Q&A: helping a partner with PPD

Jim writes:

"I have a question for you -- my wife and I have a 3 month old son, and I think she's going through a bout of depression right now.  Looking back, I guess all of the ingredients were there for it  -- we live far away from family and friends, and she's been at home with our son for the last 3 months.  We had a lot of family come and visit at first, but since the beginning of September we've been alone.  It doesn't help that her dad tells her things like "you know, I think that whole PPD thing is baloney - if anyone would have had it, it would have been your mother and she was fine."

My question is what can I do about it as her husband and as a father? No matter what I do (try and take the baby, let her get extra sleep, etc.) it doesn't seem to help - I realize this is a medical issue, and it's not her fault. If it's a hormonal imbalance, obviously more sleep and help aren't going to fix things.  I've tried to get her to consider seeing the doctor, but she flat out refuses.  She's been saying things like "I wish I was dead" and "I just want to go away."  Obviously this scares me, more than a little ...

When I got to work this morning I called her doctor and left a message to talk to a nurse.  I worry though that I'm going around her back and she'll be hurt.  But right now I don't think I have an option.

So, long story short, what can a partner do for someone suffering PPD?"

Oh, you poor family. This must be so scary.

It does sound like she has post-partum depression. Many non-depressed moms think or say things like "I just want to go away," but we mean on a long weekend by ourselves to the Canyon Ranch, not to really disappear. And wanting to be dead is a sure sign of depression.

I agree that you don't have an option, even if it makes you feel bad to be going behind her back to try to get her help. If she had another illness, like diabetes, you wouldn't think twice about calling her doctor and getting her meds if you saw she was crashing. You'd know she wasn't able to get help for herself. This is no different. Her denials that she needs or wants help are part of the disease.

(Having been there with regular depression, I can attest that even when you know something could make you feel normal again, it still feels like shameful weakness to admit that you need help. If you were a worthy person you'd be able to get a grip and pull yourself up out of it. Except that you can't, since it's not anything you caused or had control over. But still you think you should be able to fix yourself.)

And better she be hurt right now that you sought treatment than she spend weeks or months in pain, or do something to hurt herself or the baby. Let her really give you hell for going behind her back once she's feeling normal again. Except that once she's feeling normal again she'll be grateful you loved her enough to look for something to pull her out of the pit.

I'm deliberately not talking about what could happen to your son if your wife stays depressed or gets worse. You're probably scared shitless about it already, so there's no need to belabor it. Your wife and son are a unit, and as she goes, so he goes. So to protect him you have to protect her.

It might take a few phone calls to get someone to help her. Not everyone takes PPD seriously. I hope that the nurse called you back right away and you somehow convinced your wife to go to the doctor, who prescribed an anti-depressant for her immediately. But if that didn't happen, don't give up. If the nurse doesn't take it seriously, ask to talk to the doctor. If they don't take it seriously, call the maternity department of the hospital she gave birth in and ask for a recommendation of a doctor who treats PPD. If they can't help, call a local midwife and ask for a rec. If they can't help, call a local lactation consultant (even if your wife isn't nursing they'll still help you find help for PPD).

There are several antidepressants that are safe for nursing moms and babies, if your wife is nursing. The preferred heirarchy according to researcher Thomas Hale, PhD (the medication-and-breastmilk researcher) via Kellymom.com is:

1. Zoloft
2. Paxil
3. Celexa
4. Effexor
5. Prozac

It can take up two weeks for the anti-depressants to start working. (If nothing changes in a few days, don't switch from one to another hoping for a quick resolution. That can just prolong the depression. If things get worse, though, call the doctor who prescribed them ASAP.) While you're still making calls or waiting for the meds to take effect, you can do some other things to help your wife:

• Don't let her be alone too much. If you can arrange for friends to come spend time with her and the baby during the day that would make things a lot better for all of you. If you don't have a local support system, see if you can hire a post-partum doula for a few hours a week at least. Even a local teenager who could come over after school and play with the baby would be a help.
  
