One of the most commonly asked questions I hear from women who come to my practice suffering from perinatal mood and anxiety disorders - and even from professionals learning about PPD treatment is: “How long will it take be well again?”
This question is inevitably prompted by either the story of someone who fully recovered in two weeks (making it unlikely it was a PMAD) or because someone said to them, "You mean you are STILL not feeling well?" You can imagine how such implications would lead to further despair and a feeling that their own situation might be hopeless.
There is great danger in attempting to compare your recovery time, symptoms, or treatment, to that of other women you may know who are going through the crushing experience of PMAD’s or who have had it in the past.
As with any other medical illness, NO TWO EXPERIENCES ARE THE SAME. Each woman’s illness brings its own unique biological, psychological and social factors – the intensity, disability and presentation varies as widely as a cold does to pneumonia.
Sometimes, there’s unity and connection when women talk about what they are feeling. Knowing you are not the only mother who thought about giving her baby up for adoption, who wished the baby had never been born, or who feel resentment instead of joy at the constant cries for attention can be hugely relieving.
It can be comforting to know that sleeplessness is its own hell, that partners don’t do the right thing, that no one rises to motherhood without questions and imperfections and wishing to have your former life back again is perfectly normal when you are feeling so badly.
The horrific guilt that plagues such mothers can be reduced by compassionate and even humorous exchanges with other moms. The PSI weekly Chats are testimony to the relieving effects of ending isolation and lonely despair when you think there is no one in the world who could possibly understand – or have compassion – for what you are feeling or thinking.
But when recovery time-line or treatment comparisons are made, it can lead to women feeling worse if they do NOT bounce back in the two weeks or two months offered as a recovery standard by well meaning friends. Some women will feel better with sleep and a few good talks with a friend, therapist, pediatrician or neighbor. That is great, but that is NOT postpartum depression. The feelings of associated despair if your symptoms outlast these time-lines can add further hopelessness as the conclusion becomes, “I must be really crazy if I am not yet well”.
This also applies to the form of treatment - therapy, meds, no meds - which MUST be individually constructed for each woman and fully responsive to all her presenting signs and symptoms. Since recovery can’t begin until treatment starts, the length of time someone with true PMAD has suffered or will suffer, depends on accessing that help. . . how soon they get to the right professional and the right treatment for their own unique symptom presentation.
While all PMAD's are medical illnesses (sometimes a biological predisposition increases vulnerability), there are other contributing circumstances known as risk factors. The National Institute of Mental Health is devoting much energy into research to better understand how biological predispositions become activated by chemical, psychological or social stressors. Having a biological predisposition doesn’t mean you will definitely develop a mood disorder. But, as risk factors increase, so does vulnerability to a mood disorder. This wasn’t caused by anything you did and you can’t compare your circumstances or unique biological make up to anyone else on the planet.
For example, when isolation and lack of social support is prominent in a clinical presentation, we can work hard on developing a woman's helping network and often see great progress. When certain ways of thinking keep women locked in an endless loop of intrusive thoughts or obsessions we have Cognitive Behavior Therapy strategies to help manage unwanted ideas. And when other behaviors such as addictions or eating disorders complicate the recovery from PMAD’s, we have therapies like Dialectical Behavior Therapy that help clinicians target all of the symptoms impeding a woman’s progress.
Finally, medication may be critical in any of the preceding scenarios because when we feel better, we can make new cognitive or behavioral choices that will support the recovery from depression. Or, medication may not be needed at all. There is no one formula that works, no one size fits all.
The best course of action is always to seek treatment from an experienced PMAD practitioner who is also credentialed in the form of therapy indicated by your set of symptoms. This person can assess and identify each component of the disorder, prioritize goals and treatment plans with you and work toward recovery.
The ONLY meaningful comparison for a woman in treatment for a PMAD is to notice if she feels better than a month ago, a week ago, an hour ago, and to give herself the patient love and space to fully recovery without adding the pressure of someone else’s recovery time-line.
For more information, visit www.perinatalpro.com