We Can't Forget About Postpartum Psychosis When Talking About PPD

"Pregnant Woman" By duron123

There has been much attention given to postpartum depression recently since the U.S. Preventative Services Task Force is now recommending screening of all pregnant women for postpartum depression both prenatally and postpartum.  This is great news and a great stride in bringing much needed attention to an under-addressed public health crisis.  That being said, when the general term of postpartum depression (PPD) is used, it can be misleading and the spectrum of perinatal mood & anxiety disorders can be overlooked.

Although postpartum psychosis may be considered a rare perinatal mood & anxiety disorder, it affects many women and families worldwide.  More awareness, education and research are needed in the area of postpartum psychosis as well as properly identifying and diagnosis the illness.  As things move forward in addressing the public health crisis of perinatal mental health, it is important that postpartum psychosis not be forgotten. 

Of course, many of you know that my efforts are to increase the awareness and understanding of postpartum psychosis.  I know many others are striving to do the same.  Some of us are already joining each other in our efforts.  If any others are interested in getting more involved in addressing postpartum psychosis, particularly in the United States, please let me know. 

I know the year 2016 is going to be a good year in moving forward in addressing perinatal mental health.

Interview with Colby and Amanda Taylor on their Postpartum Psychosis Experience

December 5, 2014

This month I am sharing an interview with Colby and Amanda Taylor on their Postpartum Psychosis experience.  This couple is sharing their experience publicly in order to help others.  Thank you Colby and Amanda for your willingness to share.

1. Can you tell us a little bit about yourself?

Colby: I am 34 years old and recently left the ministry of Young Life where I was involved for nearly 10 years. I am originally from Kansas and graduated from Kansas State University. I enjoy working out, spending time with my family and investing in the lives of others.

Amanda: I am 29 years old and have been married for 8 years. We have four kids, ages 5, 4, 2, and 1 (one girl and 3 boys). Some of the things I like to do are go running, read a book, mail gifts to others, play with the kids, and go on date nights with the hubs.

2. How did you first learn about postpartum psychosis?

Colby: Amanda was diagnosed with postpartum psychosis last year and had 2 stints in a Psychiatric hospital. It was while waiting in the ER that I first learned about PPP through a friend who had looked it up online.

Amanda: I had never even heard of postpartum psychosis until the doctor diagnosed me with it in March 2013. I was in the mental hospital for 7 days after the birth of our fourth child, and that is when I first heard what PPP was.

3. Since you both have different perspectives, in your own words, briefly share about the onset of your postpartum psychosis experience?

Colby: It was after the birth of our 4th son. She began exhibiting manic behavior and becoming very agitated and angry. The day I took her to the ER she had been missing for over 6 hours and when found she was in the process of buying 2 cars and a house.

Amanda: It was 12 days after our fourth child was born. It was a Tuesday. I hadn’t slept in 8 days. I was full of energy, overly happy; everything was perfect (otherwise known as manic- in my situation). I left the house and felt like God was leading me to buy a house and two new cars, so I didn’t tell Colby because I was going to surprise him. I spent $8,000 in 6 days, all without telling my husband. I became violent and angry. Something was not right.

4. What did you find the most challenging in getting the help you needed?

Colby: There is not a lot of information about postpartum psychosis out there. No one knew exactly where to go or what was going on, even the medical professionals seemed very vague as to her condition. Getting answers was probably one of the hardest parts of this.

Amanda: I felt very isolated in the Psychiatric hospital. No one knew what to do with me. I just had a baby 12 days prior, and they almost didn’t let me bring my personal breast pump in my hospital room. I was in the same room with schizophrenia patients and patients that tried to commit suicide and my situation was 100% different but I feel like they just clumped me in with the others.

5. What is the one thing that helped you the most in dealing with your experience with postpartum psychosis?

Colby: Our relationship with Christ was the most significant in helping us get through. Outside of that learning to ask for help was the most important.

