What Should We All Know About Postpartum Psychosis?

Postpartum psychosis affects approximately 1-2 per 1,000 people after childbirth and is the most severe perinatal mental health condition. It is a medical emergency that often requires hospitalization, but with prompt treatment, recovery is possible.

Dr. Ruta and Allie are joined by postpartum psychosis survivors and advocates Meghan Cliffel and Kriti Lodha. Together, they discuss what postpartum psychosis is, the symptoms to watch for, how treatment works, and what recovery can look like. They also share what it means to reclaim your story after experiencing postpartum psychosis.

People with postpartum psychosis are experiencing a serious medical illness and deserve compassionate, evidence-based care. Whether you've experienced postpartum psychosis yourself or are learning about it for the first time, this episode offers an important opportunity to better understand the condition and help reduce the stigma surrounding this often misunderstood illness.

Resources: 

• Get Help for Postpartum Psychosis: Information and Resources from PSI 
• Join a free, virtual PSI PPP Support Group for survivors and family members
• Learn more about the largest research study of PPP survivors at the MGH Postpartum Psychosis Project
• Direct provider questions about PPP to the MGH Postpartum Psychosis Consult Line for a free consultation staffed by MGH reproductive psychiatrists
• Get involved in global advocacy with the PSI Postpartum Psychosis Task Force 
• Read more from Meghan Cliffel on her website and Substack

NEED IMMEDIATE HELP? Call the National Maternal Mental Health Hotline at 1-833-TLC-MAMA

Disclaimer: This podcast is not intended to be a substitute for professional medical care. The views, thoughts, and opinions shared today are the speakers’ own. **Trigger Warning** Psychosis, hospitalization, suicidal ideation, post-traumatic stress disorder, postpartum depression

Meghan Cliffel is a writer and mindfulness teacher whose life was reshaped by her experience with postpartum psychosis. After 20 years in public education—teaching, working at the nation’s largest school district, and founding a nonprofit consulting agency—Meghan now teaches others how to understand their thoughts and emotions through mindfulness, self-inquiry, and compassion. Her lived experience with postpartum psychosis—coming too near to losing everything—informs her writing, speaking, advocacy, and coaching, where she challenges societal expectations of motherhood, achievement, and a life well-lived. Meghan has given interviews and talks to press and clinicians globally and has written for places like the Journal of Psychiatry and the Law and Psychiatric Times.

Kriti Lodha is a South Asian mom and seasoned marketing and technology executive with a track record of building and scaling multi-million-dollar businesses, brands, and teams across the SaaS and CPG industries, including Toast and Procter & Gamble. She was motivated to turn her pain into purpose and tackle the maternal mental health crisis head-on after silently battling postpartum psychosis during the pandemic. Today, Kriti proudly serves as Executive Advisor at the Center for Women’s Mental Health at Mass General Hospital, as well as on the Board of Directors of Postpartum Support International. Kriti is also in the early stages of marrying her lived experience and professional expertise to design new models of care delivery that expand access to perinatal mental health treatment for the most vulnerable, high-acuity individuals who too often fall through the cracks or into crisis-based care settings — all while centering equity, community, and the family experience. 

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So Glad You Asked with Dr. Ruta Nonacs is brought to you by the MGH Center for Women's Mental Health and the J. Willard and Alice S. Marriott Foundation. 

Transcript

Listener 1 

00:00:00

What is the best course of treatment for someone who has experienced postpartum psychosis? Are there meds that you are recommending, um a holistic approach? What is your recommendation for best course of treatment?

Dr. Ruta 

00:00:15

Welcome to So Glad You Asked, the show where real moms bring us their toughest questions. I'm Dr. Ruta Nonacs, a perinatal psychiatrist at Mass General Hospital with over 30 years of experience supporting the mental health of moms and helping them navigate the emotional highs and lows and the often unexpected challenges that come with planning a family, pregnancy, and motherhood.

Allie Hales

00:00:38

And I'm Allie Hales, a mom of four. I know what it's like to scour the internet wide awake at 2 AM with a million questions, wondering if what I was experiencing was normal. That's why we created this show. It isn't just for real moms, it's by real moms.

00:00:53

We don't talk enough about postpartum psychosis. I heard about it for the first time only after I had already had two children. And even after being in the maternal mental health space for about eight years, I still have so many questions. As an illness that can present differently for different people, what are the signs? What makes it different from postpartum OCD or other postpartum mood disorders? Are we screening for it? And how do we know if we might be at higher risk? In today's episode, we're going to break this down. What postpartum psychosis is, how to recognize it, and dispel some of the common myths and stigma surrounding this often misunderstood illness.

