Conquering Postpartum Depression

Praise for
Conquering Postpartum Depression

“The only word I could think of when reading this book was ‘lifesaver.’ Women and their families will feel not only comforted by the up-to-date and practical information, but will feel that their lives will be saved by the knowledge that their symptoms can be so easily and successfully treated.”

“This is certainly a book that will be on my bookshelf, and I will strongly recommend it as reading to any patient and her family dealing with postpartum depression. In this era of HMO medicine, few physicians devote the time needed to explain all the issues involved with this all-too widespread problem. This excellent book provides the extensive consultation that these women need.”

“This is a thoughtful, comprehensive, and user-friendly guide. Women struggling with postnatal mood disorders will identify with the case histories and find hope for their own recovery in the stories.”

“Babies need happy mothers. This book will help this happen.”

Acknowledgments

No book is a product of the authors alone. This is certainly true of this book as there are a number of people who assisted us, both directly and indirectly.

We would like to thank Dr. Alan Rosenbaum for his longtime commitment to women’s health care, and kindness in mentoring us and providing a comprehensive treatment environment that gave us a start. Furthermore, Dr. Rosenbaum deserves special recognition because he has been instrumental in bringing the psychopharmacological treatment of women to the forefront in metropolitan Detroit.

Dr. Lee Cohen, director of reproductive psychiatry at Massachusetts General Hospital, has been a source of inspiration because of his excellence in providing care and research in postpartum depression.

The American College of Obstetricians and Gynecologists also deserves thanks for their dedication to the health care of women.

Marie Osmond deserves a standing ovation for bringing her own story of postpartum depression to the awareness of countless women who needed someone to speak out and describe what it feels like to live through postpartum depression.

There are a number of people who generously provided us support and their own personal stories throughout the writing of this book. In particular we would like to thank Karen Schroeder; the staff at the Beaumont Hospital Parenting Center in Royal Oak, Michigan, which includes Beth Fryblewicz, Deanna Robb, and Julie Kouziak; and Vickie Rupert, Katie Conti, and Deb Farwell. We want to thank many other people whom we could never begin to name. However, these women and their husbands were open and honest in sharing aspects of their personal life—all with the intention of helping other women and families. The women who allowed us to use their quotes and their often painful personal situations in the writing of this book deserve our special gratitude.

We want to thank the many obstetricians and gynecologists in the Detroit area who are compassionate, caring, and willing to listen to their patients and to send those patients for treatment. And we want to thank all of those people in the health care community for their receptivity to our team approach to treating postpartum depression.

Finally, we want to thank our agent, Denise Marcil, who believed in this book from the beginning, and to our editor, Marnie Cochran, who was the intellectual midwife who has helped to shape it into the story we wanted to tell.

Authors’ Note

It’s often difficult to determine how it is that people with diverse backgrounds come together to work as a team with a common cause. We’re not exactly sure why our paths were destined to cross and how it was that we ended up in the same place, but that’s exactly what happened. And we’re not just talking about our work with postpartum depression—all three of us authors, remarkably, live in the same neighborhood.

It might be destiny, but the fact is we each took different roads in order to end up together helping women and their families overcome postpartum depression (PPD). For example, Ron Rosenberg remembers exactly what case represented a turning point in his professional life when he was practicing as an obstetrician and gynecologist. The day after Ron delivered Samantha’s baby, he stopped in her hospital room to see how she was doing. Samantha was not doing well at all. She was severely depressed and talking in a way that frightened Ron. He immediately transferred her to the psychiatric ward of the hospital—a move that was not only extremely unusual at the time, but highly criticized. There she was treated with medication and within a few days was able to go home and care for her baby.

Three years later, Samantha’s husband made an appointment at Ron’s office to talk. He said he came to thank him for saving the lives of both his wife and his child. It was that thank you from a husband and father that galvanized a thought that had been circling in Ron’s head for a few years into a plan of action. He would return to a second residency and become a psychiatrist.

“I knew that as a psychiatrist I could do more for depressed mothers than I could as an obstetrician,” Ron says. “They needed someone to listen to them and take their emotional needs seriously.”

Debby Greening, after raising three daughters, went back to graduate school to get a Ph.D. in psychology. She began working with women who had been traumatized. “I was really drawn to these women who had been through so much,” Debby says now. “Maybe that was because of the trauma I had experienced in my own life, especially during pregnancy, that I felt like I wanted to help other women.”

