Postpartum Duh

So last time, I realized way too far in retrospect that I had, indeed, been suffering from PPD. Why did it take me so long to figure that out? I'm no stranger to depression, having had several bouts of it in high school, college, and beyond. I've learned a lot about how to recognize it, what helps (Zoloft, metformin, low-carb diet, outdoor exercise) and what doesn't (doing nothing, berating self). And yet there I was, with a three-month-old baby, miserable but hiding it, going quietly nutso on the inside.

Beyond depression's tendency to make you think you most certainly are NOT depressed, no sir, don't you dare seek treatment, there was this: PPD was absolutely unlike anything I'd ever experienced as depression. Instead of crying, sleeping, fixating on how terrible I was, I found myself obsessing about toxins in the environment (remember the plastics phase?) and the coming environmental apocalypse, and compulsively washing my hands. I had constant, intrusive thoughts about awful things happening to people I loved (never the baby, strangely). Instead of feeling sad, I felt angry. Furious. I broke the iron throwing it at the floor; I yelled at my baby to stop crying. I punished myself for not having timed a grocery store visit well -- by slapping myself in the face. I couldn't go anywhere in the car without having an angry meltdown -- invariably baby Sophia would cry, I would be furious at myself for being such a terrible incompetent mother, and then I would smack myself some more.

But I never cried. And I never felt sad. Therefore I didn't have depression. It literally never occurred to me that I might.

Eventually it wore off -- time, hormone shifts, metformin and exercise, who knows what cocktail finally made it better. And I felt sane again. I wonder about the damage done to Sophia, who had a rather jacked-up mommy for a while -- much of it prenatally, meaning she probably got a serious dose of cortisol every day.

What caused it? Well, I was under tremendous stress during that pregnancy. On top of the radical identity shift (read: mindfuck) of years of infertility, finally coming to terms with that grief and then making happy plans to adopt, and then getting pregnant, we moved when I was about 30 weeks. New job for Sean, no job for me, new city, poorly selected house in which we did not feel at all safe. Therefore another move planned (Sophia was not even two weeks old) to a better area, where I still knew almost nobody. So there was all that. I think I had started getting obsessive during pregnancy, but didn't have a frame of reference -- I figured it was normal pregnancy stuff.

I also ate a shit-ton of carbs every day when I was pregnant with Sophia. It was the only self-medication avenue open to me, and carbs, they are nice for the serotonin rush. But I also gained 60 pounds -- a problem for me, since it signifies my insulin response is way out of whack (though I did great on the GTT). And it probably continued to be so a few months postpartum. This time, everything is different: I have a solid support network, my home feels like home, and I ate pretty well during pregnancy.

But who can say what pushed things over the edge? The thrust of the problem remains the same: I had depression, but it was completely unrecognizable to me. When health care providers would ask me if was feeling "blue" or crying or having trouble sleeping, the answers were, truthfully, no -- but if anyone had asked me about unreasonable anger, that might have given me pause.

Lately I've been coming across more firsthand descriptions of postpartum women as being crazy-angry, irrational, obsessive -- and being told it's PPD (and responding well to medication). I would love to know if anyone is being given alternate descriptions of PPD (other than "the blues that don't go away"); if anyone is being diagnosed according to different criteria. I would love to know if you had an atypical experience with PPD -- or if my experience was, in truth, typical.

And a note about the placenta-eating: You will read everywhere that it's not something medically substantiated, but then, it's not something medically disproven either. Basically there's no relevant data on it whatsoever -- that's what "no research to substantiate" means. I did find this funny little snippet, which contains the following:

Mark Kristal -- a professor at State University of New York-Buffalo, who focused his 1971 doctoral dissertation on why animals eat their placentas -- said, "People can believe what they want, but there's no research to substantiate claims of human benefit." He added, "The cooking process will destroy all the protein and the hormones. ... Drying it out or freezing it would destroy other things."

Well, duh, dude. That's why I ate it raw. (Although I will point out that I thought hormones, not vitamins, were the most important things to preserve -- so avoiding heat was my main concern.)

Also, there's this from the USA Today article:

...a spokeswoman for the British counterpart, the Royal College of Obstetricians and Gynaecologists, told the BBC last year: "Animals eat their placenta to get nutrition, but when people are already well-nourished, there is no benefit. There is no reason to do it."

Is it really just the nutrition? Was Kristal's dissertation the last word on that? Because our knowledge has changed in the past forty years. Could there be an unstudied hormonal benefit? Kristal says in the USA Today article that withholding the placenta from animals hadn't caused them to be depressed or reject their offspring, but most pregnancies don't end in PPD either.

