When I think of the newborn days of each of my daughters, I think of fire and ice. The fire is my first daughter, born leap day 2020 at the very beginning of the Covid Pandemic. My emotions were enormous and white hot – the ferocious, all-consuming love of being a mom to my new baby girl, the white-hot anxiety of being a first-time mom with no real idea of what I was doing, and the bright terror of having a newborn during a never-before-seen pandemic in which I was high-risk from asthma and planning on going back on immunosuppressants for my psoriatic arthritis as soon as possible. I was so incredibly happy to be safe at home with my husband and new baby, and equally terrified of what the future held. Despite my anxiety and the terrible postpartum flare I suffered when she was three weeks old, I was still just so happy with the new life in our house. I marveled at the extremes of my feelings, and how some days could be so happy and so terrifying simultaneously.
We knew we wanted another baby, but considering when we had our first one, we had no idea what to expect. I remember telling friends before and throughout my second pregnancy, “there’s no way the newborn phase this time can be any worse than with our first!” I was right in some ways, of course, we had no new pandemic start in November of 2023. But the multitude of fiery, intense emotions I had felt with my first was instead replaced by the icy emptiness of postpartum depression.
I felt detached from myself, like I got up from sleep one morning and left half the wires unplugged in my mind. My pregnancy was difficult, and I believe now my depression started when my OB called me after my 8-week ultrasound to let me know they found a potentially fatal problem with my baby. Concerns were lessened and then eliminated after a lot of genetic testing and multiple ultrasounds, but the fear stayed with me, and it was a much less happy pregnancy compared to my first.
I also felt guilty about my oldest daughter, because between going off almost all the medications managing my chronic illnesses, my morning sickness, and some painful pregnancy complications, I went from being a very active mom to being a lump on the couch for most of the day. I had already tried and failed all the pregnancy safe medications available to me, so I had no way to treat my joint pain and swelling beyond short courses of Prednisone. This was true of my first pregnancy as well, I was diagnosed at 25 and spent about three years trying different medications before I became pregnant with my oldest, but now it wasn’t just about me! It was about my daughter too, and I knew I wasn’t behaving how she was used to.
As the birth approached, I was probably more excited to be done being pregnant than I was to meet my baby. I put all my focus on getting ready for my maternity leave at work and getting our daughter ready to be a big sister as I tried to ignore how I felt. The fear of my first trimester had turned my insides to ice, I still felt afraid to connect with my baby and just didn’t want to think about my pregnancy any longer. I was in pain, nervous for the birth, exhausted from not sleeping, worried how my daughter would adjust, and just so ready to not be pregnant anymore. I knew I was unhappy, but I don’t think I ever considered it was depression. I just felt unplugged from my personality, my wants and needs, and my happiness. My skin was warm, but my head and heart felt encased in a chilly fog.
My delivery was a little complicated, but eventually my second healthy baby girl was born and it was overall easier than my first delivery. The day we came home from the hospital, I remember sitting on the couch holding my new baby and feeling all kinds of physical feelings – the pain from my stitches and my uterus contracting back down, hunger, thirst, the pins and needles of my milk coming in. I considered each feeling as it floated to the top of my awareness, but I just didn’t care to meet any of my needs and had no desire to get up and do anything for myself. I would get up if my baby or older daughter needed something, but otherwise I’d just sit on the couch holding my baby and feeling unplugged from myself. I had nothing I wanted to watch, eat, or think about beyond the basic needs of my kids.
I have a wonderful support system between my husband, my mom, and my friends, but I just didn’t want to engage with anyone. I answered their questions, but had nothing to contribute to the conversation. My only concerns were my kids and when I could go lay in bed next. The endless sitting made me feel stiff and achy, but I had no desire to get up and do anything, so I continued to sit. I tried watching happy shows, but it upset me to see other people happy. So I tried to watch a drama, but the stress and sadness was overwhelming. Eventually, I just turned off the tv and either looked at my baby or vaguely around the room. Hours would pass, and my only concern would be of my baby and her immediate needs. After two weeks of feeling this way and not feeling any more like myself, my mom and husband pushed me to see my primary care doctor. I had no feelings about it either way, so I called my doctor mostly so they’d stop asking me. I was able to get a same day appointment, and saw my doctor that day.
Truthfully, the nice part about having chronic illnesses and postpartum depression (PPD) together was I already knew how to care for myself and do what was expected and required of me despite not feeling well. I went to my appointment already feeling defeated and like my doctor wouldn’t help, as I had felt many times before my arthritis diagnosis. I just wanted to lay in bed, but I still went to the appointment, showed up on time, and detailed my symptoms as well as I ever have. I felt a spark of myself again when the nurse asked if I was in any pain and I had to ask the clarifying questions so many people with chronic pain have to ask: “right now? In general? Relevant to my appointment? New or chronic?”
My doctor diagnosed me with PPD, which did not come as a surprise, and we settled on trying Zoloft. I kicked into “New Chronic Illness Diagnosis Mode,” which is something I had done many times before as my list of diagnoses grew longer in my 20s. I am usually a positive person with a growth mindset, so even with PPD there was a part of me that wanted to fix my problem so I could get back to wanting to do things. My main motivator was my oldest daughter, who I knew was deeply affected by my sadness and lack of enthusiasm. I explained it to her as best as I could and I compared it to an arthritis flare, which she did understand to some extent, but she wasn’t used to those lasting weeks and I think she could tell something was different.
