Postpartum psychosis - how it happened to me (Part I)

I was online this afternoon and came across a story in our local online newspaper about a woman who had experienced postpartum psychosis after the birth of her second child. She stopped her car in the middle of DC afternoon rush hour traffic, took off all her clothes, and was running along the shoulder of the road towards a bridge over the Potomac River. She was convinced that she needed to be baptized in the water because the world was ending. The details of her story are eerily familiar to me. I feel for her that she had to go through something as embarrassing as stripping down naked in public. Could you imagine?

But at the same time I am so incredibly proud of her for standing up and telling her story - publicly. She is a brave woman and I truly respect her. She is not afraid of speaking out about this rare disorder that affects only one to two women out of 1,000. It doesn't sound like many at all, but when you do the math, that computes out to 4,100 to 8,200 women in a year based on the average number of annual births.

I think it's about time that PPP gets a voice. There is so much information out there about postpartum depression, but if you ask anyone if they know anything about postpartum psychosis, I would venture to bet that they'd bring up Andrea Yates, the Texas mother who killed her five young children by drowning them in the bathtub in June of 2001. But only five percent of women with postpartum psychosis commit suicide and only four percent commit infanticide.

Those numbers could be so much lower, if the general public were aware of the signs and symptoms of postpartum psychosis so that they could intervene before a tragedy could occur. When a woman finds out she is pregnant and begins reading the various pregnancy books out there, there is always a chapter on postpartum depression. I wish those authors would cover the other side of the spectrum too. There are lives at stake.

It happened to me after the birth of our first child in September of 2008. He was a healthy 6 pounds, 12 ounces, delivered via emergency C-section. (He wasn't tolerating the contractions since his heart rate was taking a nosedive with each one, and I wasn't dialating past 5 inches, so the decision was made and at that point I was so exhausted I just couldn't wait for him to be out.) I was absolutely determined to breastfeed him, yet had no clue what I was doing. I just felt all of this outside pressure to make breastfeeding work - all of my friends had breastfeed their children, the books and magazines you read all say that "breast is best" and of course all the literature at the doctor's office was the same. Even the formula company's marketing materials pushed breastfeeding. So of course I put a ton of pressure on myself to make it work. It made those first few days and weeks with baby boy so grueling, draining, and sad. Due to the C-section, and the added stress I was putting on myself to be successful at nursing, my milk took almost a full week to come in. I was breaking out in hives up and down my legs every night because I was so stressed out. Instead of enjoy my baby, I was feeling like I was failing as a mother because I couldn't feed him. The pediatrician had us start supplementing with formula at his 2-day check-up because he had lost too much weight. I was barely sleeping at all. That is how the mania started to spiral me into psychosis.

The days and nights started to mush together as I started to live life in 2-hour increments. The baby would nurse for 45-minutes, then we'd do a diaper change, then he'd nap, but in the hour that he napped I felt as though I had a million things to do so I never napped myself. And it wasn't as if I didn't have help with me. My parents stayed for a week after the baby was born and my husband was off from work for two weeks. So I did have times when I could hand over the baby, but yet, things still had to get done.

It was about seven days after he was born that I remember breaking down in tears in front of my mom with the phone in my hand, outstretched to her, pleading, "Please call my OB and ask her what med I can take that will help me sleep! I can't sleep!"  My mom called and they said I could use Tylenol PM while nursing, and so I did that afternoon and slept four hours straight, the longest stretch of sleep I had gotten since having the baby. The next day my mom changed her flight so that she could stay a few extra days to help out.

I remember feeling as though my mind was starting to race uncontrollably at times during those first four weeks after my son's birth, but somehow I was able to hide it from my husband and my parents. I wanted to be able to breastfeed my son and I knew I couldn't do that while taking medication. So I continued to fight the racing thoughts, but they quickly caught up with me in a big way.

We had our son baptized when he was four weeks and two days old. My parents flew back into town for the ceremony, and stayed with us for that weekend. I drove them and my brother and sister-in-law to the airport on Monday morning. On Tuesday morning I had become manic to the point of psychotic, and had to be hospitalized because I refused to take medication.

I spent a week in a psychiatric facility where the doctors stabilized me using a combination of anti-psychotics, sleep medications, and the mood-stabilizer Lithium. I could not believe that I had missed out on my son's fifth week of life. Completely.

