Understanding postpartum psychosis

Symptoms include an inability to tell what’s real from what’s not. Moms may experience confusion, paranoia, severe mood changes, a decreased need for sleep, hallucinations like hearing voices or seeing things that others do not, and delusions, which are strongly held false beliefs (for example, believing your baby has been replaced by an impostor).

While the exact cause is not known, medical professionals believe there are multiple factors such as drastic hormonal shifts after childbirth, environmental factors like lack of sleep, and potential genetic vulnerabilities.

Women with a history of psychotic disorders or bipolar disorder or those who have had previous episodes of postpartum psychosis are at higher risk. A family history of these conditions can also play a role.

However, postpartum psychosis can occur in those with no prior psychiatric history. In many cases, a woman can exhibit signs of an underlying psychotic illness such as bipolar disorder during the postpartum period.

The symptoms of these two conditions can overlap at first, such as feeling overwhelmed, not being able to sleep and feeling more anxious. But with postpartum psychosis, women lose touch with reality.

Women with the condition may also not fully realize what is happening to them or that something is wrong. Postpartum depression is more common, and women typically recognize they are struggling and can better describe what they are feeling.

Intrusive thoughts are unwanted thoughts that cause significant distress. It is common to have intrusive thoughts in the postpartum period. For example, some may think, “what if I drop my baby while walking down the stairs?”

Parents have no intention of acting on these thoughts and often will avoid stairs altogether because of their fear of their own thoughts. These thoughts in of themselves do not signify postpartum psychosis. In postpartum psychosis, women experience an impaired sense of reality, hallucinations, delusions and disorganized behaviors. They may believe the experiences are real, rather than recognizing them as unwanted thoughts.

The encouraging news is that postpartum psychosis is highly treatable. Most people recover with appropriate care, which may include hospitalization, medications to stabilize mood or treat psychosis, psychotherapy and ongoing follow-up. Early treatment often leads to better recovery.

No, psychiatric medications do not generally cause psychosis. Psychiatric medications and mood stabilizers are actually commonly used to treat postpartum psychosis.

However, in individuals with underlying bipolar disorder, certain antidepressants can sometimes trigger a manic episode, which may include psychotic symptoms. In these cases, the medication does not create bipolar disorder or psychosis, but it can unmask an underlying vulnerability.

This is why careful screening for bipolar disorder is important before starting antidepressant therapy, particularly during the postpartum period.

Take the symptoms seriously and act immediately. Stay with the person, keep the baby safe, and seek emergency medical care by going to the nearest emergency department or calling emergency services if there is an immediate safety concern. It's much better to have someone evaluated and find out they don’t have postpartum psychosis than to delay care.