Most important, though, is the fact that even if no benefit can be discerned by studies at present, there's no harm in it either. We might not understand whether or why it works, yet, but it certainly won't hurt you. And frankly, if you've ever dealt with PPD, you would consider eating a fresh cowflop in a waffle cone if you thought it might help. SSRIs are a godsend for many, but they have side effects and other worries; the only side effect I noticed from eating some placenta was that my lochia lasted just a couple of weeks and was never heavy or clotty. Why not try placenta first, if you are so inclined?

I would love to see a study done on women with risk factors for PPD -- either a previous episode, or a history of depression and anxiety -- in which population one would expect a higher than normal rate of PPD. Let some of them eat placenta fresh or dried; give others a placebo. See what shakes out.

Comments

[Sandra]

I had PPD and it was HORRIBLE. I had it right after the birth of my second child. I denied having any problems when asked by my dr. because I was ashamed and didn't want her to think I was weak. I then got pregnant again (clearly, I was not thinking straight). And I was depressed almost the whole pregnancy. It wasn't until I found myself actually planning my suicide that a light finally went off in my head and I got help. I am so thankful for Zoloft. It saved my life and my baby's life. If someone had told me that eating raw placenta after the birth of my son would have prevented PPD and the horror I experienced (and which still haunts me today) then you better believe that I would have eaten the whole damn thing. I'm still angry that PPD is not as widely talked about...but that's a story for another day I guess.

[TB]

I had post-partum anxiety and OCD. I also didn't have sad or blue periods. In fact I was mostly deliriously happy and very energetic - everyone remarked at how well I adjusted to having a newborn. But I was super worried about germs and toxins and also obsessed with being the perfect AP parent...I felt guilty about lying my daughter down for a nap instead of holding her for it even when she was content! Yeah, crazy.

It got worse before it got better. No, no care providers picked up on it. At some point the OCD was really bad and I thought of getting meds but was afraid I'd be advised to quit breastfeeding and didn't want to fight with a doctor about it. (I also didn't want to take meds and breastfeed...part of my OCD was concerned with keeping my milk 'pure'!)

Anyway, it went away eventually but I feel bad that I had to suffer that much. I don't worry so much about my baby because I think I was a very good mom in spite of the craziness in my head, as I'm sure you were.

Re cortisol, I read something somewhere - oh yeah, recent Newsweek article on stress - that linked maternal stress during pregnancy with higher IQ scores for the baby! The theory is that mild jolts of stress give the fetus something to think about. So, you may have inadvertently done something good for Sophia by being a bit stressed-out...

Re the placenta, I know that mammals regularly eat it, but I thought that besides nutrition, an important reason for doing so was to get rid of the evidence of a recent birth, which might attract predators. Are there any human cultures that regularly eat raw placenta? I definitely think it would be interesting to see the results of the research you propose, but how would you have a double-blind study using raw placenta? There aren't many things that credibly resemble it, I'd wager...but if the placebo were easily discerned from the placenta, people would know what group they were assigned to, which would skew the results.

[j]

I had a similar experience to you - a lot of anger. Took it out on my wife most of the time, unfortunately. It wasn't until about 6 months after the birth, when I also couldn't sleep, that I realized I really did not want to be that angry all the time anymore.

No one asked me anything about anger. In fact my psychiatrist even seemed a little surprised that that was what brought me back to his office.

[amy]

I had PPD with my daughter, had the sudden crying bouts, couldn't sit still for a moment (even though that would cause me to bleed profusely, I'd still get up and make dinner cause the baby! was sleeping!), slapped my DH when he asked what was wrong with me, felt unreasonable rage at nothing/everything.

I talked to my doctor and she hmmm'd and hawww'd and nothing got done. No drugs, no counselling, no referrals. I 'got over it' on my own. After my son, I had NONE of that. No crying, no rage, no flipouts. And no, I didn't eat any of the placenta.

But now? I have looked back and have been living with an underlying chronic depression most of my life. I guess it just didn't 'flare up' with my son's birth.

[Michelle H.]

Thanks for this post. My second child is due sometime in the next 2 weeks, and this list of everyone's different PPD experiences will be a great reference point.

With my first child I didn't get sad or weepy much, other than the night when the baby was 3 weeks old and my husband found me bawling at 2am, with a crying baby in my arms, and I told him I had changed my mind and didn't want to be a mom anymore.