• Encourage her to go outside and get some sunshine. 30 minutes a day would be great.
• While she's outside, why not take a walk with her for 20 or 30 minutes? The exercise will help her immensely.
• Make sure she's still taking her prenatal vitamins. Try to get her to take an Omega 3 supplement (I'm still not sure what's at the bottom of this flax seed oil thing yet, despite lots of helpful analysis from kind readers on studies that all seem to contradict themselves and each other), too, as we know Omega 3s help stabilize mood.
• Sleep deprivation greatly influences hormones, so you're totally on track with helping her get some extra sleep. If she has trouble falling asleep the Omega 3 supplements will help, as will a calcium and magnesium supplement right before bed.
• Protect her from ignorant and negative influences telling her it's all in her head, like her clueless father. I'd like to write more about him, but I can't think of anything to say about him that isn't profane, violent, or both.
• Encourage her to make local mom friends. Having a support system of other women going through the same things is invaluable.
• Check out kellymom.com. She has a bunch of great resources about PPD, including a quiz on how to tell if you have PPD.

I just want to say thank you for taking this so seriously and for being willing to do the heavy lifting your wife is going to need for the next few months to get out from under this disease. You're saving her, and you're saving your son, and you're saving your family. Please let me know how it's going.

Comments

[Gretchen]

Thanks for the great response to this question. I'd like to suggest a few other strategies that might help this family out.

One other resource you can check with for help with PPD is the child's pediatrician. After a day of crying on the phone to various healthcare providers, I finally called my pediatrician's office to see if they could recommend someone who could see me right away. They had me come by the office with the baby, and one of the nurses sat with us until one of the other nurses could track down someone to help me out. More than anyone else, I think the pediatricians realize how damaging PPD can be for the kid, and they're more than happy to help prevent the damage (instead of mopping up later when the worst happens).

Another thing that helped me was to be out in public as much as possible, because if I was in Wal-Mart or the coffeeshop I knew I couldn't do anything to the kid or myself. We spent LOTS of time at Wal-Mart buying things we didn't really need, then returning them a few days later, then buying diapers, then ... well, you get the picture.

Also, if there are any child-related groups the woman could join, she'd find out that PPD isn't as rare as the literature seems to indicate. I recommend people find out what programs local libraries have for infants. Ours has a babytime meeting once a week for under-twos, and all of my mommy friends come from there. It gets the mom out of the house, gets the kid used to being around other kids, and you get to meet other moms. Even if the baby doesn't get much out of it, the mother can get a lot of help that way.

Finally, you can always look into having someone come by to help out once or twice a week. Even if you have to hire a high school or college kid to come over one afternoon a week, giving the wife some time to herself will do wonders. There are days when you can't remember the last time you actually took a long shower, read a book, or sat down on the couch without a feeding infant in your lap. Having someone come by to give the wife an hour or two of rest during the day could make a lot of difference.

[SheilaC]

Here's an interesting PPD resource I found yesterday - I think it was via author Ann Douglas' blog, the Mother of All Parenting Blogs.
This link is for Perinatal depression resources. "When you are feeling blue, here are some simple things you can do."
www.perinatalweb.org/content/view/59/157/#5 Click on the "Simple Things you can do" tear-off sheet and it will take you to the pdf file. Unfortunately it can't be printed but it's a good read.
The first 2 pages are in English, the second two in Spanish.
Moxie has covered the main points, and this gives more detailed suggestions.

From my own experience, cognitive-behavioural therapy can also be very helpful. Best wishes,

[Gillian]

Speaking from personal experience, it can definitely help to get out of the house, but actually getting out of the house is one of the hardest things to do. Even when my daughter was young and the diaper bag was all packed and ready, I just couldn't make it out the door a lot of days. The smallest of things would deter me: oh, it's too cold; oh, I'll get sweaty carrying her; it's so boring walking around this neighbourhood; I don't like walking where there are so many cars; etc., etc., etc. If your wife has any friends who are free during the day, mobilize them to provide coverage. It would be great if they helped organize outings and meetings at other people's houses, so that your wife has a reason to get out. Even better if they swing by your house first to help your wife and son make out the door.

I didn't start to feel better until I found a great playgroup that hung out together a few days a week last winter. No matter how much it helped to talk to my husband about my problems, nothing was as reassuring as learning that other mothers had felt exactly the same way.

