Postpartum Psychosis Guide
The perinatal period is a time of significant adjustment, both physically and emotionally, for new mothers. While many are familiar with postpartum depression, fewer people are aware of postpartum psychosis, a rare but severe condition that can develop after going through childbirth. Postpartum psychosis requires urgent medical attention, and recognizing its symptoms early is crucial for ensuring the safety of both mother and baby.
What Is Postpartum Psychosis?
Postpartum psychosis is a rare but serious mental health condition that typically begins within the first 10-14 days after childbirth. Out of every 1,000 women who give birth, about 2 will experience perinatal psychosis. It is characterized by a complete break from reality. Symptoms may include hallucinations, delusions, and extreme mood swings, which often escalate quickly.
Unlike perinatal depression and anxiety, which are more common, perinatal psychosis is considered a medical emergency. Women experiencing psychosis are often unaware of their condition and may not seek help on their own, making it critical for family members and healthcare providers to step in.
Postpartum Psychosis Causes and Risk Factors
Only about ⅓ of women with postpartum psychosis have any previous history of psychiatric experiences. While exact postpartum psychosis causes are not yet defined, a combination of biological, psychological, and situational factors contribute to an elevated risk:
History of Bipolar Disorder: 20-30% of women with bipolar disorder will likely experience perinatal psychosis, heightening the risk compared to those without a bipolar diagnosis.
Previous Episodes of Postpartum Psychosis: Women who have experienced postpartum psychosis in previous pregnancies are at a much higher risk of recurrence.
Family History of Mental Health Disorders: Having a close family member with conditions such as bipolar disorder or schizophrenia increases the likelihood of postpartum psychosis.
First-Time Mothers: Evidence suggests that first-time mothers may face a higher risk of perinatal psychosis, with heightened stress and hormonal changes leading to psychiatric episodes after childbirth.
Sleep Disturbance: Sleep deprivation is a well-known trigger for mood disorders, particularly mania, and has been linked to postpartum psychosis. Women who experience sleep disturbances during pregnancy, and especially those with longer labors or who give birth at night, may be at higher risk. This is especially relevant for women with bipolar disorder, as sleep loss can trigger manic episodes.
Immune System Dysregulation: Emerging evidence points to immune system dysfunction and autoimmune conditions, such as thyroiditis, and abnormal immune responses in women, as a potential factor in perinatal psychosis.
Postpartum Psychosis Symptoms
Postpartum psychosis symptoms often develop rapidly, becoming apparent within the first few days to two weeks after childbirth. While psychosis can co-occur with perinatal depression or anxiety, women with psychosis usually lack insight into their condition and may not realize that their thoughts and behaviors are abnormal. In these cases, family members must act quickly to ensure the mother gets the help she needs.
Key Postpartum Psychosis Symptoms Include:
- Hallucinations: Hearing or seeing things that aren’t present, such as voices commanding the mother to act in dangerous ways.
- Delusions: Holding irrational and false beliefs, such as thinking the baby is in danger without any real threat.
- Severe Mood Swings: Rapid fluctuations between extreme euphoria and deep depression within short periods.
- Paranoia: Heightened sense of suspicion toward others, believing that family members or healthcare providers want to harm the mother or baby.
- Confusion and Disorganized Thinking: Difficulty making sense of thoughts, leading to erratic speech and behavior.
- Agitation: Restlessness, pacing, or becoming overly active, often accompanied by aggression.
- Insomnia: The inability to sleep for long periods, even when exhausted, often due to racing thoughts or paranoia.
- Thoughts of Harm: Suicidal thoughts or thoughts of harming the baby, driven by delusions or hallucinations.
If any of these symptoms are observed, it is critical to take the affected mother to the nearest emergency department as quickly as possible. Postpartum psychosis can escalate rapidly, making immediate medical attention essential.
Postpartum Depression vs. Psychosis
Postpartum depression is a common mood disorder, affecting about 1 in 7 women. Symptoms of perinatal depression are less urgently severe than those of psychosis and typically include, but are not limited to:
- Persistent feelings of sadness or hopelessness
- Difficulty bonding with the baby
- Constant fatigue or lack of energy
- Changes in sleep patterns, such as insomnia or oversleeping
- Irritability and frustration
The main difference between postpartum depression and psychosis is the presence of hallucinations and delusions in psychosis. Women with depression may feel overwhelmed or disconnected from their baby, but they remain grounded in reality. In contrast, psychosis involves a complete loss of touch with reality, requiring immediate intervention.
While perinatal depression does not typically develop into psychosis and is a distinct disorder, it is possible to develop into it, making it important to address any escalating symptoms with a healthcare provider to ensure accurate diagnosis and treatment.
Postpartum Anxiety vs Psychosis
Postpartum anxiety affects many new mothers and involves excessive worry and physical symptoms, including:
- Constant worrying about the baby’s health or safety
- Panic attacks with symptoms like shortness of breath, rapid heart rate, or dizziness
- Difficulty concentrating due to persistent worry
- Restlessness or trouble sleeping
Unlike psychosis, postpartum anxiety does not involve hallucinations, delusions, or a loss of connection to reality. Women with anxiety may feel overwhelmed by constant fear, but they do not experience the disorganized thinking or dangerous behaviors seen in psychosis.
While untreated perinatal anxiety can worsen and lead to increased stress and exhaustion, it does not directly evolve into psychosis. However, severe anxiety and sleep deprivation may exacerbate underlying conditions, increasing the risk of psychosis in some.
Postpartum Psychosis Treatment
Postpartum psychosis is a medical emergency that requires urgent care. If a woman is showing signs of psychosis, it is crucial to take her to the nearest emergency department immediately and begin treatment without delay. Family members and close friends play a critical role in this process, as women experiencing psychosis may not recognize their own need for help.
Stabilization
The first step in postpartum psychosis treatment will be stabilizing the mother. This may involve medications such as antipsychotics, mood stabilizers, or sedatives to reduce agitation and manage hallucinations or delusions. Stabilization focuses on addressing the immediate dangers posed by the condition and ensuring the safety of both the mother and her baby.
Inpatient Treatment
Once stabilized, most require inpatient treatment at a specialized mental health facility. Inpatient care provides a safe, structured environment where the mother can receive intensive support, psychiatric care, medication management, and therapeutic interventions. There are a few inpatient treatment facilities in the US designed specifically for mothers with postpartum mental health needs. These are:
Ongoing Care
After the inpatient phase, ongoing care is recommended for relapse prevention and long-term recovery. This can include regular psychiatric follow-ups, medication adjustments, an intensive outpatient program and individual or family therapy.
Barriers to Seeking Help for Postpartum Psychosis
One of the main barriers to seeking help for postpartum psychosis is fear—fear of being separated from the baby, fear of child protective services getting involved, or fear of being judged by others. Some mothers may also feel ashamed or embarrassed about their symptoms, delaying treatment. However, perinatal psychosis is a treatable condition, and early intervention can significantly improve outcomes for both mother and baby. By seeking help early, families can ensure a quicker recovery and a safe environment for all involved.
Hope for Postpartum Psychosis
Postpartum psychosis is a severe condition that requires immediate medical attention. Recognizing the signs and symptoms early, understanding the differences between psychosis and other perinatal mood disorders, and knowing the steps to take when a loved one shows signs of psychosis can be life saving. Spouses, loved ones and family members play an essential role in helping new mons with psychosis receive the urgent care they need. With timely intervention and ongoing support, mothers can recover fully and go on to have happy, fulfilling lives with their families.