Also, a legal secretary and my first bachelors was in linguistics. I see a lot of posts by doctors saying Post Partum Psychosis, PPP, isn’t in the DSM5, but neither is tobacco addiction. Because the DSM5 terminology for the latter is nicotine use disorder. And so to, we have MDD with peripartum onset, Bipolar I with peripartum onset, and Brief psychotic disorder with peripartum onset. All 3 discuss the risk of infanticide with psychosis.
Something that’s been on my mind a lot is that Brief Psychotic Disorder with peripartum onset is defined as within 4 weeks of giving birth. In the ICD-11 (which started implementation in 2019, but… COVID) it goes out to 6 weeks. The MDD and Bipolar I with peripartum onset discuss mood disruption having an incidence of 7% in the 12 months after giving birth.
A lot of people will offer the caveat that they aren’t proferring an opinion on the Clancy case. My caveat is that due to having PPP, I have avoided knowing much about the case until after the mistrial, and then my sources have been limited to AP news and other psychiatric prescribers on substack starting only on September 10. (My news bubble got disrupted by a relative on Labor Day.) So I don’t know things like whether Clancy was ever offered brexanolone (an IV form of allopregnanolone that was discontinued in favor of oral zuranolone in 2023) or whether she ever returned to her work as a labor and delivery nurse. I do know that at least she was treated with a benzodiazepine, which shares a mechanism with allopregnanolone that is the reason it’s not approved for regular depression.
One post I read equated judgment of Clancy as just so much misogynism. But it is troubling to think that in most cases, she would have been back at work at 3 or 6 months, as a labor and delivery nurse. And it was 8 months postpartum that the defense argues that she experienced command hallucinations to kill her own children.
The thing that has tipped me into considering that under the standard of the statute she was tried under, the prosecution might not have met beyond reasonable doubt, is that antipsychotic medications can induce hyperprolactinemia. I don’t know quite if it makes sense if her dopamine (which is literally prolactin)levels were fluctuating, it may have increased a remote chance of psychotic symptoms. I don’t know if any hypothetical fluctuations were the result of contemplating return to work or just the progression of her youngest from sole breastfeeding to solid foods.
When I say I had PPP, I mean in 1992 I was involuntarily confined to an inpatient ward and during the times for which I even have intact memory, I alternated between beliefs ranging from me being Sinead O’Connor to the Queen of England. IPSRT has worked well for me to manage my Bipolar phenotype.