Working through the court system, she was counseling traumatized women who had been assaulted or victimized by a violent husband or partner. Finally out of school, she was excited, enthusiastic, and passionate about her work. Over time, she found herself frequently frustrated that she wasn’t helping as many women as she thought she could—or as much as she had hoped. “The cognitive behavioral psychotherapy I was practicing,” Debby says, “wasn’t helping many of these women who were so anxious and depressed that they often couldn’t even leave their homes to come to my office for treatment.”

Over time, she learned that many of her colleagues were referring their clients to a psychopharmacologist who specialized in women who were difficult to treat because of a serious depressive or anxiety disorder. “I began to hear the name Ron Rosenberg,” Debby remembers, “and what I kept hearing was that Dr. Rosenberg often seemed to work miracles with his use of medication.”

Soon, she began making referrals to Dr. Rosenberg, and he began referring women to her for individual or group therapy. Planned or not, Debby Greening was beginning to treat—and even to specialize in treating—women with mood disorders, including postpartum depression.

During an internship while completing her Ph.D., Debby worked at a juvenile court psychological clinic, where James Windell was on the staff. Jim, the author of several parenting books, had developed a parent training program for parents of delinquents. During Debby’s year long internship, she and Jim became friends, although it would be a few years before they started working together. In the meantime, she continued to work in the court system as well as in women’s shelters where she counseled thousands of people involved in violent relationships. She would also work with judges and referees in the courts in the role of expert witness and consultant, which led to certification in forensic medicine and as a forensic examiner.

As Debby continued to treat women, she began to realize that there was a major ingredient missing in her attempts to aid the healing of women. That missing ingredient was the role of parenting. “The women I was working with were frightened of their own babies,” Debby has said. “They were terrified of not being good enough mothers, they were terrified of not meeting their own expectations, and ultimately, they were terrified of failing completely. Many of these women had only one road map to follow—that of their own mothers—and that was often not the map they wanted. And that frightened them even more. But I didn’t always know how to help them either.”

That’s where Jim came in. While he was working with delinquent and defiant children and adolescents, both in and out of the juvenile court system, he had come to believe that many of these kids had spent the first few years of their lives with one or more depressed parents. Often the depressed parent was the mother. When Debby related her work with women with postpartum depression and asked him to become part of the emerging “postpartum team,” he began to see that postpartum depression could be the link that helped him make sense of the problems that children developed in school and in the community.

The Postpartum Depression Team

Together we bring to the table more than sixty-five years of experience working with women and families. More importantly, our efforts to help women with postpartum depression have enabled us to develop a treatment program that has been proven to be effective. Because each of us brings something different to this working relationship, we now see the team approach as essential in the successful treatment of postpartum depression.

Besides being an obstetrician/gynecologist, a psychiatrist, a psychopharmacologist, and an addictionologist, Ron Rosenberg is one of only a few doctors in the United States who has practiced the two specialties of OB/GYN and psychiatry simultaneously. Prior to becoming a doctor, Ron studied pharmacology at the University of Michigan. As an obstetrician and gynecologist he has been chief resident at William Beaumont Hospital in Royal Oak, Michigan, one of the largest hospitals in the country. He has also been in charge of the Obstetrics and Gynecology Department at William Beaumont Hospital in Troy, Michigan. These credentials and experiences make him especially skilled in treating women with mood disorders and with treatment-resistant depression. Ron is dedicated to helping women who have “fallen through the cracks” and have suffered longer and more severely than necessary.

Debby Greening’s work as a clinical psychologist in private practice, as well as a consultant and expert witness in the area of domestic violence, stalking, and family violence, gives her special insight into the psychological stress experienced by women. In her private practice over the last several years, she has conducted group and individual therapy sessions with hundreds of women suffering from postpartum depression. She has arguably had more experience with women’s postpartum depression groups than any other psychologist.

Jim Windell published his first parenting book, Discipline: A Sourcebook of 50 Failsafe Techniques for Parents, in 1991. Since then he has written seven books, all devoted to helping parents with various issues in the struggle to raise healthy children. As an author, court psychologist, and newspaper columnist, his focus has been on teaching parents for much of his career.

