Postpartum Depression Doesn’t Look the Same Across the Board

I always try to keep up with the multitude of articles that feature Karen Kleiman, MSW, LCSW, founder of The Postpartum Stress Center and author of numerous books on perinatal mood disorders.  This particular article from October 4, 2017, titled “Postpartum Depression May Look More Like Anxiety Than Sadness” that appeared on Well and Good, by Annaliese Griffin,  caught my attention.  It caught my attention because it’s because when my doctor told me 13 years ago that I had postpartum depression (PPD), I didn’t believe him.  I thought “How could I be depressed if I’m not even sad?”  He explained that depression could manifest as anxiety, but did I understand that at the time?  Nope. Little did I know that I was about to embark on a journey to discovering what PPD really was….that it’s a catch-all term that encompasses all postpartum mood disorders, which includes postpartum anxiety, postpartum OCD, and postpartum psychosis.  That my PPD caused insomnia, weight loss, loss of appetite, and being a shell of a person unable to enjoy anything, and unable to pretty much do anything.  I was so concerned about my baby’s cradle cap and eczema and her bowel movement/feeding schedules that, by the time her colic came and went at my 6th week postpartum, PPD set in and I had no idea what was happening to me.

This article is very important because the number of women suffering from postpartum mood and anxiety disorders (PMADs) is pretty common.  And I should know because of the number of hits I get on my blog for the symptoms that I experienced.  So, if it’s been over 3-4 weeks since you had your baby and if you are feeling anxious, unable to sleep even when the baby sleeps and unable to function and enjoy things you’re normally able to enjoy (like listening to music), having moments of rage, having panic attacks, and/or having obsessive and even scary thoughts, please go the Postpartum Support International (PSI) website to seek help near you.  You are not alone, there is nothing to feel ashamed of, and you will get better with the right help.  Do not be afraid to ask for and accept help.

Jessica Porten’s story went viral a week ago because she admitted to the nurse at her OB/GYN office that she was experiencing feelings of anger, and that admission was unfortunately not handled correctly.  This, my friends, is why I have been blogging for the past nearly 9 years.  My mission is to help spread awareness and in so doing dissipate the stubborn stigma that refuses to go away because there is still so much ignorance about PPD.  My mission is to also help mothers as much as I can to get the help they need.  Anger/rage is another way that PPD can manifest for some mothers.  Everyone’s PPD experience is unique to that person because we are all complex people that– when emotions, temperaments, hormones, heredity, childbirth experience, and history come together–symptoms manifest differently from one person to the next.  Symptoms can range from feelings of sadness to anxiety, anger and even rage to insomnia, sleeping too much, lack of appetite, eating too much, obsessive/intrusive thoughts, etc.  As such, treatment of these moms will vary from one mother to the next.  Some moms need medication. Some moms need therapy.  Some moms need a combination of medication and therapy.  The duration of treatment will vary as well.  But there is one thing in common among all mothers suffering from PPD:  they need help.  They don’t need to be treated the way Jessica Porten was treated.  They don’t need to be treated like I was treated 13 years ago.

Erica Chidi Cohen, a doula and co-founder and CEO of  Loom in Los Angeles attributes postpartum anxiety to first-time mothers feeling uncertain and anxious about going through childbirth and taking care of a baby for the first time. It is more common than you think for first-time mother to feel anxious but when the anxiety morphs beyond worry to insomnia, lack of appetite, etc. is when medical attention is needed.  A traumatic childbirth experience increases the chances for a new mother to experience PPD.

Click here to visit Kleiman’s The Postpartum Pact. It is an important postpartum toolkit for expectant mothers and their partners and loved ones to review before baby’s arrival.  It truly pays to be prepared, regardless of whether you think you may be at risk for PPD or not.  One never knows, as I have said in prior blog posts and in my book, whether something may happen during pregnancy/childbirth that could lead to PPD.  It can’t hurt to review the pact and prepare to have folks lined up to help once baby arrives to ensure the new mother has adequate practical support, especially if this is her first baby or if she has another little one(s) to take care of already.

Speaking of adequate support, it’s organizations like Loom in Los Angeles and Whole Mother Village  in W. Orange, NJ — two examples of many childbirth, pregnancy, and reproductive wellness communities that have sprouted around the country to provide support, information, referrals and services from preconception to parenthood– that are critical because it takes a village when it comes to a family’s well-being.  Going it alone is not a viable option nowadays, especially when the significant other needs to work to support the family and the new mother is not well and family members are not close by and/or are too busy to provide emotional and practical support.  It really is no wonder there are so many cases of PPD.  Please see my past posts about the importance of mothering the mother and how it takes a village to minimize the occurrence of PPD here and here.

