I am interested in hearing from other mothers who have experienced major depression after the birth of a child.  Have you had any more children after that?  If so, what did you do to help things go better, or did you have problems again?  Did anyone take antidepressant medication during a pregnancy?  If so, are you glad you did?

--Name Withheld

I experienced a pretty major depression seven months after the birth of my first child.  I think a lot of it came from:

1. An infant who refused to sleep through the night until he was thirteen months old and a mom who was plain "worn out";
2. Not much help from my spouse and my own ignorance at not asking him for help;
3. An older stepchild in our household who had his own problems and agenda;
4. Isolation  -- I had worked full-time for almost 20 years before deciding to have a child and stay home;
5. Missing my life from #4;
6. Overall adjustment to a baby and to life at home.

The warning signs were there, but I ignored them -- poor self-image, crying or wanting to cry at anything that was remotely sad, feeling like there was something wrong with me because, unlike other at-home mothers, I was not convinced staying home with my child was the greatest thing since sliced bread and, lastly, feeling unappreciated and under-valued in my new role at home.

One day, about 7 months into the mommy-thing, I lost it.  I could barely make a decision to go downstairs.  I cried all the time.  Not wanting to "disturb" my husband at work, I called my parents who live about one hour away.  I called my primary care physician and broke down crying on the phone.  The office staff had no idea what I was going through and gave me a late afternoon appointment.  My parents arrived and I was embarrassed that I was in such a state of "uncontrollability".  They knew something was really out of whack.

Luckily, my doctor was able to assess the problem pretty quickly.  I think a whole lot of this had to do with the fact that she was a woman and had children of her own.  She initially gave me a prescription for Prozac and also something to help me sleep at night.  She assured me that I was not "going crazy" but told me I was probably experiencing a late postpartum depression and that both stress and hormones changing can make this occur.  She said I needed to get a mental health counselor because a large part of the cure would be talking out what was bothering me.  She did not tell me to get with the program of mothering or ask me what the heck was wrong with me because I had a healthy baby and raising kids was hard work, so just get through it. 

I was on several antidepressants including Prozac, Zoloft, Paxil and an anti-anxiety drug called Klonopin.  The anti-depressants made me feel weird -- dizzy when driving, extremely dry-mouthed.  The only thing that worked for me was Klonopin.  I took it for about a year and I still take it occasionally. 

When my son was 18 months, my husband and I discussed having another child, but, because we are both in our forties, decided against it because of age.  I have to admit that the depression factor also figured into my decision.  I had to admit to myself that I NEVER wanted to feel that bad again.  Also, a large part of my getting better was therapy and joining mothers groups in which both my son and I could participate.  I knew if I had another child that I would not have the time to continue these things. 

Also, there are several web sites on the internet that have chat rooms where you can talk to other mothers who have experienced depression.  I communicated with a woman from Australia who had experienced similar problems to mine.  There is also an organization referred to in past Welcome Home issues called Depression After Delivery.  They may be able to help you.

Check with your OB/GYN and tell him or her if you experienced past depression after childbirth.  There are some new antidepressants that are "allowed" while you are pregnant, and your doctor will know the pros and cons of taking medications.

You are very courageous for even contemplating having another child if you have been through a previous depression.  Every time I wake up in the morning and feel a little down, I am scared to death that the big, dark shadow is about to descend upon me again.

Good luck to you.

--Anonymous

 I am a 29-year-old mother who experienced major bouts of postpartum depression following the birth of both of my sons, now ages four and two-and-a-half.

When my first son was two-and-a-half months old, the depression began, but lifted by his sixth month.  When son #2 arrived, I had difficulties immediately and they lasted through month eight, when I began taking medication.

My best advice to you, based on my experience, input from counselors and reading is the following:  Be prepared in advance.

Be sure to have people ready to help you and your child(ren), have a counselor and/or psychiatrist in place so there is no delay in getting an appointment, talk to your OB/GYN/midwife about your past postpartum experiences so he or she can best help if a crisis develops.  Keep dad involved and informed as he will also need a great deal of support and reassurance.

Remember, the depression will lift and disappear, but sometimes not on its own.  Many larger hospitals offer care and support to women who are experiencing postpartum depression or are at risk to develop symptoms.  There are medications available to ease mom's symptoms which can be used while pregnant and nursing.  The key is to become informed before problems have a chance to develop.

Two books I found of help are:  This Isn't What I Expected (1994) by Karen Kleiman and Postpartum Survival Guide (1994) by Anne Dunnewold and Diane Sanford.

Our family is complete with two children.  Postpartum depression was a factor in that decision, but certainly not the only one.

Best wishes to you and your family.

--Hilary in Ohio

I have experienced postpartum depression as well as major depression and anxiety before I ever had children.  After the birth of my first daughter, my "blues" gradually turned into depression that wouldn't go away.  I was committed to breastfeeding but could only continue for six months for fear of taking antidepressants while breastfeeding.  (I had previously taken Prozac.)

Is there any evidence that antidepressants or St. John's Wort are harmful to the baby while breastfeeding?  Any long-term effect information?  I need to know now because I am breast feeding my second daughter who is two months old and I am experiencing depression/anxiousness again.  My doctor has recommended Zoloft.

I have tried exercising, yoga and relaxation which help but do not eradicate the depression as does the medication.

Please seek help from your doctor about medication as soon as you can tell that you have depression symptoms.  I waited too long until I got physically run down and sick, besides having the postpartum depression.

--Sonja in Indiana

I suffered from depression after the birth of my second child.  I found help in counseling but chose not to take antidepressants because I wanted to breastfeed.  After two years I stopped breastfeeding and started taking Paxil.  The Paxil helped me feel much better.  About six months later I found out I was pregnant, and after talking with my doctors, I decided to discontinue the Paxil, even though both my obstetrician and family doctor said there was no proven risk of birth defects.  I am now three months pregnant and I have good and bad days.  The first two months were kind of tough but I do feel better now.  I am still seeing a therapist and I've just started a weekly yoga class.  If I really need to go back on the Paxil I will but I'm trying to get by without it.  What I am worried about is how I will do postpartum.  If I have a really difficult time I may need to forego nursing this time, although it would be painful for me to do so.  One of the most helpful things for me has been the therapy.

--Name Withheld

I experienced postpartum depression after the birth of my daughter, Hannah, in December of 1996.  In April of this year, I gave birth to my son, Henry, and successfully avoided postpartum depression (PPD), but only through a lot of hard work prior to delivery.

My first PPD experience was severe and I was put on Prozac five weeks after my daughter's delivery.  I had stopped breastfeeding two weeks earlier.  This was, of course, after I went through weeks of hell, not knowing what was going on or what was wrong with me or if it was normal.  I couldn't sleep, eat or think well.  I presume you know all too well the hell of which I speak.

I continued on antidepressants for a year and a half and during that time became a full-time mom.  We wanted another child, and through a support group had met women who had a much better experience with their second child.  Age was also a factor in getting pregnant again (I turned 40 on the same day I took my son home from the hospital).  PPD and childbirth forced me into a giant look at myself and my upbringing, something I though I had settled during previous therapy.

Prior to being pregnant, I had sought help for depression off and on over a ten year period, although I had never taken medication.  I found out later women who suffer from depression will almost certainly experience PPD at some point during pregnancy or postpartum.  I feel very fortunate my depression was diagnosed early on.

To help things go better the second time around and to help myself recover from a very difficult first delivery and PPD, I regularly saw an accupressurist.  I continued to do so while pregnant, however, I phased out the use of Prozac.  I did not want to have any antidepressants in my body while I was pregnant so I did not consider using them and believed all would be well.

As my pregnancy progressed, I found myself miserable and in need of help.  I started on Nortriptylene which successfully controlled my depression.  Nortriptylene has been around for about 30 years and has been proven not to cause harm to fetuses.  It gave me severe dry mouth the entire time I took it, a common side effect.  I also began to see a psychologist again.

