Postnatal Depression and Postpartum Psychosis
Around 10% - 15% of women may suffer postnatal depression (PND)—or postpartum depression as it is also termed. As we do not know if all all mothers seek help with their depression, this number could be underestimated. Thankfully, you are much less likely to suffer with puerperal psychosis or postpartum psychosis. There is a big difference in presentation between the two and the psychotic element usually demands hospitalization.
I suffered with postpartum psychosis, or puerperal psychosis as it is also known, after the birth of my second child. I would like to tell you about the treatment I received after my subsequent children were born.
Most women get a degree of the baby blues shortly after delivery of their baby, but this is usually transient. It rarely lasts more than a couple of weeks and may even be felt for just a few hours.
Varying levels of postnatal depression can be experienced. For some, the baby blues doesn’t seem to go away but the mood deteriorates further and after several weeks, a new mother or partner perhaps, recognizes that the mood is simply not picking up. It is also believed that the depression can start any time from the birth up to around a year later.
For some women there may already have been a level of depression during the pregnancy and therefore not so surprising that the arrival of a new baby has made this depression worse. For some it may come as a complete surprise with no apparent warning.
Imagine you have just had a baby with all the huge hormonal changes that take place. You suddenly have a huge responsibility to be a good mum. You can become anxious and irritable made much worse by an overwhelming sense of tiredness. You may feel you are failing your motherly duties and then guilt sets in as this is supposed to be a wonderful time in your life. Everything seems to be worrying you and you just don’t have the energy to do anything about it. Your partner may not fully understand how you feel, and expects that within a few weeks things should be feeling normal. Instead he is faced with a tearful, angry, confused and distant woman who appears to have gone off sex also.
Things can get so bad that you even resent your baby or believe there is no love between the two of you. Everything simply gets on top of you and you feel a failure. This is postnatal depression. Treatment for postnatal depression depends on its severity but counseling and/or antidepressants are likely to be offered. It is thought to be caused by hormone levels but social factors, stress, history of depression and even those suffering bouts of pre-menstrual tension seem to be at risk.
Around 0.02% of women develop this post-delivery condition. It is thought to be genetic and linked to sufferers of bipolar disorder and schizoaffective disorder. It can also set off these mental health disorders. It usually presents itself quite quickly in the first week or two after delivery but it is commonly seen within days. Symptoms are usually sudden in onset with extreme fluctuations in mood from mania to total withdrawal. Insomnia or wanting to sleep all the time, panicky, confused and lack of concentration are also common symptoms. Avoiding the baby is usually evident.
It is thought to be a genetic condition but hormonal changes and having an existing bipolar or schizoaffective disorder are also listed as potential causes. Once you have had puerperal psychosis there is up to a 50% chance that you may get it again with subsequent babies. I have to add here that it can happen to anyone, you do not have to have a mental illness before suffering this condition.
A Personal Journey Through Severe Postpartum Psychosis
My Postnatal Depression and Psychotic Experience
I had no idea that a woman could become psychotic post-delivery when I had my second baby many years ago. I had heard of postnatal depression and I had experienced baby blues with the arrival of my first child which passed in a few days. This time however my pregnancy was unplanned and I was stressed and anxious throughout, but after my baby was born I remember only the first two days post-delivery.
I felt confused because I wasn’t elated, but I remember holding the baby in the first couple of days and obviously trying to make an effort. The next thing I remember was finding me and baby in a mother and baby psychiatric unit. Apparently I had been found by a friend staring into space at home. I was totally unresponsive and she had immediately sought medical help for me. This was only about four or five days after my baby was born. There followed hallucinations of the visual kind which were extremely frightening. I seemed to have also been lost in some kind of void…a black hole.
Early on in the unit, I wasn’t even aware that I had given birth to a baby. In fact I remember wondering why someone kept giving me a baby to look after! Several antidepressants and other medications were tried but in the end electro-convulsive therapy had to be used. After this I seemed to get slowly better but I was in hospital for over seven months. I did bond with my baby eventually and to this day he is very special to me.
What Risk Factors Play a Part in Postpartum Depression?
It is thought that hormonal changes have something to do with both postnatal depression and puerperal psychosis. Where both are concerned I can see the rationale that social factors could also put someone at greater risk. Once a baby is born there is a sudden drop in progesterone. This drop initiates the release of another hormone to bring on lactation. Oestrogen and cortisol levels fall also. What if this is the major cause for these postnatal conditions? Could it be that the social factors as causes in both postnatal depression and puerperal psychosis are merely an insult to the injury so as to speak?
Around 1993 I became pregnant with my third child. I did a lot of research at the time to try to find out what I could do, if anything, to ward off the risk of me getting puerperal psychosis again. The sudden drop in progesterone factor kept coming up. What if the drop was so sudden and so big that it perhaps even had negative effects on other hormones such as serotonin which is thought to be linked to depression? I thought of premenstrual problems, the menopause and how moods are commonly affected by these conditions too.
I happened to come across some information about a UK gynaecologist named Katharina Dalton. She saw a connection between premenstrual syndrome and postnatal depressionand had used natural progesterone on herself to find relief from premenstrual symptoms. It worked. Although other professionals doubted some of her work, I felt I had nothing to lose and wrote to her. I told her of my depression, psychosis and the fact I was pregnant again.
This lady wrote straight back to me and arranged through my general doctor for me to have progesterone injections and pessaries. I took my ampoules of progesterone with me into hospital. I had the first injection immediately after my baby was born. I believe I had an injection every day for up to ten days followed by progesterone pessaries for some weeks after. Not only did I not get puerperal psychosis but I didn’t get any amount of depression.
The same happened with my fourth child. I had the same treatment with the same results. I cannot be entirely sure the progesterone stopped either from happening but in my mind it was highly likely.
I would suggest anyone who has had either postnatal depression or puerperal psychosis would be wise to talk to their doctor during any subsequent pregnancy about progesterone treatment to be arranged for immediately after the birth. You have nothing to lose and everything to gain by doing so. Selective serotonin re-uptake inhibitors (SSRIs) are used widely for postnatal depression, but there may not be a need if a more natural treatment is considered first.