Over the last few months I have been thinking a bit more about the path to recovery from depression and the catch 22 of taking antidepressants. For post natal depression and recurrent depression the research shows that a combination of medication, cognitive behavioural therapy, excercise and good nutrition can help people to recover and maintain good mental health. But the problem with research is that despite it being very convincing, resources are limited and medication remains the cheapest and seemingly easiest option.
I have had a lot of counseling over the years, including CBT, but I still had a severe depressive episode. At the time I was too ill to do any of the self help techniques I had learned and forget diet and excercise when you are recovering from a cesarean and breast feeding round the clock. So for me medication was the miracle I needed to keep me in the land of the living. Over the months the sense if joy and hope I experienced was something that had been missing from my life for the past decade, as I struggled with what I now recognise was chronic low level depression. It was like I was seeing what life was like for other people for the first time and I finally saw what all the fuss is about. It is decidedly scary that I lived for so long being so unhappy and thought that was an acceptable way to live and that it was my fault. So medication has really been a miracle for me.
But there is a down side to having such a positive experience with medication. It means you are easy to treat and it has given me the false idea if I just pop my pills each day, I don't need to think about my mental health or take any greater responsibility for my recovery. Also at the time of deciding to accept medication it really wasn't the time to discuss side effects, long term issues or how to wean myself off them. So 18 months on I am realising that "mother's little helpers" are not a quick fix and that I am still unwell. Well people don't need medication every day to function. And I do.
I recently changed medication. The drug I was on is Paroxetine. It is the best SSRI to use while breastfeeding as it is not transferred into breastmilk in any large amount. However it is also the most difficult of the SSRIs to discontinue and has awful side effects when you withdraw. I tried cutting down my dose and within three days definitely was struggling. That really scared me. Suddenly I felt trapped rather than freed by this medication and I also felt a bit angry that I hadn't know more about it. It wouldn't have changed my decision to use it but I may not have been so naive and "pollyanna" about it. Thankfully it is possible to make a direct switch from Paroxetine onto Citalopram. Citalopram is not as safe for breastfeeding but Paroxetine has a risk of causing birth defects. There are no plans afoot for number two but I wanted to change so that if and when we decide to have another we didn't have to have doctors involved and there would be no pressure on me to change medication in order to conceive.
Thankfully in New Zealand these drugs are subsidised by the government drug agency Pharmac and so the cost has been nearly zero for me. However, in changing medication and struggling a little with anxiety and accepting I still have depression, I have been comtemplating what I can do to help myself. The next step for me is to see a psychotherapist who specialises in PND. However, there is no funding or services for me because my daughter is over one year. While she was under one I could have gone to a support group and had more counselling. But I thought I was doing so well, and I was. So I was discharged. I have only praise for the Maternal Mental Health team who cared for me. They are operating with limited resources and have to prioritise. But I am a statistic waiting to happen. I know that if I don't do something either I will never have any more children for fear of PND, or I will just end up back in the same position. Or possibly take drugs for the rest of my life when they was a possibility I didn't need to.
Now therapy is expensive. $100-200 an hour usually and most people can't afford that. So for those who suit antidepressants it is hard to afford to do the best for yourself so that you can eventually manage life and depression better. It seems a strange logic to give people drugs but not help them make the long term changes to their lives to promote long term health.
It shows that though there is more recognition that health does not just mean the body but includes the mind and that holistic treatment is the most effective, the money just isn't there to turn knowledge into practice.
Monday, 27 December 2010
Mothering Tank
Christmas has come and gone and the dust is settling. Just before Christmas Ella and I were struck down by a nasty bug and I was busy with finishing off at school. We also had some family worries on our minds. So by the time we packed up for the road trip to my sister's for Christmas I was feeling pretty stretched and like I might topple over in a stiff breeze.
Through all of this my mothering tank had got a little empty. For me it is the sense of having enough to give to my child and the patience and thoughtfulness that a busy toddler needs. Ella has been feeding like a newborn since she had the tummy bug and with the heat I have been feeling a little sucked dry. And the family road trip, though heaps of fun, doesn't leave much room for Mummy time. Throw in time with family who are watching your child and commenting on their development - supportively! but still commenting, it is a recipe for a Mummy breakdown.
