Postpartum psychosis: How to spot the symptoms and what to do next

It’s no secret that having a baby is a huge life change that can turn your world upside down. Thanks to hormonal changes, broken sleep, and the responsibility of caring for a newborn, the first few weeks after birth can be a challenging time for new parents. 

These first weeks after you’ve given birth are called the postpartum period. There’s currently some discussion about how long the postpartum period should be defined. It’s often considered to be the first six to eight weeks after you’ve given birth. However, pregnancy and birth can impact everyone’s bodies differently. This is why the American College of Obstetricians and Gynecologists considers the postpartum period to extend up to 12 weeks after birth. You might have heard this time referred to as the fourth trimester.

A small percentage of new moms will experience a form of mental illness after giving birth that requires urgent medical attention. If you or your loved ones notice that your moods become erratic or extreme, you have less need for sleep and don’t feel tired, you start to have thoughts or beliefs that are unlikely to be true, or you see or hear things that don’t exist outside of your mind, you might have postpartum psychosis.

If you suspect that you or someone close to you might be at risk, get help immediately. Postpartum psychosis is rare and affects about one or two in 1,000 new moms, but it’s considered to be a mental health emergency. Left unchecked, it can be serious for you and your baby. It can be a confusing and sometimes frightening experience, but if you act fast and get the right treatment and support, most moms will fully recover.

Here, clinical psychologist Kelly Vincent, Movement Therapy Spaces, California, US shares everything you need to know about postpartum psychosis.

Key takeaways

• Postpartum psychosis is rare and affects about one or two women out of 1,000 after childbirth.
• Symptoms can develop within the first few days after you’ve had your baby up until around six weeks.  
• Early treatment increases the odds of a good outcome, so it’s important that you get help right away. 
• Postpartum psychosis can affect anyone who recently gave birth, even if they’ve never experienced a mental health problem before.

What is postpartum psychosis?

Postpartum psychosis (also known as puerperal psychosis) is a mental health emergency that affects a small number of women after giving birth. “This change in behavior and thought process is due to several factors,” says Vincent. “There are physical and hormonal changes, lack of sleep and exhaustion, and the beginning of a new role and commitment in caring for a newborn, which are both physically and emotionally challenging.”

It’s common for new moms to experience mood changes after having a baby. But postpartum psychosis affects your sense of reality. Symptoms can include “extreme confusion, loss of touch with reality, paranoia, delusions, disorganized thought processes, and hallucinations,” explains Vincent.

If you or someone close to you experiences symptoms, it’s important that you reach out to a medical professional and request an urgent assessment. Although rare, postpartum psychosis is considered a psychiatric emergency that “warrants immediate medical and psychiatric attention and hospitalization if there’s a risk of suicide,” warns Vincent. It can be a frightening experience, but this is a very treatable condition. With the right treatment and support, you have a really good chance of getting better.

Postpartum psychosis symptoms 

According to Vincent, common symptoms of postpartum psychosis include:

• Delusions and hallucinations or strange beliefs
• Irritability
• Severe depression
• Flat affect: when a person shows no emotion or verbal reaction to how they feel
• Depersonalization: when it feels like everything that is happening to you is detached or out of body
• Anxiety or feeling guilty 
• Rapid mood changes
• Difficulty communicating, talking more or faster than usual, or stumbling over words
• Feeling confused
• Insomnia and not feeling the need to sleep as much
• Increased energy despite lack of sleep

It’s worth noting that people with postpartum psychosis can’t always recognize their own symptoms or understand that something is wrong. So, if you are acting on behalf of a loved one and any of the symptoms mentioned above sound familiar, get help.

How you might feel

Symptoms can vary a lot and change very rapidly, but in most cases, people who are experiencing postpartum psychosis might experience psychotic symptoms such as delusions or hallucinations:

• Delusions are strong beliefs that are unlikely to be true, for example, that people can read your mind, someone is trying to hurt you or your baby, or that you have special powers. 
• Hallucinations are when you experience things that others around you don’t, such as hearing voices that don’t exist outside of your mind or seeing things that no one else can.

Postpartum psychosis can also closely resemble an episode of bipolar illness. You might have dramatic mood changes and feel very sad one moment and very happy the next, or you might feel confused or disoriented.

How you might act

From the outside, you might appear to be restless, irritable, or erratic and behave in a disorganized or manic way. 

“The individual might not be acting like themselves,” says Vincent. “They may appear out of touch or disconnected from themselves or the outside world.” You might notice that this behavior appears periodically, and at other times, your behavior is more normal. This is why postpartum psychosis is sometimes described as having a “waxing and waning” character, and it makes diagnosis more challenging.

Only a small number of women experience violent tendencies or delusions, but psychosis can put both you and your baby at risk, so it’s vital that you get urgent medical help.

When to get help

Symptoms of postpartum psychosis should always be treated as a medical emergency. “Seek help immediately,” advises Vincent. “If you are experiencing any of the associated symptoms, please contact a maternal mental health provider or your obstetrician and gynecologist (OB-GYN).” You can also go to the emergency room at any time, day or night.

