Lauren Hale

Lauren Hale tells it like it is about Perinatal Mood & Anxiety Disorders over at My Postpartum Voice. She is also the founder of #PPDChat, an online Twitter & FB Community dedicated to supporting moms on their journey by harnessing the power of the Internet. You can find her on Twitter @unxpctdblessing.

The Truth About Postpartum Psychosis

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emergency-stop-buttonThese are the kind of posts we don’t like to write. But they are also the posts we must write because these situations carry the most potential for stigma and misunderstanding as they relate to the Perinatal Mood & Anxiety realm.

A recent situation in Cincinnati is the reason for this post. I won’t link for safety reasons, and if you are fragile, I would recommend you NOT Google for the story. (If, however, you do, and you need someone to talk to about it during the day, find me on Twitter here: @unxpctdblessing. I will be happy to chat with you.)

Media sensationalism along with misunderstanding by society at large can turn a singular incident into a large scale stigma fest. THIS is why we write posts like this. To educate and prevent misunderstandings in the future. It is a delicate balance to write these posts without triggering our audience, hence the emergency stop picture. While I have tried to keep this post as non-triggering as possible, again, if you are fragile, you may want to skip this post.

When a mother with Postpartum Psychosis follows through with behavior which is limited to a very small percentage of mothers who do experience psychosis, it is splashed across the front pages and often combined with the term “postpartum depression” or “baby blues,” leading readers to believe a depressed mother is capable of this act.

Let’s get a few things straight here.

Postpartum Psychosis only occurs in 1-2 of every 1000 births, or .1% of births.

Of those .1%, only 4% may commit infanticide, and 5% may commit suicide.

Postpartum Psychosis is NOT Postpartum Depression.

Postpartum Psychosis is defined by hallucinations, delusions, rapid mood swings, decreased sleep, and increased paranoia.

Postpartum Depression is defined by increased sadness, irritability, increased sleep, feelings of guilt, and loss of interest in usual things. It also carries the risk of thoughts of harming your child or yourself, but mothers with Postpartum Depression are highly unlikely to follow through.

Baby Blues is experienced by up to 80% of all new mothers and is NOT a disorder found on the Perinatal Mood & Anxiety spectrum.

It’s important to note here that I know more than a few mothers who have successfully fought back against psychosis and won. They (and their children) are still with us. Psychosis also does not always equal the death of a mother or a child. It is, however, the one disorder on the spectrum which carries the highest risk for loss of life.

I want to add that Postpartum OCD is the other disorder on the spectrum closest to the signs and symptoms of Postpartum Psychosis. How do you tell the two apart? OCD moms are typically disgusted by the thoughts which flit through their heads while moms with Psychosis believe the thoughts they are experiencing, no matter how delusional, are real and rational. They are driven to follow through with them, while moms with OCD fight against them and do everything to make them go away. Am I saying moms with Psychosis WANT to follow through with their delusions? No. I’m saying that because of the nature of the disorder, they are unable to fight back without help.

From the Postpartum Support International Website:

It is also important to know that many survivors of postpartum psychosis never had delusions containing violent commands. Delusions take many forms, and not all of them are destructive. Most women who experience postpartum psychosis do not harm themselves or anyone else. However, there is always the risk of danger because psychosis includes delusional thinking and irrational judgment, and this is why women with this illness must be treated and carefully monitored by a trained healthcare professional.

So what should you do if you or a mother you know and love shows signs and symptoms of Postpartum Psychosis?

She should immediately be seen by a physician. She should not be left by herself, or alone with her infant at any time. It is possible she may need to be hospitalized for a short (or longer) time until she begins to respond to any prescription medications to balance her psychosis. Unfortunately, we do not live in a perfect world and mothers often fall through the cracks. Compliance with medications outside of the hospital setting (which is the alleged case in Cincinnati), is something no one can monitor. What we can do, however, is continue to educate the population at large about the signs and symptoms, encourage them to not leave the mother alone, and encourage compliance with any treatments set forth by a medical professional.

Healing from a Perinatal Mood & Anxiety Disorder is not a solo journey, nor is it an easy journey. We need a village to wrap their arms around us as we learn how to walk again. Be a part of that village. Please.

Here are some resources to get you started:

Signs & Symptoms of Postpartum Psychosis

Suicide Hotlines

Know that above all, you are not alone and you will get through this.

