Sarah Short Circuit

Heal, Nourish, Nurture

Category: Enlighten (page 2 of 4)

Full recovery is possible

My story of postpartum psychosis has been published in The Guardian today alongside some great new research! I am so proud of the mother I have become and proud to be a PANDA Community Champion raising awareness of postpartum psychosis in our community.

“People can mistakenly describe what women like me go through as ‘baby blues’ or ‘depression’, but I was definitely not depressed,” West says.

West received treatment after a friend told her she was not behaving like her usual self and called the National Perinatal Anxiety and Depression Helpline [Panda]. They advised that West should be taken to hospital immediately for psychiatric care, and West is now a strong advocate for the helpline.

“I have to speak up because I don’t like the thought of other families going through what we did. This has to change and to do that we need better recognition of the condition.”

Source: Postpartum psychosis: research reveals full recovery possible within weeks | Life and style | The Guardian

 

Know the signs and seek help early. PANDA National Helpline 1300 729 360 panda.org.au

Mum ‘intentionally’ drowns baby

The mother of a baby girl who drowned in a bathtub has pleaded not guilty to murder, on the grounds she was suffering a mental illness at the time, but guilty to manslaughter.

Source: Mother of baby girl who drowned in bathtub pleads guilty to manslaughter

Additional source:  Mum ‘intentionally’ drowns baby over mistaken fears she had dwarfism

Another mother who did not receive the support she needed, though the article does not specifically refer to the mental illness as postpartum psychosis. It highlights the importance of having support around you as a new mum, with no mention of a husband or family only friends who were ‘fed up’ with her obsessions.

Soon after the girl was born in April 2010, the mother had begun worrying obsessively that her daughter had genetic abnormalities.

This mum was in North Strathfield, only about 10 minutes away from NSW’s only Mother Baby Unit, though it’s private. It highlights the lack of support in the NSW health system yet in the same week Queensland Health announce the first public Mother Baby Unit and the week before Bendigo, Victoria announced its new public Mother Baby Unit. How many other mothers have to reach this stage and how many more deaths have to occur before the NSW government recognises perinatal mental health and the importance of early intervention. #ActNowNSWPublicMBU

“This is an important step forward because we know that intervention during the perinatal period is critical to improving the health of mothers and their ability to care for their baby.

– Queensland Health

Every year, PANDA helps thousands of Australian families affected by perinatal anxiety and depression. We believe it’s a journey no one should go through alone. Know the signs and seek help early. PANDA National Helpline 1300 729 360 panda.org.au

Postpartum and the Thyroid

Listening to Dr Kelly Brogan on the Thyroid Sessions back in 2014 was the first realisation that my thyroid may be a piece of my postpartum psychosis puzzle. Dr Kelly discussed the triangle of psychiatric symptoms, gluten intolerance and thyroid dysfunction and this was the first time I heard a medical doctor discuss postpartum psychosis directly. Women with first episode postpartum psychosis were 19% positive for thyroid antibodies and within 9 months 67% had a higher risk to develop autoimmune hypothyroidism (1). Dr Kelly discussed how postpartum thyroid symptoms can be easily attributed to being a new mum, such as lead limbs, feeling fatigued, super forgetful, mentally disorganised which at 9 months postpartum could be symptoms of Hashimoto’s disease or postpartum thyroiditis. Postpartum issues lead straight to psychiatry, no acknowledgement of the female hormones, not even a test for thyroid function. Dr Kelly says that psychiatric symptoms are usually endocrine related: thyroid or adrenal or blood sugar regulation with insulin or leptin or your sex hormones progesterone or oestrogen. Also, zinc, selenium, magnesium and iodine are key nutrients in thyroid function. To find out more about these psychiatric pretenders I recommend reading A Mind of Your Own.

Typically when you go to your General Practitioner, the thyroid test is limited to blood test TSH, which is a pituitary hormone measure, an indirect measure of thyroid function. To get the full picture of your thyroid free thyroid levels T3 and T4, reverse T3 and thyroid autoantibodies. My GP was reluctant to do further tests as my TSH came back ‘normal’ until I showed him a copy of the research paper (1). Remember there is not one size fits all, you may have symptoms even being in the ‘normal’ range.

The Thyroid Secret is on now and I am looking forward to tuning in to Episode 7: Motherhood Interrupted to discover more about the role of thyroid in the postpartum period (starts on Wednesday 8 March 10am Sydney time).

PS: My test results including my thyroid antibodies came back all good and my GP has noted on my file to check and monitor my thyroid function  if and when I fall pregnant.

