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Why am I blue?
or
The Face of Post-Partum Depression

By Karen Pollak

I stood in my living room with my closet friends and family rejoicing, celebrating the birth of my beautiful sons. As the rabbi wrapped the four of us in a talis and bestowed upon our boys their carefully chosen Hebrew names, there was not a dry eye in the house...except mine. I looked around the room, knowing the journey my husband and I had taken to fill our house and home, and the support we had from those surrounding us. As I looked down at the baby I cradled in my arms, and his brother resting quietly in his father's lap, I knew something was terribly wrong-with me.

After the ceremony I stepped outside with a friend. In a quiet voice I said, "I felt nothing. Something's not right." That night, I stood at our kitchen sink crying and repeating to my husband, "Please help me. Something's wrong with me."

Postpartum depression. What was that? Didn't that affect only those terribly hormonal, PMS-prone women I knew?! A friend of mine once said, "I have PMS, pre-PMS, post-PMS..." she surely would be a more likely candidate than I! I thought of myself as even-keeled, upbeat and well-adjusted (okay, sort of well-adjusted!) So it came as a shocking surprise that here I was, three weeks post-partum, with two healthy boys that I had yearned for, depressed.

I contacted my obstetrician, who prescribed an antidepressant and advised me to find a night nurse-certainly I was sleep deprived and overwhelmed. One girlfriend told me to just ignore it and it would go away. And although I did get the night nurse, and some much needed rest, it didn't go away. How lucky for me that a brochure I had picked up somewhere along the line listed the name and phone number of a woman who specialized in Prenatal/Postpartum Mood Disorders.

Without hesitation, I picked up the phone and called. Dr. Shoshana Bennett, who is the Director of Postpartum Assistance for Mothers and practices in Castro Valley, was my savior. On the phone she was kind and empathetic. When we met in person I immediately felt understood. There were no judgments. No 'just push it away'. Only the acknowledgement of what I felt and the assurance that it would, in time, resolve. I was afraid of what I was feeling, but not afraid of finding out why I felt the way I did. I felt sad and overwhelmed and, more frighteningly, a complete lack of connection toward one of my sons. I would look at him and feel this distance. I couldn't imagine that I would ever feel close to him. Shoshana assured me that "bonding" was a process, not an event.

The prescription that my OB had written for me sat on my nightstand for a week or two. I was reluctant to have it filled. Instead, I struggled to manage my feelings of inadequacy and sadness without the aid of medication. I suppose I was a bit judgmental about "the kind of person" who would need an antidepressant. I mentioned the idea to a couple of close friends and my mother, but no one blinked an eye. Yet there is a stigma associated with depression and antidepressants. Why is society so afraid of depression? Why is it judged? My mother asked me, "If you broke your leg, would you get a cast?" Well, of course I would! So why wouldn't I accept the remedy for my broken spirit?

After meeting with Shoshana several times over the course of the next few weeks, I finally decided to begin taking Zoloft. It was actually a heartbreaking decision, because at the time there wasn't enough medical data to support nursing while taking it. I wept over that decision. But my husband convinced me that a well-functioning mother bottle feeding her babies was healthier than a depressed nursing mother.

Additionally, Shoshana had me keep a journal. My assignment each day was to record the percentage of how close to my "old self" I felt. To my surprise, as the weeks went by, that number kept growing. Within a month or two I really felt like I was doing well. I was coping with the stress and demands my two little ones required of me and was starting to enjoy being a mother.

Little by little, I saw my old self returning. I cried less, felt less alone, less incompetent as a mother. I was more upbeat, more joyful, more me. My connection to my son(s) grew in leaps and bounds...as I write this, I cry. I am so close to these boys (and their little brother) that it pains me to know how disconnected I once felt.

What is Post Partum Depression? Why do so many women experience it? Post Partum Depression is caused by a hormonal imbalance and it has nothing to do with how well equipped you are to be a good mother. There is a span of emotion and depth to the condition. It can range from just feeling "numb" to having a sense of hopelessness to, in extreme cases, the inability to function, fear of hurting ones baby or thoughts of suicide.

