Letter From 100 Days of Motherhood With a Perinatal Mood & Anxiety Disorder

By Amelia Toporsh

Dear Friend, 

If you’re reading this you are likely suffering from, a survivor of, or a support person to an individual suffering from Perinatal Mood & Anxiety Disorder (PMAD).

There is something I want you to know – & I don’t want you to be offended.

But I think you should hear this:

Your disorder is not unique

Okay, now bear with me.

Right after Naomi was born before I felt any discomfort during the postpartum period.

Today I am 3 months & 13 days postpartum with the cutest, 12ish pound, brown-haired, blue-eyed baby girl. She looks like her dad, has the cutest smile & a developing personality. 

This means I have had over 100 days of cuddles, cooing, changing diapers, morning walks, breastfeedings, & experiencing all the love & cuteness a newborn baby has to offer.

It also means I’ve experienced 100 days of the scariest intrusive thoughts, most debilitating anxiety, & annihilating depression I’ve ever had. Alongside the 10-20% of other moms in the U.S. & in a blink of an eye, I had found myself in the depths of Postpartum Anxiety, Depression, & a new diagnosis of OCD. 

I had waited over 11 years to have my second baby, & was elated & grateful when my partner & I received a positive pregnancy test only after a few months of trying. My pregnancy was mostly typical, except for the few short stints of depression I had experienced while isolating due to COVID (turns out this increases the likelihood of PMAD – who knew). Even so, we went into our January delivery prepared & with a positive attitude. After just a few hours of laboring, we had our baby girl. As our oldest daughter remained home due to the pandemic, we decided to leave the hospital a day early & return home to the comfort of our condo to introduce the new bundle to her older sister, our English Cream Retriever, & a couple of cats.

The first few days home are blurry due to lack of sleep & adrenaline, but nonetheless I was deeply enchanted & in love with this tiny doll-like human, & my family as a whole were adjusting to our ‘new norm’. 

Then, when my daughter was just shy of a week old, I was struck like lightning in the middle of the night with what I now know were intrusive thoughts, extreme discomfort, panic & anxiety. My mind began to race & explore the deepest & darkest pits, latching on to the most fear-inducing thoughts it could find. In my case, the intrusive thoughts grabbed on to my fear of & inability to sit with or process death, existentialism, questions about the afterlife, mortality, hopelessness & purpose. As my new baby lay on top of me & my partner snored to my right, I was glued to the bed with confusion & overwhelming fear – while going deep down a google rabbit hole. These are the delicate moments where everything after shifted, & the first of many nights I felt like I was truly ‘dying’. 

A snap shot from when I started really recognizing something was seriously off – a friend brought over this amazing food & it was the one meal a day that I could actually get down & found a little comfort in

As the days & weeks progressed, my questions over death & mortality & existentialism became a full out obsession, the intrusive thoughts were taking up an extensive amount of real estate in my mind (all of it), the anxiety I experienced was overwhelming enough to glue me to my bed for hours & hours in the morning, afraid to move, afraid to watch tv, afraid to eat. Every joyful aspect of my life was tuned to grey. I was functioning like a robot, or as my partner put it, a shell of a person with no affect, & I was 100% certain that I had gone completely ‘crazy’.

At first, I had no idea what was happening to me. I was completely overtaken by the anxiety, depression, & what I know now, an OCD flare-up. I felt incredibly confused, scared, alone, broken, guilty, numb & hopeless that I would ever feel better or anything like ‘myself’ again. I wanted nothing more than to be present for my new baby, for my family, & to be enjoying this experience like ‘my old self would have’. I felt robbed from this experience with my loved ones, & so much guilt for the person I had suddenly ‘become’.

& here, Dear Friend
I pause to ask if these symptoms sound familiar. 

While the details of my story may be different than yours, my gut tells me that you can relate to many or most of the symptoms, the hardships, the emotions, & the manifestations of PMAD that I mention above. 

Check, check, check, double-check, & check!

So it’s here that I circle back to what I shared with you at the beginning of this letter – the bit about ‘your disorder not being unique’ (as if you’ve forgotten). Throughout the last several months I have learned through therapy, gathering information, & having the privilege of connecting with dozens of moms who are navigating their own postpartum journey, that our PMAD symptoms are generally the same. While PMAD may present itself differently for each of us, at different times, through different diagnoses & agendas, our stories & our reactions to our experiences are more similar than different. 

