NOTE: Please follow us for this three-part series written by members of Gifford’s Psychiatry and Counseling team. Part one will focus on Postpartum Psychosis and Mood Disorders. Part two and three will be personal reflections shared by on two of our team members and will be posted Wednesday April 12 and Thursday April 13.
Postpartum Psychosis and Postpartum Mood Disorders
Written by the Gifford Psychiatry and Counseling Team
Many of you have likely heard the tragic story of the Duxbury, Massachusetts mother, Lindsay Clancy, and her three children that took place in late January, 2023. For many parents and many people in general, this story was exceptionally tragic and rattling. For many of us at Gifford, perhaps even more so, as Lindsay is a health care worker, a labor and delivery nurse.
What this story highlights is a need for more education, information and support around postpartum mood disorders, which includes the most severe postpartum psychosis. It also indicates a need for more conversations around what it takes to return to work as a new parent, as this was perhaps Lindsay’s main stressor as reported in the news. We want to be careful to note that not all cases of postpartum mood disorders or postpartum psychosis reach this level of severity or have the same outcome, but we should treat all cases of postpartum psychosis and postpartum mood disorders as having the potential to reach this level of severity and ensure support is offered as soon as possible to avoid such a tragedy, as well as to minimize suffering. Offering supports during the pregnancy and not just after the baby is born is key.
Postpartum psychosis is a psychiatric emergency that ALWAYS requires hospitalization.
Postpartum psychosis can be caused by:
- Major Depressive Disorder with postpartum onset
- Bipolar I, this is the MOST common cause
- Bipolar II
- Schizophrenia or Schizoaffective Disorder
- Brief psychotic disorder
This isn’t to say that having Bipolar Disorder, Schizophrenia, etc. causes you to develop postpartum psychosis, but rather that if you do have this diagnosis, you are at increased risk of developing postpartum psychosis. It’s important to be aware of this and to be proactive.
The expectation in our society that women who have a baby will love that baby immediately is strong and ingrained. As a result of this, moms may feel guilty and are reluctant to confide in their spouses, family or healthcare providers about their feelings. Reducing stigma and normalizing an array of reactions to motherhood and parenthood is perhaps the most important work we can all take part in. In a recent study, it was the reasons why moms avoided seeking help included: shame, guilt, not caring, not thinking it required treatment and fear of being stigmatized for having a mental illness, as well as the fear of being perceived as a weak or bad mom. If we want to help these parents, our best intervention option is to eliminate the stigma associated with postpartum mood disorders, which not only increases the likelihood of diagnosis, but also increases the subsequent adherence to treatment. Education to patients and their support system is key.
Postpartum mood (major depressive or manic) episodes with psychotic features are thought to occur in as many as 1 in 500 or 1 in 1,000 pregnancies. Once a parent has had a postpartum episode with psychotic features, the risk of recurrence with each subsequent delivery is 30-50% higher. Symptoms typically show up the first few days or weeks after childbirth, but can show up later, as well. Among mothers experiencing postpartum psychosis, about 5% will attempt suicide and about 4% will attempt infanticide. In nearly all cases mothers are trying to protect their babies from a perceived worse fate.
Postpartum psychosis symptoms include:
- hallucinations – hearing, seeing, smelling or feeling things that are not there
- delusions – thoughts or beliefs that are unlikely to be true
- a manic mood – talking and thinking too much or too quickly, feeling “high” or “on top of the world”
- a low mood – showing signs of depression, being withdrawn or tearful, lacking energy, having a loss of appetite, anxiety, agitation or trouble sleeping
- sometimes a mixture of both a manic mood and a low mood – or rapidly changing moods
- loss of inhibitions
- feeling suspicious or fearful
- restlessness
- feeling very confused
- behaving in a way that’s out of character
How do you know if you need professional help for your mood before, during and after pregnancy? Answer the following questions honestly:
- Have you been much more down, depressed or sad than usual?
- Have you been unable to sleep because your thoughts are on overdrive?
- Have you, or others, noticed that you’ve been much more irritable or short-tempered?
- Have you found yourself crying “out of the blue”?
- Has your stomach been “in a knot” to the point that you can’t eat?
- Have you been more jumpy, shaky, or jittery?
- Have you noticed that things you normally look forward to are no longer fun or interesting?
- Have you noticed that you have a hard time concentrating or are excessively distracted?
- Is it harder for you to “get going” or find the energy and motivation to do things that normally come easily?
- Have you thought of killing yourself?
- Have you experienced thoughts or images that frighten or upset you?
If you answered “yes” to any of these questions, you should seek help and support.
An estimated 50% of “postpartum” depression episodes actually begin during pregnancy, so depression screening should be started during, and NOT after, the pregnancy. About 1 in 8 mothers are affected by postpartum depression (CDC) while around 10% of moms experience postpartum anxiety (Postpartum Support International).
In looking at Lindsay’s particular position as a health care worker, we wanted to also touch on vicarious trauma. Between 40% and 85% of “helping professionals” develop vicarious trauma, compassion fatigue and/or high rates of traumatic symptoms, according to compassion fatigue expert Francoise Mathieu (2012). Healthcare is inherently both draining and incredibly rewarding. These daily stressors have a substantial impact on the mental health and wellness of healthcare workers. Many have been working increased hours, days and nights, with increased exposure and risk for themselves and their families. They are witnesses to tremendous human suffering, grief, and unprecedented loss of life. In the healthcare field there also exist widespread concerns that the stigma for reaching out for help could have career consequences. “Will I lose my job if I admit I’m not okay?”
We’d like to share some personal stories in the hopes of offering some community and normalizing these experiences and struggles.
Part two and three of this special blog series will be personal reflections shared by on two of our team members and will be posted Wednesday April 12 and Thursday April 13.
