Relapsing on The Road To Recovery From Postpartum Depression

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This week has been really, really difficult. To give a little backstory, I’m on medication right now for PPD stemming from the birth of my second son, who is now 16 months old (I also had it with my first). I’ve been on the meds for two months, and after they kicked in around week three, I was doing amazingly well. I’ve been feeling even better this round than the first time (I got a prescription immediately after the birth, then went off nine months later, then back on two months ago after a relapse). I’m not sure if it’s due to a change in the dosage, or some difference in me, but I’ve been legitimately happy, rather than just relying on the medication to keep my head above water. For those of you who’ve had PPD, you probably understand what that’s meant to me.

I was happy and healthy for five weeks, in which I was able to enjoy my sons, keep my house clean, cook a couple nights a week–even when my husband was out of town for a days at a time, I felt capable. Then about a week ago I crashed, hard.

The funny thing is, if I’d been having the kind of issues that I have during the worst of my depression, the last week would have been a good week. I was still able to function, take care of my children, get out of the house, and remember my first name. But I was so unhappy, so unfocused, so…blah. And because I’d been in such a great place just the day before, it was a colossal letdown.

It got me thinking about the process of recovery from mental illness, and how it truly is a process: there are pitfalls, there are setbacks, and there are triumphs, and sometimes all of these things happen in the same week (or even in the same day).

I’m not sure how it works for other women with postpartum mood disorders, but I find that hormonal imbalances–for example, those revolving around menstruation–really throw a wrench in my recovery process. I should have known last week when I started to have very dark thoughts that something wasn’t normal. Instead, I fell right back into my typical PPD pattern of guilt, shame, and doubt. Rather than examining my feelings and attempting to identify their cause, I let myself think that the depression was coming back, and that I’d never recover, and my life would never be good.

Even though I’d had a wonderful month and my medication was working and I’d felt so optimistic, the minute the bad thoughts crept in, I succumbed. I allowed myself to be dragged under, and I wallowed in the negativity. It was as though I had just been waiting for the demons to return and embrace me, and I fell into their arms almost willingly.

Why does this happen? And does it happen to everyone? Or am I the only one who is unable to accurately distinguish a passing sadness from the crippling numbness that is postpartum depression? Now that my hormones are regulating themselves and I am not in physical pain from cramps and backache, I can see that the bad week I’d been having was temporary, and that I’m all right. But while I was in it, I genuinely believed that the medication really wasn’t working, that I’d failed at getting better, and that I’d never be sane or healthy.

Now that I’m writing about this and attempting to understand this small backslide, I see that I need to be more proactive in my mental rehabilitation. If I had been prepared with the knowledge of what was happening with my body–i.e., if I had been more aware of when my period would be coming–I might have been able to prevent the hopelessness that came with feeling as though the medication had stopped working. I might have been better able to deal with the mood swings and crying if I’d known that it’d probably be over within the week.

I’m hoping I’ll be able to take this experience and make next month better. I know I’ll never really be free of the hormones that come as part and parcel of womanhood, so I need to deal with the implications of those hormones. Most importantly, this past week has reminded me that the road to health will be paved with disappointment and hard lessons. I just need to remember what I’m doing here: I’m living life. As long as I’m breathing, I’ve triumphed, and one bad week doesn’t change that.

Alexis Lesa

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About Katherine Stone

is the creator of this blog, and the founder and executive director of Postpartum Progress. She has been named a WebMD Health Hero, one of the fiercest women in America by More magazine, and one of the 15 most influential patient advocates to follow. She is a survivor of postpartum OCD.

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  1. Alexis, I am so happy you wrote this.. The same exact thing happened to me… I was starting to feel good and being about to do things and then BAM i would get my period and go back down… I have a really good doctor that helped me realize this and had me watch how i felt during the next 3 cycles… it cycle got a little better.. now it has been 8 months and now when i get my cycle i can tell i get anxious and weak but nothing like the first 3 periods..also she got me on natural progesterone cream that i use everyday that helped me as well… Because your progesterone levels drop right before your period that enable your body to have a setback of depression and anxiety… It was the best thing for me.. Ask your doctor about it..and again thanks for writing this…

  2. PS–sorry for the misspells– but yes it gets better with every period you have… you will get stronger and stronger and it will not be as bad as the last..

  3. I totally get what you're going through. EXACTLY. When we have a bad hour, bad day, bad week, bad month I think it's more easy for us to accept "defeat" and to fall into that negative thinking pattern. It is so hard to be postive when it's so much easier to roll with the negative crap.
    Look at how far you've come. Look at how much you had to overcome. You are stronger and wiser. I hate it when people say this to me "This too shall pass" but it is true. It will pass. You know this.
    We're all here for you.

