I’m a little ashamed to admit that I didn’t know how prevalent postpartum depression and other perinatal mood disorders were until a couple of years ago when I experienced it myself. As a therapist, I’ve worked with people suffering from these conditions in my clinical work but it all became much more real for me once I had my son in December of 2019 and I was thrust into my own bout of postpartum depression and anxiety.
In hindsight, I’m not surprised; I’ve always been sensitive to normal fluctuations in hormones, but because of my training as a psychotherapist and someone who has a lot of support and internal and external resources, I assumed I’d be protected from the baby blues. I was pretty disillusioned when I was holding my 6-month-old, weeping from the struggles of breastfeeding and truly believing that he might be better off without me.
Just writing that last sentence fills my eyes with tears. Even though my son is now 2 years old and I’ve mostly recovered from postpartum depression and anxiety, the memories of that time are still very close and visceral. And it is why I’m so passionate about supporting other people who are navigating this particularly challenging transition.
My own experience with postpartum depression was also compounded by PMDD-Premenstrual Dysphoric Disorder which is not uncommon. About 6 months postpartum, triggered by weaning from breastfeeding, my menstrual period came back. I was surprised it was pretty regular and though there were some differences from pre-baby menstruation, it wasn’t as bad as I had imagined it would be.
However, after a few cycles, I felt the early indications of PMDD. Looking back, I’d always had pretty gnarly PMS symptoms but they were usually only a few days and I could kind of isolate myself and work through it. But now, my symptoms were stretching to 10 days or more and I had a tiny person who depended on me every single day, no matter what time of the month it was. I kept figuring it would kind of balance out as my cycle found its groove again.
About a year later when I found myself screaming at my partner again and those familiar feelings of thinking that he and my baby would be better off without me, I knew I needed more support. I was already regularly going to therapy, something I think is beneficial for almost anyone, especially therapists. I was doing all kinds of processing around the birth trauma and the trauma of early postpartum both with trusted friends and a variety of professionals as well but I still felt like I was spinning and knew I needed something else in addition to what I was already doing. I found this additional support in the form of microdosing and ketamine assisted psychotherapy (KAP).
Postpartum: Ideal vs Reality
Ideally and historically, postpartum is a time when the birther can be wrapped up in their cocoon with their baby to rest and recover while the community takes care of them. Many cultures have rituals to support the new parent in this precious time such as “lying in” where a birther is relieved of all household duties (Johnson, 2017). Postpartum is a time of deep integration after a profoundly transformative ordeal.
If you think about psychedelic journeys, often it is recommended to integrate for weeks or months afterward to glean all of the lessons that were illuminated and to me, birth is a potent psychedelic experience (Kincaid, 2021). Ideally, people are there to help hold the baby or cook dinner while you snuggle your baby. There are quiet witnesses present when you need to share an insight about the ordeal you just went through and to reflect how amazing and strong you are.
It’s also a time for the birther and the newborn to deeply integrate their new roles and skills, such as nursing and learning from each other. Ideally (and more common historically) before trying to nurse, the mother has seen people nursing their babies and heard about the challenges before you’re crying from a shallow latch while watching youtube videos about how to get your baby to bite into you like a sandwich. Better yet, while you’re waiting for your milk to come in, an experienced mama could nurse your baby and show them how it’s done while their baby, with a more experienced and stronger latch, could help call your milk in.
In western cultures, we’re lucky if we get a few weeks of unpaid time off of work and a meal train after giving birth. And the pandemic made new parenthood all the more isolating than it already is. On top of processing an often traumatic and extremely non-ordinary state of consciousness that birth is, we are left to figure out breastfeeding, usually alone, in the wee hours of the morning while our hormones are still balancing. We also have to navigate very polarizing advice and often shaming messages about the best/only way to parent.
It’s a struggle to stay connected to your intuition and to be resourced enough to assert what you need, especially when you really don’t yet know what you need. You’re walking out of the labyrinth of birth and you can’t see the path. It’s no wonder that 1 in 7 women may experience postpartum depression in the year after giving birth (postpartumdepression.org).
What is PPD and what is the prevalence?