 

 

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Postpartum Bipolar Disorder: The Invisible Postpartum Mood Disorder

In response to my blog post from February 3, 2016 titled “15%-21% of Moms Suffer from a Perinatal Mood Disorder” in which I mention yet another mother who suffered from a postpartum condition that resulted in tragedy, fellow maternal mental health advocate Dyane Leshin-Harwood left me a comment that prompted me to offer her to explain why it’s so crucial to know the difference between postpartum bipolar and postpartum psychosis.  I explained to her that I haven’t seen much out there on a comparison between the two, and of course, the more we speak up about these conditions, the better off we all are!  These are illnesses that are extremely misunderstood, which can result in unnecessary stigma, mothers not getting the help they need because they don’t know who to go to for help, doctors not necessarily knowing how to properly diagnose and/or treat these mothers……and sometimes leading to tragic circumstances.

So, without further ado, I’d like to share Dyane’s story and important information about postpartum bipolar disorder.  Thank you, Dyane, for all the work that you do as a maternal mental heath advocate!

Postpartum Bipolar Disorder: The Invisible Postpartum Mood Disorder

Like father, like daughter: I grew up close to my father, a professional violinist who had bipolar disorder. In this photo I was eight months pregnant, and I never suspected that childbirth would trigger my bipolar disorder.

Like father, like daughter: I grew up close to my father, a professional violinist who had bipolar disorder. In this photo I was eight months pregnant, and I never suspected that childbirth would trigger my bipolar disorder.

By Dyane Leshin-Harwood 

Bipolar disorder, postpartum depression and postpartum psychosis have recently made media headlines. Katie Holmes stars as a lovestruck poet with bipolar disorder in the film Touched With Fire. The British hit television show EastEnders featured a postpartum psychosis storyline that gained national attention. Last January in a landmark decision, the U.S. Preventative Task Force called for screening for depression during and after pregnancy.

While the greater awareness of postpartum mood disorders is promising, postpartum bipolar disorder, the mood disorder I was diagnosed with, is virtually unheard of. Postpartum bipolar is also known as bipolar, peripartum onset, and it’s arguably the least known of the six postpartum mood and anxiety disorders.

It might seem unimportant to publicize an obscure mood disorder, but every mom’s postpartum experience counts. Many medical professionals are unaware that postpartum bipolar exists. Some postpartum and bipolar organizations are unfamiliar with postpartum bipolar or they’re unclear about its definition.

When I was pregnant, my obstetrician didn’t question me about my mental health or my family’s mental health history. My father had bipolar disorder, but before and during my pregnancy I didn’t show any signs of mental illness.

When I went into labor, my life changed overnight.

We went to the hospital and I stayed up all night in pain. When my daughter Marilla was born the next day, I became hypomanic. I was exuberant and talkative (both signs of hypomania), but I appeared relatively normal. My baby attracted most of the attention, and no one noticed that I was in trouble. Exhausted, I sensed something was off, but I kept my fearful feelings inside.

Within forty-eight hours I had hypergraphia, a rare condition in which one compulsively writes. I wrote at every opportunity, even during breastfeeding, when I should’ve been resting and focusing on my baby. I could barely sleep as my mania escalated, and poor Marilla didn’t gain enough weight because I didn’t breastfeed her sufficiently.

A month postpartum, I knew I was manic; after all, I had witnessed mania in my Dad. I frantically searched the internet about postpartum mania, but my search only yielded postpartum psychosis statistics. During Marilla’s six-week checkup, her observant pediatrician heard my racing voice and pressurized speech (symptoms of bipolar) and blurted out “Dyane, I think you’re manic!”

I burst into tears. While I felt ashamed, I was relieved that he realized what was happening. It was clear I needed hospitalization, but leaving my newborn was agonizing. I admitted myself into a hospital’s psychiatric unit where I was diagnosed with postpartum bipolar disorder.

After years of hospitalizations, medication trials, and electroconvulsive (ECT) therapy, I’m stable and doing well. While bipolar disorder ravages many relationships, my husband and I have stayed together, in part, thanks to the guidance of counselors and psychiatrists. Life will always be a challenge, but my two daughters inspire me to take care of myself.

