Good Help is So Hard to Find

The two most common ways to treat PMAD are medication and therapy. I will start by coming right out and declaring that I am pro-medication. However, I have learned from talking to many moms (in group and on forums) that there is a LOT of misinformation regarding medication which may be causing undue avoidance. Unfortunately, I find that an alarming amount of this misinformation is coming from healthcare professionals themselves.

First and foremost: Sertraline and Zoloft are safe to take while breastfeeding. These drugs have been studied (along with many others) and it has been determined that no effective amount of the ingredients get into the mother’s breastmilk to be transmitted to the infant. If you seek antidepressants and your doctor tells you that you cannot have them because you are breastfeeding, PLEASE get a second opinion from another practice. Unfortunately, this is an example of how foreign PMAD still is in the medical world, and how much educating still needs to be done. I know I’m just some woman on the internet and you won’t want to listen to me over your doctor (that is safe and healthy skepticism, good for you!), but I am telling you this because the two mental health professionals who run my support group (a MSW LCSW-C, and a APRM-PMH BC who collectively have over 20 years experience and specialized, focused training and education regarding reproductive mental health) preach it regularly. If you have no reason to believe me, please believe them and their professional expertise – they have dedicated themselves to learning all there is to know about this. All I’m asking is that you seek a second opinion.

Personally, I used Sertraline for several weeks following my hospitalization. My doctor put me on 50mg at the beginning. This is a starting dose and is not considered a “therapeutic dose” (meaning it isn’t enough to actually resolve your symptoms). Antidepressants are often prescribed this way because, for best results, they should be slowly introduced into your body rather than all at once. This also gives you a chance to determine if you have any severe side effects on a low dose before you move up and they are potentially worsened. I did well on the starting dose, so I went back in 2 weeks and was bumped up to 100mg. My doctor wanted me to set a follow up appointment for 90 days after that to assess and see if we should increase to 150mg. She said if I felt like I needed more sooner than that (but after 30-45 days) I could reschedule and come back earlier.

As helpful as medications can be, this is the problem with them. They are not free. Doctors are not free. Every visit to my doctor cost me a copay (at minimum), not to mention the cost of the actual medication. Also, I had to schedule all of these appointments around my work and home life. This is asking a lot of women who are already feeling overwhelmed and having trouble juggling all of their responsibilities. Let’s look at a rough, low estimate breakdown of getting medication:

Initial visit and assessment: $20 copay
50mg prescription: $15
Follow up visit and assessment: $20 copay
100mg prescription: $15
Follow up visit and assessment: $20 copay

So already, assuming there are only copays, no deductible or coinsurance, and relatively inexpensive medication, this problem costs $90 (not to mention the cost of potentially missing work to attend appointments). But what if the first medication doesn’t work? That’s more appointments, more missed work, more copays, and more prescriptions as you keep trying. Also, this process is not a short one – these medications can take 4-6 weeks to reach full effect. That is a lot of time, money, and stress to put on someone who is struggling with a mental health issue. Also, if you are not satisfied with a medication, you have to slowly wean off of it which brings me to another potential problem you could encounter: antidepressant withdrawal.

It’s real, and it’s HORRIBLE. I had to stop taking Sertraline because it gave me insomnia and I found that when I didn’t get sleep, all of my symptoms were exacerbated. I’ve had issues with Zoloft in the past, so I was worried about this, but tried anyway. I told my doctor and she told me to wean off by going back down from my 100mg dose to the 50mg. I did this for a few days, but was so desperate for sleep that I stopped entirely one day and that was a bad idea. Even right before my hospitalization, I have never felt depression like this. This was thicker, this was darker, this was different. My mind was completely dedicated to horrible, negative, self-loathing thoughts. I hated myself more than usual. I wanted to hurt myself more than ever, but the lethargy and lack of motivation were so much stronger that I could’t get out of bed to do it. I barely survived until the sitter arrived, then I took days off of work to lie in bed. I did this to myself by stopping my medication the way I did, so I implore anyone who wants to stop an antidepressant to PLEASE wean down!

