Fertility

Everything You Need To Know About Postpartum Psychosis

Updated on 27 March 2022 • 8 minute read

 

Overview

Clinicians since the time of Hippocrates over 2,000 years ago have noted postpartum psychiatric disorders. (1)

Today, it’s estimated that around one to two new mothers out of every 1,000 childbirths can develop postpartum psychosis. This is a serious psychiatric illness characterized by hallucinations, hyperactivity, extreme agitation, or confusion. (2)(3)

Although it’s more rare than other conditions experienced by moms after childbirth, postpartum psychosis is considered a severe mental illness that requires immediate medical attention. (1)

Moms with this mental health issue might be unaware of their actions, putting them at a 10% risk for suicide or infanticide (the crime of killing a baby under one year of age). (3)

Early diagnosis and treatment are crucial. So, what are the warning signs of postpartum psychosis? Who’s at risk, how is it diagnosed, what are your treatment options, and how soon can you recover? Learn more below.

 

What Is Postpartum Psychosis?

Also known as puerperal psychosis, postpartum psychosis is a severe mental illness. It’s similar to other forms of psychosis; the only difference is that it happens during the puerperal or postpartum period (from birth to six weeks).

It’s such a rare condition that the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5) doesn’t consider it as a separate clinical diagnostic entity. Instead, it falls under the psychotic disorder section of “schizophrenia spectrum and other psychotic disorders.” (4)

Onset is often dramatic, starting within the first two weeks from childbirth. 

Surprisingly, studies show that women with postpartum thyroid dysfunction (a small gland in the neck responsible for metabolism) might have the same symptoms as depressive psychosis. (3)

 

Is Postpartum Psychosis Serious?

Yes. Moms with postpartum psychosis might be unaware of their actions. During a psychotic episode, her delusions or hallucinations seem real. These irrational thoughts can put her at a 10% risk for suicide or infanticide (killing her baby). (3)

 

What Are The Symptoms Of Postpartum Psychosis?

Sometimes it might be difficult to realize that you or a family member might have postpartum psychosis because people often think that new moms are prone to being sad or anxious. 

Also, it’s a rare condition. So, many think that these symptoms are just like the baby blues which go away after a few days.

But considering that it puts you and your baby at serious risk, it’s important to keep a close watch for these warning signs: (4)

  • Severe anxiety and depression
  • Extreme and sudden mood swings
  • Constant restlessness
  • Severe insomnia (inability to sleep)
  • Feeling very confused or disoriented
  • Paranoia (feeling too suspicious or fearful)
  • Behaving out of character
  • Irrational thoughts or behavior
  • Food rejection
  • Being very agitated
  • Hallucinations or changes in perception (talking to, smelling, seeing, hearing, or feeling things that aren’t there)
  • Delusions (thoughts or beliefs that aren’t likely to be true)
  • Manic mood (feeling “high” and talking or thinking too quickly or too much)
  • A mix of manic and low moods (or a sudden shift between these moods)
  • Loss of inhibitions
  • “Flat affect” (lack of emotional response or a blank facial expression)
  • Planning or thinking about harming yourself or your baby (e.g., my baby is better off without me)

 

In extreme situations, a mom with postpartum psychosis can exhibit strange behaviors such as muttering to herself, staring off into space, voicing out seemingly irrational statements, or refusing to eat.

Often, she has no idea that she’s experiencing this. But even if she knows, she might be too afraid to ask for help. 

Also, it might be easy to overlook these symptoms because they’re fluctuating or even hidden. (5)

That’s why it’s important for immediate family members to also know about postpartum psychosis so they’ll know what to expect and the warning signs to look out for. Family members can also help encourage her to seek treatment.

 

Is Postpartum Psychosis Temporary?

It’s temporary. Around 20-50% of moms with postpartum psychosis experienced this within the vulnerable postpartum period only. But it can lead to complications if left untreated. (5)

 

How Long Does It Take To Recover From Psychosis?

With treatment, a mom with postpartum psychosis might no longer show psychotic symptoms after the postpartum period ends (around six weeks after birth). (5)

 

Complications

A woman with postpartum psychosis has a 50−80% chance of developing another serious psychiatric condition, usually within the bipolar spectrum. (5)

 

Treatment

Postpartum psychosis is a medical emergency. Call 911 or seek treatment at the ER if you suspect you have this mental health condition or notice a family member exhibiting any warning signs. 

Due to the increased risk for suicide or infanticide, treatment for a psychotic episode is often done at an inpatient facility for close monitoring. (5)

Ideally, you’ll be admitted into the MBU (mother and baby unit), a specialist psychiatric unit in a hospital. If unavailable, you’ll be admitted to a general psychiatric ward.

