The Fateful Week – A Journey with Postpartum Bipolar Disorder

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Yesterday I was honored to be asked to submit a piece of writing about my experience with postpartum bipolar disorder to Postpartum Progress (www.postpartumprogress.com).  Postpartum Progress is a highly acclaimed organization helping women with postpartum mood disorders all over the world.  Here is a description on their website about what they offer:

“Postpartum Progress® offers in-depth information, community and hope for pregnant and new moms with postpartum depression and all other mental illnesses related to pregnancy and childbirth (including postpartum anxiety, postpartum OCD, depression during pregnancy, post-adoption depression, postpartum PTSD, depression after miscarriage or perinatal loss and postpartum psychosis). We know that perinatal mood and anxiety disorders like PPD are temporary and treatable with professional help.  We are fiercely proud to be the world’s most widely-read blog dedicated to these illnesses, with more than 1.1 million pageviews annually. Our award-winning site is consistently ranked among the top blogs in both the categories of depression and pregnancy/childbirth.”

The below article is a highly condensed version of what took place before and after my diagnosis.  This post will give you an idea of the main events that occurred during the fall when I was diagnosed with postpartum bipolar disorder.  

On a warm Indian summer night, I was a sweaty nine months pregnant when my water broke.  During my pregnancy I tested positive for Group B streptococcus, a bacterium in my body that could result in a life-threatening infection to my baby. Right after my water broke, my husband Craig called the hospital to see if there was a room available. Due to my having the Group B bacterial infection, he was instructed by the maternity nurse to get us to the hospital right away. In pain, I stayed up all night in labor, not sleeping one wink.  This innocent-sounding act — enduring one night without sleep — would be my biochemical trigger for postpartum bipolar disorder.  Despite my having a strong family history of bipolar disorder, at age thirty-seven, I didn’t have any inkling that mental illness was latent in me.  My first daughter Avonlea had been born almost two years earlier, and I was incredibly fortunate that I did not have a postpartum mood disorder following her birth.

My second daughter Marilla was born at noon, on August 26th, 2007; I was thrilled she was a robust seven pounds.  During the first two days of Marilla’s life, obstetricians and nurses examined me at the hospital, and I visited with family and friends, but no one detected that I was in jeopardy.  At first I was hypomanic, exuberant with joy over the birth, and I appeared relatively normal.  Sweet Marilla attracted most of the attention.  However, I sensed I was in growing trouble of some kind, but my fear of being an inept mother caused me to keep my feelings inside.

Since we didn’t have family members immediately available to help us, my mother gave us the gift of a postpartum doula named Grace.  Grace and I had planned that she be with us after Marilla’s birth, but she had a completely unanticipated allergic reaction.  She wasn’t able to join our family until four days following Marilla’s debut.  As Grace hadn’t known my personality well before coming to work with us, and she didn’t realize that my manic behavior was different than how I had been before Marilla was born, although she was absolutely concerned with what she witnessed.  Grace was wonderful with our girls and with me and Craig; she was an excellent doula, but she couldn’t rescue me from my dire situation – no one could at that point.  Grace had worked with over 150 mothers; while some of them suffered from postpartum depression, none of them presented with postpartum mania like I did.

The deceptive part of postpartum mania is that people often think the new mother is simply happy to have a baby.  After Marilla’s birth, I was filled with an overwhelming amount of joy and energy.  However, not one of my state-of-the-art maternity center nurses, OB-GYN’s, or our pediatrician detected my mania right away.  My father had bipolar one disorder, so I had a genetic predisposition to the mood disorder.  Furthermore, I had suffered clinical depression ten years prior to Marilla’s birth.  (Recent studies have shown that women with clinical depression prior to childbirth have a much greater chance of being diagnosed with postpartum bipolar disorder.) 

