Not long ago I wrote a piece which has now become THE most popular post I've ever written for Postpartum Progress. It was called "The Symptoms of Postpartum Depression & Anxiety (In Plain Mama English)". It really struck a chord with people, I think, because it was the first time some had seen the symptoms described using the lens of actual sufferers, rather than being described as a doctor might.
I'm happy to share with you a new piece in the same format focused on women with postpartum psychosis or postpartum depression with psychotic features. I'm pretty sure you've never seen such a comprehensive list of postpartum psychosis symptoms described in this way. I'm hoping it will be useful for women who are suffering who have insight, and for those who don't but whose family members or friends can read this and recognize these symptoms in their loved ones. Since I haven't been through a psychotic episode myself, I reached out to some smart and brave survivors to help me. I am sincerely indebted to Heather, Teresa Twomey, author of"Understanding Postpartum Psychosis: A Temporary Madness",Jeremy andHK.
The Symptoms of Postpartum Psychosis & Postpartum Depression with Psychotic Features (In Plain Mama English)
What does it feel like to have postpartum psychosis? What are the symptoms? How do you know when you have it?
Below I will share the signs of these illnesses in "plain mama English". We won't use words like hypomania or delusions or psychomotor agitation. Instead, we will use the words we hear in our heads when we think about what the hell is happening to us …
When you read the list below, keep in mind you may not be experiencing all of the symptoms below or even most of them. These are not "one-size-fits-all" illnesses. Your experience may be focused on just a few of the following symptoms and you may not have others at all. Also, as with any postpartum illness, this can occur after childbirth, miscarriage or other perinatal loss.
You may have postpartum psychosis or postpartum depression with psychotic features if you have had a baby within the last 12 months and are experiencing some of these symptoms:
- You have more energy than you've ever had in your life. This is like nothing you've ever experienced, and you just had a baby! You feel great. You may even feel like you don't need sleep because there are things that must get done. Conversely, you are exhausted, have no energy, and wish you could sleep but your mind just refuses to shut down.
- You feel like suddenly you understand EVERYTHING, like your brain is functioning on a new and different level. You are able to make connections you've never noticed before between people, places and things. Everything in your whole life makes sense to you now.
- You keep hearing and/or seeing things that no one else does or that you know are not there. You may have what seem like voices in your head that won't stop no matter what you do. The voices comment about your actions or tell you appalling things, even that you may need to hurt someone or do something you would never do otherwise. Perhaps you feel the radio, television, nature or God is speaking directly to you and you alone or giving you secret messages.
- You believe that you can't trust people or have become suspicious of your family and friends — people you always trusted prior to this. You may even feel like your family, friends, healthcare providers or the government are out to get you. You may feel they are trying to get rid of you or stop you from doing what needs to be done. You also may feel that people (family, friends, strangers or outside forces) are going to purposely or accidentally harm you or your child.
- You believe you are suddenly unique and special in some way, have some greater purpose, mission, powers or have been possessed (however, you don't want to talk about it to anyone because you know, for whatever reason, they won't understand. Or you feel these same things are true of your baby.
- You cannot remember how to do thing you knew how to do in the past — like how to make a batch of cookies, read a map, program your phone or find the doctor's office. You may also have trouble focusing, like reading or doing math or following a plot on TV.
- You feel like you are losing track of time. Or time seems either very sped up or extremely slowed down.
- You may be having strange sensations, for example feeling like things are crawling on you.
- You are getting into conflict with those around you. Although there may be real issues between you and others, the fact is that you are getting into way more conflicts with others than you ever used to.
- People who care about you think there is something wrong with you or say that you are angry, sad, acting strange and/or weird. In any case, they note that you are different from how you used to be.
- You may feel as if you are being controlled by some outside force. This force may be telling you to harm someone. Or you may have strange violent urges that have nothing to do with choice. These urges can best be understood if you think of how it feels when you experience the urge to urinate. One has little control over whether one wants to urinate or not, it is just a powerful urge one is compelled to tend to. These strange violent thoughts may present themselves as possible solutions to a myriad of problems.