While chances of postpartum bipolar are low, it can affect any mother. Obstetrician and Perinatal Mental Health Lead Dr. Raja Gangopadhyay of West Hertfordshire Hospitals NHS Trust, UK, explains,

“The risk of developing new-onset severe mental illness is higher in early post-childbirth period than any other time in women’s life. Family history, pre-existing mental health conditions, traumatic birth experience and sleep deprivation could be potential risk factors. Bipolar illness can present for the first time during this period. Accurate diagnosis is the key to the recovery.”

Confusion abounds regarding postpartum bipolar and postpartum psychosis. While the two conditions can present together, postpartum bipolar isn’t always accompanied by postpartum psychosis. Perinatal psychologist Shoshana Bennett Ph.D., co-author of the bestselling classic Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression and Anxiety says,

“Many women I’ve worked with had been previously misdiagnosed with postpartum depression. I always make a point of discussing this during my presentations. In addition, postpartum bipolar disorder deserves its own category separate from postpartum psychosis.”

Mental health screening during pregnancy would be of immense value to every mom. Women with a family history of bipolar disorder could be observed postpartum, and if symptoms manifested they’d be treated immediately. It’s imperative that doctors and other caregivers assess women not only for postpartum depression but also bipolar symptoms.

Everyone who lives with a stigmatized illness deserves a chance to find support and empathy from others who understand her experience. Through connecting with those who can relate to our mood disorder, we may not find a magic cure, but virtual support can be profoundly helpful. Postpartum Support International recently created online support groups in English and Spanish led by trained facilitators, while the Postpartum Progress website offers moms a private forum to interact with one another. I’ve never personally met another mom who has postpartum bipolar and I yearn to do so. If you or someone you know is or might be suffering with postpartum bipolar disorder please reach out — I’d love to hear from you!

Kona

My daughters Avonlea, Marilla and husband Craig stood by me through the roughest times.

Dyane’s bio:

Dyane Leshin-Harwood holds a B.A. in English and American Literature from the University of California at Santa Cruz. A freelance writer for over two decades, she has interviewed luminaries including Madeleine L’Engle, Dr. Kay Redfield Jamison and SARK. Dyane was diagnosed with postpartum bipolar disorder (bipolar, peripartum onset) in 2007. Dyane was selected as an International Bipolar Foundation Story of Hope and Recovery, and a PsychCentral Mental Health Hero. She’s raising her daughters Avonlea and Marilla with her husband Craig and serves as women’s postpartum mental health advocate. Dyane founded the Santa Cruz, California chapter of the Depression and Bipolar Support Alliance (DBSA) and facilitates free support groups for moms with mood disorders. She’s a member of the International Society for Bipolar Disorders and Postpartum Support International. Dyane’s memoir Birth of a New Brain – Healing from Postpartum Bipolar Disorder will be published by Post Hill Press in 2017. Dyane is a Huffington Post blogger. Visit Dyane’s blog Birth of a New Brain at: www.proudlybipolar.wordpress.com and find her on Twitter: @birthofnewbrain

FOR MIRIAM

Has it really been over 2 months since my last blog post?  I did say previously that I’ve been slowly losing momentum over the past year or so.  As most bloggers can appreciate, my tendency is to blog in reaction to something that either upsets me or excites me.  While there’s been a general lack of negative news (including ignorant things uttered by the public and journalists about incidents that only serve to further stigmatize postpartum mood and disorders, or PMADs), there’s also been a dearth of exciting new research, legislative and/or postpartum support services developments over the past couple of months to motivate me to put pen to paper—or fingers to keyboard.  The former is good; the latter not so good.

Well, I’ve taken up the virtual pen to write today’s blog post.  It’s a blog post that will share the same title with numerous others (based on the support the For Miriam FB page has received in the past few days) who are banding together to spread awareness about PMADs.  These blog posts are dedicated to Miriam Carey.

Miriam.  We know she was a mother.  We know she had her one year old child in her car.  We know that that child is now without a mother.  We know from what has been shared by Miriam’s loved ones that she was being treated for postpartum psychosis.  We know that medication was found in her Stamford, CT, home.  We know she was using her vehicle in a way that caused law enforcement to, unfortunately, shoot to kill.  We know (but far from like the fact) that they are trained to do that.  Though, I’m not sure the one who shot her feels too good about what they had to do.  This loss of life is, simply put, tragic….and the reason why my dear friend, Dr. Walker Karraa, decided to corral this blog carnival in Miriam’s name.

