Treading Water: Fighting Postpartum Depression and Anxiety

“This is such an awful feeling… like you are in an alternate universe from the rest of the world. I feel like my body is always buzzing.”

“I feel like I’m in a constant state of crawling out of my skin. I’ve never wanted to escape my own body so desperately.”

“This is such a dark place… I can’t put words to it. The urgency… the hopelessness.”

The quotes above are texts I sent to friends at some of my lowest points postpartum. When those were sent, I was starting to recognize that what I was feeling was not “normal”.  This was beyond the typical “baby blues”.  Life felt out of control and I was not okay.

After we were released from the hospital, we tried to settle in to some semblance of a routine and figure out life with a newborn. While I can clearly recall the events surrounding Everett’s birth in chronological order, postpartum is a blur. Hours bled together and there was no difference between night and day. At one point, I realized that I hadn’t brushed my teeth in three days, because there was no time that felt like “night” or “morning”… and I was so preoccupied with anxiety and caring for Everett that I didn’t even clue in that my mouth tasted like a camel had crawled in and died.  I spontaneously burst into tears every few hours, unable to bat away the overwhelming and terrifying thoughts that would pop into my head multiple times a day. At one point I looked at my mom and sobbed, “I have to keep him safe for the next eighteen years?! How am I going to do that?” I felt emotionally naked and exposed to the elements; the slightest stressor would pierce me like hail.

The first month or so postpartum I felt like I went through our routine – feed, diaper, sleep, feed, diaper, sleep – as if I had a wet blanket draped over me. Every movement was hard.  I knew I was depressed. I felt miles away from the person I used to be, the person I thought I was. I tried desperately to swim upwards, to get my head above water and feel sun on my face. But no matter how hard I paddled, I never broke the surface. There was always more water. Always more water. Always more water.

I remembered reading that sometimes during postpartum you become very close to your partner and other immediate caregivers. It was true that I almost always wanted someone nearby. Yet it wasn’t that I felt close and bonded to them; the relationship felt one-sided, clingy, panicky. I clung to them as if they were my life raft, and I was certain that without them I would drown. I knew I was stressing people out, but honestly, I didn’t care. It’s not that I didn’t WANT to care, or that I wanted to suck the lifeblood out of the people I love most. It’s that I didn’t have the capacity to think beyond myself, because I was absolutely in survival mode. It’s like they were giving me emotional and psychological CPR; I couldn’t even think about their arms being tired, because I was certain I could not survive without them.

If you were to look back at my search history on my phone during that time, you’d see a common theme: difference between baby blues and postpartum depression, stories about postpartum depression, does postpartum depression get better, when will I feel bonded to my baby, effect of traumatic delivery on bonding. I am an information gatherer by nature, and this is no exception when I’m stressed. I kept frantically Googling with the intensity of an addict, searching for the one bit of information that would make things “click”.  I remember my mom taking away my phone on several occasions, saying “Look at that incredible baby you created.” But while I cognitively knew he was our miracle so long hoped and prayed for, I struggled to look at him in this light. This little being we had waited so long for was here… and I felt more miserable than I ever had in my life.  As hard as I tried, I could not conjure up the overwhelming feelings of love I had dreamed of, or anything close to it; I still felt as if I was babysitting a stranger’s baby, and I wondered when they would come home.  The guilt and disappointment was crushing.  So, often, I would retreat to my world of “research”, living as much in my head as possible, as acknowledging emotions was like wrapping myself in a cold wet towel… uncomfortable and chilling to the bone.

Despite every task feeling nearly impossible, somehow just before Everett was five weeks old, Seth and I packed him up and got on a plane to Michigan for my brother’s wedding. At the time, this trip was a source of major anxiety, as I was absolutely certain he would for sure contract measles and every other scary condition on the plane. Looking back, however, this trip was a massive blessing. For one, I was able to be present for the most important days of my brother’s life. I learned that even when I feel terrible, I Can Do Hard Things. And finally, I was able to spend the most difficult postpartum days with family nearby nearly 24/7.

