Postpartum depression more than the 'blues'

• To order self-help book
• Some tips on easing stress

By Beverly Creamer
Advertiser Staff Writer

Marcia Mager – here with 3-year-old son Reyn – is writing a book about postpartum depression and her own experience with it. Kyle Sackowski • The Honolulu Advertiser

Only trouble was, they were wrong.

"During the first few months of motherhood I was horrified at the intense emotions I felt," the Mililani resident writes in a book she's in the process of completing.

Instead of bliss, joy and boundless maternal love, she was awash in feelings of terror, anger and isolation. Nights without sleep, a colicky, screaming baby, and a sense of inadequacy and guilt, left her feeling desperate and betrayed.

But Mager sought help. With anti-anxiety medication, weekly counseling and a supportive husband, she weathered two years on an emotional roller-coaster. And she began to write about what she feels is far more common than is usually acknowledged: the life-numbing impact of postpartum depression.

"It's such an enormous taboo to say anything about not liking motherhood," says the 46-year-old writer. "Or to say anything about wanting to throw your baby against the wall. It's the ultimate thing you don't speak about. Who will really admit to thinking this?"

That's what Mager hopes her book will do — give voice to the transitory turmoil, rage, angst, depression and terror some women may feel as motherhood unfolds. She also hopes it will help the world understand how a mother could be driven "over the edge."

Perhaps it will also help prevent another tragedy.

In the aftermath of what Texas authorities call an "unimaginable" crime — the bathtub drowning of five children in Houston three weeks ago, allegedly by their suicidal and depressed mother — intense scrutiny is being given to postpartum depression and what role it may have played. Her husband has said she was overcome by the "psychotic effects" of postpartum depression, and her attorney is considering an insanity defense.

At the same time, media outlets are taking a new look at what Honolulu psychologist Rosemary Adam-Terem says can be a highly volatile emotional state for a new mother, caused confusion for both the unsuspecting individuals immersed in it and the culture at large.

Jane Honikman, director of the Santa Barbara, Calif.-based Postpartum Support International, said at least 10 percent of mothers suffer from postpartum depression — 400,000 women in this country alone — but a Canadian support group puts estimates at twice that. Yet there's little societal recognition of the impact that intense sleep deprivation, fluctuating hormones, the demands of a newborn, and a dramatic life change can sometimes cause.

"If postpartum depression isn't recognized and treated, it becomes chronic," said Honikman, who founded the California support group 15 years ago. "That may be why there's divorce, substance abuse, neglect. Depression is a very terrible disease, and women suffer in silence."

But Adam-Terem stresses that postpartum depression, a serious and debilitating condition, is not the same as "baby blues."

'Baby blues' more common

"'Baby blues' are real common," she said, affecting anywhere from one-third of new mothers to almost all of them.

"And people confuse the blues with postpartum depression. But they happen in the first couple of days or a week, and they're characterized by weepiness and emotionality. You can be really happy and suddenly you're touched to tears for no apparent reason. I remember seeing a bunch of dead flowers and starting to cry. It's probably due to the sudden change in hormones. Right after birth there's a sudden drop in all the hormones that sustain pregnancy, that in the third trimester were making you feel pretty good."

While baby blues can be upsetting, they're not usually very serious, should go away quickly and aren't associated with other mental changes, said Adam-Terem.

By contrast, postpartum depression can settle in for the long haul, showing up within the first few months and lasting months or years if not treated.

"It doesn't whomp you," said the psychologist, "it comes on in the first six months and becomes a persistent depression where you can't cope. You feel hopeless, helpless, very negative, sad, down. But sometimes you can also be agitated with worry. I've seen women pace the floor, unable to sleep. And then decision-making and judgment go. You're just not yourself, and no one is quite sure what's causing it."

How do you know the difference between the blues and depression?

"It has to do with duration and intensity and timing," said Honikman.

According to Kerry O'Donohue, a group facilitator and counselor for the Pacific Post Partum Support Society based in Vancouver, British Columbia, Canada, new mothers need to pay attention and get help "when the bad times outweigh the good times."

"Women feel they're going crazy," said O'Donohue, "and they're often isolated and alone, and it doesn't fit society's concept of how mothers should feel."

They may also be besieged by unwanted and unbidden thoughts.

Postpartum depression also should not be confused with postpartum psychosis, an acute emotional state that needs immediate intervention and is characterized by a loss of contact with reality. The woman may have a sudden onset of "really crazy thinking," said Adam-Terem, and may start thinking things like "my child is evil" or attribute strange thoughts to her baby. But this emotional breakdown is rare, with the incidence far less than 1 percent, she said.