Amanda: Honestly, we could not have gotten through it without the Lord. I was so close to hurting myself and/or the kids. I am so thankful for God’s help and protection. I also am thankful for modern medicine and counseling. Those two helped me greatly.

6. What message would you like to share with families facing postpartum psychosis?

Colby: That you can get through this and that you are not alone. This illness is beatable and we are here to help you get through it. Your marriage is worth fighting for and keeping your family healthy is not impossible. Be transparent and ask for help, surround yourself with a community of believers that will help walk through this with you. Seek professional help for your spouse and for you, be proactive in safe guarding your marriage and family. Don’t be intimidated by doctors or medical professionals. If you feel that you are not getting the answers you need than ask until you do. Pray on your knees every day and seek Christ with all of your heart! Allow God to teach you what true reliance on His strength looks like. Learn to get away and take time for yourself. It is most beneficial to find something to distract your mind from your situation. Allow yourself grace as you will make mistakes and you will learn from them, no one expects you to handle this perfectly and that is ok.

Amanda: It is not a long-term illness. It can be. But it also, doesn’t have to be. 18 months out, I feel like good ol’ normal Amanda. I never thought I would feel normal. It took a little over a year to feel like I was back to normal. I want to tell others to not be afraid to ask for help. I can’t imagine going through this alone. We need help and support from others. Also, don’t be opposed to medicine. Faith is very important to me, but I couldn’t pray my way out of postpartum psychosis. I had to take medicine, seek counseling, and be on top of my healing. Be pro-active. You will make it through! We are here to help with whatever you need!

Thank you, Amanda and Colby Taylor, for this interview and your willingness to reach out to others. Readers can learn more about the Taylors on their website at www.colbyandamandataylor.com

The interview questions are prepared by Jennifer H. Moyer for her website/blog and answers will be published on her website www.jennifermoyer.com with permission from Amanda and Colby Taylor.

We Must Prevent Tragedies Surrounding Postpartum Psychosis

August 9, 2014

Why do tragedies continue to happen when postpartum psychosis is a preventable and treatable illness that can strike any mother after the birth of a baby?  It has been over 18 years since the onset of postpartum psychosis occurred in my own life and we still have not properly addressed the illness.  This is one of the reasons why I wrote the recently published book, A Mother’s Climb Out of Darkness.

When I was struck with postpartum psychosis at 8 weeks after my baby was born, my family and I had no idea that the illness existed let alone what the symptoms and risks were.  My son was 4 years old when I learned more about postpartum psychosis.  It was then that I became motivated to increase awareness, treatment and prevention of mental illness related to childbearing.

Back in 1996, the internet and technology were not what they are today.  The resources were not available as they are today.  In order to forgive and move on, I had to contribute the way I was treated by the medical and professional community to ignorance.  But that is not a legitimate reason today.

What are the reasons that tragedies surrounding postpartum psychosis continue?  Why are moms still dying by suicide when with the proper care and treatment they can get better?  Why does the media sensationalize the tragedies and rarely address the solution to preventing the tragedies?  I wish I had all the answers to these questions but I do not.  What I do have is my opinion on what can be done to prevent further tragedies.

• Prenatal education and screening for prevention and early detection

• Properly trained and experienced professionals in the area of perinatal mental health
• Community-wide resource networks for prevention, early intervention and proper treatment
• Medical evaluation, counseling, appropriate medication and support must all be addressed in treatment

This all seems easy enough to accomplish so why are we still so far behind? Is maternal mental health not a priority in the United States?  Maybe not but the good news is that there are many, many of us out there doing what we can to prevent these tragedies and work towards achieving what is recommended above.  If we all do our part, even if it is as simple as asking a mom how she is doing and not just focusing on how the baby is doing, more progress can be made. Support and education are critical in prevention.

Every mom holds a critical role in the family and the community.  Let’s take a stand for them and start addressing their mental health needs.

