September 29, 2020

By Nicole Arzt, LMFT

Postpartum psychosis is a rare but severe condition that refers to a temporary break from reality after giving birth. This experience can be incredibly scary for new mothers, their partners, and surrounding loved ones.

It’s crucial to understand the risk factors and symptoms associated with this disorder. If you think you are struggling, help is available, and it’s important to reach out for support. Let’s get into what you need to know.

Psychosis vs. mania vs. bipolar disorder

A manic episode refers to having an elevated mood characterized by racing thoughts, easy distractibility, and a reduced need for sleep. People often feel a sense of euphoria or invisibility during a manic episode.

Extreme mania can lead to psychosis. Psychosis refers to the loss of contact with reality through symptoms like delusions, hallucinations, and rapid mood swings. During this time, a person experiences false beliefs (known as delusions) or might see or hear things that are not there (known as hallucinations). It can be hard to distinguish what is legitimately real or not.

Both mania and psychosis may be isolated, or a symptom of bipolar disorder. Bipolar disorder is typically characterized by two phases, mania and depression. Bipolar disorder, mania, and psychosis can all develop at any time, but the risk is higher during pregnancy or postpartum.

Are postpartum hallucinations normal?

Almost all new mothers experience intrusive thoughts, which may be disturbing or uncomfortable. Intrusive thoughts do not necessarily indicate psychosis. You should be concerned if you feel obsessed or paralyzed by these thoughts. Moreover, if you start experiencing joy or relief instead of distress, the thoughts could indicate psychosis.

Related: What does it mean if I’m having scary or intrusive thoughts?

What is postpartum psychosis?

Compared to other perinatal mood disorders, postpartum psychosis is rare. It affects approximately 1-2 women out of every 1,000 deliveries (0.1-0.2% of births).

The common symptoms of postpartum psychosis include:

• Experiencing delusions or strange beliefs
• Experiencing hallucinations (seeing, hearing, or feeling sensations that are not there)
• Extreme and rapid mood swings
• Difficulty with communication
• Paranoia and suspiciousness
• Hyperactivity
• Decreased need for inability to sleep
• Excess irritability
• Feeling like a “super mom” due to intense levels of energy
• Believing that the baby is connected to God or the Devil
• Disorientation and confusion
• Believing that certain things/events are connected in special ways (i.e., TV shows have certain personal meanings)

How do I know if I am at high risk for postpartum psychosis and what can I do about it?

For some mothers, this condition may emerge suddenly, and without any real warning. However, certain risk factors may increase the likelihood of developing postpartum psychosis, including:

• Having a past history of psychotic episodes
• A personal or family history of bipolar disorder or schizoaffective disorder

There isn’t a method for completely preventing postpartum psychosis. However, high-risk populations can take some precautionary steps in advance.

If you intend to have a baby, let your psychiatrist and primary care provider know your plans ahead of time. They can help assess appropriate medication and advise you on how to take care of yourself. If you don’t have a psychiatrist, your primary care provider can refer you to a perinatal psychiatrist—a professional who specializes in pregnant and postnatal women with histories of mental health conditions.

If you’re already pregnant, it’s crucial to share your mental health history with everyone on your care team. They need to know that you are at a higher risk for postpartum psychosis, so that they can facilitate appropriate care and support for you and your baby.

It’s a good idea to identify your personal triggers associated with mania or psychosis. Triggers may include high levels of stress, changes in sleep patterns, seasonal changes, and abusing recreational drugs and alcohol.

Of course, many of these triggers are prevalent in pregnancy and after the baby is born. It’s crucial to reach out for help and talk to your loved ones. You should have a plan to manage stress, get enough sleep, and feel supported during this time.

If I had postpartum psychosis once, will I experience it again in future pregnancies?

Women who have a previous postpartum psychotic episode have a 50% risk for developing it again. However, taking precautionary steps may reduce some of the risk.

How long will it take me to recover and how will this affect care for my baby?

If you begin developing postpartum psychosis symptoms, seek immediate evaluation. Call your primary care provider to schedule a same-day appointment. If that’s not an option, go straight to the emergency room.

Most women need hospital treatment during this time, ideally in a mother and baby unit. Those units allow both mothers and babies to admit together. This opportunity allows trained staff to support you in bonding with your child. It also provides practical help in taking care of a newborn.

If that option is not possible, you may need to admit to a general psychiatric ward. In those instances, a partner or family member or another temporary guardian will look over your baby until you are well enough.

Most mothers benefit from antipsychotic medication, mood stabilizers, or both. It’s still possible to breastfeed while taking medication. However, some women may not feel well, or they are physically apart from their baby. If you feel guilty or ashamed, remember that psychosis is never your fault, and you are doing what you can to take care of yourself and your baby.

The most severe symptoms tend to last for 2-12 weeks. It can take 6-12 months or more to recover from postpartum psychosis. Most women recover fully.

Partners can play an important role during this time. They should aim to remain calm and supportive. They can also provide practical support in looking after the baby, helping with housework and cooking, and letting the mother get as much sleep as possible.

After an episode, you may feel more depressed, anxious, or ashamed. It may take some time to accept what happened, and it is normal to grieve parts of early motherhood. However, most women get back to feeling like their usual selves.

Final thoughts

While postpartum psychosis can be frightening, treatment is available. If you are pregnant (or planning to be), and feel concerned about your risk, talk with your care team. They can provide you with the support and resources you need during this time.

Sources:

Bergink, V., Rasgon, N., Wisner, K. L. (2016). Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood. American Journal of Psychiatry, 173:12, 1179-1188

Sit, D., Rothschild, A. J., & Wisner, K. L. (2006). A review of postpartum psychosis. Journal of women's health (2002), 15(4), 352–368. https://doi.org/10.1089/jwh.2006.15.352

Bipolar Psychosis (2018). Retrieved from https://www.medicalnewstoday.com/articles/314450#bipolar_psychosis

Nicole Arzt is a Licensed Marriage & Family Therapist with nearly a decade of experience treating women's issues related to parenting and family dynamics, complex trauma, and substance use disorders. She is the proud mama of her newborn son.