Understanding Postpartum Psychosis

Mental health is an integral part of everyday life. And, there are times in life when you're more likely to deal with situations that may be challenging to your mental health. The time period after having a baby is one of those times.

The baby blues and postpartum depression (PPD) are two of the more well-known mental health issues that may arise, but other conditions can develop. One dangerous illness is postpartum psychosis. Here's what you need to know about the symptoms, causes, and treatments of this rare postpartum mood disorder.

Postpartum Mood Disorders

It is very common to have a change in your mood or emotions after giving birth. In fact, experiencing ups and downs and even a few tears is normal. But, certain mood changes could be dangerous. Postpartum mood disorders fall into three basic categories.

• Postpartum blues: In the days and weeks following childbirth, as many as 60% to 80% of moms experience the baby blues. The symptoms tend to be mild and last for just a few days or up to two weeks. If you have the blues, you can still safely take care of yourself and the baby. It is not a dangerous condition and doesn’t require any medical intervention.
• Postpartum depression: Postpartum depression affects about 10% to 15% of new moms. The symptoms are more severe and last longer than the baby blues. This condition is more serious because it makes caring for yourself and baby more challenging. Postpartum depression needs treatment.
• Postpartum psychosis: Also known as puerperal psychosis and postnatal psychosis, this condition is the least common but also the most severe and dangerous of the postpartum mood disorders. Postpartum psychosis is rare and only happens in one or two out of every 1000 births (0.089% to 0.26%). It is a very severe condition that requires immediate medical attention.

Symptoms

Postpartum psychosis may present within a day or two of delivery or up to weeks and, in rare cases, months postpartum. It is also important to note that one of the most common initial presenting symptoms is an inability to sleep and that women become disconnected from reality.

So, it's helpful for you and your partner to know what to watch for once you're home with your newborn. The symptoms include:

• Delusions
• Confused or disorganized thinking
• Hallucinations

In addition to the above, there also may be:

• Acting distant and withdrawn
• Aggressiveness
• Agitation
• Anxiety
• Confusion
• Depression or extreme sadness
• Fear
• Hyperactivity
• Illogical thoughts
• Insomnia
• Odd or uncharacteristic behavior
• Paranoia
• Poor judgment
• Restlessness
• Severe mood swings
• Suicidal thoughts
• Violence

It is difficult to recognize the symptoms of psychosis in yourself. If you do see it, you should get help right away. But, it is more likely that your partner, a family member, or friend will notice that you're acting out of character. If this is the case, they should call for help immediately to get you the care you need.

Causes

Experts aren't quite sure why some women experience this rare condition. Because it can show up out of the blue in women without a history of mental health illness, the exact cause is not known. However, the risk of developing postpartum psychosis is greater if you have:

• A personal health history of bipolar disorder or schizophrenia
• A close family member such as a mother or sister with a history of postpartum psychosis or another psychiatric illness
• Discontinued mood stabilizers and/or antipsychotic medications
• Previous experience with postpartum psychosis after pregnancy

Other risk factors are:

• Being a young teen mother
• Having your first baby
• Having complications during your delivery
• Having a baby with health complications

Extreme stress may increase the risk of postpartum depression but not necessarily for postpartum psychosis.

Treatment

Postpartum psychosis is a medical emergency. It must be addressed, or it can get worse and become dangerous very quickly. The good news is that it’s treatable. Treatment for postpartum psychosis may involve:

• Hospitalization
• Psychiatric evaluation and treatment
• Medication
• Individual, family, and group therapy
• Support for partners and family members
• Electroconvulsive therapy (ECT)

Recovery

Early detection and treatment can lead to a quicker recovery. The worst symptoms last approximately two to 12 weeks, but recovery can take six months to a year. Most women fully recover, but it can be a long and challenging process. Along with a relief of the symptoms, there may be:

• Anger
• Fear of having more children
• Fear of the judgment of being a bad mom
• Fear of the stigma of mental illness
• Guilt for the lost time and bonding with the baby
• Sadness
• Shame
• Strain on family relationships
• Worry about it coming back

After recovering from postpartum psychosis, you may wonder if it will come back; and it may. There is a chance that it could return outside of pregnancy, and there is about a 25% to 40% chance of it returning with a future pregnancy. But, that doesn’t mean you cannot have more children.

Once you have been through it, you will be much more prepared if it happens again. You can work with your doctors and your support system to have everything in place in case you need it.

Complications

Postpartum psychosis is a serious illness. Without treatment, it could be life-threatening for moms and babies and have a negative effect on the entire family. This condition carries a 4% risk of infanticide and a 5% risk of suicide. In general, suicide is the most common cause of maternal death during the first year postpartum.

Studies show that family members of moms who experience postnatal psychosis have a higher chance of taking their own life, and the moms have a higher rate of suicide later in life.

However, it’s important to note, that while there is a danger of aggression during an episode of postpartum psychosis, not all delusions are violent. Most new moms who have postpartum psychosis do not cause any harm to themselves or others.

Breastfeeding

Breastfeeding can be more difficult for women with depression or symptoms of altered mental health. It may even be a source of distress. Breastfeeding difficulties and dissatisfaction can lead to early weaning. And, if weaning is sudden, it can lead to more severe symptoms.

The safety of breastfeeding during treatment for postpartum psychosis depends on:

• The medication prescribed
• If the baby can stay with mom during hospitalization
• The mother's preference to breastfeed
• The benefits for the baby
• The risks to baby due to treatment
• The risks to mom if she doesn’t take her medication or doesn't take enough

Preventing Postpartum Psychosis

There are things in your life that you cannot control such as your family history or genetics. But, there are some risk factors that you can control, which means that you can try to prevent postpartum psychosis—or at least prepare for it.

• Talk to your doctor about your personal mental health history and family history.
• Keep all your appointments with any other health care providers that you see or your doctor refers you to. 
• Discuss your risk with the health care team.
• Learn about the condition.
• Have realistic expectations about delivery and motherhood.
• Talk to someone about any negative feelings you have.
• Try to get enough sleep.
• Try to reduce your stress.
• Learn, practice, and use healthy coping skills.
• Include your partner in your prenatal appointments and care.
• Prepare your tribe by telling trusted family and friends so they can be helpful, supportive, and encouraging.
• Know the signs of psychosis, and make sure your support system knows them, too.
• Consider individual and group counseling for support.
• Tell someone right away if you have any symptoms.
• Have help at home and frequent health care check-ups in the days and weeks after your baby is born.

A Word From Verywell

Bringing your baby home from the hospital can be an exciting time. But, for some new moms, the postpartum period is especially challenging. Changing hormones, lack of sleep, and the stress of adjusting to life with a newborn can be physically and emotionally demanding. You may not feel like yourself, or you may have more trouble coping than you usually do.

Dealing with any illness right after giving is birth is difficult. It can be especially devastating to go through something as serious as postpartum psychosis. Not only can it be scary and traumatic to feel paranoid or experience hallucinations and delusions, but without treatment, it could be dangerous and affect the entire family.

So, although it is rare, it is still important to understand this serious mental health condition. Learning the risk factors and symptoms can help you and your family recognize the signs and seek help as early as possible. Remember, it is a treatable condition, and it's also temporary. With time and proper care, most moms make a full recovery.