My four week old lay playing on his blanket, pumping his arms and legs as he watched the mobile I made. It twirled in the gentle breeze blowing in from the open windows while I sat next to him on a floor pillow, talking to my mom.
“I just don’t think I feel right”, I said.
The second child is different, they said. Maybe it was just because I was balancing taking care of toddler and baby, they said. Maybe it was just the baby blues, they said. You’re just tired, they said. It will pass, just give it time, they said. Once your hormones settle down you’ll feel better, they said.
There it is: the ubiquitous “they”. “They” was everyone and no one at the same time. It was a “they” that was a supposed knower of things. This anonymous source, a catchall for advice, made family and friends feel like they were saying something helpful, something proven, something known. Well-meaning, I’m sure, these offerings of advice intended to make me feel better (or to make the person saying it feel better), but it did the opposite. All I wanted was some validation that I wasn’t any crazier than I was already feeling, for someone to acknowledge my suspicions instead of diminishing and dismissing them. It was incredibly disorienting to experience and I am not sure that even now I can accurately describe how it felt to feel something was not quite right and have it justified into oblivion by those around me.
As I had rounded the corner on postpartum week three, a subtle nagging feeling persisted. My intuition continued to nudge me. I was curious: did I have postpartum depression? Late night google searches led me to postpartum depression screening quizzes and blog posts and articles about extremes. No, I didn’t want to kill myself or harm my kids. Yes, I was still showering and brushing my teeth and eating. So, where did that leave me?
The symptoms of my postpartum depression were more insidious than I expected which made it harder for me and those around me to realize it, to accept it. I felt detached. Empty. Disconnected. Apathetic. Quick to anger. Irritability would roar up unexpectedly, so swiftly that it would take even me by surprise. I would retreat to cry; confused and bewildered and sure that I was just a terrible mother. A terrible wife. A terrible person. I didn’t want to harm myself. I didn’t want to harm my children. I was still diligent with toddler and baby: changing diapers and clothes and breastfeeding on demand and rocking to sleep and holding baby for hours when he didn’t want to be put down and doing bath time and story time and singing songs. But I felt like I was babysitting someone else’s kids. An empty robotic shell of a mother. Like a Stepford Mom: smiling and functional on the outside and dead on the inside.
There is a pervasive reference to “baby blues” in postpartum land. I argue that this term may do a disservice to women postpartum; that it opens the door to normalizing depressive symptoms and delaying recognition and treatment for women who are suffering. Suffering. For weeks. For months. I remember coming across this chart from Running in Triangles during a late-night Pinterest surfing session:
This is what helped me to start to see that what I was feeling was not normal.
Normal is a tricky word. I paused as I wrote it just now. Postpartum depression is not a normal physiological state. But it is common; so, so, so common. One in seven women, and one in ten men, have postpartum depression. And those are just the ones who manage to recognize their symptoms, and then share that with their provider, and who are then properly diagnosed. So, that number might be even higher. Like, way higher. I have been completely surprised by the number of women that I when I casually mention that I have postpartum depression, say:
“Oh, yeah, I did (or do), too. I remember…” and then proceed to tell me their story.
These stories fall on a spectrum as varied as the rainbow; anxiety to apathy, sadness to anger, eating too much, not eating enough. Insomnia. Crying all the time. Afraid to leave the house. Feeling trapped in the house, suffocated by a vague overwhelming pressure. And those are just the stories they shared in passing, in brief conversations. Some got by with great social support, others needed medication, or counseling. Or both. All of these women – all educated, most in the healthcare field in some way – had one thing in common: it took them weeks, sometimes months, before they realized that something was not right. Before they realized that this was not normal. Before they got up the courage, the strength, the will to seek out the support and treatment they needed. And they suffered, needlessly, because we are not talking about this the way we should be.