Resources and References:

Postpartum Support International

International Marce Society

The UK Action Postpartum Psychosis Networ

The Spiritual Side of Postpartum Psychosis

April 14, 2013

In most cases of postpartum psychosis, there are symptoms of a spiritual nature.  Why do symptoms that are not tangible or material present themselves when experiencing postpartum psychosis or psychosis, in general?

I wish I had a concrete, definite answer to this question.  Instead, I will share my personal experience and opinion relating to the spiritual side of postpartum psychosis.

I believe that each of us are created and designed with a mind, body and spirit.  I also believe that we are all on a spiritual journey.  Each of us is at a different point in that journey based on our own personal experiences and beliefs.  When I was suddenly struck with postpartum psychosis, I had a strong faith and belief in God.  I believe, in my case, that my strong faith and belief as well as the faith of my family and friends, was a big factor in enabling me and my baby to survive the illness.

When my son was eight weeks old and the sudden fear entered my life, I did not even know postpartum psychosis existed.  I was sure it was an evil being or force trying to kill me and take my baby.  I had never experienced such intense fear previously so I did not understand why I had such fear or where the fear was coming from. As a result I turned to my inner spiritual strength to fight the evil force that I was certain was going to kill me and take my baby.

In my opinion when someone experiences such intense fear, the “fight or flight” response occurs.  For me, I felt I could protect my son and I by shouting a bible verse over and over again.  I felt I had no other resources to draw on as I was terrified and exhausted from lack of sleep. I began to distrust everyone, even those closest to me.  Why?  I did not know so I felt I could not ask for help.

It was not until a second hospitalization and a second opinion from another doctor (the first doctor I saw when hospitalized at eight weeks told me I had postpartum depression) that I learned of postpartum psychosis.  Once I learned the symptoms of the illness, I could better understand the illness and what had happened to me.

Thankfully, receiving the diagnosis of postpartum psychosis, enabled me to come to the realization that what I experienced was an illness.  However, at that time, I never had the opportunity to discuss or come to an understanding of the spiritual symptoms of my illness.  It would take several more hospitalizations before I had the opportunity to address the spiritual side of my illness.  It was almost three years after I was struck with postpartum psychosis before I had a professional discuss with me some of the aspects of how my personal spiritual journey impacted my illness.  It is unfortunate that it took so long for it to be addressed.

It has been a long process and journey but I am finally in a place of peace and comfort with the illness and all I have been through.  It has been critical for me to get spiritual support from others, who share my beliefs, in order to understand my journey.  One of the resources that helped me better understand the spiritual journey of my illness was the book Further Along the Road Less Traveled by the well-known psychiatrist Scott Peck.  I highly recommend the book to anyone that wants to gain insight into the role of spirituality in mental health.

In my opinion, anyone experiencing mental health issues or health issues, in general, should receive treatment not only physically and mentally but also spiritually.  Once I began receiving treatment in all three areas, I was able to move further along in my journey of recovery and wellness.

Spirituality is personal and uniquely affects each of us.  I welcome the thoughts and opinion of others.  Better understanding comes through discussion and communication.

Here are a few links to resources related to this topic.

Living Beyond Postpartum Depression

The Book Further Along the Road Less Traveled

Spirituality and Mental Health

The Blessing of Postpartum Psychosis

November 24, 2012

It was all worth it

The title of this post may seem strange but postpartum psychosis has been a blessing to me.  How can a serious, life-threatening condition be a blessing?  How could numerous hospitalizations, numerous attempts at treatment, numerous sleepless nights and an illness that nearly cost me my life be a blessing?

Nearly seventeen years ago I was struck with postpartum psychosis.  It came on suddenly without warning.  I did not even know that postpartum psychosis existed.  During my pregnancy, I read everything I could to educate myself about pregnancy, the postpartum period and beyond.  Not once did I read about postpartum psychosis. I learned nothing about the symptoms or risk factors of postpartum psychosis let alone what to do if it should occur.

Although my doctor was wonderful, not once did she discuss mental health issues related to childbearing with me.  The only thing I was prepared for was the baby blues.  My childbirth instructor briefly mentioned the emotions associated with pregnancy and the postpartum period but nothing specific.  Of course, no possible symptoms were presented or risk factors identified that would have given me the slightest indication that a problem could occur.

