Elizabeth Petrucelli

Author, Blogger, Educator

Category: depression

#SuicideAwareness

#SuicideAwareness has been circulating the internet over the last year or so. I am sure it has been around much longer but recent events have caused this hashtag to spread dramatically. It’s a great hashtag and is usually preceded by someone asking to post a status that says, “Share this so others can see that someone is always listening,” or something similar.

Honestly, I roll my eyes at this. Before you jump on the hate train, let me explain why.

I have experienced postpartum depression.

I have been in the depths of postpartum depression. It sucks and I don’t wish it on anyone. It was a surprise to me as I had not experienced postpartum depression after the birth of my first baby. 10 years later, following the birth of my second living child, postpartum depression appeared. I didn’t realize that’s what was happening to me. A therapist pointed it out when I arrived to her office, in tears, fearful that what I was about to say meant that my baby was going to be taken from me.

I don’t share this story lightly. I realize this can hurt my career and any future career. I know that in sharing this part of me there will be judgment and that clients may question my abilities. I also want to assure you that postpartum depression or depression for that matter, does not occur in a vacuum and people can be extremely functional with depression. This is why suicide can be so shocking. There isn’t always a sign that can be seen before, sometimes it occurs after an attempt or completion of suicide.

For over five years, I sat with suicidal patients in a hospital. These patients had either attempted suicide or had what is called suicidal ideation (they are contemplating suicide or have had thoughts of suicide but may or may not have a plan to act on it). Twice I sat with patients who actively tried to kill themselves in front of me or my staff.

I empathized with them although I didn’t understand completely how they could be in such despair. They had people in their lives that loved them and they had their own children and families (people who were worth living for). I sat next to one person who had just attempted suicide. I asked them why they felt so deeply that they should be dead.

The emotional pain hurts much worse than any physical pain I have experienced. 

I will never forget that statement. This person explained that cutting off a leg would hurt less right now than the pain they were feeling. I asked many more questions but ultimately it boiled down to this one statement; how to calm the emotional pain so they wouldn’t want to die. I am not saying there aren’t other excuses for wanting to commit suicide, there certainly are but this really struck me. This person had so much going for them.

As I sat in my therapists office, it took me several tries to say these words, “The other day my baby was crying and I wanted to throw him into the wall.” She stared intently at me and didn’t say a word as I blurted out, “Please don’t take my baby away from me.” She smiled and stated that was not in the plan at this time. I felt safe to also share, “Another time he was crying, I just wanted to smother him.”

I was glad that it was a safe place to share these thoughts with her. They were horrible thoughts and I felt extremely guilty and scared about them. I had lost a child a few years before, why wasn’t I cherishing every moment I was having with this child? Then I made one of the most shocking statements, as if what I haven’t already disclosed wasn’t shocking enough.

My husband left his gun on the counter and when the baby was crying the other night, I looked at it and thought, “If I just blow my brains out right now, the crying will stop.” Then I picked up the gun. Obviously I didn’t use it. I picked it up and placed it in the gun locker and locked it away. Then I closed the door to the storage room it was in. Sure I had the key but I had also placed several steps in front of me that may stop me from using it.

There was so much that went into why I was having these feelings. Lack of sleep, a difficult baby, feeding problems which meant sleeping problems (for the baby and me), unresolved grief from the miscarriage, little help at home (an inability to ask for help),  expectations for how my baby should be compared to my last baby, and hormones. What was even more confusing for me was that I was at least five months postpartum. How could this be happening now?

We talked and came up with some plans. I had already had a day where I handed my husband the baby, bawling as I looked at him and said, “I am not leaving you or the children but I need to leave. I need sleep.” My husband looked at me and replied, “You do what you need to do, we will be here when you get back.” If that night away didn’t help me, what would?

When my therapist said to me, “I know you don’t want to hear this and don’t believe it but you have postpartum depression,” I didn’t want to believe it. I couldn’t have depression. People like ME don’t have it. I have a good support system, people who love me, children and family to live for, and very little wants and needs. Plus, I was at least five months postpartum. How could I have “it?”

Ultimately, it didn’t matter, I was in the depths of postpartum depression.

The plans we came up with did not involve medication. I was glad for that and after a few months of therapy, I was feeling so much better. By the time my son was nine months, the fog had lifted, I felt sane again, and I bonded and fell in love with him from that point forward. By twelve months, I was contemplating another child.

Roughly a year later, we were pregnant again but sadly, our son Gus had triploidy and passed away at 10.5 weeks gestation. I processed his loss very well and move through my grief more quickly. I think it really helped having a commendation ceremony/funeral for him.

