Latest / Long Distance Friends / Postpartum Psychosis 101 **Non-Fearmongering** - with Victoria Edgington, LMHC, PMH-C
Transcript
- Anna Casey: how do you actually define postpartum psychosis? Victoria Edgington: it really is extremely confusing. So the hard part about postpartum psychosis is it doesn't exist in the DSM. Actually none of the postpartum disorders exist in the DSM, So that's Anna Casey: Okay, Victoria Edgington: a big problem. Anna Casey: what's it what when is a psychosis diagnosis an emergency versus like let's start working on this, Victoria Edgington: it's always an emergency. Anna Casey: Yeah. Victoria Edgington: I'm seeing symptoms that cause me to believe you need to be evaluated for this. Anna Casey: Today. Victoria Edgington: yes, immediately. Anna Casey: Wow. Victoria Edgington: So one with help you will be well. Like that is the hope Anna Casey: Wow. Victoria Edgington: to hold on to. If you get the right help, you will get better. there's nothing in this space that we can't solve. Anna Casey: Quick trigger warning Today's episode covers postpartum psychosis. It includes psychotic episodes where mom and baby may not survive or experience severe physical implications. Although Vic is a licensed clinical mental health counselor, the content provided in this podcast is for informational purposes only. it is not intended to be taken as or substituted for professional medical or mental. Health advice, diagnosis, or treatment. Please consult your medical or mental health care professional for your mental and physical health questions or concerns. If you are not in a headspace to listen to this episode today, please feel free to skip this episode entirely. Postpartum psychosis is a topic that can bring up a lot of fear. And we want to approach this conversation with care. Our goal is to help make this topic less scary and talk about bringing awareness, understanding, and education to it. So moms and families feel more empowered and know that help is available. But we also want to be clear that reducing fear doesn't mean downplaying the seriousness of postpartum psychosis or the experiences of those who have lived through it. This can be an incredibly serious and difficult experience, and we want to honor that While helping create more space for honest conversation, earlier recognition, and compassionate support. With that said, postpartum psychosis requires immediate medical attention. If you or someone you love is experiencing symptoms, seek medical care at your nearest emergency room. Victoria Edgington: Yeah. Anna Casey: Today's conversation is a heavy one. We're talking about Postpartum psychosis. If you've been following the news lately, you know there's a murder trial related to postpartum psychosis. And while I have personally chosen to not follow the trial to protect my own mental stability as a mom of Littles, I believe that there's a way, and Vic believes that there's a way, to have an educated conversation about what postpartum psychosis is. without the fear-mongering and with information that can actually provide peace of mind for you and for your loved ones. it's important for me as a host of this podcast to have qualified guests to speak on such delicate and important topics. And not only that, I just wanted anyone listening to know that it's important to me that whatever guest speaks on these topics does three things. The first thing is admit what they don't know. The second thing is I wanted to have someone on that could explain the nuance of all of this in a way that is easy to understand. And the last thing is is I wanted to have someone on who cared deeply about the minds and the hearts of Anyone who is taking in this information. And so for this reason, I'm honored and beyond excited to share that today's guest is Victoria Edgington. Victoria is a birth trauma therapist who specializes in anxiety therapy for moms with trauma. She helps moms with coping skills and healing at the root. She has over 10 years of experience in trauma recovery. And Vic, I know personally, cares deeply about providing information and tools. To moms in a non-fear-mongering and nervous system-friendly way. So, Vic, thank you so much for coming on today and discussing this. Victoria Edgington: Thanks for having me. I really don't take it lightly to be asked to talk on such a heavy topic that I know can trigger people in so many different ways. Anna Casey: Yeah, absolutely. So, Vic, what do you hope comes out of our conversation today? How do you hope someone feels after they listen to this episode? Victoria Edgington: I am really hoping to reduce the anxiety about this in my training, although I don't specialize in psychosis. I'm trained to assess for it and know what to do in those situations. And so it's actually a topic that doesn't make me feel nervous because I know exactly what to do in these situations and what's needed. and Anna Casey: Mm. Yeah. Victoria Edgington: so I actually really hope to pass that along to any moms listening so that they don't have to carry this heavy weight or feel nervous about something that either is likely not going to happen to them or if they do notice things, they know exactly what to do. Anna Casey: That's so awesome. I as you say that, that reminds me of a metaphor that Dr. Becky uses a lot, which is how the pilot of the plane of parenting is like being like the pilot of a plane and you want to know that the pilot is not scared. You want to know that they have been through this and that they know what to do. And I feel that talking with you right now, I feel like okay, we have someone that is not scared by this because they have the information and the tools and they know what to do. So thank you for providing that feeling going Victoria Edgington: Yeah. Anna Casey: into this. Victoria Edgington: Totally. I have a silly story to share. that's a little unrelated, but how I hope to leave people feeling. Anna Casey: Yes. Victoria Edgington: when I was postpartum with my first, I had like taken a trip with my husband. We'd gone out of the country, come back, and then like shortly thereafter I started getting like s weird skin reaction things going on, and I felt very nervous because I did not know what it was. And of course, having had anxiety, I was like, it's the worst case scenario. And you Google things and you're like, I am dying. but exactly. Anna Casey: It's smallpox. Victoria Edgington: So I was like, okay, I need to make myself just go to my primary care and get it checked out. And I'm sure they'll be like, this is fine. Here's this cream, whatever. Well I went to Anna Casey: Yeah. Victoria Edgington: my primary care And they don't know everything. but when I went