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post-partum anxiety

I’d choose anaphylaxis over depression any day of the week and twice on Sundays

A couple weeks ago, I was doing what I usually do on a Monday morning: sitting in a room full of upholstered chairs with other allergy sufferers, applying ice packs to my arms while waiting the mandatory 30 minutes after getting my allergy shots. I often bring a book to read, but this time I was huddled over my phone, getting all teary-eyed over a text AJ had sent:

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I’m gonna let our wack-a-doo nickname slide for now and cut to the chase. For me, there is no more sublime feeling than AJ’s empathetic response when I finally break down and tell him that I’m depressed. Is there any larger comfort than this: to have a person you love respond with caring and softness when you admit to them that you’re struggling with the feeling you hate the most in the whole world? (No, I don’t think there is.)

I’ve admitted depression to AJ a handful of times over the course of our relationship, and this time, like all the others, it fell out of my mouth like defeat. If I’m telling him, it means it’s true. And I never want it to be true. Despite the fact that I know depression well, I will still run and hide when I feel it again, like a child convinced that if she can’t see it, it isn’t there.

For most of January and February and March of this year, I felt it nibbling around the edges, but I’d try to rationalize it away. It was just the rain, the winter, the Trump presidency, my lack of creative inspiration. Finally, though, I blurted it out to Aaron while he stirred something at the stove and I cried a little bit, and then we got distracted by something and it was over. Until I checked my text messages in the allergy clinic waiting room.

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Photo by Kevin Moreira

The ice was numbing the dull pain in my arm, and I sat there soaking in the relief that comes when someone you love really sees you. As I blinked through tears and started to text him back, a soft wheeze caught in my throat and made me cough. Oh, the familiar rasp of asthma. It intensified even after I dosed up on my inhaler. My throat started to thicken and itch. My nose congested. My face felt unbearably hot. All this in the space of a minute.

I walked into the nurses’ room and told the first one I saw that I was wheezing quite a bit. She calmly said, “Let’s find a room for you.” By her tone, I expected to wait.

I no sooner entered the room that a blood pressure cuff was slapped on my arm and a pulse/blood oxygen thing on my finger. In the next moment, the doctor walked in, and after I listed off all my symptoms, she asked me to please take off my pants and get on the table. She requested .5 somethings of Epinepherine and the nurse’s eyes widened. She had .3 waiting in the syringe already, and dove it back in to suck up another .2 before injecting it into the meaty part of my left thigh.

After I put my pants back on, I was presented with a tray full of little plastic ups with various pills and potions, all of which I sucked down. I then proceeded to “feel like I had drunk 10-15 cups of coffee” just as the doctor explained I would, and the nurse kept me company and took my blood pressure and pulse every 5 minutes.

“When you walked up to me, your face and neck were completely red,” she said. “Some people get really blotchy when they go into anaphylactic shock, and some people get flushed like you did.”

The doctor came back, and ordered another shot of Epinepherine for my virgin thigh, since she wasn’t pleased with my continued wheezing. Once I was re-pantsed, and the nurse deemed me stable enough to leave alone for 10 minutes, I sat in my chair, uncontrollably shaking on my now 20-30 cups of coffee, and checked out the anatomical ear, nose and throat poster next to me. It turns out that the laryngoscopic view of a larynx looks pretty vaginal.

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See?

As I sat there, wired as a Christmas tree next to the vaginal larynx poster, I couldn’t help but compare the satisfaction of this medical experience to the deep uncertainty of my own depression.

Thirty minutes ago, I had some physical symptoms for a single minute, walked a few feet and told a nurse about it, and was whisked into a room where I was given all of the help I needed, immediately.

For the last few months (and on and off my whole life) I’ve been struggling to understand, talk about and address my bouts with depression.

