Postpartum Psychosis Archives - Postpartum Progress

What The New DSM-V Says About Postpartum Depression & Psychosis

By Katherine Stone May 21, 2013 Comments

The new Diagnostic Statistical Manual — the DSM-V — has officially been released by the American Psychiatric Association. So what does it say about postpartum depression?

Not what I thought it would. In the DSM-IV, to diagnose Major Depressive Disorder with Postpartum Onset, symptoms needed to appear in the first 4-6 weeks. As you know, many moms don’t recognize postpartum depression symptoms until much later in the first year. It’s my belief that this has led to moms going to see their docs and being told they couldn’t have PPD because it was too late.

My understanding was that in the new DSM-V, that would change. To make the qualification for Major Depressive Disorder with Postpartum Onset, symptoms could appear any time in the first four months. Others have said the discussion leading up to revisions of the DSM also revolved around extending it to as far as six months.

Yet yesterday I got a copy of the new pages (pg. 186 and 187) and it still says 4 weeks. So frustrating.

With peripartum onset: This specifier can be applied to the current or, if full criteria are not currently met for a major depressive episode, most recent episode of major depression if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery.

The DSM does now recognize antenatal depression, since the listing has changed from a postpartum onset specifier to a peripartum onset specifier.

The DSM-V also offers a detailed note on using the Major Depressive Disorder with Peripartum Onset diagnosis:

Note: Mood episodes can have their onset either during pregnancy or postpartum. Although the estimates differ according to the period of follow-up after delivery, between 3% and 6% of women will experience the onset of a major depressive episode during pregnancy or in the weeks or months following delivery.

What the heck made them decide on that low number? 3%? Y’all must be kidding. It’s more like 10-15%.

Fifty percent of “postpartum” major depressive episodes actually begin prior to delivery. Thus, these episodes are referred to collectively as peripartum episodes. Women with peripartum major depressive episodes often have severe anxiety and even panic attacks.

Good. Great points to have added about antenatal depression and about the anxious nature of postpartum depression.

Prospective studies have demonstrated that mood and anxiety symptoms during pregnancy, as well as the “baby blues,” increase the risk for a postpartum major depressive episode.

Peripartum-onset mood episodes can present either with or without psychotic features. Infanticide is most often associated with postpartum psychotic episodes that are characterized by command hallucinations to kill the infant or delusions that the infant is possessed, but psychotic symptoms can also occur in severe postpartum mood episodes without such specific delusions or hallucinations.

Postpartum mood (major depressive or manic) episodes with psychotic features appear to occur in from 1 in 500 to 1 in 1000 deliveries and may be more common in primiparous women.

Primiparous means first pregnancy.

The risk of postpartum episodes with psychotic features is particularly increased for women with prior postpartum mood episodes but is also elevated for those with a prior history of depressive or bipolar disorder (especially bipolar 1 disorder) and those with a family history of bipolar disorders.

Once a woman has had a postpartum episode with psychotic features, the risk of recurrence with each subsequent delivery is between 30 and 50%. Postpartum episodes must be differentiated from delirium occurring in the postpartum period, which is distinguished by a fluctuating level of awareness or attention. The postpartum period is unique with respect to the degree of neuroendocrine alterations and psychosocial adjustments, the potential impact of breast-feeding on treatment planning, and the long-term implications of a history of postpartum mood disorder on subsequent family planning.

There you have it. What do you think about the new postpartum depression listing?

Photo credit and citation: American Psychiatric Association

May 21, 2013 9:38 am Filed Under: Postpartum Depression, Postpartum Psychosis

Jennifer Marshall: On Coming Out Stronger After Postpartum Psychosis

By Katherine Stone May 12, 2013 Comments

Dear Mama-to-Be,

I was diagnosed with Bipolar Disorder type 1 in 2006, and after two separate hospitalizations for mania, spent the entire year in the darkest depression I have ever faced. Each and every day of that year I cried. I cried for the person I thought I was. I cried for the life I had lost. I cried for the future I thought I had ruined by getting sick. I didn’t think I would ever see my dream of becoming a mom turn into reality. Not now. Now that I had a mental illness. I just didn’t think it was possible anymore.

Through the support of my loving husband, my family, and my friends, I somehow made it through that horrible year, what felt like the longest year of my life. I fought the demons of anxiety, overcame thoughts of suicide and emerged a fighter. Someone who will not give up hope; someone who refused to give up on her big dream of being a mom.

And at the very end of 2007, my husband and I found out that we had made that dream a reality.

We were expecting our first baby. Leading up to the pregnancy, I had been working closely with my psychiatrist and he agreed to allow me to taper off of my medications in order to conceive and complete the pregnancy without exposing the baby to any unknown side effects they might cause. (Looking back now, I should never have come off of my meds, but hindsight is 20/20 and this is the reason I am writing this letter – to share my experience in case it can help others.) I was very fortunate, in that my entire pregnancy was completely normal and surprisingly, despite the challenges of pregnancy sleep, I didn’t experience any symptoms of my illness whatsoever. It was as if it has disappeared from my body all together. [Read more...]

