By Nancy W. (Part 4 in a series)
Research is discovering more and more about the biochemistry of depression. We know that depression is linked to a faulty mechanism for regulating various neurochemicals in our brains, like Serotonin, which regulate our feelings of happiness or satisfaction. “Designer” drugs (SSRIs) such as Zoloft, Prozac, and others help to regulate these chemicals. Some other, older, antidepressants can be very helpful too. But I am getting the cart in front of the horse here.
Depression has been found to run in families, and often a major depressive diagnosis can be made without a precipitating episode; some of us may have had this tendency long before our loss. Other people may become depressed after a major loss in their lives. This is thought of as a “situational” depression, and undergoing the abortion of a wanted pregnancy certainly qualifies one for this. Then there is the whole topic of postpartum depression.
Because of the tremendous hormonal shifts at the end of pregnancy, nearly all women encounter some degree of “baby blues.” These are self-limited, lasting two to four weeks, and usually consist of intense emotionality, even when the outcome of the pregnancy is normal and happy. Postpartum moms cry more, and are more emotional for usually up to a month, or as long as it takes for their hormones to balance out. We all can relate here. This is a major contributor to our crazy feelings after we lose our babies.
A diagnosis of postpartum depression is made when the feelings are generally more intense and longer lasting. The mom may feel unable to get on with her life. Medication and counseling are usually in order.
There is one further diagnosis which can be made, but it is very rare. That is of postpartum psychosis. In this case, the mom loses all touch with reality, and needs intensive psychiatric help.
All three are points on a continuum which is loosely called postpartum depression. It is now recognized that the hormonal shifts after weaning may also trigger depression.
You have lost your precious baby. You are experiencing grief. You are postpartum. Your emotions overwhelm you. Your spouse may be struggling in his own way. Your relationship is stressed, and provides more of a challenge than a comfort some of the time. It is hard to get up in the morning. Hard to go to work. Hard to be there for your other children. Hard to be “up” for your extended family. Are you depressed? Probably. Do you need help? Maybe. Medication? A good question, but one I can’t answer over the internet.
There are more questions to ask, things which you should discuss with your doctor, or your counselor.
- Are you sleeping?
- Are you sleep deprived?
- Are you eating too little?
- Are you eating too much?
- Are you able to control your emotions or are they controlling you?
- Are you having trouble functioning in your daily routine?
- Is your work suffering? Are you able to leave the house?
- Are you suffering additional problems like anxiety or panic attacks?
- Are you feeling irritable?
- Are you able to experience pleasure in the things you used to?
- Are you feeling overwhelmed by guilt? Are you having trouble concentrating?
- How is your memory?
- Are you having trouble making decisions?
- Are you feeling restless, or are you much less active than you usually are?
- Do you feel hopeless?
- And finally are you having thoughts of suicide or death?
All of these are important things for a professional to understand.
The way I respond to the questions people online ask about whether their depression is “normal” or not and whether to go for help is to ask:
- Can you function? In other words, are you able to do the things you need to do in your daily life?
- Are you seeing any pattern to your feelings?
- Are you getting gradually better?
- Or are you spiraling down?
- Or are you absolutely stuck?
If you answered yes to either of the last two questions, it would be good to talk to a licensed counselor, or a mental health professional like a psychologist or psychiatrist. Please know that there is no shame in needing help.
If you are put on medication, try to avoid addictive medications like barbiturates or tranquilizers which may actually compound your depression. Antidepressants are not addictive, however you must take them for a period of time for the blood level of the medication to reach a therapeutic level. They are definitely not a quick fix, usually taking from one to three weeks before any effect is felt and up to 6-8 weeks, or more, to reach a truly therapeutic level.
It is not wise to quit antidepressants “cold turkey,” as that can precipitate a sudden onset of significant depression. It is really important to talk with the prescribing physician about your response to the medication, or any side effects. Not every drug is right for every person, and it is not unusual to have to try another type of antidepressant before the right one is found.
An group member recently told me that she was so relieved to be on the medication, saying it allowed her to function for the first time in months. Antidepressants don’t make you high. They just bring you up from the basement to the ground floor, so you can get on with the business of your life.
Another group member recently wondered if antidepressants would get in the way of trying to conceive, or if they might harm the baby. This is a question for your doctor to answer. But the way I look at it is this: if you can’t even function, how are you planning to get pregnant? I have known of women who had severe problems with postpartum depression who were able to work out a plan for management with their doctors. So, if you need them, talk with your doctor and then use them and heal from your loss enough that you can be fully prepared to undertake the process of trying to have another baby again, or just simply healing your grief.
Dads get depressed too
Dads, while we are talking about depression, some of you would probably benefit from help too. Please get it. You do not have to live your life in pain, suffering silently, while trying to be strong for your wife and family.
One more little “momily” while I am on this subject. Bereavement is not the time to take up drinking or substance abuse. Avoiding your grief through “self-medication” with drugs or alcohol can be very self-destructive.
Is it normal to have suicidal thoughts after a heartbreaking decision? Many of us have said the classic statement to ourselves, ‘I just wish I could die!” But, as a mental health clinician myself, I want to be straight with you: If you entertain serious thoughts about suicide, a pregnancy loss support group is not the forum for that discussion. You need professional help immediately. Please share with your spouse, or someone else responsible, your thoughts and let them know if you are serious in your intent. Ask for help. And to you spouses who suspect or hear such ideas, take it seriously and get help for your mate, please. Call a mental health center, a mental health professional, call your doctor, go to the emergency room, or even call 911.
The loss we have suffered is devastating to be sure. Some of us are dealing with multiple losses in a short period of time. These losses do not help us to be rational about what matters in our lives. Please get help! Please keep the lines of communication open.
Editors note: Nancy W. has given us permission to divide her “long post on grief” into this series of five articles: