June 16, 2012
(Some names have been changed to protect identity)
In early 1996, eight weeks after the birth of my son, I was struck with postpartum psychosis, a rare, life-threatening illness, the most serious mood and anxiety disorder associated with childbearing. My son was just 8 weeks old when I went three nights without sleep. I never thought I could experience such a frightening and consuming illness. I had no prior history of mental illness and was unaware that postpartum psychosis even existed. Perinatal (includes pregnancy and the first year after a baby is born) mood and anxiety disorders include a spectrum of disorders. The disorders affect women of every culture, age, income level and race. Postpartum psychosis can strike 1.1 to 4 out of 1,000 deliveries (Gaynes et.al, 2005).
My first pregnancy ended in miscarriage and I experienced a long and difficult labor and delivery. Both of which can be risk factors for a mood and anxiety disorder associated with childbearing.
By six weeks my son began sleeping through the night but I could not. By seven weeks, I was feeling sleep deprived and agitated. I believed I would soon die. It was an unexplained feeling but very real. I found myself so frightened that I could not sleep at all. The next thing I knew, I was afraid someone was going to kill me and take my baby. I would learn much later, that I was having a delusion or strange belief, which is a symptom of postpartum psychosis. But at the time it seemed very real and not at all false. After the third night without sleep, I was so frightened that I would not even let my husband, the baby’s father, hold our son.
Kelly’s son was nine months old when she knew she wasn’t feeling well but couldn’t describe nor understood what was happening. She knew she was feeling depressed as she had been away from her baby for a week. After she returned from her business trip she was struck with postpartum psychosis. She experienced extreme anxiety, false and delusional thinking and great fear. Kelly also did not have a prior history of mental illness. Kelly would go on to experience postpartum psychosis with the birth of her second child. The second time Kelly experienced postpartum psychosis, it came on very suddenly. She was taken to the hospital by her husband but she was sent home with just a mild sleep medicine. By the time she was taken to the hospital again she was not even aware of her surroundings. Both times Kelly experienced postpartum psychosis she was forced to stop breastfeeding while in the hospital.
The single most predictor or risk factor for a mood and anxiety disorder associated with childbearing is a previous occurrence. Kelly did not know this as she was not educated about her illness the first time she experienced postpartum psychosis.
Jessica new something was wrong while still in the hospital after giving birth to her first child. She knew something happening but the nurses didn’t listen and no one explained to her what to expect. Jessica also experienced some medical problems while still in the hospital. Once the doctor learned what was happening, she was given an antidepressant. Soon after she started taking the medicine, she realized that she was going to die but thought it would be okay. In the night, she began imagining that angels were coming for her. She even passed out. The next day her family took her to the doctor. She tried to escape from the car several times. After taken to the doctor, she was forcibly hospitalized. The doctor did not know what was wrong with her.
Postpartum psychosis is often misdiagnosed. In fact, it is often thought to be postpartum depression. Postpartum depression is a less serious mood disorder than postpartum psychosis but is more common. About 20% of mothers experience postpartum depression after the birth of a baby. In both Jessica and my case, we were thought to have postpartum depression. Many doctors are not familiar with postpartum psychosis hence the misdiagnosis. Jessica, Kelly nor I had a prior history of mental illness prior to our pregnancies. Having a history of mental illness makes a woman at much greater risk for a mood disorder associated with childbearing. That was the case with Amanda.
Amanda had been diagnosed with bipolar disorder about five years prior to having her son. She had been stable on medication during that time. She was off her medicine prior to and during her pregnancy up until the final month of her pregnancy. She was planning to breastfeed so she was taken off her medicine again after her son was born. It was not until her son was about three or four months old that she recalls having trouble sleeping after feeding her son at night. She had gone back to work when her son was eight weeks old. She told her husband about her sleeping problems so he offered to take over one of the feedings. It was too late. She soon began feeling as if people where talking about her and following her. It heightened into her threatening her husband with a knife and thinking he was trying to take her son from her. Amanda was aware that she was at a greater risk for some kind of relapse after the birth of her baby since she would be off her medication. Although she was never actually diagnosed with postpartum psychosis, a link between postpartum psychosis and bipolar disorder has been found.
In the November 2003, the Journal of Clinical Psychiatry published a review. The review reported a link between postpartum psychosis and bipolar disorder. The review concluded that understanding the relationship between postpartum psychosis and bipolar disorder has implications for childbearing related treatment as well as long-term treatment. In fact, the review indicates that similar treatment should be given to women experiencing postpartum psychosis as women experiencing bipolar disorder. Although Amanda recovered from her postpartum episode, she still undergoes treatment for her bipolar disorder. Jessica fully recovered from her postpartum psychosis and with preventive measures in place, went on to have a successful second pregnancy and postpartum period. Kelly and I both were eventually diagnosed with bipolar disorder, postpartum onset. The recovery period for all of the women was different but treatment with medication, therapy, as well as emotional and spiritual support was necessary for our recovery.
Although mental illness related to childbearing is now better known and understood, there is still ignorance and prejudice surrounding these illnesses as well as mental illnesses, in general. Mental illness is not a character flaw or a punishment from God. Mental illness has biological, emotional and spiritual aspects. All aspects should be addressed in recovery. Unfortunately, very often all aspects are not addressed. In the cases of Jessica, Kelly, Amanda and I, if it was not for proper medical care and support from others, the outcome of our stories may have been very different as there is a 5% rate of suicide/infanticide with postpartum psychosis. It is for this reason that immediate medical attention is required. If you or someone you know is pregnant or has recently given birth, please offer them practical and emotional support. If they are experiencing any symptoms of depression or psychosis, advise them to seek medical attention as soon as possible.