Ep. 165 | Postpartum Depression, Anxiety, OCD, and Psychosis: Recognizing the Signs

Karin Ryan (00:01.602)
Hello and welcome to another episode of Everyday Therapy Sage and Behavioral Health Podcast. I am Dr. Karen Ryan, your host. And I am here with Dr. Stephanie Kohlhi. I get to work every day with Stephanie Kohlhi, Dr. Stephanie Kohlhi here at our office. And Dr. Kohlhi is a therapist, so does therapy with clients here for outpatient.

she is also does diagnostic testing and different types of testing. So meaning she will sit with people and do their testing, give them results and kind of explain what that means, testing for different things. And then she is also a specialist in perinatal mental health. So she is somebody who runs our mother-baby program and leads group and works with individuals who are experiencing perinatal.

mood and anxiety disorders and she has been a lovely guest in the past and I'm thrilled to have her joining me today. So thank you so much, Doctor Kohai, for joining me again for the podcast. Thanks, Karen. I'm thrilled to be here.

And so we have talked about perinatal kind of mood and anxiety disorders in the past, and we felt like this was a really helpful opportunity and time in our culture and space and community to really talk even more in depth about the different perinatal or postpartum

mood disorders that can happen because people are really interested. And so I feel like it's such a good thing that people are interested right now. And so I know you were just excited, like let's talk about it. Let's keep the conversation going to help raise awareness about postpartum needs, correct? Yeah, correct. This is the moment. Yeah. Yeah. Yeah. Mm-hmm. Yep.

Karin Ryan (01:57.772)
We've got people looking for it and wanting to know. And so our hope today is just to kind of talk from our clinical wisdom, but especially from, you know, Stephanie's experience working with moms and families. And so kind of getting into it, right? Where we know that when we have a baby, when we bring a baby into our family, it is a huge thing that happens to families. Like it is this miraculous, amazing thing that happens to human bodies and families. And it's a really big change.

It sure is. I think of different types of change that impact us and this one is so

Three sixty in my mind. Like if we move, yes, that's really tricky, right? We're sometimes changing, you know, who our you know energy provider is and whatnot. This changes yourself, your relationships, how you do things at in your home and how you run it. Yeah. could you know, a lot of biological things when we're thinking about the gestational parent and you know, there is so much that just feels like

A night and day change. Yeah, absolutely. Just huge changes that happen. And we know that as humans, right, when we go through big changes, like sometimes we have reactions to that or we have responses to that, and our bodies respond to that. Of course. Of course. And so we're gonna kind of break down some of the different kind of mood and anxiety disorders that can come with that postpartum period. and the first is talking about you know, baby blues. So baby blues is not necessarily a mental health disorder.

But something that many, many women experience. Mm-hmm. Right? Like it is up to seventy five percent in new moms those first few weeks, right? Yeah. Just experience baby blues. So what are baby blues, Dr. Kohlhai? baby blues, I do get imagery of a roller coaster in my mind. So if you can bear with me and ride. whenever I click. Hang on tight. when you think of pregnancy

Karin Ryan (04:02.922)
It might not feel like it in the moment, but you're kind of getting a slower climb. This is you going up the hill, and it's little slower, it's steep. but you're s you know, so you are experiencing hormonal changes, and baby blues happens about somewhere seven to ten days after delivery when the body realizes

not pregnant anymore. I don't need to support a pregnancy. Then you go down the hill. Yeah. Okay. So I I've heard many different phrases for it. you know, like hormone release, hormone dump. The the point is is you're going on a ride. Yeah. It's a big release all at once. And so that hormonal shift is sudden. Mm-hmm. You know, and so I think the suddenness is part of why we notice the big volume. It's sudden. Yeah. You know, and so

we we expect to see an emotional response to that. Yeah. Right. Yeah. Big emotional shift. Unexpected crying, feeling low mood, some you know, sadness can occur around around this time. And this is the probably the one yeah because of its commonness we think of. Yeah. Yeah the its relatableness. Like I went through that. I went through that. Yeah I probably did. Yes yes yeah and for this one I know you do such a good job at like educating you

you know, moms to be, families to be, about this, you know, this roller coaster ride of like this is going to happen. Your hormones will naturally like I thought like a crash, right? But it's whoop drop. Woo. And that huge change because it's the it's the way our bodies are designed, where they are very connected. The hormones are very connected to then our brains and our bodies and everything impacts one another. And so that's this natural time where and it's shorter lived, right? So baby blues tends to not

like lasts a long time. It can be intense, but it doesn't last the same way like a postpartum depression will. Yeah. Yeah, for sure. It's it's under the th criterion for major depression, like more like seven to ten days. So it's s about seven to days seven seven to ten days after delivery and then it lasts about

Karin Ryan (06:12.12)
seven to ten days. Yeah. Two weeks. That's helpful. Okay. And when she says criterion that's where like we are kind of trained to say like, hey, to assess something, to give a kind of a diagnosis, it's at least two weeks and it really impacts your functioning. And so that's what we would be looking for, right? And that's what we encourage you to look for as you're going through your own postpartum period or a loved one is, is kind of checking in and how are they doing then?

