Sandra Cothran started feeling anxious when she learned she was pregnant almost seven years ago.

As her pregnancy continued, her anxiety grew, but she figured her feelings would pass once the baby came.

"I pretty much bottled it up," the 39-year-old Roanoke physical therapist said. "I thought it was just part of my first pregnancy."

Instead, Cothran descended into a severe bout of postpartum depression and psychosis. She didn't emerge from her personal turmoil until she received electric convulsive therapy nearly six months after her daughter was born.

After she recovered, Cothran wanted to form a group where women could talk freely about the stigma of mental illness and the stresses of motherhood.

She wanted to work with a therapist or a psychiatrist who could help lead the group. She put an ad in The Roanoke Times and placed fliers in obstetricians' offices.

But all she received were calls from other women in need of help.

Postpartum mood disorders are widespread but often unrecognized. Between 10 percent and 20 percent of mothers experience postpartum psychiatric issues that are more severe than the normal "baby blues" experienced by nearly 80 percent of mothers, according to the national nonprofit Mental Health America. In the most extreme forms, such conditions can include delusional and intrusive thoughts that can lead to suicide and infanticide.

But very few mothers receive help. Only 15 percent of the 800,000 American women who experience postpartum depression annually are assessed or treated, according to Postpartum Support International, a nonprofit dedicated to perinatal mood disorders.

"There's a sense because women don't talk about these things that they're the only ones like this," Cothran said.

After struggling to find a partner to help her lead the group, Cothran instead became a moderator of an online support group.

Then, almost five years later, Andy Matzner reached out to her.

Several of the Roanoke therapist's patients had suffered through the illness. He asked around but couldn't find anyone in the area who specialized in postpartum depression. Most often, obstetricians and gynecologists treat depression and anxiety related to pregnancy, according to Diane Kelly, executive director of Mental Health America of the Roanoke Valley.

"It was amazing to me that with something as debilitating as postpartum stress, there was no support," Matzner said. "It struck me as very disturbing."

What Matzner did find was an editorial that Cothran had written about Andrea Yates, who drowned her five children and was diagnosed with postpartum psychosis.

He contacted Cothran and told her that he wanted to start a group where mothers could share common feelings of anxiety, guilt and helplessness.

In June, the two started a small support group that meets twice a month. One to three women typically attend.

Years earlier, shortly after she recovered, Cothran wrote: "It is my deepest wish that I can help other women who are going through this type of personal hell. To help them realize that although this cruel disease robs women of some of the most precious moments of their lives, it is only temporary and soon they will begin to enjoy motherhood and experience the ultimate joy of relating to their babies."

Descent into psychosis

Following her anxiety-ridden pregnancy, Cothran had a difficult delivery on June 16, 2001.

Her daughter Madeline was born four weeks early and had to be put on oxygen.

"She pretty much was whisked away, and I didn't get a chance to hold her and do all the things I wanted to initially," Cothran said.

That's when the feelings of inadequacy and guilt began.

She started taking antidepressants about six weeks after delivery. But her anxiety turned her into a hypochondriac, she said, and she kept switching medications, never allowing any one to take effect.

Much of what ensued is a blur as she started to lose touch with reality, she said. Delusional thoughts filled her mind:

I'm not like everybody else.

I'm going to spend the rest of my life in a mental institution.

I've been crazy all along, and I just didn't realize it until now.

Numbness consumed the normally emotional and joyful woman. She started group therapy but felt unnerved and alone as the only one battling postpartum depression.

Cothran began to clam up once her thoughts turned suicidal.

In late October 2001, Cothran took an entire bottle of anti-anxiety medication and another one of sleeping pills. When her husband found her, she was unresponsive but alive. She was rushed to Lewis-Gale Medical Center.

Weeks later, she drove herself to the Blue Ridge Parkway intending to jump off a mountain. Before taking action, though, she called her husband, who took her back to Lewis-Gale. She was transferred to UVa Medical Center, where she received four treatments of electric convulsive therapy. She immediately snapped out of her depression, and her anxiety disappeared, she said.

"For the first time since she [Madeline] was born, I was looking forward to going home and being with her," Cothran said. "I felt hope for the first time."

Hope for the future

Cothran believed that she would never have another baby after Madeline. About a year and a half after her daughter's birth, though, she began to have strong maternal feelings for another child.

About that time, Cothran was on an antidepressant and seeing a psychiatrist. She was working again and feeling like her old self.

Despite her husband's fears, Cothran decided to become pregnant again. With the support of loved ones and a psychiatrist, her second delivery -- of a son named Nicholas -- went smoothly with no postpartum depression.

"It's a very treatable disorder," said Dr. Hilda Templeton, a Roanoke psychiatrist who specializes in postpartum mood disorders. "It really pained me to hear that there were a lot of women who didn't want to have second babies because of depression."

She described the postpartum period as the most vulnerable time in a woman's life to develop a psychiatric disorder. She emphasized that women should be watched if they have a history of depression or a record of the illness in their family background. She also noted that many women make the mistake of cutting off their antidepressant once they learn they are pregnant.

Templeton started one of the nation's earliest postpartum support groups close to 20 years ago in New Jersey, she said.

She also testified to help pass New Jersey state legislation requiring doctors and hospitals to screen mothers for postpartum mood disorders.

Federal legislation that's moving through Congress now would expand the benefits of the New Jersey law to the rest of the nation. The Mom's Opportunity to Access Help, Education, Research and Support for Postpartum Depression, or MOTHERS Act, and the Melanie Blocker-Stokes Act seek to screen mothers at risk for postpartum psychiatric illnesses and provide them with needed services.

Both bills also seek to increase research into the causes, diagnoses and treatments of the complex disorder.

"Without understanding what it is, women stay sick and don't get help," Templeton said. "Childbirth is supposed to be a wonderful time, and so women suffer in silence."

In addition to increased medical knowledge and legislation, support groups such as Cothran's can also provide mothers with hope.

"We let them know we've all been through this," she said. "There's light at the end of the tunnel."