Yesterday I was honored to be asked to submit a piece of writing about my experience with postpartum bipolar disorder to Postpartum Progress (www.postpartumprogress.com). Postpartum Progress is a highly acclaimed organization helping women with postpartum mood disorders all over the world. Here is a description on their website about what they offer:
“Postpartum Progress® offers in-depth information, community and hope for pregnant and new moms with postpartum depression and all other mental illnesses related to pregnancy and childbirth (including postpartum anxiety, postpartum OCD, depression during pregnancy, post-adoption depression, postpartum PTSD, depression after miscarriage or perinatal loss and postpartum psychosis). We know that perinatal mood and anxiety disorders like PPD are temporary and treatable with professional help. We are fiercely proud to be the world’s most widely-read blog dedicated to these illnesses, with more than 1.1 million pageviews annually. Our award-winning site is consistently ranked among the top blogs in both the categories of depression and pregnancy/childbirth.”
The below article is a highly condensed version of what took place before and after my diagnosis. This post will give you an idea of the main events that occurred during the fall when I was diagnosed with postpartum bipolar disorder.
On a warm Indian summer night, I was a sweaty nine months pregnant when my water broke. During my pregnancy I tested positive for Group B streptococcus, a bacterium in my body that could result in a life-threatening infection to my baby. Right after my water broke, my husband Craig called the hospital to see if there was a room available. Due to my having the Group B bacterial infection, he was instructed by the maternity nurse to get us to the hospital right away. In pain, I stayed up all night in labor, not sleeping one wink. This innocent-sounding act — enduring one night without sleep — would be my biochemical trigger for postpartum bipolar disorder. Despite my having a strong family history of bipolar disorder, at age thirty-seven, I didn’t have any inkling that mental illness was latent in me. My first daughter Avonlea had been born almost two years earlier, and I was incredibly fortunate that I did not have a postpartum mood disorder following her birth.
My second daughter Marilla was born at noon, on August 26th, 2007; I was thrilled she was a robust seven pounds. During the first two days of Marilla’s life, obstetricians and nurses examined me at the hospital, and I visited with family and friends, but no one detected that I was in jeopardy. At first I was hypomanic, exuberant with joy over the birth, and I appeared relatively normal. Sweet Marilla attracted most of the attention. However, I sensed I was in growing trouble of some kind, but my fear of being an inept mother caused me to keep my feelings inside.
Since we didn’t have family members immediately available to help us, my mother gave us the gift of a postpartum doula named Grace. Grace and I had planned that she be with us after Marilla’s birth, but she had a completely unanticipated allergic reaction. She wasn’t able to join our family until four days following Marilla’s debut. As Grace hadn’t known my personality well before coming to work with us, and she didn’t realize that my manic behavior was different than how I had been before Marilla was born, although she was absolutely concerned with what she witnessed. Grace was wonderful with our girls and with me and Craig; she was an excellent doula, but she couldn’t rescue me from my dire situation – no one could at that point. Grace had worked with over 150 mothers; while some of them suffered from postpartum depression, none of them presented with postpartum mania like I did.
The deceptive part of postpartum mania is that people often think the new mother is simply happy to have a baby. After Marilla’s birth, I was filled with an overwhelming amount of joy and energy. However, not one of my state-of-the-art maternity center nurses, OB-GYN’s, or our pediatrician detected my mania right away. My father had bipolar one disorder, so I had a genetic predisposition to the mood disorder. Furthermore, I had suffered clinical depression ten years prior to Marilla’s birth. (Recent studies have shown that women with clinical depression prior to childbirth have a much greater chance of being diagnosed with postpartum bipolar disorder.)
During my hypomanic state, I could feel my brain thinking much, much faster than it had before. I also had a very rare condition triggered in tandem with bipolar called hypergraphia, which is compulsive writing. I had been a freelance writer for years, but this kind of writing was totally different than how I wrote before childbirth. Once I returned home from the hospital, I simply could not stop writing. I wrote at every opportunity, even during breastfeeding, and it was completely bizarre!
During my sleepless nights postpartum, in a well-meaning effort to get me to stop typing, Craig hid my laptop. As he slept, I cleaned for a good part of the night as quietly as I could. While I scrubbed countertops and organized drawers at 3:00 a.m., I yearned to have some semblance of peace and balance in my life. I also went online and typed lengthy emails to friends. I didn’t realize that my friends would be able to view the actual time I sent their emails, and some of them later told me they were puzzled that I was writing such lengthy epistles to them in the wee hours, night after night.
After I barely slept for so many days in a row, I was feeling much the way I imagined a coke addict would feel. I was revving with energy, but I felt exhausted and I was on the brink of an emotional outburst. Still, nothing too dramatic happened, so no one thought I should consult a psychiatrist. During that fateful postpartum week, my brain chemistry was markedly awry in every part of my body. Apart from cleaning the house, I had the other classic signs of mania: tons of energy, pressured speech, no appetite and loss of weight. Because it was hard for me to sit still for any length of time, my mania affected my ability to adequately breastfeed my baby. At Marilla’s one-week check-up we discovered her weight had dropped almost a pound, which perplexed my pediatrician, but at that point he did not recognize my mania.
After five days without sleep, I knew that I was sinking fast and that something needed to change. I called my OB/GYN and told her medical assistant Priscilla I couldn’t sleep. Priscilla suggested I try an over-the-counter drug such as Benedryl, but I sheepishly asked if I could try something stronger than that, because Benedryl had never made me sleepy in the past. With my OB/GYN’s approval, Priscilla phoned in a prescription for Ambien.