Five weeks postpartum, I headed out to the requisite one (yes, one!) postpartum visit – I’m looking at you with jealous eyes, Switzerland! – baby screaming all the way as I cranked the air conditioning to stave off the 104 degree heat beating down. I will pause here to mention, because I just can’t get over it on many levels, that my beautiful friend who lives in beautiful Switzerland with her beautiful husband and beautiful new baby gets sixteen (sixteen!) weekly postpartum visits. By a midwife. Of her choosing. To her house. TO. HER. HOUSE. For free. And I’m over here, sweating – and not so much because it was 104 degrees, but because I had (and still have) hormonal postpartum sweats that rivaled the combined perspiration of a thousand Ancient Roman foot soldiers – as I hauled a crying baby in and out of a car, up the stairs, to frantically try breastfeeding to calm baby while waiting in a waiting room to see the wonderful midwife of my choosing.
As I waited in the exam room, I looked down at the generic depression questionnaire the medical assistant had given me; holding the clipboard in one hand and my beautiful breastfeeding five week old in the other and, blinking through the tears that welled up in my eyes, I filled out the PHQ –9. It asked: Over the past two weeks, how often have you been bothered by any of the following problems? and I was to answer by assigning a frequency. As an old friend and I recently joked, not only was this questionnaire cold and disingenuous but the questions were definitely not postpartum friendly. One could almost muster a laugh. Feeling tired or having little energy? Uh, yeah. I have a 5 week old who cluster feeds all night. Poor appetite or overeating? Well, I am breastfeeding so I am basically Chris Farley’s SNL Gap Girls character in the fries sketch. Trouble concentrating on things? Yep. Mom brain is so real I’d lobby for it to have its own ICD-10 code. This is part of what makes it so hard to suss out what is normal postpartum because it is normal to be tired, to be emotional as your hormones surge and plummet, to feel urgently hungry while breastfeeding. When I finally finished the form, I was so overwhelmed and exhausted from the effort and stress to get there, nervous to broach the subject, and anxious of how what I had been feeling would be received that I just wanted to crawl in a hole.
Choosing a provider you trust is so important. In hindsight, my anxiety about this discussion was unfounded because the midwife I chose to see I knew to be kind and professional and good at her job. I tried to keep my brave face on, even for her in the privacy of the exam room, but it didn’t last long. Tears that had welled up broke free and rolled down my cheeks as I recounted the feelings of apathy, the irritability, the disconnection. She told me that too few women get the help they need; that she was proud of me for recognizing the symptoms, for speaking up, for asking for help. We discussed my social support, counselling options, medication. She thoughtfully and respectfully discussed my hesitation to take medication; I was (and still am) breastfeeding and concerned about what impact it might have on baby. Zoloft is one of the most, if not the most, well studied medication for postpartum depression in breastfeeding women. Assuaging my fears, Zoloft well surpasses the 10% threshold with only 2.5 to 5% of the medication reaching the breast milk. In the end, I left with a sense of relief, of validation, and a prescription for Zoloft. My intuition had been right – something wasn’t right. But it wasn’t my fault.
“So, how do you feel about it?” my husband asked, his voice crackling on speaker phone as I drove back home through the sweltering heat. I had just been officially diagnosed with postpartum depression.
“I don’t know,” I said. “I guess I feel validated but… I don’t know”.
Validated but vaguely… ashamed? Guilty? Dramatic? I felt embarrassed for anyone to know that I, the high functioning woman who valued being perceived as having everything dialed in, was struggling. But I also ached for comfort, for support, to say it out loud to someone and have it be okay. Stigma around mental illness is so prevalent. Even typing those two words – mental illness – makes me hesitate, like they are too severe for what I am talking about right now. For some reason it is challenging for us to collectively wrap our heads around the fact that it is a disease process and not the fault of the person, not a choice. I have been trying to pin down just what exactly made me feel like I had to qualify it. In one of my late-night Pinterest perusal sessions, I came across some interesting quotes regarding this. Here is one:
“Telling someone ‘Why are you depressed? Look at how great your life is!’ is like telling someone ‘What do you mean you have asthma? Look at all this air!’.”
