Worried About Developing Postpartum Psychosis? Here Is Everything You Need To Know
Becoming a mother is one of the biggest identity shifts a woman can go through. When so much about your life changes almost overnight, it can feel disorienting, overwhelming and confusing.
And if you're someone who is used to being capable, driven and always in control, the uncertainty of motherhood can be especially difficult to navigate. You might be used to planning ahead, anticipating problems and finding the perfect solutions.
But with a new baby, there are so many things you can't predict or control and as a new mom, it can be incredibly hard to know whether you're doing enough or getting things right.
Given all the talk about postpartum psychosis in the last few months, you might find yourself worrying about things even more than you did before, asking yourself questions like:
What if something like that happens to me? Is what I’m going through considered psychosis? I feel so different now - does that mean something is wrong with me?
These are the kinds of worries and questions that come up for many of the women I work with in my private practice. And yet, despite how frightening these thoughts can be, postpartum mental health still remains something that feels really difficult to talk about openly.
As always, the key to being able to treat postpartum conditions like postpartum psychosis quickly and effectively is awareness and education. So, for the sake of destigmatizing the topic a little, I want to address these worries and concerns head-on.
In this article, we'll explore some basic info like what postpartum psychosis actually is and which warning signs to look out for. But more importantly, I’ll talk you through how you can go into your postpartum period knowing that you are prepared for the unlikely scenario that you show signs of postpartum psychosis.
My hope is that by the end, you’ll have a clearer understanding of what’s normal during the transition into motherhood and when something might need closer attention. More than anything, I hope this helps ease some of your worries, gives you a little more peace of mind and helps you feel less uncertain about what you’re experiencing or what the future might hold.
What exactly is postpartum psychosis?
Postpartum psychosis is a rare but severe psychiatric disorder that involves the sudden onset of psychotic symptoms shortly after a woman gives birth, such as losing touch with reality, drastic mood changes, delusions and hallucinations. It affects approximately 1 or 2 in every 1,000 births.
It most often occurs within the first two weeks after giving birth, but it can also show up as late as a few months later. Usually, the symptoms show up quickly, so it can feel like it just appeared overnight.
Postpartum psychosis is a very serious and sometimes dangerous condition which means that it is categorized as a mental health emergency that requires urgent medical diagnosis and treatment. That being said, when you get the proper treatment at the right time, PPP is also highly treatable and most people recover well within a few months.
Symptoms and warning signs of postpartum psychosis
One of the things I hear from moms is how difficult it can be to make sense of what they're experiencing after having a baby, especially when they're feeling unlike themselves.
So, let's talk about some of the signs of postpartum psychosis to look out for and what to pay attention to if you're worried about yourself or someone close to you.
Changes in thinking and perception
Hallucinations, such as hearing voices or seeing things other people do not
Delusions or strongly held beliefs that are not based in reality, such as believing the baby is in danger for unusual or implausible reasons
Confusion, disorientation or difficulty understanding what is happening
Disorganized thoughts or speech, such as jumping rapidly between topics or saying things that are difficult to follow
Suspiciousness, paranoia, feeling watched, targeted or threatened
Unusual interpretations of ordinary events, coincidences or messages
Thoughts about harm
Thoughts or beliefs involving harm to the baby or themselves
Believing the baby is possessed, evil, in danger or needs to be protected through unusual actions
Commands from voices or delusional beliefs that may influence behavior
Changes in mood and behavior
Extreme mood swings or rapidly changing emotional states
Unusually elevated, euphoric, irritable or agitated mood
Severe anxiety, fear or distress that seems out of proportion
Uncharacteristic behavior, impulsivity or acting in ways that are very unlike the person
Withdrawal, unusual preoccupation or difficulty engaging with others
Appearing unusually energized or restless despite very little sleep
Being unable to sleep even when given the opportunity to rest
A drastically reduced need for sleep, especially alongside elevated energy, agitation or racing thoughts.
Worried about being able to recognize postpartum psychosis in yourself?
An important thing to note about postpartum mental health is that many of the unwanted and frightening thoughts and feelings can occur with a variety of conditions - postpartum anxiety, postpartum OCD, postpartum depression as well as postpartum psychosis.
I know that for many moms, it can be confusing, scary and overwhelming to figure out whether what they’re experiencing is something serious, like postpartum psychosis or something else. This can be especially difficult during a time when you’re already feeling vulnerable and sleep deprivation may be affecting your ability to think clearly or trust your own judgment.
However, one thing to always keep in mind is that due to the seriousness of the matter ANY concerning symptoms deserve a proper professional assessment. It doesn’t matter whether you or your loved one is unsure what it is that may be causing your symptoms.
