What Is Postpartum Psychosis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

A small number of new mothers experience disturbing thoughts and an emotional flatness — red flags that signal postpartum psychosis.

Postpartum psychosis is a severe mental illness characterized by extreme difficulty in responding emotionally to a newborn baby — it can even include thoughts of harming the child.

The condition is different from postpartum depression, though the two conditions may occur together.

"It usually represents a bipolar disorder, not just a depressive disorder," says psychiatrist Charlotte Ladd, MD, associate professor of psychiatry at the University of Wisconsin in Madison.

In fact, Dr. Ladd qualifies postpartum psychosis as a "psychiatric emergency," because of the potential for harm to the baby or the new mother.

Who Gets Postpartum Psychosis?

Postpartum psychosis is a relatively rare condition.

It's estimated that 1 to 2 of every 1,000 new mothers faces postpartum psychosis, according to a report published in January 2014 in Psychiatric Times.

Approximately half of mothers with postpartum psychosis also have a history of mental illness — which means the other half have no reason to suspect it.

The causes of postpartum psychosis are not well understood. It's possible that the abrupt shift in hormones after delivery could trigger the condition.

And some research suggests that being an older mother may increase risk, but a mother who has diabetes or gave birth to a large baby may, for some reason, be protected.

While postpartum depression is most likely to emerge in the three months after delivery (but can appear within the first year of the baby's life), one of the hallmarks of postpartum psychosis is its early onset, often in the first 1 to 4 weeks after the baby's birth.

Most mothers will be home from the hospital and away from the watchful eyes of their medical team when it strikes, but the depression symptoms are so worrisome, says Ladd, that a spouse or other caregiver almost always notices that something's wrong and calls a doctor or a family member to express concern.

Signs and Symptoms of Postpartum Psychosis

Symptoms go beyond those associated with postpartum depression.

Here are some signs to watch for:

• Sudden thoughts of throwing the baby or harming it in some way
• Delusions (beliefs that have no basis in reality)
• Hallucinations (seeing or hearing things that aren't there)
• "Flat affect," or a lack of emotional response or blank facial expression
• Difficulty responding emotionally to the baby
• Difficulty sleeping beyond the normal interrupted sleep of new motherhood
• Changes in appetite or eating
• Irritability
• Confusion
• Agitation
• An inability to bond with baby
• Thoughts of suicide, or the belief that the baby or the family would be better off without the mother

In extreme situations, a woman with postpartum psychosis may exhibit behaviors such as staring off into space, muttering to herself, refusing to eat, or making seemingly irrational statements.

"It's usually pretty dramatic in the sense that the husband might call up and say she's not responding to the baby, she's not sleeping. It doesn't usually go undetected," says Ladd.

Ladd adds that any mom being seen by a doctor for a mood disturbance in the first days or weeks after delivery should be asked whether they have had any thoughts about harming themselves, their baby, or other people.

Treatment and Medication Options for Postpartum Psychosis

While the mother herself is likely to know she has a problem, she may not want to seek help or treatment for postpartum psychosis.

"Intrusive thoughts of throwing a baby out the window or across the room often seem to come out of nowhere, and women are afraid to talk about them," Ladd says.

These thoughts may be due to a "nesting instinct gone awry," she notes, explaining that these moms sometimes feel almost obsessive in their baby-focus.

Women may keep these thoughts to themselves because they are afraid that doctors or family members will take their baby away, and this unwillingness to talk leaves women with postpartum psychosis feeling very alone.

In fact, one of the first things Ladd does when treating women with postpartum psychosis is let them know the thoughts are a normal part of their illness.

If caregivers or other family members suspect psychosis — or if you suspect it in yourself — an immediate response is necessary.

"If someone has psychosis, it's important to get them to a psychiatric facility right away and to separate mom from baby during that assessment period," she says.

This separation does not mean the baby will be permanently taken out of the mother's care.

The goal is to move both mother and baby into a safe situation and then evaluate the mother so she can receive the appropriate medical treatment.

Treatment for postpartum psychosis generally includes:

• Hospitalization
• Antipsychotic medications
• Antidepressants
• Electroconvulsive therapy (ECT)
• Counseling with a psychiatrist, psychologist, or other qualified mental health professional