 

Counseling

Counseling with a qualified mental health professional, such as a psychiatrist or psychologist, using the following methods: (6)

  • CBT (Cognitive Behavioral Therapy) – to help manage your negative thoughts
  • IPT (Interpersonal Therapy) – to help identify and deal with interpersonal relationship issues (with your partner, family, neighborhood, or work) 

 

Medications

Treatment plans can vary, depending on your symptoms, but medications can include: (5)

  • Antidepressants or antianxiety medicines – to manage depressive symptoms
  • Mood stabilizers – to reduce manic episodes (e.g., lithium, lamotrigine, carbamazepine, or divalproex sodium)
  • Antipsychotics – to reduce the incidence of hallucinations (risperidone, ziprasidone, olanzapine, or aripiprazole)

 

Studies show that treatment with lithium can be more effective than antipsychotic drugs. However, your doctor might also prescribe combination treatments, depending on your symptoms. (5)

Inform your doctor if you’re breastfeeding because some of these medications might harm your baby.

 

Procedures

ECT (electroconvulsive therapy) creates seizure-like activity in the brain using controlled amounts of electromagnetic stimulation. It can help “reset” chemical imbalances in the brain that might be causing the psychotic episode. (7)

This treatment is also used for major depression and bipolar disorder.

 

Causes

Little is known about why postpartum psychosis actually occurs. Still, studies suggest that it may be triggered by a combination of physiological changes (including hormone levels and immune system activation) after birth. (5)(8)

 

Can PPD Turn Into Psychosis?

Yes. PPD (postpartum depression) has the potential to turn into psychosis. (9)

In a 15-year study published in the Archives Of General Psychiatry (2012), as many as 14% of women with first-time psychiatric visits during the postpartum period had a bipolar diagnosis within this period. (9)

Surprisingly, the study discovered that only around 4% of women who visited a mental health professional for depression unrelated to childbirth received the same diagnosis. (9)

 

Who’s At Risk For Postpartum Psychosis?

It’s still possible to develop postpartum psychosis without risk factors, but having the following can increase your risk for the condition: (5)

  • First pregnancy
  • Unplanned pregnancy
  • Discontinuation of psychiatric medications due to pregnancy
  • History of postpartum psychosis (previous pregnancy)
  • History of bipolar disorder or bipolar spectrum
  • History of schizophrenia or schizoaffective disorder
  • Family history of a mental health condition (especially postpartum psychosis or bipolar disorder)

 

Can You Prevent Postpartum Psychosis?

Before Delivery

The U.S. Preventive Services Task Force suggests depression screening for pregnant women to help recognize signs that might already be beginning to develop during pregnancy. (5)

Here are also some ways to help reduce the risks:

  • Inform your doctor or health care team about your risk factors, especially if you have a personal or family history of bipolar disorder and/or postpartum psychosis.
  • Your doctor will monitor your perinatal mental health condition (the period from pregnancy to the first year after childbirth).
  • Educate your loved ones or partner about the warning signs and symptoms because you might not recognize them in yourself.
  • Keep track of your thoughts, moods, and feelings during pregnancy.
  • Find support groups for postpartum psychosis (e.g., “PPTalk”).
  • Arrange childcare for your baby or older children, especially during the first few weeks after childbirth.

 

For high-risk moms-to-be, your doctor might also schedule a pre-birth planning meeting around 32 weeks of pregnancy with you and everyone involved in your care:

  • Perinatal mental health professional
  • Your partner
  • Family or close friends
  • Midwife or obstetrician

 

This ensures that they are aware of your postpartum psychosis risks, create a care plan, and help monitor your symptoms during pregnancy and after giving birth.

 

After Delivery

If you have an increased risk for postpartum psychosis, your doctor might recommend lithium prophylaxis (preventative treatment) immediately after delivering your baby. (5)

Prevention strategies also include proactive safety monitoring. 

Other things you can do:

  • Get enough sleep (rest when your baby is sleeping).
  • Continue to monitor your mood, feelings, and thoughts.
  • Ask someone (your partner or another loved one) for help in monitoring your behavior.
  • Minimize accepting visitors, especially for the first few days, so that you can rest.
  • See your doctor, especially for the postpartum follow-up checkup, even if you feel that you’re alright.
  • Don’t feel guilty if it’s difficult for you to breastfeed. 
  • Keep a mood diary.
  • Ask for help around the house from friends and family.

 

Diagnosis

Mental Health Assessment & Psychiatric Evaluation

A mental health professional makes an assessment based on the following: (5)

  • Direct questions about infanticidal or suicidal thoughts
  • Assessment of auditory and visual perception
  • EPDS (Edinburgh Postnatal Depression Scale) – a self-rating questionnaire to check for persistent low mood, guilt, anxiety, anhedonia (inability to feel pleasure), and thoughts of self-harm
  • MDQ (Mood Disorder Questionnaire) – checks for past or current symptoms of racing thoughts (fast-moving but repetitive thoughts), pressured speech, hyper (high) irritable mood, excess energy, and other mania or hypomania symptoms

 

These tools are used to screen for depression, mania (abnormally elevated or extreme changes in mood or emotions), or hypomania (less severe symptoms of mania).