During my hypomanic state, I could feel my brain thinking much, much faster than it had before.  I also had a very rare condition triggered in tandem with bipolar called hypergraphia, which is compulsive writing.  I had been a freelance writer for years, but this kind of writing was totally different than how I wrote before childbirth.  Once I returned home from the hospital, I simply could not stop writing.  I wrote at every opportunity, even during breastfeeding, and it was completely bizarre!

During my sleepless nights postpartum, in a well-meaning effort to get me to stop typing, Craig hid my laptop.  As he slept, I cleaned for a good part of the night as quietly as I could.  While I scrubbed countertops and organized drawers at 3:00 a.m., I yearned to have some semblance of peace and balance in my life. I also went online and typed lengthy emails to friends.  I didn’t realize that my friends would be able to view the actual time I sent their emails, and some of them later told me they were puzzled that I was writing such lengthy epistles to them in the wee hours, night after night.

After I barely slept for so many days in a row, I was feeling much the way I imagined a coke addict would feel.  I was revving with energy, but I felt exhausted and I was on the brink of an emotional outburst. Still, nothing too dramatic happened, so no one thought I should consult a psychiatrist.  During that fateful postpartum week, my brain chemistry was markedly awry in every part of my body.  Apart from cleaning the house, I had the other classic signs of mania: tons of energy, pressured speech, no appetite and loss of weight.  Because it was hard for me to sit still for any length of time, my mania affected my ability to adequately breastfeed my baby. At Marilla’s one-week check-up we discovered her weight had dropped almost a pound, which perplexed my pediatrician, but at that point he did not recognize my mania.

After five days without sleep, I knew that I was sinking fast and that something needed to change. I called my OB/GYN and told her medical assistant Priscilla I couldn’t sleep. Priscilla suggested I try an over-the-counter drug such as Benedryl, but I sheepishly asked if I could try something stronger than that, because Benedryl had never made me sleepy in the past.  With my OB/GYN’s approval, Priscilla phoned in a prescription for Ambien.

I also felt compelled to speak with another mother who had experienced a postpartum crisis.  I called our local Postpartum “Warmline” but the number was disconnected!  I was incredulous and angry that such an important hotline had vanished. (I later found out it disappeared due to a budget cut.) I called information asking if they had some kind of a postpartum support line, but the operator couldn’t find a number, and I got even more discouraged. Finally, I called our local maternity hospital’s lactation center and they gave me the number of the Postpartum Support International (PSI) Bay Area hotline. The PSI volunteer I called, Linda, encouraged me to consider medication to help me sleep.  Her suggestion validated my earlier decision to ask my OB/GYN for a sleep aid.  After we ended our conversation, I felt so comforted in speaking with someone who understood how difficult the postpartum period was.   After taking my first sleeping pill, I got the first decent night’s sleep I had in five nights and I felt a little rested the following day. 

A month after Marilla was born, I knew I had mania; after all, I had witnessed mania firsthand in my Dad.  Before I told Craig or anyone else, I surfed the internet looking for anything related to postpartum mania.  I located a statistic that one in one thousand mothers who give birth will succumb to postpartum mania.  Then the name “Dr. Alice W. Flaherty” appeared in my postpartum mania search.  She was a neurologist at Massachusetts General Hospital, a Harvard professor, and renowned author of The Midnight Disease, an examination of the drive to write, writer’s block and the creative brain. In The Midnight Disease Dr. Flaherty courageously shares her own experience with hypergraphia, the heartbreaking death of her newborn twins, and her hospitalization for a postpartum mood disorder. I couldn’t believe my luck, for I had the gut feeling that this woman could help me.  I made the necessary calls to track down her assistant. 

Miraculously, I was able to reach Dr. Flaherty the following day.  Before we spoke, I shared with Craig about my suspicions and he wanted to be part of our conversation.  Dr. Flaherty generously made time for us to have a brief, pro bono phone consultation. Dr. Flaherty recognized my mania as she heard my pressurized speech pattern, and helped me calm down.  She said right off the bat, “I need you to focus right now.”  Focus I did.  Dr. Flaherty shared with me how medication stabilized her own postpartum mania.  She also strongly encouraged me to consider using formula as a supplement for Marilla, which I did. 

