Journey Through the Darkness

One Woman's Personal Account of Postpartum Psychosis and Recovery...  

Part 3 of 3:

Over the next six days, I participated in group activities, talked to the other patients, and watched other people come and go. Whenever I asked my doctor when I'd be able to go home, she said that we'd have to wait and see. I was getting used to having a shadow. Most of them were nice and some talked to me. It took four days before the staff decided I was no longer a danger to myself and I lost the shadow completely. The staff kept asking me if I was happy to be rid of the shadow, but I actually felt a little lonelier. Even if it was someone being paid to keep an eye on me, it was nice to have them there.

The nighttime pills helped me sleep; the daytime pills tried to balance me out. My one and only thought was getting discharged. The focus was completely wrong, but I didn't know that at the time. I was trapped and away from home. I found myself trying to convince everyone that I was ready to go. I wasn't. I was a long way from being better. But the point of being inpatient isn't to get you ready to take on the world again, it's to stabilize you so you can continue getting treatment. I thought it would all be over once I got out.

When I was discharged, I was passed on to a partial hospitalization program. I would sleep at home but by day I would be in an adult’s recovery program. There was group therapy first thing in the morning, late morning brought small group classes, we all ate lunch together and the afternoons varied depending on the day. It could be art therapy or recreational exercise or relaxation. While I was in the program and my days were structured, I did quite well. I didn’t think much of the program at first, not until a day class that gave me some insight into my behavior.

 What was this amazing insight? My husband had been telling me for years but it never quite clicked. I learned that most of what I had been going through was largely me seeing myself as a victim of chemicals and hormones - this was partly correct. My hormones had taken plunge after I'd given birth, but that hadn't started it all. I was severely depressed and suicidal all through my pregnancy. I did not confide my mental state to anyone, not my OB/GYN, my therapist, or family. I was so scared of what MIGHT happen to me that I ignored getting treatment. I had visions of being committed for the whole of my pregnancy. The irony is that me avoiding treatment is precisely what put me in lock-down.

When I was released from the psychiatric inpatient unit and attending the partial hospitalization program, I started journaling again. I was still living with my parents and some days I would write for hours. I still harboured resentment toward my son. I still believed he was to blame for my condition, but I had accepted that he was now a part of the family. I would have to be patient and see if my maternal instincts ever developed.

When I wasn’t journaling, I started reading everything I could about postpartum depression and psychosis, including looking for postpartum support groups. I found one about forty minutes away. I was excited and apprehensive at the same time. I didn’t know what to expect and I was very afraid I would be forced to share my story and then stared at blankly while the others muttered what a horrible person I was. After talking to my parents about it, we all decided that I needed to go to at least once.

My mom went with me the first time. It was a dimly lit conference room filled with young women, held in a hospital I’d never been to before. They chatted away waiting for the session to start. My anxiety started building from the moment I sat down. I looked at them and wondered who would be the first to call me a monster. They gave me the option to just listen but I decided to just get it over with.

Talking through sobs, I shared my story. Everyone listened quietly and let me finish in my own time. When I was done I felt a moment of panic, thinking I said too much, but no one called me a monster  or defective. They went around the room giving their reactions to what I had said. In one form or another, they made a point of saying they could relate. When I said that I wasn't living at home with my baby, one of the other ladies said the same had happened to her. When I said I was feeling resentful, another lady said she was still struggling with that after months of therapy. We talked about our medications. We laughed about things no one outside that room would find remotely funny. By the end of the night I was crying again, but only because I was so happy that I went. If I had to point to one event that helped start things turning around for me, talking with these brave and experienced women was it.

Unfortunately, as the days went on, the resentment continued. When I woke up with the baby in the middle of the night, I resented not being able to sleep. When I was late for work because I dropped him at daycare, I resented having to make the extra trip. When I had to buy formula or diapers, I resented the extra expense. And when he cried for no reason and wouldn’t calm down, I resented my situation.