You know, after that natural kind of time frame and we're thinking through hormones and those changes. So at three to four weeks, you know, at any time though, but really checking in and then watching for postpartum depression. Yeah. 'Cause that will look like what? What will that look like for moms? Yeah, that will look very similar. It could have a similar vibe to, you know, that of like that hormonal shift. you know, it's a little different. You might not get some of the hormonal elements.

of it. Like when I think of hormonal drops, like your body's working hard to release those hormones too. So like it's through water, you know, tears, sweat and your urine. you're not seeing some of those things. But what you are seeing is, you know, more days and nut.

Low, sad mood, maybe crying spells, maybe low energy. And moms in particular can shape thoughts oriented towards parenting. Yeah, yeah. Good at this. I kind of self-doubt. Yeah. Self-doubt. you know, and maybe feelings of hopelessness, like this is my life now, and it's not gonna change or it's not gonna get better. Yeah, you know, yeah. Can feel really tricky, like as baby goes through phases, and you know, I always kind of say like

Like those first two weeks for me like felt like months, you know? Yeah. Yeah. because of changes, time in our brains and how we process time kind of changes. You're up more literally. So you are more having more wakeful time. And so like our circadian rhythms are all off. Yeah. Yeah. So yeah, feelings of hopelessness. sometimes you can feel like this lack of attachment. So like bonding, how do you feel about baby? Sometimes that can really be there. So I want to normally

Karin Ryan (08:25.552)
Normalize there's there's no wrong way, you know, to experience depression. Sometimes I work with moms and they're like the baby's the best part, but I'm just so bummed about everything else and how it's changed my life. Yeah. I love my baby, I feel the joy, I feel connected. That's not the problem. I just I have not showered in so long and my or I don't get to do the other things I normally like to do and enjoy and I really miss that, right? There's yeah, yeah. I miss my spouse, I miss my friends. Yeah, I miss eating a hot meal regularly.

or just what I used to rely on for coping and have to shift. So this a depression, postpartum depression lasts longer. Yeah. You know, so like how long does it take to lift as well? Yeah. So it's the how how long?

Yeah. And as you're describing this, I'm thinking about like what does that look like or what does that feel like for some f and some examples. So example of like, not enjoying the things that you used to enjoy. And the difference would be, let's say I wanna go to the movie and I know I can't go to the movie because, you know, I gotta baby in Goldar I gotta stay home and I gotta breastfeed or I gotta do this and then go to bed myself, right? And so it's a little bit of like I don't really wanna go 'cause I don't wanna have to then like pump or do this or that.

Whereas depression would be like, I just don't wanna go. I don't have any interest in watching a movie. It won't bring me any joy. Even if I get to the movie. Right? Or we all kind of question ourselves as we're like trying to figure out how to care for a newborn and each baby's different, right? Even if we've had babies. But I imagine like there's a difference between being like, gosh, am I doing this right? versus a depressive thought is like I can't do anything right. Right. What's wrong with me? Yeah.

I'm a failure. Right? Versus like, gosh, I am not good at diapers. I gotta figure this out versus that s and I think that piece of like personalizing it, like I am bad, I am wrong, I'm never gonna feel better, there's something wrong with me versus like being able to like separate a little bit and be like, This is really hard. okay, I figured it out. Mm-hmm. Yeah. Absolutely. Like I'm learning a more gracious thought, right? Like going which is

Karin Ryan (10:26.85)
more accurate, you know, I think of it sometimes in terms of grading. Like how do you grade yourself like if I'm giving myself a C or a D you know, but it's like, but you're not remembering you're in the what grade are you in? Right, right. Right. You know, like just really yeah being less tapped into those types of thoughts that are like reminding yourself of like, you know what, I'm new, I'm learning. Yeah this is more of that I didn't get it right.

