“How long will I need to be on the medication?” It seemed like a harmless question, the sort you’d see on a suggested list of questions to ask your doctor when starting a new treatment or regimen, right up there with “What are the possible side effects?” and “How soon should I expect it to take effect?”
Looking back on that conversation with my obstetrician now, nearly a full year later, I realize that question and her subsequent answer has significantly shaped my understanding of my diagnosis and my expectations for treatment and recovery.
My postpartum depression diagnosis last fall was my first experience with any sort of depression—as far as I knew, anyway. Depression, anxiety, and other mental health issues may have plagued a number of relatives on both sides of my family, but I had always seemingly dodged that mental health bullet.
My doctor noted, though, that given my family history my previous experiences with baby blues following the births of our other three children may have actually been mild cases of postpartum depression that went undiagnosed due to my ability to function relatively normally. Regardless, I went into my depression treatment with a number of assumptions that may have set me up for the frustration, anger, anxiety, and despair I find myself wrestling now.
This Has to End Relatively Soon, Right?
During that discussion about an increase in my dosage, my doctor never offered definitive dates for when the treatment would end. Yet somehow my mind, in its desperation for healing and a return to normalcy, took her “at least until March, perhaps after your son weans” answer as a firm deadline to mark on my calendar and aim for. Despite her limited expertise on treating mental health issues, I trusted her so implicitly I not once sought out additional information or data on my condition.
Sure, I talked with friends who had experienced it, understood it, and survived it. I listened to friends who had battled depression and anxiety their whole lives and navigated the complexity of treatment during pregnancy and breastfeeding. I spoke with some who had found healing through non-medication treatment, others who had found relief with mild dosages of medication alone, and a handful who waited out the internal storms when no treatments worked.
But despite my high dosage of medication needed to maintain an even keel, I always assumed my depression would become easier to handle and end sooner rather than later. Not once did I expect to still be battling it a year after our son’s birth. But I am. And it is frustrating and defeating. And completely normal.
Long-Term Symptoms Are Common
It wouldn’t be until 11 months later, after a scary downturn in my mood led me to contemplate veering my car into traffic or off an overpass to spare my family the burden of my failures, that I actually looked up the limited facts available about postpartum depression. I had hoped for comfort in the data, but there was little to be found.
Of women suffering from postpartum depression, 38 percent experience chronic symptoms. In those being treated for their depression, 50 pecent still suffer more than a year after childbirth, while 30 percent of those who forego treatment are depressed up to three years later.
It was certainly a relief to know my lasting symptoms were relatively common, but it left me with a slew of questions and few answers. If half of women treated for this condition suffer longer than a year, as I do, how much longer could it last, exactly? Or will I be one of the unfortunate whose symptoms are chronic—perhaps a result of undiagnosed pre-existing depression or maybe a side-effect from the years of emotional and verbal abuse I endured in past relationships?
I’ve finally found a good counselor, and we’re trying eye movement desensitization and reprocessing therapy, but is it the right treatment? What if I had started counseling sooner—would I be feeling better by now? Is my medication and dosage still appropriate and effective? How can I explain to people that I’m still suffering a year later and expect them to understand when most days I don’t even know what’s going on with me?
In those questions lies much of the problem with mental health ailments, including postpartum depression. This brokenness isn’t like a broken limb, a bacterial infection, or other common maladies. Mental health treatment isn’t cut and dry with set timelines or a slew of established best practices. While mental health care has improved by leaps and bounds over the years, and some best practices do exist, the treatment may never be a one-size-fits-all-or-even-most.
It’s the Uncertainty that Frustrates Me Most
Natural remedies may or may not work. Available medications are hit or miss for each individual, and the trial and error process is time-intensive, frustrating, and emotionally taxing, with medication management likely being handled by a non-mental health specialist, as access shortages for both psychiatric services and mental health as a whole plague populations across the nation.
How about counseling? Even without factoring in the access issues, finding a counselor or therapist who can effectively treat you can be just as time-intensive, frustrating, and emotionally taxing as the medication game. Therapy is more than simply finding someone who is competent and available; it requires a level of trust, rapport, and comfort that is not typically necessary with other health providers.
To top it off, seeking treatment means facing and overcoming the public stigma of mental health issues. It’s no wonder that half of postpartum women forego treatment, or even diagnosis. The stigma and shame surrounding the illness seems to only grow the further away from birth we get, so even if we are fortunate enough to have the support and resources needed to seek diagnosis and treatment, we can find ourselves more than a year later with a new sense of shame for not being better despite being well past the newborn phase.
It’s Embarrassing to Be Ill So Long
That stigma weighs on me daily. I never felt shame for my diagnosis early on, but now that our son is a toddler, I find myself battling constant pressure to be healed and okay and normal, to see results from my treatment. Yet all those questions remain, with the “When?” most prominent.
I don’t know when I will get an answer. So I face each day as the crap shoot it is, not knowing if it will be a good day or a down one; if I’ll be able to function normally or if the dark thoughts will plague me; if I’ll be able to smile and laugh with coworkers and friends or struggle to fight back tears of frustration. I know I’m not alone, which sucks as much as the depression itself, as it means so many other women are suffering along with me, or have known this suffering in the past.
But perhaps this knowledge may help you or someone you know. You don’t have to be alone in your darkness, even when that darkness lasts much longer than you expected. If you are the friend or loved one of someone who suffered from postpartum depression following birth, please don’t assume they are fine months later. Reach out. Talk to them. Listen. Offer a shoulder to lean on or a helping hand. Be there to fight the darkness and stigma.
Someday we may find respite from the pain, but while we are still asking “When?” what we need is the support, understanding, and care of those around us.