there it made it so much worse because the guy clearly had no idea what was going on and started taking me Anna Casey: wow. Victoria Edgington: down this route of like, have you been overseas lately? You might have a really rare disease. I don't really know what this is. so let me just send you to a dermatologist. So by that point I was like, if my primary care thing doesn't know what's going on, I'm even more terrified. so by Anna Casey: Mm. Victoria Edgington: the time I get to the dermatologist's appointment, they're kind of just looking at these like skin things going on and she's just taking her notes, whatever, and I just break down in tears and I'm like, Am I gonna die? And she's like, Anna Casey: Well Victoria Edgington: Honey, my gosh. She's like You are fine. I'm gonna give you this cream. This this is an inflammatory response. And if this cream doesn't work, then we'll try this. You're gonna be just fine. And that is really the feeling I wanna leave people with. That when you see the right provider that specializes and knows this type of thing inside and out, you're gonna leave with that feeling of being like, We know exactly what to do for this, and these are the steps we're gonna take. And if this doesn't work, then we're gonna do this, then we're gonna do that, we're gonna get you through it, and it's gonna be fine. Anna Casey: Wow, I have chills all over my body. I know that that was meant to be a silly story, but that was Victoria Edgington: What's that? Anna Casey: really profound. So thank you for sharing that. That's so good. Victoria Edgington: True. Totally. Anna Casey: so as we start this conversation, could you tell us, do you personally see clients that deal with postpartum psychosis? And how rare is this? Victoria Edgington: Totally. Yeah. So like you said, I've been doing trauma recovery work in various roles for about ten years. I started exclusively working with women postpartum in twenty twenty one. And since then I have seen one or two cases. in my practice since I'm outpatient, that is always an immediate referral. so I think my experience actually does line up pretty well with the statistics they say one or two out of a thousand is the likelihood of having postpartum psychosis. Anna Casey: And how do you actually define postpartum psychosis? I feel like it's really important as we start the conversation today that we have a a clear understanding of how you would even categorize or or define what postpartum psychosis is. Victoria Edgington: Totally. And it really is extremely confusing. And like I said, I do not specialize in this. For me it's an immediate referral and I'm so grateful to be in a place where we have actually a mother and baby inpatient hospitalization unit. So there are about Anna Casey: wow. Victoria Edgington: five of those that exist across the US, which maybe we can link for people. Anna Casey: Okay. Sure. Victoria Edgington: But that is an immediate referral there because they do the official psychosis assessment and make the decision of whether hospitalization is needed at that point. But in terms of what I'm trained to assess for, it's actually helpful to really zoom out. because I'm assessing for any of the following postpartum disorders that can happen. So that's postpartum depression, postpartum anxiety, postpartum OCD, postpartum PTSD, panic disorder in the postpartum period, perinatal bipolar disorder, and then postpartum psychosis. there are a lot of overlaps. Which I think Anna Casey: Mm. Victoria Edgington: is why this topic is triggering to so many people, because many people we know that Anna Casey: Yeah, that's a great point. Cause cause part of you may resonate with like, I've felt that feeling before or I felt that feeling Victoria Edgington: Yes. Anna Casey: before. So then it's like, do I have is this? Do I have this? Okay. That's so true. Victoria Edgington: Right. Yes. Yeah, totally. a ton of overlap. So that is why it's so, so important to get someone trained to assess, because I think anyone could have the fear, my gosh, I had this thought, I had that thought, does that mean it's postpartum psychosis? Anna Casey: Sure. Victoria Edgington: It can mean a lot of things, that are much less severe. But having the right person assess will help you know exactly what you need to do to solve that. And one of the things that they stressed so much in the training and certification I did was that every single postpartum disorder is treatable. It is treatable, it is temporary, you just need the right diagnosis and the right treatment for what you're dealing with. So the hard part about postpartum psychosis is it doesn't exist in the DSM. Actually none of the postpartum disorders exist in the DSM, which is what we use to diagnose mental health disorders. So that's a big problem. Anna Casey: Okay, ca what's what's it what is what is DSM? 'Cause I feel like I've heard you talk about this, but I don't have a Victoria Edgington: Totally. Yeah. Anna Casey: understand because I'm not in this world. So what what do you mean by Victoria Edgington: I'm so glad you asked. Anna Casey: that? Victoria Edgington: Okay, I've got it here. the Diagnostic and Statistical Manual of Mental Disorders. If you have a mental health diagnosis, it came from here. so Anna Casey: Okay. So it's what your providers use to reference what you may have, like to help diagnose you essentially. Okay. So Victoria Edgington: Yes, yes. Anna Casey: if postpartum psychosis is not even an option as something Victoria Edgington: I think. Anna Casey: to be diagnosable, then is that what you're saying? Wow. Victoria Edgington: Yes. So what we have is, you know, you could be diagnosed with major depressive disorder, right? Generalized anxiety disorder, post-traumatic stress disorder. We've got all these disorders in the DSM, and if someone experiences it postpartum, we add a peripartum onset, which means this came on in either pregnancy or postpartum. Anna Casey: I can see how that would be really problematic. Because Victoria Edgington: Yeah. 