What I needed was some deposits in my mothering tank. And they have come just as I really needed them. Watching Ella enjoy family and new experiences while we were away has made me marvel again at how much of a miracle the growth and learning of children is. As she soaks up life and explores it is such a joy and a reward for the hard work I put in each day. Hubby and I also had a great talk as we drove home about how much we love Ella, her quirks, her confidence and even the things that other people may see as not so convenient or acceptable. I also got home to find the first issue of The Natural Parent magazine in my letterbox. Reading about the things which I think about as a mother, provides nourishment and inspiration. And the La Leche League magazine Aroha is full of the personal experiences and struggles of Mums just like me.
I think the holiday season can be full of excitement and lovely time as a family. But it can also be exhausting and a time when the tank runs low. So I hope you find ways to fill your tank as a parent this holiday season and remember that your children want you. Just you. And you need nourishment yourself for that to be possible.
Through all of this my mothering tank had got a little empty. For me it is the sense of having enough to give to my child and the patience and thoughtfulness that a busy toddler needs. Ella has been feeding like a newborn since she had the tummy bug and with the heat I have been feeling a little sucked dry. And the family road trip, though heaps of fun, doesn't leave much room for Mummy time. Throw in time with family who are watching your child and commenting on their development - supportively! but still commenting, it is a recipe for a Mummy breakdown.
What I needed was some deposits in my mothering tank. And they have come just as I really needed them. Watching Ella enjoy family and new experiences while we were away has made me marvel again at how much of a miracle the growth and learning of children is. As she soaks up life and explores it is such a joy and a reward for the hard work I put in each day. Hubby and I also had a great talk as we drove home about how much we love Ella, her quirks, her confidence and even the things that other people may see as not so convenient or acceptable. I also got home to find the first issue of The Natural Parent magazine in my letterbox. Reading about the things which I think about as a mother, provides nourishment and inspiration. And the La Leche League magazine Aroha is full of the personal experiences and struggles of Mums just like me.
I think the holiday season can be full of excitement and lovely time as a family. But it can also be exhausting and a time when the tank runs low. So I hope you find ways to fill your tank as a parent this holiday season and remember that your children want you. Just you. And you need nourishment yourself for that to be possible.
Sunday, 19 December 2010
Christmas Stocktake
My lack of posts recently is really reflective of a general feeling that my life is too full. And adding blogging to my life which seems to already be bursting at the seams, seemed impossible. But as I have been lying awake at night in the awful Auckland humidity I have been wondering how things ended up like this and conducting a little stocktake of my life.
I am not one for New Year's resolutions. They are always made in a fit of idealism and never seem to be achieveable in my actual life. It is also a little depressing when they are the same every year. Maybe 10 years on this year will be different? Somehow I don't think so. They also seem to feed into my tendency for perfectionism and unrealistic expectations for myself. I went through a phase where I just felt allergic to goal setting at all. Now I seem to have reached some sort of happy medium where I want to reflect on how my life is going and what I enjoy and what I would like to change. But no crazy goals which just lead to disappointment and seem to be based on some other version of me who needs and cape and to wear her undies on the outside.
The pre Christmas madness is the perfect time for a stocktake of my life. It highlights my priorities and the imbalances. It also is the time I feel the most strung out it limits what I think I can manage so stops me from being unrealistic. And I tend to be focussed on what is truly important and my values.
So the short version is that I need to take better care of myself and do less. I need to stop thinking of new things I 'should' do and enjoy doing less. If I see a problem around me it doesn't mean it is mine to solve. And that I am an adult and try to deal with my own issues so the other adults around me should do the same and I don't have to try to keep everyone happy.
The practical side of this is:
I am not one for New Year's resolutions. They are always made in a fit of idealism and never seem to be achieveable in my actual life. It is also a little depressing when they are the same every year. Maybe 10 years on this year will be different? Somehow I don't think so. They also seem to feed into my tendency for perfectionism and unrealistic expectations for myself. I went through a phase where I just felt allergic to goal setting at all. Now I seem to have reached some sort of happy medium where I want to reflect on how my life is going and what I enjoy and what I would like to change. But no crazy goals which just lead to disappointment and seem to be based on some other version of me who needs and cape and to wear her undies on the outside.
The pre Christmas madness is the perfect time for a stocktake of my life. It highlights my priorities and the imbalances. It also is the time I feel the most strung out it limits what I think I can manage so stops me from being unrealistic. And I tend to be focussed on what is truly important and my values.