Anyhow, without Miriam’s doctor coming forward and confirming the actual diagnosis, let’s just say that we are going to take this opportunity—since misinformation was once again so quick to be released to the public—to educate the public about PMADs.  Postpartum depression (PPD), postpartum psychosis (PPP), and postpartum obsessive compulsive disorder are some of the PMADs that exist.  They are real and they are treatable.  Problem is, all too many mothers suffering such disorders are 1) failing to seek treatment for whatever reason, 2) seeking help but are either not getting the right treatment or are getting the right treatment but not staying on it long enough for it to become effective, and/or 3) not getting enough support during recovery.

A lot of people have this tendency—a tendency that is in serious need of a reality check—to use PPD to generalize the spectrum of PMADs that exist.  It does not help anyone to report in such a fashion as to fan the embers of stigma and myths that PMAD advocates are trying so desperately to put out.  It definitely does NOT help when you have psychologists who are claiming that “postpartum depression has led mothers to kill their children.”  We know we have a lot of work to do if a psychologist is saying things like this on a show watched by over 4 million people.  Talk about taking 1 step forward and 2 gigantic leaps–not steps–backward.  Geez Louise.  Can’t the networks do a better job of finding true subject matter experts from organizations like Postpartum Support International (PSI)?  They should have PSI on their list of subject matter experts under the category of Mental Health (or more aptly Maternal Mental Health).  PSI should be the very FIRST place to consult with in times like this!

I can’t say that absolutely nothing grates me more than major news agencies spreading misinformation, because I do have a couple things that grate me more….but I won’t get into that here.  But I have to say that it angers me enough to want to do something.  Since video/television opportunities are not something I actively seek—and I’m probably the last person anyone would ever call on anyway—the only thing I can do is lend my voice today, on World Mental Health Day 2013.  Today, I join with other bloggers in a For Miriam blog carnival to try to increase the reach of getting our voices out there for the world to see.

PPD is quite a common illness.  It is experienced by one out of eight new mothers.  I am, in fact, a PPD survivor.  Many of the For Miriam bloggers are PMAD survivors.  Many of us took up blogging to try to reach other moms suffering from a PMAD and making sure they don’t suffer as much and feel as alone as we did in our experiences.  We don’t like it that there’s stigma.  We don’t like it that there are unknown numbers of women who fail to seek treatment due to this stigma.  And we definitely don’t like it when we hear about yet another PMAD-related tragedy.

Granted, information is nowadays very accessible when you search on the Internet for information and blogs about PMADs.  However, I still have yet to see posters and pamphlets in all the offices of medical health practitioners (i.e., general practitioners, OB/GYNs) in this country!  Between misleading statements made by mental health care practitioners, like the psychologist interviewed for The Today Show, plus the lack of information proactively being given to the public, we still find ourselves stuck in a similar ignorance- and stigma-filled rut that we were stuck in 12 years ago after the Andrea Yates’ tragedy.   I can’t say how disappointed and frustrated I really am.

The good that’s stemming from this tragedy is the number of advocates speaking up and sharing their subject matter expertise on PMADs, specifically PPP.

With that <clearing throat>….

AHEM, ALL MEDIA OUTLETS!  Please DO NOT continue to focus on publishing news in a rush because you want to be the first to get your article out to the public.  Ask yourselves:  Is your priority to get your headline to trend?  Or is it to serve the public well by disseminating accurate information?  Please, please, please read the For Miriam posts and please, please, please go to the below sites for ACCURATE information about PPP:

Postpartum Support International
Dr. Walker Karraa
Postpartum Stress Center (Karen Kleinman)
Perinatal Pro (Susan  Dowd Stone)

Now, as I end this post, I would like to humbly ask you to consider doing the following, as part of World Mental Health Day 2013….and for Miriam:

First, to join me in prayer for Miriam’s loved ones.

Second, to go and read as many of the other For Miriam blog posts that you can find the time to do, and share them on Facebook and Twitter to help spread the word that we will NOT cease in our quest to banish the ignorance and stigma when it comes to maternal mental health matters.

Third, if we see a mom who is in need of support, reach out to her.  Ask her how she’s doing.  If she had a baby within the past year, tell her about PSI.  She just might benefit from speaking to someone on the PSI warm line or seek local PMAD resources.  Remember that  approximately one in eight new mothers will experience a PMAD.

Our mothers matter.  Our families matter. 

Do it for Miriam.

Do it for yourself.

Do it for all the other moms out there who have suffered, are currently suffering, and may someday find themselves suffering from a PMAD.