When Postpartum Depression isn’t Depression

Our youngest daughter was conceived via IVF. When we went in for the transfer, the on-call doctor matter-of-factly informed us that our embryos were all doing very poorly and were not going to survive. In fact, he all but assured us that the transfer wouldn’t take and suggested that we start planning our next attempt. But 11 days later, the lines on the pregnancy test told us she was here.

Her hCG numbers crept up slowly. Increasing, but never quite doubling. Our nurse mentioned the possibility of a chemical pregnancy. Blood was drawn again and again and again. But then  the hCG levels finally skyrocketed. She was still here.

At 20 weeks, I found myself in Labor & Delivery due to severe dehydration from a stomach virus. During the ultrasound, we learned that I had only 1 artery in my umbilical cord, instead of the usual 2. She was getting only 1/2 of the nutrients that she should be getting. But she grew. At appointment after appointment, we learned that she was barely hanging on to the very bottom of the growth curve.

At 39 weeks, my water broke. It was 16 hours of not-much-happening, followed by the terror of hearing your OB call for an emergency c section. The urgency of the race down the hall, seeing nurses literally drop their files to run along side me, and the doctors and nurses shouting over each other, all sent me into a panic. Probably unfounded, but when the anesthesist finally put the mask over my face, I knew in my heart we had lost her.  But just 11 minutes after my OB’s eyes told me something was very, very wrong, my baby was delivered and unwrapped from the cord that she had been trussed up in. She was breathing and pink. She was here.

Our baby had proven herself a fighter every step of the way. But I couldn’t see it like that. In my mind, I imagined a figurative Grim Reaper hiding in the shadows, determined to finally take the baby who wasn’t supposed to be here. I started imagining every sort of horrible death that you could imagine – for both of my girls. Drownings, fatal car wrecks, falls down stairs. There was suddenly danger everywhere. And the images weren’t just fleeting thoughts, they were nauseatingly graphic and they lingered, haunting me for the better part of the day or night. I avoided going downstairs while holding the baby out of fear I would trip and crush her. While wearing her at the grocery store, I had to kiss the top of her head at every aisle to convince myself that she was there and not forgotten in the car in the 90 degree heat. At one point, I was so worried about SIDS that I decided to stay awake while my baby was sleeping so I could make sure she was breathing. I settled into my rocking chair, leaned towards her bassinet & just sat, determined to watch until morning — that night and every night after until the danger of SIDS was gone. That is the moment when it finally occurred to me that something was very wrong, but I didn’t know how to gain control of the horror film that was constantly running through my head.

I wasn’t depressed.  Once the initial hormone dump was over, I wasn’t crying. I wasn’t lethargic and down and unwilling to get out of bed. If anything, this intense need to protect my children had me at near-manic alertness. As I called around to find a therapist to talk to, one said,

“It sounds like you have some postpartum depression and I think you need to be seen as soon as possible.”

“Ok, but I’m not depressed, so this isn’t PPD,” I insisted.




And that started my journey to understanding that Postpartum Depression is very often not actually depression. Of course, in many cases it is, but it is also anxiety, OCD, and more. Recently, it has been recategorized to Perinatal Mood and Anxiety Disorders to attempt to better reflect the reality of the range of experiences that women (and men!) can have. And this is one case where wording matters, because if you’re only looking for depression, it’s easy to miss some of the other symptoms, and early detection and treatment is important in getting “you” back. Even many OBGYNs who are (thankfully!) now screening at the 6 week check up are using a standard depression screening. You know…the one that asks the mother of a 6 week old if she has experienced any changes in her sleep schedule.

Thankfully these days, women are more alert to signs like lingering baby blues, crying spells that last beyond the first few weeks, difficulty bonding, disinterest in things that used to bring joy, and more, during the first few weeks or months after birth. But it’s important to know that PPD/Perinatal Mood and Anxiety Disorders may also start at any point in the first year…or even during pregnancy. It may present as anxiety, anger/rage, intrusive thoughts, or even physical symptoms.

Every one of these feelings can be normal in the weeks and months after adding a baby to your family. But it’s the severity and length that will tip you off to the need for help. If you have not felt like yourself for 2 weeks, if you’re having more bad days than good, and/or if your feelings are starting to affect how you live your life then it is time to reach out for help.

It’s now estimated that 1 in 8 women suffer from Perinatal Mood & Anxiety Disorder.  If you’re feeling a little out of control, it’s important to remember that you’re not alone – by any stretch of the imagination – and that you don’t have to live like that. You can get you back, and the earlier you can get help the better it can be.

If any of this sounds familiar, or if you suspect you may have Perinatal Mood and Anxiety Disorder, please reach out and get help. Ideally, try to find someone who specializes in postpartum care. Someone who is familiar with different treatment options, who can paint a realistic picture of what recovery looks like, and who is up to speed on the latest research regarding medication and breastfeeding (if that is a possible hurdle to seeking treatment).

Here are a few resources to help you learn more and find support, if needed:

  • For 6 Surprising Symptoms of Postpartum Depression and Anxiety, check out this article.
  • For a full list of symptoms of depression, anxiety, OCD and psychosis, look here.
  • Both of the above links go to PostpartumProgress.com which is an incredibly helpful site in general.
  • For local support as well as general information, check out Postpartum Support International. The Georgia listing is here and includes contact information for the local Atlanta Coordinators and several nearby support groups. The coordinators will help folks get the resources they need during this period. Depending on your needs, that may be a therapist, support group, lactation consultant, doula, warm-line, fitness group, reference book, blog etc. They also offer training and talks to help educate the community on Perinatal Mood and Anxiety Disorders.
  • Mental Health America of Georgia also has some great information on their Project Healthy Moms site.
  • And a brief word of caution. There is an incredible amount of information and support online, but be careful not to let yourself be drawn in to online support at the expense of real-world help. During vulnerable periods, anxiety and doom and gloom can be contagious. A new mom support group or playgroup can be a great first step in building your support network, since much can be resolved when a mom doesn’t feel isolated.

And it bears repeating one more time: PMAD is treatable and the quicker you get treatment, the quicker the symptoms will decrease.


A big thank you to Elizabeth O’Brien, LPC, who helped me with the resources section of this post. She is a volunteer co-coordinator for Postpartum Support International and has been in private practice since 2004. She has had the opportunity to train doulas, public health nurses, early childhood educators and the community on Perinatal Mood and Anxiety disorders, runs women’s groups on Mindful Mothering, and is currently co-developing a lecture series on the psycho-social aspects of the postpartum years. Currently, Elizabeth is facilitating a free New Parent Support group every Friday at Intown Midwifery from 11:00 am-noon, and a Free New Moms Support with NorthSide Hospital every other Thursday 10:30-11:30 at the Baby’s “R” Us in Dunwoody. She is currently accepting clients. You can reach her via her website, facebook page, or call her at 907-378-6972.





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    A New Orleans girl turned Georgia peach and stay at home mom to 2 daughters. Before taking the leap into full time mothering, I worked at at an Atlanta-based advertising agency. I have lived in Smyrna for almost 10 years and am still not sure how I managed to find a job more chaotic and unpredictable than advertising.