So the short version is that I need to take better care of myself and do less. I need to stop thinking of new things I 'should' do and enjoy doing less. If I see a problem around me it doesn't mean it is mine to solve. And that I am an adult and try to deal with my own issues so the other adults around me should do the same and I don't have to try to keep everyone happy.
The practical side of this is:
- one day a week as an at home day.
- work on my fitness and sort out my back pain.
- I love to write so make blogging a priority and something I do for me.
- Remember that I work so I can't act like I am at home everyday and do all the things that Mums who are at home can commit to.
- Spend more time with my hubby
- Focus on enjoying now rather than planning the next thing.
- No more commitments! I have enough in my life to be doing right now.
Monday, 8 November 2010
Sharing my story
WARNING - this is a pretty happy clappy Christian post. I feel uncomfortable writing it. I have not suddenly joined a cult or had one of those "moments". I am just being honest and it is how a truly feel. I apologise in advance if it reads as cheesy. Sometimes even in these sophisticated and cynical times cheesy is where it is at.
I was recently asked to share my story at a Mum's group which meets at my church. I am relatively new there so it was a bit weird to think about sharing my life with people who I am only just getting to know. But, I really felt that the time was right and that it was an important step for me to take. In the last few years I have felt like my life is such a wreck and I couldn't see any point in sharing it with others because I couldn't make sense of it myself, let alone give any encouragement to others.
Sitting down to write some notes was really challenging. It is not often that we look over our lives and try to make sense of the story. As I prayed and wrote it was amazing the thread and the meaning I began to see. Things that a few years ago were some important and I was sure were central to my journey just didn't feature and things which seemed incidental or tiny grew into major turning points in my life.
Over the days beforehand I was very scared. I tend to share very openly about my life but sometimes that leaves me with regrets and feeling very vulnerable. Sometimes I have been burnt by sharing with people who just were not safe and who I couldn't trust to treat me gently with the knowledge I had given them. I was also aware of the fact that I didn't want it to be about my ego, even though inevitably it was to a certain degree. And I wanted to provide some encouragement and hope even though I knew some of my story seems sad and full of grief. It was challenging for me to think through those painful times and be honest with myself about whether I had ackowledged them and felt the hurt of them before sharing them with others.
I talked with a close friend about all of my concerns which helped with all my analysing and worries. I also asked a close friend who has know me a long time to be there so there was at least one face who I knew well and who had walked with me through much of my life. I was so nervous beforehand, which is unusual for me. I am pretty confident speaking to a group but the nerves actually reminded me how important this was to me and also how much I was relying on the Holy Spirit to guide my words.
Once I got started it was like riding a bike when you are first learning and you are afraid to stop because it might tip over. I wish I had referred to my notes a bit more but overall it went well. There were a few tears, not just mine, but I was able to keep going. And I hope I shared not just the pain but also the hope I have now as God continues to work in my life. I really do feel that my life is wonderful now, that so much healing is taking place and that the future looks brighter, fuller and more exciting than it ever has before.
When women share their story in the group it is normal for that women to be prayed for. Being surrounded by these wonderful Mums with all their wisdom, strength and love was very healing for me. Their prayers and the encouragement they gave me was so powerful and felt like God directly speaking to me at this time. For someone like me, who has struggled with doubt and disbelief, it is wonderful to feel open to God again and to truly know he is active in my life right now.
When I was a little girl I read a book about a girl who went to live with relatives in the country in Wales. The family she lived with was huge and loud and messy and as an only child and quite spoilt, it was rather a shock to they system. She struggles with feeling like she doesn't belong and with the reality of the hard things which happen in life. As she learns how good life can be a verse which she comes across in "In My presence is fullness of joy". As I have grown up that verse has stayed with me and as we prayed one of the women said it.
I can say that now I don't just wish for that and wonder what it means. I really do know "fullness of joy" and that even though my journey has really only just begun I can trust that it will be true as I walk, stumble, kneel and dance along with Jesus.
I was recently asked to share my story at a Mum's group which meets at my church. I am relatively new there so it was a bit weird to think about sharing my life with people who I am only just getting to know. But, I really felt that the time was right and that it was an important step for me to take. In the last few years I have felt like my life is such a wreck and I couldn't see any point in sharing it with others because I couldn't make sense of it myself, let alone give any encouragement to others.
