“Back to Life,” Working Mother

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Depression is the last thing most moms expect to experience once their babies are sleeping through the night, talking up a storm and walking around. But one in five working women is depressed—and the illness can hit years after a child is born. We spoke with a few brave working moms about the crippling darkness that overtook their lives and their steps toward recovery.

Teresa Bagan had every reason to be elated. After four years of bruising fertility treatments, stress and disappointment, she was finally holding her beautiful son, whose piercing blue eyes and sweet smile made her feel that at last all was right with the world. “I thought, The most difficult part is behind me,” recalls Teresa, 41, a manager at a publishing company in New York City. But just as her child was turning 2—and thriving—Teresa began to feel anxious. Though usually calm and deliberative, she felt easily unnerved. She grew impatient with her son. All she wanted to do was sleep. Doomsday scenarios flooded her mind. She developed stomach pain, which grew steadily worse. Soon she was convinced she had stomach cancer, but she refused to go to the doctor, in part because she didn’t want to face the diagnosis. “If you feel rational, ultimately you want to go to the doctor,” she says. “I wasn’t rational.”

At the office, Teresa found it increasingly difficult to maintain her composure. In the middle of a staff meeting, she couldn’t breathe. Her heart was racing. She excused herself, escaped to the ladies’ room, locked herself in a stall and sobbed. Though she could retreat to the bathroom at work, at home there was nowhere to hide. Her attacks of breathlessness and sobbing increased, sometimes striking in the middle of the night. Despite her exhaustion, she couldn’t sleep.

On a getaway weekend, she confessed to her husband that she thought she was dying. He insisted she go to the doctor. When she refused, he became angry. She walked around feeling “like a bad mom, a bad employee—and a bad wife because I was frustrated that my husband wasn’t rescuing me.”

One day, after three long months of veiled suffering, Teresa knew that she couldn’t continue like this for one more second.

“My son grabbed me as I walked through the door from work and I shook him off, handed him to my mother, who babysits for me, and drove to the emergency room. I couldn’t care for my child—and that was my breaking point.” The diagnosis wasn’t cancer. It was anxiety disorder and chronic depression. “I was stunned,” Teresa says. “It was the last thing I’d suspected. I mean, depression, that’s what happens postpartum or when there’s a history of it in your family.” With the help of medication and therapy, she came to realize that she had been in such a just-push-through-this state, managing her pregnancy struggles, marriage, new motherhood and a demanding job with such compartmentalized focus, that she’d suffered a breakdown precisely at the moment when she could finally draw a breath. “It was as if the minute I let my guard down, boom, I was hit. This darkness was just waiting in the wings.”

Deadlines & Diapers
These days, most women learn about the risks of postpartum depression, the haze of new motherhood that can threaten to plunge them into a crippling, if brief, depression. About 15 percent of new mothers succumb to it, according to the National Alliance on Mental Illness. What most women don’t read about in brochures in their ob-gyn’s waiting room is that some of the triggers for postpartum depression—feelings of isolation and overwhelming stress—can wallop you years later. It’s often their can-do qualities—juggling deadlines and diapers, deal-making and day care—that enable many working women to sail through the challenging early years of their baby’s life, only to tip them into serious depression once the hardest part has passed. “It’s a strong-woman feature: High-functioning people keep on going,” says Sharon Dobie, MD, a family medicine physician and professor at the University of Washington in Seattle. The working moms who “think they can get everything done are going to hit the wall at some point,” she adds, especially if they insist on the same level of performance. Those conditioned to keep going in the face of all obstacles may be particularly vulnerable to depression and least likely to seek the help they need.

“We are getting more and more calls from women who say, ‘My baby is four and I am depressed,’” says Karen Kleiman, founder and executive director of the Postpartum Stress Center in Rosemont, PA.

Because working mothers are under pressure to be productive and maintain their composure, she notes, they have a strong incentive to hide their depression—even from themselves. “I treat women who are attorneys and physicians, and their inclination is to pretend it will go away by itself,” says Kleiman. “Women who run corporations and have a hundred people below them seem to be doing really well at the office, but they go home and cry themselves to sleep, thinking of ways to kill themselves.” Indeed, a key trigger is the gap between how a working mom feels she should be behaving and performing and how she believes she actually is.