I didn't get it right again. Yeah. You know, or I had this feeling and it must mean something bad. Yeah. You know, about how how I am as a mom. Yeah. Yeah. Lots of guilt. Yeah. Lots and lots of guilt. Lots of guilt, yes. Yes. Yes, and sometimes irritability, right? So there's sometimes they're like just kind of annoyed and frustrated and like at weird things, right? But if it feels like like this irritability is like not taking over where I'm like

a rage monster, but where it's this piece of like, I can't shake this irritability. Like I just feel annoyed all the time. Cause some people with depression and postpartum depression don't necessarily feel that leth lethargy or sadness. Sometimes it's it's like a little activated too. So I appreciate how you said it can look very different for different people. Absolutely. It's

very internal, so you're gonna be the one that sometimes that catches it. You know, like it's like how I feel, what are my thoughts, what are my emotions going on, but depression can absolutely look like a very

productive five functioning mom. Yeah. Doing all the things. Yeah. You you can walk around being very functional, like doing the things and feel that heavy blanket, that heavy load. And so it's it's hard hurt harder to tell from the outside if someone's depressed. So it can be very internal.

Karin Ryan (12:15.222)
And so that importance of like talking about how we're really doing, how we're really feeling and asking each other. Yeah. Right. Yeah. And we talked about, you know, kind of different things that can come up and we're talking about kind of irritability and anx and I'm thinking about anxiety. And there is like the thresh that not a threshold, but there is a whole range of like ways we experience anxiety as a new parent.

Right. And there are natural things that have like of course we're going to feel anxious about this. Like and then sometimes it's how do we recognize and know when it's shifting more into like a postpartum anxiety? how do we know and kind of what are some signs, you know, Dr. Kohl High when it is becoming more of postpartum anxiety? Yeah. yes, this is both expected and unexpected, right? Like you know, the what to expect is I'm probably going to have more.

thoughts about how to care for my baby. Yeah. What's wisdom and you know, and I I do wanna pay just I guess mad respect to to modern parenting and the unique challenges that we've walked into. Like, I mean, I feel like it's challenging for me not to mention the role of social media and like how you can for every do there's a don't. Yes. Yes.

And there's lot of information age unique challenges. And so like I I do feel like we are in modern parenting era, like the common thing is that we are asking these questions and new expectations amongst ourselves is that we're researched and that we're informed. Yeah. and so there there is a balance. Yeah. Right. And so I want to acknowledge there's this part of being research and informed that can be part of it. we can have

our anxiety that's very helpful.

Karin Ryan (14:13.088)
Mm-hmm. Like, okay, what do I need to be aware of in my new Motivates us. Motive us. Yeah. To do the best we can, right? Yeah. Yeah. Engines running. Yeah. And when does it actually get in the way of my goals? Yeah. When does it get in the way of that life worth living right now? Mm-hmm. enjoyment of the baby. I think a lot of times what I will notice is because it's get your engines running, what moms will experience is that irritability. Like I'm I'm I'm up. Yeah.

so you can experience that irritability, but also the inability to turn the engine off when you need to. And fatigue. Big, big, you know, you're tired already, you're doing a lot. But my engines are running and I can't turn off that car, my engine's gonna overheat. And so I notice a lot of exhaustion. Yeah, and you're describing the engine running, which is literally what happens is when we are anxious, our heart rate increases, our respiration increases, the way our blood flow changes, our digestion slows.

Yeah all of these really big shifts like kind of happen because again our bodies are amazing and sometimes like when we're anxious about am I giving enough skin to skin contact or am I giving or am I not letting the baby learn to sleep on their own, right? Like you just highlighted, like as dialect and both end. Right, like it that when we have those really sometimes it's we can think about and let it go, but if we find ourselves ruminating on it or really overthinking it

Then that's when our body's being activated and then it's that's anxiety. Yeah, it's anxiety. You know what anxiety does unique, I feel like in the postpartum experience. Like we expect to have sleep go out the window in some way. What's new sleep look like in this new era for you? And so we expect to be sleep deprived.

what I look for is like can you sleep when you have the chance? Yeah. You know? Yeah. And so if you can't turn your engines off, very hard to sleep. Yeah. Very hard to sleep if I'm worried, like is the baby okay? Is you know did I do the right thing before I laid down? What whatever Yes, did I miss something? Yeah. Yeah. Like or maybe I should stay up and research that one last thing. Yeah. That's been on my mind or you know, and so like can you sleep when you have opportunities?

