These were not the “baby blues.” Three months after giving birth to her first child, Sally cried most of the time, hardly left the house, and felt she couldn’t adequately care for her baby. She might have been right about that.
Up to 80 percent of new mothers feel vulnerable or have crying spells, and often they get irritable or restless – “blues” that usually pass on their own. But Sally was in a postpartum depression. All forms of depression can be debilitating, and 10 percent of Americans have it in any given year – twice that for the first year of motherhood.
Sally was too ill to call me. It was her mother, frightened and pleading, who spilled out her worries. Whenever she offered to help with the newborn, Sally would refuse, saying mothers are supposed to take care of their own babies. This type of response is not unusual for someone in the throes of postpartum depression; nor is extreme agitation or panic attacks. Many are afraid both for the baby and of the baby. A small percentage develop a psychosis that can include delusions and paranoia.
When I saw Sally several days later, however, her most noticeable symptom was to constantly berate herself for being a bad mother and a worthless person. Depression’s typical shame and guilt get compounded when felt as a mother’s inadequacy – so much so that the vast majority never seek treatment.
In my office, Sally did nothing but cry for the first 10 minutes. When she caught her breath, this 28-year-old woman said that although she had been anxious during pregnancy, she was looking forward to being a mom. But when the baby came, her anxiety turned into fear so overwhelming that she felt incompetent to even protect the child from harm. She stayed up all night worrying that she would lose the baby – and wondering if that was her real intent. It all fed on itself, she withdrew from the world and got worse.
We don’t know the exact causes of postpartum depression, but Sally had several risk factors. She had a history of insecurity, and was treated for depression in high school. Her parents divorced when she was 7. And she was a single mother. None of these is a cause, but they increase the risk.
After a few sessions, Sally understood that her nightmare was about hormones, genetics and exhaustion (and plain bad luck), nothing more. And that she had a treatable, surprisingly common illness. This helped her feel less ashamed, which in turn enabled her to share some of the baby’s care with her mother and a few close friends while she rested and recovered.
The big question in postpartum depression is always medication: What happens if it gets into breast milk? Research has shown that antidepressants do get into breast milk, although some release only minimal amounts. And there are risks to the baby from not taking medication – a mother’s depression and agitation can create bonding difficulties that may have lasting effects.
After consultations with her obstetrician and a psychiatrist, Sally opted for a newer antidepressant. Although she didn’t feel the full benefits for about a month, her anxiety began to diminish, as did her need to isolate. A sense of relief came quickly. Joining a support group would have been helpful; pressed for time, she found one online.
Sally did well, and so did the baby. Toward the end of the three months that we worked together, I suggested some ways that she could lower her risk of future episodes. All mothers must take extra care of their bodies, but this is especially true for women with a history of depression. Exercising, healthy eating and sleep should be high on the priority list. Meditation, yoga and massage also contribute to balance and well-being.
Key to Sally’s success was learning that depression is a disease of the brain, not of one’s character. She had an illness, she suffered, she needed care. Sometimes it’s that simple.