Postpartum Psychosis

Aug 26

What it is, how to spot it, and what to do if you or someone you love experiences this rare and serious but treatable disorder.

EMERGENCY NOTICE / READ THIS FIRST
Postpartum psychosis is a medical emergency. If you or someone you know is experiencing severe mood changes, hallucinations, paranoia, or thoughts of harm, please seek immediate help:
Call 911 or go to the nearest Emergency Room.
Call/Text 988 for the Suicide & Crisis Lifeline (US/Canada).
Call/Text 1-800-944-4773 for Postpartum Support International (PSI).

Every few years something happens that forces the topic of perinatal mental health into wider conversation. Unfortunately, due to the nature of our news cycle, that something often involves unspeakable tragedy. If you follow the news or your social media algorithms are anything like mine, you have probably been seeing a lot about the Lindsay Clancy trial lately. I won’t speak to the details of the tragedy beyond expressing how much my heart goes out to the family and everyone involved. While I won’t offer my opinion on clinical aspects of the trial, as a certified perinatal mental health provider, I have found myself engaging in increased discourse about postpartum psychosis and other perinatal mood and anxiety disorders (PMADs) in general.

Growing, birthing and caring for a baby is an extraordinary feat that brings about immense change on a literal cellular level. The emotional and physical changes the birthing body undergoes are massive, and the hormonal shifts after giving birth, along with sleep deprivation, physical recovery, and adjustment, all while being responsible for the life of a fragile, defenseless human can understandably be destabilizing. Most birthing people experience some temporary shifts in mood caused by the plunge in the hormones estrogen and progestrin stored in the placenta. This period of emotional lability is what’s known as the “baby blues,” and affects up to 80% of birthing people in the first two weeks after birth. The baby blues can cause mood swings, tearfulness, feelings of joy followed by sadness, tend to peak within 3-5 days after delivery, and subside within two weeks.

While some fluctuations in mood and cognition are expected and typical after birth, about 1 or 2 in 1000 birthing people will experience a much more serious condition known as Postpartum Psychosis. Postpartum psychosis (PPP) is not the same as or caused by Postpartum Depression, but is rather a distinct disorder, with different symptoms, risk factors and speed of onset.

Symptoms and Onset

Symptoms of Postpartum Psychosis typically emerge within one to two weeks after giving birth, although can occur up to 6 weeks postpartum.

Typical Symptoms of Postpartum Psychosis include:

Hallucinations - seeing or hearing things that aren’t there, without being able to tell what is real vs. not real.
Delusions - Strongly held false beliefs, such as believing someone is trying to hurt you, or that you are being given special instructions from a real or imagined authority.
Mood changes - such as feeling down and detached, or manic or hypomanic (increase in energy or mood outside of typical energy fluctuations)
Depersonalization - a feeling of being outside of your body
Disorganized thinking or speech
Insomnia - not being able to sleep when the baby sleeps
Racing thoughts
Agitation or irritability
thoughts of self harm or thoughts of harming others, including the newborn

It is important to note that symptoms of psychosis can wax and wane, so an individual can be experiencing psychosis and present typically to family members or providers depending on the moment in time. If you are a provider in an emergency or other clinical setting, it is important to conduct a thorough assessment and gather information from close family and friends to develop an accurate diagnosis and evaluation of risk.

Risk Factors

Below are some of the known risk factors of developing Postpartum Psychosis. Please note, that while these factors can increase risk, they do not mean that someone will necessarily develop PPP.

personal or family history of certain mental health disorders
- the most common co-occurring diagnosis for postpartum psychosis is bipolar I or bipolar II disorder. Psychosis occurs in 20-30% of women with known Bipolar Disorder.
- Other diagnoses that are correlated with risk are disorders on the schizophrenia spectrum and major depressive disorder.
sleep deprivation
- Prolonged sleep deprivation can have a significant impact on mood and cognition. For individuals with bipolar disorder, sleep deprivation can induce a manic episode, making birthing people with bipolar disorder highly vulnerable to postpartum psychosis if not treated in postpartum.
First baby
- first time birthing people are more at risk for developing postpartum psychosis.
Previous bipolar episodes, psychosis or postpartum psychosis
- While first time birthing parents are at a higher risk, 30-50% of people who have had postpartum psychosis are at risk for developing it again in subsequent pregnancies.
Discontinuation of a mood stabilizer
- As bipolar disorder is a known risk factor for developing PPP, for birthing people with this diagnosis it is very important to consult with a psychiatrist or psychiatric NP with a background in reproductive health to determine the safest course of treatment for birthing person and baby.
Obstetric complications
Perinatal or neonatal loss

