What to Know About Postpartum Psychosis

Postpartum psychosis can be a serious and scary mental health emergency for new moms. Here’s how to spot the signs.
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By Nehal Aggarwal, Editor
Published March 16, 2023
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Image: Irina Polonina

In recent years, there’s been a collective call to put a stronger spotlight on the mental health issues many new moms face during the postpartum period. And thanks to a more open and honest public dialogue, more people have become aware of the mental and emotional challenges that can accompany this vulnerable stage of life. But while the stigma around postpartum depression and anxiety has diminished, and stories of personal struggle have unified moms, there are other important—albeit less common—issues that warrant attention. One serious postpartum mental health disorder that’s been gaining traction in the news cycle: postpartum psychosis. When not treated in the appropriate time frame and manner, postpartum psychosis can have devastating consequences for families. But exactly what is postpartum psychosis—and are there symptoms to look out for? Keep reading to learn more about this serious condition, potential causes and treatment options—plus, get tips on how to help a loved one potentially dealing with postpartum psychosis.

What Is Postpartum Psychosis?

Postpartum psychosis is a rare and severe condition that can occur during the postpartum period. Within the Diagnostic and Statistical Manual of Mental Disorders (DSM), widely used by psychiatric experts, postpartum psychosis is classified as a short psychotic disorder. “Postpartum psychosis is a sudden departure from [a person’s] previous level of functioning,” explains Kylie Chaffin, MA, LMHC, PMH-C, a mental health counselor and founder of The Spokane Counselor in Washington state. “It impacts a person’s sense of reality and how they interpret the world around them.”

Postpartum psychosis usually shows up within the first two weeks of childbirth, but may occur anytime within the first year. “I’ve seen it show up most often in the first few days to two weeks, but I’ve had clients experience episodes three months postpartum or even 8 months postpartum,” says Chaffin. Sanam Hafeez, MD, a neuropsychologist based in New York City, adds that postpartum psychosis doesn’t follow any specific timeline, as “the duration and symptoms vary from woman to woman.”

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How common is postpartum psychosis?

Postpartum psychosis periodically makes headlines after devastating stories emerge of moms struggling with postpartum depression (and likely postpartum psychosis) fatally harming their children. Still, despite these references within the news cycle, postpartum psychosis is rare. It occurs in approximately one to two out of 1,000 postpartum parents, says Chaffin, emphasizing that it’s considered a medical emergency. In fact, in the national wake of the devastating case of Lindsay Clancy, a mom accused of killing her children—potentially in the midst of a psychotic episode—some perinatal mental health experts are advocating for postpartum psychosis to no longer be classified as rare—arguing that it may affect more people than previously believed. It can have serious consequences if not addressed immediately, and they don’t want the “rare” label to deter anyone from seeking immediate help.

What Causes Postpartum Psychosis?

Due to limited data, experts don’t definitively know what causes postpartum psychosis; instead, they have to rely on “probability” and risk factors, says Laurie Kramer, PhD, a licensed psychologist and a professor of applied psychology at Northeastern University. It’s believed to be triggered by a combination of certain genetic and psychological risk factors. Based on the current research, experts agree that some of the biggest postpartum psychosis risk factors include:

  • Previous history of psychosis: One of the strongest postpartum psychosis risk factors is having personal or family history of psychosis or schizoaffective disorders, including bipolar disorder, a “mental illness characterized by mood swings ranging from depressive lows to manic highs,” explains Carolyn Rubenstein, PhD, a licensed psychologist in Florida. Studies have also found a correlation between postpartum psychosis and bipolar disorder. “Bipolar has a strong connection to postpartum psychosis… it’s the biggest thing I look for when doing a mental health history on a postpartum parent,” Chaffin says, as “they’re likely to have experienced psychosis symptoms before.”

  • Medication hiatuses: This one’s closely linked to a previous history of schizoaffective disorders. “Sometimes during pregnancy, individuals who are being treated on medications may want to stop taking them to protect their baby,” Kramer says. However, that may increase the odds of the disorder coming back or developing into something else postpartum. One example of this is lithium, which is commonly used to treat bipolar depression, a 2022 study notes. While the drug isn’t recommended during pregnancy, as it can increase the risk of congenital malformations, it is recommended postpartum to prevent relapse.