When I was about seven months pregnant, The Journal of the American Medical Association published a study about Prozac and pregnant women, the result of which was no apparent side effects to the fetus.  I had planned to go back on Prozac about a month before my due date.  My psychiatrist and I decided to re-introduce it sooner, in light of this study.  I had success with Prozac after my first pregnancy, and wanted to have it in my system immediately after I delivered in an effort to prevent PPD.  Breastfeeding was not a possibility.

I delivered 10 lb. 6 oz. Henry on April 19, 1998.  I did not have an epidural, I used morphine and my accupressurist, plus a lot of help from my husband and my mom.  Several days after discharge, I felt myself falling again.  What I experienced was probably normal baby blues, however, I did not know at that time, since I never knew normal.  My psychiatrist and I increased the Prozac to the level it was prior to pregnancy, and so far, I am feeling pretty good.

I am certainly not experiencing what I went through with my daughter.  Believe me, being on medication is not what I wanted to do.  I have accepted the fact that this is what I need to do for me right now.  I do have moments and I have to wonder if it's the depression or parenting.  What absolutely changed from the first pregnancy was my ability to accept help and let people know when I needed it.  And after the first experience, my family and friends were very much on alert.

Being a stay-at-home mom is the hardest job I've ever had.  It's also the most challenging, fascinating and rewarding.  In the midst of PPD I would not have believed that I would ever be able to have another child.  I worked hard and saw a lot of doctors, that's what I can tell you worked for me.  Take from my experience what you will.  I must say a second birth was -- and is -- very healing for me.

--Cathy in Illinois

Having a baby changes many things in our lives.  Some things we are aware of, others, we are not.  For a woman, having a baby is an experience that affects us in a number of ways and on a number of levels.  It affects us physically, psychologically, biologically, spiritually, and emotionally.  It is not even the end result, that begins this process, but the mere fact of conception -- of becoming pregnant.

My husband and I had always wanted children. The first 7 years of our marriage proved to be unfruitful and then, very suddenly, I suffered an ectopic pregnancy.  Apart from the tremendous physical pain, there was pain on every other level, and no guarantee that we would ever have another chance.

I suffered from profound depression that lasted for three years.  Some days were better, some were worse.  At a few points, it almost ended our marriage.  It required a total of three hospitalizations, the result of which ended in several different diagnoses.  What I ultimately learned from all of this is that we do not go through these times alone.  We are blessed with a support group.  Sometimes, we may have to look for it and accept help from those we may not have thought of before.  Then we must use that support.

I would have to say that based on experience, drugs are a last ditch resource.  Sometimes they may be necessary, but only after everything else is exhausted.  First try changing how you do things.  Give yourself reasons to get up in the morning, like having someone bring you breakfast in bed.  If you are a new mother for the first time, or the second, third, or fourth time, you deserve these things.  Pamper yourself.  Let others do some of the work, and you take time to enjoy your new baby.  Study how they nurse, memorize their face while they sleep.  Cherish these precious times.

One final piece of advice, let yourself cry.  Don't let anyone tell you that you shouldn't, that you have everything to be happy about, or that you are being silly, etc.  Cry as much as you need to cry.  Emotions are never of any use, and are never over, until they get spent.  I had to learn how to let myself grieve for the baby I lost.  Until I did, I could not get on with my life.  You have to let yourself feel whatever you need to feel, and communicate that to those who can help you.  I don't think drugs are ever really the answer, we need to look elsewhere.

--Cynthia in Indiana

I'm not sure what you mean by major depression.  PPD includes baby blues, depression and finally psychosis, the most severe form.  I suffered depression for 14 months after my first daughter was born.  I tried to talk with my OB, but she didn't believe PPD is a real disorder and I was too upset and didn't know where to look for help.  I never took any medication, but after reading The New Mother Syndrome:  Postpartum Stress and Depression by Carol Dix, I did start taking 200 mg. of B6 and began to feel normal again.

I went on to have a second daughter after having my gallbladder out.  I had read about progesterone treatment in a PPD newsletter.  I requested the treatment from my midwife and she agreed.  In fact, she has always had positive results with progesterone.  The first shot is administered right after delivery and every day for a week, then suppositories are used for two months.  It worked for me.  The idea behind it is to keep your hormones from crashing.

You don't know if you will have PPD again, and you shouldn't wait to see if you will or not before receiving the progesterone treatment.  It has to be started the day of delivery.  Ask your caregiver about the treatment and have your questions answered.

Hope everything works out okay for you.

--Leah in Washington

I had a mild depression after my first child (a girl), and it went away on its own when my daughter was about 3 months old.  My second child was a boy and I had no problems.  When I had my third child (a girl), I went into a dark, depressing time.  I couldn't sleep at night.  I had no interest in my baby.  I had to move back home with my parents for 4 months.  PPD is what I had and I took Pamelor (an antidepressant) for 9 months after my daughter was born.  If I were to have more children, I would definitely take Pamelor during my pregnancy.  My friend took it, and both of her sons are fine.  I don't want to risk having that depression again.  It was the darkest time of my life.  My daughter was 2 in May and we are doing fine now.

I love your magazine.  I wish they had stuff about PPD when I was going through it.  I'm glad there is more awareness now.  A lot more people suffer from PPD than I thought.  Remember, you're not alone -- there are support groups at libraries.

--Teri in Ohio

I experienced depression after the birth of my first child, and it lasted for at least six months.  I am now the much happier mother of my second child who is seven months old.  What I did to make things better was to return to a therapist I had seen in the past who I trusted.  I attended a weekly group from the time my first son was about four months old until he was over a year old. 

As I anticipated the birth of my second son, I contacted the therapist again, to prepare for the possibility that I might get depressed again.  She suggested I drop the expectation and not worry about it.  Having learned that my habit of worrying and focusing on the negative around me brought on my depression and other negative states, I took her advice.  As I reflect back on that time, when I was so depressed with my first child, I see that I was likely suffering from hormonal changes, but also struggling with sleep deprivation and a complete transformation as a person.  I wanted to be perfect, I was indecisive about returning to work and school, and I had tough decisions to make.  Being a new parent was quite overwhelming to me and I felt very insecure.  I remember a moment when I though I had made a mistake by having a child.  I was overcome by a feeling of dread.  I believed this thought, which made me feel worse, and then led me to conjure up more negative thoughts.  This caused things to snowball and resulted in my lengthy depression.  With a more secure perspective, I can now see that I was overtired and had been dealing with major changes in my life.  Perhaps I would not have believed so many of my thoughts had I more perspective at the time!

I never took antidepressants during pregnancy, or when I was nursing, though the first time around I really wanted to.  I had taken them in the past, but given what I have learned about the role of thought and moods in the development of depression, I have not needed them since.  I just don't get depressed anymore.  I highly recommend George Pransky's tapes on depression and other topics.  He can be reached at Pransky & Associates, P.O. Box 498, La Conner, WA   98257 (phone:  360/466-5200).

--Name Withheld

I, too, experienced an incredibly difficult PPD following the birth of my firstborn child.  At first I thought it was just the blues, then I thought it was due to the emergency C-section I had due to fetal distress.  I always read anything and everything I could on the subject of PPD.  As a nurse, I never knew that this would happen to me after 9 blissful months of an uneventful pregnancy.  I then thought it was due to breastfeeding.  I didn't dare talk to anyone about it, as I was afraid of what people would think, and I was completely against the idea of medication.  My biggest fear was having a lifelong label as one with a "psych history".  I weaned my baby at six months.  I was feeling truly normal and myself again at around 9 months.  I did pray a lot and cried, too.