Karin Ryan (16:32.172)
Does it get in the way of your joyful moments? Like is your mind somewhere else? Yeah. You know, and does that bother you? How do you respond to that? Or can you turn it off? Like, you know, we're we're talking about how much? Yeah. And does it get in the way? So it absolutely can

in some ways be a joy suck. Just like depression, you know, we have to experience that but maybe a little different path to it. Like it's like it's hard for me to be here 'cause my mind's somewhere else. Yeah. I can't tap into those feelings 'cause my engine running is overshadowing yeah. The other good stuff. Right. Yeah. Right. Yeah. No, thank you. It's so helpful that what does that kind of sound like and feel like for people? Yeah. And we're talking about

Like sometimes checking on the baby and sometimes being worried about the baby. And we know like postpartum anxiety can affect one in five new moms, right? And then we know that there's also postpartum OCD. Yes. Right? Where postpartum OCD is like when it is associated with having intrusive thoughts or images, right, that kind of go against what the mother wants. So how do you kind of recognize or what do you watch for and what's the difference between anxiety?

And O C D. You know, how do we know the difference and how can we watch for the difference? What's O C D postpartum O C D Yeah. Thanks for no naming like kinda this intrusive experience. Yeah. Right. I think that's a big key. And I one thing that's a little bit of a mind melt. So if you join me in some confusion, let's

Live in that space together. Yeah. Uh-huh. let's tolerate that. Yeah. Yeah, let's tolerate that together. So ninety six percent of parents experience intrusive thoughts. I think of it it maybe a little bit in terms of like that little pop up on your screen as you're going along throughout your day, and it might be related to what you're doing right now or not. Yeah. You know, and for

Karin Ryan (18:22.868)
some parents, like, you know, we do experience these and they're un sometimes absolutely unpleasant. Right. I get imagery of some harm coming to my baby. Yeah. while I'm here in this space I wanna normalize, like sometimes we can have wacky wild ones, you know, thoughts, but it it's not fun. Yeah. You know, to have these thoughts. And so like the definition of intrusive right, Doctor Cole is like they just kinda like pop up.

Right. And it's like a for me, like what I'm picturing is like it's a very distinct kind of like sharp. So when you're talking about like a pop up, it's like it's bold. It's clear. It's like brrrr period. Right. Like that's my visualization for intrusive thoughts. Like boom. Pops up, takes a forefront, and sometimes like disappears really fast and you're like, What the heck? Yeah. And other times it like stays there and you're like, Whoa, I can't make this move. Like it is there in the front and for forefront.

Right, right, absolutely. Like it's intrusive. It gets in there and it's like what how did you get there? Yeah. It's kind of that response of like, wait a minute, you just intruded, you wait who who are you? Yeah. you know, very out of the blue, not necessarily related to what you're doing or thinking in the moment. Yeah. but our b our bodies do this. Yeah. And I I do feel like it's very noticeable postpartum because of the nature of the thoughts and

you know, nothing more scary to think about, right? For other parents. And do you mean w when you say that, do you mean 'cause they're oftentimes like about the baby. About the baby's health, about the baby's wellness. Am I gonna do something bad to the baby? Is something bad gonna happen to the baby, right? Accidental harm. Okay. So I will name an example. So like, not uncommon for parents to be worried about walking down the stairs with their baby.

Makes sense, right? my gosh, like I'm carrying something, I can no longer see my feet. Yes. Yes. Yes. And the thought comes off like, my gosh, what if I fall? And your brain's working in that moment. It does h happen to be more congruent in a way of like saying, Well, yes, be a little more careful when you walk down the stairs, right? But, you know, it's like you're having maybe the imagery. Yeah. So it could be the thought, you know, like you know, like what I'm my conscious talking to myself, my own voice, but it also can be

Karin Ryan (20:35.736)
I just had the image. Right. And so like and that's like kinda what you what you said, like I have absolutely no desire.

Yeah. For that to happen. Yep. You know, this is not me daydreaming or fantasizing it. Right. I'm a pleasure seeking. Right. Which is very different from other types of images we sometimes get. This is the kind that's upsetting. Yeah. And it's like not like me. I don't want that. Ish ish ish. And so when we can have this anxiety, you know, like my many parents experience this regardless of having a mood anxiety disorder or not. and but how we how our body

Responds to that. How how are they really sticky? Yeah. That's the language I always use. Yeah, that's a sticky thought. Super sticky. Is it tacky? Does it stay? How you know how what's your emotional response, your thought response to it? So with anxiety, it's uncomfortable. Yeah, it might not be your main thing, or you get really action-oriented, you know, you could you know drive up some action, but in OCD

We we have the horrific thought, like, no, that's completely not what I want. That's so disturbing. Yep. But we also maybe go to this lens of like, Why did I think that? Yeah. W my God, what's wrong with me? How dare I think that? no, no. I'm so now I'm scared of myself. Yes. and so a lot of in O C D you see a lot of protective actions of like and it can go one way or the other. I'm going to protect my baby.