In stating that, it is my intention that you will feel less alone, less ‘crazy’, & less frightened, as most of us seem to feel when these symptoms first present. In recognizing that you’re diagnosis & the way you are feeling are not unique, it is my hope that you yourself, find hope.

A rare photo of my girls during the the toughest of times.

As you read these words, take solace in knowing that there are hundreds of thousands of women in the U.S. alone experiencing the very same symptoms as you – waiting to welcome you, relate to, & support you on your PMAD journey.

With that said,
100 days later, am I still coping with PMAD? Yes, I am.
Has this journey been easy? Nope, not at all.
But am I drowning like I was those first few weeks? 
With the help of therapy, medication, support groups, vitamins, movement & my family, I’m happy to say, I am not.

I have hope. I have relief. I have perspective. I’m able to connect with my family, friends, & values again. & I have an amazing community of women I’ve met through group meetings. Empathetic, strong, vulnerable women who remind me of the same messages I’ve shared with you today when I’m feeling down, flaring up, or just need a friend. 

The journey through PMAD is scary, it is hellish, & it is hard. 
But it is also manageable, it is treatable, & often curable. 

& you, my friend, do not need to do this alone or on your own.
Please consider reaching out, &/or taking advantage of the free resources listed below.
In this together & in deep solidarity & love,
Amelia Toporsh

Join a support group & connect with PMAD mamas:

Mom’s Mental Health Initiative – Southeastern Wisconsin
Facebook Support Group

Hey Peers!
Pregnancy Mood Support Group
Perinatal & Postpartum Support Group
Pregnancy and Infant Loss Support Group for Parents
Parenting Support Group
& more!

NOCD – Those with Postpartum OCD/general OCD
Mom Support Group

Postpartum Support International

Connect with me via Email or Instagram:

Postpartum Anxiety Happened So Quickly

Trigger warning: Suicidal thoughts and ideation 

Stock Image by Jenna Norman via Unsplash

My perfect little boy was born in January 2019. Nothing was unusual about my pregnancy except, perhaps, the fact I seemed to have it pretty easy. No morning sickness, no real physical discomfort or pregnancy related ailments, low weight gain, high energy, no complications. Labor was a bit of a different story – it was long, slow, complicated and, at the end, even scary. But then he was here and, to be honest, I forgot about the unpleasant details within days. 

I was lucky enough to have a generous, paid, twelve-week maternity leave from the law firm where I had recently made partner and, once we were home, it took a little time but we soon hit our stride. I figured out how to fill a day – the Today Show is a bit of a guilty pleasure, I enjoy working out, I was able to make plans with friends to maintain a sense of sanity and adult conversation, and it wasn’t too hard to change my pre-baby, twice daily walking routine with our Goldendoodle into a dog and stroller regime. Being at home was so different from my work life, but I tried to enjoy the downtime while it lasted, and for the most part, I succeeded. 

Anxiety Sets In- Quickly

My return to work was pretty seamless and easy. I eased in but was quickly back to my pre-baby stride. I felt like I was making it as a young professional, wife and new mom. I can’t tell you the exact date things changed, but it happened so quickly. I remember feeling stressed (and now I know, anxious) when my husband and I went out to dinner to celebrate our wedding anniversary. The week leading up to that dinner I had reached out to some of my senior colleagues in the same practice group to express a willingness to take on additional work – the return-to-work buzz had sort of faded, and my plate wasn’t quite full, which any professional who has to bill someone else for their time knows isn’t a great thing. I got a positive response and plenty of cases in my practice area needed staffing. My excitement quickly turned to apprehension when I realized some of these cases were a bit different than most I had handled before. I spoke up and asked for support from my colleagues and, again, received a positive response. But, the first of many irrational or pathological anxieties had begun and they were starting to fester. 

My husband was concerned enough by my anxiety to suggest I talk to someone. Thankfully, I was able to snag an appointment with a psychologist’s graduate student the very next morning. I went, hopeful I could learn something or that she could say or teach me something to help nip this anxiety in the bud. At the end of my appointment, I also met the perinatal specialist for a few minutes. We agreed I was having at least some postpartum anxiety and would benefit from additional treatment; however, I also learned the perinatal specialist had a pretty significant wait period before I’d be able to see her again. Her perinatal psychiatrist counterpart had the same wait period. So, if I needed medication, I’d probably have to wait on that too. I left the appointment down, but feeling a little lighter and more hopeful. I had taken a step, what else could I do? 

