Brought to you by the Depression Is Real Coalition, The Down & Up Show is dedicated to the reality of depression. Our hosts will talk with some of the world's top experts on depression, as well as people who have been impacted by this illness. The reality of depression is that it is a debilitating and potentially deadly medical condition that affects more than 15 million Americans every year. The other reality of depression is that there is hope.

Down &Up Show #40: Motherhood and Depression

DR. REEF KARIM:
Welcome to the Down and Up Show on depressionisreal.org. I'm your host, Dr. Reef Karim, psychiatrist, addiction specialist, and relationship [inaud]. Today we'll be talking with one woman who has lived with depression most of her life. With us here today is former Washington Post reporter Tracy Thompson.

Miss Thompson described her experience with depression in her compelling book, [inaud], Journey Through Depression. After becoming a mother, her battle with depression drove her to write her latest book, The Ghost in the House: Motherhood, Raising Children, Struggling with Depression, which is based on her experience with depression during motherhood or maternal depression.

Miss Thompson, thank you for taking the time to speak with us today.

TRACY THOMPSON:
Thanks for having me.

DR. REEF KARIM:
All right, so you can talk to us about your experience with depression before you became a mother?

TRACY THOMPSON:
Yeah, but first a minor correction. You said the second book was a novel, and it's nonfiction.

DR. REEF KARIM
It is nonfiction, okay.

TRACY THOMPSON:
Yes, right [inaud]. My experiences before I became a Mom. Well, it was pretty typical sort of meandering journey through trying to come to terms with the fact that something was wrong and then figuring out what that was, and then figuring out what to do about it. And that's condensing about 20 years into one sentence there.

I came from a family who was obviously genetically predisposed to depression. I can find it in my family tree all over the place, although of course it's not always called that. And then you grow up, you get life stresses, and it became a big problem for me when I was in college. And I had really no idea of what was going on. I just knew I wanted to die.

And I went into therapy at that point. Unfortunately, I didn't find a really good therapist. Was off and on in therapy for the next ten years, I guess. Never took any anti-depressants, because I was still resisting the idea that I had a mental illness. And then in 1989 I moved to Washington, worked with the Post. I had lived in Atlanta till then. And a combination of moving, job stress, relationship stress, a whole bunch of things happened at one time and I wound up extremely, suicidally depressed.

I was really nonfunctional. And my then boyfriend drove me one night to Georgetown Hospital and checked me in, because I was a danger to myself. And I was really planning to kill myself, and I had the pills on hand with me to do it. So at that point, I think that was finally the point where I really had to come to terms with the fact that I had psychiatric illness.

And at that point that was the first time I ever got really appropriate medication [inaud], and I began to get better, but even then it was a very, very long and jagged path, because it took me about two years, really, to fully recover from that whole episode. But eventually I did and I began to kind of get a grip on what was going on with me and what the name of it was.

And actually, the first book I wrote was a part of that. I got to the point where once I had finally figured out that this was a real illness, and just not some defective personality part, I found myself wanting to know everything I could about it. I started reading everything I could find, including medical histories, neurobiology textbooks, you name it.

I really was fascinated with trying to figure out how my brain worked and what was going wrong. And so, and then eventually I got to the point where I thought that it would be useful to write about how it's possible to be a very high-functioning depressed person, because that was an aspect of the illness that I don't think anybody had really written about before the early 90s.

And then there was kind of a spate of memoirs along those lines. Coinciding, I don't think coincidentally, was the introduction of the new SSRI drugs [inaud] market. I think that allowed a lot of people who formerly wouldn't have been functional enough to hold down a job, much less write a book, to do both. It certainly did in my case. And so that's when I wrote my first book, which got a pretty big reaction at the time.

And I got tons of people who said that was the first thing they've ever read that described their own experience. It wasn't Sylvia Plath and it wasn't some suffering artist and it wasn't a trip into the snake pit. It was just an account of how it's possible to be really, really sick and still go to work every day.

So that was pretty much my experience with it prior to motherhood. I met my husband in '93 and we married the following year, and I had, I thought, a pretty good handle on keeping track of myself and monitoring my moods and keeping in touch with my psychiatrists and taking my medication [inaud].

And then I discovered that the whole pregnancy process was just hormone hell. And like a lot of women, I had major problems with it, and I had my first child. I went off my meds during her pregnancy because I just thought that was the thing to do. And after she was born, I had really, really severe post-partum depression, which took me about a year to recover from.

And then I realized I was not in a position anymore to kind of go the office and leave my worries at the office door, because my work was me and I was at home and I was fulltime childcare provider. So it became a whole different ballgame after that.