And sometimes it's I'm not gonna give my baby to anybody else. Yeah. Yep. Okay. Yep. and sometimes it's the other way, like do not let me around the baby. Yeah. Or be alone with the baby. Yep. Mm-hmm. so maybe more than your fair share of delegation or your more than your fair share of ownership. Yeah. Okay. So it might be hard to get someone else in or for you to approach. Yeah. So Right. Or I could see too, right, with O C D it's

Karin Ryan (22:41.2)
when we start doing actions to try and prevent the fear and it takes more and more and more time, right? So if I'm worried about my baby being sick.

I might go from washing the bottles once where now like I'm gonna wash the bottles five times. Yes. Right? Mm hmm. Or I I imagine like, what if I fell down the stairs? And then I picture like and then the intrusive thought like, What if I threw my baby as I fell down the stairs? Now I have the image of throwing my baby. And like you highlighted, then our brain gets all activated. It's a sticky thought and then we're more likely to have it 'cause it's scared us. Yeah. And then maybe we avoid like going down the stairs. So we have this super long process that takes us now thirty minutes to get down the stairs and we have to go up and down the stairs five times a day.

Yeah. Absolutely. Like, yeah, or I'm gonna rehearse excessively without the baby in my case. Like and you know, and and I think there's for people with O C D it's like there is some level of awareness of like no this isn't really gonna prevent a freak accident. Yeah. I'm aware that me walking up and down the stairs is not gonna prevent

a freak accident. but you do it anyway. Right. And sometimes it can, you know, just accelerate and with O C D a lot of it is how much are we doing?

But you want to say we all have sometimes our own little OCD like things. Yeah, for sure. Absolutely. Our own things like I gotta do it. Doesn't make sense, but you know what? It's seconds a day. It doesn't get in the way of anything. Yeah. Not overly disturbed. Like, not necessarily OCD. Yep. You know, this crosses the line. It was like when we think about frequency again, like how much and how impairing is it? Like, what does this what's the trickle down effect of doing this? Yeah. You know, so thinking about that. I've absolutely heard a variety.

Karin Ryan (24:24.272)
of you know experiences like someone being trapped on the second floor of their house because they won't go down the stairs. Yeah. Right. or you know, for some it's driving. for some it's you know feeding or what have you and so there's a lot of ways our brain can get our in our heads and again I just I heard a o parenatal OCD specialist talk about this and I like how she talked about it. When we're faced with new responsibility, our brain just goes wild with suggesting like what if I did the opposite of that?

And so like I think she normalized and it felt good to me even. I like, my gosh Like she's like, Do you ever walk across a bridge or a catwalk or something and go, What if I jumped over? And you're like, I don't wanna jump over. I'm happy. Yes, yes. I'm content with my life. I wanna keep it going. Yeah, yeah. But it was there. Yeah. Yeah, and we do. 'Cause all of a sudden when we're walking across that catwalk, we're responsible for keeping ourselves safe. Yeah. And on the catwalk. Yeah. So then our brain goes, Well

Here's a Yeah, what it's like, right? Yeah. Yeah. Yeah, and I appreciate you so we highlight it, right? And we're talking about, you know, we've talked about postpartum anxiety and depression and OCD now. And I think now we're like talking about postpartum psychosis. Yeah. And like what how how is that unique? How is that different? What does that look like? Yeah. And you highlighted in

postpartum OCD, there's an awareness. There's an awareness of I'm using this word lovely, like I'm lovingly, like ridiculousness. Like this is kind of ridiculous. Or I know part of you is like, I know that I probably don't need to do this, but I'm still gonna do anyways because I'm too worried about if I don't. Right? or an awareness where psychosis there is kind of a shift where there isn't often that insight or awareness. Is that accurate? Yeah. Yes. Yeah, and postpartum psychosis is much more rare

then you know postpartum depression postpartum O C D is about like three to five, but sometimes new studies are saying we're like seventeen percent because we're getting better at researching for a OCD. But the postpartum psychosis is not as common, but really important to recognize. Yes. And that's why we wanted to like let's really talk about this today. For sure. Uncommon yet severe. Yeah. Uncommon yet a medical emergency. Yes. and

Karin Ryan (26:46.252)
Thinking about what is it, how is it unique? You know, I talked about earlier we were talking about depression. Yeah. So this is a sometimes a very internal experience. You might not be able to see it. Yeah. Yeah. Yeah. Yeah. this is different. Somebody with psychosis doesn't have that insight. Yeah, they can't hide it. They can't it. They can't mask it. And the person that might notice is someone else.