With the birth of my second baby, I changed to a medical practice which was incredibly supportive and reassuring.  They comforted me when I expressed my past experiences and fears of re-occurrence.  I never did experience PPD with my second baby.  I nursed my second for 13 months. 

I commend you for your courage in seeking help.  I feel the more support you have (partner, parents, siblings, friends) to help you during this time of need, will help you in your return to feeling like yourself again.  Unfortunately, I had no support system, and I just waited it out.  Perseverance and determination will get you through this very difficult time. 

Good luck to you.

--Name Withheld

As soon as I read your letter, I wanted to respond to you.  I, too, suffered from depression after the birth of my second son.  While I had experienced the "baby blues" after my first child, this was different.  I was diagnosed with PPD.  An estimated 10-20% of women experience PPD and, unfortunately, many go untreated, because women are too afraid or embarrassed to seek help.  PPD has several symptoms, and these symptoms range from mild to severe.  Your OB/GYN can help you if you are suffering.  He may suggest a treatment option, or refer you to someone more qualified.  There are many treatment options available.  I benefited from an antidepressant.  In fact, the antidepressant restored me . . . and my marriage and family life!  I only wish that I would have sought help sooner.  I used medication for about 18 months, and now I am fine!  I would encourage you to seek support from a national, non-profit organization, Depression After Delivery (P.O. Box #1282, Morrisville, PA   19067 (phone: 1-200-944-4PPD).  They will gladly send you a packet of helpful information, including the names and phone numbers of professionals in your area who specialize in PPD. 

--Mary Ann in Minnesota

Thanks to the new class of antidepressants, the decision for me to carry a child was much easier.  I became pregnant with my first child in 1995 while taking Paxil.  Because of the depth of my depression, going off my medication was not an option.  At that time, the effects of Paxil on developing fetuses were still being studied.  Although the results were optimistic, no conclusions had been drawn.  I gave birth to a healthy child in 1996, and then faced a second hurdle:  breast vs. bottle.  Again, the studies were reassuring but remained inconclusive.  I consulted 10 medical doctors, including OB/GYN, pediatricians, psychiatrists, and family practice specialists.  Only one of them felt that the possible risks outweighed the obvious benefit.  I nursed my child for 19 months.  I am now pregnant with my second child whom I also plan to breastfeed.  The research on Paxil has yielded enough information to deem it safe for pregnant and lactating women within recommended dosage levels.  Although this comforts me, I will always wonder if the medication has or will affect my children.  However, for me, the proven benefits of remaining on medication (I no longer suffer from anorexia, suicidal tendencies, and am a recovering alcoholic) far exceed the possible effects on my children.  Good luck!

--Mother At Peace

I experienced a major depression after the birth of my second child, a girl (my first was a boy, 2 years earlier).  When I discovered that I was pregnant with our third, I immediately quit taking my antidepressant.  I did well during the pregnancy and while nursing.  I eventually went back on medication and currently still require it.

--Nancy in New York

I only had a brief episode of PPD after my fourth child.  One remedy that helped was to legitimize all of my anxieties and then to respond to each one.

I made a multi-page list.  In one column was the anxiety and in another column was the resource person, someone who could help me try to solve that particular problem.  The third column was to be filled in with what I did and how I felt about what I did.

My problems ranged from child care to body image.  My helpers included clergy, therapists, self-help groups, etc.  By breaking my overwhelming feeling (the cause of my PPD) into bits and and my making each bit important and real, I was able to cope with many issues.

Three months after I made the list, I looked back at it and discovered I had been blessed to resolve two-thirds of these anxieties.

--Karen

I suffered PPD with my first child.  It went undiagnosed until my child was about 18 months old, by which time I had become quite unhappy in my life, and it almost cost me my marriage.  Luckily, I discovered help in the form of marriage and individual counseling.  This led me on my journey of discovery about PPD.  It really helped to give a name to my problems which at first seemed so insurmountable.

There are two organizations I can recommend for information about and support for those going through PPD.  The first is Depression After Delivery and they can be reached at 215/295-3994 or 1-800-944-4PPD.  They have information packets available for identifying the symptoms of PPD for both professionals and parents, as well as support group audio tapes and transcripts from speeches and meetings having to do with PPD.  They can also put you in touch with doctors in your area specializing in PPD.  Note:  Not all OB/GYNs are familiar with its symptoms or are necessarily supportive, either out of ignorance, or because some people actually still believe it is all "in your head".

The other organization is Postpartum Support International, which can be reached at 805/967-7636.

Considering another child is a scary thought if you have gone through PPD before.  I was reluctant to try to get pregnant a second time on the chance that my husband and I, as well as a child, would have to witness my transformation and go through the months of agony I went through the first time.  Becoming informed was probably the biggest help.  Doing lots of reading and talking to others who had gone through it really helped me prepare mentally for the possibility of a second PPD experience.  I felt that at least now I knew what signs to look for, and that it was not just me acting crazy, but that there was support and treatment if I and my family needed it.

I went to see a psychiatrist who had been recommended by my counselor, who got background information and a sort of "baseline" of my normal behavior.  Six weeks after my second child was born, I could go see the psychiatrist and she could assess how I was doing.

I kept several lists in a notebook of useful information.  One list was of things I could do to relax or make myself feel better.  I made this list before I had the baby, because when you're in the midst of PPD, you can't think straight, and nothing seems like it will help.  On my list were songs or music that helped me feel happy or relaxed, television shows or movies that really made me laugh, places that were comforting to me.  Another list was of people I could call for support if necessary, either just to talk, or to come over and be with me or to help out with the kids, meals, housework.  I checked with all the people ahead of time to make sure they wouldn't mind my calling.  Another problem with PPD is that you are embarrassed to ask for help or don't think anyone will want to be around you when you are depressed.  This list helped me to remember there were people who promised they'd be there for me, and had okayed my calling them for help.

I asked all my play group friends and my siblings in the area to help out in the following ways:  organize a meal delivery system so I wouldn't have to cook much those first few weeks; take turns having my older child over for a play date.  Even if you don't have PPD again, this will be an enormous load off your mind.  I also finally took some of that advice in all the books.  I cooked lots of meals and froze them so I wouldn't have to even think about what to make for dinner (a daunting decision when you are sleep deprived and down).

I purchased a white noise generator for myself so that when I lay down for rest and someone else was there for the kids, I could really sleep.  I've always been a light sleeper, and with my PPD I often couldn't fall back asleep if awakened by a baby's cry or other sounds.  These are available through Hammacher-Schlemmer Catalogs.

Last of all, I splurged on a "doula", a maternal-infant care assistant to help me after my husband had to go back to work.  I hired someone through an organization called Mother's Matters in Reston, VA  (703/620-3323) to come help with the baby, answer questions about lactation, make the occasional lunch for me and my toddler, or throw in a load of laundry.  She also sat with the baby a few times so my older child and I could go for a walk or spend some one-on-one time together.  This was expensive, but I felt it was worth it for the peace of mind it gave me beforehand, just knowing I'd have help if I needed it.  A less expensive alternative would be to have a relative come and stay, or hire a teenager or some other baby-sitter to help out with child care.

As it turned out, I did not experience PPD with my second child, but all the extra help and security I felt in my knowledge of PPD and how to deal with it made my second pregnancy and the postpartum period all the more relaxing and enjoyable.

--Rebecca in Virginia

In the ten years since I was first diagnosed with clinical depression, I have become a mother twice and experienced severe PPD both times.  While the second experience was much more difficult than the first, I am glad to be able to share some of the approaches that worked for me.  I must say that motherhood overall has given me such joy that I would be willing to experience another episode of depression in order to have another child.  I think the most important thought that I had on my lowest days was of my children and the knowledge that I had to work hard to heal and to raise healthy children.  I learned that it is important to do only the bare minimum when you aren't feeling well.  Spring or deep-cleaning can wait.  Laundry has to be done regularly and even little children can help with picking up and putting toys and games away as soon as they are done using them.  For me, having a clear countertop, a clean sink and a path through the family room were the basics.  My family was very willing to help with these things, knowing that they were helping mom feel better.  I also discovered the importance of adequate sleep.  We began to eat well-balanced meals and get regular exercise, which not only helped improve my level of fitness, but also improved my ability to get to sleep and stay asleep at night.  As a family, we kept a calendar of events -- birthdays, scheduled overtime for my husband, appointments, etc., so that I could schedule in a baby-sitter for one child.  This way I could spend private time with the other.  As my spouse was away from home for long periods of time, organizing my private time was a requirement, so that I had something to look forward to.  Most important -- be sure to stay connected to other people and your spouse.  I got a membership to the local YMCA and began to go three or four mornings a week.  Not only did I make a few new friends, my children made some, too.

While I am not an accomplished writer, I hope some of these things help someone.

--Juanita in Wisconsin

I, too, had major depression after the birth of our firstborn son.  I ended up in a mental health facility seven weeks after his birth for about two weeks.  My psychiatrist put me on antidepressant/anxiety pills for six months.

Seven months after my son's birth I found out I was pregnant again.  I was so worried about the pregnancy, but I was also scared to think of what would happen to me if I stopped taking the medication.  My doctor assured me there would not be any problems if I slowly diminished my prescription over the period of one week.  He also said that I would not experience depression, if any, to the extent that I had before.  He was right.  We had no problems after my next son was born.  We also had a third boy a few years later, and no PPD after his birth.

Through all of this we had special friends who helped out with meals, laundry, baby-sitting, housework, etc.  This helped us a lot. 

Talk with your OB and a therapist.  They can help you through this very difficult time.

--Diane in Texas

I have so much to say to you, to encourage you.  I experienced postpartum anxiety, which I'm sure is as devastating as the depression.  You're just not yourself, you feel hopeless, and time stands still.  There are so many factors and variables as to what triggers a postpartum disorder.  While it's true that your chances of a recurrence are greater than someone with no history, this doesn't guarantee that you will have a recurrence.  I had no repeat episode with my second child 20 months later.

I did not take any medication, since I was determined to breastfeed.  It worked out for the best, because the nursing helped me bond with my child in a way that he and I needed to, and it also increased my "mothering" hormone.

The parts to the formula that trigger PPD are so varied, that no episode can be guaranteed or predicted.  PPD is more common with first pregnancies, also.  These episodes are intensified when a new mother is caught off guard by its occurrence.  You've already beaten that odd by knowing the possibility exists.  My episode was triggered by the anxiety of being a first time mom, of being home after working my entire adult life, being isolated since I had no stay-at-home mom friends, a colicky baby, sleep deprivation, poor diet, and a difficult pregnancy and delivery.  Fortunately, I found "Depression After Delivery" support group information, and that was the beginning of recovery for us.  I then got myself and my new baby involved in baby and me groups, made new mom friends, and my child's colic ended at 10 weeks.  Those 10 weeks seemed to last forever, but they passed.

I feel that if you were to have another child, things would go better for you, also.  You can be a confident, experienced mom now, you're already used to being home, you've made other mom friends by now, you have your first child for company, and you know you made it through the last bout.  It's all the newness and unknowns that got you the first time.

This time, I was prepared for my second child with confidence, support group phone numbers, nutrition information, my mom friends, and my beautiful 20-month-old son for company.  I knew I had lived through it before -- albeit, unpleasant -- but I’d go through it again for my precious child.

--Sandy in Wisconsin

I experienced a prolonged and severe depression after the birth of my first child.  I needed to stop breastfeeding and be medicated.  Then, we unexpectedly conceived our second child while I was still on medication.  The baby was seven months along in gestation by the time we knew.  I titrated off the medication within a week.  I didn't have any depression during the pregnancy and after the birth things went much smoother.  I'm happy to report that I had an uneventful pregnancy and a healthy baby.

Symptoms of depression returned when the baby was four months old.  But we recognized them much sooner and I was medicated before there was a crisis.

My husband discovered a great organization called Depression After Delivery (D.A.D.).  They sent me a lot of helpful information that I was able to pass on to my sister when she needed it.

For me, medications alone were not enough.  I have been in counseling and support groups as well.  It helps to know you are not alone and that other people have experienced similar difficulties as you have and made it though. 

--Name Withheld

After my daughter was born, I thought it was normal to be overwhelmed, depressed and completely out of sorts.  All I could think about was jumping in front of a truck so I did not have to deal with my infant.  I thought what I was experiencing was just normal postpartum blues because everyone I was talking to were agreeing with how I felt.  I finally realized after six weeks that my depression wasn't getting any better and I decided to talk to my OB/GYN about it.  She said it is common, that I shouldn't feel guilty, and that I should take an antidepressant.  I have been on Paxil ever since and it only took about a week after my first dose to start feeling like myself again.  My OB/GYN said that my hormones could take up to two years to completely level out, so I will continue to take my medication until my daughter is two.

I don't plan to have more children (not due to depression).  But I would recommend if you were going to have another child to talk with your OB/GYN and plan on taking medication right after the baby is born.  I did not need medication while I was pregnant, but if the depression was really bad, I would.  Again, talk to your doctor about a possible solution.

I hope you realize that you are not alone and there is help out there.  I wish someone would have told me that it is okay to take an antidepressant as soon as needed.  I hope you did not have the added problem of having a colicky infant as I did.  Good luck if you hare having another child!

--Lisa in Minnesota

I had PPD after my first and second child.  I think a lot of things contributed to the depression -- we had ill and dying parents, financial struggles and job changes.  Take into account all of the stresses around you 
and try to minimize them.

I believe the primary reason I had PPD with my first child was because I thought I could be a "lone ranger mom".  There is no place in motherhood for that attitude -- trade child care with a friend or, if you can afford it, arrange for paid care.  Get involved in a support group for moms such as Mothers of Preschoolers (MOPS).   We have no family in our area, and this group quickly became family for us.

Also check into private counseling -- we were able to benefit from this service free of charge through my husband's work benefits.  Remember, you can't take care of your children if you don't take care of yourself.  Let the housework go and get as much rest as you can, try to eat properly, and exercise, even if it's just a brisk walk.

I didn't take an antidepressant with my first bout of PPD, but I did with my second.  Be realistic -- statistics show that once a woman experiences PPD, she is likely to experience it again and possibly worse.  That was true for me with my second child.

Yes, I had to give up my expectations of breastfeeding because of the drug I took, and I was disappointed with that.  But the bottom line is the baby got fed and mom got help.  In the end we were all happier.

I did manage to wean myself off my medication recently, as I would like a third child.  My doctor and I have no illusions this time . . . I will not breastfeed and I will begin taking my antidepressant as soon as possible after the birth.

Unfortunately, it is not recommended that women take an antidepressant during pregnancy.  If you can, and with your doctor's help, you should gradually wean yourself off all drugs.  But don't do this without your doctor's knowledge -- I believe there are some drugs available that you may be able to take.  Again, rely on your doctor.

--Liz in Indiana

I experienced major PPD after the birth of my first two children.  This was a major factor in our deciding not to have any more children.  However, six years later we decided to try again.  We tried to address each factor we felt contributed to the depression.  During pregnancy, I swam every day -- regular exercise is a big help in combating depression.  I also made rest, good nutrition, and avoiding sugar a high priority.  I also had people who prayed for me regularly.  After our third child was born, I had some of the difficulties and complications after I had after the first two -- but no depression!  Gary and Marie Ezzo' s book Babywise was significant in helping me establish good sleep patterns for my new baby, and therefore for me.  This, I think, was among the biggest helps.  God bless you and may He give you more children.

--Nora in Michigan

My husband was in the Air Force, and we were preparing to move from California to the Northeast, when we discovered we were expecting our first child.  The timing seemed great!  We were going to live closer to our families again, and I would put my engineering background on hold and stay home with the baby.  Everything seemed to be on track, until just a few weeks after we settled into our new home, when I started hemorrhaging.  I was placed on strict bed rest for the remainder of my pregnancy.  For a while I was able to stay at home, but after several ambulance trips, my doctor decided that I needed to stay in the hospital.  My son was finally born via C-section just three weeks early.  I thought we were through the worst, but after a short time my baby was rushed to a larger hospital's neonatal intensive care unit because he was in respiratory distress.

We were thrilled the day we finally were able to bring my son home, a week later.  Shortly after that, however, I noticed that he got hives when I nursed him.  He became extremely colicky.  It took several months and a trip to the emergency room before my pediatrician finally tested my son for food allergies.  Sure enough, he was diagnosed with multiple, potentially life-threatening food allergies.  Several months later, we started seeing signs of asthma, as well.

I appeared to be handling the stress involved with these experiences very well, as viewed from the outside, but my husband and I knew the truth.  I was falling apart.  I had terrible insomnia, even when my son had me up every hour and a half during the night.  My husband helped me as much as he could, but I was frequently angry because his job required him to travel quite a bit.  I felt very inadequate as a mother because my child was having so many difficulties, and because the other mothers in our play group seemed to be handling motherhood so much more easily.  I was losing weight much quicker than I should have.  When my son was 7 months old, I was 20 pounds below my pre-pregnancy weight and constantly in tears.  I became suicidal.  I knew that I needed help.

I went to see a psychiatrist, who immediately diagnosed me as clinically depressed, and attempted to prescribe an antidepressant.  I was apprehensive that if I took any medication, it would have an adverse effect on my son's health, because I was still nursing him.  I refused the medication, and I struggled for several months until I stopped nursing.  I finally agreed to try some of the newer antidepressants, which are in the same family of medications as Prozac, but they worsened my insomnia.  Through trial and error, we found that I got some relief with an older medication, called Nortriptyline.  My symptoms improved but never were completely eradicated.  I had always suffered from PMS, and every month I could count on a week-long spiral downward.  I continued taking the medication and psychotherapy as my son grew bigger and I grew more despondent.

When my son turned two, my husband started talking about having another child.  We had always planned on having at least two children.  The fact that we had come so close to losing our son had different effects on the two of us, though.  While my husband was now driven by the fear of not having a child in his life, I was equally determined that I did not want to relive our experiences.  I avoided the subject for several months but eventually I knew I needed to tell my husband how terrified I was of the risks involved.  I didn't want to disappoint him, but I was not certain that he realized the impact that my depression was having on us.  My son was a very bright and active child, but as he grew older, he had also become willful and very challenging.  Particularly during my premenstrual times, I began feeling extreme resentment and anger toward my son for causing such stress in our lives.  I began to feel more animosity toward my husband as he persisted in his pursuit of having another child.  Mixed with those emotions was a sense of loss because my son would not share the companionship of a sibling, as well as the guilt for wanting to renege on an agreement with my husband, and for having such negative feelings toward the two people whom I loved most dearly.  My husband and I talked about our concerns, and ultimately I agreed to stop taking my medication when our son was three years old so that we could try to conceive again.

By this time, my husband had gotten out of the military, and we had taken up a new residence in New Jersey.  My husband was still traveling frequently and working long hours.  Since we were planning to expand our family, we decided that my husband should take advantage of an opportunity to get off the fast track and move to an area with a lower cost of living.  Three days before the movers arrived, I discovered that I was pregnant.

My second pregnancy was much different than my first.  I had morning sickness this time, and I was living in temporary housing with minimal furnishings while trying to entertain an extremely active child.  I prayed for all I was worth that I would not end up on bed rest!  As soon as I could, I sought the assistance of a new psychiatrist, in preparation for the months ahead.  Fear forced me to try to remain detached and unemotional toward this new child.  When I was four months pregnant, I went in for a detailed ultrasound to determine whether or not bed rest would be an issue.  It was then that we learned that the baby had cysts in its brain, which in some cases have been associated with Down's Syndrome or worse, fatal chromosomal anomalies.  I felt like the ground had dropped from under me.  I literally was in shock, as the doctor performed an amniocentesis that afternoon.  The next few weeks seemed to last forever as we awaited the results of the tests.  My husband and I both knew that our family could not handle a severely handicapped child.  My therapist attempted to prepare me for the worst.  We discussed the likelihood that I would need to restart my medication.  My doctor argued that since I was past the first trimester and the baby was potentially in trouble already, the risk of my taking the medication was not as high as it once was.  We decided to wait.  We closed on our new house during this time, and I began to show signs of pre-term labor, so my parents (God bless them) came up from Florida to help us move in and to help with my son.  The results from the amniocentesis indicated that the baby had no signs of trouble and eventually the cysts dissipated, after all.

By the second trimester, however, the stress had taken its toll.  My son's behavior had steadily worsened between the stress of being in a new environment and the fact that I could not keep up with his energy.  He was waking up several times per night and screaming for hours at a time.  I voluntarily went to the emergency room after spending an entire day vacillating between utter despair and absolute rage.  I realized at this point that my son was in danger of being abused.  I agreed to go on a low dose of Nortryptyline.  My parents came up to help us with our son as much as they could.  Three days before her due date, my daughter was born.

Her birth was unremarkable in the sense that it was very normal, but her entrance into our lives was a significant turning point for us.  Until this point, I had heard from a number of therapists that my son's behavior was most likely due, at least in part, to ADD.  I felt certain that it was really an issue of my poor mothering skills.  My daughter was the one person who really opened my eyes.  It was apparent, from early on, that her personality was much different than my son's.  She was alert, but very easy-going, and she slept through the night by the time she was three weeks old.  As she grew, she was capable of entertaining herself quietly for long periods of time.  As I realized the differences between my children, I finally understood that I was not the cause of my son's behavior problems.

Now I see that my son's health issues have certainly had a tremendous impact on his behavior.  He has indeed been diagnosed with ADD by a prominent child psychiatrist.  He is too young at this point to even consider doing anything medically.  However, I read everything that I can get my hands on about ADD and temperament, in an effort to understand better what may be going on.  We have also begun working with a child psychologist to find a more effective means of handling his behavior.  Like her older brother, my daughter has been diagnosed with food allergies, as well as environmental ones, but her allergies are not as severe, and are more easily managed.  My husband and I continue to strive to avoid the allergens in hopes that they will both outgrow the allergies.  As my son has gotten more mature, he is gaining an understanding of his allergies which has allowed me more freedom.  He now knows that he needs to ask me about the ingredients of any foods that he is offered before he can accept them.

In addition to learning to better deal with him, I have also finally recognized that I need to take better care of myself.  I am now much more aware of how irritable I become when I don't eat or sleep, as necessary.  I had grown up with the belief that if I kept pushing myself, I could do anything, but now I have added a new axiom to that belief.  If I keep pushing myself, I can do anything, provided that I make the effort to take care of my health.  I now have three eager young ladies come over to my house regularly, to help with the kids, while I take care of paying bills or writing letters or whatever else needs to be done, so that I can get to bed on time.  Sometimes they go with us to a park or the pool, so I can get some one-on-one time with each of my children.  Sometimes they keep the kids occupied so that I can get a little exercise.  They also come over monthly, so that my husband and I can go out on a date.

I am still taking medication.  My psychiatrist and I spoke with a number of other sources, primarily OBs and pediatricians, about my taking the medication while I was pregnant and nursing.  Everyone agreed that we needed to find a balance among my health, the baby's health, and my son's welfare.  After my first trimester was over, the doctors felt that taking a low dose of Nortriptyline would be safe.  I was also told that nursing, short term, would also be safe.  I increased my Nortriptyline to a more therapeutic level after my daughter was born.  She nursed for 5 months and then I weaned her down to once a night for weeks before we finally stopped. 