Advice coming from friends and my therapist now was much more realistic. The sugar-coated clichés were over and I was told that these frustrations were normal. Things would slowly get better. “But when?” I would ask, “Haven’t I been through enough?” No, I had to be patient and appreciate the small victories.

One day, it did. I had picked up my baby after breezing through the diaper change and realized that today had been a good day. Yesterday had been pretty good too. Now that he was happily sleeping through the night, life had gotten much easier.

More good days than bad. Wow.

Sometimes you can't learn a lesson until you've lived through it. I'd been on antidepressants since I was 20. I'd been diagnosed by psychiatrists and spent a lot of time in therapy, but I never really worked on getting better. Maybe I never had a good enough reason. My depression was so deeply ingrained I'd convinced myself I would never get much enjoyment out of life. My perfectionistic nature left me berating myself for falling short of the outrageously difficult standards I set.

When I finally emerged from the shade of postpartum psychosis, I was weary but armed with new knowledge. My two lessons learned were that I could actively affect my recovery, instead of being a victim of my own depression and psychosis, and that I could merge the many aspects of me into a new whole.

My one piece of advice to others, is to be honest with yourself. I believe we all know when we are in trouble or need help. Moments of clarity do exist. Maybe it's just a feeling that something is wrong or identifying a pattern in your behavior that is not in character. Whatever it is, bring it out into the light of day. Call your doctor, therapist, a friend or family member… whoever it is that you trust. When recovering from postpartum depression or postpartum psychosis keeping these thoughts bottled up inside simply gives them a place to breed. If you would tell a friend to find help for a similar problem, apply that same logic to yourself. Seek out others who are experiencing the same thing. The peace of mind that comes from finding other brave souls helps in so many ways. For me, it was the relief that came from knowing I was not the only one and I could recover with my family intact. There are always people out there who have experienced similar situations. There are always people who can help. Don’t suffer in the dark places our thoughts sometimes make for us. Break free.

 Written by H.W.

Hollie Scinta edited this article with permission from the author.

Journey Through the Darkness

One Woman's Personal Account of Postpartum Psychosis and Recovery...  

Part 2 of 3:
 

I just needed a few hours sleep to recharge. But if I couldn't sleep, I should really get some things done around the house.

I'm getting behind on laundry. The car seat base needed to be installed in my car... Maybe if I bought some night-time pain medicine that would help me sleep...My damn brain won't turn off...

"Honey?" my Mom said. "Did you sleep?"

My chest got really tight. My stomach sank. The muscles at my temples contracted. Breathing rapidly I was panicking as my eyes teared up. I started to turn away but she stepped toward me. She inhaled to speak but didn't get a word out. A sob exploded from me like a balloon overfilled with air. 

"Oh my God, Mom. I don't know what I'm doing! I can't do it.” I held her so tight.

My husband came out of his office and took me from my Mom. "You can't go on like this. Call your doctor.” I had her paged and she told me to take Benadryl, wear ear plugs and feed the baby the formula. I explained I was breastfeeding. She said that me getting six solid hours of sleep was absolutely essential so feeding him a bottle of formula would be fine. Mom got us dinner and picked up the Benadryl. I took it and barely ate. I nursed the baby once more before bed. God willing this insomnia was finished... But it wasn't.

The beginning of my third day home brought a crushing depression. I laid on the couch when I wasn't breastfeeding. My father came to visit and replace a bulb for my car light. He looked over the couch and I managed a few words. Later I heard my parent's whispering in the kitchen. I knew it was about me.

That night I was in bed thinking.

Why is this so hard? How do other mom's do this? Why can't I make this work?!?

I listened to the spinning fan. Under the noise of the motor I heard something else. 

You know it's all his fault don't you? He's ruined everything.

Was I thinking this or hearing this? I couldn't quite tell.

You're not sleeping because you're on baby duty.  You're falling apart. Everything was going good until HE came along...

I shut my eyes tight and held my head. I brought my knees up into my chest. Stop, stop. 

I don't hear this. This is not real.