References

1. Prevalence of autoimmune thyroid dysfunction in postpartum psychosis. The British Journal of Psychiatry Mar 2011, 198 (4) 264-268

Further Reading

 

Pharmacological Lactation Suppression

Contemporary models of severe psychotic forms of mental illness assume it is triggered by dysregulation of dopamine, i.e. chemical imbalance, arising from adverse interaction of predisposing risk genes and environmental factors. All successful antipsychotic agents have the ability to act as a D2 receptor antagonist (dopamine inhibitor), raising the question as to whether those with have or at risk of psychosis are susceptible to onset or exacerbation of psychosis when prescribed D2 agonists (dopamine activator).

Early postnatal period is a time of high risk for psychosis. The underlying pathophysiological mechanisms of postpartum psychosis are poor understood.

FDA recommends against the practice of prescribing D2 agonists (activator) due to longstanding evidence about cardiovascular disease and neurological risks.

Pharmacological Lactation Suppression with D2 Receptor Agonists and Risk of Postpartum Psychosis – Dr Josephine Power, International Marce Society Conference 2016.

Reference

Snellen et al. 2016. Pharmacological lactation suppression with D2 receptor agonists and risk of postpartum psychosis: A systematic review.

Transmission of Trauma

Post Traumatic Stress Disorder (PTSD) is the long lasting effects of stress. In the flight/fight response to a threat, the sympathetic nervous system is activated, adrenaline is released to cope with the stress, then cortisol is released to stop the stress response and breaks down when the threat is removed. In PTSD the cortisol levels are lower, which are a reflection of a greater dysregulation of the HPA axis, including circadian rhythm alteration, glucocorticoid receptivity and alterations in cortisol metabolism.

In trauma survivors the stress responsive can be a transformative experience. The offspring of trauma survivors, such as the Holocaust, were also more likely to experience anxiety and depression and have lower levels of cortisol associated with child adversity.

Offspring make their own changes – is this transmission or accommodation? Developmentally programmed changes allow more flexible responding but may be a mismatch for the offspring.

Intergenerational Transmission of Trauma – Epigenetic mechanisms, the in Utero Environment and Early Attachment – Dr Rachel Yehuda, International Marce Society Conference 2016.

Further reading

Yehuda & Le Doux 2007. Response variation following trauma: a translational neuroscience approach to understanding PTSD.

Yehuda & Bierer 2008. Transgenerational transmission of cortisol and PTSD risk.

Prenatal stress

A mother’s emotional state while pregnant has long lasting effects with cultural, environmental and biological differences. Foetal programming has different sensitive periods and our environment starts in the womb. Sensitive early mothering helps attachment, and can counteract some of what happens in the womb.

It is not just toxic stress that is associated with changes in development and behaviour. Prenatal stress can be pregnancy specific anxiety, maternal mental health and daily hassles. The associated risks in children are that they are more likely to have anxiety and depression, increased aggression, impaired cognitive development, sleep problems, temperament issues. There are risks of physical changes including low birth weight, preterm delivery, decreased telomere length (impacts longevity), decreased immune function and altered microbiome. Some are more affected than others due to the gene-environment interactions, for example, the more depressed, more methylation, more epigenetic changes. 

Just think of the impact globally stress may be having on the next generations. For more info check out http://www.beginbeforebirth.org/

Effects of prenatal anxiety, depression and stress on the child: global implications – Professor Vivette Glover, International Marce Society Conference 2016.

Factors influencing decision making

1 in 5 risk of postpartum psychosis and half are considering pregnancy plans. Research is revealing the large variety of factors influencing decision making for women with bipolar disorder including social support, family history, stigma and fear.

Understanding the importance of stigma, contextual factors such as time pressures and social support from their partner and family, local service provision, fear including the fear of becoming ill and fear of social services, and the centrality of motherhood.

This study also enabled the inclusion of views of women who decided against having a child because of bipolar disorder (26%).

This highlights the problems of getting reliable information and advice to women with bipolar disorder and what women want from services as well as the need for more training for health professionals.

Read the full study here http://bjpo.rcpsych.org/content/2/5/294 (open access).

Factors influencing women with bipolar disorder when making decisions about pregnancy and childbirth: a qualitative study – Clare Dolman, International Marcè Society Conference 2016.

At risk

131,000 women a year with postpartum psychosis, of which it’s suspected they do not get top care if getting any care at all, with a higher prevalence and worse care in developing countries.
Launch of the Global Alliance for Maternal Mental Health – Dr Alain Gregoire, International Marce Society Conference 2016.

Severe Postpartum Mood Disorders – Who’s Really at High Risk? – Professor Ian Jones, International Marcè Society Conference 2016.

