Some Things Drugs Just Can't Do....

Today I spoke with a mother of 2 small kids on the phone for 20 minutes. For confidentiality reasons I'll change her name to Carrie and some other identifying details. Carrie's Internist referred her to me. She'd been complaining of symptoms of depression for about 2 years and also referred to herself as "anxious", especially since she's had kids. She works as a mother full-time (see how I worded that?) with her 4 and 1-year-old and has been on Zoloft for the last 8 months for her depressive symptoms. She wondered if coming to counseling would help, but was also "afraid" her symptoms were getting worse despite her Internist upping her dose of Zoloft to 150mg (usual starting dose is around 50mg and I would consider a high dose 200mg). She blamed her depression for her recent weight loss and described herself as "underweight." She said she likes staying at home, but also feels it is "really hard" and "mundane". 

I wondered outloud if she was "afraid" of the depression resurfacing or getting worse that it must have been "pretty bad." She agreed that with her 2 small kids she just "didn't want to go back there." Having 2 small children myself I was able to validate her feelings that her role as mother takes a tremendous amount of work and energy and that the days that I work outside the home are far easier than the 4 days I'm home with my kids. I also validated her sense of feeling trapped with 2 different nap schedules by sharing that it's fairly new in our history as a species that mothers are "going it alone" like we do on our side of the world (villages where aunts, sisters, cousins, and playmates abound are probably more "normal" considering we are very social creatures). She said she's always trying to explain to her husband how hard it is not to have any other friends who stay at home and how alone she feels. [...]

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She said she'd just finished nursing her 12-month-old in March and was currently having her first menstrual cycle and wondered if this could be contributing to her mood. I agreed that this was a definite possibility. The body goes through hormonal changes when transitioning from lactating to not lactating. I was able to share with her that when I stopped breastfeeding both my kids I suddenly dropped 10 pounds because the body holds on to stores of fat while nursing. Post-nursing I weighed less than I ever had...and I gained it back. Low weight also impacts hormone levels as fat releases estrogen. She seemed somewhat relieved to hear all of this. I sensed she had been blaming herself.

She said, "So...what can I do?" I said, "Carrie, if your son had a fever would you expect him to do the things he normally does?" She said, "NO, of course not." I said gently, "No, you would be more compassionate with him. You would give him a break." She agreed. "And while your body is going through this transition you might need to be more compassionate with yourself, be easier on yourself, you might need to work in more breaks for yourself, you might need to reach out for more support." In that moment I made where Carrie was okay and I convinced her to apply her compassionate motherly perspective to herself.  I could tell she started to cry, "I needed to hear that. I'm so hard on myself."

Drugs couldn't do that.

What am I not saying? I'm not saying I cured Carrie of all depressive symptoms, or even of her anxiety, or that our work is done. I'm also not saying that there is no place for anti-depressants and that they are never helpful or necessary. I really just wanted to share this clear and simple example of what counseling CAN do...in 20 minutes.  

In more than 20 minutes we might explore what her feelings are telling her. I can't even begin to accurately speculate on what those messages might be, but I can guesstimate. Maybe she's naturally very extroverted and more socialization is necessary for her to feel satisfied? Not getting these needs met may cause uncomfortable feelings (a message that something needs to change). The number of solutions vary on the spectrum from going back to work full-time to starting a play group of moms in her area and everything in-between. Different solutions work for different people and different situations. My job is to help her find what feels good, and is possible, for HER and deal with feelings that may surface with the change which are based on her beliefs. Maybe she has a belief that people who need others are weak? This is at odds with her need and may get in the way of getting it met. Maybe she just lacks good examples (we all do) of moms who make their own needs a priority while simultaneously meeting the needs of her children and are HAPPY.  Maybe she's just not great (like most of us) at being aware of her needs and asking for her needs to be met and would benefit from learning some skills to do so. I have gone through many periods of trial and error to figure out what works for me and keeping the balance requires constant monitoring and re-evaluating. Shifting a "never having it right" attitude to a "always a work in progress" attitude may be in order. With the latter attitude it's possible for things to just get better and better and better and leaves more room to be a little easier on yourself.