Another piece of advice: make sure your wife is eating regular, healthy meals. I find it's very hard for me to eat well when I'm feeling down, and unfortunately the drop in blood sugar just reinforces my bad mood. So, work on healthy dinners, but also make up some lunches and snacks for her to eat during the day. If they're all packaged and ready in the fridge, then she's far more likely to eat them. You can definitely enlist the help of friends and family for this job, whether to actually make some meals or to contribute for delivery of pre-cooked meals.

And last point: just wanted to echo what Moxie said about finding a doctor who will take you seriously. When I finally called my family practitioner's office and said I wanted to talk to someone about PPD, the receptionist assured me that she would clear some time for me to come in that afternoon if I wanted. That's the kind of reaction you want from your health-care provider.

Good luck to all of you. It's tough to be the person who's depressed, but I know it's also tough for the partner, so take care of yourself too.

[Menita]

I am just in awe of this husband, seeking help for his wife that way. Good for you, Jim, and I hope she gets the help she needs and recovers soon.

[Allison]

I second Menita's awe toward this husband. This mama is one lucky woman!

While I didn't experience classic PPD, I have been through severe depression before, and went back onto Effexor after a 2-1/2 year break (pregnancy, nursing, a few months beyond that) this summer. My experience with Effexor has been largely positive, and I'm delighted to read that it's approved for nursing moms, even if it IS 4th on the list.

For the dad -- if it seems that your wife's depression involves anxiety at all (always a hefty component of depression for me), I highly recommend Effexor; it affects dopamine levels as well as seratonin, and works well for anxiety...for me, it put me back in my own head, for lack of a better way to put it.

Good luck to you! Moxie -- thanks for addressing this one.

[anon]

Hi, I'm the wife in question. I'm feeling a lot better the last few days (wednesday and thursday were pretty much rock-bottom) but I still have an appointment with my OB tomorrow (and they responded immediately at the office. My doctor is awesome). I talked to my dad thursday night and he, without any prompting, suggested I go see a doctor so I am not sure where his previous comment, mentioned above, came from. My mom has been dead for 8 1/2 years so I don't have the opportunity to ask her how she did.

As for having friends/family come by, we're pretty isolated here. we have lots of acquaintainces but no one I'd leave the baby with. I did get to go to Target for an hour and a half on Saturday and that did help. It's hard to get away for any length of time with the nursing.

I'll send an update after I see the doctor tomorrow. Thanks for all the good thoughts!

[Anon]

I am really surprised and disappointed at your answer here, Moxie. What about a psychologist for therapy? Why does it automatically HAVE to be an anti-depressant that will cure her PPD?

Yes, it's worrisome that she has PPD and something should be done. But I totally disagree with the notion that her husband should get a prescription for her, or that ADs are the ONLY answer to PPD.

[Moxie]

Anon (the second Anon, not the "wife in question"), I don't know if you've read my posts on preventing PPD, but if you have you'll know that I am aware of many ways to prevent and treat PPD. I'm really not sure how you got the idea that I'm saying antidepressants are the only treatment for PPD from this post (especially since I listed a bunch of other things to do).

The reader said his wife was saying she didn't want to live. That's serious. It's an indication that her brain chemistry is seriously off, and the most direct way to pull her out of the hole is to use antidepressants. Once she's stable enough she should look into other forms of treatment (possibly including therapy), but expressing the wish not to be alive is not something that therapy is going to address quickly.

I wouldn't send someone with a fractured leg to go to a physical therapist--I'd send them to the ER. Once the healing is underway physical therapy will help, but it shouldn't be the first step for someone with a serious medical problem.

I don't think antidepressants are the answer for everyone suffering from PPD. But I also have to say that I don't think therapy is helpful for everyone suffering from PPD. For some women there are a lot of emotional issues contributing to the depression, but for others it's just body chemistry and therapy (except for behavioral therapy, maybe) isn't going to address that. Once they get the body chemistry back on track everything's fine again.

We're all different. I was addressing a particular question from one reader, and I wouldn't give the same answer to everyone. But I will say that anyone who expresses a wish not to be around needs serious, immediate help.