I exhaled sharply. Whatever was happening to me, it was true. I hated this. I wanted things back the way they were before the baby. Shutting my eyes I saw angry faces, dogs barking at me, blood...A life of agony and torment being previewed for me. 

Could you be strong enough to take your life back? There's a way to fix it. You have to get rid of the baby. If  you make him choose, your husband will choose him and he'll make you leave. You have to get rid of the baby.

Stop. Stop.

So I made a plan. It would have to look like an accident. 

I'll carry the baby upstairs. I'll pretend I tripped. I'll drop him over the staircase. He won't survive and  then my husband won't have to choose. I'll get my old life back.

I have never been much of a religious-type, but I honestly think God has intervened in my life three times... twice during my pregnancy. What followed was the third:

My mind cleared - for an instant - and I realized what I was thinking. I called for my husband. "I'm not safe. I need to go to the hospital." Riding in the car to the hospital, I didn't know if I was going to die, if I'd ever see my family again or if my husband would leave me. Whatever person I had been, that facade, was gone. Someone capable of killing her baby had been left in her place.

Hospitalization

The intake process took forever. We had come late at night and there was no one to provide a psych consult. "We've paged the doctor on call," the nurse said. So we waited. When I finally got to my room I went to shut the door and a security guard told it needed to stay open. Other people had their doors shut. I was annoyed. I realized he was there to make sure I didn't try to kill myself. 
It was early morning by the time I got my psych consult. I asked my husband to leave the room because I couldn't bear to say these things in front of him. She asked me why I was in the ER tonight. I sobbed. I told my story of having given birth three days ago, my history of depression and that I asked my husband to bring me here.

"Are you thinking of hurting your baby? Have you made a plan?”

"Yes, I know how I was going to do it."

"Are you having hallucinations?"

"I hear whispering. A voice telling me my life is over and it's the babies fault...When I close my eyes I can't stop the pictures. Blood. Me throwing the baby down the staircase. Dogs barking at me."

(I still don't know why, but dogs barking at me was very significant. I never asked why at the time.)

It didn't take long to have me admitted. I said goodbye to my husband and the heavy double doors for the behavioral health unit opened. The click they made when they closed behind me scared the hell out of me. It sounded so... final. CLICK.

I told my husband that I rationalized my mental illness by a series of degrees. At first, I was ashamed that I needed antidepressants, but I rationalized that it was okay because at least I didn't need therapy. Then I was in therapy... but at least I didn't need a psychiatrist. Then I needed a psychiatrist... but at least I wasn't on something like Lithium. I was prescribed Lithium. And on and on... check, check, check, CLICK. 

Many of my belongings were confiscated. The staff took my bra, my shoe laces and drawstring sweatpants for safety. No phone or electronics. At the end of it all I had a pair of tennis shoes with no laces, three pairs of panties, some socks and two t-shirts. They understood I had just given birth so they made sure I had plenty of pads.

I would have a "shadow" 24/7 by my room. I got under the covers of my bed and they reeked of bleach. I grabbed a handful tightly and decided to rest. The irony is that I missed the biggest surprise of the night. Away from home, scared and alone, face swollen from crying- I drifted off to sleep. It was completely lost on me too, because waking up the next morning all I felt was panicked and trapped. I wish I had been able to recognize that one little thing, that I was finally able to sleep. But I was at the emotional and physical Ground Zero. Yet for the first time in a long time, I was safe.

-to be continued-

 Written by H.W.

Hollie Scinta edited this article with permission from the author.

 

Journey Through the Darkness

One Woman's Personal Account of Postpartum Psychosis and Recovery...


Part 1 of 3:

Everything in this world has an opposite. Up, down. Left, right. Good, bad. This is parenting. I haven't found anything else in this world that could lift me up or drive me down; keep me awake at night or comfort me as I fall asleep. This is a difficult story to write because I am someone who didn't fit into the role of "mother" easily. I thought it would be natural. I believed that from the moment I laid eyes on my baby, I would fall in love, feel a connection, be washed over with joy and devotion. It didn't happen.

