In the past few years, postpartum depression has had a lot of press. Brooke Shields had it, Marie Osmond had it. Tom Cruise denied it exists. All good for raising awareness. Now we all know it exists, and maybe some of us know the warning signs. But no one talks about this: What if you have post-partum depression and you must continue working?

Three years ago, I was in this position. I haven’t written about it because it was bad. Very bad. I keep waiting for someone to write about what it’s like to have to continue working even with post-partum depression. I guess I will be the one.

Here is what you need to know about postpartum depression if you are the breadwinner of the family:

1. Take maternity leave. Even if you have to make it a little unconventional.
I was a freelance writer, with a husband who did not work, and we were living paycheck to paycheck. I thought there is absolutely no way I could take maternity leave. We’d starve.

But I tried to think of ways to craft an unofficial maternity leave by getting ahead with my writing. I didn’t tell my editors I was doing that, but my plan was to not have to write very much.

2. Plan ahead, for the worst-case scenario.
In our heart of hearts, we know that the best case scenarios don’t actually need planning for. So why make plans assuming best case? Make contingency plans.

I did that a little. Because I’m a freelancer and my husband and son are nearly uninsurable, for prior medical conditions, we usually have crappy, near-nothing insurance. But we raided the last of our savings to buy great health insurance for the baby and me, just in case something happened during delivery.

Other than that, I assumed that things would go smoothly when we got home from the hospital since this was our second child, and I already knew how to care for a baby.

3. Admit that no time off means you’re high-risk for postpartum depression.
The baby came early, and I was not really ahead on columns, and my book wasn’t finished.

So right after the baby arrived, I had to finish my book, which was behind schedule. And, my agent told me that there was no way I could promote the book when I was 40 pounds overweight. After all, there was a chapter about how bad it is for your image to be overweight. So I spent two or three hours at the gym every day.

The baby came everywhere with me—to my book publisher, to my agent, to my newspaper syndicate, to the gym. I breastfed in everyone’s office. I breastfed in the cardio room and the weight room.

I cried all the time, and I felt that I had no idea how to take care of the baby, but I looked okay in all my meetings, so I kept going.

4. Ask for help from people you don’t work with.
Then, one night, the baby was screaming and our three-year-old wouldn’t go to bed and my husband was telling me that I needed to get the three-year-old some milk and I was saying that he should and I’ll get the baby and he rolled his eyes, and then I took a knife out of the dirty dishes and stabbed my head.

I don’t actually remember doing it. I remember my husband saying, “Oh my god. There’s blood everywhere.”

Here’s how crazy I was: I just put the knife back in the sink and went to get the baby.

The next day I went back to my old therapist and told him. While I breastfed the baby.

My therapist said he didn’t think I’d ever hurt the kids, but he had to send me to the emergency room to be checked out. So I went there. With the baby, and my cell phone, and I handled edits for my Boston Globe column from the hospital hallway.

The doctor I saw wanted to admit me to the mental ward. I had a friend call all over looking for a hospital that could take me and the baby into a mental ward together, and not one could. “It’s a huge breaking point in the mental health system,” she said.

The psychologists did not want me to leave, but I was convincing, telling them that we would not be able to support ourselves if I did not work. And I was also convincing telling them that I did not want to risk losing my breast milk permanently by separating from the baby for a week in the mental ward.

The doctor said I could go back home with the baby but I couldn’t be alone with the baby.

5. Postpartum depression is one of those times when you should break the bank.
When I left the hospital, I told myself I would just ignore the doctor’s advice because it would be impossible to not be alone with the baby. My husband had to take our older son all over the city for school and activities. And we could never ever afford round-the-clock care.

But on the way home, I remembered Andrea Yates. I had always felt empathy for her, but now I felt like maybe I could be her. I know it came out of nowhere to her: first she was just sort of depressed, and then she was killing her kids.

Plus, I remembered two times when people had asked me how the baby was and I said, “Sometimes I want to slam his head into the wall.” Both times I got very concerned looks. So stopped saying it, but I knew it was not good.

So I hired someone to stay with the baby and me. Only then did I realize that I was terrified to be alone with the baby. I still cry thinking about how I was probably a danger to my own child. The babysitter was as much for me as for the baby.

I kept working. I kept seeing a therapist. And we went into huge debt in order to pay for the babysitter.

In hindsight, I wonder, What could I have done differently?

My career could not have handled a three-month maternity leave. But I should have hired the nanny at the first sign of trouble, even though it caused a lot of debt. I was so scared of spending money. I cut corners on things that I thought I could handle but couldn’t. And the biggest thing, in hindsight, that I thought I could handle, was being a working mom with no support system. No one can do that and stay sane.