When Trina Mallett's third child, Hailee, was born, nothing went the way Mallett had planned. Unlike her older siblings, Hailee had colic, so for the first 12 weeks she cried nonstop from 6 p.m. to 10 p.m. Nothing would soothe her, including being fed. In fact, nursing was a disaster. "She just wouldn't latch on properly or take a bottle, so I could never leave her with anyone," recalls Mallett, a stay-at-home mom in Idaho Falls, Idaho. Very soon, Mallett grew as weepy as her baby. Life became a total daze -- she couldn't sleep, eat, or focus on anything. Her husband tried to be supportive, but he traveled frequently for work and didn't fully understand how bad things had become.
Mallett struggled in silence, thinking she was just going through a hard time. Then, after about a year, the panic attacks started. Every morning she'd wake at 5 a.m. and promptly throw up, and she grew so paralyzed with fear that she couldn't even go to the grocery store without another adult. One day her two older children, then 3 and 11, asked to go to the playground, and Mallett realized that a minor outing like this had become insurmountable. "I had to tell them we couldn't go because Mommy wasn't feeling well," Mallett recalls. "I felt like such a failure. Why couldn't I handle this?"
Hailee was almost 3 years old when Mallett finally sought help, at her mother's urging. She described her problems to her ob-gyn, who immediately suspected she was depressed. "I thought, 'What do I have to be depressed about?' I'd always been a happy person," Mallett recalls. "I had no idea that my problem could be an actual illness until my doctor explained it to me." Like many depressed moms, Mallett thought that if she could just soldier on, she'd overcome her troubles on her own.
This isn't surprising to Diana Lynn Barnes, Psy.D., a psychotherapist and founder of The Center for Postpartum Health, in Los Angeles, who herself was hospitalized for postpartum depression (PPD) after the birth of her second child. Our society portrays motherhood as a time of ultimate fulfillment, which promotes unrealistic expectations in the minds of new moms, she explains. "As a result, women go for long periods of time without treatment because they feel unbearable guilt. They also worry that they'll be considered weak," says Dr. Barnes. In fact, half of Americans who suffer from clinical depression don't receive any treatment, according to a survey by researchers at UCLA and at Wayne State University, in Detroit. But going without help only makes things worse.
"Unrecognized and untreated depression among parents is a potent risk factor for children," says William R. Beardslee, M.D., chairman emeritus of the department of psychiatry at Children's Hospital Boston and author of When a Parent Is Depressed. To begin with, depression interferes with a mother's ability to properly bond with her children. Studies from the National Institute of Mental Health now show that infants of depressed moms get less interaction, fuss and cry more often, and show higher levels of physiological stress than do babies of mothers who don't have the condition. Some studies even hint at a connection between a mom's depression and a child's physical health. Recent research from Johns Hopkins Children's Center found that children with asthma whose mothers showed signs of depression experienced more frequent asthma symptoms. "Fortunately," says Dr. Beardslee, "many treatments for depression have been proven to work."
What Is Depression, Really?
No one yet completely understands depression's origins, although researchers now believe that the condition is a dysfunction of the brain's neurotransmitter system that affects emotions, sleep, and appetite. The textbook definition of depression is a constant state of malaise, lethargy, weight gain (or loss), and excessive sleeping (or insomnia). But it may take on different guises, especially in mothers. Often it feels like the worst kind of hopelessness, combined with an inability to cope with daily activities and a lack of interest in much of anything.
Though fathers experience depression more often than was previously believed (a recent survey showed that 26 percent of dads show signs three to six months after their baby's arrival) women have always suffered at a higher rate than men. Experts think this could be due to the difficult role women have taking care of children while facing multiple other demands. The condition is known to run in families, but environmental causes may play a much larger role. Depression can be in part a reaction to stress, especially stress that is chronic, and the marathon of motherhood is chronically stressful.
In fact, a survey conducted by Harvard Medical School and the University of Michigan found that 10 percent of women with children under the age of 18 had major depressive disorder in the last year. Stay-at-home moms with more than one child younger than 3 experience depression more than women with older kids; so do working moms who have trouble arranging or paying for child care, according to the American Psychological Association's National Task Force on Women and Depression.
