(CNN) Nima Bhakta was that college friend who everyone knew would be a great mother.
We met in 2006, and I could see that she was always at ease when she interacted with children.
Kind and confident, she was also the friend who talked about how excited she was to have children of her own.
That's why it was such a devastating loss to her family, friends and to me, when she lost her battle with postpartum depression and died by suicide on July 24. Suicide is one of the leading causes of death in women with postpartum depression.
In a letter to her family before she died, Nima wrote that she tried to tell her loved ones about her struggle with postpartum depression but she hadn't been able to find the words to explain the depth of her suffering. She wrote that she had a loving and supportive husband and that no one was at fault for her pain.
It started, she wrote, after her son was born in 2019. She felt completely changed as an individual, wife, sister, daughter and aunt, and she didn't understand how she couldn't even attempt cooking or other things that she once enjoyed.
Her constant worry about the future and self-blame for any difficulties with her son overwhelmed her. She got to the point that she believed that she was a complete failure as a mother and was scared that she would cause him harm in the future. Throughout her letter was a sense of shame for needing help taking care of her son, and guilt that she wasn't feeling better despite having an incredibly supportive husband, Deven Bhakta, and her sisters and family.
In her text messages to me she expressed she was experiencing postpartum depression. "Everything I do for Keshav just seems like a task for me, it's been hard to have that bond between me and him. Really didn't expect all this since I love kids but with Keshav I've been struggling. I haven't been out of the house either unless it's for a doctor appointment, it's pretty bad. Deven's been such a big help it's ridiculous."
She couldn't see what a wonderful mother she was to her beautiful baby boy. I saw her as a devoted mother diligently attending to all of his daily needs. I could see she loved him so much.
How did a mother who didn't have any of the risk factors for PPD -- factors that include a personal or family history of depression and lack of social support -- still succumb to it? It can be harder for Indian women like us to ask for psychological help because these issues are not always discussed in our community, but there are other reasons women suffer from this misunderstood condition.
During pregnancy and in the hours after childbirth, women experience a dramatic drop in their estrogen and progesterone hormone levels, and that fluctuation is thought to contribute to postpartum mental health problems, according to the American College of Obstetricians and Gynecologists.
In addition to the changes in hormones, emotional factors, fatigue and general life stressors may contribute to PPD, experts say. Postpartum depression may begin in the days or weeks following childbirth, or it may begin months later, and it can last weeks, months or years if untreated.
While the experience of PPD can look different for each woman, common symptoms include a loss of pleasure or interest in doing things she once enjoyed; eating and sleeping much more or much less than usual; experiencing panic attacks or anxiety most or all of the time; feelings of guilt, worthlessness and self-blame; sadness or crying uncontrollably; fear of not being a good mom; fear of being alone with the baby or disinterest in the baby; difficulty making decisions; and thoughts of hurting oneself or the baby.
Postpartum depression is not the so-called "baby blues," which 70% to 80% of all moms experience, according to the American Pregnancy Association.
While baby blues may begin soon after birth, its symptoms -- which can include crying for no apparent reason, anxiety, insomnia and mood changes -- should dissipate two weeks after childbirth. If they continue past two weeks, mothers should be examined for postpartum depression.
Anywhere from 10% to 20% of new moms in America experience postpartum depression, which means that about 400,000 to 800,000 mothers are impacted annually, according to the US Centers for Disease Control and Prevention. Furthermore, studies have found that up to 50% of cases may go undiagnosed.
Suicide is a leading cause of death in the United States during the postpartum period, accounting for about 20% of postpartum deaths, according to a 2005 study.
Despite its prevalence, there is no universally designed or approved screening process, and the experience of going through PPD is often a surprise to new moms.
The experiences of women of color are not well documented in research, and this leads to a discrepancy of care for mothers of color, according to a 2016 survey by Robert Keefe, a professor at the University at Buffalo School of Social Work. Women of color may not reach out for mental health support because they believe that their depression is a normal part of motherhood.
Women of color face further pressures due to cultural expectations. Furthermore, our mental distress may present in a different manner than a medical practitioner has been trained to look for, as the majority of research reflects the experiences of white women, according to Keefe's survey.