- You don't like what is happening to you and are frightened to death. You know that something is terribly wrong and you don't understand it. You think you've gone "crazy".
- You are afraid you will never get better. You may even believe that the only way to get out of this or to protect the ones you love is to commit suicide or abandon your family.
Though you might fear that you will be locked up forever if you were to ever reveal what is happening to you, you can get better with professional help. There are countless women who have been there and recovered 100%.
The key is getting urgent help for how you are feeling before you lose all insight into the fact that you are ill, which is what happens with this illness. Get yourself (or anyone you suspect of suffering from this) to an emergency room immediately and be open about being homicidal, suicidal, hearing or seeing things, and describing any other concerns you have.
If you don't see yourself (or your loved one) getting anywhere with a healthcare provider, tell them you are concerned you may have postpartum psychosis or postpartum depression with psychotic features. You can print out this symptomlist, bring it with you, and share with them the items on it that you are experiencing.
If you suspect that you or someone you love has this illness, you/she should be accompaniedat all timesuntil a professional diagnosis is received and you/she are under the 24/7 care of a healthcare provider. It only take moments for a needless tragedy to occur.
About Katherine Stone
Thank you for sharing the symptoms of Postpartum. I really have less idea regarding on this type of depression. This would help me a lot.
My experience from online support group messages is that added conflict/anger/rage, feeling like one has "gone crazy" and the urge to run away or that one's family would do better without you, are frequently symptoms of regular "PPD/A".
Some of the other symptoms, yes, seem clear, but still do "bleed over" into regular "PPD/A". Like, are the voices really voices or is it your inner critic over-analyzing every little thing you do and say (KWIM?)?
I don't think I've talked to a mom with psychosis, so it's a mystery to me. With only 1 or 2 per 1000 new mothers having PPP, I'm probably not alone. Thanks for starting the conversation and providing the 1st person links.
Agreed Diane. I tried to keep some of the symptoms that may be similar (anger and irritability, or feeling your family might be better off without you) lower down on the list, compared to ones that are more unique to psychosis (for example: seeing or hearing things that aren't there, feeling as though everything in the world is now strangely connected, feeling that you may be communicating directly with the TV/radio).
I haven't had much experience around PPP either, which is why I asked my four guides for their direct feedback and ideas. I am, of course, open to adding anything that needs to be added or discussing these ideas even further.
You are correct in that some symptoms may seem like "bleed overs" from PPD/PPA. However, I have found in my personal experience with PPP and experience in helping other PPP-afflicted moms that this is because in some cases, the underlying issue that spiraled into postpartum psychosis was severe untreated postpartum depression
Note: This form of postpartum psychosis is specifically termed severe postpartum depression with psychotic features to distinguish it from postpartum psychosis with underlying bipolar. Both of which require a different concoction of medications.
I also think you are right in that women with PPD/A are the ones who feel more like one's family is better off without them. And this is very different from wanting to kill yourself because you'd rather kill yourself than harm others in your family (which is how I felt) or wanting to kill yourself because it is what your mind is telling you you MUST do to be a good person/fight the devil.
Finally, (I am sorry for being so long – but I think it is important to understand this) the voices one hears when they suffer from PPP is not your inner critic. An inner critic is one that you recognize as such. The voices in PPP are foriegn to you, taunting you relentlessly, ones you are fighting with. They tell you appalling things that you cannot relate to and are voices you are confident are not your own or are certain have been put there by someone/something else. And, they never stop but tend to get more and more aggressive.
Again, sorry for being long-winded but I think it is essential that we understand this illness which has and will continue to result in tragedies until and unless it is more widely understood.
Hope this clarifies some of the issues.
This isn't long-winded. Your input is important. Thanks for sharing this!
Great response by HK.
Also, although it is obvious, it is worth adding that that those around a woman with PPP cannot see or hear their thoughts. Anger or rage is one of the symptoms that may be more obvious to those around you – whether you have PPP or PPD. Therefore it is not so much a symptom that distinguishes it from PPD, but rather is one of the red flags that indicates this woman is have some problem that needs further exploration.
