As A Psychiatrist, I Thought I’d Be Immune To Postpartum Depression. I Was Wrong.

Today’s post comes from Dr. Aparna Iyer, a board-certified psychiatrist and assistant professor at UT Southwestern in Dallas, Texas. She also has a private practice in Frisco, Texas.



By Aparna Iyer

I am a psychiatrist who treats mental health issues during pregnancy and the postpartum period. I had thought that this would somehow make me immune to postpartum depression, as though I could have seen it coming from a mile away and warded it off. But I was wrong. Quite frankly, I never thought it would happen to me.

After nine months of a blissful, uneventful pregnancy, I had an emergency c-section when the baby’s heart rate dropped. Although I imagine I could have been thrilled with the prospect of simply having a healthy baby, I instead found myself in a fog afterwards. People kept gushing over the baby, saying how beautiful he was, but the reality is that I couldn’t see anything past that fog.

My family and friends started to notice as I became progressively more detached and dysphoric. Many friends wondered why I kept dodging their calls or avoiding their requests to come over to see the baby. It just seemed like such a unsurmountable chore to even get dressed in the morning and to put on a smile to meet people, to give off the semblance of the romanticized mother-baby experience that we are all so convinced we will have.

A rock amidst the choppy waters — it’s what we psychiatrists aim to be. We strive to be the calm that our patients need during their darkest times. But in those moments, I found myself immersed in the deepest of those water, grasping for anything that would give me a moment of relief. I was shocked that I, someone who works to give her patients relief from such struggles, could be experiencing it myself.

The reality is that postpartum depression does not discriminate. Although it can impact certain groups of people more than others, it really can happen to anyone. It doesn’t care whether you’re younger or older, rich or poor, healthy or medically complicated. Frankly, it didn’t give a hoot that I was a psychiatrist either. It arrives, often unannounced, angry and ready to plunge us into a vortex of sadness and irrationality. It drives a wedge between us and our friends, family, partners. It leads some of us to act dangerously, towards ourselves and our newborns. In fact, around 80 percent of women report mood changes in the postpartum period, and about 15 percent go on to experience postpartum depression.

And yet, we cannot talk about it. The reality is that we’ve spent the better part of the last nine months preparing for this beautiful experience. We’ve had the baby showers, sifting through countless names to find the perfect one, reading numerous books on parenting philosophies to find the one that fits you best, wondering how you’re going to do anything productive on your maternity leave when all you want to do is stare into those gorgeous little eyes. And now this — is this the ultimate failure, many of us wonder? It’s hard not to believe that it is, although thankfully the world and the medical community have slowly started to truly understand postpartum depression for what it is: an unfortunate but common medical phenomena, one of the most common side effects of pregnancy.

The author and her newborn son.

Oftentimes women come into my office seeking help for postpartum depression and various other postpartum ailments. Many describe the struggle to keep their symptoms a secret, trying so desperately to maintain the image of that idyllic beginning of motherhood. Those of us who have experienced postpartum depression know that can be a strong sense of shame and stigma surrounding postpartum mental illness; likely some of this stigma is perpetuated by the pressure placed on mothers to do it all in a seemingly effortless, fashionable way in a society that sneers at the very concept of depression.

Depression and anxiety during the postpartum period need to be taken seriously, by the postpartum mother, her partner, her family and her physician. It is everybody’s job to compassionately support the mental health and wellbeing of the mother and her baby. Untreated postpartum depression can have terrible consequences. These mothers are less likely to get postnatal care, more likely to self medicate with drugs and alcohol, and ultimately this may all result in their babies experiencing worsening outcomes.

Luckily, postpartum depression is very treatable. In many cases, these women can opt for talk therapy, which is often sufficient and a great source of relief and support. In some cases, we might have to also add an antidepressant. While this can make a patient nervous, especially if that patient is breastfeeding, many of my patients feel more confident with this decision once I present the data regarding the risk profile of antidepressants versus the risks of uncontrolled depression or anxiety.

Depression at any stage of life can be a debilitating experience, and I am not glad to have had it, especially during a time I would have wished to have enjoyed bonding with my baby. However, I suppose that this could be viewed as an extension of my training, an opportunity to have experienced what many of my patients experience. Sometimes when my patients are in their darkest times, I express to them that I can see the light, the relief, at the end of this tunnel, and that they have to trust me that we can get there. As I write this and pause frequently due to my now three-year-old rambunctious toddler smiling up at me and vying for my attention, I smile back and am grateful that I reached the light at the end of my mine.

