The Warning Signs of Postpartum Psychosis

To help us understand what postpartum psychosis is, we invited top experts in their fields to be here. Dr. Berndorf is a reproductive psychiatrist and the CEO, co-founder, and medical director of the Motherhood Center in New York City, which treats pregnant and new moms. And we welcome you here to this conversation. So let's start with the basics. I think people are confused by the difference between postpartum depression and postpartum psychosis. What is the difference? Well, first, thank you for having this conversation on the national stage and for your stories. I really feel for you and know how hard it is to get help. The difference is postpartum depression is what we know as depression. It's happening in the postpartum. It can happen during pregnancy. You're not interested in things you used to be, low mood. You may be exhausted, not motivated, not really wanting, you're barely pushing yourself out of bed to get things done, but you can look quite fine. And in the worst cases, you can feel suicidal. Postpartum psychosis is completely different. Okay, so before you finish that answer, does postpartum depression lead to postpartum psychosis? It can. You can have psychotic thinking within a depression. Can you have psychotic, can you have postpartum psychosis without ever being depressed? You can. You will also have mood symptoms at some point, kind of like you described, Ayana, right? That you start with the psychotic symptoms and then, we haven't heard your whole story, kind of how things end up. But postpartum psychosis is a medical emergency. It is a break with reality that requires, almost invariably, hospitalization. Okay. I think that's really important for everybody who's ticking and talking to get the word out that it is a medical emergency, and when you Googled nine years ago, it didn't note that, is what you're saying? Yeah, it did not. Had it noted that, I think that would have changed how my story went. I don't think I would have been another year before I got help. Yeah. Okay. So, and how do you know whether you are in psychosis or whether it's just depression? Well, as described, psychosis can be paranoia, hearing things, seeing things that aren't there, but you believe them. There's a delusional quality to it, right? A fixed false belief that what you are seeing or hearing is absolutely true. It wouldn't have mattered if you asked your husband if he saw it, and I love how you said that. You were gaslighting yourself. I mean, so well said, and it's really true that you so unshakably believe what you are seeing, hearing, and feeling is true. Nobody else may, and that's why people don't share. You seemed somewhat incredulous as you were hearing she didn't tell her husband. That's not uncommon. People feel crazy. They don't want to be labeled that way. They don't want their kids taken away, should they tell a medical professional, right? We have the responsibility to, you know, call Child Protective Services if we think there's harm that could come to a baby. Not think, but, you know, I always wondered, if someone tells you that I'm thinking of harming my children, you should believe that. Yes, 100 percent. One billion percent. Okay. So if someone says, I'm thinking of harming my children, and they're willing to admit that they're thinking of harming their children, shouldn't their children be taken away? I wouldn't say that. I would say it is, there you've got your emergency right in front of you. You need to get to the hospital. You do need separation. I mean, Trevor, you did all the right things. I'm just sorry you had to make a home hospital. Yeah. Right? You did the things we say. It is protocol to say, don't be alone with a baby. Don't be alone yourself. So you should be immediately separated from your children. Correct. But not taken away. I don't want to scare anyone with that. Okay. Right? You need treatment. And you often need hospitalization for your safety and for your baby's safety. Okay. You need treatment. Treatment. And hospitalization. Okay. And so, you're, we talked about the pink flags. Yeah. So, the pink flags are... This is... Yeah. Well, this is red. Yeah. This is... By the time you're in psychosis, you're in red. You're in red. Right? When people are acting out of character, when they start to not be behaving like themselves, when they're a little off and you're thinking to yourself, huh, that doesn't seem right. Those are pink flags. And I know we're going to hear more about that, but you are discussing a red flag. When someone can say, I am worried I am going to hurt my child, or I could, do not pass go directly to the emergency room. Or if you hear paranoia. I had a patient once, I heard on the phone, seven days after she delivered, I'd seen her in the hospital doing great. Her husband called me. I could hear in the background. She was in the background and she said, who is that woman you are on the phone with? You're having an affair with her. And I said, we have an emergency on our hands. You need to, can I meet you at the hospital? Can you get in a taxi? Do you want me to call an ambulance? Where are you? That was it. She was done. She was going to be hospitalized for that emergency postpartum psychosis. Okay. I want to show you this, uh, Lindsay Clancy's attorney, Kevin Redington gave an interview this week on good morning America. Take a quick look at what he said. A lot of the interlay between the medications, between the selective serotonin reuptake inhibitors, the SSRI drugs in combination with that, it's, it's horrific what, what these people are dealing with. And what do you say to those critics who say this is a rationalization we're talking about here is just plain evil. Oh, please. It's not, it's not evil. These people don't understand. They don't know what she went through. They didn't see her text messages. They didn't see her journal. They didn't see the notes that she wrote. They didn't see the text. She sent her mother in October saying, mommy, can you please come to here? I am sick. Something's wrong. And it was a result of the medications. They don't know about the number of times that she reached out. She went to the woman, an infant. She went to the suicide hotlines. She reached out to everybody and anybody that would listen to her and kept saying, I am not good. I am not well. And it was ignored. So Dr. Burndorf, uh, what about SSRI medication for depression? They're wonderful medications. So tell us what that is. Okay. Selective serotonin reuptake inhibitors. Those are medications like Prozac or Zoloft or Lexapro, right? They're the most very commonly used. Okay. For postpartum depression, sure. What kind of impact do the SSRI drugs then have on psychosis? So you're in depression, you're taking the SSRI drugs and what happened? So these medications in a certain population that is predisposed biologically, if they are given this medication can flip into mania. It is a known side effect slash something that can happen if someone is not responding to a medication like this, they have kind of an agitated, sometimes euphoric experience or dysphoric where they don't feel good. You think to yourself, huh, that's not working. What's going on? They're having an unusual reaction to this. But isn't it the case that I've known several people who've suffered from mania and the case with mania is you're feeling so good, you're feeling so high, you're cleaning, you can stay up all night, you can party, you can do all those things. You don't know you're manic. No. You lose insight. I've never talked to a manic person who realized they were manic. Many people really enjoy this state, right? It can also be quite irritable or it can be euphoric. Yeah. But you have no insight. You don't know what's happening. And this medication can trip people into what it does is it exposes a previously unearthed bipolar disorder. And what happens if you are on an SSRI drug and now you are also psychotic? The SSRI drugs impact psychosis. How? Well, when you're manic, you can also become psychotic. So if you think the medication is working, you might increase the dose. You may not recognize that it's not working. Oh, it doesn't seem to be helping with the depression or the anxiety. I'm going to increase the dose. The exact wrong thing to do, you actually need to bring in other medications and get someone off that medication that's stimulating, activating them into a state of bipolarity. So are you saying SSRI drugs stimulate or activate psychosis? They can.