I am at the midway point of weaning off Mirtazipane. At least, so I think! The plan is for me to gradually reduce my dose over the course of four weeks, but I can of course slow it down even more if that feels appropriate.
Spoiler alert: I have no idea if I’ll be fully weaned in four weeks.
But: that doesn’t matter. What matters is I’m taking care of my health.
I am still sleeping great. I have not felt any increases in the anxiety department.
It is still a little more difficult to wake up in the morning, but today, I set my alarm for 6 a.m. and I was indeed awake at 6 a.m.
I have decided to be more intentional about the way I use my time in between the kids’ bedtime at 8 p.m. and my typical bedtime of 10 p.m. I’ve been spending more time reading and journaling and less time watching t.v.
Last night, I meditated for the first time in months. That felt good. That felt right. If I need medication to sleep, fine. But if all I need to do is meditate and journal, I’d rather build some new habits and ditch the pills.
There are at least 872 things I want to tell you about journaling:
That you don’t need to write a chronicle of your daily life.
That you get to write whatever you want.
That you don’t have to write perfectly or adhere to any rules of grammar or worry about an audience because this is all for you, glorious messy wonderful you. And if you want to write something for public consumption, then you can revise, but first, just get it all out on the page.
And there is so much more I want to tell you, but if I write it all, my wrist will fall off and you will feel paralyzed by information overload.
Because ultimately, you have to figure out what journaling is for you and you alone.
Because you might just write gibberish.
Or you might write lists.
Or you might actually sit and doodle.
Because there’s no right way to do this.
You just do it.
I’ll save the other thoughts for later posts, or maybe a book – who knows? I sure as hell don’t! My muse does not believe in memos or Ten Year Plans, so I just have to see where my writing and journaling lead me.
I just know that journaling is an essential part of my self-care plan, and I want to mention it again and again, so I can inspire as many people as possible to write messy glorious incoherent journal entries.
If you want to read more about journaling, then I cannot recommend enough The Artist’s Way by Julia Cameron. This book inspired me to write morning pages way back when I was a miserable lawyer. Now that my kids are five and 2.5 years old, I’m working on getting back into the practice of writing morning pages (a.k.a. expressive journal entries at the beginning of the day.) Cameron advocates journaling by hand, but I journal on laptop, and I’m a firm believer in doing what works for you. Also, if your kids are early early risers, then just do your Mama Pages whenever it works. Your kids will not always need you in the morning, and as remarkable as this may sound, they will eventually sleep later than you. (It’s true. Hello, teenagers of the world!)
Go forth, my adventurers! Journal! Just get the words flowing because next up: I want to talk about writing your postpartum story. Writing my memoir was such an essential part of my recovery from postpartum depression that I want to help other mamas write as much of their stories as their heart desires. (Spoiler alert: I’m not going to try to make you write and publish a memoir, though I will share that information if that is where your heart is leaning. But I am going to share journaling prompts to get the wheels in your head turning…)
Did you know dads get PPD? Well, it’s true. Dads get PPD. (Equality of the sexes, baby.)
I have still not had a dad with PPD come on my show. Hopefully that happens sometime during the next 74 episodes! (Note to self: scour internet and find dads with PPD who are willing to talk about it on podcast.) (Note to readers and listeners: if you know any dads who have or had PPD and are willing to talk about it on my podcast, send them my way! Email Courtney@PPDadventures.com. and we’ll set something up.)
In the meantime, there are resources out there for dads who experience a mood disorder:
We do not have enough resources for moms, but we have even fewer resources for dads. My advocacy focuses on moms because that is what I know, but dads are struggling and need help, too. I especially worry about the pressure on men to act like they have their shit pulled together and are not struggling with Big Feelings.
But I know that we are getting better, and if we keep working together, we can have resources available for all parents struggling with a mood disorder.
Writing about my postpartum experiences was such an essential part of my recovery from PPD, that I am now writing a series of blog posts to inspire more moms to write their stories. In the first part of this series, I am sharing tips and ideas for journaling.
I don’t actually use a proper timer when I’m journaling. Instead, I check the time on my laptop, and then make a mental note to write without stopping for at least 20 minutes.