 

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New Study: Postpartum OCD and New Mamas

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washing my handsThe thoughts marched onto the battlefield when my daughter was less than a week old. They closed ranks around my brain and held on voraciously until they squeezed every bit of sanity out of me. Their arrows whizzed by, carrying horrid thoughts which would disappear as soon as the arrow sunk in – then the compulsions began. I washed my hands. I cleaned. I twitched. I watched movies. I read. ANYTHING, anything to make the whispers of danger stop.

I struggled mightily with Postpartum OCD during my first and second postpartum periods. With my second, my OCD was coupled with the trauma of being a NICU mama. All the pumping fed my compulsions, and quite frankly, may have provided some source of solace for me now that I look back.

Postpartum Obsessive Compulsive Disorder, or postpartum OCD, is an ugly stop on the spectrum of Perinatal Mood & Anxiety Disorders. It catches moms off-guard. We often wonder if the thoughts we have are normal – is this part of normal motherhood worry? When should we consider the possibility of having crossed the border into seeking help?

A new study out of Northwestern states that new moms are “FIVE TIMES more likely than their peers to experience OCD up to six months after their child is born.” Normal population rates of OCD sit at three percent. Among new moms? Eleven percent.

Dr. Dana Gossett had this to say regarding how to tell when mom needs to seek help:

“It may be that certain kinds of obsessions and compulsions are adaptive and appropriate for a new parent, for example those about cleanliness and hygiene,” Gossett said in a press release. “But when it interferes with normal day-to-day functioning and appropriate care for the baby and parent, it becomes maladaptive and pathologic.”

It’s encouraging to see researchers exploring additional stops on the spectrum. Postpartum Depression has been a catch phrase for so long that all too often, moms think that if they’re not sad or weepy, they aren’t experiencing a mood disorder after the birth of a child. Research like this, however, goes to show that a new mom doesn’t have to be sad to experience a mood disorder. Signs and symptoms of postpartum OCD, according to Postpartum Progress include, but are not limited to the following experiences:

  • You feel like you have to be doing something at all times. Cleaning bottles. Cleaning baby clothes. Cleaning the house. Doing work. Entertaining the baby. Checking on the baby.
  • You may be having disturbing thoughts.  Thoughts that you’ve never had before.  Scary thoughts that make you wonder whether you aren’t the person you thought you were.  They fly into your head unwanted and you know they aren’t right, that this isn’t the real you, but they terrify you and they won’t go away.  These thoughts may start with the words “What if …”
  • You are afraid to be alone with your baby because of scary thoughts or worries.  You are also afraid of things in your house that could potentially cause harm, like kitchen knives or stairs, and you avoid them like the plague.
  • You may feel the need to check things constantly. Did I lock the door?  Did I lock the car? Did I turn off the oven? Is the baby breathing?
  • You can’t sleep when the baby sleeps.

It is important to note that OCD symptoms may also appear during pregnancy. Note that symptoms would differentiate from that of nesting – if it interferes with day-to-day functioning, always see a professional.

The most important aspect of the symptom list above, for me, is this one:

“Moms with postpartum OCD know that their thoughts are bizarre and are very unlikely to ever act on them.”

When I had thoughts, I remember the immediate repulsion which followed them. I didn’t seek a higher level of help after my second daughter (once I was on meds) until these thoughts began to make sense and I started to rationalize them. OCD is frightening. But there is always help and you are absolutely not a bad mother if you have intrusive thoughts flitting through your brain.

One of the other interesting things which came out of this study was that of the 11 percent of moms who experienced OCD, 70 percent of them also experienced a form of depression, leading researchers to the following:

“There is some debate as to whether postpartum depression is simply a major depressive episode that happens after birth or its own disease with its own features,” Miller said. “Our study supports the idea that it may be its own disease with more of the anxiety and obsessive-compulsive symptoms than would be typical for a major depressive episode.”

In my experience, I also was depressed. But it was exactly as they posit in the second sentence – it was a depression heavily laden with anxiety and obsessive-compulsive symptoms. My experience was not solely depression, despite what the psychiatrist seemed bent on telling me.

Bottom line? If YOU think something is off with you, seek help. Know the signs and symptoms, know yourself, and if you’re not quite you and haven’t been for awhile, talk to a professional. You’re not alone.

photo credit: “OCD-Washing My Hands” by mstinas on flickr.
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Breaking Down The Privilege of Me Too

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women talking and woman standingThis past week, I had the privilege of speaking about Perinatal Mood and Anxiety Disorders with the Moms’ weekly group I attend. It was a bit beyond my comfort zone as I am accustomed to supporting and disseminating information in cyberspace more than in person, something I hope to change this year.

