Rejection of Stigma Leads to Renewal
Mother, 13 States Advocate for Awareness of Pregnancy-Related Depression

By Gene Kuleta
Special to The Washington Post
Thursday, November 9, 2006

Looking back, Nicole Barnett thinks the symptoms started shortly after her youngest daughter, Joy, was born a little over two years ago.

Barnett, 36, noticed that she wasn't quite feeling like herself. She tired easily and, no matter how much sleep she got, she always felt exhausted. In time, she could barely muster the strength to do the laundry or wash dishes. She lost interest in her church, and she stopped going to the hair salon. Even braiding her three girls' hair and making such mundane decisions as what color school folders to buy her oldest daughter seemed overwhelming.

"I started doubting my abilities as a mother," said Barnett, of Upper Marlboro.

Barnett eventually learned that she was suffering from perinatal depression, also known as postpartum depression when it occurs after birth. With medicine and therapy, she's been feeling better for more than year. Now she's trying to enlighten other women she meets and medical professionals about pregnancy-related depression from a patient's perspective.

Her personal message is bolstered by a new national campaign established to highlight the problem and seriousness of perinatal depression in pregnant women and new mothers. Maryland, Virginia, 11 other states and the District recently received federal grant money through the U.S. Department of Health and Human Services to provide education about the illness in their jurisdictions.

Maryland's portion -- $250,000 -- will help pay mental health experts to teach health-care professionals about how to identify, treat and work with women struggling with the illness. Of the $250,000, Prince George's gets $16,462, according to Christine McKee, director of public education at the Mental Health Association of Maryland.

The state's campaign, "Healthy New Moms: Maryland's Campaign to End Depression During and After Pregnancy," has also set aside part of the grant for a toll-free hotline for women with perinatal depression, and to operate a new Web site about the condition.

According to health statistics, perinatal depression affects one in eight women who are pregnant or recently gave birth. Barnett was astonished to learn that she was one of them.

"Nobody ever talked to me about depression," she said. "I hate to say it, but in the African American community, we just don't talk about mental health."

Barnett, a homemaker, said she tried to avoid accepting what her doctors suspected was postpartum depression. In February 2005, when Joy was 4 months old, Barnett said she hit a low point. She was so tired and overwhelmed she could barely function.

She called her doctor, who said she could have an iron or thyroid problem. But the more likely scenario, the doctor said, was that she was suffering from postpartum depression.

Barnett, not wanting to be identified as someone with a mental health issue, chose to take iron pills and thyroid medicine. They didn't help.

By this time she was having trouble mustering the strength or desire to care for her kids. On her worst days, she would take her oldest daughter to school, return home and drag herself through her chores, then pick up her daughter. Exhausted, she would then barricade herself and her kids in her small den, closing off the room with baby gates so the girls couldn't get out, and sit there until her husband, Jeff, a survey manager with the U.S. Census Bureau, came home from work.

Concerned about her health and children, Barnett returned to the doctor in May 2005. This time she accepted her doctor's diagnosis of postpartum depression likely triggered by Joy's birth. She started taking a prescribed antidepressant.

"To me, admitting that it was depression was like admitting defeat," Barnett said. "Motherhood, the one thing that I put my all into, was now coming back to haunt me."

Within weeks of starting the antidepressant, Barnett said, she felt like her old self. Today, she describes herself as still in recovery, but feeling much better. She occasionally speaks in public about her condition, including to medical staff members at Southern Maryland Hospital Center in Clinton and Doctors Community Hospital in Lanham, in hopes that her story will help other women.

Pinpointing a Diagnosis

Diana Cheng, medical director of women's health at the Maryland Department of Health and Mental Hygiene, recently spoke to nurses about depression in women who are pregnant or have just given birth.

"It's really under-recognized and under-treated," said Cheng, adding that pregnant and new mothers are not always screened by their doctors for the condition.

Symptoms of perinatal depression, which is triggered by hormonal changes, can include sadness, anxiety, appetite changes, inadequate or excessive sleep and lack of interest in one's baby. The extent of depression in pregnant women and new mothers can range from mild to severe. In the most severe cases, women can harm themselves or their children, such as in the case of Andrea Yates, the Texas woman who was convicted of murder for drowning her five young children in 2001.

Barnett said she never had thoughts of harming herself or Joy, now 2, and daughters Naomi, 4, and Karis, 7. She said she is in recovery from the more classic form of the illness, whose symptoms include extreme fatigue, anxiety and panic attacks and lack of interest.

"That's one of the reasons I want to talk about it, because most women who have this don't try to drown their kids or throw themselves or their babies over a bridge," Barnett said. "This is not a psycho illness. It's something that can be subtle or come and go like mine did. The point is, nobody has to suffer in silence. There is help."

Still, some women and their doctors may have a hard time distinguishing between postpartum depression and the stress of new motherhood that usually subsides in a few days to a week.

Cheng points out that up to 80 percent of women can experience periods of sadness and mood swings, "the baby blues," after giving birth. But those blues might be a more serious case of depression if they last more than two weeks, Cheng said.

According to Cheng, breastfeeding mothers need not fear taking medication to treat depression because studies have shown that the antidepressants used to treat postpartum depression are generally harmless to babies. But, Cheng said, as with any drug, patients react differently to medications and should discuss treatment with their doctors.

Additionally, Cheng said, treating depression with medication is important because research also shows that untreated, the condition can lead to problems in cognitive, language and behavioral development in babies.

Overcoming the Stigma

Those possibilities flashed before Barnett's eyes on June 1, 2005 -- the day her daughter Karis graduated from kindergarten. Barnett recalled that she was embarrassed to tell relatives and friends she was being treated for depression because she thought she would be seen as a failure as a mother. But then she thought about the dark days when she could not play with her girls -- could not read to them and color and build blocks with them. She thought about the constant sadness she felt and the long hours she spent sleeping or dragging herself around.

And she wondered whether her mood swings and inability to interact with her children would negatively affect them. She thought about how she might miss out on feeling happy about her first child's graduation. Suddenly, she didn't care about feeling embarrassed anymore. All she wanted was to get better.

The medicine and the support from her husband, family and friends have helped her do that, she said. So, too, have the talks she's had with members of depression support groups and the talks she gives.

"I felt like I had a cloud over my head," Barnett said. "When I saw my daughter walk across that stage, it hit me. I felt genuinely happy and content seeing her on that stage."

For information about depression during and after pregnancy, contacthttp://www.healthynewmoms.org.