Avoiding postpartum mental illness?

You already know that depression lies to you. Postpartum depression is no different, but you'll be on the lookout for the lies, so that's a good thing. The most interesting thing I saw about postpartum depression (besides the Times articles) is that it may not be post-pregnancy hormones per se, but a "normal" reaction to extremely difficult circumstances. That explains a lot about why moms and dads tend to get depressed in pairs. There is tremendous variability in newborns, so while everyone experiences some sleepless nights, those with more challenging babies are getting 4 hours or less for months. I (a dad) started straight-up hallucinating from sleep deprivation. If you get to that point, I think it's safe to say you need to change things. Beg friends and family to watch the baby so you can nap, hire a night nurse, switch to formula if it would let you sleep, etc. It's better to get the help you need than risk endangering yourself or your baby because you're "supposed" to be able to handle an infant on your own. I knew someone who, in advance of the birth, hired a staff member from a local day care that was closed for the summer.

I wrote a damn book and am editing it down for you and it's still a book, sorry. Friends/spouse can do your cooking/cleaning/laundry as much as possible in the first 6 weeks. This is the time to be an absolute princess and just rest/eat well (as in chicken soup, quinoa, oatmeal, cookies, vegetables), build your milk supply if you're breastfeeding, and let your body heal. They say for every time your sleep is disrupted you need an extra hour, so even if you are being woken up "only" once or twice a night give yourself some slack about how you're going to feel the next day. Think of the first year as a marathon, and you need to build up stamina. Keep lots of easy, fresh foods (fruits, granola bars, oatmeal cookies) on hand. For exercise wait until your bleeding has slowed down and go out for walks and build up to longer ones. Carry baby in your arms or use a carrier or a stroller, just get some fresh air. Life can get very small if you are alone inside and your baby can seem larger than life, their cries sound larger too. Going outside would put my baby's absolute tininess and tiny cries in perspective in those early days. Spouse can learn all the non-boob/bottle-based soothing techniques. The earlier your spouse is alone with baby the better. Not for hours, just long enough that he learns how baby likes to be held, talked to and so on. Let your partner do the diapers wrong, dress him/her wrong, etc. He will learn and you'll all be better for it. Zen Mama is a great book, I really like it for new parents and still like to reread it. Don't see your job as keeping baby happy at all times. Babies have so many growing pains/transitions, they will cry sometimes. It is not your fault. I took it so personally when my baby would cry. People also like to blame sleep "issues" with babies on mother's milk, routine, what baby is wearing, etc. Some babies wake up a lot, some don't, it's not you. If you feel overwhelmed put baby down somewhere safe (on the floor on a blanket is safe momentarily if baby isn't crawling yet, crib is safe, stroller buckled in is safe) and try to take a moment to breath, walk around, scream, etc. AskMoxie has a PPD prevention plan you may not have seen: http://askmoxie.org/blog/2006/02/preventing_ppd_-5.html. I have a family history of depression and anxiety too, and had full blown panic attacks a couple of years before having my son and went off of an SSRI before getting pregnant. I had no PPD issues. Only once did I resent (like I was experiencing anger) my baby for waking me up and it was when I stayed up online too later and got woken out of a very deep sleep. I woke my partner up and stayed up in a different room until I felt ok being close to the baby again, I really think I was just deeply asleep and responded with the reptile part of my brain. Try to practice good sleep hygiene (going to bed at the same time every night mainly, and no bedtime screens). Do something nice for yourself every day. For me it was a long hot shower before bed. If needed my spouse would take baby out of the house so I wouldn't think I could hear him crying (because of the white noise and my hypersensitivity to his sounds). Rough points for me where I wasn't sleeping and feeling insecure tended to be cyclical and to predictably pass as baby got easier again or I caught up on sleep. I think if it starts to be the norm day in and day out is when you tell people and try to do something about it. I know breastfeeding can stress mothers out, but I also think the hormones can make things easier too once it's established, and weaning is definitely a tough time, for me it was worse than the early days in terms of how emotional I was, and some people tend to treat it as something to celebrate but it doesn't feel that way necessarily at first. I found nursing at first hard because it's simply so many hours of the day at first, it gets harder, and then much easier for most but it is a huge shock. There is a weird syndrome though where some women will feel super horrible after their milk lets down (most women feel very good at that point). So if you feel terrible when you nurse emotionally look into that, and consider stopping breastfeeding, my friend had it and felt so alone when it happened, weaning helped. Also the first night with a baby where you are on your own is sort of scary, and feeling like you've been handed a wrinkled little alien you're afraid of dropping does not mean you won't love your baby and think they're absolutely precious very very soon, but I got weirded out by people calling me "mom" while I was still pregnant and talking about how incredible I must feel right after the birth. Feeling protective of your baby, loving your baby, and feeling bonded with your baby all take time so don't overthink your early reactions. I found talking to baby from day 1 helped me overcome that initial trepidation and weirdness. People who say everything is "natural" are not being helpful, you may feel instantly bonded and in love and content and you may not, it doesn't bode well or poorly either way. Same if nursing is hard or easy, or your birth is hard or easy. Oh and it's normal to imagine something horrible happening to your baby. It doesn't mean you have PPD or OCD to have flashes of picturing something bad happening, like baby falling, it just means you are tuned in to your baby and want to protect them. I was always picturing my baby falling and hitting his head, it never happened, I obviously didn't want it to happen or enjoy the thought, but it was there somewhat regularly. It's like imagining your partner is in a car accident and being upset at the thought, it's just a thing.

