I sat in a paper gown on the examining table of Dr. Washington’s office. I wasn’t sure what I wanted to say to her. I had chosen her because she was an OB with expertise in hormonal changes over a woman’s lifetime. Her website said, “A Woman-Friendly Practice,” and listed under her services was “PMS management.”
The paper gowns and exam tables were the same as the regular “woman un-friendly” practices I had frequented. A breeze wafted up the back of my paper gown, and I shivered. The smell was a combination of rubbing alcohol and air freshener. I got up to put on my socks. I had made an appointment for a routine check-up, but what I really wanted to do was talk about medical avenues for treating my depression.
Dr. Washington knocked on the door, and my heart started pounding.
What should I say? The weight of all that had happened to me stunned me into silence. Where would I start? Hi. I’m nuts. What are my options?
I was worried my explanation would sound strange or come out convoluted, even though to me it made perfect sense. I hadn’t treated my depression medically up to that point, but I was considering it now. I was no longer severely depressed, but I had somehow come to a plateau of moderate depression. I was in therapy. I was no longer banging my fists against walls or biting myself in frustration, yet I didn’t feel happy or fulfilled. Simon was happy in preschool, and I now had free time, but my life didn’t feel richer for it.
I had also begun to notice a pattern. Every month before my period, I’d find myself feeling like I did right after Simon was born. The air would start to feel thick, and I couldn’t think straight. I’d snap at the slightest thing. The worst part was that I’d find myself furious with everyone around me but couldn’t pinpoint why. For nearly ten days out of each month, I felt this way.
I hadn’t noticed it before because I was unhappy all the time. Now that I was in “recovery,” my tolerance for unhappiness was shrinking. I wanted my life to be better for me and those around me. I had been reticent to follow my therapist’s numerous gentle suggestions about antidepressants and estrogen therapy, but it was beginning to dawn on me that there was only so much I could do by sheer force of will.
My therapist was a psychoanalytic psychologist, so she couldn’t prescribe meds. I didn’t have a doctor I felt comfortable asking about them. Then I heard about Dr. Washington from a friend. Her bio was impressive: Harvard Medical School, a tour in the Army — she sounded like someone who would be on top of all the latest treatments. Perhaps she could offer me options to deal with these monthly mood swings. But how to explain all of this in one short office visit?
I took a deep breath. Check-up. First things first. She opened the door and walked in.
She was beautiful, confident, smiling. She reached out and gave me a hearty handshake. I simultaneously trusted her and hated her. She would likely be able to help me, but Jesus, what a confident career woman! I was sure she saw me as a shlumpy housewife — the kind of person a young, hip Mick Jagger would immortalize in satirical song lyrics. He’d spot me at a park through a tinted window and a whirl of marijuana smoke, a stereotypical blip as his tour van whizzed by . . .
Okay, maybe I was being just a teeny bit judgmental. Another deep breath.
We went through the motions of a first check-up. The routine exam and pap smear. She asked about my general health, my pregnancy, and how long it had been since I had stopped nursing.
Then: “How was your post-partum period?”
“Well, I had post-partum depression, but I’m a lot better since I’ve been in therapy. Except I’m having mood swings, and I think they might be related to my periods. I feel like my quality of life could be a lot better.” I sort of mumbled it out in one breath, but she got the gist.
“How bad did your depression get?” she asked.
“I had some minor self-inflicted injuries, but that’s better now.” An image of banging the door frame until I left a bruise leapt into my head. Oy. Now this woman must think I’m certifiable. Crazy, just like my father. What if she thinks I’m going to harm myself? Or worse, my kid? I couldn’t deal with having her see me that way. She was perfect, a titan. I was a housefrau, a mere stereotype of a person. Just like my mother.
Depression winds a spidery web through the maternal line in my family, as many generations back as I can remember. My mother got caught, by depression and by her marriage. My father’s untreated mental illness ran rampant through our lives, too. He was abusive, confrontational, terrifying. For the duration of my childhood, my mother never had the emotional strength to stand up to him. Neither of them expected any more from life than the unhappiness they had.
Until I had Simon, I had led a successful, stable life. Getting caught wasn’t part of my plan, and succumbing to depression felt unbelievably shameful. Did growing up — having a child, buying a house, simply stacking up the years — mean I would turn into my parents? What a drag it is getting old.
“The therapy is going well, but I’m still not better. Before my periods, my moods feel out of control. I feel like I’ve been transported back to the grip of depression. I start thinking that I’ll never get better. I mean, my son is three years old. I should be better. I came here because I wanted to explore my other options, along with the therapy. I’m curious about antidepressants but I can’t help wondering if they could be harmful.” The little yellow pill. “Are there other options?”
“Well, only you can decide what is right for you. There are changes you can make in your diet, natural remedies, and some women take estrogen or birth control pills. Personally, I think it’s a matter of what works with your body and how depressed you are. The level of depression you describe here seems to be moderate bordering on severe at certain times of the month. While you can try estrogen therapy, the level of depression you describe would make me inclined to suggest antidepressants. All of the antidepressants are serious medications with side effects that need to be managed and monitored. That said, I’m confident with their level of safety. They are certainly safer than being depressed and all that comes with it. And they may help you take better care of yourself and your child.”
It was so nice to hear her explain these options in a way that wasn’t loaded or judgmental. Her job was to simply explain to me what worked and what she thought would be best for me.
Dr. Washington continued: “It sounds like your post-partum depression has settled in to premenstrual mood swings — what’s known as premenstrual dysphoric disorder, or PMDD. It’s basically a fancy way of saying premenstrual depression that is more serious than PMS. It’s going to be up to you as to how you wish to treat it,” she said.
“I’d like to try antidepressants, but I can’t help feeling like taking them would make me weak. Like I just couldn’t handle my life.” A crutch, an addiction. Mother’s little helper. Asking too much. Besides, who said life was supposed to be perfect anyway?
“Whatever you decide, it’s not fair to yourself to think that way. You are treating an illness, the same way you would treat asthma. Allowing yourself to go through a depression is always going to be more harmful to you physically and emotionally than treating it.”
I had never thought about it that way. I let the relief sink in. Maybe I could give myself a break and try something that could help me. After all, I’d learned that my negative thoughts couldn’t always be trusted. They didn’t just belong to me. My father’s bitterness, my mother’s despair, even the dangerously addictive lines of The Rolling Stones. Like the chorus in a Greek tragedy. Mother needs something today to calm her down.
I went home that day with a prescription for antidepressants in my pocket, but I was still unsure if I was going to take them.