Even though it has come and gone dozens of times since my first real depressive winter as a 13 year old, I still feel like I barely know it at all. And it’s hard to talk to other people about something you hardly understand. It comes and goes mysteriously, a shape-shifter, each time with a slightly different texture, weight and character. The closest I’d come to explaining it with a friend recently, when he’d asked me how I was doing, was to admit, “Somewhere between fine and mentally ill.”

And after admitting depression, you rarely get whisked away to a room for effective and immediate treatment. More commonly, people get uncomfortable, nervous, or offer unhelpful advice. So you learn again and again that depression is something that scares people, and you have a short list of confidants—often others who experience it too.

The two times I have sought medical help for it, I was prescribed Zoloft by my OB. It worked a treat the first time, but she never followed up with me about how and when to decrease and come off my dose, so I figured that out alone. The second time, she referred me to a psychiatrist for the anxiety side effects I was experiencing. Riddled with depression, anxiety, a baby and 3-year-old, I called all 5 numbers on the referrals list she emailed me—3 were out of practice and the other 2 had no availability.

I must have called 30 different psychiatrists that I found online before I found one who could see me and took insurance. Once I finally sat in her office, she asked all the right questions and adjusted my dose so that both the anxiety and depression lifted. It was a hard won victory.

Hardly the direct simplicity of my bout with anaphylaxis.

The nurse at the allergy clinic said I could leave once the epinephrine had worn off, as long as none of my symptoms returned. So less than an hour later, I walked out of the old vagina larynx room, and away from the fastest and most effective and satisfying medical treatment of my life. I drove home, breathing easily through my open lungs, that dull, familiar pull of depression in the background, and AJ’s text still unanswered.

My thank you note to Zoloft, and some constructive criticism

Dear Zoloft,

I wasn’t sad to see you go, but saying goodbye last week stirred up some feelings for me.

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Photo by Divine Harvester

I know it won’t come as any surprise that I have a love-hate relationship with you. Remember how much I didn’t want you either time? And yet both times, I wound up profoundly grateful. You stepped up when I needed you to. You yanked me up from the flat heaviness. So thanks. You’re really good at that.

I’m sure you knew it was coming, so here it is—I have a few bones to pick. I’m not sure if you’re open to feedback, but since we’ve had such close relationship on and off for the last 5 years, I feel pretty qualified to give it.

Do you think it’s really necessary, when lifting someone from the pit of despair, to simultaneously smash their already-ailing libido down into the mud with the heel of your boot? I’m betting you’d have a way better reception with, say, every depressed and anxious person on earth if you could figure out how to focus on the job you were invited in to do rather than mucking around with one of the most basic and sublime pleasures of life.

And another thing: I think you should consider listing anxiety much more prominently as a side-effect on your label. That way, I would have felt less like a strung-out psychopath trying to explain my symptoms to the pharmacist.

“Hmmm,” she said, eyes scanning down the computer screen. “Nope. I don’t see anxiety listed here as a common or uncommon side effect.” (I can see how she missed it, since when I looked, I also scanned right past it; it was tucked near the bottom of a laundry list of delights like “loss of bladder control” and “unusual secretion of milk.”) She read the list for me, none of which I identified with until the last. “Mask-like face?” she asked. “Is that what it feels like?” Well, sort of.

So here’s the deal, Zoloft. After I started taking you the second time, my body started to feel like it was constantly in a war zone. Twitchy. On-guard. The muscles in my arms, hands, face and neck were taught and achy, my mind sharp and over-alert. So sure, mask-like-face covers a bit of that, but how about just bumping anxiety up in the list, or maybe adding body-like-a-war-zone? I know you’ve probably heard this before, because after I left about 300 phone messages and finally found a psychiatrist who specialized in post-partum mental health and was covered by my insurance, (BLESS HER) she told me that anxiety is a relatively common side effect of Zoloft.

Believe me, I know there’s a lot more to you than potential for anxiety, but you might as well be up front about it so that people like me and their pharmacists aren’t so ill-prepared, you know?