DR. REEF KARIM:
There are many interesting statements here that you've made. One of them is being a high-functioning depressed person, because there are many people out there that still have the stigma that when you're depressed you're not a functioning member of society. So if you're a depressed person, you're not functioning. If you're not depressed, you're functioning.

But the reality is there are a lot of people walking all over the place that are functioning enough, they're just not functioning in an optimal way. So that if they were treated for their depression, they'd be functioning that much better.

TRACY THOMPSON:
Yeah. Yeah, I think that's right. And it is kind of hard, if you've never been there, to understand. But there were times when I was going to my job every day and doing it at an acceptable level, maybe not my best level, but acceptable, and going home at night and packing up my stuff to be sent to my family after my death. I mean, it was really, really pretty awful at one point.

And yet I never missed a day at work. In fact, in frightened me to death to miss a day of work, because when you're in a situation like that, your professional identity is sometimes kind of a lifeline, and it can be the last thing to go. You hang on to that with white knuckles, because that's really all you have, is the semblance of normality, and that's what the job represents.

DR. REEF KARIM:
So, in your book, you say ‰ÞÏmaternal depression is a bad day that comes for a visit and refuses to leave.‰Þð Can you tell us a little more about what you mean by that?

TRACY THOMPSON:
Yeah. I wanted to put it that way because there is not a parent alive who hasn't had a day when everything went wrong and they screamed at the kids and then they felt awful about it, or they just didn't want to be around their kids, or whatever. That's just part of normal parenting. What I wanted to get across was that when you're a depressed parent, specifically mother, in this case, you, what you're doing is you're functioning at a level where you're not really able to bring your emotional resources to bear on a job that's very emotionally demanding.

And so you, what I discovered in talking to women who were dealing with this issue, was that they were habitually walking around feeling extremely, just hyper-irritable. Snapping at their kids for not doing much of anything wrong. And then also withdrawing from their kids. It's just this kind of like every nerve is on edge, and you can't stand any kind of noise. All you want to do is go to bed and sleep.

That kind of thing, that goes on day after day after day. That's what I'm talking about, because I wanted to distinguish it from just the regular old ordinary bad days everybody has [inaud].

DR. REEF KARIM:
Okay. Your book includes experiences and information from other mothers, right, 400 other mothers who are also, experienced depression as well.

TRACY THOMPSON:
Right, yeah.

DR. REEF KARIM:
Did your experience‰ÞÓwas it similar to theirs, or did it differ, or how did it relate to theirs?

TRACY THOMPSON:
Well, I found it very similar in a lot of ways, but every woman's story was a little bit unique, which only makes sense when you think about it. But there were several over-arching themes, and I've already named two of them‰ÞÓthe hyper-irritability and the withdrawal. And then the third thing, which kind of went along with the first two, was an ability to set limits.

Because being consistent and disciplined takes an awful lot of energy, and when you're depressed, you don't have any energy. And so a kid whose mother is chronically depressed is often going to be a kid who misbehaves, because they don't know where the limits are, because mom doesn't have the energy to be consistent about setting them.

And, so that's, those were the three over-arching themes that I saw, and that was pretty much common to everybody. But within that, there were all kinds of differences. I talked to some women who had just white-knuckled their way through the whole parenting experience and really never enjoyed a day of it.

And then I talked to women who suffered from really extreme post-partum depression, but then recovered and were feeling fine. And I talked to women who had recurrent cycles of depression and you know, it sort of ran the gamut as to how often you were dealing with this issue, whether you were doing it all day every day or whether you just kind of trouble some times.

DR. REEF KARIM:
The Depression [unint] coalition seeks to diminish the stigma around depression, right? Did you find other women who spoke, who you spoke to, but did not seek treatment because of the stigma, specifically?

TRACY THOMPSON:
Well, actually, no, in my research I didn't, because we‰ÞÓand by we I mean my collaborator on this survey was Dr. Sheryl Fidman [ph] at Emory University‰ÞÓwe limited the survey to women who had a medical diagnosis of depression, because we wanted to just make sure we weren't getting folks, we wanted to be conservative about the group of people we were talking to.

And so, no, I didn't find that many women who had never sought treatment for it. I did talk to a lot of women who could look back on their lives and see a pattern of illness that had gone on for years before they finally did go to the doctor.

DR. REEF KARIM:
Can you talk to us a little bit about some of the symptoms of what you consider maternal depression? You said irritability, and can't set limits, but when you look at traditional depression‰ÞÓwhen I'm doing an assessment on somebody to assess whether they're depressed, I look at a depressed mood or feeling blue a couple hours a day every day, things that you normally find pleasure in you don't find pleasurable any more, feelings of helplessness, hopelessness, worthlessness, fatigue, sleep problems, appetite problems, potentially suicidality, a bunch of other stuff.

