She rarely cried, and when she did, she was easy to console. Whereas I was nervous about nursing, Mattie latched right on and never looked back.

Which was a pleasant surprise—emphasis on the surprise.

Friends had warned me about how hard the first couple of months would be, about the stress, exhaustion, and loneliness that come along with caring for a baby. My doctor had prepared me to look out for postpartum depression symptoms, and nurses on the maternity ward evaluated my mood daily. The first week home from the hospital, my mom came over every day, allegedly to help as I recovered from a C-section—but in reality, to make sure I was holding up emotionally.

There were difficult moments, sure, but mostly I couldn’t believe that I got three months off from work to binge-watch Netflix with such an agreeable little creature. I found myself thinking, “I must be naturally good at this motherhood thing.”

And then toddlerhood arrived.

When the twos are truly terrible

“It’s only after having a toddler that you look back and say, ‘Oh, babies are easy.’”

These are the wise words of Dr. Harvey Karp. This interview is the first time we’re speaking, but I’ve known his name for quite some time.

Dr. Karp’s book, The Happiest Baby on the Block, is a parenting classic and a mainstay on baby registries. Before going on maternity leave, a former coworker handed me her copy reverently, referring to it as the “sleep bible.” I never reached for it, but by the time my daughter arrived, there were three copies on my bookshelf should I have needed any newborn advice.

So why had I never heard about his follow-up book, The Happiest Toddler on the Block? Because like many first-time parents, I wasn’t aware that babies turn into werewolves around 18 months old.

“You don’t expect it. You’re mentally prepared for the stress of having a baby, and everyone tells you, ‘it gets easier.’ But that’s not what happens,” says Karp. “It’s more like a roller coaster. You go through periods where things are easier, but then the house of cards collapses.”

“Collapses” is a gentler word than I would choose on some days. Dr. Karp and I are speaking at 2 p.m. while my daughter is napping. This is what my morning looked like:

• 7:30 a.m.: Matilda is delighted to be eating apples for breakfast—until I tell her the apples are, in fact, pears. A nuclear meltdown ensues.
• 8:30 a.m.: You’ve never truly been gaslighted until a 20-month-old pours milk in your new boots, then waddles over to plant a kiss on your cheek.
• 10 a.m.: After a half hour of trying to coax Matilda into wearing shoes, we leave the house barefoot. It is 40 degrees outside.
• 10:01 a.m.: In the same breath, my neighbor asks me 1) when Matilda is getting a sibling, 2) why she isn’t wearing shoes, 3) if I plan to do something about the leaves in my yard. I smile while making a plan to poison her rose garden.
• 11:30 a.m.: Matilda hands me her dirty diaper. She is still wearing her pants. I will spend the rest of my day trying to figure out this act of sorcery.

“Toddlers blindside people and make them think, ‘I’m not doing a good job,’” says Karp. “It’s not surprising that many mothers feel anxious or depressed during this journey—misalignment of expectations coupled with having a person scream at you all day will do that.”

Changing the discussion around postpartum depression.

I’m not clinically depressed. For whatever reason, my brain doesn’t go there, and I feel incredibly lucky for winning this particular grey matter lottery. But it’s easy—very, very, easy—for me to see how toddlerhood and mental health are at odds.

Raising a toddler routinely pushes me to my emotional limits, making me question my capabilities and sanity every hour, on the hour.

I know I’m not alone. When I dig a little deeper than the usual polite playground talk, other mothers confess they’re more than tired, that this is bigger than the “terrible twos,” that the “fun part” can be … well, kind of a nightmare.

What confuses me is, why aren’t we talking about this? Why did I know so much about postpartum depression symptoms, but feel wholly unprepared for toddlerhood?

Fortunately, that discussion might be changing.

“Most experts now agree that the term ‘postpartum depression’ is somewhat restrictive, and suggests that the condition is time-limited,” says Karen Kleiman, founder and director of the Postpartum Stress Center, as well as the author of books including Good Moms Have Scary Thoughts. “We used to say that women were most at risk for postpartum mood and anxiety symptoms between three weeks and three months postpartum. As more studies are carried out, we are learning that symptoms of depression and anxiety can surface anywhere along a spectrum experiences and emotions.”

Understanding "delayed" postpartum depression symptoms.

Sometimes referred to as “late-onset” or “delayed” postpartum depression, the medical community commonly refers to symptoms experienced after the first year of motherhood as “maternal depression.”

“It’s difficult to say, with certainty, how common late-onset postpartum depression occurs,” says Kleiman. “But what we do know is that the spectrum of postpartum distress stretches further than we previously understood, bringing attention to the fact that women are struggling longer and well beyond the first postpartum year.”

Toddlers, while overwhelming, aren’t exactly to blame. Rather, it’s the complex intersection of modern living, personal relationships, and biology.

Contributing factors to maternal anxiety and depression include the following, says Kleiman:

• Genetic predisposition
• Work and financial stress
• Relationships with partners and support networks
• Hormonal fluctuations associated with birth, breastfeeding, and weaning

When to get help for maternal & postpartum depression symptoms.

While a certain amount of stress and frustration is almost synonymous with parenthood, it’s important to recognize when the feelings of anxiety, hopelessness, irritability, and fatigue are consistent and overwhelming.

“One of the things we often say is that it is not the emotion itself that is the problem. It’s the frequency, intensity, and duration of the emotion,” says Kleiman. “Every new mother cries. All new mothers feel overwhelmed. Every new mother is exhausted. But if she is crying all day, if she is so overwhelmed she is unable to function, or if her fatigue interferes with her ability to get through the day, that’s too much distress.”

But of course, when you’re depressed, it can be difficult to advocate for yourself. Women need families and support networks to stay vigilant after the first few weeks of motherhood, says Kleiman.

“We ask families to be alert for signs that mom is not functioning the way she would like or the way she expected to,” says Kleiman. “When symptoms of distress occur later in the postpartum period, families are less inclined to be looking for it and mom may be better at disguising it.”

Treatment for postpartum and maternal depression is available, effective and improving. In fact, the FDA recently approved the first-ever drug specifically indicated for postpartum depression. But as always, the trick is recognizing the symptoms.

“Our hope is that with greater awareness, we will encourage more women to speak out,” says Kleiman.

"No one has ever done this before".

Dr. Karp offers some additional advice that many women—myself very much included—are hesitant to take, even during the most difficult times: If possible, get help taking care of your kids.

Whereas previous generations relied on the proverbial “village,” today’s mothers often lack the support of family. After all, in many cases, grandparents are still working full-time, and siblings are pursuing their own careers, often far from home.

Not only is it OK to leave your toddler with a nanny or a babysitter, but it’s also the way humans have historically handled the psychological stress of raising children, says Dr. Karp.

“Everyone thinks, ‘A normal mother would enjoy being home with her kids—this is what we’re supposed to do.’ But no, actually, no one has ever done this before,” says Dr. Karp. “It’s an incredible burden—this is the first time in the history of humanity that we’ve asked this of mothers.”

I’m trying to be professional during our chat, but I’ve needed to hear these words for six months, and I feel myself start to tear up as he’s speaking. I press mute, pull it together and move on to my next question.

But then I hear it—Matilda is crying in her crib. Naptime is over, so I quickly wrap up our interview, head upstairs, and prepare myself for the rest of the afternoon.