About 50% of women with bipolar disorder receive their diagnosis after the birth of a child — during the postpartum period. Despite that large number, there is little information available on the possibility of pregnancy triggering an initial episode of mania or other symptoms of bipolar.

Jessica Ekhoff joins us as the first guest of Inside Bipolar. Ekhoff has postpartum bipolar disorder. She shares her diagnosis story and what she did next.

Jessica Ekhoff

Jessica Ekhoff is an attorney and postpartum mental health advocate living in Chicago with her husband and son. She is the author of “Super Sad Unicorn: A Memoir of Mania,” which chronicles her experience with postpartum-onset bipolar disorder and psychosis. You can contact Jessica or order a copy of the book at https://www.jessicaekhoff.com/.

Gabe Howard

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com.

Dr. Nicole Washington
Dr. Nicole Washington

Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.

Find out more at DrNicolePsych.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Gabe: Welcome, everyone. My name is Gabe Howard and I live with bipolar disorder.

Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe: We have a third person with us. But before we introduce her, I’d like to explain why we’re actually having a guest on the Inside Bipolar podcast that has never had a guest. Were you surprised, Dr. Nicole, that that there is a third person here? Like when you walked into the studio, were you like, Who the hell is this?

Dr. Nicole: Well, of course not. Of course not.

Gabe: Because of the emails and the prep beforehand?

Dr. Nicole: Because of the emails, Because of the communication, the introductions. Of course not. But somebody listening might be very surprised.

Gabe: Being on this long meant that obviously we were going to start we were we were going to want to cover things and our audience is going to want us to cover things that were just not in my wheelhouse. They’re not in my lived experience. They’re nothing that I have person first knowledge on. Now, Dr. Nicole, being a doctor, she can just talk about doctor stuff. But when it came to the lived experience part, I was just like, I don’t know, I didn’t do that. It’s not a problem for me. So, while we were sort of trying to figure this out, Pete Earley, who wrote the book Crazy and who is a Pulitzer Prize nominated author, introduced me to Jessica. He said, and I quote, she lives with bipolar disorder. She’s got a really cool story and she’s really cool. So, Jessica and I met, we talked some stuff out. And it’s true, she has a very interesting story, very compelling. And we also found out that it’s important to the bipolar community, especially people who are thinking of having children becoming pregnant and everything that goes along with that. So, normally this is the part where I would read Jessica’s bio, but it occurred to me that she’s just sitting right there. So, Jessica, first off, thank you for being our guinea pig. You are officially the first guest on Inside Bipolar. So, thank you.

Jessica: No, thank you. I am honored to be here. I am thrilled to be the resident guinea pig. And I’m glad to get the chance to talk to you both.

Gabe: Well, we are super excited that you are here as well, and I know that our audience is going to love you. Tell the folks a little bit about who you are and what brings you here today.

Jessica: Sure. So, my name is Jessica Ekhoff. I live in Chicago with my very cute, newly two-year-old son, Wells, and my husband, Dane, who is my college sweetheart. And we moved to Chicago right after college together so I could go to University of Chicago Law School. And afterwards became an attorney. I practiced trademark and advertising law at a law firm here in Chicago. I’ve been there my whole career, which at this point is a little over ten years. And, you know, things were going along really well. Dane and I had been married, I think, nine years and decided that we were ready to start a family. We had no trouble getting pregnant. I had a very normal pregnancy. And then I had my son Wells, and everything fell apart pretty immediately. And that is the very short version of how I ended up here talking to you.

Gabe: If we can back up for just a second. When were you diagnosed with bipolar disorder?

Jessica: So, I was diagnosed with postpartum onset bipolar I disorder. So, I did not have bipolar disorder prior to having my son. But I was diagnosed pretty shortly thereafter.

Gabe: Wow. Wow. I have a question for you, Dr. Nicole. Is this. Is this typical to have a I’m not trying to put words in your mouth, Jessica, but it seems like I don’t want to say you were symptom free, but was there any worry the way that you tell the story, you’re like, we met, we fell in love, we got married, we had a baby. Everything was going along swimmingly. And then bam, bipolar disorder.

Dr. Nicole: Yeah. So honestly, this is how I see it happen the most when I’m covering the E.R. or when I’m covering inpatient. A lot of times I will see this scenario where the person has no mental health history and then all of a sudden, they have a baby and bam, they are manic as all get out or psychotic or just not stable mentally. And they end up in front of me in the E.R. on the inpatient unit. And that’s when they’re first introduced to this concept of mental illness. What is this? And it’s a super scary time for a new mom because you have a new baby and you’ve never had this before. And there’s all the thoughts swirling about what does this mean for me? And oh, my gosh, can I be a mom? And all those things? I mean, it’s just a really rough time.

