To begin with the biggest, most challenging improvements first, I am working with my psychiatrist in the hope of improving my resilience to anxiety and depression - those things that sucked the joy out of my pregnancy and threaten always to return - in the future. As I mentioned in a previous post, depression is a risky state to be in when you're pregnant, and the medications used to treat it are also still so misunderstood, each carrying an often conflicting collection of risk factors that no one has yet really managed to isolate or address in any meaningful way.
When I look to the future, just beyond the grey fog that is clouding my present, I see my wish for a baby, a younger sibling for Max, float up haltingly on the face of a lonely balloon. It's not a confident wish on a strong helium balloon, but one that's perhaps been lost along the way and is now just ambling along on the breeze in the background, making itself visible only when there's a small gap in those dark, grey clouds.
If there's even a glimmer of hope that I might one day be fortunate enough to find myself pregnant with another baby, I owe it to myself, to Max, and to that little being to do my very best to enjoy, not endure, the miracle of pregnancy. In order to hope that things might be different in the future, I need to do some hard work right now. Though it remains fairly likely that I would have to continue the medication I now have so many doubts about, there are some other things that remain firmly in my control that I can alter and improve. If these alone cured my depression that would be an amazing result, but even if they lessen its impact or duration, or do absolutely nothing at all, I have nothing to lose and everything, potentially, to gain.
I've worked with psychologists for well over a decade now with the gritty, messy, emotional side of mental illness - its origins, its triggers, its impacts. I can say with some confidence that I'm a very self-aware, reflective person as a result of all of this mind work, and that I definitely live a deeper, more rewarding life because of it. Still, though, after a lifetime of therapy, my depression recurs. I've built a thousand different weapons to fight it, but sometimes the ongoing battle to stave it off is more exhausting than the enemy itself. As strategies in a war, the avoidance and re-framing techniques I've learned through cognitive behaviour therapy don't do much to relieve the tensions. Rather, they prolong the state of war until you're so run down you have no other option than to surrender.
It's taken me a long time to come to terms with the fact that any therapy or mind work I've done has not cured my depression. It has never gone away, although it has given me relatively long periods of reprieve at times. I'm tired of the fight, and scared of the impact of its repeated negative outcome, so I'm changing tactics. I'm not going to try and eliminate the enemy but rather to accept it as an ever-present foe and get on with my life nonetheless. Looking forward, I will be working on a combination of mindfulness practice, which I am very familiar with already, and Acceptance and Commitment Therapy (or ACT) as a way to better live with the demons on deck of my ship and stop wasting my energy trying to push the bastards overboard. For those interested in ACT, Dr Russ Harris's book The Happiness Trap is a fantastic resource that explains it in layman's terms. I have read it innumerable times and always it has re-grounded me and reminded me that expecting life to be happy and free of suffering is an unrealistic fairytale.
For the first time ever, I now also have a list of practical ways I can better support and nurture my mind and body that don't involve simply talking about my feelings - not even once! This coming week is the first where I will try wholeheartedly to implement them all to the best of my ability. It is, I know, going to be a tough and tiring week. Here is a brief description of what my new 'wellness' plan entails:
- Mindfulness meditation each and every day. This practice aims to strengthen the brain's neo-cortex, the part that's responsible for reasoning, and which does not operate as effectively as it should in depressed people. Daily practice of these meditation principles teaches you to be more aware of which parts of your brain are in control and whether you should pay any attention to the stories each part will inevitably tell you throughout the day.
- Vitamin supplements. There are a couple of vitamins that have been identified as being complicit in making nerves and brains work correctly, and whose deficiency have been linked to some kinds of mental illness. These are: B Vitamins, Vitamin D and Omega 3 fatty acids.
- B Vitamins: I have pernicious anaemia, which means that I cannot properly absorb Vitamin B12, so I'm already at a distinct disadvantage in this area. This condition is in itself associated with higher rates of depression. B complex vitamins are needed to manufacture serotonin, melatonin and dopamine - all the feel-good chemicals that are needed to regulate our moods and cycles. B vitamins are destroyed by things like refined sugars, which make up so much of our modern diets, so it's really easy to become deficient in them.
- Vitamin D is also something that I am deficient in. You probably are too. The slip, slop, slap campaigns have been so effective that no one wants to go outside anymore, despite the fact that we know that like plants, we need sunshine to grow and thrive. Vitamin D deficiency has been linked to a variety of serious health conditions, including multiple sclerosis, as well as depression.
- Omega 3 fatty acids are essential for normal brain development and there is increasing evidence that it can improve the symptoms of depression and bipolar disorder.
- Time outdoors - at least an hour a day. This is important not just because it aids the production of Vitamin D in our bodies, but because we need daylight to set our biological rhythms. There's also the added benefit that if you're outside you're more often than not walking or being active, which brings me to my next point...
- Exercise - at least 30 minutes a day. Swimming is good as it's rather meditative in itself, but walking is good too. This, along with good nutrition, are obvious contenders as medal winners in the wellness battle. Both reduce the work your body has to do to keep you functioning. As I found out when I was pregnant and suffering for months with hyperemesis, being physically run down has a significant impact on the way you feel.
All of these, I know, sound just like common sense - things that everyone should do as a matter of course. But I've never had a reason before for making these small things count, and for measuring the changes they might bring in a real and tangible way.
This week it is my homework to figure out how I can practically incorporate each of them into my life on an ongoing basis - how I can make sure I get the exercise even when I don't feel like it; how to take time for the meditation no matter how busy I am. This is going to be the hard part, as so much is hard when you change your routine. We're creatures of habit and habits are hard to break. But they're not as hard to break as babies are to lose. I will do everything I can, no matter how small or seemingly inconsequential, to stay well for my baby Max and to show him how much he has changed my life in the most positive and meaningful of ways.