[Shandra]

anon-wife - good for you and your husband. You both are doing really great to address this for your child and yourselves.

I think the suggestions are really good.

For me, any kind of exercise - walking around, yoga to dvds, etc. - helps with depression and anxiety, although let me tell you with a wee babe and post-partum I wasn't very good at it. But I did load the babe up in the carrier/stroller and walk around and around the block and that was a boon, esp. when there was sunlight. I also loaded up iTunes with a killer playlist and danced.

I know these are not easy things to do the way you feel and no stress if you don't want to/can't do 'em. I'm just tossing them out there. It sucks to be depressed.

I also personally found that I really needed to eat a lot while nursing, and if I went below a certain number of calories (enough to start losing weight fast) it made me irritable and nasty, often to myself. A Luna bar (or equivalent: something reasonably high quality, reasonably tasty, and above all easy to grab and eat one handed) at regular intervals helped. That is not the same as PPD, but my theory in posting this is anything else that might be going on that you can eliminate might help.

If you can get over the whole nurse in public thing it might help in getting out, but then again it might just feel stressful.

Hang in there!

[anon in RI]

I haven't had time to scroll through the other comments yet -- they'll have to wait until I get home from work. But I wanted to post this as soon as possible so you could call today.

The Warm Line at Women and Infants' Hospital is a free hotline for any (and I do mean any) question you may have about the baby or your wife (they can help with anything in those first few months). It's free to call anywhere in the US. Please call them to see what resources might be available to you and your family. 800-711-7011.

Good luck to you and your family.

[Kate]

I had a serious bout with anxiety/ppd when my son was 8 weeks old. He didn't nap unless he was being walked in a sling (stop walking, he'd wake up in less than a minute!). I tried to get help in the form of a postpartum doula, and I talked with SIX doulas in a row who gave me advice about how to get the baby to nap lying down, rather than helping ME. It was terrible...we'd already spent weeks trying to solve the napping problem, and not being idiots, we'd tried 90% of what was suggested to me already, and I was pretty sure by then that warming his bed or playing some music was not going to help.

Finally I spoke with a lactation consultant who just said sometimes babies are really really hard, and all you can do is take care of yourself the best that you can. She helped me to realize that I needed to be keeping track of my water intake and eating a LOT of food (between the nursing and the walking), and she helped me to find some really reliable high school girls to help me out. She thought they would be more helpful since they would just do what I needed done, rather than give advice, and she was totally right.

I guess the moral of the story is to keep on seeking help even if the first (or sixth) place you look isn't helpful. I hope you find help sooner rather than later!

[Num Num]

Just saying, I agree totally with Moxie. And so glad that husband and wife in question are together on this. It's very important to the health of the family.

[Joanne]

Great advice, Moxie. As usual, so thoughtful and insightful.
Although I didn't suffer PPD per se, my hormones went so nutty that at one point I ended up sitting in my closet sobbing because I hated how everyone kept coming over to see our daughter. I was thoroughly annoyed that everyone flooded the house the first few days home from the hospital (And in my defence no one brought meals, and expected me to wait on them - after a C-sect)
In a nutshell, I can still relate to this mother-wife. I wish you well.

[anon]

I'm back from the doctor. We chatted for a bit and decided that I do not need to be on medication at this point. She thinks I am chronically sleep-deprived and gave me some ideas to help me sleep better. I am to call her next week with an update to tell her how I am doing. She said she was in this place with her kids and she understands what I'm going through. I love my doctor -- she's really really good.

Thanks again to all of you for the good advice and tips. I appreciate all your good thoughts and suggestions.

[Phc]

Moxie- Can you address what post-partum depression can look like? I do not feel depressed at all, but am sleep-deprived, an anxious mess, and have horrific insomnia. Is that PPD? Or is it just having a baby?

[8 easter egg season simpsons]

I've pretty much been doing nothing worth mentioning. I haven't gotten anything done today. I haven't been up to much , but oh well. I've just been staying at home waiting for something to happen, but so it goes. Pfft.

[Sandra]

I haven't gotten much done , but it's not important. Not much on my mind lately. Today was a total loss, but so it goes.

[bab]

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