War of Words

New York Times/July 1, 2005
By Brooke Shields

I was hoping it wouldn't come to this, but after Tom Cruise's interview with Matt Lauer on the NBC show "Today" last week, I feel compelled to speak not just for myself but also for the hundreds of thousands of women who have suffered from postpartum depression. While Mr. Cruise says that Mr. Lauer and I do not "understand the history of psychiatry," I'm going to take a wild guess and say that Mr. Cruise has never suffered from postpartum depression.

Postpartum depression is caused by the hormonal shifts that occur after childbirth. During pregnancy, a woman's level of estrogen and progesterone greatly increases; then, in the first 24 hours after childbirth, the amount of these hormones rapidly drops to normal, nonpregnant levels. This change in hormone levels can lead to reactions that range from restlessness and irritability to feelings of sadness and hopelessness.

I never thought I would have postpartum depression. After two years of trying to conceive and several attempts at in vitro fertilization, I thought I would be overjoyed when my daughter, Rowan Francis, was born in the spring of 2003. But instead I felt completely overwhelmed. This baby was a stranger to me. I didn't know what to do with her. I didn't feel at all joyful. I attributed feelings of doom to simple fatigue and figured that they would eventually go away. But they didn't; in fact, they got worse.

I couldn't bear the sound of Rowan crying, and I dreaded the moments my husband would bring her to me. I wanted her to disappear. I wanted to disappear. At my lowest points, I thought of swallowing a bottle of pills or jumping out the window of my apartment.

I couldn't believe it when my doctor told me that I was suffering from postpartum depression and gave me a prescription for the antidepressant Paxil. I wasn't thrilled to be taking drugs. In fact, I prematurely stopped taking them and had a relapse that almost led me to drive my car into a wall with Rowan in the backseat. But the drugs, along with weekly therapy sessions, are what saved me - and my family.

Since writing about my experiences with the disease, I have been approached by many women who have told me their stories and thanked me for opening up about a topic that is often not discussed because of fear, shame or lack of support and information. Experts estimate that one in 10 women suffer, usually in silence, with this treatable disease. We are living in an era of so-called family values, yet because almost all of the postnatal focus is on the baby, mothers are overlooked and left behind to endure what can be very dark times.

And comments like those made by Tom Cruise are a disservice to mothers everywhere. To suggest that I was wrong to take drugs to deal with my depression, and that instead I should have taken vitamins and exercised shows an utter lack of understanding about postpartum depression and childbirth in general.

If any good can come of Mr. Cruise's ridiculous rant, let's hope that it gives much-needed attention to a serious disease. Perhaps now is the time to call on doctors, particularly obstetricians and pediatricians, to screen for postpartum depression. After all, during the first three months after childbirth, you see a pediatrician at least three times. While pediatricians are trained to take care of children, it would make sense for them to talk with new mothers, ask questions and inform them of the symptoms and treatment should they show signs of postpartum depression.

In a strange way, it was comforting to me when my obstetrician told me that my feelings of extreme despair and my suicidal thoughts were directly tied to a biochemical shift in my body. Once we admit that postpartum is a serious medical condition, then the treatment becomes more available and socially acceptable. With a doctor's care, I have since tapered off the medication, but without it, I wouldn't have become the loving parent I am today.

So, there you have it. It's not the history of psychiatry, but it is my history, personal and real.