00:01:31

Dr. Ruta and I are joined by two incredible survivors advocating to improve the diagnostic and treatment experiences of moms. 

Meghan Cliffel is a writer and mindfulness teacher whose life was reshaped by her experience with postpartum psychosis. Her lived experience with postpartum psychosis coming too near to losing everything informs her writing, speaking, advocacy, and coaching, where she challenges societal expectations of motherhood, achievement, and a life well lived. 

Kriti Lodha is a South Asian mom and seasoned marketing and technology executive with a track record of building and scaling multi-million dollar businesses, brands, and teams. After silently battling postpartum psychosis during the pandemic, she was motivated to turn her pain into purpose. Today, Kriti serves as Executive Advisor at the Center for Women's Mental Health at Mass General Hospital and is also on the board of directors of Postpartum Support International. Kriti is also in the early stages of marrying her lived experience and professional expertise to design new models of care delivery that expand access to perinatal mental health treatment for the most vulnerable, high-acuity individuals who too often fall through the cracks or into crisis-based care settings. 

We're so grateful you're both here and so excited for this conversation.

00:02:49

Dr. Ruta, how common is postpartum psychosis?

Dr. Ruta

00:02:53

Postpartum psychosis occurs in about one to two per thousand deliveries or childbirth, and some people feel like it's an uncommon or rare event, but just to keep things in perspective, postpartum psychosis is actually more common than sudden infant death syndrome or SIDS. And all moms and healthcare providers know about SIDS, but not all women and providers know about postpartum psychosis. So that's why this episode is so important in terms of educating people about postpartum psychosis.

00:03:33

So before we get started, I just want to make sure that we're all on the same page about what postpartum psychosis is. I know Meghan and Kriti know a ton about it, so this is for the listeners. But postpartum psychosis is basically the most severe type of psychiatric illness that we see. And it can happen to anyone who's given birth. And although it is less common, it can also occur during pregnancy or at least psychotic symptoms can occur during pregnancy or after a pregnancy loss.

00:04:08

Really at the core of postpartum psychosis is psychosis. So this is a break from reality, and typically those with postpartum psychosis will have delusions. These are fixed false beliefs. They can be very irrational or unusual. Um, and they can often involve the baby. Um, so sometimes the delusions are like a mom can be very convinced that her child is gravely ill. Um, or sometimes they might be quite extreme. So a mom could think that the baby is evil or that the baby is not her own.

00:04:47

The other things we see wrapped up in postpartum psychosis, which can also make it challenging to diagnose, are women who present with depressive symptoms or sometimes manic or mixed symptoms, and that can make the diagnosis difficult. And also what we see with postpartum psychosis is that sometimes the symptoms or often the symptoms wax and wane. So sometimes mom looks fine and other times she doesn't.

00:05:17

And I think as a clinician, I've learned the most from my patients who have had postpartum psychosis or reading the lived experiences of moms who've had postpartum psychosis because I think there's so many different ways the symptoms can present. And I was hoping we could start with you, Meghan, and you can talk a little bit about your experiences.

Meghan Cliffel 

00:05:43

Sure. So I experienced postpartum psychosis after the birth of my second baby girl, when I was eight months postpartum. And in some ways that experience, having her was kind of like the best of times until it was suddenly the worst of times. I had like the confidence that comes with having a second kid where you're not like worried about every little thing with the baby and so I had a really beautiful maternity leave. And then went back to work and went back to a fairly stressful, not fairly, a very stressful situation. And I started to not feel like myself, but I couldn't put um any further language to it than that, that I don't feel like myself.

00:06:24

I'd languaged that to my husband, but we kind of kept going. We were living in New York City, kind of working a lot to make rent and all of the things that go with being two working parents without much help. It all looked really good on paper until one day the kind of bottom just fell out. So I stepped on the subway on Friday December 4th, 2015, and I was suddenly convinced that everybody was following me, that I was being surveilled, and my mind just started working more quickly than I've ever had it work before.

00:07:01

I use work because it just felt like it was figuring things out. And that experience, and just to talk about it briefly, kind of culminated with me suddenly believing not just strangers were surveilling me, but there was some giant plot out to get me and my children, like a cult or a scheme that I couldn't quite put my finger on. And believing when I was meeting up with colleagues that it actually wasn't like a social gathering, it was a recruitment event. And when they asked where my children were, I believed they were threatening that my children were going to be killed.

