The Lindsay Clancy case has brought renewed attention to postpartum healthcare and what the appearance of severe psychiatric symptoms can look like. The circumstances of this case and other individual cases like it should always be approached carefully, particularly when questions of diagnosis and legal responsibility remain contested.
At the core of these cases is a conversation that needs to be had about the difference between postpartum depression (PPD) and postpartum psychosis (PPP). It is important that we understand the distinction between these two conditions, along with the appropriate level of care for both.
Postpartum Depression Is More Than the Baby Blues
The baby blues is a term used to describe mild and temporary emotional changes that many people experience shortly after giving birth. Many women have an adjustment period after bringing a new baby home that can be considered the baby blues. It is a big change to your life, whether you are doing it for the first time or the fourth.
Physical recovery, hormonal changes, disrupted sleep, and the demands of caring for a newborn can all affect how you feel. What is important is knowing the distinction between what may be the baby blues and what requires a call to your doctor.
Those who experience the baby blues may report fatigue, difficulty sleeping, and mood swings. You might be irritable or lash out more frequently. Anxiety is also common, along with tearing up or crying for no obvious reason. If it is the baby blues, symptoms will often resolve on their own within two weeks. Rest and support from loved ones may help during this adjustment period.
Common Symptoms of Postpartum Depression
So, how is this different from PPD? PPD can last for months, and the symptoms tend to be more persistent or severe. Here are some common symptoms of PPD:
Mood and Self-Worth
Feeling worthless, excessively sad, or guilty.
Loss of Interest
Losing interest in your usual hobbies or forms of entertainment.
Focus and Fear
Having difficulty focusing, thinking, or staying on task, or feeling like something bad is going to happen.
Appetite, Sleep, and Energy
Experiencing a loss of appetite or overeating, feeling overly tired throughout the day, or having difficulty sleeping.
Bonding and Anxiety
Having difficulty bonding with or feeling connected to your baby, or feeling excessively anxious around your baby.
Thoughts of Harm
Having thoughts of death, harming yourself, or harming the baby.
Postpartum depression can begin during the weeks or months following delivery and may develop anytime within the first year. Symptoms that persist for two weeks or longer, become severe, or interfere with daily life should be discussed with a medical professional. A qualified provider can determine whether the symptoms are related to postpartum depression or another medical or mental health condition.
Postpartum psychosis is a psychiatric emergency.
How Does Postpartum Psychosis Differ?
To understand PPP, we first need to talk about what may contribute to PPD. Doctors and researchers have not identified a single cause. After having a baby, a woman's body experiences a significant shift in hormones. Levels of progesterone and estrogen, which increase dramatically during pregnancy, suddenly drop after delivery.
Researchers are still studying the connection between these hormonal changes and the onset of postpartum depression. Genetics, previous psychiatric history, sleep disruption, physical recovery, and social or environmental stress may also contribute. If you have experienced mental health issues in the past or they run in your family, you may be more likely to experience PPD.
The causes of PPP are also complex. Doctors cannot say with certainty who will experience PPP instead of PPD. However, people with bipolar disorder, a personal or family history of psychosis, or a previous episode of postpartum psychosis face an increased risk. Severe sleep disruption may also contribute.
Unlike PPD, postpartum psychosis often begins abruptly, frequently within the first days or two weeks after delivery.
Postpartum Psychosis Symptoms to Know
Mood or Energy Changes
Extreme mood fluctuations or irritability, inability to sleep and severe restlessness, or feeling unusually energized despite being sleep deprived.
Loss of Contact With Reality
Delusions, paranoia, hallucinations, severe confusion, or disjointed thoughts.
Reduced Responsiveness
Catatonia or significantly reduced responsiveness.
Thoughts of Harm
Thoughts of harming yourself or the baby.
Postpartum psychosis is a psychiatric emergency. If you or someone you love is experiencing hallucinations, delusions, severe confusion, loss of contact with reality, or an immediate risk of harm, call 911 or go directly to the nearest emergency room. Do not leave the person or baby alone while arranging emergency assistance.
Unwanted and frightening intrusive thoughts can also occur with postpartum depression, anxiety, or obsessive compulsive disorder. Having these thoughts does not automatically mean that someone has postpartum psychosis or intends to act on them. However, they should still be disclosed to a healthcare professional so the person can receive an appropriate evaluation without judgment.
Why Postpartum Mental Health Can Be Complicated
Mental health is still an area that can be stigmatized. Whether due to culture, religion, fear, or misinformation, many people still struggle to speak openly about their mental health. Who would want to tell their doctor that they think they might harm their baby or themselves? It takes a lot of courage to find your voice and speak up for yourself and your child.
Postpartum healthcare can also involve several providers, including an obstetrician, primary care provider, therapist, and psychiatric clinician. Gaps in screening, communication, monitoring, or access to care can lead to women slipping through the cracks. This is why ongoing monitoring and open communication are important throughout the postpartum period.
Medication Management Requires the Full Picture
Those who are experiencing PPD may benefit from therapy, psychiatric medication management, or a combination of approaches. The appropriate treatment will depend on the person's symptoms, their severity, medical and psychiatric history, personal preferences, and individual circumstances.
The Center of Excellence takes an individualized approach through careful evaluation, personalized planning, and ongoing monitoring. After a psychiatric evaluation, a care plan is created through a collaborative effort between you and your doctor.
It is crucial that your doctor has a full picture of what you are experiencing so they can offer appropriate care. Every patient will have different needs. Maybe you have tried other medications in the past that have not worked for you. Or maybe you have a separate mental health issue that also needs to be addressed. Your doctor should also know whether you are pregnant or breastfeeding when discussing medication options. Whatever the case, your story is unique, and it matters.
Getting Help Early Matters
We believe everyone deserves a personalized approach to their mental health journey. Reaching out for care is the most crucial first step. Early evaluation can help prevent symptoms from escalating and connect patients with the appropriate level of care and support.
With effective treatment, recovery is possible. Many patients experience meaningful improvements in their symptoms, daily functioning, and ability to connect with their families.
At the Center of Excellence, we have three core pillars that ground our approach to care: we want your whole story, we will tailor a care plan to your specific needs, and we will be here for ongoing care as your journey evolves. Our compassionate psychiatric providers offer individualized and judgment-free care by telehealth across Oregon, Washington, and Alaska.
If you or someone you know is in immediate danger or experiencing symptoms of postpartum psychosis, call 911 or go to the nearest emergency room. For crisis support, call or text 988. The National Maternal Mental Health Hotline is also available by calling or texting 1-833-TLC-MAMA (1-833-852-6262).