'Cause what do you Anna Casey: you're like, I have anxiety, thanks. Like, I know. Victoria Edgington: Right. Right. It's it's very problematic and Anna Casey: Wow. Victoria Edgington: the organization I got certified by has really been pushing for a long time to have postpartum disorders classified as their own diagnosis. Which I think any mom can agree, like it's its own thing. There's Anna Casey: Yes. Victoria Edgington: so much going on. So Let me get into the psychosis piece of things because there isn't Anna Casey: Yeah. Victoria Edgington: even a just psychosis diagnosis. What we're Anna Casey: Yeah. Victoria Edgington: talking about is a group of symptoms called psychotic symptoms that can occur in different mental health disorders Anna Casey: Okay. Victoria Edgington: or even physical health disorders. So the symptoms we're talking about is this idea of a mental state that's disconnecting from reality. So that could look like hallucinations, that can look like delusions. delusions are like a fixed belief that is strange and other people wouldn't believe that. And maybe someone's trying to talk you out of that. Like, no, that's not what's going on here. an example of that would be like you're watching TV and you're like, my gosh, this person is speaking to me through the TV. They're sending me a message, it's personal to me. I know they're talking to me right now. Anna Casey: Okay. Victoria Edgington: Or my husband is actually out to get me and I can't trust him with the baby. Again, if that's not based in reality, that would be a delusional belief. And then disorganized thinking and speech. So those are all what we call psychotic symptoms. And they can occur in schizophrenia, they can occur in a bipolar episode, they can occur in severe depression. they can occur during substance use or withdrawal from a substance, even marijuana. I think that's something to be aware of. even alcohol use. So you can have an experience of disconnecting from reality in those moments. Anna Casey: Yeah. Victoria Edgington: it can also come from certain medical conditions like a severe infection, extreme stress or trauma, extreme lack of sleep. Any of those things can Anna Casey: Mm. Mm-hmm. Victoria Edgington: trigger those psychotic symptoms, but in and of itself it's not a diagnosis. Anna Casey: what would make someone more at risk to to have these symptoms? Victoria Edgington: Yeah. So the main one I would point to, it's not the only one, but the main one is b having an underlying bipolar disorder. So we know there's a Anna Casey: Okay, wow. Victoria Edgington: correlation there and Anna Casey: Mm-hmm. Victoria Edgington: as well as schizophrenia, although I think if you have had schizophrenia there's more awareness from people around you to be on guard about that postpartum. Anna Casey: Sure. Yeah. Victoria Edgington: But if you have bipolar, it's not something everyone thinks about. You also could have undiagnosed bipolar or a genetic predisposition to it that then starts postpartum. So that's actually one of the questions we ask in the assessment is we ask about a family history of bipolar, any bipolar episodes. I've since all this has happened, I've started using a mood disorder questionnaire to be even better at scanning for bipolar symptoms that people may have had. Anna Casey: cool. Because they may not even realize that they have it. And so you're asking Victoria Edgington: Yeah. Anna Casey: more detailed questions that would help you know than maybe they do and they just don't know. Yeah. Victoria Edgington: Yeah. Yeah, totally. Anna Casey: Cool. Okay. one thing I've I've heard you talk about, as you've been so great to share about this on your social media in a non-fearmongering way is lack of sleep. So Victoria Edgington: Mm-hmm. Anna Casey: is that a a risk factor for maybe having an onset of some of these symptoms? Victoria Edgington: Yeah, it can be. it it definitely can contribute, but I also want to be careful and say like lack of sleep can also very easily be related to anxiety, O C D, and they're having a newborn, you know, it's just Anna Casey: Yeah. Victoria Edgington: I I think what we really look for there is if the lack of sleep is not getting better with intervention. So like if you know, you've been able to help baby sleep and you're still not sleeping, if maybe you've been prescribed medication but you're still not sleeping, that's really when it's more of a red flag. Anna Casey: Okay. Got it. So one of the questions that we received as we were preparing for this episode was can this happen for any postpartum? Even if you've already had one or two babies and you maybe didn't really see these symptoms, but then with a third baby, all of a sudden you're seeing these symptoms. can that happen? Victoria Edgington: Yeah. It can happen if you think about the different things that could trigger it. it's possible. it's not as likely. if if you have that underlying condition, it's more likely that it'd show up with the first. and then you'd be at higher risk in subsequent pregnancies. It's a lot less likely that it would show up later on, but not not impossible, especially if there's, you know, that genetic bipolar component. Anna Casey: Okay, okay, got it. and then how are most people diagnosed? So I think about like the the chain of events that happen, you know, having two babies myself, I know that when you go to a pediatrician appointment, af you know, and you're fresh postpartum, you fill out a survey, right? And I saw a social media post where someone was sharing about how they don't like that survey and how they Victoria Edgington: Mm-hmm. Anna Casey: felt like they couldn't they didn't want to be honest on the survey. And then a lot of the comments on that post, which was like so sad to see, they were like, Yeah, no, like I just I lie. Victoria Edgington: Mm-hmm. Anna Casey: But is that the thing that really catches this most of the time or I mean I'm sure you don't have any d data on this, but I guess just from what Victoria Edgington: Yeah. Anna Casey: you've heard and seen and read, like, or is it more women starting to have some of these symptoms and then they're like, like or someone around them is is saying, like she needs help, like let's book her Victoria Edgington: Yeah. Anna Casey: an appointment with a therapist. Do you have any indication of how this is often like caught or diagnosed? Victoria Edgington: Totally. Yeah, so probably the assessment you're talking about is the either the Edinburgh postnatal depression scale. Yeah. Anna Casey: Yes, that one. Yes. Victoria Edgington: they didn't used to do that. So that's actually newer that you get it so often, but it's less helpful Anna Casey: Mm. Victoria Edgington: if the person giving it to you doesn't create this really safe space to be honest. Yeah. Anna Casey: That's what it is, yeah. I think. Victoria Edgington: I think so too. So I'm glad that they're trying to assess more for it, but again, Anna Casey: I'm in here. Victoria Edgington: that's not always the the best place to feel like you can share those thoughts. Anna Casey: Sure. Victoria Edgington: and it's scanning for depression, so it's not always going to be scanning for psychosis. So usually what I see it is more typical for postpartum psychosis to present in the first two weeks. postpartum and for it to present as more of a manic episode of bipolar. So