When postpartum sadness isn't depression, but something even worse
Eighty-five percent of women experience some sadness post-baby, but little is understood about the most severe form, postpartum psychosis
Iowa mom Molly Roth was excited to give birth to her long-awaited second child — a girl she named Gracelyn — in January 2017. Her happiness quickly gave way to a deep depression that her doctors initially blamed on the "baby blues" and, eventually, postpartum depression.
The 32-year-old was put on medication, but even then she couldn’t complete even the most basic of daily tasks.
"I had to show her the simple steps of turning on the water and getting a towel," her husband, Jamison Roth, told The Des Moines Register. She was a "shell" of her former self and talked of suicide. Things seemed to get better after a few weeks on the medicine. "She was back to her old self, joking around and being happy," Roth said. The happiness was short lived.
She hanged herself a few days before Easter.
It’s estimated that about 85 percent of new mothers experience some type of mood disturbance post-delivery. However, 10 percent of women experience more intense feelings, typically split into two categories: minor depression (the "baby blues") and postpartum depression (PPD). PPD is often characterized by feelings of sadness, anxiety, guilt, feelings of hopelessness and extreme mood swings, but can typically be treated. However, Roth’s husband believes she wasn’t suffering from PPD, but rather a more serious, but less known, condition known as postpartum psychosis.
Postpartum psychosis is rare, affecting only one or two in 1,000 new mothers, according to the MGH Center for Women’s Mental Health. Onset of postpartum psychosis is fast — typically within the first two weeks after delivery, and some women even start showing signs within the first few days.
The symptoms are vast and scary, too: Early signs include irritability, insomnia and moods that shift rapidly from depressed to elated, along with extremely unpredictable behavior.
"It usually represents a bipolar disorder, not just a depressive disorder," psychiatrist Charlotte Ladd, MD, associate professor of psychiatry at the University of Wisconsin in Madison, told Everyday Health, adding that it qualifies a "psychiatric emergency." The reason: Many women with postpartum psychosis also experience delusions that are often focused on their new babies, sometimes leading them to commit murder or complete suicide.
The problem with treating postpartum psychosis is that it’s not as widely recognized as other forms of depression and getting the right diagnosis is often difficult. Writer Vonny Leclerc described how doctors discharged her from the hospital after concluding that she was faking the illness for sympathy.
"The assessment was that, despite previous serious postnatal depression, I was a malingerer taking everyone in," she wrote in a 2014 essay for The Independent. "I was accused of manipulating hormone results through expressing the milk my baby couldn’t have, in order to gain treatment."
Leclerc was one of only 7 percent of women who get treatment for postpartum mental illness, but it wasn’t easy to get.
"When it comes to physical symptoms you can see them, test them and treat them. But if you’re a new mother, paralysed by fear and suffocated by despair, you had better convince the doctors. Asking for help isn’t always enough," she wrote.
Actual treatment for postpartum psychosis ranges from medications — like antidepressants and antipsychotics — to therapy, hospitalization and even electroconvulsive therapy (ECT).
"Psychosis doesn’t live up to its Hollywood image; instead it’s often a silent erosion of your own existence, which makes it hard to spot," wrote Leclerc. "When delusions and reality blend so seamlessly, you don’t have the self-awareness to shout out. The voices are your reality. And the toxic thoughts. You become caged inside yourself so abruptly that you simply cannot find the fortitude to reach out."
Though it’s too late for Roth, her husband hopes to bring as much awareness to postpartum psychosis as other forms of depression through working with the National Alliance on Mental Illness.
"[Doctors] should treat them like queens, not mental (cases)," he told the Des Moines Register of how new moms should be treated post-delivery. "They haven’t done anything but have a baby. They did everything they were supposed to."
For more resources on postpartum psychosis, visit postpartumhealthalliance.org