PostPartum Depression and PostPartum Psychosis

POSTPARTUM VULNERABILITY: What Every 
Pregnant Woman Should Know about DEPRESSION
and PSYCHOSIS After Childbirth

By Helen Borel, R.N.,Ph.D.

This article is addressed specifically to you, the pregnant woman or the new mother.
As well, it is imperative reading for the father-to-be or the new father. Ideally, too,
prospective or new grandparents and extended family should also become
familiar with the facts, professional treatments and supportive strategies about the
two major mental illnesses associated with post-childbirth.

Please read my article (below)
“DEPRESSION: SYMPTOMS AND TREATMENTS” to learn, in easy-to-read
language, about what depression is and the many ways it can be treated.

As for PSYCHOSIS, usually this designation refers to schizophrenia where
patients hear voices, see visions; to the mania of Bipolar episodes; to ultra-severe
depressive delusional states, where patients' thinking is distorted and bizarre beliefs
emerge; or to drug-induced psychotic behaviors of some addicts. In the case of
psychosis arising post-childbirth, it is possible this is a temporary, curable state.
Particularly valuable to realize because the earlier such a condition is diagnosed
and treated, the better the prognosis (outcome).

In many psychotic conditions, patients must be hospitalized for their own safety and
for the safety of others.  This is because delusional thinking and psychosis-induced
voices may instruct the patient to do something dangerous to herself or to kill
her infant.

It’s not necessary to here go into the many psychopharmacologic and physiologic
treatments for psychotic states.  Fortunately, we’ve graduated from only the one
antipsychotic medication of decades ago for schizophrenia – Thorazine(R)
(chlorpromazine) –  to a wide array of pharmaceutical options prescribed by
psychopharmacologists (MD-Psychiatrists who specialize in the Rx psychotropic
treatment of mental illnesses, including the psychoses).  And these treatments must
be begun stat! (immediately!) in the hospital.  And the postpartum psychotic new
mother must remain in the hospital, not sent home on strong psychotropic meds
unmonitored.

Not sent home without Psych-RN care and supervision. Never sent home because
of Insurance Company Nonpayment.  Never sent home...until no longer psychotic.
Never discharged from the Psych Hospital or the Psych Unit of the General
Hospital until healthy and able to safely care for her newborn and her other
children.

I am mindful of the fact that the prospect of a new baby is usually joyously anticipated.
By no means is this article meant to dampen that happiness or to scare you.  However,
among all the popular books for new parents with their many helpful instructions for
pregnancy post-birth self-care and newborn care, the two major mental health crises of
new mothers are either glossed over or never brought up at all.  And you can’t protect
yourself from what you know nothing about.  So, you can anticipate the new baby’s life
while remaining aware of signs and symptoms that should send you for immediate
professional help.

Psychiatrists and Obstetricians Have a Duty to Discuss in-depth
Postpartum Psychosis and Postpartum Depression with Child-Bearing
and Postpartum Mothers...AND TO DISCUSS THESE IN  PUBLIC
MEDIA so everyone is prepared and can take appropriate medical action
before a catastrophe such as maternal suicide or infanticide.
I’ve always felt that all behavioral and mental health conditions should be openly
addressed, by medical professionals, to the public.  And where issues specific to
psychiatry are concerned, psychiatrists should speak up!

The Silence of the Doctors Who Should Speak Publically
Unfortunately, in the case of the two major postpartum mental illnesses, even
when a tragedy like the Andrea Yates case screams in the headlines, MDs
are maddeningly silent.

In her severely psychotic state and just recently wrongly-discharged by a
a misguided hospital psychiatrist (probably due to insurance company
noncoverage) from badly needed hospitalization, on antipsychotic medication,
with no psych RN in her home to care for her, Mrs. Yates killed
all 5 of her babies and children.

‘Though prime news at the time, I was astounded by the LOUD SILENCE FROM
THE OBSTETRICAL AND PSYCHIATRIC COMMUNITIES about this
tragedy and how the healthcare professions, specifically obstetricians and
psychiatrists can and must do better than this.  Especially since, in many cases,
both postpartum depression and postpartum psychosis may be temporary 
conditions probably attributable to drastic hormonal shifts in the estrogen-
progesterone balance immediately and subsequently to childbirth.

Why psychiatrists contribute little-to-nothing to public awareness of obstetrical-
related mental illnesses, necessary to mount timely preventive measures....And
why obstetricians contribute even less to what should be maternal-family and
ongoing, in-depth public discussion, public health awareness and prophylaxis
against the two post-childbirth mental health downward  roller coasters
...is a mystery.

There has always been a societal stigma attached to mental illness.  Today,
however, with wide-ranging research demonstrating the biologic basis for many
mental illnesses – such as Bipolar Disorder, Chronic Depression, Panic Attacks,
yes and even schizophrenia, the mentally ill have begun to be embraced as
“one of us” after all.

Furthermore, it’s impossible to extricate your mind from your body (our brains
are bathed in neurochemicals similar to those that impact our immune systems
 for illness or wellness).  So, the interplay between bodily-brain physical processes
and the functions of the mind – thoughts, feelings, experiential memories, dreams,
nightmares, griefs, etc. – is inescapable.  Awareness of this interaction is crucial
to this new century’s scientific and societal grasps of mental illness as
biopsychologic or psychobiologic.  And that it’s to everyone’s benefit to
publicize the advent of improved diagnostic tools and the many new physical,
pharmaceutical and psychotherapeutic treatments now available to significantly
improve the lives, the general health and the emotional health of patients with
health conditions that manifest as thought and behavioral distortions.Many of
which can now be ameliorated to varying degrees, some even to cures.

Therefore, with these thoughts and imperatives in mind, let the elements of this
article heighten everyone’s awareness to two physically-caused mental illnesses
that can be diagnosed early when obstetricians and obstetrical RNs heighten
their awareness levels of the signs and symptoms the new mother and/or family
members should immediately report to them upon having them, feeling them,
hallucinating them, etc.  Early diagnosis or suspect diagnosis should   result in
immediate referral to a psychiatrist who will evaluate and usually prescribe
appropriate antidepressant or antipsychotic medication and hospitalization.
The latter essential in the case of postpartum psychosis.

© Copyright 2006-2015 Dr. Helen Borel. All rights reserved.

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