The postpartum period is fraught with challenges. Along with physical healing, new parents often face sleep deprivation and a range of emotional and personal upheavals, from hormone changes to adjusting partner dynamics. This is the baseline for many.

When it comes to more serious postpartum conditions, postpartum depression is the most well-known, followed by postpartum anxiety. However, despite its severity, postpartum psychosis is rarely discussed and often misunderstood. Clearing up confusion and addressing the shame around perinatal mental health, especially postpartum psychosis, is key to helping more people.

What is postpartum psychosis?

Postpartum psychosis is a rare but serious perinatal mental health condition that usually develops within the first few days up to the first week after childbirth. While postpartum depression and postpartum anxiety may require immediate attention, postpartum psychosis always requires immediate attention.. Although it affects only 0.1-0.2% of births, its severity can lead to crisis episodes if not treated promptly.

Common signs and symptoms of postpartum psychosis

Postpartum psychosis is often overlooked during standard screenings or assessments because it doesn’t typically involve suicidal thoughts, a common misconception. Abnormal behaviors may be misattributed to ‘normal’ postpartum challenges. Additionally, a person experiencing psychosis may show a flat affect, lacking visible emotional response, which further complicates diagnosis.

Symptoms of postpartum psychosis Include:

  • Delusions
  • Hallucinations
  • Paranoia
  • Rapid mood swings
  • Disconnect from reality
  • High anxiety

These symptoms make it difficult for patients to express what they are experiencing–as frightening as it can be–and fear of potential consequences like being “sent away,” having their baby taken away or shame and stigma, may prevent them from seeking help.

Understanding risk factors and prevention in postpartum psychosis treatment

Understanding risk factors is crucial for preventing crisis episodes. A combination of family and personal mental health history plays a significant role in postpartum psychosis. A psychosis disorder of any kind, especially bipolar disorder, is a key risk factor, with 20-30% of postpartum psychosis cases tied to this condition.

Proactive mental health planning

Monitoring and managing these risk factors during pregnancy is essential. If they are identified, establishing a proactive perinatal mental health plan, which includes psychotherapy, medication management and crisis planning, can make a big difference if a crisis does arise.

  • Psychotherapy: An established relationship with a therapist before a crisis can help manage symptoms if psychosis occurs.
  • Medication management: A well-structured medication plan, especially if a prescription was paused during pregnancy, helps control symptoms.
  • Crisis planning: Knowing who to call and where to go saves valuable time, especially when everyone is sleep-deprived and less able to react quickly with a new baby in the house.

It’s important to note that while mental health care and planning are helpful, postpartum psychosis can still happen even with the best care. Prevention isn’t always possible because risk factors can’t be entirely mitigated.

How postpartum psychosis is diagnosed and treated

Diagnosis is typically made by a healthcare professional, such as an obstetrician, therapist, emergency room provider, or in-patient specialist. A partner or family member should take immediate action as soon as symptoms are noticed, taking the postpartum parent to a hospital or contacting a mental health professional. In cases of severe safety concerns, going directly to the ER or a psychiatric hospital is essential.

Treatment Options

Postpartum psychosis is an acute mental health crisis, but it is treatable and often resolves with proper care. However, ongoing mental health support is usually needed to ensure stability and prevent future episodes. If symptoms continue after treatment, it may indicate another underlying mental illness.

Treatment for postpartum psychosis almost always involves medication, such as antipsychotics or mood stabilizers, and often includes an inpatient stay. After initial treatment, an ongoing care plan (like the one above) with therapy, medication management and peer support or parenting groups, is crucial to ensuring long-term stability. While the process can be overwhelming, early intervention and proper care can stabilize the condition and prevent long-term complications.

The importance of planning and early intervention

Planning and early recognition of postpartum psychosis is essential for quick and effective intervention, which can prevent a crisis and lead to better long term outcomes. Though it’s difficult to have these conversations—both about potential risks and what to do in situations of crisis—being upfront with patients and their families helps them understand what to look for and how to respond. Talk to your provider about your mental health history and ask for a referral to a behavioral health clinician.

For further information and resources, visit Postpartum Support International.