By the time I got to work that day, my hopefulness had faded, and I was even more anxious than before. “I don’t know how to do this…How can I learn these things?…What if I make a mistake?” By the next day, I could not escape the anxiety and it had sky-rocketed. I had trouble concentrating on work long enough to get anything done. By mid-day, I was shooting out panicked texts to my husband and best friend. Feeling terrified, I told my office managing partner I was struggling with some postpartum issues and needed a day or two off work. He was surprised, but supportive, telling me to work it out with HR and let him know what I needed to make it happen. With a quick call to HR, I found I had more paid medical leave available and learned what I needed to do. I made a list of my cases, short-term case tasks and deadlines and I left, praying no one would see or talk to me. What would I tell them? 

Driving home, I was in a daze. On a whim, I called a friend who urged me to call my OB and suggested that OBs can often see women who are struggling with postpartum and get them started with treatment. I promised to call the next morning. I got home, and my very supportive mother-in-law greeted me and offered her support. I felt so appreciative, but I also felt ashamed for the first of many times. People have babies and are successful at work all the time, I thought. What’s wrong with me? 

The next morning I woke up with a pit in my stomach thinking I made a mistake by taking time off and might have even ruined my career. I called my OB’s office. She was off that day, but I spoke to a nurse who contacted the on-call OB. Within an hour, I had an appointment with him for later that morning. He listened to my story and agreed it sounded like postpartum anxiety and depression. He prescribed a standard antidepressant and suggested I take two to three weeks off work, if that was an option for me, to give the medication time to work. “You’ll get back to yourself,” he assured me. Relieved, I headed home, armed with a plan. The relief was fleeting, though. How could I take more time off?

I was hardly able to function

Unfortunately, things got worse. I was lucky that my mom and mother-in-law were at our house and able to help because I was hardly able to function. I had my first appointment with the perinatal psychologist late that week, and she honed in on my irrational thoughts and gave me some reframing exercises – a facet of cognitive behavioral therapy – to work on. I felt better leaving the appointment but that hope barely lasted the drive home. What I was feeling felt so overwhelming and chaotic that it was hard to believe it when those I loved and my healthcare providers told me that things would get better. I couldn’t believe them. My next vivid memory is experiencing my first suicidal thoughts. I was so sure that everyone could see the anguish I was feeling. How could life be moving as normal? Doesn’t everyone see that I’m about to explode, that I’m hurting? Time passed and I started having trouble sleeping. 

I woke up after the weekend hoping and praying for relief. I had asked for two weeks off, and this was week two. I could focus on myself this week and on getting better. I could go back to work next Monday. But, my hopeful plan didn’t even last that day. I contacted the psychiatric hospital that had been recommended to see what sort of outpatient groups they offered, and I “failed” the intake process for outpatient therapy. This meant I was sent to the psychiatric hospital for evaluation, where I admitted to the providers and to my husband that I had begun to develop a suicidal plan that day. 

Admitted to the Psychiatric Hospital With Postpartum Anxiety & Suicidal Thoughts

I was admitted for the standard three days, which I know now wasn’t enough. But, the minute I got there, I realized that I had to say whatever they wanted to get out. Most of what I felt inpatient was shame. The women I was with were dealing with some horrific issues and circumstances, and I was sad, anxious and suicidal five months after having a baby. I couldn’t come to terms with it. I participated in my individual and group therapy sessions, but there was no true breakthrough. I was scared, and I was numb. 

By the end of the three days, I realized I’d have to lie or exaggerate the “betterness” I was feeling to be discharged. I know my husband knew it was too soon, but he trusted the experts who said I was ready. Unfortunately, it was enough for me to tell them I no longer had suicidal thoughts. I cycled through a few different psychiatrists and the various medications they were trying weren’t working, but I had to get out of there. I would have said anything.

The next step after inpatient was an intensive outpatient program (IOP), which I started the next day. I felt immediately that it wouldn’t help me, but what other choice did I have? My husband and I agreed I had to try. I had a lot of support but, if I’m honest, it was hard to take at the time. I didn’t feel like I deserved it. 