  4. Bingo! I wish all psychiatrists and books that address ppmds discussed this phenomenon of mini-relapse pre-menstrually. It is the toughest the closer you are to having recovered from ppmd. I think this is because regular premenstrual symptoms are combined with the anxiety/trauma we have from having been ill with a ppmd.
    Initially, I remember it was like I was tossed right back into the hell of my ppmd every month and I feared this is what my life would be like forever – so long as I was fertile and got periods. Fortunately, I was wrong. As months turned into years postpartum, my pms has returned to better then before my postpartum struggles and they will for you too.
    Also, one thing that helped me was a daily ratings of symptoms menstrual chart that my doc gave me to chart my symptoms and actually see how my mood was really fluctuating because of my pms and not because of a relapse. This really helped me and my hubby see I wasn't relapsing.
    My point: This will pass. Give it time and know that you are not alone!

  5. Wow! I just found your site yesterday while seeking information on this exact phenomenon. My little one is now 16 months old. I stopped nursing him at 13 months and had no idea that this would send my ever-reeling hormones into a tizzy. I'd been working hard for the last 5 months (it took me 8 months to even realize that feeling the way I did wasn't normal) to get out of this rut that is PPMD and after finally feeling like I was getting on top of things, I sunk to one my lowest lows. At the time I had no idea it was PMS. Now I definitely see a pattern and am planning to talk to my doctor about it next week. I, too, am wondering if this will go on forever. I know it shouldn't, but it's so hard to see the other side of this disorder.
    You definitely aren't alone and seeing your post today was just what I needed to realize that I am not alone in this either. Thank you.

  6. Thank you for sharing your story. My journey has been ongoing. I found there were days when I felt happy, optimistic, able to get things done (in my own way: conquer the world) then next day… crash. Over time it was a pattern that repeated and I just learned to come to expect the "come down" (I imagine it's what taking hard drugs is like) and that the down day would pass. Progress doesn't occur in a linear fashion. Hang in there.

  7. Wow! You are not alone. I am SO happy to have read this post today! I was definitely meant to, as I just had a really difficult few weeks myself and fell into the negative thought patterns big time. I decided I was feeling well enough a few months ago and weaned myself down to a very small dose of my medication that I have been on for over a year. Basically taking just enough to help me sleep but no longer a therapeutic dose. I desperately want off of it because of weight gain, which is a source of depression all on its own. Anyway, I am almost 18 months postpartum and 21 months into this journey (started during my 3rd trimester) and thought it was time. I must admit now, that something still felt "off", but I had come leaps and bounds from where I once was, which was a terrifying place. My periods have not only been irregular at times (not normal for me), but they have definitely brought on the symptoms, pretty much since my cycle returned postpartum. Some months are tolerable and some months are REALLY bad. Looking back, they got better with time, but now that I am not on the meds as I was, they seem to be getting bad again. I had PMS before PPD, but always knew what to expect and could blow it off as just that…PMS. I agree with the comment about having the trauma of PPD to deal with now as well. PPD was so traumatic for me, that whenever I feel anything that reminds me of that terror, I freak and start the catastrophic thinking. I too fall right into the negative thinking…exactly as you stated it. Just yesterday, I weeped all day long at work and ended up sobbing on the phone with my mother last night. Fearing that this is my new reality and I won't go back to the "old" me, etc. Devastated that I still need medicine all this time later. Today I realized that I had been ovulating and I feel much better. Could have been the big cry, or just that yesterday was a bad day. I also upped my dose of my medicine last night. I will do whatever it takes to beat this. Thank you for letting me know that I am not alone. I too need to take the bull by the horns and will definitely be contacting my Dr. about the hormone thing. Hang in there! I'm right there with you!

  8. Mandy Moore says:

    I am going through a setback too. I was fine a couple of weeks ago, but then BAM. It's back and when people ask what's wrong, and I tell them my PPD is bad again, they look at me and say, "Your daughter is 14-months-old. That's impossible." So I suffer in silence. The only thing that keeps me going is that I'm her sole provider and if I'm not here, she'll be raised by who knows? It's terrible. Just know you aren't alone. Thank you for this post.

  9. I don't know whether this will help or not, but after my fourth bout, I finally got help, and eight years later I am still on some form of medication. It's changed from postpartum to major depressive disorder, but it's been the same thing, really. My cycles throw a wrench into things too, which is funny since it never factored into anything at all before I had children. Now, on the IUD, several meds for anxiety and depression, and trying very hard to be patient and pace myself, I still get bad PMS. I was almost forty before any discernable symptoms arose.
    So, long story short, it takes time. Sometimes the imbalance becomes the normal and it takes longer to correct, and the longer the correction is in effect, the harder it is to wean and the longer the return to normalcy (i.e. no more meds). I'm looking forward to that day, but my Doc hasn't felt in all those years that my life has settled sufficiently.
    Here's hoping. Hang in there. You know you have us, and you are not alone and we are here for you every steo of the way.

