I saw a patient with post-partum psychosis this week. Wow…this was the first case I’ve seen in primary care, and it was intense. The patient had a history of depression, including post-partum depression with her first child, but had been feeling well for the past few years. She gave birth to her most recent child 2 months ago, and had been feeling just a tad depressed over the past couple of weeks. Then suddenly, she was overcome by a wave of suicidal depression which developed quickly over the course of a few days. Worse still, she developed auditory hallucinations of voices telling her to kill herself. She came to the clinic at the urging of her family members, who had advised her to seek help (good call, family!). She had already made a suicidal gesture the day before, and could not assure me that she would be safe if allowed to go home. In fact, she told me she was pretty sure that she would try to kill herself if we sent her home. Ok then…this was one patient who was not going home. We do have a crisis evaluation team for our city, but when we called they told us that the wait would be several hours before they could have someone come out and evaluate the patient. At 4pm on a Friday, this was not ideal. We called EMS and sent the patient to the ER, keeping our fingers crossed that she would get a sympathetic provider and an official evaluation by a psychiatrist. I’ll have to look at her record when I get in to work tomorrow…I hope that she was at least admitted for a 72-hour hold.
Perhaps this was more scary to me because I’m currently pregnant, but geez…how awful to descend so quickly into a severe depression (with psychotic features). I can add this to the mental list of “Stuff I Hope Doesn’t Happen to Me During Pregnancy/Birth/Postpartum.”