I decided against trying to take Baby G to a 90 minute psychiatry appointment and opted to see my primary care physician first. There are a number of reasons for this but chief among them is that she could get me in quickly, she knows me, she has my medical and medication history, and the visit was covered by my insurance.
Turns out that I was her fourth possible depression case of the morning (which she apologized for as these appointments tend to go long and ours went just shy of an hour). She is a first time mom with a son just a bit older than Baby G, so in addition to being an MD, she has some of her own similar recent history (sleep deprivation, managing newborn/infant care, BCPs, etc).
As is often the case with me, she admitted that while, yes, I present as clinically depressed based on my reported symptoms, the length of time I’ve felt this way, and their severity, at times, things are likely more complex. She thinks it is a combination of factors: possibly my thyroid levels (I do best when I am borderline hyperthyroid), the onset of perimenopause, possible post partum, and the BCPs). While, generally, perimenopausal women report feeling better with replacement estrogen, some report feeling edgy, agitated, stressed, snappish, and quick to anger.
After a lengthy discussion about the convergence of factors and a number of ‘if-then’ scenarios, we agreed that the first order of business was that I come off of BCPs. Since I am only 2 days into this pill pack, last night will be my last pill. I will contact her in a month and if my symptoms haven’t markedly improved and persist to any degree, she will prescribe a ‘baby dose’ SSRI (Prozac or its kind). This class of SSRIs have the added benefit of reducing (or eliminating) hot flashes associated with perimenopause. And, since the dosage of estrogen in the BCPs I was taking didn’t provide that benefit, it’s nice to know that some other medication might. Bonus.
She was adamant that I was to contact her in a month and that I not let any remaining symptoms go unchecked and she is ready to prescribe something without seeing me again. She was compassionate, kind, thorough, knowledgeable and willing to work through the number of scenarios I threw out. She explained, in detail, what depression is and its causes and how different anti-depressants work. She encouraged me to continue working out as often as I can and to continue to eat as well as I can (on that front, I’ve lost 5 lbs which she applauded because perimenopause makes it almost impossible to lose weight).
She is also my husband’s primary care physician so she knows him a bit. She was very specific in asking how much help he provides with the running of the household and with child care. She shared that there is an increase in depression in women after the birth of #2 and that often times an underlying factor is not enough help at home. She went on to say that caring for an infant, especially one Baby G’s age who is teething, eating more solids, on the verge of crawling, etc, requires a diligence that impinges upon a mother’s ability to also care for other children and run the household on her own. The more involvement on the part of one’s partner, the better able mothers of two can cope. She gave me specific instructions to give my husband, which I did.
She wanted me to apprise my endocrinologist and OB about our appointment, which I did. As I thought, my endocrinologist immediately wrote orders for me to have my thyroid levels checked which I will do this week. And, if it turns out that I stay off BCPs, my OB will provide other treatment options should the horrific bleeding return.
I happened to also be her second case of tennis elbow which is another common post partum condition. I had carpal tunnel syndrome after the birth of my older son and my then-GP gave me a shot of cortisone in my wrist. They aren’t as quick to prescribe that for the elbow so she gave me some at home treatment/exercises and if it doesn’t improve by the time I’m to contact her, she’ll refer me to an orthopedist for cortisone (which, given how much that injection hurt in my wrist, makes me woozy to consider in my elbow).
So, how do I feel? I feel like I am taking steps toward moving the ball down the court. Might it have been better to see the psychiatrist straight away? Maybe. But I do like and tend to fare well with an integrated approach to my health care. And, I can see my therapist and/or psychiatrist down the road.
For now, I look forward to seeing how I feel off BCPs and will take it from there. Thank you for the encouragement to seek treatment and for sharing your stories of and experiences with depression. The sisterhood I have here means so much to me on so many levels. Thank you.