  10. Mandy, anyone who tells you "that's impossible" has not been in your shoes. PLEASE do not listen to them Listen to you body and your heart. We all walk a different path to recovery.

  11. Oh thank God i am not the only one who feels that I am back to day ! of the worst of PPMD. I had no idea until a very close friend of mine said you know I'm beginning to see a pattern here. So I started logging it and bang PMS. The only problem is I really do go back into that deep fog and I hate myself for it once its over. It just feels so real and I instantly e-mail my psychiatrist…bless her heart…and feel this need for more and more reassurance that it isn't a relapse. That I am in fact moving forward.
    My disappointment is that I also find the anxiety hits during my ovulation time as well. My doctor has recommended for me to see a endocrinologist, so that I can rule out any major hormonal issues.
    Alexis and all the women out there who commented on this article thank you!!!!! This is such an ongoing topic in my household right now.
    A very important note: For anyone who is taking Effexor, I made the mistake of switching directly from the name brand:Effexor XR to the generic brand. I did this only because of cost. What happened was very scary because I simply could not get out of my funk for weeks, and I was simply TERRIFIED. So please consult your doc before doing this. i didn't and I will NEVER do this again.
    Thanks Alexis and Katherine!!! I know we have never met but I truly love you both dearly!!!!

  12. Thank you for this post. I've struggled and struggled with relapse experiences. At first I felt so baffled by it…I hadn't read anything about ppd relapse or how to build skills to manage it. Even though I've worked as a mental health counselor working with folks to manage relapse, it took me a long time to turn the "relapse is part of recovery" focus onto my own healing and start to identify my relapse triggers (including hormonal ones – big time!). I've found working through relapse so very, very lonely and that there's even less support and understanding than there was for dealing with the main event of ppd. And I spiral down so quickly into wondering if this is always going to be the way it is…and like you, sometimes my worst despair is when things have been going well bc it is so far to fall.

  13. As someone who also went off meds at 12 months postpartum and experienced a relapse of symptoms, I am so appreciative that you wrote a post on this topic. Like so many other aspects of postpartum mood disorders, this is another one that doesn't get a lot of attention. The fact that you will have ups and downs, and just because you feel better and feel back to normal, it doesn't mean it will always be like that. Once my cycles started regulating after pregnancy, I could definitely identify that certain times of the month were going to bring about some major irritability and tearfulness. The not knowing what to expect and not always seeing the hard times coming is such a battle. And it's so hard to not QUESTION yourself every time you are a little cranky or sad – like, oh crap – is this going to pass, or is it coming back? I hope next month is much better for you. And again, thank you for being so open about this.

  14. Katherine Stone/Post says:

    Turns out some generics are not as effective as the brand names, Michelle, so it's definitely something worth discussing with your doctor!

  15. Katherine Stone/Post says:

    It is SO NOT impossible. Don't suffer in silence. We're here.

  16. Katherine Stone/Post says:

    "Progress doesn't occur in a linear fashion." Love that!

  17. Katherine Stone/Post says:

    Both weaning and PMS can impact recovery, and can send people back "down the drain" for a while. It's only temporary though, so keep talking to your doctor and sharing these patterns.

  18. Katherine Stone/Post says:


  19. Thank you, Mindy. I'm starting to feel, like you, that maybe the imbalance is just going to be a part of my life and I need to learn to deal with that. And I think I'm OK with it. I just need to relearn how to live this new life.

  20. It is most definitely not impossible. I wasn't even diagnosed the first time until my son was 8 months old, and I was on medication until I got pregnant with my second son, so 10 months after that. People who say that just don't know what they're talking about.

  21. Good! Talking to your doctor sounds like a really great way to be proactive in your recovery. I need to do that too, and I will as soon as I've logged my moods for a month or two to find out when I'm relapsing. Thank you for sharing your story!

  22. Oh, you have no idea how much I hope for that! I really take courage from your words, because knowing that other people have some semblance of normalcy after PPD helps me understand that my time will come, too.

  23. Thanks for the tip, Janna! I'll have to look into that.

  24. Thank you so much for writing this!!! The same thing happend to me. I was finally feeling good for a long stretch of 4 weeks and then major crash, right before my period and was depressed and anxious partly b/c i WAS so disappointed that I had had a setback and thought i WOULD never get well. but each cycle has gotten better and better w/ less lows. thank you for helping me understand this better and that it's more common than what I thought. thank you so much for your thoughts.