The insomnia was the first and most prominent symptom for me. The delusions and hallucinations are a close second. I refused to eat at times. Each and every sound I hear is amplified one hundred percent. These are the symptoms that I experienced every time I had been hospitalized. Which up until that point had been twice.

The common theme that I experience when I become manic to the point of psychotic is the feeling that the world is ending. Let me tell you - it has got to be the scariest feeling in the world when you are absolutely convinced that it is happening. The time I lost touch with reality after our son was born, I remember that I had been sleeping upstairs since my husband said he would take care of the baby so that I could get some rest. I woke up at some point in the middle of the night and went downstairs to find him asleep on the couch, the gas fireplace blazing, with our son snoozing peacefully on his chest. For a split-second I thought about grabbing my camera to take a picture, but I had no idea where it was or else it seemed like too much of an effort to find it, so I didn't bother. I just woke my husband up and we went upstairs to bed, putting the baby down in the bassinet by our bedside.

A few hours later I couldn't sleep because I kept thinking I heard the baby crying. But he wasn't. My husband kept telling me to go back to sleep. But I couldn't. When he woke up an hour or so later to get ready for work, he knew right away that I wasn't right and he needed to call for help.

(To be continued...)


A "deficiency" or mental illness?

I was discussing my blog with my father over the weekend because I was still torn over the issue of whether or not to disclose my true identity in my writing. He and I both agree on the point that there is an incredible amount of stigma still attached to the label of bipolar in our society, and then he said something that really made me think. He told me that he doesn't consider me to have a mental illness, per say, he feels that I simply have a "deficiency in my brain chemistry" which causes me to become psychologically impaired during times when I am unmedicated. Humph. Good point Dad. Especially because all three of my hospitalizations prior to the first where we had no clue that I was Bipolar, happened when I was not on my medications.

But are you saying this simply so that you do not have to be constantly reminded that your child has a psychiatric condition? I guess "deficiency" just makes it feel better.

I mean, I see your reasoning. And it does make sense. It is true that I really only require a small amount of Lithium to function at a completely normal level. So, as long as I take my meds (which I do religiously - my past has taught me some very valuable lessons, let me tell you) I'm normal. Balanced. Sane.

Not mentally ill.


History has proven for me that within a week of going off my medication, I'm spinning out of control and am clinically psychotic. It takes a couple of weeks on anti-psychotics to bring me back to the middle.

So yeah, I guess you could say that my brain is deficient. It's so weird to me that all it takes to keep me normal is a small amount of a naturally occurring salt. When I looked up Lithium Carbonate on Wikipedia, I wasn't surprised to read this:

Upon ingestion, lithium becomes widely distributed in the central nervous system and interacts with a number of neurotransmitters and receptors, decreasing norepinephrine release and increasing serotonin synthesis.

After my most recent hospitalization, I was released to the care of my regular psychiatrist who had been helping me try to stay off Lithium during the pregnancy since I wanted to be medication-free for the first trimester to give the heart time to form without being exposed to Lithium. At my first appointment with her post-hospital, she and I agreed to continue using the anti-psychotic, but to try to stay away from the Lithium as long as possible. That next month was really hard. I literally had trouble putting words together to form sentences. I couldn't talk right. I jumbled my speech. I couldn't write with a pen and paper. I avoided my friends because I didn't want them to see me that way. I remember telling my psychiatrist, months later once I was stabilized again on Lithium, that at the time it felt like the neurons in my brain were broken, they weren't firing the way they should have been so that I could think and make sense of things. It was awful. I needed Lithium in my blood.

I specifically remember the morning that I called my high-risk OB-GYN to tell him I had recently come home from a hospitalization. I told him I wanted to stay off the Lithium for the first trimester, but he said it sounded like I needed it. That was when I made the decision to go back on it. It was a good decision. The benefits outweighed the risks.

But back to my original topic - deficiency or mental illness? I don't know. I'm still torn on this. Bipolar Disorder is a mental illness which people live with their entire lives. Just like heart disease, once diagnosed, is a condition that a person lives with the rest of their life. Sure, there is a deficiency in my brain chemistry that when treated allows me to function at a normal level. But that doesn't mean that I don't live with this diagnosis for the rest of my life. I still think about it about twenty times a day, on an average day. And if I don't take my meds, or they suddenly stop working for me, then yes, I will become mentally ill.


It's just that 99.8% of my life has been spent not feeling mentally ill. And I'd like it to stay that way.

What's your take?