Postpartum psychosis is the most severe form of postpartum conditions, but it doesn’t affect every new mother. For those women who do experience it, however, it’s a serious, potentially life-threatening mental health condition that needs immediate attention.

Postpartum psychosis symptoms can cause new mothers to disconnect from reality. They may experience visual and/or auditory hallucinations and can start to believe that falsities are facts. They may also experience fast mood transformations or exhibit paranoia. It’s a condition that should be treated as a medical emergency that must be treated as soon as possible. 

Continue reading to learn about the causes, signs and symptoms, diagnosis, and treatment options for this intense condition that affects about 1 to 2 out of every 1,000 new moms.

Causes of Postpartum Psychosis

We don’t know for sure what exactly causes postpartum psychosis. Even though the causes of postpartum psychosis aren’t well understood, what we do know is that there are some significant risk factors that might increase a postpartum woman’s chance of developing it. We’ll look more closely at some of the risks to be aware of later. 

“Postpartum psychosis is when the new mother has a rapid decline in her mental facilities. The causes of postpartum psychosis are unknown, but there are some contributing factors such as a history of mental illness and family history of mental illness and/or postpartum psychosis that can increase the likelihood of postpartum psychosis.”

Talkspace therapist Minkyung Chung, MS, LMHC

Signs & Symptoms of Postpartum Psychosis

What is postpartum psychosis? Postpartum psychosis is one form of postpartum mood disorder. While other conditions such as postpartum anxiety and postpartum rage may occur, postpartum psychosis is the most severe. According to a group of research, postpartum psychosis is like an overt presentation of bipolar disorder that co-occurs with intense hormonal changes. Symptoms typically begin to appear suddenly and within the first couple of weeks after delivery.

Postpartum psychosis symptoms can be similar to manic episodes in bipolar disorder, but they can also present as very low moods or a depressive state. A mother might show signs of impaired cognition and severely disrupted behavior that’s vastly out of character.

Other postpartum psychosis symptoms can include:

  • Suicidal ideation
  • Being unsure of location, date, or time
  • Delusions
  • Inability to sleep
  • Restlessness and irritability
  • Extremely rapid mood swings, from energetic to sad
  • Behaviors and mannerisms that are vastly out of character
  • Experiencing repetitive and compulsive thoughts about harming the baby
  • Hearing voices, possibly encouraging harm to self or baby
  • Unfounded beliefs, typically related to the baby (like fearing someone is about to harm them)

Postpartum psychosis is frightening and dangerous for both mother and child. If you notice any symptom in yourself or in someone you know, get help and see a doctor as soon as possible. If symptoms are severe, call 911 immediately for a medical emergency.

Postpartum Depression vs Postpartum Psychosis

It’s common for new mothers to experience “postpartum blues.” They might have feelings of anxiety, irritability, tearfulness, or mood swings. However, these symptoms are normal reactions to hormone fluctuation, emotional rebalancing, and the stress of new motherhood. 

If these symptoms persist for more than 2-3 weeks, or if they begin to impair daily functioning, it might be more than just a simple case of the baby blues. At that point, a postpartum woman may actually be experiencing what’s known as postpartum depression, and once diagnosed, postpartum depression treatment is the best route forward. 

Postpartum depression is a more serious form of postpartum blues (although not as severe as postpartum psychosis). In fact, postpartum psychosis is a much rarer condition than postpartum depression and can lead to a sudden onset psychotic symptoms such as hallucinations and delusions, both of which can be harmful to the mother and baby. On the other hand, postpartum depression can last for quite some time if not treated.

Postpartum depression symptoms may include:

  • Persistent feelings of sadness or guilt
  • Feeling worthlessness or inadequacy 
  • Difficulty concentrating
  • Persistent anxiousness
  • Changes in appetite (eating more or less than normal)
  • Disrupted sleep
  • Chronic fatigue

In some cases, postpartum depression can cause a woman to experience suicidal thoughts. If the symptoms of postpartum depression persist, or if they intensify to the point that they’re dangerous, you need to seek professional help immediately.

“Most people are likely aware of what postpartum depression is and may end up confusing some symptoms of it with postpartum psychosis. The difference lies in the specific symptoms that are present. Both postpartum depression and postpartum psychosis have symptoms of irritability and mood fluctuations. With postpartum psychosis, delusions, hallucinations, and other severe symptoms can be present.”

Talkspace therapist Minkyung Chung, MS, LMHC

Postpartum Psychosis Risks and Complications

For some women, postpartum psychosis can develop even without known risk factors present. That said, we do know that some of the following factors might increase someone’s risk of developing this condition. 

Risk factors of postpartum psychosis include:

  • A family history of bipolar disorder or postpartum psychosis 
  • A history of postpartum psychosis after a former pregnancy
  • A history of bipolar disorder
  • A history of schizophrenia
  • A history of schizoaffective disorder 
  • Prenatal depression during a current pregnancy
  • First pregnancies
  • Discontinuation of psychiatric medications  

Additional factors that may play a role in a woman developing postpartum psychosis might include culture, environmental factors, genetics, or sleep deprivation. 

