Postpartum Psychosis Awareness: Signs to Know
Medically reviewed by Peter Weiss, MD
Postpartum psychosis (PPP) is a rare and severe mental health emergency requiring treatment. It occurs in about 1 to 2 out of every 1,000 births. PPP typically begins between 24 hours and three weeks after delivery. The onset of PPP is sudden and may involve:
Erratic behavior
Mood swings
Not sleeping
Altered sense of reality
Confusion
Violent thoughts
This article reviews the link between postpartum and psychosis, emergency signs and symptoms, stigma, and treatment.
Dobrila Vignjevic / Getty Images
Related: What Is Postpartum Depression, and What Helps?
What’s the Link Between Postpartum and Psychosis?
Childbirth can trigger mental health disorders such as PPP. The highest risk for developing PPP is within the first two weeks after birth. The onset of this condition could be due to a sudden drop in reproductive hormones such as estrogen or an increase in the stress hormone cortisol, but research is unclear.
Postpartum Psychosis (PPP) Diagnoses
While the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) contains diagnostic criteria for psychosis, it does not contain PPP-specific criteria. This can make diagnosis challenging as PPP often presents differently than other types of psychosis.
Hormonal shifts can impact neurotransmitters (chemical messengers) in the brain and change brain function. These changes occur in the area of the brain that regulates mood, thoughts, and perception.
A history of mental health conditions, such as bipolar or schizoaffective disorder, is the most significant risk factor. PPP affects 20% to 30% of those with bipolar disorder. However, anyone can get PPP, and only 33% have a prior psychiatric history.
The following are other risk factors.
Stopping bipolar disorder medication
Being a first-time mother
Having a genetic predisposition (runs in families)
Not getting enough sleep
Experiencing immune system changes
Having inflammatory disorders like thyroiditis (swelling of the thyroid)
Experiencing pregnancy complications (including preeclampsia, which is high blood pressure during pregnancy)
Postpartum Mental Health Comorbidities
While each of the following mental health concerns is a unique, separate disorder, childbirth can trigger them independently or alongside another mental health condition, including the following:
Depression
Generalized anxiety disorder
Schizophrenia spectrum disorder
Substance use disorder
Emergency Signs Someone May Have Postpartum Psychosis
In addition to hallucinations and delusions, PPP may also present with mania, depressive symptoms, cognitive problems (such as disorganized thoughts), or a mixture.
Early warning signs of PPP may include:
Insomnia (not sleeping, especially for over 48 hours)
Mild confusion
Anxiety
Irritability
Mood swings (anger, irritability, uncooperative)
Not caring for their self (neglecting hygiene and grooming)
Emergency signs that someone may have PPP and need immediate medical intervention include:
Disorganized thoughts and speech
Disorientation or confusion.
Violent thoughts
Severe mood swings
Disturbed sleep
Catatonia (being "frozen" or rigid)
Refusing food or water
Suicide Prevention
If you have thoughts of harming yourself or your baby, immediately ask your partner or a loved one to take care of the baby. Call or text the 988 Suicide & Crisis Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one is in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
Postpartum Psychosis and Hospitalization
Postpartum psychosis is a mental health emergency requiring immediate psychiatric evaluation and hospitalization. It is an emergency because it is associated with a high risk of maternal suicide or infanticide.
Hospitalization provides specialized care from mental health providers, monitoring, and medical treatment that protects the parent from hurting themselves or their babies.
Severe symptoms of PPP typically resolve within two to 12 weeks of starting treatment. However, it can take up to a year to completely recover.
Stigma Around Postpartum Psychosis
The stigma (negative attitudes, beliefs, stereotypes) surrounding PPP can harm the individual and family coping with this condition.
Many people lack accurate information about PPP, leading to misconceptions and misunderstandings, harsh judgment, and blame. Some may misperceive PPP as a personal weakness. However, this is not the case, as PPP is a medical condition.
This stigma that comes with PPP discourages people from getting the help they need due to fear of judgment or rejection. The delay in treatment has severe consequences for their well-being and the safety of their baby.
