Not Mutually Exclusive

There is no need to shame a control-freak, God-fearing Catholic. There is no need to add to the torment she has already inflicted upon herself.

Yet, that is exactly what I found a quote from Marianne Williamson doing last night.

It has been six years since I started medication therapy for my postpartum depression and anxiety. Six years of low dose, slight increases, attempts at doing without – and it still serves me. And yet, a small part of me still questions my need for it.

Why isn’t this glorious life God has given me enough reason to rejoice? Why aren’t the three gorgeous gifts of heaven that are my children a daily cause for celebration? Am I not grateful enough for God’s blessings that I need an antidepressant to merely function, never mind embrace this life?

Catholic guilt is a strong force, but not one I blame for these thoughts. I confessed to my pastor that I feared my mental struggles were tied to a crisis of faith. I worried that turning to secular talk therapy turned me away from God’s gentle care. I fretted that medication was a crutch that kept me from leaning on God’s healing power.

My pastor told me that spirituality is an important piece of one’s healing, but not to the exclusion of other beneficial treatments. My trained counselor was helping me process my feelings without judgment and not keeping me from turning to God for quiet reflection. And if prescription medicine existed in God’s world, created by one of the people He put on this earth, why would I not avail myself of this beneficial tool? Most importantly, my pastor told me that God did not cause this suffering to befall me. It was not a punishment for some wrongdoing or turning away on my part. If I gleaned something good from the experience, perhaps God allowed the growth in me, but He certainly did not beset me with these troubles.

As always, the rational mind, while fully aware of such life-affirming and freeing arguments, still can fall prey to its irrational side. I thought I’d have no problem reading the social media post that started a furious online debate about postpartum mood and anxiety disorders. Yet, as I did, I felt some of the angst I’d been slowly putting to bed for the last six years come creeping back up.

marianne williamson

This statement plays to all the fears of the postpartum mother.  The guilt of needing medication to enjoy the miracle of life and her role in it.  The fact that she can’t come to terms with ‘normal’ changes in her body chemistry.  That she has somehow failed by not meditating enough; praying enough; eating healthily enough.  And then to judge her own success by the love of others – something over which she has no control.  Or does that speak to the love she fails to feel for her child?

I am only living a modicum of successful motherhood because of the very real diagnosis of postpartum depression and its treatment with medicinal drugs.  And yet, this statement still elicits a shameful, guilty feeling in me.  After SIX successful years of such treatment.  

What of the mother just beginning to wonder if she is struggling postpartum?  What thoughts and feelings assault her when she reads this?  She is already doubting herself and ‘succumbing’ to the crutches of medicine.  She already thinks she’s failed.  And now to tell her it’s all a ploy by ‘Big Pharma’?

‘Big Pharma’ is not issuing me any big paycheck.  I’ve written thirteen different posts about the decision, pros/cons of taking psychotropic drugs, most notably Happy Pills.  When the news initially hit that new recommendations called for all pregnant women and mothers to be screened for depression this was my reaction:

duh

I never dreamed news that was so obvious to me would be seen as a negative by others.

I’m going to imagine that Williamson’s comments were born of the assumption that those standing to make a financial gain would encourage a mindless mass to pop a pill and forget their troubles – and a meaningful life.  I do not encourage anyone to medicate their troubles away without also doing the hard personal work of introspection and spiritual growth.  Meds are not successful in a vacuum.  They must be supported by close medical monitoring, therapies, and lifestyle changes.

Choosing medication is not a mutually exclusive option over meditation, prayer, and love.

I fear that the way Williamson’s stance has been presented, the ensuing social media storm will portray just that.  God-fearing people do not fear medical marvels.  God-fearing people do not judge others for decisions they make concerning their own care.  God-fearing people would never want someone to suffer needlessly while thinking it was a fatal flaw of character.

Stuff We All Get

When I got married, I inherited a staggering amount of pharmaceutical office supplies. Some women marry into wealth. Some women carry a substantial dowry; others, a hope chest full of handmade linens and needlework. I got a cardboard box full of sticky note pads and ball point pens bearing the name of brand-name drugs. A distant cousin on my husband’s paternal side, a salesman for a pharmaceutical company, had a wealth of such products himself, to which I was now a party.

Not one to turn up my nose at anything free, I welcomed this surfeit of stationery. The pen on a lanyard came in handy as I made circuits around my classroom – not only did hanging it about my neck ensure I didn’t lose it, but the big block letters emblazoned along the side. You found an Androgel pen, you say? That’s mine. Unless there was another twenty-something female teacher with stock in Androgel, there was no doubt who the pen’s rightful owner was.