I just pretty much always felt like I was drowning. Not sad or angry, just overwhelmed. Anything that needed to be done, from getting the kid a social security card to buying diapers, just seemed like far too much for me to handle. Luckily my OB had dealt with me for depression before (related to out of whack hormones from not ovulating regularly), and recognized something in my voice at my checkup. He changed my prenatal vitamins to something with a higher level of DHA, and it really helped.

[mothergoose]

Such an important topic!

I too had a lot of anxiety at first- physical panic about my son's health and safety that went around and around in my head- Cosleeping is good for attachment! Human beings evolved this way! Of course babies are happiest snuggled up to their mamas! But what about SIDS! What if I crush him! What if he's too hot! But I can't sleep this way!

Knowing this anxiety had physical cause (hormones, sleep deprivation, physical changes) helped me. I could understand cognitively that the feelings would pass, and they did eventually. I talked a lot with a few close friends and my partner and that helped. Finding blogs such as yours helped too. I felt less alone. I also did not seek professional help because of fears of medication in my breast milk.

I do have a background in mental health, so talking myself through situations helped. I had to force myself to leave the house- I was always afraid he wasn't in the car seat properly, or that it was too cold, or that he'd cry and I wouldn't be able to comfort him.

Slowly it got better. Thanks for bringing this up!

[Anne]

Hmmmm...It sounds like what you are describing is closer to "post partum anxiety" than PPD, but, of course, anxiety and depression are often comorbid. I have a friend that had symptoms similar to what you are describing, with a lot of anxiety and obsessing and worry that bad things were going to happen after the birth of her baby, so I think it may be more common than we believe, but no one has yet recognized it as a "syndrome."

I think it's great you are talking about this here, so that women can recognize that something may be going on with their emotions even if they don't fit the stereotypical PPD mold...

In any case, I'm glad things are going better for you this time!

[Micaela]

Thank you for bringing this subject up PPD and the reason for placenta consumption.

I was a zoology/pre-vet major and everything I read about mammals said that the ones that eat their placentas do so only to cover up the smell of birth (which predators love). But I don't buy it--I think that's ONE reason, but consider this: The animal could simply walk away from the birth site with its young in tow (depending on mammal--could be carried in mouth or baby could just walk, etc.). So there's got to be more going on. My untested theory--the other factors are nutrition (Moms are usually starving right after delivery and placenta is as rich as liver) and there is something in the placenta that helps the Mom do her Mom job and stay calm. Just like breastfeeding induces a big prolactin increase and can drop your blood pressure immediately (anyone ever got spaced out/sleepy breastfeeding? Good). So I think there's at least a trifecta of factors for eating placenta--safety, calories, and some sort of hormonal/nutritional boost to the Mom.

No, I didn't eat my placenta after my one and only birth. But had I to do over again .... I'd consider it. But how do you do it? You said you eat it raw--I'm not sure the logistics of that. Do tell. Did you chop up then freeze cubes? Did you just chuk down a slice? Why am I thinking about Silence of the Lambs?

[Micaela]

Oh and some people are putting it into capsules and selling it, and apparently, some men even are taking it.

See: http://depression.about.com/b/2007/07/24/would-you-eat-your-placenta-to-avoid-postpartum-depression.htm

[Erin]

I had PPD with my second and it was horrible, uncontrollable anger. I was a constant time bomb who went off without any notice. My husband and my son (who was four at the time) took the brunt of it, neither could do a single thing right in my eyes. I would say I was a good 2.5 months post-partum before I finally looked at my husband and asked for help.

I should have known I was in trouble at my final check-up with my OB, when I described the day of my best friend's funeral (he died of brain cancer) as a "bad day". Like I was just having a bad day/off day. No details, just that it was a bad day. I am sure in hindsight that if I had told him what had made it so bad, he would have had lots of questions for me and probably booked me another appointment. I however refused to admit that anything was wrong. I had waited years for my daughter, I held my breath her entire pregnancy waiting for something to go wrong and yet there I was, finally a mother of two and it felt like the world was crumbling.

I am grateful for my husband's patience with me and his immediate reaction when I told him I needed help. He had his EAP on the phone within minutes and I had an appointment before the week was out. I ended up on medication and it was only then that I truly realized how bad it was. I didn't realize how much of myself I had lost, till I started to get it back.

[Laura]

I'm a graduate student in psychology in Philadelphia, but I don't think I'd be able to convince our IRB to let me do a study on placenta-eating. Considering the number of forms I have to fill out in order to ask women if they might be feeling a little sad, I cannot imagine the crazy red tape that would ensue if I suggested that I might ask people to eat something that came out of their own bodies. Although, come to think of it, it might be worth submitting, just to see the responses.