I made myself focus on asking my doctor the standard questions before I start any new medication: “What are the side effects? How long will it take to start working? What time of day is best to take it? Food or no food? Are there any interactions?” I was skeptical it would help, as I have been with many medications I’ve tried for my chronic illnesses, but all my questions had been answered, I found no reason not to take it, and so I agreed to start Zoloft. My doctor gave me a list of things to do to help my depression, much like the lists I’ve gotten from other doctors to improve my chronic pain. I said I’d try to follow it, and I thought I may have meant it. I did want to feel better, after all, I just wasn’t sure how it would be possible.
I think the split-second decision to treat my PPD as another chronic illness, which honestly had become a place of comfort over the years, helped me see it as a problem to be fixed instead of a cloud of permanent, icy fog in my brain. There was an emotional component to my depression that started from the fear of my early pregnancy, but this was also likely physical too. I was physically miserable for months, and I just went through the enormous hormonal shift of giving birth. It was reasonable to expect I may not feel my best self right now, and it was the same thinking I had had with my enormous arthritis flare after having my first daughter. I needed to rely on medication and lifestyle changes to treat my depression after having my second daughter, just as I had relied on medication and lifestyle changes to treat my arthritis flare after my first daughter. Here are the main things I did to help improve my depression as I waited for the Zoloft to work:
Rest.
This was massive for me because my pain and mood has always been deeply affected by a lack of sleep. With my oldest daughter, I was so happy to have a baby I didn’t mind the sleep deprivation of the newborn days, but with my youngest I was almost four years older, I had a 3-year-old to take care of during the day, and I needed to prioritize rest more. The schedule we had to care for our oldest during the newborn days was not working for me with our youngest, and this time around we were able to have more help from our family so I could get longer stretches of rest.
I changed what wasn’t working.
While my first daughter was exclusively breastfed, we switched to combination feeding with my second when she was a few weeks old. My husband could feed her baby formula while I slept, and I would nurse her when I was awake and up to it. My husband felt more useful being able to feed our baby himself, which I think helped his mood as well. I was against this with our first daughter when Covid made formula short in supply and I was still learning how to establish my milk supply, but I knew times were different now and I had to accept the help. My milk supply remained fine, and my baby took to the bottle and formula just fine too.
A meal schedule.
I had no appetite with depression, and my pain and mood is also deeply affected by not eating. I wouldn’t eat because I didn’t care to get up and make myself something or even ask my husband for something, and then I’d be more upset because my blood sugar was crashing and I felt terrible. I put myself on a meal schedule just as I had in the past when Methotrexate ruined my appetite, and I made myself follow it. My husband, always the fixer, made or bought my favorite meals to entice me into eating more often. In the first weeks all food tasted like cardboard, but I saw the effort he went to and I ate the food even if I didn’t enjoy it. Eventually, it did start to taste better.
I left the house more.
I am a homebody, and having a baby at the beginning of flu season meant I wanted to stay home even more to protect her. But getting myself ready, feeling fresh air and sunlight, and filling my day with more than just caring for my baby and feeling sad helped me feel productive and a little more like myself. My husband was also on paternity leave, so I was able to leave home and know my baby was well cared for. One morning, I went to get coffee and a doughnut by myself. The sun was shining, my coffee and doughnut were fresh, a song I liked was on the radio, and I was still miserable. But I made the effort to do it, and the next time I took myself on a coffee date I enjoyed myself a little more.
I told my close friends and family.
The urge to isolate was very strong with PPD, as it usually is for me when I’m feeling sad or stressed. But I noticed a difference in my mood after I made myself talk to my loved ones, so I told them how I was feeling and did my best to respond and engage when they reached out to me. They did a wonderful job of sending me regular, no pressure texts and pictures and kept the conversation going if I did respond. Eventually, I started to reach out to them first.
And eventually, Medication.
For me, starting the Zoloft was very helpful. I had reacted poorly to psychiatric medications when I tried them for chronic pain in the past, but a low dose of Zoloft started working after about two weeks and worked well without side effects.
My PPD didn’t disappear as soon as the Zoloft started to work, or even when it reached peak effectiveness a few weeks later. It also didn’t disappear as my body healed from birth, as my doctor thought it might. It slowly started to ebb as I followed my meal schedule, rested, and leaned on my friends and family for support. Some days, I’d have a trigger that would tank my mood and I’d be sad the entire day after. Over time, these triggers started to affect me for less time until finally it was something I could shrug off as I usually could have before. Some mornings I’d wake up and just feel happy, like one of the unplugged wires in my mind got plugged back in overnight. Other mornings I’d wake up feeling sad, like someone pulled them out again. Eventually, I just woke up as I normally would and got on with my day without thinking about my PPD.
And the best part of all, what made my difficult pregnancy and PPD all worth it, is the bond I now have with my youngest daughter. The ice around my heart has thawed, and I allowed myself to finally fully bond with her. She’s a happy, hilarious, spunky little one year old and I am so, so happy to be here to watch her and her big sister grow up.
