My year with postpartum depression Molly Balint posted: March 23, 2011, 10:35 am

My year with postpartum depression

Molly Balint

posted: March 23, 2011, 10:35 am

I remember the drive to my OBGYN. Snaking through the back roads to avoid the beltway traffic, taking deep breaths to calm my heart, racing in my chest. Blinking back tears as I thought about the conversation I needed to have with my doctor.

It had been months leading up to this visit, but a few days of scary symptoms had forced me to finally make the call.

If I’m honest with myself, the first glimpses of this began just hours after Birdy’s birth. My first night alone in the hospital, unable to sleep. I felt pangs of panic–shortness of breath, a racing heart. I felt alone in my room. Exhausted. Baby number four in my arms. Number four. I should be a calm, collected pro at this. But here was a baby I couldn’t quiet no matter how much nursing and skin to skin coddling, and cooing and swaddling I gave her.

When I came home, the crying continued. Hers. And mine. I put on a chin-up, happy face for everyone. I wanted to believe I had everything under control, as much as I wanted everyone else to believe it, as well. There were no regrets. Everything was fine. I could handle this.

But as weeks gave way to months those baby blues never seemed to disappear. As we shifted and adjusted to life with four, we reached a new normal in our home and things seemed to settle down.

Those hard newborn days were behind me. We were in the swing of things.

Everyone seemed just fine. Everyone, except for me.

Six months after Birdy’s birth I finally gave in. I was frightened by the symptoms I was experiencing and they were getting worse. Were these panic-attacks? Did I have a heart problem? A blood clot? Was I dying?

I was always in a funk. Deep down I knew that sitting in the dark baby’s room, feeding her a bottle and sobbing was not normal.

Eventually, my period returned and with it raging hormonal ups and downs. I had two okay weeks. I would ovulate. And then my hormones would crash and burn. I would fight with my husband. But not your normal bickering. Emotionally charged arguments that would hit him out of nowhere. “But I don’t understand where this is coming from?”…I heard those words from his mouth more often than I care to think about. Everything was something.And those somethings were always major marital crises.

I had no desire to do anything. Go anywhere. Create. Make. Cook. Clean. Teach. All the roles I normally filled felt lifeless and dull. Nothing interested me.

My patience was a ticking bomb. The littlest mess, sibling argument, chaotic moment, could set me off on an angry spiral that seemed to have nothing to do with the issue at hand.

I knew I was on an emotional roller-coaster but I couldn’t pull the brake.

I prided myself on being easy-going, emotionally stable, happy, strong, confident. There had to be some way for me to pull myself out of this lonely darkness.

But I couldn’t do it alone.
And that’s why, six months after Birdy’s birth, I found myself sitting in the office of my OBGYN, finally telling the truth. Finally admitting that I couldn’t keep it together. That something was wrong. That I needed help.

She listened, nodded her head, and handed me tissues. And when I finished, she asked me a simple question :How old is the baby?

She went on to explain that it is a myth to think postpartum depression only lasts those first few weeks beyond birth. That it can linger and deepen months beyond baby’s arrival. That it can last even the entire first year. As we talked, I felt like I had walked into the arms of change and answers, relief and hope. Slowly, I felt that cloud of loneliness and darkness lift. It wasn’t just me. I wasn’t the only one.

Today marks Birdy’s first birthday. And I have been off medication just shy of two months. And I feel good. I am cautiously and carefully optimistic.

The funny thing is, this is a story I have yet to tell. At first, I admit to being embarrassed. The thought that I needed to be medicated, that I was depressed, was something I didn’t want anyone, but my husband, to know. Even today, as I write this down, my mother, my sister, close friends will be hearing my story for the first time. But I knew it was something I needed to share. Because I remember how lonely and dark those months felt. I remember what it felt like to be putting a bright face on my sad heart. And I hope that by sharing it here with all of you, someone reading my story, and living my same experiences will realize that they are not alone. 

We discussed my options–taking a more natural herbal approach to my care, or going right to an anti-depressant medication. I chose the later. I wanted to get out of this hole.