Gabe: Jessica, when you talk to your Dr. Nicole and they told you all of this and they hospitalized you, did you believe it? Did you accept it? Did you agree that something was wrong or was there just a lot of like fight or pushback on your behalf that, hey, look, I’m not crazy? What are you talking about? I’m just fine.

Jessica: I would say the prevailing emotion for me was shock, because I was in this intensive outpatient program specifically for pregnant and postpartum women when I got the diagnosis. So, there were a few other women in the program with me who had been diagnosed with bipolar disorder. But in their experience, they said things like, oh, you know what? It actually makes sense. Like if I look back at my life, I can now identify that I did have periods of mania or hypomania. I did have periods of depression. So, it all kind of makes sense. And for me, I looked back at my life and think I am positive I did not have periods of that, particularly with the mania. I had some circumstantial depression, but in situations where it made sense because of what was going on at the time. But I feel confident that I never experienced anything like the mania or hypomania that I experienced after the diagnosis. So, I was really shocked. The thing that I struggled with was this concept that I now have bipolar disorder forever. And I looked at the other women in the IOP with me, you know, many of whom had either postpartum depression or anxiety. And I knew that for them, the postpartum depression was eventually going to resolve. You know, it might take some time and treatment and medication. But generally postpartum depression is for a limited period of time. And I remember asking the therapists, but when does my postpartum bipolar go away? And then just like very gently and very kindly telling me it doesn’t.

Jessica: This is a condition that you’re going to have for the rest of your life. You’re going to have to manage it. We’re here for you. We’re going to come up with a plan. You’re going to be okay. But this is a lifelong thing now. And the idea that this most natural thing in the world of a woman having a baby, that this would leave me with a lifelong mental health condition was so difficult for me to wrap my head around, especially because I’m a big planner. I like to know what’s coming. And while I was pregnant, I felt like I read just about every book out there about pregnancy and postpartum. I have already worked with therapists at many points throughout my life and a big advocate for therapy, so I felt like I knew all the signs and symptoms for postpartum depression and anxiety. And I knew I had a plan in place. I knew what I would do if it happened to me and who I would contact. I had no idea that postpartum mania was a possibility. The only thing I ever encountered about postpartum psychosis and everything I read was like, this is really serious, but it’s also incredibly rare. Basically, it’s not going to happen to you, so don’t worry about it. But then it did happen to me and I was completely unprepared because I didn’t know what to look for and neither did my husband or anyone in my family. So, the prevailing emotion was shock.

Gabe: Dr. Nicole, I want to ask you a real quick question. When Jessica was talking, it sort of felt like had she never had a baby, she would not have bipolar disorder. But that doesn’t seem right to me. But at the same time, we know there’s triggering events. How does all this line up?

Dr. Nicole: We see it with onset after a stressful situation. We see it in people who experience traumas. We see it after people are in the military and experience things. We see it after childbirth. It’s a stressor on your body. I mean, there’s not much that could happen to a woman more stressful on the body just physically than giving birth. There’s all the hormone fluctuations. Who’s to say that another stressor could not have set this off? But we have no way of knowing that. That’s why we’re still in this. I think of psychiatry as the final frontier of medicine because there’s still so many unanswered questions.

Gabe: Would it be fair to use this analogy? We talk about post-traumatic stress disorder a lot, and we always table it with soldiers. Some soldiers go to war. They come back. No issues. Other soldiers go to war. They come back with PTSD. But what a lot of people talk about is the soldiers who come back with PTSD. Had they never been in war, they may never have developed PTSD. But clearly there was some underlying risk factor because they were impacted and other soldiers were not.

Dr. Nicole: I think that’s a little bit different just in that the trauma is necessary to get the PTSD right. You’re absolutely right, though. Some people experience the same trauma as someone else. One gets PTSD, one doesn’t. Bipolar disorder is just a little bit different. We think that those genes are there and they just get turned on by certain things, Childbirth being one of those things.

Gabe: Jessica, back to you. So. So here you are. You’ve been diagnosed with bipolar disorder. It’s a lifelong illness, but you’re still a mom. How did those two things coalesce?