More working mothers suffer from depression than anyone might think. Consider this: One out of every five women in the workplace will experience depression in her lifetime, according to the National Mental Health Association. Women are about twice as likely to suffer depression as men. And it’s estimated that more than a third of women in their child-bearing years have symptoms of the disease. Despite the prevalence, about 40 percent of afflicted women don’t seek help, a result of the continuing stigma of mental illness. “Men are seen as troubled, while women are seen as nuts,” says Kleiman.

Experts say that, clinically, depression is depression, whether it happens to men or women. And it can come days, months or even years after the delivery of a child. The symptoms include feeling tired, sad and hopeless. Activities and hobbies that you usually can’t wait to get to seem like chores, and the deep funk persists for two weeks or longer. Recognizing these signs for what they are is critical, because depression can be a chronic relapsing illness that requires swift treatment. “There are brain changes that occur during depression,” says Anita Clayton, MD, the David C. Wilson Professor of Psychiatry at the University of Virginia. “The longer depression goes untreated, the more those changes occur.” Once mothers return to work, they may chalk up their fatigue, negative outlook or changes in weight or sleep to the stress of juggling motherhood and career. But for the working mother who forgoes treatment and is “just holding her breath,” says Kleiman, the result can be “catastrophic.” Being aware of what triggers depression, understanding high-risk factors and seeing symptoms for what they really are can save your life.

Neglecting Yourself
Six months after the birth of her second child, Michelle Hogan,* a sales manager for a software company, was exhausted. She had a demanding boss, a work environment that was “sort of endless” and a husband whose idea of child care was to tell his wife the baby’s diaper needed to be changed. Michelle, 37, would work all day, get home, nurse the baby, make dinner for their 2-year-old, throw in a load of laundry and read Goodnight Moon until both her children fell asleep. By contrast, her husband took up competitive canoeing two nights a week and during game season was away all day on weekends. The division of labor was, as she puts it, “I’m on duty 24/7. He’s on duty when I tell him.”

While having an unsupportive spouse doesn’t necessarily trigger depression, it certainly doesn’t help. Spousal support is so vital to a mother’s emotional well-being that many psychologists insist on husbands being part of any treatment plan. Not being able to share responsibility—to offload tasks when you’ve hit your limit—can put moms at a higher risk for depression, say experts. Depression can also affect the immune system, making someone more vulnerable to other illnesses. Indeed, Michelle’s body began to break down. She developed an ulcer, tendinitis and insomnia.

She was neglecting herself and failing to tend to her own needs. Yet as she grew more and more exhausted, she still encouraged her husband to pursue all of his activities. She went to visit a friend in the hospital who was on bed rest with a ruptured intestine and recalls feeling envious that her friend “could just lie there, with no pressures and demands.” At the time, Michelle didn’t recognize that she was suffering from depression, but reflecting back, she realizes that she knew something was wrong.

In an attempt to make things right, Michelle took a two-month leave from work to bond with her baby under California’s Family Rights Act. She spent the first three weeks of it in bed, sleeping. Then, slowly, she began to make changes. “When you’re in this state, it’s not one thing that brings you out of it,” Michelle says now.

“It’s a number of things, and it’s time.” She called her ob-gyn and asked to be put on antidepressants. She went to counseling. She started to take charge of her schedule, making time to exercise. She stopped canceling her own doctor, dentist and hair appointments. Instead of waiting for her husband to say, “Oh, honey, go play tennis,” she’d grab her racket and go: “I stopped asking for permission because I wasn’t going to get it.” Michelle also drew more boundaries at work. She volunteered for fewer projects and stopped trying to be the go-to person.

Her counselor advised her, “You need to either be okay with being a B student, or be an A student but take fewer courses.” It was good advice.