we kind of think of postpartum psychosis as a bipolar disorder and you can have psychotic symptoms in that manic period or you could have psychotic symptoms in that depressive period. So that Anna Casey: Okay. Victoria Edgington: Edinburgh Postnatal depression scale is great for tracking depression. And that depression Anna Casey: Mm-hmm. Victoria Edgington: could be regular old depression, could be bipolar depression. but really the person who's probably gonna notice psychosis first is your spouse, your mom, Anna Casey: Yeah. Victoria Edgington: family member, who sees you earlier on. And you know, this this is not very clinical, but a lot of times people are like, this is weird. Something's just weird. This is not how she usually is. And it might Anna Casey: Mm-hmm. Victoria Edgington: not even be like she's depressed or sad or anything, but that's she seems way overly happy. She seems really energetic. She seems like she doesn't need any sleep. Those are some of the the flags of a manic episode that could indicate. Anna Casey: Mm-hmm. Victoria Edgington: was part of psychosis. Anna Casey: Yeah. Victoria Edgington: so that's a question we ask in assessment is like, hey, how's sleep going? And if it's like, I'm not really sleeping that much, then the follow up question is, not sleeping much because baby's not sleeping much, not sleeping much because you're anxious, or not sleeping much because you have so much energy you feel like you don't need sleep. And that last one's gonna be a red flag. Anna Casey: Okay. Okay. Okay. Okay. when is a psychosis diagnosis an emergency versus like more like okay, like let's start working on this, or it does that make sense or is it always Victoria Edgington: Yeah. Anna Casey: an emergency? Like, okay, you have postpartum psychosis, like emergency Victoria Edgington: Mm-hmm. Anna Casey: intervention now. Victoria Edgington: Yeah, it's always an emergency. Anna Casey: Yeah. Victoria Edgington: part of that is because of how quickly these symptoms of psychosis can come and go postpartum. and you know, worst case scenario go to your emergency room and get evaluated, have you know, a professional evaluate you and worst case scenario it's a postpartum mood disorder that's more along the lines of O C D or anxiety, that doesn't require hospitalization, but we're always Anna Casey: Mm-hmm. Victoria Edgington: gonna make sure you get that level of care just in case. Anna Casey: Okay, so you ha you're seeing a client, for lack of a better phrase, I'm diagnosing you with postpartum psychosis. Is it like I don't mean to be is it I don't mean I don't know how to ask this pack your bags, you're going to the hospital. Like let me how do I how do I say that? Victoria Edgington: Ask all your questions. Right. Right. Yeah. Yes. Anna Casey: is it literally like Pack your bags like you're going to the ER, or like how what do you tell someone who is receiving this diagnosis and it is an emergency? Victoria Edgington: Yeah. Totally. Yeah. So what I will say, and other clinicians might do this a little bit differently, but I don't Anna Casey: Yeah. Victoria Edgington: actually give that diagnosis. I say I have a high level of concern that I'm seeing symptoms that cause me to believe you need to be evaluated for this. Anna Casey: Today. Victoria Edgington: yes, immediately. Anna Casey: Yeah. Victoria Edgington: So one Anna Casey: Wow. Victoria Edgington: thing that's really important if you're not a clinician, or even if you are, is to know that based on that person's state of mind. We don't wanna rely on them to get themselves to the hospital or to recognize that Anna Casey: Sure. Yeah. Victoria Edgington: that is what they need. So we're immediately gonna involve family members to Anna Casey: Okay. Victoria Edgington: bring them in ideally into the session with mom. you're always gonna still wanna talk to mom and say, Hey, we're concerned about this. We're gonna get you the help you need, we're gonna make sure you get the best assessment possible. Anna Casey: Mm-hmm. Victoria Edgington: This is where we need to go, depending on what diagnosis they give you. It could involve a bit of a stay to make sure you're on the right medication, or it could involve a discharge pretty immediately after. Anna Casey: Okay. Okay. So are you I'm just practically thinking like are you like, okay, bring your partner into the room with you. I want to talk to your partner. Is that okay? Victoria Edgington: Yeah, some moves. Yeah. Anna Casey: Okay. Or if it's a a remote session, like let's add the X, Y, and Z to the call. So okay. Wow. Victoria Edgington: Mm-hmm. Yep. Yeah. And in as as supportive a way as possible to be like, hey, Anna Casey: Sure, sure. Victoria Edgington: we want to make sure everyone understands what's Anna Casey: Mm-mm. Victoria Edgington: going on. Can we bring your husband in? Can is mom or dad there? Is your friend there? Can we have somebody with you so we can talk through what's going on here? Anna Casey: Okay. Aww. Wow. Victoria Edgington: Yeah. Anna Casey: Vic, you'd be such sidebar. You would just be such an amazing person to be walked Victoria Edgington: Thank you. Anna Casey: through that. That would be I can s I can totally see that. And your clients are so lucky. Victoria Edgington: Thank you. Anna Casey: yeah, I can I just feel the tender heartedness and compassion. So that's really it's really special. Victoria Edgington: Yeah, yeah. I wanted to share just a little bit about very, Anna Casey: Yeah. Victoria Edgington: very practically what that looks like in Anna Casey: Yeah, please. Victoria Edgington: different settings because I'm in Raleigh, North Carolina, and one thing I like to really Anna Casey: Mm. Victoria Edgington: w reassure my clients about is that it's one of the best places you could be if you had Anna Casey: Yeah. Victoria Edgington: the most severe postpartum crisis because we have an inpatient hospitalization unit specifically for moms going through a postpartum mental health crisis. And they have lots of accommodations for moms being able to pump, moms having Anna Casey: Yeah. Victoria Edgington: people who can properly assess them and even access to their baby when it's appropriate. Anna Casey: wow. Victoria Edgington: that is like ideal standard of care that we Anna Casey: Yeah. Victoria Edgington: and there are about five of those that exist across the US Yeah it Anna Casey: That's so sad. Wow. Victoria Edgington: really is when I was trained in twenty twenty there were only two Anna Casey: my gosh. Victoria Edgington: Yeah, there are only two options for that. so what that looks like if you're in a very rural area without like a psychiatric inpatient place, you go to an