In the first few weeks after Everett was born, I mainly struggled with depression. I constantly felt like I was walking around with that wet blanket on top of me and I couldn’t shake it off. I felt anxious, but the anxiety would come and go based on circumstances. Yet at about 5 weeks postpartum, it hit – severe, nonstop anxiety. It ruled every waking (and what few sleeping moments) I had. Little tasks felt not only herculean but entirely impossible. At one point, my cousins suggested we meet at a restaurant about 15 minutes away from me. The thought of it felt so impossible it was nauseating. I could not comprehend the thought of putting myself in the driver’s seat and navigating to a new restaurant. Not only was it overwhelming, but also almost physically painful. I felt like the little button that turned on the vibrating feature of Everett’s bouncy chair was on me, and someone turned it on. No matter what the circumstances, I was constantly on edge. Not the feeling of being a little keyed up - the feeling of constantly being frantic, eyes darting around, pacing, trying to escape my racing mind and the constant buzzing that ran through my whole body. I couldn’t find an escape. It is the most terrible feeling I have ever experienced.

My mom said later that she knew it had gotten bad when I stopped sleeping. At some point, that happened. I couldn’t sleep. Even when family would take over Everett duty and I had 4 hours to sleep between pumping sessions, I’d be lucky to get an hour. My mind never stopped, and I really started to feel like I was going crazy. Thoughts that didn’t feel like me began to invade my psyche. With my mental health background, I knew what they were – intrusive thoughts. I knew I wasn’t actually heading towards psychosis, because I KNEW the thoughts weren’t from me. That’s the thing about intrusive thoughts – they are exactly that. Intruders. They invade where they are not welcome. They throw open the doors and tromp inside, putting their feet on the furniture and never using a coaster. Yet even though I rationally knew what they were, they were still awful. I had repeated nightmares that I died, or that I wasn’t able to take care of Everett. Those intruders continued banging on the doors throughout the day, and I didn’t know what to do. It was the most helpless I have felt in my life.

When we feel like we’ve lost our mind, the only things we’re able to do are the things that we do without really thinking.  For me, thankfully, one of these things was making a treatment plan. Once I got to the point where I knew definitively that I needed help, I went into action. I knew what I needed: I needed meds and I needed intensive therapy. From my mom and stepdad’s house in Michigan, I began first calling every psychiatrist on the list of providers covered by my insurance. I wouldn’t be back in Utah for a couple weeks, so I hoped I’d be able to find someone who specialized in postpartum mood disorders and could see me shortly after my arrival. I made call after call, repeating the same mantra: “I’m looking for a psychiatrist who specializes in postpartum mood disorders and who can see me within the next few weeks.”

“Our first available appointment for new patients is June 9.”

“I’m sorry, none of our physcians are accepting new patients at this time.”

“Please give me your email, and I will send you our new patient paperwork. Once you fill that out and fax it back to us, we will put you on our waiting list.”

Eventually, I decided to drop any sort of request for experience with postpartum issues. I essentially asked for anyone licensed to practice psychiatry who could see me in the next month.

Dead end, dead end, dead end.

In tears, I battled increased feelings of hopelessness. I knew it would be nearly impossible for me to go back to work after maternity leave unless I got feeling better. I could function barely enough to care for my baby – with help. That was it. The thought of getting dressed and going to work and stringing a coherent academic sentence together seemed impossible.  I began to worry about losing my job.

And even in that state, the social justice advocate part of me was furious. “What about people who are truly in crisis and don’t have a support system?” I said to my mom, in tears. I was one step ahead of a crisis and only stayed there because I had people taking care of me. I was functional – barely.

I then found myself back in front of my phone, frantically researching some more. I posted on a local Utah Facebook group, Pregnancy and Parenting after Infertility, asking for any recommendations for psychiatrists in the area. At this point, I didn’t care if the doctor was covered by insurance or not. I’d pay out of pocket if I needed to. I was not okay, and I needed help.

Quickly, a couple fellow moms responded: “Dr. Dan”. He was brand new in the area, paneled with my insurance, and still building his practice.  I found his number, called, and expected a voice mail or secretary. Instead, I got Dr. Dan himself. I explained my situation, and he listened empathetically. He talked about a few possible options and I made an appointment for the day after we returned to Utah.  And for the first time, I felt a little hope.

