The good news doctors will tell you about postpartum depression (PPD) is that it isn't terminal. The bad news, I can tell you, is that it most definitely feels that way. And like some kind of slow-growing cancer, postpartum depression has a way of creeping up on its victims, who usually discount or ignore the symptoms until the day when they realize they can't.
For me, that day came one week after the birth of my second daughter, Kate.
I hadn't felt like myself for a couple of weeks; but then again, what nine months' pregnant woman -- or newly delivered mom -- does? I cried as I loaded laundry, as I helped myself to the salad bar at a restaurant, as I did a puzzle with my preschooler, Anna. I cried when I said goodbye to my husband in the morning, and I cried when he came home at night.
But in the weeks before and after the birth, I was also finding sleep increasingly difficult. And so I blamed my tears on exhaustion and hormones, and everyone around me seemed to agree. What I didn't tell anyone—and what I didn't want to acknowledge—was that along with the tears, I had to constantly reassure myself that I loved being a mom. I could remember that I liked it, that I'd wanted two kids, and that I'd been eager to have a second go at long days snuggling with a newborn. Trouble was, I couldn't feel those feelings again.
And then, one night, I didn't sleep at all. My mind was jumbled, cluttered, racing. What would I fix for lunch for my daughter's preschool? How would I manage trips to town -- an hour away -- with two kids? Who would I get to babysit next summer? How old would I be when Kate turned 40? I listened to the rhythmic breathing of my husband and my baby, wandered into Anna's room to see her sleeping soundly, and returned to my own bed where I found no comfort. As I restlessly kicked and turned and tried to sleep, struck with hot flashes followed by chills and nausea, I became increasingly frightened. Was I sick? And if so, what was wrong with me? When it was finally light enough to count as day, I woke my husband up and told him there was something wrong. He took my temperature. It was normal, but I clearly was not.
Trying to Bounce Back
I began to cry uncontrollably over pain I couldn't accurately describe to him. It seemed both physical and mental, and since it was a Saturday, my husband called the hospital. Physically, he reported to the doctor, my recovery after birth had been exceptionally swift: I had lost weight almost immediately and had little pain related to the birth. At the same time, I was clearly in more distress than he had ever seen me. I could barely stand in the shower, and getting dressed required his help. An hour later, as I sobbed in the doctor's office at the hospital, almost unable to speak through my tears, the doctor had no doubt that I was far from well. My tears, my weight loss, and my difficulty sleeping— especially the early morning wake-ups—were telltale symptoms of postpartum depression.
Having never suffered from depression of any sort before, this diagnosis had me instantly defensive, horrified by the prospect of being mentally ill, and insisting that a little rest would get me back on my feet. In my mind, depression was for the weak, the troubled and unhappy, the down-on-their-luck, descriptions that certainly didn't apply to me. Instead, I told everyone I was simply exhausted. People are always hospitalized for that, aren’t they? Surely a pregnancy that had made it difficult for me to eat or drink for months on end was the culprit. I managed the strength to talk and make a few weak jokes, declined the antidepressant medication that the doctors and nurses were recommending, and worked to make myself appear strong enough to be released two days later. I was determined through the sheer mental strength and will I had always depended on in times of stress to get through this on my own. What I didn't take into account was that my mental strength and will were exactly what was missing: My mind was sick, depleted of the chemicals that made it function properly, and it was obviously in no condition to heal itself.
Which didn't mean I stopped trying to do just that. Back at home, I insisted on cooking dinner, and told myself out loud as I changed the baby's diaper that I could do this, a mantra I began to mutter over and over in some kind of desperate attempt to will it so. I straightened up and tried to look and act like I remembered myself being before, as if the pretending alone would magically transform me into my pre-baby self. But my body quickly betrayed the flimsiness of my act. Simply put, I couldn't cope. The first full day back home, I somehow managed to drive my daughter to preschool, then returned to collapse in my bed where instead of sleep, I thrashed in the covers sobbing uncontrollably. The next day, I tried to go out to lunch with a friend, but couldn't stave off the tears: We left before the food arrived.