"This is a medical emergency and requires immediate hospitalization," said Honikman. "The woman could be hallucinating or delusional."

Programs proposed

Because of tragic cases in the last few months blamed on severe postpartum depression, there's now a congressional move to provide new programs. Two weeks ago, Honikman helped Chicago congressman Bobby L. Rush draft legislation that, if passed, would provide money for research and support services for postpartum depression.

Called the Melanie Stokes Postpartum Depression Research and Care Act, named for a Chicago woman who committed suicide after giving birth, it would fund programs to develop and deliver services including in-hospital mother/baby units and outpatient programs for families.

"When we don't have our own families to support us, we need to turn to friends and community services so a woman can heal," said Honikman. "Pregnancy needs support, too. One of the most common complications in both pregnancy and the postpartum period is depression."

When Adam-Terem worked with Kapi'olani Medical Center, she ran a Honolulu group for mothers suffering postpartum depression. But now that she's in private practice, the group has ended, and no formal group exists here. Mager tried to start one with an informal ad in a community newspaper. While a number of women called to talk, only one made the first meeting. Far more is needed here, they both say.

It could begin just with an awareness on the part of hospital staff, obstetricians and pediatricians, she said. "Follow-up is fairly poor. We need to alert pediatricians to ask mom how she's doing."

The "mother/baby" bond is one clue to a new mother's feelings of depression, she said. "Most moms gaze at their babies for long times. They're very interested in very uninteresting things, like how many times they poop. And there's this mutual gaze going on, and body-shaping, and a desire to hold the baby. In a depressed mom you won't see all that. The baby will be lying in the crib and she won't be looking because she can't reach that part of her."

Husbands and friends can also help, she said. "When people are depressed, they don't always recognize they're depressed. That's when the support system has to be alert and take that person in hand a little more."

"If their partner is supportive they're likely to get through it faster," agrees O'Donohue, a group facilitator and counselor from Vancouver. "We work on things like self-care and acknowledging the hard work of mothering, and that this is a life-changing event and there is adjustment. Our mission is to end the isolation and distress that mothers feel."

As a new mother who went through an indelible postpartum depression herself, Mager knows how crucially important that mission is. "Had a few courageous parents sat me down and told me the larger truth," she said, "I think I could have embraced and enjoyed early motherhood much more."

You can reach Beverly Creamer at bcreamer@honoluluadvertiser.com.

To order self-help book

To order the book "Post Partum Depression and Anxiety: A Self-Help Guide for Mothers," call (604) 255-7999. The Pacific Post Partum Support Society in Vancouver (www.postpartum.org) will send an invoice for the cost of the book and postage, which is $15.50 in Canadian funds. Banks will draw a check in Canadian funds. Find Postpartum Support International of California at www.postpartum.net.

Some tips on easing stress

More tips and insights from psychologist Rosemary Adam-Terem to help the new mother who is feeling stressed and isolated:

• Fathers may want to help, but often don't know how, she said. They want to "fix" the problem but can't. However, they can offer their wife some respite, rest or a good night's sleep. Even if they take the baby for an hour, it will help so mom can take a break and maybe just get away and visit a friend for a little while. "Getting out just to see other people and to express your feelings is really, really important," said Adam-Terem.
• If you're the friend of a new mom, don't be afraid to ask her how things are going. And if she looks stressed out or sad, don't be afraid to say something like, "You look sad. How are you really feeling?" Just being able to express emotions is important.
• "If you don't have extended family here," said Adam-Terem, "make a family out of your friends."
• If you're a new mom, don't be afraid to ask for things that would help you out. Line up a friend or relative to babysit to give you a break. "A lot don't like to ask for help," said Adam-Terem. "There's a lot of guilt or sense of failure. I try to undo that and normalize those feelings."
• Self-care is up there in importance. While your baby is asleep, take time to just relax and do something you enjoy. Don't try to get all the laundry done instead.
• Try to get perspective back in your life by doing something you enjoy, even if it's just briefly.
• If you're feeling trapped by having very little maternity leave from your job, and you don't feel there's enough time to emotionally or physically heal, ask if you can take some unpaid leave.
• Equally important is feeling free to be truthful about negative feelings. "Moms have told me they don't like to say anything about how things are not perfect," said Adam-Terem. "There needs to be a place where you can be totally honest. That's where spouses can be helpful. But they can't minimize it with, 'Oh, it's nothing, you'll be alright.' That's crushing. That's the last time she'll tell him anything."
• If your feelings of depression persist, seek professional help.