It's essential to raise public awareness and provide accurate information to decrease misconceptions and change the stigma surrounding PPP.
Racial Disparities
Research shows disparities (unequal treatment or access to care) for psychosis among people in traditionally underrepresented communities, including people of certain racial and ethnic groups. Racial disparities can cause mistrust in the healthcare system, impacting treatment.
Some key factors contributing to racial disparities include:
Misinterpretation of cultural expressions that influences how providers perceive and diagnose symptoms
Decreased access to care and insurance
Treatment disparities (less likely to receive treatment, which increases the risk of poor outcomes)
Higher risk of misdiagnosis
Higher risk of involuntary hospitalizations
Medications to Treat Postpartum Psychosis
Medications to treat PPP include:
Benzodiazepines (benzos): Medications like Ativan (lorazepam) quickly create a calming effect. They are typically a short-term solution due to the risk of dependency or drowsiness.
Antipsychotics: Medications like Haldol (haloperidol) can help manage hallucinations, delusions, and disorganized thinking.
Mood stabilizers: Mood stabilizers like Lithobid and Eskalith (lithium) decrease mania. They are typically given for several months to help prevent remission (return).
Antidepressants: In some cases, antidepressants are necessary to treat people with coexisting depression.
Electrical convulsive therapy (ECT): ECT is when providers send small amounts of electricity to the brain under general anesthesia (medications to make a person sleep). While highly effective, providers typically reserve it for severe cases.
Complementary Therapies During Postpartum Psychosis Treatment
Complementary therapies can be valuable for stress reduction, relaxation, and well-being. However, for those with PPP, they should not be the primary initial treatment. They should occur in addition to medical treatment.
Examples of complementary therapy include:
Yoga
Mindfulness and meditation
Deep breathing, such as the 4-7-8 technique (breathing in for four counts, holding that breath for seven counts and exhaling for eight counts)
Massage therapy
Aromatherapy (inhaling essential oils like lavender or bitter orange)
Acupressure, or foot reflexology (applying pressure to specific areas to help relieve symptoms)
Art therapy
Music therapy
Consult a healthcare provider before considering any natural supplement or herbal remedies, as they could decrease the effectiveness or interact with medications that treat PPP.
Postpartum Psychosis Patient Support
The following are some possible forms of support for those recovering from PPP:
Family meetings: It can be helpful to have family meetings to discuss treatment progress or ways to give the primary caregiver breaks.
Healthcare providers: Once home from the hospital, attending medical appointments and regularly communicating with providers is essential.
Child Protective Services (CPS): In some cases, CPS respresentatives monitor the infant's safety.
Therapy or counseling: This involves mental health therapy for the person with PPP, the caregivers, couples, or the family. You can try virtual counseling services if appropriate.
Online organizations: Postpartum Support International (PSI) is an organization that can help you connect with a postpartum psychosis coordinator, support groups, and educational resources.
Postpartum doula: A doula is a trained professional who can provide physical, emotional, practical, and informational support.
Social support: Friends and family can help with daily tasks and caring for the infant.
Respite care: The primary caregiver of the person with PPP must take breaks. Trusted loved ones or professional caregivers can help offer this support.
Self-care: Encourage the person to eat nutritious meals, perform light exercise, get plenty of water, and engage in self-care activities that promote relaxation, stress reduction, and well-being.
SAMHSA National Helpline
The Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-HELP (4357) provides around-the-clock information and referrals if you or a loved one are facing mental health or substance use issues. This confidential service does not provide counseling but can direct you to helpful resources, treatment facilities, and support groups in your area.
Summary
Postpartum psychosis PPP is a rare and severe mental health crisis that involves erratic behavior, mood swings, altered sense of reality, confusion, and sometimes violent thoughts. It requires emergency medical treatment and, often, hospitalization. However, with treatment, it is reversible. It's essential to address the stigma surrounding this condition by raising awareness and providing accurate information to increase understanding.
Read the original article on Verywell Health.
