whether she has a history of mental illness.  I don't know if she's had suicidal thoughts.  I don't know if she's taken antidepressant medication before and it didn't work or caused unacceptable side effects for her.  I don't know if she's tried therapy.  All I know is that she has received advice from people with no medical training, some of whom have a bias against medication but claim to know what will work to fix her postpartum anxiety. 

To be sure, there were women who responded to the Mamapedia question who I felt had some good suggestions, including reaching out to other moms for support, getting your thyroid checked and getting adequate sleep, nutrition and exercise.  Medicine is not the only answer, and it's not the answer for every person.  But that doesn't mean it's evil incarnate, and that going to your "herbologist" is the right answer for people with moderate to severe perinatal mood and anxiety disorders.

I see this all the time.  Natural is better, right?  You'd think so if you watch Oprah (thereby ensuring I will never be asked to appear on the Oprah Winfrey show) or surf the internet.  But here's what you need to know.  It's not just pharmaceutical companies that have an agenda to sell you their drugs.  There are also lots of people who are trying to sell you their unproven, often untested remedies.

Alternative medicine is highly unregulated and not necessarily any more effective, or safer, than mainstream medicine.  According to the Associated Press in a story this year on alternative medicine:

"Ten years ago the government set out to test herbal and other alternative health remedies to find the ones that work. After spending $2.5 billion, the disappointing answer seems to be that almost none of them do.

Echinacea for colds. Ginkgo biloba for memory. Glucosamine and chondroitin for arthritis. Black cohosh for menopausal hot flashes. Saw palmetto for prostate problems. Shark cartilage for cancer. All proved no better than dummy pills in big studies funded by the National Center for Complementary and Alternative Medicine."

You probably didn't hear about that, because it's not a positive outcome for such a popular concept.  If you were aware, you likely heard proponents argue that the research wasn't conducted correctly.  You were probably told that the fact that many alternative health remedies work no better than placebo is no different than the fact that some prescription medicines are found to work no better than placebo.

Antidepressants, in fact, have been found in certain studies to work no better than placebo.  After reviewing those studies, Dr. Steve Novella, who writes the blog Science-Based Medicine, wrote a great piece about this called "Do Antidepressants Work?  The Effect of Publication Bias". 

"At this time it is premature to conclude that modern antidepressant medications do not work. There is sufficient evidence for efficacy to continue to use medication as part of the overall treatment approach to depression. The current consensus is that therapy is also a critical component of the long term treatment of depression, and therefore looking at the use of medications in isolation may not reflect their actual clinical use. Multiple studies have now shown that combination treatment (medications and therapy) are better than either alone. There is also evidence that medication treatment is more successful when multiple agents are tried in order to find the optimal treatment."

I like Dr. Novella's blog because he gives everybody the "business" if they don't get their science right, whether it's claims made about homeopathy or antidepressants. He explains his belief that the problem with Complementary and Alternative Medicine (CAM) is " ... that they aggressively market CAM as 'harmless' and 'natural.' They point to the warning labels and informed consents associated with science-based medicines as evidence that the alternative must be safer. In reality, many alternative practices are less effective, and can carry serious risks (usually undisclosed to the patient)."

We need more research on what causes postpartum depression and what the most effective methods are to treat it.  This should include looking more closely at alternative forms of treatment, whether it's acupuncture or yoga or light therapy or omega-3s, to make sure that we aren't missing anything.  Unfortunately, there's just not a whole lot of information available on that yet, especially for moms who are breastfeeding.

One interesting piece, the best I've found so far, took a look at the more common natural treatments suggested to women with postpartum depression.  It was published in the Journal of Midwifery and Women's Health in 2004 and looks at both pros and cons. Their conclusion?

"Especially for women with moderate to severe symptoms, complementary and alternative medicine is a complement to conventional treatments, not a replacement for it."

So what should you do?  One of the MDs who writes the blog Denialism suggests the following in his post "There is No Such Thing As Alternative Medicine":

"When someone offers you an 'alternative therapy', ask them what it is an alternative to. Does it work better than something else? Is it safer? How do you know? Why should I believe you?"

Then, talk to your doctor.

Update to this piece:  I think some readers are getting the impression I think alternative treatments are bad.  That's not my point at all.  I simply think we should always look at both sides of any treatment suggested.  Everything has side effects of some sort.  Everything has risks and benefits. Just because a treatment method is "natural" doesn't necessarily mean it is safer or more effective.  That's all.  If you want to try an alternative method, you should.  That's why I report on them here and here whenever research comes out.  I want you to know everything that's available.  You have to make your own choices.