Yeah. It's an observer. Yep. So I I you know, when I when I do educate, you know, and like preparing, you know, new you know, parents to be and I do talk about postpartum psychosis, you know, I talk

I really, really want support persons, partners there. Those are the people I need to talk to. Yes. it's going to be an observer. Yeah, 'cause even any type of psychosis, yeah, it is very oftentimes a loved one or a family member or a coworker who will first notice it as opposed to the individual themselves. Yes. Yes. Yes. Yeah. Yeah. And and so I feel like that's a hallmark, you know, you know, like a lot of times in

therapy work, things like that is about getting in touch with your instincts and what you know, what's true for you and you know, you have to tell me I can't read this. Psychosis is not that. Yeah. Yeah. Yeah. And there are 'cause some of the symptoms, right? So sometimes you can be heard like, okay, what is psychosis? And we hear the words hallucinations, delusions, paranoia. Let's like just spend some time, Dr. Kohai, like talking about them. So like hallucinations

Or when the brain seriously acts as if it's getting input. So when you look at like an MRI of somebody who is having hallucinations, like psych psychotic hallucinations, if th they will say they're hearing something and the part of their brain associated with hearing is like lit up. If they feel like they're seeing something, the part of that brain is lit up. So it truly is an experience where they're experiencing different hallucinations. Yeah. Yeah. What are some of the types of hallucinations that people might experience? yeah. So I was thinking of

Karin Ryan (28:48.07)
an example I heard of from a a postpartum psychosis survivor story and what she shared was that she had this experience of taking a scissor yeah and stabbing her baby with it. Okay. Blood everywhere. Yeah. She said in the moment she experienced it as real. Right? This really, really happened. Yeah.

You know, and she said she took for a moment, she took the sharps in the home and put away somewhere. In the video when she talks about it, she says, I don't know why it didn't make sense. I was like, actually makes sense. Let's make some barriers. Yeah. But she was scared to go back to the room 'cause she was of what she was gonna see. Yeah. She saw it. She said she saw that the blood. She saw the injury. Yeah.

Came too later. Baby's just fine.

Yeah. But the risk in the emergency is then if she doesn't go in let's say mom doesn't go into that room for five hours, six hours, that sort of time. So you can see why this is an emergency. This is layers of types of risk in emergency. Yeah. You know

things can happen multiple ways. So right, if she had thought she had done this and was like afraid to go in, yeah, baby could be alone, unattended. Yep. and there's like commute command hallucinations where people hear a voice telling what to do. There'll be like smell where they imagine that there's smoke or chemical, so then they're trying to protect baby or maybe ki keep baby, you know, from breathing it in and there's tactiles, feeling like there's things on you, in you. Yes. Yeah. You know, and I was thinking about

Karin Ryan (30:38.946)
You know, this played out as real and we were talking about intrusive thoughts before. Yeah. Right. And we get there's this connection to like uncanniness, like, nope, nope, I know that's not real. You know hallucinations, you're living this story. It's being played out for you.

in a three dimensional way. And and your your brain is really t ha seeing that inform really responding to that as if it's happening. Yes. I was I was thinking about like how would I explain this to someone that hasn't experienced something like this and to be clear I haven't either. So like how do I reconcile this? You know? and I was like I don't want to make a connotation that like or connection that doesn't exist, but I did I did think of dreaming. Yeah.

You know, and you know, you have a dream and it just feels very real. Mhm. You know, and it takes some time after you wake up to go

Wait a minute. Yeah. You know, like was that real? Was that not? Or something emotional happened in a dream and it's like I wake up and you're still crying. Yeah. Something like that. Or maybe someone that watched you sleep would did you know you were talking? Yeah. Did you know you were like kicking? You know I walk.

And you have no idea. Yes. You know, it's kind of I feel like I wonder if that might be what it's like for some. It's like it was so real, and I was actually doing things and it wasn't to my awareness. Yeah. It was that three-dimensional experience, vivid, real. You can maybe even touch, feel, see all those sensories. Yeah. like you said, in the brain, it's on. Yeah. So it feels very real. so yeah. And I think watching for it in another person, like you'll see sometimes like darting eye movements, you'll see like

Karin Ryan (32:25.136)
responding, we call it internal stimuli. So you can kinda like they might be kinda like talking back. You can see kind of their like their movements might be kind of disorganized. So we see that with like delusions, like that's a belief that is like so strong that even with like convincing evidence it still feels true. So that might be like somebody's out to get you, somebody's trying to get the baby, that there's an imposter in your family or the caregiver. Right? Or this feeling like I didn't even have a baby or the baby's possessed.