  • Sleep deprivation: New moms infamously don’t get much sleep, but the lack of rest and stress that come with newborn care can increase the risk of developing postpartum psychosis. During those first few months with baby, Chaffin emphasizes the importance of sleeping and having a strong support system to help mitigate this burnout.

  • Hormonal changes: It’s no secret that pregnancy and postpartum drastically change a person’s hormone levels. In fact, postpartum triggers a sudden drop in estrogen and progesterone and an increase in oxytocin, explains Chaffin. This, in turn, can trigger mood changes and may also contribute to postpartum psychosis.

  • Medical conditions: Certain medical conditions, such as autoimmune disorders, thyroid problems or certain infections might also increase someone’s risk of developing postpartum psychosis, Hafeez says.

While these potential postpartum psychosis risk factors are important to know, Chaffin emphasizes that this isn’t an exhaustive list: “Even though certain risk factors may increase the likelihood of an episode happening, it can still happen to anyone (even with no prior history of mental health problems).” As one 2019 study notes, only one third of women who develop postpartum psychosis have a previous psychiatric history—and risks may be higher for new moms. But, again, due to limited data, there’s still a lot that experts don’t understand about postpartum psychosis risk factors.

Who does postpartum psychosis affect?

Postpartum psychosis is often seen in new moms, but may also occur in women who’ve experienced a stillbirth or infant loss. “[They] experience the full effect of the changes in hormones [postpartum], plus the trauma of losing a child,” Chaffin explains. She adds that there’s little research on whether someone can experience postpartum psychosis after miscarriage. “In my experience, I’ve seen women have a psychotic episode after a miscarriage and/or abortion,” she adds. “Whether that’s due to psychological distress, trauma or postpartum related—the research just isn’t there yet to say for certain what the cause is.”

So can a non-birthing parent experience postpartum psychosis? Chaffin classifies cases in non-birthing partners as paternal postnatal psychosis rather than postpartum psychosis. “It isn’t so much related to being postpartum,” she explains, as the hormonal changes that occur in the birthing partner aren’t playing a role. “Some men who have bipolar can be at risk for a psychosis episode if they aren’t sleeping after baby is born, or if the stress puts them into a manic episode,” she adds.

Postpartum Psychosis Symptoms

There are three categories for postpartum psychosis symptoms: depressive, manic or mixed presentation (also known as atypical). Manic symptoms are a little more erratic and active, while atypical and mixed symptoms usually involve a lot of confusion, weird comments and odd behaviors, notes Chaffin. She adds that depressive symptoms as the most common, affecting around 40 percent of those with postpartum psychosis. These are also the most dangerous, as they can result in suicidal thoughts, suicide or infanticide. While this is terrifying to think about, cases are rare: Less than 5 percent of new moms with depressive symptoms harm themselves or their children, Chaffin says. “Regardless of the low rate, it’s still an emergency that should be addressed immediately,” she adds.

The biggest symptoms within all three categories to look for are:

  • Extreme anxiety or depression: The postpartum period is associated with hormonal changes, which can cause mood shifts, but anything out of the ordinary, sudden or extreme can be a marker of postpartum psychosis, Rubenstein says. One example is a new mom who feels like baby would be better off without them.

  • Delusion, hallucinations and paranoia: Delusions are beliefs that aren’t based on reality, Rubenstein says. “Examples include thinking you have special powers or abilities, that baby is possessed or that someone is trying to harm you or baby.” Religious delusions are also very common, Chaffin adds, as one may think their baby is “extra special or holy” in some way. Hallucinations also involve seeing, hearing or feeling things that aren’t real. This may lead to paranoid thinking and behavior, Kramer says.

  • Behavioral changes: Acting out of character, such as becoming quickly agitated, irritated or aggressive, can also be a postpartum psychosis symptom. Chaffin cites some examples of unusual behaviors as rearranging furniture over and over; excessively cleaning one spot; catatonia; talking very fast or excessively or the inability to speak to anyone.

  • Confusion and disorientation: This one may be hard to pinpoint because disorientation goes hand-in-hand with sleep deprivation, which is a big part of the postpartum period. But if someone is confused, disoriented, having trouble remembering things or speaking in a disorganized manner, it could potentially indicate postpartum psychosis.