The night before the appointment, I sat with my mom and Seth and wrote out a list of things to share and what I wanted to ask him. I had every detail that might be pertinent laid out and had practically written my own treatment plan. I expected that when I went there, I would need to convince him that I was really struggling. I firmly planted myself in my academic mind, put on my Social Worker Warrior breastplate, and marched in with my proverbial fists up, ready for battle.  The door to his office opened and a friendly, unassuming face appeared. He listened without judgment as I read my editorial entitled Why I Need Help Immediately. And then – he agreed with me. He saw that I was not okay, and he was going to help me.

I sank back into his couch with far too many throw pillows, and cried.

I listened as he told me that my sleep patterns were severely disturbed. He looked me in the eyes and said, “We need to get you sleeping. Sleep is medicine. If I have to hospitalize you in order to give you the meds you need to sleep, I’ll do that. We are going to get you sleeping.”

As he said that, I felt one of the most profound feelings of relief in my life.

I left the office with a starting dose of Ativan, an anti-anxiety med that is safe for breastfeeding. That night, my mom and Seth took the night shift and sent me to our extra guest room. My only job was to sleep for as long as I could.

I slept for five hours in a row, and felt like an entirely new person.

After I started sleeping again, it was like every thing changed. The buzzing stopped. The intrusive thoughts came much less often, and I could manage them when they did.  I began to enjoy my son. I found myself wanting to be around friends and engage with people. I began to laugh again and even make some of my own jokes. I began going to therapy twice a week with a therapist I really liked. I made plans with other mom friends during the day and actually began to enjoy the last couple weeks of my maternity leave. At one point, I even had the idea to invite a bunch of friends over for a barbeque. I felt like I was beginning to stand on my own two feet again, and even begin to take some steps. They were shaky steps, to be sure, but I actually began to feel like I was moving forward.

And then.

One day, I noticed strange bruising on my wrists, and little dots that appeared on weird places over my skin. I brushed them off – the bruises were from carrying the carseat, the dots a result of where my glasses rested on my face. All easy enough to write off.

What was more difficult to write off was waking up the next morning with the taste of blood in my mouth, seeing red when I spit into the sink, and looking in my mouth to see it full of blood blisters.

The rest of the morning happened quickly, as I ran to show Seth, he called into work, I drove myself to the ER, and Seth joined me later when our neighbor was taking care of Everett. I was quickly transferred from the “oh, you just have an ear infection” ER to the “oh crap, there might be something more going on here” ER.  I shook as I waited. A nurse came and took my vitals, and I waited. A doctor came and talk to me, and I waited. The nurse came back and drew my blood, and I waited again. And then the doctor and nurse were both in my room sharing the results of my blood test. Normal platelet levels are least 150,000. Mine were 6,000.  I was quickly given a diagnosis of Immune Thrombocytopenic Purpura (ITP), an autoimmune condition where my immune system attacked my platelets.

Five days of dexamethasone, a high dose steroid, was prescribed as a first step to “quiet” my immune system. The doctor also took a look at my list of current medications, which included the anti-anxiety meds that were my lifeline to feeling remotely functional. He lowered his voice to the uber-calm, semi-patronizing tone that says “I’m going to tell you something that is going to make you completely lose your crap. Buckle up.” He proceeded to tell me that Ativan is very rarely, but sometimes, contraindicated with bleeding disorders, and that I shouldn’t take it.

Had I been in a better emotional place, perhaps I could’ve strung some halfway intelligent words together and pulled out my Social Worker Warrior breastplate again to be a self-advocate.  But as I struggled to understand what was happening to my body, not knowing if I was physically safe and terrified of falling back into my previous mental state, I lost all grip on logic and “went limbic”, my emotional brain running the show. Instead, I sobbed hysterically to Seth and my mom on speakerphone, “Please don’t take away my meds! Please don’t take away my meds! I can’t go back to that dark place!”

Just a little advice – I don’t recommend shouting this in a busy ER when you are trying to convince the medical team you aren’t a drug seeker.

