Beyond the Baby Blues: Postpartum Depression and Psychosis
(winner of National Headliner Award)

Texas mother Andrea Yates drowned her five children; her family says she was suffering from postpartum depression and psychosis. This week, we look beyond the headlines to explore these potentially devastating illnesses. Guests include psychiatrist Dr. Deborah Sichel, who co-founded the Hestia Institute, a mental health center for women and families; law expert Michelle Oberman, who has written about mothers who kill their children; and Dr. Joseph Hibbeln, a psychiatrist, lipid biologist and Chief of the Outpatient Clinic at the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health; and women who have suffered from these illnesses.

Host Dr. Fred Goodwin begins the show with an essay about the joy he felt over the recent birth of his own granddaughter, and the shock and dismay that followed in the same week when he heard of the Andrea Yates tragedy in Texas. According to her family, Andrea Yates was suffering from postpartum depression and psychosis. Dr. Goodwin explains that, in women with a preexisting vulnerability for clinical depression, the physiological, hormonal, and psychological disruptions of childbirth can trigger a postpartum depression. And for those with a vulnerability to manic depressive illness, or bipolar disorder, the outcome can include psychosis. Plus, today's young mothers, isolated from extended family in neighborhoods where almost everyone is at work, may be even more vulnerable to postpartum depression. Many women do not even realize there is a name for the despair they feel. He says that if there is any silver lining in the dark cloud of tragedy, it is the increased public awareness of postpartum disorders that the Yates case has generated.

Next, Dr. Goodwin conducts a roundtable discussion which includes psychiatrist Dr. Deborah Sichel, co-founder of the Hestia Institute, a center for Women and Families in Massachusetts and co-author of the book, Women's Moods: What Every Woman Must Know About Hormones, the Brain, and Emotional Health; Michelle Oberman, a professor at DePaul College of Law in Chicago who has consulted on numerous cases involving postpartum depression and psychosis and is co-author of the book, Mothers Who Kill Their Children; and Andrea Dresser, a mother of two living in Las Vegas who, ten years ago, suffered severe postpartum depression with psychotic hallucinations.

Dr. Goodwin begins with Ms. Dresser, who describes her own case of postpartum depression, which included hallucinations in which she imagined herself throwing her baby and seeing his blood on the wall. Ms. Dresser was left home alone with her two children and found her doctors and her husband (who is now her ex-husband) unsupportive. Ultimately, through the help of the support group Postpartum Support International and a sympathetic family doctor whose wife had suffered from PPD, she got a correct diagnosis and began to look for appropriate medications.

Dr. Goodwin then asks Dr. Sichel whether Ms. Dresser's case sounds typical. She says that in many ways, it does -- many women suffer without getting support or a correct diagnosis. Dr. Sichel believes (and Ms. Dresser confirms) that Ms. Dresser was suffering from a bipolar-type depression. Women who become psychotic postpartum are likely to be predisposed to bipolar depression (also known as manic-depressive illness), while women with postpartum depression are likely to have unipolar depression.

Dr. Sichel then goes on to explain the different types of postpartum disorders:

Postpartum blues or baby blues affect up to 80% of new mothers, and so are considered basically normal. Symptoms include frequent and prolonged crying, irritability, poor sleep, mood changes and a sense of vulnerability, which may continue for several weeks.

Postpartum depression affects between 5-20% of new moms and is characterized by despondency, tearfulness, feelings of inadequacy, guilt, anxiety, irritability, fatigue, difficulty sleeping or sleeping more than usual, worries about hurting the baby, and thoughts of hurting yourself. It can also manifest as an anxiety or obsessive-compulsive disorder. Approximately 25% of women suffering from PPD will not recover without the help of medication.

Postpartum psychosis is a relatively rare disorder affecting about 1 in 1000 new moms. Symptoms are similar to general psychotic reactions and include confusion, fatigue, agitation, alterations in mood, feelings of hopelessness and shame, delusions or auditory hallucinations, hyperactivity and rapid speech or mania. Another symptom is making plans to kill your baby or yourself. Postpartum psychosis requires immediate medical attention.

The discussion continues with a caller, Pec Indman, a therapist in California. She talks about the affect the Andrea Yates case has had on many women suffering from PPD. She says several of her clients fear that they will "snap" and harm their babies -- one went so far as to stop bathing her children for a week, out of an irrational fear that she would drown them. Ms. Indman and Dr. Sichel discuss how women with PPD almost never "snap," and the very fact that these mothers describe their thoughts as "irrational," is a good sign that they are not psychotic, since women with PPP will think their hallucinations are rational.

Next, the guests are joined by another caller, Ms. Carol Blocker from Chicago. Sadly, her daughter did "snap," in a way -- she even told her mother she felt "a snap in her brain." Ms. Blocker's daughter suffered from postpartum psychosis but was never correctly diagnosed. Doctors told her she just had the blues, and although they offered her medications (none of which worked), they did not keep her in the hospital, despite Ms. Blocker's protestations that her daughter was suicidal. Ms. Blocker's daughter did commit suicide a few months after her baby was born. Dr. Sichel has talked to Ms. Blocker in the past and believes doctors missed signs that would have indicated her daughter was prone to this kind of depression and psychosis.

Professor Michelle Oberman then joins the discussion to talk about the legal aspects of cases like Ms. Yates', in which mothers kill their children. She begins by saying, having studied many of these cases, she sees them all as part of a larger problem -- in our increasingly mobile and fragmented society, women are often left alone to care for their young children. This can be incredibly difficult on any new mother, let alone one suffering from a clinical depression or psychosis. She says that for women who kill their children, it can be hard to prove insanity, since PPD and PPP are treatable, so once the women are diagnosed and made capable to stand trial, they seem perfectly sane.

To contact Dr. Sichel, please write to: Dr. Deborah Sichel, Hestia Institute: Center for Women & Families; 12 Mica Lane, Wellesley, MA, 02481.

To contact Professor Oberman, please write to: Professor Michelle Oberman, DePaul College of Law; Office 720; 25 East Jackson Boulevard; Chicago, IL 60604. Or visit www.law.depaul.edu.

Next, Dr. Goodwin is joined by Dr. Joseph Hibbeln, a psychiatrist, lipid biologist and Chief of the Outpatient Clinic at the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health. Dr. Hibbeln has studied cross-cultural data and discovered a surprising link between omega-3 fatty acids, which are found primarily in fish, and rates of postpartum depression. In the past, he had uncovered similar findings for depression and manic depression, but he did not expect the association to be as strong for PPD, since there seem to be so many other cultural factors involved. Yet, the correlation was the same -- a fifty-fold difference in the rate of PPD depending on fish consumption. The more fish consumed, the lower the rate of postpartum depression.

Dr. Hibbeln recommends substituting olive oil for corn and soy oil, and eating fish two to three times per week. Omega-3 supplements are also a good option for pregnant women, particularly if they are worried about mercury contamination in their fish.

To contact Dr. Hibbeln, please write to: Dr. Joseph Hibbeln, Chief of the Outpatient Clinic; National Institute on Alcohol Abuse and Alcoholism; 5600 Fishers Lane; Room 110; Rockville, MD 20857. Or visit: www.niaaa.nih.gov.

Finally, commentator John Hockenberry reflects on the Andrea Yates case and the wild range of emotions felt by every mother -- even his own.

If you would like more information about postpartum depression or psychosis, please contact a support group:

Postpartum Support International can be found at www.postpartum.net or 1-805-967-7636. Depression after Delivery can be found at www.depressionafterdelivery.com or 1-800-944-4773. Additional support can be found through the National Alliance for the Mentally Ill and the National Mental Health Association.

 

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