Jessica: I was scared. I was really, really scared. I thought, how, you know, I guess I should backtrack and say that when I when I was first discharged from the hospital and I was in the IOP program, I was still pretty hypomanic. So, for a while I was just kind of flying high and I felt great and I thought like, I can conquer the world, this is no problem. And then of course, as you do with bipolar, I swung in the opposite direction and I got really depressed. And at that point I started really questioning my capability as a mother for several reasons. For example, breastfeeding didn’t work out because I was in the psychiatric ward, starting when my son was ten days old. I was there for six days, obviously wasn’t able to breastfeed during that time. By the time I got home, you know, my supply was starting to dry out. I was still really hypomanic. I just couldn’t seem to sit still long enough to pump to try to get my supply back up. So that didn’t work out. So that was one strike where I felt like I’m failing as a mom. Then, of course, I learned that lack of sleep is one of the biggest triggers for bipolar episodes. So, I was very concerned about waking up for night feeds. My husband, who, you know, bore the brunt of my actions while experiencing psychosis, was terrified of me having another psychotic episode and absolutely did not want me having disruptive sleep in the night.

Jessica: So, from the day that I got home from the hospital, I didn’t do a single night feed. My husband did every single one, so he was getting up like three and four times a night to feed our son. I was just sleeping, you know, eight, nine hours through the night, which was good from a sleep perspective, but really bad from a bonding perspective because I felt like, you know, my husband is doing all these night feeds. He’s the one who’s like snuggling our son at two in the morning and giving him his bottles and, you know, having this time to connect with him. And I’m not. So, you know, my son is going to, like see him as the caretaker and not me. So right from the jump, I just felt like this disorder is preventing me from being an active mom, from being the kind of mom that I feel like my son deserves. And on top of that, I learned that bipolar has a genetic component. So, I thought, you know, now I feel like I am passing along this gene to my son where maybe he’s going to be at risk of developing bipolar at some point, and I’m going to feel like it’s my fault, even though it doesn’t run in my family. Interestingly, or at least not as far as I know. But I had that fear, too. So, I mean, fear, you know, like I said, what was my prevailing emotion when I was first diagnosed? It was shock. And how did I feel about my ability to parent after the diagnosis? It was fear.

Dr. Nicole: I think that’s a really, really good kind of synopsis of what that postpartum period is like from my mom’s standpoint. I do not have bipolar disorder. I don’t live with bipolar disorder. But I had some medical issues after my second kiddo. And as a result of that, I was in the hospital, you know, three days postpartum. And just all the mental stuff that goes with. Here I am and I should be nursing. And there’s all that mom guilt right out the gate of I’m not nursing, my kid’s going to be dumb because I’m not nursing because everybody says you should nurse. If you want your kid to be smart, you should nurse. And then here I was on meds that just weren’t conducive with nursing and couldn’t and I felt like, oh my gosh, I’ve literally failed my three-day old daughter because I haven’t done these things for her. And I remember that feeling of just feeling so guilty and just like just horrible as a mom. Like I felt like I really, really failed three days in. And then you add the fact that on top of that, now you have to think about, oh my gosh, you know, what does this mean for this little bundle that I have, you know, to deal with? That is that is that was a really good picture that I think and something that a lot of moms who are in your situation deal with.

Gabe: One of the things that I’ve noticed is that the Internet is mean to women. I know that is not a controversial statement, but the Internet is just mean to women. But they’re really, really mean to moms. It doesn’t matter what happens. Any news story ever. You can have mom, dad, grandpa, a whole host of uncles who are capable of bench-pressing cars. And if that kid gets hurt, they’ll be like, where is the mother? I just there was seven male family members standing around and they’re like, right. And that mom failed. It’s again, from the male perspective, it’s absolutely stunning to me. There is a question in here. I promise. Which is forget about bipolar disorder for a minute. I really feel like moms are terrified from the moment they decide to become moms because everything that they see is just about how they’re going to fail and about how all their mistakes are going to be wrong and how they can’t rely on anybody else.