I alternated between pretending I was ok and being unable to pretend. I could hardly stand being with friends and trying to act normal. “Can’t you see I’m in pain?” was a constant refrain in my head but I didn’t feel like I even understood my own struggle, as raw and overwhelming as it was, so I didn’t expect that anyone else could either. Yet, all I wanted was for someone to help me – to save me from this anguish. One evening a few days later, I began to fear I had (and began obsessively researching) postpartum psychosis. While it didn’t seem to fit, I saw no other postpartum anxiety (PPA) stories like mine. I wasn’t worried about the baby. It was me, it was work, it was everything. 

I continued IOP going through the motions and feeling worse and worse. Soon, there was a plan in place for me to finish IOP and return to work on a reduced schedule so I could continue group therapy. I was part of the plan making, but I didn’t believe it could work. I didn’t know what else to do so I convinced myself I had to move forward. I completed my second and final week of IOP with the plan to go back to work the next Monday. The baby started daycare and he did great. I was embarrassed to meet his teachers and see the other moms. I felt like a fraud. If they only knew what was going on in my head. By Sunday, I was a wreck with the thought of going back to work. I actively considered and researched ways to commit suicide. 

Another Return to Work

Monday was horrible. I was almost childlike, refusing to go to work on my own and forcing my mom to drive me there, pick me up and take me to partial therapy that afternoon. I did my best to get through, but felt panic and doom almost every minute. I made it 15 days. The weekend before the 15th day, a close friend visited for the weekend. We sat down and talked about my work anxieties and how I could take small steps to get through them. We made a plan. I wanted so badly to be able to follow the plan the next day, but I didn’t believe it was possible. That Monday I sat in my office with the door closed for 15 hours, completing about 1 hour of work. My mind raced, but time crawled. My husband and friends finally convinced me I had to go home, and that I needed to take another leave.

Thankfully, I had an appointment the next morning with the original perinatal psychiatrist, returning to her after shifting to the psychiatric hospital and IOP program who were not perinatal specialists. She decided to try a very different medication, one that my mom had been on for thirty years to treat her obsessive-compulsive disorder (OCD). She told me she couldn’t accept what I’d told her about feeling hopeless and that, for this to get better, she needs me to have at least a small amount of hope that we can get through this with the right treatment.

Another Leave, A Glimmer of Hope & Healing

With the perinatal psychiatrist’s guidance, I was off work for a second leave, this time, fully removed from work (i.e. no email access) to allow myself time to heal. About a week into the new medicine, I had an appointment with the original perinatal psychologist. We made a plan involving cognitive reframing exercises and I committed to trying to practice the reframing exercises daily, maybe even hourly, over the next few weeks. I felt the smallest glimmer of hope again that night. While it still felt a bit like “faking it”, it was different. I believed her that maybe this could work. The next day I woke up and felt just the slightest bit better. I told my family and close friends, but I was scared to be hopeful. Could the new medicine be working? 

Over the next few weeks, I had regular visits with the perinatal psychologist and perinatal psychiatrist. Things were trending up and we were all hopeful. Of course, I was scared of being disappointed if I was not actually getting better. The final week before returning to work had a few roadblocks. It was tough, but I felt ok. My debilitating anxiety was starting to ease and everyday life was becoming more manageable. I had my final perinatal psychologist session before I was set to go back to work and I went in armed with a notebook. I told her my coping plan and went through all my reframing. She told me I was ready and I actually believed it that time. 

I was Ready, I was Better

I returned to work that Monday, and things were so much better. I followed the plan and it worked. That afternoon was my last day of group therapy, and we had a substitute. The substitute was one of the therapists I had had while I was inpatient, and it felt like I may have come full circle. Things fell into place at work and I continued regular visits with the perinatal specialists – psychiatrist and psychologist – for months, and I still take a low dose of the OCD medication that finally helped me. 

I’ve been back to work for over a year-and-a-half and all is well. There are even some days that I forget about what I went through. But, truthfully, I don’t want to forget. I’m hopeful that I’m a better mom, wife, family member, friend and even professional because of what I went through. I certainly don’t take anything for granted. I feel an amazing sense of gratitude for the resources and support I had in helping me through the hardest thing I’ve had to deal with in my life. I’m also certain that whether you call it luck, God, or some other higher power, it played a huge role in me making it to the other side. The least I can do is share my story in an effort to pay it forward or help even one other woman in a way she may not even realize she needs. 