Even after my experience, I am still a supporter of medication for PMAD. In my case, my best medication so far has been the Pill, but that is because of my PCOS and is not going to work for everybody. What the Pill does for me is balance my chemicals in a way that optimizes me. That’s what other women can get from antidepressants, and the medical field could really stand to catch up on the latest information. While I do promote medication to treat mental health issues, I definitely understand and value the importance of therapy when treating PMAD, as well. But if you thought the hoops required for medication were bad, hold on to your butts as we go through the process of getting therapy…

The most important thing for therapy when it comes to treating PMAD is making sure that the professional you are working with understands the condition. Nearly every therapist will tell you that they have treated Postpartum Depression or that they handle “life transition issues,” but this is not at all the same as specializing in PMAD or reproductive mental health. Mostly mental health professionals have an idea in their mind of what PPD is and looks like. When I was being processed for intake at the hospital, I heard one of my nurses tell the other that she didn’t think I had PPD because she’d seen me with my baby in the ER and I had been making eye contact with him. To her, that’s what PPD should look like – I should be detached from my baby. However, as most moms suffering PMAD can tell you (especially in the spotlight of social media), we’re excellent pretenders. No one who saw me with my baby knew that I wasn’t bonded to him. Hell, I put on a show so the baby himself wouldn’t know. A properly educated mental health professional would know that potentially 1) I am a pretender because it is socially unacceptable to not be in love with your baby or 2) Detachment from my baby isn’t one of my symptoms.

Upon discharge, I tried to find a therapist that my insurance would cover. Unfortunately, both of the women who run my support group are out of network. At first I tried working with the insurance to find someone in network. I tried using their online tool which did not work, so I called and spoke with a rep. I described what I wanted (an in-network therapist within 10 miles of my zip code who said they treat PPD). The search yielded literally hundreds of results. I’ll tell you now, I know suburban life can be rough, but it’s  not “hundreds of therapists within 10 miles” rough. As I found out (by calling and emailing dozens of therapists suggested by my insurance), the insurance’s information was severely out of date. None of the people they recommended were 1) still in practice 2) still in the area and 3) still accepting my insurance.

I decided to talk to my insurance and request a special case agreement that would allow me to see a therapist of my choice and be reimbursed. I was told that because there were so many in-network therapists in my area that it would never be approved. I gave up and never found a therapist. Talking to my insurance was so defeating and painful that I stopped trying to find help. I want to mention here that I was a medical biller for 7 years before I decided to stay at home; it was my job to call and talk to insurances about these kinds of things, and I was good at it. But when it came to getting treatment for myself, I wasn’t able to get through the red tape and actually get help.

The difficulty (and ultimate failure) I encountered in trying to seek medical help for myself is disgusting. I hear similar stories from other moms in group and online all the time, and I am absolutely devastated by the lack of resources, education, and assistance available to women who are struggling with PMAD and other mental health issues. It’s bad enough that we often have to convince our families and friends that PMAD is real and requires treatment, but when that is not the hardest part of this process, the process is clearly broken.

 

Hostage in My Own Body

As I mentioned in an earlier entry, I stopped breastfeeding on June 1st. Because of this, I was able to go back on my old birth control pill that I had used for nearly a decade up until we started trying to get pregnant. So, let’s talk about how different I am now that I am back on that.

I feel like the little IT guy in my brain just noticed the “Not Everything Has to Suck” cable in my brain lying uselessly on the floor, said “whoopsie,”  and plugged it back in. It’s like the “Be Happy Sometimes” section of myself was blocked off for renovation or some bullshit and they just reopened it to the public. Like the last several months have been a roller coaster of bad to worse, but now I’m on the sky tram of “doing alright” coasting smoothly above all of it. Have I made enough weird analogies? The point is, I am back and who the fuck was that lady who’s been here raising my kid all this time?

Hormones are assholes. They come in whatever amounts they please (or don’t), and they do whatever they darn well want regardless of what you have planned. This is terrible because they make YOU do whatever they darn well please. I tried to come up with a clever and amusing example, but it’s just exactly like Patton Oswalt talking about his depression when he went off his Prozac for a month, so here’s that (from the start I set to 4:20 – watch the rest at your own risk/enjoyment):

I love this bit because until I saw it, I had never heard someone else personify their depression the way I do, and more importantly, I had never heard anyone else express the thought that it deserves to be “taken for a walk” every once in a while. I absolutely have had times when I give myself up to my depression and indulge it in whatever ridiculous ways it chooses. The difference between this and how I’ve felt over the past several months with PMAD is that the depression indulgences seemed more temporary. They felt like I could bargain with them. I’d say “Ok, the rest of today I’ll lay in bed and stare at the wall, but tomorrow I have to put on pants.” And a lot of times that worked. But with PMAD, I’d try to bargain and the hormones causing the depression and anxiety were like unrelenting little toddlers who couldn’t be reasoned with. I’d say “ok PMAD, today we’ll lay on the floor and cry and think about killing ourselves, but seriously, tomorrow, no more of these self injury thoughts.” and PMAD would go “NO!” and think REALLY hard about where all of the sharp objects were in the house. For days.