Sitting down to write some notes was really challenging. It is not often that we look over our lives and try to make sense of the story. As I prayed and wrote it was amazing the thread and the meaning I began to see. Things that a few years ago were some important and I was sure were central to my journey just didn't feature and things which seemed incidental or tiny grew into major turning points in my life.
Over the days beforehand I was very scared. I tend to share very openly about my life but sometimes that leaves me with regrets and feeling very vulnerable. Sometimes I have been burnt by sharing with people who just were not safe and who I couldn't trust to treat me gently with the knowledge I had given them. I was also aware of the fact that I didn't want it to be about my ego, even though inevitably it was to a certain degree. And I wanted to provide some encouragement and hope even though I knew some of my story seems sad and full of grief. It was challenging for me to think through those painful times and be honest with myself about whether I had ackowledged them and felt the hurt of them before sharing them with others.
I talked with a close friend about all of my concerns which helped with all my analysing and worries. I also asked a close friend who has know me a long time to be there so there was at least one face who I knew well and who had walked with me through much of my life. I was so nervous beforehand, which is unusual for me. I am pretty confident speaking to a group but the nerves actually reminded me how important this was to me and also how much I was relying on the Holy Spirit to guide my words.
Once I got started it was like riding a bike when you are first learning and you are afraid to stop because it might tip over. I wish I had referred to my notes a bit more but overall it went well. There were a few tears, not just mine, but I was able to keep going. And I hope I shared not just the pain but also the hope I have now as God continues to work in my life. I really do feel that my life is wonderful now, that so much healing is taking place and that the future looks brighter, fuller and more exciting than it ever has before.
When women share their story in the group it is normal for that women to be prayed for. Being surrounded by these wonderful Mums with all their wisdom, strength and love was very healing for me. Their prayers and the encouragement they gave me was so powerful and felt like God directly speaking to me at this time. For someone like me, who has struggled with doubt and disbelief, it is wonderful to feel open to God again and to truly know he is active in my life right now.
When I was a little girl I read a book about a girl who went to live with relatives in the country in Wales. The family she lived with was huge and loud and messy and as an only child and quite spoilt, it was rather a shock to they system. She struggles with feeling like she doesn't belong and with the reality of the hard things which happen in life. As she learns how good life can be a verse which she comes across in "In My presence is fullness of joy". As I have grown up that verse has stayed with me and as we prayed one of the women said it.
I can say that now I don't just wish for that and wonder what it means. I really do know "fullness of joy" and that even though my journey has really only just begun I can trust that it will be true as I walk, stumble, kneel and dance along with Jesus.
Sunday, 10 October 2010
Name change
Just thought I should acknowledge the name change for my blog. For years the Real Life name hasn't matched the website address. Blame it on blogging naievity when I first set it up. I liked the Real Life name but wanted to make it all make a bit more sense and be easier to find. So welcome to NZgirl. Feeling less of a girl now but still definitely in NZ.
Thursday, 7 October 2010
Thanks for your thoughts
Thank you for all your comments yesterday. I am letting the dust settle and thinking about why it hit a nerve so much for me. Hopefully with time I will know what to do about the doctor issue. But I think I need to let the sting settle before I make my next move.
Wednesday, 6 October 2010
Advice for the vulnerable
I am incensed, and not in a zen and smokey kind of way. I haven't posted for ages as we have been suffering through the winter of viruses. Finally I thought we were through it but Ella and I are sick again and so off to the doctor I went, suspecting we both needed antibiotics. Now I love my doctor, I have been to her since I was a child and I like her straightforward approach and how honest I can be with her. This has been so important to me as I have struggled with so much over the last few years. But today's visit has left me wondering whether I need to make a change.
After writing our prescriptions and getting us all sorted I made a passing comment as I breastfed Ella that she was desperately trying to get to sleep and that the plunket nurse the week before had commented that we were parenting in a way not usually seen by her in her middle class and predominantly pakeha practice. And before I could blink I was told in very serious tones that I had to stop feeding Ella to sleep and that it should be my goal before she got to 18 months and that research showed she had to learn to go to sleep alone and go back to sleep alone. At this point the appointment was basically over and we were heading for the door. I felt there was no chance to explain that I was not just taking the 'easy way' because I had been sick and that it was a conscious choice for us to deal with sleep this way. I also picked up the slight hint that because of my depression I was being indulgent or didn't have the strength to deal with the issue. This is something I notice more and more as Ella gets older and people are less scared that they might upset me by what they say.