00:07:35

And so that Friday night I ran home to our apartment essentially in the Lower East Side, threw open the door and my husband's there and he says, "Why are you home?," and I think those words mean that he's in on it, that he kind of wanted me to join this scheme. So from that moment on, I am what I would call logically behaving in a totally deluded reality.

00:08:00

So I believe everybody's out to get me. I think my husband's on their side. I think my kids are in grave danger. So I am keeping everything in I know from my partner despite being in this tiny apartment, you know, because I think he's trying to kill us or trying to get us into this cult. And so the next kind of, you know, 12 or 16 hours is basically like a battle with him. I'm like internally trying to figure out “Is he more on their side or more on ours” while keeping all of these wild thoughts in. I'm starting to have visual hallucinations as well, but he doesn't seem to see them. I'm trying to pretend like they're not there.

00:08:49

And despite spending from 6 p.m. that evening with him until I eventually went to bed because I felt like I was gonna, I couldn't keep it in any longer, he still doesn't know that I'm in a totally deluded reality. Even the next morning, he's not sure. I am doing my best at really keeping it in. And then eventually it does become obvious that I am just not well. And that period of my illness before hospitalization ends with him being like, “What is going on?,” but afraid to call 911 because he's worried about me losing custody of the children.

00:09:26

So eventually he does call 911 and in the interim before the police arrive, he is racing between keeping me from the bedroom door where he has the kids plugged into Elmo, and keeping me from our apartment door, because I'm saying I want to go to the roof. In my deluded reality, I felt like if I got up there and I showed that I was willing to jump, that I would prove my loyalty because I thought I had no more moves left and it would stop the whole thing.

00:10:01

So he's just racing back and forth keeping me from the kids and keeping me from the roof until eventually the NYPD arrive and I'm handcuffed and then taken to Bellevue Psychiatric Hospital.

Dr. Ruta 

00:10:11

I'm so sorry that you had to have that experience and it's unfortunately common that things evolve so rapidly, and I think because of that paranoia sometimes partners and family members don't know what's going on. And as a clinician, one of the things that I hear a lot is that something “didn't feel right.” And that might be from the mom who's experiencing it, but she doesn't have words for it.

00:10:47

But it often comes from the family members and they know that something isn't quite right with with mom, but they don't know what to do, they don't know what it is, and way too often, I feel like they're saying, “I wish I had said something earlier, I wish I had done something earlier.” And maybe not so much in your case, there it sounds like it was good one hour and then bad the next, but maybe Kriti, you can also contribute to a discussion of kind of like what the early signs and symptoms are, what can we tell families to be on the lookout for?

Kriti Lodha 

00:11:28

Yeah, sure. First of all, Meghan, it takes so much courage to share your story, and I feel the pain, I feel the pain, sister, and I'm so glad you're here.

00:11:37

The only thing I would add, which I think is a telltale hallmark sign, is really lack of sleep. You know, I think persistent lack of sleep is a recipe for a mental health crisis, be it postpartum psychosis or something else. And I think, you know, I come from the marketing world and used to market a lot of brands that are targeted to women, and I think we often have this harmful adage of sleep when the baby sleeps. So, I think the only thing I would add is as you're seeing signs of lack of sleep and, in my case it was not sleeping for four days straight and truly not sleeping, how do we get ahead of protecting mom's sleep just like we're protecting baby sleep or feeding?

00:12:14

How do we really plan around? You know, whether that's a partner or a pastor or if you have the privilege, you know, maybe it's a night nurse or actually a lot of states now cover doulas, doula care, postpartum doula care, through Medicaid or even private insurance. So, how do you really get ahead of that would be, you know, I think a warning sign that, you know, I'm sure Meghan can speak to this too, but that I think as I've gotten to know a lot of survivors, our stories might look really different, but I do think sleep is the only other thing I'd add to to what she said. And then I think the reality is natures of delusions can look really different.

00:12:49

So, I think what you're hearing in Meghan's story, which is similar in mine, is sort of self-preservation or protection that kind of goes into these delusions that's really hard to explain. And so in my case, for example, I actually, one of my delusions was that I have postpartum depression. I was convinced I have postpartum depression. And I was convinced that I was unfit to be a mother. And I was also convinced that my partner was unfit to be a father at the time, and that he was also ill, that we both had severe postpartum depression. And in my case, I called 911 myself actually and made my husband my daughter's medical proxy.