If you’re at all worried about whether what you’re experiencing is “normal”, it’s always better to be safe than sorry and seek out a professional opinion - whether that be from a nearby perinatal psychiatrist, another mental health professional or the emergency room at your nearest hospital.
These professionals are trained to assess your symptoms, help you understand what might be happening and determine what level of care would be most appropriate for you. If it turns out that you’re not experiencing postpartum psychosis but are struggling with something that can be treated through outpatient therapy or another form of support, they can help connect you with the right professionals and resources.
Causes and risk factors for postpartum psychosis
“What causes postpartum psychosis?” and “Am I at risk of getting this?” are another two of the most common questions that I get from moms who are worried about their own postpartum experience.
The truth is that there is no single confirmed cause. It is thought to involve a combination of genetic, hormonal and psychological factors triggered by all the changes happening during and after birth. What is important to note though is that it is NOT caused by being a bad person or a lack of maternal instinct.
Generally speaking, there a few risk factors that have been established as increasing the likelihood of developing postpartum psychosis, such as:
A personal history of bipolar disorder, particularly bipolar I disorder
A personal history of severe mood episodes, especially mania or psychosis
A previous episode of postpartum psychosis
A family history of postpartum psychosis, bipolar disorder or other psychiatric illnesses
Severe sleep deprivation, especially in someone already at elevated risk.
Extreme stress/trauma from complicated childbirth, especially in someone already at elevated risk
Again, it’s important to caveat this type of list with the fact that these risk factors aren’t meant to predict whether or not you will develop postpartum psychosis. Having a risk factor does not mean you will automatically develop the condition and not having them does not mean you won’t.
More than anything, understanding your risk factors can help you understand the condition better and guide how you monitor your postpartum mental health after birth.
How postpartum psychosis is treated and what to do if you think you have postpartum psychosis
Like I said at the beginning of the article, postpartum psychosis is considered a psychiatric emergency that requires immediate medical assessment and usually hospital treatment.
If you’re reading this article because you suspect you or someone you love is showing symptoms of postpartum psychosis, please seek immediate medical care (by calling 911 or going to your nearest emergency room) rather than waiting for a routine medical appointment or a standard therapy session with your therapist.
Initial treatment typically involves hospitalization, psychiatric care as well as medications, such as antipsychotics or mood stabilizers, depending on the person's symptoms and needs.
The hospital can provide a safe environment for stabilization, monitoring and rest. In many cases, hospitals have mother-and-baby units available, where parents can receive proper treatment while also maintaining contact with their baby.
Treatment usually also continues past the initial hospitalization period. Your medical team will help you set up follow-up psychiatric care, psychological support like outpatient therapy, sleep management and a detailed plan for your or your loved ones to recognize early warning signs in the future.
When this proper treatment process is followed, the recovery from postpartum psychosis can be effective and long-lasting. So seeking out the right kind of support as soon as you can is key.
If you want to learn more, you can find additional medical information about the treatment of postpartum psychosis by the Cleveland Clinic here.
What to do if you can’t stop worrying about developing postpartum psychosis after birth
If you're someone who likes to feel prepared, stay in control and know what to expect, the uncertainty regarding the entire postpartum period can be particularly difficult to cope with. You might find yourself researching every possible risk, worrying about what could go wrong or feeling pressure to do everything “perfect” so you can keep yourself and your baby safe.
While it's understandable to want things to go well, a big part of becoming a mother is learning that you can’t plan for every possibility or guarantee that everything will go perfectly. For highly ambitious, driven women who are used to being in control this can be especially difficult.
What you can do however is put a few things in place beforehand so you know what to do if you need support and help your mind feel slightly more at ease going into your birth and postpartum period:
1. Talk to your healthcare team during pregnancy.
Regardless of whether you have a history of bipolar disorder, psychosis or previous postpartum psychosis, make sure to speak with your psychiatrist and maternity care team during pregnancy. They can help you understand your individual risk, discuss preventive treatment if appropriate and plan for monitoring your mental health after birth.
2. Make sure someone else knows what to look out for.
The dangerous thing about postpartum psychosis is that the person suffering often can’t recognize that something is wrong. So make sure you talk to your partner or another trusted person in advance about keeping an eye out for certain warning signs. Knowing that someone in your life will watch out for you and be able to recognize when something is wrong without it needing to be your responsibility can be a great relief and weight off of your shoulders.
3. Plan ahead to get the support you’ll need
Going into the postpartum period with a detailed plan on how you will protect opportunities to sleep and how you’ll share tasks and responsibilities can help you feel so much less overwhelmed and prevent negative consequences during this stressful period.