I reached out to an old friend before I told anyone beside my mom and my husband, to check with her that the email I was going to send a few women close to me asking for support sounded okay. She called me back and left a voicemail. She, with a newborn of her own, was on her way to buy a couple of essentials before traveling with baby later that day: Clorox wipes and panty liners – now there’s a name for a mom blog if I ever heard one. She said,
“I think that’s great, I think it’s totally great but I don’t think you have any explaining to do for yourself at all.”
But I couldn’t fight the urge to explain it, to contextualize it, to make it seem less weird, less intense, less…whiny. Postpartum depression is not weird. It can be intense. And I did feel like other people would think I was whining about it, making a bigger deal about what people think are the normal challenges of new parenthood. Here’s what I sent:
“My midwife recommended I reach out to a few trusted people in my life- I have postpartum depression. I started treatment and am slowly feeling better. 1 in 7 women struggle with postpartum depression and, as in my case, its symptoms can be more insidious than the stuff that reaches headlines. I usually have trouble asking for help and I feel uncomfortable talking about this but studies show that increased social support is a big factor in helping reduce and treat postpartum depression which is why I am reaching out to ask for your support.”
I even included a link on how to support a woman with postpartum depression, just to hedge my bets. And I lied: my midwife hadn’t recommended I reach out but saying that made it feel like I was only asking because my midwife told me to, like I was just following orders. To send a plea like this otherwise, well, I don’t think I could have done it. As it was, the pit in my stomach gnawed at me as I waited for a reply. One of my aunts responded and, among other kind loving things, said this:
“As you know, there is no shame in having postpartum depression. It is a mix of a chemical imbalance and your hormones that is unique to you”.
Even now I tear up reading that. I did know this. Intellectually, as a nurse and an educated woman, I knew this but I still felt ashamed. Waves of guilt and dread and failure rose up and crashed down on me. Sitting on the couch, I stared at the bottle of Zoloft – my bottle of Zoloft – trying to figure out where I went wrong.
I thought I had been proactive and I had. Knowing that I had some predisposing risk factors, I had conversations in late pregnancy with my husband about the fact that I was a risk for postpartum depression and what my strategies were going to be. I even recall seriously discussing moving our bed nearer a window. I knew I would be lying-in for most of the first week – I thought seeing the trees and having the sun shine in on me would be helpful to my state of mind. I recalled that being so nice after the birth of our first child. But raised eyebrows, sighs, and hesitant agreement from him made me change my mind. Maybe that was going a little far. I decided to set realistic daily goals for myself: sleep when baby sleeps, stay hydrated, eat healthy snacks, and do the following daily: shower, brush teeth, put on clean clothes, and get outside.
To someone who has not experienced the disorienting fatigue that comes with a newborn that list may seem ridiculous – ridiculously easy. But I assure you, at least for me – and validated by other new moms – this list was deceptively difficult to achieve, depending on the day. I wanted to be able to feel that I had accomplished something for me, something that had nothing to do with anyone else. I wanted it to be some low hanging fruit. I was throwing myself a bone here. And I had been able to accomplish all of those things postpartum (with the exception of outside because the air was often choked with smoke from nearby fires). Every day I dutifully performed these small tasks for me and this left me feeling successful. And accomplished. And clean. But it hadn’t been enough to stave off something that was just out of my control (gasp). Awash with guilt, the thought of taking a medication that would get into my breast milk made me hesitate. I knew I shouldn’t feel guilty but I did. And after two days of looking at that bottle just sitting there, trying to rationalize my way out of it, I took my first dose. And I cried as I swallowed that tiny pale green oblong pill. I cried because I felt that I had failed and now my child was being exposed to medication for a problem I didn’t think I could fix without it. But outweighing that was the fact that baby needed me to be well. He needed me to feel attached and present. I couldn’t take care of anyone else properly until I honored the importance of taking care of myself.