Jessica: Well, I’ll start by saying you are absolutely right that the Internet is not nice to women and especially not nice to moms. However, I like to think I’m pretty careful about what corners of the internet I spend time in, so I try to be really mindful about spending time in kind and supportive quarters. So, I’m also not a huge social media user, which I think is a big help, especially on the mom front, because women and especially mothers are inundated with all these like momfluencer accounts of these perfect arts and crafts and perfect little plates with the exact right ratio of veggies and proteins and whatever. So, I have always been pretty careful to stay away from that kind of stuff. So, I actually, you know, like I mentioned at the top, I was lucky to have a really healthy pregnancy. I felt confident about my ability to be a good mom. I had a really happy upbringing. I feel like my parents set a good example. I have the best partner in the whole wide world who I had no qualms about his ability to be a great parent. So, I felt and like I said, we got together when we were 21-year-old babies and we had already been married nine years when we had my son. So, we knew each other really well. We knew how to work together really well. We had established this nice, calm, cozy, safe home, and I felt like we were going to be bringing my son into this very stable, loving environment. So, I felt actually very confident about my ability to be a good mom. And then I got this bipolar diagnosis and all of that was just stripped away instantly. And I suddenly felt like, I’m just going to be incapacitated in like a cave of depression, unable to get out of bed. And my husband is now going to be a solo parent. That’s just my life. That’s what’s going to happen to me. I was sure of it.

Gabe: How did you move past that?

Jessica: Well, I mentioned that I was in the intensive outpatient program for four months. So that was that was a big part of it. The biggest part of it, I would say actually, I was in the program for about three months and then I discharged and thought I was going to be okay. And then the depression got really, really bad and I ended up going back into the program and was in it for another month. One of the big benefits of the program is that I had access to a perinatal psychiatrist twice a week, so she was able to make a lot of adjustments to my medication. And when I came back the second time, we made some changes to my medication regimen. And fortunately, we’re able to find something that works really well for me. So, by the time I discharged the second time, I felt much more confident and capable. But yeah, there were definitely some months there where I thought, I’m not going to have the capacity to be a good mom.

Gabe: As I’m listening to you talk, the thing that I did not know that perinatal psychiatrist existed, I had no idea that was a thing. It perfectly makes sense that it’s a thing. I just did not know that this existed. Dr. Nicole, what what’s the difference between, I hate to say a regular psychiatrist, but. But what exactly is a perinatal psychiatrist and how do they differ from typical psychiatry?

Dr. Nicole: So, for psychiatrists in general, you go through your residency training and you come out just a regular psychiatrist escape said. You’re an adult psychiatrist. But if you decide you don’t want to be just a regular adult psychiatrist and treat general psychiatric things, you can do fellowships. And so, there is a reproductive psychiatry fellowship that can be done. There are people, though, who specialize in this without having done the fellowship because the reproductive psychiatry fellowships were not around, you know, decades ago. And there are people who have just committed their practice to this topic. But these psychiatrists do exactly what she’s describing. They work with women who are in the postpartum phase, who are pregnant, who are looking to get pregnant, and they just work with them during that during that time.

Gabe: I just want to fall down a tiny little rabbit hole and say that it’s difficult to find a therapist, a psychologist, a psychiatrist. We talk about this a lot on inside bipolar about how difficult it is to get care. And now we need this very special just a special psychiatrist. I just. And even you mentioned that there doesn’t seem to be a lot of them. I don’t want to call Jessica lucky because that just hits my ear weird. But is this available to everybody? It seems like this must be, you know, what I’m getting hit with. It takes nine months to have a baby, but it takes six months to see a regular psychiatrist. Is the waiting list for perinatal psychiatrists like two years? In which case your baby is one and a half. It all seems so cumbersome and disconnected.

Dr. Nicole: Yeah. Bigger cities are going to have the chance of having this specialty a little bit more than smaller cities or especially rural areas. So, a lot of times, general psychiatrists like myself, I take care quite a bit of people in the postpartum phase. I’m not a reproductive psychiatrist. I don’t claim to be. But I do encounter a lot of women who are in this phase. So, it’s something that if there’s a specialist, fantastic, take advantage of it. But if there’s not, you may actually need to see a general psychiatrist. And really most of us should be able to adequately help you during that time.


Gabe: And we’re back talking to Jessica Ekhoff talking about her experience with postpartum bipolar disorder. So, you have a perinatal psychiatrist, Jessica. Four months of intensive outpatient treatment. You’re obviously wrapping your head around this. What came next in your story? Because at this point in the story, your son would be around 4 or 5 months old. Correct.

