Postpartum Psychosis

What Is Postpartum Psychosis?

Postpartum psychosis (or perinatal psychosis) is a serious mental health issue that can affect new mothers who have recently given birth.

It is not uncommon for women to experience stress and anxiety after childbirth. In fact, it is natural for them to feel overwhelmed by the challenges and responsibilities imposed by motherhood. This may result in mild to moderate symptoms, such as mood swings, fear, and irritability.

However, in some cases, women may develop intense psychological symptoms. If not managed properly, these symptoms can become worse, resulting in postpartum psychosis, which is known to cause serious, life-threatening consequences.

It is important to identify and treat postpartum psychosis to relieve the symptoms and prevent complications.

Here is a brief discussion about what postpartum psychosis means, how it is different from postpartum depression, and the best ways to treat this condition.

Postpartum Psychosis Definition

Postpartum psychosis is a severe form of mental illness that affects women following childbirth. It is sometimes referred to as “postnatal psychosis” or “puerperal psychosis.”

It is important to note that the development of postpartum psychosis may occur abruptly, “out of the blue,” in women with or without any history of mental illness.

Postpartum psychosis usually begins in the initial few days to weeks after the delivery. It often becomes worse very quickly and hence, needs to be treated as a medical emergency.

Postpartum Psychosis vs. Postpartum Depression

The diagnosis of postpartum psychosis is often confused with that of postpartum depression due to the similarities in their symptoms and their tendencies to affect women during the postpartum period.

However, both these conditions have differences in terms of their clinical presentations, the intensity of symptoms, and the development of complications.

Postpartum depression usually lasts more than two to three weeks and impairs routine functioning.

The common symptoms associated with this condition include:

  • Feelings of guilt, worthlessness, and inadequacy
  • Consistently sad mood
  • Fatigue
  • Anxiety
  • Sleep disturbances
  • Appetite changes
  • Difficulty concentrating
  • Suicidal thoughts

These symptoms are common in women during the postpartum phase, though they are usually quite mild. Also, it is not uncommon for first-time mothers to experience episodes of anxiety, sadness, and fear. These episodes require medical intervention only when symptoms persist or lead to potentially dangerous consequences, such as having suicidal tendencies.

Postpartum psychosis, on the other hand, is considered a medical emergency, as it develops suddenly and involves the risk of life-threatening complications. A diagnosis of postpartum psychosis is considered when symptoms similar to that of postpartum depression develops, though abruptly and at a very high intensity.

Postpartum Psychosis Risk Factors

The factors increasing the risk of postpartum psychosis include:

  • First pregnancy
  • History of postpartum psychosis in one or more previous pregnancies
  • History of bipolar disorder
  • History of schizophrenia and schizoaffective disorder
  • History of a traumatic pregnancy
  • Depression during pregnancy
  • Recent stressful or adverse life events
  • Inadequate social supports
  • Family history of bipolar disorder or postpartum psychosis
  • Discontinuation of psychiatric medications during pregnancy

Postpartum Psychosis Causes

Several factors seem to play a role in the development of postpartum psychosis. Family history of postpartum psychosis and genetic factors have been found to contribute to the risk of developing this condition.

Hormonal imbalances and disturbed sleep patterns could also be responsible for the increased risk of this condition.

It is believed that the development of postpartum psychosis is linked to rapid fluctuations in certain hormone levels, including cortisol, adrenaline, and dopamine, within the nervous system during the postpartum phase.

Imbalances in the levels of these hormones can lead to mood swings. Increases in cortisol levels may contribute to mental stress and anxiety, while lower production of feel-good hormones like dopamine and serotonin can lead to sadness.

Sudden fluctuations in these hormones may trigger emotional upheaval, putting women at risk of developing postpartum psychosis.

Postpartum Psychosis Symptoms

The symptoms of postpartum psychosis usually begin suddenly within the initial two weeks following childbirth. In rare cases, symptoms develop nearly four to six weeks after a baby is born.

The symptoms of postpartum psychosis usually include:

  • Visual or auditory hallucinations
  • Delusions or having uncharacteristic beliefs and thoughts
  • A manic mood with a tendency to be overwhelmed by thoughts and speaking very quickly
  • Feeling “high,” as if on the top of the world
  • An extremely low mood with signs of depression, such as being tearful, lack of energy, loss of appetite, severe anxiety, and difficulty sleeping
  • Feeling fearful and suspicious
  • Restlessness and confusion
  • Behaviors that seem like a departure from the mother’s usual nature or habits

Postpartum Psychosis Treatment

Postpartum psychosis is considered a medical emergency. Ideally, a patient is admitted with their baby in a specialist psychiatric unit called the mother and baby unit (MBU).

Hospitalization will usually be required for a few days to weeks, or until symptoms are relieved and mood is stabilized, such that a patient no longer exhibits a tendency to harm herself or the baby.

Postpartum Psychosis Medications

Women with postpartum psychosis are prescribed medications aimed at relieving symptoms, improving hormonal balances, and preventing the risk of complications.

The following medications are commonly used in the management of postpartum psychosis:

Antipsychotics

Antipsychotic drugs, such as risperidone, ziprasidone, olanzapine, and aripiprazole, help prevent incidences of hallucinations.