Anxiety and depression have plagued me in the past. I was on Zoloft for a few years at one point; my dose at that time was 25mg. This is a very very low dose, I know – I can hear the collective eye-roll of providers everywhere who wouldn’t be wrong to speculate that this might not have even been a therapeutic dose. 25mg is often a starting point to a recommended 50mg or more– but I wanted to take it slow. It is important for me to stop here and call out the fact – the hopefully painfully obvious, common sense fact – that determining the appropriate dosage of any medication regimen should always be done in conjunction with your health care provider. Your adventure may be different and that is ok; individualized care plans, baby! All this to say, that because I had therapeutic benefit on 25mg in the past, I wanted to start there; start low and go slow.
Zoloft is in a class of medications called SSRIs: selective serotonin re-uptake inhibitors. Basically – like, really basic – don’t cite this in your term paper – it blocks serotonin from being reabsorbed so there’s more of it floating around. Serotonin is a neurotransmitter known colloquially as “the happy chemical”; it plays a role in regulating mood, among other things. SSRIs and medications like them can take up to four to six weeks for a dose to reach full therapeutic effect but most people see an improvement in their mood within two weeks. Anecdotally – read: not proved by science, not backed by research – I and other women I know felt better in a couple days. Like, way better. I knew better than to feel better this quickly…was it possible? Was it placebo effect? And if it was placebo effect… did it matter?
I rejoiced at the dissipating irritability and the return of happiness, connectedness, deep caring. It was like Aslan’s breath was bringing me – this stone cold Stepford Mom – back to life, like Dorothy seeing the world awash in color after being thrashed about in a monochromatic twister. All of those feelings I had known to be possible, to be true, rushed back: how my heart can swell with such joy and love at the littlest coo, the tiniest twitch of a smile, drinking in the sweet smell of my baby. Gleeful anticipation of greeting my toddler when he arrived home from preschool. Excited to nurse baby instead of annoyed. Happy to walk him and rock him back to sleep instead of irritated that he had interrupted a brief binge session of Westworld.
For all my efforts of self-care, all the non-pharmacological interventions I had implemented, it hadn’t been enough for me to get over this hump. And that is okay. I am keeping the conversation going with myself, with those close to me. I am continuing to take my medication (as of the writing of this I am at 37.5mg, going up a whole 12.5mg – eye-rolling providers, I see you – after noticing some irritability creeping back in). I am continuing to reach out to others and build up my social support.
My husband, my mom, my sister, my cousins, my aunts, new friends and old friends have all rallied around me in their own way but I’d like to give a specific shout out now to my beautiful sister-in-law. She congratulated and acknowledged. She validated. She encouraged and offered support she could follow through on. With her permission, because I think her words can be helpful as a template for those supporting someone, and for those who don’t feel like they have anyone to say these very important words but need to hear them, here is what she wrote to me:
“First, I want to say how proud I am of you for reaching out. Postpartum depression affects too many women and is often something people are ashamed of and don’t want to recognize or seek help, and believe it is something they can just handle. As mothers, wives, and women we are often fixers and caregivers. It is hard to reach out for assistance, and so, I applaud you for doing so and want you to know that I am here to support you in every way I can. I sometimes feel like the women who came before us centuries ago had it right when it was the tribe that raised a child. We are not only family but your personal tribe. Here to help raise you and lift you up when needed. We can bear some of that heavy load when the weight just gets too much. Please know that we will continue to pray for you, love you, support you, and listen to you. I will be reaching out to help in direct ways. I am here for you and love you.”