It sounds like doctors are not asking exactly the right kinds of questions, although it's heartening to hear that so many of them are at least touching on emotional issues (whether or not they do anything competent to deal with it ... *sigh*). Your doctor might have been better served by asking what your emotions were like, rather than if you had experienced specific ones (one of the first things that we learn about interviewing is not to ask yes/no questions!). Other people have covered a lot of this, but depression isn't the only thing that hits women during pregnancy/postpartum. Any problem you can have at any other time can hit during this period, and some are actually more likely during the postpartum period. PPD is on people's minds, so when something goes wonky it's likely to be called 'depression,' but not everything that goes weird in your brain is a depression issue. Anxiety, OCD, bipolar disorder, etc. are different beasts, and mostly treated differently.

[electriclady]

I had postpartum (and hell, a little prepartum) anxiety and OCD, too. Fear of plastics, fear of germs, fear of toxins. Fear of leaving the house. I also cried a lot, but I thought that was normal because breastfeeding went horribly (low supply, bad latch, feeding each other in one big ball of suckitude, then pumping and feeding) so of course who wouldn't cry over that? I thought the anxiety was understandable too because I'd been on bedrest and hadn't left the house in months. Again, it was, but what I was feeling was out of proportion. And I, too, didn't recognize until much later (like, now, 2 years later) that it was some form of PPD, because, as you said, it didn't feel anything like the depression I've experienced before. I think I even posted on my blog, "I've dodged the PPD bullet, whew!" or some such.

Oh, and I don't remember my OB asking me anything about my mood or emotional state. I had a postpartum doula who is trained to look for that sort of thing, but she was with us until 3-4 weeks postpartum and I don't think the difference between what I was feeling and regular postpartum mood swings was clear until later.

[Toni]

I had PPD with my second. I blame it on going back to work too soon when I wasn't really ready - being overwhelmed by said work - and it being the middle of winter. I don't discount the SAD aspect of PPD too. In fact, while I can't say I really planned this pregnancy (child #3 due in July) - I can say that I'm glad that I'm having him in the summer. At least going outside will help with whatever may happen.

That and I told my husband not to ignore the symptoms. He admits that he kept thinking I'd 'snap out of it'.

A girlfriend of mine - her best friend had PPD after her second child - and ended up taking her life. All of us that know this story are a lot more vigilant after that.

I hope this time, you're able to avoid the PPD.

[emjaybee]

Wow, thanks for posting this; lots of moms-to-be in my ICAN group, I will give them this link. Probably at least a few can relate.

I was more of a classic case; feelings of hopelessness, futility, failure. The anger I did feel was an entirely justified one at the truly crappy treatment my midwife group/hospital gave me (long story) but that certainly didn't help my depression any.

Never was suicidal in the classic sense, more of a constant feeling that death would be easier than what I was dealing with. But it was alarming to keep thinking that 20x a day.

[Perfectly Disgraceful]

Thanks for writing about this. I would not have thought of anger as a PPD or even a depression symptom, but it clearly is.

I remember a lot of moments of extreme irritability, lots of exhaustion, but not much sadness. I can't say whether I had PPD with either kid, but I probably had a little something since I've had depression on and off most of my adult life.

Not that I could have chowed down on my placentas, though, as they were taken to the path lab because both were suspected of causing rather serious problems. Bad placentas.

[lesley]

I never thought of anxiety as being part of ppd but it sounds like it is. With my first I was afraid to leave the house. Our pediatrician told us not to take her anywhere for 2 months because it was rsv season. I think that intensified my fears even more. The only person I trusted around my daughter was my mother and my husband. I though everyone else was going to take her. I compared myself to an animal when it is taking care of their babies. If you get too close they growl. I really didn't have a lot of crying until she was 6 months old. We moved to a new state. I did not know anyone and she was extremely attached to me. She would only sleeps on top of me and would cry if I got out of her sight. Eventually I started going out alone a little more and meeting people which all helped my state of mind.

With my second I had just moved again to another state when I was 8 months pregnant. I did not feel as isolated as with my first because I had to get out more. I did have a hard time connecting with her and had a very short fuse when she was about 6 months old. Everything would overwhelm me and I would yell. I was too embarrassed to tell anyone I thought I had a problem. I started taking flax seed oil and noticed an improvement with my emotions by the next day.