emergency room. Now I would always encourage people You're going. Talk to Anna Casey: I'm stressed right now. Victoria Edgington: me. Talk to me. Anna Casey: I because listen, I was just in the emergency room a few weeks ago and y it is it's not a fun place to be. Like you're sitting there and you're surrounded by people who are hurt or there was a woman in the emergency room that was like screaming and like you know, it's just a stressful place and that makes me so sad that I don't know, that you would be Victoria Edgington: Yeah. Anna Casey: in such Such a tender, like, spot, and then have to go like sit and wait for hours because so many people that's what they do. They sit and they wait for hours. And so it Victoria Edgington: Yeah. Anna Casey: makes me really sad. And I think about like after Emmy was born, she she had some respiratory issues as as like a fresh, fresh hours old baby because she had meconium in the womb and inhaled some of that and so she had some respiratory issues and so but we were at an amazing hospital that was or I was at an amazing birth center that was connected to the Vanderbilt Medical Center. And I got to, you know, they took her they took her away in an ambulance to the hospital. But I even as a fresh postpartum mom, I felt Okay, knowing that I would be with her like again soon, you know, and and that Victoria Edgington: Mm-hmm. Anna Casey: she was in the best medical care and I was in the best medical care. And so I think I'm just feeling this like this tenderness towards postpartum moms that have to be Victoria Edgington: Yeah. Anna Casey: separated from their babies or or sort of like shoved into an emergency room. Victoria Edgington: Totally. Anna Casey: to be dealt with, So I think that's some Victoria Edgington: Yeah. Yeah. Anna Casey: of the feelings that are coming up right now. Victoria Edgington: Yeah. that is so valid and it's, you know, a a giant conversation on women's health. And Anna Casey: Mm-hmm. Victoria Edgington: I I think even in our conversations so far we've talked about postpartum disorders not being in the DSM and Anna Casey: Yeah. Victoria Edgington: there being five of these hospitals for women and babies across fifty states, you know, it's Anna Casey: Yeah. Because what's the alternative if you don't have an inpatient mom and baby facility, The alternative is the emergency room. Victoria Edgington: So what I will say is we say the emergency room is like a blanket statement because that's where to start and it's the simplest. Anna Casey: Mm-hmm. Victoria Edgington: other places are still going to have like psychiatric care. so that's eventually where you're gonna end up is some some form of psychiatric care. And really what we need is to get the right assessment and medication to reduce those psychotic symptoms. Anna Casey: Yeah. Okay. So a psych ward essentially. Right. Okay. Okay. Victoria Edgington: Yes. Which is meant to be very temporary. and what we wanna see is we have several routes to take and again Anna Casey: Mm. Victoria Edgington: in my training when they talked about psychiatric medication, they talked a lot about we treat to remission of symptoms. So there may be other times Anna Casey: Yeah. Victoria Edgington: when you are trying to take less medication for various reasons when it comes to postponing. part of mental health, there is no reason to be dealing with symptoms and medication. So if we're gonna have the symptoms, we wanna treat until those symptoms are gone. Anna Casey: okay, that makes a lot of sense. One of the questions that we received prepping for this was should postpartum psychosis diagnosis equate to a temporary loss of custody to protect the baby? Victoria Edgington: Yeah, that's a valid question. I I think one thing that's important to know is so postpartum psychosis happens once or twice out of every a thousand births that happen. Out of those one or two in a thousand, only four percent are going to cause harm to their children. Anna Casey: Mm-hmm. Victoria Edgington: so that's a what point zero zero zero zero eight, I think I'm getting that right. I'm not sure on the number of zeros, but even within such a rare diagnosis, it is even far more rare to be doing something to harm your children or yourself. Anna Casey: Okay. Victoria Edgington: so just because you have it doesn't mean you're immediately a danger. It's really the content of those hallucinations and delusions. Either way, if you've got psychotic symptoms, we want the right medication on board so that you don't have to deal with those symptoms. Anna Casey: Yeah. And you would be an inpatient patient, right, at that point, upon receiving Victoria Edgington: Yes. Yeah. Anna Casey: diagnosis. So in that in that scenario, upon receiving diagnosis, you would be removed from your baby until there was a decline or a decrease of symptoms, right? Or a decrease of behaviors. Victoria Edgington: Yeah, but usually the route we're trying to go, and I actually was able to ask the director of an intensive outpatient program here in Raleigh and I asked her about how often that happens where women are, you know, forced to be separated from their children in that way. She told me that she's only seen that happen once or twice and when it has happened it was very, very necessary based on not just mom but the family dynamic. So usually what we're trying to do is get family around her to say who's who's able to care for baby? Is dad able to care for baby? Is are your parents able to? What's your support system? We're wanting family to do that in this brief interim where mom's getting treatment. In very rare circumstances, safe family members aren't available. and that's when there might be some temporary foster care involved to make sure baby's safe. but again, we're treating mom to remission of symptoms so that she can be reunited with baby, and it really helps to have a trained therapist as your advocate. to help everyone else involved understand. Even CPS doesn't always understand what how much of a danger there is or how little of a danger there is. So having a trained therapist that you're seeing is really helpful to just advocate for you. Anna Casey: Can you tell me more about that? I guess I didn't understand that role of a a licensed therapist. Like Victoria Edgington: Yeah. Anna Casey: what that advocacy piece. Like what would that practically look like? Victoria Edgington: Sure, sure. So this is something that I would recommend, especially if you don't have access to a mom and baby unit, is your first step is gonna go be to go to the emergency room, right? I think your next step should be to get a perinatal mental health certified therapist and or psychiatrist on your team. so what