PMAD (Perinatal Mood & Anxiety Disorder) Gets No Respect

[David Baxter PhD]

My PMAD (Perinatal Mood & Anxiety Disorder) Gets No Respect! Part One
by Dyane Leshin Harwood, Birth of a New Brain
July 2, 2015

Postpartum bipolar disorder is often ignored or misunderstood by the postpartum and bipolar communities. It helps to know what postpartum bipolar disorder is, exactly, as different definitions are floating around the world.

So here goes ? a little bit ?o explanation ? PPBD 101, if you will!

My mood disorder postpartum bipolar disorder (PPBD) is also sometimes referred to as postpartum onset bipolar disorder. While I?m currently seeking a more recent statistic, in 2008 it was found in the United States that 29 out of 1000 women were affected by postpartum bipolar disorder.*

Here?s what PPBD is not:

• PPBD is NOT postpartum depression (PPD or PND) or antenatal (during pregnancy) depression.
• PPBD is NOT postpartum obsessive compulsive disorder.
• PPBD is NOT postpartum anxiety, postpartum panic, or postpartum post-traumatic stress disorder/PTSD.
• PPBD is NOT postpartum psychosis (PPP).

It?s important to note that postpartum psychosis and postpartum bipolar disorder often manifest together, but postpartum bipolar disorder is NOT always accompanied by postpartum psychosis.

To reiterate, the two severe mental illnesses PPP and PPBD are NOT always one and the same!

Unfortunately medical professionals, websites, and articles are misinforming the public about the correct definitions of PPP and PPBD.

Most of the time PPBD is omitted from lists of perinatal mood and anxiety disorders (PMAD?s). This bums me out, especially when these omissions occur on high-traffic websites such Postpartum Progress, which I?ll discuss in Part Two as there?s an personal twist involved.

Here?s an example of the kinds of errors I encounter:

I created a Google alert for the phrase ?postpartum bipolar? in order to be notified of the latest research. Once in a blue moon I?m alerted about women with PPBD profiled in the media, such as this article that popped up last month about an awesome mom named Sarah Hutchison.

Sarah Hutchinson is someone who fits the PPBD diagnosis bill, and it turns out I know her from my Facebook days.

As cool as Karen Longwell?s Sarah Hutchison Finds a New Path article is, the piece contains subtle-yet-erroneous information. Sarah was diagnosed with postpartum bipolar disorder in 2008. Longwell states, ?On Mother?s Day, 2010, she was hospitalized and doctors determined she had bipolar disorder, but it was no longer a postpartum illness.?

Gong!

Longwell was off the mark. Once a mother is diagnosed with postpartum bipolar disorder, she has bipolar disorder. The ?postpartum? qualifier simply explains when the bipolar disorder was triggered.

A 2013 CTVNews article that got PPBD right was titled Baby Pinks? Postpartum Euphoria Can Be As Dangerous as Baby Blues. It contains an interview with a Toronto-based psychotherapist specializing in postpartum mental health named Maya Hammer.

Regarding postpartum hypomania/mania Hammer remarked, ?In many women, the condition eventually clears up. But for others, it?s the beginning of a long battle with postpartum bipolar disorder.?

?Long battle? is an excellent way to put it. I?ve suffered with PPBD since 2007 and until there?s a cure, my battle shall continue. I was so glad to find this article, and I wish there were more mainstream articles published with such accurate information.

I was faced with a more significant error a few weeks ago.

I spoke with a local psychiatrist who told me that he considered postpartum bipolar disorder and postpartum psychosis to be the same. While postpartum psychosis often presents with manic symptoms, which is what makes this confusing, it?s not always associated with postpartum bipolar. In other words, I had postpartum mania, but I wasn?t psychotic. The stack of my hospital records delineating my diagnostic codes backs that up.

Make any sense? I know it?s confusing.

Despite my nine years of PPBD research, after the exchange with the physician, I grew paranoid about my knowledge, so I consulted a doctor and nurse who have studied perinatal mood and anxiety disorders in depth. I couldn?t believe my luck ? within just an hour of my contacting these brilliant, busy women, they emailed me substantive, definitive research material supporting that PPP and PPBD can most definitely be two separate conditions.

In the DSM-5 (The Diagnostic and Statistic Manual of Mental Disorders ? i.e., the "Holy Bible" of psychiatrists) there is a peripartum onset specifier with bipolar disorder (pp. 152-153 DSM 5). I was emailed a scan of the DSM-5 pages so I could see it for myself. There is no mention of psychosis in the section delineating the peripartum onset of bipolar disorder

After my friends came to my rescue, I felt confident enough to email the doctor. I haven?t received a reply yet.

The fact that even psychiatrists experts aren?t clear about what postpartum bipolar disorder entails is a major reason why I?m writing my book. Part Two of this blog post will further examine about why any of this really matters. I?ll explain the Postpartum Progress conundrum and throw in an ode to my high school English teacher ? it?s all connected.

 

[David Baxter PhD]

My PMAD (Perinatal Mood & Anxiety Disorder) Gets No Respect! Part Two

My PMAD (Perinatal Mood & Anxiety Disorder) Gets No Respect! Part Two
by Dyane Leshin Harwood, Birth of a New Brain
July 9, 2015

My favorite high school English teacher was Mrs. Redclay.

Mrs. Redclay was different than my other English teachers at Palisades High School. Instead of the Shakespearean canon, she taught us Robert M. Pirsig?s Zen and the Art of Motorcycle Maintenance. In her 70?s era outfits she stood out among the conservative, monied set of West Los Angeles; not quite a hippie, yet definitely eccentric.