Now I am expecting my third and am not that worried. I will take flax seed oil regularly. I am curious about eating my placenta but can't get over the yuck factor. I have been a vegetarian for 15 years and have recently started to think about eating meat again. Did you ever gag while you were eating it? It doesn't gross me out to think about someone eating their own placenta but to think about me eating my own does.

[Jo]

Answers! Some to questions nobody asked.

1) Yes, I guess technically I had PPA, or PPOCD, or something. But I'd never even heard any of those existed -- and I am trained as a postpartum doula! Skeery.

2) It did not gross me out at all to eat my placenta -- the first chunk I had was raw and still warm, about the size of a thumb, and I rinsed all the blood off, held it under my tongue for a few minutes, and swallowed it whole. It didn't taste like anything! Subsequent chunks were pureed in strawberry smoothies (first from fresh, then from frozen chunks) and really didn't taste like much either. Maybe a slight metallic tang to the smoothie.

3) Also this time I'm taking a DHA supplement and tons of essential fatty acids in my diet.

4) TB and electriclady: that's eerie. Especially with your comment, TB, I thought for a second I was reading part of my own post!

5) Micaela, good point about the animals/mobility. I do feel like I got a hormone buzz akin to the breastfeeding buzz, whenever I'd down a chunk.

[Menita]

with #1: terror and anxiety and panic and terror. I was afraid of the baby, of breathing, of being outside, of being alone at home, etc., and had some suicidal thoughts.

with #2: RAGE. Mostly taken out on DH. Who also had PPD that time around and had...RAGE. It was an awesome, awesome time, it was...

[KrimoJo]

Wow - I just had my second Dec. 24th. I don't have the same feelings with him that I did with my daughter three years ago.

With my first, our childbirth instructor had talked about women who have psychotic breaks with PPD and I was all obsessed that I was going to want to hurt my child. I didn't have urges to, but I obsessed that I would. Does that make sense?

I also obsessed that I would drop her/I would trip and fall down our long flight of stairs.

Also, I was freaked out that I was walking around with the most important thing in my life with me. I felt very vulnerable and obsessed about something happening to her.

It wasn't standard depression, so I didn't recognize it as PPD. It wasn't until I had my son that I realize how messed up I was after my daughter's birth.

I also had a lot of birth trauma with her (no amniotic fluid/induction/epidural/episiotomy/vacuum) and it took me a long time to process.

This time, my labor was similar to yours (long pushing phase at the birth center only to transfer to the hospital and have him practicallly fall out on arrival). Even though his birth was more painful than hers (natural childbirth), it was emotionally healing.

One more thing: my daughter wanted to nurse 24 hours a day. She still would, if I let her. She used me as a pacifier. My son doesn't use nursing that way, he eats and then is content to just look at me/do other things. I don't get so "touched out" even though I have two kids now.

Great topic!

[Emily]

This is really interesting. My son is four months old and now I'm sort of wondering if I have/had PPD. I hardly ever feel sad or "blue" and I don't have any trouble enjoying my baby (things I thought were flags for PPD) but I have had several episodes of almost uncontrollable rage - punching the wall, wanting to tear chunks of my hair out, shrieking and shrieking until my throat hurts. These are things I never EVER did before my son was born.

The last time it happened I told my husband I felt 12 years old again, like I was having all kinds of intense -- inappropriately intense - emotions I didn't understand and couldn't control. (SOMETHING is wrong! I don't know what it is! I don't have any idea what would make me feel better!)

I don't think I've ever connected feelings of anger and rage to depression, but it does make some sense. Maybe isolated episodes are just fluctuating hormones though....?

It's interesting and reassuring other commenters felt the same way.

[Superlagirl]

I'm sorry you went through that, Jo, and so glad to hear it's better this time around. I don't think I'll be having any more kids, in part because my postpartum experiences were so horrid, but if I do, I'll strongly consider munching on some placenta. Whatever works.