And the change wasn’t immediate. And the change wasn’t dramatic. But I felt me return. I felt leveled out. Even-tempered. Calm. Dare I say, happy? It had been quite awhile.

One Mother's Story Postpartum Psychosis: Rare, Frightening and Treatable

Feb. 18, 2002 -- Today in Houston, a jury will begin hearing testimony in the murder trial of Andrea Yates. She's accused of drowning her five young children last June. Her lawyers have said she'll plead not guilty by reason of insanity, citing her history of postpartum depression with psychosis. For Morning Edition, NPR's Joanne Silberner reports that the condition is rare, frightening -- and treatable. 

When Shelley Ash of San Jose, Calif., was pregnant five years ago, she read all the baby books she could. She never came across the term postpartum psychosis. Then she gave birth to her son.

"I knew right away something was wrong," says Ash. She sensed she was watching the delivery from above. She was terrified. Hospital nurses told her the feeling would pass. It didn't, even after she and her baby went home.

Ash says was pacing all the time, and caught in a horrible depression. She was constantly crying, couldn't sleep and couldn't eat.This wasn't the "baby blues," a temporary anxiety and depression that hits about three-quarters of mothers. Nor was it the postpartum depression that afflicts one in 10 new mothers. As Ash eventually learned, she was suffering from postpartum psychosis, which hits about one in 500 to one in a 1,000 mothers within three months of birth. 

"Postpartum psychosis is condition in which the person loses touch with reality," says Dr. Ralph Wittenberg, who runs a postpartum screening project in Washington, D.C. Mothers hear voices, see things and feel an irrational guilt that they've somehow done something wrong, he says. Without treatment, women may try to hurt themselves or those around them. 

What was happening to Ash was beyond her control. Postpartum psychosis sometimes develops out of postpartum depression, or hits women who've had previous psychiatric problems. Sometimes, as in Ash's case, it shows up out of the blue. Psychiatrists aren't sure what causes such a sudden and powerful break with reality, but they believe the changing hormones and stress of childbirth are somehow involved. 
Ash knew she was getting worse. The midwife in her obstetrician's office told her to call a psychiatrist. But that was the last thing Ash wanted to do. 

"I was terrified," says Ash. She was having delusions and was afraid that if she told anyone about what she was thinking or seeing in her mind, they would take her son away.

But after one episode, she became desperate.

She remembers watching David Letterman drop watermelons from high places on his television show. "But that turned into my son," she says. "I kept imagining how it would be to drop him out of his bedroom window and he would go splat on the pavement below and shatter into a million pieces." 

The image was too much for her. Ash went to her bathroom cabinet and took an overdose of painkillers she had been prescribed for a previous back injury.

Her husband came home from a run to find her on the floor in the front hall, babbling, and he rushed her to the hospital. That pattern isn't unusual, says Dr. Nada Stotland, who specializes in women's health. Stotland says women with postpartum psychosis tend to know that something's wrong, but like Ash, they're often terrified to let anyone else know. Health professionals and family members need to recognize that delusions and really erratic behavior are sure signs of trouble, and that hospitalization and medication are needed, says Stotland. 

Ash was hospitalized for a few days. She then spent 18 months on anti-psychotic, anti-depressant and anti-anxiety medications. Her son is now 5 years old and healthy. Ash got a graduate degree in public health so she could educate people about postpartum psychosis. She couldn't be happier now about her own health, or the health of her son. But she's not having any more children. 

It's not worth the risk of getting sick again, she says. There's a 10 to 20 percent chance that without treatment, she would, according to British research. But Stotland and others say that with treatment at the first sign of a problem, women with a history of postpartum psychosis can safely have more babies. And while neither psychiatrist would comment on Andrea Yates -- the woman who killed her five children -- both say that the tragedy whenever a case of postpartum psychosis ends badly is that most likely it could have been prevented. 

Join the Discussion

Postpartum depression and psychosis often go unrecognized and untreated. Weigh in with your thoughts or experiences with the disorders at NPR's discussion board.

