Understanding Perinatal Mood Issues–When is it a Problem?

By Dr. Julie Bindeman

Recently I came across a blog about postpartum depression and distinguishing it from no depression post-baby and the baby blues. While well intentioned, I was dismayed to see how inaccurate the information was, as it not only combined postpartum depression with postpartum anxiety (two VERY different issues) but also over-inflated the baby blues and short-changed the variety of postpartum depression symptoms that exist. Postpartum mood disorders impact 1 in 8 new parents (for the non-pregnant parent, it tends to occur in 1 in 10 people). Perinatal mood disorder can be serious and even deadly if not treated. Fortunately, treatment is effective. A consultation with a trained mental health provider and/or psychiatrist that has specific training in reproductive health can reverse the symptoms and help you feel more like yourself.

 

To clear up any misconceptions, here is my chart:

 

Not impacted Baby Blues Postpartum Depression Postpartum Anxiety
Tears of joy or frustration on occasion Random tears (even for a toilet paper ad) that come out of nowhere Tearfulness that may or may not have a direct cause. Tears around thoughts that might be scary.
Sleep deprived, but able to take naps during the day. No issues falling or staying asleep. Learning to sleep when the baby sleeps. Getting used to sleep/wake cycle that isn’t what one is used to. Sleep is interrupted in one of two ways: difficulty rousing oneself (consistently) or not able to fall and stay asleep. Difficulties falling and staying asleep. Not able to sleep due to racing thoughts.
Your mind might feel clumsy at times and forgetful, but you are able to carry on a conversation (unless the baby interrupts) Your mind feels a little foggy and it might be hard to focus. Your mind feels full and it can be hard to express yourself. You might feel forgetful or distracted. Carrying on a conversation can be difficult, and not because of the baby. Your mind is racing and it is hard to slow it down.
You seldom worry  about things that are new for you. You worry a little, and sometimes check in with others, and sometimes keep it to yourself. You feel too sad or angry to worry. You worry constantly and some of your worries might scare you. You are afraid to tell others about ALL of your worries, though you might share some.
The changes in your life are exciting and make you look forward to the future. The changes in your life are temporarily overwhelming, but you are able to adjust with a little practice. The changes in your life are completely overwhelming and you are having difficulty adjusting to them. The changes in your life cause you perpetual worry as you struggle to make sense of them.
Bonding with your baby isn’t something that you spend time thinking about, as you do so by caring for your baby. Bonding with your baby is initially awkward, but with practice, you adjust. Bonding with your baby is hard as you feel detached from your baby and attending to its needs. Bonding with your baby is something that you are thinking a lot about: are you doing it right? Is your baby attached enough?
After a few weeks, you relish in your new routine as your “new normal.” After a few weeks, you are getting the hang of things and start to feel more like yourself. After a few weeks, you feel as bad, if not worse. After a few weeks, the worrying persists.

 

 

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Managing Weight During Vacation

By Dr. Kelly Theim Hurst

For many of us, summer has been a chance to take a vacation – to get away for a bit, to hit the pause button on work or the demands of the school year, and to catch up on anything you didn’t have as much time for while you were wrapping up that last work deadline (or trying to pack for vacation!)

But for those who struggle with weight management, vacation can bring with it the risk for weight gain and/or less healthy eating behaviors. After all, you’re on vacation! You’re off the hook! The trouble is, the mindset of being “off” can easily transform into thinking that you’re off the hook for doing self-care – when ironically, you may have taken the vacation in the first place so you can devote more time to self-care.

As a psychologist specializing in weight management, eating behaviors, and related health concerns, I sometimes see people take a “break” from healthy habits and then return from vacation not feeling as recharged as they expected, further fueling the “on/off” rollercoaster so common in weight management. Here are some tips to help your vacation truly feel like vacation, rather than a step back in your health and self-care efforts:

1) Think carefully about what it means to you to take a “break.” What exactly are you taking a break from? You may be taking a break from work; are you planning to stop anything else? If you view vacation as a break from a particular diet or exercise routine, it’s OK to allow yourself that change – a mindful, strategic, carefully planned departure from your regular habits can be healthy, as long as you have a Plan B (see below). On the other hand, if you are at risk for taking a break from your self-care, you may want to reconsider how you’ll feel when you return from your time off.