For the first time in my life, I took sleeping pills, which had been recommended by the doctor. But almost as soon as they wore off, I woke to more sobs; powerful, gut-wrenching waves of grief unlike anything I had ever experienced. They made me in turns nauseous, chilled, flushed, and tingly. My hands and lips fell asleep while I hyperventilated. As my husband and friends held me close to calm me on the bed, or, often, on the bathroom floor where I spent hour after hour huddled in blankets, it was clear that my sadness went beyond normal comprehension and certainly beyond the baby blues. I wasn't crying over any one thing, or any group of things. I was crying in utter despair, as if everything that had made my life happy, everything that I had previously loved and enjoyed, was gone.
Searching For Help
As a former camp director and author of children's activity books, I had made doing creative things with my older daughter a centerpiece of our life together. Nearly every day we would set aside time to play or draw, hike or explore. Now I couldn't think of any way to use my time with her, and even the prospect of being alone with her made me anxious and tired. What could we possibly do together? As an avid skier and walker, I was also accustomed to greeting the Montana mountain landscape out my bedroom window with joy: A big snow meant taking off for the slopes, a blue sky signified a perfect day for hiking, something I did every day with my dog. Now the weather (the day, really) meant nothing to me, except, something to be endured. I watched the dog pace, waiting for me to come out, but I couldn't muster the energy to care. And I didn't think I ever would again.
Fortunately, my memory of who I was before wasn't gone. And I wanted that person back enough to acknowledge that simply wishing that to happen wasn't going to make it so. The doctors who had so strongly recommended antidepressants had compared a severely depressed person not taking medication to a diabetic not taking insulin. Why wouldn't I take it?
In addition to the stigma I felt about taking antidepressants, I was afraid of the effects they might have if they went through my breast milk to baby Kate. But less than a week after I had been discharged, my friends and husband convinced me that the medication was what I needed. Unlike my pre-baby self, I was now indecisive, pliable, and above all, desperate to get well. For the first time in my 10-year marriage I found myself doing whatever my husband suggested might help me, a notion that in other circumstances we both would have found funny. Yet the decision to take the medication was just the beginning of my ordeal. Antidepressants can take up to six weeks to reach their full effect and in the interim, I was to plunge even deeper.
My friends and husband set up a schedule to be with me around the clock, and together we endured what seemed to me to be interminably long days. They would begin with tears and a slow group effort to get me fed and out of bed, something that was usually accomplished by lunch. Then came the afternoons, which were filled with more tears. By dinnertime, I was usually able to be out of my room and with my family, the best time of the day for me, if only because it meant I would soon be able to take a pill and go to sleep. Each night, my husband, my two daughters, and my dog slept in another room together to try to give me rest, which worked until my sleeping pill wore off, usually around dawn. And so each of my days went, with all of us counting exactly how long I had been on the medication and waiting.
Daring to Hope
For the next three weeks, I continued to feel as if I had literally lost myself. I saw Kate to nurse and hold her and tried each day to connect with Anna, encounters that invariably left me exhausted and near tears as I worried about when I would ever be able to be the mother I had once been. I tried to resume my daily schedule of walking, even if it now meant holding on to a friend's arm as we moved slowly around the block.
Gradually, my friends and husband began to see small stretches of improvement and told me they could look in my face and see the real me returning. I was impatient and dubious and continued to insist my condition was permanent. But in these clearer-thinking moments I tried to figure out why this had happened to me. Was it my hormones? The medications I had been on for the nausea and vomiting that had dogged my pregnancy? Or sheer exhaustion and malnutrition? I found the literature and the answers from the professionals frustratingly vague. While there are things that make certain people more likely to experience PPD, and while there are suspicions of the causes (hormones and other chemical imbalances, as well as a host of environmental factors), no expert could tell me exactly why this had happened to me.
At the same time, well-meaning friends and acquaintances who were not involved in my day-to-day care spoke of causes and cures that made me see exactly how difficult the depression is to comprehend from the outside. A neighbor asked if perhaps I had secretly wished for a boy. An acquaintance said my illness was completely understandable, since I'd had such a difficult pregnancy and my house was being remodeled. I was told (by more than one person) that having two children was an adjustment and that I'd just have to lower my housekeeping standards in order to cope. A dear friend suggested going to the beach, unaware that I could barely make it to the post office. And everyone seemed to want to remind me that I was older this time than last time. In the face of such debilitating depression, these suggested causes and cures would have seemed laughable, had I any sense of humor. And although these people were only trying to relate to my illness in terms they understood, I couldn't help but feel more isolated in a sickness no one could understand.
