This past week there’s been a great deal of discussion about the tragedy in Jerusalem, the young woman who took the lives of her four children and herself. The youngest was 11 months old. Apparently, the woman had contacted Ministry of Welfare employees to ask for help. As the term PPD, post-partum depression, has been used a great deal in these discussions. I felt it important to weigh in on this conversation.
The terms we use
To clarify, the DSM V, the “bible of diagnostic criteria” used by the international medical community as its rule of thumb, defines PPD as “a major depressive episode with an onset in pregnancy or within 4 weeks of delivery.”
Post-partum psychosis is defined as a “psychotic episode in 1 or more of 5 domains: delusions, hallucinations, disorganized thinking, grossly disorganized or abnormal motor behavior, and negative symptoms, in general”. Clinicians are allowed to apply the “with postpartum onset” within 4 weeks of delivery.
Post-partum depressive order, which includes anxiety, panic, and obsessive-compulsive disorders, are also technically considered post-partum, if they are diagnosed within four weeks of delivery. However, most providers agree that if an incident occurs within one year of delivery/pregnancy, it’s post-partum related.
Post-partum psychosis is extremely rare. Although when we meet its aftermath, as could be in the case of this young woman and her family, we are horrified and distressed. Yet, post-partum depression is much more common, in as much as 6% of all deliveries, and often goes undiagnosed.
Case in point.
Many years ago, I had a friend who told me, in confidence, after many tears, that after her baby was born, she had overwhelming thoughts that she would take the baby and throw him out the window, to save him. Or that she could picture herself smashing him with a hammer. She was horrified by these images and thought maybe she needed to be committed or put on heavy duty medication. I assured her that those thoughts are not uncommon. Many women have those obsessive thoughts after birth; the thought is NOT connected to action and these women will not harm their babies, but they need reassurance. This is not post-partum psychosis, but rather post-partum anxiety disorder.
Another case in point. I had a client who had normal pregnancies, no issues at all. During her sixth pregnancy, she experienced what took her some time to realize were panic attacks. After an emergency room visit, and fruitless encounters with doctors, it wasn’t until after the pregnancy, that she diagnosed herself with post-partum panic disorder, a real and devastating illness that affects roughly 2% of women who’ve given birth.
Women can experience a panic attack, racing heart, feeling like they’re going to faint, dizziness, feeling like they’re going to pass out or die. These episodes may come on suddenly with no warning, and pass after twenty minutes or so. If this happens several times during the week, she may be suffering from post-partum panic disorder, a diagnosable illness that can be triggered by pregnancy, especially after multiple births.
SSRIs (Selective serotonin reuptake inhibitors often used to treat depression), cognitive behavioral therapy, SE (somatic experience therapy), Eye movement desensitization and reprocessing (EMDR) have all been found to be effective treatments for these disorders. The most crucial aspect, though, can be recognizing the problem and getting the proper assistance.
What resources exist in Israel for women experiencing these issues?
- Nitza – 02-500-4523 – a small non-profit that offers referrals, workshops, a hotline and subsidized therapy, if needed.
- Even though the kupot are now responsible for mental health as well, there is still a network of clinics for Family Health that include a staff of trained psychologists, for free, that can offer initial intake, and evaluation. A complete list (in Hebrew) can be found at here.
- All Tipat Chalav nurses have been trained to recognize the symptoms of post-partum depression. Although not all of them practice what they have learned, it is an important resource to access, especially if you have a prior relationship with the Tipat Chalav nurse.
Diagnosing Post Partum depressive disorder, panic disorder, anxiety disorders, and psychosis
It is not always easy to recognize these illnesses either in ourselves or in others, but there are some warning signs that women can take into account. Feeling overwhelmed after birth is normal; feeling teary-eyed, vulnerable and fragile is as well. If, however, like in the case of my client, the thought of your husband going to work in the morning fills you with unbelievable dread and you beg him to stay, that is not always normal. Feeling like you can’t possibly manage when the children come home, and you just want to go into your room and enter mind-numbing sleep, is not where you want to be. If you experience periods of extreme anxiety, where you are sure you will faint, or you’re having a heart attack, this is not normal. Seek help early. Tell your doctor, the Tipat Chalav nurse, your husband, a close friend.
You are not alone.