Help is available- click here to find the right resources for your healing journey

Story Shared Anonymously. Do you have a Story of Hope to share? Reach out to our marketing & communications coordinator- Casey White- to connect with our community!

Dear Postpartum-OCD

Dear postpartum-OCD,

I hate you. I hate you for SO many reasons. I hate you for creeping up on me at a time in my life that was supposed to be filled with joy. I hate the what-ifs and the images you played, re-played and then played again in my mind. I hate how you tried to convince me that I was capable of horrific, gut-wrenching things. I hate that you made me feel that it was best to avoid my children. I hate the way you berated me with intrusive thoughts each one more graphic and terrifying than the last. I hate that you made me want to avoid certain activities and places therefore depriving my kids of experiences they deserved to have. I hate that, because of you, I missed out on so much with my babies. But most of all, I hate that you told me that the only way they would be safe was without me.

I hate that no one even told me you existed. This fact made it so easy for you to convince me that there was something wrong with me…that I was some sort of monster that didn’t even deserve to be a mother. I hate the way you made me view myself. How you stripped me of what little self-compassion I had and made me feel worthless and unlovable.

I hate that you made me feel trapped…that you made me feel like a prisoner in my own mind. I hate that some days you made me wonder if I would ever be well. If there was any end to the agony I was in…if there was any other way out…

But that was before. Through treatment, medication and time, I’ve learned to see you less as an enemy and think of your more as a friend. Because, the reality is that, you’ve made it your mission to protect me, and those I love most. Despite the fact that your warning signals may misfire, I have learned to appreciate the motivation behind them. For your own good (and mine), I’ve learned to challenge you and your screams. I have practiced letting your alarm blare incessantly in my head, in an effort to show you that there’s no real need to be afraid. And in some odd way, I need to thank you. I need to thank you for showing me that I had strength I didn’t know I possessed. For allowing me to find courage to speak out and advocate for other moms who might have a friend like you. But please know that you can rest now. I’ve got this.

–Written by Alexis Bruce

PPD is a Disease

Moms Need to Know PPD is a Disease.

With recent news of the FDA’s approval of Zulessro (brexanolone), a new drug to treat postpartum depression (PPD), there has been a plethora of responses both positive and negative. Zulresso currently comes in the form of an injection through intravenous use and requires 60 hours of inpatient stay at a certified medical center. Although not an ideal form of treatment, it has promising results. As a two time survivor of postpartum depression and anxiety and a maternal mental health advocate in the greater Milwaukee area, I think this is a big win in the world of maternal mental health and here’s why:  Zulresso is the FIRST MEDICATION SPECIFICALLY DEVELOPED AND DESIGNED FOR POSTPARTUM DEPRESSION. In all of the years that Moms have been suffering, there has never been any researched treatment that addresses the complexity of this form of depression. So many of us have been fighting an uphill battle to give PPD and its treatment options legitimacy because frankly, much of our culture, community and medical community, do not think it is a legitimate disease.

We know that PPD and other Perinatal Mood and Anxiety Disorders (PMADs) are the number one complication of childbirth (as common as 1 in 7). We also know that suicide accounts for approximately 20 percent of postpartum deaths and is the second most common cause of mortality in postpartum women (Archives of Women’s Mental Health). Unfortunately, many people consciously and unconsciously believe PPD is a defect of character or is simply brought on by mental weakness. Some think it’s purely an emotional response to the stresses of motherhood, particularly in America where our culture fails to truly support mothers or families. I was told by a maternal educator that I should have “gotten a massage” to get over my PPD. Others deal with OB doctors who think PPD symptoms are normal for sleep deprived new mamas (PPD is not normal. It is common, but not normal). Of course, sleep deprivation plays a role in PPD and usually worsens the symptoms, but moderate to severe PPD often isn’t solved by just getting more sleep. One psychiatrist told me she doesn’t really believe in medication as treatment for PPD and that it’s caused by what we eat – the misconceptions around this condition only intensify and exacerbate the problem.

