BC’s Mental Health and Addictions Journal visionsVol. 7 No. 3 2012 having a baby depression in pregnancy and postpartum: early treatment yields good results postpartum depression: fathers get hit by it too visions Published quarterly, Visions is a national award-winning journal that provides a forum for the voices of people experiencing a mental illness or substance use problem, their family and friends, and service providers in BC. It creates a place where many perspectives on mental health and addictions issues can be heard. Visions is produced by the BC Partners for Mental Health and Addictions Information and funded by BC Mental Health and Addiction Services, an agency of the Provincial Health Services Authority. editorial board Representatives from each BC Partners member agency editor Sarah Hamid-Balma structural editor Vicki McCullough editorial coordinator Stephanie Wilson design Sung Creative/Jennifer Quan layout Renee Mok issn 1490-2494 subscriptions and advertising Subscriptions to Visions are free in BC to those experiencing a mental illness or substance use problem, their families, and public or non-profit mental health or addictions service agencies. For all others, subscriptions are $25 for four issues. eVisions electronic subscriptions and back issues are available for free on our website. See www.heretohelp.bc.ca/publications/visions. Advertising rates and deadlines are also online. bc partners and heretohelp Heretohelp is a project of the BC Partners for Mental Health and Addictions Information. The BC Partners are a group of seven non-profit agencies working together to empower people to improve their quality of life by providing useful, accurate and good quality information on mental health, mental illness, substance use and addictions. We represent AnxietyBC, British Columbia Schizophrenia Society, Canadian Mental Health Association’s BC Division, Centre for Addictions Research of BC, FORCE Society for Kids’ Mental Health, Family Services of the North Shore’s Jessie’s Legacy Program and the Mood Disorders Association of BC. BC Partners work is funded by BC Mental Health and Addiction Services, an agency of the Provincial Health Services Authority. Visit us at www.heretohelp.bc.ca. photography disclaimer: Please note that photographs used for Visions are stock photographs only for illustrative purposes. Unless clearly captioned with a descriptive sentence, they are not intended to depict the writer of an article or any we want your feedback! other individual in the article. If you have a comment about something you’ve read in Visions that The opinions expressed in this journal are those of the writers and do not necessarily you’d like to share, please email us at reflect the views of the member agencies of the BC Partners for Mental Health and [email protected] with Addictions Information or any of their branch offices. ‘Visions Letter’ in the subject line, or you can mail or fax us at the address to the right. Letters should be no longer than 300 words and may contact us be edited for length and/or clarity. Please include your name and city mail Visions Editor of residence. All letters are read. c/o 1200 - 1111 Melville Street, Vancouver, BC V6E 3V6 Your likelihood of being published phone 1-800-661-2121 or 604-669-7600 will depend on the number of fax 604-688-3236 submissions we receive. email [email protected] Cover photo: ©iStockphoto.com/molka Pg 3 photo: ©iStockphoto.com/photolyric visions background 4 Editor’s Message Sarah Hamid-Balma 5 Starting Conversations: Five messages for women and those who care for them Shaila Misri 7 Depression in Pregnancy and Postpartum: Early treatment yields good results Jules Smith and Jasmin Abizadeh experiences and perspectives 10 Intrusive Thoughts? Not What We’d Planned... Jolene H 12 Having It All, Together—A Love Story Sara Levy 14 Postpartum Depression—Fathers Get Hit By It Too Albert* 16 A Careful Treatment Plan Helped Dreams Come True: Managing lithium in pregnancy Julianne 19 The Weight On My Shoulders—And When It Lifted Gail Johnson alternatives and approaches 21 I Was Hoping for a Fairy Tale, But What I Got Was Stinky Poo Linda Foster 23 Help for Perinatal Depression and Anxiety: What you can expect from a psychiatrist Trisha Bowering 26 Problematic Substance Use in Pregnancy: The Vancouver approach Ron Abrahams 28 resources *pseudonym 2012 Vol. 7 No. 3 VISIONS 3 editor’s message letters to the editor I went on maternity leave—my first—last summer. In many ways I was prepared. I had great support from my husband, family, friends and I read the edition of eVisions on Borderline workplace. I practiced healthy eating, sleeping and exercise habits. I