I also felt compelled to speak with another mother who had experienced a postpartum crisis. I called our local Postpartum “Warmline” but the number was disconnected! I was incredulous and angry that such an important hotline had vanished. (I later found out it disappeared due to a budget cut.) I called information asking if they had some kind of a postpartum support line, but the operator couldn’t find a number, and I got even more discouraged. Finally, I called our local maternity hospital’s lactation center and they gave me the number of the Postpartum Support International (PSI) Bay Area hotline. The PSI volunteer I called, Linda, encouraged me to consider medication to help me sleep. Her suggestion validated my earlier decision to ask my OB/GYN for a sleep aid. After we ended our conversation, I felt so comforted in speaking with someone who understood how difficult the postpartum period was. After taking my first sleeping pill, I got the first decent night’s sleep I had in five nights and I felt a little rested the following day.
A month after Marilla was born, I knew I had mania; after all, I had witnessed mania firsthand in my Dad. Before I told Craig or anyone else, I surfed the internet looking for anything related to postpartum mania. I located a statistic that one in one thousand mothers who give birth will succumb to postpartum mania. Then the name “Dr. Alice W. Flaherty” appeared in my postpartum mania search. She was a neurologist at Massachusetts General Hospital, a Harvard professor, and renowned author of The Midnight Disease, an examination of the drive to write, writer’s block and the creative brain. In The Midnight Disease Dr. Flaherty courageously shares her own experience with hypergraphia, the heartbreaking death of her newborn twins, and her hospitalization for a postpartum mood disorder. I couldn’t believe my luck, for I had the gut feeling that this woman could help me. I made the necessary calls to track down her assistant.
Miraculously, I was able to reach Dr. Flaherty the following day. Before we spoke, I shared with Craig about my suspicions and he wanted to be part of our conversation. Dr. Flaherty generously made time for us to have a brief, pro bono phone consultation. Dr. Flaherty recognized my mania as she heard my pressurized speech pattern, and helped me calm down. She said right off the bat, “I need you to focus right now.” Focus I did. Dr. Flaherty shared with me how medication stabilized her own postpartum mania. She also strongly encouraged me to consider using formula as a supplement for Marilla, which I did.
I scheduled an appointment with the psychiatrist I had seen for depression, but before I saw him, it was time for Marilla’s six-week checkup. I brought Marilla in to our razor-sharp, UCLA-trained pediatrician. Before arriving at his office I had gathered a bunch of thank-you gifts for him. When I greeted him, he listened to my racing voice and observed the plethora of presents. I’ll never forget how he blurted out, “You’re manic!” I immediately burst into tears. While I felt embarrassed and ashamed, a part of me felt relieved that he figured out what was happening with me. From the point on, my mental condition deteriorated and instead of seeing my former psychiatrist it was clear to me that I needed hospitalization. It broke my heart to leave my family, but I admitted myself into our local hospital’s mental unit. It was there I was officially diagnosed with bipolar one disorder and I took my first mood stabilizer.
In the eight years since I was diagnosed, research organizations have been studying postpartum bipolar disorder. A prominent 2013 study appeared in the journal Bipolar Disorders. This study suggests that women with a prior history of depression should be screened for hypomanic symptoms after giving birth. Canadian researchers asserted that childbirth is a potent, specific trigger for mania or hypomania. They found the number of women who transition from depression to bipolar II disorder following birth is 11 to 18 times higher than rates reported for women who hadn’t recently given birth.
I feel that it’s imperative the doctors and other caregivers who assess women for postpartum depression also screen them for hypomanic or manic symptoms. My two daughters and husband have suffered immeasurably due to my postpartum bipolar disorder. On the bright side, they have also observed my hard-won recovery. After years of trying many medications, numerous hospitalizations and even two courses of electroconvulsive therapy, I am finally stable. Bipolar disorder ravages many relationships, but Craig and I have been married for fifteen years. With the guidance of counselors and psychiatrists, our marriage is stronger and more precious than ever before. I am a member of the International Bipolar Foundation’s Consumer Advisory Board and I blog for them as well. With any mood disorder, community support can be incredibly helpful. To that end, I founded the Depression and Bipolar Support Alliance (DBSA) chapter where I live and I facilitated a free women’s support group for two years. I’m now focusing on my family and working on my book Birth of a New Brain – Healing from Postpartum Bipolar. Life will always be a challenge living with bipolar one disorder, but my girls have inspired me to work on my recovery with every ounce of my being.
Dyane Leshin-Harwood’s bio:
Dyane holds a B.A. in English Literature from the University of California at Santa Cruz. Dyane was diagnosed with Type I Bipolar Disorder in 2007 at age thirty-seven. A writer, Dyane’s articles have been published in numerous magazines. She has worked with one of her favorite authors, Madeleine L’Engle, author of the classic A Wrinkle In Time. She had the thrill of meeting Dr. Kay Redfield Jamison, author of the groundbreaking book An Unquiet Mind, to interview her for an article about women, depression and exercise. Dyane is a certified personal trainer with the American Council on Exercise. Dyane founded the Santa Cruz, California chapter of the Depression and Bipolar Support Alliance (DBSA). She is a member of the International Bipolar Foundation’s (IBPF) Community Action Board and blogs for them at www.ibpf.org. She was selected as the IBPF’s first 2014 “Story of Hope and Recovery”. Aside from raising her two daughters Avonlea and Marilla with her husband Craig, Dyane is a women’s mental health advocate. She is a group facilitator for women with bipolar disorder, anxiety and depression. Dyane lives in the beautiful Santa Cruz Mountains that attracts a variety of holistic health experts, and she enjoys researching alternative fields in her quest to thrive with bipolar disorder. She is working on her first book Birth of a New Brain – Healing from Postpartum Bipolar Disorder and you can read Dyane’s blog “Birth of a New Brain” at http://www.dyaneharwood.wordpress.com.