State of New Jersey. Department of Health and Senior Services

perinatal mood disorders. speak up when you are down


Alicia and her childrenWhen Alicia Cooley, a 38-year-old from Barrington, began feeling depressed early in her second pregnancy, she attributed it to the recent death of her father-in-law. It never occurred to her that the feelings she was experiencing could be a perinatal mood disorder.

"I was very close to my father-in-law. We had a very difficult three weeks prior to his death, and we had to make the decision to take him off life support. I attributed my feelings of depression and grief to losing him. I also injured my knee and was out of work for awhile, which didn't help." Alicia's husband, Dale, tore a ligament in his knee at the same time, so he was also out of work. Tight finances and worries about his upcoming surgery were adding to the couple's stress.

Alicia's entire pregnancy was difficult. Since she was over 35, the doctors did a lot of tests on her as she got closer to her due date. Things were further complicated by the fact that the baby was breach. Doctors talked to Alicia about the possibility of a C-section, which she did not want. She had recurring nightmares that she died on the operating table.

Alicia tried a number of home remedies to get the baby to turn, but nothing worked. One day when two doctors were pushing externally on Alicia in an attempt to get the baby to turn, the baby's heart rate dropped and doctors had to do an emergency C-section.

"It was the scariest moment I've ever had. Her heart rate was dropping and all of a sudden they were cutting. After her birth, I had flashbacks for two weeks." She was later told this was a sign of post-traumatic stress disorder.

While still in the hospital, Alicia made one attempt to breastfeed the baby although it hadn't worked with her first child. The baby kept trying to position herself right on top of the scar from the C-section.

"I knew she'd be fine on formula. I didn't have the mixed feelings I'd had with my older daughter about trying to make it work. This time I just thought I've got enough going on."

Something else was wrong as well. Alicia noticed immediately that she didn't have the same feelings toward Sarah, the baby, as she had toward her first daughter, Megan, who was 18 months old at the time. She had no symptoms of depression at all after Megan's birth. WWith Megan I was just stressed from the lack of sleep and difficulty with breastfeeding."

"I knew something was wrong. I knew I shouldn't have been feeling like that. I was elated after the birth of my first daughter. This was just different. With Sarah I was grateful that we were both alive and OK after the surgery, but I didn't feel a connection with her. I was really exhausted and just wanted to sleep."

Fortunately for Alicia, her postpartum depression was caught before she left the hospital. As part of the state-mandated screening process, she was given a questionnaire to fill out to determine if she had, or had the potential for, postpartum depression. Given her score, she was referred to a counselor.

"I'd heard about postpartum depression, but no one ever thinks it will happen to them. I'm very conscious of depression because it runs in my family, but it still didn't occur to me I could have it."

At home, however, Alicia found her depression and anxiety worsening. She was tearful all the time, couldn't sleep much, and had no appetite. When Dale would come home from work, she would say "I don't know what you feel like having for dinner. I already fed the kids, but I'm not hungry so I didn't cook anything." Then she'd go upstairs and go to bed. That, she said, was completely out of the norm for her. She says Dale would ask her what was wrong and she would say "I don't know how to do this. I don't know how to be a mother to two. One I could handle."

To further add to the complications, Sarah developed colic and both Alicia and Dale were sleep-deprived. Then Alicia was diagnosed with pneumonia. "So I was dealing with feeling lousy from that, the depression, the constant needs of an infant, and trying to keep my 21-month-old occupied and not have her feel left out because of the new baby."

"I thought of running away. I kept thinking if no one was here I could get into a cab and go to a hotel and just sleep. My constant thought was 'I have to get out of here.' I didn't feel any bond with the baby, or any obligation to her. I felt like anyone out there could do a better job than I could. My husband, my mother-in-law, a stranger off the street."

Alicia went back to work right away, part-time, as an occupational therapist at a rehabilitation hospital in Philadelphia. She said work was the one place where she felt competent. "No matter how sleep-deprived I was, I could do my job. At home I felt like I couldn't do anything right."

Alicia first sought help through a social worker, then she was referred to a psychiatrist who had other clients suffering from postpartum depression. The psychiatrist tried different medications for Alicia's depression, but she experienced a number of side effects and complications before they found what worked for her.

"My social worker has been so great in helping me finally express my feelings about the pregnancy and birth, and just anything in general that was bothering me. I really trust her."

At her therapist's suggestion, Alicia brought her husband to one of her early sessions so that he could better understand that what his wife was battling was an illness and not something she could control.

"I think that made a huge difference in his understanding, but he wasn't going to talk to anybody about it outside the therapist and myself. He's not a joiner. He's not big on going to meetings. I do know he was looking at some Web sites and trying to find out as much as he could. He felt like the weight of the world was on his shoulders, and I felt like it was on mine. He was helping me to the best of his ability but I needed more than he alone could give."

Also at her therapist's suggestion, Alicia also began attending a support group. After almost a year of being a virtual shut-in, she was able to make friends and connect with other women who knew what she was going through. Other mothers, many with their first child, often looked to her for advice since she had two children.

"It was such a relief to be around people who knew what I was experiencing, and not feel judged. It was hard to spend time with 'regular moms' because they just didn't understand how it takes over your whole life."

Two years have now passed, and Alicia says that although she still experiences the normal stresses of any mom with two children under five, things are much better.

"My recovery was so gradual. There wasn't a giant turning point. Probably about nine months after Sarah was born I started noticing I was feeling better. I had the strength to plan her first birthday party, and three months prior, I wouldn't have been able to handle even that."

Looking back at all she's been through, Alicia says she knows how fortunate she is to have gotten the help she needed.

"I think I did a good job of faking being normal at first to other people, but I just felt hollow inside. It's like being at the bottom of a well. You can look up and see that the rest of the world is up there, but you can't fight your way out, and you don't have the strength to even try. You feel hopeless, helpless, and like a terrible mother. No one should have to feel like that."