The personifying of the PMAD seems entirely accurate to me, because it feels alien and like someone or something else running me. I feel like a hostage in my own body. I was still in here, but I wasn’t in control. On so many occasions, it made me sit and think “why am I doing this?” or “why can’t I stop?”

The number one example of this for me was crippling, debilitating, absolutely agonizing Mom Guilt. I told my sister a few months ago “I just feel SO guilty ALL THE TIME.” She said “that’s Mom Guilt, every mom feels that.” To some degree, I think she’s correct, but I think mine was like Mom Guilt on steroids because of PMAD. Literally everything I did made me feel devastatingly guilty. If I was home with the baby all day, I felt guilty that I was “hogging” him to myself, but if I gave my husband time with him, I felt like I was ditching him and not helping out enough. If the baby got sick or hurt or sad, it was definitely my fault. I felt guilty because I worked and wasn’t the one caring for my baby all week, but I also felt guilty because he wasn’t in daycare socializing with other kids. I felt guilty in a box, I felt guilty with a fox. I was a walking Dr. Seuss book of Mom Guilt. And when I say I “felt guilty” I mean I felt a gross horrible ball of shame, sadness, and anger directed at myself swirling and burning in my stomach, and it almost always resulted in crying. So I cried, all the damn time. That’s what I mean when I say I think my Mom Guilt was in overdrive. And no amount of telling myself that something isn’t my fault would ever put a dent in the guilt. See the entry from when I stopped breastfeeding as evidence of that (you know, that time I pumped until I bled but wasn’t trying hard enough). It’s like I was in the passenger seat saying “well that’s not really something you can control” or “that doesn’t make you a bad mom” and the driving hormones said “LA LA LA LA I CAN’T HEAR YOU.” Since getting back on my medication (as I refer to it, but again, it’s just the Pill), my Mom Guilt is in check. Yes, I still feel guilty for some things, but I’m not unable to function because of it.

When I stopped breastfeeding, my son developed yeast diaper rash. It got horrifically bad for a while there, and it was agonizing for him. Every time we’d go to change his diaper he’d start preemptively crying knowing what was coming. His poor little bottom was broken out, red as a beet, and in the worst areas, raw and cracked to the point of bleeding. Seriously, fuck yeast diaper rash.
We fought with it for weeks with several different medications, several different tricks (like diaper-free time in an inflatable pool in my living room), and several trips to the pediatrician. At one visit his doctor said “I want to get to the cause of the problem… has his diet changed recently?” She had a hunch that the change to 100% bottle feeding might be the issue and had us switch to soy-based formula instead of milk-based. That, in addition to some serious medication, solved the issue. But why am I telling you about my baby’s butt rash?

I started my pills when I stopped breastfeeding. Shortly after this, my baby developed his rash. After a few weeks, we determined that the formula was causing (or at least exacerbating) his rash, and I felt a twinge of guilt knowing that if I was still breastfeeding, this wouldn’t be happening. But that was it. I felt a twinge. It was a sharp little jab, and then I moved on to just being determined to treat it and get rid of it. If news like that had hit me under the influence of my full blown PMAD hormones, I would have been unable to function for days. I would have sobbed uncontrollably, I would have made someone else change nearly every diaper because I couldn’t face it, and I can almost guarantee you that I would have self-injured (as penance, because that’s how mine tries to work). But I didn’t. I had a few times when it did make me cry (I think this is nearly impossible not to do when your baby is bleeding and screeching in pain), and there were definitely times when I thought “if someone came to my door right now with a stranger and a gun and said ‘if you kill this person your baby’s rash will go away.’ I would hardly let them finish the sentence before I fired (these are the thoughts you have when you’ve set alarms to change diapers at all hours of the night), but it didn’t destroy me. I don’t know if I’ve made my point yet, but what I’m getting at is that that’s a really big deal, you guys.

Now that I’m back on my original pill (which was first prescribed to me as a teenager to treat my PCOS) I really feel like a bunch of old wires that hooked up the “functional” section of my personality have been plugged back in. I know things won’t be perfect all the time forever now, but I feel so much more functional and capable of handling things than I have in nearly a year.