00:13:26

I don't like to think about why I did those things, and I feel so fortunate that, you know, Meghan and I both got the timely treatment to be here today. I think we can psychoanalyze the delusions all day. I think the reality is that something happens where we are not fit to parent and that can be a really shameful thing to say, but as a postpartum psychosis survivor, whatever my delusion, whatever my command actions were, whatever Meghan's were, we were truly not fit to parent. And so this is a medical emergency and we are not ourselves in their situation.

00:14:00

And so nothing Meghan thought about or did or nothing that I thought about or did, we shouldn't judge any of it any way or the other. It truly is that medical emergency.

Allie Hales 

00:14:09

One thing I wanted to ask both of you, Meghan, you talked about it a little bit in one of the articles I read, but just how much of a relief it was to name what had happened to you. Like you understood what had happened in the context of like it wasn't just you and it wasn't, you know, there was an actual name to what you experienced. And I think just going through listening to both of your stories and how incredibly brave you are, but also, you know, your partners and people that were supporting you through this. How can we work to better inform our teams?

00:14:42

I mean, I think about when I was first pregnant or, you know, even through subsequent pregnancies, we didn't, my husband and I never really evaluated options of what could happen throughout pregnancy or postpartum. Like it was, we'll just meet it as it comes sort of approach. And I think what's so incredibly valuable and brave about the work that you're both doing is educating people on the warning signs so that not only maybe you'll recognize it in yourself, but also a member of your team might be able to recognize it as well.

00:15:18

So I'm wondering if you could just speak to that a little bit, like talking about postpartum psychosis as a medical emergency and how do you know when to ask for help?

Kriti Lodha 

00:15:29

Yeah, I think that's a great question. I have my two quick things. What can providers do to educate themselves and then what can they do to prepare and educate caregivers as you put it. So it's a great question. In terms of themselves, listen to this full episode as hard as parts of it might be for you to listen or as much as you need to take care of yourself after. Look at the resources, whether it's from Meghan or myself or Ruta or Allie that we share in the show notes. I often say, you know, there's a bevy of resources and I know Ruta might speak to this from the Postpartum Psychosis Project or Postpartum Support International. Take 30 minutes out of your day and read them. Read all the things.

00:16:04

Where are the treatment programs? What are the signs and symptoms? You know, listen to some of the stories, look at the discussion tool which actually has a checklist that providers —and it's in English and Spanish—can hand to caregivers to actually see and kind of pressure test signs and symptoms. I think the only other thing I'd add is to make a mental health plan early. So I often tell people like at my 20-week anatomy scan or even earlier, I remember hearing about like, okay, if postpartum hemorrhage happens or preeclampsia happens or you need an emergency C-section or whatever it might be, here are the plans.

00:16:35

And so, I think even having those tough questions of if mom is not fit to parent or needs protections as we talked about earlier, who will take care of baby, right? You know, we haven't even talked about child protective services or that kind of getting involved with the criminal justice system. Like, who will actually be there to take care of mom? Who will protect sleep? Are there specialized programs near me that can take care of mom if she does need to be hospitalized for a mental health crisis or postpartum psychosis emergencies? So I think there's a little bit of like how do you educate yourself, but how do you have these conversations early? And the last thing I'll say is with everyone.

00:17:11

I don't remember someone telling me, “Oh, I'm only going to talk to you about postpartum hemorrhage if you fall into a certain risk profile or risk strata.” So really, I think if you educate everyone and cast a wide net, you can make sure you catch folks and that you see more stories like Meghan and myself getting that timely treatment, if for some reason this terrible crisis occurred.

Meghan Cliffel 

00:17:30

I guess I would say like if I bucket it differently for providers and caregivers, like I think yes, providers should know about this deeply. Unfortunately, reproductive psychiatry is still treated as niche in this country instead of affecting half the population. There's a national curriculum on reproductive psychiatry that's great that came out, you could take that.

00:17:53

I would say on the care on the family side, I really do feel like it's a fundamental reframe around, you know, there's like almost there's no other period in somebody's life when we know they're going to be at risk as much for a mental health condition than after the birth of a child. And so really reframing the conversation around the tender nature of the postpartum period. I do think there are broader questions that you could consider around how do I safeguard my well-being? What makes me well? How do I take care of myself? What people stress me out?

00:18:31

How do I protect my sleep? And I went on to have a third child and put together some of that thinking on paper and memorialized it. But, the troubling thing is that we know exactly from the research what keeps mothers well. It's just not standard care. And so I would say the move right now for caregivers is to get into that role of advocacy for the mother during this tender nature, this tender period, the postpartum period, and sort of reframe around how do we keep mom well?