All was going beautifully during the first several weeks after my son was born.  I loved being a mother.  The confidence and assurance I felt taking care of my son was tremendous.  So I was totally unprepared when postpartum psychosis struck.  I did not realize that my inability to sleep or my unnecessary fears were not normal or that they were something to be concerned about.  I had to learn the hard way what postpartum psychosis was.

So how could postpartum psychosis be a blessing?  The illness itself was not a blessing but there was a blessing that would change me forever.  The biggest blessing is having my son in my life.  As we celebrate my son’s birthday today, I reminisce about the wonderful six weeks we had together after he was born.  Despite the fact that life as I knew it changed forever after I was struck with postpartum psychosis, I would go through it all again just to have my son in my life.

Although I have found blessing in my own experience, my family and I never should have had to endure the devastation and havoc that postpartum psychosis causes.  If we would have known the symptoms of postpartum psychosis or that postpartum psychosis even existed, maybe the severe onset could have been prevented.  Maybe the long and difficult recovery would have been shortened.  We will never know what the outcome could have been.  We only know what the outcome was.

It may not seem possible that an illness that can cause devastation and tragedy could ever be a blessing.  Tragedies are not blessings. Illnesses are not blessings.  But a blessing, according to thefreedictionary.com, is something promoting or contributing to happiness, well-being, or prosperity.  Although it may never happen for some, in my case, I am stronger, happier and healthier as a result of my experience with postpartum psychosis.

Although your experience may never seem like a blessing, I hope you can find the strength to be a blessing by sharing your story so others know they are not alone, they should not feel guilty and that there is hope in the midst of postpartum psychosis.

For those women and families that are experiencing postpartum psychosis or have experienced postpartum psychosis, my hope is that, in time, you can overcome and prevail not matter what your situation may be.  My hope is that by sharing my story, I am able to help and encourage others.

What is Postpartum Psychosis?

Why was Postpartum Psychosis Not Considered a Medical Condition?

November 18, 2012

Back in 1996, when I was struck with postpartum psychosis, there was still a separation of mental health insurance coverage and medical insurance coverage.  This separation was devastating to my husband and I’s financial situation.  It also exasperated my condition.

After two hospitalizations, my life-time mental health insurance benefit reached its maximum.  The life-time maximum for mental health coverage was considerably less than the maximum benefit for medical coverage.  The question of why the diagnosis of postpartum psychosis was not considered a medical condition puzzled and stressed me.  Here I was having to take prescription medication to stabilize me and help me get better yet my insurance was telling me I did not have a medical condition.

How could this be happening?  I anguished over my dilemma.  I needed medical care yet I could not afford my medicine and visits to the medical professionals.  I had insurance coverage but had never had to use it for anything other then my pregnancies.  When I was in a crisis and needed the medical insurance, I discovered how limited the insurance coverage was for mental health.

My husband and I had to use our lifetime savings to pay for the medical expenses.  We began the process of appealing the insurance company’s decision of not recognizing postpartum psychosis as a medical condition.  My doctor recognized it as a medical condition supporting us in our appeal process.  But the process would involve the hiring of an attorney, additional costs as well as additional stress and anxiety for me.  I struggled with what to do as I did not feel recovered enough to take on the huge task of fighting an insurance company.

Our saving grace was when the contractor changed at my husband’s job.  This enabled us to have new insurance coverage hence a new life-time maximum for mental health conditions.  I was so thankful but it should not have taken an employer change to get the insurance coverage needed.  I would learn that such discrimination between medical and mental health coverage occurred for years.

Thankfully, later in 1996, the Mental Health Parity Act was passed.  The Act required equal coverage with respect to aggregate lifetime and annual dollar limits for mental health benefits.  Although this Act did not help me during my initial onset of postpartum psychosis, it would help me later in my recovery.