After Postpartum Depression, The Decision To Have Another Child Is Fraught With Anxiety

Today’s Warrior Mom guest post comes from S. Prescott.


By S. Prescott

Sometimes, I’ll see babies in the store or at the kid gym, and my ovaries will scream. I’ll want to sniff their sweet heads, and enjoy their quiet cuddles. The perfect little cries, and gentle hands. Then, I’ll snap out of my daydream to ask myself:

Do I really want to do that again?

My mind suddenly shifts to the scary reality that was my postpartum mental illness two years ago. I’ll be taken back to the days when I just wanted to lay in bed and cry, but I still got up, and pretended I was fine. I’ll remember how I lost my spirit in the cloudy whirlwind. I’ll remember how I felt completely detached from the light that was my life.

The decision to grow one’s family is never a simple one, but for those who’ve had postpartum depression before, it comes with an extra layer of emotional distress. Those who’ve had postpartum depression or anxiety or psychosis before have a 50 percent higher risk than the average mom of experiencing one of these illnesses again.

Could I handle it again?

I’ll ask myself this as I see a tired, new mom shuffling through Target.

Could I handle a toddler, a newborn, and postpartum depression?

I can hardly handle one tantrum, let alone a tantrum from two kids. Would it make my depression worse? Would I become unattached to either child?

Will it affect my relationship with my son, and my husband?

My husband adapted so well to having a newborn — would he be able to do that again? My son gets so jealous. He might hate me.

My whole adult life, I was told kids would not be in my future. My husband and I accepted that, and enjoyed our life. We didn’t plan to try meds, or to adopt. We were content living our lives, just the two of us. Then, when we found out that what I thought was a kidney infection was actually a baby, we were horrified — and elated.

The typical fear-driven questions filled my head. Will I be a good mother? What if it hates me? The pregnancy was rough on my body, but I had no idea what was the storm getting ready to take over my mind and soul.

Our son was born at 42 weeks gestation, and sent to the NICU three hours after a 20 hour labor. I had a failed induction under my belt, a past term baby, an infection, and a sick baby. I spent the next nine days crying. At one point I couldn’t even hold our sweet boy. Going home to an empty nursery was crushing. However, I powered through. When we finally got discharged I felt a light in my heart, and clear air in my mind. The NICU had him on a perfect schedule, and he was an amazing eater. Life was great. Then the storm hit.

We were back in the NICU with RSV. I was sad, but this was different.

Having postpartum depression is like being in one of those dreams where you are running, but going nowhere. There is this fear and isolation, but you aren’t 100 percent what sure is causing it. In my case, I was surrounded by wonderful people, yet I still felt completely alone. Looking back at it now, I knew what was going on with my mind, but I was scared to admit it. I already felt like a total failure. I couldn’t even keep my baby from getting sick for a week. I blamed myself for both of his NICU trips, and for every problem around the sun. My fuse was short, that even the smallest thing would make me cry, or explode.

My best friend took me to lunch, and told me she thought I wasn’t okay. I didn’t deny it. I was not okay. I sat in the parking lot of our favorite diner and called my OB. My best friend sat in the passenger seat of my car, and told me it was all going to be okay. She assured me that I wasn’t a bad mom, and no one thought I was a failure. I still don’t think she understands how much I appreciate her for saving me.

I spoke with my doctor. I worked up the strength to say, “I think I have postpartum depression.”

He prescribed medication, and on Day One, I felt a change. I wasn’t better, but I wasn’t sliding into a hole of darkness. Within the week, I noticed I was someone different. I wasn’t quite my old self, but I wasn’t the “damaged” hot mess that I was before. I was handling my emotions better, and my fuse grew. I wasn’t flying off the handle, and I was no longer numb. I found Postpartum Progress, and for the first time, I didn’t feel alone, crazy, or like a failure. I felt empowered.

There isn’t a day that goes by that I don’t think about my struggles with postpartum depression. The ups, the downs, the tears, and the true breakdowns fueled by mental illness, stigmas and self doubt.

My husband and I have reached a point in our lives where we are discussing having more babies. We both have incredible siblings that have greatly impacted our lives. We don’t want our son to miss out on that incredible bond.