I really appreciate you reading this far – if you have – and let me please re-iterate that I really also appreciate you. Small, green, ovoid you. Once we sorted out all the anxiety stuff this last time, you really did the trick. And while I’m glad I don’t need you anymore, I have to remind myself that we may meet again.

I also want to acknowledge that I know it must be hard for you. I mean, you’re this awesome little pill that saves people from deep dark pits of hell and yet tons of people dread you and talk smack about you because we tell ourselves that you are a sure sign of our failure. That must really suck, since Tylenol and antihistamines and others in your cohort don’t really get that reaction. I’m sure you wish we could just see you more like that—a tool for coping with a symptom. Just so you know, I know that’s what you are. And I’ll have to remind myself of that if I need you again. But I hope I don’t. Because—no offense—I will feel like a failure of a person when I’m filling my prescription for you. Anyway, just know that I realize that’s my stuff, not yours. You really are good at your job. I know that. Lot’s of people know that.

Thanks for reading. I do hope you’ll consider some of my suggestions. And thank you, really, for all your help.

Take care,
Steph

Some relief, courtesy of big pharma

Well things are leveling out around here. Sort of.

I *might* be finding a new Zoloft dosage that works better for my new friend, Anxiety, who has decided to hop on the post-partum emotions bandwagon. It’s only been a few days at the new dosage, and it’ll take a few weeks for things to level out.

We’re still not out of the woods yet, but I actually experienced what it is like to live in the body of a normal, non-anxious person for two nights in a row, thanks to a bit of Lorazepam. I’m always nervous to take a new pharmaceutical, but my friend C nudged me to give it a try, after two horrible mornings of feeling what can only be described as hyper-hell-restless-everywhere syndrome. In the early morning, between 5 and 6 when AJ would bring Cal up for his early morning feed, my body would come online in a bunch of worried, jittery bursts that kept firing over and over and over. As if my whole self was trying to jump/stretch out of my body. And then I’d spend the next several hours reminding myself that I was not dying and that I and my family are all perfectly okay and even doing well.

So an hour after I took the first wee, white circle of Lorazepam, my entire self heaved a huge deep sigh. Relief. I didn’t realize how long my body had been feeling this way until I had my first real break. I’ve been walking around with this tight, fearful, panicked body every day for the last few weeks. And it has been draining as hell.

Last night, after I took my new favorite drug, I just laid on the couch and soaked in the feeling. No aching limbs. No tightness anywhere. Just a tired lady on the couch at 9 pm. Oh, the joy of feeling like a regular person.

Photo by Jorbasa
If I were a cat with a small, wicker ottoman, this is what I would look like after taking my Lorazepam.  Photo by Jorbasa

I feel somewhat guilty for being reliant on prescription medication for my basic sense of wellness these days, but that guilt can just shove it. There will be a time and place when I have more time and resources to try other things. Life is long. Maybe in a few months or a couple years, I’ll be feeling great with an occasional therapy session and the drops of some horrendous tasting tincture. For now, though, I need the big guns, and I’m gonna use them.

Anxietyville USA

It’s been so touch and go around here that when I wrote this post last week, I decided to focus on my recent experience of depression. I just didn’t have enough time to go into the whole kit and caboodle. The truth is, a couple weeks after starting the Zoloft, I found myself smack dab in the middle of Anxietyville USA. The last time I visited anxiety-town was during that special time in Jo’s 4th/5th month of life that I often refer to as “The Downfall.”

Like then, the anxiety has had a consistent and tight grip. The layer of my body beneath my skin and above my muscles is always tense and on alert, particularly in my arms and face.

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Photo by arbyreed

My mind and body feel as though things are always about 13 seconds away from complete catastrophe, even if I’m just strollering baby C up the sidewalk while Jo runs and whollops everything he passes with a stick he found.

Anxiety. A real dream come true, let me tell you.

