What Is Postpartum Psychosis? Symptoms, Causes, Diagnosis, Treatment, and Prevention
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What Is Postpartum Psychosis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

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Updated on October 30, 2024
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Postpartum psychosis is a rare but severe mental health condition that some people experience soon after giving birth. It can cause someone to lose touch with reality and experience paranoia, delusions, hallucinations, and thoughts of self-harm or harming the baby.

Because of the way postpartum psychosis can affect the lives of mothers, babies, and families, experts deem it a “psychiatric emergency.”

Postpartum psychosis is different from postpartum depression, but the two conditions can occur together.

Signs and Symptoms of Postpartum Psychosis

The signs and symptoms of postpartum psychosis tend to start suddenly and can occur within two weeks of giving birth.

 However, they may also develop up to six weeks after birth.
Symptoms can include the following:

  • Confusion
  • Being out of touch with reality
  • Disorganized or odd thinking and behavior
  • Trouble sleeping
  • Delusions (beliefs that have no basis in reality)
  • Hallucinations (seeing or hearing things that aren't there)
  • Paranoia
  • Problems with appetite
  • Trouble functioning or going about daily tasks in a way that’s immediately obvious to other people
  • Irritability
  • Mood swings
  • Episodes of mania (feeling very high) and depression (feeling very low)
  • Suicidal ideation
  • Thoughts of harming the baby

Causes and Risk Factors of Postpartum Psychosis

Researchers do not yet fully understand what causes postpartum psychosis, but they know some factors make it more likely.

For example, women with a previous history of other psychotic and mood disorders are more likely to experience postpartum psychosis. In fact, about 60 percent of mothers with postpartum psychosis have a history of bipolar disorder or schizophrenia.

These other factors may raise the risk or contribute to the illness:

  • A family history of bipolar disorder or psychosis
  • The fast drop in estrogen and progesterone levels after giving birth
  • Lack of sleep
  • Problems with the immune system resulting from pregnancy

How Is Postpartum Psychosis Diagnosed?

Postpartum psychosis is not recognized as a stand-alone diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). As a result, many cases may go unreported or underdiagnosed, and researchers are currently working on changing this.

Using specialized questionnaires, healthcare providers will ask about your medical history and your mood, feelings, and well-being throughout your pregnancy and after birth to help formulate a diagnosis.

They will also conduct tests to ensure that your symptoms aren’t caused by something physical. For example, your doctor may order blood tests and brain scans to rule out insulin shock, very low or very high blood sugar, conditions that affect your thyroid, infections, a stroke, and more.

Treatment and Medication Options for Postpartum Psychosis

Postpartum psychosis can be sudden and severe, but it usually responds very well to treatment such as medication, electroconvulsive therapy (ECT), and psychotherapy.

Medications for Postpartum Psychosis

  • Antipsychotics can help manage symptoms such as delusions or hallucinations.
  • Mood stabilizers are prescribed to balance your mood.

Common medications from these drug classes include the following:

  • lithium
  • sodium valproate
  • lamotrigine
  • carbamazepine
  • benzodiazepines
  • quetiapine
  • olanzapine

ECT and Psychotherapy

Electroconvulsive therapy is an effective treatment typically used for those who may not respond to medication. While researchers are still trying to understand why it works, ECT alleviates symptoms of postpartum psychosis, depression, and other related forms of psychosis.

Psychotherapy is usually recommended alongside medication or ECT. It helps by teaching those living with the condition how to manage their thoughts and behavior. 

Prevention of Postpartum Psychosis

Screening for signs of mental health problems during pregnancy and after childbirth is a good prevention strategy. People at higher risk should receive counseling and information about the risks and what they can do to stay well, so they can make informed decisions about their pregnancy.

People who are at a clear risk of postpartum psychosis (for example, those with a diagnosis or history of bipolar disorder) may be able to prevent it by seeing a psychiatrist during pregnancy. Speak to your healthcare provider about your medical history so that you can work together to create a prevention plan.

A healthcare provider can help provide strategies to ensure that you get enough sleep and prescribe medications you can safely take during and after pregnancy. Early detection of postpartum psychosis is critical for preventing complications.

How Long Does Postpartum Psychosis Last?

Postpartum psychosis symptoms can last anywhere between a few weeks and a few months. Although the condition is severe and can progress quickly, it is usually brief, and most people recover fully.

The disorder itself may be short, but receiving psychological and psychosocial support in the long term is vital for a good recovery, for both the mother and the family as a whole.

Some people who have experienced postpartum psychosis may be at risk of having it again the next time they have a baby. But the research on the long-term impact of postpartum psychosis is still emerging, so more studies are necessary.

Complications of Postpartum Psychosis

If untreated, postpartum psychosis can cause complications such as a higher risk of maternal suicide and infanticide.

However, it’s important to remember that the risk is still low. For example, infanticide is very rare — it happens in 1 to 4.5 percent of all cases of postpartum psychosis. Suicidal thoughts and thoughts of self-harm are more frequent.

The condition can also significantly affect mother-baby bonding.

Research and Statistics: Who Has Postpartum Psychosis?

Postpartum psychosis is a rare condition, affecting 1 or 2 of every 1,000 new mothers after giving birth.

Having bipolar disorder raises the risk of postpartum psychosis quite significantly. According to some estimates, 1 in 5 women with bipolar disorder have postpartum psychosis or mania.

Women with a family history of related conditions are at a higher risk. Specifically, 40 to 50 percent of women who had postpartum psychosis have a first- or second-degree relative with a mood disorder.

Conditions Related to Postpartum Psychosis

Conditions related to postpartum psychosis include the following:

  • Baby blues affects more than half of new mothers and involves mild symptoms like mood swings, anxiety, and irritability. Baby blues usually goes away in about 10 days and doesn’t need any treatment. However, consult your healthcare provider to receive a proper diagnosis.
  • Postpartum depression (also called postnatal depression) can range from mild to severe and includes symptoms like feeling low, thinking negative thoughts, having trouble sleeping, lacking energy, and lacking appetite.
  • Postpartum bipolar disorder is a condition that causes drastic mood swings and changes in energy and behavior around giving birth.

The Takeaway

  • Postpartum psychosis occurs in 1 or 2 out of every 1,000 women after giving birth. The signs and symptoms of the condition tend to develop suddenly and within two weeks of giving birth.
  • Symptoms of postpartum psychosis include confusion, odd thinking and behavior, trouble sleeping, delusions, and hallucinations.
  • Women with a previous history of psychotic and mood disorders are more likely to experience postpartum psychosis.
  • While the exact causes aren’t entirely understood, treatment options such as medications, ECT, and psychotherapy are often effective. 

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Kara Smythe, MD

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Kara Smythe, MD, has been working in sexual and reproductive health for over 10 years. Dr. Smythe is a board-certified fellow of the American College of Obstetricians and Gynecologists, and her interests include improving maternal health, ensuring access to contraception, and promoting sexual health.

She graduated magna cum laude from Florida International University with a bachelor's degree in biology and earned her medical degree from St. George’s University in Grenada. She completed her residency in obstetrics and gynecology at the SUNY Downstate Medical Center in Brooklyn, New York. She worked in Maine for six years, where she had the privilege of caring for an underserved population.

Smythe is also passionate about the ways that public health policies shape individual health outcomes. She has a master’s degree in population health from University College London and recently completed a social science research methods master's degree at Cardiff University. She is currently working on her PhD in medical sociology. Her research examines people's experiences of accessing, using, and discontinuing long-acting reversible contraception.

When she’s not working, Smythe enjoys dancing, photography, and spending time with her family and her cat, Finnegan.

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Resources
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