Ultimately, and as if to underscore the bizarre nature of the illness, I got well, seemingly as quickly as I had gotten sick. I was three weeks into the medication, and had been experiencing longer "good" periods each day. I was driving, turning a corner I've turned a thousand times, when I suddenly felt like myself again. I looked at the landscape around me and didn't just remember but actually felt how much I enjoyed my life. And then that night, I went to bed and slept without sleeping pills for the first time in nearly a month. Although relapses are not uncommon with PPD, I never went back after this day, in a recovery so miraculous it sometimes seems impossible to believe I could have been so sick.
In reading about PPD since recovering, I've come to learn how lucky I was. Unlike many women, who suffer for months after birth, my husband recognized that I was sick and I received care immediately, and a network of wonderful friends stayed with me until I was well. And while I was nervous and somewhat disconnected from my children during my illness, I never once wanted to harm them.
Today, I find myself changed in subtle but important ways. Now off my medication, I've found a new mission in making sure that no one I know or hear about ever suffers alone or in silence from postpartum depression. And having recovered the pleasures in life I thought for one horrible month I had lost forever, I've come back to my old self with a fresh outlook.
These days, I wake up happy simply knowing that I've slept. I take my walk at the first sign of a blue sky. I never forget how my friends and husband rallied around me when I needed them most. And although I still don't think my fast-paced life made me sick, I find that I am happier to slow down and enjoy my days with my daughters. Like a survivor of a near-death experience, it's no cliché to say I no longer take the simplest things for granted—including my current happiness. I watch myself for any signs of a relapse, still a little unnerved by the memory of my mind's recent betrayal. In the meantime, I regularly indulge in an extra chapter of a favorite book with Anna or a few more minutes of blowing raspberries on Kate's tummy. And at night, after I kiss both my sleeping girls, my dog, and my husband, I drift off, contented. I know I've survived the worst days of my life for a reason: to be free to truly enjoy the best ones.
Barbara Rowley is a contributing editor at Parenting.
When to Get Help
By Beth Howard
Here's how to tell if what you're feeling is the "baby blues" or something more serious, according to Diana Lynn Barnes, Psy.D LMFT, a psychotherapist and author of The Journey to Parenthood: Myths, Realities and What Really Matters.
Who: 3 of 4 mothers
What: moodiness, irritability, and teariness similar to PMDD
When: symptoms typically peak 3 to 4 days after childbirth and last for 2 to 3 weeks
Cause: probably the abrupt dip in hormone levels that occurs after childbirth, but women without plenty of support during this period are also vulnerable
Treatment: Baby blues are now considered a normal postpartum experience. Ask family and friends for help with the baby. Make sure to get enough rest and good, healthy food. Try to find other moms who can relate. It’s important to understand that the baby blues are normal.
Postpartum Depression (PPD)
Who: 10 to 20 percent of mothers
What: persistent feelings of inadequacy and guilt, profound sadness, difficulty concentrating, sleeping and/or eating problems, feeling emotionally detached toward the baby
When: typically occurs 2 to 4 weeks after childbirth and may continue for as long as a year postpartum
Cause: Experts think that biological, psychological, and social influences combine to trigger PPD. Major risk factors include a previous diagnosis of depression or a family history of mood disorders, ongoing conflicts with a spouse, a history of trauma or abuse, an unwanted or unplanned pregnancy, a traumatic birth experience like an unplanned cesarean section or major blood loss, or prior pregnancy loss like miscarriage or stillbirth.
Treatment: Call your doctor as soon as possible. The most effective approaches include therapy and antidepressants. There are many mood-boosting drugs that have few side effects and are generally considered safe for breastfeeding infants. Your doctor might also prescribe anti-anxiety medications or sleeping pills. Discuss options with your doctor.
Who: about 1 or 2 in 1,000 mothers
What: a life-threatening emergency that requires immediate medical treatment, including hallucinations or delusions, agitation, restlessness, and serious thoughts of suicide or harming the baby. Five percent of women will commit suicide, 4% will commit infanticide.
When: usually within 3 to 4 days after delivery
Risk factors: Personal or family history of mood disorders, such as bipolar disorder or schizophrenia.
Treatment: hospitalization and antipsychotic medications (Zyprexa) and/or a mood stabilizer (Lithium) or antiepileptic drug (Valproate)