I will be reaching out to help in direct ways. And she did. We have a standing weekly date. Every week. This could look like a million different things to different people. Send a postcard. Don’t just text – call and leave a voicemail. Bring by dinner. Invite for a walk. Come over to chat. Mop floors. Do dishes. Mow the lawn. Listen. So, I would invite you all this week to reach out in a direct way to someone, anyone in your life. Extra points if they are a new mom or dad. Not with a Facebook message. Not with a friend request. Not with a text message. But in a direct, personal, and genuine way. And let’s open the door, and keep it open, to talking about our feelings, our challenges, our successes. Let’s talk about mental illness. Let’s talk about postpartum depression. It’s okay to not be okay sometimes. Let’s keep talking about it.
I overcame my self-consciousness about having postpartum depression the more that I gave myself the grace to share it. Why was I trying to put a “brave face” on it? I sure didn’t feel brave hiding it. The thought that one of my friends or cousins who were new moms could be feeling this way and suffering in silence, alone, out of ignorance or fear or guilt pushed me to be brave – and share it. After all, there’s no shame in it. It is a mix of a chemical imbalance and hormones that is unique to me.
A few weeks back I went to a dark place. Not homicidal dark. Not suicidal dark. But bottom-of-a-pit dark. Rock-bottom dark. Drowning dark. Sylvia-Plath-poem dark.
This darkness had been building for several weeks. Maybe a month. Before the air was choked with smoke from the most recent California fires, I had found my groove. I was killin’ it. Routine was dialed in. I’d get out the door, carrying baby in the carrier, and would jam on a walk for over an hour. Get back. Shower. Settle into the rhythm of baby: eat, play, sleep, diaper change, repeat. Then the air quality plummeted. And I was trapped. Trapped inside with a baby for weeks. I got cabin fever. I couldn’t go for a walk. I gained weight. When the rain finally came and the air finally cleared, I didn’t make it back into my routine. I had sunk down into the muck and didn’t have the energy, the will, the strength to pull myself out.
I could feel the darkness accelerating, revving up inside. It had started to make my skin crawl. I wanted to escape my own body, to slither out of it like a snake shedding its skin.
Depression is not an emotion. It is not sadness, though you may cry and look sad. J.K. Rowling said it well:
“It’s so difficult to describe depression to someone who’s never been there, because it’s not sadness. I know sadness. Sadness is … to feel. But it’s that cold absence of feeling — that really hollowed-out feeling.”
I am going to say it again because it is important: Depression. Is. Not. An. Emotion. Depression is not something that I can fix by listening to a nice song. Depression is not something that I can just decide not to feel anymore. It is not a choice. It is not a decision. It is not a mindset. It is a mental illness. I cannot will it away any more than a type two diabetic can will away their insulin resistance. I actually think diabetes may be a good analogy here: a walk might help but won’t cure it. Diet might help but won’t cure it. Having support might help but won’t cure it. Sometimes these non-pharmacologic things are all one needs to keep it in check. But sometimes it’s not. Sometimes medications are needed. Sometimes things get bad. Sometimes it takes a hospital stay.
Mental illness is real. To those going through it: keep fighting. You are worth it. To those walking with someone going through it: be patient. It is going to be so hard to do but, please, be patient.
I am not sharing my story for pity. I am not sharing my story for support. I am sharing my journey so that the other women and men who are out there – suffering, searching, fighting – can see they are not alone. I am sharing to advocate, to lend words to those who may not have any so they can maybe send this article to a loved one and say, “Here. Read this. This is how I am feeling”. I am sharing for you. For me. To explain. To cry out for understanding. To be seen. To be heard. To be well. I am still on this journey. I haven’t quite got it all figured out yet. But I am taking each day, fighting each day, and honoring my postpartum depression journey.
Fight on, friends. You are not alone. And you are worth it.
Rachel Teixeira is a Registered Nurse, wife, and mother to two boys. Known for her wit and sarcasm, she remembered her love of writing while in the throes of postpartum depression and turned to words as part of her self-care. You can follow along with her journey via her blog at www.thispostpartumlife.com.