Review: A Deeper Shade of Blue

Dr. Ruta Nonacs’ A Deeper Shade of Blue is ambitious because the book addressed many aspects of female-specific depression, from pregnancy to postpartum.

The theme that recurred almost constantly was Dr. Nonacs’ reminder that Depression is Not Normal and should be treated. I cannot overemphasize how important this message is, because we tend to minimize or trivialize depression, and as a result, do not seek treatment for a very treatable illness. This is a great tragedy and has consequences beyond individual suffering. When a mother is depressed, it affects how she cares for her child and interacts with her child, and in many ways, creates challenges for her child that may even lead to the child developing behavioral problems and depression. Dr. Nonacs was quick to point out that children are resilient, and that a mother suffering from depression does not automatically mean a life sentence of suffering for her child.

I can personally attest to the profound effects that a depressed mother can have on the emotional development of her children. As a child of a depressed mother, my growing up was colored by the shades of my mother’s depression. Amid my distorted self-perception, I developed depression during my childhood years that worsened in young adulthood. Although I ultimately sought help, am currently “in remission”, and have worked hard to relearn a healthier view of myself and the world, I wish fewer children have to walk through the same paths I had to walk through. I wish fewer children have to suffer the same pains I had experienced growing up, and endure the emotional traumas that cut so deep. Yet this cycle of pain can stop when a woman seeks help for her depression, and remains vigilant against the attacks of depression throughout her childbearing years.

On page 47 (hardcover edition), Dr. Nonacs stated that “A child who is intelligent and insightful can better understand a parent’s illness and recognize that she is not to blame for the illness or how a parent behaves.” I had emphatically scribbed in the margin, “Doesn’t Happen!” because as a child, I had been conditioned to believe that I was and should be responsible for my mother’s behavior. It took me at least a decade of soul-searching, self-hurting, treatment, and learned acceptance before I finally arrived at the point that Dr. Nonacs described for the intelligent and insightful child. I don’t think I was an exception to the rule: a depressed mother manifests her illness in part with the emotional manipulation of a child, even as the mother may not necessarily mean to hurt the child. Still, Dr. Nonacs’ book should be required reading for healthcare practitioners who interact with and care for expecting mothers and women desiring children.

Dr. Nonacs addressed issues that women who consider becoming pregnant may wonder about, but may be afraid to ask. Even though I currently don’t have children, Dr. Nonacs had answered some of the nagging questions that I have when I think about the prospect of becoming a parent. Would the hormones “tip my chemical balance” and will my depression flare with full force? Would I need to consider returning to medication should I become pregnant and depression returns, and would this hurt the baby? Was I now more vulnerable to postpartum depression? … And most fearful of all, would I turn into my mother?

Dr. Nonacs included scientific studies that are available to answer many of these questions, and made this information very accessible to the readers. I also liked the section on “Improving Communication with Your Partner” (page 201, hardcover edition); Dr. Nonacs put the ownership of our behaviors back to us and asked us to take responsibility for the quality of our relationships. Too often I’ve seen the temptation of pointing a finger at depression or a illness to excuse our own poor behaviors. While depression and illness clouded our perception, we could often make a choice of whether we wanted to continue living in this distorted reality. The section on communication gave good advice for couples in general, not just for depressed women in relationships.

Dr. Nonacs devoted an entire chapter on Seeking Professional Help, which also included information on different types of menta health professionals who can help a depressed mother. You can find information on different modalities of treatments – both pharmaceutical and non-pharmaceutical. I do want to note that some of the medications or agents listed in this chapter, either as a pharmacologic treatment or as a side effect management agent, may be a nonapproved (“off-label”) use of the drug, which means that there are no substantive evidence submitted to the government for a particular use. In the medical community, doctors are given the freedom of exercising their clinical judgment to treat patients with drugs that may not always have been approved by the FDA for a particular symptom. This is with the understanding that a doctor has taken the necessary precautions and medical history of a patient, and has decided that a drug used in a situation offered more benefit than risk to the patient. However, with some accessible agents like herbal supplements, I’d warn patients not to self-medicate, and to share with your doctors all the supplements and vitamins you’re taking to reduce risks of drug interactions and other side effects.

A Deeper Shade of Blue is an excellent companion for women who are of childbearing age and are concerned with depression in all aspects of pregnancy. Partners and spouses will also find this book valuable for gaining insight into a woman’s unique challenges as a mother who may suffer from depression.

Related: Dr. Nonac’s Bio on Massachusettes General Hospital.