Am I Depressed?
We all have our mopey moments. So how do you know whether you’re just having bad days or suffering from depression? This checklist will tell you if you should seek professional help. More than five checks might mean you need help

*A lack of interest or enjoyment in usually pleasurable activities and hobbies
* Feelings of hopelessness and/or pessimism
* Feelings of guilt, worthlessness and/or helplessness
* Irritability, restlessness, anxiety
* Fatigue and decreased energy
* Decreased interest in sex
* Difficulty concentrating and making decisions
* Sleep problems, such as insomnia, wakefulness at night or excessive sleeping
* Overeating or appetite loss
* Thoughts of suicide
* Persistent aches or pains, or digestive problems that do not ease with treatment

Source: Women and Depression booklet, National Institute of Mental Health.

Help, I Need Somebody
What to do if you think a coworker or loved one is depressed

1) Educate yourself about depression and its symptoms.

2) Speak softly. Start by saying how much you care about her. Make it clear that you’re not trying to judge her but that you can see she’s struggling and you want to help.

3) Reach out, whether it’s offering to watch her child while she sees a doctor or just listening to her concerns.

Sometimes it’s best to simply ask, “What can I do for you?”

4) Remind her to say no if she’s feeling overwhelmed or inundated. If she realizes she has options, she will feel more in control.

5) Allow her to vent, and let her know you understand. But don’t offer advice or solutions unless she specifically asks you to.

Source: Cara Gardenswartz, PhD, psychologist, Beverly Hills, CA.

The Work Lifeline
Having a job—whether you love it or hate it—is not in itself a risk factor for depression. But the office culture can make a critical difference. Is it supportive or survivalist? Flexible or rigid? Does it offer opportunities for evaluation and treatment through an employee assistance program? Or is it a company that says “You’re fired” at the first sign of diminished performance? Sometimes the workplace functions as both obstacle and lifeline to recovery: an additional weight on the teetering scale but also a structure and community, a reason to get out of bed and a way to access treatment. More than half of U.S. companies now offer employee assistance programs that help staffers cope with personal problems, according to the Families and Work Institute. This is smart economics. Untreated depression costs businesses $44 billion a year in lost productivity, medical expenses and more.

A flexible work environment allowed Melissa Mackey of Lansing, MI, to recover from a serious bout of depression. At 30, the upbeat and athletic marketing manager for a media company endured a difficult pregnancy with twins that put her on bed rest for almost two months. At 37 weeks, she developed a devastating form of preeclampsia called HELLP syndrome. Her liver and kidneys were failing. Melissa almost died in the delivery room. Her doctor later told her that it was the first time he’d had to transfuse someone during a C-section.

Despite the traumatic labor, Melissa had no choice but to return to work after two months. The Mackeys were broke: Their health insurance had only covered 80 percent of their bills. Her husband, an investment advisor at a bank, took a promotion that involved a longer commute, resulting in a 7:00 a.m. to 7:00 p.m. workday. As Melissa grappled to cope with a life she now barely even recognized, she felt like “a mess, physically, mentally, emotionally.” But she soldiered on.

Then one morning, she snapped. The twins were in the house buckled into their car-seat carriers, but instead of loading them into the car, Melissa got in and turned the ignition key. “I wasn’t even really conscious of starting the car,” she said. “I was in such a fog, ready to drive away and leave them.” She didn’t. Instead, she slumped over in the driver’s seat and bawled. She felt like “one of those people you see on television news shows who abandon their children.”

Like so many women, she blamed herself. “I thought, I am the worst mother in the world. What’s the matter with me? Most moms would be so thrilled to have two healthy babies. Everyone else can do this, why can’t I?” That day she called her doctor. He referred her to a therapist, who diagnosed her with anxiety and post-traumatic stress disorder from the near-death experience of her delivery and subsequent stress. “PTSD,” Melissa asked, “isn’t that what soldiers on the battlefield get?”

Work played a vital part in Melissa’s recovery. A supportive management team and a flexible schedule allowed her to pursue therapy, and after three months she started to feel like herself again. At the office, “I didn’t share a lot of details like, ‘Gee, I’m in therapy, I’m a basket case,’” she says, but adds that “without flextime, I could have lost my job.”