The postpartum period is characterized by a rhythm shift that can feel (and look) a lot like depression. Those that have struggled with depression in the past may be triggered by feelings or actions that are normal or even necessary in postpartum such as not showering and staying in your robe all day, disengaging from day-to-day duties or social obligation.
We are primed hormonally to protect our babies, so you’ll be more sensitive than usual to energy and words. Things that wouldn’t normally bother you might get under your skin. Approximately 70% to 80% of women will experience the ‘baby blues’ and the reported rate of clinical postpartum depression among new mothers is between 10% to 20%.
Keep in mind, these aforementioned prevalence rates are only based on the people who report these feelings. They often go unreported because it’s so rarely talked about, though I hope that’s changing. So many people struggle with them but feel ashamed and stay quiet about it. Many people get shut down if they start to share what’s hard about being thrust into their new role as a parent and get bombarded with messages about how this is “such a blessing” and “these are the happiest days of your life so try to enjoy them”.
But it’s not an either-or situation. It is possible to feel profound joy and gratitude for your baby AND profound grief about your new identity and the loss of your old life. No one tells you about the grief that often accompanies parenthood and we often collectively gaslight ourselves into thinking only the positive emotions are to be shared and the hard ones are to be treated or eradicated. I can’t tell you how healing and affirming it is for people to share about the sadness and grief they feel about becoming a mother and that doing so permits others to share about theirs too. When these heavy emotions are brought out into the light, they can move and be transmuted.
Motherhood, even when it’s going well, is full of grief. I heard a quote somewhere that “grief is the mother of all emotions” and it helped me be more willing to sit with the grief that I think is normal but often unacknowledged which then becomes sublimated and suppressed. Postpartum depression is a trauma that has far-reaching effects, it creates a seed of doubt that takes years to overcome.
Parenthood is full of duality, the most difficult and most beautiful experiences. You can’t get enough time to yourself but you miss your babies once they go to sleep. A common saying that new parents hear is “the days are long but the years are short” and I’ve found this to be true. Time is distorted just like in non-ordinary states of consciousness. Birth expands your energy field allowing you to open to greater wisdom and strength but need to shrink it back to a manageable size for day-to-day life.
What is PMDD?
I’m not suggesting that pregnancy and birth or postpartum depression (PPD) cause premenstrual dysphoric disorder (PMDD), but many women who are sensitive to hormonal fluctuations might be affected by both. In my case, I do believe that lingering postpartum depression lowered my ability to cope with the hormonal changes of my returning menstrual cycle, and anecdotally I’ve heard similar experiences from hundreds of other women in a large support community I am a part of. For this reason, I am also a passionate advocate about supporting people with PMDD.
PMDD is characterized by mental and physical symptoms in the 7-10 days before the onset of menstruation. It’s more intense than PMS and it’s estimated that it affects 3-7% of women of reproductive age which translates to millions of women worldwide (Halbreich et al, 2003). Symptoms include mood swings, tearfulness, sensitivity to rejection, irritability or anger, depressed mood, hopelessness, self-deprecating thoughts, anxiety, loss of interest in usual activities, lack of energy, changes in appetite or sleep, and suicidality. This syndrome differs from other mental health disorders in that symptoms are absent at other times of the month.
The etiology is still unclear about why some women struggle with this disorder and others don’t. Some believe it is a combination of genetic factors, stress, and normal hormonal fluctuations, especially the declining levels of estrogen during the luteal phase (the final phase of the monthly menstrual cycle). PMDD can cause substantial and often severe signs of depression for days or even weeks every month. To make matters worse, many women with PMDD do not respond to the traditional treatment options.
Psychedelics as an Alternative Treatment
There is no doubt that microdosing and psychedelics are having a moment. Microdosing for postpartum depression and PMDD feels somewhat newer than the conversation on microdosing in general. I think historically many mothers have been afraid to share about exploring psychedelics or microdosing for fear of being labeled as a drug-using, inadequate mother. Women, especially BIPOC women have had their children taken away in the hospital simply for testing positive for cannabis despite its recent medicalization and legalization.
