I'm a mom with depression. Does that bother you? It used to worry me, but now I refuse to let it define me or my abilities as a mother.
I have been in and out of therapy since my late teens. I've been diagnosed with chronic depression and anxiety—and even had one psychopharmacologist tell me I have "bipolar tendencies." I've taken antidepressants on and off for around 10 years. I hated being reliant upon them and abandoned them many times, most recently during the long journey toward pregnancy. I have thought I was done with them.
Like, really done.
But then this past fall, after suffering a major depressive episode while trying to take care of my toddler, I took an antidepressant for the first time in five years. And I realized I might never be done with medications.
Recently, the United States Preventive Services Task Force (USPSTF) recommended screening for depression in the general adult population, including pregnant and postpartum women. Why? Because depression is among the leading causes of disability in adults, and not only does it affects those individuals, but also their families, businesses, and society in general. But while I celebrate depression screening because it will help people get the treatment they need, whether it's medication, cognitive behavioral therapy (CBT) or other non-medically-based treatments, there are risks, too. The USPSTF notes the the potential physical risks toward women—mostly side effects from medications—but the task force entirely fails to consider the psychological ones: the negative stigma that so many women diagnosed with chronic depression face.
Past research has shown that stigma is perhaps the biggest barrier to mental health care, and that even medical professionals carry negative prejudices against those with mood disorders. These negative stereotypes also include the perception that people who struggle with mental illness are dangerous. And all of this negative stigma from others only leads to negative self-stigma as well.
In a New York Times piece related to the USPSTF announcement, the author answered common questions about maternal mental illness, defining it as encompassing not only postpartum depression, but also anxiety, bipolar disorder, obsessive-compulsive disorder, and psychosis. "Several of these disorders may be experienced at once," wrote Pam Belluck, the New York Times health and science writer, "and symptoms can vary from mild depression to thoughts of suicide; or from intense worry to terrifying visions of causing harm to the baby. Most women never hurt their babies, but their stress can undermine their ability to care for their children, and can affect children's emotional well-being, social behavior and cognitive skills."
Reading those words made me think of that time, five years ago, when I stopped taking my medication because I wanted to start a family. Research on the possibly adverse effects of SSRIs on fetal development was still inconclusive then, and I didn't want to take that chance. When I shared my decision to have a baby in an article online, however, I was berated by commenters for my selfishness. The general consensus seemed to be that women with chronic depression should not breed at all. Reading these comments shattered me. Was I supposed to give up my dream of motherhood because of a condition that is only the tiniest part of who I am? Was I supposed to give up being a mom for a condition that might or might not end up being the tiniest part of who my child becomes?
I didn't get pregnant for the next three and a half years. During that time, I felt the absence of my pills in a burning at the back of my throat and a pressure at the backs of my eyeballs. A gauge inside my head was always trembling toward red, and I was forced to find other ways to manage my anger and my grief and my relentless disappointment. I sweat my sadness out on my yoga mat four to six times a week. I began to breathe differently. I meditated every afternoon and every night. After a while, I stopped missing my pills. I thought I was cured.
After my daughter Emily was born, however, it was no longer as easy for me to hold it all together. But even when I cried for several hours straight, I gave Emily everything I had. Even when I had to clench my fists, cutting my palms with my fingernails, I didn't let Emily know anything was wrong. I didn't want the story of depression to be the story of myself. I didn't want those commenters who had called me selfish all those years ago to be right.
At the end of 2015, when Emily was almost one and a half, I had a major depressive episode and began taking medication again for the first time in five years. It felt like some kind of failure, but what else could I do? Several months later, I read the study that mothers may pass a brain wired for depression on to their daughters and I began to watch my own daughter. I began to watch all of the things she had inherited from me—her face, her interests, her temperament—and I wondered what else we might share. What else would I start to see as my daughter grew into a woman?
But over time, I came to realize it didn't matter. I knew Emily was perfect no matter what she might carry inside of her. And I knew that even though I myself was not perfect, I was still a good mother. I was still a person who, despite depression, would always be strong, would always do what had to be done.
Mothers are constantly judged for their choices, no matter what they do. Breastfeeding or formula. Cloth diapers or disposable. Sleep training or soothing baby to sleep. All of these choices are placed onto a slide and slipped underneath a microscope and eyeballed by those who know nothing of the women's lives they are so closely scrutinizing.
And so, yes: I worry about all of the women who might be shamed for their desire to be mothers after being diagnosed with depression at a mandatory screening.
But these women, too, will do what they need to do. These women, too, will hopefully get the care they need, will do what must be done to be better mothers, to be healthier humans. And they will do this despite the stigma. Despite this great shaming that so often occurs.