MenGetPregnantToo

Postpartum Depression: Early Symptoms and Preventive Measures

Few life experiences introduce feelings of euphoria and despair more quickly, consecutively and frequently than becoming a first-time parent. The elation of holding your first child can be as acute as the melancholy of postpartum depression.
But what if the latter were not only more manageable, but also foreseeable?

Dawn Kingston, a registered nurse, and PhD is Canada’s only endowed research chair in perinatal mental health. Before specializing in the causes and prevention of postpartum depression, she was a neonatal nurse focused on preventing preterm birth. Her research led her to examine the effects of stress on premature births, and low birth weights. The data began to lead her to the cause-and-effect relationship between a mother’s perinatal anxiety and depression, and the development of more acute conditions post-delivery. In other words, as with maternal instinct after birth, women often feel something is wrong before they even become pregnant. This can then manifest itself into postpartum depression.

   “One of the biggest predictors of whether women get postpartum depression and anxiety is if they had something not only during pregnancy, but before pregnancy as well. For women who struggle with prenatal depression and anxiety, as many as fifty to eighty percent continue to have symptoms postpartum. So we’re used to thinking of postpartum depression as this globular thing that happens after women have a baby, but (if you have) those symptoms prenatally, those symptoms very often continue, which is another reason to make sure you get help in pregnancy.” Dr. Kingston said, when we spoke recently.

By radarxlove

As is so often the case when attempting to overcome mental health issues, stigma is the tallest hurdle. Women who are, or who are attempting to become pregnant, will pay closer attention to their work schedules, their diet, and their exercise routine - generally with the blessing of their partner, family and friends. But expressing concern about stress or worry is still discouraged or dismissed. I asked Dr. Kingston why women were reluctant to broach the subject.

   “I think part of it is the media propelling the myth that the only mental health issue in the perinatal period is postpartum depression - I think that’s a big part of it. I think that the other part of this is that women who are pregnant are stigmatized and silent. Without even understanding there is even such a thing as prenatal anxiety and depression, women are afraid to ask their physicians about it. It’s interesting, when we’ve interviewed women, and asked what are their barriers to raising a conversation about mental health and pregnancy, some of them have given answers like, 'We want to be a good patient. We don’t want to talk about things that might not be an issue during our seven-minute prenatal visit.'”

Like many of us, they don’t want to seem a bother to their physician.

Upon hearing that a mother is anxious or worried about her pregnancy, it is natural for a friend’s or partner’s calming instinct to take over. After all, parenting is a tremendous responsibility that a mother and father are committed to for a lifetime. “Don’t worry, it’ll be fine,” seems a responsible form of encouragement. Unfortunately, this sort of support can be one of the biggest barriers to a mother-to-be who is considering mental health treatment, or who feels despair.

   “Three-quarters of women told us, ‘If my partner, or my mother, or my sister normalized or told me I was okay, I would likely not have raised it with my doctor.’ So it becomes a barrier. I tell women, trust your gut. At this stage in our healthcare system you must raise it with your doctor. They are not going to ask, so you’ve got to trust your gut that something is wrong. What is wrong with asking? There is no cost to asking the question whether this is normal or not.”

Barefoot and Pregnant - Ryan

A woman’s personal support system may not even be the biggest obstacle. Dr. Kingston explained that, shockingly, the Canadian Medical Association guidelines don’t support depression screening in primary care. Why? There is a fear that the screening itself will make the condition worse. There is a sense that talking about depression will be a catalyst to triggering the condition. However, Dr. Kingston says, the exact opposite is true,

“There’s no evidence. And we found in our work that women actually feel validated. You want women to be able to say, ‘That’s me; that’s exactly me.’ Then the next step is, where so we go from here?”

This triggers mental illnesses most nebulous questions, “What is normal?” and, “When is it time to ask for help?”

   “A normal life anxiety or a bit of worry over the baby, or the baby’s health, or (the baby) not eating the right thing...are not going to be long-lasting in general. You won’t have those for weeks on end; maybe minutes, maybe hours, but certainly not much beyond that. The diagnostic marker is always two weeks or more; for anxiety it’s more. I think, in general, it’s the longer you have something the more you should be concerned that it’s something above normal.”

Dr. Kingston goes on to describes acute situations,

“You’re worrying about things you might not have worried about before, and your worry is relentless; you wake up with it in the morning and you go to bed with it. There is this uncontrollable, agitating, restless worry where you just can’t stop it. Your mind is spinning. All the things that you do to control your normal anxiety and worry don’t work anymore. So it becomes this relentless kind of gut-wrenching tension, irritability, (a) sense of not having control.”

Trust in your instincts is invaluable. Raise your hand, step forward, ask questions. There is never shame in self-care. Approximately 9 months after conception, a parent becomes a psychologist, a relationship and grief counselor, a teacher and a doctor to their child for the rest of their lives. Time put aside for yourself becomes inversely proportional with your dedication to your child. Talking about your anxious feelings, and your worry about becoming a mother, is more easily said than done. But going into pregnancy with joy and confidence can lead to two lifetimes of benefit. It will allow you better manage the occasional despair of parenting, also to revel in its frequent euphoria.