  25. I really needed this post. I have recently been through trying to change meds, having a relapse and changing back, starting to wean my daughter and then just ovulated for the first time in 20 months. I have also started therapy for the first time. So a very intense time. Last night I was thinking I would need to be hospitalised. But now I can see it was probably the hormones of ovulation as well as issues being raised in therapy. It is so awful to feel so bad and it is hard to accept this is something I may have to live with longterm. It is exhausting and seems so unfair.

  26. Thank you all for the insight. Three weeks after the brith of our third child my wife wanted a divorce. From the previous year or so I don't even remember a harsh word between us. I have been a monster to her ever since. How did you all recognize the problem and how did your husbands deal? We are 17 months into this.

  27. I just went through what feels like the same exact sort of setback. I was doing really well on meds for three weeks and feeling happy and even excited a few times, then my period, and on the third day of my period I sunk into a low mood, when my period left, the mood turned into despair and pure panic that the meds stopped working, I’m still having a bumpy week filled with anxiety and worry that this isn’t the right med for me and I’ll have to start all over, or that if I max out on the dose, I still won’t recover. Wondering if others have felt this mid or post period?

    • Heather King says:

      Oh yes, Emily. The hormone changes before, during and after your period can cause havoc for a week or sometimes more. That has been true for me as well. I just have to keep reminding myself that it will change, it will get better, and it does not mean I am starting over. The reality is that it improves as the hormones chill out each month, but it’s always scary and makes you feel so stuck. Hang in there, mama!

  28. I just came from my psycho pharmacologist appt back to back with my check up with my obgyn. I have been suffering with severe PPD and have finally found the right amount of therapy and meds to now be PPD-free. But yes, you are correct, our period and it’s side effects can break you down to square one. I was prescribed a birth control pill that only gives me a period once every three months. This has helped tremendously. But the week I have it, I am confined to bed, in a fetal position, similar to the one I was in when being admitted into the psych ward following the birth of my daughter. It’s all those hormonal induced memories that can just capture the right amount of pain and blues where depression finds itself no longer a stranger. I came upon this site, to see if there were any others dealing with the aftermath of PPD recovery. My family has agreed a year at home, not at work, will help my therapies have an optimal outcome. Yet, after 15 years in my profession, I find this a hard concept to swallow too. I am happy to have help with my children at home, and enjoy being home everyday. But after an extremely successful 15 year career, which was halted by my PPD, I still find I need the support of PPD recovered people who may be in my position. All the mothers who have had children and not experienced PPD, I find no point in discussing my darkest of points with the disease. Although I am better, I still find the need to engage with other mother’s who have gone through my same experience. All those immediate “baby happy” mommies annoy me, or rather, I envy. I want the memory of my PPD to go away, I want to stop feeling the guilt of not bonding with my daughter until she was 9 months old. I want to make amends with all those I have hurt or disappointed. But most of all, I guess I strive to forgive and love myself as a mother who’s DNA predisposed the PPD to occur whether I liked it or not. Whether I was rich or poor, successful or not. That was my destiny, and it is that, that I fought hardest against to recover to the place I’m in now. Everyday is a new day, and for a person who already suffered from mental illness, I get that. But I thank you for having the guts to share your story, because nobody “gets” how a hormonal induced period, can bring back all the fears, pains, and anxieties that PPD brought up shortly before.

    • Heather King says:

      Thank you for all that you’ve said here, Candace. I know that you are helping every person who reads this. You are making so many moms feel less alone in their struggle to forgive themselves for what they could not control, and to see that feeling awful every once and a while is a part of being recovered. You have such good insight and I just know you have good things ahead of you. I’m so glad you took care of yourself and continue to do so. We all need to be reminded to do that even when things are “better”. Thank you

      • Thank you so much for your positive reply. I also wanted to add that after my son was born 3 years ago, I was showing the early signs of PPD, yet once my daughter was born a year ago, that’s when the PPD turned to psychosis (due to a lack of sleep, and change in the chemistry of my body that then needed a change in meds). I feel the need to remind all mothers that recovery doesn’t happen overnight. it took a week in the hospital, and four months of intense therapy and med changes to at least get me out of the severe depression. But I still suffer from anxiety and suffer from post traumatic stress disorder from when I was going through PPD, which only spawned agoraphobia in me, that I hadn’t suffered from before. My main point is that the full recovery time is roughly the half life of your PPD. Of course with greater amount of therapy, meds, and support, you may be able to get over that hurdle a lot earlier. Sorry but I think timelines are key since most of us are working or worked and barely find time to have the baby, nevertheless plan for the unexpected PPD.