[Kaje]

I had PPD and my OCD escalated into extreme anger. My daughter was two when I went to the doctor and collapsed in his office crying that I was going mad and needed help. I have been taking prozac for six years now, just one tablet every other day seems to help me keep a lid on the anger. It doesn't stop it altogether but it seems to give me a breathing space to do something about it before I explode. It also stops my OCD from ruling my life. I tried coming off it slowly but the OCD was horrendous and drove me absolutely batty so I went back on it. I have accepted the fact that I will be on it for the rest of my live. If it means I can live my life sanely then so be it. However the shame still sticks. None of my family, with the exception of my husband, know that I am on medication. Kaje xx

[Jennifer]

I don't even know where to begin. I'm relieved in so many ways to hear all these women talk about this. I have struggled with moderate to severe depression for most of my life (I'd say at least 30 of my 38 years), but nothing compared to the flat-out crazy of the postpartum whatever-I-had.
My first pregnancy I thought I was just upset because my daughter was born prematurely. But with my second, I started to see maybe something was wrong. I absolutely refused to leave him. I was angry, and became obsessed with what he ate and played with. During this period, I began the fabric stash that is now so unwieldy, I think I'm going to have to start giving it away. Oh, and the music in my head started. And wouldn't stop.
With this last one - well, it's too complicated for a comment. But I ended up hospitalized, and probably should have been a second time except I lied to my therapist.
I'm really curious about how metformin fit into all of this for you. I wasn't willing to wean to go back on it, and I've been pregnant and/or nursing for the last 5 years. I have PCOS and used the metformin to help get pregnant with my middle child.
I have actually been planning a post about all of it, because I have to make a decision about medication (metformin and anti-depressants) and weaning. There is a poll on my site if anyone would like to vote.
I hope that we can keep this conversation going, and nudge care providers to recognize the multitude of depression symptoms that are beyond the norm.
Thank you, Jo, for handling this topic with so much honesty (as always!)

[Jennifer]

Oh, and I hope it's alright to post a link to the poll. The more input I can get, the better :)

http://barelyknittogether.com/2009/03/11/antidepressant-use-during-breastfeeding/

[Anonymous]

But it doesn't sound like postpartum depression, rather like postpartum obsessive-compulsive disorder and postpartum explosive behavior.

An experiment involving women eating placentas not their own wouldn't be wise, so experimenters would have to be set up to prepare the placentas for the participants right after individual deliveries, since experimenters would need to do the preparing or substituting for it to involve placebos and be at all blind, so probably one of those studies where people are simply followed would be in order.

Placentas and placebos was sounding familiar to me as I was writing the above, and now I figured out it was because of an episode of Mad About You.

[Jo]

Agreed, anon, not PPD but other things. However most of those get heaped into the PPD category for -- what, easiness? I dunno.

Why would the women have to eat placentas not their own? Everyone's placentas would be collected and put right in the fridge (or whatever). Liver seems like a pretty close substitute for placebo purposes. Which would rule out vegetarians, I guess?

I think in a study that simply followed women, you would get a lot of interference from the fact that people who are driven to eat their placentas to avoid PPD (or whatever) are also highly likely to take other PPD-preventing measures like setting up a support system, taking other supplements, etc. It might be harder to tease out any effect. Since it's an imaginary study in my head that nobody will ever actually conduct ;P, I say we assign women randomly to categories.

Oh and Jennifer, I was totally comfortable taking metformin while breastfeeding, based on the admittedly small but growing number of studies available.

[Jo]

Oh, and this whole issue is making me think about medication for mental health issues and the stigma that is still attached. And medication and breastfeeding and how utterly ignorant most health care providers (including pharmacists) can be on that count.

The short version of my commentary on those points is as follows:

1) If it helps, you probably needed it. Like a diabetic needs insulin. (If it doesn't help, maybe you need a different one, or a different type of therapy.)

2) It is almost always preferable to continue nursing and take your medication. There are VERY few medications that cannot be safely taken during lactation. The only resource I trust on this matter is Dr Hale's _Medications and Mother's Milk._ The PDR is worse than useless.

[Erin]

My PPD was not typical "depression" for me either. Of course, I had a tiny preemie in the hospital for 100 days, was pumping around clock, was stuck in a strange city, and took the evil drug Reglan to increase my milk supply, so I should have known it would come. I was very obsessive and seriously anxious. I could not get outside of a few mile radius of the hospital without feeling like horrible things would happen. I started throwing up every morning, and thought I had the flu -- turns out it was terrible anxiety. Finally, the anxiety and depression got so bad, that I could not get out of bed, and I literally thought I was going to die. The only thing that helped was to sleep. I got some good help, and some good drugs -- lexapro, but while we waited for that to kick in I took lorazapam -- and that's what got me through. That, and a loving family and a good week back at home with no responsiblities, knowing my wonderful mother was taking care of my baby in the hospital. So, I think PPD can really present in serious anxiety. I was "this" close to going to the emergency room -- I was almost psychotic with anxiety. I think, though, that I would have had a milder case of PPD even if Isaac's birth had been "normal". Depression and anxiety have always been caught up together for me, and I think for lots of people!

Erin

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