Jessica: Yes. Yep, like I said, we did make a lot of changes to my meds when I went back into the intensive outpatient program. And we did find a regimen that worked really well for me. So, by the time I discharged the second time, I did feel probably about 80% myself. I was doing pretty well, but I certainly wasn’t cured. You know, this I mean, this is going to be a lifetime management thing, just as it is for anybody else with bipolar. So, I had a therapist who specializes in working with pregnant and postpartum women. And like you said earlier, you were hesitant to refer to me as lucky. But I am. I’m really lucky. I have a bunch of privileges. I live in a big city that does have these resources. You know, I’ve mentioned this IOP program that I was in several times. There’s only about 20 of those in the entire country. So, the fact that I had access to one was huge. And I’m a huge advocate of group therapy. I think it’s so helpful, particularly for a brand-new mom. And I had this experience that was so unexpected and so traumatic and so isolating. I thought that I was never going to meet anybody else who had gone through what I went through and who would understand it. And then I joined this IOP, and there were several other women who had had psychosis and who had been hospitalized and who had gone through what I went through.

Jessica: But that is so rare for me to have gotten to have that experience. And it was extremely healing for me. So, I mean, you don’t have to call me lucky, but I’ll call myself lucky. I am for lots of reasons, and that’s one of them. But another reason was I had access to therapists who were also specialists in working with pregnant women and new moms. So, I have a therapist who is trained in those areas and who I meet with once a week and has been a big part of my recovery. I also did support groups through Postpartum Support International, which is an amazing organization, and they have so many great free resources. And one of them is, I think at this point over 25 different specialized online free support groups that are all led by at least one person who has lived experience with whatever the group is about. And the groups are for everything from parents who had babies in the NICU, parents who have medically fragile babies, parents who are in the military, moms with postpartum mood and anxiety disorders. There’s a bipolar group now. I’m actually one of the support group leaders for the bipolar group.

Jessica: There’s a group for women who experience psychosis. There’s tons. So, getting to be part of those support groups was a big part of my healing. And now I would say an ongoing part of my healing is getting to be a support group leader because it gives me an opportunity to make meaning out of this really traumatic experience. And that was something that was really emphasized in the IOP, was the value of trying to make something meaningful out of something really hard and gave you touched on this earlier in the podcast that people are hardwired to say, yes, this awful thing happened to me, but then this good thing happened as a result. And so that’s kind of what I was trying to do. So, getting the chance to be a support group leader has been part of my journey. Another big part of my journey was writing. When my son was about six months old, I started what was initially just journaling about my experience and everything that had happened to me. Just trying to get it all out of my head and onto paper and just process. And as I started writing more and more, I found that I was really enjoying the process. I’ve always loved to write and I do a lot of writing for my job, but it’s legal writing, it’s briefs and things like that, so it’s different.

Jessica: But in writing about my experience, I started thinking, you know, maybe there’s a benefit in sharing this story. Because when I got home from the inpatient psychiatric ward, one of the first things I did was try to find examples of other women who this had happened to and who had gotten over it and were leading successful, happy lives. And I was not able to find much of anything. What I did find was really sad and discouraging and upsetting. And so, I thought, you know, maybe I will just write the book that I wish I could have read when I got out that details what it felt like to be having this altered mental experience, what it felt like inside my brain while I was going through psychosis and then also talking about my recovery and where I am now and how I am living a happy and thriving life. Even though I have a bipolar disorder diagnosis now. So, I ended up writing that book. It’s called “Super Sad Unicorn.” I published it earlier this year and I’ve gotten some very kind feedback about it. So that’s been a big part of my healing journey to feeling like I’ve been able to create something that I hope is of value to other people.

Gabe: Jessica, I’m glad you brought up the book because I love the title “Super Sad Unicorn” is just an awesome, awesome, awesome title. It evokes so much with bipolar disorder. Right? Because unicorns are magical and manic and awesome. But yeah, they can be sad too. And with bipolar disorder, I really feel like everybody sees the unicorn part, but nobody ever sees the super sad unicorn part. So, I do want to say excellent, excellent title. But switching gears ever so slightly, I want to ask a few questions about your husband, if I may, because

Jessica: Sure.

Gabe: You’ve described him as, hey, he stepped up. He did what he needed to do for his wife. He did what he needed to do for his kid. And that is incredible. It’s incredible for a couple of reasons. One, because it’s uncommon and it’s not uncommon because spouses are mean or family members or mean. It’s uncommon because people don’t know what to do. And then resentment comes in. You know, families get together. They’re trying to support; they’re trying to help. But as you pointed out, your husband was also a new parent. He was doing all the nightly feedings and he was taking care of a sick wife. You have described him in wonderful, wonderful, wonderful ways. But is that true? Was it completely perfect? He just stepped up, hit the ball out of the park every time he comes up. Just home run after home run. Did he ever strike out? Were there any issues? Did he need any support?