Postpartum Depression and the Baby Blues

Having a baby is stressful—no matter how much you've looked forward to it or how much you love your child. The baby blues are perfectly normal, but if your symptoms don’t go away after a few weeks or get worse, you may have postpartum depression. Postpartum depression can interfere with your ability to take care of your child, so it’s important to get help right away. With treatment and support, you can get back on the road to happy motherhood.

The baby blues

You’ve just had a baby. You expected to be basking in new mom bliss. You expected to be celebrating the arrival of your little one with your friends and family. But instead of celebrating, you feel like crying. You were prepared for joy and excitement, not exhaustion, anxiety, and weepiness.

You may not have been expecting it, but mild depression and mood swings are common in new mothers—so common, in fact, that it has its own name: the baby blues.

The vast majority of new mothers experience at least some symptoms of the baby blues, including moodiness, sadness, difficulty sleeping, irritability, appetite changes, concentration problems. Symptoms of the baby blues typically show up within a few days of giving birth and last from several days to a couple of weeks.

The baby blues are a normal part of new motherhood—probably caused by the hormonal changes that occur following birth. If you have them, there is no cause for undue worry. You’ll feel better once your hormones level out. Aside from the support of your loved ones and plenty of rest, no treatment is necessary.

Signs and symptoms of postpartum depression

Unlike the baby blues, postpartum depression is a more serious problem—one that you shouldn’t ignore. However, it’s not always easy to distinguish between the two.

In the beginning, postpartum depression can look like the normal baby blues. In fact, postpartum depression and the baby blues share many symptoms, including mood swings, crying jags, sadness, insomnia, and irritability. The difference is that with postpartum depression, the symptoms are more severe (such as suicidal thoughts or an inability to care for your newborn) and longer lasting.

Signs and Symptoms of Postpartum Depression

Lack of interest in your baby Negative feelings towards your baby Worrying about hurting your baby Lack of concern for yourself Loss of pleasure

Lack of energy and motivation Feelings of worthlessness and guilt Changes in appetite or weight Sleeping more or less than usual Recurrent thoughts of death or suicide

Postpartum depression usually sets in soon after childbirth and develops gradually over a period of several months. But postpartum depression can also come on suddenly, and in some women, the first signs don’t appear until months after they’ve given birth.

Signs and symptoms of postpartum psychosis

Postpartum psychosis is a rare, but extremely serious disorder that can develop after childbirth. It is characterized by loss of contact with reality. Postpartum psychosis should be considered a medical emergency. Because of the high risk for suicide or infanticide, hospitalization is usually required to keep the mother and the baby safe.

Postpartum psychosis develops suddenly, usually within the first two weeks after delivery, and sometimes within 48 hours. Symptoms include:

Hallucinations (seeing things that aren’t real or hearing voices) Delusions (paranoid and irrational beliefs) Extreme agitation and anxiety Suicidal thoughts or actions Confusion and disorientation

Rapid mood swings Bizarre behavior Inability or refusal to eat or sleep Thoughts of harming or killing your baby

Postpartum depression causes and risk factors

The exact reasons why some new mothers develop postpartum depression and others don’t are unknown. But a number of interrelated causes and risk factors are believed to contribute to the problem.

Causes of postpartum depression

• Hormonal changes. After childbirth, women experience a big drop in estrogen and progesterone hormone levels. Thyroid levels can also drop, which leads to fatigue and depression. These rapid hormonal changes—along with the changes in blood pressure, immune system functioning, and metabolism that new mothers experience—may trigger postpartum depression.
• Physical changes. Giving birth brings numerous physical and emotional changes. You may be dealing with physical pain from the delivery or the difficulty of losing the baby weight, leaving your insecure about your physical and sexual attractiveness.
• Stress. The stress of caring for a newborn can also take a toll. New mothers are often sleep deprived. In addition, you may feel overwhelmed and anxious about your ability to properly care for your baby. These adjustments can be particularly difficult if you’re a first time mom who must get used to an entirely new identity.