A Long One about PPA

I contemplated breaking this up into two posts, but whatever. If it’s too long, take a break & come back later. Or skim it for the most interesting parts! Godspeed if you’re on mobile.

May is National Mental Health Awareness Month, and some states also recognize it at Maternal Mental Health Awareness or PMAD Awareness Month. PMAD stands for Perinatal Mood and Anxiety Disorders, most commonly postpartum depression, anxiety, and/or psychosis. Is it as fun as National Ice Cream Month? Probably not. But it’s vitally important to talk about so the stigma and shame are removed from parents going through it. I was officially diagnosed with postpartum anxiety at my first postpartum check up, and as with everything else on this blog, I can only speak to my experience.

I’m incredibly thankful to have a forthright group of friends who became moms before me, and I’m grateful to be a patient of a hospital system that is putting continually more resources towards parental mental health education pre- and postpartum. PMADs don’t just affect the birthing person; partners can absolutely suffer, often silently, as well. I wouldn’t say I had negative expectations about my mental health after becoming a mom, but I had realistic ones. I was definitely more versed in the signs of postpartum depression, however, so when my provider first said “postpartum anxiety,” I tried to brush it off as hormones and a lot going on in my life.

In retrospect, I suffered from anxiety my whole pregnancy (and, let’s be honest, my life.) My husband had his pay permanently cut by 25% due to COVID two months after we conceived, and my small business was greatly affected by the uncertainty of quarantine. We’d had our house listed for sale then took it off the market. We went for a month without health insurance (not recommended when pregnant AND in a pandemic!) Thankfully my business stabilized, he found a new job with insurance, and we moved when I was 36 weeks pregnant. In those final few weeks, I laid awake at night ruminating over how we were going to keep our baby safe from COVID, mass shootings, and being bullied by other kids while trying to not outright have a panic attack any time I glanced at news about the upcoming election.

All of this is relevant because at my six-week postpartum appointment, when the conversation turned to my mental health, I reported that I was “back to normal,” and I meant it. I was now in the process of selling my business and transitioning to a new job while figuring out how to be a mother to an unsleeping newborn with a husband who only had five days of “if HR asks, tell them you’re working from home” under the table paternity leave. We had supportive family nearby, a new home with tons of potential and a healthy baby. Nothing to actually complain about! Situational anxiety was my normal.

What wasn’t my normal was the panic I’d feel leaving my son with my mom or husband if I had an appointment. I’d get shaky in the Trader Joe’s parking lot thinking about how I had to rush home because they’d be mad at me for being away too long. (They weren’t. They would never be. This was something I’d made up in my head.) I thought it was “just hormones” that for the entire 12 minute drive to my son’s first doctor’s appointment with just me taking him, I was convinced he wasn’t breathing in his car seat. On more than one car trip, I’d pull over to check on him in the backseat despite having a mirror where I could see him while driving. During the really gnarly first week of baby blues home from the hospital, my husband went upstairs to take a shower, but I had insanely dark thoughts that he was doing something else up there and would never come back down. I had terrible insomnia, and it would take hours to go to sleep even when it was my husband’s turn to be up with the baby.

I didn’t realize that when I got up to do anything away from my son, I wasn’t breathing. (I mean, technically my brain stem was doing what it needed to in order to keep me alive, but it was the shallow breaths of a panicked person. I probably didn’t take a full, deep breath his entire month of life.) I was constantly waiting for him to need something from me and anticipating his cries. He’d meltdown during diapers changes his first two months of life, he hated getting dressed– I was constantly on edge. I thought since my anxiety wasn’t always about him, though, it wasn’t PPA. Since I felt confident as his mom and had bonded right away with him, I figured this was just how I handled life now.

My doctor finally convinced me it didn’t have to be this way. She prescribed me a low dose of Zoloft which I took for a few weeks. I shared on Instagram that I was taking it for a PPA diagnosis and so many other people commented or sent private messages that they, too, had been there. But I didn’t want to be medicated. I know, I KNOW. I believe in medication for other people, I believe there should be no stigma around medication for your brain, and yet I’ve got a lot of subconscious baggage from being raised in a “tough it out” (or drink through it) environment that had me wanting to get off the meds. So I decreased my dosage and eventually stopped taking them after maybe a month.

Things were fine; nothing crazy happened. The business transaction closed, I got more comfortable in my role at my new job. I stopped breastfeeding and tried to embrace formula feeding. Most of my clothes started to fit again. Things got even worse with his sleep, but then we Ferber-ed and our lives were suddenly *clouds parting, angels singing.* Out of the woods, baby!

Oh, boy. It was like once my brain knew he could actually sleep through the night and would be fine, it came completely unglued. This was not the situational anxiety of before; this was full on PPA. Did you know that PMADs can happen any time the first year postpartum? I didn’t! So many of the other parents in my Reddit monthly bumpers group were experiencing the same right around that four month mark. Did you know your body has another insane hormone surge (or drop, I don’t remember which- I’m not a doctor) around 16 weeks after birth? I was a ball of panic. I had to leave Walmart because I couldn’t find Total in the cereal aisle but couldn’t take the time to slow down and look again for it because I had to get home to my baby.

Thankfully, I’d kept picking up my prescription when it auto-filled and this time, I felt no shame in using it as a tool in my mental health toolbox. My son is now over six months old, and things are a lot better than they were two months ago. In the next post, I’ll share the litany of things that have helped get me to this place, fully realizing that this really is a journey I’m not at the end of (and I loathe when things are described as a #journey!!)