As I was admitted to the hospital for monitoring until my platelets got to a safe level, the ER doc talked to Dr. Dan, and they settled on a combination of meds that would not affect my platelets and would at least partially address my anxiety. Yet the cocktail approved by the ER doc didn’t really decrease my anxiety, only temporarily sedated me. I would wake up in the middle of the night after sleeping 2-3 hours and stare at the clock, counting the hours until I could take another dose and sleep again. I was profoundly depressed. It was the lowest I have ever felt in my life.

As I reflect on this time, one thing that stands out to me was a sentence that lived on the tip of my tongue, waiting for an opportunity to leap off. Every time a doctor appeared at my bedside, I found myself wanting to ask, “Am I going to die?”

Honestly, I truly believed I was.

I know now that was unlikely. I know now that ITP, though not a fun disease, is manageable. But I didn’t know any of this then. I needed a doctor to sit down, look me in the eye, and speak to me on my level. I needed a doctor to tell me that remission is possible. I needed a doctor to tell me that I could still manage my job and being a mom while also managing this new diagnosis. I needed someone to tell me I really was going to be okay, that my worst fears of bleeding out were likely unfounded. I needed these things, but no one knew it, so no one told me. And thus I spent three nights living from sedative dose to sedative dose, hoping the steroids would work and my morning blood draw would show a rising platelet count.

The third morning, they did, and I was sent home. I continued to struggle with the side effects of a high steroid dose – nausea, dizziness, extreme anxiety. (Because I needed a med to make me MORE anxious. Oh, the irony.) The dose was so high the pharmacist at Target wouldn’t let me leave until he had confirmed that the prescription was accurate. Once the five days of meds were up, though, the effects began to wear off and I started feeling human again. Dr. Dan found a new set of meds that worked better. Due to the steroids, I chose to stop breastfeeding; while this was hard to swallow at first, it was actually a blessing in disguise and, combined with new meds, began to improve my mental health.  My blood counts rose, then fell; again, I woke up with unexplained bruising and a mouth full of blood blisters. My doctor then switched me from dexamethasone to prednisone – a lower dose but over 6-8 weeks.

On prednisone, my counts again rose, this time with fewer side effects. Over the course of a few weeks, they continued to rise and finally stabilized around 260,000, which was my “normal” before. I began to very tentatively wonder if life would stabilize along with my platelet count.

Slowly, with the help of intensive therapy, I began to find peace and healing. I began to truly bond with Everett. I often meditated on the Scripture verse “Today has enough worries of its own” and began to learn the power of being fully present.  As the “What ifs” continued to bombard me, I developed a mantra: “We’ll figure it out.” What if my counts drop again? “We’ll figure it out.” What if my counts drop again and insurance won’t cover the med that costs $40,000? “We’ll figure it out.” What if I have to go back into the hospital and we need help taking care of Everett? “We’ll figure it out.” Slowly, my anxious thoughts grew bored with the same response repeated over and over, and they began their retreat. My conversations with God began to soften, slowly shifting from bitter, hopeless mutterings to include receptive listening and prayers of gratitude. Finally, I began to exhale, and I noticed bits of Joy beginning to leak into my being.

  It was like waking up from a terrible nightmare – and in this new reality, I had a beautiful son. The child for whom we prayed for years.  The child we thought would never come. The child who existed only in our imagination is now in front of us in the flesh. And I get to be his mom.

The months since have consisted of settling into the “typical” parts of motherhood – diapers, bottles, sleep training, watching him explore and grow, developing his personality and slowly learning he is a separate being. I have begun to feel the deep, profound connection and love I had wondered if I would ever experience.

And also, interspersed both during and between the feedings and naps and super-fast-crawler-chasing, I have continued my own healing. I have learned to recognize and admit that the events of the past few months – a traumatic delivery, severe postpartum depression/anxiety, and my ITP diagnosis at an extremely fragile time (not to mention the infertility and loss up to that point) – are capital-T Traumas and thus require time, love, and work to heal. Part of this is directed inward with prayer and introspection; part is directed outward with a newfound passion for helping other moms who are struggling.  I feel compelled to share the mission statement of the amazing organization Postpartum Support International: “You are not alone. You are not to blame. With help, you will be well.” And, as I continue to reach out to others, I will further believe these words to be true for me:

I am not alone. I am not to blame. With help, I am becoming well.