Mrs. Redclay wrote my college recommendation letter and noted, ?Dyane has a fine value system that reflects deep respect for herself and others.?

While I must admit that wasn?t exactly true back then, I?m all about r-e-s-p-e-c-t now!

Especially when it comes to recognizing ALL of the perinatal mood and anxiety disorders.

Sock it to me!

In our essays Mrs. Redclay always implored us to answer the question ?So what?? Sometimes students received their papers back with a ?So what?? scrawled at the top instead of the anticipated ?A?. My teacher?s ?So what?? lesson has stayed with me for a whopping 29 years.

And in this post I?ll attempt to answer ?So what?? (Please don?t grade me.)

You may be wondering, With all the important things going on in our world, who cares if people don?t know about this obscure postpartum mood disorder. There are thousands of other rare diseases. You don?t hear folks afflicted with those maladies whining; they?re just trying to survive, for Pete?s Sake!

Good point.

Why postpartum bipolar disorder isn?t as common as the other PMAD?s, I wouldn?t classify it as ?obscure?. Even if postpartum bipolar disorder was an obscure condition, we all have issues close to our hearts, and this one is mine.

I know I?m not the only one who has suffered with PPBD, but I feel that way. I was diagnosed in 2007 and now I?m reaching out in the hopes I can connect with others who understand life with this type of mood disorder.

Whenever I check my Twitter feed (Still Facebook-free!) I?m reminded that both the postpartum and bipolar communities ignore PPBD. Why? Ignorance or thinking that PPBD doesn?t count as a bona fide perinatal mood and anxiety disorder. The best way I can channel my frustration is to publicize PPBD?s existence, its definition, and to share anecdotal experiences through this blog. I?m also contacting PMAD and bipolar organizations, doctors, researchers, and advocates. I?m always on the lookout for other women who were diagnosed with PPBD.

Now it?s time for the Postpartum Progress follow-up. In Part One I wrote, ?Most of the time PPBD is omitted from lists of perinatal mood and anxiety disorders. This bums me out, especially when these omissions occur on high-traffic websites such as Postpartum Progress, which I?ll discuss in Part Two as there?s an ironic, personal twist involved!?

I think Postpartum Progress is a fantastic organization, and I hope I didn?t offend any Postpartum Progress supporters who read that section.

Thankfully Postpartum Support International (the largest U.S. postpartum nonprofit aside from Postpartum Progress) found my post perfectly fine to retweet. The International Bipolar Foundation shared it too and I was very grateful to both organzations for doing that.

In retrospect perhaps I should have explained my discontent in Part One, but better late than never. Here?s the story?

In late 2013 I made headway with my fledgling PPBD awareness campaign when I contacted Postpartum Progress founder Katherine Stone. I asked her to include an in-depth piece about postpartum bipolar disorder on the Postpartum Progress website which receives over 1.6 million pageviews a year. Luckily my pestering wasn?t in vain. Stone assigned a wonderful editor named Cristi Comes (founder of the popular blog Motherhood Unadorned).

In 2014 Postpartum Progress published an essay I wrote about PPBD. I considered that to be a major coup and I was thrilled. The article got a healthy amount of views, shares and validating feedback from moms.

While writing Part One for this blog, I double-checked the Postpartum Progress website to see where postpartum bipolar disorder was mentioned apart from in my article. I looked at their Common Questions page and in the section titled Here is a list of perinatal mood and anxiety disorders we think you should know about, PPBD was not mentioned as one of the PMAD?s, either there nor on any of the other primary information pages.

I was perplexed.

Because of Postpartum Progress? publication of my PPBD article, I thought they classified postpartum bipolar as a legitimate PMAD. The exclusion of PPBD within key parts of their site is what prompted me to write that I was ?bummed out? with Postpartum Progress.

Additionally, as a reader of numerous postpartum mood disorder blogs, I noticed many of them had Postpartum Progress-designed ?I Survived Postpartum Depression? or ?I Survived Postpartum Anxiety? badges on their pages. A visit to the Postpartum Progress Survival Badge Bling page on their site confirmed there was no ?I Survived Postpartum Bipolar? Warrior Mom Badge.

That?s minor thing, I know; I?d love to display a PPBD on my blog, but since there isn?t one, I feel like my PPBD gets no respect! I?ll email Postpartum Progress and ask if PPBD can be added to their list of PMAD?s. I?ll throw in my Warrior Mom Badge concern too. I?ll let you know how that goes?

While I have certain significant things in common with women diagnosed with some of the other postpartum mood disorders and with bipolar disorder, PPBD is unique.

To visit numerous PMAD websites and never see anything mentioned about my specific mood disorder has made me feel that PPBD isn?t valid or worthy of support. Pardon my potty mouth, but it feels like crap. Sounds ridiculous, but if you haven?t experienced it firsthand, I ask for your empathy.

Whenever an opportunity arises I share my information about my PPBD. An hour ago while surfing Twitter, @WmnMentalHealth (Women?s Mental Health, a perinatal & reproductive psychiatry information center at Massachusetts General Hospital) tweeted a link to the Washington Post article, 8 Things You Didn?t Know About Perinatal Mood Disorders. I jumped to read the article.

Due to the title, I thought that PPBD might be mentioned, but that wasn?t the case. There was no mention of PPBD. I took time to write a detailed comment thanking the article?s author for addressing perinatal mental health, and I provided information about PPBD. I shared my PPBD Part One post with the author via Twitter. She ?favorited? it. She chose not to retweet it.

In time, the postpartum and bipolar communities will recognize the ignored PMAD: postpartum bipolar disorder. PPBD counts too.