Yes. Baby's defective. And so it's a really powerful like belief that this is true. So even though the person's holding a baby, they might feel like that's not my baby. I didn't have that baby. Right. Right. Yes, absolutely. So like there's layers to this. So there's like, you know, hallucinations, but also very, very strong beliefs that you can't be convinced even though it's not grounded in what we all expect. Yeah. Right.

And I you know, religiosity does play a role. Like, you know, yes, maybe I'm I'm possessed, maybe my baby's possessed, or maybe both. Or, you know, there a lot of sometimes religious like savior, like I need to save my babies. Yes, yes from this terrible harm that's gonna come. Yes. I'm I'm saving my baby. Which kinda ties into like paranoia too, right? It's like paranoia thinks 'cause this is another one that I will see.

sometimes it might not directly be about

But it might be themes I've heard is the hospital of which you did do labor and deliver delivery. Okay, so the doctors are still watching me. The they switched my baby. They are they just want me to come back in. because I know why. Yeah. You know, like they wanna have me tracked or you know, so like this is there's this a paranoia element. Yeah. There is high suspicion, yeah. and things that would be what we accept as our

Karin Ryan (34:24.752)
Yeah. You know. And so as a loved one, right, you're gonna be watching for like are you not able to convince them even though you're lovingly trying to like give reassurance or explain or like the evidence doesn't line up or it's kind of these grand like you know, people out to get me, or hearing messages from the T V or radio or books and feeling like they're for they're for you. Yeah. Someone's talking to me, someone's telling me to do things, what is that?

yeah. Yeah. Right. Or like I didn't have control over that, like like the feeling like they don't have control over their body and what they do. Mhm. And there's there's a disorientation element. So like you know, and that's like confusion.

I think of. Very, very confused can also happen. So what day is it? What time is it? Who's president? you know, like disoriented very confused. But that also fit for like if let's say their behavior is kinda disorganized 'cause they're paranoid, right? Or they're kind of doing some delusional behaviors and if you ask them like, Well, what are you doing? What my guess is they'd be like, Well, I don't know. Right. And just gonna respond with some like hostility or like

Confusion, is that accurate? I think that would be very fair. Like it's you're not gonna have a sit down, you know, over coffee tea kinda chat with this person. It's gonna be like, wait a minute, what? What? It's gonna feel like a very much struggle. Yeah. to talk to this person and feel like, you know, they're speaking in a way we understand.

Yeah. Like we're I think we're familiar with you know, sometimes we can get excited and I jump from one topic to that and like this is has more of a flavor of the stranger bizarre. Yeah. So like yeah, maybe agitated because they don't know what's going on. Yeah. You know, like don't ask me. You tell me. Or you know And so oftentimes with paranoia and delusion there's fear. There's so much fear there, it's very scary for the person. So like even though they know you're a trusted

Karin Ryan (36:17.856)
loved one partner, they're gonna be maybe like not fully trusting of you. Yeah, I appreciate you like that, having that conversation. Cause my experience too when I'm working with individuals and there's you know the start of psychosis, like but the thought that often comes to my head is like, what is going on? Yeah. Like what? And I'm trying to put the pieces together and it's like this loving example of like the pieces don't line up because they're not

You know, they're not based in reality, right? 'Cause it really is a true thought disorder where there's other factors at play that we can't see or experience, that only they are. Yeah. Yeah, absolutely. And if you're feeling confused, it's 'cause you're feeling the you know, I like to think of confusion, it's a mental state, but it's also an emotional state. Yes. a hundred percent. So like if you're feeling confused, you're absorbing that confusion from the other person. And to use that information to give you like yeah, I think

That's what's happening. It's what I'm experiencing. And so I'd imagine, right, that people listening, right, are thinking, like, my gosh, like what if this happens to me? Could this happen to me? Right. And I think it's helpful to know like this tends to come up quickly, like, you know, within seven forty eight to seventy two hours kind of develops fast. We kind of will lose touch with reality in in a matter of like a couple of days. And so that's why it's a mental health emergency.

And some of the red flags or pink flags they even call them to watch for, like that severe insomnia, like if you start getting restless, irritable, some racing thoughts. Yeah. Right? Yeah. And so what should what do people do, right, when they realize that this might be happening for them? Yeah. Yes.