The most dangerous thing one can do is to ignore the signs and symptoms. Nearly 85% of new mothers have some form of Post Partum Depression, often called the "baby blues". Their symptoms generally peak during days 3-5 postpartum. But, in the roughly 15% of the cases where the condition is more extreme, the symptoms can appear within the first four weeks or as late as 12 months post-partum or even after the cessation of nursing. Factor in the double (or triple) dose of hormones those of us carrying multiples have, and the risk is even higher. Often times, the mildest cases will resolve themselves without intervention of any kind. Sometimes an anti-depressant is prescribed to help the mother balance her emotions until the body's hormones return to their pre-pregnancy level. (It is important to note that today's research shows no risk to breastfed babies of mothers who are taking one of several studied antidepressants.) In the most extreme cases, women are hospitalized and provided with medical and psychological assistance, including, but not limited to, psychotherapy and medication.

Look around you at a mothers' club meeting or function. It's a very dynamic environment; women laughing, catching up with each other; congratulating the proud mommies and cooing into the strollers and baby seats carrying our precious, newest members. Who has, or is, suffering from this painful and frightening condition?

Being involved as I am in my twins club, I hear a lot of stories from a lot of moms. You might be surprised at what the face of a Post Partum Depression sufferer (or former sufferer) looks like. It's mine. It's the trim, pretty, blond woman sitting next to you; it's the active, popular club member who stands up and speaks confidently to the group; it's the career mom. Post Partum Depression is non-discriminating. It can hit anyone, regardless of age, education or socio-economic standing. The most important thing you can do for yourself is to understand it, recognize its symptoms and acknowledge it if you find yourself feeling "not quite yourself"... or worse.

The happy ending is that it does resolve itself, as you can see by my story. Although it can be slow and painful, there is light at the end of the tunnel.

When I learned that I was pregnant with my singleton, one of the first things I did was to contact Shoshana to find out if there was anything preventive I could do to reduce the chances of experiencing this frightening illness for a second time. Although she did warn me that my chances were higher, being that I was a previous sufferer, it wasn't a certainty. Some of the things she suggested I do to reduce the chances of a recurrence included; getting a minimum of 4-5 hours of uninterrupted sleep each and every night after giving birth; carving out time to eat nourishing meals even if I didn't feel hungry or was too tired to do so; choosing foods to help keep my blood sugar level even (which can affect your mood); and surround myself with emotional and physical support (partner, parent, doula, nanny, night nurse, etc.) Additionally, some women who have a personal or family history of depression may begin taking an antidepressant in the third trimester as a preventive measure.

If you have any of the following symptoms after your babies arrive, and they linger for more than a couple of weeks, you may be experiencing Post Partum Depression:

*memory loss *despondency
*just feeling 'numb' *tearfulness
*easily angered *feelings of inadequacy
*fear of harming one or both babies *restlessness
*sluggishness, exhaustion or fatigue *panic attacks
*hopelessness, inability to cope *intense anxiety or fear
*feeling guilty, worthless, helpless or pessimistic *frightening feelings and thoughts
*persistent sad, anxious or 'empty' mood *fast, pounding heart rate
*uncontrollable crying, irritability *lack of interest in one/both babies
*appetite and sleep disturbances *depression ranging from sadness to thoughts of suicide

There are innumerable resources in the community that are available to you:

- First and foremost, contact your OB/Gyn.
(S)he should be able to help you assess your symptoms, refer you on to a specialist or treat you themself.

- Dr. Shoshana Bennett, Director of Postpartum Assistance for Mothers.
Shoshama leads support groups in Lafayette and at the Women's Health Center for John Muir/Mt. Diablo Health Systems in Walnut Creek. She also offers individual counseling. You can contact her directly at 510-889-6017 or at drshosh@beyondtheblues.com. Her web address is listed below.

- The Internet is an invaluable resource for information.
The following websites have some great information and links:

- There are a number of books available on the subject: