When I turned forty, I tumbled slowly into a deep hole. While caring for a six-month-old infant, two older children, and starting a new job in a new city, I was expectedly busy, some days nearly frantic. I had always been full of energy and drive, able to handle anything that either my NICU practice or my children hurled at me. We transferred to a new city and new jobs four months after my third child was born. Then I turned forty and everything changed.
Despite taking night call in the hospital twice a week, and pumping at work, I continued to enjoy nursing my last baby. She had been easy from the start, and I planned to cling onto nursing (and oxytocin) for as long as possible. At first, I noticed my sleep pattern changing, but assigned it to my workload, the stress of moving, and fatigue. I could not go to sleep, and when I did fall asleep, I awoke at 4:00 or 5:00am each day, ruminating over all my worries (call schedules, a new school, new teachers for the kids, a brand-new nanny). Despite running in overdrive, I rarely felt hungry, began to eat less, and lost some weight.
When I became grouchy and short tempered with the kids, I attributed it to stress and my workload. There was always so much to do, both at home and at work. However, sometimes I erupted in anger at my children for no good reason. They were adjusting to big changes in their little lives, too. I observed myself continually furious at my husband and resented his enjoyment of his new job (when I was not). Yet, because I continued to work full-time and take night call in the hospital, the fatigue I felt was extraordinary. Some days it felt like the typical “post-call” funk, and other times it felt much worse. I literally forced myself to drive into work for my night shifts.
Then one morning while in the NICU attending to sick babies, I noticed that I was unable to make the most straightforward of clinical decisions. Should we treat the patent ductus arteriosus with indomethacin or move straight to surgical ligation? My thinking had slowed until my brain felt foggy. This was noticeably different, since my pattern of practice had always been decisive, even borderline impulsive. I began to have terrible throbbing headaches, and my poor husband complained about my lack of interest in sex. I was so busy with work and the stresses of my new life, not to mention goings on with the children, that I had not noticed my lack of interest in intimacy.
For two months, my anger, irritability, and general unhappiness progressed until one day at lunch while whining about my situation to a colleague, also a critical care physician, she opined that I was depressed, and recommended I see a psychiatrist friend of hers. Fortunately, this physician worked me into his schedule quickly, put me on an effective medication, and over the next six months, I gradually recovered. Thank goodness I never felt hopeless or suicidal, as some women do.
As a neonatologist I knew plenty about postpartum depression but never considered that diagnosis for myself. It is amazing to me now that I was unable to identify what was happening. My symptoms of depression were both classic and comprehensive: fatigue, poor sleep, foggy thinking, inability to focus or concentrate, headaches, lack of interest in food, weight loss, irritability, inappropriate anger, and lack of interest in sex. I quite simply assumed that I was transitioning poorly to my new job and ruled out postpartum depression since my baby was already six months old when my mood changed.
During this period, my feelings of guilt and self-doubt were inexorable. I felt like the worst mother and wife ever. It is only because I saw a good psychiatrist, and because medication and psychotherapy worked for me, that I recovered. These last fourteen months - this stressful pandemic living - have been difficult for many working mothers. Our jobs and our home lives have changed dramatically.
If my story resonates with you, and you recognize any of these feelings or symptoms, please talk to someone – a counselor, a therapist, a social worker, a pastor. Feeling this way is not normal despite how much we may convince ourselves otherwise. These symptoms indicate a severely depressed mood, which may occur anytime within the first year after giving birth. Or you may have a major depression unrelated to childbirth.
You are not a bad mother if you develop depression. Mental illness is a genuine biological illness, like diabetes, or asthma. Moreover, depression is treatable. With medication and psychotherapy, you can feel better. I am living proof of that.
Susan Landers, MD
Her new book, “So Many Babies” can be found here.