Is that consistent with what you felt maternal depression was, or do you think maternal depression has an extra or a different kind of set of symptoms?

TRACY THOMPSON:
No, I don't think of it‰ÞÓI'm not trying to establish a new clinical DSM category here. I'm just, I think my definition of it focused more on the aspects of depression that directly interfere with parenting, but all those other symptoms that you talked about were definitely part of the picture too. It's just that when mom loses her appetite that's not going to directly affect the kids.

DR. REEF KARIM:
Right, so what's happening is you're getting the symptoms of depression, but because you're a mom, you have some extra responsibilities and you're, quite honestly, your physiology is still changing, as in pregnancy.

TRACY THOMPSON:
Well, yeah, except I'm also talking about women whose kids were 8, 9, 10 years old. So it's not just, I didn't want to just limit it to the child-bearing experience [inaud].

DR. REEF KARIM:
Yeah, because there's depression, and then there's post-partum depression, and then there's post-partum depression leading to maternal depression, or bringing out or facilitating the underlying depression that was already there.

TRACY THOMPSON:
Right, right.

DR. REEF KARIM:
Okay. So, you talked about kids. How does depression affect raising kids?

TRACY THOMPSON:
Well, I talked about one aspect of this already. I think one, with kids who don't know what their limits are. A lot of kids, a lot of moms I talked to said their kids became kind of almost parental towards them. It put a burden on the child that they were aware of and felt helpless to do anything about, which is the child being excessively concerned with how the mom was feeling, and feeling like it was their job somehow to take care of their mommy, which is I think a normal thing that any child would feel.

But it's not something you want to have placed on your child day after day after day. That's just too much to ask, so I think that was one aspect of what happens. And the other things that moms spoke about were their fears that because they were depressed that they were going to somehow transmit this to their kids, which in genetic terms is a very real possibility.

DR. REEF KARIM:
One thing you mentioned earlier that I want to touch on is going off medications during pregnancy. What are your thoughts on that now?

TRACY THOMPSON:
Well, I sort of tried it both ways. With my first child I went off my medications because, in 1996 that was just kind of the standard medical advice. When I had my second child, in 2001, the advice had changed, and my own experience had taught me that I was playing with fire if I did go off my medications. So with my second child, I talked to my doctor and I got‰ÞÓI had a new ob-gyn by then‰ÞÓI got my ob-gyn and my psychiatrist talking to each other and I stayed on medications.

Yeah, and the other thing that I knew from very vivid experience was that‰ÞÓby then my first child was four years old and I could see in her‰ÞÓthere were all kinds‰ÞÓthere was‰ÞÓshe suffered because of my depression. And I was well aware that my illness could affect her just as much, if not more, as a little bit of exposure to drugs in utero.

I felt like, when I weighed those two things, the drug exposure was much the lesser of the two risks.

DR. REEF KARIM:
That's interesting, yeah, because in one way it's placenta related, but in another ways it's environmental related, that you're just frustrating the kid.

TRACY THOMPSON:
Yeah, well, and also that first year of motherhood for me with my first child was just hell, and I don't think it was much fun for my daughter, either. I mean, she did fine, and my husband, fortunately was very level-headed and plugged in a lot of the gaps, but it was just not an easy transition.

DR. REEF KARIM:
Well, do you have any final thoughts you wish to share with our listeners?

TRACY THOMPSON:
Well, I guess I would, I still think that women who suffer from depression and feel like it's interfering with their parenting suffer from a great double whammy, and that is they're afraid to talk about it, because in our culture motherhood is just supposed to make you happy, and any other feeling of unalloyed happiness, unless it's couched in comic terms, is just not really allowed.

So I would just encourage women out there who are struggling with the whole parenting thing to not be afraid to find somebody to talk to and get some help. It used to be the case that ob-gyn's were not very educated about psychiatric issues, but I think that's changing and I also think that just family doctors are a whole lot more aware of how common depression can be than they used to be.

So it's worth talking to your doctors about and maybe even opening up to your friends, because you'd be amazed how many people out there struggle with it.

DR. REEF KARIM:
Good words of advice. All right, well thank you for speaking with us today, Miss Thompson.

TRACY THOMPSON:
Okay, thank you for having me.

DR. REEF KARIM:
Great. And your latest book, obviously, provides important help and solace to women who are currently living with depression.

TRACY THOMPSON:
Yeah, except it's not a novel.

DR. REEF KARIM:
Right, thank you for the correction. Your latest book.

TRACY THOMPSON:
Yes.

DR. REEF KARIM:
Okay. Join us next time for another segment of the Down and Up show on depressionisreal.org.