00:19:05

And yeah, I think there will be smaller pieces around emergency plans and whatnot, but I actually think it's like a broader reframe around how do we set parents up for not just wellness but joy? Yeah, I've done it both ways. I've had kids under one system and then the one I created myself due to privilege and and motivated by fear with my third child and I'm positive that that's the better way. And so, how do we actually advocate and live into that system which I actually think should be how we treat parents and caregivers in this country.

Dr. Ruta 

00:19:41

Right. So we're talking more about prevention before these emergencies occur and can the prevention and caring for moms can actually decrease the risk of these disorders. Just to be super concrete, I just want to say what a medical emergency is because it's not like chest pain or suddenly losing vision or something like that. And I think most people don't know when it's appropriate when it's in the sort of mental health realm. So just to be very specific, if a mom is expressing thoughts of harming herself or harming her baby, that's an emergency. If she's saying anything that sounds like delusional thinking or having auditory or visual hallucinations, that's an emergency.

00:20:31

Or if her behavior seems off or disorganized or she's agitated, that would also be a reason that you want to call 911 or 988, which is the mental health emergency line, or go to the emergency room. Unfortunately, as we saw from Meghan's story and many other stories, sometimes we don't know what's going on inside that person who's experiencing psychosis. So, we know something's not going quite right, but we don't know what it is. And there are some resources that potentially can be helpful if mom already has a mental health provider, that's someone to contact. But we also want people to know about the National Mental Maternal Mental Health Hotline, which is 1-833-TLC-MAMA. And that is staffed by perinatal mental health professionals and they can really provide information and a back and forth about what's going on, what's an emergency, and when to to seek help and where to find help, because I think not finding providers continues to be a big issue for moms.

Allie Hales 

00:21:48

I think you said in something that you had written too where you hadn't really heard much about postpartum psychosis before, and I remember hearing about it for the first time after I had already had two kids. I mean, I'd already gone through it twice and I didn't even know what the name for it was and I think just being able to have that plan.

00:22:08

There's this um book I read, it's called The Unthinkable, and it talks about disasters and it's, you know, not obviously in this context with medical health emergencies, but it's just saying how a lot of times we try to avoid thinking of worst-case scenarios, just as a population. But really, if we do think about worst-case scenarios, you know, not in an end of world type of negative viewpoint, but just sort of planning what we would do, then when we actually get into an emergency, our brain has already wired a path into what our plan is, and we're able to just leap into action much sooner. And I think with what you and Kriti have both been saying. If we're able to as a society be able to support people giving birth and being able to be there for them in an educated way, how powerful will that be? So thanks for sharing that reframe. I think it's so important.

Kriti Lodha 

00:23:11

I love that, Allie, and I think the other thing I'd add is it's interesting because people often bring up fear. I think there's so much power that Meghan and I are here. Like I think if you had seen us in the state that we were in as Meghan touched on, we know the treatment, right? Ruta's shared some of this, I'm sure we'll share more throughout this episode. And so to me, what's unthinkable is that even when the unthinkable happens, there's a path. Now, obviously there's a lot of right set of circumstances in our system, and there's a lot of privilege that frankly Meghan and I had, let's name privilege here, to even be here. And so I'm not going to sit here and say that there isn't a lot of luck and privilege that went into this. But if we can redesign those systems together, there's a pathway to care.

Dr. Ruta 

00:23:55

Yeah, I think that's a super important point because I think although postpartum psychosis is the most severe thing that can happen, women with this disorder with treatment do incredibly well. They go back to being a mom, a wife, a sister. They go back to their regular lives. Unfortunately, it's a traumatic event, but recovery is really dramatic and the important thing is just getting the treatment early.

Meghan Cliffel 

00:24:26

I would add to that, Ruta, I was just facilitating a support group yesterday. And I was with like ten or so women who have recently had postpartum psychosis. And I wouldn't just say you go back to your regular life, you go back to being better. I was like, I am Meghan 2.0 at the top of the call. And I'm like, I recognize that maybe you are in it and I have been there, but I promise that through prioritizing your own wellbeing and really sort of seeing the work of healing as a job,um and like a continuing set of deepening, you don't just come back, you come back better.