The question, why is it that the insurance company did not recognize that postpartum psychosis was a medical condition?, remains unanswered for me.  I can ponder why but it was many years ago.  I am just thankful that my husband and I had a savings to pay for the medical care I needed and that I was able to recover from postpartum psychosis.  My hope is that we can eliminate the stigma often associated with mental health and continue to conduct more research supporting the fact that you can not separate mental health from physical health.

I am sure many of you reading this have had similar situations or even worse situations.  I would appreciate any feedback and comments.

Additional Reading:

Mental Health Parity

A Review of Postpartum Psychosis

Can Postpartum Psychosis Be Prevented?

July 10, 2012

Can postpartum psychosis be prevented?  This is a tough question but one that I think needs to be addressed.  I, personally, have seen that postpartum psychosis can be prevented.

As a Volunteer Coordinator with Postpartum Support International, I provided emotional and informational support to many moms experiencing mental illness related to childbearing.  I recall, one mom, who was high risk for experiencing postpartum psychosis since she experienced postpartum psychosis with her first birth.  Mothers, who have experienced postpartum psychosis with previous births or have a history of bipolar disorder are most at risk.  The mom, who I gave support to, went on to have a successful second pregnancy and postpartum period without any incidence of postpartum psychosis or depression.  She worked closely with her doctor and support team in preventing a recurrence.

Another mother I gave support to began exhibiting early warning signs of postpartum psychosis a few days after the birth of her first child but with early intervention, there was no progression of postpartum psychosis.  The key for her was that I knew her personally.  She was aware of the possibility of experiencing problems so she contacted me as soon as she exhibited symptoms.  Her family and I got her the help she needed before the symptoms escalated.  She went on to have a second child without any problems.

I, personally, have seen that postpartum psychosis can be prevented and with early intervention can be stopped.  But what does the research indicate?

According to an article published in The American Journal of Psychiatry, a study of the prevention of postpartum psychosis and mania in women at high risk, concluded that it is recommended that appropriate preventative medication be initiated immediately postpartum in women with a history of psychosis limited to the postpartum period in order to prevent postpartum psychosis.  In addition, the study concluded that patients with bipolar disorder require continuous preventative medication throughout pregnancy and the postpartum period to reduce late pregnancy or the first few months postpartum relapse risk.

The bottom line in prevention is that women, who are at high risk of experiencing postpartum psychosis, should work very closely with a medical professional, properly trained in the area of mental health related to childbearing, during their pregnancy and postpartum period.  Having a plan in place for receiving emotional and practical support during pregnancy and the postpartum period is also highly recommended.

Despite having everything in place, a woman can still experience postpartum psychosis.  The risk can be greatly reduced but not always prevented.  Early intervention is critical in the onset of postpartum psychosis.  The more we talk about the illness and recognize that it can be properly treated, the more it will be prevented.

In my case, I was never blessed to have another child but if I would have, I would have been better equipped because I never knew that postpartum psychosis even existed when my son was born.  There is now better awareness of postpartum psychosis but still there is ignorance and misunderstanding of the illness that needs to be overcome.

Sources and additional information:

Subsequent Pregnancy in Women with a History of Postpartum Psychosis

The Prevention of Postpartum Psychosis and Mania in Women at High Risk

Postpartum Support International

An Illness That Can Attack Mothers

The Symptoms of Postpartum Psychosis

APP Network: Action Postpartum Psychosis

An Illness that Can Attack Mothers

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.

NAMI First Episode of Psychosis Survey Results

The National Alliance of Mental Illness survey results are in and for those that have experienced psychosis, the most shocking finding is that the majority of individuals found no one was helpful when they first experienced psychosis.  I believe this shows the isolation, stigma and lack of understanding of psychosis.  How can we change this?  In my opinion, more individuals need to talk openly about their experience as well as the medical community better understanding of how to treat all aspects of the individual.  Complete treatment includes treating a person’s mind, body, and spirit.  What do you think can change this?

http://www.nami.org/Template.cfm?Section=first_episode