I’m a recovering addict who published a memoir about my addiction to alcohol and pills earlier this year. A few weeks ago, I was being interviewed on a podcast and the host asked me when I thought I had become an addict — specifically, why I had first started taking Ambien, the pill to which I developed an addiction.
I’ve been asked this question before, and I have developed a stock answer of sorts: I think I was born an addict, and becoming addicted to a substance, for me, was inevitable. But this time, the question hit me differently.
“To be honest,” I said, after what I’m sure was an uncomfortably long pause, “I think I was treating undiagnosed postpartum anxiety with Ambien. I think that if there weren’t such a stigma around postpartum and other issues that affect women, I might not have self-medicated the way I did and possibly could have had a different outcome.”
On Aug. 4, the Food and Drug Administration approved Zurzuvae (a brand name for zuranolone), the first oral medication specifically designed to treat postpartum depression. This pill is different from most other antidepressants, as it is fast-acting and designed to be taken for a shorter period — just 14 days. Also, because zuranolone is a pill, it is more convenient to take than the only other FDA-approved treatment for postpartum depression, the IV infusion brexanolone (which costs $34,000).
Obviously, it’s game-changing to have a treatment in pill form. But just as importantly, I think, this announcement has created much-needed conversations about a condition that affects 1 in 8 new moms. Conversations that weren’t being had when my son was born almost 26 years ago.
“Do you think I might have postpartum depression?”
It was December 1999, and I was sitting in my obstetrician’s office in a scratchy paper gown that hurt my raw-from-breastfeeding nipples. I shut my eyes briefly and shifted uncomfortably after the words were out of my mouth. I hoped that he would smile and say that I was mistaken. That someone who was as together, young and upbeat as me couldn’t possibly have postpartum.
Even though I’d screwed up my courage to say the words, I had no idea what I would do if he said yes. Because if he said yes, that would mean it was true. And if it were true, then I was defective.
Six weeks prior, I’d given birth for the second time in two years. After my first son was born in 1998, I was overwhelmed emotionally, but I felt fine physically. I’d bounced back easily, and went right back to working out five days a week and a heavily scheduled social life.
I really don’t see what all the fuss is about. This was easy.
What I knew about postpartum was what I saw on the news. Women who killed themselves or their babies were usually reported to have been suffering from it. These women were typically white and visibly unstable. None of the young moms in my life admitted to having experienced postpartum. And when it was discussed in our little group of Black moms, it felt judgy, like: “Did you hear about Liza? She’s having a really rough time since she had the baby, poor thing.”
The subtext was that we who weren’t “having a rough time” were somehow better moms (and people).
My second pregnancy was a carbon copy of my first one, worry-free and smooth. My labor was brief (three pushes) and nearly painless. But a few days after I got home, the reality of my new situation started to set in. I was a mother to a sweet newborn and an equally sweet (but very active) toddler, neither of whom slept for more than a few hours at a time.
After a full week with barely any sleep, I became vaguely aware that an alarm bell was ringing somewhere in my head. And although I didn’t have the language for it, I was consumed by anxiety.
I knew I was supposed to sleep when my babies slept, but I just couldn’t. The anticipation of them stirring in their beds kept me awake. I was always scanning the house with my ears, listening for the faintest pre-wake-up whimper.
At first, it didn’t occur to me that I might be dealing with postpartum. I didn’t feel flat or listless. And unlike those women on the news, I loved my babies and never had a thought of harming them or myself. I had never heard of postpartum anxiety, and had no idea that it affects up to 20% of new mothers.
I went to get my nails and hair done before my six-week postpartum appointment. (I also got waxed before I gave birth both times — just to show you where my head was.) I thought if I looked better I might feel better, and if I’m being honest, I wanted to impress my OB. All through my pregnancies, he’d told me that I was his “easiest patient.” He’d even boasted to the nurses.
I eagerly accepted this role. I worked out to quickly lose the baby weight, made sure I was always put together (no matter what), and I didn’t complain or play the victim. I didn’t want to lose that “better-than” status with my OB.
But I desperately wanted that internal alarm bell to stop ringing.
“Why do you think you have postpartum?”
“I don’t know. I can’t sleep when the babies sleep and I can’t seem to relax, like ever.”
“Are you experiencing a lack of appetite? Mood swings?”
“What about feelings of hopelessness or crying jags?”
“No, nothing like that.”
I could feel relief spreading through my body. I didn’t have those symptoms, so I couldn’t have postpartum.
“You’ve had two babies back to back,” he smiled. “Let’s just give your body a chance to recover and then see where you are, OK? In the meantime, if you’re having trouble relaxing, just try an evening glass of wine. It should be fine while you’re nursing.”
In the car on the way home, I scolded myself for not telling him about the alarm bell or my feelings of hypervigilance.
Is a gold star from your doctor more important than getting better?
It was a few months later that my regular doctor first prescribed Ambien for me. I’d told him that my babies still weren’t sleeping and neither was I (something I had kept a secret from everyone else). What I didn’t mention was that the alarm bell was louder than ever, and I’d started to experience feelings of hopelessness.
The moment, and I mean the moment, the first Ambien hit my bloodstream, that alarm bell went silent. I got under the covers and reveled in a previously unknown blissful, velvety quiet. The next morning I woke up invigorated without a trace of a medication hangover. I felt like a superhero.
Everything is going to be all right, I thought. As long as I have these pills (forever), I can show up for my family.
My descent into addiction happened like in that Hemingway quote about going bankrupt — “gradually and then suddenly.” I started off by treating my condition with one Ambien per night. Fast-forward six years and I was taking up to 10 Ambien in any given 24-hour period. What’s more, my anxiety and insomnia were worse.
In July 2008, I would check myself into treatment to get help. But even though I was evaluated by several medical professionals, including therapists, no one ventured the idea that my addiction to Ambien began when I started self-medicating my undiagnosed postpartum.
Researchers have found that women with postpartum are at a greater risk for substance abuse compared to postpartum women without depressive symptoms. Conversely, women with a history of substance abuse are more likely to show symptoms of postpartum depression.
I was ashamed to even say the word “postpartum” out loud — I thought doing so would make me a bad mom. When my doctor then dismissed my symptoms, I ended up treating my postpartum anxiety with Ambien.
So when I first read about Zurzuvae, I wondered: What if this pill had been available after my babies were born? Would I have been a better mother? Would I still have become an addict?
Pregnancy and post-delivery are considered risky times for depressive symptoms. Couple that with addiction and you’ve got a recipe for tragedy. As long as we are afraid to speak up about what we are experiencing, we will be more likely to self-medicate with substances.
Hopefully, Zurzuvae is just the beginning of a long-overdue trend of medications and conversations aimed at giving new moms, and their children, a chance at a better life.
Need help with substance use disorder or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.