My pregnancy was plagued by major depression; three days after delivering my son I developed postpartum psychosis - the more rare and severe form of postpartum depression marked by hallucinations and often suicidal/homicidal ideation. Even though there was a medical diagnosis for my condition, I believed myself a monster- damaged and defective. I surrendered myself to science and was admitted to a psychiatric hospital for treatment. Emerging, the world was unfamiliar to me. Everything felt false... and then there was the baby. He didn't seem to be mine either. Nothing in this new world made sense.

The nine months of my pregnancy and the year that followed was a journey of fear, shame, discovery and redemption. Some days I lived second to second, and others I wished would never end. So you see, with all things, there are opposites. It IS possible to journey from one extreme to the other and emerge intact, albeit changed. With time, trial, error and science, I finally found a place for myself in this new world and discovered a love for my son that is limitless.

Emerging Psychosis:

The return home was an anxious start to this new beginning. I didn't know it yet, but psychosis was already setting in. My house seemed strange - not my own. I remembered it, but it felt like something I only recognized after studying pictures or hearing someone describe it to me. Everything felt wrong. I thought I'd been inserted into someone else's life.

That night I went out on the deck to breathe. I could see the baby though the patio doors, sleeping in his carrier. My husband came out after a while and asked how I was doing. I remember trying to act normal, but my body felt like it wanted to run away. I was so scared; I didn't want to be a parent.  Looking at Jay outside that night, I hoped desperately that he was as confused and scared as I was. I tried to make my voice sound like I was joking and said, "I suppose we have to keep him, huh?" He nodded and stared at me, and I could see in his look he knew I wasn't kidding. When he went back inside I had to work hard to keep from crying.

The next two days were a blur of breastfeeding, trying to eat - and failing, trying to sleep - and failing. I was getting lots of practice changing diapers, so at least I wasn't failing at that. Still so tiny and pink, the baby stayed mostly in his infant carrier. I lived on his schedule - feeding, changing, trying to interpret the cries. My mother would take him occasionally so I could nap. I tried but mostly I stared at the ceiling fan because my body wouldn't relax. A sleep mask over my eyes only made me focus on the noises I heard - the baby, my husband's voice, my mother's voice, the dogs walking over the hardwood floors. I found no comfort there.

During those nighttime feedings, my mother would come and sit with me. We chatted about this and that and I did my best to sound like I was taking this all in stride. Chances are she saw it was an act. At a minimum, she knew I wasn't eating and when she asked if I slept I could only say that I rested. We decided it would be a good idea to try pumping breast milk tomorrow; she could wake up with the baby at night while I slept. The idea gave me hope that it wouldn't make me so necessary to him.

That second morning my efforts to pump breast milk failed. I didn't want to feed the baby formula as long as I could breastfeed, so I angrily resigned myself to being at the baby's beck and call. Minutes later I was berating myself for being so selfish. Eating and napping had the same success rate as the breast pump. My husband was concerned because I was sounding increasingly anxious and needed to get some sleep. I had to visit my Ob/Gyn for a well-check that morning, so I promised I'd talk to her about not being able to sleep.

At the doctor's office, we talked at length about how I was feeling. I didn't think I sounded that frazzled but everyone seemed to be concerned when they talked to me. Sitting in her office, I didn't pretend that I had it all under control. I was tired and frustrated and I wanted help. She knew my history of depression and said I had to be extremely cautious about postpartum depression. I admitted I was having trouble. We talked about the last antidepressant I was on and she wrote me a prescription. The prescription would get me thought the next 30 days and I told her I had a psychiatrist to call for an appointment.

On the way home we stopped at the drugstore to fill my script. I realized we had talked about depression but I hadn't asked for any sleeping pills. I couldn't believe I'd forgotten. Getting the prescription for an antidepressant made me feel a lot better about things and I was completely exhausted. It wouldn't be a big deal because I'd fall asleep today for sure. Maybe as soon as my head hit the pillow. I told myself things will get easier now.

