QUESTION: I've had postpartum depression
twice. With my first child, I started having symptoms 20 weeks into
the pregnancy and I hit rock bottom six months after my son was born.
With my second child, the symptoms started 12 weeks into the pregnancy
and I went on Paxil, which prevented me from hitting bottom again.
My daughter is now eight months old, and I can still "feel" postpartum
depression lingering in the background. I really want to get off the
Paxil. Can I do that without losing ground?
ANSWER: Becoming a mother is one of
the greatest identity changes that you will ever experience. Yet,
the impact of motherhood on women's health remains largely unrecognized
in our culture. Postpartum depression is in part a result of the lack
of emotional support available for women going through this transition.
Our society simultaneously pressures women to be "good"
mothers and devalues the work of nurturing. Though we give lip service
to the importance of motherhood, women still experience disrespect
for the unpaid work of caretaking. Cultural pressures inherent in
motherhood, coupled with "invisibility" of the work being done, is
internalized. Is it any surprise that the adjustment to motherhood
becomes a breeding ground for low self-esteem and resulting depression?
Women are brought up to defer their needs to nurture
others. This is our culture's simple means of differentiating between
a "good" mother and a "bad" mother. No wonder so many women, like
yourself, do not even notice the early signs of depression. The first
step in prevention is to understand your own emotional needs, the
forces that exist to forget these needs, and find an appropriate balance
which includes self-care.
Women are additionally vulnerable to depression during
pregnancy or postpartum because it is also a transition which brings
up our personal family history. Let's take a look at several of the
most common sources for depression during this life transition. Consider
whether any of the following possibilities could be contributing to
depression in your life.
The first is cultural gender programming that kicks
in when you take on parenting roles in the family. For example, women
often lose decision-making power in their marriages when they no longer
bring in money. They may unconsciously "defer" to their husband's
needs or decisions, rendering them depressed and powerless without
realizing it. Or they continue jobs outside the home, without changing
their workload inside the home, contributing to work overload and
again, depression.
The second reason is past neglect or unresolved family
conflict experienced in childhood. Motherhood brings us close to our
own experience of our mothers. How did you feel about your mother's
role in your family when you were a child? Was she happy, powerful,
depressed, victimized? What kind of messages did you absorb about
women's experiences of motherhood, pregnancy and childbirth? If positive,
do you identify with her or not? If not, why not?
How did you see your mother's position in her marriage
to your father? Were they happily married? Unhappily married? Was
there a loss through death or divorce in your childhood? Pregnancy,
childbirth and early parenthood is replete with unconscious expectation
for repeating losses that occurred in childhood. You cannot help but
relive the ghosts of the past as you create your own family constellation.
Your depression can in part be a result of unrecognized
fears and unresolved experiences that live in your past, but are affecting
your current feelings. If so, individual therapy can help you separate
yourself from your past and shape your own future more positively.
Refer to my book, "An Easier Childbirth" for questionnaires exploring
your personal experience as preparation for a healthy adjustment to
pregnancy and motherhood.
Consider whether you got the nurturing you needed
from your own parents. If not, it can be quite a stretch to emotionally
give to your children what you did not get! Motherhood already requires
some significant sacrifice. Childhood feelings of neglect or abandonment
can add additional stress to your adjustment when triggered by your
own baby's cries. Motherhood is instinctive and it is also learned.
What you did not get, you can learn to give. But first you must become
aware of the lack!
Unresolved feelings about the pregnancy and childbirth
can also contribute to postpartum depression. Because childbirth is
an experience of great magnitude, it is NOT a neutral event for any
woman. The very physical ordeal that is childbirth can be empowering
or it can be humiliating, depending on how women are treated throughout
the process.
Hormonal changes in pregnancy and postpartum can magnify
feelings and contribute to depression. However, the underlying emotional
vulnerability stems from the meaning of this transition in women's
lives. Many things besides low serotonin levels (for which antidepressants
such as Paxil are prescribed) conspire to cause depression. Antidepressants
are best used as a compliment to psychotherapy when the counseling
alone has not been successful at reducing feeling and thinking patterns
that lead to depression.
Consider ongoing counseling with a therapist who has
prenatal and postpartum expertise as long as you are on the Paxil.
When you have identified patterns of thought and behavior that contribute
to your depression and you feel you have the "tools" and a supportive
and empathic connection with your counselor to work through life events,
talk with your psychiatrist about gradually decreasing the anti-depressant.
(Do not take an anti-depressant prescribed by a physician without
psychiatric training or consultation. Like any specialty, mental health
should be treated for cause and symptom, not symptom alone. In addition,
psycho-pharmacology is constantly changing and requires expert consultation.)
Certainly you should use the Paxil if it is necessary
for functioning or if it helps you get a "step-up" on changing persistent
self-defeating behaviors. But it is not wise to use an antidepressant
in lieu of therapy. It is likely that you will discover that your
dependence on the drug is, at least in part, your compensation for
depending on a primary relationship. With guidance, you may discover
ways your husband and others can give you the emotional support you
may need, but have not as yet identified.
