The Baby Blues And Beyond

After Leslie Wolter gave birth to her second child, Aidan, last year, she felt she was losing control. "I couldn't relax, I couldn't calm down, I was worried all the time," says the 31-year-old English teacher from O'Fallon, Ill. She cried constantly, went days without sleeping and obsessed about whether Aidan's birth would ruin her close relationship with her 7-year-old daughter, Sloane. "My husband was, like, 'What's going on with you?' " she says. "I was just freaking out." Eventually, Wolter found her way to Diane Sanford, a St. Louis psychologist who specializes in postpartum depression. And Wolter, who says she "won't even take aspirin," reluctantly agreed to try Paxil. Now back at work--and back to her old self--she wishes she had started taking it earlier. "I could have felt better a lot sooner," she says.

Wolter's experience with postpartum depression is vastly more typical than Andrea Yates's. Indeed, PPD very rarely results in the kind of tragedy that unfolded in Houston last week. Still, it is a serious and debilitating disorder that calls for prompt treatment. Unlike the "baby blues," a temporary period of weepiness that up to 80 percent of new mothers undergo, PPD is characterized by persistent feelings of anxiety, hopelessness and guilt, insomnia, lack of motivation and, sometimes, thoughts or fantasies of harming oneself--or even the baby. Doctors estimate that between 5 and 20 percent of all new mothers suffer from it. A much smaller number, about one woman in 1,000, experience the far more severe symptoms of postpartum psychosis, including hallucinations, paranoia and delusional, suicidal or homicidal thoughts. Like Yates, virtually all new mothers who harm their children are suffering from postpartum psychosis--not plain old PPD. "Every mom who's taking Prozac--or ought to be--is not going to smother her children and hang herself," says child psychiatrist Elizabeth Berger.

Since PPD first became widely recognized in the mid-1980s, doctors have come to understand it much better. For one thing, they believe it is caused largely by physiological factors. During pregnancy, estrogen and progesterone levels skyrocket, then drop back to pre-pregnancy levels soon after delivery. "[Childbirth produces] more pronounced changes than at any time other than death," says Raphael Good, an Ob-Gyn and psychiatrist at the University of Miami. Other stressors, such as marital problems, sleep deprivation and pre-existing mental illnesses, clearly exacerbate PPD and postpartum psychosis. Giving a new mother lots of support is especially important. "We know that social isolation is a big factor in a mom developing something like this," says Sanford. Treatments are becoming more pre-emptive. Some doctors have even begun giving postpartum women nicotine-style estrogen patches to help ease the hormonal fall, though the practice has not yet been approved by the FDA. In May the Journal of Clinical Psychiatry published a small study from the University of Helsinki showing that estrogen pills reduced severe depression in postpartum women.

Doctors typically treat postpartum depression with medication, talk therapy or both. Many believe that women with PPD can take certain antidepressants like Paxil or Zoloft before and after the delivery--even if they want to breast-feed. "Interpersonal psychotherapy"--short-term intensive counseling--has also proven successful with some PPD sufferers. For women with postpartum psychosis, doctors may prescribe a mood stabilizer, such as lithium, in addition to antipsychotic and antidepressant drugs. Those with a known history of bipolar disorder might be given lithium within an hour of delivery. Such women should be closely watched by their families, as well as by doctors--and should be hospitalized immediately if they become dangerous.

No one is more susceptible to PPD than a woman who has experienced it before. "We think that it's kindling," says University of Chicago psychiatrist Valerie Davis Raskin, coauthor of "This Isn't What I Expected: Overcoming Postpartum Depression." "The brain remembers past childbirth-related disorders." Randy Berman, who tried to commit suicide after her son, Jordan, was born seven years ago, was gripped by anxiety and obsessive thoughts when she became pregnant again nearly three years ago. She tried to control her moods with exercise and therapy but needed to take Prozac toward the end of the pregnancy--which many doctors say is safe for the fetus. Medical ethicist Arthur Caplan says that doctors may want to recommend that women with severe PPD limit their family size. After all, if the woman suffered from a physical problem, such as diabetes, doctors might advise her to think twice: "You've had these problems in the past. Should you have another child in terms of your own health?"

Left untreated, PPD will usually go away by itself in six to eight months. But that's a long time to be miserable. And it doesn't always disappear; sometimes, says Miami psychologist Arlene Huysman, "postpartum depression can be a trigger for a lifetime of illness." That puts a lot of stress on a family. Linda Meyer, 41, recalls how helpless her husband felt when she was stricken by overwhelming anxiety and irritability after the births of their daughters, now 8 and 11. "He just was dumbfounded," she says. "He had no idea what he could do to make me better." But when a mother is depressed over the long term, it is usually the children who suffer most. "If you can't take pleasure in anything, that is very crushing for a child," says Berger. "What children need to thrive is the twinkle in the mother's eye. And that is what depression robs the mother of."

Thanks in large part to highly publicized cases like Yates's, awareness of PPD is growing. But when it results in infanticide, the American public has trouble being sympathetic. "What can we say about a mom who kills her five kids?" asks Carol Steiker, a professor at Harvard Law School. "She's got to be evil, or she's got to be crazy." Legally, there is no difference; infanticide is treated as homicide. And homicide laws vary widely from state to state, depending on the jurisdiction and the facts of the case.

Postpartum disorders have rarely been used as successful defenses for infanticide. Last month an Indiana jury convicted Judy Kirby, 31, of killing seven people (including three of her children) when she crashed her Pontiac Firebird into a minivan while driving at high speed in the wrong direction. Kirby, a mother of eight children including a 5-month-old, had a long family history of paranoid schizophrenia and had in fact recently been hospitalized for "a major depressive disorder with psychotic features," says Jennifer Auger, one of her attorneys during the trial. Even so, a judge sentenced Kirby to 215 years behind bars. She's planning to appeal, says Auger. "It's very sad that it's not understood as an illness."

Elsewhere in the world, it is. "Many countries reflect the attitude that a woman who commits such a crime is probably mentally ill and shouldn't be treated as a capital murderer," says Daniel Maier-Katkin, dean of the Florida State University school of criminology. In Britain, the Infanticide Act of 1938 allows women who kill their offspring within the first 12 months to plead the lesser charge of "infanticide" instead of murder. Such cases are extremely rare, but if a woman can prove that "the balance of her mind" was disturbed by pregnancy, childbirth or lactation, she may receive a much more lenient sentence, including community service or even conditional discharge.

Gradually, Americans are recognizing how treatable PPD really is. More and more obstetricians are looking for warning signs in their patients. At Massachusetts General Hospital, doctors require patients to fill out questionnaires evaluating their emotional state. New York and New Jersey recently passed legislation requiring hospitals and clinics to distribute brochures on the subject. There are now shelves of books to consult, as well as support groups like Depression After Delivery. And perhaps most important, women are openly discussing the difficult realities of motherhood. "I thought [having a baby] was going to be the happiest moment of my life, and everything would be great," says Meyer. "It was not what I thought it would be. It was so hard."

There's still a long way to go. In June Carol Blocker's 41-year-old daughter, Melanie Stokes, jumped to her death from the ledge of a Days Inn just three months after giving birth to a much-wanted baby girl, Sommer Skyy. After the delivery, Stokes became despondent. She was treated--but it was too little too late. Blocker says severely depressed women like her daughter need lengthy hospital stays in cheerful rooms, supervised time with their babies and more accurate medications. Before the baby was born, Stokes was beautiful, bubbly and outgoing. And that, no doubt, is how Blocker will remember her to little Sommer Skyy.