Looking back, I regret waiting until I was desperate before I finally agreed to restart my medication.  It wasn't good for any of us.  The Nortriptyline has been very helpful, but again I was finding that I would still have short periods of rage or severe sadness, so a few months ago, my psychiatrist suggested that we drop the level of Nortriptyline a bit and add a low dose of Zoloft.  Zoloft had been one of the first medications that I had tried, but by itself it increased my insomnia problem.  For me, the Zoloft and Nortriptyline are working together beautifully.  I haven't felt this good in a long time, and for the first time since I reached puberty, my emotional PMS symptoms are gone.  I was so excited to call my mother and tell her that for the first time, since we've known about PMS, my menstrual period caught me by surprise!

My therapist recently asked me how I felt, knowing that my depression is caused by chemical imbalances in my body and brain, as opposed to a decision, conscious or otherwise, to feel badly.  I told her that in some respects, it felt good to know that it was not due to something that I had done wrong in my life, and it was nice to know that I am finally developing the tools to handle it more effectively.  In spite of that knowledge, my husband and I have decided that we will most likely not have any more children.  Although we have endured a great deal of emotional upheaval in our lives as parents, we do not, in any way, regret the birth of our children.  They have allowed us to grow in ways that we otherwise would have never even considered.

--Name Withheld

I had a severe case of PPD after the birth of my son in September 1997.  I had no prior history of depression or other mood disorders, and was surprised at the despair and fear that overwhelmed me.

Although reluctantly at first, I began taking an antidepressant medication three weeks after delivery, when my symptoms were unbearable.  The medication worked slowly but surely, and within a few months I was fine.  Aside from assistance from my family and friends, two non-profit organizations that helped me through this difficult time are:  Postpartum Education for Parents ("PEP") (P.O. Box 6154, Santa Barbara, CA   93160), and Postpartum Support International ("PSI")(927 North Kellogg Ave., Santa Barbara, CA   93111).  Among other services, PEP offers a weekly postpartum depression support group in Santa Barbara.  I would encourage you to seek out similar services in your area, even before delivery if you are concerned about PPD.  In this way, you will already be connected with a support system should you experience PPD and perhaps the group can give you ideas about preparing for the birth and postpartum resources specific to your area.  PSI is an organization with the stated purpose of increasing awareness among public and professional communities about the emotional changes women often experience during pregnancy and after the birth of a baby.  Two of the 8 objectives of the organization are:  1) to provide current information to members on the diagnosis and treatment of postpartum mood and anxiety disorders and 2) to advocate research into etiology, diagnosis and treatment of postpartum mood and anxiety disorders.  PSI was a way for me to learn more about PPD, as well as serving as emotional support during the difficult time.

--Name Withheld

I am a RN and mother of five children who has experienced PPD after each of my children's births.  Also, for seven years I ran a PPD support group in the Metro-Detroit area and set up a network to help new moms cope with this very common but quite distressful disorder.

The good news is PPD is very treatable.  Because there is a range of severity in these depressions, there is also a range of treatment options.  Sometimes short-term psychotherapy is all that is needed.  Often dietary and activity changes can assist the mom.  Yet the vast majority of serious PPDs respond to antidepressant drug treatment with or without supportive psychotherapy.  Where available, a PPD support group is of unparalleled help.

The bad news is the medical community -- and society in general -- still have a great deal of difficulty recognizing PPD and treating it.  A national support organization, Depression After Delivery, helps provide information and has a list of contact people within many states. 

Generally speaking, any time a depression occurs after the birth of a baby, or after miscarriage and remains for over a period of two weeks, one should seek professional help.  Some signs of depression include feeling sad, hopeless, worthless; inability to feel pleasure, especially with regard to things that brought pleasure in the past; changes in sleeping or eating; feelings of anxiety, panic; blunting or numbing of feelings for self, spouse, and/or baby or children.  Seek immediate help if you experience extreme thoughts of suicide, hearing voices, loss of reality, or a desire to harm your baby.

Though extremely rare (1-2 cases in l,000), a more serious disorder, postpartum psychosis, sometimes develops which involves the last group of symptoms listed.  Unfortunately, these are the cases which are frequently highlighted in the media.  The more common types of PPD are not given much air time, and thus many of us who need to know remain in the dark.

My youngest child is 4 and I am thankful to have used a combination of drug therapy, psychotherapy, and the awesome support of PPD moms I met in the support group.  My personal experiences of PPD are but a scant memory now as I feel blessed by the presence of my children in my life.  It is this sense of hope I like to pass along to other moms who live out this dark time in desperation.

--Kathie in Michigan

PPD is real and I never realized how dangerous it can be.  As each month passed, I got worse.  I began to devise ways to harm my son.  When I reached the point that I really felt that I was about to kill my son, I confided in my husband.  I didn't know what was wrong with me and I was scared.  My husband immediately got a relative to watch our son and took me on a vacation.  After we came home, he hired a sitter to come in and help me and our son.  When our son was 10 months old, the depression ended.  It was when I was pregnant with our second child did I realize that 5% of PPD women can seriously harm their child.  Knowing that, I asked for help from my doctor and was given antidepressant drugs after the second child was born.  Unfortunately, I kept reacting to them and eventually discontinued them.  My depression was not as severe as the first one, but it did last 8 - 9 months. 

--Name Withheld

I, too, experienced a major depression after the birth of my first child (now six years old).  I was very scared this would happen again if I became pregnant.  I am happy to report that I now have two other children and did not suffer any type of depression after they were born.

About a year after the birth of my first, I took the antidepressant Zoloft for 6 months (the minimum time recommended by my psycho-pharmacologist).  It helped immediately.  I also continued therapy with a psychologist for another six months after that.

Both professionals strongly discouraged me from taking the drug during my subsequent pregnancies.  These drugs are new and the long-term effects are still unknown. 

Advice I’d give to prevent the depression from recurring includes:  lining up an enormous amount of help for housekeeping, child/baby care, meals, etc.; avoid making any big changes in your life (don't move, quit your job, etc.); let your doctor, friends, relatives know that you had a depression and would like extra support once the new baby is born; make sure you see a therapist experienced with PPD (the first therapist I went to did not diagnose my depression and told us to try marriage counseling!); try to resolve or at least come to terms with any issues relating to your own mother or your role as a mother. Do your best not to get sleep deprived.  It is o.k. to let someone else give a "relief" bottle so you can get some sleep.  Try really hard to take a nap.

Also, do not be surprised if you get a little weepy during the first week or two.  This is normal and does not mean you will get a major depression.  I also would get very hot and sweaty and then could be freezing cold a few minutes later.  This is a result of the hormones going back to normal.  Good luck!

--Name Withheld 

Unfortunately, I've had lots of experience with depression both during and after my pregnancies.  When I was depressed during my first pregnancy, I thought it was because I was a nervous first-time mother.  (In addition, I could not stand for my husband to touch me, even to hold my hand.)  But when I felt back to normal within two days of delivery, I suspected that hormones had played a large part.

Thus, when I was depressed again during my second pregnancy, I mentioned it to my doctor, but he did not take me seriously.  Since I hadn't heard of anyone else with this problem, I didn't pursue it and just marked time until I delivered and felt better.

Since then, I have read more and feel that antidepressants could have helped me.  Don't let your doctor dismiss your symptoms as mine did because no one should have to suffer like this for nine months.

My problems of PPD started when my second son was six weeks old and developed severe colic which lasted more than seven months.  I became very depressed, agitated and cried all the time, but I thought that I would get better when Scott got better.  I didn't seek help because I felt that I should be able to handle everything and was ashamed of my feelings.  I saw depression as a sign of weakness.