By Adam Hilliker

 

Parents Should Claim Their Baggage

    “You have to stop looking at everything through the lens of your childhood.” 

    Shit.

    Therapy.

    Kenny Bodanis, oversize baggage is now being offloaded on carousel 7. Please report to the loading/unloading area and claim your slough. Then sift through it, and avoid bringing it home.

    I’ll soon be 47-years-old. I know have many good years ahead, although I doubt there will be many formative ones. I am fully formed. Any course corrections may not be impossible, but the rudder has rust, and the tanker has fewer kilometres ahead than it used to before reaching its final, fateful destination. And, of course, there is no backing her up.

    We are all the result of our genetics and our upbringing. Nature and nurture. The percentages of the recipe may be debatable, but the cake’s out of the oven: we are our parents’ products, for better and for worse.

Happy Mothers Day by Thomas Hawk

    
    We openly cite our childhoods as examples of wishes and fears for our children:

    “I don’t want my children to grow up with the same…”

    “I only hope my kids can experience what I…”

    “When I was young I was left to my own devices and I turned out...”

    “As a kid, no one took any interest in my passions; I don’t want that for…”

    Environments change drastically over a generation. Most parents are blessed with wanting what’s best for their child, and cursed with believing they know exactly how to make that happen.
We are also in the unique (and often overwhelming) position of being the sole authority, expert, and origin of our young children’s experiences and truths - as our parents were with us.

            The parenting tools we use to tweak our kids were accumulated in a box over decades. They are what worked for our parents, but they may not be ideal for our children.
Coming of age in a household fraught with strife and dissent may result in a parent with an exaggerated aversion to conflict.
An opulent and insulated childhood may produce a parent who crumbles at adversity and is incapable of self-reliance.
Patterns of abuse can be repeated from one generation to the next, as a child learns that physical confrontation is the sole solution for dispute.

    So much sifting, and straining, and skimming. Our childhood experiences are like trees overhanging a pool in the fall, it’s nearly impossible for everything to always be clear. Some leaves are so deep, they just have to be left as part of the basin. The pressure of retrieving them is too uncomfortable to be worthwhile.

Mother by Thomas Hawk

    
    As for the rest, often the work is difficult, but worthwhile.
Unlocking the oversized trunk and sorting its contents is daunting:

    Don’t need that; I held onto that?!

    That’s been there the whole time?!   

    Oh, that’s why this is so heavy.

    I’m learning the trunk is huge, but it’s never too late. That carousel keep turning, offering me my baggage with each pass; a Lazy Susan of my youth.
One item at a time. One today, two tomorrow, another next Tuesday. Eventually, I hope to have only the essentials - a little psychological gym bag.

    Gotta get started, though. My children are products of their parents, for better and for worse.

Alive Magazine - Falling Into a New Routine

May latest article from Alive Magazine talks about using September - the notorious back-to-school month - as the real springboard from which to launch changes and/or improvements to your own routine. New Year's resolutions are fine, but motivating yourself to make positive changes is challenging enough without kickstarting them during the dark, cold winter months.

 

Falling Into a New Routine

From Alive Magazine - Is Improvisation a Cornerstone for Dealing with Dementia?

From the July edition of Alive Magazine, this article -  entitled "As You Go Along" - asks : When you are a parent of a child, and also a child of a parent afflicted with dementia, how do you plan for what’s coming? And then asserts that sometimes, you just don't.

I'd like to thank two people who were not only instrumental in contributing to this article, but also as much in guiding me through a challenging year: Sabrina Dion and Caroline Meynard. These two women, thankfully, have as much experience with dementia as they do patience.

 Thank you for reading:

As You Go Along

 

Caring for Caregivers - Expert Advice on Coping with Dementia

Throughout the various stages of parenthood, people have always referred to “the woods.” As infants, once our children slept through the night we were (supposedly) “out of the woods.” However, the forest was far more expansive than those early parenting metaphors suggested. Toilet training? Woods. Feeding themselves? Woods. Walking? Woods.Tropical, temperate, boreal. Woods, woods, woods.

Recently, when my eldest child turned 13 years-old, I benefited from the wisdom of friends whose sons and daughters have passed through the fires of adolescence. I realized I was not out of any woods. I am now, rather, strolling the pastures between them. Drivers licenses and drinking ages were crouched like bandits in the forest beyond the next bluff.

But, as with many of my sandwich generation peers, the next thicket bloomed even sooner than predicted; my mother was diagnosed with Alzheimer’s disease and Lewy Body dementia. I have reflected on the trials, fears, and compromises necessary to see to it that she is being well cared for, as well as to accept what I cannot change. Through that article, and conversations since, I realized what a comfort it was for me to talk with not only other children of parents afflicted with dementia willing to share their struggle, but also to have access to the reassurance and expertise of those who support and treat victims of cognitive illnesses.

Though these diseases can manifest themselves through myriads of different symptoms, the caregivers’ challenges (and stresses, and fears) are remarkably similar. While families are often thrown into a state of panic by the realization of what steps must be taken to protect their parent, medical staff who specialize in caring for patients and their families rarely encounter a scenario they are not familiar with.