I know for me, doing my own ketamine assisted psychotherapy (KAP) changed my life and helped me heal from some postpartum induced anxiety and OCD. In my first KAP session, I recall the feeling (and the imagery) of my neurons being stretched and pulled like taffy. It felt like yoga asana for my brain and I literally felt more spacious afterward. I went into the first session with the intention to get to know some of my ruminations and hopefully understand why I had a hard time letting them go. But instead, it felt like I had just forgotten what it was that I was obsessing about, they were just gone and I didn’t even want to try to look for them to understand them.
Microdosing protocols are ever emerging and though there are some commonly accepted protocols, many of them are more intuitive and it’s recommended to find what works for you individually. Often these protocols are found through personal exploration and sharing results by word of mouth by other professionals or friends. Again, there are very limited papers or research on the matter.
There are almost no articles about microdosing ketamine and any talk of microdosing ketamine is passed around word of mouth. One mentor told me to take a quarter to a half of a 100mg lozenge of ketamine, swish for ten minutes and just lie down and listen to music for an hour on consecutive days during “hell week”.
Another mentor shared that anecdotally they are seeing good results for low-dose ketamine lozenges for hormone-related issues in their clinic. Their protocol involves using a low dose (25-50 mg of the RDT) daily for 7-10 days (most only need it 3-4 days but it depends) and then taking 7 days off of the medicine entirely. During the low-dose protocol, some also do a bigger dose (200-300mg RDT) as needed.
As I was writing some of this article I was sitting in the hospital with my friend in a long slow labor. I was thinking about what kinds of wisdom I want to impart to her, my former self, to all people transitioning into motherhood. Thinking about how I so desperately longed for a guide and companion during my transition to motherhood that would leave room for all of my doubt and grief but also who could assure me that I would re-emerge, that I would make it out of the disorienting labyrinth of the early days of postpartum.
After her baby came, my dear friend asked me about when the baby blues would set in because right now she's just so happy. With tears in my eyes, I said “Maybe never! Maybe it won’t happen for you!” And I truly hope that it doesn’t. As I said this to her, there was a twinge of sadness and pain for my own harrowing experience.
Part of me longs for the blissful baby vortex that I was hoping to have and that so many women probably do have, especially if they are well supported by their community. And then I sense a familiar feeling of disappointment that it didn’t happen like that for me. But a larger part of me knows it was perfect the way it was; that my postpartum depression was a spiritual emergency that woke me up to living and loving with more presence. And I’m grateful that I had all these tools, including entheogens as my guides along the way.
About the Author: Kate Kincaid is a licensed professional counselor in Tucson, AZ. She runs a group private practice that specializes in working with LGBTQIA+ clients, people in ethically non-monogamous relationships and people seeking psychedelic integration therapy. She has long been interested in non-ordinary states of consciousness and believes in the healing wisdom of plant medicines.
She is currently a student in the CIIS Center for Psychedelic Studies and Research and her practice has applied to establish eligibility with MAPS PBC to offer MDMA-Assisted Psychotherapy if it becomes an approved treatment. In the meantime, she works in collaboration with providers doing Ketamine Assisted Therapy. Kate’s therapeutic style is informed by feminism and social justice, seeking to help collectively dismantle systems of violence and oppression. She believes that many issues clients come to therapy with are rooted in a logical response to an oppressive system that is then pathologized and stigmatized.
Instagram @okatekincaid or @tucsoncounselingassociates
Grace SL, Evindar A, Stewart DE. The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Arch Womens Ment Health. 2003;6:263–74.
Halbreich U, Borenstein J, Pearlstein T, Kahn LS. The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology. 2003 Aug;28 Suppl 3:1-23. doi: 10.1016/s0306-4530(03)00098-2. PMID: 12892987.
Johnson, K.A. 2017. The 4th Trimester. Shambala Publications, Inc.
Kincaid, K. (2021, August 24). Birth as a potent psychedelic space: A three part model. Psychedelic.support.https://psychedelic.support/resources/birth-potent-psychedelic-space/?mc_cid=5184ff51db&mc_eid=eefa458ca3
Wolfson, P. Cole, R. Lynch, K, Yun, C., Wallach, J., Andries, J., and Whippo, M. year The pharmacokinetics of ketamine in the breast milk of lactating women: Quantification of ketamine and metabolites. Authorea. February 13, 2021. DOI: 10.22541/au.161325028.80476344/v1