Understanding Postpartum Psychosis

Symptoms, Causes, Treatment, and Recovery

Eyes behind blinds. Woman looking through the blinds.

parema/E+/Getty Images

In This Article

Mental health is an integral part of everyday life. And, there are times in life when you're more likely to deal with situations that may be challenging to your mental health. After having a baby is one of those times.

The baby blues and postpartum depression are two of the more well-known mental health issues that may arise, but other conditions can develop. One dangerous illness is postpartum psychosis. Here's what you need to know about the symptoms, causes, and treatments of this rare postpartum mood disorder.

Postpartum Mood Disorders

It is very common to experience a change in your mood or emotions after giving birth. Most of the ups and downs and even a few tears are normal. But, certain mood changes could be dangerous. Postpartum mood disorders fall into three basic categories.

  • Postpartum blues. In the days and weeks following childbirth, as many as 60-80% of moms experience the baby blues. The symptoms tend to be mild and last for just a few days. If you have the blues, you can still safely take care of yourself and the baby. It is not a dangerous condition and doesn’t require any medical intervention.
  • Postpartum depression. Postpartum depression affects about 10%-15% of new moms. The symptoms are more severe and last longer than the baby blues. This condition is more serious since it makes caring for yourself and baby more challenging. Postpartum depression needs treatment.
  • Postpartum psychosis. Also known as puerperal psychosis and postnatal psychosis, this is the least common but most dangerous of the postpartum mood disorders. Postpartum psychosis is rare and only happens in 1 or 2 out of every 1000 births (0.089% to 0.26%). It is a very severe condition that requires medical attention.

Symptoms

Postpartum psychosis can come on suddenly as soon as three to four days after delivery or within a few weeks. So, it's helpful if you and your partner to know what to watch for once you're home with your newborn.

The symptoms include:

In addition to the above, there may also be:

  • Severe mood swings
  • Fear
  • Anxiety
  • Restlessness
  • Confusion
  • Insomnia
  • Paranoia
  • Hyperactivity
  • Agitation
  • Acting distant and withdrawn
  • Depression or extreme sadness
  • Illogical thoughts
  • Poor judgment
  • Odd or uncharacteristic behavior
  • Suicidal thoughts
  • Aggressiveness
  • Violence

It is difficult to recognize the symptoms of psychosis in yourself. If you do see it, you should get help right away. But, it is more likely that your partner, a family member, or friend will notice that you're acting out of character. If this is the case, they should call for help immediately to get you the care you need.

Causes

Experts aren't quite sure why some women experience this rare condition. Since it can show up out of the blue in women without a history of mental health illness, the exact cause is not known. However, the risk of developing postpartum psychosis is much greater if you have:

  • A personal health history of bipolar disorder or schizophrenia.
  • A close family member such as a mother or sister with a history of postpartum psychosis or another psychiatric illness.
  • Discontinued your psychiatric medication for pregnancy.
  • Previous experience with postpartum psychosis after pregnancy.

Other risk factors are:

Treatment

Postpartum psychosis is a medical emergency. It must be addressed, or it can get worse and become dangerous very quickly. The good news is it’s treatable.

Treatment for postpartum psychosis involves:

  • Hospitalization
  • Psychiatric evaluation and treatment
  • Medication
  • Individual, family, and group therapy
  • Support for partners and family members
  • Electroconvulsive therapy

Recovery

Early detection and treatment can lead to a quicker recovery. The worst symptoms last approximately two to twelve weeks, but recovery can take six months to a year. Most women fully recover, but it can be a long and challenging process. Along with a relief of the symptoms, there may be:

  • Sadness
  • Guilt for the lost time and bonding with the baby
  • Shame
  • Anger
  • Fear of the stigma of mental illness
  • Fear of the judgment of being a bad mom
  • A strain on family relationships
  • Worry about it coming back
  • Fear of having more children

Recovery can be ongoing. It takes time and support to process the experience and work through your feelings.

After recovering from postpartum psychosis, you may wonder if it will come back. It may. There is a chance that it could return outside of pregnancy, and about a 25% - 40% chance of it returning with a future pregnancy. But, that doesn’t mean you cannot have more children. Once you have been through it, you will be much more prepared if it happens again. You can work with your doctors and your support system to have everything in place in case you need it.

Dangers

Postpartum psychosis is a serious illness. Without treatment, it could be life-threatening for moms and babies and have a negative effect on the entire family. This condition increases the danger for suicide, violence against the baby or others, and infanticide.

Studies show that family members of moms who experience postnatal psychosis have a higher chance of taking their own life, and the moms have a higher rate of suicide later in life.

However, it’s important to note, that while there is a danger of aggression during an episode of postpartum psychosis, not all delusions are violent. Most new moms who have postpartum psychosis do not cause any harm to themselves or others.

Infanticide is rare, and suicide during the first year after giving birth is also extremely uncommon.

Breastfeeding

Breastfeeding does not prevent postpartum mental health issues, but it can offer some protection against depression and other symptoms. Studies show that breastfeeding hormones decrease inflammation in the body. They also encourage calmness and a higher mood. Plus, breastfeeding can help to reduce stress in moms and babies.

However, breastfeeding can be more difficult for women with depression or symptoms of altered mental health. It may even be a source of distress. Breastfeeding difficulties and dissatisfaction can lead to early weaning. And, if weaning is sudden, it can lead to more severe symptoms.