One of the things I love about sharing information is the inevitable “Me too,” which reverberates among the group, much like a pinball caught in a continuous loop in a pinball machine, refusing to exit until it has hit every available surface.

Me too.

Think about how huge that is for so many of us.

Despite the fact that up to 10% of new moms struggle with a Perinatal Mood & Anxiety Disorder, many of us don’t have the PRIVILEGE of having someone we can say “Me too” with at the end of a hard day with the baby in our arms and the struggling brain in our head.

“Me too” shouldn’t be a privilege.

It’s something we should be able to say without guilt, without fear, without shame, without stigma.

I have intrusive thoughts.

Me too.

I didn’t love my baby at first sight.

Me too.

I cried all the time.

Me too.

I was inexplicably and illogically filled with rage.

Me too.

I still wonder if my baby loves me.

Me too.

I am scared to talk to my doctor about what’s wrong with me.

Me too.

I wonder if I will ever be well.

Me too.

I worry about everything and think everyone who sees me knows I am a horrible mother.

Me too.

We all have these thoughts. They’re on parade in our head on a daily basis. For me, I even went as far to keep all the blinds down in my house because I was convinced that if anyone saw in, they would know I was a horrible mother. I felt as if I were living in a fish bowl. Saying “Me too,” finally, helped that feeling to fade and I finally allowed the sunshine into my life.

This privilege, this “me too” phenomenon, is why I started #PPDChat and why I will always listen when a mother begins to talk about the emotional roller-coaster that is motherhood. Because we ALL deserve to have someone with whom we can say, “Me too.”

What’s the one thing you wish you had been able to tell someone and have them respond with “Me too?”

Tell us in the comments. Or take to Twitter and use the hashtag #ppdme2.

 

photo source: “women talking and woman standing” by kalexanderson on flickr
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Research uncovers various classes of PPD

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brainHumans compare themselves to others around them. She has prettier hair. He has a nicer car. Why does she get the corner office when I have worked just as hard? Or the ever popular gym comparisons: I do the SAME exercises as her and yet, nothing. Then we beat ourselves up because we are not achieving the same end results as those around us.

We do the same when we are fighting a Perinatal Mood & Anxiety Disorder. “I’m on Zoloft. It only took so-and-so this many weeks to feel better so I should be feeling better by then too!” Then we hit that milestone and we may not be feeling better. It is so difficult to handle, perhaps even more so than the comparisons in the first paragraph because all we really want is to be better, to be back to ourselves and yet while we are running our own personal marathon toward mental wellness, we compare to those on the same road, forgetting that even on the jogging path, there are those who pass us.

New research out of Chapel Hill, by Dr. Samantha Meltzer-Brody, examined the heterogeneity (that’s a scientific word for diversity) of postpartum depression via a latent class analysis. What she discovered may put some minds at ease when it comes to fighting the battle of postpartum depression.

Turns out, according to Meltzer-Brody, that there are various “classes” of postpartum depression. What does this mean? It means we all are fighting different battles. It’s the same war, but think of it as different levels of skirmishes.

What varies?

“Women in class 1 had the least severe symptoms…., followed by those in class 2…, and those in class 3. The most severe symptoms of postpartum depression were significantly associated with poor mood, increased anxiety, onset of symptoms during pregnancy, obstetric complications, and suicidal ideation. In class 2, most women (62%) reported symptoms onset within 4 weeks postpartum and had more pregnancy complications than in the other two classes (69% vs 67% in class 1 and 29% in class 3).

Their conclusion?

“PPD seems to have several distinct phenotypes. Further assessment of PPD heterogeneity to identify more precise phenotypes will be important for future biological and genetic investigations.”

Why does this matter?

It matters because the more in depth our understanding of how PPD behaves is, the more successful we will be in treating it, and possibly even minimizing any severe episodes. In addition to external influences, there are also internal influences and biochemistry at work here. Thanks to Dr. Meltzer-Brody and other researchers like her, the very real possibility looms of truly individualizing PPD treatment.

For now, we continue to propel ourselves forward, going with what works for us, and in addition to fighting our own battles, remember not to judge those who are doing a bit better than we are. We are all on the same road but we are walking to our own struggles.

(photo source: https://flic.kr/p/d9soWC)

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