End in sight for PPD?

• New mom to an 11 week old (who was 6 weeks premature). Postpartum depression still spiraling downward. I spent the last 5 weeks convinced the PPD was caused by a lack of support and put a lot of energy into setting up that support network, but it hasn't helped. How long did it take, and what did it take, before you started recovering from your postpartum depression? It feels like I've got the whole works in terms of support: a supportive lactation consultant; weekly counselling; fish oil/iron supplements/probiotics; health care providers aware of my situation. I'm taking part in a study of online CBT for PPD and should probably be able to continue online CBT after the study is done. My mom has been traveling 4 hours to my house to help almost every weekend. She takes the baby overnight when she's here so I only have to get up to nurse once in the night. During the week, my mother-in-law comes in the morning for 2 or 3 hours so I can sleep a little (the kid only sleeps in 2-3 hour stretches at night or often not even that much). There isn't really any additional support (like babysitters) in my small community and I'm maxing out the mom support as it is. We're in the middle of harvest on our farm, so my husband is working all the time, and as we get into later September and October, it will only get busier. After harvest, he'll be able to be a lot more supportive and involved, but who knows when harvest will be over. Zoloft is an option, although the psychiatrist I saw last week thinks I should manage without if I want to continue breastfeeding. The bigger problem is that it too will take several weeks to kick in. I am so, so done, and there's still another month and a half minimum before harvest is over. I'm weepy and low and regret having this kid so much. Other than meds, I am doing everything everyone recommends doing for PPD and it just doesn't get better. It is so discouraging to put so much energy into all of this -- going to appointments, going for walks, doing relaxation exercises, doing online therapy -- and I just keep feeling worse. Looking for advice on anything else to try, and your experience on how long it took before you started feeling better.

• Answer:

  I'm so sorry. Up front let me say that I feel like I really understand where you are. And it did get better for me. I too had a premature kid, and I am convinced it's a huge factor in post-baby despair, if for no other reason (such as trauma, health issues, etc.) than that it takes the kid so much longer to go from newborn blob to "baby who makes eye contact and sleeps". "Support" made kind of a minimal amount of difference to me. Sleep and getting outside made bigger differences. So support and/or talking to people about my feelings only made a difference insofar as that allowed me to sleep longer stretches or be outside in the light. Anyway. I imagine you are super tired and don't want to wade through huge blocks of text, so here are my lessons learned in list form: *Amount of prematurity+extra three months of the "fourth trimester"=kid turns into a person who looks at you and smiles and sleeps. YOU CAN DO IT. Mark it on your calendar. Things will not always be this lousy and unrewarding. *Co-sleeping was super crucial for us. Not for philosophical reasons, but because it allowed me to get the maximum amount of sleep. Eventually we learned to nurse lying down (on our sides) and it was like magic, because then I barely had to wake up to nurse. But even before that, just not having to wake up enough to get out of bed and go somewhere else to nurse let me fall back asleep more easily. It also let my kid stay asleep for much longer stretches, as did: *Swaddling for nighttime sleep. Much longer stretches of sleep. May or may not be especially true for preemies. (Dr. Karp has those "Happiest Baby on the Block" books, or DVDs, and they are helpful. But basically the info is mostly "Swaddle the hell out of that kid!") *Wearing my kid constantly when I wasn't in bed with him. I used a stretchy cloth wrap like a Moby, because I could keep the wrap on and pop the kid in and out. I think (and again, I don't think this is a philosophical issue, just a practical one) it let him, as a really grouchy preemie, regulate his systems more. He was calmer when worn. I would do absolutely anything to make your baby calmer. A calmer baby is less despair-inducing to mother. *Getting outside really, really helped me. Going for a walk when it was light out. Mood-regulating like nothing else. *I felt totally crazy and isolated. I didn't even need to TALK to other women who understood (although that was ideal). Going to a bookstore that had a coffee place for 40 minutes was enough. Just to be around humans and hear people talking to each other. *In retrospect I sometimes feel like talking about the despair was counterproductive, because so much of it was caused by the sleep deprivation and the general life upheaval. So talking about it often made me feel worse, because those things were just facts of my life for a while. Whereas in retrospect I realize that what improved my mood was: sleep, outside time, going to a mall to walk around and see other humans, and the moments when I understood that this was situational and temporary and things would improve without me really doing anything in particular. *In retrospect, I wish I had drastically lowered my standards and goals for EVERYTHING but keeping my kid alive. I wish I had understood that it was okay for us to eat frozen lasagne every night. I wish I had understood that my ONLY JOB was to keep this kid alive and keep myself alive. When I was having the hardest time, just those two things were legit acts of heroism and enough. *Same point, really: I wish I had understood that if I just thought to myself "Today, I am going to take a walk outside with my kid. And then the rest of the day literally my only goal is to sit in the rocking chair and nurse my baby and hold him while he sleeps and read trashy novels and watch reality TV and eat sandwiches. My spouse is totally on his own." that was more than enough to try to do when you have a grouchy preemie and you are battling despair. More than enough. I wish I had understood that I just needed to slow way, way, waaaaaaaaaay down. (I don't know if this will apply to you - my personality may be weird and especially sensitive.) *Things do get better. They got better just with time, for me. In retrospect, I wish I had somehow magically been able to grok that because my despair was situational - no sleep! the what have I done monster! - it would also improve really significantly as time passed. I wish I had really understood, and let myself feel, how problematic sleep deprivation is for me. Maybe other people are just more tough or something. But I honestly felt like so much of the despair I felt was purely because of the sleep thing, which was ultimately a self-limiting problem. I hope you feel better. I felt the way you feel, and I do feel better now. I think things got better when my kid was about two-and-half months old, which is when we worked out nursing lying down, and he began to sleep in longer stretches at night. (I mention this not because I think you should try this method, but because I have heard from others that this was the moment when things started to improve slightly.)