However, this example also illustrates one of the disadvantages of pharmaceutical swag. Your use of said promotional product could be construed as endorsement of said drug.

This wasn’t a problem with the note cube advertising Flonase. Nasal congestion and seasonal allergies don’t carry much of a stigma with them. No one cares if your nose is running or you’re snorting floral scented mist up it. Same with the cute little calculator whose flip-top lid schilled for blood pressure medication. No one will judge me for the inner cleanliness of my arteries.

But I always thought of my audience when I wrote a note on the Wellbutrin pad.

I didn’t want anyone to think that I actually needed an antidepressant; that I was such a frequent flier, I’d earned promotional prizes; that the ‘dealer’ and I were such good buds, I got benefits.

Forget that it doesn’t work that way. It’s not like filling the card of stamps at the grocery store of yore to earn a full set of ceramic dishware. One doesn’t get a sticker for each pill ingested. But I didn’t want anyone to get the wrong idea . . . whatever that meant.

Fast-forward nine years and I’d be fighting my own internal battle with stigma as I debated whether to go on low-level sertraline while I battled postpartum depression. I did. Don’t know which side of stigma won, but I started on the meds I’m still on today.

Today.

The day irony served me a big slap in the face.

The day my physician suggested I add Wellbutrin to my prescription regimen – because sertraline doesn’t seem to be cutting it; because I need a ‘lift’ in the morning to get me going; because while I don’t have ADHD, I need help focusing, prioritizing; because all my labs came back normal and there is no organic reason for my symptoms other than plain old depression and anxiety.

Whoop-ti-do-da-freakin’ DAY.

Four to five years after I started my first antidepressant. Two to three years after I finally (or so I thought) came to terms with ‘succumbing’ to the help of an antidepressant.

Seemingly light years away from that time when I humorously pointed out the name on a sticky-sided square of paper – thinking my worst worry was that people would mistake me for a person who needed medicinal balancing of her brain chemicals.

I have so much more to worry about now.

Solitary Confinement

 

It’s not that I didn’t believe her . . .

My therapist told me that, while I may have had underlying anxiety for years, it hadn’t presented itself until I had one, two, three children because up until that point, it had been manageable. I could handle it. I’d organically and subconsciously found coping mechanisms. The fact that I could no longer manage it didn’t signal failure, but a new tenor to my life that was above and beyond – and that wasn’t going to change anytime soon. I balked at taking medication to control it, but she pointed out that there is nothing I can do to control the level of stress that accompanies three children – while I can assist my bodily systems and psyche with medication.

Intellectually, I understood it. I trusted her and her care. But there was a part of me that didn’t truly want to buy it. The control freak in me raged. I can do this! Even while popping the pills, I thought somehow, someday, I’d overcome this. I’d whip that three-kid schedule and lifestyle into shape and surmount the odds.

Then one day, four years, ten months into the anxious maelstrom that had become my life, I found myself alone. There was movement, noises on the edges of my consciousness, but it was gentle, distant. My husband came to kiss me goodbye before leaving for work and then I was truly alone.

I debated going back to sleep, but figured I’d be in that half-conscious state that would leave me feeling worse than if I’d gotten up early. I did roll around in my head various scenarios of what I might do with my time, but more mind blowing than my options sans kids was the quality of the time sans kids; that is, unfettered. There were things I wanted to do, things I should do, but nothing I absolutely had to do. For several hours, the majority of this fine day, I had to answer to no one.

I could eat when I felt like it. Nap when I felt like it (which I did end up doing to counteract the non-sleeping-in). Pee when I felt like it. I could open that new bag of crispy treats at midday and eat as many as I wished without vultures swooping down upon me. I could concentrate unencumbered on the tutorial for a new software program that’s been languishing on my desktop for lack of time (and be inspired to take said nap before returning to it 😉 )

There’s no such thing as perfection. I did need to intersperse my chosen activities with household duties due to the threat of family members coming to see the house for the first time. But even that may have been a blessing in disguise, as I finally found a home for the mound of summer attire that had taken over a chair in my room – which, again, would never have happened had I not been alone.

It was at some point during all this alone time, however, that I sat on the couch and stared at the gloomy scene out the rain-speckled window. I was still tired, I was still mushy-mush. I wasn’t channeling Gene Kelly in all my solitary resplendence. I was still the non-prioritizing, neurotic perfectionist able to unravel at the drop of a hat if things didn’t go according to plan.

The thing was – the plan was much more likely to stay stuck without three little whirling dervishes to spin it apart from the inside out. And if not, I could adjust accordingly, changing course according to my needs and neurosis. Or just chill out for the day until my thin skin thickened up accordingly.

