Understanding Postpartum Psychosis

After giving birth, there are a number of challenges ahead – feeding, managing sleep schedules, making sure the baby is healthy, and many more.

Some people live with postpartum depression or anxiety in the weeks after having their baby – roughly 12 percent of new mothers, according to some estimates. Postpartum psychosis occurs much less often – for about 0.1 percent of new mothers – but the signs appear more quickly and are more noticeable to others.

Jennifer Richman, MD, is the Associate Director for the Psychiatric Medicine Residency Program at Rochester General Hospital and explains what we know about postpartum psychosis, what to do if you think someone is experiencing it, and how the condition is treated.

What is postpartum psychosis?

Postpartum psychosis is a severe mental health disorder that affects people who recently give birth to an infant. People diagnosed with postpartum psychosis experience a total disconnect from reality, often with hallucinations and paranoid delusions.

“It is important to treat postpartum psychosis quickly because there is a high risk of harm for both the mother and infant,” Dr. Richman said.

People with an increased risk of developing postpartum psychosis include:

• Those with a history of bipolar disorder
• Those with a history of schizophrenia
• Those who were diagnosed with postpartum psychosis after a previous birth

A majority of women diagnosed with postpartum psychosis did not have any risk factors before giving birth. However, anyone with any risk factors who is considering becoming pregnant should talk with their OBGYN about taking medication to reduce the risk of postpartum psychosis.

Signs of postpartum psychosis

Both postpartum depression and postpartum anxiety tend to develop within 4 weeks to a year after giving birth. Signs of postpartum psychosis start to show up within a few days to one month after someone delivers their baby.

Symptoms of postpartum psychosis might include:

• Delusions
• Depression
• Disorganized thought process
• Extreme confusion
• Hallucinations
• Loss of sense of reality
• Paranoia

“Most patients will not realize they are behaving differently. Their partner or family will realize it,” Dr. Richman said. “Usually, it consists of very bizarre behavior – the person not acting like their normal self. What they say in a conversation is not in the logical realm of discussion. They may talk about people trying to hurt them or the baby. It is not subtle.”

If you or someone you know is experiencing the signs and symptoms of postpartum psychosis, visit one of our Emergency Centers

Diagnosing and treating postpartum psychosis

Postpartum psychosis is a psychiatric emergency and needs to be diagnosed at a hospital or other location where someone can be admitted to stay. The best place to go for a diagnosis would be an emergency department.

Once a person arrives, they will be clinically interviewed and evaluated by a psychiatrist. If diagnosed with postpartum psychosis, the patient will be admitted to the hospital for treatment.

Patients with postpartum psychosis are treated using medication for their symptoms. Medications might include:

• antidepressants
• antipsychotics
• mood stabilizers

In more severe cases, the FDA has approved electroconvulsive therapy as a treatment for patients with postpartum psychosis. After the psychosis has resolved, cognitive behavioral therapy (also called CBT or talk therapy) is also important.

Most patients require at least 1-2 weeks of inpatient treatment before they begin to return to their level of normal.

“Once the patient is treated, most women go back to their normal relationships with their family and babies,” Dr. Richman said. “These women don’t know what’s going on until it’s too late. The family is never wrong in bringing them into the emergency department.”