I see you're already aware that you need to get enough sleep. As the mother of a 7 month old who is an absolutely terrible sleeper, I want to warn you that it may not be obvious HOW to get more sleep. Even if you have help. You may need to be more aggressive about figuring out a way to sleep than you ever thought possible. My husband is a devoted father who is willing to take on his share of the work in all things. Even so, I am unbelievably sleep deprived. -We live in a small apartment, so I can't go somewhere else and sleep while others take care of the baby. Even through earplugs and 2 closed doors and a pillow over my head, I *will* hear it if our baby cries, and I CANNOT sleep through those cries. I am a good sleeper; I've never had any trouble sleeping in my life. There is just no way I can stop listening for that sound. -I'm breastfeeding my baby, so if somebody else takes night feedings, I *must* pump milk to replace what was given at night. This means either pumping first thing in the morning (which means either getting up extra early or having a flexible day) or pumping at night. And it means having a cooler in the room with us with the pumped milk so we don't have to fumble for it at night. AND it means accepting that bottlefeeding doesn't put the baby back to sleep as effectively as breastfeeding, so there may be more crying. -At times, our baby WILL. NOT. SETTLE. unless he's been nursed in our bed so he doesn't have to be transferred. This means that both adults have to be present, or we need a bedrail and a person who can safely cosleep wit him. This means I MUST be present; my husband is not a safe cosleeper for various reasons. When I am on duty, I wake every 90 minutes with the baby. -I'm a full time PhD student; "napping when the baby naps" is not a thing I can do without totally screwing up my work and experiments. It requires extra work and planning to take a break. You know? It's not easy. I can't just take a nap - I take a nap and then have to make up all the chores I skipped because I can only do chores when I'm not at work. -If I nap in the late afternoon after work, I have trouble falling asleep early at night, which is the only way to cobble together enough sleep before morning. Many of these may not apply to you, but I just want you to see an example of how complex it can be to figure out a way to get more sleep. The more help, the better. If you have an isolated quiet spot to retreat to, fabulous. If you have a place you can go for a night to get respite, AWESOME. Consider giving your baby a bottle of expressed milk once a day starting around 4 weeks (after breastfeeding is established) if you want to be able to use a bottle in a pinch (if you plan to breastfeed, of course). Severe sleep deprivation has been an eye-opening experience in to JUST HOW FREAKING BAD you can feel, and how ghoulishly your entire world and mind and heart can be rearranged into misery, if you haven't slept. It makes you feel awful, but IT GOES AWAY QUICKLY ONCE YOU GET EVEN A FEW MORE HOURS OF SLEEP. If you find yourself in the trenches, know that. Sleep is a very, very effective cure for the misery of sleep deprivation, obviously, although it's surprisingly easy to forget that. When our son was born we had tightly budgeted everything except food. We basically allowed our grocery budget to balloon out of control. I eat a ton because I'm feeding the baby; we buy pre-cut veggies and fancy drinks and other things we didn't previously allow ourselves. Organic everything. I won't mention here what the monthly budget for food has become, but it's HUGE. We have cut back on everything else. This has gone a long, long way toward keeping us sane. If you are financially able, I suggest it.