It is important to know more about the risk for postpartum psychosis as an opportunity for intervention and prevention to avoid devastating outcomes. Postpartum psychosis has a rapid onset with the vast majority of cases in the first 3 days to 1 week.

The risk for developing postpartum psychosis is not evenly spread across the perinatal spectrum. Certain groups of women are at a higher risk including  bipolar disorder and those who have previously experienced postpartum psychosis.

The risk for postpartum psychosis is about 50% if the mother has experienced a previous episode. The recurrence rate range is 14-57%, the differences in rates accounted by the differences in methodologies, differences in managements and the differences in the classification of bipolar disorder.

The risk profile for postpartum psychosis is different to bipolar disorder warranting different approaches for treatment. The lifetime pattern of postpartum psychosis has a strong association with bipolar I. A problem with diagnosis of postpartum psychosis occurs as 10% of the population is on the bipolar spectrum, along with with over-diagnosis, perceptions of psychiatrists, pressure from patients to give a label. All this matters because of the overburden of services, worry women unnecessary, combining bipolar disorder with postpartum psychosis underestimates the risk and can include the wrong women in research studies.

Women who have no perinatal episode have a 32% risk of postpartum psychosis. Further variables do not add to the predictive value of having an episode in a first pregnancy. There is a vulnerability of sleep loss in experiencing a manic episode.


There is research into the genetic markers of postpartum psychosis however this is dependent on sample size. Professor Ian Jones is seeking DNA samples from women who have experienced postpartum psychosis.

References

Di Florio et al. 2013. Perinatal episodes across the mood disorder spectrum.

Langan Martin et al. 2016. Admission to psychiatric hospital in the early and late postpartum periods: Scottish national linkage study.

Kendell et al. 1987. Epidemiology of puerperal psychoses.

Robertson et al. 2005.  Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis.

Bergink et al. 2012. Prevention of postpartum psychosis and mania in women at high risk.

Katie Lewis et al. 2016. Is sleep disruption a trigger for postpartum psychosis?

Jones & Craddock 2007. Searching for the puerperal trigger: molecular genetic studies of bipolar affective puerperal psychosis.

Bergink et al 2013. Immune system dysregulation in first-onset postpartum psychosis.

 

 

Marce Conference books

I indulged at the International Marcè Society Conference for Perinatal Mental Health in getting a few books!

📗Eyes Without Sparkle by Elaine Hanzak – the first book I read about a lived experience of postpartum psychosis.

📘Another Twinkle In The Eye. Contemplating another pregnancy after perinatal mental illness by Elaine Hanzak – haven’t been able to read this yet despite borrowing a few times from the library. May bring me closer to making peace with my decision.

📙 Beyond The Baby Blues by Catherine Knox, Benison O’Reilly & Seana Smith – a must have after hearing Dr Vijay Roach speak at the Gidget Foundation breakfast and chatting with Catherine personally.

📗A Mother’s Climb Out of Darkness. A Story about Overcoming Postpartum Psychosis by Jennifer Hentz Moyer – Jennifer is pioneer spokeswoman for education and support for postpartum psychosis and shares her lived experience in this book. This can be a tricky book to find.

📘The Polyvagal Theory. Neurophysiological Foundations of Emotions Attachment Communication Self-Regulation by Stephen W. Porges – been on my wish list since meeting Holly Bridges at the MINDD forum.

📙Scared Sick. The role of childhood trauma in adult disease by Robin Karr-Morse with Meredith S. Wiley – how our innate fight-or-flight system can unexpectedly become an agent of chronic illness if overworked in the early stages of life. This intrigued me with knowing the SD Protocol.

If you can’t find me you may find me curled up with a book…

PPD ACT

Want to be part of the largest ever international study of PND and postpartum psychosis? I know I do (especially as I am a researcher!)

The Queensland Brain Institute and Postpartum Depression and Action Towards Causes and Treatment (PACT) have introduced a free app to launch the largest ever international study of postnatal depression (PND) and postnatal psychosis. Available on iPhone and iPads (and desktop), the app aims to help researchers understand why some women get PND or postnatal psychosis and others don’t. The results will then assist in developing more effective treatments and help new mums struggling with PND or postnatal psychosis.

The Australian arm of the PPD ACT study is designed to collect more detailed information about health and lifestyle as part of our “Genetics of Risk and Response to Treatment of Depression” study.

Mothers must be over 18 to participate and have struggled with either PND or postnatal psychosis at some stage in their life. Those currently being treated and those who were affected years ago all qualify to take part in the study.

Visit pactforthecure.com to find out more and join in!

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