Inside a Mom's Mind
"It's especially difficult to recognize depression in mothers because they're so busy taking care of others and they appear competent," says Dr. Beardslee. Washington, D.C., journalist Tracy Thompson fought depression when her daughter was a toddler. She knows it can be hard for family and friends to spot the warning signs. "Nobody can see anything wrong with you and yet you're in agony, so you just suffer through," Thompson says. As the author of The Ghost in the House: Motherhood, Raising Children, and Struggling With Depression, she surveyed nearly 400 mothers who'd been diagnosed with depression. The most common symptoms they reported were irritability, an inability to set limits with the kids, and a craving for solitude.
During the first days after giving birth, many women will experience what's known as "baby blues," marked by mood swings, crying, anxiety, irritability, and difficulty concentrating and sleeping. It usually goes away within two weeks and doesn't require treatment. If the symptoms persist and worsen over the next several months, the condition is considered postpartum depression. When PPD isn't treated, it can last for a year or longer. By that time, though, moms are less likely to connect their depression to childbirth. (In rare cases, untreated PPD can take a dangerous turn into suicide or psychosis, which occurs when a mother becomes delusional and harms or even kills her children.) Trina Mallett most likely had PPD -- along with anxiety -- that became chronic because it wasn't addressed.
It's a vicious cycle: Mom wants to be alone, but her kids want her to play with them. When the little ones inevitably push the boundaries, she is so depleted that rules go out the window; baths get skipped, one hour of TV slips into two. Betsy Landis, of Los Angeles, who was diagnosed with depression when her daughter Josie was 1, remembers a need to escape. "I wanted to be away from Josie," she recalls. "I felt like I was in a black hole." These thoughts are common for depressed moms. "They may say they won't go outside because they don't want anyone to touch or hurt the baby, and when you probe further it often turns out that they're afraid of hurting the baby themselves," says Patrick Finley, M.D., professor of clinical pharmacology at the University of California, San Francisco. "Anxiety often accompanies depression." Landis only began to feel better after taking the antidepressant Celexa, starting therapy, and joining a PPD support group. "The moms were suffering in different ways: One wouldn't smile, one was frantic, one was agitated, one wouldn't let you touch her kid," she recalls.
Happily, once a mother begins treatment, her children can also benefit, finds a study from Columbia University and the New York State Psychiatric Institute. Trina Mallett remembers the first time she felt genuinely content after starting her treatment of Lexapro and psychotherapy. Hailee was 3 and Mallett's son was 5, and she took them on a Western-themed trip to Wyoming. "We went to a dinner show and on a wagon ride, and I found myself laughing with my kids," she says. "I was able to enjoy myself like I hadn't been able to in many months. I think my kids were a little too young to know what a milestone it was, but they knew that we'd finally done something fun."
How Drugs Can Help
Moms shouldn't resist medication; the risks of untreated depression are worse than those of the commonly prescribed treatments, says Dr. Patrick Finley. And drugs can be enormously effective in alleviating the crippling symptoms of depression. Some can be safely taken while breastfeeding, so nursing doesn't need to be a reason to avoid medication. The drugs show up in breast milk, but in concentrations low enough that doctors don't believe they cause harm.
Doctors generally start patients on the lowest dose. It may take several tries before they hit on the right drug, and once that happens, Dr. Finley recommends staying on it for at least six months because studies have shown that going off antidepressants too soon ups the risk of relapse.
Talking To Kids About Depression
As tempting as it is to dodge the topic entirely, experts say it's best not to shield your children from what you're going through. You can bring it up with kids as young as age 3. More advice:
- Sit down as a family. Present a unified front with your spouse. Discuss any scary events the kids may have witnessed. Try something like, "I have an illness that's making me tired and cranky -- you are not making me feel that way. And we've got a plan to help me get better." (Dr. William R. Beardslee recommends avoiding the word depression until a child is at least 8.) Above all, kids need to know that their parents are going to be okay.
- Let them ask questions. Young kids might worry that they can catch Mommy's illness, or they might feel responsible and want to cure it. Encourage open communication; depression should never be stigmatized by secrecy or shame.
- Reinforce the family bond. Recall earlier happy times and point out to your children that their beloved rituals -- Sunday dinner, birthdays, holidays -- will remain.
- Keep talking. It takes time for children to understand depression and voice their concerns. Kids who do well in these circumstances are able to grasp that depression might recur, and they can articulate protective strategies, such as talking to other supportive adults and participating in activities
Originally published in the June 2011 issue of Parents magazine.
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