  • Insomnia: Chaffin points to insomnia as one of the most common early signs of postpartum psychosis, and it’s sometimes followed by irritability and restlessness. “Sleep disturbances tend to be one of the major indicators of an episode. [Patients] may stop sleeping altogether,” she says. “But some mothers will report grandiosity where they feel super-great and like they don’t need to sleep at all.” Of course, not all postpartum insomnia is related to a psychotic episode.

In general, experts say loved ones should look out for odd behaviors, strange verbalizations, weird comments and any other postpartum psychosis symptoms. The person experiencing them may not be aware of what’s happening, but “these symptoms can be severe and interfere with a person’s ability to care for themselves and their child,” says Hafeez. They also serve as crucial markers for seeking timely help. Kramer advises friends and family members to seek help right away following the first odd symptom, as psychosis can come and go very quickly. “If you see someone who’s looking pretty intact after they’ve had a psychotic episode like that, it doesn’t mean that it won’t repeat,” she explains. “They still need to be seen, evaluated and treated.”

How Is Postpartum Psychosis Diagnosed?

Postpartum psychosis is diagnosed through multiple evaluations, Rubenstein says. This includes:

  • A psychiatric evaluation conducted by a mental health professional
  • A medical evaluation with a physical exam performed by a doctor
  • Lab tests (such as blood and urine), as well as imaging tests, to rule out any underlying conditions

“It’s mostly based on observation and a clinical interview of the client and their partner,” Chaffin adds. It’s also important to note that, due to the limited data available around postpartum psychosis, the condition may be misdiagnosed.

A 2018 clinical review notes that postpartum psychosis, which involves delusional thinking, can be difficult to distinguish from postpartum OCD, which involves intrusive thoughts. “I’ve seen some people get diagnosed with psychosis when they really just had severe OCD—their thoughts were so disturbing that someone assumed it was psychosis,” Chaffin notes.

Postpartum psychosis may also initially be diagnosed as postpartum depression. “They’re very different but can have similar features,” Chaffin says. So can postpartum depression become psychosis? It’s not likely. “While other postpartum mental health concerns—such as anxiety, OCD and depression—can increase the risk of developing postpartum psychosis, they don’t necessarily ‘turn into’ postpartum psychosis,” Rubenstein explains.

The main difference between the two comes from the severity and nature of the symptoms. “Some people characterize postpartum psychosis as being a gradient of increasingly serious symptoms,” Chaffin says, adding that while postpartum depression is usually chronic and can last for months, postpartum psychotic episodes are typically shorter, with more severe, uncontrollable mood changes. Plus, postpartum depression affects up to 15 percent of new moms and is much more common than postpartum psychosis. “While postpartum depression can be debilitating and interfere with a woman’s ability to care for baby, postpartum psychosis requires immediate attention and can be life-threatening to a mom, infant or both,” Rubenstein adds.

What to Know About Postpartum Psychosis Treatment

The reassuring news is that postpartum psychosis can be effectively treated with psychiatric help. That said, there’s no magical medication, cautions Abbie Goldberg, PhD, a professor of psychology at Clark University in Worcester, Massachusetts. Instead, treatment for postpartum psychosis usually includes:

  • Inpatient hospitalization that can last a few days to a couple of weeks (or more based on individual circumstances)
  • Medications that stabilize mood and reduce psychotic symptoms
  • Individual or group therapy

Of course, treatment will vary based on individual symptoms and will probably involve a combination of options. “I don’t think most physicians feel comfortable just having a person take medications if they’re talking about psychotic symptoms, or having some suicidal or homicidal ideation,” says Kramer. Moreover, as is true with all medications, there may be side effects, including negatively impacting the ability to breastfeed. Luckily, there are multiple medication options available. “It’s possible to try one drug and see how that’s working and switch to something else if it doesn’t seem to be having the desired effect, or if there are side effects,” Kramer says. But when it comes to minor side effects, Chaffin recommends looking at the bigger picture: “In general, the quality of life and safety of Mom and baby outweigh the side effects.”

How long does postpartum psychosis last?

