Let me introduce myself: I myself am a psychiatrist, and I take pride in being able to diagnose and treat mental health issues during pregnancy and the post partum period.I would have liked to believe that this somehow made me immune to postpartum depression, as though I could have seen it coming from a mile away and could have warded it off.
I approached the topic of post partum depression from a very academic, intellectual place, since I had spent years reading about it in textbooks, understanding it from a biological and psychological place, and hearing painful accounts of it from my patients. But somehow the therapy comes from a different place when it is driven by the depths of your own experience.
After nine months of a blissful, uneventful pregnancy, I had an emergency c-section when the baby’s heart rate dropped. Although I imagine I should have or could have been thrilled with the prospect of simply having a healthy baby, I just found myself in a fog afterwards. In the days following his birth, I tried my best to understand what others were seeing when they said he was a beautiful child. The reality is, I couldn’t see anything past that fog. One time, I found that I didn’t have the energy or motivation to get up after he made a dirty diaper; I am ashamed to say I waited a few hours for the nurse to discover it and change it herself. I was haunted by the image on the box of Huggies resting on the bedside table; there was a grinning baby held by his mother, who had such a look of serenity and love on her face.
My family and friends started to notice. Many friends, all of whom expressed such excitement at meeting my first born child, started to wonder when I would allow them to come over to meet him. The answer was that I didn’t know when I would feel well enough to allow this to happen. It seemed like such a chore to even get dressed in the morning and to put on a smile to meet people, to give off the semblance of the romanticized mother-baby experience that we are all so convinced we will have. I remember bursting into tears when my father said his next trip would be to another town for work; “How could he even think of traveling anywhere except to see me?”, I wondered, and my father became alarmed.
And the breastfeeding, oh the breastfeeding. Early on, my son chose not to cooperate with the whole breastfeeding process, struggling to latch and impatient about waiting for the nourishment that would still take longer to come. But society teaches us that breast is best, that this is the most wonderful and natural thing we could offer our babies. So what happens to those moms who simply cannot or choose not to breastfeed? Is that some sort of epic failure early on in motherhood, a sure indication of many failures to come as a parent?
A rock amidst the choppy waters - it’s what we psychiatrists aim to be. We strive to be the calm that our patients need during their darkest times. But in those moments, I found myself immersed in the deepest of those water, grasping for anything that would give me a moment of relief.
How could this happen to me? I felt like I should know better. I felt like I should be armed and immune against anything aside from total health and happiness in my post partum state.
The reality is that post partum depression does not discriminate. Although it can impact certain groups of people more than others, it really can happen to anyone. It doesn’t care whether you’re younger or older, rich or poor, healthy or medically complicated. Frankly, it didn’t give a hoot that I was a psychiatrist either. It arrives, often unannounced, angry and ready to plunge us into a vortex of sadness and irrationality. It drives a wedge between us and our friends, family, partners. It leads some of us to act dangerously, towards ourselves and our newborns. In fact, around 80% of women postpartum report mood changes, and about 15% go on to experience post partum depression.
And yet, we cannot talk about it. The reality is that we’ve spent the better part of the last nine months preparing for this beautiful experience. We’ve had the baby showers, sifting through countless names to find the perfect one, reading numerous books on parenting philosophies to find the one that seems to fit you best, wondering how you’re going to do anything productive on your maternity leave when all you want to do is stare into those gorgeous little eyes. And now this - is this the ultimate failure? It’s hard not to believe that it is, although the world and the medical society in particular have started to truly understand it for what it is: an unfortunate but common medical phenomena, one of the most common side effects of pregnancy.
Often times women, many of whom are physicians as well, have come into my office seeking help for such symptoms, many of whom are shocked that it could ever happen to them. Many describe the struggle to keep their symptoms a secret, trying so desperately to maintain the image of that idyllic beginning of motherhood. There is a strong sense of shame and stigma surround post partum mental illness; likely some of this stigma is perpetuated by the pressure placed on mothers to do it all and appear happy.
Depression and anxiety during the post partum period need to be taken seriously, by the post partum mother, her partner, her family and her physician. The reality is that it is everybody’s job to compassionately support the mental health and wellbeing of the mother and her baby. Untreated postpartum depression can have terrible consequences. These mothers are less likely to get post natal care and more likely to use drugs and alcohol to self medicate.
Luckily, postpartum depression is very treatable. In many of cases, these women can opt for talk therapy, which is often sufficient and a great source of relief and support. In some cases, we might have to also add an antidepressant. Many patients, including those in the medical field, can be wary of taking antidepressants during the post partum period, especially if breastfeeding. However, when I present the data regarding the risk profile of antidepressants versus the risks of uncontrolled depression or anxiety during pregnancy, many of my patients feel more confident in opting to add an antidepressant as part of their treatment.
Depression at any stage of life is an unfortunate and debilitating experience, and I am not glad to have had it, especially during a time I would have wished to have enjoyed bonding with my baby. However, I suppose that this could be viewed as an extension of my training, an opportunity to have experienced what many of my patients experience. Sometimes when my patients are in their darkest times, I express to them that I can see the light, the relief, at the end of this tunnel, and that they have to trust me that we can get there. As I write this and pause frequently due to the interruptions of my now three year old rambunctious toddler smiling up at me and vying for my attention, I smile back and am grateful that I reached the light at the end of my tunnel.