Postpartum Psychosis: How to Deal With It

Medically Reviewed by Jabeen Begum, MD on December 06, 2023
Written by Natalie Slivinski, Shawna Seed
6 min read

Postpartum psychosis is a condition you can get after giving birth. It affects your sense of reality. You might have hallucinations or delusions. In severe cases, you might try to harm yourself or your newborn. 

Postpartum psychosis, or PPP, is a mental health emergency. If you have signs of postpartum psychosis or you think someone you know does, seek help right away. 

 

Some who get postpartum psychosis have been diagnosed with bipolar disorder, schizophrenia, and other mental illnesses before giving birth. But most have no previous psychiatric problems.

Postpartum psychosis can come within a couple of weeks after you give birth. Usually, it happens suddenly. The symptoms differ from person to person. But they might include:

  • Delusions (belief in something that’s not real)
  • Hallucinations (seeing, hearing, or experiencing imaginary things)
  • Agitation
  • Heightened energy or sex drive
  • Depression, anxiety, or confusion
  • Severe insomnia (You may not even feel the need to sleep.)
  • Paranoia and suspicious feelings
  • Constant mood swings
  • Feeling disconnected from your baby

It can be tricky to tell if your symptoms are a normal part of recovering from childbirth or something more serious. This is why it’s important to have a loved one or a friend keep an eye on you in the early days and weeks.

Postpartum psychosis is divided into three types.

Depressive postpartum psychosis symptoms 

The depressive type of PPP is the most common. It's also the most dangerous. Some people with this type will have hallucinations or delusions commanding them to hurt their baby. Most cases of PPP that involve self-harm or harm to the newborn are the depressive type. If you have depressive postpartum psychosis, you may:

  • Feel anxiety or panic 
  • Have delusions or hallucinations 
  • Feel guilty
  • Lose your appetite
  • Not enjoy things that used to make you happy 
  • Have thoughts of hurting yourself or your baby, or thoughts of suicide 

Manic postpartum psychosis symptoms

This is the next most common type of PPP. The risk of harm to you or your baby is still there, but it's lower than with the depressive type. If you have manic PPP, you may:

  • Feel irritated or agitated 
  • Talk more than usual or faster – or both 
  • Behave in a way that's aggressive or disruptive
  • Not need sleep
  • Have delusions of greatness; for instance, believe your child is a religious figure 

Mixed or atypical postpartum psychosis symptoms

This is the least common type. If you have this, you may seem to others to be unaware of things going on around you. You might also: 

  • Speak or act in a disorganized way
  • Seem disoriented or confused 
  • Have hallucinations or delusions 
  • Say or do inappropriate things 
  • Stop speaking altogether, which is called catatonia 

Doctors believe that the big hormonal changes before and after childbirth may help trigger postpartum psychosis. 

Caring for a newborn can leave you sleep-deprived. Researchers know that lack of sleep can kick off mania in people with bipolar disorder, and they suspect it could play a role in PPP.

Psychosis can have physical causes, and you're at higher risk of some of those conditions during pregnancy or right after giving birth. They include: 

  • Autoimmune disorders
  • Inflammatory diseases 
  • Electrolyte imbalances 
  • Thyroid conditions
  • Vitamin deficiencies 
  • High blood pressure

 

Your chances of postpartum psychosis are higher if you or a close family member has bipolar disorder, or if you’ve had previous episodes of psychosis.

Other things that can increase your risk of PPP include: 

  • This is your first baby.
  • Your pregnancy was unplanned.
  • You have big mood swings while pregnant.
  • You stopped your psychiatric medications during your pregnancy.
  • You have asthma, diabetes, or are overweight. 
  • You needed a cesarean section or had excessive bleeding with your delivery. 

Some studies have suggested that if you're younger than 25 when you give birth, you may be at higher risk for PPP. Other things that could play a role include poverty and the lack of a supportive partner. 

 

There's not a specific test for postpartum psychosis. 

Your health care provider will observe you and ask questions about your behavior. You'll also have tests to rule out a medical reason for your symptoms. These might include: 

  • Blood tests
  • Urine tests 
  • CT scan of your brain 
  • MRI of your brain 

The tests will check for kidney infections, electrolyte imbalances, liver problems, and vitamin or mineral deficits that might affect you mentally. They'll also check for anything abnormal in your brain structure. 

Your health care provider might use a checklist or questionnaire as a screening tool to help diagnose your condition.  

Postpartum psychosis is a very serious illness. About one in 20 women may try to harm themselves or their baby. Your risk of suicide can rise for a year or longer after your delivery.

Fortunately, the psychotic state is only temporary. It is important to know what to do if it happens, both before and after your delivery.

Before delivery:

  • Talk to your doctor about your risks. They might send you to a specialist called a perinatal psychiatrist.
  • Tell your doctor and other members of your care team about any family history of bipolar disorder or postpartum psychosis.
  • Educate your partner or other loved ones about the symptoms, because you may not be able to recognize them in yourself.
  • Keep track of your moods during pregnancy.
  • Connect with an online support community for postpartum psychosis, such as “PPTalk.”
  • Arrange care for any children you already have. (For instance, a place for them to stay in case you’re unable to manage on your own after the baby is born)

After delivery:

  • Ask your partner or another loved one to help you keep a close eye on your behavior.
  • Get enough sleep.
  • Don’t feel guilty or pressured if it’s hard for you to breastfeed.
  • Minimize visitors, especially for the first few days.
  • See your doctor regularly for checkups.
  • Keep a mood diary.
  • Lean on friends and family for help around the house.

Postpartum psychosis is treatable. 

Because it's a rare condition, researchers don't have a lot of information on what approach is best. Mental health professionals have several tools to work with. 

Involuntary hospitalization

PPP is an emergency, and you'll need to be admitted to a mental health facility to get the right level of care. Because psychosis disrupts your grasp of reality, you may not realize how serious your condition is or the best way forward. Your partner, a friend, or other loved one may have to decide on hospitalization for you. 

Medications

There are several types of medication that can help with postpartum psychosis. They include: 

  • Anti-psychotic drugs
  • Anti-seizure drugs
  • Mood stabilizers
  • Lithium

Electroconvulsive therapy

Electroconvulsive therapy, or ECT,  uses an electrical current to cause a mild seizure. This disrupts your brain activity and can reduce or stop the symptoms of PPP. It's a safe treatment that works well, although portrayals of it on television and in movies have given it a scary reputation. You're under anesthesia during the procedure. 

Postpartum psychosis is an emergency that requires action right away. You're at risk of harming yourself or your newborn without treatment. It's important to understand the risk factors and symptoms before you give birth. When you have PPP,  your sense of reality is altered, and you might not understand that you need help. You'll probably need inpatient mental health care while you recover. Medication and electroconvulsive therapy are some of the treatments that can help. 

How long does postpartum psychosis last?

With treatment, most people recover within a few weeks. If you don't receive treatment, PPP can last for months and become more dangerous. 

When does postpartum psychosis start?

PPP usually shows up in the first few days or weeks after you've given birth. But in some cases, it develops as long as 12 weeks after childbirth.