In the wake of the tragedy in Duxbury, two reproductive psychiatrists clear up myths around postpartum psychosis, postpartum depression, and medication for mental health.
Thanks very much for this write-up so valuable and very interesting. I have two question or concerns though. The first one relates to the comment made by Dr Hutner: "Postpartum psychosis is a rare condition. " from a statistical perspective this may make sense 1-2 in a 1000 is not a great chance on an individual basis but from a public health perspective it is significant if it happens that frequent, healthcare professionals should be better trained and general awareness should be higher. There was a powerful article about this by PPP Awareness: https://pppawarenessday.org/calling-ppp-rare-sends-the-wrong-message/. The second one related to another comment by Dr Hutner on the relation between PPP and bipolar disorder. "In general, we think of postpartum psychosis as a presentation of bipolar disorder. [...] never have symptoms like it again; however, cases like this are rare." I think this is not in line with academic literature, and perhaps also approach differently in the UK were first occurrence of psychosis in the postpartum stage is not considered bi-polar disorders. This makes sense as there is a fair share of women who never suffer a psychosis again, with literature stating "3.5% of women with postpartum psychosis have no manic or psychotic recurrence outside the postpartum period over a mean follow-up of 16 years (Gilden et al. 2020)" and "Over two thirds of the women included in this study did not have major psychiatric episodes outside of the postpartum period during follow-up. The overall recurrence rate of mood/psychotic episodes outside the postpartum period was ~ 32%." (Rommel et al. 2021). I myself find it quite stigmatizing and also sending the wrong message that most women who suffer PPP already had either a diagnosed/undiagnosed psychiatric disorder and will remain patient in the future. I hope you can share this message with her. Thanks very much, Willemijn de Bruin (PPP survivor without prior mental health condition and not diagnosed as bi-polar either)
Thanks for sharing this and specifically for your comment on the use of the word "rare"—how it applies both statistically (especially as it relates here to incidences of PPP versus other PMADs like PPD and PPA) and the more nuanced and important ways in which the term can land with people. Language is important and, as you note, something can be statistically rare and also have a way of making someone feel stigmatized or like something "can't happen to them" if it's rare.
We need more dialogue around all of these topics, and ultimately it's absolutely crucial that healthcare professionals are more specifically-trained and public awareness of all PMADs is higher. As Dr. Hutner notes in the piece, PPP can and does certainly present without bipolar disorder and in cases where postpartum psychosis is the only instance throughout someone's life. I would love to see more research being done in these important fields.
Thanks very much for this write-up so valuable and very interesting. I have two question or concerns though. The first one relates to the comment made by Dr Hutner: "Postpartum psychosis is a rare condition. " from a statistical perspective this may make sense 1-2 in a 1000 is not a great chance on an individual basis but from a public health perspective it is significant if it happens that frequent, healthcare professionals should be better trained and general awareness should be higher. There was a powerful article about this by PPP Awareness: https://pppawarenessday.org/calling-ppp-rare-sends-the-wrong-message/. The second one related to another comment by Dr Hutner on the relation between PPP and bipolar disorder. "In general, we think of postpartum psychosis as a presentation of bipolar disorder. [...] never have symptoms like it again; however, cases like this are rare." I think this is not in line with academic literature, and perhaps also approach differently in the UK were first occurrence of psychosis in the postpartum stage is not considered bi-polar disorders. This makes sense as there is a fair share of women who never suffer a psychosis again, with literature stating "3.5% of women with postpartum psychosis have no manic or psychotic recurrence outside the postpartum period over a mean follow-up of 16 years (Gilden et al. 2020)" and "Over two thirds of the women included in this study did not have major psychiatric episodes outside of the postpartum period during follow-up. The overall recurrence rate of mood/psychotic episodes outside the postpartum period was ~ 32%." (Rommel et al. 2021). I myself find it quite stigmatizing and also sending the wrong message that most women who suffer PPP already had either a diagnosed/undiagnosed psychiatric disorder and will remain patient in the future. I hope you can share this message with her. Thanks very much, Willemijn de Bruin (PPP survivor without prior mental health condition and not diagnosed as bi-polar either)
Thanks for sharing this and specifically for your comment on the use of the word "rare"—how it applies both statistically (especially as it relates here to incidences of PPP versus other PMADs like PPD and PPA) and the more nuanced and important ways in which the term can land with people. Language is important and, as you note, something can be statistically rare and also have a way of making someone feel stigmatized or like something "can't happen to them" if it's rare.
We need more dialogue around all of these topics, and ultimately it's absolutely crucial that healthcare professionals are more specifically-trained and public awareness of all PMADs is higher. As Dr. Hutner notes in the piece, PPP can and does certainly present without bipolar disorder and in cases where postpartum psychosis is the only instance throughout someone's life. I would love to see more research being done in these important fields.