PPD is a real disease that can be complicated or bettered by our emotional state, our environment, our prior traumas, the way we experienced our child’s birth, our life stressors and our community of support. But at its core, it is a disease. A disease that is not a mother’s fault. PPD looks different on each Mom and symptoms range from mild to severe. Stigma around mental illness, particularly in relation to motherhood, prevents Moms from getting the help they need. Hopefully now, Moms with PPD will have more credibility as they advocate for themselves to their employer, to their family and to their medical providers.

When it comes to helping a Mom recover from a PMAD, it will take more than a drug to fully heal her (sometimes she may not need medication) and I believe most perinatal professional providers know this. A Mom is going to need as many options and tools as she can get to feel better and navigate the physical, mental and emotional toll of this disease.

Better prevention strategies and a cultural shift in attitudes and practices around parenthood are needed to combat PPD but we also need more tools to heal. To think that this medication is pathologizing a life threatening disease isn’t accurate because a Mom could have the ideal situation for bringing home a baby and still get PPD – it is not always preventable. My friend said to me once, “What a Mom needs is medication when she needs it.” I couldn’t agree more.

Moms with PPD need us to call PPD what it is, a disease, like diabetes, like cancer, like many other illnesses that are not equated with shame and stigma. A disease that has a promising chance of being treated quickly with this new medication. A disease that needs more research in prevention and treatment.

This drug isn’t right for everyone, not everyone will have easy access to it, not everyone will need it but for those of us who talk everyday with Moms fighting for their health and well-being, this new drug provides more hope and hope is what keeps our fellow mamas alive.

-Written by Sarah Bloomquist

“FDA approves SAGE Therapeutics’ (SAGE) treatment for post-partum depression”
“It Will Take More Than a $34,000 Drug to Stop Postpartum Depression”
“Brexanolone, life saver or bust?”
-Photo Credit: Rosaliartbook

The Silent Struggle after Miscarriage

You are not alone. We hear this phrase in the maternal mental health community so often. But to a mom who who has experienced a miscarriage, it probably doesn’t feel that way. We are missing the mark by not talking about miscarriage and the anxiety, depression or even PTSD that can accompany one. While this post will focus on miscarriage, it’s important to acknowledge moms who have experienced stillbirth or infant loss as well. In my opinion, they each deserve a later post of their own.

According to the March of Dimes, “Miscarriage (also called early pregnancy loss) is when a baby dies in the womb (uterus) before 20 weeks of pregnancy. For women who know they’re pregnant, about 10 to 15 in 100 pregnancies (10 to 15 percent) end in miscarriage. Most miscarriages happen in the first trimester before the 12th week of pregnancy. Miscarriage in the second trimester (between 13 and 19 weeks) happens in 1 to 5 in 100 (1 to 5 percent) pregnancies.”*

These stats give a sterile view of an incredibly real and devastating experience. Because miscarriages often occur early in pregnancy, it’s possible that very few people were aware that a mom was expecting and this can, understandably, lead her to feel misunderstood, isolated and hopeless. Furthermore, watching life continue effortlessly for those around her can make those feelings even more intense.

Knowing that these moms are at a higher risk for developing anxiety and/or depression, both after a miscarriage and after subsequent births, we need to be doing more. We need better screening; both immediately after a miscarriage and at regular intervals thereafter. We need to give moms space to feel safe sharing what they need to feel supported. We need to recognize that grief is a process and that it might include a wide rage of shifting and unexpected emotions. We need to let moms know that there is no “right way” to deal with pregnancy loss and she is the only one who can determine what that process looks like for her. We also need to let moms know that while the emergence of grief, anxiety, depression or PTSD after such a harrowing experience is valid and completely understandable, it is also treatable. Depending on the severity of symptoms, support groups (in-person or through social media), therapy or even medication are valid options to help a mom who is struggling.

I almost feel like I don’t have a right to talk about this issue because I have never experienced a miscarriage myself. However, in this mom-tribe, we have to support one another. We need to be reminded to be sensitive and compassionate towards those around us because we might not know the internal battles they might be facing. Maybe I’m able to speak up when someone who is more closely affected cannot. Or, maybe my “you are not alone” is speaking to someone in a different way…a way that she’s been longing to hear. Your pregnancy matters. Your baby matters. Your experience matters. You are allowed to grieve, to be vulnerable, to be cared for by both yourself and others. You deserve to seek and receive help should you need it. You don’t ever have to go through this alone.

Written by Alexis Bruce