“Raising children is one of the hardest jobs in the world,” he says. “However, these days the job seems to be compounded by numerous new and unique stressors. In addition, we know more about what is involved in raising well-adjusted children. The mental health of the mother in the early months and years of life is critical.”

It is because of this concern that we teamed up to bring together the skills he’s developed in helping parents be more effective. Each of us brings a unique background and expertise to the team. And that, we feel, is essential in helping depressed women.

Introduction

Like girls almost everywhere, Lisa grew up playing with dolls. She never seemed to tire of feeding, changing, bathing, and dressing her babies. Lisa took them for long walks and summer picnics. She had entire conversations with her dolls, pretending that they were all part of her family.

Lisa loved playing at being a mommy, and eventually playing house became her favorite pastime with the boys and girls in her neighborhood. They each took on roles, which not surprisingly resembled both the jobs and personalities of their own families. Some kids got to be the children, while others got to be the dad—who drove his car into the driveway when it was time for dinner. Whoever was low on the totem pole had to be the family dog. But Lisa always got to be the mommy. She insisted.

As soon as she was old enough, Lisa began baby-sitting. Earning spending money was a secondary reward, as Lisa was a natural with little ones, truly enjoying their company. By the time her older brothers and sisters had children, Lisa was the one they called to baby-sit. Her siblings even looked to her to reassure them in their new roles as parents. For Lisa, the step to motherhood would be easy and natural. After all, she had been preparing for this all of her life.

After falling in love and getting married to Jason, Lisa’s dream came true. She was pregnant. Both Lisa and Jason were ecstatic about becoming parents. As soon as the doctor confirmed she was pregnant, Lisa and Jason began planning. They would paint the nursery, buy baby clothes, read books about naming their baby, and sign up for a childbirth preparation class at the local hospital where the blessed event would take place.

A few months later, in the first session of their childbirth classes, they felt a sense of camaraderie with the other couples. They compared notes and smiled at stories of the in-laws arguing over what to name their babies. Somehow, that seemed to be the worst problem that any of them could imagine.

At the end of the first class, all the couples were given a handful of brochures, including one with a few paragraphs on postpartum depression. Lisa and Jason quickly scanned it and set it aside, believing that it had nothing to do with them.

Lisa’s dream came true when her beautiful baby arrived. However, having her baby was not everything she had ever imagined. What she had never anticipated was postpartum depression. In fact, there are nearly 400,000 women, like Lisa, in the United States each year who experience depression during or after the births of their babies.¹ A majority of women, we now know, experience some sort of mood disorder during their pregnancies.²

Like Lisa and Jason, most expectant parents look forward to all of the exciting events surrounding a new baby. Depression, though, is not one of the events that’s anticipated. Yet, eight out of ten women will experience some form of alteration in their moods during or following pregnancy.³

Despite these odds, which are not well understood by most of us, depression is a taboo subject. Most people won’t talk about it, and in childbirth classes almost no information about postpartum depression is given. Some childbirth classes cover caesarian sections in detail, yet postpartum depression is more likely to occur than a woman having a C-section delivery.⁴ A significant number of women and their families wait until there is a crisis before acknowledging that depression has touched their lives. Part of the problem is that depression is not something that you anticipate. It just sneaks up on you—sometimes with shocking abruptness.

Our purpose in writing this book is to take some of the surprise— and a lot of the fear—out of this mood disorder called postpartum depression. We want you to know that there is every reason to be hopeful and reassured. You should understand that if you, or a woman you know or love, is depressed during or following pregnancy, recovery can take place.

In our work with hundreds of women and their families, we have discovered three key ingredients to a restoration of health. These key ingredients, when carefully considered and followed as we suggest, will help you or your loved one return to a pre-pregnancy level of functioning, and will help maintain good health through subsequent pregnancies. These three essential ingredients can assist you in fulfilling whatever dreams or expectations you have of motherhood and raising a family. The three proven keys to recovery from postpartum depression are:

1. Know your postpartum depression risk factors.
2. Make sure you receive a comprehensive assessment for postpartum depression.
3. Receive a multi-dimensional treatment approach by a team of postpartum depression specialists.

