The Truth About Postpartum Psychosis
There is more than the media reports
At first Jennifer Moyer settled easily into motherhood. She recovered from a difficult delivery and the baby blues and was enjoying her role as a mom so much that she decided not to return to work. And then, one night when her son was 8 weeks old, Moyer was seized by the fear that someone was going to kill her and take her baby.
Moyer could not sleep that night or the next two. By the third sleepless night, her fear had ballooned into an unshakable belief that her husband and friends were evil. She did not trust anyone to be near her or her baby. While sitting in a church pew at her niece's piano recital, Moyer hallucinated that the priest was going to sacrifice her baby.
Moyer's husband quickly understood that she was not in her right mind and called her OB who called 911. When the paramedics arrived, Moyer screamed scripture at them to protect her son. She was taken to the hospital by force. "I had no idea what was happening to me," says Moyer, now 46 and living near Pensacola, Florida. "My family and I were totally unprepared for this. I had never had a history of mental illness."
Moyer was experiencing postpartum psychosis (PPP), a rare, but very serious condition that affects only one or two women in 1,000. Though she was familiar with postpartum depression, which some 15 percent of moms experience, and the baby blues, which can affect more than three-quarters of moms, Moyer had never heard of PPP. When she was diagnosed with it, she felt immense relief. "It was like, 'Oh my gosh, I'm not crazy. I'm not possessed.'"
'A tornado that comes out of nowhere'
Women with PPP lose touch with reality, which can be dangerous for both them and their babies, says Susan Hatters Friedman, MD, an associate professor of psychological medicine at the University of Auckland in New Zealand. As a result, she says, in some cases a woman with PPP "is not able to bond with the baby or keep it safe."
The symptoms of PPP often appear without warning, usually soon after giving birth (between a day and a couple weeks), although the condition can appear anytime in the first year. "PPP is like a tornado because it can come out of nowhere," says Moyer.
The symptoms of postpartum psychosis:
• Paranoid delusions. Friedman often sees women who have irrational beliefs about their baby or partner such as thinking that "their baby was switched at birth or their husband is cheating on them."
• Rapid mood swings. Most women who develop PPP have symptoms similar to bipolar disorder, says Margaret Spinelli, MD, director of the maternal mental health program at Columbia University. They can flip from feeling energetic and powerful to depressed and anxious, typically several times a day.
• Depression. Although less common, some women with PPP experience only depression with no mania, such as losing interest in normal activities, having trouble sleeping, or feeling tired or anxious. But PPP differs from postpartum depression and postpartum anxiety because women with the condition become irrational and disconnected from reality and experience delusions and/or hallucinations.
• Confusion. It is not uncommon for women with PPP to get confused about normal activities, such as how to warm up a baby's formula or which bottle to use.
• Thoughts about harming the baby. In less than 10 percent of cases, women with PPP have thoughts of wanting to harm their babies. In much rarer instances (about 4 percent) women with PPP kill their babies or take their own life (0.2 percent).
If a woman is experiencing paranoia, confusion, or depression, she should get help as soon as possible, says Friedman. She should call her OB or any trusted healthcare provider who can connect her with a mental health specialist. But if a woman has more serious symptoms, such as hallucinations, severe mood swings, or the desire to hurt herself or her baby, she should go immediately to the ER.
Stigma keeps women from getting help
The complex range of symptoms associated with PPP is a very different picture from the one that comes to mind when many people think of the condition. The trial of Andrea Yates, the mother who, in a postpartum psychotic state, drowned her five children in the bathtub in 2001, attracted worldwide attention. "Journalists would say that the good news is we brought attention to this, but the reality is there was so much misinformation," says Karen Kleiman, MSW, LCSW, founder and executive director of the Postpartum Stress Center.
Even though the number of women with PPP who hurt themselves and their babies is small, their dramatic experiences often make headlines in the media. This skewed perception "can scare women into paralysis and prevent them from getting the help they need," says Kleiman.