It’s so much easier when things fall apart for one person than a whole tribe. And much easier to put the pieces back together. Actually, it would be more accurate to say that the whole tribe does not fall apart; in a poignantly fortunate way, I suppose, just its leader. And when it’s up to the leader to keep the tribe together, her own loose pieces rattle together until she has a day alone.

And since those days are few and far between, medication it is. At least I don’t drug alone.

 

Dosage

A split pill in a shot glass every other night

 

imagesSwinging open the cabinet door,

tired on the nights it’s empty,

still annoyed on the night’s it’s not.

 

A twitch, a shake, tension.

 

A task, another tired tendril pulling me down.

 

I’d stop if I could.

It’d be worse if I did.

 

What’s worse –

The ailment or the cure?

 

An oblong blue missile and its snapped companion.

One and a half ovals.

 

Tiny pale packages with the ability to contain my fears.

And yet, they dissolve and disperse throughout my body.

 

Is the volume the same – just not in a concentrated form?

You Got Some ‘Splainin to Do

i-love-lucy

This morning my daughter sat down to some interesting breakfast reading.

Coming home late after an evening “med check” appointment with my physician, I had left the visit summary on the dining room table.  Yesterday’s visit went swimmingly well.  No problems to report.  Successful treatment measures.  A-ok – until the next six month visit.

The chart information on the second half of the sheet told a different story, though; that of my history.  The medication I’m on; my ‘problem list’.

Depressive Disorder Not Elsewhere Classified.

I’m hoping that eight years old is not old enough to know what that means.  Hell, I don’t really know what that means.  The first time I saw it, I stopped in my tracks.  I remember the NOS designation on IEPs from my teaching days.  I remember the frustration of parents and teachers who knew something was up, but no diagnosis could be made.  How would this individual get the help he or she needed without a direction to go in?

Now that was me!

My eight year old wouldn’t be able to recognize the name of the medication I’m on either, Sertraline sounding more like a foreign language than a medicine to help her mother get through life.

Thank God, in this case, for medical illiteracy.  I’m all for blowing apart the stigma, but haven’t quite figured out how to explain it to my young children yet.  How much information would help them see it’s perfectly acceptable to struggle and receive help and how much would open them to an overwhelming, suffocating side of this world they don’t need to know exists yet?

I didn’t know there was a family history of whatever the hell ails my family until I was an adult starting to suffer from similar problems myself.  As a child, there was an underlying tension at family gatherings, but having no explanation and no other frame of reference, I just thought that was how it was.  Do I let my kids live in ignorant ‘bliss’?  Do I give my oldest an age-appropriate mete-ing out of Momma’s struggles so she doesn’t think she’s responsible for Momma’s wrath?  Or will I be giving them the framework for their own self-fulfilling depressive prophecy?

All important questions.  All of whose answers will remain unspecified for now, just like my diagnosis.  I’m still trying to wrap my head around all this.

You Can Call Me Peri?

So I crack open this month’s issue of Family Circle, the latest installment from the gift subscription my mother-in-law gave me for Christmas, and see an article on menopause.  Ok, think it’s safe to skip that one.  But oddly compelled to read all printed matter that comes across my radar regardless of whether it pertains to or interests me, I scan the first page.  In speech bubbles strewn about the page are various questions, worries, and anecdotes from peri- and post-menopausal women.  More than half the bubbles could have been direct quotes from me!  And I am not very peri at all!

The article invites me to “read on to find out how to outwit, outplay and outlast the next chapter in your life.”  Thus begins a decade-by-decade breakdown on how to outwit this personified beast that threatens to overtake all women all over the world.  “In [my] 30s,” I can expect my fertility to decline.  Yes, knew that and no, that does not bother me in the least.  I should become my healthiest self as “what [I] do now impacts how early menopause starts, how intense the symptoms are and how they affect my body.”  Right about now, my dander is starting to get up – and it’s not just the lack of the third comma in the lists of three things that is doing it.  I need to “bust stress” as “mini-meltdowns will be happening.”  I should try tai chi or yoga or a “peaceful play list on [my] iPod” to “help alleviate menopausal related anxiety.”

It’s about now that I realize I’m fucked (and, no, I don’t mean the uncomfortable sex that I can look forward to in my 50s).

Either I’ve been perimenopausal since my prenatal visits for my third bambino or it’s gonna get a whole lot worse.  How does one who seems to be suffering from post-partum post-trauma prepare for a whole lot more of the same?