Red flags include indications of poor self-care, childcare difficulty, confusion, and threats to harm yourself or your baby.

 

Clinical Laboratory Testing

Postpartum psychosis is a mental health condition, but other physical medical conditions can have similar symptoms. 

So, it’s essential to rule out these conditions or find the treatable causes of psychosis, including peripartum blood loss and anemia, acute infection, and certain diseases (e.g., thyroid problems). 

Your doctor might also conduct these tests: (5)

  • Thyroid peroxidase antibody levels – to check for thyroid function 
  • Comprehensive metabolic screen – because childbearing can cause physiological challenges to your body’s metabolic processes
  • Complete blood count – for evaluation of an infectious process, such as mastitis (breast tissue inflammation) or endometritis (inflammation of the endometrial lining in the uterus)
  • Urinalysis – to assess for cystitis (bladder inflammation)
  • Head CT or MRI scan – these brain scans rule out the presence of a brain-related problem such as hemorrhage (from uncontrolled hypertension or aneurysm)
  • Urine drug screen
  • Electrolyte levels – to check for evidence of fluid/electrolyte imbalance

 

Some postpartum women with primary hypoparathyroidism (underactive thyroid gland) might show symptoms similar to psychosis. This is actually common, with around 5-7% of postpartum women possibly having thyroid autoimmune diseases. That’s why thyroid function is tested. (5)

 

Other Postpartum Mental Health Concerns

Baby Blues

As many as 85% of moms experience baby blues (crying for no reason, fatigue, or impatience), but it usually goes away without treatment after a few days. (10)

 

Postpartum Depression

Around 21.9% of new moms might experience postpartum or postnatal depression within the first year after childbirth. (11)

 

Postpartum Anxiety

You show more symptoms relating to anxious behaviors than depressive symptoms, such as persistent fears or worries, worthlessness, and high stress if you have postpartum anxiety. (3)

 

Postpartum Panic Disorder

It’s characterized by repeated panic attacks and extreme anxiousness. (3)

 

Postpartum OCD (Obsessive-Compulsive Disorder)

Around 3-5% of moms might experience postpartum OCD. Symptoms can include hypervigilance in protecting your baby or compulsions (doing the same things repeatedly, such as constantly rearranging your baby’s things) (12)

 

Postpartum PTSD (Post-Traumatic Stress Disorder)

Around 9% of new moms can experience postpartum PTSD, usually after a traumatic delivery (e.g., complications or injuries during delivery such as postpartum hemorrhage). (3)

Symptoms can include avoiding trauma triggers (which might include your baby) and repeatedly having flashbacks of the traumatic experience. (3)

 

 

 

REFERENCES

(1) https://www.researchgate.net/publication/234071150_Predictors_of_postpartum_depression_in_a_sample_of_Egyptian_women

(2) Sit, D., Rothschild, A. J., & Wisner, K. L. (2006). A review of postpartum psychosis. Journal of women’s health (2002), 15(4), 352–368. https://doi.org/10.1089/jwh.2006.15.352. https://www.academia.edu/16633398/A_Review_of_Postpartum_Psychosis

(3) https://www.postpartumdepression.org/postpartum-depression/types/

(4) https://jag.journalagent.com/ejm/pdfs/EJM-62207-REVIEW_ARTICLE-ISIK.pdf

(5) Bergink V, Rasgon N, Wisner KL. Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood. Am J Psychiatry. 2016 Dec 1;173(12):1179-1188. doi: 10.1176/appi.ajp.2016.16040454. Epub 2016 Sep 9. PMID: 27609245. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2016.16040454

(6) https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/perinatal-depression-preventive-interventions

(7) https://www.nami.org/About-Mental-Illness/Treatments/ECT,-TMS-and-Other-Brain-Stimulation-Therapies

(8) Perry A, Gordon-Smith K, Jones L, Jones I. Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review. Brain Sci. 2021 Jan 4;11(1):47. doi: 10.3390/brainsci11010047. PMID: 33406713; PMCID: PMC7824357. https://www.researchgate.net/publication/348219902_Phenomenology_Epidemiology_and_Aetiology_of_Postpartum_Psychosis_A_Review

(9) https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1151054

(10) https://www.researchgate.net/publication/24187626_The_preconditions_of_postpartum_dysphoria

(11) https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1666651

(12) https://www.postpartum.net/learn-more/obsessive-symptoms/

 

 

 

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