It's hard to predict the toll motherhood will take on your emotions.
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Stigma, disbelief, and lack of support from others keeps women who have postpartum depression from getting the treatment they desperately need.

One of the surprises of childbirth is how much preparation you get—childbirth class, parenting lessons, breast-feeding training, how to "childproof" your home, even classes on installing a car seat correctly and securing your baby inside.

But as birth approaches, it's rare for anyone to offer a forecast of the emotional turmoil ahead—except on the fatigue front—and rarer to hear a postdelivery woman asked how she is faring emotionally.

"Most ob-gyns are done with you after your six-week postpartum checkup," says Ruta Nonacs, MD, associate director of the Center for Women's Health at Massachusetts General Hospital in Boston. As for treating postpartum depression, she says, "many feel out of their league."

"I was quite suicidal"

Until recently, help has been hard to find, even for women who pleaded for support. Psychologist Shoshana Bennett, PhD, founder and director of Postpartum Assistance for Mothers, endured two life-threatening postpartum depressions in the mid-1980s. Bennett's horrific experiences inspired her to get licensed as a therapist and specialize in postpartum depression. She has now counseled more than 15,000 women with the condition.

"I was quite suicidal. My doctor told me to go and get my nails done," she says. So she plowed ahead. What made her situation even worse was an unsupportive mother-in-law, who had been a postpartum nurse for 30 years. "She popped out five kids without so much as the baby blues, so when my husband, Henry, asked her, 'What's wrong with Shoshi?' she said, 'She's spoiled. It's not just about her anymore,'" Bennett says. "He was angry and confused and upset with me. But I hated me too." After her first child was born, Bennett plummeted and went to her ob-gyn for help. "I walked in 40 pounds overweight and told him, 'If life's gonna be like this, I don't wanna be here.' He laughed and said that all women go through this."

Finding the right health professional

Women with supportive spouses and doctors, like Suzanne, 35, of New Paltz, N.Y., can also feel so stigmatized they keep their postpartum depression to themselves. "My husband had noticed that I was blue, but he had no idea how extreme it was," she says. She couldn't keep up the act forever.

"One day he came home from work and I was inconsolable," she says. "I was thinking of harming myself, not the kids. My husband phoned the doctor. They saw me right away. It was a relief to get it off my chest. But I was ashamed when I went to the doctors and had to admit all this out loud to a professional."

Once Suzanne's husband intervened, she made some first steps. "I called a counselor and made an appointment, but couldn't keep it. That was like admitting I was crazy. My ob-gyn prescribed a medication. I took one pill. That was the end of it," she says.

"So I suffered longer than I needed to. My advice is to get help and do something sooner than I did. I could have gotten through it faster," she says. "It's like night and day when you finally come out of it and can enjoy your life and love again."

Katherine Stone, 38, of Atlanta, went to a therapist recommended by her company's employee assistance program. "I was convinced that when she heard my story, she'd call the call the police because I wasn't a fit mother. Instead, she said she'd heard stories like mine many times, told me more about the disorder, and explained the difference between intrusive thoughts, which I had, and psychosis, which I didn't. I wanted to marry her," laughs Stone.

The first psychiatrist Stone went to treated her with four or five medications, but the side effects were terrible. She used word of mouth to find a practitioner who specialized in the treatment of postpartum mental disorders.

When she finally saw the therapist who helped her, she was afraid of being called psychotic because of her obsessive, paralyzing concern for her son's safety and well being. But that therapist asked her if she considered her thoughts normal. "And I said, 'No, of course not,'" says Stone. "I told her that I avoided driving over dead squirrels because I didn't want to hurt their souls, and I knew that wasn't normal. Then she said, 'Good. I'm not worried about you,'" remembers Stone. That therapist switched her to just one medication, and she felt improvement in a week.

Dr. Nonacs recommends asking your ob-gyn if the hospital in which you delivered offers postpartum depression services or sponsors support groups for new moms like you. "OBs may be a good first resource, but also ask the nurses and social workers. Call Postpartum Support International [800-944-4773] to find a support group near you. I also recommend seeing your family doctor. They're treating people with depression all the time and can also help with referral to a therapist," she says.

Stone found out the hard way that not all psychiatrists are experts in treating postpartum depression. "So many psychiatrists don't understand the condition, don't have tools to treat this, and aren't trained in the varying ways in which women with this disorder need to be cared for," she says.