Wide-eyed and smiling, the little baby cooed at her mother. Mariam Ishaq frowned. “I remember feeling low all the time, worthless and asking myself, ‘What have I done to myself? Why did I have a child?’” says the now 34-year-old Dubai expat.
Depression, specifically postpartum depression, hovers like a spectrum, invisible, unyielding and yet exercising great pressure. She counseled herself. “Your life completely changes when you have a child, right? So I figured that maybe this is that [shift in responsibility],” she tells Gulf News in an interview.
“Slowly, as my child got used to me and I got used to my new life, it was fine, so three to four months in, I was fine,” she says.
Is postpartum depression common?
PPD affects up to one in five women, says Dr Marie Thompson, Clinical Psychologist and Clinical Director at UAE-based clinic Vivamus. The US-based website Postpartumdepression.org explains, “Postpartum depression generally lasts three to six months, however, this varies based on several factors. It is estimated that nearly 50 per cent of mothers with postpartum depression are not diagnosed by a health professional.”
Four years on, the couple decided to have a second child. She sussed out a new hospital this time around – Ishaq suspected the trauma caused during delivery; a 24-hour labor with a mis-directed epidural; had lent itself to her discontent. So prepared, the mum to be headed to the new spot for a check-up at 37 weeks – where she was told she was already dilated. “Everything seemed to be okay on the ultrasound, but when he was born he had underdeveloped lungs. So he went on the ventilator for 14 days. That was a very traumatic experience for me because ultimately my doctor told us, ‘He’s probably going to die and you guys need to make your peace with it.’”
Voice shaking she says, “Fortunately, he survived and 14 days on, we took him home. It was all good.”
Or so she thought. Things came to a head a month later, when after a family vacation in London – “I had always wanted to go there,” she says – Ishaq came home and started to argue with her husband. “I remember telling him, ‘You never make me happy and you’ve never given me anything’ and he was just staring at me, because we’d just been on a two-week holiday. He had spared no expense.
“My husband was stumped and asked, ‘How is your life bad?’ that’s when I realized that all the tick marks were there [on her checklist]; beautiful house, kids, financially fine. And yet, I was unhappy,” she says.
“So I reached out to my gynaecologist and she asked me questions related to my other arguments with my husband. She asked me a ton of questions and then she said, ‘You know Mariam, I think you are headed towards PPD if you are not in it already. But I’m going to have my colleague give you a call and you guys talk things out.’
“That is the exact moment that I realized that my life is literally perfect and I’m not finding it even worth living. After that it became intense because I became suicidal – I didn’t attempt anything but I did have dark thoughts,” she says.
Plus the loneliness – and work – was getting to be overwhelming. “I went through this horrible experience of my child on a ventilator alone. No one from the family came because of logistical issues. Later when I took him home … breastfeeding is not easy – and I remember, I didn’t have any house help or anything. So that really contributed to my despair. Like, my husband is a very hands-on parent, always has been, but there are some things he can’t do – like he can’t get up and feed the child.
“Another thing [that led me to reaching out for help] was, my daughter was four years old and I used to put her to bed at 5.30pm, because if I didn’t and I had to deal with two children, I would lash out at her. I remember the second or third time this happened, I had this conversation with my husband, ‘This is not me. I adore my kids and I don’t know what is happening to me’,” she says.
Signs of PPD
Key signs are symptoms to look out for, says Dr. Thompson include:
Lack of enjoyment in things you used to enjoy (including the baby)
Low mood or feeling number
Difficulty sleeping even when the baby is sleeping
Negative thoughts that go round and round your mind
Thoughts of harmonizing yourself, your baby or your other children
Feeling like you can’t cope.
“So then she [my doctor] put me on medication – which I initially fought – she wanted me to do six months, but I did three months and then she tapered it off. Then I enrolled in this intense exercise program, because of course you can’t just stop taking your medication [without any other intervention],” she says.
Dubai-based pre-and post-natal fitness instructor Carly Dyas says, “Many of the mums I work with have said getting back to exercise has been the key to keeping them sane in the post-natal period. It has lifted their mood, given them more energy and generally helped them feel better.” According to a paper in the international journal ‘Evidence-Based Practice’, exercise alleviates the symptoms of PPD.
Medication and breastfeeding – what’s okay?
Dr. Thompson explains: “There are some antidepressants that are safe to take in pregnancy and when breast feeding and some that are not. It is essential to speak to your general physician or a psychiatrist to ensure that you’re taking the types of anti-depressant that are safe to take during pregnancy or when breastfeeding.
“When considering taking medication prescribed for any mental health condition, it’s important to weigh up the risk of taking it with the risk of not taking it. Sometimes people can overlook the risk to the infant of its mother being significantly depressed. Infants need mothers who are attuned to their emotional and physical needs – this can be really hard if you’re struggling with depression.
“Talking therapy (Cognitive Behavior Therapy – CBT) is recommended for the treatment of mild and moderate depression. CBT together with medication is recommended for mothers with moderate to severe postnatal depression,” she explains.
“It took me a very long time to come back to myself. Like even today, I’m talking to you, it’s one of the good days in my life. I still have anxiety to deal with,” Ishaq says.
Ishaq says there’s a lot of stigma still attached to talking about mental health. “In my country, everyone has a tendency to make you feel like a horrible parent if you don’t breastfeed. Or if you are not a certain kind of parent. All that stigma attached to culture still holds true. Like, half of my family doesn’t know that I went to therapy. They are now finding out about it, because I write about it on Facebook and stuff.
“I actively was doing therapy until a few months ago. That was helping me. The doctor prescribed an anti-anxiety medication, so anytime I feel like it’s getting out of hand I reach out to the doctor, so she tells me, ‘You take it for two months, three months whatever….’”
It’s been a long journey. “The second time I got PPD, I couldn’t breathe. So I went and I took help. I’m glad I did,” she says.
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