May 12, 2013 11:00 pm Filed Under: Bipolar Disorder, Mother's Day Rally for Mental Health, Postpartum Psychosis

Alison Parson: On Discovering Postpartum Psychosis Exists

By Katherine Stone May 12, 2013 Comments

To the Mother who never knew,

I gave birth to my son in March. He was my second. My daughter was only 13-months old. My husband and I hadn’t planned on having children back-to-back, but, as the stale cliché goes: The show must go on. And it did. I tried my hardest to be a better mother than I was the first time. With my daughter, I cried and slept, cried and slept, cried and slept. If anyone asked to my hold my sweet beautiful baby girl, I’d jump at the chance to give her away, only fearing the time she’d come back. I thought I was terrible mother. But, I never knew.

My infant son, my toddler girl. I would do right by them. I would be motherly, I would be nurturing, because we all needed that. They deserved it, they were babies. For three months, I was a machine. I was my own assembly line. I fed, changed diapers, played, repeat. I never knew my emotions were running on fumes. I never knew I was about to have a break down. I never knew that each day my body gave me clues to the arrival of something spectacularly destructive.

One day, it was racing thoughts. I tried to “Google” it, but that was no help. Another day I was hit with mania. Elaborate and dramatic happiness, untouchable excitement. Nothing could stop my high. Then came the talking. The endless run-on sentences I blurted out one night. Words flying out erratically—a high speed chase, with no one who catches up with them. [Read more...]

May 12, 2013 6:00 pm Filed Under: Mother's Day Rally for Mental Health, Postpartum Psychosis

The Amazing Synchronicities of Postpartum Psychosis

By Katherine Stone April 10, 2013 Comments

Warrior Mom and two-time postpartum psychosis survivor Heather (a pseudonym), who lives in London, shares the story of her hospitalization after the birth of her second son in 2012.

I was taken to a specialised psychiatric Mother and Baby Unit nine days after the birth of my second son to be treated for postpartum psychosis. I had my own room, and my baby was cared for by the nurses primarily for the first few weeks while I was off in a world of my own. The volume was turned up on my inner monologue. It felt like the speakers might blow. I was uncharacteristically uninhibited. Things got worse before they got better. Just how bad they got can be gauged by the following note I made to myself: “If I was actually god, would I ever find out?”

I could not stop talking. I was full of theories and ideas and puns. When I wasn’t talking, I would write, screeds of concepts falling over one another in a shorthand I can no longer decipher half the time. I wrote lists; I wrote schematics linking my various theories together. I wrote in the margins and on the covers of magazines, I wrote on scraps of paper. I even wrote on a sanitary towel at some point. One night I had no paper left to write on so I covered all six sides of a tissue box.

Sometimes I couldn’t be bothered to write so I talked out loud to myself instead – or, as I believed, to the hidden microphones. I thought recording devices in the walls would make sense because the staff needed to know what was on the patients’ minds. I kept noticing amazing synchronicities which could be put down to coincidence or which could – if you took a leap of faith – be attributed to manipulation. A kind of divine intervention with psychology in place of the celestial.

Every day on the unit was like groundhog day: I started off calm, focussed, trying to relax and go with the flow, or to ‘play’ the ‘game’, as I saw it. I would gradually wind myself into a frenzy of expectation and delusion, anticipating the big reveal where I would get to go home. I got increasingly hectic, until by 1am I was pacing the ward or writing screeds of thoughts.

I wasn’t wholly taken in by my delusional constructs. I realised there are four categories of puzzling anomalies: conspiracy, coincidence, miscommunication and cock-up. My trouble was simply in discerning one from another. I went down one blind alley after another, readjusting my conspiracy/ coincidence/ miscommunication/ cock-up assessment at each stage, learning to de-escalate my delusions to theories of less cataclysmic proportions as I came across them.

Over time, during my stay at the Mother and Baby Unit being treated for postpartum psychosis, I increasingly realised that my theories were nonsense and I was seeing meaning where there was none. The remaining trouble was that now, with my mania on the way out, I was increasingly anxious and seemed to see the possibility for catastrophe at every turn. I felt on edge and spaced out all at once. I learned that this feeling is called depersonalisation or derealisation – it helped somehow to have a label for it, to know that it’s ‘a thing’.

At my Mother and Baby Unit discharge meeting I was prescribed antidepressants at my request. Only trouble is, antidepressants take a few weeks to begin to work. It’s hard to describe what on earth was wrong, but I could hardly bear existing.

But it got better. It was very hard waiting for the antidepressants to kick in, and they took a while. I went and begged the psychiatrist for a higher dose. A couple of weeks after that I started to feel less heavy, more capable, less sleepy. Gradually, instead of being a grinding ordeal, life became a series of triumphs over postpartum psychosis: I cooked a proper meal, from a recipe and everything. I went to the gym. I got out to baby groups. I took the kids to the park with friends. I got started on a diet. The meds started to work, and then they worked some more, and then a few weeks later I was really feeling normal again.

Then I began writing.

Heather’s book, Babies and Brainstorms, is available here.

April 10, 2013 9:15 am Filed Under: Postpartum Psychosis