Aug. 30--The turning point came when Monique Weston's husband discovered her downstairs in the middle of the night, unable to sleep and crying her heart out.
Until then, she figured, she could will herself to snap out of the postpartum depression that had gripped her for two months and made her interpret even the vacuum cleaner's quirky knack of stopping her baby's crying jags as a sign of her inadequacy.
"It's so insidious the way it turns your mind against you," says Weston, a Houston artist and intelligence analyst who knew about postpartum depression before she became pregnant but felt powerless to combat it when it hit. "It's the closest I can imagine to hearing voices, or being possessed. It really does feel alien, like something else is at work inside you."
Weston, now 37, got help and turned it around. But lots of women aren't so lucky.
Postpartum depression -- the debilitating mood disorder that can seem an almost logical consequence of a stressful, vulnerable time in a woman's life -- is finally coming into the open after decades as mothers' dirty little secret. Turns out, the condition is more common than was previously thought and the number of therapists trained to handle the problem is less than what might be expected.
Houston mental health leaders have launched an effort to do something about the discrepancy, training more psychiatrists to treat the disease, educating primary-care doctors, pediatricians and obstetrician-gynecologists to better recognize symptoms and setting up programs in clinics and hospitals to identify at-risk women.
The condition affects some 15 percent of the more than 4 million women who give birth in a given year, according to a new report, up from the previous estimate of 10 percent. The number rises to as high as 40 percent among certain at-risk populations.
According to experts at a Houston conference on postpartum depression held this summer, only a handful of psychiatrists in most cities are well-versed in the illness and its treatment, a combination of talk therapy and antidepressants.
The stakes are considerable. Untreated, women with the disorder typically have recurring bouts of depression, particularly at times when hormones change, such as after another delivery or during menopause. Their babies tend to have more episodes of diarrhea, become clingy as children and score lower on IQ tests as adults, according to studies.
"The most tragic consequence is the psychiatric spiral it causes," says Betsy Schwartz, president of Mental Health America of Greater Houston, which hosted the Postpartum Support International Conference in June. "We know children of mothers with postpartum depression have more emotional problems as adults. For instance, they struggle to develop and sustain healthy relationships."
Postpartum depression dates back to ancient times -- Hippocrates described it in the 4th century B.C. -- but there's been little focus on it until the last few decades. It was only added to the DSM, the manual of psychiatric diagnoses, in 1994 and even then as a form of depression, not a distinct condition.
Today, it is recognized as the most common complication of childbirth, characterized by anxiety, trouble sleeping, feelings of worthlessness or inappropriate guilt and even thoughts of suicide.
The cause isn't well understood, although it is believed the illness is triggered by the changing hormones that occur after delivery. Sleep deprivation, genetics and emotional or lifestyle factors can play a role.
Weston describes her case as the classic example of postpartum depression, the new mom who could not have been happier to bring home her son. But amid everyone else's oohing and aahing, she soon found herself irrationally depressed, worried that she would "mess him up," that he'd sense her despair.
She mentioned her depression to her obstetrician-gynecologist, but his dismissal of it as sleep deprivation only reinforced her resolve to handle it herself. Her husband thought something was up, but she wouldn't share.
"New mothers are very sensitive to the idea they should be good mothers, that their maternal function is paramount," said Dr. Nidal Moukaddam, a psychiatry professor at the University of Texas Medical School at Houston. "When they perceive they're failing in that role, it creates both shame and a tendency to conceal it."
Experts say it's not uncommon for doctors to dismiss postpartum depression as baby blues, the term for the mild mood swings, irritability and crying that can last up to two weeks after birth and occurs in eight of 10 new mothers.
Doctors are much more sensitive to postpartum psychosis, the rare condition that led Clear Lake mother Andrea Yates to drown her five children in 2001. It occurs in one of every 1,000 new mothers. The Yates case focused the nation's attention on postpartum mood disorders, making it easier for new mothers to admit depression. In Texas, the case prompted the state Legislature in 2003 to pass a law requiring hospitals, birthing centers, doctors and midwives to provide pregnant women or new mothers with a list of places that provide postpartum counseling.
The new national statistics come from a report this summer by the Centers for Disease Control and Prevention that found the highest rates of postpartum depression occurring in teenage, less educated and low-income mothers.
Although Moukaddam wonders whether modern forces such as spread-out families and single and working mothers play a role in the overall higher rate, most experts attribute it to greater awareness and openness in the aftermath of the Yates case.
"The goal is to make postpartum depression a more mainstream conversation," says Dr. Lucy Puryear, Houston's leading expert on the condition. "That's the first step in getting women to realize they can do something about the problem."
The second is to find a therapist who understands postpartum depression. Many psychiatrists are uncomfortable treating breastfeeding women because they're not up to date about what's safe and what's not.
Puryear, a former Baylor College of Medicine professor and one of the leaders at the international conference in Houston, laments the shortage of such therapists. She frequently gives lectures to health-care professionals about how to recognize and treat the disorder.
Dr. Stuart Yudofsky, chairman of Baylor's psychiatry department, says one problem is that, because of the shortage of psychiatrists, the American Board of Psychiatry and Neurology is not particularly open to the creation of new subspecialties -- such as women's mental health -- that would make it easier for more therapists to specialize in postpartum issues.
Baylor has a program at Ben Taub Hospital in which an instructor and a trainee provide psychiatric care for at-risk pregnant women, typically those with a history of mental-health issues. It also will partner with Texas Children's Hospital on a program that will provide in-house psychiatrists at its maternity center due to open in 2011.
The outreach gets a big thumbs-up from Weston, who recovered quickly once she got to Puryear and started on Zoloft and talk therapy. Happy to report her son is now 3 1/2 and well-adjusted, she says her key motivation to get help was the realization that she had to get better, because someone was depending on her.
"I would hope anyone who feels the way I did would see a doctor and if the doctor brushes her off, she should find another," Weston said. "No one should have to deal with it themselves. No one deserves to feel that way."
todd.ackerman@chron.com To see more of the Houston Chronicle, or to subscribe to the newspaper, go to http://www.HoustonChronicle.com. Copyright (c) 2008, Houston Chronicle Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
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