by Dr. Saxon Burnett BA (hons) MBChB (hons) DRCOG
I never thought postnatal depression would affect me. I don’t know why exactly I thought this- after all, it is common amongst postpartum women (more than 1 in 10 will experience it within a year of giving birth), especially those who have a family history of the condition. My maternal grandmother suffered from particularly bad postnatal depression after all three of her children were born. Given this, I’m not sure exactly why I was so complacent. I suppose I thought that because I am a doctor, there was no way I wouldn’t spot the signs and symptoms early. I also consider myself to be a positive person most of the time, and so I had no reason to think I would be affected by any form of depression during what was supposed to be a very happy time in my life.
Following the birth of my first son in September 2017, I had felt fine. I was lucky to have several friends who all had babies of a similar age and so I got out and about regularly with friends I had known for years and that I could easily spend time with and relate to. I loved motherhood so much and wanted another child as soon as possible. I was fortunate to get pregnant again soon and was expecting my second child for November 2018.
I returned to work full time in June 2018. Unfortunately, in between me finishing work last time to have Henry and returning afterwards, quite a few of my colleagues had fallen ill- about 3-4 had been diagnosed with life-changing illnesses. Many of them were only a little bit older than I was (mostly early to mid thirties) and the others were certainly not old by any stretch of the imagination. This had understandably caused quite a bit of shock and anxiety amongst all of us at work. Secondly, I was back to working a full-time NHS rota (this is a lot of hours and includes night shifts and weekend shifts) with a 10 month old child who still wasn’t sleeping through the night. The lack of sleep on top of the long hours and an advancing pregnancy was not especially easy to handle. By September I was off work with a flu-like illness that didn’t improve with bed rest. Unfortunately the following week I was admitted to hospital with sepsis secondary to pneumonia. Luckily I recovered after treatment with intravenous antibiotics and intravenous fluids. I was advised not to return to work before I started my second maternity leave after I was discharged from hospital, but I did (doctors tend to be stupid like that, but I guess I didn’t want anyone to think I was slacking just because I was pregnant). When I finally finished work for maternity leave, it’s safe to say that I was exhausted.
Edward, my second child, arrived in November 2018. I think it was around mid-December when things started going wrong in my mind. I started feeling increasingly anxious. I was scared that something was going to happen to me and that I would leave my two young children behind without a mother. I thought this was all just hormonal and as a result of the worry caused by several of my colleagues having become unwell, and that eventually it would disappear on its own. However, things gradually started escalating. I soon became convinced that something was wrong with me. For some reason, I became fixated on the belief that I had somehow contracted a blood borne virus, such as HIV. Because I come into frequent contact with blood as part of my job, I convinced myself that I must have been stuck with an infected needle without realizing it, or that I must have been splashed with infected blood at one time or another. Before long, I was spending almost all of my free time looking up risk factors for blood borne viruses and convincing myself I had one. Gradually, I started to become more and more disinterested in socializing and pursuing other hobbies, which is not like me at all. It wasn’t long before I was mostly staying in the house worrying all day. I started experiencing physical symptoms of anxiety such as my heart racing at rest. It became all-consuming. I had also started drinking heavily in the evenings, which is also not like me. I don’t think that this was because I had an addiction to alcohol, but rather because I felt like it would help me to relax. Of course alcohol does not help with anxiety at all; rather, it worsens it in the long-term. So this was probably adding to my problems.
My husband started to notice that things weren’t right over the Christmas period and started to suggest that I should see a doctor. When the health visitor came to do a routine follow-up she agreed with him. After I saw a close friend at a Christmas party and thought I had been acting normally, she sent me a text message asking me if I was ok because “you didn’t seem yourself.” It seemed to have become apparent to quite a few people who knew me well that something was amiss. At this point, I hadn’t accepted or acknowledged that anything was wrong and so I didn’t visit the doctor. Over the Christmas period, one colleague passed away. By January, things started to escalate rapidly. I slowly became completely consumed with the idea that I was sick. My husband essentially forced me to see a doctor when, one morning, I told him he couldn’t touch me because my blood was poisoned and he would get ill if he did. We tested my blood with a home HIV test and it was negative. Yet still I was convinced that the test was wrong and I was infected. He called the doctors’ surgery and told them what was going on. They wanted to see me straight away.
I was completely honest with what had been going on when I saw the doctor. I told them about the delusional beliefs I had, about the drinking, and the loss of interest in daily activities. They screened me for suicidal ideation (which luckily I did not have. Throughout the whole process I was highly anxious and delusional about being sick but I am glad to say that I never felt suicidal). I was started on some anti-depressants and told to return shortly afterwards for a follow-up appointment.
By this point, I had definitely accepted that I was mentally ill and I had insight into the fact that what I was experiencing was not normal. Luckily for me, the antidepressants worked and soon I was able to accept the fact that the ideas I had been having were completely delusional. The anxiety, etc. hadn’t completely gone, but things did improve rapidly. I also made a conscious effort to stop drinking as much (this wasn’t easy, but I realized things had to change quickly here and being on the antidepressants helped with the anxiety that I had been using alcohol to try and counteract). Unfortunately, with all this going on I stopped breastfeeding, which I didn’t really want to do so early but I had to focus on getting better and doing what was right for me and the family at the time. By the time I went back for the follow-up, I was able to confirm that all of the things I had been saying about being sick were completely not true. The doctor told me that I should be on the anti-depressants for at least 6 months. They advised that I organize some counselling (but I am highly ashamed to say that I never did this, although in hindsight I feel like I definitely should have).
I am very lucky that I managed to get off the anti-depressants after 6 months, although it can take a lot longer for people to wean down medication. As a doctor, I never thought that things would get so out of control for me. I always thought I would recognize and acknowledge the symptoms of PND and get help early if I experienced them. However, when you are the one with irrational thoughts and beliefs that isn’t always easy to do. I wish I had listened to those closest to me at the time when they first raised concerns. I now know that PND can manifest in different ways. For instance, mine began as a more anxiety/OCD type thing, but as it escalated, I also became depressed. Luckily, nothing too terrible resulted from my ordeal, and I realize that my case is by no means the worst, but PND can be very serious and in the worst-case scenario can even cost lives. At the end of the day, PND is a common illness and it is nothing to be ashamed of. It can happen to all of us, even doctors.
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