I took my pills, fed the baby, then happily announced I was going to take a nap. I had practically fallen asleep in the glider feeding the baby and I was ecstatic. Finally I was going to get some sleep. I was sure I'd feel like eating again too once I work up. So into bed, sleep mask on, earplugs in. I made my breathing slow and steady. I practiced some visualization exercises. I made it to the end of the visualization but was still wide awake. I shifted and took off my socks. Maybe that would help. I got comfortable again, slowed my breathing, and restarted my visualization. Thoughts kept intruding:

You're overtired now. That's why you can't sleep. Ugh. Maybe that's true. Why didn't I remember to ask the doctor for some sleeping pills? Maybe if I tried to exercise I would be able to sleep. No, I can't exercise yet; I'm not up to it anyway. Falling asleep should be easy, I'm so exhausted. I just want to get some sleep. Just a couple hours. Something!

I lifted my sleep mask to look at the clock. Forty-five minutes had gone by with no luck.
Why is this happening?!? Is someone TRYING to make me crazy?!?...

                                                               -to be continued-

Written by H.W.

My Postpartum Story: Then and Now

I am so happy to volunteer for the PHA Warmline.  I just wish there had been this kind of support for me when my babies were born.

Thirty-two years ago my son was a happy breastfeeding baby, but in order to return to my job as a flight attendant I needed to wean him, rather abruptly. As a result my hormones went crazy, and coupled with the stress of getting back to work, I found myself spiraling out of control. I couldn’t sleep or eat and eventually became delusional and was hospitalized.  Fortunately, a week in the hospital with medication helped me get the deep sleep I desperately needed and I was able to bounce back to normal… juggling a new baby and busy work schedule.

When my daughter was born three and a half years later I decided to hang up my “wings” and quit flying.  She nursed until about 15 months and everything seemed perfect.  We even built our first home.  No postpartum.

A miscarriage and five years later my third baby was born. I figured I had all kinds of help, having done this twice already. It never occurred to me that everyone needed me! My baby was jaundice and needed monitoring in one of those portable bilirubin beds.  My husband almost missed her birth due to food poisoning, so he wasn’t much help.  By the time Lauren was a week old I was physically exhausted, but never saw the signs of postpartum – fortunately my husband did.  Again I was hospitalized, while a friend cared for my baby, and once again the deep sleep I needed helped to restore my mind and body.

Surviving postpartum and not just becoming a statistic has given me a passion to share what I’ve learned and experienced with new moms. Perhaps I can help them avoid the some of the consequences of “untreated” postpartum by sharing my story and the resources now available. Postpartum Health Alliance is such an awesome support network, and just knowing they are there is a huge comfort. 

Submitted by Donna Kole

A Powerful New Tool for Reaching Moms

We are pleased to announce the release of a video created for PHA that provides information on symptoms of PMADs, shares the story of one mother who suffered, and encourages mothers to find help.  We will soon be featuring this video on our website, but you can get a sneak preview here!

A Mother's Journey Through PPD/A

Fourteen years ago I gave birth to a beautiful, healthy baby boy, at 7 lbs. 9 ounces, and named him Owen (not his real name). I’d been waiting for Owen for a few years. I’d had two miscarriages before him: one in my 10th week of pregnancy and one in my 14th week of pregnancy. Right after the second miscarriage, I needed a D&C and lost 1.5 liters of blood during the procedure, which was quite scary. The medical staff in Europe, where I was living at the time, told me, however, that the blood loss was a fluke. As I found out after delivering Owen, it really had not been a fluke because after he was born, I lost 3 liters of blood due to the uterus not contracting, and it took medical staff 6 hours, from 1PM until 7PM, to get the blood loss under control. It was a life-threatening situation; thank goodness for blood transfusions! I don’t really remember much of this because I was mostly out of it, but my husband will never forget… to this day he says those 6 hours were the longest hours of his life. A doctor had talked to him twice during this time to tell him they were trying to do everything they could, but were not sure if I was going to make it. Obviously I did.