Sabrina Dion is a registered nurse at a private residence which specializes in caring for men and women at various stages of loss of autonomy.

She sympathises with those living with the emotional weight of moving a parent into a home for the first time. While altruism is an able motivator, the burden can detract from - and begin to deteriorate - the caregiver’s relationship with their spouse, their children, and their career. Dion says this can have devastating emotional costs:

Families are very upset, families feel a lot of guilt, families are going through a crisis.
Parents are no longer in their home, their safety’s at risk. So it’s a rush to get them into a safe environment.
It’s a struggle between, “How I am going to handle my home life?” and, “How am I going to make sure my mom or my dad, or either, or both is ok?”
And then I remind them, “What you’re doing is looking out for your mother’s or father’s best interests. You know they’re in an unsafe environment, and you know you can give them a better quality of life given you can’t change the outcome of dementia or Alzheimer’s.” 
This is where it becomes a mish-mash, this is where it becomes really challenging. You have to have a career, you have to get to work, you have to take care of your children. The you have to make sure that your parents - if they’re compromised with the loss of autonomy or of cognitive deficits - are taken care of as well. It’s a lot. Caregiver burnout, that’s the big thing that I look for...that’s my red flag.
Because you taking mom or dad to your home, and not being able to be there and not being able to understand, and burning out, is not going to help them in the long run.

Dominic Smith - Elder and Rehabilitation Care

Caroline Ménard is a psychologist, and coordinator of the Behavioural and Psychological Symptoms of Dementia team at the University of Montreal Geriatric Institute. She says it is often easiest to think of this time as a time to mourn^*:

It is no longer the mother or the person you knew. It is like mourning for the person you used to know; mourning for them before their passing. It is mourning for what was their daily life, which has now become the loss of a driver’s license or the person leaving their apartment. There is also the loss of the person they used to be; they may have been very reserved and now they act out. Those changes can be very, very emotionally difficult.

 Once the elderly parent is removed from the dangers of autonomy, the child and lifelong friends of the patient become spectators of the slow, long-term ravages of cognitive decline. The patient’s personality changes, their physical abilities diminish, and their memory becomes confused and diffused. Dion spoke to me about those feelings of helplessness:

You can visit your parent, and the parent doesn’t recognize you. That’s a really difficult one for children to deal with. That’s when a lot of the children come to my office and it’s like, “Wow, I can’t believe that just happened, that person is my mother.”
So it’s to remind them that if they call you your brother or your husband or tell you, “I know you but I don’t know your name,” just keep going with the conversation. Because there is no point in trying to pull things out of a person. It will get them frustrated, it will get them upset, it will get you upset.

Ménard points out that while specific memories may no longer be viable, emotional memories may last until the very end, and should not be ignored:

The person may not recognize a person as being their son or daughter, but they will still feel happiness when they see that person because of the history they shared.
I have seen people nearly unresponsive in their beds, but upon hearing their spouse’s voice, their eyes open and they smile. That is their affective memory.

Photo: Mariano Cuajao

Victims of Alzheimer’s may also become physically abusive to those they formerly cared for. This impulsive behaviour is the disease, not its host. It is an uncontrollable impulsive reaction. Although it may seem a very personal, hurtful act, the recipient must remind themselves they have done nothing wrong. They are caring for someone losing their filter.

Ménard iterates that each person digests the realities of Alzheimer’s in their own way. Some may react with urgency, while other need time, and distance. Reactions of families and friends can be as varied as the effects of the disease itself:

For some children, accepting what’s coming creates too much anxiety, it’s too difficult. Sometimes it’s better to just deal with this moment. But, eventually, you have to express your emotions. Support groups can be extremely helpful navigating a person through the changes which lie ahead.

She also stresses the importance of asking for help before burnout takes a physical and emotional toll:

There are many more resources than there used to be. There’s the Alzheimer's Society of Canada, for instance. It is important for the child to understand the illness. Since you yourself are a child, and you may also have young children in your life, you have to be able to express what you’re living through, and the emotions which are being triggered; that can be very helpful. You have to ask for help.

Guilt. That emotion that often forbids one from finding their way out of the woods. It is all-powerful, and ironically had its profile created throughout our upbringing with our parents. And no one can trigger a more pointed guilt reflex in a child than their mother or father. There is often so much unresolved, so much unspoken. And, now, as a result of cognitive decline, that relationship may be beyond redemption.

Dion reassures families that that time has passed, and children can feel pride in refocusing their energies:

I think a good reminder and takeaway is for children who have parents who have Alzheimer's or any type of vascular dementia or Lewy Body, is to remember that, whatever choice you’re making, if it’s for your parent’s best interests, it’s always the right decision. And you have to understand that you have permission to live your life and raise your own children. It’s the natural cycle of life.

Being lost in the woods is also part of life's natural cycle. With dementia, that journey can take years to complete. Perhaps the challenge is not seeking a path out of the forest, but to try to find the right tools for long-term survival, as well as company for the journey ahead.

Wayne S. Grazio - Lost (in one's thoughts)

* Interview with Caroline Ménard conducted in French. I provided the English translation.