I’ve come to a point where I no longer cower in fear at thought of having PPD once more. There are so many things that I know now that I didn’t know then. I know more about caring for a newborn baby, handling lady-part goo, and I know more about my mind. I can tell when something isn’t quite right, and I’m no longer afraid to get help. I don’t see postpartum depression as a shameful thing anymore. I know about all the amazing references, organizations, and helpers there are out there. The more I think about, and look into having more babies, the less fearful I become. I know that I can make it through.

We haven’t started trying for number two just yet. But I know when I do, I’ll have a world of strength behind me.

P.S. More on the question: Should you stop having children if you’ve had postpartum depression? 

What Do Postpartum Anxiety ‘Aftershocks’ Feel Like? This Mother Explains.

Today’s Warrior Mom guest post comes from Jen Bullett, who lives in Chicago.


By Jen Bullett

Hours, days or weeks after a major earthquake hits, the world braces itself for the impending lesser shock known as the aftershock. The tragic nature of the earthquake is drawn out. We wait to see if the aftershock is truly destructive or more of an inconvenience.

If you have experienced any number of challenges with trying to get pregnant, being pregnant, dealing with loss or postpartum issues, you probably know a thing or two about aftershocks. They come in so many different forms and appear at the most unlikely of times.

Like when you are filling out a form at a new doctor’s office and it asks you how many pregnancies you’ve had, followed by how many of those pregnancies resulted in live births. Then there’s the one that asks whether or not you’ve been hospitalized or had procedures. I don’t know whether a D & C is considered a noteworthy procedure. I put it down, just in case, and then cringe a little while a doctor glosses over it. “I see you had a D & C after a miscarriage.” Aftershock.

And then there are the times when marketers, having purchased your name from one of the many pregnancy apps, decide to send you formula in celebration of your soon-to-be-delivered baby. I guess their database didn’t inform them that there was no baby. I remember having to log into the pregnancy tracking site, and choose the setting that noted that my pregnancy was not successful. It was the only way I could stop receiving notices saying my baby was the size of a grape or a nectarine. Aftershock.

If you’ve experienced loss or complications with pregnancies, you may also be hyperaware of other people’s situations. Your heart aches when a friend, colleague or acquaintance has a loss, or complication, or postpartum struggle. When this happens, I remember exactly how I felt in those moments in my own life. I would give anything for this person not to have to feel this pain or sadness. Aftershock.

The author and her son.

Finally, there is the question, “Did you just love your maternity leave?” When someone asks that, the blood drains from my head to my toes. If by “love” you mean I felt like Sisyphus most days and I often felt so anxious I wanted to claw my way out of my own body, then yes. I love my son. He is literally the sweetest little boy ever and he makes me smile pretty much every second I am around him. It was all worth it and yet, I will never forget my lonely and scary maternity leave. Aftershock.

Over a year after the birth of my son, with the accumulation of aftershocks, combined with the normal stresses of life, I got hit with a real whammy. Turns out my postpartum anxiety decided it needed a sequel. In May, I found myself in the familiar spot of feeling panicked, struggling with insomnia, battling a racing mind, and coping with a constant physical buzzing through my body. How did I get back here? Only months earlier, I had cavalierly transitioned off medications. I was cured. But bad habits creep in when you are living your life. I forgot to take care of myself. I forgot to take time to be healthy. I tried to be tough through every aftershock and I never asked for help.

The thing about most aftershocks is that they aren’t as strong as the first shock. Yet it’s a double edged sword — you’ve already pulled yourself out of it once, so you know how to do it, but you also know how bad things can be. When you know what hell feels like, you are petrified of finding yourself back there. You will do anything to prevent that. You might be like me and begin a quest to find a quick fix.

But there isn’t a quick fix. The only path is to start again from the beginning. You make goals. You celebrate small accomplishments. You give yourself a break. You ask for help. You put yourself first. You climb up. You rebuild. You construct an even stronger foundation and reinforce supporting structures so you’ll be ready for the next aftershock.

Aftershocks are going to happen. This is a reality of life. Nobody means for them to happen. If you do find yourself in the middle of an aftershock, I hope that you have the good fortune, as I did, of being surrounded by a spouse or partner, family, colleagues, bosses and experts who are compassionate and supportive. And don’t forget: There is an end. As noted by Winston Churchill, “If you are going through hell, keep going.”

