One of the most commonly asked questions I hear from women in my practice suffering from perinatal mood and anxiety disorders (PMADs)– and even from professionals learning about PMAD treatment — is "How long does it take to become well?" This question is inevitably followed by a story of someone who recovered in two weeks or of someone who still appears to be suffering months or years after giving birth.
There is great danger in attempting to compare your own symptoms or treatment to other women you may know who are going through the crushing experience of a PMAD or who have had it in the past.
As with any other medical illness, NO TWO EXPERIENCES ARE THE SAME. Each woman's illness brings its own unique biological, psychological and social factors. The intensity, disability and presentation varies as widely as a cut on a kneeand a broken leg.
Sometimes there's unity and connection when women talk about what they are feeling. There is huge relief in knowing you are not the only mother who thought about giving her baby up for adoption, who wished the baby had never been born, or who feel resentment instead of joy at the constant cries for attention. It can be comforting to know that sleeplessness is its own hell, that partners don't always do the right thing, that no one rises to motherhood without questions and imperfections and that wishing to have your former life back again is perfectly normal. The horrific guilt that plagues such mothers can be reduced by compassionate and even humorous exchanges with other moms. The Postpartum Support International weekly Chats are testimony to the relief of ending isolation and lonely despair when you feel there is no one in the world who could possibly understand — or have compassion for — what you are feeling or thinking.
But when recovery timeline or treatment comparisons are made, it can lead to women feeling worse if they do NOT bounce back in the number of weeks or months offered as a standard by well meaning friends. The feelings of associated despair can add further hopelessness as the conclusion becomes: "I must be really crazy if I am not yet well."
This also applies to the form of treatment. Some women will feel better with sleep and a few good talks with a friend, therapist, pediatrician or neighbor. That is great, but that is NOT postpartum depression. Since recovery can't begin until treatment starts, the length of time someone with true PPD has suffered or will suffer depends on accessing that help … how soon they get to the right professional and the best practice treatment for their own unique symptom presentation.
While all depressions are MEDICAL ILLNESSES (sometimes a biological predisposition increases vulnerability), there are other contributing circumstances as well known as risk factors. The National Institute of Mental Health is devoting much time and research to further the understanding of how biological predispositions become activated by chemical, psychological or social stressors. Having a biological predisposition doesn't mean you will definitely develop a PMAD, but as risk factors increase, so does vulnerability to a mood or anxiety disorder. This wasn't caused by anything you did and you can't compare your circumstances or unique biological makeup to anyone else on the planet.
When social deficits are prominent in a clinical presentation, we can work hard on developing more support and often see great progress. When certain ways of thinking keep women locked in an endless loop of intrusive thoughts or obsessions, we have Cognitive Behavior Therapy strategies to begin management of unwanted ideas. And when other behaviors such as addictions or eating disorders complicate the recovery from PMADs, we have therapies like Dialectical Behavior Therapy that help clinicians target all of the symptoms that are impeding a woman's progress. Finally, medication may be critical in any of the preceding scenarios because when we feel better, we can make new cognitive or behavioral choices that will support the recovery from depression. Or, medication may not be needed at all. There is no one formula that works, no one size fits all.
The best course of action is always to seek treatment form an experienced PMAD practitioner who is also credentialed in the form of therapy indicated by your set of symptoms. This person can assess/identify each component of the disorder, prioritize goals and treatment plans with you and work toward recovery. The ONLY comparison of any value for a woman recovering from a PMAD is to notice if she feels better than a month ago, a week ago, an hour ago … and to give herself the patient love and space to fully recover without adding the pressure of someone else's recovery timeline.
Susan Dowd Stone, MSW, LCSW, is the chair of the President's Advisory Council of Postpartum Support International, an NJHSS Certified Perinatal Mood Disorders Instructor, an adjunct lecturer at the Silver School of Social Work at New York University and a public reviewer for NIMH. Her website is www.perinatalpro.com. (Note: Susan Stone and Katherine Stone are not related.)