The ability to breastfeeding during treatment depends on:

  • The medication prescribed. 
  • If the baby can stay with mom during hospitalization.
  • A mother's preference to breastfeed.
  • The benefits for the baby.
  • The risks to baby due to treatment.
  • The risks to mom if she doesn’t take her medication or doesn't take enough. 

Preventing Postpartum Psychosis

There are things in your life that you cannot control such as your family history or genetics. But, there are some things you can control. So, you can try to prevent postpartum psychosis or at least prepare for it. Here are some tips.

  • Talk to your doctor about your personal mental health history and family history.
  • Go to all of your prenatal visits.
  • Keep all your appointments with any other health care providers that you see or the doctor refers you to. 
  • Discuss your risk with the health care team.
  • Learn all you can about the condition.
  • Have realistic expectations about delivery and motherhood.
  • Talk to someone about any negative feeling you have.
  • Try to get enough sleep.
  • Try to reduce your stress.
  • Learn, practice, and use healthy coping skills.
  • Include your partner in your prenatal appointments and care.
  • Prepare your tribe by telling trusted family and friends so they can be helpful, supportive, and encouraging.
  • Think about breastfeeding or using kangaroo care to encourage the release of oxytocin.
  • Know the signs of psychosis, and make sure your support system knows them, too.
  • Consider individual and group counseling for support.
  • Tell someone right away if you have any symptoms.
  • Have help at home and frequent health care check-ups in the days and weeks after your baby is born.
  • Get some exercise.
  • Seek alternative health therapy such as acupuncture.
  • Get all the nutrition you need by eating well and taking vitamin supplements or your prenatal vitamins.

A Word From Verywell

Bringing your baby home from the hospital should be an exciting time. But, for some new moms, the postpartum period is challenging. Changing hormones, lack of sleep and the stress of adjusting to life with a newborn can be physically and emotionally demanding. You may not feel like yourself, or you may have more trouble coping than you usually do.

Dealing with any illness right after giving is birth is difficult. It can be especially devastating to go through something as serious as postpartum psychosis. Not only can it be scary and traumatic to feel paranoid or experience hallucinations and delusions, but without treatment, it could be dangerous and affect the entire family.

So, although it is rare, it is still important to understand this serious mental health condition. Learning the risk factors and symptoms can help you and your family recognize the signs and seek help as early as possible. Remember, it is a treatable condition, and it's also only temporary. With time and proper care, most moms make a full recovery.

Was this page helpful?

Article Sources

Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Jones I, Chandra PS, Dazzan P, Howard LM. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. The Lancet. 2014 Nov 15;384(9956):1789-99. doi:10.1016/S0140-6736(14)61278-2


  2. Manjunath NG, Giriyappa Venkatesh R. Postpartum blue is common in socially and economically insecure mothers. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine. 2011 Jul;36(3):231. doi:10.4103%2F0970-0218.86527


  3. Matsumoto K, Tsuchiya KJ, Itoh H, Kanayama N, Suda S, Matsuzaki H, Iwata Y, Suzuki K, Nakamura K, Mori N, Takei N. Age-specific 3-month cumulative incidence of postpartum depression: The Hamamatsu Birth Cohort (HBC) Study. Journal of Affective Disorders. 2011 Oct 1;133(3):607-10. doi:10.1016/j.jad.2011.04.024


  4. VanderKruik R, Barreix M, Chou D, Allen T, Say L, Cohen LS. The global prevalence of postpartum psychosis: a systematic review. BMC psychiatry. 2017 Dec;17(1):272. doi:10.1186/s12888-017-1427-7


  5. Spinelli MG. Postpartum psychosis: detection of risk and management. American Journal of Psychiatry. 2009 Apr;166(4):405-8. doi:10.1176/appi.ajp.2008.08121899


  6. Meinhard N, Kessing LV, Vinberg M. The role of estrogen in bipolar disorder, a review. Nordic journal of psychiatry. 2014 Feb 1;68(2):81-7. doi:10.3109/08039488.2013.775341


  7. Focht A, Kellner CH. Electroconvulsive therapy (ECT) in the treatment of postpartum psychosis. The journal of ECT. 2012 Mar 1;28(1):31-3. doi: 10.1097/YCT.0b013e3182315aa8


  8. McGrath L, Peters S, Wieck A, Wittkowski A. The process of recovery in women who experienced psychosis following childbirth. BMC psychiatry. 2013 Dec;13(1):341. doi:10.1186/1471-244X-13-341


  9. Rai S, Pathak A, Sharma I. Postpartum psychiatric disorders: Early diagnosis and management. Indian journal of psychiatry. 2015 Jul;57(Suppl 2):S216. doi:10.4103/0019-5545.161481


  10. Brockington I. Suicide and filicide in postpartum psychosis. Archives of women's mental health. 2017 Feb 1;20(1):63-9. doi:10.1007/s00737-016-0675-8


  11. Wambach K, Riordan J, editors. Breastfeeding and human lactation. Jones & Bartlett Learning; 2016.


  12. Ystrom E. Breastfeeding cessation and symptoms of anxiety and depression: a longitudinal cohort study. BMC pregnancy and childbirth. 2012 Dec;12(1):36. doi:10.1186/1471-2393-12-36