Mood stabilizers

These drugs are prescribed to prevent or relieve manic episodes. Commonly used mood stabilizers for the management of postpartum psychosis include lithium, lamotrigine, carbamazepine, and divalproex sodium.

Antidepressants

Antidepressants are recommended for relieving signs of depression, such as sadness, anxiety, and suicidal tendencies.

Postpartum Psychosis Management

Other than medications, management of postpartum psychosis also involves a combination of treatments and therapies, some of which are discussed below:

Psychological therapy

Cognitive-behavioral therapy (CBT) can be included in a treatment plan for postpartum psychosis once symptoms start improving.

CBT is a form of counseling, a talking therapy, aimed at providing support for patients, helping manage stress and anxiety by modifying thinking and behavior.

Electroconvulsive therapy (ECT)

ECT is an invasive form of brain stimulation recommended in cases where other treatments have failed to provide any significant relief or when a patient is likely to develop serious complications.

Prognosis of Postpartum Psychosis

With timely diagnosis and treatment, women with postpartum psychosis usually recover completely and are able to live a normal life.

Recovery may take a few weeks to several months and the journey can be difficult. The condition may be shocking, as well as frightening, for both the woman and her family.

Fortunately, the occurrence of postpartum psychosis in the mother has not been shown to affect the long-term growth and development of the child.

Postpartum Psychosis Statistics

It is estimated that postpartum psychosis affects about 1 or 2 out of 1000 women who have delivered a child recently.

Postpartum Psychosis Famous Cases

It was about 20 years ago when Andrea Yates shattered the silence around postpartum psychosis when she drowned her five young kids in a bathtub. This high-profile murder case drew worldwide attention due to the tragic deaths of the children.

It also highlighted the issues surrounding a lack of awareness about postpartum psychosis that could deprive women of timely diagnosis and treatments, putting them and their kids at risk of serious consequences.

How Long Does Postpartum Psychosis Last?

The most severe symptoms of postpartum psychosis usually last about 2 to 12 weeks. However, it may take 6 to 12 months, or even more, for some women to recover completely.

That being said, with proper treatment, most patients are able to make a complete recovery within a shorter duration.

In some cases, an episode of postpartum psychosis may be followed by a period of severe anxiety, depression, and low confidence. And it may take a while to come to terms with these changes in moods, behaviors, and actions.

Some mothers may have difficulty bonding with their baby even after an episode of postpartum psychosis has passed, while some may feel sad or guilty about missing the opportunity to care for their baby.

However, with support from their partner, family members, friends, and healthcare team, they can overcome these feelings.

Postpartum Psychosis: Frequently Asked Questions

What is postpartum psychosis?

Postpartum psychosis is a serious psychological illness known to affect women during the postpartum phase.

The symptoms of postpartum psychosis often become evident suddenly without any warning signs. Postpartum psychosis can also occur in women who have no apparent history of any mental illness.

When does postpartum psychosis start?

Postpartum psychosis often begins within the first few days following childbirth. It tends to become worse quickly and needs to be treated as an emergency.

How common is postpartum psychosis?

Postpartum psychosis is a comparatively rare condition affecting approximately 1 or 2 in 1000 women during their postpartum period.

How long does postpartum psychosis last?

When treated properly, women with postpartum psychosis usually recover within a few weeks.

Most women are able to resume their routine activities and be their normal selves within a few months. They are able to contribute to their responsibilities towards motherhood efficiently upon complete recovery.

Conclusion

The period after delivering a baby can be challenging for parents, especially first-time mothers.

It can be devastating to experience a severe psychological illness like postpartum psychosis during this phase.

However, being alert about changes in behaviors and mood during this critical stage can help in the timely diagnosis of postpartum psychosis and allow for appropriate treatment.

Timely, appropriate treatment generally supports faster recovery and reduces the risk of life-threatening complications.

Proper diagnosis and treatment of postpartum psychosis also plays a role in restoring a mother’s natural ability to resume her routine activities in a shorter duration.

PostpartumDepression.org Team
Reviewed by:Kimberly Langdon M.D.

Medical Editor

  • Fact-Checked
  • Editor

Kimberly Langdon is a Doctor of Medicine and graduated from The Ohio State University in 1991. She completed her residency in Obstetrics and Gynecology at The Ohio State University Hospitals, Department of OB/GYN. Board-Certified in 1997, she is now retired from clinical practice after a long and successful career. Currently, she is the Founder and Chief Medical Officer of a Medical Device Company that is introducing a patented products to treat vaginal microbial infections without the need for drugs. She is an expert in Vaginal Infections, Menstrual disorders, Menopause, and Contraception.

Written by:

Jenna Carberg was diagnosed with postpartum depression following the birth of her daughter in 2016. It was a healthy birth but in following days, Jenna's mood changed quickly. Doctors suggested that it might be the "baby blues", but her husband Chris suggested she seek a second opinion. Jenna was diagnosed with postpartum depression and began a journey that lasted 9 long months with significant ups and downs. Jenna's mental health care and her experiences became a passion for her to share with the world. She and her husband Chris founded PostpartumDepression.org as a support website designed to help women suffering in silence and their loved ones.

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