“While most postpartum disorders are temporary, the risks of postpartum disorders like postpartum psychosis are: a family history of postpartum disorders, a history of bipolar or schizophrenia, or discontinuing any psychiatric medication. The risk of suicide is high in mothers diagnosed with postpartum psychosis. Through therapy and medication management, these symptoms can improve.”

Talkspace therapist Minkyung Chung, MS, LMHC

How to Get a Postpartum Psychosis Diagnosis

A psychiatrist or doctor will assess postpartum psychosis by first interviewing a new mom who’s exhibiting symptoms. They’ll ask how long symptoms have been present and inquire about symptom severity. They will also want to know about past medical conditions and history, including: 

  • History of chronic anxiety, bipolar disorder, or depression
  • Thoughts of self-harm or suicide
  • Family history of mental health conditions
  • Alcohol or drug abuse

During diagnosis, it’s essential to be open and honest with the doctor. This will allow them to rule out other possible conditions that may have overlapping symptoms. It can also ensure a new mother gets the essential help she needs as soon as possible. Blood tests, thyroid hormone level tests, white blood cell counts, and depression screening may all be necessary to help a doctor determine the best course of treatment.

Treatment for Postpartum Psychosis

Postpartum psychosis is a critical condition that requires rapid medical intervention. The first line of treatment is usually medication in an effort to stabilize the mother’s mood, alleviate depression, and reduce any psychotic symptoms that are present. 

Inpatient treatment

Most women with postpartum psychosis will spend at least some time in an inpatient treatment facility or center. This will allow time for treatment to begin to reduce the risk of her harming herself or her baby. The time spent there will also focus on stabilizing her mood, beginning to manage depression, and reducing psychotic episodes. 

Medication

Types of medications that might be prescribed include, but aren’t limited to:

  • Antipsychotic medications to manage and reduce hallucinations. 
    • Aripiprazole (Abilify)
    • Olanzapine (Zyprexa)
    • Risperidone (Risperdal)
    • Ziprasidone (Geodon)
  • Mood stabilizers to level out depressive and manic states. 
    • Carbamazepine (Tegretol)
    • Divalproex sodium (Depakote)
    • Lamotrigine (Lamictal)
    • Lithium (Lithobid)

Some new mothers experiencing postpartum psychosis may respond better to anti-anxiety or antidepressant medications instead of mood stabilizers or antipsychotics. Each person is different, and there’s no golden standard of medication for doctors to go by when treating this condition.

Electroconvulsive therapy (ECT)

In severe cases, if a mother doesn’t respond well to traditional treatment protocols, electroconvulsive therapy (ECT) might be used. ECT uses targeted, controlled electromagnetic brain stimulation to create seizure-like activities that can help stabilize brain chemical imbalances that might be a factor in postpartum psychosis.

Individual/group therapy

Since postpartum psychosis is a medical emergency, the above methods are recommended first. Once stabilized, it’s important to preserve your mental health as a new mother. Individual talk therapy or group therapy can be an effective way to manage any continued symptoms of postpartum depression. Know that you aren’t alone and that there are licensed therapists and other mothers to connect with.

Getting Help

It’s not uncommon for new mothers to feel tired and emotional after having a baby. Hormones are shifting, life is changing, and the entire process can be overwhelming. That’s not necessarily always a bad thing. In most cases, women recover from the baby blues quickly and without any need for major intervention.

Some new mothers are affected by the blues more intensely and develop postpartum depression. Their symptoms strengthen and persist, possibly resulting in the need for medical or psychological intervention. Short-term use of medication and talk therapy are often helpful to get a woman back on track to feeling happy and positive again.

Sometimes symptoms are more than just the baby blues or even postpartum depression. When a new mother slips into a deeper realm of despair, and her condition worsens to more than just the “normal” hormone-related post-birth complications, it’s time to get help.

Postpartum psychosis is a rare but profoundly serious mental health condition. It’s a medical emergency, and symptoms can rapidly grow worse, to the point that they’re even a matter of life and death for both the mother and baby.

If you think someone you know might be suffering from postpartum psychosis symptoms, call 911. Prompt treatment almost always supports a quicker recovery and a significant reduction of life-threatening complications.

Ongoing therapy and other forms of treatment can help virtually all types of depression. Talkspace is an online therapy platform that makes getting therapy convenient and accessible. We know that, especially for new moms, finding time to do something for yourself can be incredibly challenging. That’s why we eliminate this part of the equation by offering therapy that’s available when you are, without the need to even leave your home. 

Find out how Talkspace can help you get the support and therapy you deserve, so you can be the best version of yourself for your family and your baby.