A physician once explained to me that depression suppresses clarity. Someone feeling depressed can't make decisions easily, and in my case, receiving treatment helped me realize I was engaged to a good friend, not the man with whom I was supposed to spend my life.
Almost 10 years later, in 2009, I sat nervously on the exam table while my obstetrician prepped for an internal exam. I was about 10 weeks pregnant with my first child and anxious about the baby's and my health.
As the OB stood at the counter with her back to me, I mustered the courage to speak. "So, I have a question for you," I began. "I have a history of depression, and I kind of feel like I'm delving into it a little bit again. Is that something I should talk to you about?"
Without turning around, she let out a little, "hmmm," followed by, "Well, really, that's something you should talk to your primary care about."
I never did. Ashamed, embarrassed and inundated with other emotions that flood a woman's body along with hormones, I withdrew and didn't pursue treatment.
That was five years ago, five years before a government panel announced — this week — that women should receive screening for depression during pregnancy and afterwards. The United States Preventative Task Force has now recommended doctors provide screening along with "adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up."
That didn't happen for me.
What came next for me was a pregnancy full of sadness. I chalked up most of it to fear and anxiety about our unborn baby's health issues. We learned he had Down syndrome and, soon after that diagnosis, he developed a life-threatening condition. While the worries of Down syndrome paled in comparison to our new terror that he might not survive, the mix of stressors took its toll on my health. I put on a brave face at the office and barely made it to my car at the end of each day before dissolving in tears and sobbing on the drive home.
When Charlie was born seven weeks early, he — and I — spent four weeks in the NICU. Each morning I drove the 25 miles from our home to the hospital, and each evening I drove home, feeling a smattering of unprecedented love, fear, anxiety and sadness.
Health care providers had so many opportunities to screen me for depression, but no one did. We had weekly (sometimes twice weekly) ultrasounds to monitor Charlie’s condition in utero. My husband always accompanied me, and his unwavering sense of humor bolstered me and provided a welcome shield. It's not that I didn't want treatment. It's that I didn't realize, fully, that I was depressed. I thought the stress of the pregnancy explained it all, which of course it did, partly.
But the depression I experienced during the pregnancy was merely the start of a months-long dive into worsening darkness after I gave birth and sat for hours in the NICU, holding Charlie and praying for my body to produce enough milk to sustain him. It never did.
In retrospect, I wonder how the NICU nurses didn't see my pain. At the slightest correction from them — about about how I fed Charlie, how I responded to his bradycardia, how my body lacked interest in feeding him — I melted into a cascade of tears. No one said, "Honey, I think you need to talk to the doctor." I just turned away from their exchanged glances and tried to pull myself together.
Then I brought my preemie home with a heart monitor that seemed intent on driving me to the brink of insanity. That was awesome.
I cried. I couldn't sleep. I worried about everything, from taking Charlie's temperature to monitoring his diaper achievements. Don't ask my husband about the white board I used. I literally micromanaged Charlie's infancy, and you can imagine how well that went with a fairly new marriage.
I never sought help. Not until Charlie came home after a month-long stay in the NICU and not until we had been secluded in the house, just the two of us, for another three weeks while my husband worked long hours at a brand-new job.
The OB who saved me will forever have my gratitude. The diagnosis wasn't hard: She had one foot into the room when I began weeping like she had just removed my heart. In fact, she helped me rediscover my heart, my brain and my rational emotions. Over several months of therapy, I steadied. When I returned to work, I realized what a lifeline my colleagues could be.
Sometimes having to pretend I am OK is the closest thing to being OK when I'm going through a depression.
That's not ideal. But it's a step toward healing.
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