When motherhood isn't a joy

Julie Cugali is recovering from postpartum depression after the birth of her son, Alex, five years ago. Anne-Marie Jackson/The Globe and Mail

Julie Cugalj had a storybook pregnancy: She was one of those mothers-to-be who glowed. “It was the most blissful nine months of my life," she says.

The delivery itself, on Halloween night of 2004, was also a breeze, only four hours from beginning to end.

But the new mother had trouble breastfeeding her son, Alex. She was suddenly and profoundly exhausted, and wanted to sleep day and night. Her appetite vanished, along with her confidence.

“I could feel myself tumbling down the slope, but I couldn't reverse it," Ms. Cugalj says. “You come to a crisis point very quickly. You lose your sense of self-worth."

In retrospect, the 32-year-old Gatineau, Que., mother suffered classic symptoms of postpartum depression but, like many, she put on her happy mom face and struggled with the demons of depression behind closed doors.

Valerie Whiffen, a Vancouver-based psychologist, says internalizing and hiding the problem is a common reaction. “The main reason women don't seek professional help for their depression is they don't want to admit that they're not happy about the joyful event of motherhood like everyone expects them to be," she says.

When they do reach out for help, their concerns are often sloughed off by friends, family and health professionals. “Everybody says, ‘It's just hormones,' but there's absolutely no scientific basis for this," Dr. Whiffen says.

While many new mothers do suffer the baby blues – a week or so of hormonal readjustment after birth that is marked by mood swings – that is not to be confused with postpartum depression, she says. Postpartum is depression like any other – a mental illness triggered by stressful life events – and motherhood can be a big stressor.

About 2.5 per cent of women of child-bearing age in the general population suffer from severe depression; in the postpartum period, that jumps to 10 to 15 per cent.

When Ms. Cugalj finally sought help, five months after Alex's birth, the doctor prescribed antidepressants. They didn't work. Over the next couple of years, she would try a dozen or so medications, but her condition worsened. Depression interfered with her ability to bond with her son, strained her marriage and affected her work.

“The mental-health care provided by the system was horrendous. We screamed from the rooftops for help and no one listened," Ms. Cugalj says.

Only when she sought psychological help did the cloud begin to lift. “To be honest, I was a skeptic about therapy: I mean, how can you get better by just talking? But it worked."

Dr. Whiffen says therapy often succeeds where drugs do not because it can get to the root causes of the depression – the overwhelming demands on women and the guilt they feel when motherhood is not all rosy.

“When a woman gets depressed, it ripples out into every relationship in her life," she says. “In particular, depression gets really tangled up in marriage."

One of the best predictors of who will suffer postpartum depression is whether a woman's relationship is strained before the birth, she says. The other is a history of mental-health problems prior to pregnancy.