There is a sidebar by my decade entitled, “Get the #1 Test You Need Now.”  Apparently a baseline hormone panel (“an easy blood, saliva or urine test that determines [my] optimal hormone levels”) will assist my doctor in prescribing hormones “specific to [my] ideal range instead of the range of an average woman” when the time comes.  I actually laughed out loud when I read this, eliciting strange looks from my daughters.  My oldest asked what I was laughing at; how would I even begin to explain?  That, when it comes to Mommy, there is no such thing as ‘optimal hormone levels’?  That if the doctor prescribed me hormones based on the ‘range of an average woman’, the cocktail would be akin to a stiff drink of water?

While discussing “the (formerly) ‘silent passage’ is no longer taboo,” many women are still petrified by the thought of it.  Except maybe for my friend – who has such irregular periods, she was almost wishing for it.  But when I mentioned this to my mother-in-law, joking about it, she responded very seriously, “No, she doesn’t want it.”

So where does that leave me?  No, I don’t have hot flashes.  I haven’t gained mysterious pounds regardless of what I do or eat.  But mood swings, irritability, anxiety – all de rigueur already – and I’m only in my first decade, according to this handy little guide.

I’m starting to view women’s susceptibility to hormones as this insidious little secret that was only hinted at as my mother described my body’s cycles to me as I sat on the bathroom floor over two decades ago.  By no means was my mother light on the details; I understood my body’s workings in what, to a twelve year-old, was a revoltingly clear manner.  But I didn’t know how pervasive those pesky little hormones were.

Yes, I knew there’d be a few days of PMS.  Yes, I knew I’d be overly emotional during pregnancy.  Yes, I knew there’d be a few days of baby blues.  Then I noticed extra irritability that seemed to coincide with ovulation.  Then those damn hormones ganged up on me with crazy, heart-wrenching situations in my life to send me into a swirling storm of anxiety and depression.  Thankfully, my head broke water a while ago, but only with medication and therapy.  And I still struggle.

I’d like to say that an awareness helps me prepare for and deal with the effect hormones have on my life – just as the article touts the “18 Things Every Woman Should Know About Menopause.”  To a certain point, it does.  But when you know the beast is coming no matter what – and you can’t run and hide because life won’t allow it – what do you do?  Grin and bear it?  Pray to the gods that in your next life you come back with a penis?  I love yoga, but unless I take my strap and choke the hell out of the beast, it’s not gonna make it go away.  Maybe I can drown it out with the soothing sounds of my peaceful play list while I try to achieve optimal hormone levels.  Maybe instead of ‘silent passage’, it should be ‘silent scream’.

UPDATE May 2014: I spoke too soon on the hot flashes!  My past three menstrual cycles have been ushered in by a week of night sweats.  Good, clammy times!

 

 

Happy Pills

Is it bad that I cannot get through a day in my life without drugs?  I’m not talking about some narcotic to give me a buzz or knock me through a loop.  I’m talking about a low dose of what my husband refers to as my ‘happy pills’.

Ironically, I was the girl who, even in high school, had to request liquid antibiotics from her doctor because she couldn’t swallow pills.  I suffered through terrible sinus pressure and congestion because I didn’t want to take decongestants.  Severe morning sickness during my first pregnancy only added insult to injury as I gagged on humungous prenatal vitamins.  And deciding on natural childbirth was all the easier for me as it precluded a giant needle being stabbed in my back for the epidural.  I often joked with my parents that they never had to worry about me being a drug addict because I couldn’t swallow pills and hated needles.

But all this made my decision to start antidepressants during a bout with postpartum depression after the birth of my third child all the more difficult.  I was the woman who rarely took ibuprofen for a headache.  Now I was going to take a daily medication altering my hormonal chemistry?

Really, though, the issue was much more about control than anything else.  I’d had a hard time coming to terms with my diagnosis, thinking that I was a bad mother because I couldn’t handle caring for my three children.  And now the fact that I couldn’t hack it with therapy and lifestyle changes was an even more resounding affirmation of my failure to control things – that I was a failure.

Then a few months of feeling like I’d been dragged through mud and up again changed my mind.  I wasn’t able to do it on my own, but I wanted to change.  I wanted to stop feeling subterranean.  I wanted to rejoin the land of the living.  And enjoy the lives of my children.

However, I did always look to the weaning of my one-year old as the end date of my medicinal therapy.  I figured my hormone levels would regulate themselves and things would go back to ‘normal’.  Nearly three months after that, I was nearing the end of my last refill and decided I wouldn’t request another.  Actually, the procrastinator in me decided since I hadn’t reordered in time.  I lasted a week.  In that one week, which happened to coincide with the week of Christmas and all its resulting chaos, I relived all the instances that had put me on the medication in the first place.  Afterwards, I told my therapist that one week reaffirmed my decision and that I never wanted to be there again.