We had decided that our family was complete and began our journey of utilizing Natural Family Planning (NFP) to avoid having another child. With my age (I was now over 40) and the depression I had experienced, we decided it wasn’t healthy for us to attempt another pregnancy. In Gus’s short life, I had experienced several weird illnesses and was under the care of a GI specialist. This can happen when a woman is pregnant with a baby who has triploidy.

To our surprise, God had other plans for us an in September last year, I became pregnant. Ensuring my mental health was priority and this is something we planned ahead for. I will blog about this journey on another date but it is important to share with you my thoughts on the #suicideawareness and how it may not really be that successful.

It is suspected that a friend and former employee of mine may have committed suicide. There is some speculation on how that happened (not necessarily related to depression) but friends are left wondering how they missed the signs. What signs are those people, who are not experiencing depression, looking for? Are you looking for someone to say, “I am going to kill myself.” How about, “I just want to die.” Or, “I am in the depths of despair.”

What does it look like to you to see that someone is depressed or contemplating suicide. You see, I have reached out in the past and no one noticed. I felt I was pretty blatant in my post. I was really struggling and needed some help that evening so I shared something on Facebook and seven out of 500+ friends of mine responded with a “like.” It was the only way I knew how to ask for help because a person like me doesn’t ask for help. Yet, no one knew. No one saw that my message was asking for help and if they did but did not reach out to me, well…I don’t want to think about that.

So the signs can be there and can be extremely subtle. I am highly functional through my postpartum depression. I smile, I laugh, I visit with friends. I am not crumpled up on the floor.  If you ask me, “how can I help,” or “let me know what I can do,” you won’t get an answer. If you want to help, HELP. Say, “I am going to bring you dinner on _________ night,” or “I will hold your baby so you can take a shower,” or “I am going to pick you up and take you out on _________ night. I have already talked with your husband and he is going to watch the children.” Just help someone when they are experiencing depression. (After I wrote this blog, a friend passed along this article. It has pictures and explains the faces of depression well.)

When I write these down, I see they are familiar. These are some of the same things that can be done when someone is experiencing grief or just had a baby. These are helpful things and when you are doing these helpful things, you are opening the door to conversation, for planning other ways to reduce stress, anxiety, and depression, but most of all, you are showing this person that they are loved.

I see it all the time. “Didn’t _________ know how much we loved them?” Or, “I told them I loved them and that I was here for them but they still are still sad or they still committed suicide.” It might not be enough to say, “I love you.” So it might not be enough to say, “Could one friend please copy and repost? I am trying to demonstrate that someone is always listening. #SuicideAwareness”

My Unexpected Pregnancy

When I received the positive pregnancy test, I wasn’t met with feelings of excitement and joy; rather, I experienced intense fear and anxiety. I had just been to my priest to confess that I had been having thoughts about abortion if I were to become pregnant again. Shocking, I know. If you know me, you will also be very shocked to see me write that. I am a devout Catholic yet there I was, contemplating abortion if I were to ever become pregnant again. I didn’t feel like I could handle another child.

Here’s why.

I was already extremely irritable and distant with my kids. I already felt run down to the max trying to care for them and to be there for them. I already felt extreme exhaustion trying to manage my household and enjoy my marriage and children. I had experienced suicidal thoughts and intrusive thoughts after I had my last baby. I did not want to suffer through baby blues and postpartum depression ever again. And I had just finally started to feel “normal” again after having lost a child the year before.

There were other concerns as well. My age was one. Being over 40 at the time was a huge concern and worrying about issues, disorders, and conditions with the baby and the risks of an older woman being pregnant, were among them. There was not much I would have control over either. I also wanted to retire at some point with my husband and have an empty home. Having another child would render that nearly impossible, especially if the child were to have special needs.

Much of my thoughts seemed to be selfish. I certainly wanted to be alive for my living children and a pregnancy at my age could cause my demise but most of my concerns were selfish. This was a motivating factor in seeing my priest. I just couldn’t handle another pregnancy so if I were to become pregnant, I told him I was considering abortion. I wasn’t pregnant at the time I confessed this. I had only gone in because my husband and I had not been careful the month before and I was actually relieved that I did not become pregnant. I was panicking though, because I knew that we would make another “mistake” in practicing natural family planning and we might not be so lucky the next cycle.

You see, we don’t use any form of contraception. We have been tracking my cycles for 19 years. For 18 of those years, we were trying to become pregnant. We finally became pregnant for the first time after seven years of marriage. I was mostly infertile for those 20 years of marriage but we always joked that God would somehow make me fertile in my 40’s. Apparently, we were correct.

As I got older, I became more fertile and this became a challenge later. Since every cycle was purely another attempt at conceiving, we found ourselves in a precarious situation when we all of a sudden needed to avoid sex during the most fertile time. I will say that it is an extreme challenge and we felt shameful that we had never mastered this. After all, we were in our 40’s so we should have this mastered. In our 18 years of marriage (at the time), we had only used a condom once and that was a horrible experience.

