- What is postpartum psychosis?
- What causes postpartum psychosis?
- Symptoms of postpartum psychosis
- Diagnosis of postpartum psychosis
- Treatment for postpartum psychosis
- How to reduce the risk of developing postpartum psychosis?
- How long does postpartum psychosis last?
- How can you manage yourself with postpartum psychosis?
Psychological ups and downs are as common as physical changes in pregnancy. But some women have severe episodes of mental illnesses.
Postpartum psychosis is one such psychiatric illness that is known to occur in one or two out of every 1,000 women, in the initial two to four weeks after delivery (1).
What Is Postpartum Psychosis?
Postpartum psychosis is a severe mental illness characterized by the mother’s inability to respond emotionally to the baby.
It is also referred to as postnatal or puerperal psychosis or postnatal onset bipolar disorder.
Health professionals qualify it as a psychiatric emergency since it can be frightening for the new mom, her baby, partner, family, and friends (2).
The condition might affect a woman out of the blue, even when she has not been ill before. It is, however, less common than postnatal depression or baby blues.
What Causes Postpartum Psychosis?
The causes of postpartum psychosis are not clearly understood. Most doctors believe that it could be because of the hormonal changes during and after pregnancy. Some other aspects including genetics, environmental and biological factors, and disrupted sleep patterns could also cause the condition (3).
[ Read: Postpartum Anxiety Symptoms ]
New mothers are at a higher risk of this condition in the case of:
- A history of postpartum psychosis, schizophrenia or schizoaffective disorder
- Bipolar disorder
- Close family (mother or sister) experiencing postpartum psychosis or bipolar disorder
- Stopping psychiatric medications during pregnancy
Symptoms Of Postpartum Psychosis
Symptoms usually start within 48 hours to two weeks of giving birth, and in rare cases, even after 12 weeks after birth. The signs and symptoms associated with a psychotic bout can be distressing for both the mom and the immediate family (4).
Early behavioral symptoms include:
- Talking more than usual
- Feeling high, unbeatable and powerful
- Not sleepy, restless
- Seeming confused
- Feeling spiritual
- Having strange notions
The signs mentioned above are associated with a combination of specific bipolar or manic symptoms:
- Hallucinations, such as hearing voices or sounds, smelling non-existent smells or seeing things that others cannot see
- Delusions related to the baby, such as ‘the baby is evil in some way’ or ‘someone is trying to kill the baby’
- Low or depressed mood and alternating mood states
- Confusion, muddled or rapid thinking
- Lack of insight about her own behavior; for instance, it is obvious to others that the woman’s behavior is odd, but she is unaware of it
- Suicidal thoughts
- Sudden thoughts of harming the baby in some way
The woman may not be able to look after herself or the baby when the symptoms are persistent. Sometimes, she may not even realize that she is unwell. Her partner, family or friends may notice that something is wrong with her and seek help.
Diagnosis Of Postpartum Psychosis
The doctor will diagnose the condition by understanding the woman’s medical history, family history, symptoms, and their duration.
The doctor will first rule out conditions such as postpartum infections and fluctuating thyroid hormone levels which could also be causing behavioral changes.
Blood tests for white blood cells count and thyroid levels help too.
The doctor might recommend a depression screening test, which is a set of questions that the patient has to answer. The doctor will determine if it is postpartum psychosis or depression based on the answers.
[ Read: Depression During Pregnancy ]
Treatment For Postpartum Psychosis
Once the condition is confirmed, the healthcare provider will refer the patient to a psychiatrist for treatment.
Postpartum psychosis treatment lasts until the woman’s condition is stabilized or there is no longer at the risk of the mother harming the baby.
Treatment options include:
There are two types of medications the doctor could prescribe.
- Antipsychotics: They lower the incidence of hallucinations. Commonly prescribed antipsychotics include risperidone (Risperdal), ziprasidone (Geodon), olanzapine (Zyprexa) and aripiprazole (Abilify). However, they can only be used if the potential benefits outweigh the risks to an unborn baby (5).
- Mood stabilizers: They lower manic bouts by stabilizing the mood and also decrease the likeliness of relapse. Carbamazepine (Tegretol), lithium (Lithobid), divalproex sodium (Depakote) and lamotrigine (Lamictal) are the commonly prescribed mood stabilizers (6).
Discuss all the benefits and risks of these medications with the psychiatrist before taking them. Also, check if they can be taken when the mother is breastfeeding. Always consult the psychiatrist before trying to stop or change the medications. Never stop the medication abruptly, as that can have adverse effects on the user’s health.