Fast-forward a year.  Again, my ninety-day supply of meds was dwindling; again, with no refill.  I think my stubborn will to conquer this on my own was still lurking inside somewhere because I watched the pills disappear one by one, the rattle against the side of the bottle getting softer and softer, and yet, doing nothing to secure another script.

“I should be over this by now,” I thought.  “Surely I can handle life as it is without a pill.”

As sick as I’d grown of remembering to pop a pill each night and worrying if I’d taken it too long after supper so that it’d rip my stomach apart, I took the last pill with a gulp of regret.  Would I be able to do this on my own?

The answer came just days later.  Acutely aware of the placebo effect, I wondered how much of it was my own imagining, but I felt myself getting tenser by the day.  I found myself jumping on my kids for the smallest infraction.  I heard my voice taking on the tone of the beast I’d been in the beginning.  I saw my oldest start to tune out my overreactions like I’d seen my former students do when I’d lost it and all they heard was noise, not warnings.

And the crying.

If I can call it that.  The sudden, overwhelming urge to cry.  Usually when things were too much to handle: a particularly hectic pick-up at school, all three of them fighting and hurting each other.  But also at unexpected times: discussing home-heating options with my husband, reading a particularly poignant editorial in the newspaper.  That last one gave me pause, as it reminded me of the tears that sprang up after watching a Haagen-Dazs commercial during one of my pregnancies.  And though the idea of being pregnant again scared me enough to make me wonder for a second, I knew it was just my emotional response to things getting to be too much.

My husband wondered if I just had a good cry, let it all out, would I be able to then feel better and move on?  But the tears wouldn’t exactly come.  Just the feeling of despair and my face squinched in anguish, but no tears.  It’s not like I was holding it in; it was just a pervading feeling lurking below the surface all the time.

Just like the feeling that I had each night as I wallowed on the couch.  I was so exhausted I needed to go to sleep, yet couldn’t get myself up and into my pajamas.

But through it all, I knew God was watching out for me and I knew He had a sense of humor amidst the direst circumstances.

Nearly a week after I’d taken my last pill and wondered daily if I’d made the right decision, I took my two youngest into the basement with me.  With one New Years’ resolution being to finally complete a play area downstairs for the kids, I set about cleaning while they played nearby.  They played well and stayed right by me until I ran upstairs for something.  They followed, but didn’t return downstairs when I did.  I noted this and made a mental note to check on them as soon as I finished the task at hand.  Then I worked a few more minutes, and a few more, a few more – until I realized I’d taken far too long to finish and leave them alone at some unknown activity.  I returned to the main floor and they were nowhere to be found.  I continued on upstairs and heard muted voices behind the closed bedroom door.  Julia, my four year-old, was seated at her play table, about to open multiple cans of Play-doh, but yet to do any damage.  Angela, the two year-old, however, was seated on the counter above the built-in drawers – and above the mounds of toys and books and other things she’d flung onto the floor.  Before I finished my tirade, I noticed a slimy blob on the floor, and then another.  My hand slid across the seat of the hand-painted rocking chair as I leaned on it to get a closer look at the floor.  Angela had uncapped two of her oldest sister’s lip balms and squeezed the sticky substance onto the floors and furniture rather than her mouth.

Part of me raged and another part of me, much less adamant than the first, knew that this was my fault.  While it was easier to finish cleaning downstairs without them, it wasn’t smart to leave the two of them unattended with modeling clay and make-up.  I really was lucky they had only made a mess and not hurt themselves.

I cleaned a little and then stomped downstairs, figuring it was better to do that than remain and scream bloody-murder (see previous paragraphs).  And that’s when I realized God’s impeccable timing and sense of humor.  While all I could see was a supreme annoyance, something my kids did that was about to send me over the edge, it was, in fact, a very teachable moment.  The answer to my quandaries was right in front of me.  Was it better to rain down holy hell on my kids for doing something well within the realm of acceptable for an unsupervised two and four year-old or to take a pill that helps me keep things in perspective?  When relating the story later that day, I joked that God was telling me I’d better take the pills so I wouldn’t kill my kids.

It took me two more days before I called my doctor to request the refill.  Old, stubborn habits die hard, I guess.  I still feel a little weak for not being able to live life as I now know it without one of my happy pills, but life as I know it is not changing anytime soon.  And my attitude certainly does need to change if I’m going to be happy and be the best mother I can.

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