Differentiating between Intrusive Thoughts/Perinatal anxiety or OCD and Postpartum Psychosis

Up to 80% of birthing people experience intrusive thoughts after giving birth, and these can include thoughts of intentional or accidental harm coming to baby. Intrusive thoughts in postpartum are often repetitive, and highly distressing. These thoughts can get stuck in a “what if” cycle, lead to feelings of guilt and shame, and can create behaviors such as hypervigilence and lead to behaviors aimed to avoid harm or reduce triggers.

Intrusive thoughts are common, can be highly upsetting, and can lead to extreme anxiety or compulsions to reduce or avoid the thoughts. Perinatal Anxiety and Perinatal OCD are worthy of (and will receive!) their own blog post, and it is always okay to reach out for help if you are disturbed by these thoughts or if you find yourself preoccupied with the thoughts themselves or behaviors to try to avoid them. However, intrusive thoughts are not the same as or indicators of PPP.

Intrusive thoughts in postpartum are ego dystonic, meaning they are distressing to the person experiencing them because they are not in line with their goals and values. In fact, intrusive thoughts are thought by some to be an adaptive reminder that we are taking care of a baby, and so shouldn’t, say, drop the baby down the stairs (thanks brain!) Most importantly, the parent recognizes the intrusive thoughts or images as unhealthy.

In PPP, on the other hand, thoughts may be ego syntonic (although not always), meaning the parent may have less anxiety around these thoughts, may not recognize the thoughts that the actions or thoughts are unhealthy, and may have minimal insight about the distortion of the thoughts.

Perinatal anxiety and OCD poses a low risk to the baby and birthing person as typically the person experiencing them is distressed by the thoughts, does not want to harm their baby, and has taken steps to minimize risk. Postpartum psychosis, on the other hand, is high risk, as they indicate a loss of touch with reality, may be delusional in nature, and are either not distressing to the person experiencing them, or may be distressing but the person may feel compelled to act on them.

If you are not sure if what you are experiencing is postpartum psychosis or perinatal anxiety or OCD, do not be afraid to reach out to a professional to discuss your experiences and to find help and support.

Reducing Risk and Accessing Help

It is very important to note that the vast majority of birthing people who experience Postpartum Psychosis do not harm their baby. Postpartum psychosis is treatable, and most people who experience it will recover and go on to be excellent parents and live rich, fulfilling lives. Recovery is dependent on treatment, however, so it is essential to seek treatment IMMEDIATELY if you are experiencing any of the symptoms listed above.

As a history of Bipolar Disorder is the strongest risk factor for PPP and discontinuing mood stabilizers also increases risk in postpartum, if you are pregnant and have a diagnosis of Bipolar Disorder and are considering or being advised to discontinue medications, it is very important to consult with a provider who specializes in perinatal mental health to determine the best course of treatment for you.

Protecting sleep is a huge protective factor against not just PPP, but all PMADS. Developing a postpartum support plan prior to giving birth or taking over care of a newborn can be very helpful in ensuring the birthing parent is able to get enough rest (reach out to book your free consultation if you would like to discuss postpartum support planning and ensuring mental health supports after birth).

Conclusion

There is a lot of misinformation about Postpartum Psychosis, and while it is a very serious medical complication related to childbirth, like all PMADS, it is also very treatable when birthing and their support people are empowered with information and awareness. If you are curious about learning more about perinatal mood and anxiety disorders please reach out to book a consultation, or check out my class on September 18th, at the Honest Weight Food Coop in Albany.