As far as the "feeling like you are going crazy" – I wonder if there are those with PPD who could put into words the underlying thoughts to that experience. For me with PPP, I knew I was experiencing things that were not real (although usually in hindsight and some of what was not real I thought was real). I had one (and only one) auditory hallucination that I (on some level) knew was not real AS I experienced it. Because I knew my experiences were not alway real, I thought I was "going crazy." (The irony is that I WAS "crazy" – not "GOING crazy". The good news was that not long after that I "went sane" again.)
I agree that a person who has these symptoms should be under 24/7 care. Sometimes the "treatment" actually makes things worse if the mom is treated as just a patient with psychotic symptoms. Every person is unique, and one person's life is not more valuable than another's. One sick person does not deserve better health care than another, but new moms with mental health issues require a different treatment regimen. For example, my wife Jennifer was admitted to the psychiatriac floor. She recieved little to no one-on-one attention from the staff there. Staff was very defensive when I talked to them about her unique situation. They belittled me and told me that deviation from the standard protocol would be elitist and unfair to the other psychiatric patients. Visitation was very, very limited for her extensive network of supportive family and friends (this healthy network had a better chance of helping her get better than a psychiatric ward), and her baby was not allowed on the unit. She was breastfeeding prior to her admission and was required to stop all breastfeeding immediately. New moms have special circumstances that must be considered in treatment. We advocate admitting moms with postpartum psychosis, but with some simple, inexpensive concessions. They should be admitted to an Internal Medicane department instead of a psychiatric wing, ideally with 1:1 specialized care, which could come from staff of the psychiatric department. This would allow more relaxed visitation, the important contact with the baby (if desired by mom), more options for breastfeeding or weaning, and a more normalized environment. The psychiatric ward can be a terrifying place for anyone for several reasons, especially for a new mom that had never had a mental health issue and is now suffering from psychosis.
I wholeheartedly advocate for special and separate psychiatric units for women with these illnesses, like the one at UNC Chapel Hill or the one at Women & Infants in Providence, RI. They work with breastfeeding moms, they bring mom and baby together where appropriate and they understand the specific set of needs of a new mother. It can be a much better situation. We need more like the ones in NC and RI.
I didn't know about those. Jennifer got one of her degrees at UNC Chapel Hill. Thanks for the info!
It's very good article! Wrote very understandable and in detailes.
Thank goodness there's more awareness of this and would that my mother had gotten help for it after she had given birth to me. I love her to death, but she wasn't herself, and nobody realized — until I was being rushed to the hospital.
The fact that she broke so far as to stab me, a three month old, in the chest… has made me severely afraid of having my own children. I feel, though, that perhaps it's safer now? Safer than then? If I have people watching out for me, so that this might never befall my first forays into parenthood?
Thanks so very much for putting attention toward this. In a way, this eases my mind on the subject, to know others know. They can put eyes upon me, and watch for me.
Yes, people can watch out for you. Just make sure your OB knows about your family history of postpartum psychosis. If those around you are fully aware of the symptoms and agree to take responsibility for watching carefully for them, and you have a mental health professional looking out for you as well, then they will take care of you and get you treatment ASAP should such symptoms arise. Preparation is the key.
Thank you Katherine. I thought I was totally over PPD. My baby is 6 months old, and I had been feeling better a lot of the time. I felt SO good at Type-A, like I was on top of the world, and I was glad to be my "old self" again. Then I came home from the conference and crashed. I have know since I got home that something is very wrong with me, and I spent hours of my birthday crying in the shower because I just wanted to kill myself. It was awful, but it passed by early afternoon and I felt okay and went out to lunch with my husband and kids and felt mostly okay.
I'm not sure how I landed on your site this morning, but I'm glad. I'm needed to read this page. I'm calling my doctor tomorrow at 8.
I'm so sorry to hear that Tara. I'm glad you are calling your doc. Let me know how it goes. Good for you for reaching out for help!
– K