She was 28 and pretty and sweet and came in for depression.  It was only systematic questioning that confirmed she was manic-depressive. Actually her next-door neighbor had seen a television show on manic-depression and had made the diagnosis a couple of years before, long before this woman had ever seen a psychiatrist.  Her episodes had curiously enough been regarded more as amusing than as dangerous, so nobody had ever done anything about treatment.

By the time I knew anything about her, she had already had one child, and was pregnant with her second.I always believe in coordinating forces with the obstetrician/gynecologist when caring for a pregnant woman.I rarely get phone calls returned, but this is the way it should be, especially if someone has brought up the question of psychotropic drugs. She had never seen a doctor; her first child, and this one, had been delivered by a nurse practitioner midwife. The one thing I am absolutely sure this woman did better than any physician (except me) is answer phone calls. She was obviously thumbing through the old chart on the other end of the line when she told me: “After the birth of her last child she ran after her husband with a kitchen knife.  She destroyed a bunch of stuff in the house.  We did not know whether or not to believe the husband.  After all, he had a serious history of drug abuse.  They were sent to counseling; there is nothing more in the notes.”

It took all I had to keep from yelling into the phone at the top of my lungs. Read more on “Postpartum Psychosis”…