Last week’s tragedy in Duxbury shed light on postpartum mental health. Lindsey Clancy, of Allegedly, he suffered from postpartum depression, of many crimes after the death of her three young children in the family home. Clancy remains in the hospital with injuries sustained in an apparent suicide attempt. While authorities have not said whether or not they believe mental illness played a role in Clancy’s alleged actions, similar cases in the past have been linked to postpartum mental health conditions, including postpartum psychosis. Dr. Nancy Pyatt, a perinatal psychiatrist at the University of Massachusetts Medical College, has joined GBH All things considered Host Arun Rath to describe the differences in pregnancy-related mental health conditions and how they manifest. This text has been lightly edited for clarity and length.
Aaron Rath: Before we get into the conversation, I want to make sure we’re using responsible terms here because we’re talking about mental health and we’re talking about a tragic situation. So right from the start, can you set the terms of the conversation for us? How do we broadly understand postpartum depression and postpartum psychosis?
Nancy Pyatt: One of the things we hear a lot about is postpartum depression, as I just mentioned. I like to think of it as perinatal depression — depression that occurs during pregnancy or within a year after giving birth — because depression can strike at any time during that time period. And when we think of perinatal depression, which includes postpartum depression, that’s very different from postpartum psychosis, because depression … does not include psychotic symptoms. This is really one of the main differences. Another illness that is getting more and more common during this time period is anxiety. Recently, those working in this field often use the term “perinatal mood and anxiety disorders,” meaning depression during this time period, anxiety disorders, and also includes bipolar disorder.
I also want to point out that postpartum psychosis is very different from mood disorders, and this is very rare. So perinatal anxiety mood disorders generally occur in one in five individuals; Postpartum depression or depression perinatal usually occurs in one in seven; [and] On the other hand, postpartum psychosis occurs in one to two out of every 1,000 individuals. So it is much less common and much rarer than any other mood or anxiety disorders that we see during this time period.
When we see postpartum psychosis, it often occurs in the context of a mood disorder. Primarily, we see it in the context of bipolar disorder. People have depressive episodes with bipolar disorder but we also see episodes of mania, or we can see something called hypomania, and that includes symptoms that one can think of as the opposite. [of] depression. With depression, people tend to have bad moods, and they tend to feel hopeless or helpless. They may have thoughts of death or wish to die. With obsession, it’s just the opposite. What we see is elevated mood, high energy, not much sleep, but still a lot of energy, triggering thoughts and irritability.
With bipolar disorder, people can experience psychotic symptoms in the course of it. When those psychotic symptoms appear in the postpartum period, that can be when we see postpartum psychosis. What we see there are psychotic symptoms and may include hallucinations. So, for example, they may hear voices commanding them. And in cases where we see infanticide or suicide, it can sometimes be voices ordering people to harm their children.
The other thing we see with postpartum psychosis is that people have delusions that are altruistic in nature. So, for example, people might think the world would be better off without their children. They may think that there is something wrong with their child or that something is wrong with them, that they may be possessed or that some evil is happening – something so evil is happening that they save themselves and the world from something worse happening, by taking them in. spirits. I think a common misconception with postpartum psychosis is that people often ask, “How could someone do this?” The missing thing is that people often actually do this from a place of love and doing what they feel is best for themselves, their children, and even the larger world or community.
Rath: We seem to expect a lot from moms. I wonder if one of the effects of this is that it makes it harder for people who are going through this to seek help? We kind of expect moms to be able to handle it all.
Byte: I think this is a contributing factor. You know, when we think of childbirth, when we think of the parallel time period, it’s historically glorified as a very wonderful time period, and mother and child are very happy. The truth is, it’s not always that great. And in fact, it is often very difficult. … I think because this fantasy or that myth persists, it makes it difficult for people to talk about this, to get help.
I also want to add that even when people feel comfortable talking about this and asking for help, it’s hard to get help. Often, the mental health care system faces a lot of challenges. There is not always the ability for them to respond and the ability to provide the appropriate response if people are calling for help, or if someone is being examined in this setting and detected.
Rath: I know something we’ve talked about a lot over the past couple of years is how the pandemic has affected the mental health baseline of almost everyone. I mean, it’s an environmental issue that affects every aspect of us. What is the impact of the pandemic on the prevalence of mental illness in the perinatal and postpartum period?
Byte: she has. We have certainly seen an increase in the prevalence of these diseases. I think some things have happened. The first is that the spread itself appears to have increased. So, for example, we’ve been talking about depression as being more common than anxiety. But recent studies show that anxiety can actually affect one in five people. We have believed that depression is one in seven for many years. So, we definitely see an increase in anxiety, which is likely related to COVID. Secondly, we’re also seeing increased awareness and increased discovery, which is amazing. There have been recommendations from the American College of Obstetricians and Gynecologists and many other professional societies and policy makers to screen individuals during this time period for depression and, more recently, marginal disorders as well. So with these recommendations, more midwifery practices and providers are screening individuals. So while also figuring this out and getting to know him more than we used to.
Rath: Dr.. Bayat, it was nice talking to you about this and hopefully you will spread some awareness as well. Thank you so much.
Byte: you are welcome. It is my pleasure to be here.