So as I walked out the door of the clinic I felt totally gobsmacked. How could a health professional I thought I had known well get me and my choices so wrong? And also what does my parenting have to do with her that she would think she could tell me what to do? It is not a medical issue. She must have picked up how I was feeling because she admitted that other cultures have raised babies well doing things differently. But she also stated that she didn't think parenting could be defined along those lines. Well neither do I. But there are patterns about modern western parenting and especially to do with sleep that I don't feel comfortable with. And as Ella's parents we can choose to do what we believe is best without needing her permission. Doctors are not trained in parenting and I suspect much of the advice given is from their personal experience rather than research and evidence.
So as my rage and hurt subsides I feel I need to address the issue. My first instinct is to change GP. But that is mainly because I don't want to be put in the position of justifying myself and explaining that I think she is wrong. I also pay a lot at my doctor's because of the area she is in. And then if I do leave where do I go? How do I find a GP who will respect me and my husband as well informed parents who are happy with the choices we are making.
Above all I wish that those people who are the 'experts' and deal with parents and especially Mums, would realise that advice is not very helpful if it undermines a parent's confidence in themselves as a parent and their knowledge of their child. There is not one way to do things and just because it is different doesn't mean there is a problem. If my doctor has paused before hitting me with her advice and asked a few questions then maybe she could have been more sensitive in addressing the 'issue' which is not an issue for me. Maybe she would have realised that even though I am tired and breastfeeding a lot while Ella is sick that that is not a problem to be solved for me, it is just how it is and what Ella needs.
So I want to try to give less advice to other parents and instead affirm their role and that they are the ones who know what is best for their child and their family.
After writing our prescriptions and getting us all sorted I made a passing comment as I breastfed Ella that she was desperately trying to get to sleep and that the plunket nurse the week before had commented that we were parenting in a way not usually seen by her in her middle class and predominantly pakeha practice. And before I could blink I was told in very serious tones that I had to stop feeding Ella to sleep and that it should be my goal before she got to 18 months and that research showed she had to learn to go to sleep alone and go back to sleep alone. At this point the appointment was basically over and we were heading for the door. I felt there was no chance to explain that I was not just taking the 'easy way' because I had been sick and that it was a conscious choice for us to deal with sleep this way. I also picked up the slight hint that because of my depression I was being indulgent or didn't have the strength to deal with the issue. This is something I notice more and more as Ella gets older and people are less scared that they might upset me by what they say.
So as I walked out the door of the clinic I felt totally gobsmacked. How could a health professional I thought I had known well get me and my choices so wrong? And also what does my parenting have to do with her that she would think she could tell me what to do? It is not a medical issue. She must have picked up how I was feeling because she admitted that other cultures have raised babies well doing things differently. But she also stated that she didn't think parenting could be defined along those lines. Well neither do I. But there are patterns about modern western parenting and especially to do with sleep that I don't feel comfortable with. And as Ella's parents we can choose to do what we believe is best without needing her permission. Doctors are not trained in parenting and I suspect much of the advice given is from their personal experience rather than research and evidence.
So as my rage and hurt subsides I feel I need to address the issue. My first instinct is to change GP. But that is mainly because I don't want to be put in the position of justifying myself and explaining that I think she is wrong. I also pay a lot at my doctor's because of the area she is in. And then if I do leave where do I go? How do I find a GP who will respect me and my husband as well informed parents who are happy with the choices we are making.
Above all I wish that those people who are the 'experts' and deal with parents and especially Mums, would realise that advice is not very helpful if it undermines a parent's confidence in themselves as a parent and their knowledge of their child. There is not one way to do things and just because it is different doesn't mean there is a problem. If my doctor has paused before hitting me with her advice and asked a few questions then maybe she could have been more sensitive in addressing the 'issue' which is not an issue for me. Maybe she would have realised that even though I am tired and breastfeeding a lot while Ella is sick that that is not a problem to be solved for me, it is just how it is and what Ella needs.
So I want to try to give less advice to other parents and instead affirm their role and that they are the ones who know what is best for their child and their family.
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