Asian and Asian American women often express psychological distress in physical symptoms, such as gastrointestinal problems, or headaches and backaches, according to a 2014 study by Dr. Sandeep Grover and Dr. Abhishek Ghosh, both psychiatrists with the Post Graduate Institute of Medical Education and Research in India.
This may be because psychological expression of distress is culturally frowned upon.
In Keefe's survey, Latina women reported that having a medical provider of the same cultural background made them more comfortable to confide in, but there are fewer providers of color to serve them. One solution that would benefit women of all cultures is to create more support groups for mothers of the same cultural background.
Despite having a supportive family and friends who encouraged her to seek out medical support, Nima still felt detached from everyone. In the midst of a pandemic, when people are more isolated than usual, it's important to check in on the new moms in your life.
If you know someone who is a new mom, there are things you can do. Talk to your new mother friends and make the conversation about her, not just the baby. Don't try to solve her problems; instead, listen and validate her feelings. Celebrate all the little victories she achieves, both with her baby and personally.
This is a medical condition, and people with this condition need medical assistance. If we break a leg, we wouldn't hesitate to visit a doctor, take medications to treat the pain and then go to therapy to strengthen the muscle, right? Taking care of our mental health is the same! Asking for help is a sign of strength, not weakness.
Friends can't be therapists. However, we can normalize and encourage psychotherapy. While taking medication, usually antidepressants, is thought to help treat PPD, as a mental health professional, I find that therapy is also often needed but underutilized.
Through therapy, a mom can better understand her experiences and discover healthy ways to cope with her feelings, solve problems, set realistic goals and respond to situations in a positive way.
Despite its prevalence and potentially fatal outcome, only one drug has been developed to specifically treat postpartum depression. An intravenous infusion of the drug brexanolone, sold as Zulresso, was approved by the FDA in 2019.
I wish I had been more open with Nima about my own experience with having suicidal thoughts during my pregnancy. I spent most of my pregnancy in bed, in the dark, getting most food from a PICC line inserted into my arm because of hyperemesis gravidarum, a medical condition that affects 0.3 to 2.3% of pregnant women.
Hyperemesis gravidarum is characterized as extreme and continuous vomiting and nausea during pregnancy. It can cause weight loss of more than 5% of the pregnant woman's body weight, lead to dehydration and potential complications for the baby.
Some days I felt like I simply couldn't go on. Other than my therapist, I did not share these thoughts with anyone. I wondered what was wrong with me and how I could be a good mother when I thought about ending my own life.
But I was not myself. I was experiencing perinatal depression. As my therapist explained to me, depression is a powerful force that hijacks your brain and doesn't allow you to think clearly. I didn't want any visitors. I didn't even want to talk to or text anyone. I wanted to lie in the dark without so much as the curtains being open. Sometimes I just lay on the bathroom floor waiting for my next bout of vomiting because I didn't have the energy or motivation to make it back to my bed.
Luckily, I have an educational background in psychology, and I recognized the signs of slipping into a depression. I reached out to my therapist, and therapy and medication helped me get through that difficult time, and continue to help me manage my anxiety.
I hope that sharing my experience from three years ago will encourage more people to share their experiences, because only then will we shatter the stigma. That way others experiencing similar things know that they are not alone.
I am so thankful that I could reach out to my therapist during those difficult times, and that my family encouraged and supported my journey. If you are having or ever have had any mental health struggles, especially related to PPD, and are open to sharing, please do so. It may save someone's life. Also, give therapy a chance; it will be worth it.
To honor Nima's wish to break the stigma surrounding mental health issues, Nima and Deven's families started the #BreakTheStigma4Nima hashtag on social media.
In response to this hashtag, friends and strangers have been sharing stories about their own struggles related to PPD, including some who had never openly discussed their experiences before. Ultimately, this is what inspired me to share my story as well.
To get help, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). There is also a crisis text line. For crisis support in Spanish, call 1-888-628-9454.
To learn more about postpartum depression, call Postpartum Support International at 1-800-944-4773 or visit its website.