I Diagnose Postpartum Depression, But Not on TV

(WOMENSENEWS)–Standing on the ledge of the hotel roof as she contemplated jumping to her death, in a recent episode of "Nashville," Juliette Barnes, the character played by Hayden Panettiere, could apparently no longer endure the pain of postpartum depression.

It was clear that she had given up the fight and then, just in the nick of time, her manager saved her from the ledge. Then he slipped, accidentally plunging to his death while pulling her to safety.

Due to self-medication with drugs and alcohol, Juliette did not immediately recall how close she was to death. But when the memory returned the reality was overwhelming. She decided it was time to ask for help and was voluntarily admitted to a treatment center.

Tonight, viewers will get to see what happens on her road to recovery.

As both a fan of the show and a perinatal psychiatrist, I am rooting for the Juliette character to get the appropriate diagnosis and treatment she needs to recover. And of course, I am also rooting for Panettiere, who in real life suffered from postpartum depression after the birth of her child and has been public about her treatment in a facility and her recovery.

At times it appears that television, social media and pop culture are the predominant ways many Americans gain awareness of mental health illnesses, and postpartum depression in particular.

Applauding Celebrities

For this reason, I applaud the courage of celebrities such as Panettiere and those before her including Brook Shields, Gwyneth Paltrow and Celine Dion, who have spoken out about postpartum depression. Collectively, they shine the spotlight on this illness and how it can affect anyone.

However, we shouldn’t have to watch a fictional TV program to diagnose what may be harming us. And television shows are not written to provide the nuances of a skilled diagnostic exam. Better education in hospitals, clinics and doctors’ offices can illuminate awareness and perhaps save anyone from going over the edge; in real life.

Meanwhile, what does Juliette’s profound struggle with her mood after having a baby tell us about the real nature of postpartum depression? Consistent with symptoms of depression in the recent months after giving birth to a healthy baby boy, she had been sad, tearful and detached from her newborn baby and contemplating suicide.

But the term "postpartum depression" has become a misnomer, a blanket term used to casually describe all mood changes in the postpartum period.

To my trained eye, Juliette’s behavior went beyond depression.

I recognize the character’s enraged outbursts, impulsivity, increased energy and around-the-clock focus on her career with less need for sleep as typical characteristics of a bipolar disorder mood episode. It is a diagnosis often missed post-birth or confused with what many believe is "postpartum depression."

Postpartum depression, a growing public health issue, is a complication of pregnancy that affects 1-in-7 women, or at least half a million women each year. Despite its prevalence, it is not well understood by the public.

Suicide Risk

Here are a few key facts.

Suicide is the second leading cause of maternal death and accounts for 20 percent of deaths among women with postpartum depression. Infanticide, a rare act that is associated with postpartum psychosis, is not typical.

Many women with mood changes after birth may feel more anxious or agitated and thus they don’t identify with feeling "depressed." Some of these women don’t have postpartum depression but have postpartum anxiety, postpartum obsessive-compulsive disorder or postpartum bipolar depression or mania.

Often a woman’s experience of postpartum depression differs from that of another. But too often there is something these women share: feelings of embarrassment, shame and silent suffering.

Families unfamiliar with postpartum depression or other postpartum mental illnesses are torn about what to do and when to seek help. Some may also take the mother’s behavior personally or feel that it is just a "hormonal time" and not recognize that this seemingly intangible illness, although not diagnosable by a blood test or X-ray, is real.

More awareness, education and risk assessment of women early in pregnancy is required to destigmatize the illness, empower women to seek help and arm families and friends with the knowledge needed to be supportive.

In my evaluations of women seeking care in the postpartum period, I have witnessed the prolonged debilitation, impairment and suffering experienced by them and their families when the disorder goes undiagnosed or is inappropriately treated. Prolonged suffering inhibits the natural bonding between a mother and her child and has adverse implications for the mental, behavioral and cognitive development of an infant.

On "Nashville," the depiction of this one character’s symptoms underscores the spectrum of symptoms that women may experience in the postpartum period and how important it is to seek help from a mental health professional.