For related articles on this topic, you might want to check out the following blog posts:

Psych Central: Consumer Reports on Antidepressants

Mamapedia: The Postpartum Prozac Roller Coaster

Mayo Clinic: Postpartum Depression and Alternative Treatments

Dr. Shoshana Bennett: Natural and Alternative Treatments for Perinatal Mood Disorders

MGH Center for Women's Mental Health: Fish Oil and Postpartum Depression and Using Omega-3 Fatty Acids to Treat Depression During Pregnancy and Can Estrogen Be Used to Treat Postpartum Depression?

Psych Central: Alternative Practices May Complement Western Medicine 
 

This week, as part of the debate over healthcare reform, the U.S. Senate passed an amendment to Senator Harry Reid's healthcare bill that would support funding for postpartum depression screening.

This amendment, led by Senator Barbara Mikulski (D-MD), is unrelated to and separate from the Melanie Blocker Stokes MOTHERS Act, which does not include screening for postpartum depression among its provisions.  (The Melanie Blocker Stokes MOTHERS Act was passed by the U.S. House by is still stuck in committee in the Senate.)

As reported in the New York Times yesterday:

"Under Ms. Mikulski’s proposal, a federal agency, the Health Resources and Services Administration, would develop “comprehensive guidelines” recommending preventive care and screenings for women, and insurers would have to cover the services without any cost-sharing.

Ms. Mikulski said the services would include screenings for breast, cervical, ovarian and lung cancer, heart disease and diabetes, as well as postpartum depression and domestic violence."

Thanks to Sara R. and Jennifer L. for sending me their photos for the Surviving & Thriving Mothers Photo Album!  It's an awesome thing to see pictures of smiling faces when I know that not so long ago those same faces were filled with despair.  You both are an inspiration to mothers suffering from postpartum depression, anxiety and psychosis. 

If you are someone who suffered from depression during pregnancy and survived, or from post-adoption depression, please know we want your photos as well!  Send them to me at stonecallis@msn.com!

Brooke Shields recently received an advocacy award from the Hope for Depression Research Foundation in Manhattan.  At the event, she spoke about her experience with postpartum depression and about the stigma of mental illness.

People magazine covered the event here.  Of interest to me was this bit about her treatment for depression:

"Shields was prescribed medication, though she stopping taking it one point, thinking she didn't need them. 'That was the week I almost did not resist driving my car straight into a wall on the side of the freeway,' she told the crowd. 'My baby was in the back seat and that even pissed me off because I thought she's even ruining this for me. I just wanted to drive into the wall and my friend stayed on the phone with me and made me safely get home.'

She later called her doctor to ask for more help, and was eventually diagnosed with a chemical imbalance. 'I learned what was going on inside my body and what was going on inside my brain,' she said. 'I learned I wasn't doing anything wrong to feel that way. That it was actually out of my control.'  

Two things. 

One, I don't think People magazine got it right when they wrote that Brooke Shields was diagnosed with a chemical imbalance.  People don't get diagnosed with a chemical imbalance.  It's not like there's a test given in your physician's office, like swabbing your throat or having you pee on a stick or something, that tells you whether your neurotransmitters are messed up. 

Shields would have been diagnosed with postpartum depression, which has, as far as we know at this moment, several causes including both genetic, biological and environmental factors.  As Dr. John Grohol at Psych Central has often stated:

"Sorry, mental disorders such as depression and bipolar disorder are not simply 'brain illnesses,' without any significant psychological or social components that must also be treated. They are complex disorders that involve genes, biology, personality, social development, environment, relationships, and a whole lot more in most people. Buying into the simplistic and discredited model of 'brain chemical imbalance' isn’t something that’s beneficial for research or public advocacy or policy."

Does this mean the serotinin or dopamine in your brain aren't involved somehow with your postpartum depression?  No.  Does this mean that there isn't some portion of the illness you're experiencing that is indeed out of your control?  No.  Does this mean it's your fault if your illness isn't biochemical?  No.  But it does mean it's way too simplistic to say you simply have a "chemical imbalance". 

This Just In:  I checked two MDs who are specialists in perinatal mood and anxiety disorders this afternoon just to make sure I'm not making this up and they said what I've written is correct.  There are no consistently identified biomarkers for depression.   There is a test that can be done of cerebrospinal fluid apparently, but it is invasive and not necessarily diagnostic.