With the help of a combination of medication and therapy, you have a very good chance of getting better. You might need to spend time in the hospital but try to remember that you’re in a safe space where you can rest and recover. It may take a little bit of time, but remember, you will then be able to go on to enjoy this precious time with your new baby.

Causes of postpartum psychosis

It’s not clear what causes postpartum psychosis, but a number of things can increase your risk. “The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder or a previous psychotic episode,” says Vincent. 

That said, postpartum psychosis can affect anyone who recently gave birth, even if they’ve never experienced a mental health problem before. “It’s important for women and their loved ones to be aware of the signs and symptoms of postpartum psychosis and to seek help immediately,” adds Vincent.

What to do if you’re at high risk of postpartum psychosis 

If you’re at high risk of developing perinatal mental health issues of any type, you should receive specialist care during pregnancy and the postpartum period. Psychosis is usually only temporary, and following proper treatment, most people make a full recovery, but it is important to know what to do if it happens:

• Talk to your doctor about your risks: Postpartum psychosis can happen to anyone who gives birth, but the odds of having it are higher for people with certain mental health conditions. If you have previously been diagnosed with bipolar disorder or schizophrenia or you have a family history of these conditions, let your doctor know as soon as possible. They can refer you to a perinatal or reproductive psychiatrist, which is a specialist doctor who can support you during this time. They may also provide you with the names of charities and organizations dedicated to spreading awareness and support for people who are at risk of developing postpartum psychosis and their loved ones.
   
• Make a care plan: Make a care plan with your crisis team so that if you do become unwell, they can act fast and speed up your recovery. “Talk with your OB-GYN when you confirm your pregnancy,” says Vincent. “It may be helpful to have both your medical and mental health providers collaborate on a preventive plan to ensure you are provided with the support you need leading up to the birth and in those critical weeks after delivering.”

• Talk to your family about potential symptoms: It’s important that you share your care plan with your family and friends and talk about potential symptoms. If you have postpartum psychosis, you may not realize you’re ill. Those closest to you will need to know the signs so they can take action. That way, if you are unable to make decisions, your family can advocate on your behalf for your safety and that of your baby.
   
• Discuss treatment options with your psychiatrist: It might also be helpful to take a trusted relative or friend to the consultation so that you feel supported and everyone is kept informed.
   
• Seek support: Postpartum psychosis can be a frightening experience, and you might feel isolated and alone. Surround yourself with a supportive network of family and friends, and join online support groups to connect with other moms who are going through something similar. “It may be helpful to seek support from family and friends and to participate in therapy or support groups,” says Vincent. “It’s important to remember that recovery takes time, and it’s OK to ask for help along the way.”

If you’ve been affected by anything in this piece or are struggling with your mental health and would like to speak to someone, Flo has gathered links to support services that might be helpful. Please visit this page for helplines in different countries.

Treatments for postpartum psychosis 

Postpartum psychosis is a medical emergency, so you will need urgent care. Fortunately, psychosis is treatable, and a few different approaches may work. “The best treatment options typically involve a combination of medication and therapy,” says Vincent. 

“Hospitalization may be necessary to ensure the safety of both the mother and the baby.” Everyone responds differently to treatment combinations, so your doctor will discuss your options with you so that you can make a decision together.

In some parts of the world, treatment may be provided in a psychiatric mother–baby unit so your baby can stay with you while you receive care. You may be placed in a general psychiatric ward or hospital, which may mean you can’t stay together with your baby during your treatment. This may sound incredibly scary, but many units encourage visiting during the course of treatment. 

You may also be offered a type of talk therapy alongside medication. Postpartum psychosis can be very traumatic, so talking about it can help you process your experiences and make sense of it. 

Your doctor may also suggest solo or group counseling sessions along with techniques such as meditation, relaxation exercises, and mindfulness to help you look after your mental health. “Therapy, including individual and group therapy, can be beneficial in helping new mothers learn coping strategies and manage stress,” says Vincent. 

Medications

Treatment for postpartum psychosis usually involves medication. Your doctor will sit down with you and a loved one to jointly decide on the best option for you. You may not be in a position at the time to make decisions about medication, but your doctor will work closely with you and your loved one. According to Vincent, you may be prescribed one or more of the following:

Antipsychotics: Antipsychotic medications are often prescribed to help manage symptoms such as hallucinations and delusions.

Mood stabilizers: Mood stabilizers and antidepressants may also be used to help regulate mood and reduce anxiety.

Electroconvulsive therapy (ECT)

If you experience a severe psychotic episode, electroconvulsive therapy (where small electric currents are passed through the brain) may be recommended if all other treatment options have failed or when the situation is thought to be life-threatening.

Tips for managing your symptoms and mental health

People with postpartum psychosis often lose contact with reality and aren’t actually aware that they’re experiencing a mental health emergency, so it isn’t a condition that you can manage on your own. That said, in addition to following your care plan while you recover, there are a few things you can do at home. 

According to Vincent, the following lifestyle choices can help you manage your mental health:

• Getting enough sleep
• Eating a healthy diet
• Staying physically active
• Avoiding alcohol and drugs

Experiencing mood changes after having a baby can be overwhelming, but help is available. If you feel at risk of harming yourself or others, call emergency services immediately.