you're looking for is that PMHC designation for a therapist or a psychiatrist. they're gonna be the ones who have the same training that I've gone through, who know how to assess, who understand level of risk, that can be on your team in terms of helping everyone else involved who might not have that training. understand what mom needs, what level of care she needs, when she's safe to be reunited with baby. Anna Casey: Okay. So would that look like your doctor calling your therapist or are you would you be there like in in person if you were local? what would that look like? Victoria Edgington: That would look like I I n I do know of therapists who've gone in person to visit, Anna Casey: Mm-hmm. Victoria Edgington: but more likely it would be the family reaching out on mom's behalf, getting set up with that therapist, getting set up with that psychiatrist. Anna Casey: Mm-hmm. Victoria Edgington: to make sure if emergency department workers are not as highly trained, they have someone to refer to to go, Okay, what should our next step be medication wise here? Anna Casey: Okay. Okay, so they'll actually ask your opinion. Okay. Victoria Edgington: Mm-hmm, yeah. Anna Casey: I didn't realize that. That's cool. Victoria Edgington: Yeah. so yeah, the training piece is important. And then also realizing that in okay, let's play out worse worst case scenario. You're not getting the care you need in your emergency Anna Casey: Mm-hmm. Mm-hmm. Victoria Edgington: department, having the knowledge to know that you can reach out to these other inpatient units across the US and in the worst case scenario you can go there. You can go to Anna Casey: Okay. Victoria Edgington: one of them. That's obviously not ideal in terms of travel all the time, but I think many people don't realize that that's an option in the worst case scenario if you're not getting better. Anna Casey: Wow. Okay. So you're in rural Georgia or whatever and you receive this diagnosis and you're not getting the support or care that you need, you can get on a flight, show up and say, you know, to Raleigh, for example, and and go and reach out and be like, I need I need help. I've received Victoria Edgington: Right. Anna Casey: this diagnosis and they'll take you in, essentially. Victoria Edgington: So you do have to call beforehand to be clear. I don't totally encourage Good Good question. Anna Casey: That's what I meant. Sorry. Take me. Victoria Edgington: Good question. Yes. Have your Anna Casey: Ha ha ha. Victoria Edgington: your family member call and ask about a bed, ask about assessment, all of that. Anna Casey: Okay, cool. A bit of comedic relief. Victoria Edgington: Right. Anna Casey: goodness. Victoria Edgington: thing I was gonna mention was if we look at like a pie graph of all the postpartum mental health disorders, postpartum psychosis is such a small, small piece. And then like I said, the piece where you are more likely to harm yourself or your child is so much smaller than that. But the context around that is like all these disorders with some overlapping symptoms. And the one that most the two that most get misdiagnosed is postpartum O C D because I think Anna Casey: Mm-hmm. Victoria Edgington: what many people don't realize we think of O C D we think of, mom must be cleaning everything and arranging Anna Casey: Right. She's particular. Victoria Edgington: Things in straight lines and that is not always what postpartum OCD looks like. And actually the highest percentage of obsessions in postpartum OCD is not obsessions around orderliness or cleaning. It's actually around causing intentional harm to your child. So that makes up forty-one percent of the obsessions. and really it's just a miscalculation of your brain, like you're trying to protect baby, but the thoughts you're having are like, I'm gonna throw my baby against the wall, I'm gonna drop my baby out a window. And you have those thoughts and you're just like, my gosh, this is a terrible thought to have. Like and that's when people really worry about psychosis and that's where you need Anna Casey: Mm-hmm. Victoria Edgington: someone really trained. To assess those thoughts that are O C D thoughts versus those thoughts that are psychosis. Anna Casey: Because then the treatment is gonna be different. Yeah. Victoria Edgington: Yes. And I do want to put this little caveat in there that the gold standard treatment for OCD is exposure response and prevention therapy. ERP. Anna Casey: Mm-hmm. Victoria Edgington: So one option is to see a therapist for that. That's not a therapy I do, so usually if my clients have that, I will give them the option of seeing someone who does ERP. And or I will say I have never had an OCD client who didn't do very well on 40 plus milligrams of Prozac. that is in the training that we received that 40 Anna Casey: yeah. Victoria Edgington: milligrams of Prozac and Beyond is a great treatment for those thoughts. And if you have OCD, in all likelihood you're gonna see improvement. One or two of those Options. in general I don't start off with pushing medication and I really want to be supportive of how mom wants to do things. I think there are some legitimate concerns. There's breastfeeding to take into account. There's questions. I know for myself I put off medication and honestly what allowed me to actually get on medication myself was that my functional medicine doctor eventually was like have you ever thought about maybe Anna Casey: Mm. Victoria Edgington: some medication I was like if my functional medicine person is suggesting this it's supposed to be all natural like maybe it's time you know we've done all the supplements Anna Casey: Yeah. Yes. Design. Victoria Edgington: but I do want to respect like taking the route that you feel most comfortable, starting it when you're most comfortable. So usually I'll give people options like based on the diagnosis. So I know with trauma, it's like if you have high panic, you might want to just kind of wait it out. We do some EMDR therapy and that gets better. Or you might feel like I can't manage it. Let's get some medication on board while we're doing trauma treatment. same with anxiety, mild depression. There may be a lot of treatment we can do before we're looking at medication. in my experience, medication has been super helpful when we're talking about moderate to severe depression, OCD symptoms, and it is essentially really important when we're talking about psychosis. So those are times where I might just provide more information and encouragement to make sure people are getting the right care. Anna Casey: That's helpful to know. there's an option that is going to Victoria Edgington: Yes. Anna Casey: very likely help with those