00:25:06

And it's wild. I think that's probably true with postpartum depression and anxiety, but for me, the experience of working through that suffering, because it's just so hard, has enriched my life in so many ways. So I feel like that's important to note that not only do you uh to not expect yourself to be the same, but actually to develop through the experience and to find growth and meaning and um to really commit to that and and know that kind of mothering yourself into becoming that next version of you is like generous work for your kids, for everybody around you, for the world. 

Dr. Ruta 

00:25:48

I'm so glad you said that because it's often been my impression that some of the women I've worked with who've gone through these horrible things, they do end up being really remarkable people and often so many of my patients have become advocates because they want to change the world. So, you know, I think it's a great example of post-traumatic growth or whatever we want to call it, but it's a terrible experience that a lot of people go on to do really wonderful things with.

Allie Hales 

00:26:22

As before we go into listener questions because we did get so many listener questions on this topic, what are the one or two most important things you want listeners to know about postpartum psychosis?

Meghan Cliffel 

00:26:35

It's highly treatable. It's temporary and the path to like and it's a deeply, deeply ground-shifting experience that warrants your time and attention to heal from, to kind of become this new version of you. But just to know that it's temporary and it can enrich your life, I think.

Kriti Lodha 

00:26:57

The reason I'm smiling is I think Meghan so beautifully articulated something I say which is “Postpartum psychosis has firmly made me the mom and the person I meant to be.” And I often say it's like there's these little gifts that come. I remember my therapist being like, you'll see these gifts and allow them to reveal themselves. My aura score sleep score y'all is like on fire every day. I have amazing sleep after having terrible sleep. And I know that's going to have longevity dividends.

00:27:24

I've pivoted my career to healthcare, working with amazing folks like Dr. Ruta and Allie and others and helping other people one family, one woman at a time. I probably would still be in the career I was in before that. So I think you said that beautifully, Meghan. I think the only other thing I would add, and I'm actually quoting my friend Tina Cartwright, she's an advocate in this “Community is the antidote to trauma.” So the other thing I say is that I don't want what I'm saying today to also read as toxic positivity if you're in the thick of it. I have so much anger and pain, so I've turned that into as Dr. Ruta would say, post-traumatic growth. And I'll be honest, the fuel there for me is still anger.

00:28:08

There's a lot of anger. There's a lot of grief. There's a lot of loss. I had clinical postpartum posttraumatic stress disorder and PPD after it. However, there is a community of folks, whether it's fellow survivors like myself or Meghan, whether it's amazing providers or advocates like Dr. Ruta and Allie, there's a community here to help you. You're not in this alone. So while you might have been very alone in your own brain and body and spirit of what you were going through, as you come out of this treatable crisis on this really long, lifelong journey, frankly, of recovering, healing, there is a community that's out there, to be there for you if and how you want it and where you need it. So we're here for you. And we feel your pain, and we're gonna help you get to the other side, whatever that looks like for you.

Allie Hales 

00:28:52

It's clear from our discussion so far that early diagnosis and treatment of postpartum psychosis is key. For more resources on what postpartum psychosis is and how to get help, visit Postpartum Support International's postpartum psychosis help page linked in the show notes. We received so many great listener questions about postpartum psychosis, and we're going to try to answer as many of them as we can. So the first one is: What is the best course of treatment for someone who has experienced postpartum psychosis? Are there medications you recommend? A holistic approach?

Dr. Ruta 

00:29:27

I'll start off with the medication piece, or first of all to say that it's a medical emergency. So, women with postpartum psychosis are typically hospitalized and that's for safety for mom and safety for baby. In terms of medications, because it's a psychotic disorder, we typically start with antipsychotic medications, but we also know that moms do better if we supplement those antipsychotics with things like lithium. Getting sleep under control, as Kriti mentioned, is incredibly important. 

00:30:09

So, sometimes we do that with medications that are sedating and those can be sedating antipsychotics or benzodiazepines, that's an anti-anxiety medication. And sometimes there are a lot of medications involved. And, I always feel like, okay, we have this situation that's an emergency, and we're going to throw everything at it because basically our goal is to get mom home quickly.

00:30:39

We want her to get home so that she can be with her family and sometimes that involves a lot of medications, but we figure it out later what's important, what's not important. So in terms of the medication piece, that's the medication. I think we never want to ignore all the other things like therapy and peer support. And we want to bring family in very early while mom is hospitalized or very early in the course of illness because we want to know what mom needs to get better when she goes home.

00:31:13

I think this is a traumatic event and we need to have everybody figuring out what to do to help mom, to help her process the information so that she can go on and be the mom that she wants to be, or as Meghan said, even better than what she expected to be. But it's really a team approach. And I think all those pieces are really important.