How long postpartum psychosis lasts can depend on the person’s individual circumstances and how quickly they receive help. With proper care and treatment, some cases may resolve in a few weeks, Hafeez says, while others may take months. “Early intervention can help improve outcomes and speed up recovery,” Hafeez adds. If left untreated, the outcomes of postpartum psychosis can be devastating. Plus, since postpartum psychosis can recur under select triggers, it’s essential to keep an open line of communication with your ob-gyn and other medical caregivers.

Are There Ways to Prevent Postpartum Psychosis?

While there’s no way to completely prevent postpartum psychosis, there are steps you can take to manage certain risks, says Chaffin. She emphasizes that having a great support system is crucial. Plus, it’s also important to proactively get counseling for any personal and family mental health concerns early on. “For my clients who have a history of bipolar, we come up with a post-birth plan to implement and have ready for when baby comes,” Chaffin says. “If financially possible, I encourage them to have a postpartum doula to check in with them all the time.”

How to Help Someone With Postpartum Psychosis

It’s no secret that new moms in the US are severely underserved when it comes to adequate postpartum resources, especially for mental health. Many women aren’t taken seriously or don’t get the level of support and care they need. “Everyone just sort of expects them to pull themselves together or [for it to] fade away,” Kramer says. “Yes, that may happen, but it can take some time—and in the process, we may be leaving a lot of women in pain and shame.”

It can be hard to watch a loved one struggle, but there are several ways to help:

  • Be intentional about a postpartum support plan: Take steps to ensure the new mom in your life is getting enough sleep and rest during those early weeks with baby, and offer to help out around the house, do chores, make meals and pitch in.

  • Don’t judge them—ever: “Stay out of judgment,” Chaffin says. And take their concerns seriously. The postpartum period is incredibly challenging and comes immediately after the difficult journey of pregnancy. “Anyone can get postpartum psychosis,” Chaffin adds. “It’s not a mental failing, and it doesn’t mean that [they’re] flawed or evil. It’s okay to ask for help and to build a supportive community.”

  • Ensure their doctors are looped in: If the new mom hasn’t been able to do so, ensure her ob-gyn and other providers are looped into any concerns and prior history, Kramer says. This way they can work together to find the best postpartum care plan.

  • Don’t leave them alone: Postpartum psychosis—and many other postpartum mental health disorders—can be hard to spot, but if your gut feeling is that it isn’t safe for them to be alone, ensure that someone stays with them.

  • Seek help immediately: While there’s not much that can be done to mitigate postpartum psychosis symptoms without treatment, it’s imperative for loved ones to seek help immediately if they spot any postpartum psychosis symptoms or warning signs. Flag these symptoms with the new mom’s ob-gyn or another medical health provider, or head straight to the emergency room.

Postpartum mental health should be a priority for every new mom. The idea of postpartum psychosis is incredibly scary, but timely treatment and attention can make all the difference.

About the experts:

Sanam Hafeez, MD, is a neuropsychologist based in New York City and the founder of Comprehensive Consultation Psychological Services, which supports mental health advocacy and special education. She received her doctorate at Hofstra University and completed her postdoctoral work in neuro-developmental psychology at Coney Island Hospital. She’s also part of Columbia University’s faculty for their PhD program in clinical psychology.

Carolyn Rubenstein, PhD, is licensed psychologist in Florida, as well as the author of Perseverance: How Young People Turn Fear into Hope—and How They Can Teach Us To Do The Same. She earned her bachelor’s degree from Duke University; her master’s degree in psychology from Harvard University and her doctorate degree in counseling psychology from the University of Miami.

Kylie Chaffin, MA, is a licensed therapist, perinatal mental health counselor and founder of The Spokane Counselor in Washington state. She received her undergraduate degree in psychology from Brigham Young University, Idaho, and her master’s degree in community counseling from the University of Detroit Mercy.

Abbie Goldberg, PhD, is a professor of psychology at Clark University in Massachusetts. She earned her bachelor’s degree from Wesleyan University and her master’s degree and doctorate from the University of Massachusetts. She has been a professor with Clark University since 2005.

Laurie Kramer, is a licensed psychologist and a professor of applied psychology at Northeastern University. She received her bachelor’s degree in psychology from Stony Brook University and her master’s degree in psychology from Long Island University. She earned her doctorate in clinical psychology from the University of Illinois and completed her residency at Northwestern University’s Feinberg School of Medical and the Family Institute of Chicago.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

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