What About the Kids?
Children of depressed moms may suffer also. Plus, depression can be hereditary. William Beardslee, MD, professor of child psychiatry at Harvard Medical School, recommends these preventive steps.

1. Help your children get where they need to be—school, music lessons, sports practice—to accomplish what they need to do.
2. Praise them when they do well.
3. Encourage and facilitate their friendships.
4. Make sure your kids realize that your depression isn’t their fault; help them understand what you’re doing to overcome it. Answer all their questions.

Single Supermoms
While most working mothers are all too familiar with stress, exhaustion and financial anxiety, the difficulties are exponential for single working moms. Despite the unique joys of raising a child on one’s own, many single moms battle depression. Lutishia Hawkins, now an executive administrative assistant at a luxury retailer in the Southwest, had a fast-track career as a telemarketing trainer but decided to take a demotion at age 30 before her daughter was born.

“You experience lots of loneliness, doubt and isolation,” she says.

Lutishia managed to get through the boot camp that is that first year of motherhood. But as her daughter reached 2, she was overcome with a feeling of hopelessness and a belief that she would never again find love. At the time, she was suing her daughter’s father for child support, and the court case brought back the painful feelings of failure. She was walking through life “like a mummy,” she says, in wrinkled clothes and without makeup, in a state of constant sleep deprivation. She sought counseling and recalls the decision as “a fight for life. There was a lot hidden within the heart that needed to come out,” she now says, from feelings of rejection to worries that her daughter was being rejected as well.

“Can you think of any more stressful situation than being a single mother?” asks Dr. Clayton. “Women need to take care of themselves in order to take care of their families.” And being a single mother makes that necessity a lofty goal.

Lutishia would love to buy herself a new pair of hot shoes or go on dates. But with the strained resources of a single income and concern for her daughter’s well-being, even small indulgences are out of reach. She feels she must put her daughter first. “I want to be able to exceed my daughter’s expectations, but it puts pressure on you when you’re not able to do that.”

She feels happier and more hopeful these days, thanks in part to sympathetic bosses, one of whom allowed her to stay home when her daughter was ill. And Lutishia is learning to take better care of herself, staying committed to therapy and growing stronger against the demons of depression.

Getting Better
Lots of circumstances can lead working mothers into depression, but a basic principle of self-care can lead them out. First and foremost is treatment, which can mean talk therapy, medication or both. Exercise and adequate sleep are also crucial, say experts. “Often it’s the self-care things that go by the wayside when you’re dealing with work and trying to keep a household running,” Dr.

Dobie notes. Patience, self-forgiveness and understanding are also important. “Women still believe it’s their character flaw,” says Margaret Rukstalis, MD, a clinician and investigator at the Geisinger Health System in Danville, PA. “They take it so personally, as though they could will their brains to be undepressed.”
Recovery for depressed working moms often boils down to recognizing that they need help, then being able to ask for it—and workplaces making it possible for them to get it. Often, the employee assistance programs that more and more companies have today provide self-diagnosis screening tools that can help employees figure out whether they might be depressed and in need of professional care. Many of the Working Mother 100 Best Companies offer everything from counseling on depression and anxiety to health insurance plans that cover mental health as fully as other medical conditions.

The women who seek help usually have only one regret: that they didn’t do it sooner. And many are surprised to find sympathy where they least expected it—from a compassionate boss or colleague, or a spouse they may have been too worried to tell. Finding the courage to ask for help is what rescued Teresa Bagan. “I logged quite a few hours on my therapist’s couch before I understood why I didn’t reach out sooner,” she says. Depression distorts your thinking; medicine and therapy enable you to see things for what they really are. “Still, as disoriented as I was,” Teresa says, “I knew my son was suffering. I was backing away from all the tickling, snuggling, intimate moments that I usually craved. My two-year-old’s mommy was MIA. Ultimately, I didn’t find the strength to save myself. I found it to save my son.”

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