In fact, that kind of terminology sometimes frustrates me because in some way I feel it adds to the stigma of mental illness.  Rather than as an evidence-based, medically acceptable diagnosis, I think the term "chemical imbalance" is often used by the media as a sugarcoated, societally acceptable way of referring to depression or postpartum depression. We can't just say we have a mental illness, because that's too hard to prove, supposedly?  Can't be seen on an X-ray?  Too hard for people to believe?  But if we use the phrase "chemical imbalance" then that's acceptable?  That makes it all okay?  I don't know why we have to wordsmith the truth.  I hope someday that stating you have a mental illness like postpartum depression won't require any sort of PR spin.

Now that I got that off my chest, the second thing I wanted to point out is this:  I'm glad to see that Shields spoke so openly about something I hear about quite a lot from moms -- this idea of deciding you should be your own doctor and quit your meds whenever you feel like you don't need them.  Bad idea.  You can see what can happen when you do that, as described by Brooke in the quote above.  Whatever form of treatment you are undergoing, talk with your healthcare provider about whether you should end it, and when and how you should go about doing that.  It's for your own good.

What does it feel like to have postpartum depression or postpartum anxiety?  What are the symptoms?  How do you know when you have it? 

I thought we'd have a talk today about the signs of postpartum depression and anxiety, and we'd do it in "plain mama English".  We won't use words like hypomania or dysthymia or suicidality or psychomotor agitation.  We will use the words we hear in our heads when we think about what the hell is happening to us ...

When you read the lists below, keep in mind a few very important things: 

1. You may not be experiencing all of the symptoms below or even most of them.  Postpartum depression and anxiety are not "one-size-fits-all" illnesses.  Your experience may be focused on just a few of the following symptoms and you may not have others at all.  For instance, some women with postpartum depression are sad and crying all the time, whereas others don't experience the sadness but are instead very angry and irritable.
2. Many people have a feeling like the ones listed below every now and then.  For a day, or maybe two.  We all have bad days.  Postpartum depression and anxiety are not bad days.  Women with postpartum depression or anxiety have symptoms like these most or all of the time, for a period of at least 2 weeks, and these symptoms interfere with their ability to function on a daily basis.
3. Postpartum depression and anxiety are sometimes "comorbid".  This means you can have a bit of both, or all of both.  If you have symptoms on both lists, that's not out of the ordinary. 

Okay.  Here we go. 

You may have postpartum depression if you have had a baby within the last 12 months and are experiencing some of these symptoms:

• You feel overwhelmed.  Not like "hey, this new mom thing is hard."  More like "I can't do this and I'm never going to be able to do this."  You feel like you just can't handle being a mother.  In fact, you may be wondering whether you should have become a mother in the first place.
• You feel guilty because you believe you should be handling new motherhood better than this.  You feel like your baby deserves better.  You worry whether your baby can tell that you feel so bad, or that you are crying so much, or that you don't feel the happiness or connection that you thought you would.  You may wonder whether your baby would be better off without you.
• You don't feel bonded to your baby.  You're not having that mythical mommy bliss that you see on TV or read about in magazines. 
• You can't understand why this is happening.  You are very confused and scared.
• You feel irritated or angry.  You have no patience.  Everything annoys you.  You feel resentment toward your baby, or your partner, or your friends who don't have babies.  You feel out-of-control rage. 
• You feel nothing.  Emptiness.  You are just going through the motions. 
• You feel sadness to the depths of your soul.  You can't stop crying, even when there's no real reason to be crying.
• You feel hopeless, like this situation will never ever get better.  You feel weak and defective.  You feel like a failure. 
• You can't bring yourself to eat, or perhaps the only thing that makes you feel better is eating.
• You can't sleep when the baby sleeps, nor can you sleep at any other time.  Or maybe you can fall asleep, but you wake up in the middle of the night and can't go back to sleep no matter how tired you are.  Or maybe all you can do is sleep and you can't seem to stay awake to get the most basic things done.  Whichever it is, your sleeping is completely screwed up, and it's not just because you have a newborn.
• You can't concentrate.  You can't focus.  You can't think of the words you want to say.  You can't remember what you were supposed to do.  You can't make a decision.  You feel like you're in a fog.
• You feel disconnected.  You feel strangely apart from everyone for some reason, like there's an invisible wall between you and the rest of the world.
• Maybe you're doing everything right.  You are exercising.  You are taking your vitamins.  You have a healthy spirituality.  You do yoga.  You're thinking "Why can't I just get over this?"   You feel like you should be able to snap out of it, but you can't.
• You might be having thoughts of running away and leaving your family behind.  Or you've thought of driving off the road, or taking too many pills, or finding some other way to end this misery.  Or you may have thoughts of harming others.
• You know something is wrong.  You may not know you have a perinatal mood or anxiety disorder, but you know the way you are feeling is NOT right.  You think you've "gone crazy".
• You are afraid that this is your new reality and that you've lost the "old you" forever.
• You are afraid that if you reach out for help people will judge you.  Or that your baby will be taken away. 

