Third time was not a charm: Postpartum Psychosis (PP)

The goal of this post is that you will be able to recognize the warning signs of postpartum psychosis and know where you and your loved ones can turn to for help. I (Jo) really struggled during postpartum with my first two babies and I prayed that my third would be a charm. It was far from that. The days following her birth I had an unusual amount of energy. Two days after delivery I was running kids to swimming lessons and shopping for cars. I felt overly happy and asked friends if it was normal. My friends stated that they could tell that I was acting a little irrationally and was not myself. I was no longer thinking through things. Living in Arizona, I took my kids to the park on a day that it was over 115 degrees, with a newborn. Sleep continued to be a problem and I eventually went 36 hours without sleep.

By that point I was agitated, was talking excessively, seeing spiders crawling from vents, and having religious delusions. As embarrassing as it is, at my father-in-law’s 50th birthday party I was dressing in camo clothes, wearing socks with flip-flops, and telling people the world was going to end. My "odd" behavior caused my husband to take me to the hospital to get evaluated. They held me for a few hours and since I was not a threat to myself or my baby they sent me home regardless of the fact that I was obviously out of touch with reality. I was suffering from a type of postpartum psychosis. Thankfully, I had a team of supportive family, friends, and medical providers who helped me through the following year. I was on 24-hour watch for 2 months following my E.R. visit. I was on antipsychotic medications, in therapy, and attending support groups.

Postpartum psychosis “usually occurs while in the hospital and often starts within 48 hours of the delivery” (Rosenberg, 2003, p. 9), but can also appear later. It occurs in 1 in 500 to 1 in 1000 deliveries (American Psychiatric Association [APA], 2013, p. 187). To give you a better sense of its prevalence, this number is similar to the number of children born with Down syndrome which happens in 1 in 880 newborns (Arnell & Fischler, 2012).

The following are some of the symptoms of psychosis:

· Delusions or strange beliefs

· Hallucinations (seeing or hearing things that aren’t there)

· Feeling very irritated

· Hyperactivity

· Decreased need for or inability to sleep

· Paranoia and suspiciousness

· Difficulty communicating at times (Postpartum Support International [PSI], n.d.)

· Bizarre behavior (American Pregnancy Association, 2015)

· Irritability

· agitation

· Rapidly shifting moods

· Hearing voices that tell her to harm herself or the baby (Harvard Health Publications, 2011)

Note: Having bipolar disorder puts you at an increased risk of developing postpartum psychosis (Harvard Health Publications, 2011). Having postpartum psychosis with a previous pregnancy increases your chances of having it again between 30% and 50% (APA, 2013, p. 187).

One study found that “The most prevalent symptoms of PP are irritability (73%), abnormal thought content (72%) and anxiety (71%)” (Kamperman, Veldman-Hoek, Wesseloo, Blackmore, & Bergink, 2017, abstract). Another study looked at an underlying bipolar disorder and they found that “The most commonly recalled symptoms were feeling excited, elated or high (52%), not needing to sleep or not able to sleep (48%), feeling active or energetic (37%) and talking more or feeling very chatty (31%)… These symptoms should be carefully monitored in individuals at high risk of PP episodes” (Heron, McGuinness, Blackmore, Craddock, & Jones, 2008, abstract).
It is a myth that all moms with psychosis have suicidal or infanticidal ideation. Suicidal ideation occurs in only 19% of those patients and infanticidal in only 8% (Kamperman et al., 2017). Regardless of whether or not you are a threat, this illness is still an emergency and is not a condition that anyone, the mom or family, should hide (Rosenberg, 2003).

It took me a great length of time to gain back my self-confidence after losing touch with reality. I feared that I would forever be in a state of the unknown, not knowing if I would return to my usual self. I am living proof that this is a temporary state. When I found that I couldn’t control what I was mentally experiencing I could control my physical experience. Focusing on what I could control gave me a sense of empowerment. I had never run a mile in my life prior to having my 3rd baby, so I am grateful for a mom and friends who pushed me to get out of the house and go for walks. Those walks turned into jogs, and those jogs turned into runs. One mile became two, two became three, and then soon this girl who had never run a mile in her life completed multiple half marathons. By the end of my journey, I found hope, healing, and strength. I am a firm believer that you will too! Here is a great site to visit if you or someone you love is struggling with PP https://www.app-network.org/.

Photo courtesy of pixabay.com

In conclusion, I am so grateful to have had a support network that knew the signs of postpartum illness. My husband knew who he could call for help and my network of family and friends bent over backward to make sure I was taken care of.

We always encourage those who read this blog to come up with questions you would like to have answered about postpartum illness in future posts. Please comment with your questions or leave a note in the survey below. We love feedback!

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References

American Pregnancy Association. (2015). Do I have a form of postpartum depression? Retrieved from http://americanpregnancy.org/first-year-of-life/forms-of-postpartum-depression/

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Arnell, H., & Fischler, B. (2012, November). Population-based study of the incidence and clinical outcome of neonatal cholestasis in patients with Down syndrome. Journal of Pediatrics, 161(5), 899-902. http://dx.doi.org/10.1016/j.jpeds.2012.04.037

Harvard Health Publications. (2011, September). Beyond the "baby blues": Postpartum depression is common and treatable. Harvard Mental Health Letter, 28(3). Retrieved from http://library.byui.edu/

Heron, J., McGuinness, M., Blackmore, E. R., Craddock, N., & Jones, I. (2008, February). Early postpartum symptoms in puerperal psychosis. BJOG: An International Journal of Obstetrics & Gynecology, 115(3), 348-353. http://dx.doi.org/10.1111/j.1471-0528.2007.01563.x

Kamperman, A. M., Veldman-Hoek, M. J., Wesseloo, R., Blackmore, E. R., & Bergink, V. (2017, September). Phenotypical characteristics of postpartum psychosis: A clinical cohort study. Bipolar Disorders, 19(6), 450-457. http://dx.doi.org/10.1111/bdi.12523

Postpartum Support International. (n.d.). Retrieved from http://www.postpartum.net/learn-more/postpartum-psychosis/

Rosenberg, R. (2003). Conquering postpartum depression: A proven plan for recovery. Cambridge, MA : Da Capo Press.