I scheduled an appointment with the psychiatrist I had seen for depression, but before I saw him, it was time for Marilla’s six-week checkup.  I brought Marilla in to our razor-sharp, UCLA-trained pediatrician.  Before arriving at his office I had gathered a bunch of thank-you gifts for him.  When I greeted him, he listened to my racing voice and observed the plethora of presents.  I’ll never forget how he blurted out, “You’re manic!”  I immediately burst into tears.  While I felt embarrassed and ashamed, a part of me felt relieved that he figured out what was happening with me.  From the point on, my mental condition deteriorated and instead of seeing my former psychiatrist it was clear to me that I needed hospitalization. It broke my heart to leave my family, but I admitted myself into our local hospital’s mental unit.  It was there I was officially diagnosed with bipolar one disorder and I took my first mood stabilizer. 

In the eight years since I was diagnosed, research organizations have been studying postpartum bipolar disorder.  A prominent 2013 study appeared in the journal Bipolar Disorders.  This study suggests that women with a prior history of depression should be screened for hypomanic symptoms after giving birth.  Canadian researchers asserted that childbirth is a potent, specific trigger for mania or hypomania.  They found the number of women who transition from depression to bipolar II disorder following birth is 11 to 18 times higher than rates reported for women who hadn’t recently given birth. 

I feel that it’s imperative the doctors and other caregivers who assess women for postpartum depression also screen them for hypomanic or manic symptoms.  My two daughters and husband have suffered immeasurably due to my postpartum bipolar disorder.  On the bright side, they have also observed my hard-won recovery.  After years of trying many medications, numerous hospitalizations and even two courses of electroconvulsive therapy, I am finally stable.  Bipolar disorder ravages many relationships, but Craig and I have been married for fifteen years.  With the guidance of counselors and psychiatrists, our marriage is stronger and more precious than ever before.  I am a member of the International Bipolar Foundation’s Consumer Advisory Board and I blog for them as well.  With any mood disorder, community support can be incredibly helpful.  To that end, I founded the Depression and Bipolar Support Alliance (DBSA) chapter where I live and I facilitated a free women’s support group for two years.  I’m now focusing on my family and working on my book Birth of a New Brain – Healing from Postpartum Bipolar.  Life will always be a challenge living with bipolar one disorder, but my girls have inspired me to work on my recovery with every ounce of my being. 

 Dyane Leshin-Harwood’s bio:

Dyane holds a B.A. in English Literature from the University of California at Santa Cruz. Dyane was diagnosed with Type I Bipolar Disorder in 2007 at age thirty-seven.  A writer, Dyane’s articles have been published in numerous magazines.  She has worked with one of her favorite authors, Madeleine L’Engle, author of the classic A Wrinkle In Time.  She had the thrill of meeting Dr. Kay Redfield Jamison, author of the groundbreaking book An Unquiet Mind, to interview her for an article about women, depression and exercise. Dyane is a certified personal trainer with the American Council on Exercise.  Dyane founded the Santa Cruz, California chapter of the Depression and Bipolar Support Alliance (DBSA).  She is a member of the International Bipolar Foundation’s (IBPF) Community Action Board and blogs for them at www.ibpf.org.  She was selected as the IBPF’s first 2014 “Story of Hope and Recovery”. Aside from raising her two daughters Avonlea and Marilla with her husband Craig, Dyane is a women’s mental health advocate.  She is a group facilitator for women with bipolar disorder, anxiety and depression. Dyane lives in the beautiful Santa Cruz Mountains that attracts a variety of holistic health experts, and she enjoys researching alternative fields in her quest to thrive with bipolar disorder.  She is working on her first book Birth of a New Brain – Healing from Postpartum Bipolar Disorder and you can read Dyane’s blog “Birth of a New Brain” at http://www.proudlybipolar.wordpress.com.

