Pregnancy, Depression and “Please Don’t Use My Name”

Not one of the three friends expected her life to be touched by depression, postpartum or otherwise, yet it was depression that brought them together.

In the past 15 years, the three friends estimate they've come together over dining room and restaurant tables more than 1,000 times. They've shared joy and hardships that have included five marriages, two divorces, eight family deaths, six pregnancies, a stillbirth, four live births, a bankruptcy, an early miscarriage and an attempted suicide. Not one expected her life to be touched by depression, postpartum or otherwise, yet it was depression that brought them together.

"I don't think we became friends in a traditional way — that, at first, we really liked one another," one of the friends admitted in little more than a whisper. "We came together more out of necessity."

Their differences are striking. One, a petite redhead, is a stay-at-home-mom. She married her high school sweetheart and never intended her life to be anything less than perfect. Another, a busty brunette, has always put career first and graduated from an Ivy League school. She works 10-hour days and often proclaims antacids to be a modern miracle drug. Not one of the friends can remember the third's natural hair color, but describe her as a tightrope walker, always working to achieve balance between family and home.

Normally, the group is talkative. Voices often overlap or one will finish another's sentence. Today, the women steal glances at the recorder sitting in the middle of the table and shift uncomfortably in their seats.

"What will you write?" the brunette asks and her eyes scan the room like a spy discussing national secrets. "My co-workers have no idea. Hell, my husband has no idea."

The redhead doesn't wait until her friend's thought is complete before voicing her own. "The other parents think I have it so together. I really couldn't bear for them, or anyone, to know. Please don't use my name."

The Stigma of Depression

Carolyn Turvey, who holds a doctorate from Yale University and serves as an associate professor for the University of Iowa's Department of Psychiatry, said it isn't unusual for people to feel ashamed of depression.
"A lot of people still believe, wrongly of course, that depression is a sign of moral failure," Turvey said. "They believe that if they are depressed that they don't have their act together or that they don't appreciate things in life. Some people even believe that if you're depressed then you are crazy."

While attitudes have been changing in terms of society's view of depression over the past decade, such myths related to the disease persist.

"Depression is a medical illness and it can be treated," she said. "There is no more reason to be stigmatized by it than to be stigmatized by having diabetes or any other illness. These beliefs, however, do persist and they often keep people from seeking the help they need and also staying with the help they need to relieve the depression."

Depression, according to Turvey, occurs consistently twice as often in women than in men. Although this has been studied extensively, there are no definitive answers as to why women are more susceptible.

"There has been full gamut of explanations," she said. "Some say it is due to societal depression. Others say it is due to hormones."

In today's psychology research, she said, there is also a strong belief that women, through their tendency to go over and over issues in their minds and with friends, might not solve their problems as well and be more likely to become depressed.

Living With Depression

Symptoms of depression can be different for each person. Some people just feel numb while others feel sad or helpless. Others are easily irritated. Some crave food while others have to be reminded to eat. Almost all who suffer from depression, however, report no longer having interest in things previously found enjoyable.

All three friends had different experiences with depression. The stay-at-home redhead suffered from postpartum depression after the birth of her first child and has agreed to allow use of her middle name, Meghan, for this article. She pays cash for her antidepressants because she doesn't even want her insurance company to know that she's taking them.

"My doctor thinks I might be coming to a place where we can start moving away from the medication," she said. "I'm really scared about that. I seriously thought I had lost my mind before I started using the pills. The only thing I could think about was death — not ever wanting to hurt anyone or hurt myself — but just planning for death. We all know that we will die someday, but I thought I was going to die every day. I was afraid to fall asleep because I thought I wouldn't wake up. I had jugs of water at strategic locations throughout the house because I was sure a fire would start and we'd all die."

The Road to Treatment

A news story of an Iowa mother accused in the death of her infant was the tipping point for Meghan.

"The depression started before I even gave birth," she said. "I knew that something wasn't right — that I wasn't reacting to things like I should. First I was told that I was nervous about the upcoming delivery. When I took no interest in my daughter after she was born, I was told that I had the 'baby blues' and that it would pass. I went home after that doctor's visit and put my daughter in the crib. She was crying and I just stood there and thought, 'Shut up. Shut up. I can't take this anymore. I don't know what you want. Shut up.' Then I walked away from the crib and went into the back yard. I think I fell asleep. I'm not sure."

Meghan's husband came home a few hours later and found the couple's daughter still in the crib. He was nearly to the point of calling police to report his wife missing when she came in the back door.

"He just looked at me like I was the worst piece of garbage in the world," Meghan said, oblivious to the tears that now streaked her face. "I knew he was right. A good mother doesn't walk away from her child… but I did."

She turned to the internet for information and discovered news articles about Heidi Anfinson, a Des Moines mom who is now serving a 50-year sentence for the death of her son. Anfinson said her son accidentally drowned at home in his bath and that she panicked and placed his body in a nearby lake. The state claimed that she purposefully drowned the infant in the lake. Anfinson's family asserted throughout the criminal investigation and subsequent trial that the mother suffered from either postpartum depression or psychosis.

"As I read about Heidi, my skin began to crawl," she said. "I became physically ill because I thought I was heading down the same path."
Meghan made an appointment with a different doctor for a second opinion.
"When I told the nurse on the phone why I wanted the appointment, she told me to be at the office in two hours," she said. "I knew then that I was going to find help and that, one way or another, everything was going to get back to normal."

Finding Normal

Postpartum psychosis — the most extreme form of postpartum mood disorders — is very rare, according to Dr. Robin Kopelman, and occurs in only about one out of 1,000 women who give birth. When it does strike, however, it can be devastating if untreated since it carries a 5 percent suicide and a 4 percent infanticide rate.

"Often [postpartum psychosis] is the first manifestation of bipolar disorder," said Kopelman, who sees perinatal patients with mood disorders through the University of Iowa Hospitals and Clinics and is an assistant professor in the Department of Psychiatry. "This is due to a variety of reasons that often contribute to a disruption of social rhythms for these women. In particular, sleep disturbance and sleep deprivation, but also just a general disruption of their daily rhythms and routines leave them pre-disposed to a mood episode with psychotic symptoms."

Because the cases involving psychotic episodes — such as Andrea Yates — have been so widely publicized, Kopelman said that is often what people think about when they think of postpartum depression. Such misconceptions can further add to the stigma and, perhaps, prevent a young family from seeking help.

"I think that some of the research we've been doing is finding that stigma isn't keeping women from getting treatment to the same degree as it once was," she said. "That being said, there are still many other barriers that exist to getting treatment."

In Iowa, those barriers are a shortage of mental health professionals and the fact that women are diagnosed on a case-by-case basis. Women who are taking anti-depressant pharmaceuticals when they become pregnant or are planning a pregnancy, may or may not cease the medication.

"We certainly take into consideration what medications the woman is taking and the medication's track record during pregnancy," said Kopelman. "We take into account how many depressive episodes she's had and how severe her symptoms are and have been. We consider what her experience has been coming off medication in the past. We also take into account if the woman wants to come off of medication or not."

Iowa residents who are in need of help have a new avenue available to them through the Iowa Perinatal Depression Project, a Health Resources and Services Administration grant-funded venture through the Iowa Department of Health. Partners in the project are Iowa State University Extension and the Iowa Depression and Clinical Research Center. The website includes information on the various levels of depression that can follow pregnancy and has a hotline number for women who need assistance.

"As a part of that project, we've put together the website where families can go for information," Kopelman said. "As the website expands, we will have information on the various medications oriented toward families, more information on psychotherapy and a link to the University of Iowa Women's Wellness and Counseling Service."