Tuesday, July 05, 2011

Anxiety, Depression, and Me

Throughout this pregnancy (and frankly the life of this blog) I haven't really gone into much detail about my "mental health issues".  The good news is that I haven't shared much because there hasn't been a ton to share.  Over the last year (plus some) I have shared with you how I am feeling in general, but I have been hesitant to share much more.  I feel like I am in a place now where I am not only able to share this with you, I feel as though it is important for me to share it.  

I have a diagnosis of depression and general anxiety disorder (as well as ADD, but that is another story for another day).  When I am not pregnant or nursing, my medications for the depression and ADD do a good job treating those issues and holding off my anxiety.  However, when it has creeped back into my life, I have added a medication for that as well. 

I think my symptoms for depression and anxiety seem pretty standard.  When I am depressed I tend to eat more, do less outside the home, and begin to close myself off to the rest of the world.  Internally I beat myself up for every little flaw that I see myself as having and see that there is no way that I will ever live up to the person I think I should be.  I am very concerned about pleasing other people and when I am depressed I struggle to see how I will ever be "okay" enough for those around me.  This is what usually leads to the anxiety...the fear of losing everything around me.  I not only worry about the every day type of details in my life, but I begin to have panic attacks that are obsessive and completely irrational.  The worst symptom I have during an anxiety attack is that I have a hard time breathing.  This always makes things worse because I begin to beat myself up for having the attack in the first place and I get mad that I can't control my emotions.  I try and relax and sometimes just focusing on the attack itself makes things worse.  Many times I need to distract myself from what I am obsessing about until I have calmed down, then I go back and deal with why I was so anxious. 

So what do I do about this all?  Well, I am under the care of a psychiatrist, whom I see regularly, that specializes in pregnancy and postpartum care. I was seeing a therapist regularly as well, but she did such a great job building up my skill set for dealing with my "issues" that I have not seen her since the early part of this pregnancy.  She is available if (when?) I need her.  

I mention this because when it came time for us to think about having children, I was terrified that my depression and anxiety would get worse.  It was suggested to me by a previous psychiatrist that when it came time for me to get pregnant, it would be wise for me to set up a "team" of support personal.  This not only included a psychiatrist and therapist, but an OB/midwife that was keenly aware of how my sudden change in hormones may impact depression and anxiety.  My team also included my husband and mother, obviously since they were going to be the ones with me postpartum.   I suppose you can also say that part of my "team" also includes medication.  This is a very personal decision and one that each person needs to make based on the information provided to them.  I am very confident and comfortable with my decision (so please don't judge). 

When I got pregnant with Superman we were all pleasantly surprised to find out that pregnancy hormones agreed with me.  In fact, towards the end of the pregnancy (even though it was in the middle of winter), I suffered from no noticeable Season Affective Disorder symptoms for the first time in many, many years.  I was able to continue the same minimum dosage for my medication throughout the pregnancy and postpartum.    This is especially impressive considering many women need to increase their medications at the end of the pregnancy to maintain the same effects.

We were also pleased to learn that my body adjusted nicely postpartum and I suffered from minimal signs (if any) of depression or baby blues.  HOWEVER, around the time my husband went back to work and we had no family visiting, I began to have anxiety attacks.  I had them sitting upstairs nursing S, worried that someone was going to break into the home.  I had them driving, worried that someone was going to crash into us.  I had them crossing bridges, worried that we would somehow end up going over the edge.  I imagine many of you had similar concerns when you became a new mother, wanting to protect your child.  In fact, it is very common for women to have these worries.  What is not common or "normal" is what you do with these worries and that is what separates me from most women.

If you avoid an activity (like going to the store) because of the fear and anxiety of what might happen, that is not a "normal" response.  If you obsess over your worries to the point that you can't think about anything else (or take one of the above worries and have to play them out in your mind so that you are sure you know what you will do just in case it happens, but then realize that nothing you can do will make it okay and you begin to freak out a little more because of this), that is not a "normal" response.  If you are having anxiety (or panic) attacks, this is not a "normal" response.   This is where I was with my anxiety and I was grateful that I had my "team" in place so that we could take care of it and within a few weeks, I began to have very few anxiety attacks.  The treatment for Postpartum Anxiety (PPA) is different for each patient, just as the treatment for Postpartum Depression (PPD) is different for each person.  I believe that because I had my team of people in place and because of my history with anxiety and working through it (both with therapy and medication), I had an easier time "fixing" it.  By no means was it a walk in the park, but it could have been worse. 

