Fighting Postpartum Depression - Postpartum Depression and Postpartum Psychosis

Written by Louise Kiernan

'No good to myself'

Later that afternoon, Melanie stood with her husband in their immaculate townhouse, which she had decorated in her confident, colorful style--a trio of giant tin giraffes in the bedroom and silk curtains the shade of saffron in the kitchen.

Her voice was as flat as her surroundings were vibrant.

She needed Sam to drive her to the emergency room, she said, because her obstetrician thought she should be evaluated by a psychiatrist for postpartum depression.

Sam didn't know what to say.

His wife was beautiful. She was smart. She had a husband who loved her. A successful career. A comfortable home. Enough money to buy almost anything she wanted to buy and go almost anywhere she wanted to go. On top of everything else, she had the daughter she had dreamed of since childhood.

How could she be depressed?

Sam didn't understand what was happening. As he and his wife left for the hospital in silence, they headed into a world that would offer Melanie and the people who loved her little in the way of answers.

The causes of postpartum mood disorders remain unknown, but recently, some experts have come to believe that the dramatic physiological changes that occur with birth and its aftermath may play a role in their onset.

During pregnancy, a woman's estrogen and progesterone levels skyrocket, then plummet to pre-pregnancy levels within a few days of giving birth. Other hormones, including oxytocin, which is known to trigger maternal behavior in some mammals, and cortisol, which is released in times of stress, also change dramatically during pregnancy and afterward.

Hormones act upon the brain in ways that can influence mood and behavior. Some researchers think that in women who may already be vulnerable for some reason--because of a prior bout of mental illness, for example, or stressful life events--these biological shifts may trigger psychiatric illness.

Melanie came back home from the emergency room at Michael Reese Hospital that evening. The emergency room doctor didn't think she was sick enough to admit, hospital records show, and referred her to a psychiatrist.

Whatever strength Melanie had mustered to maintain control evaporated. Over the weekend, she became more agitated and upset. She couldn't stop pacing. Early Sunday morning, Sam awoke to find Melanie gone. He went outside and found her walking back from the lakefront in the dark.

Later that morning, they returned to the emergency room at Michael Reese and Melanie was admitted to the psychiatric unit.

By the time Melanie got help, she was so sick she needed to be hospitalized. Most women with postpartum mood disorders can be treated as outpatients, with a combination of medication, therapy and social support.

Drugs work in about 60 to 70 percent of cases, but they can be tricky to administer. Finding the right mix of medications and doses can be a matter of trial and error. Some medications produce serious side effects; most don't take full effect for weeks.

At the hospital, Melanie told a social worker that she had become increasingly anxious about parenting, her medical records show. She thought that she should do that as well as she had done everything else in her life. She couldn't tell anyone how desperate she felt. Finally, she said, she couldn't function anymore.

"I can't care for myself or my child feeling like this," she said. At the hospital, doctors placed Melanie on antidepressant and antipsychotic drugs, as well as a nutritional supplement, because she wasn't eating.

No one used the word "psychosis," her family says. But depression didn't seem to describe the distant, agitated woman who sat in the hospital room, stony-faced and fiddling with her hair.

"How can I explain to anybody how something has literally come inside my body," Melanie wrote in her journal. "(T)ook away my tears, joy, ability to eat, drive, function at work, take care of my family. ... I'm just a useless piece of rotting flesh. No good to anyone. No good to myself."

From her 10th-floor condominium, Carol Blocker could see Melanie's hospital room.

Every night, she stood at the window with a flashlight. She flicked it on and off so her daughter would know she was there.