Originally shared on our Center's website, womensmentalhealth.org.
Postpartum psychosis (PPP) is a rare but serious psychiatric illness, occurring in 1 to 2 per 1000 women in the weeks. Because postpartum psychosis is so rare, we do not have specific guidelines regarding its treatment. While the last decade has brought increased awareness of the prevalence and treatment of postpartum depression, our knowledge regarding the ideal acute treatment for postpartum psychosis, and our understanding of the etiology of this most severe form of postpartum mental illness, remains elusive.
We are now in the midst of what we call our MGHP3 Study, the MGH Postpartum Psychosis Project. We are collecting clinical and demographic information, as well as genetic samples, from women who have experienced postpartum psychosis, in an effort to better understand the etiology of illness. We are also gaining considerable information regarding how postpartum psychosis is managed around the country. We are not yet at the point of formally analyzing these data; however, some interesting themes have emerged.
There is considerable variation in how healthcare providers conceptualize postpartum psychosis. Some treaters appear to view postpartum psychosis as a variant of postpartum depression. This misconception can lead to less aggressive and/or less optimal treatment. Although postpartum psychosis bears a strong link to bipolar disorder, many women with PP psychosis receive treatment with antidepressants and are not treated with mood stabilizers, like lithium.
Many women experience illness over a prolonged period of time. Misdiagnosis and uncertainty regarding the optimal treatment for PP psychosis may prolong the course of illness. While we have data to indicate that electroconvulsive therapy can lead to a rapid reduction in symptoms, ECT is not commonly used in this population and is often recommended only when other treatments have failed. We have less data on the time it takes for women to return to their baseline after other types of treatment.
Strategies which have been shown to reduce risk of postpartum psychosis are not frequently used. We can identify women who are at higher risk for postpartum psychosis, and there is clear evidence that prophylactic treatment with lithium can decrease this risk. This is, however, not a widespread practice in women participating in the MGHP3 program. However, it must be noted that this observation may be due to selection bias; only women who have experienced PP psychosis are eligible to participate in this study. It is plausible that many women receive some type of prophylactic treatment and therefore do not experience PP psychosis.
Ruta Nonacs, MD PhD