That they have this. Sure. And I don't want to minimize and say you don't like absolutely get help. Come in and ask. Come in and ask Dr. Quire. Say like I'm worried that I have this. And don't reconcile it amongst yourself. Yeah. Don't do that alone. but like if you have any suspicion or like as you as the observer, you see this and like I th

Karin Ryan (38:20.536)
Don't worry that you have to be the diagnostician. Yes. You know, we're talking about this, about this or that. That's that's my job. Yeah. Like you let me do that level of thinking. You bring them into the ER. Yep. This is a medical emergency. It will not go away at some on its own. Yep. Okay. There is immediate like im intervention that needs to happen. Yep. High risk.

Okay. For multiple layers. Not always does it result in infanticide or suicide, but there's layers of risk. Yeah. Absolutely. And so you need to go right away. Go yep, go to it. Yep. This is a drop everything like maybe after work or something like that. This is a drop everything. Yep. Go to the ER. Yep. 'Cause they will nobody will ever be upset for you coming in if for some reason that's not what's going on. Yeah. Yep.

Right? Like ever. And so this is yep, drop everything and go in. Yes. Everything go in. Use your network. use the words that you have learned from here now, like I think we might be experiencing postpartum psychosis. I'm very worried. I've seen a significant change in the past forty eight hours or twelve hours even. Yes. As the observer, you're bringing them in. You're and saying to the clinicians 'cause they might not

your person might not be able to speak on their own behalf, right? Yeah. you say they just had a baby. Yeah. You know, or or our baby's three months old. Or a baby, like you you make it very clear that pregnancy postpartum is part of this. Yeah. and that like what you're seeing. What if the person won't go with you? What if you say, Let's go in and they refuse? What should they do? So hard. Yeah. And this is nine one one. Yep. Yeah you gotta have someone.

You know, this is this is not something you just say, Okay, you know, this is they gotta go. Yep, because you call nine one one and those EMTs and those people who come have an awareness of postpartum needs and psychosis. So again you say

Karin Ryan (40:19.724)
Had a baby recently, have noticed this and this, they will understand and help get care. Same conversation that you have with that we call it the dispatcher, right? Yeah, like the person you talk to, just same conversation of like this is what I'm noticing. Yeah. It's an emergency. Please have someone come. They're saying no.

You know, they might ask you other questions, you'll be prepared. Yes. but the important thing is they have to go. Yeah. And how long then is treatment for somebody as we kinda wrap up here with postpartum psychosis? So thinking through like how long does that take and what does that look like? Kind of what's your guidance for people on that? And like kind of a message of hope. Because my understanding is this is extremely treatable with amazing results. Where moms are able to say, I went through such a terrible

Heart wrenching time and I'm so thankful for the support I got. And I am doing so wonderfully. I'm an amazing mom. I'm so thankful for everything. Yeah, yeah. I said it in black before and I'll say it again. I haven't met a bad mom yet. Okay. It says no judgment on your moral character. Yeah. Right? So treatment. It is a lot of hope. They're there

You know, you you get stabilized. Mm-hmm. Okay. You start there. You start with your ER treatment, hospital treatment, you get stabilized and And medications can help so quickly. Yes, they can. Yes. Absolutely. And you stick it out. 'cause what I'll say in treating those who have experienced postpartum psychosis, I'm not there to treat the psychosis. I can't. Yeah. I'm not medicine. Yeah. Yep. but what I am there is to help you with your feelings and for afterwards, 'cause there will be kind of in

a way like an after aftermath process. Yep. And some coming back to like can I trust myself reconciling what happened. So there's treatment, there's support. You know, you work with someone like me, I'll get you know you would be connected with peers. Yep. You know, so that you're not alone. Yep. and you stick with treatment. The the course of treatment is about a year, but it looks different all throughout that year. Yeah. But knowing you're gonna have that support. So on one hand it's like my goodness a but then

Karin Ryan (42:29.978)
Then, good. Yes. I have support for a year to make sure my body's fully adjusted, my medications have worked, I have all the resources I need. I've worked through any unwarranted but guilt, shame, yes, all of those things, and then have a really good understanding about what you experienced, which is so helpful. Yep. And we will talk to you about your really nagging questions like, do I dare have another child? Yeah.

you about that in therapy. Talk about all the things with non-judgment, with wisdom and experience, which we so deeply appreciate. Dr. Kohai, thank you so much for just spending so much time talking through the different ways that we experience mental health needs and in particular postpartum psychosis with us today. Really appreciate it. well, I'm so glad to be here and talk about this very important topic. Yeah, and so what we encourage you all is just keep talking about it too, right? And reaching out to those that

you know are around childbearing time and just educate and check in. Yeah, absolutely. Yeah. Take care all.