Personality Disorder and found it incredibly went through all the right books and prenatal classes. Because of my informative. Thank you for such an easy history of depression, my doctors and loved ones were monitoring to read and comprehensive coverage of me closely for signs of relapse in pregnancy or after the birth. I’d been this disorder. My sister in England was well for a long time, but I knew I was high risk. I was warned to let diagnosed with borderline personality go of expectations around a lot of things. I expected sleep to be bad disorder about 20 years ago and I have never and showers to feel luxurious, so neither shocked me too much when really known much about it or understood they happened. the diagnosis so I found the info contained in the newsletter very interesting and it But there were a lot of things I didn’t expect the first six months. I has helped me to better understand her. didn’t expect to feel like I was back at high school when I went to mom I also loved the book reviews and have and baby drop-in groups. I didn’t expect there to be such enormous ordered the Family Guide for Healing & pressure to breastfeed exclusively (even though I had twins, I still felt Change from Amazon which I hope will I had to justify why I nursed and used a bottle). I didn’t expect it to help me to support her! She is one of those be so hard to live on parental leave benefits. I didn’t expect that four success stories—having gone from being weeks of colic could be so hard. I didn’t expect to feel different in my institutionalized for many years to now marriage. I didn’t expect my girls to stop breastfeeding before I was living independently in the community. ready to stop. No one talked about these things openly. No one said ‘me too.’ —Sue MacPhail, Surrey When no depression came after three months, we all thought I was in the clear. So it surprised me that I went into a moderate depression at six months. It was different than my past episodes: more guilt, more grief, more inadequacy. And bad days peppered with some normal days so you think you’re coming out of it (I’ve since learned that’s a glossary common feature of postpartum depression). My episode only lasted a few weeks because I got help right away. I knew I needed to connect • perinatal - during pregnancy up to the with other moms who could talk about the deep stuff and not just the time right after birth cutest new baby gear. My recovery came in finally hearing ‘me too.’ • postpartum or postnatal - after birth • caesarean section or C-section - This issue of Visions had a long gestation but I’m humbled by the when a woman’s abdomen and uterus courage, passion and resilience of our contributors. And I count myself are cut surgically to deliver a baby in their mix. My husband and my baby girls are the joy of my life, probably more so because the path to joy was winding. Sarah Hamid-Balma footnotes reminder If you see a superscripted number in an article, that means there is a footnote attached to that point. In most cases, this is a bibliographic reference. For complete footnotes, see the online version of each article at www.heretohelp.bc.ca/ publications/visions. If you don’t have access to the internet, Sarah is Visions Editor and Director of Mental Health Promotion at the please contact us for the footnotes by phone, fax or mail Canadian Mental Health Association’s BC Division. She also has personal using the contact information on page 2. experience with mental illness. 4 VISIONS Vol. 7 No. 3 2012 Starting Conversations FIVE MESSAGES FOR WOMEN AND THOSE WHO CARE FOR THEM Guest Editor Shaila Misri, MD, FRCPC Joy, anticipation and excitement are some of the feelings experienced by women who have travelled the path of pregnancy and childbirth. Shaila is a Clinical Professor of Psychiatry/ Obstetrics & Gynaecology at UBC and the Founder/former Medical Director of the Reproductive Mental Health Program at BC Women’s and St. Paul’s Hospitals in Vancouver. She is the author of Pregnancy Blues and Shouldn’t I Be Happy? Shaila is the mother of two sons ©iStockphoto.com/CourtneyK Carrying a healthy baby to term and role in the onset of mood and anxiety developing a strong attachment with disorders in vulnerable women. the newborn is our primary goal. The journey of motherhood, however, The effects of untreated psychiatric may be fraught with uncertainty and illness on the mother and baby are emotional turmoil from the moment of a growing concern to clinicians and conception. researchers alike. Untreated depression in the mother can lead to poor prenatal Research shows that pregnancy doesn’t care, increased substance use, medical protect women from mental illness.