The truth is that PPP can develop many different ways. The vast majority of women with PPP are not a threat to themselves or their children (and those who are need immediate help), and there are many early signs and successful treatments.
The bipolar connection
Most experts now believe PPP is a form of bipolar disorder that occurs after women give birth. "About 75 or 80 percent of women [with PPP] will end up having bipolar disorder," says Friedman, even if they did not previously have the condition or it was not diagnosed.
For women who already have a bipolar disorder, the postpartum period is a much riskier time than it is for women without the condition. Between 25 and 50 percent of them will experience PPP.
Jennifer Marshall, a 34-year-old mom of two in the D.C. area, was diagnosed with bipolar disorder two years before she had her first child in 2008. Her psychiatrist cautioned her about relapsing and having a manic episode in the postpartum period.
Marshall went off her medication during pregnancy because she was concerned it could hurt her developing baby and, just as her doctor worried, experienced symptoms almost immediately after her son was born. "I was up all night and I was on this high like my whole body was buzzing…When we got home, I didn't need sleep, [and] I didn't need to eat. I felt like I had superhero powers," says Marshall, who is cocreator of a show about people with mental illness, This Is My Brave. "Thank God I had that meeting with [the psychiatrist] because my husband knew to call her."
Marshall's husband called the police, who forced Marshall to go to the hospital, where she began to accept that she did have a persistent mental illness and needed to keep taking her mood stabilizer. Marshall continued treatment under close supervision for most of her subsequent pregnancy and had a healthy daughter and a much easier postpartum period.
The importance of being prepared
Women who experience PPP are at greater risk for having an episode in the future. A 2005 study of 103 women in the UK who had PPP found that 57 percent experienced psychosis after having another child, and 62 percent had an episode not related to childbirth at some point in the following nine years. Having a close relative who has experienced PPP or has bipolar disorder also increases a woman's risk of either condition.
Three ways to prevent or prepare for postpartum psychosis
Plan ahead: Friedman encourages women at high risk of PPP to see a psychiatrist specializing in perinatal mood disorders before and during pregnancy to have their mood monitored and receive treatment quickly if it becomes necessary.
Monitor your sleep: For many women lack of sleep is both a major trigger and an early warning sign of PPP. Looking back, Marshall says that her PPP and manic episodes all came on during periods when she was too excited or stressed to sleep. "If a woman feels hyped up and is not able to sleep, that is a warning sign that she should see her doctor," says Friedman.
Put a support system in place: Friedman talks with all women, especially those at high risk of PPP, about the importance of having a strong support system of family and friends during the postpartum period. She encourages women to have their partner or a baby nurse do night feedings so moms don't lose sleep.
Family and friends also play a crucial role in noticing the symptoms of PPP, because "women with PPP cannot be shaken from delusions and do not believe they are ill," says Spinelli.
Symptoms that friends and relatives should watch out for include:
• Being unable to sleep
• Acting very energetic or agitated
• Being unable to get out of bed
• Showing unusual or nonsensical behavior
• Acting fearful or paranoid
• Believing bizarre ideas, such as thinking that the baby is the devil
"If a family member of friend notices a woman having one or some of these symptoms, they should err on the side of safety and call a doctor or go to the ER," says Spinelli. They should also ask the woman if she feels like hurting herself or her baby and get help immediately if she does.
Postpartum psychosis is treatable
PPP is "perfectly treatable," says Spinelli, though it is a more severe condition than postpartum depression and requires medication. Women usually take a mood stabilizer and an antipsychotic. Doctors generally keep women on medications for a year before tapering them off.
"It is important to help women build themselves back up," says Preble, a 35-year-old mom of two in Buffalo, New York, who supports struggling mothers through her Victorious Moms site.
Like Preble, Moyer now works to help women going through what she did and to let them know, "there is a light at the end of the tunnel."