Postpartum Psychosis: Symptoms and Resources

An estimated 1 to 2 out of every 1,000 women experience postpartum psychosis after giving birth. The condition is rare and usually occurs within two to three days of delivery.

Doctors have identified several types of postpartum psychiatric illness. Some common terms you may have heard of include:

Postpartum blues

An estimated 50 to 85 percent of women experience the postpartum blues within a few weeks of delivery. Symptoms associated with the postpartum blues or “baby blues” include:

• tearfulness
• anxiety
• irritability
• quick changes in mood

Postpartum depression

When depression symptoms last more than two to three weeks and impair a woman’s functioning, she may have postpartum depression. Symptoms associated with the condition include:

• consistently sad mood
• feelings of guilt
• worthlessness, or inadequacy
• anxiety
• sleep disturbances and fatigue
• difficulty concentrating
• appetite changes

A woman with postpartum depression also may have suicidal thoughts.

Postpartum psychosis

Most doctors consider postpartum psychosis to have the most severe mental health effects.

It’s not uncommon for all new mothers to have episodes of sadness, fear, and anxiety. When these symptoms persist or turn into potentially dangerous thoughts, they should seek help.

Psychosis is when a person loses touch with reality. They may start to see, hear, and/or believe things that aren’t true. This effect can be very dangerous for a new mother and her baby.

Postpartum psychosis symptoms are similar to those of a bipolar, manic episode. The episode usually starts with the inability to sleep and feeling restless or especially irritable. These symptoms give way to more severe ones. Examples include:

• auditory hallucinations (hearing things that aren’t real, such as suggestions for a mother to harm herself or that the baby is trying to kill her)
• delusional beliefs that are usually related to the infant, such as that others are trying to harm her baby
• disoriented as to place and time
• erratic and unusual behavior
• rapidly changing moods from extreme sadness to very energetic
• suicidal thoughts
• violent thoughts, such as telling a mother to hurt her baby

Postpartum psychosis can be severe for a mother and her little one(s). If these symptoms occur, it’s vital that a woman receive medical help immediately.

While some women can have postpartum psychosis with no risk factors, there are some factors known to increase a woman’s risk for the condition. They include:

• history of bipolar disorder
• history of postpartum psychosis in a previous pregnancy
• history of schizoaffective disorder or schizophrenia
• family history of postpartum psychosis or bipolar disorder
• first pregnancy
• discontinuation of psychiatric medications for pregnancy

The exact causes of postpartum psychosis aren’t known. Doctors know that all women in the postpartum period are experiencing fluctuating hormone levels. However, some seem to be more sensitive to the mental health effects of changes in hormones like estrogen, progesterone, and/or thyroid hormones. Many other aspects of health can influence causes of postpartum psychosis, including genetics, culture, and environmental and biologic factors. Sleep deprivation may also play a role.

A doctor will start by asking you about your symptoms and how long you’ve been experiencing them. They will also ask about your past medical history, including if you’ve had any history of:

• depression
• bipolar disorder
• anxiety
• other mental illness
• family mental health history
• thoughts of suicide, or harming your baby
• substance abuse

It’s important to be as honest and open as possible with your doctor so you can get the help you need.

A doctor will try to rule out other conditions and factors that could be causing behavior changes, such as thyroid hormones or postpartum infection. Blood testing for thyroid hormone levels, white blood cell counts, and other relevant information can help.

A doctor may ask a woman to complete a depression screening tool. These questions are designed to help doctors identify women who are experiencing postpartum depression and/or psychosis.

Postpartum psychosis is a medical emergency. A person should call 911 and seek treatment at an emergency room, or have someone take them to an emergency room or crisis center. Often, a woman will receive treatment at an inpatient center for at least a few days until her mood is stabilized and she is no longer at risk for harming herself or her baby.

Treatments during the psychotic episode include medications to reduce depression, stabilize moods, and reduce psychosis. Examples include:

• Antipsychotics: These medications reduce the incidence of hallucinations. Examples include risperidone (Risperdal), olanzapine (Zyprexa), ziprasidone (Geodon), and aripiprazole (Abilify).
• Mood stabilizers: These medications reduce manic episodes. Examples include lithium (Lithobid), carbamazepine (Tegretol), lamotrigine (Lamictal), and divalproex sodium (Depakote).

No single ideal combination of medications exists. Each woman is different and may respond better to antidepressants or antianxiety medicines instead of or in combination with a drug from the above categories.

If a woman doesn’t respond well to medicines or needs further treatment, electroconvulsive shock therapy (ECT) is often very effective. This therapy involves delivering a controlled amount of electromagnetic stimulation to your brain.

The effect creates a storm or seizure-like activity in the brain that helps to “reset” the imbalances that caused a psychotic episode. Doctors have safely used ECT for years to treat major depression and bipolar disorder.

The most acute symptoms of postpartum psychosis can last anywhere from two to 12 weeks. Some women may need longer to recover, from six to 12 months. Even after the major psychosis symptoms go away, women may have feelings of depression and/or anxiety. It’s important to stay on any prescribed medications and seek continued treatment and support for these symptoms.

Women who are breast-feeding their infants should ask their doctor about safety. Many medications used to treat postpartum psychosis are passed through breast milk.

An estimated 31 percent of women with a history of postpartum psychosis will experience the condition again in another pregnancy, according to a study published in The American Journal of Psychiatry.

This statistic shouldn’t keep you from having another baby, but it is something to keep in mind as you prepare for delivery. Sometimes a doctor will prescribe a mood stabilizer like lithium for a woman to take after giving birth. This could potentially prevent postpartum psychosis.

Having an episode of postpartum psychosis doesn’t necessarily mean you’ll have future episodes of psychosis or depression. But it does mean it’s important for you to know the symptoms and where to seek medical attention if your symptoms do start to return.