What Is Postpartum Psychosis (and What to Do About It)?

What is postpartum psychosis?

It's hard to imagine a mother who bears thoughts of harming her child. For most mothers, the child's safety is the main concern and an emotional need. Postnatal depression can grow into postpartum psychosis, putting both baby's and the mother's life at risk.

Risk of postpartum psychosis follows the sudden hormonal imbalance after giving birth. It strikes 1 in 1000 women who have given birth. Risk factors include history of bipolar or psychotic disorder, first pregnancy, family history, recent discontinuation of psychotropic medication. 

How does postpartum psychosis differ from postpartum depression and baby blues?

Baby blues disorder is common 2-3 days after childbirth but should pass. In some cases, the depressed mood lingers for more than 2 weeks and months after the labor, when some women receive a diagnosis of postpartum depression.

Unlike postpartum blues symptoms, postpartum psychosis is treated as a medical emergency and requires urgent treatment. Most women get committed to a mental hospital, residing either in Mother and Baby units, at the general psychiatric ward, or in postpartum depression treatment centers.

While it is the best for both the mother and the baby to stay together, more serious cases will require the mother to spend some time healing on her own before reuniting with the child.

What causes postpartum psychosis?

Exact causes of postpartum psychosis remain unclear, but symptoms of postpartum psychosis appear to be triggered by hormonal imbalances typical for the postpartum state, along with personal and family history of mental illness.

Mothers who have experienced postpartum psychosis can expect the same outcome with future pregnancies, as well as women who have from bipolar disorder or schizophrenia. 

What are the common symptoms?

Sudden mood swings, ranging from calm to frantic and paranoid, are typical postpartum psychosis symptoms. Mood swings after childbirth are common to a certain degree. If you're unsure whether or not your mood swings are within the range of normal, you can track them with Flo.

Postpartum psychosis strikes 1-2 out of 1000 women postpartum, affecting between 0.1 and 0.2% of births. Symptoms usually show about two weeks after childbirth. Newborn mothers might experience signs of being depressed, delusions and hallucinations, irritated feelings, decreased sleep or insomnia, hyperactivity, paranoid thoughts and irrational fears, sudden mood swings and problems with communication. 

Bipolar disorder, whether in personal or family history, is a known risk factor for postpartum psychosis.

Suicide and infanticide, the most devastating outcomes of severe postpartum psychosis, occur in between 4 and 5% of women afflicted with the illness. Tragic outcomes happen when the symptoms in a mother worsen to the point of detaching from reality. Mothers become deeply affected by irrational, paranoid ideas that make sense to them.

Most often, infanticide takes place when the mother believes that the child is in danger, often from supernatural forces, so ending the baby's life looks like the only remaining option. Tragic outcomes can only be avoided through urgent medical treatment.

What is the treatment?

Management of postpartum psychosis includes medication (atypical antipsychotic e.g. Olanzapine, Risperidone), mood stabilizer (Lithium, Valproate, Carbamazepine) or both psychotherapy, and hospitalization in more severe cases. Postpartum psychosis treatment also includes cognitive-behavioral therapy, which proved to be efficient in helping mothers cope with lingering symptoms.

Electroconvulsive therapy is mostly abandoned but helps in cases of severe depressive or manic episodes. With the right treatment, full recovery from postpartum psychosis is possible.

Can I help myself to cope with psychosis?

Postpartum psychosis can go undetected and pass spontaneously in many women. Considering the risks, the best way to help yourself is to surround yourself with support. Being open and honest about your feelings, thoughts and fears will help your family and friends understand your condition better.

Here are some of the things you can do to cope with postpartum psychosis:

• Be open about your thoughts, fears, and doubts. The postpartum period is always a rocky emotional and mental journey and a time of great mental adjustment. 
• Beat fear and shame. Most women who experience aggressive or irrational thoughts about themselves and their babies feel ashamed of talking about it. Sharing your thoughts with close ones helps them help you. Once you've experienced and received support, you will feel more confident in your recovery and gradually regain faith in your own judgment.
• Be kind to yourself and understand that postpartum psychosis doesn't define you. You're no less of a mother because you have a mental illness. You didn't choose to get sick, and you are equally valuable to your baby and your family regardless of your mental state.
• Follow your care plan. Stay devoted to taking medication as prescribed and keeping up with appointments. At times, you might too tired or drowsy to stay on schedule. Make sure to have a backup plan to meet all of your appointments, including someone to drive you and someone to stay with the baby.
• Focus on rest, recovery, and bonding with your child. Recovery from postpartum psychosis isn't the time to worry about housework. Rely on friends and relatives to help as much as possible so that you can spend plenty of time resting and bonding with the baby.

When should I seek professional help?

If you're feeling agitated, have trouble sleeping, or your mood swings are so severe that your family starts to concern, seek professional help. It will take some time to diagnose psychosis, and it will require many appointments and tests. Seek urgent help if you have suicidal thoughts, hallucinations, or feel aggressive towards your baby.

When will I get better?

Postpartum psychosis can disappear gradually in the months after labor, but can also linger for years. Those women who choose to speak openly about the illness and seek help, often find that peripartum psychiatrists and medication have a beneficial long-term impact.

Can I plan the second pregnancy?

You can plan as many children as you want, even with history of postpartum psychosis. However, you will have to set up a support system and be prepared for the illness right after childbirth. Those with high risk from postpartum psychosis should have a support team monitoring their state during the pregnancy and after childbirth.

If you're expecting to experience postpartum psychosis after childbirth, specialist care during the pregnancy, as well as consultations with a psychiatrist are a good way to support mental health. At around 32 weeks of pregnancy, everyone involved with your care, including family and friends, midwife, GP, and obstetrician, should meet to exchange information and agree on the postpartum care plans.

The best solution for your postpartum care is to define the treatment course after the delivery. Some women have symptoms so severe that they need to be admitted to the psychiatric ward right after the childbirth. Others rely on the help of friends and family with housework and the baby. In some cases, mothers are under constant supervision from family members and never left alone with the baby. Though it might seem unsettling to know you can't be alone with your child, this is the only way to ensure the safety of both of you. When someone is always present to help out with the baby, you are left with more time to recover and bond with the child.

The majority of postpartum survivors rarely or never experience violent tendencies and delusions. The vast majority of women who survive postpartum psychosis won't harm themselves or the baby. However, staying quiet about the debilitating condition and having in loneliness deprives both mother and the children of bonding and forming the strong connection that would otherwise occur.

Babies need a stable emotional environment for healthy development and mothers to deserve to feel comfortable and receive help and support from the loved ones. Being aware that their own thinking becomes irrational and that their judgment is impaired is a painful experience for a mother that affects the entire family.

Ultimately, maintaining the connection between the mother and the child is necessary for the sake of the baby's health and future mental stability. Understanding that a mother has a mental illness and that aggressive behaviors aren't an expression of a malicious character is important to support the pair. Whenever and for whatever reason this need is unfulfilled, it is the child that suffers the most.