You don’t have to start with twenty minutes. Journaling is a practice that becomes more natural over time. It’s like a muscle that gets stronger with practice.
So if you want to start journaling, just decide you will write for five minutes, check the time or set the timer on your phone or microwave or whatever, and then GO. Write write write write write whatever pops into your mind, it’s okay if it’s nonsense, it’s okay if it’s the shopping list, no one is ever going to read your journaling, just write write write and enjoy the minutes.
If five minutes sounds daunting, start with four. Or three. Or two. Or one. Just start.
Then slowly, as you get comfortable with journaling, you can increase the length of your sessions. Remember: this is not an Olympic sport. There aren’t any medals. You are just doing this for yourself. So let the journaling journey unfold as it will.
And yet, organic as this adventure might be, there’s something about the timer that helps me stay in the flow. Something that keeps my butt in the chair, even when I want to refill my drink. (By the way, I could use a Diet Coke refill RIGHT NOW but I want to finish this post, so if someone could get me some???)
Above all, remember that your journaling practice is YOURS. You get to decide what tips and tricks work for you best. The timer is only helpful if it gets you writing.
I’m sure I’ve mentioned this before, but it has been so helpful for me, it bears repeating: you do not have to follow the news.
I used to turn on a morning show when I was getting ready for work in the morning. At the gym, I turned on the little television wobbling above my elliptical and checked in with the cable news networks. Then, if I needed a break at work, I hopped over to various news providers to stay on top of the latest breaking stories.
After I had Julian in November 2015, I decided to take a media fast. I did not watch the news on television. I disabled various apps on my phone that fed me headlines. I stopped visiting any website concerning current affairs. I even stayed off Facebook.
I have never looked back.
Okay, that’s not entirely true. I am back on Facebook, and two or three times a week, I check the news online. (And no, I’m not going to tell you my favorite websites for current affairs because I don’t want to inspire you to check out a new website if you are in the middle of a mental health crisis.)
I don’t know if there was a drug bust in downtown L.A. yesterday. I don’t know if there was a high speed chase during rush hour. And I certainly couldn’t tell you the last thing tweeted by Trump.
But I do know the big stuff. It’s not like I’m living in a bubble. I go out into the world and mingle, and I hear enough to know about the Big Stuff. I can especially rely on my Facebook friends to keep important headlines in my news feed.
Every now and then, someone expresses astonishment or dismay over my lack of awareness about the latest scandal. I shrug it off. My neighbor or friend might think I’m an idiot. That’s their problem, not mine. I don’t have to prove to anyone that my mental health benefits from limited contact with current affairs.
The headline for this post is “Mental Health Tip: Stay Off the News.” But really, it should be “Consider A Current Affairs Fast.” I’m not saying that every woman with a maternal mood disorder should stay away from the news. I don’t know you! Maybe the news is the bedrock of your mental health. We are all wired differently, and we all respond to life in different ways.
But, I would love to convince everyone I know to take a Current Affairs Fast for a month, or a week, or even a day, just to see what happens to their happiness levels.
You might find that the news is a vital part of your mental health. If so, that’s great to know.
But if you are like me, you might discover you feel better without the news. We only have 24 hours in a day. The time you spend scanning negative headlines could be used for some sort of self-care, whether that means a bubble bath or karate lesson.
If you take a fast from current affairs, and someone criticizes you for doing it, just blame me. I’ll be your mental health fall guy any day!
I’m almost done with Week One of Mirtazipane Weaning. To recap, this is a four week process: I’m taking a half dose (7.5 mg) every night for two weeks; then taking a half dose every other night for one week; and finally, taking a half dose every third night for on week.
I feel compelled to blog about this journey because it forces me to pay attention and make sure I’m doing this right. I don’t want to rush weaning just for the sake of being done.
Since halving my dose, I feel a little groggier in the morning and have trouble waking up before my kids. This is frustrating. I want to be up first. I want to enjoy a slow morning with some coffee and journaling before I get sucked into the whirlpool of motherhood.