Having always given our full selves to each other, using a barrier made us feel sick and used. Instead of feeling close to each other, we felt like we were selfish and used each other as a pleasure toy. This did not go over well in our relationship but since both of us felt the same way, it was something we vowed we would never do again. We would have to master avoiding each other during our most fertile time.

After my confession, I left feeling empty. I did not feel good like I normally did. I felt like something was missing and I remember walking through the parking lot thinking to myself, “That was pointless.” I don’t know what I was expecting. Maybe I wanted him to tell me no? Maybe I wanted him to tell me some amazing story about how I will be converted to being open to life again? All I remember him saying was that women my age struggle with this and I wasn’t alone. That didn’t seem helpful at all.

As the next few days progressed, my fertile time came. It was impossible to avoid. We were like teenagers who could not hold ourselves back. It doesn’t help that we are intrinsically designed to desire each other during the fertile time and that it is the time where it is the most pleasurable. God wasn’t dumb in making this so.

I prayed that I would not conceive. I worried that I would and prayed hard that I wouldn’t. As the days progressed though, I went through times of panic about having to choose abortion and times of openness to life and feeling like I could do it if I were pregnant. By the time the pregnancy test was positive, I had experienced a conversion. I was at peace with being open to life despite being extremely scared and anxious that I had found myself in this position.

I messaged my sister right away and told her I was pregnant but that I couldn’t do this. I didn’t feel like I could but I knew I couldn’t kill the new life inside me. I tried to justify it though, thinking that I was only 3 weeks 4 days pregnant and it’s not really anything but a ball of cells. I thought about not taking vitamins, drinking alcohol, not taking progesterone supplements, and other things that could potentially be harmful but I knew I was only hurting myself and of course, not providing for the baby inside me.

I struggled. It was hard. I didn’t think I could love the baby inside me. I was concerned with loss and how I would manage another loss. I thought a lot about and planned this child’s funeral. I had plan, after plan, after plan as my pregnancy progressed. If the baby dies at this gestation, I will do (blank) and have (blank), and ask for (blank) and plan for (blank). It was a constant planning for the death of this baby.

I talked with my sister numerous times about how I didn’t think I could do this but somehow I was doing it. I never really thought past going to the hospital. This brought on some anxiety about if I would love my daughter, how I would fit her into our life, and I was extremely scared about baby blues and postpartum depression.

I wished she would just die inside me in the first trimester. I knew how to plan for that. I knew how to manage it and I knew how to grieve that loss. Morning sickness was horrible and I blamed her for it. I almost hated her for it but then I took solace in it because being sick likely meant she was healthy and growing. It was such a roller coaster. Yes, there were times I was excited. The kids really made me happy because they were excited. They were overjoyed and hubby was ecstatic about another baby. When we discovered the baby was a girl, he was over the moon and just wanted her out so he could be her daddy.

Those were the times that really helped me to feel better about the journey we were on. My pregnancy was so hard. I couldn’t exercise. I couldn’t even walk. I was pretty much bound to my couch and even my couch hurt. I sat in the chair in my room more than anything because it was one of the only places where my pubic bone didn’t hurt. I blamed her for that too. I am surprised she lived but I knew she was strong. Because she was strong, I needed to be strong.

I made plans with several care providers to help reduce the baby blues and depression but I didn’t know if they would work. I had back up plans for back up plans. But as I worried about these things, I didn’t think I would be taking a living baby home. My prayers began to change because as she grew, I wanted her to be born alive. “God, please let me bring this baby home alive.” The plans for combating the depression really helped and we worked with a doula to help with my concerns about labor.

We also came up with postpartum plans and hired a postpartum doula. These were imperative to helping reduce baby blues and postpartum depression. Hubby knew I would need daily naps and he was prepared to do what was needed to keep me mentally sound. If he wasn’t so supportive, I don’t know where I would be headed.

When I labored with her, I didn’t think I would actually see her alive. Her heart was beating like crazy but I still felt like apathy towards the whole situation. I questioned why my induction wasn’t working and felt like my emotional state and how I felt about this baby was blocking my induction from working. I literally would have contractions for an hour and then they would fizzle away. Pitocin would be turned up. I would contract for an hour and they would again fizzle. Up the Pitocin, repeat. Up the Pitocin and repeat.

I wasn’t even in labor with the Pitocin. I would contract but they weren’t that bad and if I did have any contractions that were remotely uncomfortable, they didn’t last. Labor was enjoyable and we had a grand old time. Once things picked up, I literally had her within 35 minutes.

