I am a recovering addict who recently released a memoir detailing my battle with alcohol and pill addiction. During a recent podcast interview, the host asked me when I believed my addiction began and why I initially started taking Ambien, the pill that eventually led to my addiction. While I typically respond by stating that I was always predisposed to addiction and it was inevitable, this time the question struck me differently.
“To be honest,” I replied after a momentary pause, “I think I turned to Ambien to self-medicate undiagnosed postpartum anxiety. If there wasn’t such a stigma surrounding postpartum issues and other challenges women face, I may not have resorted to self-medication and the outcome could have been different.”
On August 4th, the Food and Drug Administration approved Zurzuvae (known as zuranolone), the first oral medication specifically designed to treat postpartum depression. Unlike traditional antidepressants, this pill acts quickly and is only taken for a shorter duration, just 14 days. Additionally, being in pill form makes it more convenient compared to the only other FDA-approved treatment, the expensive IV infusion brexanolone ($34,000).
The introduction of a pill-based treatment marks a significant advancement, but more importantly, it fosters the much-needed conversations surrounding a condition that affects 1 in 8 new mothers. Conversations that were virtually nonexistent when I had my son almost 26 years ago.
“Do you think I may have postpartum depression?”
It was December 1999, and I was sitting in my OB-GYN’s office, draped in an uncomfortable paper gown that irritated my sore nipples from breastfeeding. After blurting out the question, I briefly closed my eyes and shifted uneasily. I secretly hoped he would dismiss my concerns, reassuring me that I was mistaken. I convinced myself that someone as put-together, youthful, and optimistic as me couldn’t possibly experience postpartum depression.
Despite mustering up the courage to voice my worries, I had no idea how I would react if he confirmed my suspicion. Because if he did, it would mean it was real. And if it was real, then I was flawed.
Six weeks prior, I had given birth for the second time in two years. After having my first son in 1998, I struggled emotionally but was physically fine. I quickly recovered and resumed my regular exercise routine of five days a week, all while maintaining a busy social life.
I genuinely couldn’t comprehend what all the fuss surrounding postpartum depression was about. I thought this motherhood journey was easy.
My knowledge of postpartum depression was limited to what I had seen on the news. Typically, women who committed suicide or harmed their babies were reported to have suffered from this condition. These women were usually white and visibly unstable. None of the young mothers I knew admitted to experiencing postpartum depression. In the rare instances where it was discussed among our group of Black mothers, it felt judgmental. The undertone suggested that those struggling were somehow inferior parents and individuals.
My second pregnancy mirrored my first, uncomplicated and worry-free. Labor was quick, only three pushes, and nearly painless. However, a few days after coming home, the reality of my new situation hit me. I was a mother of a sweet newborn and an equally sweet (yet incredibly active) toddler, both of whom refused to sleep for more than a few hours at a time. After a full week of hardly any sleep, I became faintly aware of an alarm bell ringing in my head. Although I couldn’t articulate it at the time, anxiety consumed me.
I knew I should sleep when my babies slept, but I couldn’t. The anticipation of them waking kept me awake. I was always hyper-alert, listening for the slightest signs of awakening. Initially, I didn’t consider the possibility of postpartum depression. I didn’t feel emotionally numb or uninterested. Unlike those women in the news, I loved my children and never entertained thoughts of harming them or myself. I had never even heard of postpartum anxiety, unaware that it affected up to 20% of new mothers.
Before my six-week postpartum check-up, I decided to treat myself to a nail and hair appointment. (I even went for a wax before giving birth — that’s how focused I was on appearances.) I believed that looking good might make me feel better, and, if I’m being honest, I wanted to impress my OB-GYN. Throughout my pregnancies, he would comment on how I was his “easiest patient,” boasting about it to the nurses.
I willingly took on that role. I worked out diligently to shed the baby weight quickly, made sure I appeared put together at all times, and refused to complain or play the victim. I did not want to risk losing that “better-than” image in the eyes of my OB-GYN.
However, I desperately wanted the incessant alarm bell in my mind to stop ringing.
“Why do you think you have postpartum?” he asked.
“I don’t know. I can’t sleep when the babies sleep, and I can never seem to relax,” I responded.
“Are you experiencing loss of appetite or mood swings?”
“What about feelings of hopelessness or uncontrollable crying?”
“No, nothing like that.”
Relief washed over me. I didn’t exhibit those symptoms, so I couldn’t possibly have postpartum depression.
“You’ve had two children in quick succession,” he smiled. “Let’s give your body time to recover, and we’ll reassess later. In the meantime, if you’re struggling to relax, try having a glass of wine in the evenings. It should be fine while you’re nursing.”
As I drove home, I scolded myself for not revealing the full extent of my distress to him. I didn’t mention the alarm bell or my chronic hypervigilance.
Is receiving a gold star from your doctor more important than getting better?
A few months later, my regular doctor prescribed Ambien for me. I confided in him about my ongoing sleep issues caused by my babies’ sleep habits, a secret I hadn’t shared with anyone else. However, I failed to mention that the alarm bell had grown louder, and feelings of hopelessness had started to emerge.
The moment the first Ambien entered my system, the alarm bell silenced. I climbed into bed and relished in the newfound tranquility, an experience I had never encountered before. The next morning, I woke up refreshed, free from any medication hangover. I felt invincible.
Everything is going to be okay, I reassured myself. As long as I had these pills (forever), I could be the mother my family deserved.
My descent into addiction unfolded much like Hemingway’s quote about bankruptcy — “gradually and then suddenly.” It began innocently enough, with just one Ambien each night to manage my condition. Fast forward six years, and I found myself consuming up to 10 Ambien pills within a 24-hour period. Ironically, my anxiety and insomnia worsened.
In July 2008, I took the courageous step to seek treatment and receive help. However, even after multiple evaluations from medical professionals and therapists, no one proposed that my addiction to Ambien stemmed from my self-medicating undiagnosed postpartum anxiety. Research indicates that women with postpartum depression are at a higher risk for substance abuse compared to those without depressive symptoms. Similarly, women with a history of substance abuse are more likely to experience postpartum depression symptoms.
The shame I felt prevented me from even uttering the term “postpartum” aloud, as I feared it would make me a deficient mother. When my doctor dismissed my symptoms, I resorted to treating my postpartum anxiety with Ambien.
Reflecting on Zurzuvae, I can’t help but wonder: what if this treatment had been available after I had my babies? Would I have been a better mother? Would I have still succumbed to addiction?
Pregnancy and the post-delivery period are precarious times for developing depressive symptoms. When combined with addiction, the potential for tragedy looms.
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