Jessica: He definitely did need support, but luckily, he had it. My parents were really involved. They came and stayed with us for a while. His dad was also involved, you know, and came and helped out with Wells. So that was huge. We have a big network of friends in Chicago, so they were really helpful. But he also went to therapy. I mean, right away it was traumatic for him, too, especially when I was going through the psychosis. I had periods of really extreme rage that were directed at him through no fault of his own. And that was very traumatic for him. And so, he also started going to therapy and worked with he also worked with a therapist who specialized in pregnancy and new parents, including men. His therapist was a man, which I think was kind of nice just to have a male perspective. And so, he you know, he did that. But honestly, I mean, I know it’s surprising and I know it would lead to a better story if I could talk about some like big dramatic blowup that we had that we had to overcome. But honestly, nothing like that happened. My husband is truly the best person in the whole wide world, and he just handled it all like a champ.

Gabe: Jessica, thank you so much for not just making up drama. I really, really appreciate that. I also appreciate you saying how atypical that is. I want to go over to Dr. Nicole for just a quick second, because I’m kind of looking at her and I’m like, is this all your patients? They just come in with support out the wazoo. Dr. Nicole, what do you see a lot out there support wise for, for people that are that are experiencing this?

Dr. Nicole: You talked about how the Internet is mean to women and mean to moms, but sometimes even the women in our lives can be not mean, but it’s the tough love. It’s the Well, I took care of all my kids by myself. Why can’t you take care of all your kids by yourself? You know, why do you need help? And sometimes it’s the mom who won’t ask because they feel like if they ask, it means something about them as a mom. Like if they ask for help with night feedings or if they ask for someone to come over and allow them to take a nap or any of those things that it means somehow, they’re inadequate as a mom. So, it’s double sided. And I do see both sides. I see family members who are not supportive and I see women who are afraid to ask. I will say that typically if we can provide education to families and then the mom is asking for that help, usually somebody is willing to if they can. But we have to realize a lot of women who are having children, their parents are still working and they can’t afford to come over and help or there are a lot of people are moving out of state. We don’t live near our parents and things like we used to. And sometimes those barriers are really difficult and it’s just not something that as a culture we’re used to asking people who aren’t related to us, hey, can you come over and wake up with my kid while I get some sleep? But that one question could be the difference between you being able to stay out of the hospital and not. So, I think we do have to start thinking about what kind of support, what kind of respite can we give to those ladies who are postpartum and struggling and need that extra support?

Gabe: Dr. Nicole, obviously, when we talk about treating bipolar disorder, you know, medicine always rides to the top. Seeing a doctor is always right up there because that’s how you get the medication therapy group support. But one of the things that gets sort of some lip service, it gets discussed, but it’s always like sort of on the bottom. It’s that support system. But it sounds to me that the support system is almost just as important as the treatment plan there. I don’t want to call them equal because they’re very different. But it I think you would agree, I think everybody listening would agree that support system is always like a well, I got a doctor, I got medicine and oh yeah. And I had like all this wonderful support. But it was the medicine that saved my life. It’s like you had like a lot of support. Do people who have a strong support system do better than those who don’t?

Dr. Nicole: Absolutely. It’s a puzzle. And there are pieces and they all have to come together to create this whole picture. And your picture is going to be very incomplete if you don’t have at least some level of support. And what does that look like? Does that look like your significant other wakes up so many nights a week and allows you to sleep so many nights a week? Does that look like parents, grandparents of the baby are coming over to help? Does. What does that look like? Does that look like somebody helping you with your laundry during the day so you can sleep when that baby sleeps or whatever it looks like? I think we have to kind of re-envision what support on that end looks like, but it makes a huge difference.

Gabe: And it also sounds like parents who accept that support do better than parents who are, you know, sticking out their hand and saying, no, no, I can do it myself. I can do it myself. Is that also a fair statement?

Dr. Nicole: Absolutely, because we have to learn to ask for help really in all phases of the illness. We talk all the time about support systems and having your team and all these things, but you have to be willing to say, I need a team and I need help. But in that postpartum period, it’s just so weird because we’re new moms, moms in general. We I don’t know, we’re weird. We think we have to do everything and we think it says something negatively about us. So that’s what we need to work on is people being willing to say, I don’t have to do everything.