I was in the ICU for 2 nights and then was wheeled into a room with 2 other mothers who had just delivered their baby. Between the 3 of us, we always had one baby that was up and needed to be fed. So, needless to say, I got very little sleep; so little that I broke down crying on my 5^th day at the hospital and begged my husband to take me home. He supported my decision, and I checked myself out of the hospital. That first night at home, I experienced my first panic attack ever. I asked my husband to call 911 because I thought I was dying. I could feel extreme tingling in my whole entire body from head to toe, so much so that I felt I was leaving my body, which I thought meant that I was about to die. My husband called the doula that had helped us deliver Owen and, over the phone she explained that I was experiencing anxiety. She recommended my husband normalize the experience, turn on some calming music and make me a warm drink. He did all of that while I experienced one panic attack after another and had yet another night of no sleep. And so our journey to hell (as we refer back to it) had begun.

I became an insomniac (even though I used to fall asleep at the drop of a hat) and had absolutely no appetite, even had an aversion to food (even though I had been a total foodie my whole life). I lost about 30 lbs. in a little over 2 weeks (pregnancy weight included) and became thinner than I’d ever been. I experienced many more panic attacks and started having intrusive thoughts, which were very graphic and therefore very disturbing. I saw danger everywhere, literally everywhere! I would look at things and worry about how those things could potentially hurt my baby. For example a window: he could fall out, a bath: he could drown, a knife: he could get cut, a belt: he could get strangled, a washer/dryer/ oven: he could end up in there and would never make it out alive. I had stopped nursing Owen about 2 weeks after he was born – very heart-breaking decision, but I’d come to realize that as long as I kept breastfeeding, my body would be unable to catch a break - and had started bottle-feeding. Every time I mixed up the bottles I thought for sure I was using the wrong water or not the right amount of formula, and that would eventually kill him. Owen’s level of dependency on me seemed to be a responsibility I could not handle; he just seemed too vulnerable to be put in my incapable hands. I had thoughts of disappearing, of no longer having to be a part of Owen’s life or my husband’s life, not just for their own good, but also for my own survival. Owen felt like a leech, sucking the life right out of me. Because of his existence, I felt myself just withering away… slowly, but surely. My thinking scared me tremendously because I thought I had gone completely crazy. I did not know what the thoughts meant: did they mean I wanted to hurt my baby? Or maybe they meant I became “bad” overnight and was turning into a criminal? As I was trying to make sense of it all, I knew one thing with certainty: I no longer trusted myself. So, I told my husband (who I thought, without a doubt, was going to leave me and take the baby with him, but at that point, I had already come to terms with that). When I told my husband that I no longer wanted to be left alone with Owen and why, he immediately went down the stairs to talk to our neighbor, a psychiatrist. The psychiatrist came to see me that same day and listened to my story as well as he could because I was sobbing the whole time. He wrote me a prescription for an anti-depressant - one that also helped with sleep and appetite -, which I started taking that day. I slept well that same night for the first time in almost 2 months! I also started seeing someone for therapy, just a handful of times, but it helped. I also stopped spending time alone with the baby. We were expats, so we flew family and friends out to help us. Once my thoughts were back to normal and I trusted myself again, which was about 2 months later when Owen was around 4 months old, I started taking care of him by myself again. And so our journey back from hell had begun.

Being diagnosed with Post Partum Depression & Anxiety was such a relief to me! It showed me that psychiatrists had heard of this illness before and that I was not the only one suffering from it. I was so happy about the diagnosis that I told everyone about it: family, friends, and neighbors. My guilt about being the most ungrateful and undeserving mother on this entire planet started to subside little by little. I would say, all in all, it took about a year for me to feel completely like myself again, but I did get consistently better once I reached out for help. In hindsight, I guess I had a few things going against me: giving birth in a foreign country with no - to a very low - support system, changing from having a full-time job to becoming a stay-at-home mom and the isolation that comes with this, a traumatic birth, prior miscarriages, an extremely colicky baby who could cry for 7 hours straight, and finally, a genetic pre-disposition to depression and anxiety. This temporary “soul loss,” as I call it, and permanent loss of a large part of my innocence and naiveté luckily did end up serving a much greater purpose.