When it first crept in, I thought it was because I’d had a couple nights of sort of crappy sleep and because baby C started doing the old 40 minute napping routine that Jo started doing just before The Downfall. (Thanks to my sister-in-law, I’ve learned that this whole 40 minute thing is a Thing commonly referred to on blogs and parent forums as “the 45 minute nap intruder.”)

Desperate to reign in the anxiety, I made a plan to get more sleep (Ambien) and to simplify my daily routine (put the cloth diapers on hold and supplement with formula a bit if necessary). Check and check. I was going to nip this in the bud.

I got the sleep, and am still getting it. Our trashcans overflow with disposable diapers. And we did supplement with formula a few times. But my little friend Anxiety is still kicking. Right now as I type, I’ve got that old familiar tight ache in my biceps and wrists, as if to say, “Stay on guard. Be ever vigilant. You might be needed for swaddling at a moment’s notice.”

I’ve started to wonder if the anxiety could be a side effect of the Zoloft. I don’t remember this happening the first time I started taking the stuff, but I was also goggle eyed with exhaustion and depression, and anxiety already had me white-knuckling it through every day. (It was quite a time, let me tell you.) My primary care doc confirmed this for me today–anxiety is a common side effect particularly during the first few weeks on Zoloft. But I’m already 5 weeks in.

Whether it’s a side effect or situational doesn’t really matter, though. Because it’s happening. So what I need to do is figure out how to manage it while its here and hopefully to help it go away.

I made an appointment to talk with a psychiatrist (it only took 26 phone calls to find one who could see me this month and accepts my insurance–such a joy to do that while parenting 2 kids and feeling emotionally unstable) so I can wade more efficiently through my questions about side effects and what the best meds (if any) would be for me, given that I’m breastfeeding.

And I also have had some great revelations about things that calm me down and things that leave me feeling like a frayed live wire.

  1. Trying to connect with the anxiety in my body makes it feel better than trying to wish it away. Thanks to yet another great idea from my miracle therapist, I try to find the time to sit quietly for a couple minutes during the day and touch my arms and face where I feel the coiled up tightness. That physical connection often makes it feel better within seconds, and helps me feel less afraid of it. Yep. That layer of my body feels tight. And here I am. And everything’s okay.
  2. Trying to control things makes it worse. When I nurse baby C in the early morning between 5 and 7, I try and get one or two of his infinite burps out of him and then put him back down to sleep in the co-sleeper. Then I creep over to my side of the bed and lay down. And then I find that I’m barely breathing because I’m trying to disappear any possible sound I might make for fear of waking anyone up. I lay there, in whatever strange position I landed, worried about rustling the covers because I might wake AJ or the baby. I flinch when I hear a blunt thud –is Jo waking up? Is he going to burst in the door with his new helicopter and wake up the baby? Shockingly, being in a state of hyper-awareness and frozen silence does not help me get back to sleep. And on those rare and blessed mornings when everyone else actually sleeps till 7:30, it would be lovely to be sleeping myself or at the very least resting and relaxed in bed. So I’ve trying to breathe a lot more deeply in the morning, and, god forbid, let myself make some noise. I walk around like a normal person who takes up actual space. I even flush the toilet. If I wake someone up, so be it. We’ll figure it out. Cause its not worth the emotional and physical toll it takes to try to make myself so small and silent. And even when I barely breathe and tip toe around, they still wake up sometimes.
  3. Simplicity rules.

I might be am trying to make myself feel better with all these lists. Groping for some sort of structure in the midst of the soupy uncertainty of my days and hours. Here’s the deal–I don’t know if I’m okay. Sometimes I feel brave. Others, I’m scared and defeated. Either way, I have two boys in my care, and I’m still feeding them and smiling at them and trying to find ways to maintain an environment of safety when one of them (take a guess) rages in his little kinetic body and wants nothing more than to hit, kick and throw things at me. At any moment, I can’t say how my seretonin-challenged brain is going to react to all of this, but I do know its flipping out sometimes. I’m just hoping I can stay above water.