Jessica: I was very scared about my son being taken away. But it was actually during the time that I was experiencing psychosis. I had a lot of paranoia that my husband was actually trying to call DCFS and have our son taken away from me because I didn’t want to exclusively breastfeed. I was convinced that because I wanted to do combo feeding, a mix of formula feeding and breast milk, that my husband thought that I was an incompetent mother and that I didn’t deserve to have my son. So, I was very concerned about that. When I did the intake interview for the IOP program that I ended up doing, I was very, very fearful about all the intake forms. There were these forms that were just like pretty basic medical intake forms, but I was convinced that they were designed to trick me and get me to admit something that would make me be perceived as an incompetent mom and that DCFS was going to swoop in and take my son away. So, I was very scared about that. I, I would say the fear resolved by the time that I got out and I joined the IOP and I kind of stabilized, I wasn’t fearful about that anymore. But while in the throes of psychosis, I was very fearful about it.

Gabe: I can only imagine. It just all of this is scary. I mean, just, you know, let’s call it like it is. It’s all scary. Being a new parent is scary. I mean, the baby babies are so little, right? And you’re responsible for everything. And I can only imagine how overwhelming that has to be. Relying on other people is scary. It just is. Especially if you’re, you know, a self-reliant person and you’ve never had to rely on other people before. Being diagnosed with any illness is scary. Just it doesn’t matter who you are being diagnosed with a mental illness and being worried about losing your job, which of course is where you get your health insurance. And you pay for all of this is scary. Any one of those things is terrifying. So, the fact that you were able to manage them all and make it through to the other side is it’s sad to say that it’s miraculous. Like I, I wish that all of these things would happen. And it’s just like, well, yeah, but you got the help that you needed and it was okay. But as I’m fond of saying, podcasts like this wouldn’t need to exist if everything was going fine. We’re discussing this because there’s just gaps in the system. I am so happy that you did not fall through any of those gaps. I know that we’re running out of time. But you first off, I want to know how you’re doing now. And do you have anything else that you want people who may be in your situation, who are in your situation to know? Give us the update and the takeaways.

Jessica: Okay. I love it. So, the update is, as I mentioned, up top. My son is two years old. He just had his second birthday. He’s just a healthy, happy, chubby little dude who were working on potty training. So that’s a whole adventure. But I am happy to report that I’m doing really, really well. My I’ve been stable on my medication for the past year and a half. It’s continued to work really well for me. I’m lucky that I haven’t experienced side effects. I have been working with the same perinatal psychiatrist that I had when I was in the IOP, so it’s been really nice just having that continuous care and her monitoring. I have also been working with the same therapist since when I was in the IOP, so that’s been great. And like I said, I’m now a support group leader for the bipolar group that Postpartum Support International has, which I’ve really, really enjoyed. It’s been nice feeling like I have that opportunity to give back. It’s been really great to promote the book and to hear from people saying, you know, I went through something like this, but I had never read anybody else’s account of it and it just made me feel less alone. And that is like the number one thing that I want to hear is that I made somebody feel less alone. So, the opportunity to do that has been great for me. The thing that I want people to know, I want them to know a couple things, um, that I guess are going to be more relevant to people in the postpartum period than anything else, just because that’s my particular lived experience.

Jessica: But a big thing that I learned when I did the training for being a support group leader with PSI is that about 50% of women who are diagnosed with bipolar disorder are diagnosed in the postpartum period. And I was shocked to learn that that number is huge. And I was really shocked that despite that, I came across literally zero references to postpartum onset bipolar disorder in anything that I read while I was pregnant and trying to prepare for parenthood. So, the number one thing that I want people to know is that postpartum onset bipolar disorder exists. And you may think that you’re prepared to deal with depression or anxiety if it hits, but are you prepared to deal with mania? Do you even know what it looks like? Because I didn’t know what it looked like. I didn’t know that it was a risk. I’m really lucky. There’s that word again. But I am I’m lucky that I have the supports that I do. And they jumped into action and they didn’t know exactly what was wrong, but they could definitely tell that something was wrong based on my behaviors and what I was saying and doing. Um, so I’m, I’m lucky that I was able to get help quickly, but not everybody is going to be so fortunate.

Jessica: So, I wish that there was more education about the fact that mania is a possible result of having a baby and what that looks like and what should be done. And also psychosis. I think that there is a ton of stigma about postpartum psychosis. And there was just a story in the media a couple of weeks ago about a very, very traumatic experience that happened with postpartum psychosis. And people hear those stories and I think kind of want to bury their heads in the sand and think, well, it’s super rare. It’s never going to happen to me. And so maybe they don’t even want to educate themselves about it because they don’t want to acknowledge that it could be a possibility. And I think that’s a huge mistake. Um, I think that it’s something that we should talk about more and that should be acknowledged as a possibility of postpartum mental health and also to know that there’s treatment and that there’s resources and that, you know, Gabe, you said that you didn’t even know that perinatal psychiatrists existed. Like now I hope your listeners know. And if you know, if you have bipolar and you want to get pregnant and you’re scared about the medicines that you’re taking, you know, maybe you can talk to a perinatal psychiatrist. They have, you know, specialized training about medicines that are safe for pregnancy and for breastfeeding.