symptoms. Victoria Edgington: Yeah. And then the only other one that tends to get misdiagnosed is postpartum depression. Anna Casey: Mm. Victoria Edgington: it's really important to monitor postpartum depression to see if it is only depression or if it's bipolar depression Anna Casey: Okay. Victoria Edgington: because that's where we're gonna be a little more at risk of potentially some symptoms of psychosis coming out, but in general we don't see that with postpartum depression. But Anna Casey: Okay. Victoria Edgington: it's something to keep an eye on. Anna Casey: one of the things that I've loved that you've shared about is and how you even started this conversation off is you can get help. There are tools, there are medications. and so what medications or practices have been proven to help moms who are experiencing psychosis? Victoria Edgington: So there may be different psychotic medications that a psychiatrist or treatment provider might start with. Anna Casey: Mm-hmm. Victoria Edgington: however I think something that people are hesitant to prescribe, but there is a lot of good research. If those other medications are not working, we are looking at lithium and it's something we want to monitor for if physical health side effects long term, Anna Casey: Mm-hmm. Victoria Edgington: but we also shouldn't be afraid to use lithium in cases where mom is not responding to treatment and we're talking about psychosis. beyond that, there's some research behind electromagnetic therapy, I believe. I think I had this in my post. but when you get the right medication and the right treatment, there is a very high success rate of recovering from this. I think Anna Casey: And you're addressing sleep at the same time, right? These are paired Victoria Edgington: Yes. Anna Casey: like getting higher quality sleep and consistent sleep is one of the top priorities, right? In tandem with the medication. Yeah. Victoria Edgington: Exactly. Absolutely. So likely you will be prescribed something for sleep and then some sort of antipsychotic and then potentially lithium if if it's not responding to other medications. One thing that's, you know, Let's say a provider thought it was postpartum OCD, thought it was regular old depression, not bipolar Anna Casey: Mm. Victoria Edgington: depression. Usually a first line of treatment medication-wise is an SSRI. What we want to watch out for is a poor response to an SSRI. Because Anna Casey: Okay. Victoria Edgington: a poor response, your symptoms getting a whole lot worse after those two weeks on an SSRI could Anna Casey: Mm. Victoria Edgington: indicate maybe there's some underlying bipolar here that we didn't know about. Or Anna Casey: Yep. Okay. Victoria Edgington: hmm, this isn't helping with intrusive thoughts. That's Anna Casey: Yeah. Victoria Edgington: interesting. that higher dose is not helping. In fact, we're seeing a worsening of sleeper symptoms. after that the initial two weeks. so those are some things to watch out for. Bipolar can get worse with an SSRI and so we want to be very vigilant about that. Anna Casey: There's two things that kinda stick out to me about that. Number one, the importance, as you said, of having a provider that is trained to diagnose properly, right? and then the second is if you are experiencing worsening symptoms, to not just be like, Well, that didn't work, I told you. To like Victoria Edgington: Right. Mm-hmm. Anna Casey: go back and advocate for yourself and be honest and say, no, this is not this is not actually helping. Victoria Edgington: Yes, yes. And there is a r really fine line and window of time where the reality is with a lot of mental health medications, we're looking at like giving it time, giving your body Anna Casey: Mm-hmm. Victoria Edgington: some time to respond to it and seeing if we're on the correct dose. So Anna Casey: Mm. Victoria Edgington: there's this really this there's this window of time where you really have to be communicating with your prescriber. And for them to be letting you know, is this a normal response in this period of time? Is it important to give this medication more time? Or is this really not working and you're responding in a way that is not typical for this medication? Anna Casey: Yeah. Yeah. that's really good to know. I do think it's appropriate to just ask you you talked about looking for a therapist that has the PMHC certification, but What are some other things? maybe maybe a mom is listening and she's like, Man, you sound awesome and I don't really know about my therapist. maybe there's just like this mismatch. Is there is there any advice that you would give to anyone listening where they're like, I don't really feel like I'm clicking with my therapist? Which I guess I'm kind of like answering my question, but like you can Victoria Edgington: Yeah. Anna Casey: change therapists. You can go find someone else. So do you have any just Victoria Edgington: Yes. Yeah. Anna Casey: encouragement or things you would add to that? Victoria Edgington: Totally, yeah. So we have a responsibility as therapists not to act outside of our scope of practice and what we're trained to do. So if Anna Casey: Yeah. Victoria Edgington: you're experiencing postpartum mental health symptoms and you're seeing a therapist who really isn't trained in that, It's not that we want you to abandon a therapist that you have really good rapport with 'cause that can still be a really good support. What I often try to do if someone's in that situation is say, Hey, you can keep seeing your talk therapist and you can see me on the off week and together we can make sure you're getting Anna Casey: Mm. Victoria Edgington: the making sure you're you're keeping that person in your life who's been your support and not just starting from square one. Anna Casey: Yeah. Victoria Edgington: But also seeing someone who's really certified and then we can talk and make sure we're on the same page and Anna Casey: for Victoria Edgington: seeing the same things. different if we don't Anna Casey: Yeah, 'cause you're right. you may love your therapist. Maybe it's not like maybe Victoria Edgington: Yeah. Anna Casey: maybe it's not an issue of not liking your therapist. Maybe you love your therapist, but you just don't know that that's Victoria Edgington: Yeah. Right. Anna Casey: an option to collaborate with someone that has Victoria Edgington: Yeah. Anna Casey: more specialized training. Victoria Edgington: Yeah. And there are there's different flexibility there. sometimes you might Anna Casey: Mm-hmm. Victoria Edgington: temporarily go see someone specifically for postpartum mental health and then go back to your therapist in another season. Sometimes you might do a switch