When it was time to get pregnant again I had no concerns about my depression and anxiety.  I felt like I knew how my body adjusted to the hormone levels and was sure that things would be similar the second time around...and for the most part things were the same, up until a few months ago.  

I began to have anxiety attacks similar to the ones that I had postpartum with Superman around the time of the earthquakes in Japan.  I was worried about an earthquake here.  I was worried about radiation levels and what would happen if they increased here.  I began to have anxiety attacks.  Thanks to my wonderful husband and the strategies that I have learned, I was able to work through most of it.  I had scheduled an appointment with my psychiatrist and was pretty much attack free when I saw her and thankfully, I did well... for awhile. 

Then June hit and the attacks came back.  Although I felt comfortable with most things related to the birth of my second child, I was frantic about solidifying a plan for Superman.  I became obsessed with all the different options for childcare for him and what each situation would look like depending on when I went into labor.  I had few actual anxiety attacks, but I recognized my frantic behavior and knew that I needed to deal with it.  Although not a perfect response to the actual anxiety issue, I found the fastest solution was actually coming up with a solid plan.  Sure enough, once things fell into place the anxiety was much better. 

Then I wrote this in the middle of last week early in the morning:
Now here I am, basically 39 weeks pregnant and at 3:40 am I am awake because I am having an anxiety attack...a big one. One so big that I can't seem to control my breathing and my relaxation strategies seem to just make things worse.  There has been so much talk about when I will go into labor that I have become anxious that it won't be soon.  I went into labor at 39 weeks with Superman and the midwife said it could be any day now.  But what if it isn't soon?  What if I am still pregnant in a week?  How will I handle that?  I am handling that idea really, really poorly right now.  I don't want to think about being pregnant another week. I don't want to think about all the people that are SURE that I will deliver this weekend. I don't want to think about the fact that I feel like I am somehow letting them down if I don't deliver this weekend.  

The problem is that not thinking about these things is what got me into this position in the first place.  I wouldn't be awake, unable to breath, unable to relax, unable to sleep if I would just deal with it.  If I just let myself mourn this possibility now, I could move forward.  But my body isn't letting me.  It is trying to protect me from feeling these emotions.   

Really, that is the heart of it all.  In my attempt to not feel certain emotions, my anxiety comes back and makes me miserable.  If I could just learn to face the emotions, I might just avoid all of this in the first place.  During my everyday life, I do a good job with this.  I face what I need to face and move forward. I think the main difference right now is how this birth is so public.  Everyone knows that I am pregnant.  Everyone knows that I am close to delivery, feeling "done' and had the midwife tell me that I am close to the end.  

I suppose that is the big downfall with sharing all these details with all of you.  But really, I know in the end that I am happier to have done so.  Sharing these details helped me connect with many of you in a new way.  I suppose that is why I was ready to share this personal struggle with all of you as well...in the hopes that it will allow for me to connect with even more of you.  To give you the opportunity to learn that you aren't alone if you deal with anxiety or depression.  

So where do I go from here?  Well last week I upped my medication level and since then my anxiety attacks are non-existent.  I am still struggling with the obsessive thinking.  Every time I go to the bathroom, sit down, or get down on the floor with S I wonder if this will be what causes my water to break (With S, my water broke when I sat down).  In an attempt to get rid of those thoughts, I began to try and think about all the people I have read about that either didn't have their water break initially or had it break when they were just sitting there going about their business or even sleeping in their bed.  Instead of that working, it just meant that almost every action is now connected to a quick thought by me about whether this is the time it will break or the time my contractions will start.  Not healthy, not healthy, not healthy.  

I have a psychiatrist's appointment early next week and I am also going to be scheduling a therapy session as well. I know that I need to deal with the issues, but I just don't feel like I can take that on as well this week.  And honestly? I am really hoping that much of it goes away when I have the baby.  I know that isn't likely and that is why I am making these appointments, but one can hope right?  

So there you go. 

Me...wide open and honest about my mental health issues. Take it, leave it, share it. Do what you want with it. I just hope that someone, who is going through the same thing, feels a little less lonely knowing that there is someone else that "gets it". 

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