The Massachusetts case continues to be one of the most painful cases in recent years, dubbed the “saddest court in America.” A woman accused of killing her children may have to spend the rest of her life in prison. Although prosecutors claim that she committed the murders consciously, her defending lawyers and former spouse are convinced that the blame lies with medical workers who improperly assessed the accused’s mental health condition.
This tragedy again reminded of recent stories in Lithuania.
After a few years, are we now able to timely notice a mother sinking into a dangerous state? How to distinguish postpartum depression from psychosis, which signs cannot be ignored, and is our support system ready to see them?
Symptoms that indicate – “this is not just ordinary fatigue”
Statistics show that about 20% of women experience mental health problems during pregnancy and in the first year of the child’s life, and about 10–15% of women experience symptoms of depression immediately after childbirth.
As stated in the information prepared by the Postpartum Depression Center together with psychologist Giedre Širvinskiene and psychiatrist Gabriele Germanavičiene, women may feel sadness, anxiety, depression, hopelessness, and may also not feel love for the baby or want to care for it.
Very important: if such feelings last longer than 2 weeks, it may be postpartum depression.
These signs can begin during pregnancy or in the first months after childbirth and, if untreated, can last for a year or longer.
What symptoms indicate postpartum depression?
This is depression that begins within 4–6 weeks after childbirth. However, it can also manifest over a longer period (up to 12 months), especially if the woman has had mood disorders before.
Postpartum depression has the same symptoms as other types of depression. To diagnose depression, a low mood must last for at least 2 weeks.
Main symptoms:
- Reduced interest and pleasure in activities that were previously enjoyable;
- Depressed mood;
- Lack of energy.
Additional symptoms:
- Pessimism;
- Thoughts about death, suicidal thoughts;
- Sleep disturbances (insomnia, early awakening, daytime sleepiness);
- Constant fatigue;
- Feeling of meaninglessness;
- Reduced self-esteem;
- Feelings of guilt and self-reproach.
Somatic symptoms:
- Headaches;
- Changes in appetite;
- Weakness;
- Digestive disorders;
- Various muscle pains;
- Various joint pains.
According to specialists, it is important to understand that childbirth and the postpartum period are provoking factors but not the cause of depression.
It is important to recognize postpartum depression in time and start treatment as soon as possible, as this complication significantly worsens the quality of life of the woman and complicates the formation of the mother-child bond. When recognized in time, postpartum depression can be successfully treated. This condition is not a reason to stop breastfeeding: if the woman wishes, treatment should take this into account and create conditions for the mother and baby to be together.
Although postpartum depression can affect any woman (it is also diagnosed in men – ed.), some have a higher risk. This condition more often affects women who had mental illness or disorders (anxiety, addictions, eating disorders, etc.) before pregnancy or childbirth.
It is known that about 50% of women with bipolar disorder experience mood disorders, most often depression, during the postpartum period. The risk also increases if the woman has a history of inpatient psychiatric treatment episodes or suicide attempts.
Therefore, it is especially important to recognize the symptoms of the illness in time and provide the necessary help.
What symptoms indicate postpartum psychosis?
Postpartum psychosis is a disease that appears or worsens in a woman after childbirth. It is the strongest form of mood changes (after postpartum melancholia and depression). The most important risk factors for postpartum psychosis are a personal or family history of bipolar disorder or a previous episode of psychosis.
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It is also believed that the experience of childbirth (e.g., traumatic or complicated delivery, premature newborn, or other congenital infant diseases), biological factors (temporary thyroid disorder affecting mood, hormonal concentration changes), lifestyle changes, and social circumstances (stressful events such as the loss of a loved one or serious illness) influence the development of this disease.
The most vivid sign of psychosis is a disturbed relationship of the woman with the surrounding world and a distorted experience of reality.
This manifests as:
- Hallucinations – sensory perception disorder;
- Delusions – thought disorder;
- The person may be disoriented in space, time, self, and feel lost.
Postpartum psychosis can only be diagnosed by a psychiatrist – the risk is assessed in a hospital or mental health center.
If there is suspicion about a woman’s mental health, people around her or medical workers should find out how critical the woman is about her thoughts, ask if she has plans or intentions to carry out suicidal or infanticidal (killing the baby – ed.) thoughts, and refer/accompany her to the nearest institution where a psychosocial suicide risk assessment can be performed. The highest risk is for women who had bipolar disorder before pregnancy and childbirth or have this mental health disorder in their family.
More information and advice about women’s mental health during pregnancy and after childbirth can be found on the Postpartum Depression Center’s website.
It is difficult for women themselves to recognize and assess – the responsibility falls on those around them
The head of this center, Nida Vildžiūnaitė, mentioned to the portal 15min that there is a general increase in society’s mental health literacy and attention to the acceptance of mental difficulties and disorders.
“More and more personal experiences are being shared. However, there is a lack of knowledge about help possibilities and the complex recovery process, mental health – as a part of every person’s health that should not be eliminated but accepted and cared for,” the interlocutor said.
According to her, the Postpartum Depression Center, as an independently operating organization, works with a living mission to contribute to change in Lithuania in the field of mothers’ (and also fathers’ and the whole family’s) mental health.
“We see that only by changing prevailing attitudes towards mental health in general, encouraging support and understanding about the changing role of motherhood and experienced difficulties, can we create an understanding and empathetic society where a woman, during pregnancy, childbirth, and after having a baby, feels supported and emotionally safe,” emphasized N. Vildžiūnaitė.
Mental health specialists note that the ability to recognize mental health challenges after childbirth should be possessed not only by families expecting or already having children but also by specialists working in maternity hospitals, clinics, child care institutions, in other words, in all places where a mother with a baby may visit.
“For early prevention, knowledge and understanding that the role of every close person in the family, community, or healthcare is significant, and often is the very first encouragement to seek help, is extremely important.
It is harder for women themselves experiencing postpartum depression symptoms during pregnancy and after childbirth to recognize symptoms; they tend to blame themselves, feel ashamed of the feelings and mood changes, and start thinking they have to try harder and overcome it on their own.
The attention paid by specialists to mental health, simple but humane and attentive inquiries about emotional well-being during visits not only allow early prediction of emerging mental disorders but also encourage families themselves to engage and meaningfully assess the well-being of family members,” the interlocutor said.
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