Monday, February 20, 2012

All Roads Lead To Agoraphobia

The state of mental health care in this country is truly appalling.  It embarrasses me to admit that I'm a healthcare provider.  Honestly.  

I've had really wacky hormones throughout this entire pregnancy.  I felt like I was headed towards severe post partum depression stuff.  I discussed it with both my OB and my primary care provider prior to delivery.  At that time, they both offered options, but recommended riding things out because I've never had any problems with PPD in the past.   Pretty quickly after delivery, things went awry.  Anxiety that I could normally recognize for itself was unmanageable.  I cried at the drop of a hat.  I didn't truly feel depressed .... but I was angry and pissed off and anxious.  Ohmygod anxious.  I loved the baby.  I loved my family.  But I would have thoughts of leaving.  Like.   Abandoning this family I worked so hard for.  The intellectual side of me recognized what was going on.  I went in and talked to my OB about it when Baby K was 3 weeks old.  I told her that I was struggling making even small decisions - like what we would have for dinner - because I was terrified that somehow whatever decision I made would end in misfortune for someone that I loved.  If we needed bread and I asked Monk to go buy it - he would surely die in a car accident on the way there.   If we were driving to a doctor's appointment and I chose to take both kids instead of one - we'd get into an accident and the unnecessary child would be hurt because I made the call to bring them.  It didn't end really.  It was a horrible version of magical thinking that kept spinning out of control.  Even hearing all of that ?  The OB told me that she would write whatever prescription I wanted, or that she would be comfortable with me waiting to ride out the hormones a bit longer if I wanted to.  Umm.  I think I just told you that I was incapable of making decisions, right?  So ....anyway.  I ended up waiting another five weeks before I virtually demanded medicine.   And things got ugly during that five weeks. 

We went to a mall when Baby K was just about 4 weeks old.  A2 was going insane with all the trapped in the house action and needed to get out.  He played in a play area.  About two days later, he came down with a wretched no good very bad virus which included 105 fevers, throwing up, diarrhea, and the worst bronchitis I've seen in a little one in quite some time.  It quickly spread to the rest of the family - including baby K - who ended up with RSV bronchiolitis, an ER visit, nebulizers, and projectile vomiting.  Both Monk and I got it a couple of days later and the Golden child fell victim several days after that.  It was awful.  And it happened in the middle of my anxiety - and after I made the decision to take a newborn to a mall.  Good God.   I distinctly remember telling Monk on several occasions - through racking sobs- that I was not okay and that I needed help.  He either didn't get it or didn't believe me.  But either way - my downward spiral continued for several weeks after that.  I had two follow up visits with doctors and told them about how I was struggling and never so much got even a recommendation for counseling - much less a prescription.  They kept doing whatever they could to talk me out of it.  I've never needed it before.  It would pass.   Let the hormones ride themselves out.  

I started on a low dose of zoloft - and literally within five days felt like myself again.  And almost immediately noticed a dramatic drop off in my milk supply.  I didn't see a lot about that in the literature but found some anecdotal reports on message boards from mom's wondering if there was a connection.  I reluctantly stopped the medicine to see if my supply would rebound.  It did.  I tried the medicine again - milk supply dropped off.  Went off again and it came back.   I've been off the zoloft now for several days, and while I'm not having issues with anxiety, I'm incredibly irritable.  Almost exclusively with Monk - the poor thing.  I really don't know what to do at this point.  Try Lexapro?  Try something else?  Give up on nursing and take the zoloft?  Hope that the anxiety is gone for good and I don't need it after a mere couple of weeks of inconsistent medication??  

What I want is for someone (my prescribing physician, ideally) to just tell me what to do.  I want someone to ignore that I write prescriptions and just write what they think I need. 



Amanda said...

I'm sorry that you are going though this. I've always had a lot of anxiety, but it definitely got worse for me after having a baby. These are hard problems to deal with, but you can get through it. Maybe it would help to get some therapy appointments and maybe a psychiatric appointment too. When it comes to these types of medications I think the the dosing should be done by a psych you trust who understands the medications thoroughly. Kids are hard and having 2 little ones is even harder. This might not just be hormones and assuming it will go away after a little medication might keep you from getting better for longer than if you get some quality help now.

I'm on 100mg zoloft daily (which is still considered a low dose) and it helps immensely (I don't notice a supply drop myself but everyone is different). Going on and off constantly is probably not the answer and could cause more problems in itself (I get dizzy when I miss a dose).

Breastfeeding has always been very important to me, so I'd hate to give it up due to the meds, but I think in the long run, having problems that you can't manage well is more dangerous than what you would give up if you had to quit breastfeeding. You can try glactogogues to boost your supply. I had good luck with fenugreek and domperidone (I got mine through, it takes a couple of weeks). And if it's just a drop it might mean that you have to supplement occasionally, but you can probably maintain a breastfeeding relationship. Supplementation is a slippery slope, but fitting into your feeding schedule during the time of day that works best for you might help to take some pressure off... trust me, I know how strong the pressure to nourish your child can be.

Take action and setup some appointments. Remember that the health of your child is about more than just what you feed him with.

I personally think taking other vitamin/mineral supplements has helped me a little too. I take extra vitamin D, b complex, choline, inositol, omega 3s. When I skip the extras I find it harder to enjoy my life as much as I should.

Searching for Serenity said...

I know now, after months of therapy that I dealt with pretty extremem PPA after Nugget was born. I wish I'd gotten help sooner.

I applaud you for taking control so soon. I think the biggest issue with mental health care in this country is that (just like infertility) it's a taboo subject that no one dares to discuss. I knwo better now.

I can't offer any advice on what you should do next, but I'll hope that you get some solid guidance soon.

Take care.

p.s. I haven't been able to add you to my reading list because blogger didn't retain your email. Email me at seeksserenity (at) gmail (dot) com and I'll get you added.

April said...

omg. wtf? why didn't you tell me? (although i probably would have freaked out and had an anxiety attack myself).

you have to have a heart to heart with yourself. what's the most ideal? of course you want to feel normal AND breastfeed. but, if that's not possible--what's more important? breastfeeding and feeling like a zombie/angry/anxious person? or not breastfeeding and feeling like a loving person who can make decisions?

forget it. i'm texting.

Jay said...

Have you ever had a vitamin D blood test? Most women get more vitamin D deficient during pregnancy, and deficiency is a predisposing factor to post-partum depression.

Making sure both you and your baby are vitamin D replete is a good idea anyway, more on my blog, or just google 'vitamin D deficiency and pregnancy'.

Best of luck!