Postpartum Psychosis Can Be Fatal If Left Untreated—Here's What to Know

What Is Postpartum Psychosis?

Postpartum psychosis is a serious mental illness that occurs after childbirth. It is considered a medical emergency and needs to be treated immediately.

During the perinatal period, which includes pregnancy, childbirth, and postpartum, women undergo many physical, emotional, and social changes, which can lead to mental disturbances, including mood swings, depression, PTSD, and psychosis.

Though it’s a rare perinatal disorder, postpartum psychosis occurs in one to two per one thousand women of childbearing age. The onset of postpartum psychosis typically occurs within days up to six weeks after giving birth.

If it goes undiagnosed or untreated, it can cause serious deadly harm to the mother and/or baby.

Symptoms of Postpartum Psychosis

While it's not uncommon for women to undergo feelings of sadness, worry, anxiety, or depression in those very early days after giving birth, the symptoms of postpartum psychosis are more intense than these.

Some common symptoms of this disorder include:

• Paranoia 
• Agitation
• Heightened energy or hyperactivity 
• Delusions or strange beliefs
• Irritability 
• Hallucinations
• Severe insomnia
• Rapid mood swings
• Difficulty communicating
• Loss of touch with reality
• Extreme confusion
• Appetite disturbances
• Suicidal or homicidal ideation
  

Symptoms can range in severity, with some women experiencing less severe and dangerous episodes. However, there’s also a 5% suicide rate and a 4% infanticide rate associated with postpartum psychosis.

Risk Factors for Postpartum Psychosis

Postpartum psychosis can occur in any woman following childbirth, though some face a higher risk than others. It is considered a rare mental health condition and there is evidence that both hormonal and immunological changes can precipitate postpartum depression and/or contribute to the underlying neuropathology of postpartum psychosis.

Those with highest risk have:

• A history of bipolar disorder
• A history of schizoaffective disorder
• Had a previous episode of postpartum psychosis 
• Discontinuation of psychiatric medication

Women diagnosed with bipolar disorder face a significant risk of postpartum psychosis, especially those who have a history of mania triggered by sleep disruption.

Those battling psychosocial stress and biological stress face an even higher risk. However, studies show that nearly 50% of postpartum psychosis cases in first-time mothers are among women without previous psychiatric hospitalization history.

Diagnosis of Postpartum Psychosis 

If there’s a reasonable concern to believe the mother or child is in danger, then the patient will be hospitalized before being evaluated and treated.

When screening for postpartum psychosis, providers will likely review the patient’s medical history, do a physical examination, and evaluate the patient’s mood and feelings throughout the pregnancy and postpartum, using mental health scales such as the Edinburgh postnatal depression scale (EPDS) and mood disorder questionnaire (MDQ).

Blood labs may be ordered to rule out other medical conditions and identify the cause of psychosis.

Treatment for Postpartum Psychosis 

The onset of postpartum psychosis usually occurs quickly and often requires immediate hospitalization.

The patient will then be evaluated, treated, and monitored. If treated, psychosis can resolve itself quickly, but treatment will depend entirely on the individual patient’s circumstance and prior medical and mental health history. 

Common treatments for postpartum psychosis include:

• Benzodiazepines
• Antipsychotics 
• Mood stabilizers 
• Electroconvulsive therapy (ECT)
• Psychotherapy

The good news is that postpartum psychosis is treatable. While some women may transition to bipolar disorder following diagnosis and treatment, studies show that 43.5% of women with postpartum psychosis have no manic or psychotic recurrence outside of the postpartum period.

Treatment should be discussed with the patient’s medical and mental health team, as it can have negative effects on the baby during breastfeeding.

Keep in Mind

Maintaining a strong support network in the days and months following childbirth is really important, especially for women with a history of mental illness. In the postpartum period, women are bound to experience disrupted sleep, hormonal changes, social stressors, and other common worries. It can be hard to distinguish between the “baby blues” and something more serious, which is why you should keep your doctor informed of noticeable changes. Should you experience postpartum psychosis, know that you’re not alone and help is available.