Somehow, the moment she was born and I placed her on my chest, everything was perfect and right. Yes, I placed her on my chest. My husband caught her, the doctor untangled the cord, and she was passed to me where I set her on my chest and instantly, all was right with my world. ALL was right in my life. I was at complete peace and there were no worries about her, about me, about anything. For some reason, I felt like I could handle it all now. I would have to but I wasn’t feeling pressured or like I was being forced. This was my calling. I was now the mother to a daughter. A daughter so strong and fierce she could withstand my power. A daughter whom I know, will change me.

She already has.

Antidepressants for Pregnancy Loss

Antidepressants are being prescribed by obstetricians to women who have experienced a miscarriage or stillbirth. Several of my clients have left the hospital with a prescription for an antidepressant and a few have questioned why. I have been scolded for my stance on this and told that prescribing antidepressants is very productive and should be a standard of care for all women.

I realize this can be a controversial topic and by no means is this post meant to offend women who were prescribed and took an antidepressant following their miscarriage or stillbirth. Many of my clients take antidepressants and some feel better doing so. This post is meant to bring awareness to why this may not be the best idea and why prescribing antidepressants for pregnancy loss should not be a standard of care.

When talking with some of my peers, some believe that women need an antidepressant for grief, that the loss of a baby requires medication. But why? Why would an antidepressant be needed for something that is considered normal? It’s a stigma and one that needs to be broken.

Let’s talk about what an antidepressant does. Antidepressants affect the neurotransmitters in the brain. Basically, the brain chemicals may be out of balances and an antidepressant can assist with balancing those chemicals. It changes the mood in the person but grief is not a chemical imbalance. Grief is a reaction, most commonly occurring from the death of a loved one. So if grief is not a chemical imbalance, why prescribe a medication that modifies the chemicals in the brain? Grief symptoms can mimic depression but this is where the psychotherapist or psychiatrist comes in.

  1. Are antidepressants appropriate for grief alone?

    I did some research on this topic to include talking to local therapists who specialize in pregnancy loss. Antidepressants should be utilized in conjunction with psychotherapy and should only be prescribed for depressive reactions to bereavement. This article at GLOWM states, “When medications are required, there is often prior major depression, serious personality disorder, or a history of trauma rather than solely a severe reaction to perinatal loss.” 1DSM-V states that ordinary grief is not a disorder and does not require professional treatment (therapy). 2 “Furthermore, contrary to insistent cries of alarm by some, “treatment” of post-bereavement depression need not involve antidepressant medication, except in the most severe cases.” So even the DSM-V does not believe that grief alone should be treated with antidepressants. The DSM-V allows access to treatment options even with a recent loss but that does not mean everyone should be treated with therapy or antidepressants. In fact, the article at GLOWM by Leon, I., states “The majority of couples appear to adapt within two years without psychotherapy, indicating that recommending extended counseling for all couples experiencing perinatal loss is unwarranted183 and may be detrimental based on findings challenging the universal benefits of grief counseling.70, 87

  2. Should the  obstetrician prescribe antidepressants for pregnancy loss?

    The consensus among some local psychotherapists who specialize in treating patients experiencing pregnancy loss is NO. Psychiatrist should manage and monitor a patients antidepressants as they are the experts or rather, the specialty for mental health, not the obstetrician. A patient who is prescribed an antidepressant for grief alone may not be monitored appropriately and according to the articles above, patients should be receiving psychotherapy when they are taking antidepressants. This is because antidepressants alone cannot “fix” the grief or depression. Antidepressants and therapy should be used together.

So the question remains, how should grief for pregnancy loss be treated? With compassion and empathy. The grief journey is one that needs to be experienced in order to get through it. It should not be suppressed. We know that grief is normal and it is even healthy. The family enduring the grief should find a supportive and empathetic bond, free from the boundaries that society places on how long they feel the family should grieve.

There is no timeline on grief. It changes and morphs. Families will learn to live with the pain but it may never disappear; their child will never be replaced by another child and they will not forget. Friends and family can be extremely helpful on the grief journey by providing support (meals, childcare, taking care of chores, etc) and not imposing their beliefs on the family. Helping the family know what to expect is also important and this can be achieved by hiring a bereavement doula or loss doula.

Am I saying that antidepressants should never be prescribed following pregnancy loss? Absolutely not. For grief alone, the consensus is that antidepressants should not be prescribed at time of discharge. Without proper follow-up and monitoring, there is no way to know if the medication needs to be adjusted or stopped altogether. If the obstetrician believes that there is an underlying condition or mental health disorder which requires an antidepressant, the patient should be referred to a psychiatrist and begin therapy. Referral to the proper medical profession is imperative.

 

 

Erich Fromm

REFERENCES

1. Leon, I, Glob. libr. women’s med., (ISSN: 1756-2228) 2008; DOI 10.3843/GLOWM.10418

2. Pies, R.W., Bereavement and the DSM-V, One Last Time., December 11, 2012

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