You may have postpartum anxiety or OCD if you have had a baby within the last 12 months and are experiencing some of these symptoms:

• Your thoughts are racing.  You can't quiet your mind.  You can't settle down.  You can't relax.
• You feel like you have to be doing something at all times.  Cleaning bottles.  Cleaning baby clothes.  Cleaning the house.  Doing work.  Entertaining the baby.  Checking on the baby. 
• You are worried.  Really worried.  All. The. Time.  Am I doing this right?  Will my husband come home from his trip?  Will the baby wake up?  Is the baby eating enough?  Is there something wrong with the baby that I'm missing?  No matter what anyone says to reassure you it doesn't help. 
• You may be having disturbing thoughts.  Thoughts that you've never had before.  Thoughts that make you wonder whether you aren't the person you thought you were.  They fly into your head unwanted and you know they aren't right, that this isn't the real you, but they terrify you and they won't go away.  These thoughts may start with the words "What if ..."
• You are afraid to be alone with your baby because of the thoughts.  You are also afraid of things in your house that could potentially cause harm, like kitchen knives or stairs, and you avoid them like the plague. 
• You have to check things constantly.  Did I lock the door?  Did I lock the car?  Did I turn off the oven?  Is the baby breathing?
• You may be having physical symptoms like stomach cramps or headaches, shakiness or nausea.  You might even have panic attacks.
• You feel like a captive animal, pacing back and forth in a cage.  Restless.  On edge.
• You can't eat.  You have no appetite.
• You can't sleep.  You are so, so tired, but you can't sleep.
• You feel a sense of dread all the time, like something terrible is going to happen.
• You know something is wrong.  You may not know you have a perinatal mood or anxiety disorder, but you know the way you are feeling is NOT right.  You think you've "gone crazy".
• You are afraid that this is your new reality and that you've lost the "old you" forever.
• You are afraid that if you reach out for help people will judge you.  Or that your baby will be taken away. 

Now that you've gone through these lists are you thinking "How the heck does this lady know me? Is there a hidden camera in here?"  Nope.  What this should tell you is that you are NOT alone and you are NOT a freak and you are NOT highly unusual.  If you are having these feelings and symptoms then it is possible you are experiencing a common disorder that 15 to 20% of new mothers have, and it is completely treatable.  Just reach out for help.  There are people who've seen all of this before and know exactly what is happening and how to help you.  They won't be shocked by what you have to say or what you are thinking.  There are also women going through this who you can meet with and talk to.

If you are pregnant and are having symptoms similar to those listed above, you should know that you aren't unusual either.  You may have antepartum depression or anxiety, which are just as common but occur during the nine months of pregnancy. 

Oh, and it's a good idea to speak with your physician to get a physical so that you can rule out other illnesses that may be causing your depression or anxiety symptoms, such as an underlying thyroid problem.

One last thing:  If you are having moments where it seems like you can see or hear things no one else does, if you are feeling paranoid as if others are out to get you, if you are feeling that you or your baby are somehow related to the devil or God in some way, or if you are having thoughts of harming yourself or others, it's important to reach out for help right now.  These symptoms require immediate attention as they could be signs of postpartum psychosis or severe postpartum depression.  If you have these symptoms, your illness has the potential to take over and lead you to do things that you wouldn't normally do.  In order to avoid that it is important to reach out for help right away so that trained professionals can help you get stabilized and healthy.

Since it is so hard to keep track of the research coming in almost daily on perinatal mood and anxiety disorders, I've decided to add a research page to Postpartum Progress.  You can find it on the right-hand side of your screen underneath "Help Is Here", #5. 

I won't be able to list every single piece of research that comes down the pike, but I will put links on that page to the most current, most interesting, most often cited research.  I've created categories to try and organize it, such as Genetics & Postpartum Depression, Screening for Postpartum Depression, Risk Factors for Postpartum Depression, etc.

Hope this page is helpful to you should you need to find some specific data.  If you know of a study that should be listed there and it isn't, please send me a link at postpartumprogress@gmail.com.  And to my brainy, scientific-type, evidence-based medicine readers, if you see a study on there that you don't think is valid, tell me that too and I'll remove it.