I became a Marriage and Family Therapist treating new mothers who suffer from depression and anxiety. Also, eight years ago, my husband and I adopted an adorable baby girl at birth, so Owen has a younger sister. Both kids are doing great and I’m confident I am a “good enough mother.” And last but not least, my husband and I are celebrating our 20^th wedding anniversary next year, and I can honestly say that most of our two decades together consist of fun times with memories that put a smile on my face J

The Basics

Two of our board members recently drafted an article highlighting the basics of Perinatal Mood and Anxiety Disorders. This is great information or review for everyone.

Perinatal Mental Health: Differentiating Mood and Anxiety Disorders From the Expected Emotions of New Motherhood

Perinatal mood and anxiety disorders (PMADs) are frequently underdiagnosed among health and mental health professionals alike. Too often the symptoms that coincide with these disorders are confused with “expected” emotions during this time. It is important that clinicians know the risk factors and presenting symptoms for PMADs, in order to ensure proper assessment and treatment. Without such treatment, PMADs can impair the developmental trajectory of the baby and family.

Risk Factors

There are numerous risk factors that can increase a woman’s vulnerability to PMADs. Biological risk factors can include a genetic predisposition to anxiety or depression, a family history of PMADs, a history of hormonal sensitivities (i.e. severe PMS), thyroid problems, or infertility issues. Social risk factors include family stressors, unplanned pregnancy, a history of pregnancy loss, or a lack of social support. Psychological risk factors can include perfectionist behavior, worrying, high need for control, or a history of physical or sexual abuse or neglect.

Differentiating Between PMADs and Expected Emotions

Differentiating PMADs from a “normal” reaction to childbirth primarily depends upon the factors of timing and the degree to which functioning is impaired. The DSM IV states a postpartum onset specifier of within 4 weeks postpartum for mood disorders; however, most experts in the field believe the onset to be anytime within the first year postpartum. Below, the four disorders associated with PMADs are described in brief detail.

Postpartum Depression (PPD): 80% of women experience the baby blues within the first 2 weeks after childbirth. Baby blues consists of crying, mild sleep disturbances, moodiness and sadness, but the woman can still function well enough to adequately care for her baby. In contrast, women experiencing PPD may not be able to function well enough to take care of the baby and/or herself, and she will meet the criteria outlined in the DSM IV for major depression.

Postpartum Anxiety (PPA): All new moms worry, but in moms with PPA the worry affects their functioning (e.g., a mom cannot sleep when her baby sleeps because she is watching her baby breathe, or a mom doesn’t want to leave the house for fear of the baby crying.) Generalized anxiety and /or panic disorder may be present.

Postpartum OCD (PPOCD): These women often suffer from intrusive thoughts of harm coming to their baby or of them harming their baby. These thoughts are ego dystonic. Women may change their behavior to avoid the feared image (e.g., avoiding crossing bridges for fear of throwing her baby over the edge).

Postpartum Psychosis (PPP): Research suggests that most women with PPP are those who have not been previously diagnosed with bipolar disorder or who are off their medication postpartum. The onset is usually within the first two weeks postpartum. PPP is a psychiatric emergency. It is important that women with a history of bipolar disorder be followed by a psychiatrist throughout pregnancy and postpartum.

For more detailed information on PMADs or for resources, please visit the following web sites.

www.mededppd.org

www.postpartum.net

www.postpartumhealthalliance.org

Submitted by Gretchen Mallios, LCSW and Yvonne Rothermel, LCSW on behalf of the San Diego Postpartum Health Alliance (PHA). To become a member of PHA and be listed in our provider directory, please visit www.postpartumhealthalliance.org or call 619-254-0023.