of like every other week you're seeing a different person. it can really vary, but my hope would be that if your therapist that you have now notices that they're not. quite sure what to do with your symptoms, that they are at least giving you the option of referring you to someone who knows more about that. Anna Casey: Yeah, yeah. That's that's really good to know. Victoria Edgington: And if they're not, you can seek it out for yourself. You can get on Psychology Today. Anna Casey: Mm-hmm. Victoria Edgington: You can look for that PMH C. Anna Casey: Yeah. Victoria Edgington: you can do that yourself if you need to. You can also get on Postpartum Support International's website. Even if you just need to call their hotline and be like, Where do I start? That's what they're there for. So Anna Casey: Okay. Yeah. That's great to know. I think one of the most important things that can come from our conversation today is to educate anyone listening, how to support our mom friends and like how to be a good support person. so we talked about some of the red flags with maybe distorted reality Or manic episodes, things like that. are there any other phrases, or signs that indicate we should really immediately start to intervene with our loved ones? Victoria Edgington: Yeah. Yes, totally. I think a great starting place first of all is just asking your friend, how are you really doing? Anna Casey: Mm. Victoria Edgington: really doing postpartum. Tell me the the raw, real, like what are you experiencing? It gets crazy. Like I can be that person. Like I want to know Anna Casey: Yeah. Victoria Edgington: the real deal. You don't have to sugarcoat it. sometimes, let's say again, very worst case scenario, psychosis is present. That could go in and out. So you might have a moment Where mom is lucid and has clarity and you can say, Hey, I'm I'm noticing this, this, and this. I'm feeling a little worried about you. and she may or may not agree. If you're feeling like, I'm not sure she really understood what I was saying, or I'm not really sure she's maybe even understanding kind of what's going on, just let her know, like, hey. I love you so much. I'm I'm just gonna reach out to your husband and and I I wanna make sure he's supporting you too. Or I'm gonna reach out to your mom or I'm gonna reach out to these other friends. Do your best to not go behind her back. but just say Anna Casey: Yeah. Victoria Edgington: like, I w I really wanna make sure you're supported. And then maybe you go to a family member and say, Hey, this is what I noticed, this is what I'm seeing. Sometimes that can be a symptom of something much more serious. and this is what would need to happen. Anna Casey: Okay. Yeah, and then tell that support person, hey, there's this thing called a therapist who can have a specialization in postpartum, PMH-C And then you share like this is what you can look for. Victoria Edgington: Yeah, you could either share the therapist or if it's serious enough, if a mom mentions, thoughts of harm to her child or herself, like you can let them know this is an emergency. Or if she's you know, if it is a very clear manic episode, you will know because it's so Anna Casey: Yeah. Victoria Edgington: different. there will be high energy, they won't stop talking. You won't be able to get a word in. They won't understand what you're saying. And that's when you're like, Anna Casey: Hm. Victoria Edgington: we're gonna take a little trip together. And I'm gonna help you get what you need right now. We're gonna loop Anna Casey: Yes. Yes. Yeah. Victoria Edgington: your family in and I'm gonna get you where you need to be. Anna Casey: Which would be the emergency room. Victoria Edgington: Yes. Anna Casey: Yeah. Cool. Okay. That feels really practical. And thank you for the language for that too. I love you so much. How are you really doing? And then if that escalates, these are some things that I'm seeing. I'm feeling worried. either A, we're gonna get in the car together and I'm gonna take you to the emergency room. Or B, I'm gonna, I'm gonna loop in your spouse. I'm gonna loop in your mom. and I'm gonna talk to them just to make sure you're getting support. That feels really like tangible and practical. So thank you. Victoria Edgington: Yeah, totally. Yeah. And you know, there are cases where mom really doesn't understand and may be very resistant to doing that. Anna Casey: Sure. Yeah. Victoria Edgington: and when there is a high level of concern, that's where, you know, we make the call anyway. That can just be a 911 call if it needs to be. Not the way you want it to happen, but in severe cases that can be what Anna Casey: Yeah. Victoria Edgington: needs to happen. Anna Casey: Yeah. thank you so much, Vic, for walking us through all of the all these practical steps and giving some vision onto different paths of where we may be and what to look for and questions to ask and if we do receive a diagnosis, what that looks like and where we will where we will get tangible help and who will be the people involved. I think that's like really helped me and my brain understand all of this more and and wrap my head around it more. and even contain it. Like you talked about, there's so much overlap with different diagnoses. So thank you for shedding some light on this and and helping confine it a little more so it doesn't feel as scary and as intrusive. I was wondering if you just had any lasting encouragement to anyone listening to this Like You were talking about this does not scare me because this is normal for me. So is there anything else that you would add to that or just any lasting encouragement to any moms or support people listening today? Victoria Edgington: Yeah, yeah. I think it's mainly that if there's anything going on for you postpartum, if you're feeling anything outside of, what you envision to be a typical postpartum or what you envision to just be feeling yourself, that it's so good to get that support, to get clarity. and there's nothing in this space that we can't solve. Anna Casey: Yeah, so good. Victoria Edgington: so hang in there. Postpartum is temporary. postpartum support international, I believe their tagline. I was trained by them and their tagline is with help you will be well. Like that is the hope Anna Casey: Wow. Victoria Edgington: to hold on to. If you get the right help, you will get better. And we can get through this and you're s still gonna be a great mom and you're gonna look back on this and it's Gonna feel like the hardest season of your life, but you're gonna look back and see how it shaped you and ultimately made you a better mom. Anna Casey: Beautiful. Thank you so much, Vic. Victoria Edgington: Yeah, thanks for having me.