When Scott was six months old, he way laying on the floor screaming again and I knew in my gut that if I picked him up I would hurt him.   I finally realized how bad things were.  Fortunately, I found a wonderful book called The New Mother Syndrome: Coping with Postpartum Stress and Depression by Carol Dix which I highly recommend.  For the first time, I realized that I wasn't alone and that PPD (not just the baby blues) can be fairly common because of the extreme hormonal changes a woman's body goes through during this time.  I finally saw a doctor and admitted to my depression.  Ultimately we discovered that I had a thyroid condition, probably triggered by my pregnancy and Scott's colic, which was causing my emotions to be so out of balance.

Since I've started talking of my experience, I've learned of a lot of other women who've been through this, some with colicky babies and some not.  Some also had thyroid problems and others were helped with antidepressants.  The one thing we all had in common is that we felt we were all alone.  PPD needs to be mentioned to new mothers as a possibility so they won't feel ashamed if it happens to them.  It's hard to admit to depression when everyone keeps reminding you of what a happy time it should be for you.  Too many doctors blame it just on the stress of being a mother without taking into account the incredible hormonal changes a woman's body goes through.

I feel that I missed so much during that time.  I urge you or any woman who feels depressed to find a doctor who will listen to you (my experience has shown that women doctors tend to be more understanding).  I want women to know that you're not alone, it is not your fault, and you are not a bad mother.  You deserve to enjoy this time.  Do not be too proud, independent or ashamed to ask for help as I was.  Help is out there even though sometimes it seems hard to find.

Also, I've often wondered if Scott's colic would have been better if I had been able to respond to him better.  As it was, I wasn't able to handle it and couldn't help him at all.  We had no bonding during the first year of his life (plus the pregnancy).  At that time, I never thought I could love him as much as I do now.

As for having more children, we have made the very difficult decision to not have any more.  I love being a mother so much now and sometimes I wish we had another, but ultimately my emotional health was a major factor in our decision.  Emotionally, I don't think I could handle another depression again, either from the pregnancy or postpartum.  Only in the past four months have we gotten my thyroid stabilized.  Even though I understand more about depression now, I just don't feel up to taking the chance.  I'm very happy with my life now.  I want to be a good mother to my two boys, rather than have a third and lose my mind (which I literally felt I was doing during that time).

In addition, my husband and I have finally been getting our relationship back to where it was before.  This is so stressful on a marriage.  Don't try to hide your feelings from your husband and pretend things are better than they are.  I did this for a long time; I put up walls to deal with everything.  Once I finally let him help me, he gave me strength and support and was able to deal with the doctors when I couldn't handle it.  But it's been very hard for us as a couple to get past the turmoil of the past three years.

Good luck with your decisions.  It is a very individual and difficult decision to have or not have more children.  Do what you feel in your heart is the best decision for you and your husband.  No one else has had to go through your experiences and only you know what you can handle.

--Debbie in Illinois

I, too, suffered from major depression after the birth of my first child.  I did not know what was happening to me since I never had any problems mentally before this.  After I was diagnosed and was put on antidepressant medicine for one year, I realized that this could happen again to me if I had another child.  It took 5 years to get the courage to try again and with the help of my psychiatrist, I went on a low dose of antidepressant medication while I was trying to conceive.  After I was pregnant, I stayed on a low dose of medicine during my pregnancy.  The night I delivered my second child, I went immediately on my full dosage of my medication.  I never once got depressed or regretted taking medication while I was pregnant.  My baby is healthy and happy and so was her mom!  After one year, I went off my medicine completely!  I would do it again the same way if I were to become pregnant again.  I like to compare this to a person with high blood pressure or a diabetic taking their medicine during a pregnancy.  An ounce of prevention is worth a pound of cure!  I am so glad my husband convinced me to try again.  Please don't give up -- help is out there.  My psychiatrist and GYN worked hand-in-hand to make sure mom and baby were fine.

--Sandy in Pennsylvania

I have lived with major depression, on and off, for all my life.  At 12 I tried to commit suicide, and was put on medication and was in therapy for over a year.

I had been doing well before my first child's birth and my depression after his birth came as a shock to me.  My husband and I had been trying to have a baby since our marriage four years before, and we had lost two babies in the process, so we were both thrilled to finally have a healthy baby.  I had baby-sat a lot, and our marriage was solid, so I thought I was ready to be a mom.  Boy, was I wrong!

My unrealistic expectations were in large part responsible for my depression.  I expected to sleep 12-14 hours a day as a mom -- just like I had before.  I had never baby-sat a child younger than 6 months old, and I had no clue how much care a newborn involved.  Money was tight, so I had to be successful at breastfeeding -- we simply couldn't afford formula.  Also, I planned to return to work just two weeks after my son was born.  I honestly thought that having a baby was like having a cat or dog -- feed it, diaper it, pat it on the head now and then -- and essentially go on with my pre-baby life.  Then my son was born.

The hospital was busy with several c-section patients, so I was basically ignored, since I was doing well physically.  By the time the nurses asked how the breastfeeding was going, I was already very sore.  I had read all the books, but I have inverted nipples, and I had difficulty getting my son latched on properly.  His large appetite didn't help matters.  He nursed for an hour at a time, every two hours, and then pooped after every feeding, so I was only getting maybe one-half hour of sleep between feedings.  By the time he was two weeks old, my nipples were cracked and bleeding, and I was literally ready to throw him out of a second-story window.  I never hurt him, but I had some very scary thoughts.  I called child abuse hotlines numerous times, only to hang up when they answered, because I was afraid they'd take my son away from me if they knew how I felt.  I loved my baby, and I didn't want to lose him, I just didn't know how to deal with everything I was going through. 

Not having a support network didn't help matters -- my mom was dead, my step-mom and dad both worked full-time and lived over an hour away, my in-laws and grandparents were all elderly, and in poor health, and I was afraid to confide in my friends.  They all seemed so capable, and I felt like such a failure.

Returning to work was out of the question.  I was so paralyzed by exhaustion and depression, I considered it a good day if I managed to grab breakfast before my husband returned from work at 4 p.m.  I never figured out how to shower and dress before he got home, so there was no way I could have gotten organized enough to have gone back to work.

I didn't take medication, although I probably should have, because I had to nurse, so I just never told my doctor what was going on.  I was so ashamed that I never told anyone, even my husband, how overwhelmed I felt.  Luckily, my husband seemed to understand anyway, and did whatever he could to make things easier for me.  He took over all cleaning, laundry and cooking for the next several months, did all the diapering and baby care when he was home, and continually told me what a good mom I was.

Gradually our son started to sleep longer between feedings, and I gradually got better at breastfeeding, diapering, etc.  As I started getting more sleep, and as I started feeling more competent as a mother, my depression started lifting.  I also started confiding in my friends a little -- only to discover that many of them experienced similar feelings when their babies were tiny.  Becoming totally responsible for another life when you're exhausted and going through a hormonal roller coaster is depressing for many people.

When our daughter was born, my step-mom had cut back to part-time work, and she helped me a lot.  I also swallowed my pride and admitted to my friends that I needed help.  Having a support network made a big difference.

Simply knowing what to expect made a big difference, too.  I knew I would be depressed, I knew it would be rough, but I also knew that it would get better.  With my son, it was hard to go on, because I thought the depression would last forever.  With my daughter, I knew that things would get better after a few months, and so the depression was easier to deal with.

Things were also easier with my daughter because she was a smaller baby with a smaller appetite.  She nursed 20-30 minutes at a time every 3-4 hours, right off the bat, so I got more sleep right from the beginning.  I also knew better how to deal with the breastfeeding so I didn't get sore, and I knew how to do all the other mothering skills so I didn't feel so inept -- you get the picture.  I also had more realistic ideas in general.