But I need to let my body do its thing. Mirtazipane helped me manage my anxiety and get enough sleep, but it was a medication that altered my brain chemistry. I need to be patient while my body adjusts to life without Mirtazipane.
Besides, I’m always pushing myself to do too much. A little fatigue might just be a blessing in disguise.
I was at a busy playground this morning with Julian and spotted a mom with a newborn in a carrier. Our toddlers were playing on the same equipment, so I struck up a conversation.
Me: I don’t miss having a newborn at all.
Then, there was The Pause while the mom formulated her response, which would either encourage or discourage further conversation.
I used to avoid talking to strange moms for fear of rejection – what if she doesn’t want to talk to me? what if there’s a booger hanging out of my nose and I humiliate myself? what if she thinks I’m an idiot? But when I was recovering from postpartum depression, I did cognitive behavioral therapy, and learned some tricks to manage my anxiety. When faced with an anxiety inducing situation, I ask myself, “What’s the worst thing that can happen?” In the case of talking to a mom at the park, the worst case scenario is that the mom will I’m lame. After thinking through my fear of rejection a dozen or so times, I realized: so what? If a mom thinks I’m lame or boring or weird, that’s her problem, not mine. My recovery from PPD actually helped me become less shy, and for that, I’m hugely grateful.
End tangent. Back to our conversation in progress–
Me: I don’t miss having a newborn at all.
Mom at the Park: I will be glad when this stage is over.
From there, we chatted about the difficulties of sleep deprivation and the boredom of newborns. As we talked about the difficulty of newborns, I mentioned that I had severe postpartum depression after the birth of my first child.
I don’t always tell moms that I just met at the playground that I had postpartum depression. I only bring it up if (a) the mom seems like it’s the sort of thing she needs to hear, and (b) if there is a way to bring up the subject naturally in the conversation. I don’t promenade around playgrounds with a megaphone announcing that I had PPD, like some nut job on a street corner shouting about the End of the World. But since I’m an advocate for maternal mental health, and I’m used to bringing up the subject, I have gotten pretty good at knowing when I should bring up the postpartum pink elephant.
After we had talked for about ten minutes, I mentioned that I love my kids but I don’t like babies. The mom looked so relieved to hear me say this and said, “I’m not a baby person either!”
Me: I run a postpartum support group. I try to remember to tell all the new moms that I’m just not a baby person.
Mom at the Park: Is that the support group at the Family Room?
Me: Why yes it is.
Mom at the Park: I found your group online and was thinking about going. I had a lot of anxiety…
We talked some more, and then I had to wave goodbye and chase after Julian. It felt good to connect with a tired mom for ten minutes. She might not ever make it to my support group, but at least she got to feel human during our conversation.
Advocacy does not have to be a major production. Maybe you want to do something big, like start a blog or organize an event. But playground advocacy makes a big difference, too.
As I mentioned in this post, my psychiatrist and I decided I should start weaning off mirtazipane three days ago. For the past three nights, I have taken 7.5 milligrams of mirtazipane at bedtime, which is half my usual dose.
I’m happy to report that I have slept fine the past three nights. A few observations:
Every night, I feel a flare of panic as I settle down to sleep. Will I sleep tonight? Is this a mistake? Am I messing with my brain chemistry? The thoughts come in a big rush, but I always take a deep breath and remind myself that I can take the rest of my dose if I’m still awake in an hour. This stops the Thought Train, and after a couple of minutes, any feelings of anxiety subside and fade away.
I am falling asleep just as easily with 7.5 mg of mirtazipane as I did with the full dose of 15 mg.
Which is not to say I fall asleep quickly. That’s not my style. I almost always spend 15-30 minutes with my eyes closed, letting my brain wander and play, before I actually fall asleep.
Since I started the mirtazipane weaning three nights ago, I’ve noticed I’m a little groggier in the morning. I wake up more slowly and want to linger in bed longer. I’m just going to let my body do its thing and sleep as much as I want/can while I wean off my anti-anxiety medication.
Though I will confess: this grogginess is annoying. I feel better when I can wake up at six, before my kids, and do some writing before they emerge from their bedroom.
I am about one week shy of my fifth anniversary of starting mirtazipane and Zoloft for postpartum depression and anxiety. When I was hospitalized with severe PPD, I had no inkling of how long these adventures with medication would last. I didn’t actually contemplate the issue, because I was so lost in the despair of depression, I thought something about childbirth had broken my body and no one would ever be able to fix me.
It’s been a long adventure, but I’m so grateful that mirtazipane and Zoloft were able to pull me out of the darkness of my maternal mood disorders. I don’t care how many times I have to wean off mirtazipane. I’m just grateful there were medications to save my life when I assumed it was over.
This week, I am so excited to share Tyra Fainstad’s interview on the podcast. Tyra is the mother of a two year old girl and baby boy, and as of July 2018, she is in the throes of postpartum depression.
Tyra had a history of anxiety before she became a mother. As as child, she saw psychiatrists and was put on medication. She had a phobia of vomiting and engaged in OCD behaviors to prevent puking. Around the age of 12 or 13, Tyra’s anxiety around vomiting ended. She just grew out of it. But she was still an anxious person who worried about school and work.
She went to medical school and a year after finishing her residency, Tyra became pregnant with her daughter Madeline. This was a wanted pregnancy. Tyra had not always wanted kids, but her husband Brandon did, so she eventually decided that she did in fact want to be a mom and raise a family. Once they started trying for a baby, Tyra got pregnant right away.
Tyra developed various concerns and worries about her pregnancy. When the baby was breach, she worried about that and tried acupuncture to get her daughter into the right position for a vaginal delivery. A c-section, however, was necessary and the surgery was easy. Recovery from the c-section was also physically easy.
But from the first night of motherhood, Tyra’s anxiety kicked into high gear.
When she was pregnant, Tyra thought that all her concerns would evaporate once she could see that her baby was healthy and fine. But that’s not how anxiety works. Once Tyra had her baby, she still could not convince herself that her baby was health and fine.
Tyra wanted to breastfeed. Her baby was angry, crying and hungry. Breastfeeding was tough. Baby Madeline also was colicky and cried all the time. She did not sleep unless she was snug in the Moby wrap. Tyra got the idea that if only her body could produce enough milk, then her baby would sleep and Tyra could sleep and everything would be fine.
By three weeks postpartum, Tyra was a mess. She knew she was a mess and her physician agreed that she had postpartum depression, postpartum anxiety, and a severe lack of sleep. Her doctor convinced her to take Ambien.
Slowly, breastfeeding improved. Baby Madeline started sleeping better. Tyra, however, was not getting better.
Tyra’s doctor prescribed Lexapro. Tyra obsessively researched all the medications but stopped taking Lexapro on the third day because she thought it was making her daughter fussier than usual.
Tyra went to see a therapist. She brought her baby to an appointment and was stressed that therapy would ruin the nap routine. Tyra spent therapy sessions with a baby screaming in the Moby wrap, which was suboptimal to say the least.
Tyra would not let anyone help with the baby. Her daughter would not take a bottle and she worried if the baby didn’t eat, she wouldn’t sleep, and everything would be ruined.
As the weeks passed, Tyra came up with reasons to not be healthy. She isolated herself.
Around four or five months postpartum, Tyra started working with a life coach. They did phone therapy. The life coach taught Tyra about mindfulness and cognitive behavioral therapy techniques. This was very helpful.
When her daughter was eighteen months old, breastfeeding ended because Tyra got pregnant again. Once breastfeeding was removed from the equation, Tyra felt less anxious.
Tyra knew she was at risk for a second round of postpartum depression and anxiety, so she restarted therapy. She talked about the tools that would help her cope with Baby No. 2.
Tyra did not take any medications during her second pregnancy. She’s a physician. She counsels patients all the time to stay on their SSRI while pregnant, but she could not do that for herself. She also could not convince herself to skip breastfeeding and only use formula for her second child. She can’t explain her resistance to formula. She just couldn’t give up on breastfeeding.
Tyra gave birth to her son Desmond in March 2018. The first month postpartum was great! Desmond was an easier baby and would sleep all by himself in the Rock ‘n Play. (Personal side note: the Fisher Price Rock n’ Play was a life saver when I had PPD with Pippa, and I wish I could wave a magic wand and make sure all of your babies slept beautifully in it as well, because holy crap, sleep is so essential.)
