05 Mar Still happening…
I met with my patient for a follow up. She came to me for her first visit last week, one month post-partum from delivering her first baby. She was struggling and she did not quite know where to go. She described feeling overwhelmed, depressed, anxious, and with so many fears of not being a good enough mother for her baby. It was getting to the point where she was worried that her depression would get as bad as it had been before, when she was barely functioning, and she did not want that to happen again.
We talked at length about options, including increasing support from her partner, friends, and family, self care, ways to increase sleep, making sure her nutrition status was strong, using mindfulness techniques, and therapy. And then we talked about possible medications and spent a lot of time reviewing the risks, benefits, and alternatives of taking a medication while breastfeeding. In the end, because of her personal history of depression and severity of her past and current symptoms, she made the decision to get started on an antidepressant.
When we followed up the following week, she mentioned that another medical specialist asked her “Why are you taking an antidepressant? You look fine.” She recalled that instantly, she was flooded with doubts and shame and actually held off on starting her medication.
In that moment, I realized that all of us can do better. We can all remember that even though someone may look “fine” on the outside, we don’t know the depths of suffering or anxiety or fear or depression someone may be struggling with. We don’t know if someone is running on 2 hours of sleep for the past month or in pain or hungry or grieving the death of a loved one.
And this is why mental health is hard. There might not be a flesh wound, or crutches, or a band aid, but that doesn’t mean that they’re “fine.” I wish that my patient didn’t have to hear that, especially from a medical provider. But she persisted and was able to even find humor in a really tough situation. Over time, she did great, but this was a poignant reminder to me, even as a psychiatrist, to never assume where someone might be.