Asked by Sarah, Oklahoma
My mom died nine months ago, and two days later, I gave birth to my daughter (she was full term, actually late, and completely healthy). I have been struggling with depression and all sorts of other medical problems since my mom passed. I cannot seem to get past crying over my mom. I cried all the time. We were very close, and losing her has been very hard. At the time, my husband was in Iraq, so I was dealing with a newborn by myself, as well as the loss of my best friend, my mom.
Before today, I was hoping that a new medication that my doctor put me on, combined with my daughter starting to sleep through the night and my husband finally being home from Iraq, would soon start helping. However, this morning my papa, my mom's father, died. I feel like my world is falling apart. Now I don't know what to do because all I can think about is how sad I am. I have been on a new medication for almost a month, and it was helping a lot with my mood swings, depression and lack of motivation. A week ago, my papa got very sick and was admitted to the hospital. The doctors could do nothing, and we were told bluntly he would die. Since the doctor told me that, my mood has been terrible and I have no motivation to do anything. I am having trouble doing basic things and functioning. I don't know what to do because I just talked to my doctor and we decided to keep going with this treatment, but that was before my papa got sick. I don't want to go onto heavier medication if it can be avoided because I have a 9-month-old to take care of, but I know it might happen. Is there anything I can do other than go on more medication to help myself?
Mental Health Expert
Dr. Charles Raison
Emory University Medical School
Dear Sarah: Tonight, I was looking through a new batch of questions, trying to decide which one to answer first, and yours immediately rose to the top. There is an unmistakable urgency in your situation that I want to honor with a timely response. Although I don't know enough about your situation to give specific advice, I hope I can give you some general suggestions that might help.
In my experience, knowledge is power. So the first thing you should know is that you have fallen victim to events that are very likely to make a woman depressed. No one would be surprised that losing a loved one to death (let alone two loved ones) is a major risk factor for depression. What is not as widely appreciated is that childbirth itself is also a major risk factor for depression. In fact, despite sentimental notions about the joys of motherhood, giving birth is probably the biggest risk factor for depression that most women will face in their lifetimes. It is estimated that up to one in five women will develop a full major depression within six months of giving birth. Sadly, once a woman has had one postpartum depression, her risk of having another is sky high.
So you have been struck by compounding risk factors in rapid succession. To boot, your husband, who might have provided essential emotional and practical support, was overseas at a time and place in which his life was also at risk. Under these circumstances, anyone with even the slightest risk for depression would be likely to succumb. So although depression is a serious illness, you should not be surprised, or hard on yourself, over the fact that you are struggling with so much emotional misery. The fact that you are having a lot of medical problems is also not surprising. I don't know the details of your situation, but we know that in general, depression increases the risk for both medical illnesses and physical symptoms. Medical illnesses, in turn, greatly increase the risk for depression.
You might need a higher dose of your medication, or an additional medication. I don't know enough about your situation to comment on this, other than to say that if you have been on an antidepressant for only a short period (i.e. less than a month), and especially if you feel it is helping, you should stay on it, because these medications can take eight weeks or more to have full effect.
I do know enough to know that you should do everything in your power to get more help. I would recommend contacting your doctor, telling him or her what has happened recently and asking if it might be possible to refer you to a psychotherapist. If your doctor is not able or willing to do this, I would check out what benefits are available through the military. The military -- sadly -- has developed significant expertise in helping people cope with loss and trauma. I suspect that good therapy would be hugely helpful given all you've lost at a time of such biological vulnerability (i.e. the postpartum period).
There are also things you can do in your life to help combat the depression over and above any professional help. If your husband is back, ask if he'd be willing to take a leadership role in feeding your baby overnight, so that you can get good and regular sleep. If the depression is making it hard to sleep, it would be wise to take a mild sleeping medication, which your doctor could prescribe for you.
One of the best ways to combat depression is to use your mind and willpower to get up and start doing things that you enjoy. Many data show that becoming active (known in technical terms as "behavioral activation") is a very powerful way to begin overcoming depression. Try to spend time around people who are nice to you and make you feel good. If you have a church community or other social group that fits this description, make a commitment to yourself to get out -- no matter how tired you feel -- and be with these people regularly.
I seem to say this every week, but if you are drinking more than a little bit of alcohol, cut back or quit. Alcohol can dull emotional pain acutely, but in the long term, it makes things much worse. Finally, it's very hard to feel like exercising when you are depressed, but many studies show that if you can get yourself out and start vigorously exercising, this will work as well as an antidepressant. Exercise combined with an antidepressant is even more powerful.
I hope these few words are of some help to you, Sarah.
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