Breastfeeding was fine. Desmond latched and Tyra has become an over-producer of milk. Tyra seemed to have dodged postpartum depression.
But then, when Desmond was six weeks old, he developed a minor health issue and started refusing feeds. This was a huge trigger for Tyra. During nursing sessions, he arched his body away from Tyra and was not soothed by the prospect of breastfeeding. As of the time of Tyra’s interview, he was also refusing the bottle.
When Desmond was eight weeks old, Tyra learned he was not gaining weight and had dropped down in the percentiles. The doctor was reassuring. Maybe Desmond was having trouble with dairy. Tyra’s anxiety went into high gear. She felt like something about her baby was wrong for her baby.
It turns out that Desmond does have a dairy intolerance – and issues with soy, eggs, night shade (tomatoes!), nuts, and so on. Tyra basically survives on avocados.
Desmond also stop being the baby dreaming in the sleep department. Now he will not sleep unless he is on top of a human.
Logically, Tyra knows her baby is fine. She knows they are going to get through this. But she’s spiraling out of control and everything in her life feels like a crisis.
Tyra has lots of resources to get through this second hellish round of postpartum depression, like a nanny and helpful family. But still, she is struggling. Even during our interview, when her voice sounded calm and in control, she felt like she was having a panic attack.
Tyra has a bottle of Zoloft. She took it for a couple of days but felt nauseous and light-headed. She reduced her dose to a tiny, tiny amount.
She is terrified of losing her milk supply even though she is over-producing. Zoloft rarely reduces a milk supply, but in Tyra’s case, a reduction would actually be helpful. Still, she is terrified of what might happen.
Tyra and I talked about bonding. Going into her first pregnancy, she knew a lot about mood disorders and the possibility of not bonding right away. She can see that she did not bond right away with her daughter. When her daughter was a baby, she thought that she wanted to go back to her life before she got pregnant. When Desmond was born, Tyra felt like she bonded with him much more right away than she did with Madeline. But now, she is having regrets about having Baby No. 2.
I had a really tough time ending my interview with Tyra. I wanted to keep her on the phone and keep talking and talking until she felt better and had some sort of magical epiphany that resolved all her anxious feelings. I wanted so desperately to use my words to cast some sort of magical spell that ended Tyra’s depression and anxiety. But in the end, I had to end the call, knowing that the best thing I can do is listen and share Tyra’s story.
Thank you, Tyra, for sharing your story. I could not have done what you did when I was in the depths of my postpartum hell.
Last year, I sloooooowly weaned off Zoloft. I have been off that anti-depressant since Christmas 2017. I also used to take Mirtazipane a.k.a. Remeron to help me sleep at night. I weaned off Mirtazipane in Fall 2017, no issues.
But my anxiety flared up in February 2018 when I cut sugar from my diet. I ended up going back on Mirtazipane in March 2018 and have been taking 15 mg at bedtime ever since. (I also ended up returning to sugar because meh. That’s another blog post!)
Today, I saw my psychiatrist and we decided I’m ready to try weaning off Mirtazipane again. Here’s the plan:
I take 7.5 milligrams at bedtime (half my usual dose) for two weeks.
Then, I take 7.5 milligrams at bedtime every other night for one week.
Finally, I take 7.5 milligrams at bedtime every third night for a week.
And if all goes well, I’m done and off Mirtazipane.
Here’s the thing: if I need medication to sleep, then so be it, I will keep taking Mirtazipane or whatever medication helps me get the sleep I need. Sleep is essential. For me, it’s non-negotiable.
But if I don’t need Mirtazipane to sleep, then I don’t want to take an unnecessary medication. My gut tells me that I don’t need Mirtazipane. Also, my psychiatrist says Mirtazipane should knock me out right away, but I can take my dose at 8 p.m. and not go to bed until 10. The drug is probably just having a placebo effect on me.
A placebo effect, though, is still an effect.
So, we’ll see how this weaning goes! It’s another step in the constantly unfolding adventure that is my mental health.