A stay in the hospital is needed when the mother is at the risk of harming herself or others. Hospitalization will allow the doctor to monitor her moods and behavior closely and offer the required support.
3. Psychological treatments:
As the medications start to work and the condition improves, the doctor may begin specific psychological therapies to help the woman cope with the condition. Options include cognitive behavior therapy (CBT) or interpersonal psychotherapy (IPT). Mother-infant therapy will help in bonding with the baby (7).
4. Electroconvulsive therapy (ECT):
This is a specialized treatment for psychosis, acute mania, and major depression. It involves in applying electromagnetic stimulation to the brain to reset the imbalances caused by a psychotic episode (8).
How To Reduce The Risk Of Developing Postpartum Psychosis?
If the mother-to-be falls under the high-risk category, she should seek specialist care during pregnancy and get a psychiatrist to address any issues she has.
A pre-birth planning visit that involves the partner, family or friends along with a psychiatrist, obstetrician, and midwife helps everyone understand the risks involved and plan for care during and after pregnancy.
The family will also receive written guidelines on how they can help the mother get better quickly. The psychiatrist or midwife may visit the patient regularly in the first few weeks after delivery.
[ Read: Postpartum Sleep Deprivation ]
How Long Does Postpartum Psychosis Last?
Postpartum psychosis lasts for two to 12 weeks and may take six to 12 months for complete recovery. With treatment, most women recover completely (9). In some cases, postpartum psychosis might be followed by a short period of anxiety, depression and low confidence.
Some women may face difficulties in bonding with the baby or feel sad about missing out on time spent with their baby. They can recover from these low feelings with support from the partner, family, friends, and mental health professionals.
The Risk of Relapse In A Subsequent Pregnancy
Around 31% of women with a history of postnatal psychosis will develop the condition again in a subsequent pregnancy (10). Therefore, you need to prepare for this when you want to have another baby.
Talk to your healthcare provider and work on a plan based on what has helped you the previous time. If you have been to a psychiatrist after your last delivery, revisit them for preconception counseling.
Coping With Postpartum Psychosis
These measures will help the mother recover quicker.
- Join a support group: Join a group that helps people with psychosis. Being a part of a group, the mother gets to learn more about herself and find new ways to ease manic and depressive symptoms.
- Recognize the triggers: Make a note of your moods and how your day usually is. It will help you recognize if something is wrong with your moods or behavior and what is triggering them. Being aware of any changes in your mental health and knowing what’s triggering them can prevent the condition from worsening.
- Contact specialized organizations: Connecting with local perinatal mental health organizations or associations that focus on better infant mental health can be helpful. These organizations will have a guide on how to cope with postpartum psychosis, and tips based on the experiences of other patients.
Having a supportive family is critical to coping with the mood disturbances and the newborn. Remember that you are not alone – you can always seek help from family, friends or a doctor and talk to them about what is bothering you. Remember that being prepared for postpartum psychosis will minimize the effects it may usually have on you.
[ Read: What Causes Postpartum Preeclampsia ]
Do you have any suggestions to share on coping with postpartum psychosis? Tell us about them in the comment section.
2. William Davies; Understanding the pathophysiology of postpartum psychosis: Challenges and new approaches; World J Psychiatry; 2017
3. Di Florio, S. Smith, I. Jones; Postpartum psychosis; Royal College of Obstetricians and Gynaecologists; 2013C. E. Shehu, M. A. Yunusa; Obstetric Characteristics and Management of Patients with Postpartum Psychosis in a Tertiary Hospital Setting; Obstet Gynecol Int. 2015
4. M.M. Iqbal, A. Aneja, A. Rahman, et al.; The Potential Risks of Commonly Prescribed Antipsychotics During Pregnancy and Lactation; Psychiatry (Edgmont); 2005
5. Medications; New York State Office of Mental Health; 2016
6. S. Misri, K. Kendrick; Treatment of Perinatal Mood and Anxiety Disorders: A Review; 2007
7. Rosinger, E. and Kautz, D. D. (2012). What every nurse needs to know about postpartum psychosis. Nursing, 42(8), 44-46. doi: 10.1097/01.NURSE.0000415838.59113.6b
8. Postpartum psychosis; NHS
9. V. Bergink, N. Rasgon, K. L. Wisner; Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood; The American Journal of Psychiatry; 2016
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