2) Have a plan. A vacation or holiday is a special time, and you may need to devote some time to think ahead about how it will affect your health habits. For example, you may keep a food diary regularly or eat the same thing for breakfast every morning, but pause this while on vacation. Plan B (aka the “vacation plan”) could be to focus your attention on physical activities you don’t normally get to do (e.g., morning walks on the beach) and sampling the fresh produce of the destination you’ve arrived at, while remembering to honor your hunger and fullness cues. Upon returning home – hopefully with that recharged feeling and the pride that you stuck to your Plan B, rather than bloated and hungover – you can pick right back up on your regular habits.

3) Revise as needed. Think about vacations you’ve taken in the past and how you felt during and after. What would you do differently next time? If your next vacation is many months away, take a few minutes to think this through and write it down, even if you think you’ll remember later. Think about how you want to feel upon returning from vacation, and note anything that seems important to reaching that goal.

4) Take a break after the break. If at all possible, schedule some time on the back end of a vacation to transition back into regular life. For example, if you’re away for a week, try to return on a Saturday or even Friday, if you have to hit the ground running Monday morning. Unpacking, laundry, opening the mail…it all takes time, so it helps to budget for that. Use this time to restock your fridge and pantry if needed, and prepare food for the start of the next week if this is helpful to you. Or, schedule a grocery delivery or meal delivery to arrive right when you get back. The transition out of vacation mode requires its own plan. Otherwise, you may get to Thursday without any groceries and think, “Well, the week is almost over anyway, I’ll get back on track Monday.”

5) These are year-round strategies. Ever had a snow day where all of a sudden you were home from work, with surprise unstructured time, or perhaps kids running around enjoying their own “off” days? The same thought may creep in – “Well now today is an ‘off’ day, so the normal rules don’t apply.” Try to remind yourself that snow on the ground just means a chance for sledding and unprepared DC drivers, not necessarily a departure from your healthy habits. It’s just another day. Likewise, you don’t need a day off as an “excuse” to have hot chocolate or ice cream – each day is just another day to do the best you can to make decisions that feel good to you.

Lastly, if you’re struggling with that on/off, up-and-down cycle of managing weight, eating, or health, remember that there are trained professionals who can help. Fortunately, the potential challenges of vacation don’t have to mean a departure from your self-care routine; what matters is how you think about them and how you choose to respond. Seek out the ongoing support you need, any time of the year!

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The “C” Word

If you follow our practice (ITGW) on Facebook, no doubt you’ve seen our big news: we moved. Moving (whether an office, an apartment or a house) tends to be a big deal with lots of details that need to be managed. What is often overlooked in a move is the sadness that one might feel.

Typically, moves are thought of as happy occasions–moving to a bigger space or to a new place for new opportunities. Even within these happy moments, it is important to acknowledge feelings of loss that might creep in. As we stood in our bare space last weekend, Nanci and I shared memories of finding that space. It is where we really set out on our own in independent practice, and it is where we build Integrative Therapy of Greater Washington. This is where our team formed and then grew.

For several years, Nanci and I knew that we needed more space to continue to do the work that we wanted to do. On and off again, we would look, with no potential office filling all of our needs. We would ask ourselves, “are we being too picky?” “Are we just afraid of making such a change?” We became really interested in an office in our office park about a year ago, but the finances for it didn’t make sense to go through and buy it. As we started our search again, we looked seriously at a space to rent, but were faced with sticker shock at the rent. Based upon this, we started to think about the possibility of buying a space.

As luck (and a good realtor) would have it, a space in our office park came on the market. Signing the contract to buy it was a huge step–it tied us both to the practice and to this geographical area (though we wanted to be here anyway). It was a big step and it felt far more permanent than renting. We were filled with doubts: “Can we make this work?” “Will it look the way we want?”

Taking that leap was huge and it enabled us to follow a dream that had started to germinate over ten years ago. And yet, back to that empty space, and the sadness we allowed ourselves to feel. Despite this exciting new beginning, we were aware of what we were leaving behind. We allowed the feelings of memory, nostalgia and loss to enter in and to cohabit amongst our feelings of excitement and anxiety.

Changes, no matter how good they might be, are hard. Navigating them allows us to grow.

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