You should gather information now about the different PPD resources in your area. Gathering them when you are not doing well will just add to your and your husband's stress. If you live near a university that has a psychology department, they might have a PPD support group. The person that ran the meetings where I am was able to refer me to a therapist. Just being able to think it's ok that my house is not as clean as I'd like was a big change for me. Being okay with not bathing daily. Grocery delivery was a huge help. Don't feel guilty asking visitors to leave or take care of the baby while you take a nap or take a shower. When my daughter was 9 months old, I hired a part time nanny that takes her for 4 hours a day Monday through Friday. For me, the red flag didn't come until about 6 months after when I was feeling both homicidal and suicidal. I called my OB and he told me to go to the emergency psychiatric ward at the hospital. If it gets that bad, it wasn't that scary. There were also a lot of changes, which I see now were for the better, during my baby's first year - I decided after a month of working that I wanted to stay at home and my husband and I decided to move to another state. They were stressful and triggered my depression. If you don't have to make big changes, put them off. Sorry I'm rambling. I've just never had to put these thoughts into a coherent message before. Good luck. You can PM me if you want to know more.

http://www.webmd.com/baby/news/20110412/omega-3s-may-cut-risk-of-postpartum-depression I remember listening to some science interview on NPR once and IIRC the theory is that while you're pregnant, almost all the Omega 3 you consume goes to the baby's brain development and thus you're deficient by the time you give birth. One of the great things about using Omega 3 supplements to treat depression is there are almost no side effects (other than fishy burps) and it's safe to breastfeed while taking them. http://www.omegabrite.com/ sells really high quality Omega 3 supplements.

This is pretty out-there, and something I haven't done myself, but some people believe consuming your placenta helps ward of PPD (and increase milk supply, I think). It's not that uncommon where I live, and most people who do it here hire a doula to dehydrate the placenta, grind it up and put the powder in capsules.

A belated thanks to all of you for your stories and advice! (I got some wonderfully kind and helpful memails, too.) I haven't marked any best answers yet, but I'll be rereading this thread and applying several of the suggestions. I'm planning to check with my old therapist to see if she'll see me for a few sessions, in case I need it. Overall, I think I'll be okay!

Oh and it's normal to imagine something horrible happening to your baby. It doesn't mean you have PPD or OCD to have flashes of picturing something bad happening, like baby falling, it just means you are tuned in to your baby and want to protect them. I was always picturing my baby falling and hitting his head, it never happened, I obviously didn't want it to happen or enjoy the thought, but it was there somewhat regularly. It's like imagining your partner is in a car accident and being upset at the thought, it's just a thing. There is a special permutation of "bad thought" OCD that is most common for parents, though, involving just these kind of intrusive thoughts. You might not have this happen, but since you already know you have OCD, be aware it could. At what point, time-wise or mood-wise, should I think "okay, this is getting serious"? In this particular case: if you start having scary thoughts about things happening to your child and they feel like obsessions, or you think that things you do might cause your child harm or suspect yourself of child abuse, and especially if you start developing rituals or avoidance around the way you treat your child--recognize that this is just anxiety, just thoughts, apply CBT and exposure to them, and don't wait to tell your doctor/therapist/etc about it. I think you are going to be a great parent, BTW. Congratulations.

1) prior it is your sleep over all else, really 2) ensure your husband is aware of what to look out for and prioritising your health in addition to baby. 3) avoid reading too many baby books, especially about getting baby to sleep, they will do your head in. 4) be prepared to let things go, do crappy jobs on stuff, spend money you normally wouldn't, etc. This is all only temporary. 5) never ever feel guilty for putting your needs over the baby's. Society is very down on this but healthy happy mother equals healthy happy baby. If the kid is fed, and dry, you're doing great - the rest is gravy. It's okay for them to cry a little bit, for you to take a longer shower etc. Never feel guilty. Best of luck, it's hard work but also rewarding and fun.