You Don’t Have to Feel Hopeless

Most everybody who comes through our door has begun to feel a little hopeless. By the time women come to us, many are in the throes of serious postpartum depression. And they all have similar thoughts and feelings: My life won’t go on; I’ll never be able to take care of my baby; I’m afraid something will happen to my baby; I’ve made a mistake having a child; Nobody in my family understands what I’m going through; There’s nobody to tell how I really feel; If I do tell somebody how I feel, they might take my baby away.

As postpartum depression deepens, it becomes more difficult to ask for help. This may be due to both becoming more frightened and, at the same time, having less and less energy. As a result, you may have postponed asking for help. When you become desperate and finally reach out, you may, unfortunately, receive inadequate help. Inadequate help drives fear and hopelessness. Thus begins a downward spiral. When women do ask for help and don’t get it, they frequently give up. But it doesn’t have to be this way.

If you are depressed, you can get help. You can get better and you can be the mother, the partner, the wife, and the friend you know you can be. In other words, you can be yourself again.

Today there are great advances and, consequently, there is great hope in the treatment of postpartum depression. Specialists can help you follow through with each of our three key ingredients, one at a time, so that you feel you have a team of supportive experts working with you and for you, giving you hope and reassurance every step of the way.

The Myths of Postpartum Depression

In our research and clinical experience, we have encountered many myths about postpartum depression. One of the reasons for writing this book is to dispel some of the enduring myths we hear.

The first myth we have frequently encountered is that postpartum depression is seen as a problem unrelated to the physical ailments of pregnancy or childbirth. That’s why postpartum depression is rarely written about in detail in medical and nursing books, and why it’s neglected in medical schools. Most obstetricians and gynecologists know relatively little about postpartum depression, and what they do know may be clouded by other myths.

A second myth we encounter is that there is little difference between the “baby blues” and postpartum depression. Because OB/GYNs receive so little training about postpartum depression, they mistakenly reassure women that what they’re feeling after delivery “is just a case of the blues and it will pass.” Not knowing how to properly diagnose postpartum depression, they just assume that the symptoms will pass in a few weeks.

When Dr. Rosenberg was in medical school, he never heard about postpartum depression. That didn’t change much during either of his residencies. Seldom during his OB/GYN residency did he encounter women with “postpartum depression.” The reason for this, he later learned, was because postpartum depression was rarely, if ever, diagnosed. Therefore, he wasn’t taught how to recognize it or how to treat it. This is the shame that remains in many hospitals where doctors who become OB/GYNs do their residencies. During pregnancy many women go to the emergency room with various symptoms, including panic attacks. However, they are seen briefly and then released. The reason they aren’t admitted is because no one is taking the time to listen to what they are saying. Medical doctors, especially trauma specialists in ERs, are trained to deal with physical emergencies, not depression. If you are in distress, you deserve to be heard. And you deserve not to have your symptoms dismissed.

The third myth we see is that postpartum depression isn’t serious unless the woman threatens suicide. This was brought home to us in a significant way recently when Dr. Rosenberg was having lunch with a physician. While discussing one of the physician’s patients over lunch, Dr. Rosenberg inquired as to why his patient, a woman who seemed to him to have a severe postpartum depression, hadn’t been admitted to the hospital. The physician’s answer was brief and sad, and one with which we have become familiar: “She isn’t suicidal,” the physician answered.

We’ve found that you don’t need to be suicidal to be seriously depressed with postpartum depression. There are many other symptoms of postpartum depression that we will describe in detail in this book that will help you and your doctor recognize if that is what you are experiencing.

A fourth myth is that if you wait long enough, your postpartum depression will simply go away on its own. Obviously, if your doctor thinks you just have a mild case of the baby blues, he or she will also think that these mild symptoms will fade away without treatment. The fact is, though, that there is no guarantee that postpartum depression will go away or disappear without treatment. Many women have suffered for months or years because they thought or were told that their symptoms would pass. What sometimes starts out as a mild case of postpartum depression can develop into a severe, debilitating postpartum depression that can seriously affect you, your baby, and your family.

A fifth myth that is so endemic in our society that it has become “truth” is that postpartum depression can be treated without medications. Psychotherapy can be helpful in treating depression, but most cases of postpartum depression will require one of the effective medications we have available to us these days. You are very likely a woman who dislikes taking pills, or you may believe in treatment with herbs or other alternative methods. Yet we will show you where taking pills may be in your best interest. We will also explain the errors in some alternative treatments that even doctors may engage in when treating postpartum depression.