 

 

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9 thoughts on “The Fateful Week – A Journey with Postpartum Bipolar Disorder

  1. When I read all of this, several things make more sense to me. Oh I have suffered as we slang out here. My 5th pregnancy ( although I have only 3 boys, I have been pregnant 6 good times and the story line is sad and long for here), was very mentally challenging and to make matters worse, I laboured over 24 hours, gave birth to a girl, and saw her hurried the next day. I suffered a severe depression and even some mania for 6 months thereafter. But here in Cameroon, nobody talks or cares about pre or ante natal mental health of the woman etc. I actually got so bad up to attempting suicide. I am therefore happy to come across of such blogs and learn just so much. Especially after losing my only and beloved brother to that bi fucking polar, I am becoming a very dedicated and passionate mental health advocate. Thank you Duane for sharing, friend am proud to call you my special e friend and loved your voice when we spoke

    1. You are so welcome, honey – thanks from the bottom of my heart for reading this post and fully understanding it (although I wish you didn’t know what it was like to experience postpartum depression, mania!!!!) Sending you love, so glad you survived that time……oh, we have suffered, my friend. XOXOOXXOXOOX YOU!

  2. I suffered my first mixed episode while pregnant. We’ve since worked out that second trimester of pregnancies don’t go well for me. Unfortunately no one picked it up until after it was over and even then, the severity of it, and the following depressive episode in my third trimester and after birth were not taken seriously until my daughter was 4 months, by which time I’d been battling not to kill myself for nearly 9 months. I’d done all the right things, seen a psychiatrist, seen psychologists, seen a social worker, asked for a case manager, had a regular midwife, saw my gp regularly, had weekly phone calls from a pregnancy support service, telephoned lifeline and more. Unfortunately all those who could see how bad I was weren’t in a position to get me help themselves and when they contacted those who were in a position to help such as the psychiatrist, those who were in a position to help just dismissed their concerns.

    I should have been hospitalised in September last year but instead nothing was done until may this year by which time I’d lost my job, my husband nearly lost his taking time off to care for me as well as the emotional impact on him and our kids.

    I remember the pressured speech. The funny thing is, the whole 3 months of my mixed episode where I showed the symptoms of mania nearly everyday, I was working in an acute psych ward and while in my performance review I was told other staff had made complaints about how I talk too much, that I was hyperactive some days and other days “really negative” and many other descriptions of someone obviously not well, not one single person in my workplace (not the nurses I worked with, not the psychs I regularly had to interact with or the unit manager with many years of experience) picked up that anything was wrong at all.

    Looking back on it, it was so obvious I was having really bad manic and depressive symptoms and yet none of the professionals I worked with picked up on it. None of the professionals I was seeing personally picked up on it either other than the GP I was seeing.

    I think it’s not just postnatal manic symptoms that need to be monitored for but antenatal ones too. Unfortunately as I discovered, even perinatal psychiatrists and psychologists are not so good at picking up these things in women.

    1. I apologize for taking a few days to reply; thank you so much for this comment. My jaw dropped after reading what you went through and the fact that no one at your place or work picked up on what was going on!!!

      My heart also goes out to you – I connected with everything you wrote. I also totally agree with you that there should be antenatal monitoring/screening for symptoms!

      I’m not sure if you’re familiar with the work of Dr. Walker Karraa and her website Stigmama.com (it’s about women, motherhood and mental illness – contributors are welcome and you’d be a great contributor!) Dr. Karraa created a petition to the U.S. government for universal antenatal and postpartum mental health screening and promoted it; it didn’t get the required 100,000 signatures in order for it to be brought to the government’s attention. Meanwhile stupid petitions like deport Justin Bieber and get rid of Alaksa as a state drew hundreds of thousands of signatures. Our country’s mental health priorities are clearly out of wack.

      I started following your blog & I’ll be reading it from now on. I hope you and your family are doing well!!! You deserve some calm seas after all the hell you’ve been through!