Jessica: So that’s a great resource. IOP’s for pregnant and postpartum women, Postpartum Support International, so many great free resources there. So, I want people a, to know that postpartum onset bipolar and psychosis exist, but also to know that there are a ton of resources out there and that there’s hope and that there’s a journey to healing and that you’re not alone. Just because people aren’t talking about it doesn’t mean that it’s not out there. It is out there. My story is just one of many, and I know that now. I felt very much like I was the only one at first. But now, you know, the more open you are, the more openness you receive in return. I was shocked to realize that the more open I was about my story, the more I was able to overcome the. Fear of the stigma of admitting that I had bipolar disorder. The more people have opened up to me in response and told me, oh, I can’t believe you have bipolar, so do I, or so does my sister. Oh, so does my best friend, you know, all these kinds of things. And so all of which is to say, you might feel like you’re alone, but you’re really and truly not. And if you’re able to open up, you’re going to learn even more quickly that you’re not alone.

Dr. Nicole: And even if you don’t have access to a perinatal psychiatrist or reproductive psychiatrist and you don’t have an IOP that is specific to the peripartum period. Ask around. You just talked about how now that you’re more open with it, people are giving you examples of, oh yeah, my sister, oh yeah, my cousin, or oh, I have it too. I think that’s something that we don’t do very well in the world is when it comes to mental health. We vet our hairdressers, we vet all kinds of things. We will stop a woman clear across the grocery store if we like her hair color to ask who does her hair. But we don’t say, hey, I need to know. Who do you recommend for bipolar disorder in a woman who’s thinking about having kids or bipolar disorder in someone who needs blankety blank? We just don’t do that. And I think the more open we are, we can get those recommendations. There are psychiatrists out there who are perfectly capable of taking care of a woman in the postpartum period or in the peripartum period who aren’t necessarily reproductively trained. But then there are some who that’s not their comfort level. So, we need to figure out what people’s comfort levels are. And usually, the best way to do that is word of mouth and references from people we know.

Jessica: Yeah, that’s absolutely right. There are a ton of great resources out there.

Gabe: Jessica, thank you so much for being here. I imagine your book is on Amazon, but where else can we find it? And you.

Jessica: Yes. My book is on Amazon also at Barnes and Noble. If you’re more of a brick-and-mortar person, it’s called “Super Sad Unicorn.” And if you want to read more about my story or the book or contact me, you can do so on my website, which is Jessica Ekhoff. E K H O F F like Frank. I’m easy to find. So, if you want to reach out, you can do so through my website.

Gabe: Jessica, thank you so much for being here. Well, Dr. Nicole, we made it through our first guest. Jessica, you were awesome. And what’d you think? Just Dr. Nicole. What’d you think? Our guests now? Are we doing guests all the time? Every episode, All the guests All the time.

Dr. Nicole: I think the bar is high. The any guest we have in the future will really have to bring it.

Gabe: We’re only looking for Jessica’s and above from here on out.

Dr. Nicole: Exactly. Exactly.

Gabe: So, when you inundate us with emails asking us to be on the show, ask yourself, am I a Jessica? Because you’ve got to be a Jessica. Or better. Fair? Is that a fair statement?

Dr. Nicole: Fair. Fair.

Gabe: Very fair. Thank you, thank you, thank you, everybody, for listening. My name is Gabe Howard and I am, of course, the author of “Mental Illness Is an Asshole and Other Observations,” a book that you can also get on Amazon. Or if you want a signed copy, you can head over to my website where you can also learn more about me. And that website is gabehoward.com.

Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on all social media platforms at @DrNicolePsych to see all the things I my hand in at any given moment.

Gabe: Dr. Nicole and I are both public speakers who do travel nationally. If you want to hire us, just visit our respective websites and you can learn more about that. Also, and this is super, super important. The way that the show grows is for you to tell people about it. Don’t make us the best kept secret. Just tell everybody about the show. Social media support groups, friends and family bring it up at dinner. Hell, send a text. Sharing the show is absolutely how we grow. We will see everybody next time on Inside Bipolar.

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