Meghan Cliffel 

00:31:40

I'd just add, I love, I love all that and I would add that making the turn from kind of shame and seeing it as a personal fault to self-compassion is really important to realizing that you were being sick, yet that you were sick, and that you're healing from something major and seeing that kind of as the the the root driver of the course of events. And for me, things like writing down my thoughts and just out of the hospital was really helpful, listening to certain soothing music, like I had to do it.

00:32:15

I would like run into the apartment and turn on Bon Iver because I was so overloaded from just riding the subway. To things like also moving your body: yoga was really helpful. So much of it was stored in my body, and eventually EMDR when I was ready, that therapy was really helpful to clear the PTSD that was stored there.

00:32:36

So, I often feel like our body knows what to do and some of the healing comes from things like music and movement and whatnot and of course medication, hospitalization, therapy, but really seeing the orientation towards your own wellness as feeling entitled to it and feeling like it's critical work and then finding the things that allow you to continue on that path of healing.

Kriti Lodha 

00:33:00

Yeah, and the one thing I would add, which I think is important, and I'll say this as a cultural aspect, mental illness is not really talked about in South Asian culture, and I didn't talk about my illness. In fact, wow, I think it was exactly two years ago today, I came out with my illness now that I'm looking at the calendar. My circle, my village as Allie put it, or my circle of disclosure was really small. And so I think the other thing that comes up all the time, I'm sure Meghan in your groups too, both Meghan and I facilitate support groups, is sort of like this anxiety around feeling like you owe the world everything. Like, I owe my workplace everything, I owe my extended family everything, I owe my partner everything. I think the other part of recovery is all the self-compassion.

00:33:39

That as part of that self compassion, as you beautifully put it, Meghan, I would add even self love. As part of that self love, knowing you don't owe anyone anything and what and how wide your circle of disclosure. I went from about five or seven people to now thousands of people. And that was a little bit immediate for me. That might never change. That might evolve.

00:34:00

I think would be the other piece that's unique in this illness because of the unfortunate Googling and narrative that you see around it, it can be really scary. So I would also add like thinking through what disclosure looks like for you and then to Meghan's point, if talking about it doesn't help, listen to Bon Iver or in my case, belt out Sarah Bareilles. So belting out Sarah Bareilles heals all wounds. So that would be my medical advice to anyone. Just kidding, of course.

Allie Hales 

00:34:26

No, thank you. The next question we got is, have you found any factors that are contributing to women experiencing postpartum psychosis? Genetics, trauma, previous mental health challenges. Have you been seeing any correlation between preeclampsia and postpartum psychosis?

Dr. Ruta 

00:34:45

That's a great question, and I think it is also something we're still learning about, but what we do know is that there's some genetic component. So if you have a first-degree relative that's had postpartum psychosis, a mother or sister, you're at increased risk for having it. We also know that family history of bipolar disorder, even in male relatives increases the risk. But there are a lot of other things that happen later on that influence risk. So sleep deprivation when it's very profound, especially around the time of delivery.

00:35:26

Also traumatic birth experiences can contribute to risk. Probably a history of trauma as well, contribute to risk, but it's not as if all women who've had a traumatic birth go on to develop postpartum psychosis. It's sometimes a mixture of various symptoms. And this is something that we have the research project at Mass General, the Postpartum Psychosis Project, where we're really trying to learn about risk factors so that we can better predict who's the most vulnerable to postpartum psychosis. And also just saying if you have a history of bipolar disorder that puts you at increased risk or if you've had an episode of postpartum psychosis you're at risk for having another episode after a subsequent pregnancy.

00:36:17

And getting back to the preeclampsia question, this is part of the stuff we don't understand. There's probably inflammation or some immune mediated response that goes on and that can be involved in preeclampsia and it can also be involved with postpartum psychosis. So there's about a threefold or fourfold increased risk of postpartum psychosis among women who have preeclampsia, but it probably is related to some underlying mechanistic similarity, but we don't know a lot about it yet.

Allie Hales 

00:36:54

Kriti and Meghan, given your work with PSI's postpartum psychosis task force and support groups, what do you think are the best resources for long-term recovery from postpartum psychosis? What do you recommend in your support groups?