      1. Thanks Dyane. I’ve not heard of Dr Karraa but I will definitely check out her site. I live in Australia where screening for depression in pregnancy and after birth is universal but the problem is treatment is lacking. I was referred to a community mental health service specifically for women in the perinatal period and they totally messed things up. My midwife before birth and maternal and child health nurse after birth, repeated kept telling the PMHS that I was severely depressed and suicidal and their concerns were ignored. I requested my medical records from the PMHS and was stunned to discover that every visit and phone call I had with then they’d done a suicide risk assessment – because they never asked me the questions on the assessment (are you suicidal, do you have a plan, etc) and up until about April this year they’d ticked no on all of them when the answer was yes.

        The psychiatrist there (not the person who did the risk assessments) has apologised for missing how depressed and suicidal I was and admitted he misdiagnosed me initially as having borderline pd purely because I have a trauma history. But the nasty psychologist there (who did most of the incorrect risk assessments) also wrote a lot of other untrue things (eg that I refused to contact services she suggested when in fact I had contacted them and been told I don’t meet their service criteria) as well as writing insulting things about me when I politely told her suggestions like distraction techniques don’t work for me, well she is still rude.

        Now I’m no longer seeing their service, I’m tossing up whether to make a complaint or not. I won’t complain about the psychiatrist’s incompetence even though his bad treatment choices is directly why I ended up in hospital and had to quit my job. Mainly because my boss said reapply next year and the psychiatrist I saw is one I’d also have to work with professionally at the other sites he works at (he does one day a week in perinatal and the other days in general psych) but I want to complain about the psychologist. Especially about basically falsifying the suicide risk assessments. I can prove it to because my obstetric records have the mental health assessments the midwife and nurse did and their records showing they contacted the mental health service to say I was suicidal.

        But I’m scared if I make any complaint, it will make its way back to my former boss who I’ll be going for my old job again with in the semester 2 intake next year. And that she (or the other interviewers) might not look kindly on reporting the psychologist. I don’t want to throw away a career I love just to complain about one bad psychologist.

        It’s just hard. I’ve been through two extremely mentally unwell pregnancies and even worse after birth and neither time got any help. This time around at least when my daughter was four months old, I started with a new psychiatrist who is good and accurately picked up what was wrong and got me help. And she knows now if I have another baby, to monitor me very closely during the second trimester onwards. She even picked up things like that I really badly dissociate when depressed that no other professional has picked up in the 17 years I’ve had depression and been seeing professionals.

        Anyway, sorry for the long post. It’s nice to meet someone who understands mental health and cares. My blog isn’t as good as yours but thanks for reading it. I hope to post something a little longer tonight than the few words of the last couple of days. Just still trying to wrap my head around the bad news I’ve had in the last week.

    1. Hello Dr. Fugedy and thanks for your comment and for your follow. I am not familiar with tDCS; is it related to TMS?? And one more question, I promise that’s it: Have you read my virtual friend Martha Rhodes’ book about TMS titled “3000 Pulses Later: A Memoir of Surviving Depression without Medication”? If not, I think you would appreciate it. It’s a wonderfully written memoir and she is a unique, very active advocate for TMS. While I am pro-medication as it works so well for me, I am not opposed to those who wish to try TMS. Hope to hear from you! take care, Dyane

  3. Hi
    i had postpartum psychosis too. I can so relate to the shame you felt when you realised you were not well. Its so not your fault.Im assuming you know that now… Bloody hormones mess with bipolar bears in a wicked fashion … thanks for sharing 🙂

    1. I love all your comments and your blog as well. I’m so sorry you suffered with postpartum psychosis. What a nightmare. I’ve been alerted (I get Google alerts) about recent studies being done about postpartum psychosis. There are some prominent blog posts being written about it too. But a couple years ago there was almost no awareness about it, it seems to me. Anyway, you’ve come a long way and you inspire me beyond measure!

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