Princess Diana Spoke Candidly About Postpartum Depression And Self-Injury In 1995 Interview

(Photo credit: Paisley Scotland)

This year marks the 20th anniversary of the death of Princess Diana. She remains a vivid icon, remembered for her charisma, grace and tireless activism. Now, thanks to footage and transcripts from a 1995 interview with BBC1 Panorama’s Martin Bashir, we see another facet of the late princess—her courage to talk about things no one else was talking about.

In the interview, Diana spoke candidly about her experience with postpartum depression and self-injury. She was honest and reflective, and even though us commoners can’t fathom the unique pressures of royal living, her struggles as a new mom are surprisingly relatable.

Here’s what we learned from their conversation.

Diana had PPD with her son William, but didn’t know it until later.

BASHIR: How did the rest of the Royal Family react when they learnt that the child that you were to have was going to be a boy?

DIANA: Well, everybody was thrilled to bits. It had been quite a difficult pregnancy – I hadn’t been very well throughout it – so by the time William arrived it was a great relief because it was all peaceful again, and I was well for a time.

Then I was unwell with post-natal depression, which no one ever discusses, post-natal depression, you have to read about it afterwards, and that in itself was a bit of a difficult time. You’d wake up in the morning feeling you didn’t want to get out of bed, you felt misunderstood, and just very, very low in yourself.

BASHIR: Was this completely out of character for you?

DIANA: Yes, very much so. I never had had a depression in my life.

But then when I analysed it I could see that the changes I’d made in the last year had all caught up with me, and my body had said: `We want a rest.’

She received treatment, but lacked community support.

BASHIR: So what treatment did you actually receive?

DIANA: I received a great deal of treatment, but I knew in myself that actually what I needed was space and time to adapt to all the different roles that had come my way. I knew I could do it, but I needed people to be patient and give me the space to do it.

BASHIR: When you say all of the different roles that had come your way, what do you mean?

DIANA: Well, it was a very short space of time: in the space of a year my whole life had changed, turned upside down, and it had its wonderful moments, but it also had challenging moments. And I could see where the rough edges needed to be smoothed.

BASHIR: What was the family’s reaction to your post-natal depression?

DIANA: Well maybe I was the first person ever to be in this family who ever had a depression or was ever openly tearful. And obviously that was daunting, because if you’ve never seen it before how do you support it?

BASHIR: What effect did the depression have on your marriage?

DIANA: Well, it gave everybody a wonderful new label – Diana’s unstable and Diana’s mentally unbalanced. And unfortunately that seems to have stuck on and off over the years.

BASHIR: Are you saying that that label stuck within your marriage?

DIANA: I think people used it and it stuck, yes.

It became so painful that she would self-injure.

BASHIR: According to press reports, it was suggested that it was around this time things became so difficult that you actually tried to injure yourself.

DIANA: Mmm. When no one listens to you, or you feel no one’s listening to you, all sorts of things start to happen.

For instance you have so much pain inside yourself that you try and hurt yourself on the outside because you want help, but it’s the wrong help you’re asking for. People see it as crying wolf or attention-seeking, and they think because you’re in the media all the time you’ve got enough attention, inverted commas.

But I was actually crying out because I wanted to get better in order to go forward and continue my duty and my role as wife, mother, Princess of Wales.

So yes, I did inflict upon myself. I didn’t like myself, I was ashamed because I couldn’t cope with the pressures.

BASHIR: What did you actually do?

DIANA: Well, I just hurt my arms and my legs; and I work in environments now where I see women doing similar things and I’m able to understand completely where they’re coming from.

BASHIR: What was your husband’s reaction to this, when you began to injure yourself in this way?

DIANA: Well, I didn’t actually always do it in front of him. But obviously anyone who loves someone would be very concerned about it.

BASHIR: Did he understand what was behind the physical act of hurting yourself, do you think?

DIANA: No, but then not many people would have taken the time to see that.

Yet she still performed as the Princess of Wales. The public was unaware of her struggle.

BASHIR: Were you able to admit that you were in fact unwell, or did you feel compelled simply to carry on performing as the Princess of Wales?

DIANA: I felt compelled to perform. Well, when I say perform, I was compelled to go out and do my engagements and not let people down and support them and love them.

And in a way by being out in public they supported me, although they weren’t aware just how much healing they were giving me, and it carried me through.

The interview reveals how brave Diana was at a time when there was a strong stigma of mental illness. She helped start a conversation, and for that, we have respect.