With my son, I wasn't able to shower or dress, because I thought I was a horrible mom if my son ever cried.  With my daughter, I knew she wasn't going to be permanently scarred if she cried for a minute while I finished a quick shower.

Go ahead and have another baby.  Talk to your friends, family and doctor.  Ask for help, take medicine if necessary, let yourself be human.  You are not a bad person or a bad mom because you happen to suffer from depression.  You don't have to be a super mom or the perfect mom to be a good mom.

Also -- be willing to try various things to deal with your depression.  I am happiest when I'm pregnant, so for me being on birth control pills (which mimic pregnancy) works better than antidepressants.  So now that my kids are beyond the breastfeeding years, I stay on the pill.  I also exercise to help relieve tension.  Do whatever works.  Best of luck!

--Name Withheld

PPD hit me like a ton of bricks after the birth of my second child, all the more startling because I had felt so great after the first.  Although never suicidal, I honestly felt like I was drowning -- I was scared, felt isolated in spite of a loving husband and family, and hopeless in spite of two beautiful healthy children.  All of this was so unlike me, an educated, warm mom who so wanted these kids.  I called my OB after a week and was put in touch with a therapist who specialized in PPD.  She has been an enormous help and support.  I learned that in my case, a lot of childhood issues (alcoholic parent, fear of being left, need to control) were unresolved and had been at play in my life before my baby's birth -- these issues needed to be dealt with.  I've seen my therapist for 10 months now and have become stronger and more realistic perhaps than ever before.  I resisted medication because it was my decision not to take it while breastfeeding (although many women do).  I just began taking an antidepressant now to try to get rid of the lingering residue of my depression.  Hang in there, be gentle with yourself, and don't be afraid to reach out to help yourself just as you would for a broken bone.  Someone told me that just as a broken bone is stronger when it heals, I will be, too.  I think that's true.

I highly recommend the book This isn't What I Expected:  Overcoming Postpartum Depression, by Karen Kleiman and Valerie Raskin.  With regard to medication and pregnancy I also suggest When Words are Not Enough:  The Women's Prescription for Depression and Anxiety, by Valerie Raskin.  I believe there is also a support group on-line on Wednesdays at 9 p.m. on AOL.

--Name Withheld

After the birth of my second child, only 17 months after the first, I plunged into a severe clinical depression that lasted for the better part of two years.  I was overwhelmed with the daily demands of tasks, and couldn't see past the next fifteen minutes.  Repeatedly, I would sigh with relief and think, "Oh, it's finally Friday," only to realize at some point that it was actually Tuesday.  Often by 9 a.m., I had dealt with more stressful situations than most people face in a week.  While I was cleaning the milk off the floor from my son's thrown cereal bowl, crying as I swiped the towel, I would remember the old adage, "no use to cry over spilt milk," and cry even harder at my inability to deal with a simple problem.  On one particularly terrible day, when the two of them had taken a new tin of "bag balm" (an ointment intended for cows but sold at the garden store for dry, cracking hands) and spread half of it all over the kitchen and themselves, I stepped outside for a moment.  A neighbor walking by asked how I was doing, and I mistakenly thought she really wanted to know.  I told her about the children and the kitchen, and her sincere sentiment was, "Well, honey, YOU had 'em," referring to the children.  That sums up the support I felt from the neighbors.

A doctor diagnosed my clinical depression after I wept in his office, trying to explain that my ears ached.  After months of prodding, I finally agreed to take antidepressants.  I wanted to finish nursing my newborn, and I kept thinking that surely I would "snap out of it".  The medications helped immensely.  I took them for about a year.  Counseling helped slightly, but was at least one hour of the week when I could talk to someone.

I am so happy to report that I have now had babies three and four.  Recently I cried thankful tears as I held my newest child.  I realized that if I had stopped with those first two, I would not know the deep, deep joy of these babies.  I was so sick that I cannot remember much of that period in their lives, apart from the sense of "survival mode" and desperate loneliness I felt.  Even now, with postpartum still crashing in on me (baby #4 is five months old now), I am fighting not to go back to that deep dark cave again.  It is a lonely, isolated time filled with tasks, chores and demands.  I starve for creative time, thinking time, contemplative solitude.  But I try to make myself get out of the house, no matter how terrible I look or how long it's been since I had a shower or even brushed my hair.  I try to do fun things with my 6, 5 and 2 year olds, and forget the house.  I am open to the possibility of medication again, if needed, for my fragile emotions and very stressed self.

Godspeed.  You will make it.  You will look back and wonder how.  But the darkest of days is worth walking through in order to look for rainbows and grow sunflowers with your children.

--Dale in Florida

It is with great empathy that I respond as a 35-year-old mother of a three-and-a-half-year-old son,  struggling with depression.  Although my depression was diagnosed about one-and-a-half years after the birth of my son, I believe I have fought its symptoms since I was a young teen. 

My first pregnancy resulted in the pre-term birth of our first son at 22 weeks.  He died shortly after birth, and I became pregnant about 3 months later.  I was then diagnosed with an incompetent cervix and pre-term labor, and confined to very strict bed rest for 4 months in the hospital and one month at home.  It was during this time of bed rest that I believe depression took a strong hold in my life.  On a daily basis, I was faced with grieving the loss of my son while hoping for the precious life of the child in my womb.  It was an emotional roller coaster.

The recovery period from my bed rest was anticipated to be approximately one year.  Yet after one year I still had incapacitating fatigue.  I even needed to call my husband home from work a few times because I couldn't make it through the day.  It was difficult and frustrating to watch all my new stay-at-home mom friends be so lively with their babies.

After about one year of counseling, my therapist suggested an antidepressant medication.  I was reluctant at first because of the stigma (even though I'm well educated and have worked in mental health).  My therapist made the analogy that if I was a diabetic I would take insulin just as an individual with depression takes medication.  That prompted me to begin medication.  The medication has significantly decreased my symptoms of fatigue and irritability so that I can enjoy life with my son and husband.  Many days are still a struggle.

We planned a second pregnancy carefully because prolonged bed rest was going to be involved.  I was off my medication for 6 months while trying to get pregnant.  I observed myself become extremely irritable and fatigued during this time period.  After a miscarriage at 8 weeks, my husband and I decided to count our blessings!  It has taken great courage not to have any more children.  I have struggled with deep feelings of inadequacy as I witnessed friends with their second and third child, yet I have gradually come to peace with our decision.  Remember, it takes more courage to acknowledge your limitations and work within them than to yield to the pressure of having more children.  A one-child family was not a part of my dream family, but I have become quite content (though some days I have my doubts).  Depression also takes quite a toll on a marriage.  Listen to your heart.  Accept help.  Count your blessings.  My life is an active one.  I find that if I keep my son and I active with structured classes and play dates that it helps me get through the day as does a very supportive husband.  Know that you are not alone.

--Name Withheld

As you know, depression is a serious complication of childbearing.  Every woman has the right to enjoy her ability to have children.  When the experience does not go smoothly then the woman and her family need to be fully informed about her options for intervention and treatment.  Education is the key to empowerment.  Through correct information a woman can make decisions which allow her to stay in control of her circumstances and fulfill her expectations.

It is the purpose of our organization to increase awareness among the public and professional communities about the emotional changes women often experience during pregnancy and after the birth of a baby.  Thank you, Mothers At Home, for assisting us in achieving this important goal.

--Jane Honikman, M.S.
Executive Director
Postpartum Support International
927 N. Kellogg Ave.
Santa Barbara, CA  93111
805/967-7636
 

FAHN offers a "Best of" collection of articles from Welcome Home on this subject: #125(d) Why So Blue (Postpartum Depression). This collection offers information about the various forms of PPD along with an extensive list of support organizations and publications. It also contains the personal account of one mother who was successfully treated over an extended period of time for a severe and debilitating bout with PPD.