Think about who can step in when you need rest, help with meals or household tasks or simply give you a break when everything feels overwhelming. Sleep disruption is a normal part of having a newborn, but severe sleep deprivation can affect your mental health and may increase the risk of an episode in people who are already vulnerable to postpartum psychosis so having plans in place to avoid it can be a great way to decrease possible risk and make you feel more prepared.
4. Know in advance what to do in an emergency
When everyone is exhausted, overwhelmed or you’re already experiencing changes in your thinking or behavior, it can be really difficult to figure out what to do next. So preparing a simple emergency plan before your baby arrives means you don't have to work it out in the moment.
You could write down all the essential information on a single sheet of paper and keep it in a folder somewhere. Include the names and phone numbers of your healthcare providers for different types of scenarios, who to call outside office hours, the address of the nearest emergency department and several options for who you could contact to watch the baby while you go get help.
Make sure that you, your partner and any other trusted adults in your life know about this information and have access to it if needed.
Final thoughts: Are your worries getting difficult to handle?
It’s understandable and normal to want to feel prepared for the postpartum period, especially when you’re learning about something as serious as postpartum psychosis.
However, if your worries about postpartum psychosis or other possible postpartum challenges are becoming too difficult to manage, taking up a lot of your time or affecting your ability to enjoy your pregnancy, it can be really helpful to talk with a perinatal mental health professional about your experience.
A therapist who specializes in pregnancy and postpartum mental health can help you work through your anxiety, your fears, and find ways to manage the uncertainty inherent in pregnancy and postpartum so you can generally feel more at peace as you prepare for this next chapter.
If that’s something you’d like to learn more, you can read about it here.
Summary: All your common postpartum psychosis FAQs answered in short
When does postpartum psychosis start?
Postpartum psychosis most often develops suddenly within the first two weeks after childbirth, sometimes beginning within the first few days. However, it can develop after months as well, so symptoms should always be taken seriously.
How common is postpartum psychosis?
Postpartum psychosis is rare, affecting approximately 1 or 2 in every 1,000 births. Although it is uncommon, it is a serious psychiatric emergency that requires prompt medical assessment and treatment.
How long does postpartum psychosis last?
The duration varies from person to person. With appropriate treatment, acute symptoms may improve over several weeks, although full recovery can take months or longer. Ongoing psychiatric care, psychological support and help with sleep and daily responsibilities can all support recovery.
What’s the difference between postpartum psychosis and postpartum depression?
Postpartum depression typically involves persistent sadness, hopelessness, guilt, anxiety, or loss of interest in everyday activities. Postpartum psychosis involves a loss of contact with reality, which may include hallucinations, delusions, severe confusion, or unusual changes in mood and behavior.
Some symptoms can overlap between the two and postpartum depression can sometimes include psychotic symptoms. Because the conditions require different approaches to treatment, professional assessment is important.
How can I prevent postpartum psychosis?
There is no guaranteed way to prevent every case, but advance planning can help, particularly for people at higher risk. If you have bipolar disorder, a history of psychosis or previous postpartum psychosis, speak with your psychiatrist or perinatal mental health team during pregnancy about preventive treatment and postpartum support. Planning for protected sleep, arranging practical help and establishing early follow-up care can also be extremely valuable. However, postpartum psychosis can occur even without known risk factors, so recognizing the warning signs remains important.
What should I do if a loved one shows signs of postpartum psychosis?
Seek urgent medical assessment immediately rather than waiting for symptoms to pass or for a routine appointment. Go to the nearest emergency department or contact your local emergency medical service, explaining that the person has recently given birth and may be experiencing psychotic symptoms. If there is immediate danger to the parent or baby, call emergency services.
Stay calm, avoid arguing about unusual beliefs and arrange for a trusted adult to care for the baby while help is sought. You do not need to be certain that it is postpartum psychosis before reaching out. A healthcare professional can assess the symptoms, rule out other medical causes and help determine the appropriate treatment and level of care.
Are you looking for a therapist for ambitious, driven individuals in Los Angeles, California?
Justine Gordon is a Los Angeles–based Licensed Marriage and Family Therapist who works with ambitious, driven adults experiencing anxiety, burnout, perfectionism and chronic stress. Having grown up in a high-achieving environment herself, she understands the complicated relationship that can develop between success, self-worth and well-being.
If you’re navigating your pregnancy and postpartum journey and feel anxious, overwhelmed or burdened by pressure, therapy can be a space to understand what’s going on and learn a more sustainable way of moving through life. Schedule a free consultation with Justine to see if working together feels like the right fit.