Kriti Lodha 

00:37:08

We have support groups not just for postpartum psychosis survivors at Postpartum Support International or PSI, but also for loved ones touched by postpartum psychosis. This illness, you know, I said again at the beginning like this system failed my husband and my family as much as it failed me. And I feel like now my daughter's grandparents and aunts and uncles, they're going through their own healing journey with what happened and nearly losing their daughter or sister to everything. And so I think these support groups, you know, it's kind of ironic that the first time I discovered these support groups is when I started getting trained to facilitate them.

00:37:45

Because I didn't share my illness for three years, I never never accessed peer support, and now they’re as much healing to me as they are probably to the people that I'm supposed to be supporting. And so I think there's something about having a safe and brave space where I'll be honest. Like Allie, Ruta, anyone else listening, I don't think you'll ever know me or understand me in the way that Meghan will. You know, Meghan and I have never met in person. But there's a way that we're connected in sisterhood, in a party that we never wanted to be part of, to be fair.

00:38:17

When she sees me, when she hears my story or I share my story or our pain is shared, you know, we have that collective pain and purpose. And there's a power to that, being in that space, that safe and brave space of a support group, whether it's for five minutes or ninety minutes or every week or whatever, you can come as you are, however often you want.

00:38:39

That is a type of magic that I think has accelerated my healing and my post-traumatic growth. I remember going to my first PSI conference and seeing a bunch of survivors present and meeting Julia, who's a fellow survivor and I just went to her and said, “I'm a survivor,” and she gave me this hug. And that energy of that hug is still stuck with me in a way that I can't describe, and she probably doesn't even realize that first hug. So I would say just really that safe and brave space, like it can be terrifying, but … try the support groups whether you're a survivor or whether you're a loved one, because it will be a safe and brave space where someone might see you and feel your pain and help you along your journey in a way that very few people can. So that would be what I would leave you all with.

Meghan Cliffel 

00:39:23

I feel like I've spoken to a lot of these, but at the root of it is that self-compassion, right? So seeing yourself as being entitled to being well. And then for me, EMDR was such a game changer and that really helped me go from kind of managing to freedom. I often say it's like freedom work. So that was really, really helpful when I was ready. And that's a specific kind of therapy.

00:39:57

I would also say creativity, writing, movement, those kinds of things. I feel like people who go through tough stuff and can talk about it are brave. And I would just say that I think there's a lot of power in rewriting your own story and being able to tell your story. And I don't think that should make anyone feel like they have to tell anybody or they should disclose to other people. But I think taking the time to sense make and kind of be the hero of your own story and to instead of um ...

00:40:34

I often work with people in support groups who are like , “Oh, I'm so,” you know, they're in it, they're in it. and they can't see the other side of it. And I often say to them, “I want to give you my eyes for like a second. And in my eyes, I see this person who went through this really, really hard thing and is here talking about it and finding community in it.” And so I think finding ways to do the reframe around your own story and continue to write that for yourself over time is really helpful for healing and kind of getting to 2.0.

Allie Hales 

00:41:11

Now that was beautiful.

Meghan Cliffel 

00:41:13

Thanks. That is kind of you to say.

Dr. Ruta 

00:41:16

Postpartum psychosis is the most severe form of postpartum psychiatric illness. However, it is temporary and very treatable. As you heard in this episode, we need to work toward educating expecting parents, family members, and healthcare providers to better recognize this disorder and to improve how we care for new moms, giving them the support and the attention they need.

00:41:45

Postpartum psychosis is something we don't completely understand, and we need more research. This is something we are trying to change with our Postpartum Psychosis Project here at Mass General Hospital by studying the largest cohort of people with postpartum psychosis in the world. If you or a loved one has had postpartum psychosis in the past 10 years, you may be eligible to participate. For more information, you can visit mghp3.org.

00:42:18

And to hear more stories from survivors of postpartum psychosis, you can visit mghp3.org/video-project. Thank you so much for listening. Thanks for tuning in. As a reminder, please note that this podcast is not intended to be a substitute for professional medical care. The views, thoughts, and opinions shared today are the speaker's own. Your feedback and questions drive this show, so feel free to send us an email at podcast@womensmentalhealth.org or leave a voicemail at (617) 643-9232.

Allie Hales 

00:43:00

You can find additional resources at our resource hub at sogladyouasked.org. This show is executive produced by Dr. Lee Cohen, produced by Mike Brown and Peri Barest, and edited by Mike Brown. This is So Glad You Asked with Dr. Ruta Nonacs and Allie Hales, brought to you by the MGH Center for Women's Mental Health and the J. Willard and Alice S. Marriott Foundation. Listen and subscribe wherever you get your podcasts.