About Postpartum Psychosis

The Basics

Over half of mothers will experience mild mood changes after having a baby. Some women feel anxious, irritable, down, or tearful starting around days 3-4 postpartum. Called the “baby blues”, these feelings usually go away in a few days and do not need treatment.

About 1-2 out of every 10 women will experience postpartum depression after delivery. These symptoms last longer than the baby blues (at least two weeks) and include low mood, too much or too little sleep, appetite changes, fatigue, hopelessness, concentration troubles, and anxiety, among others.

Postpartum psychosis is more severe than postpartum depression and often starts in the first few days or weeks after delivery as depression, mania, or a mixture of the two before progressing to psychosis. Symptoms can vary widely and change very rapidly, even over the course of hours. Rarely, the symptoms start later than a few weeks after childbirth.

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Postpartum psychosis occurs in about 1 per 1000 women who have recently given birth. It is much rarer than postpartum depression or the baby blues, and should always be treated as a medical emergency. Most women who experience postpartum psychosis will need to be treated in the hospital.

Causes

Unfortunately we don’t know much about what causes PP. There are likely biological factors including genetics and pregnancy-related hormones that weigh into risk for PP, but even those factors we suspect are not understood well, and there are certainly other causes that we don’t currently understand.

Symptoms

There are many varied symptoms that may occur in postpartum psychosis, and they often change very rapidly. If you have a history of bipolar disorder, depression, or schizoaffective disorder, your symptoms might be similar to those you’ve experienced in the past. Because up to half of women who experience postpartum psychosis have no prior history of psychiatric illness, these symptoms may also be completely new for you. Symptoms include:

• Mania

  • Feeling “high”, “up”, elated, over-excited, or “on top of the world”

  • Increased energy, activity, or productivity

  • Racing thoughts, being more talkative, a “busy” brain, increased creativity, or pressured speech

  • Needing less or no sleep or not wanting sleep

  • Feeling restless, agitated, or unable to keep still

  • Losing inhibitions, spending a lot of money, or being much more sexually or socially forward

  • Extreme irritability, impatience, or anger

  • Very increased interest in your surroundings

  • Easily distracted, starting many things but not necessarily finishing them

• Depression

  • Feeling low, flat, tearful, emotional, or crying easily

  • Anxiety, feeling tense, nervousness

  • Feeling withdrawn and not wanting to talk to or be near others

  • Tired, heavy, or without energy

  • Having a harder time taking care of yourself or your baby

• Psychosis

  • Severe confusion or delirium

  • Seeing, hearing, or feeling things that aren’t there – hallucinations

  • Thoughts or beliefs that aren’t within reality or that people around you think are strange and out-of-character – delusions

  • Feeling suspicious or afraid of people or events, paranoia

  • Acting like you aren’t yourself

  • Feeling detached from reality, unreal, or like you’re in a dream

You may have some, but not all of these symptoms. Some women with postpartum psychosis do not recognize their symptoms and need the assistance of friends or family to get treatment. Many of these symptoms on their own are common in postpartum women, and some symptoms are shared with other postpartum mental health disorders, like postpartum depression, postpartum anxiety, or postpartum obsessive-compulsive disorder. Sometimes women with postpartum psychosis can feel disconnected from their baby, their families, or themselves, or they can have rapid and uncontrollable mood swings. None of these feelings are your fault, and help is available for recovery.

Diagnosis and Treatment

While PP can happen to any woman after birth, it can be difficult to predict whether a woman will or will not experience an episode. You may be at higher risk for PP if you have a history of bipolar disorder or a psychotic disorder, if other women in your family have had PP, or if you have had PP in a previous pregnancy. If you are concerned about your risk for PP, it can be helpful to make an action plan during or before pregnancy with your medical team that includes a care plan for your baby and phone numbers for your healthcare providers, emergency contacts, and crisis services.

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Postpartum psychosis is always considered a medical emergency. PP symptoms can worsen very quickly, and some women will not realize they are ill. If you or a loved one suspects that you are experiencing symptoms of PP, you should seek help at the nearest emergency department immediately. If you are told that you do not have PP at the emergency room, but your symptoms later become worse, you should urgently be seen by the doctor again.

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Many names may be used to clinically describe an episode of psychosis or mania following childbirth, a fact that can be confusing for patients and families. Most doctors will use the term postpartum psychosis, but you may also hear “postpartum mania”, “puerperal psychosis”, “postnatal/perinatal psychosis”, “postpartum depression with psychotic features”, “bipolar disorder with postpartum onset”, or “postpartum bipolar disorder with psychotic features”, among others. Use of these other terms does not necessarily mean that you will have further episodes of mania or psychosis, but we encourage you to speak with your doctor about your long-term treatment plan if you have any concerns. While PP can be an alarming experience for women and families, it is a treatable illness from which most women fully recover.

Recovery can be a long and difficult journey, but most women do return to their normal selves. Treatment for PP almost always includes hospitalization, medication, and therapy. There are many medication options, so it may be a while before you and your doctor find the regimen that works best for you. After manic and psychotic symptoms resolve, many women will continue to experience depression and anxiety symptoms before becoming well. The most severe symptoms of PP typically last between 2 and 12 weeks, although full recovery can take up to a year.

Even after your symptoms have recovered, you will likely have some remaining sadness about missing out on the early weeks of motherhood. This is normal, and talking to a therapist, friends, family, or your doctor can help. It may take time to feel confident in your relationships and motherhood. For additional advice on recovery, we highly recommend the APP Guide to Recovery, published by Action on Postpartum Psychosis, a foundation in the UK dedicated to improving the lives of women who have experienced PP.